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 DECfi 1981 
 
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 CAT. NO ?3 233 
 
 PRINTED IN U.S.A.
 
 3 1822 01317 0071 
 
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 ^yv^
 
 RENOUARD'S 
 
 HISTORY OF MEDICINE.
 
 SYNOPTIC TABLE OF CONTEXTS OF RENOUARD'S 
 HISTORY OF MEDICINE. 
 
 I. AGE OF FOUNDATION. 
 
 1. Primitive Period; From the Origiu of Society to the De- 
 
 struction of Troy, 1184, B. 0. 
 
 2. Sacred or Mystic Period : Ending with the Dispersion of 
 
 the Pythagoreans, 500, B. C. 
 
 3. Philosophic Period : Ending at the Foundation of the 
 
 Alexandrian Library. 320. B. C. 
 
 4. Anatomical Period: Ending at the Death i)f (lalen. A.D. 
 
 200. 
 
 II. AGE OF TRANSITION. 
 
 •5. Greek Period : Ending at the Burning of the Alexandrian 
 Library, A.D. 640. 
 
 6. Arabic Period : Ending at the Revival of Letters in Europe, 
 
 A.D. 1400. 
 
 III. AGE OF RENOVATION. 
 
 7. Erudite Period: Comprising the Fifteenth and Sixteenth 
 
 Centuries. 
 
 8. Reform Period : Comprising the Seventeenth and Eighteenth 
 
 Centuries. 
 
 From the pjiges of Dr. Keuouard, a very accurate acqiiaiutaiice may be 
 obtained with the history of medicine — its relation to civilization, its prog- 
 ress compared with other sciences and arts, its more distinguished culti- 
 vators, with the several theories and systems proposed by them ; and its 
 relationship to the reigning philosophical dogmas of the several periods. 
 His historical narrative is clear and concise — tracing the progress of medi- 
 cine through its three ages or epochs — that of foundation or origin, that of 
 tradition, and that of renovation. — Am. Journal of Medical Science. 
 
 It is expressly from the conviction of the deficiency of the English lan- 
 guage in works on the History of Medicine, that we feel indebted to Dr. 
 Comegys for the excellent translation of the comparatively recent work of 
 Eenouard. We hope before long to find that in every important school of 
 medicine in this country, opportunities will be ottered to students whereby 
 they may be enabled to attain some knowledge at least of the history of that 
 profession to the practice of which their lives are to be devoted. — British and 
 Foreign Medico- C'hirur(/ical Review. 
 
 The best history of medicine extant, and one that will find a place in the 
 library of every physician who aims at an acquaintance with the past history 
 of his profession. "- * * There are many items in it we should like to 
 offer for the instruction and amusement of our readers. — Ameiican Journal 
 of Pharmacy.
 
 HISTORY 
 
 MEDICINE, 
 
 ORIGIN TO THE NLNETEEXTH CENTURY, 
 
 WITH AN APPENDIX. 
 
 CONTAINING A PHILOSOPHICAL AND HISTORICAL REVIEW OF MEbU INK 
 TO THE PRESENT TIME. 
 
 BY 
 
 P. V. RENOUARD. M. D. 
 
 Tbe Scn;iii-« are srailually developed. It is only by reviewing past centuries that we can 
 determine their laws of growth. 
 
 TRANSLATED FKOM THE FRENCH BT 
 
 CORNELIUS a. COMEGYS, M. D., 
 
 PBOFMSOR OF THE INSTITUTES AND OF CLINICAL MEDICINE, IN THE MEDICAL COLLFiiK OF OHIO. 
 
 PHILADELPHIA : 
 
 LINDSAY & BLAKISTON. 
 
 18G7.
 
 Entered according to Act of Congress, in the year 1855. by 
 
 MOORE, WILSTACH, KKYS & CO.. 
 
 In the Clerk's Office of the District Court of the United States for the Southern District of Ohio.
 
 € t ij t ^|l e m r it 
 
 F 
 
 M Y FATHER, 
 
 CORNELIUS P. COMEGYS, 
 
 LATE GOVERNOR OF DELAWARE, 
 
 AND 
 
 MY PRECEPTOK, 
 
 WILLIAM E. HOE NEE, M. D.. 
 
 L A T K P E O F . OF ANATOMY IN THE t' X I V E R 3 I T Y OF T E N N S Y L V A N I A 
 THE LABORS OF 
 
 THE TRANSLATOR 
 
 ARE AFFECTIONATELY AND 
 
 GRATEFULLY' INSCRIBED.
 
 TRANSLATOR'S PREFACE. 
 
 In producing the work of Dr. Eenouard in the English language, 1 
 have been actuated by the conviction that a treatise of its nature is greatly 
 needed. Indeed, if I except brief sketches affixed to some of our spe- 
 cial treatises, we possess nothing in our literature that is at all cal- 
 culated to satisfy the wants of the profession in this respect. The only 
 work on this subject, of any magnitude, by an English author, is that 
 of Dr. Freind, which is a continuation of Le Clerc, and comes down 
 only to the beginning of the sixteenth century ; besides, it is out of 
 print. 
 
 Why no history of Medicine commensurate with the dignity and extent 
 of our profession has yet been written in our tongue, I am entirely 
 unable to explain. Other languages are prolific enough in this respect, 
 particularly the German and the French. To obtain any scholarly 
 attainments on this subject, it has been necessary to read books in for- 
 eign languages. Knowing, therefore, the wants of the profession, and 
 having been greatly encouraged by medical gentlemen in diffisrent por- 
 tions of the Union, to whom I have communicated my design, I have 
 ventured to offer this translation to fill this vacuum in our medical 
 literature. I have hesitated to enter into this very difficult field of 
 authorship, from a real distrust of my abilities for the task ; and now 
 that it is done, many errors are plainly visible. Some are minor ones, 
 and are such as wiU creep into publications in spite of the utmost care. 
 There are others, more serious, which I would gladly correct, and hope 
 to have an opportunity of doing so at another time. Few of them, how- 
 ever, impair in any great degree the original, and do not, therefore, 
 materially pervert the author's meaning. My professional brethren will
 
 viu translator's preface. 
 
 be kind in their criticism, when they remember that the active duties 
 of our profession are most unpropitious to literary pursuits. 
 
 The work of Dr. Eenouard should be studied in several aspects ; 
 first, as a historical narrative, in which the relation of Medicine to civ- 
 ilization is shown, and its progress compared with that of the sciences and 
 arts ; secondly, in the histoiy of its cultivators, with the theories and 
 systems which they have proposed ; thirdly, the relation of medical to 
 philosophical theories ; lastly, the great argument of the author : Empi- 
 ricism or the Empirical method is alone applicable to the cultivation of 
 Medicine, and therapeutics, not physio-pathology, the foundation upon 
 which the science rests. 
 
 In these respects the author has acquitted himself as fully as the 
 limits of an elementary treatise will allow, and particularly in his dis- 
 cussion of philosophic methods and on the general subject of metaphysics 
 he has presented one of the clearest, most comprehensive, yet condensed 
 expositions that any single work aifords, and it will thoroughly prepare 
 the reader to appreciate properly his main argument. 
 
 Many eminent minds in our profession are steadily at work endeav- 
 oring to build up Medicine, like other branches of natural science, by the 
 careful study of facts. We have millions of well attested observations, and 
 if our reason is invoked, in the language of Kant, only to guide experience 
 in the careful study and co-ordination of these facts, we shall be able 
 by induction to reach those great general principles or axioms that 
 shall give our science a lofty rank among kindred sciences for complete- 
 ness and certainty. I humbly think that the work of Dr. Eenouard will 
 greatly aid in this conquest, by turning the mass of medical mind from 
 the vain efforts of speculation to the tried and fruitful path of observa- 
 tion. But this is a laborious route, and its difficulties were early 
 expressed by Hippocrates, in his well known Aphorism : life is short, 
 art is long, experience deceptive, judgment difficult. 
 
 The uncertainty of Medicine, and the different opinions of those who 
 cultivate it, are often referred to as an evidence of its low rank as a 
 science ; yet I believe that, excepting mathematics and pursuits resting 
 strictly upon it, no pursuit of man surpasses or equals Medicine iu the 
 certainty of its opinions, and in its positive and increasing blessings to 
 society. AVe do not assume that Medicine, as a science or an art, is
 
 translator's preface. IX 
 
 now perfect ; on the contrary, none feel its defects more keenly than 
 medical men ; yet we know that a steady and brilliant improvement is in 
 progress. 
 
 When we examine other professions, it is very plainly seen that there 
 is as much uncertainty and want of uniformity in opinions as in ours. 
 
 In theology, learned bodies are divided, not in regard to speculations 
 about mysteries more than in the meaning of words and the interpreta- 
 tion of phrases, access being had by aU parties to the same sources of 
 knowledge, to enable them to settle these questions. These varieties 
 are seen in confessions of faith, administration of ordinances, and 
 church government. 
 
 The law is said to be the perfection of human reason ; but if Medi- 
 cine is proverbially uncertain, what may not be said of law ? Its doc- 
 trines are written, its decisions are voluminous, and moreover, the 
 whole science may be narrowed down to a question of right and wrong, 
 in which the whole moral faculties of man instinctively lead the judge 
 to decide aright. In nothing have men more intuitive knowledge than 
 in law. It may be said that legal decisions are uncertain, because evi- 
 dence is defective. This is granted, but its uncertainty is seen as fre- 
 quently in interpretations of organic as of common law. The opinions of 
 lawyers are given with great deliberation, with ample opportunity for 
 research, while doctors are expected to be ready at a moment's warning 
 to decide the most momentous questions ; and I have no hesitation in 
 saying that the opinions of medical men, thus given on the spur of the 
 moment, are characterized by as much certainty as those of lawyers. 
 
 Let us compare Medicine with political economy. Are our statesmen 
 unanimous in their views on the subjects of domestic manufacturino-, 
 tariffs, banks of issue, internal improvements, educational systems, 
 modes of taxation, currency, the general rights of citizens, and on other 
 highly important topics ? 
 
 The movements of the mercantile and manufacturing world rest upon 
 calculations or estimates, but of all pursuits none are so uncertain. A 
 very small number of men who embark in commerce and manufactur- 
 ing succeed. These noble occupations, which are most important ele- 
 ments in the progress of civiliziation, offer but little hope of permanent 
 success.
 
 X translator's preface. 
 
 Uncertainty marks also tte estimates of engineers and architects, 
 althougli it would seem that ample data are in their possession to give 
 great precision to their statements. 
 
 Navigation, so far as it relates to mathematics, is remarkably accu- 
 rate. The ship is guided from port to port, and throughout her voyage 
 her exact position on the surface of the ocean can he defined. These 
 calculations are founded on the movements of the heavenly bodies ; but 
 the opinions of the captain in regard to the •weather, and the duration 
 of his voyage, are all uncertain. When he encounters the commotions 
 of nature, the fierce tempest, and the surging ocean, he has no more 
 certainty of saving his ship and crew, than the physician who struggles 
 with the conflicts of nature in the human organism. 
 
 My brief space will not allow me to say more on this topic, but these 
 examples will contribute somewhat, I trust, to wipe ofi" the stigma of 
 the greater uncertainty in Medicine than in other pursuits. 
 
 Our science is also reproached with being stationary. Thus it is said 
 that while society has been flooded with light on other topics, and civili- 
 zation has improved steadily. Medicine has contributed an inferior share 
 to this progress. Nothing can be more unfounded than these statements. 
 If we examine the great eras in civilization, Medicine will be found to 
 have progressed as rapidly as the physical sciences generally. The dis- 
 coveries of Columbus, and successive navigators, were not earlier nor 
 more important in geography, than those of Mondini, Beranger, Vesa- 
 lius, and Sylvius, in anatomy. Copernicus did not earlier conceive the 
 errors of the Ptolemaic astronomy, than Servetus, E. Columbus, and 
 Cesalpine the errors of Galenic physiology ; and Galileo, who demon- 
 strated the movements of the earth and planets around the sun, was a 
 cotemporary with Harvey, who demonstrated the circulation of the blood. 
 The universal law of Xewton for the solar system, was not greatly in 
 advance of that of Haller of the laws and special forces of life. If the 
 great philosopher established that the force manifested in the fall of an 
 apple to earth, is the same as that which keeps the planets in their orbits, 
 so the pathologist has shown that the laws of inflammation in the deep- 
 seated and vital organs are identical with those that arc seen in the 
 smallest inflammatory point on the skin. And how much might be 
 added on the application of ph} sical laws in diagnosis, the prevention
 
 TRANSLATOR'S PREFACE. XI 
 
 of small pox, the easy cure of autumnal fever, etc., to show that in point 
 of progress Medicine marches hand in hand with kindred sciences. 
 
 Literature and the fine arts offer no comparison in this respect to 
 Medicine. Our oratory does not surpass that of Greece and Eome. 
 Where have we profounder reflective philosophers than Pythagoras and 
 Plato of the ancients, and Locke and Descartes of moderns ? What 
 astronomers are adding anything to the laws developed by Xewton, Kep- 
 ler, and La Place ? In sculpture we only equal ancient Greece. Our 
 paintings are not esteemed like those of the old masters. Our jurists 
 do not surpass the Erskines and Blackstones. " Except the writings of 
 Lord Mansfield on commercial law," says a late writer, " nothing impor- 
 tant has been added for many years, and no great errors have been 
 expunged." In statesmanship, the present generation will scarcely rival 
 the past. Who shall fill the senatorial chairs of Clay, Calhoun, Wright, 
 and Webster "? The present commentators on the Bible are not superior 
 to those who have passed away ; our writers on moral science are largely 
 copyists of old authors ; our poets and prose writers do not surpass our 
 classics. There is no progress in mathematics ; the most eminent intel- 
 lects are only able to master the inventions of Euclid, Newton, and 
 Leibnitz. 
 
 In what, then, is the progress of this stimng age ? It is not in the- 
 ology, law, belles-letters, the fine arts, architecture, politics, mathemat- 
 ics, or metaphysics. It is in mechanics and the chemical and physical 
 sciences, in which our science forms an integral part. Man is strug- 
 gling to regain what was his primeval inheritance " before the fall 
 brought ruin on our race," when God said, showing him animate and 
 inanimate nature, "have dominion." We see this in his control of the 
 electrical element, which enables him to imitate the ubiquity of God ; 
 in employing the winds to waft his graceful ships ; in the ocean steamer, 
 which drives its prow in the teeth of the powerful north-wester, and 
 beats down the waves that vainly dispute its passage ; in the tunneled 
 mountain, whose icy peaks are reared in vain to barricade the route of 
 his locomotive ; in- employing the sun's rays to stamp his features on 
 the metalic plate, that the perfect image of his loved ones may remain 
 long after their frames have mouldered into dust.
 
 xii translator's preface. 
 
 Medicine relates to nature, its preservation and defence, and nothing 
 that man possesses surpasses it in ameliorating the condition of the race. 
 Our progress is not only in the structural knowledge of the system, and 
 its life laws, but our resources for the treatment of diseases are enlarged. 
 The horror of surgical operations is abated by the fact that the severest 
 work of the knife may now be endured while the mind is as blissful 
 as if wandering in Elysian fields. 
 
 But I must not deal in words only. We have undisputed figures to 
 prove "that our science is a vast blessing to the race. I will not allude 
 to individual cases, to which every one can bear some testimony of its 
 success, but take the broad results of vital statistics. 
 
 The epidemics that formerly terrified the nations, leaving in their 
 trail desolations worse than the tornado, have been shorn of their terrors. 
 The prevalence of small pox has been almost prevented by Jenner's discov- 
 ery of vaccination. The treatment of cholera is now so well understood 
 that it has lost its former desolating power. Human life has been greatly 
 lengthened in the last hundred years. The reports of the Parisian 
 hospitals show that while in 1805 one died in seven who were admitted, 
 now only one dies in twelve, thus showing that our science has increased 
 in its ability to save life in the same order of diseases, and in the same 
 buildings, seventy-one per cent in a period of fifty years. In other 
 words, in the Paris hospitals, where, fonnerly, fourteen men died in each 
 hundred admitted, now only eight die, a saving of six persons in a 
 hundred ; and in the eighty thousand who annually pass through those 
 wards, a saving of five hundred human beings. And this is not all ; 
 the period of their stay is very much lessened. The average time of 
 residence was formerly thirty-nine days, now it is twenty-four days, a 
 a diflference of fifteen days since 1805. In the treatment of special dis- 
 eases, the most remarkable evidences of improvement are shown. 
 Thus, in syphilis, in 1805, one died in fifty-six cases ; now (1850) only 
 one died in two hundred and ninety-four. 
 
 In England, according to Macaulay, "the term of human life has 
 been greatly lengthened in the whole kingdom. In 1G85, not a sickly 
 year, one in twenty of the inhabitants of London died, while at pres- 
 ent only one in forty dies. The diff"erence between London in the
 
 translator's preface. XIU 
 
 seventeenth and London in the nineteenth century is as great as between 
 London in ordinary years and London in the cholera." 
 
 In surgical practice, the saving of life at present exceeds by more 
 than thirty-five per cent, the results at the beginning of this century. 
 The returns of the Registrar General of England show a steady and nota- 
 ble decrease in the rate of mortality from 1838 (the beginning of the 
 returns) to 1845 ; in 1846 it rose again, ascribable to the prevalence of 
 epidemic intestinal diseases. In France, according to Dapin, the dura- 
 tion of life has been increasing, equal to fifty-two days for each year 
 from 1776 to 1842, or nine and a half years for the whole period. The 
 increase per annum was at no time less than nineteen days, although 
 that revolutionary and warlike nation shed seas of blood, not only in 
 her cities, but upon every battle field in Europe. In midwifery prac- 
 tice, one hundred and fifty years ago, according to Dr. Merriman, one 
 in forty died. At the close of his tables, (1828,) only one in one hun- 
 dred and seven died, and at this time perhaps not one in two hundred 
 and fifty dies. The hospital practice in our own country exhibits the 
 same gratifying success in treatment. 1 find by comparing the statistics 
 of the Philadelphia and Xew York hospitals, that they show the same 
 results, almost to a fraction, with those of Paris. In short, whether we 
 examine the reports of the Eegistrar General of England, the data of the 
 Carlisle and Northampton life tables, the statistics of the Bureau Cen- 
 trale of Paris, or the publications of the great hospitals of our own 
 country, the same results are presented. Life has been prolonged more 
 than twenty-five per cent, in the past seventy-five years, and the dura- 
 tion of treatment lessened more than one-third. Xow, it may be said 
 that the cessation of wars, and the amelioration of the general condi- 
 tion of the masses, explain this gain in human life, and deprive Medicine 
 of her claim to such titles of glory. But we present these irrefutable 
 hospital reports; their wards are the peculiar battle-ground of the 
 doctors, and showing these results, we demand that they shall be expo- 
 nents of what has been done for society at large — that this increased 
 longevity is due to our science. 
 
 Who supposes its power to benefit mankind can not be immensely 
 augmented? "Who is content that it should be stationary? Certainly 
 not medical men. Its higher success is the dream of their lives ; they
 
 XIV translator's preface. 
 
 gaze into a hopeful future, and are filled with glowing and bright pic- 
 tures of the era when this science shall be 
 
 " Above the reach of sacrilegious hands, 
 
 Whose honors with increase of ages grow, 
 
 As streams roll down, enlarging as they flow." 
 
 Another important fact is well established by the perusal of this his- 
 tory, viz : that Medicine has never flourished and been cultivated in the 
 highest degree in any country where it has had no legal recognition. 
 The want of such recognition and legislation is painfully felt in most of 
 the "States of our Union. The medical profession is wholly unprotected 
 except by its own organization, by its own regulations ; it attempts to 
 encourage a sound state of education and ethics, yet we are assailed 
 continually for what are termed our prejudices against irregular 
 practitioners. 
 
 The whole series of phenomena in the human system is in accordance 
 with the laws of vitality, precisely as the endless phenomena of the 
 universe are developed in obedience to certain laws. When, therefore, 
 the human mechanism becomes deranged, and a great contest is set up 
 between the forces of disease and the vital forces, who shall attempt to 
 interfere — the man who has made these laws a study, who knows the 
 operations of their final causes, who comprehends as far as science has 
 shed light upon the subject, their special and general operations, or the 
 man who is ignorant of the entire mechanism, and laying aside all 
 such labor and investigation, attempts to rescue the sufiering system by 
 remedies which, according to his gross views, have been successful in a 
 similar case ? Legislation offers no obstacle to the latter. It is true 
 that it has legalized the medical college and its diploma, but the 
 learned and laborious graduate has no legal level above the quack ; the 
 latter has just as full authority to practice. If any one, deceived by 
 the puffing of the self-styled doctors, falls a victim to their ignorance, 
 the law kindly allows a jH-osecution for mal-practice ! An irreparable 
 injury, or even death itself may be the result of this ignorant interfe- 
 rence, and what atonement then does the prosecution of an irrespon- 
 sible man afford ? 
 
 In regard to Medicine, every one must look out for himself. With
 
 translator's preface. XV 
 
 the same indifference, we ought not to have a standard of weights and 
 measures, nor a fixed value of coin, nor protection against issues of 
 paper money. Let every one take care of himself. Why not have 
 a board of examiners of candidates for medical practice, as we have for 
 law and teaching ? Xo man can assume to be a respectable minister of the 
 gospel without the license of a church organization ; no man can prac- 
 tice law without an approved examination before a court ; no man can 
 teach without a certificate of qualifications ; no man can sell goods or 
 peddle goods, or drive a dray, or a cab, or an express wagon, without 
 registering and a license. The public is defended from the impositions 
 of the hackney coachman, but not from the quack doctor and patent 
 medicine vender. Xo man is believed te be a carpenter, or a machinist, 
 or a master in any other profession, unless he has served an apprentice- 
 ship to it. Then why, I ask, in the name of humanity and civilization, 
 when we come to consider the human frame, the most wonderful struc- 
 ture of God, the divine idea of mechanism, in whose structure a thous- 
 and wonderful and complicated actions are in flay, many of whose 
 laws, after more than two thousand years of investigation, are still 
 unknown, why, I say, do our governments surrender this beautiful 
 structure to be prostituted to the mercenary practices of charlatans ? 
 
 When we think what interest Deity has taken in diseased humanity, 
 inspiring Moses to write those extraordinary precepts found in Deu- 
 teronomy, how he conferred on priest and prophet healing powers ; that 
 Jesus performed the functions of a physician as well as that of a divine 
 teacher, and endowed his apostles with power to heal the sick, thus 
 sanctioning the profession of Medicine, as well as giving proofs of a 
 divine nature ; that the ancient civilization of Greece and Eome legal- 
 ized Medicine, and all modem Europe lavishes upon it favors and 
 protects it from impostors ; why, I repeat, in this great Eepublic, is this 
 learned and valuable profession unsustained, and society unprotected? 
 
 The profession must appeal to legislation, not to ask for laws that 
 shall compel a man to profess the doctrines of a certain school, but 
 that no one shall be allowed to treat diseases, whether he calls him- 
 self allopath, homeopath, isopath, physiopath, eclectic, botanic, or by 
 any other name, until he has shown before a proper tribunal that 
 he has made the organism of man and his diseases, a special study.
 
 xvi translator's preface. 
 
 This is simple and fair, and society owes this, not only to itself as self- 
 protection, but also as a tribute of respect to the medical profession. 
 " For," in the language of Dr. Willis, " who, since the revival of learning, 
 have done more for every undertaking whose object has been to extend the 
 boundaries of knowledge and to exalt mankind ? Who knows half so 
 much of the wants and the wishes, of the joys and sorrows of the com- 
 munity ? Who are the friends and comforters in adversity especially, 
 of persons in every grade of life, from the sovereign to the wretched 
 outcasts of the streets, houseless, homeless, friendless, alone? Who 
 disarms pestilence of its powers, and gives Jenners to the world ? Who 
 follow in the battle field, through the thickest of the fire, not that they 
 may aid destruction in her work, but that they may staunch the wounds 
 she makes ? The servant of religion hath not more of true sanctity 
 about him than the good physician. The service, indeed, that was ren- 
 dered of old in special temples to the Divinity, conceived in one of his 
 most beautiful attributes, is not yet extinct upon earth, but has its 
 ministering [priest, ennobled by Christianity, in every worthy member 
 of the profession. Oh, let society cherish and exalt its medical com- 
 munity ; let it become awai-e that if science can not aid it in its strug- 
 gles with disease, neither can ignorance ; that nothing can by possibility 
 be known to the quacksalver and ignorant empiric that is not famil- 
 iar to the educated physician ; that a youth of devotion to his Art, 
 is all too little to familiarize him with all the varieties of disease, and 
 the means of meeting them successfully ; and that there is no access to 
 the temple of JNIedicine save through the intimate knowledge of the 
 laws by which we live, and move, and have our being." 
 
 Cincinnati, No, 258 Race Street, November 1, 1855.
 
 INTRODUCTION. 
 
 " In order to study and practice Medicine in a proper manner, it is 
 necessary to be impressed with its importance ; and to be so impressed. 
 we must believe in it."" These words of a philosophic physician, 
 whose life and writings breathe a sincere philanthropy, contain a deep 
 sense, which constitutes, according to my opinion, the moral base of all 
 Medical Practice. It is evident, indeed, that the practitioner who has 
 no faith in the efficacy of his art, can not devote himself to the study 
 and practice of it, with the necessary zeal, and perseverance. But, it 
 will not suffice for the physician only to be convinced of the utility of 
 the remedies he prescribes ; it is also very advantageous to the success 
 of the treatment, if the patient share his confidence in them. It is. 
 then, important to all of us, to form early a reasonable opinion on the 
 degree of efficacy and certainty that may be attained in medicine. Now, 
 we shall not be able to draw the motives of such an opinion from any 
 better source than the history of this science. 
 
 Another question which, though less important, does not lack interest. 
 is, "What is the origin of the Healing Art ? Has it sprung from the 
 natural wants of man, or rather, as some ancient and modern philoso- 
 phers have pretended, is it only an evidence of the degeneration of the 
 human species ? It belongs to history alone to resolve this question in 
 a decisive manner ; for, if it appears from the most undoubted tradi- 
 tions, that there does not exist, and never has existed a people, whether 
 savage or civilized, who have not had some species or other of Medicine, 
 we are compelled to conclude from this, that this art is destined to sat- 
 isfy an irresistible, imperious and natural want ; and not a factitious 
 one proceeding from effeminate habits, or some other vice of civilization. 
 
 Medicine, whose history I have endeavored to trace, was called, in its 
 origin, the Art of Healing. It consisted at that time, in a succinct 
 
 Cabanis. " Du Degre de Certitude de la Mcdecine," Preface, page 1. 
 1
 
 X INTRODUCTION. 
 
 description of diseases, which had been observed, and the indication of the 
 remedies employed to combat them. These two parts correspond to what, 
 at this day, are named Nosology and Therapeutics ; they relate to man 
 in a state of disease only. 
 
 Subsequently, those who devoted themselves to the practice of Medi- 
 cine, enlarged, gradually, the field of their observations. Nosological 
 descriptions became more extended and numerous, and the therapeu- 
 tical indications more precise. They became convinced, that to un- 
 derstand diseases well, it was necessary to study man in a state of health. 
 Thus Anatomy, or the knowledge of the structure of the human body, and 
 Physiology, or the knowledge of Organic functions, became important 
 branches of medical science. Experience, also, taught men that it is 
 always more important, and often easier, to prevent the development of 
 certain diseases, than to arrest their progress when once developed. 
 Consequently, physicians turned their attention toward this object. 
 They traced the rules for the preservation of health, and the collection 
 of these rules constituted a new branch of the art called Hygiene. These 
 successive additions necessitated a change in the definition of Medicine ; 
 the first, not embracing any longer all the departments of the science, 
 the following was then nearly unanimously adopted : 
 
 " Medicine is a science which has for its aim, the promotion of Health, 
 and the cure of Disease." 
 
 This was, for a long time, the limit of the Medical horizon ; and it 
 can not be doubted, but that the field was vast enough for the investiga- 
 tions of those who cultivated it. Nevertheless, they aspired to extend it, 
 so constantly does the genius of man deride the limits which are assigned 
 to it. Two interesting ramifications are developed recently, from this 
 majestic trunk of science devoted to physical man. The first, named 
 Orthopsedia, teaches how to correct certain exterior deformities, whether 
 accidental or congenital ; the success it has attained, and the extension 
 it has acquired, make it already a special branch of Medicine. The 
 second ramification is called Phrenology, a Greek word, which signifies, 
 literally, a discourse on thought, or on the faculties of the soul. But, by 
 thought, here, is meant the organ which serves, more particularly, for its 
 manifestation. It is then the organ of thought, that is to say, the en- 
 cephalon, of which Phrenology treats. Those who have made a special 
 study of this branch, believe that the development of the faculties of the 
 soul, or rather, the manifestation of these faculties, depends on the 
 volume and the form of certain parts of the encephalon. They hope even 
 to determine, by the exterior examination of the cephalic box, the varia- 
 tions in the volume, and the form of the brain, and, consequently, the 
 degree of development of its faculties. If Phrenology ever realizes
 
 INTRODUCTION. XI 
 
 its promises, it will become a great aid to the physical and moral educa- 
 tion of man. However this may be, the last definition that we have 
 given to Medicine, appears to me a little too restrained, and it may be 
 advantageously replaced. I think, by the following : — " Medicine is a 
 Science, which aims at the Preservation of Health, the cure of Diseases, 
 and the Physical perfection of Man." 
 
 We see already, by this simple announcement, what Medical Science 
 strives to attain, and how much it merits the attention not only of those 
 who make it a special study, but also of the Philosopher, the Statesman, 
 and whoever appreciates the advantages of good health as well as the 
 influence of the physique on the morale of man. 
 
 To the historian, Medicine presents itself in three principal phases, 
 viz : as a Profession, as an Art, and as a Science. 
 
 As a Profession, Medicine was practiced, primitively, by the chiefs of 
 families, of tribes, and of nations, and by generals and legislators. Af- 
 terward, it was joined to the Sacerdotal office for a very long time. At 
 last, it constituted a distinct Profession, which was, at a later period, sub- 
 divided even into several departments. I have indicated, summarily, all 
 these revolutions, with the circumstances that have led to them, and the 
 good or evil consequences that have resulted. 
 
 In the point of view of an Art, that is to say, in regard to the rules 
 which have been established at divers epochs for the cure of diseases 
 and the preservation of health. Medicine appears to me to have followed 
 a constantly progressive march from its origin to the death of Galen. 
 Then it remained stationary, or even retrograded, at least in Europe, until 
 the end of the fourteenth century of the Christian era. But from this 
 epoch, the Healing Art took a new bound, and acquired, from generation 
 to generation, remarkable perfection. Those who deny the progress of 
 Medicine, have never seriously studied its history. 
 
 If it is true, and it can not be doubted, that Therapeutics is really the 
 essential part of Medicine — if it, in fact, combines all the advantages of the 
 science, it can not be questioned, but that the ancients are far in our rear. 
 To prove this, it is sufficient to glance at any class of diseases, and com- 
 pare the treatment employed formerly with that of our times. Exam- 
 ine, for example, that of acute diseases, intermittent fever, apoplexy, 
 most of the anatomical lesions, the prophylactic treatment for variola, 
 and then tell me if the therapeutics of the ancients, in all these diseases, 
 can be compared with that of the moderns ! The same I'esult we find in 
 regard to chronic affections, such as scrofula, syphilis, favus, etc. After 
 this, is it not an exhibition of ingratitude or ignorance in those who pretend 
 that ^Medicine rests stationary in the midst of universal progress ? But 
 man is so oblivious of benefits he has received, it may be said that he
 
 Xll rNTRODUCTION. 
 
 has a memory only for the evils he has suffered ! The storm which destroys 
 in an instant the hope of the laborer, makes an ineffaceable impression on 
 his memory, while the gentle sprinkling that fructifies his furrow, passes 
 unperceivcd. Thus the discovery of the sulphate of quinia has made 
 less noise in the world than that of the congreve rocket, and the name 
 of Jenner is less known than that of Attila ! 
 
 As a Science, so far as regards theories. Medicine offers the picture of 
 a republic delivered up to many rival factions, which dominate by turns, 
 without ever obtaining lasting power. Theory is an arena of intermin- 
 able discussions, a real tower of Babel ; it is the apple of discord among 
 physicians. Who can flatter himself to hold the equal balance among 
 so many diverse or contrary opinions, to distribute equitably praise and 
 blame; to mark the precise limit in each where truth ends and error 
 commences? 
 
 This diiScult enterprise I undertook, not with a view of instruct- 
 ing others, but myself ; not with the intention of publishing the result of 
 my research, for I was ignorant what it would be, but pressed by a 
 desire to assure myself if there exists in Medicine anything useful 
 and certain, any principle whose evidence is striking as that of a math- 
 ematical axiom, some practical rule whose utility would be incontestable. 
 I think that a physician who is animated with a sense of his duty can 
 not remain indiftcrent on these questions, and that he must at least once 
 in his life examine them seriously. If something of this kind exist 
 in Medicine, I said to myself, the history of this science must make it 
 apparent ; and consequently I embraced with ardor and perseverance 
 the study of this history. Now, in deciding to publish the result of my 
 studies, I have no other aim than that of saving to my brethren a part 
 of the labor which I have performed, by abridging for them the road I 
 had to travel. 
 
 The only historian who has attempted to unravel the chaos of medical 
 theories from the beginning to an epoch near our own (Kurt Sprengel,) 
 has arrived at this conclusion — " that skepticism in Medicine is the top 
 stone of the science, and that it is the wisest part to regard all opinions 
 with indifference, and adopt none."* This maxim I hold to be erroneous, 
 hopeless, and impracticable. Xo, whatever this erudite historian in 
 Medicine may say,/loubt is not the last word of science, it is only the com- 
 mencement of it, the point of departure. It is merely a favorable dis- 
 position for acquiring knowledge, certainty, or at least conviction. So 
 taught Aristotle, so proclaimed Descartes, and the intimate sense of each 
 
 ^' " Hist, de la Medicine," trad, par, A. J. L. .Tourdan, Paris, 1815, t. I, Intro- 
 duction pp. 10, 11. See also the " Preface du Traductcur," p. 22, et suivantes.
 
 INTRODUCTION. XIll 
 
 one of us confirms the same. "When we undertake the search for truth, 
 it is with the desire and hope of attaining it, and if persuaded in ad- 
 vance that this desire and hope are vain, (as Sprengel pretends,) we 
 would rest in careless repose, rather than uselessly fatigue ourselves in 
 the pursuit of a chimera. Nevertheless, it may happen that our inves- 
 tigations will only produce a negative result, that we may remain in the 
 ignorance and doubt whence we were anxious to emerge ; but that is only 
 an accidental or particular result, not the general or necessary one at which 
 infallibly all human researches must arrive. We are ordinarily con- 
 ducted to this negative conclusion by a bad method of reasoning, in the 
 same manner that a false road conducts the traveler far from the true 
 aim of his journey. 
 
 But if doubt should be rigorously maintained, concerning specula- 
 tive truths, it must not be so in relation to those propositions destined 
 to regulate our conduct. In regard to these, we are constrained to take 
 a part whether we will or no ; in other words, we must decide upon 
 some conviction more or less strong. A j^hysiciau, for example, may 
 well doubt, when in his cabinet, if the difficulty of respiration realized 
 by an asthmatic, proceeds from a lesion of the heart, or great vessels, or 
 from an accumulation of mucus, or from a rheumatic condition of the 
 muscles, or, lastly, from the nerves of the chest. But this physician 
 once in the presence of his patient, after having examined him, will be 
 obliged to make a pi-escription. Can there be for him any possible 
 choice between doing something or nothing ? Now, if he orders nothing, 
 does he not so conclude from an opinion ? and he does the same if he 
 prescribes ; the choice of doing nothing or something, supposes a motive 
 more or less strong. Pure skepticism, then, is impossible in a practi- 
 tioner who each day finds himself placed in the necessity of making a 
 decision on which will depend, perhaps, the life of his fellow-man. A 
 practitioner can, therefore, not indulge in the skeptical indifiereuce of 
 which the historian I have cited, boasts ; he must, on the contrary, use 
 every effort to free himself from it, and rise to the point of rational 
 conviction. 
 
 It is with this disposition of mind that I have undertaken the exam- 
 ination of ancient and modern medical doctrines. I have studied and 
 compared them with all the attention of which I am capable ; for I wished 
 to form an opinion based on the absolute or relative value, on the advan- 
 tageous or injurious influence, of each one of them. The reader, then, 
 must not be astonished if, in the course of this history, I emit often and 
 in a very explicit manner, my own opinion on the theories under consid- 
 eration. But, in fine, that the reader may be in a condition to appreciate 
 for himself these theories, and the judgment that I form of them, I shall
 
 XIV INTRODUCTION. 
 
 present them with all the exactness I possibly can, employing for this 
 purpose, the text even of the authors who have written in our own language, 
 and that of the translations of the most esteemed foreign authors. I 
 shall not pretend to translate them myself, except in cases where no trans- 
 lation has been made. I act thus, in the persuasion that a man who 
 makes a particular and profound study of a work, translating it entire, 
 must be penetrated with the spirit of the author much better than he 
 who extracts from it a few pages only. Beside, I hope by this method 
 to avoid the reproval of misrepresenting the opinions of others, either 
 unknowingly or by design, and so preserve, as far as I am concerned, 
 their color and original forms. 
 
 Celebrated physicians influence the progress of their Science and the 
 value of their Art, not by their writings only, but by their oral teach- 
 ings, character, and conduct. Their lives offer, often, models for imita- 
 tion, and sometimes, also, faults and errors to be avoided. Often. 
 too, the early education of a man, and the circumstances in the midst 
 of which he was reared, explain the peculiarity of his genius, and give 
 the key to his successes and reverses. For these reasons, I could not 
 neglect entirely some biographic details relative to the most famous 
 physicians, especially when these details had some connection with the 
 general history of the Art, or embraced some moral considerations. 
 
 The sciences do not pursue their march isolated from each other, they 
 go hand in hand, and it is rare that their progress is not simultaneous. 
 An exception to this rule, however, presents itself in the history of the 
 human mind in Europe. During the middle ages, dialectics and the- 
 ology are cultivated successfully, while the other branches of human 
 knowledge, and Medicine in particular, merely vegetate in deep neglect. 
 But with the fourteenth century, industry, the sciences, and the arts, 
 awake from their long sleep. 
 
 On the one hand, the civil and political organization of European 
 nations becomes regulated, their material good increases ; on the other, 
 the intellectual and moral faculties of individuals are developed — the 
 mind makes efforts freer, bolder, and in a better direction. The histo- 
 rian of Medicine would fail, it seems to me, in one of his duties, if he 
 did not now and then give a general view of the state of society. 
 Therefore, at the commencement of each of my Chronological divisions, 
 I give a rapid sketch of the aspect which civilization then presented. 
 
 Another fact extremely remarkable, and of capital interest in the his- 
 tory of medical theories is, that they are all derived more or less direct- 
 ly, from some system of philosophy ; so that only an incomplete idea 
 of them could be obtained if the philosophic sources from which they 
 were drawn were unknown. But too much importance must not be
 
 INTRODUCTION. XV 
 
 attached to these analogies, nor must the value of medical theories be 
 judged bj them. It must not be forgotten that a philosophic system 
 may be false as a whole, and yet true in its particular application to 
 Medicine. On the other hand, we may, by false logic, deduce an erro- 
 neous medical theory from an iri'eproachable philosophic system. Thus, 
 then, after having indicated the philosophic ideas with which each medi- 
 cal doctrine may seem to be related, we shall judge this in itself, and 
 relative to its practical consequences. 
 
 The principal systems of antiquity concerning Cosmogony, or general 
 physics, may be ranged in three sections, as follows : 
 
 1. Those that have at their head Pythagoreanism — representing the 
 universe as inhabited by active and intelligent principles, which ani- 
 mate, fashion, and govern each material substance in a determinate way, 
 and for a preconceived end. The animals, plants, and even minerals, 
 possess, each, a vivifying spirit. Above these secondary principles rules 
 the Supreme principle, who superintends the whole, harmonizing indi- 
 vidualities, and causing them to concur to one common end. 
 
 2. Another class of philosophers, of whom Leucippus and Democritus 
 seem to be the chiefs, considered the formation of the universe as a pure 
 result of chance. They pretend to explain all the phenomena of nature 
 without having recourse to the intervention of any intelligent principle. 
 According to them, the world in general, and each being in particular, 
 exists as a necessary result of the eternal laws of matter. They deny 
 that different substances, such as plants and animals, were created for a 
 preconceived end. They ridicule what was termed in the language of 
 philosoph}-, final causes. 
 
 Finally, a third sect, which recognizes Parmenides and Pyrrho as their 
 founders, who, believing that there exist in the natural movement of bodies, 
 in their reproduction and endless changes, motives equally powerful to 
 admit or reject the presence of immaterial and intelligent principles, con- 
 cluded, from this ambiguity, that wisdom consists in remaining in doubt. 
 " What is the use," say those sectators, " of fatiguing the mind in 
 efforts to comprehend what is beyond its capabilities ? The research after 
 principles or first essences, has only resulted, thus far, in useless and in- 
 terminable disputes. We receive no real knowledge but through our 
 sensations, and we have no certainty in these beyond the objective ex- 
 actitude." Such was, in short, the language of this sect, which sometimes 
 took the name of Skeptic, to designate the perpetual doubt which they 
 professed, and sometimes that of Zetetic, to indicate that they were 
 always in search of truth, without flattering themselves to have found it. 
 To these three systems of Philosophy among the ancients, correspond
 
 XVI INTRODUCTION. 
 
 three systems of Medicine, of which I shall merely indicate, now, the prin- 
 cipal traits. 
 
 The first of all, known by the name of Dogmatism, is attributed to 
 Hippocrates, its culminating idea being, that " there is a simple principle 
 and multiple in its eflfects, that presides over the body and all its func- 
 tions, creating contraries, and vivifying the whole and each part." — 
 (Hippocr., de V Aliment, § 7.) This idea is reproduced many times in 
 the same work, and in others also, by the same author. It is the 
 foundation of Vitalism, or modern Hippocratism, a doctrine that M. 
 Professor Cayol has explained in so lucid a manner, in his introduction 
 to the " Medical Clinic," and which M. Gibert has sustained with all 
 the vigor and logic for which he is distinguished." 
 
 One of the most celebrated nosologists of the last age, Pinel, has 
 given an idea of disease conformable to this doctrine, when he says: 
 " Disease should be considered, not as a tableau always in motion, 
 an incoherent assemblage of recurring affections that are unceasingly to 
 be combated by remedies, but as an indivisible unit, from its beginning 
 to its termination — a regular totality of characteristic symptoms, and 
 succession of periods with a natural tendency, most frequently favorable, 
 though sometimes fatal, "f 
 
 This definition, which presents disease to us as a regular succession 
 of actions and movements sustained by the vital principle with a man- 
 ifest purpose, shows already the connection that exists between the doc- 
 trines of Hippocrates and the Pythagorean philosophy; but this 
 connection becomes more and more striking by the details which will be 
 given hereafter, in the course of this history. For it would be a great 
 error to suppose that the passages above quoted are a resume of the 
 entire medical theory of the physician of Cos. They must only be 
 considered as one of the principal phases of his theory — one of its char- 
 acteristic dogmas — the only one which has maintained its place down 
 to our times. 
 
 The second system which is ofiered for our examination has received 
 the name of Methodism, and recognizes as its founders, Asclepiades and 
 Themison. The former studied, with great care, chronic diseases, in which 
 the medicative force of nature is often imperceptible. He felt justified 
 in denying the existence of this force, and turned into ridicule the Hip- 
 pocratic dogmas on this subject. On the other hand, seduced by the 
 
 ^ " Considerations sur I'llippocratisme et I'Anatomisme." Paris, 1833, in 8. 
 I " Nosogr. Philosophique." 1st edition, Introduction, p. 7.
 
 INTRODUCTION. XVll 
 
 Atomic theory of Democritus, which Epicurus had developed and rejuve- 
 nated, he hastened to make an application of it to Medicine. He repre- 
 sented the human body as pierced by an infinity oi pores, through which 
 the atoms of various forms and sizes must pass and repass without ces- 
 sation. These corpuscles, excessively attenuated, were supposed to 
 move about automically, in virtue of the inherent force of matter. As 
 long as the s'ze and form of these atomic corpuscles were in exact pro- 
 portion to the passage through which they had to move, was the health 
 of the individual maintained. But as soon as the exactness of these 
 relations was destroyed, the health was deranged ; but this could only 
 occur, says this physician, in two ways, viz : either by an excessive con- 
 traction or dilatation of the pores. In this system, the animal economy 
 is regarded as entirely passive ; no reaction, no spontaneity, no natural 
 tendency whatever is attributed to it. The physician had but to direct 
 the movement of the economy by means of modifying agents which art 
 placed at his disposal. 
 
 The two preceding systems, as is plainly seen, were diametrically oppo- 
 site ; the one never lost sight of the natural activity of the organism in 
 diseases ; the other considered the human body as in a passive state 
 only. But if pathological phenomena are observed without prejudice, it 
 soon becomes evident that in the production of these phenomena, the 
 organism is, by turns, both active and passive. Thus, when, from the 
 infliction of a severe wound, general symptoms appear, such as fever, 
 delirium, and convulsions, it is evident that under these circumstances 
 the organism is at once active and passive ; passive, in relation to the 
 local lesion, the pain, and the shock experienced ; active, relatively to 
 the general functional derangement which is an effect of the vital reac- 
 tion. If I may be permitted to make use of a vulgar illustration, bor- 
 rowed from antiquity, to show the double action of the animal economy 
 in the production of morbid phenomena, I will simply refer to the ser- 
 pent, which, biting his own tail, is simultaneously the cause and the object 
 of the action. 
 
 The Dogmatists did not deny that the organism is passive at the moment 
 when it receives the impression of a nosogenic influence ; but they 
 regarded this impression as a simple occasional cause ; they pretended that 
 the disease only commences, really, with the reaction of the vital prin- 
 ciple. This reaction, according to them, is the primitive and essential 
 phenomenon, the proximate or occult cause of the morbid affection. 
 
 The Methodists, on the contrary, considered vital reaction as a sec- 
 ondary phenomenon, a species of oscillatory change, of which the proxi- 
 mate or primitive motor cause was the impulsion produced by the 
 morbific agent.
 
 XVlll INTRODUCTION. 
 
 A third class of physicians, at the head of which it has been cus- 
 tomary to place Philinus and Serapis, thinking that the proximate cause. 
 or the primitive phenomena of diseases, was inaccessible to observation, 
 hence concluded that all which was affirmed on that subject, is arbitrary, 
 hypothetical, and unworthy of consideration in the choice of a rational 
 treatment. They asked that in the description and treatment of dis- 
 eases, only such symptoms should be recorded as fall under the notice of 
 our senses. The totality of these phenomena constituted, in their eyes. 
 the whole morbid aflfection, or at least all that could be known or affirmed 
 in regard to it. 
 
 Consequently, they assumed, that in any given case, only such reme- 
 dies as had appeared to be valuable in similar cases, should be employed, 
 without any regard to the proximate, essential, or occult cause, of which, 
 they say, nothing reveals to us the mode of action. As their reasoning 
 did not go beyond those things which have already, or may yet become 
 matters of observation and experience, they took the name of empirics, 
 which signifies experimenters. They have been classed with the skeptical 
 philosophers, who place nothing in the rank of certain and positive 
 knowledge, but the sensations. 
 
 A considerable number of physicians would not adopt any of these 
 systems, exclusively, but drew from each what to them seemed to be 
 most conformable to reason and experience. They called themselves 
 Eclectics, from a Greek word, which signifies, to choose ; by which they 
 wish to imply, that they made a rational choice of what appeared to be 
 best, of all doctrines. It must be admitted, that this is a very laudable 
 design, though somewhat pretentious. They should, however, have indi- 
 cated the I'ule by which they were guided in this choice, what principle 
 they followed in discerning, among so many contradictory opinions, 
 truth from error, the reality from fallacy, and the good from evil. 
 
 This is what the Eclectics ought to have been able to do, but what 
 they have not done. They contented themselves by affirming that they 
 followed, in every case, the voice of experience and of reason, without 
 permitting themselves to be influenced by any prejudice, or systematic 
 idea. But we must take their word for it, for they have emitted no 
 axiom which enables us to see it for ourselves. Eclecticism is, in reality, 
 neither a system nor a theory ; it is, uniquely, an individual pretension, 
 elevated to a dogma. Each Eclectic recognizes no other rule, than his 
 particular taste, his individual reason, or his fancy. Two, so called, 
 Eclectics have seldom anything in common, but the name. 
 
 The Eclectic carefully avoids the discussion of principles. He has 
 little taste, or little capacity for high abstractions. He believes them 
 useless, not to say injurious to the practice and progress of the art. In
 
 INTRODUCTION. XIX 
 
 a word, the assumption of the name of Eclectic conveys a very unfavor- 
 able idea as to the iixity of their philosojjhic principles. But the Eclec- 
 tic may be, and often is indeed, a good practitioner. If, on the one 
 hand, he disregards the fundamental principles of science, on the other 
 he concentrates his attention on details ; and we all know that practical 
 skill is based, particularly, on specialties. To such may, with good 
 reason, apparently, be applied the proverb, "good practitioner, bad 
 theorist." Not that he, necessarily, has no theoretic ideas ; that is im- 
 possible : but his ideas form no system, and are not based upon general 
 principles. AVith him, medical tact, that is, cultivated instinct, takes 
 the place of principles. Such was the erudite Barckauscn, who, in 
 reviewing medical theories, found in all, something to blame, and some- 
 thing to praise, without giving to any one a marked preference. 
 
 The Eclectic of our times is, ordinarily, only an empiric in disguise : 
 but an empiric, in an honorable sense of that term ; that is to say, a 
 man whose opinions are based on the pure and simple observation of 
 facts, carefully compared ; whose theoretical ideas do not go beyond 
 phenomena. In order to form a system, his ideas only need to be united 
 by a common tie, under the guidance of a philosophic principle. 
 
 I have just expressed the idea that it is impossible for a man to prac- 
 tice Medicine without any species of theory. This is an axiom which 
 has no need of demonstration, says Professor Bouillaud." 
 
 Doctor Auber unites in this opinion. '"Be well convinced," says he. 
 " of one thing, that there is no practitioner who has not, however lim- 
 ited, his theory, and who may not, also, be carried away by it at the bed- 
 side, seeing that it is, necessarily, by reason of some idea, false or true. 
 wise or foolish, scientific or vulgar, that even the most senseless physi- 
 cian determines, or is compelled automatically, to act in one way rather 
 than in any other, and on this account it is said, with infinite reason, 
 that the practice must ever submit to the yoke and exigencies of even 
 the most contemptible theories." — (" Traite de la Philosophic 3Iedicale.'' 
 Paris, 1839, p. 185.) 
 
 To those readers who may accuse me of attaching too much importance 
 to the examination of theories, I must respond, — theories have been, and 
 will forever be, the compass of the practice. 
 
 Anciently, philosophy embraced the whole of human knowledge, 
 physics, natural history, medicine, morals, metaphysics, theology, math- 
 ematics, etc. The philosopher was not pcrmittc^ to be unacquainted with 
 any of them. Now, physics, natural history, medicine, and many other 
 
 * " Essai sur la Philosophie Medicale et sur les Generalites de la Clinique Med- 
 icale." Paris, 1836, page 302.
 
 XX INTRODUCTION. 
 
 branches of philosophy have been detached from the main trunk, and 
 constitute separate sciences. From this separation, it results that mod- 
 em Medicine has borrowed less from philosophy, propei'ly so called ; but 
 in compensation, it has been influenced by other sciences, such as physics 
 and chemistry. 
 
 From the end of the fourteenth century of our era, to the commence- 
 ment of the nineteenth, we count, in ]\Iedicine, five classes of principal 
 theories, namely : the ancient Humoralism or Galenism, the latro-Chem- 
 ical, the latro-Mechanical, Animism or Vitalism, which is confounded 
 with modern Hippocratism, and finally, Organo-Dynamism. 
 
 I shall not extend further these general considerations, or I should 
 encroach on what will be said in the course of this history, where the 
 theories to which I have alluded, and some less important ones, will be 
 properly treated. 
 
 The following is the chronological order which I have thought it 
 proper to adopt: I divide into three Books, or three Ages, all past 
 time. The First Age commences with the infancy of society, as far 
 back as historic tradition carries us, and terminates toward the end 
 of the second century of the Christian era. at the death of Galen, 
 during the reign of Septimus Severus. This lapse of time constitutes, 
 in Medicine, the Foundation Age. The germ of the Healing Art, con- 
 cealed, at first, in the instincts of men, is gradually developed ; the basis 
 of the science is laid, and great principles are discussed. The human 
 mind, always impatient, surpasses in its speculations, the limits of the 
 known and possible. Many branches of the art, such as Symptomatol- 
 ogy and Prognosis, are carried to a remarkable degree of perfection. 
 
 The Second Age, which may be called the Age of Transition, offers very 
 little material to the history of Medicine. We sec no longer the con- 
 flicts and discussions between partisans of different doctrines ; the medi- 
 cal sects are confounded. The art remains stationary, or imperceptibly 
 retrogrades. I can not better depict this epoch than by comparing it 
 to the life of an insect in the nympha state ; though no exterior change 
 appears, an admirable metamorphosis is going on, imperceptibly, within. 
 The eye of man only perceives the wonder after it has been finished. 
 
 Thus, from the fifteenth century, which is the beginning of the third 
 and last Age of Medicine, or the Age of Renovation, Europe offers us a 
 spectacle of which the most glorious eras of the republics of Greece 
 and Rome only can give us an idea. It would seem as if a new life was 
 infused into the veins of the inhabitants of this part of the world ; 
 the sciences, fine arts, industry, religion, social institutions, all are 
 changed. A multitude of schools are opened for teaching jMedicine. 
 Establishments which had no models among the ancients, are created
 
 INTRODUCTION. XXI 
 
 for the purpose of extending to the poorer classes the benefits of the 
 Healing Art. The ingenious activity of modern Christians explores 
 and is sufiicient for everything. 
 
 These three grand chronological divisions do not suffice to classify, iu 
 our minds, the principal phases of the history of Medicine ; conse- 
 quently, I have subdivided each age into a smaller number of sections, 
 easy to be retained, and which I have named Periods. The first Age 
 embraces four periods, the second and third ages, each, two. 
 
 I will now indicate succinctly, each of these secondary divisions, 
 without attempting, at present, to justify them, for this will be done in 
 its proper place in the course of the work. 
 
 The first period, which we name Primitive Period, or that of Instinct, 
 ends with the ruin of Troy, about twelve centuries before the Christian 
 era. 
 
 The second, called the Mystic or Sacred Period, extends from the 
 dissolution of the " Pythagorean Society " to about the year 500, A. C. 
 
 The third period, which ends at the foundation of the Alexandrian 
 Library, A. C, 320, we name the Philosophic Period. 
 
 The fourth, which we designate the Anatomic, extends to the end of 
 the first age, i. e., to the year 200 of the Christian era. 
 
 The fifth is called the Greek Period ; it ends at the destruction of the 
 Alexandrian Library, A. D. 640. 
 
 The sixth receives the surname of Arabic, and closes with the four- 
 teenth century. 
 
 The seventh period, which begins the third age, comprises the fifteenth 
 and sixteenth centuries ; it is distinguished as the Erudite. 
 
 Finally, the eighth, or last period, embraces the seventeenth and 
 eighteenth centuries. I call it the Eeform Period. 
 
 In this division of the past, there is wanting that portion of the 
 nineteenth century which has already passed. I have omitted it for 
 the following reasons : First — I have asked myself, is it possible to 
 write cotemporaneous history with the same independence of mind as 
 that of the past? Secondly — Is it suitable, in speaking of living 
 authors, to omit all biographic details ? Thirdly — Is there not dan- 
 ger of exaggerating cotemporaneous opinions and discoveries ? Lastly — 
 Can we seize the general physiognomy of an epoch while living in its
 
 XXll INTRODUCTION. 
 
 midst ? Does not one in such a position resemble a man who, placed 
 at the foot of an edifice, thinks himself capable of appreciating the 
 effect of the whole structure ? 
 
 All these considerations, have led me to fear that I could not trace 
 the history of our own times after the same plan as that of the history 
 of the past, and I have therefore taken, as my limit, the end of the 
 eighteenth century. 
 
 I propose, however, to give hereafter, under the title of Materials for 
 Cotemporaneous Medical History, a discussion of the theories, discov- 
 eries, and improvements that have signalized the first half of the pres- 
 ent century. This will form a supplement to the second volume.'-' 
 
 *'See Appendix.
 
 SYNOPTIC TABLE 
 
 OF THE AGES AXD PERIODS OF 
 
 THE HISTOEY OF MEDICIIVE 
 
 f I. Pruiitive Period, or Ending with the destruction of 
 that of Instinct. Troy, 1184 years before 
 
 Christ. 
 
 Age of Foundation, " 
 
 II. Sacred, or 
 
 Mystic Period. 
 
 Ending at the dispersion of the 
 Pythagorean Society, 500 
 years before Christ. 
 
 III. Philosophic Period. Ending at the foundation of the 
 
 Alexandrian Library, 320 
 years before Christ. 
 
 IV. ANATOinc Period. Ending at the death of Galen, 
 V A. D. 200. 
 
 / Y. Greek Period. 
 
 Age of Transition, -< 
 
 VI. Arabic Period. 
 
 Ending at the burning of the 
 Alexandrian Library, A. D. 
 640. 
 
 Ending at the revival of letters, 
 A. D. 1400. 
 
 Age of Renovation, 
 
 / VII. Erudite Period. Comprising the XV. and XVI. 
 
 centuries. 
 
 VIIT. Reform Period. Comprising the XVII. and 
 XVIIl. centuries.
 
 HISTOEY OF MEDICINE. 
 
 BOOK I. 
 AGE OF FOUNDATION. 
 
 EXTENDING FROM THE, ORIGIN OF SOCIETY TO THE END OF THE. 
 SECOND CENTURY OF THE CHRISTIAN ERA. 
 
 I PRIMITIVE PERIOD. 
 
 OF VARIABLE DURATION AMONG DIFFERENT PEOPLE. 
 GENERAL CONSIDERATIONS. 
 
 This period, which corresponds with the early'infancy of human society, 
 is enveloped in profound obscurity, and mingled with a multitude of 
 fables It embraces an indefinite lapse of time, during which, Medicine, 
 did not constitute a Science, that is to say, a systematic assemblage of 
 rational knowledge, but formed rather an undigested collection of ex- 
 perimental notions, vaguely described, and more frequently disfigured by 
 a series of incomplete traditions. It is easily understood, that such a 
 state of things must have existed, a longer or shorter time, in difi"erent 
 parts of the globe, in proportion to the progress, more or less rapid; 
 that the inhabitants of those parts made in the career of civilization. 
 This state of things still exists among certain tribes in the center of 
 Africa, in some parts of America, and especially in Oceanica. But for 
 Grreece, which has transmitted to us the most precious memorials of 
 antique Medicine, the Primitive Period ended, as we shall see further on, 
 at the destruction of Troy, in the course of the twelfth century before 
 the Christian era. 
 2
 
 26 PKIMITIVE PERIOD. 
 
 Before following the trace of the Art of Healing, on the classic ground 
 of the Hellenists, we shall seek the first vestiges of it among other 
 nations that preceded the hellenic nation, on the route of social progress, 
 and who furnished it, in those remote times, models, in more than one 
 sense. Consequently, we shall, in the first place, cast a glance at the 
 antique Medicine of the Egyptians, the Jews, the Indians and the 
 <-.hinese ; then we shall describe the state of Greek Medicine, before the 
 Trojan war, and finally say a few words on the manner in which this 
 Art was cultivated, primitively, among some nations less celebrated, both 
 in the Old and New World. 
 
 CHAPTER I. 
 MEDICINE OF THE ANTIQUE NATIONS. 
 
 I. MEDICINE OF THE EGYPTIANS. 
 
 If we accord the first place, in this history, to Egyptian Medicine, it is 
 not without a motive. It seems to us to merit this honor, not only 
 because its antiquity is based on monuments, the most authentic, but 
 also because it has been the source whence the Greeks drew the first 
 elements of this science; and in this respect also the Egyptian nation 
 may be justly named, the instructress of the human race. We read in 
 the Bible, that when Jacob died, "Joseph commanded his servants, the 
 physicians, to embalm him ; and the physicians embalmed Israel, and 
 forty days were fulfilled for him, for so are fulfilled the days of those 
 that are embalmed." (Gen. chap. 1.) Thus, at the death of the Patri- 
 arch Jacob, about 1700 years before the birth of Christ, Egypt possessed 
 men who practiced the art of medicine. This passage, in the writings of 
 Moses, is the most ancient authentic monument that we possess of the 
 Healing Art ; all that is more remote in the history of Egypt, and of 
 other nations, is enveloped in uncertainty and obscurity, at least so far 
 .as medicine is concerned. 
 
 Nevertheless, it is certain, that before the time of the emigration of the 
 ■sons of Jacob to Egypt, the arts and sciences had already attained, in that 
 country, a degree of perfection which could only be the result of long 
 experience, that required very many years or rather centuries of obser- 
 vation. The books of the Hebrews, furnish other more valuable infor- 
 mation on this subject. We read in them, that when Abraham was 
 constrained by the famine, to quit the land of Canaan, he entered Egypt, 
 where he found an abundance of everything to nourish his household 
 and his flocks. At this epoch, which preceded the death of Jacob 230
 
 MEDICINE OF THE EGYPTIANS. 27 
 
 years, Egypt rejoiced in a very advanced state of civilization. Agricul- 
 ture, Geometry, Architecture, Metallurgy, had all then made a remark- 
 able progress. Thebes, the city of a hundred gates, existed as well as 
 some of those gigantic edifices, destined to transmit to posterity, 
 the evidence of the power and wisdom of the Pharoahs. •■^ 
 
 But through how many phases must the Egyptian nation have passed, 
 before its intelligence and industry had acquired such a development ! 
 How many centuries must have run by. before her men possessed the 
 means of perpetuating the memory of great events and useful inventions ! 
 The arts of speaking and writing, these two indispensable instruments for 
 the transmission of ideas, how were they created ? By what series of 
 gradual improvements did they arrive at that point of clearness, requi- 
 site to produce exactly the image of the thoughts? The most ar- 
 duous and subtle researches, teach us nothing, or next to nothing on these 
 interesting questions ; the science of Champollion is mute on this point ; 
 the sacred books alone clear up this difficulty, in saying that God 
 taught to man, the names of all animate and inanimate things. 
 
 So then, the generations that have bestowed upon the human race the 
 most useful discoveries, have themselves passed away, without leaving 
 any other impression of their passage. Those who undertook, in after- 
 times, to collect the records of humanity, in place of transmitting pure 
 and intact, the few documents of which they yet held possession, envel- 
 oped them with fiction, which renders the truth more and more uncertain. 
 But it must be said, for their justification, that these first chroniclers 
 had especially in view, the inculcation to man of the principles of socia- 
 bility, morality, and I'eligion, and that their marvelous, or allegorical 
 recitals attained much more directly the end they aimed at, than if they 
 had stated the naked truth. It is for this reason, doubtless, that in- 
 stead of seeking, laboriously, the primitive source of the arts and sciences, 
 on the earth, they placed it in the heavens, and that they attributed to 
 their gods, or to men they deified, all great discoveries. On this account, 
 therefore, the cradle of Medicine, as well as all the arts of first necessity, 
 is surrounded with fables and allegories. 
 
 I shall glide slightly over this medical mythology, which, in this day, 
 can neither delude any one, nor furnish any satisfactory light on the 
 state of the science in primitive times, and would constitute nothing 
 more than a display of erudition as sterile as it would be out of place 
 in an elementary work. I shall only say on this subject, what is indis- 
 
 "Lettres de Champollion jeune, relatives au Musee Egyptien de Turin, p. 25 et 
 suivantes.
 
 28 PRiMrrivE pekiod. 
 
 pensable to be known, in order not to appear ignorant in the eyes of 
 men who have a smattering of the history of our Art. 
 
 Thoth, or Theyt, whom the Greeks name Hermes, and the Latins Mer- 
 curius (Mercury) , passed, among the Egyptians, as the inventor of all 
 sciences and arts. He has been supposed to be the author of an ency- 
 clopedic collection, in which, it is said, was comprised all the wisdom of 
 the ancient priests of the country. But this collection has been lost, at 
 an unknown period, and no writer, who refers to it, speaks of having seen 
 it : all refer to it as traditionary. There are also various statements as 
 to the number of books of which it was composed. Some say there 
 were twenty thousand ; others thirty-six thousand ; others, on the 
 contrary, reduce the number to forty-two volumes, only. It appears 
 difficult, if not impossible, to reconcile these opinions, so adverse ; never- 
 theless some have attempted so to do ; among others, Galen, Hornius. 
 and Bochard ; but none of their explanations are reliable. 
 
 Neither is there a better agreement as to the person of Hermes, nor 
 of the time in which he lived. According to many conjectures, which 
 have about equal claim to truth, this personage was Bacchus, Zoroaster, 
 Osiris, Isis, Scrapis, Orus, or Apollo, or Shem the son of Noah. Others 
 think that Hermes was a god, to whom the Egyptian priests dedicated 
 all their scientific productions, by inscribing his name at the head of 
 their writings. Benjamin Constant emits a conjecture, more reasonable 
 if not more true. " In the great religious corporations," says he, " the 
 sacerdotal instinct warns (I'avertissait) them, never to permit any indi- 
 viduality to be manifested. AVhat we have taken for the proper names 
 of the Chaldean and Phenician writers, was probably only the designation 
 of a class. The word sanchoniaton, signifies, among the Phenicians, a 
 savan, a philosopher, or, in other words, a priest. Many East-Indians 
 have assured the Chevalier Jones, that Boudda was a generic name. In 
 Egypt, all the works on religion and the sciences bore the name of 
 Thoth, or Hermes. "■■■' 
 
 M. Houdart, who agrees with this last view, and fortifies it by proofs 
 certainly more numerous than decisive, gives, beside, on the contents of 
 this hermetic encyclopedia, details which are nowhere else found as 
 well deduced. I think I cannot do better than give a textual statement 
 of his remarks. " Finally," says Houdart, " that the reader may judge 
 of the immensity of the knowledge of the savans of ancient Egypt, I 
 place before him the titles of the forty-two volumes of this hermetic collec- 
 tion. The first two contained hymns to the gods, the others, duties of 
 
 '■'De la Religion. Paris, 1824, 1. 11, p. 120.
 
 MEDICINE OF THE EGYPTIANS. '29 
 
 the kings. The four following treated of the order of the wandering 
 stars, of light, and of the rising and setting of the sun and the moon. 
 In ten others was given the key to their hieroglyphics ; a description of 
 the Nile, of sacred ornaments, of holy places ; and beside these, instruc- 
 tions in astronomy, in cosmography, and the geography and topography 
 of Egypt. Ten other volumes related to the choice of victims, divine 
 worship, religious ceremonies, festivals, public celebrations, etc. A like 
 number of volumes, which were called Sacred, were consecrated to the 
 laws, to the gods, and to all the discipline of the priesthood. Finally, 
 the last six treated of Medicine. We leave to the reader the cai-e of 
 deducing all the results of such an encyclopedia. What we wish par- 
 ticularly to refer to, is, that the last six volumes, which related to Medi- 
 cine, embraced a body of doctrines, complete and well arranged. The 
 first treated of anatomy, the second of diseases, the third of instruments, 
 the fourth of remedies, the fifth of diseases of the eye, and the last of 
 diseases of women. It must be agreed that this distribution was very 
 methodic. In the first place there was given, a description of the 
 human body, showing, by this, that it was necessary to commence with 
 a knowledge of the system on which it was necessary to operate ; then 
 they pass to the study of diseases ; thence to medicines and instruments 
 employed in their treatment. As the aifections of the eye, and the 
 diseases of women are very frequent, and as they demand particular 
 attention, they were studied separately. This is certainly a complete 
 and well arranged body of medical matter.-'^ 
 
 No one will contest the excellency of this plan of Medical studies 
 that M. Houdart has just traced, but what is most doubtful, is, that a 
 plan so well arranged can be referred to a period so early in human so- 
 ciety. Without attempting to discuss this point, I will simply remark, 
 that the Hippocratic collection posterior to this, by a thousand years, 
 according to the supposed date of the encyclopedia, does not present as 
 complete and as methodic a system. Further, how can we admit that 
 the Egyptian priests would attach a very high value to anatomical 
 studies, when it is known that the school at Cos, initiated in the doc- 
 trines of these priests, and much more advanced than they, in all 
 branches of medical science, possessed, nevertheless, but very vague 
 notions on the conformation of the human body, except in what relates 
 to osteology. Everything justifies us in believing that the plan of med- 
 ical education which is attributed to the priests of Egypt, is the work 
 of some writer of the Alexandrian school ; for it was about the epoch 
 
 ^'"Etudes Historiques et Antique sur la Vie et la Doctrine d'Hippocrate, et 
 sur 1' etat de la Medecine avant lui," par M. Houdart. Paris, 18i0, p. 135.
 
 30 PRIMITIVE PERIOD. 
 
 of the foundation of that city, that anatomical researches and medical 
 philosophy began to flourish. 
 
 Nevertheless, the description that M. Houdart gives of the progress- 
 ive march of the sciences in Egypt, and in particular of the method 
 followed by the priests in the practice of medicine, is both interesting 
 and instructive. On this account, I continue to quote his remarks, but, 
 at the same time, expressing my doubts of the exaggerated appreciation 
 of the results which this writer conceives are derived from the Egyp- 
 tian school. " It is not necessary to suppose," he adds, " that Medicine 
 reached, suddenly, in Egypt, this degree of perfection. As was common 
 among other people of high antiquity, they commenced, in the first 
 place, as we learn from Strabo, by exposing the sick in public, so that 
 any of those who passed by, that had been similarly attacked and cured, 
 might give their advice for the benefit of the sufferers." At a later 
 period, this plan was much better calculated to accelerate the progress 
 of the art ; for all who were cured of disease were required to go and 
 make an inscription in the temples, of the symptoms of their disease, 
 and the curative agents which had been beneficial to them. The temples 
 of Canopus and Vulcan, at Memphis, became the principal depots of 
 these registers, and they were kept with the same care as the archives 
 of the nation. Eor a long time, every one had the privilege of going 
 to consult them, and of choosing for his sickness, or that of his neigh- 
 bors, the medicaments of which experience had confirmed the value. 
 This method was very good, notwithstanding its inconveniences, to 
 advance science, because it rested entirely upon observation. In this 
 way, must have been collected a prodigious quantity of facts, from 
 which might be deduced correct principles in the practice of Medicine, 
 and this, indeed, was brought about. The priests, who were charged 
 with the study of these observations, did not hesitate to seize upon the 
 exclusive practice of the Art, and when they had collected a great mass 
 of facts, they formed a Medical Code, the fruit of the experience of ages, 
 which is called by Diodorus, of Sicily, the Sacred Book, from the direc- 
 tions of which they were never permitted to vary. It was, doubtless, 
 this code, which was afterward attributed to Hermes, that made up the 
 collection spoken of by Clement, of Alexandria, and which the Pasto- 
 phores followed in the practice of Medicine If, in following the rules 
 there laid down, they could not save their patients, they were not 
 held responsible ; but, according to Diodorus, of Sicily, they were pun- 
 ished with death if, after departing from them the result did not justify 
 
 ~ According to Herodotus and Strabo, the same usage appears to have existed 
 among the Babylonians and Lusitanians.
 
 MEDICINE OF THE EGYPTIANS. 31 
 
 their course. Unquestionably this was an atrocious law, and must 
 have arrested all ulterior progress in the Healing Art. Xevertheless, 
 it should be stated, that it was not made before the correctness of those 
 principles had been well established. Diodorus is decisive on this sub- 
 ject ; he says, positively, that the design of a law, so severe, was, that 
 a practice confirmed by long experience, and supported by the authority 
 of the greatest masters of the Art, was preferable to the limited expe- 
 rience of each particular physician." 
 
 I have already indicated my objections to M. Houdart, for exaggera- 
 ting so much the progress of Egyptian Medicine in these remote times, 
 and I shall not add to what I have said, but one simple cjuestion. I 
 will ask of this erudite, who attempts to justify, like Diodorus, this 
 foolish and iniquitous Egyptian law, what judgment he would give, to- 
 day, upon the Sovereign or Senate who would attempt to re-establish 
 and execute a similar one, under the pretext that our medical code is 
 the fruit of the experience of ages, and that the solidity of the princi-" 
 pies which serve as its base, is sufficiently established ? Doubtless, he 
 could not sufficiently curse such a senseless tyranny, so contrary to the 
 progress of science and the best interests of the diseased. Finally, I 
 will ask, how is it that he has conceived so high an idea of the 
 Egyptian doctrine, which rests upon some vague and doubtful traditions, 
 while he blames, with excessive severity, the Hippocratic doctrine, of 
 which there remains to us irrefutable monuments which have excited the 
 admiration of the greatest masters ? 
 
 It ia usually supposed that the practice of embalming, which goes 
 back to an immemorial period, as already indicated, was well calculated 
 to familiarize the Egyptian priests of that early day with anatomical 
 researches. But Sprengel has justly observed, that this process was 
 too rude to have contributed very much to the advancement of the sci- 
 ence. He adds, that according to Herodotus, the people had a horror 
 of these proceedings, and that they pursued and threw stones at the 
 parachute who made the incision, through which were introduced into 
 the corpse the ingredients destined to dry and preserve it. This sub- 
 altern operator was obliged to fly immediately after he had done his 
 work, in order not to become the victim of the animadversion of his 
 assistants. When Pliny assures us that the kings of Egypt permitted 
 the opening of the corpse, for the purpose of discovering the causes of 
 diseases, he always means the Ptolemies, under whose reign anatomy 
 was carried to a very high degree of perfection, f 
 
 '"Etudes Historiques et Critiques," etc., j. 136. 
 
 f C. Sprengel, " Histoire de la Me'dicine, traduction de M. Jourdan," t. I, p. 60 
 et suiv. See " I'Histoire de TAnatomie," par Th. Lauth. Strasbourg, 1815, liv. 1,
 
 32 PRIMITIVE PERIOD. 
 
 According to the authors I have just named, there were three sorts of 
 embalmments, namely : that of the first class, reserved for men of qual- 
 ity and wealth, which cost one talent ; that of the second class, which 
 was adopted by families of moderate means, which cost about twenty 
 mines ; lastly, a mode of embalmment for the poor, which consisted 
 simply in washing the body and macerating it for seventy days in lye. 
 In the process of embalming the first and middle classes, the brain 
 was removed by an opening through the nasal fossae, and an incision 
 was made on the left side of the abdomen, through which the intes- 
 tines were withdrawn, and spices and more or less costly aromatics 
 were introduced ; after which, the body was washed, as above stated, 
 then spread over with gum, and wrapped in bandages of linen." 
 
 The Egyptian nation was divided, from the earliest times, into six orders, 
 as follows : the king and princes, priests, soldiers, shepherds, laborers, 
 and lastly, artisans. The order of the priesthood was most respected 
 and the most powerful ; it was the depot of the laws, science, and reli- 
 gion. The sovereign, before taking the reins of government in his 
 hands, was affiliated to the sacerdotal order, and initiated into its mys- 
 teries. The care of the priests to conceal their doctrines is well known, 
 and that they might do it more efiectually, and transmit them to their 
 successors, they employed a peculiar language and mode of writing, 
 termed hieroglyphical or sacred, which differed essentially from the 
 common language of the people. While the vulgar prostrated them- 
 selves before rude images, emblems of the attributes of the divinity, 
 or of the wonders of creation, the learned classes, which included med- 
 ical men, recognized an invisible and eternal Sprit, the Supreme Gov- 
 ei'nor of the universe. 
 
 11. MEDICINE OF THE HEBREWS. 
 
 The Sacred History says, positively, that Moses, having been rescued 
 from the river by one of the daughters of Pharaoh, was reared in the 
 court of that Prince, and instructed in all the knowledge of the Egyp- 
 tian priesthood, in which he became a proficient. On this account, 
 when he presented himself before his sovereign, to demand, in the name 
 of the God of Israel, the freedom of his brethren, who were reduced to 
 an unjust and cruel servitude, he was not at all embarrassed by the 
 
 where the question, if the Egyptians possessed an anatomical knowledge, is exam- 
 ined and thoroughly answered negatively. 
 
 "'C. Sprengel, i6i£f«OT. — Herodotus liv. II, chap. LXXXV-LXXXVI. Diodorus, 
 chap. XCI. Pariset, " Memoire sur les Causes de la Peste." Paris, 1837, page 
 4, et suiv.
 
 MEDICINE OF THE HEBREWS. 33 
 
 prestiges of the magicians and savans that Pharaoh so frequently sum- 
 moned to meet him in the palace. He proved the legitimacy of his 
 mission, in confounding the pride of the magicians by prodigies more 
 wonderful than theirs, and finally overcame the interested obstinacy of 
 the king, and had the glory of delivering his brethren from the yoke 
 that had pressed so heavily upon them for nearly two hundred years. 
 All are familiar with the great obstacles he overcame in leading them 
 back to the land of their forefathers, and how well he availed himself 
 of long and weary wanderings in the wilderness, to give to them the 
 moral and political laws inspired by God. 
 
 The writings of Moses constitute a precious monument for the history 
 of Medicine ; for they embrace hygienic rules of highest sagacity, and 
 which may be regarded as a detached fragment of Egyptian science. 
 It is in Leviticus that the prophet-legislator has recapitulated the 
 greater part of the rules concerning the care to be given to the health. 
 The eleventh chapter contains a long enumeration of animals reported 
 impure, that is, unhealthy ; among which are mentioned the rabbit and 
 the hog, whose flesh produces no injurious effects in European climates, 
 but might have done in Egypt and India, among men whose habits dif- 
 fered so much from ours. It may be, moreover, that the species desig- 
 nated by these names were not the same as those with which we are so 
 familiar. In short, it is possible that Moses, in making these prohibi- 
 tions, had other views than those ascribed to him. 
 
 The twelfth and fifteenth chapters of the same book were designed 
 to regulate the relation of a man to his wife. In reading these pre- 
 cepts, one can not repress a sentiment of admiration for the wis- 
 dom and foresight which made such salutary regulations a religious 
 duty. The following extract will enable the reader himself to judge 
 of this. 
 
 1. " The Lord spake again to Moses, and said to him, 
 
 2. " Speak to the children, saying, if a woman have conceived seed, 
 and borne a man child, then shall she be unclean seven days ; according 
 to the days of the separation of her infirmity shall she be unclean. 
 
 3. " And in the eighth day, the flesh of his foreskin shall be circum- 
 cised. 
 
 4. "And she shall then continue in the blood of her purifying three 
 and thirty days ; she shall touch no hallowed thing, nor come into the 
 sanctuary, until the days of her purifying be fulfilled. 
 
 5. "But if she bear a maid child, she shall be unclean two weeks, as 
 in her separation, and she shall continue in the blood of her purifying 
 threescore and six days.
 
 34 PRIMITIVE PERIOD. 
 
 6. "And when the days of her purifying arc fulfilled, for a son or for 
 a daughter, she shall bring a lamb of the first year for a burnt-off'ering, 
 and a young pigeon or a turtle-dove for a sin ofiering, unto the door of 
 the tabernacle of the congregation, unto the priest, * * '•■•= and the 
 priest shall make an atonement for her, and she shall be clean." 
 
 Chap. XV, V. 19, "And if a woman have an issue, etc., she shall be put 
 apart seven days. 
 
 20. "Whatever shall touch her shall be impure till even." 
 
 24. "And if any man lie with her at all, and her flowers be upon him, 
 he shall be unclean seven days, and all the bed whereon he lieth shall 
 be unclean. 
 
 25. "And if a woman have an issue of her blood, many days out of 
 the time of her separation ; all the days of the issue of her uucleanliness 
 shall be as the days of her separation: she shall be unclean." 
 
 28. "But if she be cleansed of her issue, then shall she number to 
 herself seven days ; and after that she shall be clean. 
 
 29. "And on the eighth day she shall take unto her two turtles, or 
 two young pigeons, and bring them unto the priest, to the door of the 
 tabernacle of the congregation." 
 
 Apart from the religious ceremonies, the utility of which is incon- 
 testable, in order to secure the execution of the hygienic precepts — might 
 it not be said that these are extracts from a modern work on hygienics ? 
 What could be more salutary than the momentary separation of married 
 persons at the periodical return of certain functions which almost amount 
 to an infirmity with women ? or what could be more ingeniously con- 
 trived to prevent the disgust that might arise from an uninterrupted 
 cohabitation? The author of Emilius gives similar counsel, three 
 thousand years later. 
 
 The Bible also prescribes frequent ablutions, a custom which has al- 
 ways appeared to be necessary in hot, dry countries, and among a people 
 who made no use of body-linen. But what more excites the astonish- 
 ment of physicians, is the tableaux that Moses has made of the white 
 leprosy, and the regulations he established to prevent its propagation. 
 He has given the following characteristics of this disease, in the thir- 
 teenth chapter of Leviticus. 
 
 2. " When a man shall have in the skin of his flesh a swelling, as a 
 scab or bright spot, and it be in the skin of his flesh, like the plague of 
 leprosy, then he shall be brought unto Aaron, the priest, or unto one of 
 his sons, the priests. 
 
 3. "And the priest shall look on the plague in the skin of the flesh, 
 and when the hair in the plague is turned white, and the plague in
 
 MEDICINE OF THE HEBREWS. 35 
 
 sight "be deeper than the skin of his flesh, it is a plague of Leprosy ; and 
 the priest shall look at him and pronounce him unclean," etc. 
 
 Ancient authors have confounded under the name of Leprosy, a great 
 number of diverse affections ; hence it results, that these descriptions do 
 not agree with each other, nor with the writings of Moses. Cutaneous 
 pathology was a real chaos, which has only been reduced to a system 
 very recently, so that it is impossible now to give an opinion on the 
 exactness of the signs above indicated. Some of them conform to a dis- 
 ease called White Leprosy, by modern dermatologists, but others do not. 
 What augments our uncertainty, is the opinion universally admitted, 
 and very probable too, that by the influence of hygienic conditions, en- 
 tirely different, certain diseases may have disappeared, or become so 
 modified, as to be of no importance, while new ones may have been 
 developed. Without this consideration we would be led to suppose, that 
 it was a mere prejudice, very excusable at so early a period in medical 
 science, that caused Moses to write concerning the leprosy which clung 
 to the clothing, and to the walls of houses, and which, according to the 
 sacred writer, manifested its presence on inanimate objects by evident 
 characteristics." 
 
 After the promulgation of the Decalogue, the man most prized in the 
 Holy Scriptures for his science, was Solomon. They tell us that this 
 monarch surpassed in wisdom all the Orientals, and even the Egyptians, 
 that " he spoke five hundred proverbs, and his songs were three thou- 
 sand. He spoke of plants, from the cedar of Lebanon, even unto the 
 hyssop that springeth out of the wall; he spoke also of beasts and 
 of fowl, and of creeping things, and of fishes." The historian Josephus 
 adds, "that God gave to this prince a perfect knowledge of the proper- 
 ties of all the productions of nature, and that he availed himself of it, 
 to compound remedies, extremely useful, some of which had even the 
 virtue to cast out devils, "f 
 
 It is clear from the above, that Moses always gave his instructions 
 concerning leprosy and other infirmities, to the priests only; from 
 which it may be inferred that at this epoch, the Levites joined the 
 practice of Medicine, to their sacerdotal functions. It appears that 
 they maintained for a long time, this double relationship to society, for 
 there is no mention made of lay physicians among the Jews, except in 
 the Book of Ecclesiastes, the author of which lived in the third century 
 before Jesus Christ. The following references are made on this subject: 
 
 " Lev. Chap. XHI, et XIV. 
 
 t Liv. Vin. Chap. n. — Leclerc, " Hist, de la Medecine." Ire partie, Liv. 
 Chap. HI.
 
 36 PRIMITIVE PERIOD. 
 
 " Honor the physician, because he is indispensable, for the Most High 
 has created him." 
 
 "For all Medicine is a gift from God, and the physician shall re- 
 ceive homage from the King." 
 
 "The Science of Medicine shall elevate the physician to honor, and 
 he shall be praised before the great." 
 
 "The Most High has created the Medicines out of the earth, and he 
 that is wise will not abhor them."" 
 
 III. MEDICINE OF THE ORIENTAL INDIANS. 
 
 Under the name of Indians, we comprise all those tribes that inhabit 
 that vast extent of country, bounded on the east by China, on the west 
 by Persia, on the north by little Thibet, and on the south by the sea. 
 Though now divided into many kingdoms or principalities, the inhabit- 
 ants of these countries appear to have had in antiquity, a common 
 origin, the same religion, and similar institutions. The mildness of 
 the climate, and the fertility of the soil, which produced abundantly 
 the necessities of life, must have invited early the occupation of 
 man ; and authentic monuments attest that India possessed the bless- 
 ings of civilization, while Europe was still plunged in the darkness of 
 barbarism. Some writers even go so far, as to pretend that the torch of 
 civilization, was transported from the banks of the Ganges, to the banks 
 of the Nile ; but this is only a simple conjecture, devoid of proof, while 
 the contrary view is at least as probable. 
 
 The Indians are divided into many castes, of which the most noble 
 is that of the priests or bramins. These only have the privilege to ex- 
 ercise the functions of priests and physicians ; they alone learn the 
 Sanscrit, which is the language of the learned of those countries, and 
 in which all their books are written. Their medical knowledge is col- 
 lected in a book which they name Vagadasastir. We possess of this 
 work only a few extracts, the exactness of which I dare not guarantee; 
 for such as they are, they give too poor an opinion of the knowledge 
 and judgment of the Hindoo doctors. 
 
 This organon of Medicine, is divided into eight parts ; the first treats 
 of diseases of children ; the second of bites of venomous animals ; the 
 third of affections of the mind, which are produced, as generally sup- 
 posed, by demons; the fourth part, is consecrated to diseases of the 
 sexual organs ; the fifth to hygiene and prophylactics ; the sixth to 
 surgery ; the seventh to treatment of diseases of the eye, and of the head ; 
 
 " Ecclesiastes, Chap. XXXVIII, verses 1, 2, 3, 4.
 
 MEDICINE OF THE ORIENTAL INDIANS. 37 
 
 the eighth gives directions for the preservation of youth, and the beauty 
 of the hair. It is plain that no philosophic idea, lies at the foundation 
 of the arrangement of this medical encyclopedia. 
 
 They admit three principal sources of internal diseases, viz : flatulency, 
 wodum, vertigo, bittum, impure humors, {chestum. They further believe 
 that all cutaneous diseases, were caused by worms. According to them 
 there were in the human body, one hundred thousand parts, of which seven- 
 teen thousand were vessels. Each one of these is composed of seven tubes, 
 giving passage to ten species of gases, which, by their conflicts, engend- 
 ered a crowd of diseases. They placed the origin of the pulse, in a 
 reservoir, situated beneath the umbilicus. This reservoir was four 
 fingers wide, by two long, and divided into seventy two thousand 
 canals, which were distributed to all parts of the body. Upon a physi- 
 cian examining the pulse of a patient, he observed at the same time 
 very carefully, his countenance, believing that every change in the pul- 
 sation of the artery, answered to a corresponding change in the expres- 
 sion of his face. He examined also the feces and the urine, consulted 
 the stars, the flight of birds, the accidental incidents in his visit, he 
 drew, in a word, his prognosis from a thousand different circumstances. 
 but omitted those which alone could be available to him, namely, the 
 symptoms indicating the state of the organs. 
 
 The following maneuver, admirably illustrates the silly credulity or 
 arrant charlatanism of the Hindoo physicians. He let fall from the 
 end of a straw, a drop of oil, in the vessel containing a specimen of his 
 patient's urine. If the oil was precipitated, and attached itself to the 
 bottom of the vessel, he predicted an unfavorable result; if, on the con- 
 trary, the oil floated, he announced a favorable termination ; from which, 
 according to this method, an unfavorable prognosis must have been 
 rarely made. 
 
 With ideas so ridiculous, on the origin and diagnosis of diseases, it 
 would seem to follow, that their therapeutics must have been miserable 
 indeed. Nevertheless, we are assured that they were very successful in 
 the choice of remedies, the proper time for their use, and in the manner 
 of preparing and presenting them. They are said to have had an oint- 
 ment, that caused the cicatrices of variola to disappear. They cured 
 the bites of venomous serpents, with a remedy, whose composition is un- 
 known to Europeans. In health, as in disease, their attention was es- 
 pecially directed to the regimen. They observed in their persons, and 
 in everything about them, a minute and even excessive cleanliness. In 
 short, we find in this country still, as in ancient Egypt, several classes 
 of physicians, each of which treats certain kinds of diseases only. They 
 pretend that their science is derived directly from heaven ; and it is
 
 3S PRIMITIVE PERIOD. 
 
 owing to this belief, doubtless, that they have not made any improve- 
 ments on it, for thousands of years. 
 
 IV. MEDICINE OF THE CHINESE. 
 
 The Chinese offer to our observation the unique spectacle, in the 
 records of the human race, of a people who have preserved, for more 
 than four thousand years, their manners, laws, religion, literature, lan- 
 guage, name, and territory. This remarkable phenomenon is certainly 
 related to a concourse of extraordinary circumstances, well worthy the 
 attention of the philosopher and statesman ; but we can not dwell on 
 this subject especially, as we do not possess the documents necessary 
 thereto. 
 
 We simply remark, that in all time, the sovereigns of China have 
 taken extraordinary care to prevent all contact or exchange of ideas 
 between their subjects and foreigners.* Police regulations, customs, su- 
 perstitions, and national prejudice, have all united to isolate the Chinese 
 from the rest of the world. The language and writing of the manda- 
 rins and savans are so difficult, that it requires nearly an entire life 
 to learn them. It is only by force of perseverance in surmounting a 
 thousand obstacles, and braving a thousand dangers, that the intrepid 
 missionaries have been enabled to lift a corner of the vail with which 
 the science and history of this country are enveloped. We owe to 
 their apostolic zeal, the little we have to say on these subjects.f 
 
 The antiquity of the Chinese, as that of every nation, is mingled 
 with traditions more or less uncertain and fabulous. But from the 
 year 2357, before Jesus Christ, their chronology, says Father Du Halde, 
 is perfectly well arranged ; their tables exhibiting the names of their 
 emperors, the duration and principal events of their reigns, the revolu- 
 tions, and interregnums ; and the whole is narrated in a simple manner, 
 without any admixture of supernatural statements. This chronology 
 is supported, beside, by the observations of eclipses, whose dates coin- 
 cide exactly with the calculations of the most eminent astronomers of 
 Europe. In fine, Confucius, the greatest Chinese philosopher, a sage 
 
 '' But a new era commences ; the barriers which have excluded all strangers 
 from entering this empire, have just been broken down by British cannon. The 
 day is not far distant when the learned curiosity of Europeans may be gratified 
 by the study of Chinese monuments. 
 
 •j-The description and history of China, by Father Du Halde; the fragments 
 of Chinese medicine, translated into Latin, by Father Michael Boym, and pub- 
 lished by Cleyer, have furnished the materials of nearly all that has been writ- 
 ten up to this time on that country.
 
 MEDICINE OF THE CHINESE. 39 
 
 whose opinion is of great weight, on account of his worth and probity, 
 has never questioned its correctness. 
 
 They attribute the invention of Medicine to one of their emperors, 
 named Hoam-ti, who was the third of the first dynasty. He is said to 
 have reigned 2687 years before the Christian era, which goes back 
 many ages before the universal deluge, to an epoch of which their his- 
 tory does not treat in the same authentic manner as is referred to above. 
 He is regarded as the author of a work entitled NuyKini, which still 
 serves as a guide for medical practice. In this work is found a theory 
 of the pulse, extremely minute, which clearly reminds us of the sphyg- 
 mics of the successors of Erasistratus. For this reason, it has been 
 supposed, and not without probability, that the disciples of this physi- 
 cian, who were established in Bactriana, after the invasion of Alexan- 
 der the Great, communicated to the Chinese doctors their ideas on this 
 subject. The chronicles of the mandarins confirm this conjecture, for 
 they state that at that epoch the savans of Samarcand fixed their resi- 
 dence among them. It is, then, very reasonable that Nuy'Kim' is an 
 Apocryphal book, or rather a collection of fragments belonging to vari- 
 ous authors of different eras. This is made probable by the following 
 resume extracted from the articles edited by Cleyer.^--' 
 
 There are set forth in it two radical hidden principles, heat and 
 moisture, which give life and movement to all things. The spirits are 
 the vehicles of heat, just as the blood is the vehicle of moisture. The 
 harmony or disunion of these two principles, their excess or their 
 deficiency, in a word, their combinations and their various proportions, 
 produce that infinite variety of phenomena that are seen in the world- 
 They produce, also, the good and the bad constitution, health and 
 disease, life and death. 
 
 An immoderate degree of heat causes cold, and vice versa, just as 
 autumn succeeds summer, and spring succeeds winter. 
 
 Heat naturally ascends and occupies the highest places. It is in 
 perpetual agitation by diffusion, expansion, rarefaction, and penetra- 
 tion. Moisture, on the contrary, tends downward, and seeks repose ; it 
 becomes condensed and viscid, and stops the pores. 
 
 As in the universe, we see three chief objects, the heavens above, the 
 earth beneath, and man, who, placed between these two, participates in 
 the celestial as well as terrestrial nature ; so we distinguish in the 
 human body, three principal regions, namely: the superior, extending 
 
 - Cleyer, " Specimen Medicse Sinite." Francofurti, anno 1682. See, especially, 
 the fragment No. 2, entitled, " Tractatus de Pulsibus."
 
 40 PRIMITIVE PERIOD. 
 
 from the head to the epigastrium, which contains the heart, the 
 pericai'dium and the lungs, which are all above the diaphragm ; the mid- 
 dle, which is bounded below by the umbilicus, and incloses the stomach 
 with its annexes, the spleen, the liver and its gall-bladder, and the dia- 
 phragm ; lastly, the inferior, which comprehends the kidneys the blad- 
 der, the intestines, and the abdominal members. 
 
 To each of these three described regions, correspond three kinds 
 of pulse on the hand. The supreme or celestial pulse, which is 
 placed at the articulation of the forearm with, the wrist. It is undu- 
 lating, full, and prominent, and is governed by heat. That on the right 
 arm shows the state of the heart and pericardium ; that on the left 
 side, the state of the lungs and mediastinum. The inferior, or terres- 
 trial pulse, situated lower down, at the articulation of the wrist with 
 the hand, is influenced particularly by moisture ; on this account it is 
 deep-seated. That on the right side indicates the state of the ureters, 
 the corresponding kidney and small intestine ; that on the left side 
 shows the condition of its corresponding kidney and the large intestine. 
 Finally, the middle pulse, or that of man, properly speaking, is between 
 the other two, on the middle of the carpus. It is produced by a ming- 
 ling of heat and moisture, neither too high nor too low, but properly 
 combined. On the right hand, it marks the state of the stomach and 
 spleen ; on the left, that of the liver and diaphragm. 
 
 These three kinds of pulse are sometimes compared to a tree, of which 
 the superior pulse constitutes the superior branches and leaves ; the 
 middle pulse, the trunk ; and the inferior, the roots. 
 
 The examination of the pulse, not only enables the Chinese physi- 
 cians to show the seat of the disease, but also to judge of its duration 
 and gravity. They pi-oceed to this examination after a method which 
 appertains to them alone. They place the arm of the patient on a 
 cushion, then they apply the index, the middle and ring-fingers on the 
 anterior face of his wrist, in such a way that the index-finger may be 
 nearest the arm, and the ring finger nearest the hand. They elevate 
 and depress each finger, alternately, with more or less force, like one 
 playing on an organ. At the same time, they observe closely the move- 
 ments of respiration, being persuaded that there exists between them 
 and the arterial pulse an intimate connection. They examine, also, 
 during a limited number of respirations, each of the nine pulses, which 
 are formed, according to their doctrine, on each hand, and they deduce 
 from these their diagnosis and prognosis, which they immediately an- 
 nounce without any uncertainty or hesitation. They make their pre- 
 scriptions on the spot, and usually administer their remedies, receive 
 their fees, and retire, not to return unless they shall be recalled.
 
 MEDICINE OF THE CHINESE. 41 
 
 Independently of the two active principles of which we have spoken, 
 the Chinese admit five elements, namely: water, wood, fire, earth, and 
 metal. The following is the order in which they are supposed to be 
 produced ; water, the source of all fertility, engenders wood or plants : 
 these, when they are dry, inflame and cause fire, or ignited spirits. The 
 remains of the fire, or the ashes, form the earth, which in its turn pro- 
 duces the metals. 
 
 The Chinese physicians imagine a multitude of odd connections be- 
 tween the viscera of the human body, the elements, the seasons of the 
 year, the stars, colors, variations of the pulse, and numerous other 
 objects no less dissimilar. We give but one example. 
 
 The heart, they say, is analogous to fire, to the planet Mars, to sum- 
 mer, to spring, and to southern climes. It comes from the liver, begets 
 the spleen and the stomach, is antipathic with the kidney, and receives 
 no injurious influence from its contact with the lungs. 
 
 The natural pulse of the heart is bounding, like a full swelling wave. 
 Explored lightly with the finger, it appears large and free ; but, under 
 a strong pressure, it becomes feeble and fugitive. It has for an antag- 
 onist, the deep-seated pulse. During the spring-time, the pulse of the 
 heart is like a tense cord ; in summer it is more developed and becomes 
 exuberant ; in autumn it appears as if floating ; in winter it is rather 
 quiet. 
 
 The heart has a predominant influence on the blood, the forehead, the 
 tongue, and the palm of the hands. It is sympathetic with odors, red 
 colors, such as the comb of the cock, and lively, gay sounds, laughing, 
 the exhalation of a roast, bitter taste, and sweat. Excess of joy, heat, 
 inquietude, fixed attention, and bitters, injure the heart and the blood, 
 A black tongue, which cannot be run out of the mouth, and swelling in 
 the palms of the hands, are concomitant signs. Eolling the eyes back- 
 ward, with a pulse like a floating cord, announce the destruction of that 
 organ. 
 
 Some writers have been willing to accord to the Chinese the honor of 
 a knowledge of the circulation of the blood, but we shall see that they 
 mean by this word a phenomenon entirely difi"erent from that to which 
 we apply it. They think that the spirits and the blood, both vehicles of 
 heat and vital humidity, run through all parts of the body in twenty- 
 four hours. This diurnal circulation, they say, commences in the lungs, 
 at three o'clock in the morning, and ceases next day at same place, and 
 at the same instant. The knowledge of the canals through which this 
 is effected, constitutes, in the eyes of Chinese physicians, the fullness 
 of anatomical science. They count six canals which pass directly 
 from above downward, and an equal number which return from below
 
 42 PRIMITIVE PERIOD. 
 
 upward ; eight run transversely, and fifteen obliquely. The plates that 
 Pleyer has placed in his memoirs, suffice to give an idea of the grotesque 
 manner in which the Chinese represent these imaginary canals, and the 
 principal viscera of the human body. 
 
 Such is a summary o£ the doctrine contained in the Nuy' Kim'. The 
 physicians regard it as an infallible guide, and when they are mistaken 
 in their prognostics, which very frequently happens, far from suspecting, 
 in any respect, the excellency of the precepts of the Nuy' Kim', they 
 rather think that they have not well understood, or not properly fol- 
 lowed them. 
 
 These physicians relate that one of their ancient emperors directed 
 the dead bodies of criminals to be opened, that the interior arrangement 
 of the body might be studied. This tradition is questionable, for it 
 appears certain that, from time immemorial, the Chinese have not 
 allowed researches on dead bodies, whether of men or animals, which 
 explains their profound ignorance on the structure of our organs, and 
 the long reign of a physico-pathologic system so replete with ridiculous 
 hypotheses and glaring errors. Nevertheless, one of their emperors 
 ordered the translation by the Jesuit Father Parrenin, of the anatomical 
 treatise of Dionis; but this work, though one of the best, previous to 
 the last century, is. up to the present time, a dead letter, a light under 
 the bushel, to the Chinese doctors.-' 
 
 They divide all diseases into two great classes, accordingly as they 
 attack an organ adjoining the vital center, such as the heart, the lung, the 
 stomach, or an organ separated from the fictitious center, as the kidneys, 
 the bladder, the extremities on the skin. They have, also, multiplied to 
 infinity, the nosological scale. Thus, they count forty-two kinds of vari- 
 ola, distinguished from each other by obscure and insignificant charac- 
 teristics. They have a variola of the alae of the nose, and of the 
 circumference of the eyes, one which is characterized by pimples, sur- 
 rounded by a red circle ; others, whose pustules are acuminated or flat- 
 tened, or black, or transparent, etc. 
 
 Notwithstanding the egregious errors of these pathological classifica- 
 tions, and the absurdity of their theories, the physicians of China must 
 have been able to make, in the space of four thousand years, some precious 
 observations on the march, symptoms and prognosis of diseases, and 
 some discoveries of the means for their cure. It is, therefore, probable 
 that there may be found, in their voluminous repositories, as some 
 judicious writers believe, a quantity of useful material, both for the 
 
 •^'Pere Dionis was Professor of Anatomy and Surgery at the Jardin du Hoi, in 
 1673.
 
 MEDICINE OF THE CHINESE. 4S 
 
 history and treatment of certain morbid affections/-' It is known, for 
 example, that inoculation, by the variolic virus, vpas generally cm- 
 ployed by them a long time before it was known n Europe. 
 
 The Chinese appear to have cultivated, particularly. Materia Medica 
 and Pharmacology, if we may judge by the number of works they have 
 written on these subjects. They possess more than forty of them, of 
 which one alone, the most complete of all, is composed of fifty-two 
 quarto volumes. But the extracts that have been made from them, 
 only contain a long enumeration of substances employed in Medicine, 
 without describing the natural characteristics by which they or thei) 
 preparations might be recognized by us. 
 
 There are no apothecaries in that country. The physicians are 
 accustomed to prepare and administer their own remedies. Some of the 
 most distinguished, however, simply give a formula, and leave to other? 
 of less rank, the task of executing it. They daily retail in the mar- 
 kets considerable quantities of drugs, and various compositions, which 
 are boasted to have an efficacy against a host of diseases. One of the 
 most famous is the ginsengf root. Incomparable virtues are attributed 
 to it ; among others, those of reanimating the vital forces, putting off 
 the infirmities of age, and prolonging the life beyond the ordinary 
 term. The people who believe in its fabulous properties, buy it, lite- 
 rally, with its weight of gold. Their frightful abuse of opiates is also 
 well known. 
 
 Having no anatomical knowledge, surgery is uncultivated, so that it 
 may be said that in China this branch of medical science has neve? 
 passed its infancy. No one dare attempt a bloody operation, however 
 slight. The reduction of hernia is unknown, and a cataract ie 
 regarded as beyond the resources of Art ; even blood-letting is wholly 
 unpracticed. On the other hand, they frequently employ cups and 
 acupuncture, which they execute with needles of gold or silver ; fomen- 
 tations, plasters of all kinds, lotions, and baths. They make much 
 use of fire, by means of moxas, or red-hot buttons. They have evee 
 their magnetizers, whom the author of the " Chinese Letters " compares 
 to the convulsionists of Saint Medard. In a word, their therapeutics, 
 whether internal or external, recalls that of the Europeans during the 
 darkest period of feudal times. 
 
 " See the excellent "Dissertation sur la Me'decine des Chinois," by M. Lepage. 
 Paris, 181.5, and the article of the Diet, des Sciences Medicales,by M. Brichet«au, 
 8ur " Medecine des Chinois." 
 
 j-See Merat et Delens, " Dictionnaire Universel de Matiere Mddicale." Paris, 
 1831, t. Ill, p. 356.
 
 44 PRIMITIVE PERIOD. 
 
 Formerly, there existed, at Pekin, imperial schools of Medicine, and 
 no one could then practice Medicine without having served an appren- 
 ticeship, and given proof of his capacity. Beside, it is said, there was, 
 for each district of six leagues square, a physician chosen to instruct 
 those who were required to serve the inhabitants of the country. At 
 this time, there is no such organization, every one has the right of 
 selling, prescribing, and administering remedies, without any exami- 
 nation, authorization, or restraint. 
 
 How inconceivable is the stupid indifference of a government which 
 requires no guarantee of knowledge or morality on the part of individ- 
 uals who are every moment the arbiters of the health and the life of 
 their fellows, whose profession renders them the depositories of the 
 most sacred family secrets, by giving them easy access to persons of all 
 sexes, ages, and conditioDS. It is said that physicians in China are, 
 generally, but little respected, nor do they deserve more consideration, 
 excepting those in whom the profession is hereditary. This deep dis- 
 credit into which the Art of Healing is fallen, or rather of those who 
 cultivate it, need not astonish us ; it is the natural result of the 
 absence of all law regulating the practice of Medicine. The same is 
 true among all nations under analogous circumstances, as this historj- 
 will prove. We might refer the reader, by anticipation, to the picture 
 that Galen has drawn of the deplorable effects of the medical anarchy 
 which reigned at Eome in his time ; we might also refer to the low 
 state of Medicine during the first ages of the feudal period, before the 
 establishment of universities. But, without searching so far back into 
 the annals of the race, it will suffice to place before the eyes of the 
 reader the reflections which such a state of things suggested to the 
 author of the Medical Law of the 19th of March, 1803. 
 
 "Men united in society," says Thouret, "have, in all times, been 
 subject to evils growing out of their intercourse, which have often 
 caused philosophers to think that this intercourse itself was more inju- 
 rious than useful to humanity. The utility of this consolatory Art has 
 been felt among all nations and in all ages. There exists no govern- 
 ment which does not render it a favorable support, and which is not 
 interested, more or less, in its progress. Anarchy only, which respects 
 no institution, could ignore the importance of the Healing Art; it 
 belongs to every reformative government to restore to this branch of 
 instruction its ancient splendor and advantageous results. Profoundly 
 penetrated with the necessity of re-establishing order in the exercise of 
 a profession which interests essentially the security of the lives of citi- 
 zens, the government presents to you a project of a law, having for its 
 object the regulation of the practice of this salutary Art.
 
 MEDICINE OF THE CHINESE. 45 
 
 " Since the decree of the 18th of August, 1792, which suppressed the 
 universities, faculties, and learned corporations, there is no longer any 
 regulation for the privilege of practice of Medicine or Surgery. The 
 most complete anarchy has taken the place of the former organizations. 
 Those who have studied the Art find themselves confounded with those 
 who have not the least notion of it. The lives of citizens are in the 
 hands of greedy and ignorant men ; the most dangerous empiricism, 
 and shameless charlatanism impose, everywhere, upon credulity and 
 good faith. No proof of knowledge and skill is required ; the country 
 and cities are equally infested with quacks, who deal out poison and 
 death with an audacity that our present laws can not repress.--^ The 
 most murderous practices have usurped the place of the principles of 
 the Art of Midwifery. Impudent barbers and bonesetters assume the 
 title of " health officers," to cover their ignorance and greediness. Never 
 has the list of secret remedies, always dangerous, been so extensive as 
 since the suppression of the faculty of Medicine. The evils are so 
 grave and so multiplied, that many mayors iave sought a means of 
 remedying them, by establishing a kind of jury, charged with power to 
 examine the men who wish to practice Medicine in the departments. 
 But these local institutions, independently of the variety of tests of 
 qualification that they have adopted, open the door to new abuses, 
 arising from the superficial nature of the examinations, and sometimes 
 from a still more impure source. The Minister of the Interior has 
 been compelled to annul the permits of several mayors, from the abuses 
 and irregularities they connived at. It is, then, urgent to destroy all 
 these evils at once, and to organize a uniform and regular mode of 
 examination and reception for those who wish to devote themselves to 
 the cure of the sick."f 
 
 V. MEDICINE AMONG THE GREEKS DURING THE PRIMITIVE PERIOD. 
 
 Greece, which will, hereafter, furnish us the most interesting and best 
 preserved debris of the Healing Art of the ancients, does not give us, in 
 regard to the history of this Science, during the ages that precede the 
 Trojan War, anything more than dim lights and tradition stamped with 
 a fabulous character, and often borrowed from other nations. The 
 learned and modest Daniel Leclerc, details at great length her medical 
 mythology ; he names more than thirty gods or goddesses, heroes or 
 heroines, who were supposed to have invented or cultivated, with distinc- 
 tion, some of the branches of Medicine. He interrogates, successively, 
 
 * These remarks are very applicable to most of our state governments, 
 f "Jurisprudence de la Me'decine, de la Chirurgie et de la Pharmacie en France," 
 by Adolphus Trebuchet. Paris, 1834, page 408, etc.
 
 46> PRIMITIVE PERIOD. 
 
 history, poetry, chronicles, and inscriptions ; he neglects nothing in the 
 hope of shedding some light on the chaos of improbable or contradictory 
 traditions ; but his praiseworthy though unfruitful efforts have not drawn 
 from them any valuable truths, nor well established facts. Sprengel, 
 who undertook the same task, two hundred years later, with germanic 
 patience, has only succeeded in displaying a vast and confused erudi- 
 tion. ••' It would then be temerity on my part to enter into a labyrinth 
 where men of such great wisdom have lost themselves. I shall content 
 myself by extracting from these fabulous legends a few anecdotes, and 
 some of the best credited names, that have become common knowledge, 
 and which a physician ought to know, or suffer the imputation of ignor- 
 ance of the history of his Profession. 
 
 Melampus is the first of the Greeks, following the chronological order, 
 who immortalized himself by extraordinary cures, and to whom, from 
 gratitude, altars were erected. He lived in the times of Proetus, king 
 of Argos, nearly two hundred years before the Trojan war. He is said 
 to have cured Iphiclus of impotency, by giving him the rust of iron. 
 But this is difficult to accredit, when we are assured that Iphiclus took 
 pai't in the Argonautic expedition, one hundred and fifty years later. 
 
 The most famous of the cures attribut d to Melampus. were those of 
 the daughters of Proetus. These princesses, who had taken vows of 
 celibacy, became subject to fits of hysteria or monomania, during which, 
 they imagined themselves transformed into cows, and would leave the 
 palace to run wild in the forests, lowing like those animals. This ner- 
 vous affection was communicated, sympathetically, to other women of 
 Argos, who followed the Proetides, imitating their deranged conduct. 
 The shepherd, Melampus. having observed that his goats purged them- 
 selves by eating white hellebore, gave his young patients milk in which 
 this plant was infused, and then caused some robust young boys to chase 
 them over the fields until they were thoroughly fatiguxl. Then he en- 
 chanted them, and made them bathe in a fountain of Arcadia, called Cli- 
 torian, which completed their cure. In pay for so great a service, 
 Proetus offered to Melampus the hand of one of his daughters with the 
 third of his kingdom. The herdsman showed, on this occasion, as much 
 fraternal affection as medical perspicacity, for he would not accept the 
 offer of the monarch, except on condition that his brother Bias should 
 have a reward equal to his own. 
 
 Chiron is less illustrious in the great acts that he performed than in 
 the pupils he reared. He held his school in a grotto in Thessaly, and, 
 
 ^'See also " I'Histoire de la Chirurgie," commenced bj Dujardin, and continued 
 by Peyrilhe. Paris, 1774-1780. 2 vols, in -Ito.
 
 MEDICINE OF THE GREEKS. 47 
 
 if the chronicle may be believed, no philosopher of antiquity, no pro- 
 fessor in modern times, could count in his audience as many celebrities 
 as the Centaur saw in his cave. A majority of the heroes who distin- 
 guished themselves at the capture of the fleece of gold, or in the Trojan 
 war, boasted of having been his disciples. Among these are enumerated 
 Hercules. Jason, Theseus, Castor and Pollux, the subtle LTysses, the 
 fiery Diomedes. the prolix Xestor. the pious Eneas, and the invincible 
 Achilles. The hermit, it is said, taught them philosophy, music, astron- 
 omy, the military art, political science, and medicine. He cured Phoenix, 
 son of Amyntor. of a blindness supposed to be incurable, and his renown 
 for the treatment of ulcers was so great, that the name of C'hironians was 
 given to those which resisted all curative means, and presented a malig- 
 nant appearance. The etymologists derive the word Centaureus, from 
 Centaur, in order to remain true to the mythological tradition, and 
 doubtless from having no better substitute. Finally, it is said, that 
 this hero or demigod, so skillful in dressing wounds of all kinds, met 
 his death from the wound of an arrow, poisoned by the blood of the 
 hydra of Lerna. 
 
 Esculapius, of all the disciples of Chiron, was the most eminent, in a 
 medical point of view. He passed for the son of Apollo, by the nymph 
 Coronis. Several cities of Greece have contended for the honor of his 
 birthplace ; but the general opinion is, that he was born at Epidaurus 
 a city of Argolis, where he had a temple and a famous oracle. The 
 twins, Castor and Pollux, were anxious <liat he should accompany the 
 Argonautic expedition, which shows that he was famous at that epoch, 
 as a physician, or rather, as a surgeon. 
 
 The Esculapius of the Hellenists, being of a date posterior to the 
 Hemies of the Egyptians, and these two characters, having between them 
 many traits of resemblance, certain authors have thought that the 
 latter might probably only be a copy of the former. They have denied 
 the indivi'luality of the god of Epidaurus, and have accused him of 
 being a twin brother of his colleague of Memphis. Leclerc, after 
 having deeply studied this grave question, in every respect, has not 
 dared to decide it. My views correspond with his. 
 
 However this may be, Esculapius obtained in antiquity, nearly a 
 universal veneration. His worship, which passed from the Greeks to 
 the Romans, extended into all countries, penetrated by the arms of these 
 two nations. We shall speak elsewhere of the principal temples erected 
 to his honor, of the priests that were connected with them, and the 
 progress they made in Medical Science. For the present, wc shall con- 
 tent ourselves with relating some of the cures attributed to him, and
 
 48 PRIMITIVE PERIOD. 
 
 glance at the opinions of the ancients, relative to his manner of treat- 
 ing diseases. 
 
 It is said he brought from death to life, Hippolytus, son of Theseus, 
 a Capaneus, a Lycurgus, an Eryphile, and many others. Pluto, god of 
 Hell, alarmed to see the number of new arrivals to his gloomy kingdom, 
 diminishing day by day — complained to Jupiter, who destroyed the 
 audacious healer. On this account says a wit, the modern children of 
 Esculapius abstain from performing prodigies. But the witty writer 
 forgot, that there has always existed, and now exists, a class of self- 
 styled physicians, who have never ceased to perform miracles. They 
 are called, according to circumstances, charlatans, quacks, theosophs, 
 thaumaturgs, etc. Such were, among others, Asclepiades of Bithynia, 
 who resuscitated a corpse, in a public place in Kome, in open day ; 
 Paracelsus, who boasted of keeping in a vial, a living little man, man- 
 ufactured by himself; Piobert Fludd, the oracle of modern theosophs; 
 Mesmer, the magnetizer, and their adepts. 
 
 In regard to the method which Esculapius followed, in the treatment 
 of diseases, as well as to all else relating to this god, we possess no doc- 
 uments, entitled to much credit. The poet Pindar, who lived seven or 
 eight hundred years later, is the first to describe it in the following 
 terms: "Esculapius," says he, " cured the ulcers, wounds, fevers and 
 pains of all who applied to him, by enchantments, calming potions, in- 
 cisions, and by external applications."-' 
 
 The greatest number of writers, after the Boeotian poet, such as Galen, 
 Plutarch, Pausanias. Pliny and others, have reiterated the same views. 
 Plato, comparing the practice of Esculapius, with that of his cotempo- 
 raries, gives the preference to the former, for reasons which deserve to 
 be reported. 
 
 In the third dialogue on the republic, Socrates, when interrogated by 
 (ilaucus, responds as follows: 
 
 "Is it not a shameful thing to be compelled to call upon a physician, 
 not for the cure of wounds, or the diseases of the seasons ; but for such 
 as are produced by the indulgent life I have described, which fills us 
 with humors and unhealthy vapors, like swamps; thus obliging the 
 worthy sons of Esculapius, to invent such new names, as catarrhs, 
 fluxions, etc." 
 
 " Indeed, Socrates, these are new and extraordinary names of dis- 
 eases." 
 
 "Yes! such as did not exist in the times of Esculapius, I think, and 
 what leads me to believe it, is, that his sons (Machaon and Podalirius), 
 
 "' Third Pythian Ode.
 
 MEDICINE OF THE GREEKS. 49 
 
 during the siege of Troy, did not blame tte women who gave as a bever- 
 age to the wounded Eurypylus, Pramnian wine, upon which she had 
 sprinkled flour and grated cheese, both of which have an inflammatory 
 tendency; nor Patroclus, who cured wounds with herbs." 
 
 "It was strange, nevertheless, to give that beverage to a wounded 
 man." 
 
 "It was not, if you reflect that before Herodicus, the art of treating 
 and curing diseases, as is now attempted, was not put in practice, by the 
 disciples of Esculapius. Herodicus was the master of a Gymnasium ; 
 becoming a valetudinarian, he combined gymnastics and medicine, by 
 which combination he tormented himself, and many others after him." 
 
 "In what way?" 
 
 "By producing a slow death, for as his disease was mortal, he followed 
 it step by step, without being able to cure it, and neglecting everything 
 else to take care of himself. Distressed by anxieties, if he varied ever so 
 little from his regimen, by force of art he reached old age, by a life 
 of real agony." 
 
 "His art rendered him an excellent service!" 
 
 "He well merited it, for not having seen, that if Esculapius did not 
 teach to his descendants that system of Medicine, it was neither from 
 ignorance, or defect of understanding, but because he knew, that in 
 every well-ordered government, each citizen has a task to fulfill, and 
 that no one has leisure to pass his life in sickness, and in taking care of 
 himself. If we see the absurdity of this method, for artisans, we see it 
 none the less for the rich, and the pretended happy of the world." 
 
 " Explain yourself?" 
 
 "Let a carpenter be sick, he is benefited by a physician, who relieves 
 him by a vomit or a purge, or rids him of his disease by fire or steel, but 
 if one comes to him and prescribes a long regimen, enveloping his head 
 in cloths, and other similar treatments, he very soon must say, that he 
 has no time to be sick, and that there is no advantage in living thus, 
 occupying himself with his disease, and neglecting his labor which 
 awaits him. He says, away with such medical treatment, and resuming 
 his ordinary style of living, recovers his health, and goes to^work again; 
 or, if his system can not resist the disease, death comes in to relieve 
 him from his embarrassment. These are, according to my opinion, the 
 considerations that led Esculapius to prescribe a treatment, suitable 
 only for the diseases of persons of strong constitutions, and good habits ; 
 and to limit his remedies to potions and incisions, without changing their 
 manner of living, wishing not to harm society. But in regard to those rad- 
 ically unsound, he was not willing to assume the responsibility of prolong- 
 ing their lives and sufferings, by injections or ejections, given according
 
 50 PKIMITIVE PERIOD. 
 
 to circumstances, and thus put them in a condition, to beget other beings, 
 destined most likely to inherit their diseases. He thought that it was 
 not required to treat those who could not fulfill the career marked out by 
 Hature, because it was neither advantageous to themselves, nor to the 
 state." 
 
 "You make a politician of Esculapius." 
 
 "It was evident that he was one, and his children furnish the proof 
 of it; for while they fought with intrepidity under the walls of Troy, 
 they practiced Medicine, as I have just stated." ■ 
 
 The above argument, tending to prove that Medical Science must not 
 be occupied with valetudinarians or individuals of a debilitated consti- 
 tution, is destroyed by the simple remark of one of the interlocutors, 
 " You make a politician of Esculapius." It is certainly wrong in 
 Socrates, or Plato, as explained by him, to desire that the physician 
 sacrifice the sentiments of his nature, and the right of suffering human- 
 ity, to the exigencies of an unpitying political economy. No, whatever 
 this sage may say, a physician must not ask himself, if the preservation 
 of the individual who claims his services is likely to be burdensome 
 or useful to the State. In ancient republics, such atrocious patriotism 
 was praised, but modern civilization repudiates it. It does not permit 
 the physician to consider any such question in regard to his patients ; 
 he must do all he can for them. 
 
 Such is the view that the medical corps of France has held of its 
 duties, under all phases of our internal dissensions. A striking proof 
 of this has been given but very recently. It may be remembered that, 
 at the close of one of the bloody contests in the capital, which took 
 place during the first years of the reign of Louis-Philippe, a chief of 
 police endeavored to force the physicians to tell the names of the wounded 
 whom they attended. The magistrate thought this an honest way of dis- 
 covering the enemies of the government ; but the public, as well as the 
 medical corps, saw in this a shameful abuse of confidence, the espio- 
 nage hiding itself in the cloak of the minister of benevolence. 
 
 Policy was obliged to bend before the morale, and this is not one of 
 the least glories of our epoch. This would not have taken place in the 
 time of Plato, for the opinion which we combat here, and of which the 
 philosopher has made himself the echo, appertains much less to him 
 than to his age, it reigned in all the ancient republics prior to the 
 advent of Christianity. 
 
 Machaon and Podalirius touched the limits that separate mythology 
 from history ; these two personages participate in this double charac- 
 
 * De la Republic, Book III, translation of M. Cousin, p. 167, et suiv.
 
 MEDICINE OF THE GREEKS. 51 
 
 ter ; their biography is a mixture of fabulous and probable narrations. 
 Their existence, for example, can not be considered doubtful, for the 
 Homeric songs and other ancient writings, agree in representing them 
 as valiant captains and skillful physicians, who took an active part in 
 the siege of Troy, but the statement of their genealogy does not inspire 
 us with the same confidence. They are said to be the sons of Escula- 
 pius. and we know that the reality of this famous individual is exceed- 
 ingly problematical. Beside, the words, children of Esculapius, are 
 often employed figuratively by ancient authors, to designate men who 
 devoted themselves to the medical profession. 
 
 Machaon was regarded as the elder of the two brothers. He treated 
 Menelaus, when that prince was treacherously wounded by Pindar. 
 He cured, also, Philoctetes, who was lame from a wound which he 
 inflicted upon himseif, by letting fall upon his foot one of the arrows 
 of Hercules. This illustrious surgeon met his death in a singular com- 
 bat under the walls of Troy. 
 
 Podalirius survived him, and assisted in the ruin of the kingdom of 
 Priam, but on his return he was cast by a tempest on the shore of Ca- 
 ria. A shepherd rescued him, and learning that he was a physician, 
 he conducted him to Dametus, the kin^ of the country, whose daughter 
 had lately, accidentally^ fallen from the top of the house. She was 
 insensible and motionless, and the attendants already supposed her 
 dead, but this skillful surgeon bled her from both arms, and had the 
 happiness of restoring her life. 
 
 Here is the first example of bleeding practiced for the purpose of a 
 cure ; unhappily, it is not very authentic. Stephen, of Byzance, who 
 reports it, wrote in the fifth century, nearly 1600 years after the event, 
 and he does not indicate the source whence he obtained it. However, 
 the habit of bloodletting goes back far beyond the era of Hippocrates, 
 for he speaks of it, in several places, as a common practice in his time. 
 
 The other members of the family of Esculapius are all fictitious 
 beings, whose symbolical names only remind us of some attribute in 
 Medicine. Thus, the name of Epion, his wife, is derived from a Greek 
 word, which signifies to quiet ; those of Hygeia and Panacea, his 
 daughters, express, the one health, and the other, a remedy for all 
 diseases. 
 
 Moreover, many of the gods and goddesses of Olympus assumed the 
 honor of fulfilling some medical function. Apollo, or Phoebus, the 
 father of Esculapius, usurped nearly everything. Under the name of 
 Pseon, he assumed the privilege of exciting or appeasing epidemics. It 
 is well known that Juno presided at accouchements, and took at those 
 times the surnames of Lucina, Ilithyia, or Natalis. In short, by the
 
 52 PRIMITIVB PERIOD. 
 
 ingenious connection of many passages in the Iliad and the Odyssey, 
 M. Malgaigne indicates that Apollo was considered as the author of all 
 the natural deaths among men, and Diana of those among women. 
 
 At an epoch when yet the earliest inhabitants of Greece, called 
 Pelages, lived on the acorns of their forests, and were covered with the 
 skins of wild beasts, making their homes in caves ; Egypt, Phenicia, 
 and Chaldea already rejoiced in the blessings of an advanced civiliza- 
 tion. The emigration of successive parties from Sais, Tyre, and Mem- 
 phis, carried to the hellenic peninsula the germs of the arts and sci- 
 ences. Inachus, the victim of a revolution, conducted to Greece the 
 first Egyptian colony, and laid the foundation of the city of Argos, 
 1856 years before Christ. Several ages later, Cecrops, obliged to fly 
 from the banks of the Nile, landed on the shores of Attica, and became 
 the founder of Athens, which he consecrated to Minerva, Cadmus 
 came from Tyre with a company of Phenicians, and established himself 
 in Boeotia. He built the walls of Thebes, which citadel bore his name. 
 
 The major part of the aborigines embraced, either from taste or com- 
 pulsion, the habits of civilized life, and adopted the worship and laws 
 of the new comers, while a certain number, still preferring the indepen- 
 dence and idleness of a nomadic life, formed themselves into wandering 
 bands that devastated the country, driving off the flocks, and despoil- 
 ing and murdering travelers. The founders of the new colonies made 
 a war of extermination, and the first men who signalized themselves by 
 victories over the chiefs of the brigands, or the savage monsters of the 
 wild country, were considered as heroes, and benefactors of humanity. 
 Gratitude mingled their praise with that of the gods. Gradually the 
 recollection of these events became dim, because the narrations were 
 not committed to writing. The adventures of these earthly heroes 
 were confounded with those of the gods imported from foreign countries. 
 Names and dates were mingled together, and the national vanity grati- 
 fied itself in giving Greek origin to both, and in transferring the thea- 
 ter of all the celebrated events, and great discoveries, to the hellenic 
 territory. The earliest chroniclers appearing a long time afterward, 
 made no efibrt to go back to the source of the traditions, and clear up 
 their obscurity, by comparing them with each other ; they only made 
 themselves the echoes of popular belief. This is the reason why the 
 mythology of the Greeks, although sufficiently modern, offers as much 
 uncertainty and obscurity as that of nations much more ancient.
 
 THE ORIGIN OF MEDICmE. 53 
 
 CHAPTEE II. 
 
 MEDICINES OF SOME OTHER NATIONS OF THE OLD AND NEW WORLD. 
 
 The history of other nations offers nothing peculiarly remarkable, 
 in a medical point of view. All that can be affirmed of each one of 
 them is, that just as far as we can go back in their annals, we always 
 find some vestiges of Medicine. Thus, Hippocrates mentions certain 
 medical practices, in use among the Scythians. We have stated before 
 the practice of the Porkiguese and Babylonians, of exposing the sick 
 before the doors of the houses, in order that passers-by might give 
 them their advice. In short, we also know, that in Gaul and in the 
 Britannic isles, the Druids were at the same time priests, legislators and 
 physicians, and that their women shared with them their offices and 
 prerogatives. 
 
 In the New World, the same phenomena are produced among a people, 
 who have bad no species of communication with the inhabitants of the 
 Old World. Antonio de Solis states, that Montezuma, emperor of 
 Mexico, possessed gardens, where great numbers of plants were culti- 
 vated, whose properties were well-known to the physicians of the 
 country, who employed them with success. Cortez having been attacked 
 with a grave disease, assembled a council of the most skillful native 
 physicians, who employed various remedies, and in a short time restored 
 the eminent patient tg health. In the island of St. Domingo, the 
 priests named butios, were both physicians and apothecaries. Among 
 the Apalachicolas, a tribe in Florida, the sacrificers to the sun, practiced 
 Medicine, to the exclusion of other castes. Finally, now that all parts 
 of the globe have been explored, we are able to repeat with assurance, 
 that sentence of the elder Pliny, which says, " no nation has existed, 
 entirely destitute of Medicine, though some may be found, that have 
 had no men, especially occupied as physicians." 
 
 CHAPTEE III. 
 THE ORIGIN OF MEDICINE. 
 
 If we should be asked, what has taught men to provide themselves 
 with things indispensable to life ; to prepare their food and clothing, 
 and habitations against the inclemencies of the seasons, etc.; our unem- 
 barrassed and prompt reply would be : it is necessity, it is the instinct
 
 54 PRIMITIVE PERIOD. 
 
 of preservation. Again, if we are asked, what has inspired the same 
 men to aversion for pain, the fear of disease and death, the desire to 
 prevent sickness, not only for themselves, but also for all those that are 
 dear to them ; we should again promptly and readily answer, it is a 
 natural, irresistible instinct, which is realized by the savage of the wilder- 
 ness, as well as by the inhabitants of cities ; by the poor, as well as by 
 the rich — by the philosopher and ignorant ; in the frozen regions of the 
 north, as well as under the burning heats of the tropics. There is but 
 one step between this instinct and the invention of Medicine ; and we shall 
 proceed to see how this has been achieved. This will be comparative- 
 ly an easy task, as we possess one of the most ancient books, which 
 furnishes on this subject, very positive and explicit testimony; it will 
 be sufficient to make a textual extract. 
 
 "Necessity itself," says the author, "forced men to seek the inven- 
 tion of the Medical Art, for they saw as well as we do now, that the 
 regimen proper in health, is injurious in sickness. Moreover, in going 
 back into past ages, I think that the kind of life and nutrition in vogue 
 now-a-days, would not have been discovered, if man, for his drink and 
 food, could have employed that which is used by the ox, the horse, and 
 all other animals of an inferior order, namely, the simple productions 
 of the earth, fruits, herbs and grass. Animals are nourished by these, 
 and grow and live without any inconvenience. Doubtless in the earliest 
 times, man had no other nourishment, and that which he employs at 
 present, seems to be an invention that has been elaborated during a long 
 course of years ; for rude and coarse diet must have caused much 
 violent suifering, just as is realized now, from a similar alimentation. 
 Those who make use of such crude and undigestible materials for food, 
 are subject to pains, diseases and sudden death. But the people of 
 those times, being habituated to it, doubtless suffered less than we suflFer ; 
 nevertheless, the evil was great, even for them ; and many, especially 
 those of a feeble constitution, must have perished. Such, it seems to 
 me, was the cause of men seeking food, more in harmony with our 
 nature ; which led to the discovery of that which is now employed. 
 
 " The men who sought and discovered the Art of Medicine, having the 
 same ideas as those of whom I have spoken above, did I presume, when 
 not feeling well, withdraw something from their accustomed food; and 
 in place of a full diet, dii-ccted the sick to eat less. It happened that 
 this regimen was sufficient to arrest diseases in some persons, not in all, 
 however ; for some of them, were in such a state, that they could not be 
 relieved, even by the use of a smaller quantity of their usual food. 
 Then it was suggested to prescribe a weaker diet, and soup was invented, 
 in which a small quantity of solid substance, is mingled with much
 
 UTILITY OF MEDICINE. 55 
 
 water, and ■well diffused by boiling. Finally, those ■who could not even 
 support soup, were supplied with simple drinks ; care being taken to 
 give them neither too much nor too little. 
 
 " Did not he then, who in the opinion of all was called a physician, 
 who discovered the dietary of the sick, follow precisely the same course, 
 as he who changed the savage and brutal manner of living of the earli- 
 est men, by substituting a diet more like ours ? In my opinion their 
 method was the same and the discoveries identical."-' 
 
 This explanation, of remarkable simplicity and exactness, shows us 
 how men were gradually led to lay the foundations of Medicine. It 
 sufficed them to observe that certain things were good, and others bad, 
 so that the former might be employed, but the latter abstained from. 
 Thus, as the application of a hot cataplasm on the side soothes the 
 pain of pleurodynia, in Thrasimenus; it was naturally supposed that 
 the same remedy would relieve Eurimedon of a similar trouble; 
 so a venesection, having cured the daughter of Damatia, deprived of 
 consciousness by a fall from the roof, it was concluded that all simi- 
 lar cases should be treated in a like manner. The reasoning 
 under these circumstances was very simple ; no inquiry was made as to 
 the mode of cure by the remedy, it was sufficient to show that they 
 were cured, in order to feel authorized to apply the same treatment to 
 analogous cases. Observation and memory then, which constitute ex- 
 perience, were the principal faculties put in exercise ; reason entered very 
 little into their therapeutical considerations. Such was the first step of 
 the human mind, in the Medical career; it consisted in substituting 
 the lights of experience for the brute suggestions of instinct, a substitu- 
 tion rational and advantageous, as we shall demonstrate hereafter. 
 
 C H A P T E E IV. 
 
 THE UTILITY OF MEDICINE DURING THE PRIMITIVE PERIOD. 
 
 Those who boast of the certainty and perspicacity of instinct — those 
 who wish that man, in imitation of animals, followed only his appetites 
 in health and disease ; have never reflected on the daily and often fatal 
 errors of the appetites uncontrolled. It will suffice to give them some 
 examples to unprejudice their minds, and convince the reader, that the 
 lights of experience aye less faulty than our instinctive tastes, especially 
 among the sick. 
 
 = Works of Hippocrates, translation by M. Littre. Traite de PAncienne 
 Medecine.
 
 56 PRIMITIVE PERIOD. 
 
 1. Let a traveler, after a long walk under an ardent sun, covered 
 with dust and sweat, and dying of thirst, come to the side of a cool and 
 limpid spring; instinct would lead him to take long, deep draughts of its 
 waters; but woe to him if he does not resist the temptation. It is not 
 necessary in this place, to recall the example of Alexander the Great, 
 arrested in the midst of his triumphant career, for having yielded to a 
 similar temptation, to bathe in the waves of the Cydnus. No one 
 reaches the years of discretion, without knowing, either by personal 
 experience, or the hearsay of others, how dangerous such conduct is, 
 and how fatal it has been in many instances, 
 
 2. A miserable shipwrecked sailor, who has endured the torment of 
 hunger for many days, is finally rescued by a vessel fully provisioned. 
 Do you suppose that the commander of that ship, would allow him to 
 eat and drink to full satisfaction ? No, certainly, for it would cause 
 the speedy death of the unfortunate sufferer ; the blind and imperious 
 cravings of his appetite, would permit only a partial gratification. 
 
 3. A woman in labor, is attacked either with hemorrhage, or convul- 
 sions, or her child has a bad presentation. Would you abandon this 
 accouchement entirely to the resources of nature ? There is much reason 
 to fear, that under such circumstances, the mother or the child, or even 
 both would succumb, if Art comes not to their relief; but by a simple 
 and painless maneuver, the skillful accoucheur will, in most cases, save 
 the lives of both. 
 
 4. Let an individual be attacked with an intermittent fever ; instinct 
 suggests to him to employ much covering, during the cold stage, and 
 cast it off during the fever ; and quench his burning thirst with copious 
 draughts of water: The paroxysm passed, he resumes his ordinary 
 life without any precaution, because he is sensible of no change in his 
 condition, except a slight diminution of strength and appetite. Du- 
 ring each paroxysm, his instinct suggests only a repetition of the same 
 acts. Now what will be the result? 
 
 If the attack is mild, the climate healthy, and the patient have a 
 <^ood constitution, he will recover by the efforts of nature alone, after a 
 few repetitions of the paroxysm ; but in most cases, one or more of these 
 favorable conditions are wanting, then the scene is changed, and the 
 results are very different. Sometimes the subject succumbs in a few 
 days ; at others, the fever assumes a remitting type, and goes on indefi- 
 nitely, producing at length, visceral congestions, chronic inflamma- 
 tions, and incurable degeneration of organs ; in fine, in cases less 
 severe, the subject has a slow convalescence, and is for a long time, 
 incapable of active labor. Thanks to the progress of science, these 
 
 I
 
 UTILITY OF MEDICINE. 57 
 
 sort of affections, formerly so common and disastrous, are now rarer, 
 and much less formidable. 
 
 5. A man has a luxation of his arm, or a fracture of his leg ; what 
 does his instinct counsel ? To keep it in such repose, as prevents any 
 movement of the injured member, because the slightest motion 
 excites severe pain ; but experience teaches us, that unless he will sub- 
 mit to the momentary increase of pain, which the manipulations of his 
 surgeon will cause in his efforts to adjust it, he will infallibly lose the 
 use of his member, and very probably too, endure a great amount of 
 subsequent suffering. 
 
 In a multitude of cases more, it could be shown that the suggestions 
 of instinct arc faulty and pernicious. After having proved a thousand 
 times the danger of following so untrue a guide, a surer method was 
 sought in the lessons of experience. 
 
 The first discoveries that were made on this plan, appeared so admi- 
 rable and useful, that they were conceived to be a divine inspiration, 
 and those who were regarded as the inventors and propagators, received 
 divine honors. Thus we see, there was a real progress, an efficient 
 amelioration, by adding the lights of experience to the brute sugges- 
 tions of instinct — in passing from the state of simple nature, to 
 that of the commencement of medical science. It belonged to history 
 and medical philosophy to establish this fact, which sanctions and jus- 
 tifies these early efforts of the race, to lay the foundation of the Healing 
 Art. Thus a serious examination, refutes the eloquent declamations 
 of those philosophers who propose to us, to make the animals our models ; 
 proclaiming continually the unfailing sagacity of instinct ; and so, also, 
 is swept away the apparent wisdom of the following words «f J. J. 
 Rousseau, put in the mouth of his pupil ; "If I become sick," says Emi- 
 lius, in a letter to Sophia, " a very rare circumstance in a man of my 
 temperament, who indulges in no excess of food or care, or labor or rest, 
 do not torment me with efforts to cure me, nor frighten me to death. 
 The young animal that is sick, rests in one place, gets well, or dies: 
 [ would do likewise, and I should be the better by it."" 
 
 The grave philosopher of Geneva had never reflected, it is reasonable 
 to suppose, on the serious inconveniences of that method, in an infinite 
 number of cases ; among those cited above, there are several in which it 
 would have been fatal. 
 
 To his authority, we are able to oppose that of another philosopher, 
 who was his cotemporary, and no less celebrated than himself. "It is 
 admitted," says Voltaire, "that a good physician may save our lives in a 
 
 " Traito de I'Education. 2de Lettre d'Emile a Sophie. 
 4
 
 58 PRIMARY PERIOD. 
 
 hundred cases, and restore to us the use of our members. A man falls 
 with apoplexy : it will not be a captain of infantry, nor a counselor of 
 state that will cure him; cataracts form in my eyes: my neighbor can 
 not remove them. I make no distinction here between the physician 
 and the surgeon ; the two professions have been inseparable for a long 
 time. Men who would occupy themselves with studies and efforts to give 
 health to other men, from the sole principles of humanity, should be 
 considered far above the grand of the world; they were kindred to 
 divinity. To preserve and repair, is nearly as admirable as to create. 
 The Eoman people were satisfied to remain five hundred years without 
 physicians. That people only occupied themselves with killing, and 
 made no efforts to save life. What became of those who had a putrid 
 fever, an anal fistula, a carbuncle, or an inflammation of the lungs? 
 They died." 
 
 But the greater number of the detractors of Medicine, do not deny in an 
 absolute manner, the utility of the Art, in a thousand instances ; they 
 do not contest, for example, the utility of certain surgical operations, 
 nor the regimen in acute diseases; but they reject in general, scien- 
 tific Medicine, Medicine as an Art. Thus the elder Cato pursued with 
 his ordinary obstinacy, the philosophers, rhetoricians and physicians of 
 Greece, whom he accused of corrupting the manners of the Eomans, and 
 he finally succeeded in obtaining a decree for their expulsion ; but not- 
 withstanding all his efforts, the physicians were excepted in the decree. 
 This same Cato wrote a work on domestic and veterinary Medicine ; he 
 treated the men of his household and his animals with remedies prepared 
 by his own hands, and report says, that his wife fell a victim to his 
 prejudices in Medicine. The encyclopedist Pliny, who wrote a materia 
 medica entirely drawn from Greek authors, did not dissimulate any 
 more, the sentiment of profound jealousy that he felt, on account of 
 the superiority of that nation in science and letters. He declaimed 
 against foreign j^hysicians with a blind violence, that led him even to 
 proscribe the use of exotic plants. 
 
 At this point naturally belongs the relation of an anecdote, which 1 
 once heard told of an old doctor, which I will endeavor to state in his 
 own words. "I was one day," says the worthy practitioner, "at the 
 house of one of my patients, who had recovered from a rather severe 
 attack of illnesss, when an inhabitant of the neighborhood, who had 
 lately come from Paris, called to pay him a visit. After the first com- 
 pliments the conversation fell, as is usual in such cases, on medicine and 
 physicians. ' As for me,' said the provincial, ' I have no faith in Medicine ; 
 
 '' Dictionnaire Philosophique.
 
 RESUME OF THE PRIMITIVE PERIOD. 59 
 
 I believe that one would recover just as wel5 without, as with it. But then, 
 I have never had a serious attack of sickness.' Your incredulity, then. 
 I replied, arises from that condition, and you will do well to maintain ir. 
 • 1 speak only for myself,' added our provincial, ' for, as to others, I am 
 the first to administer remedies to them. As I dwell in the country, 
 far from the residence of all physicians, I have in my house a little 
 pharmacy, which I am careful to keep supplied, and when one of my 
 family or a neighbor falls sick, I always give them the first aid ; and often 
 I effect a cure, before the arrival of the doctor.' But then, said I. 
 you do prepare some medicines, and probably have some little faith in 
 them. ' Oh, doubtless, said the countryman, I have faith in my medi- 
 cines, because they are so very simple and natural, as I employ neither 
 strong remedies nor instruments.' " 
 
 What difference then is there, between the practice of Cato, the 
 censor ; of Pliny the naturalist ; of our rustic citizen, and that of the 
 physicians of their times ; or to speak more generally, what difference is 
 there between the practice of laymen, and that of men of science '? This 
 only : the former are ignorant and timid; the latter are relatively more 
 enlightened, firmer, and consequently more efiicacious. 
 
 There is another class of unbelievers in Medicine whom we should 
 pity more than blame ; I mean those persons who are suffering from in- 
 curable diseases, and have exhausted all the resources of cotemporaneous 
 science, without obtaining any notable advantage. Such was the case 
 with our skeptic Montaigne, who, afflicted with a urinary calculus, at 
 an epoch, when surgery, impotent by ignorance, dared not attempt the 
 operation of Lithotomy, gave vent to his spite in epigrams against the Art. 
 Alas, whatever may be done, whatever perfection this Art may attain, there 
 are, and there always will be, cases in which its aid will be inefficacious, 
 and then the patient who demands of us relief for his suffering, who 
 asks of us life, however inexorable may be the law which condemns him 
 to suffer and to die, seeing the impossibility of our aiding him, will 
 accuse us of this inevitable result ; and will declaim against us, unless 
 he be endowed with a lofty philosophy, or profound resignation. 
 
 RESUME OF THE PRIMITIVE PERIOD. 
 
 We have seen that the first notions of Medicine go back to the 
 earliest infancy of society, in all the countries of the world ; so that we 
 may repeat the statement of Pliny, that if there exists any nation 
 which, at any epoch of its history, was without physicians, there is not one 
 in which we do not find some vestiges of Medicine. W^e conclude from 
 this, in opposition to Plato, and some other philosophers, that the first
 
 60 PRIMITIVE PERIOD. 
 
 elements of the Healing Art are not at all the result of the degenera- 
 tion of human nature, brought about by softness and luxury ; but that 
 they spring from that natural instinct, which makes a man fly from 
 danger and death, and sympathize with the aflSictions of his fellows. 
 We have, therefore, endeavored to penetrate further than has been 
 done, up to this time, into the workings of the human mind, by which 
 the first materials of medical science were developed, and we have 
 found that this process consists, principally, in the addition of the 
 lights of experience to the brute impulses of instinct. In fine, having 
 sought to appreciate the results of that antique revolution, we have 
 established, by a severe analysis, that the results have been advan- 
 tageous to humanity. We now proceed to follow science through a new 
 phase ; we shall behold it expand, from its beginning, by successive 
 development, as a river swells and grows broader from its origin, by the 
 tribute of its branches. We shall have to notice more than once, the 
 errors and abuses which have disturbed, diverted, and sometimes turned 
 it backward in its course ; but let come what will, in the labyrinth of 
 contradictory opinions into which we must plunge, we shall take for our 
 motto, that of the Deontologie Medicale, of Dr. Max. Simon: " Truth 
 in Science, and Morality in Art.^^'-' 
 
 * See the dedication of that work.
 
 GENERAL CONSIDERATIONS. 61 
 
 II. MYSTICAL PERIOD. 
 
 COMPRISING A SPACE OF TIME EXTENDING FROM THE TROJAN WAR. B. C. IISI. 
 TO THE DISSOLUTION OF THE PYTHAGOREAN SOCIETY, B. C. 500. 
 
 GENERAL CONSIDERATIONS. 
 
 The Trojan war, celebrated in the Songs of Homer, appears in Greek 
 antiquity as a luminous point in the midst of profound darkness. 
 Before this memorable expedition, and for a long time afterward, the 
 history of Medicine rests on uncertain traditions, often mino-led with 
 fables. The hellenic nation, which was one day to become the instruc- 
 tress of the human race, had not yet shaken off the rust of barbarism. 
 Egj'pt, Phenicia, and Chaldea, marched at the head of civilized nations. 
 
 But after the Grecian chiefs had overturned the throne of Priam, and 
 destroyed his capital, the freedom of the seas was attained. Their ves- 
 sels could cruise, unmolested, from Palus-Mceotidus to the Straits of 
 Gibraltar. After that event, the Hellenists covered, with their colonies, 
 the coasts of Asia-Minor, the isles of the Archipelago, and the south of 
 Italy. They sent emigrants as far as Gallia, Spain, and the shores of 
 Africa. Their navigators dared even to pass the pillars of Hercules, 
 and adventure upon the ocean. 
 
 It was not solely the desire of riches and power, that caused them to 
 undertake long peregrinations ; a more noble sentiment, the love of wis- 
 dom, or of science, animated some of these travelers. They are seen 
 renouncing their families and friends for a great number of years, and 
 returning afterward to share freely with their fellow-citizens the trea- 
 sures of light they had amassed in foreign lands. Thus, a Lycurgus 
 and a Solon were worthy to give laws to their country, and place in the 
 constitutions, which are still admired, the foundation of the grandeur of 
 Sparta and Athens. So a Thales, a Pythagoras, and a Democritus, be- 
 came the chiefs of schools, or of sects, which shed upon their names so 
 much glory. 
 
 Nevertheless, science and letters had advanced but very slowly, in 
 Greece, during the space of seven hundred years, which separates the 
 Trojan war from the dispersion of the Pythagoreans. A very small
 
 62 MYSTICAL PERIOD. 
 
 number of men devoted themselves to the study of the liberal arts, and. 
 with the exception of the poems of Hesiod and Homer, there remains to 
 us no literary monument of that long period. Medicine shared the fate 
 of the other sciences ; buried in the depths of the temples of Escula- 
 pius, it made an unseen progress, which it is impossible for the historian 
 to trace. 
 
 CHAPTER I. 
 THE PRACTICE OF MEDICINE IN THE TEMPLES. 
 
 Fifty years after the destruction of the kingdom of Priam, there was 
 elevated at Titanus, a city of the Peloponnesus, the first temple in honor 
 of Esculapius. Very soon the worship of this god was spread through- 
 out G-reece, whence it passed into Asia, Africa, and Italy. Among a 
 multitude of temples which were consecrated to him, those at Epidaurus. 
 in the Peloponnesus, at Pergamus, in Asia, on the island of Cos, and at 
 Cyrene, a city of Lybia, are particularly remarkable. 
 
 In the temple at Epidaurus, there was a statue of colossal size, repre- 
 senting the god of Medicine under the figure of an old man seated on a 
 throne, holding in one hand a scepter, and resting the other on the head 
 of an enormous serpent. A dog, an emblem of vigilance, reposed at his 
 feet. This statue, made of gold and ivory, was the work of Trasyme- 
 dus. Socrates, in his last discourse with his friends, requested them to 
 ofier a cock, as a sacrifice for him, to Esculapius ; whence we infer that 
 this bird was sacred to the god of Medicine. '■■■' 
 
 The priests attached to his worship were named Asclepiadge, a word 
 which signifies descendants of Esculapias. They formed a particular 
 caste, governed by sacred laws, like the priests of Egypt. One of their 
 ancient laws said, " that it is not permitted to reveal sacred things, 
 except to the elect, and strangers must be admitted to this knowledge 
 only after having submitted to the tests of initiation." 
 
 The temples of the god of Medicine were generally very salubriously 
 situated; sometimes on the summit of a hill, or the declivity of a 
 mountain ; sometimes on the shore, somewhat distant from the sea, and 
 near to a thermal spring, or fountain of living water. Groves of trees 
 refreshed the sight of the sick, and afforded to them cool and solitary 
 retreats in their beautiful and spacious avenues. 
 
 ■' Dialogues of Plato, the Phedon.
 
 PKACTICE OF MEDICINE IN THE TEMPLES. 63 
 
 The people came from all quarters on pilgrimages to these places, sacred 
 to the god of Medicine. The sick and the convalescent found there, 
 both agreeable and healthful diversions. The wholesome regimen to 
 which they were subjected ; the pure and temperate air they breathed ; 
 the faith and hope by which some of them were animated ; the miracu- 
 lous cures that were testified to, all united to affect their minds agreeably, 
 and exercise a happy influence on their constitution. 
 
 Beside these hygienic means, the AsclepiadDe employed special reme- 
 dies appropriate to each disease, according to the notions they then had 
 of it. They prescribed according to circumstances, venesection, purga- 
 tion, vomits, friction, sea-bathing and mineral waters ; in a word they 
 neglected none of the therapeutical means they possessed in those times. 
 
 Knowing the gi'eat influence of the morale on the physiqiie. these 
 priest-doctors employed every means to control the imagination of their 
 patients. These were not permitted to interrogate the oracle, until they 
 were purified by abstinence, fasting, prayers and sacrifices. When all 
 these purifications were accomplished, the consultants were introduced 
 to receive the response of the oracle. Sometimes they were obliged to 
 lie in the temple for one or more nights. Sometimes the god spoke in 
 a mysterious manner, without showing himself to the eyes of the faith- 
 ful ; sometimes he appeared to them under the form of a serpent, de- 
 vouring the cakes on the altar ; again, he manifested his will in dreams, 
 which were interpreted by the priests. 
 
 The patients who recovered, went to their homes blessing the divine 
 author of their recovery, and leaving behind them testimonials of their 
 gratitude. Those who received no beneficial nor favorable response, be- 
 lieving that their offerings were rejected, because insufiicient, redoubled 
 their zeal and their liberality. So that bad as well as good results 
 added equally to the glory of the god, and the profit of his ministers. 
 
 There existed in the country about Epidaurus, and in various other 
 localities, serpents of a yellowish-brown color, whose bite was not ven- 
 emous, and which were easily tamed. The priests employed them in 
 those supernatural performances which filled the people with astonish- 
 ment and superstition. Aurelius Victor relates, "that during the year 
 350 of the foundation of Eome, the city was ravaged by a terrible pesti- 
 lence : the Senate sent six deputies to consult the oracle of Epidaurus. 
 After they had arrived at the temple, and were admiring the colossal 
 statue of the god, suddenly, an enmorous serpent issued from beneath 
 the pedestal. The sight of it impressed every miml more with venera- 
 tion than terror. He moved tranquilly through the astonished crowd 
 and entered the vase of the Romans, in the chamber of Ogulnius, the 
 chief of the embassadors.
 
 64 MYSTICAL PERIOD. 
 
 " The sacred reptile was piously borne away, and when the vessel of 
 the embassadors was approaching the city of Eomulus. he sprang into 
 the waves and swam to an island in the Tiber. A temple was immedi- 
 ately erected to Esculapius, on that spot, and the pestilence ceased." 
 
 Many other grave historians of antiijuity, report the prodigies effected 
 by the intervention of the god of Medicine. Nevertheless, every one did 
 not credit them, as witness the testimony of the valet to whom Aristo- 
 phanes in one of his comedies, attributes the following language: " The 
 Priests of the temple of Esculapius, after having extinguished all the 
 lights, told us to go to sleep, adding, that if any one should hear a hiss- 
 ino-. which indicated the arrival of the god, he should not move in the 
 slightest manner. So we all laid down without making any noise ; but 
 T could not sleep, because the odor of an excellent broth, that an old 
 woman held near me, agreeably excited my olfactories. Desiring most 
 ardently to slide along to it, I raised my head very quietly, and saw 
 the sacristan, who took away the cakes and figs from off the sacred 
 tables, going the round of the altars, putting into his sack every- 
 thing he could find. I believed that I had a right to follow his example, 
 so I raised to go to the old woman's pot." 
 
 CHATTER II. 
 OF DREAMS. 
 
 All antiquity has had faith in dreams, prophets and philosophers — 
 strong and weak minds, all believed that the Divinity employed these 
 means to reveal the future and instruct us in his designs. Sacred and 
 profane history are full of examples that attest the universality of this 
 sentiment. It is, then, more than probable that the Asclepiadse shared 
 in it, and, moreover, as it was advantageous to them, they must have 
 tried to maintain this belief, by pious frauds. Thus, while they endeav- 
 ored to draw from dreams some natural indication, they affected to con- 
 sider them also as a divine manifestation, above the laws of nature. In 
 all ages, the signs furnished during the sleep of the sick, have been 
 profitably studied in a semiotic point of view ; and in this sense, dreams 
 have an importance, which was, doubtless, very much exaggerated by the 
 ancients, but has been too much neglected by moderns. 
 
 My readers, I think, will not be displeased to find here some extracts 
 from one of the most ancient treatises that exists on this subject.
 
 OF DREAMS. 65 
 
 " Whoever," says the author of this book, " desires to know the in- 
 ferences that may be drawn from dreams, will find, in the first place, 
 that they are closely related to what has transpired during the previous 
 day. The soul, during sleep, is untrammeled ; but while it is distracted 
 by its service to the body, its existence is, as it were, divided ; it is not 
 entirely itself, but belonging, in part, to the bodily wants, it subserves 
 the senses, as sight, hearing, touch, and the faculty of voluntary move- 
 ments ; it directs the various operations of business ; in short, it gives aid 
 to every act of the body requiring thought, which prevents it, in some 
 degree, from enjoying its own innate reflections. 
 
 " When the body is asleep, the soul visits every part of this her habita- 
 tion, and regulates all its various functions. The body is then uncon- 
 scious, but the soul is awake, it possesses all its intelligence, it sees 
 visible things, it hears sounds, it feels, it moves, it is pained and irri- 
 tated. In brief, the soul during sleep, performs everything that relates 
 to the body and the soul, and wisdom is largely possessed by him who 
 is able thus to comprehend it. 
 
 " We see persons much occupied with this art, who pretend to under- 
 stand and explain dreams sent by the gods to announce beforehand, the 
 good and the evil with which cities or persons are menaced. Sometimes 
 they are correct, at others they are mistaken ; but no one knows why it 
 is so. 
 
 " They say there is something to be done to guarantee persons or 
 places against certain evils, but not knowing really what, prayers to the 
 gods are prescribed. It is, doubtless, good to pray to the gods ; it is 
 always apropos ; but it is necessary also, for a person to concur with 
 the divinity, and endeavor to help himself while invoking his aid."'-'' 
 
 We remark, first, that the author of the passages just quoted does 
 not deny the possibility of dreams being sent by the gods, but he 
 questions the art of those who pretend to interpret them. He judiciously 
 observes that these persons happen sometimes to be right, and at others 
 are mistaken ; that is, that the event sometimes justifies their prediction,. 
 and sometimes contradicts it, without any one knowing how or why. 
 
 He gives a theory of dreams, which he thinks is perfectly natural and 
 which may be summed up as follows : the soul, or the vital principle, or- 
 to use the language of anatomists, the encephalic organ, being free from 
 external distractions during sleep, perceives much better the sensa- 
 tions that proceed from the viscera, and manifests them more distinctly. 
 This is a theory which we may find to be contrary to observation, but 
 which, at first sight, is neither absurd nor unreasonable. 
 
 - " CEuvres Hippocratiques," Gardeil,t. Ill — Songes, § 1.
 
 66 MYSTICAL PERIOD. 
 
 Unhappily, the author of it does not exhibit the same spirit of wis- 
 dom in the applications he makes of it. He gives as the true results of 
 observations, the most singular fancies, only worthy of a theosoph of 
 the sixteenth century. I will cite but one of them : 
 
 " When one sees, in his dreams, either the sun or the moon, or the 
 sky with the pure and serene stars, it is a good sign ; it indicates the 
 health of the body. Observation has proved that the firmament res- 
 ponds to the surface of the body ; the sun to the muscles, and the moon 
 to the cavities that contain the viscera. When in the dreams, one of 
 these stars appears to be changed or is obscured, or arrested in its course, 
 the seat of the malady is its corresponding part in the body. If there 
 appears any disorder in the sky, occasioned by the air or the clouds, 
 the evil is less than if produced by rain or hail ; it indicates a separa- 
 tion of watery humors and phlegm, which are carried to the skin. In 
 this case it is necessary to take exercise by running, being clothed ; com- 
 mencing gently, then quicker, so as to sweat freely. On leaving the 
 gymnasium, long walks should be taken, while fasting. For five days, 
 one-third of the food should be left off to be gradually assumed again. 
 If the above sign was very strong, a vapor-bath should be used, as it is 
 necessary then to deplete the skin, because the disease is in the peri-" 
 phery of the body. Dry food should be used, with bitters, astringents 
 and spices, and such exercise be taken as will produce free perspira- 
 tion." •■- 
 
 The treatise from which I have drawn these fragments belongs to 
 the historic period that follows this ; but I have inserted them in this 
 ■ chapter to complete what I have to say concerning dreams, for I shall 
 have no other occasion to recur to this matter ; the great physicians of 
 following ages having occupied themselves with other objects which they 
 judged better calculated to improve the diagnosis of diseases. 
 
 CHAPTER III. 
 
 MEDICAL TEACHING IN THE TEMPLES. 
 
 The priests of Esculapius formed, as we have before said, a separate 
 ■caste, transmitting from one to another their medical knowledge as a 
 family heritage. In the remotest times, no layman, according to the 
 report of Galen, was admitted to participate in the sacred science, but 
 
 '5 " (Euvres Hippocratiques," Gardeil, t. Ill— Songes, § 111.
 
 MEDICAL TEACHING IN THE TEMPLE. 67 
 
 at a later period, this severe secrecy was relaxed. Tliey consented to 
 reveal their secrets to strangers, provided they would fulfill the tests of 
 initiation. There was, then, according to every probability, some sort 
 of iledical instruction given in each temple. Indeed, history has pre- 
 served the memory of three schools that had a great reputation, viz : 
 that of Ehodes, the most ancient of all, which had already ceased to 
 exist, at the time of Hippocrates, and of whose doctrines we have no 
 accounts whatever ; that of Cnidus, which was the first to publish a 
 small repertory, with the title of the Cnidian Sentences ; finally, that of 
 Cos, the most celebrated of all, and which has given birth to a great 
 number of illustrious physicians, whose writings constitute the most 
 valuable memorials of antique j\Iedicine. Among the means of instruc- 
 tion offered by the priests of Esculapius, there is one that deserves to 
 arrest us for a moment, because it is specially relative to the historic 
 period with which we are now occupied ; I mean, the votive tablets 
 which it was customary to faster to the walls and columns of the temples 
 after the example of the Egyptians. These tablets showed, generally, 
 the name of the patient, the kind of disease with which he was attacked, 
 and the manner of his cure. 
 
 One of these tablets, found at Eome, on the island in the Tiber, the 
 site of the ancient Esculapian temple, bears the following inscription, 
 in Greek characters : 
 
 " Lately a certain Caius, who was blind, came to consult the oracle. 
 The god required that he approach the sacred altar to perform adora- 
 tions ; at once he passed from the right to the left, and having rested 
 his fingers on the altar, he raised his hands and applied them to his 
 eyes. He recovered his sight immediately, in the presence of the people, 
 who rejoiced to see such marvels accomplished under the reign of our 
 august Antonius." 
 
 " Lucius was attacked with a pleurisy, and every one despaired of his 
 life. The god ordered that the ashes of the altar be taken, mingled 
 with wine and applied to his side. He was saved, and gave thanks to 
 god before the people, who congratulated him," 
 
 " Julian vomited blood, and appeared lost beyond recovery. The 
 oracle ordered him to take the pine seeds of the altar and eat them for 
 three days, mingled with honey. He did so, and was cured. Having 
 solemnly thanked god, he went away." 
 
 " The god gave this direction to a blind soldier named Valerius Aper : 
 Take the blood of a white cock, mingle it with honey, and make a col- 
 lyrium, which you are to apply to the eyes for three days. The soldier 
 having fulfilled the direction of the oracle, was restored to sight, and 
 returned to make' a public thanksgiving to God."
 
 68 MYSTICAL PERIOD. 
 
 Narratives of this kind, and written in such style, were well calcu- 
 lated to fortify the piety of the faithful ; but certainly, they do not serve 
 any great end for the advancement of science. The writers who have 
 boasted of this method of instruction, have not reflected, apparently, 
 upon its glaring defects. Of what advantage, for example, is the record 
 of the third case — " Julian vomited blood, and appeared to be beyond 
 recovery ?" What physician would dare rest a prognosis or direct a 
 treatment on so vague an indication ? Can we treat indifferently, in 
 the same manner, a stout man, or an infant, or an old man — a plethoric 
 or an anaemic patient — a hemoptysis, or a hematemesis, or a scorbutic 
 hemorrhage of the buccal mucous membrane ? •■■= 
 
 It requires no reflection to say that a disease cannot be announced 
 by one or two symptoms; but rather it is necessary to recall, 1st, all 
 the anterior circumstances which could have contributed, directly or in- 
 directly, to promote it ; 2d, to ascertain the age, sex, temperament, and 
 usual habits of the patient ; 3d, finally, to describe with the greatest 
 care the actual general state of the patient, and make every possible 
 effort to know the organ principally affected, as well as the nature of 
 the lesion of which it is suffering. 
 
 It is presumable that the Asclepiadse wrote down in secret the his- 
 tory of each disease, and the means employed to combat it ; but we are 
 ignorant through how many degrees science passed before it attained 
 the stage of development exhibited in the Hippocratic works. But we 
 may, at all events, judge from the exquisite taste and precision which 
 characterize some of these books, that they had for a long time been in 
 the habit of closely observing and clearly describing diseases. 
 
 CHAPTEE IV. 
 
 THE ORIGIN OF CLASSIFICATIONS IN PATHOLOGY. 
 
 WuEN a great number of pathological descriptions, sufliciently detailed, 
 were collected, the embarrassment of such an accumulation began to be 
 realized. Indeed, how could such a mass of material, arranged with- 
 out any order, be made serviceable '? How find in this pell-mell the 
 
 "'"I have seen a -woman attacked with a hemorrhage of this nature who threw 
 oflf mouthfuls of blood: she had already filled several basins. The liquid was 
 seen running from the surface of all the gums. This fearful affection brought 
 the patient within two fingers' length of the grave, and only yielded, at last, to 
 reiterated cauterization with the nitrate of silver."
 
 ORIGIN OF CLASSIFICATIONS. 69 
 
 record they wished to consult — the tableau which answered best the 
 symptoms of the disease before them ? Xo man's memory was equal to 
 such a task. 
 
 In proportion as clinical observations multiplied, it became every day 
 more necessary to arrange them after a method which would impress 
 them upon the memory, and facilitate a recurrence to them when desi- 
 rable. Such was the origin of the first pathological classification. The 
 idea was suggested, as is seen, by the necessity of relieving the memory 
 and the desire of facilitating researches. We are ignorant of the mode 
 of classification first employed. We only know that, from the begiuning 
 of the philosophic period, diseases were arranged by groups, according 
 to the locality afi'ected, descending from the head to the feet. Fevers 
 and other affections that attack the whole economy, or a great number 
 of parts, at the same time, were arranged in separate groups. This dis- 
 position, which is met with in the works of Hippocrates, was adopted, 
 with improvements and variations, down to an epoch not far from our 
 own. 
 
 The first men who reflected on the phenomena of nature, in endeavor- 
 ing to solve their causes, principles, and ends, did not imagine anything 
 better to explain the movements of bodies and their continual trans- 
 formations, than to people the universe with spirits ; that is, with invisi- 
 ble and impalpable substances endowed with force, intelligence and will, 
 in different degrees. Each body was supposed to contain at least one of 
 these spirits. This presided over and gave impulsion to all the changes 
 and anatomical phenomena which occurred in the body to which it was 
 attached. Man, whose organization is so complicated and whose func- 
 tions are so numerous — whose intelligence is carried to the highest ab- 
 stractions, to the idea of infinity — who is lost in the interpretation of 
 the most simple phenomena, as the movement of the finger or the form- 
 ation of an atom of matter — whose will controls the surrounding ele- 
 ments, but who cannot prevent a hair turning white — man, I repeat. 
 appeared to the early sages as a multiplied being, a little representation 
 of the universe : consequently, his body was divided into many regions 
 or departments, which were supposed to be governed by spirits of different 
 orders. The system of Pythagoras, which we shall soon describe, offers 
 the first example of this physiological polygarchy : it is the source 
 whence are derived a multitude of ancient and modern theories.
 
 70 THERAPEUTICS. 
 
 CHAPTER V. 
 
 THERAPEUTICS. 
 
 We liavc heretofore said that the physicians of primitive times rea- 
 soned very little on morbid phenomena, or the effects of remedies ; that 
 they contented themselves to observe which were the remedies that 
 would heal certain diseases, and to employ thereafter the same means 
 in like cases. 
 
 It appears that during the mystical period no other plan was followed. 
 Hippocrates, Celsus, Galen, and all the historiographers of Medicine, 
 agree in saying that before the introduction of philosophy into this 
 science, i. e., before the age of Pythagoras, there was no other rule than 
 empiricism. But by this, these authors do not allude to rational empiri- 
 cism, which had its origin much later, in the school at Alexandria : they 
 speak of instinctive or natural empiricism, which we have referred to 
 in the primitive period, and which is still daily followed by persons, 
 strangers to the art, when they obtrude themselves to give counsels to 
 the sick. These persons have constantly in their mouths these words : 
 ' I have seen a disease similar to this cured by such a remedy." Their 
 reasoning, however gross it appears to us, is based on an incontestable 
 principle, that may be stated as follows : Remedies which have cured a 
 disease, vmst he equally efficacious in curing analogous cases. 
 
 Nothing is clearer, nothing is truer, than this aphorism : it has all 
 the infallibility of a mathematical axiom ; and as the medical prac- 
 tice of ancient times rested on this, an author that we have already 
 quoted says with truth: " Medicine for a long time has been in posses- 
 sion of all that is really necessary in regard to principles and method. 
 With these guides, numerous and valuable discoveries have been made 
 during a long course of centuries ; and the rest will be discovered, if 
 capable men, instructed in the discoveries of the ancients, shall take 
 these for the point of departure in their researches. But they who 
 reject and disdain the past, and attempt other methods and other ways, 
 pretending to have found something new, will be mistaken and will mis- 
 lead others."" 
 
 Nevertheless, complaints are ceaseless of the uncertainty and insta- 
 bility of medicine. The science is accused of having no stable princi- 
 ples to shelter it from the caprices of fashion and in the changes of 
 
 '"'ffiuvres d'Hippocrate. " Traite de I'Ancienne Me'decine," § ii. Translation 
 .)f M. Littrc. Paris, 1839.
 
 THERAPEUTICS. 7 1 
 
 systems. The masters of the art themselves furnish often the examples 
 for this exaggerated declamation. 
 
 Pinel, frightened by the difficulties of medical practice, blames 
 justly the presumption of a writer of the last century,-' who prom- 
 ised nothing less than the solution of this general problem — " A disease 
 being given, to find the remedy." But does he not himself fall into a 
 contrary excess, and does he not mistake the true destination of Medi- 
 cine, when he proposes for the end of his labors nothing but the resolu- 
 tion of the following question : " Determine the true character of a given 
 disease, and its position in the nosological scale. "f Does not this 
 take from the medical arch its most essential support, its keystone — 
 therapeutics ? 
 
 Bichat expresses himself in these terms, on the same subject: "Mate- 
 ria medica, an assemblage of incoherent opinions, is perhaps, of all the 
 physiological sciences, that which most exhibits the contradictions of the 
 human mind. In fact, it is not a science for a methodic spirit ; it is a 
 shapeless assemblage of inexact ideas, of observations often puerile, of 
 imaginary remedies strangely conceived and fastidiously arranged. It 
 is said that the practice of Medicine is repulsive. I will go further : 
 no reasonable man can follow it, if he studies its principles as set forth 
 in our materia medicas." | 
 
 Broussais is not less explicit nor less vehement in his condemnation of 
 the therapeutics of his predecessors. (See, among others, the xv. chap- 
 ter of I'Examen des Doctrines Medicale, entitled, " De la Certitude en 
 Medecine." 
 
 Complaints so unanimous have a cause that it is the duty of the his- 
 torian to explain. Those who make them are not ignorant, certainly, of 
 the axiom set forth above, and which is in accordance with common 
 sense. Thus it is not, as think the vulgar, the absence of a fundamen- 
 tal principle in practical ]\[edicine which pains them, but rather the 
 difficulties, always great and sometimes insurmountable, that are met 
 with in its application. 
 
 To obtain a conception of these difficulties, it will suffice to glance at 
 one of the most simple cases in the practice. Suppose, for example, that 
 a case of palpitation of the heart is to be treated. On this simple an- 
 nouncement a medicaster or an apothecary would not hesitate to pre- 
 scribe digitalis, or thridace, or some other remedy indicated in the for- 
 mulary, to combat this symptom. 
 
 *^Picairii. f " Nosographie Philos.," introd., page iv. 
 
 I Bichat, " Anat. Generale." Consid. Ge'ne'rales, § ii.
 
 72 MYSTICAL PERIOD. 
 
 The true physician, one who adds to the lights of science a sense of 
 duty, would not be so prompt : he would, in the first place, know all the 
 associated circumstances ; then he would proceed to examine the patient 
 by commencing at the organ where the functional trouble was the most 
 apparent : in short, it would be only after having carefully explored all 
 the viscera and all the functions of the body, that he would feel author^ 
 ized to prescribe the treatment ; for he is aware, that often the mute 
 suffering of an organ distant from the heart may be the cause of the pal- 
 pitations, so that of ten individuals who complain of palpitation, per- 
 haps in not more than two would the same remedies be applicable. 
 Moreover, all is not finished when a practitioner has properly established 
 his diagnosis. It is yet necessary for him to choose the remedies proper 
 to fulfill the curative indications ; that is, he must be well posted in all 
 the internal and external resources of therapeutics. Finally, it is neces- 
 sary that he secure, on the part of the patient and the attendant, the 
 faithful execution of his directions, and that he carefully observe their 
 effects. 
 
 If the enlightened and conscientious practice of Medicine offers so 
 much difficulty in the simpler cases, what must it be when it is neces- 
 sary to treat complicated and insidious affections, such as constitutional 
 syphilis, or tetters, or scrofula, or leprosy, etc., which, concealed in the 
 economy for months and years, deepening their roots, and changing the 
 fluids, reveal themselves only in an ambiguous manner, after having in- 
 vaded the entire system, whence it is almost impossible to dislodge them ? 
 
 But these cases, embarrassing as they are, afford the practitioner, at 
 least, the opportunity of studying and reflecting upon them, aiding 
 himself by the opinions of authors, and trying various means of cure. 
 It is not so, though, when he finds himself in the presence of the 
 plague, the cholera, pernicious fevers, and other epidemics, which fall 
 like a tornado upon the people, carrying off, without distinction, the 
 young, the old, the feeble, and the robust, overturning at once all the 
 functions of the organism, assuming the most varied forms, and striking 
 so rapidly that they allow the physician neither time to collect his 
 thoughts or to make experiments. 
 
 Under these calamitous circumstances, he has need, not only of sci- 
 ence and discernment, but also of sang-froid, devotion, and courage to 
 contest some victims, at least, with the devastating scourge. And at last, 
 when, notwithstanding so many causes of error, he arrives at the estab- 
 lishment of an efficacious mode of treatment, it often occurs that the 
 ■constitution of the epidemic is so modified that he is obliged to com- 
 mence his researches anew.
 
 ORIGIN OF SYSTEMS. 73 
 
 In other sciences, as physics and chemistry, there is an opportunity of 
 reiterating the same experiment as often as necessary. The agents which 
 concur to produce these, are at our disposal, and we can so isolate them 
 as to obtain only their pure effects, and free from all foreign influences. 
 In practical Medicine it is entirely different ; here, nature and accidents, 
 i, e. diseases, furnish us the opportunities of experimenting ; but, in the 
 first place, the elements of these experiments are never identical ; sec- 
 ondly, much time may elapse before an occasion presents itself for 
 renewing them ; and, thirdly, it is impossible to isolate the patients 
 from a multitude of influences that alter the therapeutical results. 
 Hence it follows, that it is impossible rigorously to infer one medical 
 fact from another. 
 
 These views show why a long series of observations, collected by a great 
 number of observers, at different epochs and in different climates, are 
 necessary to arrive at the discovery of a curative method — to the acquis 
 sition of a therapeutical principle. It is this which has, in all time, dis- 
 couraged great practitioners, and has driven one of the most illustrious of 
 them to write this sentence, in which he betrays a profound melancholy: 
 " Art is long, life is short, opportunity fleeting, experience deceptive, 
 and judgment difficult. It is necessary, not only that the physician do 
 all he can, but also the patient himself, as well as his attendants and 
 friends, co-operate with him." — Hippoc. App. liv. 1. 
 
 Notwithstanding so many obstacles, which have been supposed insur- 
 mountable, man has come, by force of research, perseverance, and 
 genius, to find some remedies of marvelous efficacy in certain cases, and 
 to trace some rules which approximate therapeutics to the exact sciences, 
 as we shall hereafter show. 
 
 CHAPTEE VI. 
 
 ORIGIN OF SYSTEMS. 
 
 We have said that one of the greatest difficulties, perhaps the great- 
 est that is encountered in the use of a fundamental axiom in therapeu- 
 tics, comes from the impossibility of applying, rigorously, a past fact 
 in treatment to a case in hand ; in other words, whatever precision may 
 be obtained in diagnosis, whatever may be the degree of similarity that 
 exists between two pathological states, as there is never identity between 
 them, it follows, that a course of medication which has succeeded per- 
 fectly in one case, may, strictly speaking, fail in another. 
 5
 
 74 MYSTICAL PERIOD. 
 
 It is not less evident, that the best means of avoiding, or rather of 
 diminishing this permanent cause of mistakes, consists in perfecting, 
 more and more, the diagnosis of diseases, so as to give it the highest 
 degree of exactness possible. By this means, on the one hand, the con- 
 founding of essentially different morbid states will be avoided ; and, on 
 the other, the distinction of others but slightly differing in aspect, be 
 established. 
 
 The importance of diagnosis once recognized, as it has been by the 
 great physicians of all ages, there is no effort that the mind has not 
 made, no expedients that have not been attempted, in order to give it the 
 highest perfection possible. 
 
 The first plan suggested to the minds of observers was, to take 
 account of all the symptoms that presented themselves in the course of 
 the disease, and to record them in regular succession, as they appeared. 
 According to this plan, a great number of nosological tables were formed, 
 so that for any disease, a comparison of the phenomena that appeared 
 was made with the symptomatic tables that had been framed, and from 
 this comparison an appropriate treatment was deduced. 
 
 This method, which appears, at first sight, so natural and exact, is, at 
 bottom, extremely defective. In the first place, it has the serious incon- 
 ivenience of attributing an equal value to all the symptoms, while daily 
 observation proves that notable differences exist. In the second place, 
 a long enumeration of morbid phenomena, recorded one after another, 
 without choice or discernment, is no more a portrait of a disease, than 
 colors, thrown at hazard upon the canvass, that of a person sitting 
 for a likeness ; lastly, all classification of diseases becomes impractic- 
 able on this plan, for, before attempting a work of this kind, it is neces- 
 sary to inquire how many analagous symptoms would be required to 
 place two affections in the same class, and assign them a like treatment ; 
 it would be absurd to attempt to answer the question. 
 
 Thus we sec that there is no pathological classification possible, by a 
 simple enumeration of symptoms, yet, nevertheless, without the aid of a 
 classification, the practice of Medicine is a mere groping in the dark, 
 and does not merit the name of Art. Without the advantages of a 
 classification, the physician may justly be likened to a blind person 
 armed with a club, and striking indifferently at the disease or at the 
 patient. 
 
 Hippocrates strongly felt the errors of this manner of observing and 
 describing diseases, when he reproached the Asclepiadaj of Cnidus for 
 having adopted this plan, which led them to multiply, innumerably, the 
 division of diseases. " Those who have collected," he says, " the sen- 
 tences that are termed Cnidian, have well traced the morbid symptoms
 
 ORIGIN OF SYSTEMS. 75 
 
 as they are exhibited, as well as the manner in which certain affections 
 terminate ; but any one may do as much as this, without being a phy- 
 sician, by asking sick persons the symptoms they experience. Much 
 has been neglected in the Cnidian sentences, which it is important for 
 the physician to know, without questioning the patient, and which ie 
 essential to the exact appreciation of the disease. Some were not igno- 
 rant, however, of the various characters of diseases, and their different 
 forms, but erred whenever they attempted to make a rational classifica- 
 tion. Such errors are easily committed, if distinctions are made in 
 diseases from mere shades of difference, and if other names are given 
 to all those which are not exactly identical."-' 
 
 It is thus well demonstrated that all the symptoms of a pathological 
 state are far from having the same degree of importance. This is 
 almost a trivial statement to make to physicians ; only dull dreamers 
 and their stupid adepts, can have classed together a frightful headache 
 and a simple wrinkling of the forehead, an intense gastralgia with an 
 itching of the lobe of the ear. Posterity could not believe that such 
 absurdities were ever perpetrated, if there were not authentic docu- 
 ments to attest it.f 
 
 From the moment that the necessity was felt of making a choice 
 among morbid phenomena, they have been divided into durable and 
 transient, essential and accessory, primary and secondary, etc. Then 
 commenced the discussion on the essence of diseases, their causes, signs, 
 march, termination, etc. Thence, in short, sprung Medical Philosophy, 
 and with it, systems of Medicine. 
 
 RESUME OF THE MYSTICAL PERIOD. 
 
 During the space of about seven hundred years, which this period 
 embraces. Medicine underwent, in Greece, a first transformation ; from 
 having been domestic and popular, it became sacerdotal, and wrapt 
 itself in a mysterious habit. Until that time, the world had princes, 
 captains, shepherds even, acquiring reputation for their skill in the 
 Art: but after the Trojan war, we only hear of consultations given in 
 the name of the divinity, in the temples, or in some celebrated caves, 
 such as those of Trophonius and Charonium. Not but what there 
 were, in those times even, men also, not of the clergy, who assumed to 
 treat diseases, and dispense remedies ; but it appears that scientific 
 Medicine, if we may be allowed so to call the limited notions that were 
 
 o (> Xraite du Regime dans les Maladies Aigue's," § 1, II, traduc. de Gardeil. 
 
 t Such, and even more silly statements are found in Hahneman's "Mate'ria 
 Medica."
 
 76 MYSTICAL PERIOD. 
 
 in their possession, was entirely possessed by the priesthood, and was 
 perpetuated only in their order by an uninterrupted tradition, where it 
 slowly developed itself in the quiet of seclusion. 
 
 "The practice of Medicine in the temples of Esculapius," says M. 
 Aug. Gauthier, " may be divided into two epochs. In the first, which 
 extends down to Hippocrates, the Asclepiadoe, though employing, for the 
 most part, superstitious means, have rendered service to science by the 
 taste developed among some of them for observation. It must be agreed, 
 that in those barbarous times, Medicine could make more progress in 
 the hands of a corporation like the Asclepiadje, than if it had been 
 merely a domestic or popular Art. It is not probable that, at a period 
 80 remote, when the arts and sciences were still in their infancy, a 
 man of genius could be suddenly raised up, who would elevate Medi- 
 cine to the rank of a science. In the second epoch, which extends from 
 Hippocrates to Christianity, Medicine in the temples gradually declined, 
 and was more frequently a gross jugglery."" 
 
 The same writer adds, a little further on : " It is difficult to appre- 
 ciate, to-day, what amount of learning was in the possession of the 
 priests of the temples, and what progress Medicine made in their hands. 
 As there have always been men who have shown a tendency to admire 
 what is ancient, we must not be surprised to find in antiquity, as well 
 as in modern times, writers who have lauded immeasurably the medical 
 knowledge of the Asclepiadse. On the other hand, there are physicians 
 who deny that they ever possessed any. Thus, M. Malgaigne would 
 consign the Asclepiadae to that oblivion from which they never ought to 
 have emerged. He censures M. Littre for mentioning them, and pro- 
 poses to erase their deeds from the history of Medicine and Surgery.f 
 We think it better to avoid extravagance on both sides. It is probable 
 that the reading of the inscriptions in the temples, and the habit of 
 seeing a great number of sick, gave, in the end, a certain amount of 
 medical instruction to the priests. "J 
 
 This is, it seems to me, what may be most reasonably said of that 
 part of medical history so profoundly enveloped in obscurity. Where 
 
 ■' " Recherches Historiques sur I'Exercice de la Medicine dans les Temples," 
 etc., par Auguste Gauthier, 1844, chap, 11. 
 
 I " Lettres sur I'Histoire de la Chirurgie," inserted iu the Gazette des Hopi- 
 teaux, 1842. M. Malgaigne founds his opinion, principally, on the four Totive 
 inscriptions heretofore given ; but these inscriptions are of the epoch of the 
 Antonins, and can not give us a correct idea of those that were in the temples of 
 the times of the ancient Asclepiadse, nor especially of the clinical notes made by 
 the priests themselves 
 
 T A. Gauthier, loc. cit. chap. IV.
 
 RESUME OF THE MYSTICAL PERIOD. 77 
 
 there is default of positive documents, free course is unsually given to 
 the imagination, and it is seen that on this point, that of the erudite 
 has not been sterile. But in the midst of diverse opinions, which have 
 been emitted as to the actual knowledge of the Asclepiadse, some of 
 which I have mentioned, that of M. Gauthier, I repeat, appears to me 
 the most reasonable, the best founded, as well as most universally 
 accredited. 
 
 Finally, we touch an epoch in which the Healing Art undergoes a 
 metamorphosis far more interesting for history and for philosophy, and 
 far more advantageous to humanity. Until this time, in fact, the 
 medical edifice had been formed of materials taken at hazard, and 
 gathered, generally, without taste or method ; no harmonious thought, 
 or premeditated design, directed the researches of the men who made 
 the first discoveries ; but afterward, reason and genius unite to extend 
 and improve what accident and instinct had suggested. The scientific 
 monument of this difficult Art begins to rise, grand and majestic, grad- 
 ually harmonizing all its parts. We shall no longer follow its progress 
 through ages, by the light of vague conjecture ; but, with the help of 
 authentic memorials, and debi'is more or less well founded. We shall 
 no longer be compelled to divine the intimate thought of the laborers in 
 the diflFerent phases of its progress, but we shall read it, stamped in 
 intelligible characters upon the remaining fragments of their labors.
 
 78 PHILOSOPHIC PERIOD. 
 
 III. PHILOSOPHIC PEKIOD. 
 
 COMPRISING THE PERIOD OF TIME BETWEEN THE DISPERSION OF THE PYTHAGO- 
 RIAN SOCIETIES. IN THE YEAR B. C. 500, AND THE FOUNDATION OF THE ALEX- 
 ANDRIAN LIBRARY, IN THE YEAR B. C. 320. 
 
 GENERAL CONSIDERATIONS. 
 
 Until now, we have groped our way, having to guide us in the obscu- 
 rity of remote ages only feeble lights, scattered here and there at long 
 intervals. But now we have reached an epoch, where science is 
 striped of its mystic vail, and reveals her secrets in open day. The 
 priests who had so long been in possession of the doctrine of the peo- 
 ple, yield now the grasp of the scientific scepter to the philosophers : 
 they retained only the exclusive control of sacred rites, the monopoly of 
 religious ceremonies. Never was a happier revolution accomplished 
 with less effusion of blood ; the mind rests with satisfaction on the 
 circumstances which prepared and accompanied it. 
 
 It is a fact worthy of remark, and which has not escaped the atten- 
 tion of ancient observers, that the inhabitants of Asia, after having 
 discovered the first elements of the sciences and the arts, and after 
 having carried them to a certain degree of development, paused in the 
 pathway of improvement, or even retrograded ; while the inhabitants 
 of Europe, though entering much later into the career of civilization, 
 promptly surpassed their predecessors, and raised themselves to a hight 
 that the former were never able to attain. 
 
 Hippocrates signalized this remarkable phenomenon in his treatise ou 
 "Airs, Waters, and Places." He sought its cause, and traced it with 
 an admirable sagacity, to the combined influences of climate, manners, 
 and government. A temperature, mild and uniform, which dispenses in 
 man to provide against sudden vicissitudes of the seasons ; a soil, un- 
 broken and fertile, from which he obtains, with but little labor, a suffi- 
 cient alimentation ; the use of food almost exclusively vegetable ; a- 
 despotic government, under which the fortunes and the lives of the 
 people are at the mercy of the caprices of the monarch, where advance- 
 ment depends on favor rather than on merit : civil and religious
 
 GENERAL CONSIDERATIONS. 79 
 
 institutions, which parcel off the various classes of society, like flocks, 
 and assign to each individual, from his birth, a rank out of which it 
 is impossible for him to move ; all these circumstances appeared to the 
 the philosopher of Cos, eminently calculated to enervate the physical 
 constitution of the people, to blunt their intelligence, and extinguish 
 their moral energy ; while the opposite conditions, such as a tempera- 
 ture extremely variable, a broken soil, and a government surrounded 
 by liberal institutions, seemed to him calculated to produce on the body 
 and the mind, effects entirely contrary. In this he explains the cause 
 of the superiority of the nations of Europe over the greater part of those 
 of Asia. 
 
 To these considerations, taken outside of the nature of man, the 
 modern physiologists add others, very important, drawn from his ori- 
 ginal conformation. They teach, from numerous observations, and in 
 particular from the researches in comparative anatomy, that the develop- 
 ment of the intellectual faculties is always proportionate to the volume 
 of the cerebral hemispheres, and especially of the anterior lobes. This 
 law, they say, governs not only all the species and varieties of the great 
 family of man, but also the entire animal scale. Now in this anatomi- 
 cal aspect, it appears that the Mongolian race, to which belong the 
 natural inhabitants of Egypt, the East Indies, and China, ^are much 
 less in these physical advantages than the Caucassian race, from which, 
 most of the inhabitants of Europe take their origin. It would follow 
 from this view, that the inferiority of the first, compared with the last, 
 holds to an imperfect innate organic constitution, as much, at least, as 
 to external influences. 
 
 However true or false this theory may be, the ancient Greeks found' 
 themselves, at the commencement of the period which we named Philo- 
 sophic, in the most favorable condition, according to the views of Hip- 
 pocrates, for the development of their physical and moral faculties. 
 They occupied, besides Greece proper, Rhodes, Crete, Sicily, and a 
 multitude of other islands. They possessed an immense extent of 
 coast in Europe, Asia, and Africa. The Hellenic peninsula, which 
 does not equal in extent the half of France, had an exceedingly irreg- 
 ular and broken surface ; great extremes of temperature, mountains 
 covered with eternal snow, narrow gorges excavated by torrents, fertile 
 plains, delightful valleys, arid hillsides scorched by the rays of a tropical 
 sun, a sea subject to frequent tempests, a coast full of dangers, and. 
 indented with deep gulfs. In short, this nation was endowed, if wc 
 judge from their statuary, with the most noble physical forms, calcu- 
 lated to display, according to modern views, beauty, genius, and power.. 
 
 The political institutions prevalent in most of the Grecian states,
 
 80 PHILOSOPHIC PERIOD. 
 
 were in harmony with that happy concourse of circumstances to which 
 we have alluded. Nearly everywhere a republican government or a 
 limited monarchy had replaced the absolute power of kings. As the 
 inhabitants were not very numerous in these small states, they could 
 know, watch, and mutually estimate each other, so that public opinion 
 was not much exposed to error. Public honor generally followed merit, 
 and to obtain this it was necessary to show oneself worthy by some 
 important act, by skill in counsel, by extraordinary talents, or by emi- 
 nent virtue. 
 
 The era of brute force, of combat hand to hand with monsters and 
 brigands, had passed away, and the reign of intelligence, of strategy 
 in war and in politics, was conspicuous. The Mythological heroes whose 
 prodigious labors were so much boasted, such as a Hercules, a Perseus, 
 and a Bellerophon, were succeeded by those great men, whose lofty acts 
 have been celebrated in history, such as Leouidas, Miltiades, and 
 Themistocles. 
 
 The gymnasiums were no longer, as formerly, places devoted entirely 
 to bodily exercise ; they were surrounded by halls and porticos where 
 philosophers, rhetoricians, artists, and physicians, assembled to hold 
 their schools and dispute on questions of art. 
 
 The theaters and public amusements, also, realized this social transfor- 
 mation. Strength and address no longer solely excited the admiration 
 of the multitude ; a taste had been created, at least in some cities, for 
 the charms of the productions of the mind. We touch that epoc when 
 the spectators of the Olympic games, filled with enthusiam on hearing 
 the reading of the books of Herodotus, gave to each of them the name 
 of one of the nine muses. If Crotona was proud in sending the most 
 vigorous Athletus to those national solemnities which attracted a con- 
 course from all Greece, Athens was not less so of the crowns that were 
 obtained there by her poets, her painters, and her sculptors. 
 
 Gradaully science unrobed herself of the grave and mysterious forms 
 with which she had always been clothed in the East, to assume a dress 
 less severe and more transparent, and of the taciturnity that she had 
 had in Egypt, to become more communicative and even somewhat 
 loquacious. The vestiges of this antique Egypto-Indian civilization 
 which had served as a model for that of Greece was insensibly dis. 
 appearing. Soon the sages of Greece ceased their journeys in search 
 of light in foreign countries, for their own country became in its turn 
 a center of illumination for all nations. 
 
 Pythagoras affords us the last celebrated example of distant peregri- 
 nations in search of wisdom. He is, also, the last of the sages who have 
 transmitted their doctrines in an unusual language, and who made use
 
 PYTHAGORAS. 81 
 
 of hieroglyphical writing. As lie was desirous to continue in Greece 
 the traditions of the Egyptian school, the history of his life, and of the 
 society that he founded, interests us in a very high degree ; for it shows 
 us the contrast and the transition, from an old to a new and more perfect 
 social state. 
 
 Born at Samos, one of the most flourishing of the islands of the ^gean 
 sea, Pythagoras was, at first, an Athlete, but having heard one day 
 Pherecydes lecture on the immortality of the soul, he was so charmed, 
 that he renounced every other occupation to devote himself, exclusively, 
 to philosophy. After having followed the course of this eminent master 
 for some time, he felt desirous of knowing, for himself, the customs and 
 manners of other nations. He travelled in Egypt, in Phenicia, and in 
 Chaldea ; and it is said, that he pushed his travels as far as India, 
 where he communed with the Brahmins and Magi, and was initiated 
 into the secrets of their worship, laws and doctrines. After a great 
 number of years employed in schooling his mind by the practice of vir- 
 tue, and enriching it with the most varied knowledge, he returned to 
 his country, and was honorably received by the tyrant Polycrates, who 
 endeavored to eiface his usurpation by the mildness of his government, 
 and by the prosperity he brought upon the citizens who had become his 
 subjects. Notwithstanding the efforts of the usurper, the philosopher, 
 not being able to habituate himself to the servitude of his country, left 
 it to seek an asylum in some other land, from which liberty had not 
 been banished. Whilst traversing the Peloponnesus, he assisted at the 
 Olympic games, and being recognized, he was greeted with universal 
 acclamations. 
 
 Erom this place he sailed for the southern part of Italy, or Great 
 Greece. He landed at Crotona. say the biographers, and lodged with 
 Milo, the Athlete, with whom his family was united by the bond of 
 hospitality. It was in this city that he commenced his mission as a 
 reformer. His discourses had such success that in a very little time he 
 drew around him a great number of disciples. He required of them a 
 very severe noviciate, which lasted for five or six years. During the 
 season of trial, they were required to abstain almost entirely from con- 
 versation. They ate in common, using a very frugal diet ; they assisted 
 the master in his lessons, executed the orders they received without 
 making any observations, and in a word, led a pure, modest, temperate 
 life. Those, only, who persevered, were admitted to a participation in 
 the mysteries of the order. 
 
 The veneration of the disciples of Pythagoras, for their master, was 
 so great, that many sold their property and gave the proceeds to him, 
 for the general good.
 
 82 PHILOSOPHIC PERIOD. 
 
 An end was put to all discussion by the words, " The master has 
 said it." This philosopher joined to an immense knowledge, an easy 
 and attractive elocution. It is said, that he invented the theorem of 
 the square of the hypothenuse ; that he was the first to divide the year 
 into 365 days, 6 hours; that he had an idea of our planetary system; 
 that is to say, that he suspected the movement of the other planets 
 around the sun. But the greater part of these assertions have no solid 
 foundation. The sect of which he was the founder, is called the Italian, 
 from the name of the country in which it originated. 
 
 Pythagoras did not limit his teachings to the city of Crotona : he 
 visited the principal cities of Great Greece, among others, Heraclea. 
 Tarentum, Metapontum, and established Communities in each of them, 
 subject to the common rules. These institutions exercised, at first, the 
 happiest influence: a sensible reform was developed in the dissolute 
 manners of the inhabitants of those cities. The Pythagorians gained 
 the esteem of the magistrates and the people ; they were consulted on all 
 difficult matters, and the superiority of their knowledge, joined to a rare 
 abnegation, drew upon them the public confidence. 
 
 It appears that their success rendered them bold. Some of them 
 began to mingle in intrigues and cabals, which was against the formal 
 precept of their master, who often repeated to them, "abstain from 
 party interests, according to the general understanding of that term, 
 and do not frequent public assemblies at periods of elections." The 
 politicians, who felt that their presence was injurious to their projects, 
 accused them of aspiring to domination in public afi'airs ; the priesthood 
 launched their anathemas at them, because they did not share the super- 
 stitious prejudices of the multitude. The simplicity of their costume, 
 their symbolical language, their habitual silence, their avoidance of 
 pleasure parties, and every thing, even to the purity of their lives, 
 became a subject of reproach or umbrage. Mobs were excited against 
 them ; they were menaced and pursued by the populace in every city, 
 and because they were obliged to seek concealment, in order to save 
 their lives, the greater number expatriated themselves : in this way 
 their society was broken up, even during the life time of its founder, 
 who never again attempted its reconstruction. 
 
 Before detailing the results of the dispersion of the Pythagorians, we 
 shall present a sketch of the doctrine of their chief, a doctrine very 
 important in the history of medicine and philosophy ; for it is the 
 source of many theories which have exerted a great influence on the 
 march of the human mind ; and moreover, it is a key to the pretended 
 occult sciences, the reign of which extended down, even as far as the 
 close of the eighteenth century.
 
 DOCTRINE OF PYTHAGORAS. 83 
 
 CHAPTEK I. 
 DOCTRINE OF PYTHAGORAS. 
 
 There remains to us of the memorials of antiquity, concerning that 
 doctrine, but a single, very incomplete, and very obscure fragment. It 
 is a collection of sentences, which are attributed to Lysis, a Pythagorian 
 philosopher, and the friend and preceptor of Epaminondas ; but it 
 would be impossible for us to avail ourselves of the doctrines of this 
 precious document, without the able commentary of M. Eabre d' Olivet. 
 Thanks to this skillful interpreter, we are able to lift a corner of the 
 veil that covers the famous dogmas of the philosopher of Samos." 
 
 This commentator, in order to give a general idea of the nature of his 
 work, explains himself as follows: " I have followed, in my translation, 
 the Greek text, as it is given at the head of the Commentary of Hiero- 
 cles, expounded by the son of Casaubon, and interpreted in Latin by 
 Carterius: London edition, 1673. This work, as all those that remain 
 to us of the ancients, has been the subject of a great number of critical 
 and grammatical constructions. The authenticity of the greater part 
 of it seems to be unquestioned, and although there are some variations 
 of opinion, they are of too little importance for me to pause and consider 
 at this time. Nor is it my place to do so ; beside, each one must do his 
 own work. 
 
 The labor of the grammarians is complete, or must so be regarded ; 
 for nothing would ever be finished, if we continually recommence our 
 investigations at the same point, without being willing to rely upon the 
 previous researches of others. 
 
 As far as possible, I have extracted literally from the Commentary of 
 d'Olivet all that I give of the system of Pythagoras ; nevertheless, for 
 the purpose of abbreviating, I have contented myself sometimes to ana- 
 lyze certain passages, which I have indicated by the suppression of the 
 brackets. 
 
 " Pythagoras considered the universe as a unit animated by Divine 
 intelligences, each, according to its perfections, occupying its proper 
 sphere. It was he who designated, first of all, this totality by the Greek 
 word Kosmos, to express the beauty, order, and regularity that therein 
 reign. The Latins translate this word by mundus. from which we have 
 derived the French word monde. It is from unity, considered as the 
 
 ^ Vers Dores de Pythagore, explained and translated into French verse, by M. 
 d'Olivet. Paris, 1813,
 
 84 PHILOSOPHIC PERIOD. 
 
 principle of the world, that we get the word universe, which we apply 
 to it. 
 
 " Pythagoras considered unity as the essential principle of all things. 
 He designated God by the figure 1, and matter by 2 ; so he expressed 
 the universe by 12, because this results from the juxtaposition of the 
 figures 1 and 2." (3e Examen.) 
 
 As on the other hand, the number 1 2 results from the multiplication 
 of 3 by 4, the philosopher conceived the universe composed of three dis- 
 tinct worlds bound closely to each other, each of which was developed in 
 four concentric spheres. The inefi'able Being who, placed in the com- 
 mon ceuter of these twelve spheres, filling them all without being com- 
 prehended by any of them, was God. 
 
 The four spheres from which are formed each one of its three distinct 
 worlds, correspond to four elementary modifications of inert or amorphous 
 matter. These primitive modifications are called fire, air, earth, and 
 water, and are the elements which constitute all material substances. 
 
 " The application of the number 12 to express the universe, was not 
 an arbitrary invention of Pythagoras ; it was common to the Chaldeans 
 and Egyptians, from whom he had received it, and also to the chief na- 
 tions of the earth. It was the origin of the institution of the Zodiac, the 
 division of which into twelve constellations has been found to exist 
 everywhere, from time immemorial " (3e Examen.) 
 
 " According to this system, absolute unity, or God, was considered the 
 spiritual soul of the universe — the essence of being — the light of lights. 
 Between the Supreme Being and man an incalculable chain of interme- 
 diate beings was conceived, whose perfections or attributes decreased in 
 proportion to their separation from the creative principle."'"' (3e Examen.) 
 
 " Pythagoras, in conceiving this spiritual hierarchy as a geometrical 
 progression, regarded the beings which compose it under harmonious 
 relations, and founded, by analogy, the laws of the universe, on those of 
 music. He termed harmony the movement of the celestial spheres, and 
 employed figures to express the faculties, relations, and influences of the 
 diflferent beings." (3e Examen.) 
 
 Everything that appeared to have an existence proper, was supposed 
 to proceed from the reunion of three modalities. Thus, the universe, 
 the grand whole or macrocosm, included, as we have said, three second- 
 ary worlds. Man, the little world, or microcosm, was composed, accord- 
 ing to Pythagorean views, of a body, soul, and spirit, manifested by 
 three distinct faculties : viz., sensibility, thought, and intelligence. On 
 
 '^"' The author explains in what cases secondary spirits were angels, deities, 
 intelligences, or demons.
 
 DOCTRINE OF PYTHAGORAS. 85 
 
 the other hand, each ternary, from the one that embraced immensity, to 
 the one that constituted the feeblest individual, being comprised in a 
 perfect whole — a unity, relative or absolute — concurred to form the 
 quaternary or the sacred tetrad. (3e and 12e Examen.) 
 
 Consequently, 1 represented the active and hidden principle of all 
 things; 2, its passive principle, or matter; 3, the totality of the facul- 
 ties: and 4, the plenitude of its essence. The quaternary, was the 
 general type of all living beings, manifesting themselves by facultative 
 modifications. It could thus become the representative sign of any being 
 whatever ; but the beiag to which it was most ordinarily applied was 
 man. (Be and 12e Examen.) 
 
 " The language of numbers, which Pythagoras, after the example of 
 ancient sages, frequently employed, is now lost. The fragments of it 
 which remain, serve rather to prove its existence, than to furnish any light 
 on its elements ; for they who wrote these fragments, used a language 
 that they supposed known, in the same manner that our modern savans 
 do, when they employ algebraic characters. It would certainly be ridicu- 
 lous, before having acquired any notion of these algebraic signs, to 
 attempt to explain a problem written in them ; or what would be worse 
 still, to attempt to employ them, without knowing their value, to lay 
 down a proposition. But this is precisely what has been attempted, 
 often, relative to the language of numbers. Some have pretended, not 
 only to explain it, before having learned it, but even to write it — thus 
 rendering themselves contemptible. The learned, finding this language 
 thus travestied, very naturally despised it, and very unreasonably 
 extended their contempt to the ancients who made use of it ; acting thus, 
 in this case as in many others : creating, themselves, the alleged stupidity 
 of the antique sciences, and ended by saying, ' antiquity was stupid.' "^'■* 
 (Be Examen.) 
 
 The philosopher of Samos admitted two eternal, uncreated essences : 
 namely, spirit and matter ; and by the agency of these two principles he 
 explains the various phenomena of sensibility, intelligence, and thought. 
 " Whenever any one has pretended, or shall pretend to found the universe 
 on the existence of one sole nature, material or spiritual, and deduces 
 from the hypothesis, the explanation of all phenomena, he encounters, 
 and always will encounter insurmountable difficulties. It has always 
 been by asking what is the origin of good and evil, that an irresistible 
 overthrow has been given to all systems of this kind, from Moschus, 
 
 '^ The little sketch that we have given above of the language of numbers, will 
 serve, imperfect as it is, to give an idea of the importance that the ancients 
 attached to ternary and quaternary periods, in the determination of critical days.
 
 86 PHILOSOPHIC PERIOD. 
 
 Leucippus, and Epicurus, down to Spinosa and Leibnitz : from Parmeni- 
 dcs, Zeno of Elca, and Chrysippus, down to Berkley and Kant." 
 (31e Examen.) 
 
 " Homogenity in nature was, with the unity of God, one of the great- 
 est secrets of the mysteries. Pythagoras founded this homogenity on 
 the unity of the spirit, with which it is penetrated, and from which all 
 our souls, according to him, took their origin. This dogma, which he 
 had received from the Chaldeans, and the priests of Egypt, was admit- 
 ted by all the sages of antiquity, as is amply shown at length by Stan- 
 ley and the judicious Beausobre. Those sages established a harmony 
 in principle, and a perfect analogy between heaven and earth, the intel- 
 ligible and the sensible, divisible and indivisible substances, in such a 
 manner that what transpires in one of the regions of the universe, or of 
 the modifications of the primordial ternary, was the exact image of what 
 transpired in the other. Beside, I must say, that it is on the homogen- 
 ity of nature that rest, in principle; all the occult sciences, of which 
 the four principal ones are connected with the human quaternar, beign 
 theurgy, astrology, magic, and chemistry." — (28e Examen.) 
 
 " Man, in this system, was considered as holding the middle between 
 intellectual and sensible things, the last of superior and the first of 
 inferior beings, free to move upward or downward, as influenced by the 
 passions that control the power of the will to ascend or descend. Some- 
 times they bring him into union with immortals, and, by his return 
 to virtue, enable him to recover his proper position ; and again, some- 
 times replunging him into mortal association, and by transgression of 
 the divine laws, cause him to be stripped of his dignity. It is based 
 on this rule, that we find everywhere, though differently explained, the 
 foundation of the dogma of the transmigration of souls. This dogma, 
 explained in the mysteries of antiquity, and received by all the people, 
 has been so disfigured by what the moderns have called metempsycho- 
 sis, that it would surpass very much the limits of these comments to 
 give it an explanation that could be understood." — (32e Examen.) 
 
 "This same philosopher taught that the soul has a body, which is 
 given to it according to its good or bad nature, by the interior labor of 
 its faculties. He calls this body the subtle car of the soul, and says 
 that the mortal body is only a gross envelope." — (37e Examen. V-' 
 
 The indefinite perfectibility of nature, founded on the homogenity of 
 its essence, is also one of the dogmas of the Pythagorian school, that 
 moderns have appropriated, and which they have fortified by considera- 
 
 '•■ We shall show, at proper time and place, the analogy that exists between this 
 doctrine and that of the monads invented by Leibnitz.
 
 DOCTRINE OF PYTHAGORAS. 87 
 
 tions nearly demonstrative. Among those who have developed it with 
 most success, we cite Leibnitz, Lecat, Ch. Bonnet, BufFon, Linseus, Kant, 
 Schelling, and lastly, the author of the articles, " Nature " and " Ani- 
 mal," of the Nouveau Dictionaire (VHistoire Naturelle. The following 
 is his explanation : (.35e Examen.) 
 
 " All animals and plants are only modifications of an original ani- 
 mal or vegetable. Man is the point of union between divinity and 
 matter, connecting heaven and earth. The light of wisdom and 
 intelligence that beams in his thoughts, is reflected on nature. He is 
 the bond of co imunication between all beings. ''■' 
 
 " There may have been a time when the insect, the shell-fish, or the 
 unclean reptile, knew no master in the universe, and found itself at the 
 head of organized beings. Who knows if, in the eternal night of ages, 
 the scepter of the world shall not pass from the hands of man into 
 those of a being more perfect and worthy to bear it. It may be that 
 the race of negroes, now secondary, was once the ruler of the earth, be- 
 fore the white race was created. If nature has successively accorded 
 empire to the species more and more perfect which she has created, 
 why should she stop now? Who shall define the limits of her 
 power ? She is ruled by God alone, and it is his might and hand that 
 governs her."-- 
 
 Attracted by the grandeur, beauty, and connection of these ideas, I 
 have given to the extracts of the doctrine of Pythagoras a more con- 
 siderable extension than I was willing to, but the precious illumina- 
 tion that is found there, on a multitude of things and opinions that are 
 supposed new, have repaid the reader, I hope, and will recomj^ense him 
 more and more hereafter. A system which embraces and unites, by a 
 common bond, God, the universe, time, and eternity ; which includes 
 an explanation of all the phenomena of nature, if not true, at least 
 acceptable, at an epoch when nothing could be put in parallel with it. 
 but the gross mythology of pagan priests — such a system, I say, was 
 well calculated to captivate, at once, the imagination and understand- 
 ing. It is now easy to conceive the admiration and enthusiasm of the 
 adepts, in proportion to their progress in the autopsy of the mysteries. 
 and their submission, respect, and gratitude toward the superior man 
 who initiated them into such lofty conceptions, seems entirely reasonable 
 and natural. 
 
 ^ ■ 
 
 'See the "Nouveau Diet. d'Hist. Nat.," at the word Natitee. 
 * Same work, at the word Animal.
 
 88 PHILOSOPHIC PEKIOD. 
 
 CHAPTER II. 
 PERIODIC PHYSICIANS. 
 
 When the storm of persecution had dissolved the Pythagorian 
 societies, the members that composed it were scattered in different parts 
 of Greece. Being no longer held by the bond of the community, many 
 of them revealed in whole or in part the secrets of their doctrine, and 
 to this circumstance we owe the little light that we possess on the 
 subject. 
 
 A great number of the disciples of Pythagoras became illustrious in 
 different careers, but we can only speak in this work of those who 
 followed the practice of Medicine. History states that the latter first 
 introduced the custom of visiting their patients in their own houses ; 
 that they went from city to city, and from house to house, fulfilling the 
 duty of physicians, as is done at present. On this account they were 
 called periodic, or ambulant physicians, in opposition to the Ascle- 
 piadae, who were consulted by and treated the sick only in the temples. 
 As to the charlatans who retailed drugs in shops, or at market, it appears 
 that they have never had a rank in the medical hierarchy, however 
 numerous they may have been at certain epochs. 
 
 Among the Pythagorians who cultivated Medicine, is cited Alcmoeon, 
 of Crotona, who is said to have written on anatomy and physics. It 
 is pretended that he was the first to dissect animals ; but this is quite 
 doubtful, as Anaxagoras and Democritus were already much earlier 
 occupied than he, in zoology. At any rate, we are not able now to 
 judge either of the rsality or merit of his discoveries, as no part of his 
 writings have come down to us.* 
 
 Empedocles, of Agrigentum, was more famous than Alcmoeon. Many 
 remarkable cures are ascribed to him which attest his sagacity. Among 
 many instances that prove this, we select the following. From time 
 immemorial pestilential fevers ravaged, periodically, his native city. 
 He observed that the appearance of these fevers coincided with the 
 return of a wind named Sirocco, which blows in Sicily, from the east 
 and south. He therefore advised to close by a wall the narrow gorge - 
 which gave passage to this wind when it blew on Agrigentum. His 
 counsel was followed, and from that time the pest ceased to make its 
 appearance in the city. Some modern travelers have confirmed this 
 remark ; among others, Doctor Brayer has alluded to it, in his excellent 
 
 * Lauth, Histoire de I'Anatomie, Strasbourg, 1815, Liv. ii.
 
 THE PRACTICE OF MEDICINE IN THE GYMNASIA. 89 
 
 work, entitled, Nine Tears of Residence in Constantinople. The inhabi- 
 tants of Selinus were a prey to an epidemic disease. A stream, by its 
 sluggish course, filled the city ■with stagnant waters, from which were 
 evaporated, daily, mephitic vapors. Empedocles saw this, and caused 
 two small creeks to be conducted into it. This gave a new impulse to 
 the waters, which ceased to be stagnant and to exhale the noxious 
 effluvia. The scourge disappeared." 
 
 Agrigentum saw flourish, about the same epoch, another physician, 
 named Acron, who was not of the sect of Pythagoras. He rejected in 
 medical practice every species of physiological theory, and insisted upon 
 the value of pure experience only. On this account he is regarded by 
 some as the chief of the empirists. But it is impossible for us to 
 judge of the value of this opinion, because, no fragment of his writings 
 has come down to us. All that can be said, is, that the separation of 
 physicians into several sects, each one having principles, rules, and in 
 some sort distinct symbols, did not take place for two centuries later, 
 until the establishment of the Alexandrian school. 
 
 CHAPTER III. 
 THE PRACTICE OF MEDICINE IN THE GYMNASIA. 
 
 It is an incontestible fact, that Medicine was practiced and taught 
 in the gymnasiae of Greece, a long time before the Asclepiadae had 
 divulged the secret of their doctrines.f There were in these establish- 
 ments three orders of physicians. A director termed the gymnasiarch, 
 whose duties consisted in regulating the diet of the Athletfe, and of the 
 young men who frequented these schools ; a sub-director, or gymnast, 
 who directed the pharmaceutic treatment of the sick ; lastly, subalterns, 
 named jatraliptes, who put up prescriptions, annointed, frictioned, bled, 
 dressed wounds and ulcers, reduced luxations, fractures, etc. 
 
 Marvellous stories are told of the sagacity of the gymnasiarchs, in 
 discerning the slightest variation in the prescribed regimen. They pre- 
 tended to recognize by certain signs, if any one had been guilty of the 
 
 '•' Diog. Laert. in EmpedocL Des Sciences Occultes, par Eus. Salverte, Paris, 
 1843, pag. 334. 
 
 t See Plato — Laws : Daniel Leclerc, Hist, de la Medicine : C. Sprengel, Hist, 
 de la Medicine : M. Houdart, Etudes Historiques et Critiques sur la Doctrine 
 d'Hippocrate. Paris, 1840, in 8vo. 
 
 6
 
 90 PHILOSOPHIC PERIOD. 
 
 slightest excess in drinking or eating, if the accustomed promenade had 
 been neglected, or if there had been any indulgence in the pleasures of 
 Venus. Though the author who gives these accounts appears to ques- 
 tion their veracity, yet, nevertheless they do prove that the doctors of 
 the gymnasise had a high reputation, and possessed a certain degree of 
 skill/' 
 
 History has transmitted to us the names of two gymnasiarchs, cotempo- 
 raries of Hippocrates, but slightly older than he. The first was Iccos 
 of Tarentum, celebrated for his sobriety and continence ; the proverb, 
 " repast of Iccos," was used to signify its frugal charactei'. 
 
 The second was Herodicus, or Prodicus, of Selymbria, the same who 
 is named in the passage of Plato that we have heretofore quoted (see 
 page 49.) That philosopher accuses him of being the first who employed 
 gymnastics, in the cure of diseases, and he reprimands him severely on 
 that occasion for having succeeded too well in prolonging the lives of 
 valetudinarians. But the author of the sixth volume of Epidemics 
 reproaches him in an entirely opposite manner ; he accuses him of kill- 
 ing his fever patients by excessive fatigue.f It is said that this gym- 
 nasiarch obliged his patients to run without stopping, the distance from 
 Athens to Megara, and back again, equal to three hundred and sixty 
 stadia, which are about equal to nine French leagues. These two con- 
 tradictory reproaches may be easily explained ; for such exercise, though 
 useful in some slight chronic disorders, must have been fatal in acute 
 diseases. 
 
 CHAPTEK IV. 
 SCHOOLS OF THE ASCLEPIADiE. 
 
 We have already said, that nearly everywhere the temples of Escula- 
 pius were dispensaries, in which advice was given and remedies adminis- 
 tered, and that the young sacerdotal aspirants were there trained in 
 the practice of Medicine. The Asclepiadae had preserved, until that 
 epoch, the tradition of the Egypto-Indian school, which only allowed 
 them to transmit their doctrines to the members of their caste, and to 
 such strangers as fulfilled satisfactorily the iniatory tests. But when 
 the disciples of Pythagoras had revealed the secret of their mysteries, 
 and the philosophers had dared to teach and discuss publically the 
 
 '■ (Euvres d'Hippoer., 2e livre des Prorrlietiques, at the beginniDg. 
 I Ibid, livre 6«, aection 3e, § 48, edition of M. Littre.
 
 SCHOOLS OF THE ASCLEPIAD^. 91 
 
 principles of morals, physics, and theology, and when the itinerant 
 physicians, and the professors of the gymnasiae, had acquired the con- 
 fidence of the public, the priests of Esculapius could no longer keep 
 silence, under the penrlty of seeing the scepter of Medicine, which they 
 had held until then, fall from their hands. They were constrained to 
 bring to the light of discussion the principles and rules of their medical 
 practice. In this way the science, whose aim is the preservation and 
 re-establishment of health, came forth at last from the shadow of the 
 sanctuary, and, vivified by public discussion, made in a short time 
 extraordinary progress. 
 
 The priests who served in the temples at Cnidus were the first to 
 follow the impulse of the age. They published the little collection of 
 Cnidian sentences, of which we have already made mention. The Ascle- 
 piadse, of Cos, did not hesitate to follow their example. They pub- 
 lished a series of treatises, that were collected at a later period under 
 the title of the Hippocratic Works. This collection, which over- 
 shadowed all the medical publications of that period, constitutes one of 
 the most precious monuments of ancient Medicine. But before speak- 
 ing of the matter which it contains, we shall say a word or two about 
 the personage whose name it bears. 
 
 ART. I. HIPPOCRATES. 
 
 Hippocrates was born in the isle of Cos, of a family in which the 
 practice of Medicine was hereditary. They pretended to trace their 
 ancestry, on the male side, to Esculapius, and on the female side to Her- 
 cules. They count as many as seven of its members that had borne the 
 name of Hippocrates ; but the most celebrated of all was the second in thi? 
 range. His birth goes back about as far as the year 460, before Christ. 
 But few particulars are known of his life, and we know not his age at 
 death. Some say he lived to one hundred and ten years ; others, to ninety ; 
 and others, again, to eighty, only. It is certainly known, that he traveled 
 in Asia Minor, Thrace, Macedonia, Thessaly, and many other countries, 
 because, in various passages of his writings, he names these countries, 
 and the diseases he had occasion to treat in them. From these it is 
 ascertained that he was a cotemporary of Socrates, and slightly younger 
 than he ; therefore, he belongs to the famous age of Pericles, when the 
 sciences and arts attained, in Greece, so high a degree of splendor. 
 
 The isle of Cos, now Stan-co, situated between Milet and Ehodes, not 
 far from the coast of Ionia, was favored with a delicious climate, and. 
 in former times, was considered, also, as one of the most salubrious
 
 92 PHILOSOPHIC PERIOD. 
 
 countries ; but it has lost its antique reputation since it has been under 
 the dominion of the Turks, for it is now regarded as one of the most 
 unhealthy countries. It possessed then a temple dedicated to Esculapius, 
 and a Medical school, which was the most celebrated of all the Ascle- 
 pidian schools. Hippocrates was thus placed under very favorable 
 circumstances to receive a most careful and complete Medical education. 
 Nevertheless, he was not satisfied with this domestic instruction. He 
 visited the principal Greek cities of Europe and Asia, communing with 
 philosophers, examining the gymnasise, giving attention to all persons 
 who asked his services, collecting, at all points, observations on special 
 diseases, epidemic constitutions, also, on the influence of manners, 
 climate, regimen, etc. 
 
 After his return to his native country, being now rich in the materials 
 he had collected, and especially in those that his ancestors had amassed 
 for a considerable length of time, he published those immortal works 
 that astonished the world, and made the physical science of man, one of 
 the most important branches of Natural Philosophy. Already whilst 
 living, he had an unequal ed renown in his profession. Plato, his 
 cotemporary, and even Aristotle himself, rest on his authority when 
 referring to the organization of the human body. The habit of calling 
 Medicine the Art of Esculapius, was gradually lost, and learned men 
 more frequently spoke of it as the Science of Hippocrates. 
 
 His sons, son-in-law, and grand-children, followed the same career, 
 and added much to his professional labors. But the greater number 
 of them published their writings in his name, either to honor his memory, 
 or to obtain more weight for their opinions and precepts, or to conform 
 .to a usage immemorial in clerical families, or, for all these three reasons 
 together: thus, even in a short time after the death of the great Hippoc- 
 rates, it had already become very difficult to distinguish his own works 
 •from those of his disciples. This difficulty continued to increase in 
 proportion as the texts became impaired by the ignorance or inexactness 
 of copyists, and above all by the bad faith of bookmongers. These, 
 accoi'ding to Galen, had not the least scruple in the world, to write the 
 iname of Hippocrates on the medical writings of unknown or obscure 
 authors. 
 
 By this fraud they augmented, very much, the venal value of the 
 volumes which they had in possession ; and on this account, says Galen, 
 they had frequent recourse to it, especially at an epoch when the sove- 
 reigns of Egypt and Pontus, rivals in zeal for the increase of the libra- 
 ries they had founded, purchased in every country all the books that 
 ■ could be procured, and paid for them a price proportional to the reputation 
 -of the authors. The savans having charge of the library at Alexandria 
 
 II
 
 SCHOOLS OF THE ASCLEPIAD^. &3 
 
 very soon discovered the fraud ; so from tte commencement of that 
 collection, they were careful to place in a separate column, the 
 writings which appeared to them to have really come from the pen of 
 the physician of Cos ; and they designated them as volumes of the little 
 tablet, za zx zoo /jtr/oo'j Tzcuaxcowj. This disposition of them in the 
 library, was still seen in the time of Galen. 
 
 A great number of commentators have attempted to arrange a cata- 
 logue of the legitimate writings of Hippocrates ; but, guided by different 
 views, and resting on diverse documents, they have all varied in their 
 enumeration. Galen gives a list of these writings that differs from all 
 preceding ones ; and the moderns, in their turn, have each, after his 
 own notion, changed the list of Galen. After the learned researches of 
 Mercuriali, Foes, Grimm, Gruner, Ackermann, Sprengel, and many others, 
 one might suppose the subject exhausted. Nevertheless, at this moment 
 there appears an edition of the works of Hippocrates, in French, in which 
 the author, M. Littre, in a remarkable introduction which occupies 
 nearly the whole of the first volume, passes in review all the questions 
 relative to the authenticity of the Hippocratic books, and throws upon a 
 track, so well beaten, and apparently so sterile, a new light, and percep- 
 tions, sometimes profound, sometimes ingenious, which could scarcely have 
 been expected : so true is it of the facts of antiquity, as says the poet, 
 
 " On ne peut dans ce champ tellement moissonner 
 Que les derniers venus n'y trouvent a glaner." 
 
 But they are not simply gleanings, that the modern translator of 
 Hippocrates has gathered in the field of erudition ; it is a beautiful and 
 excellent harvest. After the example of his predecessors, M. Littre 
 examines the catalogue of writings attributed to the father of Greek 
 Medicine, and changes it again. 
 
 To guide me in the midst of this labyrinth of divergent opinions, 
 without involving myself in researches, or dissertations, which is foreign 
 to my plan, I have adopted the following rule : I admit, as legitimate, 
 those works only, which the principal critics unanimously recognize as 
 such ; and I set aside the others, as doubtful or apocryphal. This rule, 
 it seems to me, is the best to get at the truth as nearly as possible ; as 
 the commentators and interpreters have a greater propensity to extend 
 the domain of their favorite author, than to limit it. In accordance 
 with this rule, I now give what appears to me to be an undoubted list 
 of the authentic writings of Hippocrates the Second : 
 
 The Prognostic ; 
 
 Some Aphorisms ; 
 
 The Epidemics, 1st and 3d books ;
 
 94 PHILOSOPHIC PERIOD. 
 
 On the Regimen in Acute Diseases ; 
 
 On Airs, Waters, and Places ; 
 
 On Articulations or Luxations ; 
 
 On Fractures ; 
 
 Mochlic, or Treatise on Instruments for Eeduction. 
 This list does not comprise the fourth part of the entire Hippocratic 
 collection ; but, thus reduced, the portion ascribed to Hippocrates still 
 suffices, when we consider the era in which they were composed, to 
 justify the enthusiasm of his cotemporaries, and the admiration of 
 posterity. 
 
 ART. II. THE HIPPOCRATIC COLLECTION. 
 
 M. Littre establishes, by convincing proofs, that the collection which 
 we now possess, was not published as a whole until the foundation of 
 the great libraries of Alexandria and Pergamos. Until then, there 
 had been only a few books put in circulation ; the major part of these 
 writings had remained in the hands of the successors of Hippocrates, 
 who had only communicated them to their disciples. This collection 
 includes a small number of complete treatises, with a more considerable 
 number of incomplete ones, extracts, fragments, notes, and detached 
 thoughts, the imperfections of which prove, for some of them, at least, 
 that they were not destined to be made public. It is composed of writ- 
 ings of several authors who succeeded each other, from Pythagoras until 
 the Jeath of Aristotle, extending over all the space comprehended by us 
 in the philosophic period. 
 
 United to some fragments of Plato and Aristotle, the Hippocratic 
 collection forms the most ancient authentic monument in medical science ; 
 it is the first visible link of the chain that binds the doctrines and dis- 
 coveries of ancient Medicine to the doctrines and discoveries of modern 
 Medicine. Even on this account alone, it merits at once all our atten- 
 tion, by the correctness of the observations, the grandeur of the ideas, 
 and the clear perceptions which adorn several portions of it. 
 
 § I. Anatomy and Physiology. 
 
 Neither Hippocrates nor his descendants ever dissected the human 
 body ; the religious respect that was had for the dead in all Greece, 
 prevented it. We, therefore, find in their writings some generalities, 
 merely, on the form, volume, and respective positions of the principal 
 viscera. Osteology, only, is treated there with sufficient exactness, and
 
 SCHOOLS OF THE ASCLEPIAD^. 95 
 
 this fact is explained by a tradition, which says that the Asclepiadae, 
 of Cos, kept in their school a human skeleton, for the instruction of 
 their pupils. They had been able moreover to acquire some knowledge 
 on the conformation of the internal parts, in examining the entrails of 
 victims, in the case of the wounded, whose splanchnic cavities were 
 opened, and in dissecting animals. Such are, according to the opinions 
 of nearly all historiographers and critics, the sources whence the members 
 of the Hippocratic family obtained their anatomical knowledge. Never- 
 theless, I must say, that the author of the History of Anatomy, whom 
 I have already cited, denies that Hippocrates ever dissected animals, or 
 even had in his possession a veritable skeleton. Be this as it may, the 
 following are the books of the collection in which are found the most of 
 the anatomical details : Eegions in man ; Wounds of the Head ; The 
 Mochlic ; The Heart ; The Glands ; The Nature of Bones ; A Frag- 
 ment on the Dissection of the Body. 
 
 The prejudice which forbade the touch of the human corpse, did not 
 begin to abate until toward the close of the philosophic period, at which 
 time the family of Hippocrates appears to be extinct, the name of any 
 his decendants no more appearing in the history of Medicine. 
 
 Physiology, as we conceive it in our day, that is, that branch of the 
 science of man which is devoted to the description of the functions of 
 each organic apparatus, can not make one step without being guided by 
 the light of anatomy. It is, therefore, not astonishing that we en- 
 counter scarcely any traces of it in the Hippocratic writings. We 
 read in them that the glands are spongy viscera, destined to secrete 
 humidity from the surrounding parts, and that the brain, the largest of 
 the glands, attracts the vapors of all the interior of the body. The 
 muscles, which they called flesh, were for the purpose of covering the 
 bones ; the nerves, the tendons, the ligaments, the membranes, are all 
 represented as analogous organs, concurring in the same manner to the 
 production of motion. The arteries and veins are generally confounded, 
 or if they are distinguished, it is only on the supposition that the former 
 contained air and the latter blood. Respiration was supposed to 
 moderate the heat of the lungs, and especially of the heart. 
 
 But if the physiologists of those times neglected the special study of 
 the organic functions, in lieu of it, they gave themselves up to transcen- 
 dental speculations on the nature and seat of the principle of life. 
 Some placed the source of life in moisture, others in fire, others in the 
 union of two or four elements, etc. Each one endeavored to sustain 
 his hypothesis by arguments more or less specious, and aspired to the 
 glory of going back to first principles. Intermediate knowledge, or the 
 study of details, was considered as of but little value. Such was the
 
 96 PHILOSOPHIC PERIOD. 
 
 general direction given to scientific researches bj the philosophers. 
 Many books of the collection contain speculations of this kind, as we 
 shall see when we come to expose their theories. 
 
 § II. Hygiene. 
 
 We remarked, in speaking of Medicine among the Hebrews, with 
 what care Moses had regulated everything that concerned health. The 
 Asclepiada?, who, like him, owed their first scientific instructions to 
 the Egyptian priests, gave special attention, also, to hygiene. Their 
 writings on this branch of the art have in general all the completeness 
 that could be attained from the lights of that era. They are, first, a 
 treatise on Airs, Waters, and Places, a work written with great firm- 
 ness, and ornamented with all the pomp of style. The author there ex- 
 plains methodically, and on the authorit}' of his experience, the influence 
 of climates, seasons, and various topographical circumstances, on the 
 constitution of man. The work has been reproached for its superficial 
 treatment of the subject ; but it must not be forgotten that experimental 
 physics was not yet born, and that without it such a subject could not 
 be treated in a profound manner. We have already spoken of the 
 book at the commencement of our account of the present period, 
 and it may be inferred from what was there said, that no other book of 
 the period contains views of higher philosophic import. I shall add, in 
 support of my assertion, but this single remark : it contains the germ of 
 two modern productions, justly regarded as chefs-d'ceuvre — the " Spirit 
 of Laws," by Montesquieu, and the " Relation of the Moral and Phy- 
 sical Man," by Cabanis." 
 
 2. A treatise on Eegimen, divided into three books ; a well-conceived 
 and well-executed composition, notwithstanding some digressions and 
 strange associations that impair the first part. The author considered 
 man as formed of two principles, fire and water, the just balance of 
 which constituted health. The first book is entirely devoted to the de- 
 velopment of that theory : in the second he examines the various hygienic 
 modifiers, relative to their faculty for causing dryness or moisture ; 
 finally, in the third book he regulates the use which is to be made of 
 these modifiers, as regards the social position and the occupation of 
 persons, the seasons of the year, and especially in regard to the bulk 
 and fullness of the body. Already we see appear the dichotomy, to 
 
 ^ See his Lettre Bur les Causes Premieres.
 
 SCHOOLS OF THE ASCLEPIAD^. 97 
 
 which so many physiologists have since endeavored, under various 
 names, to refer all the modifications of the animal economy. 
 
 3. The small treatise on Salubrious Diet, summarily abridged from 
 the preceding work, and free from all physiological dissertation : it is, 
 however, obnoxious to the single reproach of being too succinct. The 
 author mentions in it the custom of certain persons taking one or two 
 vomits a month, as being an ordinary hygienic proceeding of his time. 
 " He who is in the habit of vomiting himself twice a month," he re- 
 marks, "will find more advantage in doing so on two successive days 
 than once every two weeks." 
 
 § III. Pathology and Therapeutics. 
 
 We have given a glance of the views which the Asclepiadse had acquired 
 on the structure and functions of different parts of the human body, as 
 well as of means employed to maintain their integrity of function. We 
 now proceed to say something on the ideas they had touching the disor- 
 ders of these functions, and the means employed to restore them to their 
 normal state. These last two branches of medicine are designated by 
 the names of Pathology and Therapeutics, each of them to be subdivided 
 in different ways, according to the views of authors and the extent of 
 the knowledge of their age. 
 
 One of the most ancient divisions of pathology and therapeutics con- 
 sisted in dividing diseases and modes of treatment into two classes, one 
 called internal or medical, the other, external or chirurgical. We shall 
 preserve this distribution ; not that it is so philosophic, but because the 
 greater part of writers whose labors we must examine have followed it, 
 and because it yet exists in science, notwithstanding its evident defects. 
 
 I will make only one prefatory remark, the truth of which will stand 
 out more and more in the course of this history ; it is, that a scientific 
 classification is nothing else than an artificial arrangement of the facts 
 and ideas that constitute a science. Now, as new facts and ideas were 
 added each day by the ancients, it follows that the same arrangement 
 would not always be suitable. For example, a pathological classifica- 
 tion which may have been satisfactory in the time of Hippocrates, would 
 to-day be very defective. The Nosology of Sauvages, so celebrated in 
 the last century, has already become superannuated. To pretend to 
 trace a systematic and an immovable list which should include all the 
 ideas and discoveries of future generations, would in some sort be like 
 digging a pit, out of which the genius of man could never emerge. 
 Some have attempted this, but no one has ever succeeded. The merit
 
 98 PHILOSOPHIC PERIOD. 
 
 of a methodic repartition consists, as I think, in embracing as far as 
 possible the totality of the materials of which science is composed at a 
 given period, and presenting them in lucid order, so as to aid the mem- 
 ory and the judgment; but it is plain that such a plan must vary with 
 the different phases of science. 
 
 During the philosophic period the animal economy was considered as 
 a whole, nearly indivisible ; the morbid phenomena being regarded as 
 the expression of a general derangement of the organism, rather than as 
 the index of the derangement of any part. Consequently, the symptoms, 
 their progress, gravity, and indications, were often studied without re- 
 gard to any particular species of disease. It was said, for example, 
 " The physician should find his patient lying on the right or left side, 
 having the arms, the neck, and the legs a little flexed, and the entire 
 body moist ; for so the greater part of men in good health repose on their 
 beds, and the most favorable position in a patient is that which is as- 
 sumed in a state of health. To lie on the back, with the arms and legs 
 extended, is less favorable. The tendency to sink in the bed and slide 
 down to the foot is still more unfavorable." " 
 
 This study of symptoms, considered in a general and abstract manner 
 was pushed very far in the school of Cos. It gave birth to a branch of 
 Pathology which is termed Semeiotics, which we will now first consider. 
 
 § IV. Semeiotics. 
 
 Semeiotics occupies a very considerable place in the medical works of 
 the Asclepiadae. Two of the most complete and best achieved treatises 
 of the collection — that on Prognostics, and the second book on Predictions, 
 or Prorrhetics — are devoted to this branch of Pathology, Beside, the 
 first book on Predictions and Coan Prenotions, a species of treatises 
 believed to belong anterior to Hippocrates, as well as the book on Dreams, 
 which is appended to the treatise on Eegimen, relate entirely to the same 
 subject. Now, all these portions united, form more than the eighth 
 part of the entire collection, without counting a great number of Semei- 
 otic sentences scattered in other works, and especially among the Apho- 
 risms. 
 
 Hippocrates, at the beginning of his work on Prognosis, gives us a 
 very precise idea of the sense that was formerly attached to this word, 
 while, at the same time, he appreciates, in the highest manner, the 
 importance of this branch of Pathology. " The best physician," he 
 
 * Prognostics.
 
 SCHOOLS OF THE ASCLEPIAD^. 99 
 
 says, " is the one who is able to establish a prognosis ; penetrating and 
 exposing first of all. at the bed-side, the present, the past, and the future 
 of his patients, and adding what they omit in their statements ; he will 
 gain their confidence ; and being convinced of the superiority of his 
 knowledge, they will not hesitate to commit themse' /es entirely into his 
 hands. He can treat, also, so much better their present condition, in 
 proportion as he shall be able from it to foresee the future. To restore 
 to health all the sick is impossible ; and although this would be better 
 than being able to. predict the successive progress of symptoms, yet, since 
 men must die, some, succumbing before calling a physician, are carried 
 off by the violence of the disease ; others, immediately after having sum- 
 moned one, surviving only a day or so, expiring before the physician has 
 been able to combat by his art, each of the accidents ; nevertheless, it is 
 important to understand the nature of such affections, and how much 
 they exceed the constitutional forces, and, at the same time, discern if 
 there be any thing to divine in the disease ; this is the great thing yet 
 to learn." In this way the physician will be justly admired, and will 
 practice his art skillfully ; indeed, those who can be cured, he will be 
 much more capable of preserving from peril, in advising them, long 
 before-hand, against certain casualties ; and, on the other hand, in fore- 
 seeing and pointing out those who must perish, and those who will 
 recover, he will exempt himself from all blame.* 
 
 We perceive in this passage, that the word prognostics had a much more 
 extended signification among the ancients, than it has among moderns — 
 that it includes, at the same time, prognosis and diagnosis. The second 
 paragraph of the same book, shows in what way the first Hippocratists 
 established their prognosis, and gives an idea of the extreme difference 
 that exists between the Medicine of their times, and that of ours. " In 
 acute diseases," says the author, "the physician must make the follow- 
 ing observations : first, let him examine the countenance of the patient, 
 and see if the physiognomy is similar to that of men in health, but 
 above all, if it is like itself. Such an appearance will be most favor- 
 able, but the danger will be greatest in proportion as the expression is 
 unnatural. The features have attained the last degree of alteration, 
 when the nose becomes pointed, the eyes sunken, the temples flattened, 
 the ears cold and contracted, their lobes shrunken ; the skin of the fore- 
 head dry, tense, and parched ; the skin of the entire face of a yellow, 
 dark livid, or leaden hue. If from the beginning of a disease the 
 patient's countenance presents these traits, and if other signs do not 
 furnish sufficient explanation, the patient should be asked if he has lost 
 
 '* Prognostics, § 1.
 
 100 PHILOSOPHIC PERIOD. 
 
 much rest, or has a severe diarrhea, or is suffering from hunger. An 
 affirmative response on either of these points, would cause the peril to 
 be regarded as less imminent ; such a morbid condition, resulting from 
 any of the causes above mentioned, may be arrested in the course of 
 twenty-four hours ; but if the patient does not communicate any of these 
 causes, and if the affliction does not cease in the interval above-men- 
 tioned, it may be predicted that death is not far distant."" How much 
 time and observation were necessary to unite thus in a single tableau the 
 evidences of decomposition in the human body at the moment of approach- 
 ing death ; to associate this frightful train of symptoms, sometimes with 
 a slight affection, that may be cured in a day, and again, with a des- 
 perate state, whose fatal termination can not be arrested ! Kemark, that 
 on these occasions the physician forms his judgment, and makes his 
 prognosis, without occupying himself with the interior organs, which 
 require much more sagacity, and would be, however much attention he 
 might give them, a source of frequent error. To-day, a physician, in 
 presence of such an assemblage of symptoms, would seek and find their 
 cause in some visceral lesion ; but this was not possible in the age of 
 Hippocrates, and for a long time after him. Deprived of the light of 
 post-mortem examinations, the physician of that time was forced to 
 make his observations on superficial phenomena, and deduce his prog- 
 nosis and treatment from them. 
 
 He who is in the habit of seeing patients, and knows by experience 
 the inconceivable variety, and inconstancy of morbid symptoms, can 
 alone appreciate the time, labor and patience it required to deduce some 
 general propositions from the observation of phenomena ; to trace, in a 
 word, those rules of Semeiotics which ancient Medicine has transmitted 
 to us, and some of which still preserve all their original value. If more 
 perfect and more varied means of investigation allow us now to carry 
 our observations still further, we must at least admire the perspicuity 
 of the ancients, who, in many cases, were able to foresee the future 
 events in diseases, with as much certainty as ourselves. 
 
 Observe also that the greater part of the rules of Semeiotics are 
 announced in an absolute manner, and in the form of aphorisms, which 
 indicate the way in which they were established. They must have pro- 
 ceeded in nearly the following manner : when the identical or analo- 
 gous symptoms were presented a certain number of times in the 
 same order, the fact of their habitual succession was established by 
 a general proposition, often without exception, because experience had 
 not yet made these known to them. But afterwards, in proportion as 
 
 " Prognostics. § 2. 
 
 II
 
 SCHOOLS OF THE ASCLEPIAD^. 101 
 
 such exceptions were observed, they were noted, and new aphorisms 
 drawn from them, which sometimes merely limited the first, or even 
 contradicted them. At length the exceptions to the first observa- 
 tions became so multiplied that those axioms lost much of their 
 value. The authors who adopted at a later period that style of writing, 
 were less aflBrmative and less absolute in their sentences, and therefore 
 inspired less confidence. This change is already seen to take place 
 between the writings of the treatise on Prognosis and the second book 
 of Predictions. The author of the latter, whoever he was, exhibits 
 less self-confidence, and is less positive than his predecessor. He com- 
 mences even by cautioning the reader against the marvelousness of 
 certain predictions, and cites for examples those that were attributed 
 to the directors of the gymnasire : "As for me," he adds, "I can not 
 divine, but I will describe the symptoms that will enable you to judge 
 which of your patients will recover and which will succumb, and 
 whether they will recover soon, or be long sick." " 
 
 It appears from some passages in the same book, and from a frag- 
 ment on dreams, which is a part of the Hippocratic collection, that it 
 was the custom of physicians of that time, to announce the probable 
 issue of the disease at the first or second visit. This custom still pre- 
 vails in China. It likewise prevails in Turkey, as is attested by my 
 respectable friend, M. le Doctor Brayer, who relates on this subject a 
 curious anecdote, in which he was in some sort obliged to play the part 
 of a diviner. f Such an usage indicates the infancy of art, and can only 
 exist as the effect of ignorance and superstition. It supposes that a 
 physician is consulted as an oracle — as a man endowed with super- 
 human science, and not as a simple mortal, who by reason of study and 
 observation has attained the fixed impression in his mind of the natural 
 progress of a given number of diseases, and groups certain character- 
 istics, by means of which he can in some cases announce their probable 
 issue. Hippocrates blames loudly these physicians, who abandoning 
 the route of truth and rectitude, assume the position of thaumaturgs 
 before their patients, constructing their replies in a vague and ambig- 
 uous manner, so that they may be adapted to the most diverse develop- 
 ments ; in short, the usage of all such artifices as are now employed by 
 sorcerers, card-drawers, and somnambulists, to deceive those men that 
 disease, ignorance, or love of the marvellous renders, and always will 
 render, easy to be imposed upon. 
 
 '^ Second Book of Predictions, by Gardeil. 
 t Ibid.
 
 102 PHILOSOPHIC PERIOD. 
 
 § V. Internal Nosography; 
 
 Nosography is the eye of therapeutics. In proportion as the first is 
 lucid, methodic, and complete, the second is sure and rational. The 
 possession of the most efficacious curative agents is of no avail to us if 
 •we can not distinguish the cases in which their use is advantageous, 
 from those in which they would be injurious. In fact the more the 
 means that the therapeutist dispensers have of power and energy, the 
 more they become dangerous in the hands of the ignorant. That which 
 distinguishes the sage and enlightened practitioner from the blind and 
 headlong routinist, is the knowledge of indications. Now this know- 
 ledge is only acquired by the comparison of the morbid phenomena 
 that are before him, with those that he has before observed, and with 
 the most faithful nosological descriptions of others. 
 
 In many passages of the Hippocratic works, diseases are termed 
 sporadic, epidemic, and endemic, a useful and well founded distinction, 
 of which the practitioner should never lose sight while the same affec- 
 tion changes in gravity and requires different treatment, accordingly as 
 it exists under one or other of the above forms. 
 
 The same writers also divide diseases into acute and chronic, but 
 they do not seem to attach a near and precise idea to this separation — 
 they only indicate it, and in their pathological works they mingle 
 indifferently, and confound these two classes of morbid affections ; in 
 general they observe no order. In one of them alone they are distin- 
 guished from each other by a more methodic arrangement, and that is the 
 work on Affections, a summary abridgment of nosography, the most com- 
 plete of the collection. In it the diseases are classified according to 
 their localities, beginning at the head and going down to the feet. 
 Thus phrenitis, that was supposed to be a disease of the diaphragm, 
 is described immediately after pneumonia ; and what is remarkable, 
 fevers follow phrenitis, because supposed to have their seat in the 
 superior viscera of the abdomen. 
 
 The following is the list of the Hippocratic books devoted wholly or 
 in part to internal nosology : 
 
 1. The treatise on the Regimen in acute diseases,, from the 29th to 
 
 the 44th paragraph, inclusive. 
 
 2. The treatise on the Regions in man, from the 16th paragraph to 
 
 the end. 
 
 3. A small monograph on Epilepsy, which was called the sacred 
 
 disease. 
 
 4. A treatise on Diseases, in four volumes.
 
 SCHOOLS OF THE ASCLEPIAD^. 103 
 
 5. A treatise on Affections. 
 
 6. On Internal Affections. 
 
 7. A fragment on Diseases of Girls, relating particularly to histeria. 
 
 8. A book on the Nature of Woman. 
 
 9. A treatise on Diseases of Women, in two volumes. 
 
 10. A monograph on Sterility. 
 
 All these books and fragments united, are far from constituting a 
 complete nosography of internal diseases. In the first pla:;e the greater 
 part of chronic affections are only designated by their names. Some 
 are not even named, and a very small number are described. The 
 omission of all that class of diseases, so important, is owing to the fact 
 that they were generally regarded as inconveniences which did not 
 merit the attention of physicians. We have already quoted and 
 refuted the opinion of Plato, who blames Herodicus for striving to pro- 
 long the existence of valetudinarians by the aid of gymnastics. Here 
 is a passage from another author, cotemporaneous with that philosopher, 
 who agrees very nearly with him : " Leprosy, pruritis, teter, white 
 spots on the skin, baldness, etc , it is said, proceed from the pituite ; 
 on this account remedies are employed to evacuate this humor ; but 
 they are rather deformities than diseases." 
 
 In the second place, though the attention of the Asclepiadge was prin- 
 cipally directed to acute diseases, the descriptions which they have 
 transmitted to us, are, for the most part, so defective, that it would be 
 difficult, if not impossible, to report a single one of them that offers a 
 tableau at all complete or well arranged, of any morbid species what- 
 ever. 
 
 I conclude from this, that the remains of medical antiquity have now 
 little interest in a didactic point of view ; but though they are com- 
 pletely sterile for the student and young practitioner, they will always 
 interest, to the last degree, the erudite man and the philosopher, to 
 whom these delus are one, as stakes that indicate the route followed in 
 antiquity by science, and serving to measure the stages through which 
 she has passed. 
 
 On this account, my readers will not be displeased, J presume, to find 
 here two descriptions of diseases, chosen from amongst those which have 
 appeared the best defined in the Hippocratic collection. 
 
 ON PERIPNEUMONIA." 
 
 " Peripneumonia shows itself in the following manner : a great fever is 
 developed ; the respiration is hot and frequent ; the patient does not 
 
 '' Traite dos Maladies, liv. 3e, § 17, trad, de Gardeil.
 
 104 PHILOSOPHIC PERIOD. 
 
 know how to contain himself ; he is feeble and totters. The pain is felt 
 at the shoulders, above and in front of the chest, as far as the breasts. 
 He grows worse — sometimes delirium supervenes. There is a species 
 of peripneumonia where the pain is only felt when the patient begins to 
 cough. These are more dangerous and longer continued. At first the 
 expectoration is small and frothy ; the tongue is yellow, and becomes 
 darker. When it is black from the commencement, the disease is more 
 rapidly developed ; it is slower in its progress when the blackening of 
 the tongue comes on later ; afterwards it becomes rough and cracks, the 
 finger adhering to it when applied. The changes in the state of the 
 tongue announce those of the disease, the same as in pleurisy. Peri- 
 pneumonia continues at least fourteen days, or twenty-one at farthest. 
 
 " During this time the cough is severe, and the lungs are depleted by 
 the cough. At first, the expectoration is frothy and copious ; about the 
 seventh or eighth day, when the fever is in full force, if the peripneu- 
 monia is moist, it becomes thicker ; unless it shall become on the 
 seventeenth day a green color, it will be slightly sanguineus. From 
 the twelfth to the fourteenth day, it will be abundant, and of a puru- 
 lent character. Such is the state amongst those who have a humid 
 temperament and constitution, and in whom the disease is severe ; but 
 those in whom the temperament and character of the disease are dry, 
 the attack is less dangerous. 
 
 " If then, on the fourteenth day, the cough is not accompanied by puru- 
 lent expectoration, and the lung becomes dry, the patient is cured. In 
 an opposite case, give attention on the eighteenth or twenty-first day, to 
 see if the expectoration is abating ; if it is not, ask the patient if it is 
 sweetish. If he says yes, you may know that the lung is suppurating — 
 this condition is determined. It may last a year unless all the pus is 
 cast off in forty days. "When the patient shall respond that the expec- 
 toration has a very bad taste, his condition is mortal. 
 
 " One may thus know what to expect from the first ; for when the pa- 
 tient expectorates all the bad pus in twenty-two days, and no new injury 
 is developed, he will recover. In the other case, he will die. The first 
 of these two species of peripneumonia leaves no vestige of itself in the 
 lungs. It is essential to be aware of all the sufi'erings the patient real- 
 izes, and what are the therapeutical resources to combat them. When 
 the symptoms are moderate, success is certain ; the peripneumonia is 
 not mortal in its nature, and it will be mild. I will now give the 
 treatment."
 
 SCHOOLS OP THE ASCLEPIAD^. 105 
 
 PLEURISY. ■•• 
 
 When an individual is attacked with pleurisy, the following are the 
 symptoms : pain in the side, with fever, shiverings and frequent respi- 
 ration ; there is cough, and difficulty in breathing while lying down. 
 The expectoration is bilious, and of the color of the bark of the pome- 
 granate when there is no lesion in the lungs ; if such exists, it will be 
 sanguineous ; when it is bilious and. there is no lesion, the attack is 
 milder. In an opposite case, it is graver, and even mortal if hiccup su- 
 pervenes ; the cough brings up saliva and clots of black blood ; the 
 patient dies on the seventh day. When he survives to the tenth day, 
 the pleurisy is healed ; but if it goes on to the twentieth, suppuration 
 is established, and pus is expectorated, which is finally vomited, and the 
 cure is rendered difficult. 
 
 " There are dry pleurisies without expectoration, which are very 
 grave. The crises occur as in humid pleurisies, but there is more need 
 of drinks. The bilious and sanguineous crises take place at the ninth 
 and eleventh days. It is cured more easily when from the commence- 
 ment the pain is moderate, and becomes acute about the fifth or sixth 
 day ; the disease continues then until the twelfth ; if the patient pass that 
 be will get well. When the suffering has been moderate from the be- 
 ginning, but violent from the seventh to the eighth day, the crisis is 
 not determined until the fourteenth, after which the danger is passed. 
 
 " Pleurisy of the back differs from the preceding, in its pain seeming 
 to be more like that of a wound. The patient groans, and the respira- 
 tion is frequent. Very soon expectoration occurs in small quantities ; 
 general prostration follows. On the third or fourth day a bloody urine 
 is voided. Death occurs commonly about the fifth or seventh day. 
 Those who pass these days may recover. The disease after this, becomes 
 more tractable. It is necessar'y, however, to be watchful till the four- 
 teenth day ; beyond that, the patient is safe. 
 
 " Some pleuretics expectorate pure phlegm only, whilst their urine is 
 sanguineous, resembling the fluids of roast meats : they feel very acute 
 pains in the front of the chest and groins. If, however, they pass the 
 seventh day, they will get well. 
 
 " When in pleurisy there supervenes redness on the back, with heat 
 -at the shoulders, a feeling of weight and uneasiness in the abdomen, 
 with green and fetid discharges, the patients will die on the twentieth 
 day in consequence of this evacuation, but if they live beyond the 
 twentieth, they will get well." 
 
 ^'Traite des Maladies, Vol. Ill, § 18, 19, 20, trad, de Gardeil 
 
 7
 
 106 PHILOSOPHIC PERIOD. 
 
 Such descriptions, as already remarked at the commencement of this 
 chapter, have no utility for a reader unacquainted with medical studies, 
 or for a beginner ; but they are valuable as historic record, to establish 
 the state of the Science at a very remote epoch, of which we have but few 
 remains. The experienced practitioner will discover in them many 
 interesting features of the diseases which he has himself observed, atid 
 which prove to a certain point, the exactness of the tableaux. 
 
 § VI. Therapeutics. 
 
 The physicians of the two preceding periods have not emitted any gene- 
 ral law in Therapeutics ; they regulated their practice instinctively upon 
 the following plan : when a remedy has cured any disease, it should cure 
 all other identical diseases. This axiom, incontestably true in itself, is 
 but a fragment of one much more general, which embraces the whole 
 philosophy of causes, and may be expressed thus: the same agents, 
 placed in the same identical circumstances, will always produce the 
 same effects. But a proposition so universal, which appertains to medi- 
 cine no more than to the other sciences, and which takes no account of 
 the internal action of medicines, appeared too superficial to philosophical 
 physicians, and too vague to practitioners who desired a rule less com- 
 mon ; in short, one more directly related to the healing art. Conse- 
 quently, both parties sought another fundamental principle, and the 
 following is the result of their speculations on this subject : it was held 
 that there always exists a species of antagonism between the cause of 
 the morbid phenomena and the active properties of the remedies that 
 cured them ; or rather, between the pathological modification of the or- 
 ganism and the curative impulse given to the economy by the treatment. 
 This law was expressed by the following aphorism : contraria contrariis 
 curantiir. 
 
 The greater number of medical writers adopted this principle, and 
 endeavored to establish the practice of medicine upon it. Now, two 
 things were necessary for that : first, to discover the essential cause of 
 each disease, or the primitive lesion that constitutes each morbid spe- 
 cies ; secondly, to determine the mode of action and the degree of energy 
 of therapeutic agents, so that the practitioner may choose from among 
 them, those which were more directly contrary to the affection he is 
 called upon to combat. The course of this history will show us the re- 
 sults of the efforts made at different epochs to attain this double end, 
 and we shall have occasion more than once to discuss the validity of 
 hypcsnantiosis, or the doctrine of contraries.
 
 » 
 
 SCHOOLS OF THE ASCLEPIAD^. 107 
 
 At present it will suffice to say, that from its commencement this 
 principle has not been universally adopted. Thus, the author of the 
 book entitled "Ancient Medicine," one of the most philosophic of the 
 collection, devotes several paragraphs to the refutation of this axiom. 
 And we read in the treatise on the liegions of JIan, that diseases are 
 sometimes cured by contraries, sometimes by similars, and, finally, some- 
 times by remedies which have neither similitude nor opposition.-' 
 
 We shall conclude this chapter by giving examples of the manner in 
 which the practitioners of those times applied the general principles of 
 Therapeutics to the treatment of particular diseases. The following 
 cases appear to me to be the best arranged and most complete of any of 
 those recorded in the collection : 
 
 TREATMENT OF PLEURISY AND PERIPNEUMONIA. 
 
 " It is necessary to examine in the following manner the peripneumo- 
 nic and pleuritic aifections : if the fever is acute ; if there is pain in one 
 or both sides of the chest ; if the patient suiFers during expiration ; if 
 he coughs, and the expectoration is rusty or livid, or thin and frothy, or 
 of a blood-red — if, in fine, it differed at all from that which is natural, 
 the following course must be pursued : the pain extending above and 
 towards the clavicle, or towards the vein and the arm, the internal vein 
 of the arm on that side should be opened. The quantity of blood drawn 
 should be proportional to the constitution of the body, the season of the 
 year, the age and color of the patient ; and if the pain is acute, the 
 bleeding should be boldly pushed to syncope; afterward an injection is 
 to be administered. 
 
 " If the pain occupies the inferior region of the chest, and if the ten- 
 sion is great, you should prescribe for pleuritics a mild purgation ; but 
 they must taste nothing else while the medicine is operating. After the 
 purgation they should have an oxymel. The purgation should not be 
 administered till the fourth day : during the first three days injections 
 should be employed ; but if they are not sufficient, the purge should be 
 given, as above said. He must be watched until the fever ceases and the 
 seventh day is attained ; after that, if he appears out of danger, he may 
 take a little barley-water, weak at first, and sweetened with honey. If 
 the convalescence progresses and the respiration is good, the tisane may 
 be given twice a day, and be gradually increased in quantity and 
 strength ; but if the convalescence is slow, the drink must be lessened, 
 and for nourishment a small quantity of a weak tisane once a day. It 
 
 - See § G7, G8, 69, 70, GardeiL
 
 108 PHILOSOPHIC PERIOD. 
 
 should be given when the patient is in the best condition, which may be 
 known by the appearance of the urine. 
 
 " To those who approach the close of the disease, it is not necessary to 
 give the tisane, before you see the coction manifested in the urine or ex- 
 pectoration; nevertheless, if, when purged, the patient has abundant 
 evacuations, it is necessary to give the tisane, but in less quantity and 
 weaker, otherwise the emptiness of the vessels would allow him neither 
 to sleep, nor to digest or await the crisis. With this exception, the 
 crude humors should be liquefied, a'^d whatever has been the obstacle, be 
 ejected : then nothing prevents alimentation. The expectoration is per- 
 fectly concocted when it appears like pus : the urine, also, when it has 
 a red sediment, like brickdust. 
 
 " As to the pains in the side, nothing contra-indicates the use of fo- 
 mentations and wax plasters. The legs and loins should be rubbed with 
 warm oil and then anointed with fat. The hypochondria should be cov- 
 ered as high as the breasts with a flaxseed poultice. When the peri- 
 pneumonia has reached its height, nothing can be accomplished without 
 purgation : it is bad if the patient has dyspnea, or the urine be thin and 
 acrid, or there be sweats around the neck and head. These sweats indi- 
 cate danger in proportion to the violence of the disease, which is known 
 by the suffocation and rattling, which increases and produces death, 
 unless there supervene an abundant flow of viscid urine or of concocted 
 sputa. Whichever of these two phenomena supervenes, it indicates 
 resolution." 
 
 An eclegma is prescribed for peripneumonia, with galbanum and grains 
 of pine-seed, in Attic honey. Other expectorants are employed, such as 
 worm-wood {Artemisia abrotannm, Lin.), and pepper in oxymel ; pur- 
 gatives : boil black hellebore {Hellehorus orientalis, Lin.) , and give it as 
 a drink to pleuritics, at the commencement, and while the pain is felt. 
 A useful remedy in afiections of the liver, and in pains proceeding from 
 the diaphragm, is a drink of opoponax {Pastinacce opoponax, Lin.), 
 boiled in oxymel and strained. In general, a remedy, which is to act 
 on the stools or urine, should be given in wine, and in honey; if to 
 act on the stools alone, it should be given in a much larger quantity of 
 diluted oxymel. 
 
 § VII. External NosoaRAPHY and Therapeutics, or Surgery. 
 
 The following is a list of the books of the Hippocratic collection, that 
 treat of external nosography and therapeutics, according to the transla- 
 tion of Gardeil:
 
 SCHOOLS OF THE ASCLEPIAD^. 109 
 
 1 . The Laboratory of the Surgeon, in which dressings, bandaging, and 
 
 the use of apparatus is taught. 
 
 2. On Fractures, a treatise which appears above the anatomical knowl- 
 
 edge of the times. 
 
 o. On Articulations or Luxations, which seems to be a continuation of 
 the preceding work. 
 
 4r. The Mochlic, an extract, or small abridgement of the book on frac- 
 tures, and the one on luxations. 
 
 5. Wounds of the Head, a monograph, extremely remarkable for the 
 
 perfection with which the subject is treated. 
 
 6. On Sight, and Diseases of the Fye,\^ mere fragments, not of much 
 
 7. On Wounds, ) value. 
 
 8. On Fistula, } 
 
 9. Hemorrhoids, j monographs, passably good. 
 
 A glance of the eye is sufficient to show that a great amount of matter 
 that belongs to Surgery, is not mentioned — such as penetrating wounds 
 of the chest and abdomen, hernia, and vesicular calculi. The Hippo- 
 cratic works describe only a very small number of surgical operations, 
 and with the exception of the treatises on fractures, luxations, and the 
 monograph on wounds of the head, it may be said of all the other 
 books mentioned above, that they only glance at the subject whose title 
 they bear. In fine, all the fragments, re-united, are very far from com- 
 posing a complete treatise on surgery, or a treatise that may be compared 
 with those that belong to the next historical epoch ; but it is probable, 
 and even certain that we do not possess all the surgical works of the 
 Hippocratic authors ; what we have, though, prove that the Asclepiadse 
 carried this branch of the healing art to a degree of perfection no less 
 remarkable than that of internal Medicine. 
 
 § Vni. Obstetrics. 
 
 If there are occasions, when the aid of medical knowledge is palpably 
 necessary and efficacious, they present themselves especially in the prac- 
 tice of obstetrics. There, often, the life of one or two individuals, in per- 
 fect health, depends on a manoeuver, more or less skillful, or an indica- 
 tion, more or less well fulfilled. Beside, the duty of the accoucheur, or 
 sage-femme, is not limited to watching and giving assistance in the act 
 of parturition : their care often extends throughout the entire period of 
 gestation and lactation. It is not, then, astonishing, that physicians 
 were occupied, in the earliest times, with this branch of the art, and
 
 110 PHILOSOPHIC PERIOD. 
 
 that legislators have subjected it to special regulations. It may be 
 inferred, that the Asclepiadce did not neglect it, from the simple enume- 
 ration of the writings that they have left on the subject. 
 
 T. n, OF GARDEIL. 
 
 1 . A monograph on Generation. 
 
 2. Do. " on the Nature of the Infant. 
 
 .3. Do. on Pregnancy, in the seventh month. 
 
 4. Do. on Pregnancy, in the eighth month. 
 
 5. A small treatise on Accouchement, entitled. On Superfetation ; an 
 
 excellent abridgement of Obstetrics, for the epoch, 
 t). A small fragment, on Dentition. 
 
 T. IV, 
 
 7. The first book of the treatise on Diseases of Women. 
 
 8. A fragment, on the Extraction of a Dead Fetus, 
 
 The treatise on superfetation does not, in fact, include but a single 
 paragraph that responds to its title ; all the rest is relative to accouche- 
 ments. We there find a succinct and methodic resume of the knowledge 
 of the AsclepiadsB on this subject, and I can not do better than refer to it 
 the reader, who is desirous to inform himself on the state of the art, in 
 the age of Hippocrates, This abridgement is distinguished for its inter- 
 esting observations, and by the absence of certain barbarous and gross 
 practices, that impair other writings of the same collections. 
 
 The practice of sacades, for example, is not mentioned there, which 
 proves that the author did not approve of it ; for be could not have 
 been ignorant of this odd proceeding, which is mentioned in several of 
 the Hippocratic works ; notably in the first book of the treatise on the 
 diseases of women, where it is minutely described,'-- 
 
 Apropos to this last treatise. I will observe, that its author, whenever 
 he speaks of matters relating to accouchements, addresses himself to 
 midwives, which makes it probable that the ordinary practice of obstet- 
 rics was committed to them, and physicians were only called, in grave 
 or extraordinary cases. 
 
 § IX. Clinics. 
 
 The clinic does not form a particular branch of medical science ; it 
 embraces all, and makes the application of them at the bedside — it 
 
 - CEuvres d' Hippocrate, § 81 de Gardeil.
 
 SCHOOLS OF THE ASCLEPIAD^. Ill 
 
 constitutes the highest degree of medical teaching. There, the master 
 unites, constantly, example to precept — practice to theory. Nothing 
 is better calculated to mature the experience of young men, than thoso^ 
 lessons which are given at the bedside of the sick, when he who has 
 charge of the patients, unites profound instruction with great probity ; 
 and by this last term we comprehend, with a modern professor, candor, 
 frankness, justice, humanity, and disinterestedness. M. Bouillaud 
 insists, justly, on the necessity of joining moral qualities to knowledge 
 in the practice and teaching of Medicine. He clearly demonstrates, 
 that in default of morality, the most beneficent act is only an instru- 
 ment of deception, and a dangerous weapon, in unsafe hands. He defines 
 the true physician to be an honest man, instructed in the art of healing. 
 Vir probus medendi peritus ; a definition which cannot be too much 
 popularized, for it shows to the public what are the qualities they must 
 seek in a man to whom they confide their health.-' 
 
 It was as much by his virtues as by his genius, that Hippocrates 
 gained universal approbation. These virtues shine with great eclat in 
 the clinical observations which he has transmitted to us. He never 
 appears there as laboring for a reputation ; the sole desire that animates 
 him is, to be useful to his fellows, in enlightening them on the means 
 of preserving health, or in curing diseases. He avows, with an ingenu- 
 ousness that finds few imitators, his reverses and faults, convinced, 
 doubtless, that instruction is as much given in pointing out an error, as 
 in showing the truth. 
 
 The most ancient collection of clinics bears the title of Epidemics. 
 These sort of afflictions leave in the minds of the people such impres- 
 sions of astonishment and terror, that other than medical writers have 
 not disdained to trace their history, as extraordinary events of interest 
 to posterity. It was then entirely natural that physicians should relate 
 detailed accounts of them ; not for the simple purpose of interesting or 
 gratifying the curiosity of the reader, but in the hope of finding some 
 means to prevent the return of similar pests, or of moderating their 
 eff"ects. 
 
 To attain this end, physicians proposed, in the first place, to ascer- 
 tain the cause of epidemics. The following is their reasoning, to prove 
 that it is always in the atmosphere : " Some diseases," say they, " come 
 from the regimen, others from the air which we breath to maintain life. 
 Where several persons are attacked at the same time and place by the 
 same disease, we must seek the cause in that which is most common to 
 all, and this is the atmosphere. It is manifest, then, that these aflfec- 
 
 » Essai de Philos. Medicale, Paris, 1837, p. 239.
 
 112 PHILOSOPHIC PERIOD. 
 
 tions do not proceed from the regimen, because they attack every one 
 indifferently ; men as well as women ; hard drinkers as well as those who 
 drink only water ; the industrious as well as the idle ; those who live 
 luxuriously as well as those who have only bread for food. So then, 
 when an epidemic prevails, the cause certainly does not exist in our re- 
 gimen, but in the air we inspire, receiving from it some deleterious 
 element.'"' 
 
 This reasoning cannot be objected to unless it be thought too absolute, 
 for epidemic affections may be developed under the influence of a bad 
 alimentation, in countries where famine prevails, in besieged cities, in 
 ahips, etc. ; others spring from moral causes, such as the discouragement 
 which follows a retreat, religious exaltation produced by fanatical 
 preaching, or from persecutions.! 
 
 Nevertheless, it cannot be denied that the air is the most active me- 
 dium — the most powerful vehicle of epidemics, especially of those that 
 ravage large districts, and for a considerable length of time. 
 
 Another very important observation, which did not escape the Ascle- 
 piadse, is that during the reign of epidemics, the most varied intercur- 
 rent affections have a particular physiognomy which is common to all, 
 and which gives them a familiar likeness. 
 
 Eesting upon this double basis, the Hippocratic writers believe it im- 
 portant to note with care, the state of the atmosphere before and during 
 the epidemics, and they have described with not less exactness, the gene- 
 ral character of intercurrent diseases. In this way, connecting the 
 meteorological phenomena with the morbid ones observed during a season 
 or a year, they describe what has been named the epidemic constitution 
 of that season or year. They hoped, that after having thus described a 
 great number of medical constitutions, they would be able to ascertain 
 what atmospheric conditions habitually preceded and accompanied dif- 
 ferent epidemics, so that it would be possible, in certain cases, to foresee 
 the advent of the scourge, and prepare for it. 
 
 Such was the hope also of Sydenham and Stohl, worthy emulators of 
 Hippocrates, when they, with admirable patience, prepared their tables 
 of medical constitutions. Too few physicians have had the courage to 
 follow in their footsteps. The happy mortal to whom is reserved the 
 honor of determining the relation or law that connects epidemics with 
 certain states of the atmosphere, has not yet appeared. 
 
 "^Hippocratic Works. Treatise on the Nature of Man, Vol. 1, sec. 10 and 11. 
 Gardeil. 
 f Raphania, or the disease of fanatics, scurvy, and convulsions of St. Medard, etc.
 
 SCHOOLS OF THE ASCLEPIAD^. 113 
 
 Seven books of the Hippocratic collection bear the title of Epidemics. 
 Xevertheless, the first and the third alone are devoted, effectively, to the 
 description of epidemic constitutions, and appear to follow each other. 
 On this account, they are considered as being connected, and are sepa- 
 ated from the others, which are not supposed to belong to Hippocrates. 
 He describes in the first place, the most remarkable atmospheric condi- 
 tions ; afterwards, the general character exhibited by intercurrent dis- 
 eases by the constitution ; finally, he traces the particular history of 
 some diseases. The following extract will enable the reader to judge of 
 the method and talent for observation displayed by the author. 
 
 FIRST CONSTITUTION." 
 
 "In the island of Thasos, during autumn, towards the equinox, and 
 whilst the Pleiades were at the horizon, (that is, for those fifty days 
 after the autumnal equinox), there were gentle, continuous and abund- 
 ant showers, southerly winds, and open winter, with slight breezes from 
 the north, and dryness ; in sum the whole winter seemed like spring. 
 The spring season, in its turn, was marked by south winds, coolness and 
 slight showers. The summer was in general, cloudy without rain ; the 
 monsoon seldom blew, and with but little force or regularity. 
 
 " All the atmospheric conditions having been southern and dry, an in- 
 terval in this constitution, opposite and northern, occurring in the be- 
 ginning of spring, developed some cases of remitting fever ; but they were 
 generally moderate. There were but few attended with nasal hemorrhage, 
 and no one died. Tumors were developed in several persons — on one side 
 only in the greater number ; but no one had so much fever as to be 
 obliged to keep his bed ; though some had a little heat of skin. These 
 tumors disappeared in all cases without any difficulty ; there was no 
 suppuration, which so often happens with tumors arising from other 
 causes. They were large, soft, diffused, without inflamation or pain, 
 and disappeared without any critical sign. They were manifested in 
 youths, in men in the flower of their age, and especially in those who took 
 gymnastic exercises ; few women were attacked. The greater number 
 of the afflicted had dry coughs, with hoarseness, but no expectoration." 
 
 Very soon, in some, but later in others, there was developed a painful 
 inflamation of the testicle, some times on one side, then on both. Fever 
 was not always present, but there was much suffering. It is to be added, 
 that the Thasians did not seek medical " advice." 
 
 The above is an account of the Medical Constitution for the end of 
 
 *""Work3 of Hippocrates, by Littre, Vol. 2, p. 599. Epidemics, Book 1, sec. 1.
 
 114' PHILOSOPHIC PERIOD. 
 
 winter and the spring. The author describes consecutively, that of the 
 summer and autumn, after which he reports some historical particulars. 
 
 " First patient — Philiscus — lived near the wall. He took to bed. 
 First day : acute fever, sweat ; a bad night. Second day : general ex- 
 acerbation ; in the evening, a small injection procured ftvvorable evacua- 
 tion ; a tranquil night. Third day : in the moi'ning, and until mid-day, 
 the fever appeared to have ceased, but towards evening, acute fever, with 
 sweat ; tongue begins to be dry ; urine dark ; he passed a painful night, 
 without sleep, and had hallucinations on all subjects. Fourth day : 
 general aggravation ; dai-k urine ; the night was passed better, and the 
 urine better colored. Fifth day ; towards the middle of the day, he had 
 a slight epistaxis of vei-y dark blood ; urine varied, a cloudy substance 
 similar to sperm, floating in it, but without precipitating ; after a supo- 
 sitory, he passed a little feces, with wind. The night was uncomfortable ; 
 short naps ; he talked much in a rambling way ; all the extremities 
 were cold, and could not be warmed ; he passed dark urine ; slept a little 
 towards day ; became speechless ; cold sweat and livid extremities. He 
 died about the middle of the sixth day. 
 
 " In this patient the respiration was, to the end, full and slow, as if 
 he had to remember to breathe. The spleen was swelled and formed a 
 round tumor: the cold sweat continixed till the last: the access was 
 every other day." 
 
 The above tableau gives an idea of the whole of the morbid phenom- 
 ena, though it leaves something to desire, as we shall show presently. 
 There is no comparison possible between a narration thus made and the 
 miserable votive tablets suspended on the columns of the temples. The 
 first and third books on Epidemics include together forty-two particular 
 histories, similar to that given above. Twenty-five of these terminated 
 fatally, and seventeen, only, favorably. 
 
 Certain critics have taken occasion, from this frightful mortality, to 
 blame the curative method of Hippocrates ; but they show that they are 
 superficial observers, or they would have seen that Hippocrates only 
 gives the detailed history of the gravest and most remarkable cases. 
 The proportion of fatal cases would have been much less, if he had in- 
 cluded all his cases. This conclusion is not a conjecture — it is proven 
 from many passages of our author ; among others, in a remark cited 
 above, in the description of the first medical constitution: "All the 
 atmospheric conditions having been southern and dry, an interval in 
 which the constitution was opposite and boreal, at the beginning of 
 spring, originated some fevers. These fevers were generally moderate ; 
 a few had nasal hemorrhages, but none died." 
 
 A reproach much better founded might be made to the clinical rela-
 
 SCHOOLS OF THE ASCLEPIAD^. 115 
 
 tions of the old man of Cos. viz : for having said nothing, or next to no- 
 thing, of the regimen and treatment to which he submitted the sick. 
 This omission is keenly felt, rendering it impossible for the reader to 
 appreciate the curative method of the physician. It forms an important 
 vacuum in the history of the disease ; for it is evident that the thera- 
 peutic or hygienic means employed during the course of a disease affect 
 the progress and duration of it, however simple they may have been. 
 It is not a matter of indifference, for example, whether a sick person be 
 placed in a convenient chamber, warmed and ventilated, or in a small, 
 obscure, cold, and infected apartment; or whether he is permitted to 
 drink wine without discretion, or only to have pure water. 
 
 The five other books on Epidemics contain clinical observations, col- 
 lected without order, and relating to all sorts of diseases. A great num- 
 ber of these histories are only simple notes or detached reflections ; some, 
 however, are edited with taste and completeness. The mention made in 
 these, of the treatment, shows a progress, compared with the preceding 
 ones. Here is one of the best, I think, though not one of the longest. 
 
 Edematous swelling during pregnancy ; great dyspnea ; expectoration 
 of a large amount of pituitous matter ; improvement. 
 
 " The sister of Harpalides, being in the fourth or fifth month of preg- 
 nancy, an aqueous swelling commenced at the feet and around the eyes ; 
 the skin became swelled up, as in phlegmatic persons : dry cough ; some- 
 times orthopnea ; the dyspnea and suffocation were such that the patient 
 sat up in her bed, being unable to lie down ; and if she felt sleepy, it 
 was when sitting up. Beyond this there was little fever : the fetus was 
 for a long time still, as if it were dead, and it fell about, following the 
 position of the woman. The dyspnea persisted for two months ; but the 
 patient making use of Egyptian beans, {nympluea nelumho, Lin.), pre- 
 pared with honey and with a honeyed eclegma, and drinking the cumin 
 of Ethiopia, in wine, her condition improved; her expectoration became 
 abundant, looked mucoid and white ; the dyspnea ceased. She brought 
 forth a female child." '■■' 
 
 § X. Aphorisms. 
 
 I will terminate this succinct review of the Hippocratic collection, by 
 the examination of a work which was intended as a recapitulation of all 
 that is set forth in the others. I mean the collection of Aphorisms, in 
 seven of his books. Ko medical work of antiquity has had a more colossal 
 
 " Works of Hippocrates, — Epidemics, book vii.
 
 116 PHILOSOPHIC PERIOD. 
 
 reputation than this ; physicians and philosophers have professed for it 
 the same veneration as the Pjthagorians manifested for their golden 
 verses. The aphorisms of Hippocrates were long regarded as the crown- 
 ing glory of the medical scientific edifice — as the most sublime effort of 
 medical genius. Only a few years past, the faculty of Paris required of 
 the aspirants to the doctorate to insert a certain number of them in their 
 theses ; and perhaps nothing less than the political revolution in France 
 was sufficient to overthrow this old relic of a superannuated adoration. 
 
 For some propositions that express general truths of recognized util- 
 ity, and some clear and profound observations, how many are there that 
 contain exceptional truths, vulgar reflections, and even errors and con- 
 tradictions. In a practical point of view, the Aphorisms appear to me 
 to be nearly an absolute nullity ; because, having no union with each 
 other, they make only a superficial impression on the mind of the reader, 
 and are easily effaced from his memory. Besides, in admitting even 
 that a practitioner might have them all at his fingers' ends, they would 
 not render him much more skillful in treating diseases. Such reading, 
 then, can offer no solid instruction to the student, nor is it valuable to 
 any but a practitioner whose judgment is ripened by experience, for he 
 alone is capable of discerning what is true and what is false, or the good 
 and the bad in these general maxims : to him they are merely a recapit- 
 ulation of scattered notions and observations. 
 
 This was my judgment of them long before M. Littre had published 
 his translation of this Hippocratic treatise. Since I have read the 
 learned explanations of this commentator I have not changed my mind, 
 for it seems to me that both of us consider these famous sentences from 
 different points of view — he as an erudite and a philosopher, and I as a 
 simple practitioner. "The Aphorisms form," says M. Littre, " a suc- 
 cession of propositions in juxtaposition, but not united. It is, and 
 always will be, disadvantageous, for a work to be written in that style, 
 and this disadvantage is increased if the Aphorisms are considered with 
 modern ideas, and with the notions we now have of physiology and path- 
 ology : they thus lose all their general signification, and the aphorism, 
 already so isolated in itself, becomes more so when introduced into mod- 
 em science, with which it has but little practical relationship. But it is 
 not so when the mind conceives of the ideas which prevailed when the 
 Aphorisms were written: then, in those parts where they seem most dis- 
 jointed, we see that they are related to a common doctrine, which unites 
 them together ; and in this view, they no longer appear as detached 
 Bentences.* 
 
 •"'Aphorismes, Argument, § 11, Tome IV., page 405, des (Euvres d'Hippocrate.
 
 SCHOOLS OF THE ASCLEPIAD^. 117 
 
 ART. III. THEORIES AND SYSTEMS. 
 
 Now, after having considered the state of Medicine under the Ascle- 
 piadce, in the isle of Cos, in an exclusively practical manner, and, in 
 some sort, material also, it remains for us to examine it in a theoretical 
 point of view — to seek the invisible bond that unites all parts of their 
 doctrines, and connects them to a common principle, as the branches of 
 the same tree. 
 
 In all times, and perhaps in ours more than any other, systems have 
 been decried. They have been and are still accused of being only a 
 tissue of errors and a source of eternal discussion. The epithet sys- 
 tematic, (theoretic — with us. TV.) applied to an author or a book, has 
 become an expression of disdain. Many would banish from Medicine all 
 theory, all system, and preserve only the facts and results of experience. 
 Their plan appears very commodious and sure, at first sight, but when 
 more closely examined, it is impracticable. Those who have recom- 
 mended it the most, have not been able to avoid violating the plan, in 
 their writings as well as in their practice. M. Bouillaud • ' demonstrates 
 this in a positive manner ; and M. Monfalcon, but little favorable to 
 systematic writers, is also forced to say : " Much has been said against 
 systems and certainly with truth. We condemn them and still we 
 are not able to do without them. Every instructed physician has a 
 way of explaining to himself life and diseases ; he wishes to form an 
 opinion of what he sees as well as of what he do:s. If the received 
 doctrines do not satisfy him, he modifies them, in a way most satis- 
 factory to himself." f 
 
 I will add, that learned physicians are not the only ones that essay 
 to interpret the phenomena of life ; for in this respect the most igno- 
 rant are no less prodigal in explanations, nor less prepossessed in 
 their manner of regarding them ; so natural and irresistible is the 
 impulse to try to explain the phenomena that strike our senses. 
 
 In fact I may say, without a theory, without some systematic arrange- 
 ment of partial opinions that tend toward a common end, there exists 
 no science. Clinical observations, collected with care, but arranged with- 
 out art and method, in a word, without system, constitute no more a 
 scientific edifice, than a confused pile of materials constitutes a monument 
 of architecture. 
 
 Theories and systems concur to the advancement of the sciences by 
 uniting by an artificial bond the diverse notions of which they are com- 
 
 ° Essai de Philos. Medicale. Paris, 18.37, deuxieme partie, chap, in, art. 1, § 1. 
 t Diction, des Sciences Medicales, the words System and Theorie.
 
 118 PHILOSOPHIC PERIOD. 
 
 posed, in a way to assist the memory, and enlighten the judgment. It is 
 true that scientific systems sometimes propagate illusions and ridiculous 
 prejudices, but the illusions and prejudices that spring from ignorance 
 and barbarism, that is to say, from the absence of all reasonable system, 
 are no less numerous, ridiculous, and absurd. 
 
 A system is true, when it is founded on real analogies ; it is false, 
 when it rests on imaginary analogies. A system may be true in certain 
 parts, and false in others ; but there are few systems that are entirely 
 erroneous. This is also the opinion of the writer that I have just cited. 
 " If systems," says M. Monfalcon, " were composed only of errors, of 
 conjectural opinions, they Avould make but few partisans ; but there is 
 not one that does not repose on some important fact or some well recog- 
 nized physiological law. Those who propose them do no other wrong 
 than exagerate these laws and make the whole of Medicine subordinate 
 to them : those who adopt them see only one side of the subject, and sub- 
 mit too blindly to the reason of one single man.--= 
 
 Thus then the most common defect of medical systems is not a lack 
 of foundation, nor the want of a support derived from correct observa- 
 tion, but it is rather the exageration of certain truths, to the neglect 
 of others not less important — the consideration of objects too exclu- 
 sively under one aspect. " The fault," says Bichat, " with these who 
 have a general idea on Medicine, is to bend all the phenomena to this 
 idea. The defect of generalizing too much has perhaps been more injuri- 
 ous to science, than that of seeing each phenomenon in an isolated manner. f 
 
 Being convinced of the necessity of theories to harmonize the various 
 ramifications of science, persuaded that without their aid the human 
 understanding could not grasp a great extent of knowledge, nor elevate 
 itself to the highest considerations, we shall accord to this important 
 branch of Medicine all the attention that it merits, without forgetting 
 that it offers only an ideal and an imperfect image of phenomena, and 
 that it can not in any case replace the study of real nature, or take the 
 place of direct observation. 
 
 § I. Theory of Coctiox and Crisis. 
 
 The theory which prevails the most universally in the Hippocratic 
 works, is that of coction and crisis. It is met with at every step, some- 
 times isolated, sometimes combined with others ; but especially is it 
 united to the system of four elements and four humors. It forms an 
 
 ^^ Diction, des Scienc. Medic, the word System, 
 f Anat. Ge'n., Considerat. Ge'n., p. 1-3.
 
 SCHOOLS OF THE ASCLEPIADJi;. 119 
 
 integral part and is the most characteristic trait of the ancient Dogma- 
 tism, and it is retained even in our time, while all its cotemporaneous 
 doctrines have heen abandoned. 
 
 The Asclepiadae, of the isle of Cos, regarded disease as an association 
 of phenomena, resulting from the efforts made by the conservative prin- 
 ciple of life to effect a coction of the morbific matter in the economy. 
 They thought that it could not be advantageously expelled until it was 
 properly prepared, that is, until after its elements were separated and 
 united with the natural humors of the body, so as to form an excremen- 
 titious material. 
 
 The vital principle that effected this preparatory work, as well as 
 sustained all other physiological functions, has received various names 
 among ancient authors, according to their notions of its particular attri- 
 butes. Som ecalled it nature, ipuai^, when they wished to indicate 
 the totality of forces and phenomena over which it presided ; motor, 
 VyOrjiiioi^, impetum faciens, to signify the prompt impulse which it gave 
 to the whole machine; soul, spirit, i^'oyr,, to signify its immaterial 
 essence, and the noblest of its faculties — the intellect. The word 
 ri/£'j«a, breath, designated, more particularly, the way in which the 
 vital principle sustained itself, the substance from which it drew its 
 nourishment: and the word dsfiuov, heat, expressed one of the most 
 immediate effects, and the most indispensable to life. 
 
 "When the morbid substance approaches the period of maturity, nature 
 seems to redouble her efforts ; the fever augments, the patient is over- 
 whelmed, or delirious, all the symptoms are aggravated and announce 
 the approach of a revolution; this was the moment of the crisis, or 
 judgement of the disease. The day on which it was accomplished, the 
 signs which preceded or accompanied it were termed critical, and required 
 the special observation and attention of the physician. He must be 
 able to discern whether these signs were good or bad, and predict, on 
 seeing them, what will be the fate of the patient. He must respect the 
 critical labor of nature, if it proceed properly, nor disturb it by vio- 
 lent remedies, and in no case attempt to aid the vital principle, unless 
 in urgent necessity. 
 
 When the coction was effected, which might be known by the amend- 
 ment of the symptoms, it only remained to evacuate the heterogeneous 
 material. Nature often accomplishes this last effort, herself, and the 
 disease terminates by a critical sweat, urination, or stools. But it also 
 frequently happens, that the vital principle, fatigued and broken down 
 by the efforts of the crisis, requires aid, and then the physician must 
 come to its relief. To accomplish this, say the authors, he must push the 
 material toward the emunctory, to which it naturally tends ; that is, he
 
 120 PHILOSOPHIC PERIOD. 
 
 must give sudorifics, or purgatives, or diuretics, according to the indi- 
 cations of nature, whose faithful minister he must show himself to be, in 
 all things. In this way diseases terminated, in the most favorable cases."- 
 
 But it might happen, that the coction could not be effected, or only 
 imperfectly. In such cases, one of two things must occur : either the 
 vital principle, overcome by the morbid element, succumbs, and the 
 patient dies, or the struggle between the vital element and the morbid 
 goes on, and a new effort at coction commences, and is continued for a 
 limited number of days, in the same manner as at first. This second 
 effort may have a termination, complete or incomplete, and so on succes- 
 sively. 
 
 The number of days necessary for the coction, or the elaboration of 
 the morbigenous matter, was termed the critical period. The most per- 
 fect period was supposed to be the quaternary, or that of four days ; 
 next, the third ; finally, in addition to these two, was the septenary. 
 which had a high consideration. 
 
 In the treatise on Prognostics, section 20, we read as follows: "the 
 same number of days which brings about the cure, or death of the sick, 
 regulates the crises of fevers. The most benign, those which are accom- 
 panied with the most encouraging signs, terminate in four days, or 
 sooner ; the most malignant, or those accompanied with the most mena- 
 cing signs, destroy life in four days, or less : such is the limit of the 
 first period. The second period reaches the seventh day ; the third, the 
 eleventh day ; the fourth, the fourteenth day ; the fifth, the seventeenth 
 day; the sixth, the twentieth day. Thus, these periods, in the most 
 acute diseases, go from the first, in four days, to the sixth in twenty days. 
 But none of these periods, they say, can be calculated, rigorously, by entire 
 days, for neither the year, nor the months, are counted by entire days. 
 Still farther, by the same calculation, and same progression, we have a 
 first period of thirty-four days, a second of forty, and a third of sixty 
 days. The most difficult part of the diagnosis is. to determine from the 
 beginning the favorable, or unfavorable termination of those cases in 
 which the crises are slowest ; for, in the beginning, all protracted dis- 
 eases are very similar. It is necessary to make observations from the 
 first day, and then examine the state of things, after each quaternary is 
 passed; in this way, mistakes in regard to the termination of diseases 
 are avoided. The nature of the quartan fever is submitted to a similar 
 course. The good or bad termination of a case, when the crisis is 
 reached in the shortest time, is more easily known, for the accessions 
 are extremely dissimilar. The patients who will recover, have easy 
 
 ^CEuvres d' Hippocrate, par M. Littre, T. V. Traite des humours, § 3, et als.
 
 SCHOOLS OF THE ASCLEPIADJE. 121 
 
 respiration, not much suflPering, sleep at night, and offer otherwise encour- 
 aging symptoms : on the other hand, those that are to die, have dyspnoea, 
 delirium, sleeplessness, and all the most alarming signs. Since these 
 affections thus act, it is necessary to establish conjectures according to 
 the time, and according to each additional period, in proportion as the 
 diseases proceed toward the crisis. With women, the crisis, after 
 accouchement, follows the same rule."" 
 
 In the above scale of critical days, it may be observed that each pe- 
 riod is formed by adding the r umber four or three to the preceding one. 
 To properly conceive of the origin of this progression, we must recur to 
 the system of Pythagoras, already described.f The number four, it may 
 be remembered, represents in that system all substances endowed with 
 proper faculties, having an existence distinct from other beings, as God, 
 man, a plant, or a mineral ; hence it follows that the Asclepiadre, inhe- 
 ritors of the doctrines and symbolical language of the Egyptians, were 
 naturally led to designate by the number four the morbid entity come 
 to its complete development. For the same reason, the number three, 
 which represented the whole of the essential properties of all beings, 
 might also indicate to them the plenitude of the faculties of the morbid 
 entity. 
 
 If any doubt yet remains on the connection that exists between the 
 system of Pythagoras and the theory of critical days, the following pas- 
 sage will remove them : — " A physician, says one, who neglects nothing 
 that may contribute to the establishment of his patient's health, must 
 observe carefully what passes each day. Among those days of even num- 
 bers, the most important are the fourteenth, the twenty-eighth, and the 
 forty-second. This is supposed to arise from the perfection of those 
 numbers, and the manner in which they are composed of other whole 
 numbers. It would take up too much time to give their reasons : it will 
 be sufficient to say that they refer to the ternary and quarternary."J 
 
 As nature is not subjected to our arbitrary limitations, it often hap- 
 pens that the duration of diseases does not respond exactly to an exact 
 number of ternary or quarternary periods ; they were therefore obliged 
 to change more than once the manner of counting critical days. Opinions 
 varied very much in that respect, even in ancient times. The author of 
 the treatise on Diseases developed in his fourth book a physiological and 
 pathological theory, according to which all the odd days are assumed to- 
 be critical days. But this rule was found in many cases to be at fault. 
 
 -(Euvres d' Hippoc, traDslated by E. Littre, Paris, 1840, T. II, p. 169. 
 
 f See page 83. 
 
 I See the Traite de la Grossesse a sept mois, § 3 ; translation of Gardeil. 
 
 8
 
 122 PHILOSOPHIC PERIOD. 
 
 SO that they were forced to admit that the rule of odd days was excep- 
 tional in numerous cases. Hippocrates himself points out several. In 
 the third book on Epidemics, section third, it is said that " all diseases 
 offer, it is true, difl&culties in crises, the absence of crisis, and a long 
 duration, which was especially remarkable in those to which I refer : in 
 some, the crisis was retarded for eighty days ; in most of them the dis- 
 ease ceased without a distinct crisis." 
 
 Notwithstanding the vagueness that existed in the determination of 
 critical days, the doctrine of crisis is maintained in our times. Pinel, 
 one of the most philosophic spirits of our epoch, wrote at the end of the 
 last century: "I suppose that no one is so little enlightened, as to 
 think he can suspend, by the aid of remedies, the course of an acute 
 disease, such as an essential fever, or a phlegmasia. On the contrary, 
 he must commence by counting the days, from the beginning, so as to 
 recognise what their actual period is. It is known that inflammatory 
 fevers, as well as gastric, continue, in general, to the end of the first, 
 second, and sometimes, third septenary ; but the gastric remitting fevers 
 continue to the sixth or seventh week, whatever method of treatment 
 may be employed, and may continue many months, if exasperated by a 
 too active treatment. =■■'" 
 
 Landre Beauvais, author of a treatise on Semeiotics, expresses himself 
 as follows: "Hippocrates, excellent observer and reliable historian, 
 has established the doctrine of crisis. Asclepiades and the methodists, 
 guided by prejudice, denied the crisis and critical days. They accused 
 Hippocrates of being led by the dogmas of Pythagoras, or numbers, and 
 they attacked Galen, who remained faithful to the principles contained 
 in the writings of the father of medicine. Asclepiades had many imi- 
 tators in succeeding ages ; Celsus was the most illustrious ; but can one 
 adopt the sentiments of those who refuse to admit the crisis, when it 
 has been so successfully sustained by Galen, Buret, Baillou, Fernel, 
 Sydenham, Forestus, Stahl, Baglivi, Van Swieten. Stohl and Pinel, and 
 when every day, clinical observations confirm the views of these great 
 masters, "t 
 
 A medical opinion which has traversed so many ages, and come down 
 to us supported by such respectable names, merits a profound examina- 
 tion. We must conclude, until the contrary is established, that it is 
 not a pure play 'of the imagination, but that it has some foundation in 
 the observation of the natural progress of diseases. 
 
 I will remark, in the first place, that the connection that exists be- 
 
 ■'Nosogr. Philos. Introduction, p. 35. 
 f Diction, des Scienc. Medicales, the word Crisis, T. 11, p. 376.
 
 SCHOOLS OF THE ASCLEPIAD^. 123 
 
 tween the doctrine of crisis and the dogmas of Pythagoras — a connec- 
 tion that it is vain to deny — proves nothing for or against this doctrine. 
 The real question is, are there diseases which proceed, or seem to pro- 
 ceed from some solid, liquid, er gaseous, deleterious substance, intro- 
 duced into the economy, exciting there a reaction, which is manifested 
 by a succession of nearly constant symptoms ? I^ow it is not doubtful 
 that there are diseases of this kind. We cite, in the first place, fevers 
 caused by vegetable emanations — formerly so common, and so destruc- 
 tive, which assume usually, a periodic form, as a quotidian, tertian or 
 quartan. I will also cite the eruptive fevers, such as variola, rubeola, 
 vaccinia, miliary, etc., which have well marked phases of incubation, 
 eruption and desquemation. It ie true, that certain authors pretend 
 that these last diseases are of modern origin — I had almost said inven- 
 tion ; but that is a controverted, and a very controvertible opinion, as I 
 shall prove at a proper time. But admitting they are so, it cannot be 
 denied that if new periodic diseases have arisen since Hippocrates, the 
 old ones could become extinct, and in this hypothesis, there would be, 
 therefore, a compensation. 
 
 Thus, then, there has existed, and there still exists a very numerous 
 class of diseases, of nearly constant periods, and it is in a great measure, 
 upon the observation of this remarkable phenomenon, that the doctrine of 
 coction and crisis has been founded. Eecall now a remark that I have 
 already made, namely, that the attention of the Asclepiadoe was especi- 
 ally directed to acute diseases, and amongst these, principally to epidem- 
 ics. The greater number of the clinical relations that have been trans- 
 mitted to us, relate to epidemics. Now febrile affections, of regular 
 periods, generally prevail as epidemics. 
 
 What then is the reproach that can be legitimately applied to Hippo- 
 crates and those who have adopted his theory of crisis ? It is that of 
 extending to all diseases that which is true only of a certain number ; 
 in a word, for having generalised too much an idea ; and this is the 
 most common defect of all systems, as has been already remarked. 
 
 § II. Theory of the Four Elements axd the Four Humors. 
 
 After the theory of coction and crisis, that which prevails the most in 
 the Hippocratic books, is the doctrine of the four elements, or the four 
 elementary qualities, heat, cold, dryness and moisture, and the four car- 
 dinal humors, blood, bile, atrabile and phlegm. This doctrine was sup- 
 posed to be an invention of the father of Greek medicine. Such is the 
 opinion of all the commentators and historiographers, among others 
 Galen, who extended and perfected it in his manner, and it reigned, ex- 
 clusively, after him. The theory of four elements and four humors,
 
 124 PHILOSOPHIC PERIOD. 
 
 harmonizes very well with that of coction and crisis, of which it ap- 
 pears to be the complement. 
 
 Empedocles, of Agrigentum, who has been mentioned heretofore, 
 was the first who introduced into physics, the consideration of four 
 elementary forms, the first termed terrestrial or solid, the second 
 aqueous or liquid, the third aerial or gaseous, the fourth igneous or ethe- 
 real. The latter, of which the ancients had only a vague notion, cor- 
 responds to what is termed an imponderable fluid, in modern physics. 
 
 Empedocles admitted, according to the doctrine of his master, Pytha- 
 goras, two principles in every thing : the one active, intelligent and 
 impalpable, which is God ; the other passive, and devoid of properties, 
 having no definite form, but susceptible of assuming any that the Crea- 
 tor might give it, named amorphous matter. The philosopher of Agri- 
 gentum, conceived, also, that amorphous matter had received from the 
 Supreme Intelligence, four fundamental or elementary modes of exist- 
 ence, and these four principal modalities of matter, variously com- 
 bined, constituted all the bodies in nature ; so that, according to this 
 system, there is no material substance which does not include four ele- 
 ments, united in variable proportions. 
 
 The element which constitutes the largest proportion in a body, de- 
 termines its permanent form : thus, the terrestial element predominates 
 in solids ; the aqueous in liquids ; the aerial in vapours or gases ; the 
 igneous in the ether or imponderable fluid. In this way, this philoso- 
 pher explained the varieties of bodies, at the same time preserving the 
 Pythagorean doctrine of homogenity in matter. 
 
 The assumption of four elementary or primitive forms was not, as 
 may be thought, the dream of an exalted imagination ; the attentive 
 observation of some very remarkable phenomena had suggested the idea, 
 and gave it the appearance of reality ; thus, water can pass from a 
 liquid to a solid or gaseous state, without changing its nature ; so, also, 
 in the phenomenon of combustion, the wood, especially when it is green, 
 oozes out water from its surface, exhales smoke, which the ancients re- 
 garded as crude air, deposits ashes, the terrestrial element, and lastly, 
 gives off light and heat, or fire, the most subtle of the elements, which 
 ascends, and is dissipated in the ethereal regions. Here the chemical 
 analysis of the ancients stopped. 
 
 I will not carry farther this exposition of the four elements, or four 
 primitive forms which served to explain the infinite diversity of the 
 body without destroying the dogma of the homogenity of matter. It 
 is sufiicient to have shown that it was neither ridiculous nor absurd 
 before the discoveries of modern chemistry. I will add that the chem- 
 ists themselves, after having augmented indefinitely the number of ele-
 
 SCHOOLS OF THE ASCLEPIAD^. 125 
 
 ments, now tend to limit them, and are not far from returning to the 
 dogma of the homogenity of matter, by the theory of equivalents.-' 
 
 Such was, at its origin, the doctrine of the four elements, which 
 Plato and Aristotle adopted, and sustained by new and extremely sub- 
 tle considerations, as we shall see hereafter. This doctrine, when Hip- 
 pocrates appeared, had all the force and attraction of freshness, and it 
 is not astonishing that that philosopher made it the basis and model of 
 his medical theory. We now proceed to show by what course of reason- 
 ing he was led to it. 
 
 He commences by saying, that to properly understand man, it is neces- 
 sary to study him with the lights of Medicine, ^. e., in a state of health, 
 and disease. He refutes the opinion of the philosophers who pretend 
 that man is formed of a single element, and relies especially upon the 
 little accord that exists among them, as to the nature of that unique 
 element — some affirming that it is air, others water, others fire, and 
 others earth. " Now," says he, " since they all contend for the same 
 principle, and yet all come to diiferent conclusions about it, it shows 
 that they do not properly understand each other." 
 
 " In regard to physicians," he adds, " some contend that man is all 
 blood, others that he is all bile, others all phlegm, and some all gas. 
 Each one adopts the same mode of reasoning ; they insist that the being 
 is one, whatever name may be given to it, and that this unique substance 
 changes its form and its powers accordingly as it is affected by heat or 
 cold. As for my views : I say, that if man were a simple element or 
 being, he would never feel pain ; for what could excite pain in him if 
 he is only of one substance ? Suppose that he was susceptible to it : the 
 remedy must be single also ; but we know that there are various reme- 
 dies for pain. He who affirms that man is all blood, ought to show 
 himself unchangeable, or at least, he should assign a season, or an epoch 
 of life, in which we can see in man nothing but blood ; for in order to 
 be sure that his opinion is correct, we should be able to see, at some time 
 or other, at least, that only in man which exclusively constitutes him, 
 viz : blood ; these remarks are applicable also to the assertions of those 
 who pretend that he is all bile or phlegm. 
 
 " At first the generation of man can not proceed from a single sub- 
 stance, for how can a single substance be developed without a union 
 with something else ? If it docs not mingle with other different beings, 
 of the same nature, there could be no generation of an economy like 
 ours. Moreover if the heat and cold, the dry and humid, are not pro- 
 
 '^ And especially is this further illustrated in the correllation of the physical 
 and vital forces. — Trans.
 
 126 PHILOSOPHIC PERIOD. 
 
 perly tempered together, if one predominates too much, the generation 
 could not take place. In like manner when a man dies, each of the 
 elements of which he is composed takes a different direction, according 
 to its nature — the humid to the humid, the dry to the dry, the heat 
 to the heat, and the cold to the cold. 
 
 " The human body contains blood, phlegm, and two sorts of bile, yel- 
 low and black. Such is its nature, and their condition determines the 
 state of health. It is healthy when each of these fluids is in due pro- 
 portion to the other as to quantity and character, and especially when 
 they are well mixed ; it is diseased when any one is in excess, or lacks 
 its due proportion to the rest, or is evacuated without being properly 
 mixed — for when it is thus evacuated, not only the region where the 
 admixture should take place must be affected, but still more, the organ 
 through which it passes off, becomes surcharged and suffers painful 
 struggles. 
 
 " I have said that I would show that the things of which man is 
 composed always remain the same. This is generally admitted, and is 
 proved by the examination of his nature. Now the blood, phlegm, 
 yellow or black bile, by common consent, are always the same, for neither 
 of these words has an equivocal or doubtful meaning. Again, these 
 elements are very distinct in their nature ; the phlegm has no resem- 
 blance to the blood, nor the blood to the bile, nor the bile to the phlegm. 
 How then can they be confounded ? — for these differences are recog- 
 nized by the sight alone, as they differ very much in color. So, if they 
 are touched, there are manifest differences in the sensations they impart. 
 So also, are they unlike in temperature and consistence. If a remedy 
 is taken that acts on the phlegm, it is phlegm that is discharged ; if it 
 acts on the bile, that is cast off ; or if the body is wounded, it is blood 
 that flows out. These results occur at all seasons, all periods of life, 
 and at all times. Thus man is really constituted of four humors, which 
 are manifest to our senses, and there is no need of special arguments to 
 prove it." =•■■= 
 
 The author, after having established his doctrine by unquestionable 
 arguments and observations, and having refuted the objections of those 
 who professed contrary views, continues thus the exposition of his 
 own : " The phlegm augments in man during the winter, and this 
 humor is more analogous in its nature to that season ; for it is the 
 coldest of all, as can be readily proved. If the phlegm, blood, and bile, 
 are touched successively, it will be found that the first is the coldest. 
 In the spring the blood augments ; for there is an affinity in its nature 
 
 *-' De la Nature de I'Homme ; Gardeil.
 
 SCHOOLS OF THE ASCLEPIAD^. 127 
 
 with the constitution of that part of the year — it is hot and moist. 
 The bile increases in summer for the same reason, and the atrabile 
 becomes most abundant and strongest in autumn." 
 
 Hippocrates then explains summarily, how diseases are engendered, 
 namely, by the influence of the seasons, or by the regimen, the tem- 
 perament, or the air that is breathed. Finally, ho establishes a general 
 rule for their cures, which consist, according to him, in inducing action 
 in the system contrary to that produced by the cause of the diseases. 
 
 AYhatever view may be formed of this system, comparing it with our 
 present knowledge, we are forced to admit that united to the doctrine of 
 coction and crisis, with which it perfectly afiiliates, it offers an interpre- 
 tation, sufliciently reasonable, of the physiological phenomena which had 
 attracted the attention of the observers of that epoch. In fact, all 
 phenomena, of whatever character, can only result from the combined 
 action of vital and physico-chemical forces, that act similtaneously on 
 the animal economy. Now, the theory of coction explains the laws by 
 which the vital principle is supposed to exercise its influence ; that on 
 the elements and humors exhibits the influence of the inorganic forces, 
 and the laws according to which that influence is applied to organized 
 bodies. 
 
 These two theories united, constitute the ancient Dogmatism — a 
 doctrine originally of the school of Cos, and of which Hippocrates is 
 regarded as the principal author. In that doctrine the humors play 
 the part of secondary or physiological elements ; they are agents en- 
 dowed with diverse, or even contrary properties, placed at the disposal 
 of the vital principle, which alone gives to them a good or evil direction. 
 But these agents can contract, sometimes, deleterious properties, in con- 
 sequence of external forces not controlled by the vital principle. 
 
 The external forces admitted by the ancients, as we have seen, are of 
 four kinds, heat, cold, dryness, and moisture, which may be easily 
 reduced to two by the augmentation or diminution of caloric and mois- 
 ture. This shows the poverty of the physics and chemistry of the 
 ancients. They had no idea either of atmospheric pressure or its com- 
 position ; neither of electricity, the chemical phenomena of respiration, 
 nor a multitude of other phenomena and influences. They possessed 
 even on the efi'ects of caloric and moisture, but vague and super- 
 ficial perceptions, and considered their actions only in relation to the 
 humors of the human body, without taking any account of the not less 
 important modifications which they produce upon the solids. Besides, 
 they attributed to the humors imaginary qualities, derived from the 
 elements that were supposed to predominate in their composition. They
 
 128 PHILOSOPHIC PERIOD. 
 
 also conceived relations to exist between these humors and the seasons 
 of the year, which were more poetic than real. 
 
 The Asclepiadse, imbued with the same dogmas as Pythagoras, believed 
 in a perfect harmony between the universe, or the macrocosm, and man, 
 or the microcosm. For this reason they admitted four humors in their 
 physiology, though observation could only distinctly demonstrate three — 
 the blood, bile, and phlegm. The fourth humor was an object of much 
 uncertainty and obscurity, among the Hippocratic authors. Some assimi- 
 lated it to the terrestrial element, and called it atrabile, attributing 
 to it extremely active properties, and regarding it ttS the cause of the 
 gravest affections ; others assimilated it to the liquid element, gave it 
 the nameof water, and regarded it nearly as a nullity, in the produc- 
 tion of diseases. It was said, by one : the heart is the reservoir of the 
 blood, the head of the phlegm, the liver of the bile, and the spleen of 
 the water. 
 
 If the physicians had been less subjected to their philosophic pre- 
 judices, and relied more upon observation, they would have been able 
 to discover more reasonable relations between the humors of the body 
 and the seasons of the year ; they would have found, for example, that 
 the prolonged action of cold, damp weather, at the close of autumn and 
 the commencement of winter, in the temperate climate of Greece, devel- 
 oped the lymphatic or pituitary temperament and humor, as well as 
 catarrhal affections ; that the damp, warm constitution of the weather at 
 the end of winter, and in spring, disposed to open inflammatory diseases 
 and hemorrhages ; and lastly, that the dry heat of summer and the 
 beginning of autumn, increased the secretion of bile, and favored the 
 prevalence of inflammatory bilious and putrid bilious fevers ; but to 
 see this they would have had to renounce the Pythogorian harmony of 
 the four humors with the four elements and four seasons. 
 
 Notwithstanding its errors and imperfections, the doctrine of Dogma- 
 tism is the most ingenious and the most complete of all the medical 
 doctrines of antiquity ; it responds better than any other to the wants 
 and tendencies of antique science, and it was received and adopted 
 with admiration, not only by the generality of physicians, but also by 
 the greatest philosophers. We shall have occasion to speak of it more 
 than once, in considering the modifications it has undergone in its long 
 reign. 
 
 What shall be said now of those who attributed to Hippocrates the 
 glory of having separated Medicine from philosophy ; and of those, on 
 the contrary, who attributed to him the glory of uniting philosophy 
 with Medicine ? It must be said of them, wliat Hippocrates says of
 
 SCHOOLS OF THE ASCLEPIAD^. 129 
 
 those Tvho saw only one element in man : they do not well understand 
 themselves. 
 
 It is certain that Medicine had been philosophized upon before Hip- 
 pocrates ; it is also equally certain that Hippocrates philosophized as 
 others, and that he shared the prejudices of his age in many particulars ; 
 but in some respects his philosophy is distinguished from that of his 
 cotemporaries by great'^r and more profound wisdom. He reminds the 
 philosophers and physicians, continually, of the maxim too often neg- 
 lected by them, and even by himself, that the nature of man can not he 
 well known without the aid of medical observation, and that nothing should 
 be affirmed concerning thai nature, until after having acquired a cer- 
 tainty of it, by the aid of the senses ; a maxim diametrically opposed to 
 the dogmas of Pythagoras, and which includes the germ of an entirely 
 new philosophy, that Plato misconceived, and of which Aristotle had 
 only a glimpse, as I shall show hereafter. 
 
 The other theories that are found in the Hippocratic collection, have 
 not now the importance of the two preceeding ; they are only met with 
 in a small number of works, sometimes in one alone. They were never 
 adopted by a large number of physicians, and must be considered as 
 the individual or particular opinions of some writers. A few of them, 
 however, have furnished the first suggestions of the great systems in- 
 vented at later periods, and on this account they merit special atten- 
 tion ; for they show us the origin and connection of the prevalent ideas 
 of past ages. 
 
 § III. Theoey of Fluxions. 
 
 This theory, one of the most simple that can be imagined, is regarded 
 as being anterior to Hippocrates. It is predominant in two treatises, 
 viz., those on the Eegions in Man, and on the Glands. A few extracts 
 from these two books will give us a sufficient idea of the doctrine. 
 
 It is said in the first, " Fluxions are caused by cold, which causes the 
 condensation of the tissues and veins of the head, if the cold strikes 
 them when they are heated ; then by their contraction the humors con- 
 tained in them are expelled. All the tissues are obliged to pour out 
 their fluids when they contract. The contraction of the skin, by com- 
 pressing the roots of the hairs, causes them to become erect. The 
 liquids thus compressed are diffused in every possible direction. 
 
 " Fluxions are also caused by heat, because the tissues become rarified 
 when they are heated, their pores enlarge, and the humor they contain 
 is attenuated, so that it flows easily when compressed. The greater the
 
 130 PHILOSOPHIC PERIOD. 
 
 rarification, the more the eiFusion, especially when the tissues are full of 
 humors ; what they can no longer contain, escapes. When a channel is 
 once formed, they pass off by it until the body, becoming dry, contracts 
 and closes the passage. As all parts are in communication, the moisture 
 that exists is attracted by the dryest. The body being permeable, it is 
 easy, in those parts which have not imbibed so as to augment their vol- 
 ume, to attract the humors ; especially is this the case, if the inferior 
 extremities are dry, the superior being charged with humidity ; for there 
 are more veins in the upper part of the body, than in the lower, and the 
 soft parts of the head are thinner, and need less humidity. The fluxion 
 in this way becomes easy from the moist parts toward the dry ; beside 
 this, all the dry parts attract moisture. Nor can it be denied, that the 
 humors tend downward, naturally, however light the force may be that 
 affects them." 
 
 It would be difficult to exhibit, in so few words, more ignorance on the 
 conformation of our tissues, and the laws of physiology and physics. It 
 will not be expected that I should seriously attempt to refute the gross 
 errors that are crowded together in these few lines. I will simply say, 
 that the body of man is there likened, sometimes to a sponge, which 
 absorbs water or allows it to escape, according to the degree of pressure 
 acting upon it; sometimes to a sieve, the pores of which are dilated by 
 heat, giving a free passage to the fluids, or contracted by cold, and pre- 
 venting their passage. There is no more mention of the organic or vital 
 forces, the effects of which are so manifest and wonderful, not only in 
 the human economy, but also in the vegetable, than if they did not 
 exist at all ! 
 
 The author of this book admits seven species of fluxions : the first 
 tends to the eyes ; the second to the nose ; the third to the ears ; the fourth 
 to the chest ; the fifth to the spinal marrow ; the sixth to the vertebra 
 and general tissues ; finally, the seventh, which flows slower than any 
 other, producing sciatica and rheumatism. In this way he explains the 
 origin of all diseases. 
 
 As to the treatment, it is worthy of such an etiology. I will quote 
 only one method, which will be sufficient to give an idea of others. " To 
 cure convulsions it is necessary to place a furnace of coals on each side 
 of the bed, and give an infusion of the root of mandrake, but not so 
 strong as to excite frenzy, and apply hot cloths to the ligamentum 
 nuchoe." The translators and commentators are much at a loss to find 
 any common sense in this passage, because the curative method laid 
 down is so absurd ; but they omit to notice, that that method proceeds, 
 naturally, from the etiology above given. In fact, if convulsions result
 
 SCHOOLS OF THE ASCLEPIADiE. 131 
 
 from too much humidity in the head, it is entii-ely natural that an 
 effort should be made to diminish this excess of humor, by a large sup- 
 ply of heated furnaces and hot bags. 
 
 I will complete the exposition of this theory, by some extracts from a 
 little monograph on the glands. The author commences thus: "The 
 structure of the glands is such as I have just stated. They are of a 
 loose, spongy nature, and of a fatty color. Their tissue is not like that 
 of other parts of the body, and may be distinguished from all other 
 parts by being granular. They have many veins. When they are cut, 
 the blood that flows out is whitish and watery. When handled, they 
 feel like greasy wool, and if strongly pressed between the fingers, a juice 
 oozes out, which looks somewhat like oil, and their organization is 
 destroyed. 
 
 '• The glands are found in great numbers in the interior of the body: 
 more numerous in the cavities than around the articulations. They are. 
 also, found in all moist and sanguineous regions. Some attract and 
 take up the humors that come from above, into the cavities, others absorb 
 those which are poured out in large quantities in the cavities themselves, 
 or those which are expressed by the working of the joints. Thus they 
 prevent the superabundance of humors in the tissues. Observe too, 
 that where there is hair, there are glands also. There is a connection 
 between the hair and the glands ; these attract the humors, as above 
 said ; the hair profits by it : it is developed by the nourishment which 
 the glands procure, and grows by leading outward the excess of humors. 
 In dry parts of the body we see neither hair nor glands." 
 
 A little further on, the author observes, that certain parts, as the 
 intestines and the omentum, have glands, but no hair, but he is not 
 embarrassed to explain this anomaly. "We see," he says, "that in 
 marshes and very wet places, the seeds do not germinate ; they perish, 
 smothered by excess of moisture. So in the intestines, the abundance 
 of fluids prevents the development of glands, and there is, therefore, no 
 hair." 
 
 These efforts to explain everything, often throws the best minds into 
 strange ramblings. We shall see many, and even celebrated examples 
 of it. The philosophers and physicians of antiquity would have 
 thought themselves without reputation, if they had announced a single 
 phenomenon without giving some interpretation of it. Eather than fail 
 in this, they made use of the most ridiculous explanations. The little 
 treatise that suggests these reflections is certainly not one of the worst 
 executed of the Hippocratic collection ; it exhibits its subject, on the 
 contrary, with all the details and comprehensiveness that the anatom- 
 ical light of that epoch would allow, yet what vagaries it contains !
 
 132 PHILOSOPHIC PERIOD. 
 
 One example more, and the last: " The head has glands ; the brain 
 itself resembles a gland, it is white, and divided into lobes, like glands. 
 It produces, also, the same effects, abstracting from the head, as before 
 said, the humors which there abound. The brain relieves the head 
 from humors, and distributes them to the extremities, by means of cur- 
 rents that flow in different parts. Observe, also, that the brain is larger 
 than the glands.^-'' The hair on the head is longer than elsewhere. 
 
 It is from the continued flow of the humors toward the head, which can 
 not contain them, as well as from their unceasing currents toward the 
 parts which need them for their nutrition, that proceed the alteration 
 of humors, and thus diseases. Either of these results, if not checked, 
 may exhaust nature entirely, although there are great differences in the 
 intensity of diseases." 
 
 § IV. Theories Founded on the Consideration of Two Elements. 
 
 The four elementary forms of matter described in the chapter before 
 the last, are so well determined, and so constantly referred to in all 
 these works, that it would be impossible to mistake them ; beside, no 
 ancient author has attempted to deny their existence ; but some have 
 assumed that only two of them are primitive elements, or even one 
 alone, the others being regarded as secondary. 
 
 I. In the little treatise, entitled, " On Fleshes, or the Origin 
 of Man," fire and earth alone, are designated as elements. Fire is 
 the active principle, which the author supposes to be endowed with 
 intelligence, wisdom, and will ; he confounds it with the soul of the 
 world, or God. The earth is the passive principle ; it receives, by the 
 action of fire, or its mixture with it, all the apparent forms of the body. 
 The physiology developed in this book is very odd, as the following 
 extracts show: 
 
 " I think that what we have called heat is immortal, that it knows, 
 sees, and understands all things in the past and in the future. When 
 all things were created, it was developed in lai-ger quantities in the 
 upper regions. The ancients, I believe, gave it the name of ether. The 
 other element, which remained below, is called the earth ; it is cold, dry, 
 in active motion, and contains much heat. The third part, which is 
 located in mid-air, is somewhat warm ; the fourth, which is nearest the 
 earth, is damp and crude. After all had been impressed with a circular 
 
 ' The author does not include the liver among the glands.
 
 SCHOOLS OF THE ASCLEPIAD^. 133 
 
 motion^ they became mingled, and much more heat accumulated in 
 some parts of the earth than in others. The quantity was consider- 
 able, but the volume was small." 
 
 " The earth, after a long time, becoming dry, a mould was found on 
 it, as is often on old clothes ; and after another very long lapse of time, 
 what there was of fat and moisture in this mould, proceeding from the 
 earth, being at last burned, formed bones. 
 
 " That which was sticky, and contained the cold element, could not 
 bum, though made hot, nor become moist. It then took a form differ- 
 ent from the rest, and was developed into solid nerves, for there was no 
 cold in them. 
 
 " The veins required much of the cold element. The exterior part of 
 this element, acted upon by the heat, formed a dense envelope and 
 became a membrane. The interior of the veins, melted by the heat, 
 became liquid. 
 
 " In this way, in man and in other animals, the wind-pipe, the 
 stomach, the abdomen, and intestines, all became hollow. 
 
 " The cold element continually growing warmer, the exterior was 
 burned and became an envelope or membrane ; the interior cold that 
 existed; being neither fatty nor viscous, became humid, and was changed 
 into a liquid."- 
 
 The author explains, after the same manner, the formation of all the 
 structures of the human body, their nature, nutrition, and various 
 functions. 
 
 "The brain," he says, "is the center of the cold element; the fat. 
 that of heat. 
 
 " The veins that come from the belly and the intestines, continually 
 attract or absorb what is thinnest, and most liquid in the food and 
 drinks. After the mixture has become heated, the grossest remains and 
 becomes excrement, and passes to the large intestine. The nutritive 
 substance, reaching the various tissues, is distributed, furnishing to each 
 what is to be permanent of its structure. These tissues, moistened by 
 the nutritious juice, all grow by the hot, cold, viscous, fatty, sweet, and 
 bitter elements. 
 
 II. The treatise on regimen, of which we have spoken in our article 
 on hygiene, includes a doctrine which is very analogous to the preceding, 
 but differs from it, in that water takes the place of earth, and is 
 a passive element. The author commences by discussing the prelimi- 
 nary knowledge necessary to write well, on the regimen of man, and 
 places in the first rank the knowledge of the human nature, of its 
 
 ~ Traite des chairs, ou du commencement de I'homme, §§ 2, 3, 4, 5, 6, 7. Gardeil.
 
 134 PHILOSOPHIC PERIOD. 
 
 origin, and the parts or elements that concur to form it. "If," he 
 says, " a physician is ignorant of what man is made at first, and what 
 predominates in him, how can he prescribe what may be useful to him." 
 After these general physiological considerations, on which he dilates at 
 large, he enters into his subject-matter as follows : " Man and all 
 animals combine, each in themselves, two principles, very different in 
 regard to their relative powers, but which concur for various purposes : 
 namely, fire and water. These two principles, alone, are sufiicient to 
 act on all the rest, and to maintain the general movements. One with- 
 out the other would not be sufficient for the animal economy, nor any 
 other being. Now I will state the powers of each. Fire is the source 
 of all motion, and water of all nutrition. Each one possesses certain 
 necessary qualities ; fire is hot and dry, water, cold and moist. They 
 borrow, also, qualities from each other ; fire borrows from water, humid- 
 ity, for there is in fire a humidity that comes from water ; water bor- 
 rows from fire, di-yness, for there is a dryness in water that comes from 
 fire. 
 
 " Nothing is entirely lost, and nothing new is made ; only different 
 combinations are formed. Men think that what is born comes from a 
 state of death, and what disappears, perishes, and that it is necessary to 
 rely more, in this matter, upon the senses than upon reason, in which 
 they are wrong. Listen to reason ! " The author then enlarges upon 
 this beautiful thought, but only spoils it by a miserable concoction of 
 physics and metaphysics. 
 
 At last, he comes to the generation of man, which he explains as fol- 
 lows : " The mixture of semen is vitalized by agitation, and it draws its 
 nourishment partly from different aliments, and partly from the air that 
 penetrates the body of the woman. At first, the mixture is entirely 
 homogeneous, but becomes swollen and rarified. It is next dried by the 
 action of heat, which renders it firm, and consumes its internal humi- 
 dity. That which is more firm in its nature, becomes compact and dry, 
 and still being acted upon by heat, it hardens, and forms what are 
 called bones and ligaments. Fire thus effects all the changes in the 
 body, according to the structure of each part, by means of its effects 
 upon moisture." 
 
 With this somewhat fantastic anthropogeny, the author attempts to 
 show connections, not less curious, between vital and astral heat. The 
 teat of the abdomen, which he terms the cavity of humidity, is, accord- 
 ing to him, under the influence of the moon: the heat which goes to 
 the surface of the body, to the fleshes, (tissues) , is similar to that of the 
 stars ; finally, the central heat of the body, which is carried by the vessels 
 from within outward, is the most potent of all ; it exerts an influence
 
 SCHOOLS OF THE ASCLEPIADiG. 135 
 
 analogous to that of the sun. " It is," continues our physiologist, 
 " this central fire which directs every thing, according to the laws of 
 nature, in an unseen, intangible, and noiseless manner. In it resides 
 the soul, the intelligence, prudence, augmentation, motion, diminution, 
 alternation, sleep, and wakefulness. It governs all things, every where, 
 and at all times ; being never in repose." 
 
 After making so poor an application of astronomical knowledge, he 
 next passes in review, the most common occupations of life, such as melt- 
 ing of metals, fulling, shoemaking, woodsawing, architecture, music, 
 and divining. He finds that each of these offers an imitation of the 
 regimen of man — a similitude with certain acts of the economy. For 
 example, in speaking of goldsmiths, he says, " the goldsmith washes the 
 gold, beats, and melts it in a moderate fire. Intense heat is not best 
 adapted to it. After being thus prepared, he employs it for every pur- 
 pose. So man gathers wheat, washes, grinds and bakes it, and employs 
 it for food, without using intense heat. It is submitted during diges- 
 tion, to a notable change, by the mild heat of the body." 
 
 When Empedocles reduced the primitive forms of matter to four ; 
 when Hippocrates put forth his beautiful theory of coction and crisis, 
 they both started on correct observations, both rested on the real rela- 
 tions, that a wise analysis had revealed to them ; whilst the inventors 
 of the two theories that we have just read, have established their syn- 
 theses, on false or trivial bases only, and by forced relations. They 
 were anxious to invent something new, but have only succeeded in the 
 hypothetical and ridiculous. It would have been much better to have 
 followed the already beaten track, thar. the vagaries of a wild imagination. 
 
 III. To the physico-physiological systems, in which only two genera- 
 tive principles are allowed for the whole body, responds the pathologi- 
 cal theory, according to which all diseases are supposed to proceed from 
 two humors only. This last predominates in the two principal treatises 
 on pathology, in the Hippocratic collection ; but it is not pure, and ex- 
 empt from admixture, for we see in them, also, the doctrine of four hu- 
 mors. The following is in substance, what we read in one of these trea- 
 tises: "all diseases, if they are internal, proceed from the bile or 
 phlegm ; if they are external, from various accidents — such as excessive 
 heat or cold, dryness or humidity. Melancholy, produced by black bile, 
 causes paralysis. '" A little farther on, we read, •' those whom atrabile 
 torments become diseased whenever the blood is overcharged by bile and 
 phlegm.'*f 
 
 ~' Traite des Maladies, livre premiere, Gardeil. 
 flbid.
 
 136 PHILOSOPHIC PERIOD. 
 
 The second treatise on pathology, in which the theory of two humors 
 reigns, is entitled " on Affections'' In this, we find the same mixture of 
 doctrines above stated, as may be seen by reading only paragraphs 1 
 and 36. 
 
 § V. Theory of Onk Single Element. 
 
 The physiologists who see in the animal economy only one element, 
 do not pretend to say, by this, that man is formed of a unique substance, 
 diversely modified, but they wish to inculcate, that among the elements 
 that enter into the constitution of man. there is one which predominates 
 over the rest, by its energy or its activity, and concurs in a preponderat- 
 ing, if not exclusive manner, to the production of physiological and 
 pathological phenomena. To establish the unity of the active forces 
 of nature, has been the dream of many physiologists and physicians ; 
 but up to this time, all the hypotheses conceived to this euu, have been 
 Utopian. 
 
 The Hippocratic collection includes two books in which the doctrine 
 of a " single element " reigns. One, a treatise on embryology, is en- 
 titled, " on the Nature of the Child," and is well executed and complete 
 enough for that epoch. It seems to be the conclusion of the book on 
 Generation. The other is a very short treatise on general pathology, 
 which has for a title, " On Air." The air, breath, or as the Greeks call 
 it, pneuma, plays the principal part in the two treatises, but its influ- 
 ence is considered in a much less clear and exclusive manner in the first 
 than in the second. 
 
 We read in the latter as follows : "An important thing to discover, 
 is the cause of diseases — the origin, the source of the evils that are 
 engendered in the body. "Whoever can comprehend the cause of a dis- 
 ease will be capable of curing it, by employing a remedy which is the 
 opposite of the evil from its commencement." 
 
 After having shown the necessity of going back to the cause of dis- 
 eases, to efi"ect their cure, the author continues i-hus : " The nature of 
 all afi'ections is the same ; they difier only in relation to their seat. I 
 think that they only show themselves under so many different forms on 
 account of the great diversity of parts where the disease is located. 
 Their essence is one, and so is the cause that produces them. But what 
 is this cause ? This is what I will endeavor to explain." 
 
 " The body of man is nourished by three things — food, drink, and 
 air ; he eats, drinks, and breathes. The air in the body is called spirit, 
 or breath ; that external to the body is called wind. It is the breath 
 that produces the greatest phenomena, and its influence merits all our
 
 SCHOOLS OF THE ASCLEPIAD^. 137 
 
 attention. Nothing can be done without air ; it is everywhere present ; 
 it fills the immense interval that separates the earth from the heavens ; 
 it is the food of fire ; how could fire subsist without it ? It could not 
 exist long. It is not difiicult to conceive that the interior of the sea 
 participates equally in its benefits. The animals that swim there could 
 not exist without respiration. There is nothing, in fine, that does not 
 feel its efiects.-'= 
 
 The author examines next, more particularly, the influence of the 
 breath for the support of human life. He observes that its influence is 
 uninterrupted ; that man may abstain more easily from drinking and 
 eating than breathing, from which he concludes that, air, being the thing 
 most indispensable to the human economy, is also that which occasions 
 in it the gravest and most frequent disorders. " Thus I can conceive 
 that the principle cause of disease is in the air. This may be too 
 strong or too feeble, or be precipitated in the body, or enter it charged 
 with miasms. It suffices to have established this as a general princi- 
 ple ; then, by descending into details, I will explain how each disease, 
 in particular, proceeds from the breath or air." 
 
 Because the air is one of the most necessary things to life, and if you 
 please, the most necessary, does it inevitably follow that it is the 
 unique source, or at least the most common source of diseases ? This 
 does not appear to me to be demonstrated. But I do not insist on this 
 general objection ; it is particularly in the face of facts or detailed 
 observation, that our systems are demolished. Let us see how the 
 pneumatic system stands this test ; this will dispense with the necessity 
 of longer argument. 
 
 The fever which supervenes after an improper diet, is explained, accord- 
 ing to this system, as follows : " Much food introduces necessarily much 
 air ; for the air enters more or less into the body, in proportion to the 
 quantity swallowed of liquids or solids. For this reason, wind is 
 belched up after eating or drinking too much. The air being thus 
 compressed, bursts the little cells in which it is contained, and mounts 
 upward. The body swells, by the excess of air, and the food remains 
 in the stomach, prevented by the great quantity of air from passing 
 into the intestines. The air is difi'used into all parts of the body, and 
 cools even the most sanguineous portions ; it goes even to the origin and 
 source of the blood, whence it is spread everywhere, and produces the 
 shivering that precedes fevers. The more air, the more refrigeration, 
 and the greater the shivering." 
 
 I will limit here my quotation ; the reader is, I think, sufficiently 
 
 ^ Traite des Vents, § 1. Gardeil.
 
 138 PHILOSOPHIC PERIOD. 
 
 edified on the value of this pathological system, by the explanation 
 which is offered for the first symptoms of fever. Let him guard him- 
 self, nevertheless, from sentiments of pity toward the ancients, on 
 account of the theoretical errors he discovers in their writings ; let 
 him remember that in regard to theory, even the most eminent moderns 
 are not exempt from illusions, which will, in a future day, excite the 
 smiles of those who shall look upon them in another and superior light 
 to ours. The deceptions of antique science should render us circum- 
 spect, and cause us to accept with reserve the assertions of cotempo- 
 raneous science. 
 
 § VI. Theory of Any Excedent. 
 
 We have seen, in the preceding chapter, synthesis pushed to its utmost 
 limit, and all the phenomena of the animal economy assimilated to each 
 other, and united by the bond of a common cause, notwithstanding 
 their infinite variety and enormous differences. But in order to arrive 
 at that, to perceive in the formation of man, in the development of his 
 parts and the exercise of his faculties, only the various modifications of 
 one single agent, such as air or fire, it was necessary to clothe this 
 material agent with imaginary faculties — to suppose it possessed of 
 instinct, intelligence, and will, which no observation could demonstrate ; 
 it was necessary, in short, to torture the facts, and create an ideal world, 
 such as is seen by those patients to whom all objects appear of the same 
 color. 
 
 These Utopias that the mind invents, by means of abstractions, in the 
 solitude of the cabinet, vanish, ordinarily, in the presence of the real 
 world, or phenomenal truths. To dissipate them, it is only necessary 
 that they be compared with daily observations — to test them by the 
 necessities of practice. This is done in a very creditable manner by 
 the author of the theory which we now proceed to examine. The work 
 which contains it is entitled, " On Ancient Medicine,'' and is justly 
 considered one of the most creditable of the collection. Going back 
 to the infancy of the Art, it developes its principles, traces its progress 
 with much sagacity, and indicates the best method to follow, to insure 
 its progress in the future ; it lays, in short, the true foundation of 
 medical philosophy. 
 
 The critics and historians are nearly unanimous in classing this 
 little work among the writings posterior to Hippocrates. M. Littre, 
 alone, of moderns, charmed by the excellent doctrines contained in this 
 book, is not willing that any other than that illustrious man shall have
 
 SCHOOLS OF THE ASCLEPIADiE. 139 
 
 the honor of its authorship." The principal document on which he 
 bases an opinion contrary to the common sentiment, is a passage from 
 Plato, in which that philosopher, without designating precisely the 
 book of Ancient Medicine, seems to make allusion to it. I avow, that 
 after having read the passage, and the learned commentary with which 
 M. Littre, accompanies it, I am still with the common opinion. 1 
 have preserved, also, in the passages which I quote from the book, the 
 translation of Gardeil, because it is on that translation that I made my 
 first study, and consequently it is better adapted to my arguments ; 
 besides, it does not differ materially from that of M. Littre ; for it is seen 
 by comparing them, that these interpretations express the same ideas in 
 diflferent forms.f 
 
 The author opens with an argument, in which he shows that Medicine 
 has not been founded on uncertain or obscure hypothetic opinions, but 
 on the manifest observation of the good or evil results which follow a 
 certain regimen and treatment, or action. He asserts, that the best 
 method for making any improvement on the discoveries of past times is,, 
 not to jump foolishly into eccentric and unknown ways, but follow with 
 perseverance the beaten route of experience, which alone will conduce to 
 real progress. 
 
 Like all the hypotheses emitted at that epoch, to explain the phenom- 
 ena of the animal economy, that of the four elementary qualities had for 
 
 "-' He expresses himself about it as follows: " The book, Ancient Medicine, so 
 remarkable for the correctness of judgment, and depth of thought, is no less so 
 in the beauty and excellence of its style. The arrangement is worthy of its 
 matter. The periods, generally long, are constructed with perfect regularity; 
 the members of the phrases are balanced and finished in a way to please the ear, 
 as well as the mind ; the style, clear, and full of truthfulness, is always grave and 
 firm, yet, nevertheless, it is enriched, (se colore) from interval to interval, in a 
 way that shows a writer, who, master of his subject and of himself, is restrained 
 within the limits of a natural taste. It is certainly a fine specimen of Greek 
 literature, and a finished model of scientific discussion, on the general and most 
 important points in Medicine." (CEuvres d'Hippocrate, De I'Ancienne Medicine, 
 page 56o.) 
 
 t I can only summarily indicate the reasons which make me take the common 
 view. 1st. The book of Ancient Medicine refutes the system of four elements, 
 which was that of Plato ; it proclaims the superiority of the experimental 
 method, and Plato, as we shall see hereafter, is the Corypheus of an entirely 
 opposite method. How then could this philosopher have proposed, as a model, a 
 doctrine contrary in all points to his own ? 2d. The passage in Plato, considered 
 in itself, seems to relate, according to Galen, as well to the book, on the Nature 
 of Man, as it does, according to M. Littre', to the work on Ancient Medicine. 
 (See the introduction to the CEvures d'Hippocrate, by M. Littre', t. 1, p. 294, et 
 3uiv., and to the first paragraphs of the book on la Nature de I'Homme.)
 
 140 PHILOSOPHIC PERIOD. 
 
 its support the most respectable authorities, such as Hippocrates, Plato, 
 Aristotle, and the majority of physicians ; but our philosopher boldly 
 attacks that hypothesis, and refutes it in an entirely special manner. 
 
 "All those," he says in the commencement, " who have undertaken 
 to speak or write on Medicine, and who have established their doctrines 
 on the hypotheses of cold or heat, of dryness or moisture, reducing thus 
 to one or two principles the causes of the death and diseases of men, are 
 manifestly mistaken in the greater part of the things that they have 
 advanced. I think, therefore, in this art it is not proper to have 
 recourse to vain conjectures, as is necessary in treating of things entirely 
 above our appreciation, and which are of no benefit to those who under- 
 take to discuss or write about them."" 
 
 After pointing out, rapidly, what it is necessary to avoid in the study 
 of Medicine, the author indicates, immediately, what it is proper to do, 
 and his entire method may be summed up by the following aphorism : 
 Observe attentively what is useful or injurious to health ; examine in 
 what each thing is good or bad ; but put no subtlety in this research ; 
 hold simply and purely to the testimony of the senses. 
 
 This method was not entirely new ; Hippocrates had alluded to it, 
 somewhat, in his work on the " Nature of Man," but it was not expressed 
 in terms as formal and explicit as are found in the work on Ancient 
 Medicine. The author of this labors constantly to join example to pre- 
 cept ; he appropriates to himself, in some degree, this method, by the 
 developement he has given it, and the proofs by which he sustains it. 
 
 " It seems to me, primarily," he says, " that in treating of the heal- 
 ing art. we must advance views, the accuracy of which every one can 
 appreciate, because the discourses and researches of physicians should 
 aim only at the diseases to which every one is subject. It is, therefore, 
 necessarily the observation of the manifestation of good or evil results 
 which has led to the search for and discovery of this Art. Indeed, it 
 has been discovered, by observing, that the sick were made worse by the 
 use of the same food that healthy men employ, which is still verified 
 every day. 
 
 " What difi'erence can be put between the invention of a man who has 
 marked out the regimen suitable to the sick, who practices what every 
 one calls Medicine, and who is recognized, generally, as a physician, 
 and the invention of him, who, in the earliest times, changed the 
 ancient, wild, crude food, for those various preparations of aliment now 
 in use. Tor myself, I think it is the result of the same method — a 
 similar discovery. The first led to the suppression of food, too gross to 
 
 '*De I'Ancienne Medicine. § 1, 3. Gardeil.
 
 SCHOOLS OF THE ASCLEPIADiE. 141 
 
 be assimilated, even in a state of health ; the second, has interdicted 
 aliment too indigestible in certain cases, considering the particular 
 circumstances. There is no other diflference. according to my view, 
 except that the field of the latter, being more varied and extensive, 
 requires, consequently, more discrimination aud experience ; but the 
 first invention is nevertheless the mother of the second."'-' 
 
 In this way the ajithor refers the creation of Medicine to the first 
 essays made by man to ameliorate the conditions of his existence. He 
 demonstrates that the same instinct, which led him, so early, to make a 
 choice among the articles of food at his disposal, prepare them by cook- 
 ing, and in various other ways, for the purpose of gratifying his taste 
 and rendering digestion more easy ; the same instinct, I repeat, also 
 suggested to him to seek means to alleviate pain ; and that experience 
 taught him, gradually, not to follow the same regimen in disease as in 
 health, and to employ for his restoration to health, a variety of means. 
 
 The first rules of hygiene and therapeutics, not being the fruit of 
 any hypothesis, but of experiment, he concludes that we may not hope 
 for perfection in these sciences, except by the experimental method. 
 "Every man," he cries out, "who rejects approved rules, and takes a 
 new path, and boasts of having added something to the art, deceives 
 himself, as well as others." He proscribes all the transcendental specu- 
 lations in which men were in the habit of indulging, in his times, on the 
 nature of man, and the essence of diseases. He regards them as a mere 
 amusement — a play of the imagination. 
 
 "There are," says he " certain sophists, among whom may be counted 
 even some physicians, who j)retend, that to comprehend Medicine well, 
 it is necessary, in the first place, to understand what man is in his 
 nature, how he was first made, and from what he was formed. For 
 myself, I think that all which the sophists wrote on the human nature, is 
 less useful to physicians than to the makers of books, and that we can 
 not hope to arrive at any certainty touching the constitution of man, 
 unless we obtain it by medical observations. All that is necessary for 
 any practitioner, who wishes to succeed in his art, to understand concern- 
 ing nature, is the relation of man to his food and drink, and the changes 
 which different kinds of these may effect in him." 
 
 We see with what sagacity our philosopher connects the question in 
 physiology with the experimental method. He does the same for the 
 problems of pathology and therapeutics. If it is required, for example, 
 to explain the generation of diseases, he does not have recourse to occult 
 causes, such as elementary fire, or radical moisture, but to causes apparent 
 
 * Traite de rAncienne Medicine, § 5.
 
 142 PHILOSOPHIC PERIOD. 
 
 and appreciable by everybody, such as excess of eating and drinking, 
 the fault in prepai-ation, or the bad quality of articles of food. He 
 does not deny that the excess of heat or cold, of dryness or humidity, 
 may become, in certain eases, the causes of diseases ; but he insists that 
 these primitive elements do not possess the character of morbid agents 
 in all affections, nor even in the greater number, and he proves it from 
 examples drawn from daily observation. % 
 
 " Let us take," he says, " a man of feeble temperament. Suppose he eats 
 grain from the garner, with raw flesh, and drinks jiure water ; this will 
 cause him much pain, his stomach will become deranged, his body waste 
 away, and he will not live long. What must be given to him ? Heat, 
 cold, dryness, or moisture ? If it is pretended that either of these ele- 
 ments has caused the disease, the cure is to be effected by employing its 
 opposite. The surest and promptest remedy will always be found to be a 
 change of food : to give bread instead of grain, cooked meat instead of 
 raw flesh, and to add wine to his drink. "=••■= 
 
 The substances on which man sustains himself are endowed with 
 secondary qualities, such as bitter, saline, sweet, acid, and many others, 
 the effects of which are more sensible, and more persistent than the 
 effects of the primary qualities ; from which, our author concludes that the 
 first more frequentl}^ give rise to diseases than the last. He represents 
 the action of the secondary principles, on the animal economy, as follows : 
 " There are in man, bitter, salt, sweet, acid, and a hundred other similar 
 humors of different powers, according to their quantity and degree of 
 energy. All these things, when well mixed and tempered by each other, 
 are harmless and unfelt ; but when one of them is separated, and ia 
 alone, it is felt, and makes great havoc in the body. It is the same 
 with articles of food ; those which are not fit for use, are either bitter, 
 salt, acid, or too strong; on this account they cause the same inconveniences 
 as the humors of which I have spoken ; but those which are suitable 
 for us, have none of these violent or excessively strong qualities." 
 
 In the other theories, no account is made of secondary qualities, 
 because they are regarded as simple compounds, but nothing proves that 
 they are so. No observation or analysis has shown how the bitter, salt, 
 sweet, and acid resulted from the combination of heat, cold, dryness, or 
 moisture. It was, then, just as rational to study the effects of secondary 
 qualities as those that were pretended to be primary. It was rational 
 to observe how each of these principles acted, either when manifested 
 spontaneously in the natural humors of the body, or when introduced 
 into the economy by alimentary substances. 
 
 '■* De I'Ancienne Medicine. § XL
 
 I 
 
 SCHOOLS OF THE ASCLEPIADiE. 143 
 
 The following extract shows the general course of action of these 
 violent humors, according to this system: " We have," says the same 
 writer, " as above shown, one example, among others, which seems to me 
 to be clear and conclusive. When we have a stoppage in the nose, from 
 a cold, and a cory'za supervenes, is it not true that this humor becomes 
 more piquant and caustic, in proportion to the abundance of the dis- 
 charge ; that it causes the nose to swell, which becomes inflamed and 
 heated to such an extent that the heat may be felt when the hand is 
 carried to it ? If the same fluxion continue long, the humor makes exco- 
 riations on this hard and fleshless part. This ardor is at length dissi- 
 pated ; but how ? Not while the humor flows, and there is inflammation, 
 but when the humor becomes thicker, less sharp, more concocted, and 
 perfectly tempered." 
 
 "It is the same for all the other derangements that I suppose to pro- 
 ceed from the acridity and severe nature of the humors ; they cease 
 only when the humors are all matured and tempered. How many times 
 do we see fluxions from the eyes, caused by every sort of acridity, which 
 ulcerates the lids, excoriates the cheeks, breaking up and destroying 
 even the thick membrane that envelopes the pujjil of the eye ! When 
 and how do pains and inflammations here cease ? It is only after the 
 humors have been matured, become denser, and have been changed into 
 purulent matter. Now this coction is eff'ected by the proper tempering 
 of the humors." 
 
 The author cites still other examples, and concludes in these terms : 
 " Must we not take, for the cause of a disease, that which, when appear- 
 ing in one form, is invariably followed by this disease, then, changing, 
 brings about a corresponding change in the state of the disease, and, at 
 last, by disappearing, leaves the patient without any affection." 
 
 The rule here laid down to discern the causes of diseases, is not as 
 well founded nor as infallible as the author thinks ; in following it with- 
 out discernment, we would be liable frequently to take for the cause of 
 a disease, that which is only an essential symptom or constant eff'ect. 
 Thus, in the examples reported above, the acrid humors which flow from 
 the nose in coryza, and from the eyes attacked with ophthalmia, are no- 
 thing more than symptoms or effects, that accompany these affections 
 nearly as constantly as the shadow does the body. The author is then 
 mistaken in supposing these humors to be the causes of the concomitant 
 diseases, and the pathogenetic rule that he has laid down admits of many 
 exceptions. Nevertheless, his theory is less erroneous than any of the 
 preceding that I have cited, because it never, or very rarely ever, for- 
 sakfes observation ; while the others, disregarding observation, lose them- 
 selves almost immediately in the shadowy field of fictions. If it is
 
 144 PHILOSOPHIC PERIOD. 
 
 untrue, to say that the humors which flow from the eyes and nose when 
 these organs are diseased, are the primary causes of the disease, it is 
 nevertheless certain that these humors give rise, at least, to some second- 
 ary accidents, such as ulceration of the lids, and margin of the nose, etc. 
 They are thus at once cause and eiFect, as are all organic phenomena. 
 
 Neither has the author of the Treatise on Ancient Medicine totally 
 overlooked the solid parts of the body ; he says something of them in the 
 last paragraphs, and insists on the necessity of studying their structure 
 and configuration. If the reader finds the reflections of our physiologist, 
 on this subject, deficient in development and depth, I shall not deny it ; 
 but I will say, that it is also necessary to bear in mind the little ad- 
 vancement of the lights of his age on this branch of physiology. It must 
 be recollected that at that epoch descriptive anatomy was in its infancy, 
 and that pathological anatomy did not yet exist, from the impossibility- 
 of making regular dissections. This writer has done all which was pos- 
 sible to do in this respect. By insisting on the necessity of acquiring 
 positive notions concerning the form and structure of organs, he has 
 traced the route that should be followed, and which since has success- 
 fully been done. 
 
 Moreover, he did not overlook the influence of the vital force or the 
 organic reaction on the development, progress, and termination of dis- 
 eases. He speaks of it more or less explicitly in several places ; notably, 
 when he recommends particular attention to be paid to the crises and 
 critical days. 
 
 Thus, then, as I announced at the commencement of this chapter, we 
 find in the book on Ancient Medicine, precious researches on the origin 
 and progress of the Art ; a reasonable development of the experimental 
 method already advised by Hippocrates ; the largest jjathogenetic system 
 which had yet appeared — a system, in short, which may be summed up 
 as follows : the causes of diseases must be sought in every agent that 
 afiects our constitution beyond certain limits, whether coming from with- 
 out or residing within us. 
 
 § VII. Resume of the Hippoceatic Theories. 
 
 The first of these theories, that of coction and crisis, is founded on 
 the capital observation that there exists in the organized body an in- 
 trinsic force, diff"used in all its parts, creating a mutual sympathy, and 
 harmonizing their various functions for a common end, by a kind of 
 instinct. One of the most distinct characters of this force is its inter- 
 mittence in regard to some of these functions, which is never seen in 
 brute forces. These intermissions, which are seen in certain diseases,
 
 SCHOOLS OF THE ASCLEPIAD^. 145 
 
 produce in them periods, more or less regular, named critical periods 
 or ci'ises. But there are also many diseases in which these periods do 
 not occur, or are not appreciable ; and the fault of the ancient Hippo- 
 cratists consisted in extending the theory of crisis to all pathology. 
 
 Force, or vital forces, would appear to be inherent to the organs, 
 being dependent entirely or in part on the constitution of these ; it was 
 then essential to study that constitution ; but the Asclepiadce were pre- 
 vented from proceeding to that study, by cotemporaneous prejudices. 
 
 On the other hand, the vital or organic forces act upon the substances, 
 liquid, solid, or gaseous, whether existing in the body or coming from 
 without. These substances, endowed with properties more or less ener- 
 getic, modify the functions of the organs, which made it necessary for 
 the physician to be acquainted with their properties. Now, as physics 
 and chemistry, which alone can furnish this knowledge, were too incom- 
 plete to afford the ancient physiologists but vague or false notions, the 
 medical theories varied much in this respect. 
 
 The greater part of the naturalists of antiquity, recognised four pri- 
 mary forms of matter, and pretended to derive from them all the physi- 
 cal properties of the body. In like manner, the majority of the phy- 
 sicians supposed four cardinal humors, on which depended all the phy- 
 siological and pathological phenomena. 
 
 Again, a small number of naturalists recognised but two, or even 
 one element ; and also, following their example, a few physicians would 
 only admit two physiological elements, and again, others only one. 
 
 In the midst of this conflict, a few men, more attentive, and less pre- 
 judiced, made the observation, that there is no proof that all material 
 substances proceed from one or two, or four elements only, and that no 
 one has ever seen the combination of a given dose of heat, cold, dryness, 
 and humidity, engender either bitter, acid, sweet, or any other pretended 
 secondary quality. They concluded that this division of the physical 
 properties of bodies into primitive and secondary, was false, or at least hy- 
 pothetical, and were desirous that only dogmas, which are experimentally 
 demonstrated, should be admitted into the science. This was calculated 
 to provoke a theoretic reform, for which the age was not yet prepared. 
 We shall see its advent in the next period. 
 
 The Medical School of Cos, after Hippocrates. 
 
 The eclat that Hippocrates had given to the teaching of the Ascle- 
 piadse of Cos, survived him : many members of his family followed in 
 his footsteps, and sustained the honor of his school. Among others, 
 may be mentioned Thessalins and Draco, his sons, and Polybius, his
 
 146 PHILOSOPHIC PERIOD. 
 
 son-in-law, to whom are attributed some of the writings that form a 
 part of the Hippocratic collection. 
 
 Not long after them, Diocles of Carystus flourished in the same 
 schools, who was surnamed by the Athenians, the second Hippocrates, 
 and Praxagoras, of Cos, the last of the Asclepiadae, of whom mention 
 is made in the history of medicine. Both composed several works that 
 are entirely lost. Praxagoras, who is supposed to have belonged to the 
 family of Hippocrates, was distinguished principally for his anatomical 
 knowledge. He supposed, like Aristotle, that the veins originated at the 
 heart. He did not confound these vessels with the arteries, as many of 
 his predecessors, and Hippocrates himself, had done. He supposed they 
 only contained air, or the vital spirit. It is thought that he dissected 
 the human body. 
 
 Praxagoras was the first to remark the close connection between the 
 changes in the pulse, and the dynamic state of the economy. He was 
 also the first who attempted to give an explanation of that singular 
 phenomenon, and thus laid the foundation of sphygmology, for before 
 him, medical men had not given this much attention. The Hippocratic 
 works rarely allude to the arterial pulsations, among the symptoms of 
 diseases, and when spoken of, only a secondary importance is attached 
 to them. But, ultimately, the observations of Praxagoras became a 
 fruitful source of indications ; this order of signs was even greatly 
 exaggerated, as always happens in great discoveries, and efi'orts were 
 made to build on this unique foundation, an entirely new system of 
 semeiology. 
 
 The reigning theory in the school at Cos, as we have before said, was 
 that which made the health depend on the exact proportion of the ele- 
 ments of the body, and on the perfect combination of the cardinal 
 humors — the blood, bile, phlegm, and atrabile. Thistheory was generally 
 attributed to Hippocrates. According to it, all diseases proceed from 
 one of the four elements, heat, cold, dryness, or moist, the excess of 
 which engendered some humor badly concocted, or too abundant, which, 
 by extravasation from its natural reservoirs, passes into parts not 
 habituated to its presence. The equilibrium is established by the coction 
 and evacuation of the piccant humor. This doctrine, which was taught 
 almost exclusively, until the foundation of the school at Alexandria, 
 constituted the ancient Dogmatism, so named, doubtless, because it em- 
 braces the most anciently professed dogmas in medicine. 
 
 Amongst the most famous sectators of the Hippocratic Dogmatism, 
 we shall name two philosophers, Plato and Aristotle, whose opinions 
 have exercised a great influence on the march of the human mind in 
 general, and particularly in respect to medicine.
 
 SCHOOLS OF THE ASCLEPIADJ5. 147 
 
 ART. I. PLATO. 
 
 The first of these philosophers was endowed with a lively and bril- 
 liant imagination, and clothed with the charms of a seducing language, 
 the purest morals in paganism. In lending to the grave teachings of 
 Socrates, the graces and liveliness of his spirit, Plato secured for them 
 immense popularity, and an eternal duration, which they would not, 
 perhaps, have obtained without these foreign ornaments. But we have 
 not to consider here, either the profound moralist or elegant writer, 
 worthy of the surname of the Swan of the Academy ; we can only 
 occupy ourselves with Plato in his character of physician, and especially 
 in that of physiologist. 
 
 Let us see, in the first place, what mode of acquisition he employed 
 in the study of the physical sciences. We shall let him speak for him- 
 self. " Very well," he says, in the Phsedon, " is anything more rational 
 than to think by the thoughts alone, disengaged from all foreign or sen- 
 sible agency ; to apply at once the pure essence of thought in itself, to the 
 research of the pure essence of each thing in itself, without the ministry 
 of the eyes and ears, without, in short, any intervention of the body, 
 whose slightest influence only troubles the soul, and prevents it finding 
 wisdom and truth. If we arc ever to attain the knowledge of the 
 essence of things, must it not be in this manner?" '■■■= 
 
 It is clear, from what we have just quoted, that Plato undertook the 
 study of the physical diseases, not by method of observation and exper- 
 iment, but by that of pure meditation — by mental intuition. The 
 following passage proves that he applied that method, not only to meta- 
 physics and morals, but also to physics and physiology: "During my 
 youth," he continues, '• 1 had an intense desire to learn that science 
 which is termed physics. I felt that it would be sublime to know the 
 cause of each thing ; what created, destroyed, and sustained it in exist- 
 ence. I was tormented, in a thousand ways, by my efibrts to learn 
 whether it is the cold and hot elements in a state of corruption, as some 
 pretend, which form animated beings; if it is the blood, or air, or 
 fire that causes us to thiak, or whether it is either of these, or the brain 
 alone, that produces in us all our sensations, sight, hearing, and smell, 
 which, in their turn, produce memory and imagination ; which, by reflec- 
 tion create science. I reflected, also, on the decomposition of all these 
 things, of the changes which take place in the heavens and the earth, 
 and at last would find myself confused and wholly disqualified for such 
 researches."! 
 
 ^ (Euvres completes de Platon, translated by M. Cousin, page 203. 
 t Ibid., p. 273.
 
 148 PHILOSOPHIC PERIOD. 
 
 The meditations of our philosopher having resulted in no positive 
 knowledge touching the questions that he was anxious to understand, 
 he did not deduce therefrom the very natural consequence, that it was 
 possible that he might have followed a false course, and that the method 
 which conducts most certainly to the discovery of abstract truths, such 
 as the axioms of metaphysics, and morals, was not as sure to attain the 
 knowledge of material things, of the truth of observation. •'•' Plato 
 never suspected the excellence of his method, and he was never tempted 
 to try any other ; thus despairing, he returns to the origin of things, to 
 explain in what their essence consists, when, having heard read in a 
 book of Anaxagoras, the following proposition : mind is the regulator 
 and 'principle of all tilings — " this idea," he says, " struck me like a 
 stream of light." 
 
 Nothing more was necessary to inflame the imagination of the phi- 
 losopher of the Academy, and create in his brain an entirely new system 
 of physics. See how he reasons : " Since the intelligence is the first 
 cause of all things, it must have ordered all things for the best possible 
 end ; then, if any one desires to find the cause of everything, how it 
 originates, perishes, or exists, he has only to ascertain to what end such 
 thing is destined. Therefore," he adds, "I comprehend no longer, 
 all the other learned causes that are offered us, but if any one 
 comes to tell me what it is that makes a thing beautiful, or gives it 
 liveliness of colors, or forms, or other similar things, I leave aside all 
 these reasons, which only perplex me, and I assume, myself, without plan 
 or art, and probably too simply, that nothing gives beauty but the 
 presence or communication of the original beauty, in whatever way this 
 coummunication may take place on this subject. I afiirm nothing, ex- 
 cept that all things beautiful are beautiful by the presence of beauty. ''■\. 
 
 The reason which Plato has given for the beauty of things, naturally 
 recalls that famous response of the schools of the Middle Ages, to the 
 question. Why does opium produce sleep? Because it possesses the sleepy 
 principle. But the passage we have just quoted, merits the attention of 
 the reader for more serious reasons ; for it shows how and why the con- 
 sideration of final causes was introduced into the natural sciences ; a 
 consideration that has played an important part in more than one sys- 
 tem of physics and physiology — one of the most unfortunate results of 
 
 * This is not the place to examine if the same mode of acquisition is applicable 
 to all branches of human knowledge, as many ancient and modern philosophers 
 have thought. This important question will become more proper in another 
 chapter, where we shall treat it with all the consideration it merits. 
 
 fCEuvres Completes de Platon, page 283.
 
 SCHOOLS OF THE ASCLEPIAD^. 149 
 
 which has been to divert the human mind from the path of observation 
 and experiment, and lull it into a species of quietism, extremely con- 
 trary to the progress of light. 
 
 But without anticipating the results that the Platonic method was 
 destined to produce — results which we shall hereafter see develope them- 
 selves — let us be content, for the moment, with examining the benefit 
 that Plato himself realised from it, in regard to the explanation of natu- 
 ral phenomena. As all parts of his philosophy are intimately connected, 
 as is the case in that of Pythagoras, I shall be compelled to say some- 
 thing of his cosmogony before exposing his physio-pathologic ideas : and 
 if I am not always able to shed upon these abstract matters the clear- 
 ness I would desire, I pray the reader to remember that the subtle 
 Aristotle himself, the assiduous auditor of Plato, sometimes found the 
 conceptions of his master too difiicult to follow. It is in the dialogue 
 entitled Timseus, that the founder of the Academic sect has deposited the 
 products of his meditations touching the nature of created beings in 
 general, and of man in particular ; and it is from it that we extract the 
 following summary. 
 
 Plato, like Pythagoras, maintained the idea, that God and matter 
 existed from all eternity ; but that matter in itself had no form, prop- 
 erty, or force. God gave it, from the beginning, a triangular form ; 
 afterward, taking a certain number of primitive triangles, he composed 
 the four primary elements, which we, in this lower world, term fire, air, 
 earth, and water. Fire, which is the most subtle, is made up of the 
 smallest number of triangles ; it has the figure of a pyramid. The air 
 represents a solid of twelve faces, a dodecahedron. Water has the form 
 of an icosahedron, or a solid of twenty faces. Finally, the earth, the 
 heaviest of all the elements, constitutes a hexahedron, that is to say, a 
 perfect cube, composed of right-angled triangles. 
 
 Thus, Plato, having borrowed from the philosopher of Samos the 
 dogma of the homogenity of matter, went yet farther than he in the field 
 of hypothesis, for he attempts even to determine the primitive figure 
 that the Creator must have given to atmospheric matter. He pretends 
 that this figure is a triangle, because, of all the surfaces, the triangular 
 is the most simple, and there is no geometrical figure which may not be 
 divided into triangles. 
 
 AVhile matter remains in its elementary state, it does not affect our 
 senses in any way. For matter to become perceptible, it is necessary 
 that several elements unite, and form an aggregate. Thus all the mate- 
 rial substances which we know, and to which we assign particular names, 
 result from the assemblage of various elements. Water, for example, 
 which we see, feel, and employ in so many various ways, is not elementary
 
 150 PHILOSOPHIC PERIOD. 
 
 water. The liquid body which we call water is, according to Plato, 
 a compound, in which the aqueous element enters in a much larger 
 proportion than the other elements. 
 
 This philosopher also admits, with Pythagoras, the existence of diflfer- 
 ent orders of created spirits. He says, that the Supreme Intelligence 
 charged the secondary gods with the formation of mortal animals. 
 These gods, having received from the hands of the Celestial Father the 
 immaterial principle of the human soul, fashioned a body for it with 
 the most regular and polished of the primitive triangles. This lumin- 
 ous and incorruptible body, which envelopes the immaterial soul, was 
 placed in the brain of man. The gods endowed, also, the visible and 
 grosser body of the animal with another, mortal soul, the seat of the 
 violent and fatal passions. This occupied the length of the spinal mar- 
 row, leaving between it and the divine soul, the interval of the neck, 
 for fear that the two substances, of a nature so different, being too 
 closely connected, the least pure might tarnish or embarrass the other 
 by its contact. 
 
 " Therefore," says the same author, " the gods placed the mortal soul 
 in the chest and the trunk ; and as this soul contains a good and bad 
 principle, they divided the cavity of the trunk into two departments, 
 just as is done with the apartments of males from females, by means of 
 the diaphragm, placed in the middle as a partition. Isearer the head, 
 between the diaphragm and the neck, they placed the manly and coura- 
 geous, or bellicose principle of the soul ; so that being submitted to, and 
 in concert with the reason, it may restrain the revolts of the passions 
 and desires, when these are unwilling to be controlled by the influences 
 which reason sends down from its citadel. 
 
 " That portion of the soul which requires food and drink, and all 
 that the nature of our body renders necessary, is located between the 
 diaphragm and the umbilicus. The gods have extended it over this 
 entire region, like a rack, where the body may find its food. They have 
 confined it there, like a ferocious beast, which it is necessary, neverthe- 
 less to feed, so that the mortal race may subsist. 
 
 " The authors of the human species having foreseen that we would 
 be intemperate in eating and drinking, and that by gormandizing we 
 should exceed very much the limits of what is proper and necessary ; 
 therefore, in order to prevent us from destroying ourselves at once by 
 diseases, and for fear that the race would thus soon become extinct, they 
 arranged what is termed the lower bowels, to serve as a receptacle for 
 the superfluous food and drinks, and they surrounded it with the folds 
 of our intestines, for fear that the aliment, by passing too rapidly 
 through the body, would create, too soon, the necessity for its renewal,
 
 SCHOOLS OF THE ASCLEPIAD^. 151 
 
 which in making us insatiable gourmands would divert us from the 
 cultivation of philosophy, and the muses, and from the obedience we 
 owe to that which is Divine, within us." 
 
 Plato enumerates this way the principal parts of the body, and sup- 
 poses that he had sufficiently explained the manner in which each one 
 was generated, when he announced its functioms ; or, to use his own 
 expression, when he enumerated their final causes. But I think I have 
 shown enough to convince the reader of the emptiness and nothingness 
 of this kind of explanations, in the physical sciences. 
 
 As to the physiology of the same author, it is extremely succinct, and 
 limited to some generalities. It emits no new idea, no principle, which 
 has not been explicitly developed in the Hippocratic works, with the 
 exception of the idea of elementary triangles, that Plato found means 
 to bring in everywhere. "The nature of diseases," he says, "has 
 something in common with that of animals. They are developed within 
 a limited period, the same as each species ; each animal is born to live 
 for a certain determined period, barring the accidents that may occur ; 
 for the triangles which constitute each animal are disposed to last for a 
 certain length of time, beyond which the animal can not survive. It is 
 the same with diseases ; but if they are disturbed before a fixed time, 
 by the employment of remedies, the smallest grow larger, and a single 
 one attracts many. It is better to treat them by regimen, as far as 
 possible, and not disturb them by medicines. Let this suffice for the 
 animal and his corporeal part." 
 
 In bringing out some of the physico-psychical naivetes of Plato, I am 
 far from desiring to cast ridicule on the conceptions, sometimes bold, 
 but always brilliant, of one of the most splendid geniuses of antiquity. 
 1 am aware that seen in the lights of his age, the fictions of this philo- 
 sopher are not as eccentric as they appear to us at first sight, since they 
 have been reproduced in many writings, in totality or in part, almost 
 as far down as our times ; but I wish to show by a great example, in the 
 first place, that the introduction of final causes into Physics and Medi- 
 cine, has only been a source of deceptions ; next, that the purely specu- 
 lative method, so exact and fruitful in mathematics, has only led to 
 futile dreams, and the play of the imagination, the sublimest minds 
 that have attempted, by this method, to seek the properties of matter, 
 and the explanation of the phenomena of nature. This will be more 
 and more apparent, as we advance in this history, and new examples, 
 not less illustrious than the preceding, will come to confirm this. I 
 will deduce, for the present, two practical results : first, that it requires 
 above all things, to choose a good method by which to acquire and culti- 
 vate the sciences ; second, that every system of physics, or of medicine,
 
 152 PHILOSOPHIC PERIOD. 
 
 ■whicli does not repose on accessible facts, or tlie immediate appreciation 
 of the senses, is, at least, very hazardous, for where the senses can not 
 penetrate, imagination reigns as sovereign. 
 
 Philosophers point out two principal modes of acquisition : the one. 
 which they name logical, or rational, consists in establishing, at the 
 commencement, some general propositions, or abstract principles, whence 
 they deduce, by reasoning, the solution of all particular causes : thus, in 
 mathematics is deducsd from the axiom, "two quantities equal to a 
 third, are equal to each other," the solution of a multitude of problems. 
 So, also, from the following moral principle, " do unto others, as you 
 would have them do unto you," the casuist deduces a mass of special 
 precepts. Plato, who knew no other method, is then, very excusable for 
 having pretended to derive an entire system of cosmology and physio- 
 logy, from that antique dogma : the Supreme Intelligence has ordered 
 every thing for the best possible ends." 
 
 The other mode of acquisition, called the empirical, or experimental, 
 consists in observing, first, a great number of particular cases or phenome- 
 na, comparing them with each other, and noting their similitudes and 
 differences ; finally, to express what they have in common, by general 
 or abstract propositions, which constitute axioms. In this way, Hip- 
 pocrates, having seen, time and again, patients who had many parts of 
 their body affected, yet complained of one only, deduced from his obser- 
 vations, the following aphorism : "in two simultaneous pains, the more 
 intense obscures the other ;" and so the natural philosophers, having 
 observed that water rises in the body of a pump, in proportion as the 
 piston is withdrawn, a little too hastily concluded that nature abhors a 
 vacuum. 
 
 The first method, it is seen, proceeds from generals to particulars, 
 from the abstract to the concrete, from the axiom to the phenomenon : 
 the second, on the contrary, advances from particulars to generals, from 
 the concrete to the abstract, from the phenomenon to the axiom. Both 
 methods have their advantages, their inconveniences, and their proper 
 uses. Far from being opposed to each other, as has been pretended, 
 these two methods fortify and enlighten each other, and the truth never 
 takes hold of us in a more irresistible manner, than when it is attained 
 by both routes at once. Certain ideologues have erroneously called the 
 first method, the synthetic, and second, the analytic : the words synthesis 
 and analysis, employed in this acceptation, make nonsense, as has been 
 well remarked by a modern metaphysician, and as I shall demonstrate 
 hereafter myself.--' 
 
 * See end of the volume — tlie doctrine of Barthez on the Vital Principle.
 
 SCHOOLS OF THE ASCLEPIAD^. 153 
 
 ART. II. ARISTOTLE. 
 
 Aristotle was bom at Stagyrus, a city in Macedonia. Having lost 
 his father at an early age, he was, though a mere youth, abandoned to 
 himself, and expended his patrimony in dissipation. At first he fol- 
 lowed the career of arms, but soon becoming disgusted with this pro- 
 fession, he left it to resume the favorite studies of his early youth — 
 philosophy and medicine. 
 
 The teachings of Plato at that time shed a splendid influence ■ over 
 Greece. Young men flocked to Athens, from all parts, to hear him. 
 Aristotle went also, and showed himself one of his most assiduous and 
 constant auditors. His ardor in study was incredible ; he consecrated 
 to it entire days, and a great part of the nights. It is said that he 
 was obliged, for a living, to take a place in the shop an herbalist, and 
 doubtless he gave medical advice, also, according to the habit of the 
 pharmacopolists of those times. Thus, the philosopher of Stagyrus, the 
 future chief of the Peripatecian sect, belongs to the history of Medicine 
 in several respects, namely, by his birth, and early education : for he 
 was the son of a physician, and received from his father the first ele- 
 ments of science ; secondly, by the profession he practiced during 
 many years of his life ; thirdly, by researches in comparative anatomy 
 and physiology ; finally, by his philosophic doctrine, which maintained 
 its empire for so long a time, over every branch of human knowledge. 
 
 When Philip, king of Macedonia, whose finesse and political discern- 
 ment became proverbial, wishing to give a preceptor to his son Alexander, 
 then fourteen years of age, fixed his choice on Aristotle, and wrote to 
 him on that occasion that well known letter, which not less honors the 
 monarch than the philosopher, we all know how well the young prince 
 responded to the hopes of the father, and the lessons of the master. 1 
 shall say nothing here of the invincible hero who overran and con- 
 quered Asia ; but I must not be entirely silent in regard to him, as an 
 impassioned amateur of science and letters, who, in the midst of the 
 embarrassments of the vastest government of the world, and unceasing 
 wars, maintained with his preceptor a scientific correspondence, and not 
 only furnished him the necessary funds to foiTQ the first known museum 
 in natural history, but also occupied himself in the collection of animals, 
 plants, and every sort of rare objects, which he transmitted to him from 
 the depths of Asia. 
 
 Thanks to the munificence of his royal pupil, Aristotle was in a con- 
 dition to gather an immense collection of the products of nature — a 
 fruitful mine whence his genius drew an incredible mass of observations, 
 that antiquity never surpassed, in many particulars, and which has 
 10
 
 154 PHILOSOPHIC PERIOD. 
 
 been the astonishment of all ages. Certain critics, not being able to 
 explain how a single man was able to treat so great a number of sub- 
 jects, and shed so much light on the greater part, have suspected Aris- 
 totle of having wickedly destroyed the writings of his predecessors, so 
 as to appropriate their discoveries to himself, just as they accused Hip- 
 pocrates of having set fire to the temple of Cos, with the design of 
 destroying the archives whence he had drawn the materials of his 
 works — pure calumnies, which fall before the slightest examination, 
 and of which all history has made itself the eternal echo. Every one 
 should read, in the introduction to the Hippocratic works of M. Littre, 
 the natural explanation that this learned philologer gives of the loss 
 of a multitude of ancient works, without resorting to hazardous con- 
 jectures against the best established reputations. But the founder of 
 the Peripatecian sect, so far from leaving unmentioned the names of the 
 authors who had written before him on the same subjects, quotes them 
 on nearly every page — he often gives their opinions, and many of them 
 are indebted entirely to his quotations for the advantage of having 
 escaped entire oblivion. 
 
 The earliest philosophers who meditated on the origin of our know- 
 ledge, or the manner in which we acquire it, and the degree of cer- 
 tainty which it offers, were greatly shocked at the frequent and gross 
 errors into which we are drawn by the senses, while they were agreeably 
 surprised, and marvelled at the character of infallibility that certain 
 abstract truths presented, and particularly those that belong to mathe- 
 matics. To give only one example of this contrast, but one which is 
 everywhere known, do not the most remote astronomical observations 
 demonstrate that the sun and the moon have, in reality, dimensions enor- 
 mously greater than their objective appearance would lead us to suppose ? 
 From this example, and an infinity of similar ones, philosophers drew 
 this general indication, that the senses transmit false, doubtful, or 
 illusory impressions, and that the soul, to attain the possession of truth 
 and certainty, must isolate itself as much as possible from the inter- 
 vention of the body, and reflect within itself. Hence arose the contem- 
 plative philosophy that Pythagoras recommended in secret to his dis- 
 ciples, and which Plato taught publically, with all the prestige of his 
 imagination and eloquence. 
 
 Nevertheless, men who devoted themselves to the study of physical 
 phenomena, physicians, above all others, could not question the neces- 
 sity of the intervention of the senses, to obtain a faithful image of these 
 phenomena. Daily experience demonstrated to them how vain are the 
 anticipated conceptions of the mind touching the operations of nature. 
 Each day new deceptions came to lead them to mistrust the principles
 
 SCHOOLS OF THE ASCLEPIAD^. 155 
 
 established a priori ; for these principles conducted them to conse- 
 quences that the facts frequently contradicted. Thus, we have found 
 in the Hippocratic collection, authors who proclaim the necessity of 
 banishing from medicine all hypothesis, and holding to immediate observ- 
 ation only ; authors who say that there is no fixed principle of treat- 
 ment; that the cure of diseases is efibcted sometimes by contraries, 
 sometimes by similars, and sometimes in other ways, without our being 
 able to say in virtue of what principles.-' These are, evidently, empiri- 
 cal maxims, but mere isolated ones, simple perceptions, which consti- 
 tute neither a system nor a method. 
 
 It was reserved for the greatest naturalist of antiquity to lay the 
 first philosophic basis of empiricism ; Aristotle, in emitting his famous 
 axiom, " all ideas come from the senses," {nihil est in intellectu quod non 
 prius faerit in sensu,) introduced into science a new principle, in mani- 
 fest contradiction to the revered dogmas of Pythagoras and Plato. It 
 is, then, very important to know how the chief of the Peripatecians 
 would justify, from the beginning, the bold principles which became, two 
 thousand years later, the germ of a scientific revolution. f 
 
 We read, in the treatise on Analysis, " It appears that all animals have 
 received, from nature, the faculty of sensation and judgment ; but after a 
 sensation has been produced, some preserve the remembrance of it, and 
 others do not. Those who retain no reminiscence of the impressions, have 
 no idea of the things, beyond immediate sensations. Those, on the con- 
 trary, whose soul retains some trace of passed sensations, can, at the 
 end of a great number of such, reason from the recollection which they 
 keep of them. In this way, the memory comes from the faculty of feel- 
 ing. The remembrance of a thing often repeated creates experience, and 
 experience, that is to say, every general notion which becomes fixed in 
 the soul, relative to the common properties of certain things, abstrac- 
 tion made from their difierences — this notion, I say, is the principle of 
 science and art."| 
 
 In another work, the philosopher of Stagy rus recalls the distinction 
 that he has just established between animals which have memory, and 
 
 ^Traite des Lieux dans I'Homme. Traite de I'Ancienne Me'decine. 
 
 fThis principle was not entirely new, since Plato makes allusion to it in the 
 passages we have cited, when he asks himself if it is not the brain that 
 produces all our sensations, " which produce, in their turn, the imagination and 
 memory, whose operations at last develop science." But Plato scarcely deigned 
 to pause and consider the opinion, while Aristotle adopted and developed it. 
 
 JAristotelis Opera Omnia quae extant Grajce et Latine. Authore Guiilemo 
 Duval. Lutitise Parisiorum, anno M. DC.XIX. Analyticorum posteriorum, lib. 
 n, cap. XIX.
 
 156 PHILOSOPHIC PERIOD. 
 
 those whicli have not ; he adds, that the first are susceptible of educa- 
 tion, while the others possess instinct only. Finally, he says that man 
 alone is capable of instruction and reason ; after which he continues in 
 these terms : "To deduce, from a great number of experiments, a uni- 
 versal idea on an entire class of similar objects, this constitutes art. 
 Thus, to possess the knowledge that a remedy has been useful in a certain 
 disease, in the hands of Callias, Socrates, and several others, is experi- 
 ence ; but to know that such a remedy is good for all individuals of the 
 same species, attacked by a given affection, for example, for all men 
 who are tormented with phlegm, bile, or a hot fever, this is what con- 
 stitutes art. "'••■= 
 
 Might not we believe, in reading these fragments, that they are ex- 
 tracted from some chapter of the modern school of sensualists ? How 
 then does it come that Condillac, one of the coryphas of this school, 
 could write the following lines : " Long ago it was said that all our 
 knowledge originated in the senses. Nevertheless, the Peripatecians 
 were so far from knowing this truth, that notwithstanding the minds of 
 several had appreciated, they were unable to develop it ; so that for 
 several ages afterward it was still a discovery to be made. I am igno- 
 rant of the motive of Aristotle, when he advanced his doctrine on the 
 origin of human knowledge ; but I do know that he has left no work in 
 which this doctrine is developed, and that, besides, he sought to be in 
 everything the opposite of the opinions of Plato." f 
 
 The best excuse that can be given for the epigrammatic insinuation of 
 this last phrase of Condillac is, that he had never read, or had com- 
 pletely forgotten the passages of Aristotle that I have quoted above. 
 There arc yet other discoveries, claimed by moderns, the germs of which 
 are found in the writings of this prince of ancient philosophers. The 
 philosophic doubt, for example, which forms one of the pillars of the 
 method of Descartes, is clearly indicated by Aristotle, when he says. 
 "Men who desire to learn, must previously know how to doubt; for 
 science is only the resolution of previous doubts ; but he who does not 
 know the knot is unable to untie it." J The doubt that Aristotle has 
 recommended is very different, as is plain, from that which the Pyrrhor- 
 nian or Zetetique sect professed. The latter regarded doubting as the 
 highest degree of science ; the Peripatecian, on the contrary, saw only 
 in it, the first step toward the light — a simple disposition of the soul 
 to elevate itself to the intelligence and demonstration of the truth. 
 
 *Opera Omnia, Metaphys., lib. i. cap. i. 
 
 t (Euvi'es completes cle Condillac — analytical extract from the Traite des Sensa- 
 tions. Paris, 1798. 
 
 I Metaphys., liv, ui., chap. i.
 
 SCHOOLS OF THE ASCLEPIAD^. 157 
 
 Having thus established clearly the claims of Aristotle, as the founder 
 of the sensualist or experimental doctrine, it remains to show in what 
 particular he afterward separated himself from the doctrine, and esta- 
 blished a method diametrically opposite to that of modern sensualists. 
 To show this I will recall the second axiom emitted by this philosopher, 
 on the development of ideas. " The first ideas," he says, " that the 
 sensations create in our minds, are general ones." Here, we observe. 
 the ancient school of the sensualists is entirely separated from the 
 modern, and here, also, commences their antagonism. It is, then, essen- 
 tial to examine upon what considerations Aristotle rests, in advancing 
 such a maxim. He involves in the support of this proposition, the case 
 of a man, who, perceiving at a great distance an opaque mass of vague 
 or undetermined forms, conceives, at first, the general idea of some kind 
 of a body. Then, as he approaches this mass, and sees it moving auto- 
 matically, he conceives the idea of an animal ; then, finally, when he is 
 near enough, he will not only recognize of what species this animal is, 
 but, also, if he gives attention to certain marks, and particular quali- 
 ties, he will be able to distinguish it from every other individual of the 
 same species ; in this way he obtains his individual ideas. It is thus, 
 according to this philosopher, that the human mind advances from the 
 most general notions, to those that are particular and individual. He 
 also cites the example of a little child, who calls all men papa, and all 
 women mamma ; but as he grows, his ideas become special, and he learns 
 to discern his father and mother from all other persons.'-- 
 
 The argument of Aristotle is captious, and may deceive mere than 
 one reader. It will not, then, be out of place, I think, to recall here 
 the manner in which Locke, one of the chiefs of the modern school of 
 sensualists, explains the succession of our ideas, and the progress of our 
 knowledge. " The ideas," says this writer, " which children form of 
 persons with whom they are familiar, arc similar to the persons them- 
 selves, and are only special ones. The ideas they have of their nurses 
 and mothers, are very well defined in their minds, and, as so many faith- 
 ful pictures, represent to them only those individuals. The names that 
 they give them, at first, are limited to them ; thus the names of nurse 
 or mamma, which children employ, are CQnnected entirely to these per- 
 sons. But after they acquire a greater knowledge of things, and observe 
 that there are several other beings, who, in respect to figure, and other 
 particulars, resemble their fathers, mothers, and other persons that they 
 arc accustomed to see, they form an idea which includes, also, these 
 
 *^ Aristotle, On Analysis, 2e partie, chap, ii and xix. Natural Principles, lir. 
 I, chap. I ; and in several other books.
 
 158 PHILOSOPHIC PERIOD. 
 
 particular beings, and they call them with all others, men. In this way 
 he obtains a general name, and a general idea. In doing so, however, 
 they form nothing new, but separating themselves from the complex 
 idea they had of Peter, of James, Mary, and Elizabeth, and which was 
 particular to each of them, they retain what is common to them all." =•■' 
 
 The last two quotations, one taken from the writings of Aristotle, the 
 other from those of Locke, oflFer us the curious spectacle of two meta- 
 physicians, who, starting with the same principle, that all ideas are 
 derived from the senses, separated immediately, to follow opposite routes : 
 the one pretending that the first ideas formed in our minds, by the inter- 
 vention of the senses, are general ones ; the other affirming that they 
 are always individual in their character. But it is easy to see, that 
 Aristotle, in the sample that he gives, confounds obscure, vague, and 
 undetermined ideas with general ideas, which is a grave mistake, and 
 scarcely conceivable on the part of such a logician as he. Thus, when 
 I say, that the whole is greater than any one of its parts, I express a 
 general idea very clearly ; instead of that, if I perceive an object very 
 distant, not being able to distinguish its form, I have only an individual 
 idea, and that vague and confused. This divergence, so slight in appear- 
 ance, and nearly imperceptible at first sight, nevertheless, misled in a 
 very unfortunate manner, the philosopher of Stagyrus, and plunged him 
 into an inextricable labirynth of sterile subtilties. Let us follow him 
 for a few moments, in this mistaken route, and see where he ends, rela- 
 tive to the physical and medical sciences. 
 
 From the moment our philosopher believed he had proved incontestibly, 
 that general ideas are the first that are formed in the human under- 
 standing, he deduced from it the conclusion, that the study of all the 
 sciences must commence in generalities, or axioms, which he named on 
 that account, principles or elements, and then must pass to particular 
 or individual notions — to the phenomena. So, after having assigned to our 
 ideas an origin, entirely diiFerent from Plato, he proceeds to advise the 
 same didactic method, the same mode of acquisition that he does. Apply- 
 ing this erroneous method to the study of physics, Aristotle commences 
 by asking how many principles there are in nature. He exhibits all the 
 opinions emitted before him on this thorny subject, and after having 
 discussed them, one by one, he ends with the following conclusion, which 
 I translate literally : " Every body knows that the principles or elements 
 exist in antagonism, and it is perfectly reasonable ; for principles can 
 not produce each other, nor be produced by any thing ; every thing, on 
 
 '^ Locke's Essay on the Human Understanding, book iii, cliap. in, § 7. See 
 also Condillac, Essai sur I'Oriuine de nos Conuaissance, sec. 5.
 
 SCHOOLS OF THE ASCLEPIADiE. 159 
 
 the contrary, proceeds from them. Thus, we have exhibited what forms 
 the essence of first oppositions — on the one hand, they proceed from 
 nothing, being original ; on the other, they do not mutually produce 
 each other, becaus:- they are antagonistic.-' 
 
 Immediately after, he proves, by an argumentation of the same force 
 that natural principles are in number, two or three, namely, the opposi- 
 tion of heat and cold, of dryness and moisture, and finally, the base, or 
 the subject on which these two primitive oppositions must exercise their 
 energy, to which he gives, in another place, the name of ether. 
 
 Aristotle admits, moreover, four elements, fire, air, earth, and water. 
 which he believes susceptible of mutual transmutation, and whose laws 
 he describes. Above them, in the most elevated zone of the heavens, 
 floats a fifth element, so called, because it moves rapidly, and eternally 
 in a circle. This was the first and most divine of all the elements, the 
 only one which is imponderable, and immutable ; the only one which 
 was original in its character, being the ofi"spring of none, and yet the 
 basis of all."f 
 
 "We have seen that Plato endeavored to explain all the phenomena of 
 nature, by the consideration of final causes only ; but Aristotle, who 
 piqued himself on being more exact, assigned to each phenomenon, four 
 causes, namely, the material, formal, efficient, and final. Thus, the clay 
 which the potter uses to fabricate a vase, is the material cause of that 
 vase ; the model, or mould after which he forms it, the formal cause ; 
 the potter himself the efficient cause ; and lastly, the purpose for which 
 it is destined, the final sause.J 
 
 If some of my readers find these details on the Peripatecian philoso- 
 phy a little too technical — if they do not comprehend what utility the 
 remembrance of these subtile and superannuated distinctions can have 
 for medical men of our times, I pray them to consider that the greater 
 part of the writings of the ancient and middle ages are more or less 
 imbued with them ; so that it would be impossible to read those writ- 
 ings, and particularly the history of medicine, without having at least 
 a superficial notion of the doctrine of Aristotle ; for the medical theory 
 of Gralen, which has reigned in the schools down to our own era, is a 
 patent deduction from it. With this short digression, I pass to consider 
 matters which have a connection, more or less direct, with medicine. 
 
 Faithful to his method of commencing by principles, Aristotle 
 
 "CEuvres d'Aristotle, Des Principes Naturel, liv. i, chap. vi. 
 
 f Aristotle, Traite tlu ciel, liv. i, chap, ii, iii, liv. iv, chap, v ; also in Traite de 
 la Generation, et de la Corruption, liv. ii, chap. iv. ; also on Traite des Me'teores, 
 liv. I, chap. in. 
 
 I Aristotle. Des Principes Naturel, liv. 11, chap, ni., et suiv.
 
 160 PHILOSOPHIC PERIOD. 
 
 approaches physiology in the most obscure manner. He inquires, in the 
 first place : What is the nature of the soul — what are its faculties and 
 functions ? To his view, the soul constitutes the essence of all living 
 bodies, vegetable and animal. It is simple, indivisible, and resides in 
 whole in each part of the organized being, as one may assure himself, 
 he says, by dividing a plant, and even certain animals, called insects : 
 for after the division, the separate parts continue to have the same life 
 as the whole structure, which proves that each of them contains the 
 soul integrally.^"-' 
 
 The soul is endowed with four primitive faculties, viz : the nutritive, 
 or vegetative, the sensitive, motive, and intellectual. The first three 
 reside equally in all parts of the body, and they are inseparable. The 
 last one — that is to say, the intellectual or contemplative — being of a 
 difi'erent species, must have, says our physiologist, a distinct and par- 
 ticular seat. Aristotle does not say positively where its locality is, but 
 we may infer, from various passages in his writings, that he regarded 
 the heart as the special residence of the intelligent soul.f 
 
 The vegetative faculty presides over nutrition and reproduction. It 
 is indispensable to all things that are born, live, and die, and is common 
 to plants and animals. The sensitive faculty, on the contrary, exists 
 only in the latter, of whom it constitutes the essence. Vegetables are 
 deprived of it, because they are formed of only homogeneous parts ; 
 that is to say, they originate from one element alone, whilst animals are 
 formed of organic parts, i. e., are composed of various elements. 
 Among animals, there are some which have the faculty of locomotion ; 
 others are deprived of this ; and lastly, according to him, a very small 
 number of the animal species appear to be endowed with intelligence 
 and reason. J 
 
 This physiologist had no distinct notion of the locomotive apparatus ; 
 moreover, he confounded the tendons and ligasnents with the nerves, as 
 we shall show presently, and he designated the muscles by the term 
 flesh. § 
 
 He places the principle of the motive faculty in the centre of the 
 body, for the reason that, in every object that moves, it is necessary 
 that there be a fixed and immovable point which shall serve to sustain 
 all the other parts, and give them impulse. || 
 
 See how the desire to give a reason for every thing may lead minds of 
 the keenest perception to offer words void of sense, for veracious and 
 
 " Traite de I'ame, livre i, cli. ix. | Aristotle. On the Soul, 
 
 f Sprengle. History of MeJicine. || Du movement des Animaux. 
 
 §De la Locomotion. Histoire des Animaux.
 
 SCHOOLS OF THE ASCLEPIADJG. 161 
 
 grave explanation ! We have already seen examples of this, and we 
 shall see many more in the course of this history. In place of observ- 
 ing carefully the natural phenomena, and describing them with the 
 greatest possible exactness, man always seems to prefer to carry his 
 judgment beyond sensations; and this is the source of the greatest 
 errors in the domain of physics. Aristotle regards heat and humidity 
 as the two conditions indispensable to life; the duration of which, 
 according to him, is generally proportionate to the volume of the fluids. 
 It is on this account, he adds, that large animals live longer than small 
 ones. That rule, however, is subject to many exceptions, of which the 
 author himself cites examples ; but he is not embarrassed to explain 
 them.^' 
 
 He had no idea of the true functions of the brain, though he describes 
 that viscus much more minutely than any of his predecessors. The fol- 
 lowing are his remarks : " That which is first found in opening the head, 
 is the brain, and it is placed in the anterior part. All animals possess- 
 ing a brain, that is to say, all those which have blood, as well as those 
 of the order of molusca, have it generally placed in the same position ; 
 but the brain of man is much more considerable than that of other ani- 
 mals, proportionably to the size of his body, and is also the most humid. 
 The brain is enveloped in two membranes ; that nearest to the cranium 
 is the strongest — the other, which rests immediately upon it, is weaker. 
 The brain is always composed of two lobes, independently of the cere- 
 bellum, which lies beneath, and whose form and structure differ from 
 that of the brain. There is usually a little cavity in the middle of the 
 mass of the brain ; its substance is naturally cold to the touch, and 
 neither veins nor blood are ever found in its interior ; but the membrane 
 which envelopes it is full of veins. f 
 
 There is nothing in all this which refers to the elevated functions of 
 the encephalic organ. Aristotle did not even suspect them; for he 
 places, as we have just seen, the seat of the soul and of sensation in 
 the heart. 
 
 Nor did he know better the functions of the nervous system, what- 
 ever Sprengle, the historian, may say, who attributes to him very gratui- 
 tously, in my opinion, the discovery of that apparatus. J 
 
 Let every one judge by the following extract : " Let us speak now of the 
 nerves," says the Greek naturalist; " they proceed also from the heart, 
 
 "De la longueur et de la brievete de la vie, chap. v. De la jeunesse et de la 
 vieillesse, de la vie et de la mort, chap. iv. 
 
 f Histoire des Animaux, trud. by Camus, Paris, 1783. 
 
 I Sprengle, Histoire de la Medicine, translated into French by Jourdan. Paris, 
 181.5, T. I, p. 384.
 
 162 PHILOSOPHIC PERIOD. 
 
 that viscus containing nerves in its structure — in its largest cavities ; 
 and what is termed the aorta is a nervous vein, whose extremities are 
 nothing else than nerves. At the points where these extremities termi- 
 nate around the joints of bones, they are not hollow, and are suscep- 
 tible of the same tension as the actual nerves. But the difference 
 between the nerves and the veins is, that the nerves do not proceed 
 without interruption, from one unique substance to all parts of the body, 
 like the veins. The nerves, on the contrary, are distributed on all sides, 
 and to the articulations of the bones. If they proceeded from the same 
 trunk, their continuity would be apparent in emaciated animals." 
 
 " The principal nerves are those of the ham, on which depend the 
 power of leaping ; then another double nerve, called the tendon ; then 
 the extensor and the nerve of the shoulder, which contribute to the 
 strength of the body. No particular name is given to the nerves which 
 belong to the articulations, because all articulations of the bones are 
 bound together by the nei'ves. In general, the nerves are found in 
 great abundance around the bones, except the bones of the head, which 
 are united by sutures." " 
 
 It is evident that in this entire description, Aristotle describes, under 
 the name of nerves, only tendons and ligaments. But Sprengle formed 
 his opinion on the following paragraph: "In the space between the 
 eyes we find three canals which go to the brain ; the largest, the middle 
 one, proceeds to the cerebellum ; and the smallest, the one which is near- 
 est the nose, leads to the brain. "| 
 
 He infers from this phrase, that very probably Aristotle had observed 
 the optic and olfactory nerves in fish, where they follow this direction. 
 "Whether or not this naturalist has observed a few nerves, it is never- 
 theless certain that he did not at all infer their functions. 
 
 Aristotle is rich enough in his own merits, without needing to be 
 adorned with the plumes of others. No man in antiquity studied and 
 searched out more things than he, and no one introduced into science so 
 many new facts. To keep to our subject, we assert that, though he 
 never dissected human corpses, he nevertheless corrects many errors 
 on the anatomy and physiology of man, in the Hippocratic collection. 
 For example, he refutes the opinion of Polybius, who supposed that the 
 veins commence at the occiput, from which they descend in pairs the 
 length of the anterior, lateral, and posterior surfaces of the body ; he 
 asserts that they originate at the head. He combated also the opinion 
 
 '■•■ Aristotle, History of Animals, livre in, chap. v. 
 
 f Sprengle, History of Medicine, t. I, p. 38. Aristotle, History of Animals, 
 livre I, chap. xvi.
 
 SCHOOLS OF THE ASCLEPIAD^. 163 
 
 that a part of the fluids drank went directly to the lungs, for the pur- 
 pose of cooling them." 
 
 As he had dissected a considerable number of animals of every spe- 
 cies, he compares, with a sagacity astonishing for his era, the organic 
 apparatus by means of which each of them lives, propagates, and fulfills 
 the various functions to which it is destined. In speaking of the heart, 
 for instance, he signalized the varieties of form and structure that this 
 organ presents amongst quadrupeds, birds, reptiles, fishes, etc. He does 
 the same in regard to the digestive tube, the lungs, and the other organs 
 successively. He does not group together, according to the method of 
 naturalists, all the characters that appertain to the same species of ani- 
 mal, so as to distinguish each of them from all the others ; yet his method 
 is not less philosophic nor less fruitful in interesting ideas ; he presents 
 the history of each apparatus of each organic function successively, and 
 shows the varieties and shades in the whole range of the animal scale. 
 In a word, he created comparative anatomy and physiology ; and the 
 plan that he traced is so appropriate to the subject, that, twenty centu- 
 ries later, George Cuvier did not choose another. 
 
 If the founder of the Peripatecian sect can be reproached for hav- 
 ing propagated a taste for scholastic subtilties, it must be acknowledged 
 also, that he has furnished an example of patient and attentive observa- 
 tion of nature. His history of animals is a treasure of curious details 
 on the manners and habits of that class of beings, their modes of fecun- 
 dation and incubation, and their diseases. His disciples, excited by his 
 example and his counsels, cultivated with a praiseworthy zeal, anatomy, 
 physiology and natural history. Theophrastus, his successor, was the 
 most eminent botanist of antiquity. Their reputation in that class of 
 studies, was so well established, that an ancient satirist makes Mer- 
 cury say, in showing a Peripatecian, whom he wishes to sell, 
 " behold a man who can tell you, in a moment, the duration of the life 
 of a fly ; to what depth the rays of the sun penetrate the sea ; and what 
 is the nature of the soul of an oyster ; he will recount to you, a quantity 
 of other things, more difficult still, on the semen, generation, and the 
 manner in which the fetus is formed in the womb of the mother, "f 
 
 Plato and Aristotle were among the ancients, the most eminent 
 propagators of two antagonistic opinions, that have divided philosophers, 
 from the origin of science. One of these opinions supposes all our 
 knowledge to be derived from mental intuition, without the intervention 
 
 '^ History of Animals. 
 
 fLuciani Opera — towards the end of the dialogue entitled, Vitarum Anctio ; p. 
 108, edition of Bourdelat. Paris, 1605.
 
 164 PHILOSOPHIC PERIOD. 
 
 of the senses ; the other claims that all our ideas are due to sensations. 
 We shall see these two scientific methods, so to speak, parallelly increase, 
 and become more perfect, without either obtaining any decided preemi- 
 nence over its rival. Both count amongst moderns, partisans of the 
 highest intelligence. It will suffice to name Descartes, Leibnitz, and 
 Kant, for the spiritual school, and Bacon, Locke, Hume, and Condillac. 
 for the sensualist school. We shall, in the course of this history, make 
 it our duty to study, and compare, seriously, the opinions and methods 
 professed by both of these schools, being well convinced that it would 
 be neither just nor reasonable, to agree, exclusively, with the dogmas of 
 either, before diligently examining the teachings of both ; and if my 
 confreres in medicine accuse me of separating myself from my subject, 
 by according too much space to the examination of medical philosophic 
 methods, I reply in this aphorism of the most learned interpreter of the 
 doctrine of Cuvier : " the first question in all science, is always a question 
 of method." 
 
 RESUME OF THE PRIMITIVE PERIOD. 
 
 During the short period through which we have just passed, we have 
 seen medical science, stripped of its mystic veil, take, suddenly, a rapid 
 bound. The principal foundations of its edifice have been laid, and we 
 see appear an outline of each of its parts, which is to form, at a later 
 period, a vast structure — an outline whose totality offers already an 
 imposing, although somewhat vague, aspect. " Antique science," as M. 
 Littre most eloquently says, " has a great resemblance to modern science. 
 From the epoch which we are forced to regard as the aurora of medicine 
 — from the first memorials that we possess of it, the fundamental ques- 
 tions are debated, and the limits of the human mind are touched. But 
 within these limits, science finds an immensity of inexaustible combi- 
 nations, the materials for its growth."* 
 
 This remark is as true of philosophy, as of medicine. Plato and 
 Aristotle indicate to us two sources whence flow all our natural knowl- 
 edge ; but do not both of them lead us into error, by proclaiming in an 
 exclusive manner, as a mode of acquisition, the one mental intuition, 
 the other exterior observation ? 
 
 Hippocrates forms the transition period between the preceding periods 
 and this ; he belongs equally to mythology and history ; for, if some 
 circumstances of his life, and some of his works are authentic, the 
 greater part are doubtful, or controverted. His doctrine was received 
 by his cotemporaries, and by posterity, with a veneration which resem- 
 
 '■' (Euvres d'Hippocrate. Paris, 1839. lutroduction, p. 567.
 
 SCHOOLS OF THE ASCLEPIADiE. 165 
 
 bles a worship, no less, probably, on account of the real merit of his 
 doctrines, than by reason of the mystery which shrouds his birth. After 
 him, no physician has ever obtained an homage so elevated, so constant, 
 and so universal. Very soon, anarchy prevailed in the midst of the 
 school which he had rendered celebrated ; a crowd of methods and theo- 
 ries were surreptitiously propagated there, under the shadow of his 
 name and authority ; so much so, that as a result, it became impossible 
 to discern, in the midst of so many writings and facts, placed to his 
 account, what was really legitimate of all that was imputed to him. 
 
 Medical science, in changing its locality, proceeds also to change its 
 aspect. After a few years of confusion, we shall see medical men divided 
 into three great sects, which will struggle with each other during 
 several ages, with balanced success, and end by uniting with, or becom- 
 ing embosomed in the most powerful.
 
 166 ANATOMICAL PERIOD, 
 
 IV. ANATOMICAL PERIOD. 
 
 COMPRISING THE PERIOD OF TIME WHICH EXTENDS FROM THE FOUNDATION OF 
 THE ALEXANDRIAN LIBRARY, SOME THREE HUNDRED AND TWENTY YEARS BE- 
 FORE CHRIST, TO THE DEATH OP GALEN, IN THE YEAR TWO HUNDRED, OP THE 
 CHRISTIAN ERA. 
 
 GENERAL CONSIDERATIONS. 
 
 It was truly a royal idea, and worthy of the successors of Alexander, 
 that of collecting together all the intellectual riches of the universe, 
 and jilacing them at the disposal of studious men, who were desirous to 
 use them for their improvement, and the advancement of science. 
 
 In order to conceive all the grandeur and munificence of such a crea- 
 tion, it is necessary to recall under what circumstance it was undertaken, 
 It should be remembered, that manuscripts were then extremely rare, 
 and consecj^uently of an exorbitant price ; that of the greater number of 
 works there were but veiy few copies, and often one only, so that those 
 who possessed, would not part with them easily, and scai'cely allow 
 copies even to be made. All the literary treasure of a family consisted 
 often of one work only, and fewer families yet were in possession of such 
 a heritage. Before the foundation of the libraries of Alexandria and 
 Pergamos, there is no mention made of any considerable collections of 
 books, except those of Pericles and Aristotle. In such a state of things, 
 the inferior classes of society were deprived of all written instruction, 
 and a poor man was able to acquire, except under very extraordinary 
 circumstances, only a very limited degree of knowledge. 
 
 Under such circumstances, the establishment of a library, accessible 
 to the public, was an act of philanthropy and liberality, above all eulog)'. 
 It was, at the same time, one of those happy creations that immortalize 
 a reign — an epoch, and that concur to consolidate a dynasty ; for the 
 good that they produce, and the gratitude they inspire, extend to the 
 latest posterity. It does not belong to me to refer to the political advan- 
 tages of which such an institution is the source ; besides, others have
 
 GENEKAL CONSIDERATIONS. 167 
 
 acquitted themselves of this task so well, as to leave nothing to desire 
 on that subject." 
 
 But, to indicate, in brief, the influence that the foundation of public 
 libraries must have exercised upon ancient civilization, it would be suffi- 
 cient for me to say that it has been compared, very justly, to that which 
 the art of printing has exerted on modern civilization. 
 
 Two of the lieutenants of Alexander appear to have conceived the 
 same project about the same time, so that it is now very difficult to 
 decide, to which of the two belongs the priority. One was Eumenes, 
 governor of Pergamos and Mysia ; the other, Ptolomy Lagos, who had 
 command of Egypt. At the death of the conqueror of Asia, the generals 
 that he placed at the head of the provinces of his vast empire, shook off 
 all dependence on the central government, and endeavored to consoli- 
 date their authority in every possible way. The greater number turned 
 their attention entirely to arms, either to maintain their own govern- 
 ment, or to invade those of their colleagues. The sovereigns of Alexan- 
 dria and Pergamos were the only ones, amongst so many captains, who 
 occupied themselves with the interests of commerce and arts, and it was 
 about that time, that they laid the foundation of the first two public 
 libraries. They took hold of the enterprise so actively, that they, and 
 their immediate successors, within about a century, had gathered two 
 hundred thousand volumes for the library at Pergamos, and six to seven 
 hundred thousand for that at Alexandria. This last was divided into 
 two parts, which were called the great and little library. The first 
 contained nearly four hundred thousand volumes, and was located in 
 the quarter named Bruchion, near the Museum and the palaces, and in 
 the neighborhood of the port, where the grain ware houses were situated ; 
 the second was in the temple of Serapis, or Serapium, situated in a dis- 
 tant quarter, nearer the center of the city. 
 
 It is not possible, from the above enumeration, to form an exact idea 
 of the accumulated riches in these two great book depots ; for writers 
 differ very much, when on the subject of estimating the volumes, or rolls 
 of the ancients, compared with modern books. Some presume that the 
 six hundred thousand Alexandrian volumes represent two hundred 
 thousand of ours ; others one hundred and twenty thousand ; others 
 ninety thousand. However it may be, litei-ary collections of such 
 magnitude were a wonderful and happy result under the circumstances. 
 The kings of Egypt, and those of Pontus, felt perfectly, what eclat such 
 
 ^^ Notably M. Matter, author of the History of the School at Alexandria, from 
 whom we have borrowed the major part of the details we here furnish on that 
 school.
 
 168 ANATOMICAL PERIOD. 
 
 institutions would throw upon their capitals and their names. At first, 
 their efforts to collect works, excited a praiseworthy rivalry, but this 
 subsequently degenerated into a contemptible jealousy, in some of their 
 successors, which led the sovereigns of Alexandria to interdict the 
 exportation of papyrus, so as to prevent their emulators of Pergamos 
 from being able to make copies of manuscripts. This illiberal prohibi- 
 tion had a contrary effect than was expected, for it led to the invention 
 of the paper of Pergamos, otherwise called parchment, the use of which 
 became general, and displaced, advantageously, the bark of the papyrus. 
 Nevertheless, the institute of Alexandria always preserved a great 
 superiority over that of Pergamos ; it had especially a marked influence 
 on medical studies, and merits, on that account, a particular notice on 
 our part. 
 
 CHAPTER I. 
 THE SCHOOL OF ALEXANDRIA. 
 
 The chief of the dynasty of the Lagides, Ptolomy Soter, was not 
 contented with collecting, at a great expense, an enormous quantity of 
 books ; he felt also the necessity of having order and choice in his col- 
 lection. To effect this, he called around him men, the most renowned 
 for their erudition, and gave them residences near the library, and cre- 
 ated a revenue for their maintenance. Some were charged with the 
 classification, collation and annotation of the manuscripts ; and the 
 copies that underwent this labor of revisal were then entered in the 
 catalogue. Other savans, equally at the expense of the State, occupied 
 themselves with the investigations and studies of their taste, being con- 
 fined to no particular task ; only, they were required to meet together 
 on certain days, to deliver lectures and discuss various subjects. The 
 king himself sometimes took a part in these re-unions, by proposing dif- 
 ferent questions for solution, and taking part in the discussions. 
 
 These re-unions became still more frequent and formal under Ptolomy 
 Philadelphus, son and successor of Soter. They were called ludi musa- 
 rum et ApoUinis, literary contests or feasts, and the palace where they 
 were held was named the Museum. Often the subject for discussion was 
 announced beforehand. Those who succeeded best, received public eulo- 
 gies and rewards proportionate to the merit of their compositions. All 
 the savans, artists and professors, that lived in Alexandria, were not 
 lodged in the Museum, nor pensioners of the king ; that honor, and the 
 privileges which were attached to it, were accorded to a very small num- 
 ber. Amongst those who enjoyed it, under the reign of the first two
 
 SCHOOL OF ALEXANDRIA. 169 
 
 Lagides, only two physicians are named, viz : Herophilus and Erisistra- 
 tus. The latter, it is said, was the grandson of Aristotle, and pupil of 
 Theophrastus. He did not reside in the capital of Egypt till the close 
 of his life ; for it appears that, in his old age, he retired to Smyrna, 
 where he founded a school. 
 
 It was under Philadelphus that the Hebrew savans were charged with 
 the translation into Greek, of the Holy Scriptures ; and it is well known 
 that the translation they made, called the Septuagint, has always been 
 highly esteemed. An Egyptian priest always presided over the museum, 
 so that the Alexandrian Institute included the debris of the antique sci- 
 ence of Egypt, the doctrines of the Jews, and the more recent compo- 
 sitions of the philosophers and literati of Greece. Besides, the sover- 
 eigns of Egypt sent more than one expedition into the interior of Africa, 
 along the coasts of the Eed Sea, and as far as the East Indies, to make 
 discoveries and establish relations in the interests of commerce and the 
 sciences. Thus the torch of civilization, which had anciently shone 
 upon the banks of the Nile with a mysterious and isolated light. 
 returned, after being increased and vivified at the free fires of the geniug 
 of Greece, to shed an eclat more resplendent than ever on its early 
 cradle ; and thus the city of the Ptolomies became not only the entre- 
 pot of Greek and Eoman commerce, but also a scientific focus, whose 
 light was shed for ten centuries upon the antique universe. 
 
 Amongst the sciences which received the most encouragement in the 
 Institute of the Lagides, we must place in the first rank that of Medi- 
 cine. By a concourse of happy circumstances which we shall presently 
 enumerate, the school of Alexandria eclipsed, from its origin, the ancient 
 schools of Cridas, Cos, and Pergamos ; and while it existed, it was not 
 equaled by any other. In the time of Galen, it sufiiced to have studied 
 in that city, or even to have resided there for a time, to obtain the repu- 
 tation of a physician. Nearly all the men who became distinguished 
 in the different branches of the healing art, for a considerable length of 
 time, had received instruction in that school, or had been there, to per- 
 fect their knowledge in their profession. 
 
 The success in the cultivation of Medicine in the Greco-Egyptian 
 Institute, was due, as we have said, to several causes, at the head of 
 which we must place the authorization accorded by the founders of that 
 establishment, for the dissection of human corpses. Doubtless that 
 authorization, nearly unique in antiquity, gave to the anatomical, physio- 
 logical and surgical sciences an extraordinary impulse. But the princes 
 of the family of the Lagidce did not content themselves with delivering 
 over to the scalpel of the anatomists the corpses of criminals ; they par- 
 ticipated themselves sometimes, it is said, in the labors of dissection :. 
 11
 
 170 ANATOMICAL PERIOD. 
 
 so anxious were they to penetrate the secrets of nature and life. Per- 
 haps, also, they did so to destroy, by the force of their example, the 
 odium to which the physicians exposed themselves by their anatomical 
 researches.'-' 
 
 The rtolomies did not favor less the progress of natural history and 
 the materia medica, by the collection of rare animals and plants that 
 were made for the museum, near their palace. They spared, if we may 
 believe the tradition respecting it, neither expense nor care to render 
 these collections as complete as possible ; they were proud to exhibit 
 them to the savans and travelers of distinction whom the renown of their 
 intellectual riches attracted to their capital ; a policy both eminent and 
 liberal, and which, even after the destruction of the kingdoms of Egypt, 
 maintained the city of Alexandria in the rank of the first cities of the 
 empire. 
 
 Nevertheless, the practice of dissections did not long continue in favor, 
 even in the city where it had its origin ; scarcely did it continue to 
 exist to the end of the second century. Consequently, science very soon 
 took a bad direction at Alexandria ; natural researches were replaced by 
 subtile discussions on subjects idle or inaccessible to the human under- 
 standing. But of all the scourges which hindered the progress of 
 medical science in Egypt, that of the Roman domination was the most 
 fatal. That royal people, who delighted to see blood flow, not only on 
 the battle-field, but also in their diversions and daily exhibitions, 
 regarded as a profanation the contact of a corpse ; so that not a single 
 anatomist of any reputation had his origin in Eome. If, on any occa- 
 sion a foreign physician, attached to the persons of the Emperors or 
 Generals, desired to avail himself of the occasions that were afforded, to 
 examine the structures of the internal parts of the human body, he was 
 obliged to conceal and carry off, during the night, some body abandoned 
 to the birds of prey. 
 
 To complete our misfortune, the labors of the physicians who illus- 
 trated the first epoch of the school of Alexandria, are all lost ; we only 
 know of them now by tradition, and by fragments that writers of a later 
 period have preserved. The burning of the great library, by Julius 
 Caesar, was the beginning of a chain of disasters with which the Roman 
 domination cursed the Alexandrian Institute. However, Queen Cleo- 
 patra, whose enlightened zeal for the sciences has rendered her quite as 
 celebrated as her beauty, her frailties, her crimes, and her death — Cleo- 
 patra, I say, repaired as much as possible this loss, by obtaining from 
 
 '* Pliny, Natural History. T. XIX., p. 5. Lanth. Hist, de I'Anatomie, Stras- 
 bourg, lb45.
 
 ANATOMY AND PHYSIOLOGY. 171 
 
 her spouse, Mark Antony, the transportation of the library of Perga- 
 mos to Alexandria. But a more grievous and irreparable Mow was given 
 to this establishment, by the atrocious and imbecile Cavacalla, who, 
 after having assassinated the greater part of the inhabitants of the city, 
 took from the pensioners of the Museum the privilege of living together, 
 and the other advantages which they enjoyed, and suppressed the public 
 exhibitions and discussions/-- 
 
 We can now only trace the progress of science through that period, 
 by collecting and comparing the debris which have been preserved by 
 Galen, Aretgeus, Coelius, Aurelianus, Celsus, Dioscorides, Pliny, and 
 some others. It is by the aid of these scattered documents that we 
 proceed to reconstruct the scientific edifice of Medicine, as it existed at 
 the end of the second century of the Christian era. In attempting this, 
 we shall follow the same order that we have already adopted, namely, 
 commence by showing the material progress of each branch of the art. 
 and reserve for the end the discussion of the themes and systems of 
 the time. 
 
 CHAPTEE II. 
 ANATOMY AND PHYSIOLOGY. 
 
 "We have seen, that after bringing together all the fragments the 
 Hippocratic writers have transmitted to us, relative to the structure of 
 the human body, it would be impossible to compose from them a regular 
 or complete treatise on anatomy ; for, with the exception of the skeleton, 
 they possessed very limited and imperfect notions of any organic appa- 
 ratus. They confounded, under a common name, the nerves, ligaments, 
 and tendons ; they did not distinguish, or very imperfectly, the arteries 
 and veins, and the muscles, in their eyes, were inert masses, designed 
 solely to cover the bones, and serve as an envelope or an ornament. 
 They possessed, in short, only gross and false ideas, on the structure 
 and functions of the brain, heart, liver, lungs, digestive and generative 
 apparatus — for the reason that they had never been able, as well 
 remarks the author of the History of Anatomy, to devote themselves to 
 regular dissections ; but this did not prevent them from adducing very 
 decisive opinions on the organs and their functions, which no one could 
 either verify or deny. 
 
 Let us now see what additions and what improvements the physicians 
 of the following period conferred upon that state of the science. Galen 
 
 "Hist, de I'Anatomie, p. 117.
 
 172 ANATOMICAL PERIOD. 
 
 is the sole author of that period, whose writings on anatomy and physi- 
 ology have not entirely perished. We have several works of his on 
 these subjects, which treat especially on these two branches, viz : First, 
 a monograph on the Skeleton, in which he recommends that the bones be 
 not studied in books only, but that they be seen and handled ; and to 
 do that, he advises the student to go to Alexandria, where the pro- 
 fessors, he says, will place before him the human skeleton. This advice 
 of Galen proves, that in his time there was not in Rome a single skeleton. 
 on which to demonstrate osteology. Secondly, a complete treatise on Ana- 
 tomy, divided into fifteen books, of which six are wanting, entitled, On Ana- 
 tomical xldministration. Thirdly, an anatomo-physiological treatise on 
 the Functions of the Eegions of the human body — distributed in seventeen 
 books, which we have entire. And finally, a quantity of anatomical and 
 physiological details, scattered in various writings, which relate to other 
 subjects. It is, then, from the writings of Galen, chiefly, that we draw 
 what we have to say on the progress of anatomy and physiology, in the 
 period extending from the foundation of the Alexandrian library, to the 
 end of the second century of the Christian era. 
 
 SKELETONOLOGY. 
 
 We have said that the osseous system was, of all the organic appara- 
 tus, the one best understood by the Asclepiadze ; nevertheless, their 
 successors added many details to the descriptions they had given of it. 
 They studied especially, with more care, the formation of bones, their 
 internal structure, and mode of union. Galen says, that the bones are 
 hard, cold, dry bodies, of an earthy nature, possessing no sensibility, 
 because they are destitute of nerves, but able to realize pain through 
 the membrane covering them, which is named the periostium. They 
 served to sustain the whole mass of the body, and are formed directly 
 from the semen ; the greater number have a marrow, from which they 
 obtain nourishment. Their various modes of union, he reduced to two, 
 namely, symphysis and articulation. By symphysis, two bones arc 
 joined or glued strongly together, so that they can not move on each 
 other. By articulation, on the contrary, they are placed in juxtaposi- 
 tion, and move more or less freely on each other. The ligaments main- 
 tain and fix the articulations ; they are white structures, flexible, and 
 elastic, harder and thicker than membranes. The cartilages, which 
 terminate certain bones, or even take their place in certain structures, 
 such as the nose, ears, and wind-pipe, have almost the hardness of bones, 
 with the flexibility and elasticity of ligaments.-' The author of the 
 
 -Galen, De Ossibus, edition of Chartier, T. IV. De Anatomicis Administra- 
 tionibus, lib. i, T. IV.
 
 ANATOMY AND PHYSIOLOGY. 173 
 
 History of Anatomy says, that Galen was profoundly versed in the 
 knowledge of the bones ; that he described them nearly all, individually, 
 and that there are few of them, which are not mentioned by name in 
 his works. 
 
 MYOLOGY. 
 
 The muscles (chairs) were no longer considered as inert masses, 
 serving only to cover the bones, and protect other parts ; they were 
 divided into distinct fasciculi, and named muscles. The form, compo- 
 sition, and uses of each muscular faciculus, was studied separately, and 
 they were recognised as constructed of minute fibres, or filaments, 
 between which the veins, arteries, and nerves ramified, carrying nutri- 
 tion, life, and sensation. It was proved by convincing experiments, that 
 the muscles are indispensable to the accomplishment of voluntary move- 
 ments. Galen, being desirous to teach the mechanism of locomotion, 
 and to prove that the muscles take an active part in it, was accustomed 
 to expose on an animal, the extensor and flexor muscles of a member, 
 and then demonstrate how the alternate tension and relaxation of the 
 muscular fasciculi set the bones in motion, after the manner of levers. 
 
 He says that the muscles are so numerous, that they cannot be easily 
 counted, and unite in such a manner, that several seem to form but one, 
 and when they divide, there appears to be as many as there are tendons. 
 It is not wonderful, after this avowal, that he omitted several ; never- 
 theless, he pointed out, and named a great number. He classed them 
 according to their uses, and this method, which has been followed even 
 till our day, by many anatomists, is the most advantageous with which 
 to arrive at the knowledge of the movements executed by the parts, 
 though it may not be the most commodious to guide us in an anatomical 
 examination.'-' 
 
 ANGIOLOGY. 
 
 The Hippocratic authors confounded the arteries with the veins. 
 
 Praxagoras was the first who distinguished these two orders of vessels, 
 but he supposed that the arteries contained air, and not blood. He 
 therefore gave them the name they still bear, which signifies, according 
 to their etymology, aerian canal. Aristotle and Erisistratus, having 
 adopted this view, it prevailed until the time of Galen, for this author 
 devoted an entire book to refute it, sustaining himself upon the observa- 
 tion, that at all times, when an artery is wounded, the blood gushes out. 
 
 " Galen, De Constitutione artis medic, cap. in., Chartier, T. II, De Anatomicis ad- 
 ministration ibus, lib. i.,iL, iiL, IV., V. De usu partium corporis humaui, lib. iii., 
 cap. V.
 
 174 ANATOMICAL PERIOD. 
 
 He added to this experimental proof, many theoretical reasons, which, 
 doubtless, he supposed appropriate to fortify it, but which now appear 
 very obscure and useless/"^ 
 
 He placed the origin of the veins in the liver, which he regarded as 
 the organ of sanguification, by which he shows himself less advanced 
 than Aristotle, who considered the heart as the common source of the 
 arteries and veins. He compares the arterial and venous system to a 
 tree fixed by its roots in the soil, from which the trunk arises, and is 
 developed by ramifications. The divisions of the vena portse form the 
 roots of the venous tree, the vena cava its trunk, whence proceeded the 
 boughs and twigs, distributed to every part. So, also, in the arterial 
 system, the pulmonary artery constitutes the roots, the aorta the trunk, 
 which is ramified like branches and twigs, to all parts of the body. 
 Among the branches of the vena cava superior, he reckons the vena 
 azygos, the internal, mammary, etc., etc., and among those of the vena 
 cava inferior, he describes the renal, spermatic, uterine, and other veins 
 of the inferior extremities. In the table of the arterial system, he 
 erroneously distinguishes a superior and inferior aorta. The history of 
 the ramifications of the superior aorta is a little confused, but the 
 description of aorta inferior is more exact. Our author makes mention 
 of umbilical veins and arteries. He is also not ignorant that the veins 
 are more numerous than the arteries ; for while the latter, he says, are 
 always accompanied by veins, the veins are often found separately from 
 arteries, f 
 
 NEUROLOGY, 
 
 G-alen states that all the nerves are derived from the brain and spinal 
 marrow, which was contrary to the views of Aristotle, who supposed 
 them to originate at the heart ; but the physician of Pergamos proves 
 that he, as well as those who followed him, confounded the nerves with 
 the ligaments and tendons. He points out also two sorts of nerves, one 
 of which, those of sensation, are soft, and proceed from the brain ; the 
 nerves of motion, are harder, and originate in the spinal marrow. He 
 enumerates seven pairs of cerebral nerves, which comprises all that are 
 admitted now, except the sympathetic, and the external motor of the 
 orbit ; thirty pairs of spinal nerves, which he divides as follows : eight 
 cervical, twelve dorsal, five lumbar, and five sacral. " Thus," observes 
 M. Daremberg, " Galen describes distinct nerves of sensation and motion ; 
 but he did not know that each nerve, by its double origin on the anterior 
 
 ' Galen. An in Arteriis natura sanguis continmtur. Chartien, Tome Til. 
 ■flbid., De Venarum et Arteriaram discestione, T. VI. De usu partium, Jh. Lanth 
 Hist, d I'Anatoniie, liv. v., part i., sect, i., chap, in., § 4.
 
 ANATOMY AND PHYSIOLOGY. 175 
 
 and posterior parts of the spinal marrow, contained both sensory and 
 motor filaments." The ganglions of the nervous system, were well 
 known to him, and he claims their discovery. " Nature," he says, " has 
 done an admirable thing, of which all anatomists, to the present time, 
 were ignorant. When she conducts, for a long distance, a fine nerve, or 
 one is destined to excite violent muscular movements, she locates a little 
 mass on its track, that resembles it in structure. Seen externally, this 
 body appears to rest upon, and surround the nerve ; but when it is dis- 
 sected, its substance is found to be in continuity with the nerve com- 
 bining with its structure, and resembling it in every particular. It is 
 by means of this substance, which resembles a ganglion, that nerves 
 augment in size.--' 
 
 Lastly, this eminent anatomist had some notions of the great sympa- 
 thetic, though he may not have formed a complete idea of that nerve. 
 
 To prove that the faculties of motion and sensation were transmitted 
 from the encephalor to other parts of the body, by the nervous apparatus, 
 he advised that the principal nerve of any member be divided ; at once, 
 he remarks, the parts situated below the section, loose their faculties of 
 sensation and motion, while those above retain both.f 
 
 ADEXOLOGY. 
 
 " Galen," says the author of the History of Anatomy, before quoted, 
 " gives no anatomical description of the glands, though he may have 
 been acquainted with the fluids secreted by several of these organs. 
 After enlarging on the secretion of the prostrate gland, he passes to the 
 mucus and saliva contained in the mouth, to the bile secreted by the 
 liver, and to the humors furnished to the intestines by various glands. 
 Sustaining the opinion of Marinus, on the functions of glands, he says 
 that the salivary glands transmit the saliva into the mouth by particular 
 veins. He terms the mammae also, glandular bodies. Is it not, then, 
 strange, that with the knowledge this great man possessed of the fluids 
 furnished by the various glands, the idea was never suggested to him. 
 to attribute to those bodies, the special function of preparing a useful 
 fluid, instead of regarding them as receptacles of an excremantitial 
 humor of the emunctory vessels ? That happy idea never occurred to 
 him ; the preparation of a fluid was always, in his eyes, a very secondary' 
 afi"air in the functions of glands ; the supposition of veins which carried 
 
 " Galen, De urn partium. Lanth. Hist, d I'Auat., liv. v., part i. , sect, i., cliap. ui. 
 §5. 
 f De Constitutione artis., cap. in.
 
 176 ANATOMICAL PERIOD. 
 
 the saliva into the mouth, was only imaginary, for his idea of them has 
 no agreement at all with the salivary duct, now called the duct of Steno.'-* 
 
 SPLANCHNOLOGY. 
 
 Galen divided the interior of the body into three cavities ; namely, 
 the abdominal, thoracic, and cranial, of which last, the vertebral canal 
 is an extension. He distinguishes in each of these, the viscera from their 
 envelopes ; of the latter, which are common to all, he reckons the skin, 
 composed of two lamina, the dermis and epidermis ; the fat ; the muscles 
 with their aponuroses, vessels and nerves ; the bones ; and some mem- 
 branes. The viscera being different in each cavity, require to be enu- 
 merated separately. 
 
 I. ABDOMINAL CAVITY. 
 
 It includes the apparatus of the natural faculties, which he divides 
 into the organs of nutrition and reproduction. The nutritive organs 
 are of three kinds. The first receive the food, dispose of, and distri- 
 bute it to all parts ; they are the mouth, esophagus, stomach, intestines, 
 and veins of the liver. The second, which appear destined to eliminate 
 excrementitial particles, are the liver, which attracts the bile, the spleen, 
 the kidneys, and their appendages. Lastly, the third class, which serves 
 for the expulsion of fecal matter, and which, in order to be controlled 
 by the will, is furnished with muscles. Galen describes in detail the 
 form, situation, and structure of each of these organs. (See especially 
 the Anatomical Administrations and the treatise on the Functions of the 
 Organs ; see also the Hist, de I'Anatomie, already cited.) 
 
 The reproductive apparatus is composed in man of testicles, placed 
 out of the body, in the scrotum, sanguineous vessels, and nerves ; the 
 epididymus, a small body placed on the upper part of the testicles ; the 
 spermatic canal, or vas deferens ; the vesiculte seminalae ; the prostrate 
 gland ; and the penis, which is a nervous and hollow body, springing 
 from the ossa pubis, but containing no humor. In women, whose nature 
 ■is colder than that of man, the sexual parts are placed in the interior 
 of the body. The testicles, which are smaller, are situated on the sides 
 of the uterus, and within the abdomen. The spermatic ducts (uterine 
 tubes) unite the testicles to the uterus, which is placed between the 
 bladder and the rectum. Galen speaks of two uterine cavities, one on 
 the right, destined for the male fetus, the other on the left, for the female. 
 From this statement we may question whether he ever examined the 
 uterus of a woman. The presumption is, that he had studied this organ 
 in animals only, for he says, that the number of the departments in the 
 
 "Lanthion, Hist, de I'Anat.
 
 ANATOMY AND PHYSIOLOGY. 177 
 
 uterus is equal to the number of mammae. The bottom of the uterus 
 is turned toward the stomach ; its neck looks downward, and is con- 
 tinuous with the vagina, which is a membranous canal, terminating 
 externally at the vulva. In coition the semen of the male, which is 
 hotter than that of the female, mingles with the latter, which serves as 
 an excipient and nutritive material ; from this results fecundation. The 
 semen changes at first into membranes, then a portion of these are trans- 
 formed into cartilages and bones ; another portion is folded and hollowed, 
 and extends itself in the form of pipes, which constitute the arteries 
 and veins ; another is drawn out like fine threads, whence proceed the 
 fibers and nerves, and so on, for the rest of the tissues.'-'^ 
 
 II. THE THORACIC CAVITY. 
 
 It is separated from the abdomen by the diaphragm, a species of 
 round muscle, large, flat, and thin, having its tendons in the middle. 
 It includes, among other things, the heart and lungs, organs of the 
 vital faculty. The heart, situated in the middle of the breast, a little 
 to the left side, lies upon the lungs, as on a downy bed. It has the 
 appearance of a muscle, but difi"ers from one in many respects. In the 
 first place, its substance is much harder, and more resisting than mus- 
 cular flesh ; in the second place, it is formed of straight, transverse, and 
 oblique fibers ; in a word, the fibers run in all directions, which is not 
 the case in ordinary muscles. Lastly, the heart possesses its own pro- 
 per movements, which do not depend upon nervous agency, as may be 
 seen by opening the chest of a living animal ; for when the heart is 
 separated from all other parts, it continues its movements for some time 
 with much force. This organ is the source of natural heat, and the 
 vital spirits ; the seat of anger, and violent passions. His opinions on 
 the movement of the blood, will be alluded to hereafter. 
 
 The lungs, a spongy viscus, which nearly fills the whole cavity, is 
 divided in its length into two unequal cavities ; the right half, which is 
 the largest is separated into three lobes ; the left one into two. These 
 lobes all comunicate, by means of cartilagino-membranous tubes, with 
 a common tube, which is called the trachea-arteria. This proceeds 
 upwards, along the median line, in front of the esophagus, to the back 
 of the mouth, where it terminates by an orifice called the larynx. He 
 divides the acts of respiration into two periods ; in the first, which he 
 names inspiration, the thoracic cavity is enlarged, and the external air 
 is drawn through the trachea into the lungs. During the second period, 
 which is that of expiration, the impure and gi-osser part of the air 
 
 * Galen, De usu partium. De semine, et alibi.
 
 178 ANATOMICAL PERIOD. 
 
 contained in the chest are expelled outwards, with the fuliginosities of 
 the heart, while the more subtle part passes into the venous artery, to 
 be carried to the left cavities of the heart, where it aids in the support 
 of the natural heat, the formation of vital spirits, and the completion of 
 the arterial blood. '••= 
 
 III. CEEEBRO- SPINAL CAVITY. 
 
 This differs from the two preceding ; first, in that it is shut in on all 
 sides by bones ; secondly, in place of being lined interiorly by a single 
 membrane, like the thorax and abdomen, there are two — one thick, hard 
 and fibrous, the other thin and smooth, precisely like the peritoreum, or 
 pleura. This cavity encloses the organs of the noblest of the faculties, 
 the animal faculty, of which the essence is nothing less than the reason- 
 ing and immortal soul. 
 
 In the upper and anterior part of the cavity is found the brain, an 
 oval, but not very consistent mass, of a gray color on the surface, but 
 white otherwise, and divided into two halves or hemispheres, by a very 
 deep longitudinal furrow. Beneath it, and behind, is the cerebellum or 
 smaller brain, whose substance appears to be firmer, though its volume 
 scarcely equals the fourth of the brain. These two fill the cranial 
 cavity, but they are distinct and separated in nearly their whole extent 
 by membranes ; they have a common bond of union, which is called the 
 meso-cephelon, which is situated at the base of the cranium. At this 
 point the spinal marrow commences, which descends the whole length of 
 the spinal canal. Its substance is analogous to that of the cerebrum and 
 cerebellum, and is a prolongation of the latter. Galen describes sepa- 
 rately each of the three portions of these viscera. He describes their 
 exterior form and connections with neighboring parts : then, peneti*ating 
 into their interior by methodic sections, he studies their intimate struc- 
 ture, the disposition of their smallest parts, the origin and distribution 
 of their vessels, etc. He follows each nerve into the structure of the 
 brain, until it is lost in the mass. 
 
 When the brain of a living animal is uncovered, by removing a por- 
 tion of the vault of the cranium, that viscus is seen rising and falling, 
 alternately. This phenomenon did not escape Galen, who compared it to 
 the pulmonary respiration, and attributes it to the same cause. He 
 thinks that the brain expands like the lungs, to draw in the air, and 
 then contracts to expel it. According to him, the atmospheric fluid 
 penetrates the cavity of the cranium, through the cribi-form plate of 
 the ethmoid bone, and passes out by the same route, carrying with it 
 
 *•' Galen, De Usu Partium. De Anatomcis Administrationibus.
 
 \ 
 
 SCHOOL OF ALEXANDRIA. 179 
 
 the excrementitial humors of the brain, which run into the nasal fossae. 
 Xevertheless, says this physiologist, the air introduced into the cephalic 
 cavity, by inspiration, is not entirely rejected by expiration. A portion 
 insinuates itself into the anterior ventricles of the brain, and unites with 
 the vital spirits, which are carried there by the arterioles of the choroid 
 plexcus, From this combination originate the animal spirits, the imme- 
 diate agents of the rational soul, and the most subtle of all the spirits. 
 These acquire their last attenuation in the fourth ventricle, where they 
 are instilled, if one may say it, drop by drop, through a round, narrow, 
 vermiform tube (the acqueduct of Sylvius) . Then the animal spirits are 
 transfused into the substance, even, of the brain, little brain, and spinal 
 marrow, where they are kept in reserve, to be distributed by the agency 
 of the nerves to all parts of the body ; and they give to each region, 
 according to the direction and wants of the animal faculty, sensation, 
 motion, and energy." 
 
 The above sketch of the anatomy and physiology of Galen, though 
 very brief, represents to us the state of these two branches of medical 
 science, at the end of the second century of the Christian era, and gives 
 us an idea of the progress that was made during the Anatomical Period. 
 This progi'ess was immense ; and when we consider that the greater part 
 of it was effected in the first two centuries of the foundation of the 
 Alexandrian school, and that it was due chiefly to the labors of Hero- 
 philus and Erisistratus, we are astonished at the rapid development, as 
 well as the happy direction, that these two great men gave to anatoraico- 
 physiological studies. Not only did they devote themselve to numerous 
 dissections of the human body, but they often resorted to vivisections 
 of animals also. The chronicle says that one of them, Herophilus, did 
 not hesitate to employ his scalpel on living criminals that were subjected 
 to his experiment, for the interests of science ; but it is proper to say 
 that this is not alluded to by any cotemporary author — it was only 
 recorded as a popular tradition, three or four centuries later ;■]■ so that 
 it is considered doubtful by many historians, who remarked, besides, 
 very correctly, that the same report has been falsely circulated at differ- 
 ent epochs, against other celebrated anatomists. However this may be, 
 the manners, too often unpitying, of the ancients — the contempt which 
 they generally expressed for the sufferings of criminals and slaves, per- 
 mit us to believe that, occasionally, men may have been found so lost 
 to the sentiments of humanity, as to deliver to the knife of the anatomist 
 the unfortunate condemned, in the hope of discovering, in the depths of 
 
 * Galen, De Anatomicis Administrationibus. De Usu Partium. 
 
 f Celse, Traite de la Me'decine, Pre'face. — Tertullien, De I'Ame, chap. x.
 
 180 ANATOMICAL PERIOD. ^ 
 
 the palpitating entrails, the secret of life and the means of prolonging 
 it ; nor is it more improbable that some fanatic in science may have lent 
 himself to this odious research ; for, alas ! all fanaticism is pitiless. 
 
 Nevertheless, as before remarked, the zeal for dissections rapidly 
 cooled off, as Galen barely mentions five or six men who devoted them- 
 selves to it, from the first anatomists of Alexandria down to his own 
 time — i. e., through the space of nearly four hundred years. He cites 
 a Eufus of Ephesus, who lived probably under Trajan; a Marinus, who 
 wrote in the beginning of the second century of the Christian era ; a 
 Quintus, who did not compose any work on anatomy, but who instructed 
 several pupils, among whom are counted Pelops and Satyrus, who were 
 the preceptors of Galen. None of these anatomists have left a reputa- 
 tion approaching that of Herophilus and Erisistratus. Galen alone can 
 sustain a comparison with these last, by the great number of his experi- 
 ments and anatomico-physiological discoveries. In vain he strove, by 
 his example and exhortation, to awaken in his cotemporaries a desire 
 for the study of anatomy, which, within proper limits, is the surest 
 guide in practical medicine ; but he could not overcome their indiffer- 
 ence. After him, the practice of dissection appears to have been lost, 
 either from the redoubled prejudice of the superstitious, who opposed 
 dissections, or as the result of the ignorant apathy of the physicians. 
 
 CHAPTEE III. 
 HYGIENE. 
 
 Hygiene, during this period, did not progress as rapidly as anatomy 
 and physiology ; nevertheless, it was not entirely stationary. Celsus 
 has recapitulated, in his first book, the most accredited hygiene precepts 
 of his time. He commences by addressing some general counsels to 
 men in robust health. Then he explains, more at length, the regimen 
 which is suitable to delicate persons ; amongst whom he classes the 
 greater part of the inhabitants of cities, and, in particular, men of 
 sedentary lives. Lastly, he traces the rules applicable to different ages, 
 seasons, sea voyages, in certain idiosyncrasies, and other circumstances, 
 His prescriptions relate principally to the choice of food and drinks, the 
 use of baths, the alternation of repose and labor, the repast, gymnastic 
 exercises, artificial dejections excited with a view to health, either up- 
 wards or downwards. If he adds but little to the materials transmitted 
 by the writer of the Hippocratic collection, he has at least the merit of 
 presenting them with more order and precision.
 
 SCHOOL OF ALEXANDRIA. 181 
 
 The writings of Galen, on hygiene, are numerous ; they form the 
 whole of the sixth volume of the edition of Chartier, in folio. The 
 most considerable are, a treatise on the Preservation of Health, divided 
 into six books, and a treatise on the Qualities of Food, in three books. 
 He divides life into four periods — infancy, adolescence, manhood, and old 
 age. He insists on the precepts relative to the first and last of these 
 periods, much more than any of his predecessors had done ; he enters, 
 especially, into new and interesting details concerning infancy. He has 
 also better appreciated than any other writer, the influence of habit, 
 and was the first to feel the necessity of making the regulation of the 
 passions a part of hygiene. This was the limit of the eflPective progress 
 of this branch of the art, from the foundation of the Alexandrian 
 library down to his epoch. 
 
 The pure observation of the good or evil which we realize after the use of 
 certain articles, was the first source of hygienic researches, as is also 
 shown by the following passage of an author whom I have frequently cited : 
 " In going back," he says, " to past ages, I think that the regimen of 
 life and nutrition which are employed in health, in our days, would not 
 have been discovered, if man, for his" food and drink, had been able to 
 content himself with that which suffices for a bullock or a horse, and 
 other creatures out of the pale of humanity ; that is, on simple pro- 
 ductions of the earth, such as fruits, herbs, and hay. Animals are nour- 
 ished by these, and grow, and live, without any inconvenience, and without 
 the necessity of any other alimentation. Doubtless, in the earliest times, 
 man had no other food than the above, and that which he now employs, 
 it appears to me, is an invention elaborated in a long course of years. 
 But food so strong and crude, would cause much violent suffering, 
 as is realized now, among those who sustain themselves on crude, 
 coarse, indigestible, and exciting food ; intense pain and diseases are 
 developed, and a speedy death. Men suffered less, doubtless, in the 
 beginning than now, on account of its habitual use ; nevertheless, the 
 evil was great even for them, and the greater part, especially those of a 
 feeble constitution, perished, while the more vigorous could longer resist 
 its injurious tendencies. Such was, it seems to me, the cause that 
 engaged men to seek a preparation of food in harmony with our nature, 
 and they gradually discovered that which we now employ. Thus learn- 
 ing how to macerate, thresh, sift, grind, and knead the grains, they 
 fabricated wheat bread and barley dough, which they have used in a 
 thousand different forms. They have boiled, roasted, made compounds 
 of, and reduced with weak substances, those articles which were too 
 strong, and prepared everything to suit the nature of man."" 
 
 ** (Euvres d'Hippocrate, De I'Ancienne Medicine. § 3 ; translated by M. Littre.
 
 182 ANATOMICAL PERIOD. 
 
 This method, both simjDle and sure, but slow and timid, did not suit 
 the taste of certain philosophers ; they imagined one much more com- 
 plicated, and which appeared to them more transcendant and direct. 
 The following quotation shows in what terms their method is described 
 by one of those philosophic physicians : "I maintain," he says, " that 
 to write well on the regimen of man, it is necessary, in the first place, 
 to be well instructed as to his nature, to know what man is, in his 
 origin, and what are the parts of which he is composed. If one is igno- 
 rant of his earliest composition, and what predominates in his constitu- 
 tion, how can he prescribe what may be useful to him?"" 
 
 Such a course has something very seducing in it, at first sight. It 
 attracts by an appearance of exactness and profundity ; but, if we judge 
 it by its results, we shall be convinced, very soon, that it is only cal- 
 culated to obscure and perplex by philosophic speculations, entirely 
 ideal, the most enlightened and experienced minds. The author from 
 whom I have taken the last extract, furnishes himself a proof of this. 
 He devotes very vainly, as we have heretofore remarked, under head of 
 Philosophic Period, all the first part of his work to demonstrate that 
 man and animals are a compound of two principles, water and fire, and 
 he endeavors, then, to rest on this philosophic base, his maxims of 
 hygiene. 
 
 Galen has followed the same course ; that is, he endeavors to rest on 
 his physiological theories, the laws relating to the preservation of 
 health ; but this plan only leads to digressions, as fastidious for the 
 reader as sterile for science. On this foundation, he wrote a book, to 
 teach what is the best constitution of the human body, and what are the 
 signs by which we may know it, and how it resists the perturbating influ- 
 ences ; also, another, to explain what is to be infered from the complex- 
 ion, and in what a good complexion differs from an athletic one ; a 
 third, in which he agitates, at great length, this question, which may 
 be reduced to a few lines — is hygiene within the jurisdiction of medi- 
 cine or gymnastics ? Thus, four-fifths of his writings on hygiene, at 
 least, may be dropped or shortened, without any real loss to the art. 
 
 Galen gives to health a definition conformed to his theoretic ideas ; 
 but so unintelligible is it, that he is obliged to accompany it with 
 an explanatory commentary of many pages. Here is his definition : 
 " Health consists in a just proportion of heat, cold, dryness, and mois- 
 ture, for similar parts ; and in the good conformation, the exact number, 
 and proper extent of all organic parts." f In short, he pretends to 
 make all the precepts of hygiene proceed from an unique principle. 
 
 *' CEuvres d'Hippocrate, Du Regimen, liv. i. § 2 Gardeil. 
 f De Sanitate Tuenda, lib. i, § 1.
 
 .GENERAL PATHOLOGY. 183 
 
 " We know," lie says, " that we must give similars in a state of health, 
 in the same way as we give contraries in a state of disease." He attempts 
 to justify this hygienic axiom, by the authority of Hippocrates, by logic 
 and examples ; but his arguments are based on subtilties, only, and his 
 axiom is not equal to that simple rule, dictated by instinct, and confirmed 
 by experience : Eat only when you are hungry, and drink only when you 
 are dry. 
 
 This would be the place to speak of exercises, baths, annointings, and 
 frictions, which the Greeks and Eomans so frequently employed, and 
 which constitute a part so important, and so curious, of their hygiene ; 
 but this subject is too vast, and I fear being drawn into too long details, 
 even if I should only attempt to touch it. I prefer referring the reader 
 desirous to acquire a satisfactory notion of it, to the learned work of 
 Mercurialis, De Arte Gymnastica, and the Histoire de la Chirurgie, by 
 Peyrilhe, vol. II. book v., page 316. 
 
 CHAPTEE IV. 
 GENERAL PATHOLOGY. 
 
 We have seen that in the Hippocratic works, the various branches of 
 medical science are not well distinguished, and that often, the same 
 treatise contains subjects very distinct from each other. It is not so with 
 the most of the treatises which we possess of the present period ; they 
 are marked, in general, by a much more rigid, didactic order. After 
 Aristotle, and by the influence of his expample, the authors were much 
 more methodic in their compositions. Diseases were divided, as hereto- 
 fore, into internal and external, acute and chronic, according to their 
 supposed seat ; but the authors conformed more to these classifications, 
 than the former had done. The treatment was divided into hygienic, 
 pharmaceutic, and surgical. In fine, it may be said, that the love of 
 method was carried to an excessive degree. There were authors, such as 
 Galen, who, from a desire to be very methodic, fell into distinctions more 
 subtle than real, and lost that greatest of the advantages of method, 
 clearness. 
 
 Many historians, among whom are Leclerc and Sprengel, supposed, that 
 at that epoch, the medical profession was divided into three orders, which 
 correspond to the three divisions of the science, shown above. They 
 say, that from that time, there were dietetic physicians, who confined 
 themselves to the regulation of the regimen of the sick ; pharmaceutists.
 
 184 ANATOMICAL PERIOD. 
 
 who prescribed internal remedies ; and surgeons, who made dressings 
 and performed all manual operations. Goulin was the first to show that 
 these statements are erroneous.* Afterwards, Shulze demonstrated, that 
 the division of j\Iedicine into hygiene, pharmacy, and surgery, as intro- 
 duced by Celsus, must be understood in a scientific, and not in a pro- 
 fessional sense. f Lastly, B. Peyrilhe, after having quoted the opinions 
 of his two predecessors, corroborates them by new considerations. " To 
 these opinions," he says, " so much the more respectable, because they 
 come from two physicians profoundly versed in the history of their art, 
 we join a reflection which could have been made before, though it has 
 not been : that if this division of Medicine existed in the profession, 
 as it did in the Art — if it was civil, as it is certain that it was 
 scholastic, we should be able to discern, very distinctly, among the 
 Eomans, three classes of physicians. Now, where shall we find them ? 
 All the efforts of some modern investigators, have not been able to show 
 the existence of a single one of these classes alone. Such, for example, 
 as surgeons, that is, men who limited themselves to surgical operations. | 
 
 CHAPTEE V. 
 INTERNAL PATHOLOGY. 
 
 § I. Sejieiotics. 
 
 The Asclepiadae, as we have already observed, considered morbid 
 phenomena, not as the expression of the suffering of any particular 
 part, but of that of the entire economy — the result of vital reaction, 
 excited by a morbid element. Starting with this philosophic idea, they 
 studied each symptom, independently, without reference to the sup- 
 posed state of the internal organs of the body. On this account, they 
 carried Semeiotics, or the knowledge of symptoms, to a very high 
 degree of perfection. These priest-physicians were remarkable for the 
 certainty and boldness of their prognosis, as we have proof in many 
 treatises of the Hippocratic collection. || We owe to one of them a capi- 
 tal discovery, and which seemed destined to give a new impulse to this 
 branch of the science. 
 
 '■' Memoires Littei-aires, pour servir a I'Histoire de la Medicine, annee 1775, p- 
 28, et suiv. 
 f Historia Medicinse, a rerum principio, 1775, p. 28, et al. 
 
 I Histoire de la Chirurgie, de Dujardin et Peyrilhe, Paris, 1780. 
 
 II See, among others, the Traitc du Prognostic, and the second book on Prorrhc- 
 tiques.
 
 INTERNAL PATHOLOGY. 185 
 
 Praxagoras was the first to observe, at the termination of the preced- 
 ing period, the close connection between the variations of the pulse and 
 the energy of vital reaction ; from that time, it was thought that the 
 regulator, or the exact measure, of all the vicissitudes which the vital prin- 
 ciple experiences in the course of the life, was found. The slightest 
 shades of variation in the arterial pulse were noted with the most scru- 
 pulous attention, and an effort was was made to attach to each variety 
 a detenninate signification. Consequently, there was defined a pleuritic 
 pulse, that is, a condition of the pulse indicating pleurisy ; a suppura- 
 tive and phthisical pulse, and so on for each disease. So, also, there 
 was a hepatic, splenic, nephrotic pulse, indicating the conditions of 
 these organs ; in a word, they pretended to be able to distinguish, by 
 appreciable variations of the pulse, all the modifications, normal or 
 abnormal, grave or slight, of the organic functions. Galen has written 
 on this subject a complete treatise, in four sections, each comprising four 
 books, and several monographs.'--' In the first section of the first book, 
 he points out more than sixty species of the pulsef. He also presents 
 and discusses the three opinions, which prevailed in his time, on the 
 efficient cause of arterial pulsations. Some attributed them to the 
 blood, that each contraction of the heart caused to flow in the arteries ; 
 others, that they were the effect of the passage of the spirits ; others, 
 again, believed with Galen, that the pulsative faculty is transmitted 
 from the heart to the arterial tubes, by continuity of tissue. J 
 
 The Greek Sphygmology was carried to the Indies by the disciples 
 of Herophilus and Erasistratus, under the successors of Alexander the 
 Great : thence it was carried to China, where it still reigns, but dis- 
 figured and contemptible. In Europe, the Sphygmic theory of Galen 
 was not subjected to any notable variation, till the discovery of the cir- 
 culation of the blood. Xext to the signs manifested by the examination 
 of the pulse, those furnished by the inspection of the urine occupied the 
 highest place in the semeiotics of the ancients ; but the chief writings 
 on uroscopy being posterior to the epoch of Galen, we shall not further 
 allude to this subject now. 
 
 To resume : if we compare the labors of the school of Cos on semei- 
 otics with those of the school of Alexandria, we shall remark between 
 them a well-defined difference. The Asclepiadre grouped together the 
 most apparent symptoms of a disease, and the circumstances attending 
 
 * See vol. VIII, of his complete works, edition of Chartier. 
 flbid., Des diflfe'rences des Pouls, liv. i. 
 
 I See the book in which he examines if the arteries naturally contain blood; 
 chap, vm., edition of Chartier, vol. III. 
 
 12
 
 186 ANATOMICAL PERIOD. 
 
 their course ; they founded upon these the rules of their diagnosis and 
 prognosis. The Erasistratians, or Herophilians, on the contrary, regarded 
 each symptom, or a single order of symptoms, separately ; they studied 
 these in every aspect — examining their most delicate shades, and search- 
 ing, minutely, their causes and various significations. The synthetic 
 method of the first is imposing, but is superficial, and often defective. 
 The analytic method of the second afi'ects exactness, and deep research ; 
 but it is also often contracted and subtile, and is lost in infinite minute- 
 ness. 
 
 § II. NOSOGEAPHY. 
 
 The AsclepiadK, as before remarked, have left us only a very small 
 number of nosological descriptions worthy to be consulted. In their 
 treatises on pathology, they follow no rigorous classification, and do 
 not well distinguish the morbid species from each other, and make 
 no effort to present, in a lucid and natural order, the symptoms, pro- 
 gress and termination appropriate to each; in a word, they have 
 neglected to establish the basis of the specific and differential diagnosis 
 of diseases. This neglect of so important a branch of pathology may 
 be explained as follows : in the first place, the defect of precise notions 
 on anatomy and physiology incapacitated them, often, from connect- 
 ing the functional derangements which they observed, with determi- 
 nate organic lesions of any of the viscera ; in other words, it was often 
 impossible for them to localize diseases ; now that localization is one of 
 the most solid bases of all nosological classifications. In the second place, 
 the general idea that the ancient Hippocratists had of diseases, pre- 
 vented them from attaching a major importance to the distinctions of 
 the morbid species. In fact, they regarded the pathological symptoms 
 as the expression of a universal disorder, rather than as an index of 
 the particular lesion of an organ ; they had not made researches, very 
 assiduously, to discover what is the special viscus affected, when such 
 or such a group of symptoms was manifested. 
 
 Therefore, it may be said, that nosogi-aphy was still in its infancy at 
 the commencement of the anatomical period ; but it was carried to a 
 very high degree of perfection during this period, as is seen in what 
 remains on this subject, in the writings of Aretseus and Coelius Aure- 
 lianus. These two authors lived, according to the most reasonable 
 opinion, in the second century of our era. We know nothing of the 
 lives of either of them ; all that can be said positively is, that the first 
 was born in Cappadocia, in Asia Minor, and that the second was a 
 native of Sicca, in Numidia. 
 
 However this may be, we possess, of each of them, a treatise, almost 
 complete, on all the diseases observed in their time ; and these treatises
 
 INTEKNAL PATHOLOGY. 187 
 
 constitute, without question, one of the most precious and useful memo- 
 rials of antique medicine. These two writers have arranged their sub- 
 jects in nearly the same order. They have divided them into eight 
 books, of which the first four are devoted to the description and treat- 
 ment of acute diseases, and the following four include the description 
 and cure of chronic diseases. But C. Aurelianus mingles, occasionally, 
 with his subjects, somewhat prolix, though interesting theoretic and 
 historic dissertations ; while Aretasus goes straight forward to the end. 
 without indulging in any digression. 
 
 The work of the latter is written in Greek, in an elegant, concise, 
 and picturesque style, which has gained him the reputation of giving 
 the finest descriptions of diseases of any writer in antiquity. The 
 work of Coelius, on the contrary, is written in bad Latin, mixed with 
 many barbarous words, very difficult to read, which is probably the 
 cause of its not being rendered into our language. It is, however, 
 worthy of being translated, for, in the opinion of all critics, there are 
 few among the works of antiquity that equal it in practical utility. 
 
 Gralen has also written, and even lengthily, on all diseases ; but his 
 accounts are scattered in various treatises, and buried among difi"use 
 and subtile theoretic digressions ; so that to form an opinion, after him. 
 on the progress, signs, and treatment of a single morbid aiFection, one 
 is compelled to turn over a quantity of books, and to confront a multi- 
 tude of passages, oftentimes difficult to understand ; an operation always 
 long and inconvenient for the practitioner, and often impracticable. In 
 short, this writer is neither an easy guide to follow, nor an excellent 
 model to propose, in what concerns nosography. 
 
 The authors of this period describe, with much detail, the leprosy, 
 tetters, nei-vous headache, and a multitude of other chronic affections, 
 which the Hippocratic writers have barely mentioned, either because 
 they supposed them incurable infirmities, or because, like Plato, they 
 regarded them as simple inconveniences, unworthy of the meditations of 
 men of science. Thus, then, for this extensive class of diseases, the 
 physicians of the school of Alexandria had considerably enlarged the 
 nosological scale. In this respect, there is no comparison to be made 
 between their works and those of the school at Cos. 
 
 In regard to acute affections, with which the Hippocratists were more 
 particularly occupied, the writers of the anatomical period have also 
 added much to improve their diagnosis, as may be seen by comparing 
 any disease described by Aretaeus, with a corresponding description in 
 the Hippocratic books. In order to facilitate this comparison. I sub- 
 join a description of pneumonia, which the reader may compare with
 
 188 ANATOMICAL PERIOD. 
 
 that which has been previously quoted, and which is one of the very 
 best descriptions of disease, in the Hippocratic collection. 
 
 ON PNEUMONIA.* 
 
 " Two principal things sustain animal life, food and respiration ; but 
 the latter more immediately, for when it is suppressed, life can not long 
 be sustained, and death occurs almost instantly. Several parts sub- 
 serve this function ; the nostrils, where it begins, the trachea, which is 
 its channel, the lung, which is its proper seat, and the chest, which is 
 an inclosure and receptacle of the lung. But while the other structures 
 named are only accessory instruments, the lung contains the cause of 
 respiration : for the heart, which is the seat of life and attraction, is 
 situated in the midst of this viscus, and communicates to it the heat 
 which it generates, exciting, thus, a desire for cool air, which is the 
 cause of respiration. On this account, when the heart is attacked, 
 death is close at hand ; but if the lung is the point of attack, and it 
 be moderate, the breathing of the patient is difficult and painful, but 
 death does not occur till a much later period, if treatment be employed. 
 If, on the contrary, the attach is severe, as, for example, in inflamma- 
 tion, then the suffocation, aphonia, and difficult breathing put the life 
 in jeopardy. It is this last disease, named pneumonia, that I now pro- 
 pose to discuss. 
 
 " This disease manifests itself by an acute fever, with a sensation of 
 weight in the chest, without any pain, if the lung alone is inflamed ; 
 for this organ, being of a spongy tissue similar to wool, is naturally 
 insensible, as well as the cartilagenous arteries which are inserted into 
 it. It has no muscles, and its nerves, being small and few, do not aid 
 its movements. The pain is manifested when some of the membranes 
 which envelop and and attach it to the thorax are inflamed. 
 
 •' The breath becomes hot, the respiration difficult, and the patient 
 seeks to be upright, so that his breathing may be easier. The counte- 
 nance becomes red, especially the cheeks ; the white of the eye pearly ; 
 the nose flat, and the veins of the temples and neck distended. The 
 aversion for food is considerable. The pulse, full at first, becomes soft 
 and small, then is accelerated, as when one walks quickly. The skin 
 is moderately warm and moist, but the patient realizes, internally, a fierce 
 and burning heat, which causes the hot breath, dry tongue, thirst, the 
 
 *Aret£eus, liv. ii, chap. 1. Xotc. — This author prefaces, admirably, the his- 
 tory of each disease with some anatomical, physiological considerations on the 
 part where it is seated, and these are generally quite interesting.
 
 INTERNAL PATHOLOGY. 189 
 
 insatiable desire to breathe fresh air, and continual anxiety. The cough is 
 ordinarily dry, but when it is accompanied with expectoration, it is a 
 frothy phlegm, or nearly pure bile, or something sanguinolent, of a rusty 
 color. This last kind has a graver signification than the former. 
 
 " "When the disease assumes a graver caste, the insomnia augments, the 
 patient sleeps but little, though he may appear to sleep. His mind, 
 agitated by a multitude of incoherent thoughts, wanders, but is easily 
 aroused to consciousness. It is seldom that the alienation is complete. 
 He does not know his condition, and if he is interrogated on that sub- 
 ject, he replies that he feels very well. The extremities become cold, 
 the nails livid, and hooked in shape ; the pulse small, frequent, and 
 scarcely perceptible, and death closes the scene, generally about the 
 seventh day. 
 
 " AVhen a change takes place for the better, there is most generally 
 bleeding at the nose, or a copious evacuation from the bowels, of bilious 
 matter, mingled with froth, which appears to proceed from the breast, 
 also a flow of similar material in the urine. If it happens that both of 
 these evacuations occur at the same time, the patients soon recover. 
 
 " Sometimes a formation of pus takes place in the lungs: in such a 
 case, it is very fortunate if it passes off by the intestines or blad- 
 der; or, if it should make a metastasis to the pleura, and an issue 
 be established in the side of the chest, so that it may pass off, then the 
 pneumonia is at an end. An ulcer is formed, it is true, which may con- 
 tinue for a length of time ; but it is finally cicatrized. If it happens 
 that the abcess bursts suddenly in the lung, this rapid effusion of a 
 great quantity of pus suffocates the patient, who is too feeble to reject 
 it at once ; or if he is able to overcome this, an ulcer remains, which 
 causes long continued suffering, and ends by throwing him into phthisis. 
 It is as rare for old men to survive such an ulceration, as it is for young 
 men, and persons in the vigor of life, to resist the violence of the iufla- 
 mation." 
 
 The above is a well drawn picture of a disease, in which nothing 
 essential is wanting, nor is the description too lengthy. More details 
 might have been given ; but none of the principal features of peripneu- 
 monia, as the disease was then known, have been omitted. All its 
 features are traced in a natural order, and easy to be remembered ; so 
 much so, that after having read and meditated on this nosological tableau, 
 the whole picture may be recalled at any future time, when in the 
 presence of a disease that offers such characteristic traits, and a judg- 
 ment be established of the present condition and future prospects of 
 the patient, and the therepeutical course that should be adopted. The 
 Hippocratic collection contains not a single description of a disease, that
 
 190 ANATOMICAL PERIOD. 
 
 can be put in comparison with this. The work of Aretaeus contains, 
 besides, a series of nosological descriptions equally as good. An opinion 
 may be formed by the comparison, of the progress that this branch of 
 the science made since the last of the Asclepiadse. 
 
 C H A P T E E Y I . 
 INTERNAL THERAPEUTICS. 
 
 iSTo new therapeutical axiom was proclaimed during this period ; the 
 edifice of the profession was still based on the foundation laid by the 
 Hippocratists, which consisted, it is said, in employing such curative 
 means as would be contrary in their action in the economy, to the gene- 
 rative cause of the disease, or to the primitive and essential lesion, to 
 which all the other symptoms are connected. Consequently, great efforts 
 were made to ascertain exactly, for each nosological species, its origin, 
 its determining cause, or the phenomena which essentially constitute it. 
 Then search was made among known remedies, for those whose physio- 
 logical action was the most directly opposite to the essence of the disease. 
 Such was, in general, the mode of reasoning, of the physicians of this 
 epoch. 
 
 However, a famous sect called the Empirics, arrayed themselves 
 against this method. They pretended that the immediate cause, or 
 essential lesion of diseases being impenetrable, so is also, the primitive 
 action of curative agents ; and to establish medicine on such a founda- 
 tion, was nothing more than building on the sand, or rather on chimeras. 
 We shall recur, at a proper time, to the arguments adduced on both 
 sides ; for a very lively and interesting discussion arose on this subject, 
 amongst the various medical sects of the Alexandrian school, and great 
 light emanated from the midst of these discussions. But, at present, I 
 wish only to take a practical view of the science, and in this respect, 
 therapeutics made great acquisition during this period. 
 
 Medical natural history did not exist in the times of the Asclepiadae ; 
 for we do not find in their writings, any methodic descriptions of sub- 
 stances employed in medicine, nor any effort to classify remedies. 
 Aristotle offers the fii'st model of a collection of the products of nature, 
 undertaken with a scientific aim. His attention was directed particularly 
 towards zoology, and he made in that branch of the science of natural 
 history, discoveries which would have been sufficient to immortalize 
 his name.
 
 INTERNAL PATHOLOGY. 191 
 
 After him, Theophrastus, inheritor of his manuscripts and his 
 museum, continued to direct the Peripatecian school, in natural studies. 
 He did for botany, what his master had done for zoology. He observed 
 the internal and external conformation of vegetables, their modes of 
 nutrition, flowering and fructification ; in a word, created vegetable 
 physiology. He described the physical qualities and medicinal virtues 
 of more than five hundred plants. 
 
 The sovereigns of Egypt made still more extensive collections, which 
 they placed at the disposal of the savans of Alexandria ; consequently, 
 they studied the properties of a mass of new substances, with which 
 they enriched the materia medica. Towards the end of this period, the 
 luxury of compound preparations and exotic remedies became common 
 at Eome, and throughout the empire, and polypharmacy was pushed to 
 a ridiculous extent. Then were invented those famous antidotes known 
 by the name of mithridate, theriaque, in which were compounded from 
 forty to sixty different ingredients. It was supposed that each of these 
 medicinal substances preserved its proper virtues, in the midst of the 
 common amalgam, which possessed the properties of all the drugs that 
 entered into its composition, and thus formed a sort of panacea, good 
 for all diseases. 
 
 The description of a great number of morbid conditions created the 
 necessity of a pathological classification ; so, in like manner, from the 
 multiplicity of medical substances, originated the want of a pharmaceu- 
 tical classification. Three authors, towards the close of this period, 
 Dioscorides, Pliny, and Galen, undertook to supply this vacancy. Their 
 works on materia medica have been preserved ; but that of Dioscorides 
 is the most esteemed, for its order, clearness, and exactness ; therefore I 
 shall say a few words about it. 
 
 The author states in the preface, that he is the first who has made 
 mention of aromatic substances, as well as remedies drawn from the 
 mineral kingdom. He divides his treatise into six books : the first 
 treats of odorous substances, such as oils, ointments, woods, juices, 
 fruits, gums, and resins; the second, of animals, of honey, milk, fats, 
 and the herbs and seeds of the gardens ; the third, of roots, herbs, 
 juices, and grains, which serve for domestic uses ; the fourth, perennial 
 herbs and roots ; the fifth, of the vine, wines of all kinds, and minerals ; 
 lastly, the sixth of vegetable and animal poisons. It is plain, that such 
 a classification of medical substances is confused and arbitrary. 
 
 The natural characters of these same substances are no better deter- 
 mined ; sometimes, indeed, they are pointed out with so little exactness, 
 and so few of them are mentioned, that it is impossible to recognize the 
 plant or the mineral in question. Again, they are not indicated at all ;
 
 192 ANATOMICAL PERIOD. 
 
 and, after naming a substance, he has contented himself with describing 
 its medical virtues. The following is one of the best descriptions in 
 the whole collection : " The nettle is of two species ; in one of which, 
 the leaves are more irregular, rougher, larger, and blacker, than in the 
 other, and the seeds are like those of flax, but smaller. The leaves of 
 the other species are not so rough, and the seeds are not as thick. The 
 leaves of both, rubbed up with salt, form a good salve with which to 
 dress the bite of dogs, gangrenous sores, chancres, open ulcers that are 
 difficult to consolidate; also, denuded parts, small tumors, or ruptured 
 abcess, and those which are named parotidotic. Applied with wax, it 
 relieves the difficulties of the spleen. Eubbed up with syrup and applied 
 to the nostrils, it restrains the flow of blood ; bruised with myrrh and 
 applied as a pessary, it provokes the menstrual flux. In touching the 
 womb with it, fresh, it relaxes, and assumes its natural position. The 
 seeds, drank in boiled wine, excite wanton desires. It opens the mouth 
 of the uterus. When used sparingly with honey, it is advantageous in 
 difficulties in the chest, pains in the side, and inflammation of the lungs- 
 It purges the chest. It may be mingled with corrosive medicines. The 
 leaves, stewed with some other substances, increase the urine, and 
 relieve flatulency. Drunk with myrrh, they produce the menstrual flux. 
 The syrup, used as a gargle, heals inflammation of the soft palate.=--= 
 
 The materia medica was, therefore, considerably enriched by the 
 labors of the anatomical school ; on the other hand, the diagnosis of 
 diseases was greatly improved. The curative indications had become 
 more precise, from which we may conclude, a priori, that the therapeu- 
 tics of the physicians of this period became more rational and precise 
 than that of the Asclepiadfe. The treatment of acute diseases is also 
 described with more method and exactness, than in the authors of the 
 Hippocratic collection. This may be seen by comparing the treatment 
 of peripneumonia, traced by the latter, with that laid down in the work 
 of Aretaeus. 
 
 CURE FOE PERIPNEUMONIA. 
 
 " When the lung is inflamed and swollen, the affliction is acute, and 
 promptly fatal ; for suifocation is close at hand. Prompt aid must be 
 afi"orded, equal to the severity of the attack. A venesection must be 
 made at once, and from both arms, in order to efi^ect on both sides a 
 revulsion of humors from the lung. The bleeding must not be carried to 
 syncope, for fear of augmenting the suffocation. When the patient com- 
 mences breathing more freely, the bleeding should be stopped ; to be 
 
 '- Dioscorides d'Aiiazarbas : De la Matiere Medicale, book iv, chap, lxxix. — 
 French translation, by Mathiolus, Lyons, 1580.
 
 INTERNAL PATHOLOGY. 193 
 
 employed again, if necessary. There is nothing, in fact, hut the hleed- 
 ing, that can destroy the disease, if it proceeds from the hlood ; and 
 even in cases where the phlegm, froth, or any other humor of that spe- 
 cies, distends the lungs, it would still be useful in disgorging it, and 
 procuring a free space for respiration. 
 
 " After the bleeding, an effort should be made to direct the humor and 
 wind by the inferior channels. To effect this, the anus should be 
 anointed with a liniment composed of honey, rue, a terebinthenate 
 liquid and nitre, mingled together. In a case where venesection is 
 impracticable, on account of great effusion, an injection should be made 
 into the fundament, in the form of clysters, of some tart substance — for 
 example, of salt with nitre; turpentine with honey; or rue boiled in oil ; 
 or a decoction of hyssop. The pulp of colocynth, boiled in water, is also 
 very convenient. It will also be useful to apply dry cups, along the 
 spine, on the hypochondria, and wherever they can be used. The fleshy 
 parts of the chest are to be preferred, from fear that the cup will fall off. 
 If, by this means, the humors can be attracted to some other part, and 
 the flatus that swells the lungs be dispersed, the patient will obtain 
 great relief; but it is necessary, in some way, to besiege every part, in 
 pneumonia. 
 
 " In the meanwhile, those remedies which can be taken with most 
 advantage by the mouth, should not be neglected, especially as the 
 lung, whether sound or diseased, attracts humidity. Therefore, reme- 
 dies should be employed that attenuate the humors, and render them 
 less tenacious, more mobile, and easier to be expectorated. To effect 
 this speedily, and thus relieve the patient, a decoction of nitred hyssop 
 should be given ; or of brine, mingled with vinegar and honey ; or an 
 infusion of mustard, in an emulsion of water. If to each of these 
 preparations there be added, freely, those of the root of the iris, and 
 pulverized pepper, it will be found very good. So, also, these powders 
 may be sifted, mingled with honey, and given to the patient. If he 
 pass several days and nights without sleep, there is reason to fear that 
 he will fall into a furious delirium. Unless the disease abates, somni- 
 ferous medicines are to be used, to calm the patient, produce sleep, and 
 prevent this unfortunate state. There is a great variety of such reme- 
 dies, which may be employed ; but care must be taken not to give them 
 when the patient is on the point of suffocation by the fluxion, for fear 
 of creating an impression in the bystanders, that your remedy has 
 killed him. 
 
 " Aliment must be used, that acts in harmony with the remedies, and 
 should, therefore, be somewhat bitter, sharp, attenuating, and detersive. 
 Among the legumes, leeks, cresses, nettles, and cabbage, cooked in
 
 194 ANATOMICAL PERIOD. 
 
 vinegar, should be cliosen. Among the farinaceous substances, vegetable 
 soup, to which is added marjoram, or hyssop, spiced with a little pepper, 
 or nitre, instead of salt, alique, boiled in sweetened water. All these 
 substances should be boiled, in order to expel the air, which is very 
 incommodious to peripneumonics. 
 
 " When the patients are without fever, a little wine may be allowed, 
 provided it is not too astringent ; for in this disease there is need of 
 relaxation, rather than constriction, so that expectoration may be facili- 
 tated. In general, the patient should have but little to drink, for the 
 lung attracts the humidity of the esophagus and stomach, which is 
 injurious. 
 
 " The chest should be covered with wool, saturated with oil, in which 
 a little nitre or salt has been dissolved. Fomentations should be made, 
 occasionally, with snail oil. A useful liniment, in such cases, is com- 
 posed of dry mustard, mixed with cerato. In short, everything that 
 can draw outward the humors, heat, and wind, must be employed ; such 
 as irritant substances to the nostrils, different kinds of ^ointment, and 
 ligatures on the extremities, are some of the means to be employed. 
 If, after all these things have been employed, the disease does not abate, 
 the case must be regarded as desperate." 
 
 The above account, except in some small particulars, would not detract 
 from a modern work on the practice of Medicine. If placed in par- 
 allel with the prescriptions directed by the Hippocratic writers, it will 
 be seen, that there is no comparison, whatever, to be established. Thus, 
 in the space of four centuries, which separate the last of the Asclepiadse 
 from the epoch in which Aretreus lived, a greater progress in the diag- 
 nosis and treatment of certain diseases was made, than has been effected 
 since, in a course of more than sixteen hundred years. 
 
 CHAPTER VII. 
 
 EXTERNAL PATHOLOGY AND THERAPEUTICS. 
 
 The want of anatomical knowledge was an insurmountable obstacle 
 to the progress of surgery, under the Asclepiadas. They did not lack 
 boldness to attempt difficult and dangerous operations, but they lacked 
 methodic and correct procedures, because the hand of the operator was 
 not guided by a knowledge of anatomy. But after the anatomical labors 
 of the school of Alexandria had thrown so much light on the conforma- 
 tion of our organs, operative medicine must have assumed a new phase ;
 
 EXTERNAL PATHOLOGY AND THERAPEUTICS. 195 
 
 and this we see exhibited in the works of Celsus and Galen, in which 
 the surgical parts are incontestably superior to those of the Hippocratic 
 books. A short analysis of the surgery of Celsus will suffice to make 
 this evident. 
 
 This author, according to all evidence, lived toward the close of the 
 first century of the Christian era, that is to say, a little in advance of 
 Galen. He wrote on a great number of subjects, such as architecture, 
 rhetoric, philosophy, military tactics, etc., but of all his works, those 
 on Medicine alone have reached us. It forms a methodic abridgement, 
 extremely complete and concise, of all ancient Medicine. The author, 
 in the commencement, gives a rapid view of the origin and first develop- 
 ment and progress of the Art, and the sects into which the medical 
 men of his time were divided. He exercises, on each of these subjects, 
 an excellent judgment ; then he traces a regimen for men in good 
 health, and for those who are valetudinarian. With these subjects he 
 fills the first two books of the Compendium. The four following, are 
 devoted to the description and cure of diseases susceptible of being 
 cured by the aid of regimen and pharmaceutical means. 
 
 Finally, the last two books, i. e., the seventh and eighth, include the 
 accounts of cases in which the aid of surgery is judged indispensable, 
 with a description of the operations then in use. Celsus has contracted 
 in a small space all the surgical knowledge of the ancients. He treats 
 not only of all matters contained in the Hippocratic writings, but also 
 of a multitude of others, of which these books make no mention. 
 Among the chapters entirely new, we cite those relating to the relief of 
 hernia, vesicular calculi, cataract, wounds of the abdomen and intes- 
 tines, etc., which form, as we know, a considerable part of surgery. 
 His arrangement of the work is sufficiently correct and natural. He 
 commences by treating of the diseases which attack all parts of the 
 body ; then he passes to those which relate especially to each part. His 
 work is the only one, of that distant period, in which we find the opera- 
 tive processes described with clearness and precision ; the writings of 
 all the distinguished surgeons, from the foundation of the Alexandrian 
 school until his time, being entirely lost. He names, himself, several of 
 them, such as Triphon, Evelpist, and Meges, the wisest of all. 
 
 I will not examine the question, so many times asked and still unde- 
 cided, if Celsus himself was a practitioner ; that is of little moment to 
 us ; but it is important for us to have a summary idea of the progress 
 made in surgery during the course of the Anatomic Period. Now, to 
 obtain this, it will suffice, I think, to exhibit some fragments of the 
 latter author, in parallel with those of the Hippocratic collection, which 
 treat of the same subjects.
 
 196 ANATOMICAL PERIOD. 
 
 ON HEMOERHAGE. 
 
 " In Hippocrates, the word aiiioppayai always signifies a hemorrhage, 
 in which the blood flows freely and forcibly. When less blood flows, 
 and slower, he calls it eppvacv, and azaXaynou when it flows only drop 
 by drop. He prognosticates that, when an unnatural effusion of blood 
 takes place in any cavity of the body whatever, it certainly becomes 
 spoiled. It appears that he stopped the hemorrhage of wounds by filling 
 them with a substance so as to produce compression. Sometimes, again, by 
 the application of fire. In dressing wounds, he used a sponge rather than 
 charpie, which was improper, because the sponge, by imbibing pus and 
 other fluids, swells up, separates the edges, and prevents re-union. "=•■■= 
 
 This is all that the author of the history of surgery has been able to 
 collect in the Hippocratic works, concerning hemorrhage. Let us now 
 see what the same author has extracted from the work of Celsus. "As 
 soon as we are assured," he says, " by the signs heretofore given, that 
 the wound may be healed, Celsus directs that attention be given to pre- 
 vent the hemorrhage, or inflammation, from causing the death of the 
 patient. Now, we know that a hemorrhage is to be dreaded, according to 
 its seat, the extent of the wound, and the rapidity of the flow of blood. 
 Then he directs that the wound be filled with dry charpie, and a sponge, 
 dipped in cold water, be held upon it. If, however, the hemorrhage con- 
 tinues, he suggests that the charpie be frequently wet with vinegar. 
 Some surgeons of his time poured it into the wound ; but he objects to 
 this proceeding ; fearing that the sudden retention of the fluids would 
 lead to a violent inflammation ; but this could only relate to aponeurotic 
 parts. This view led him, also, to proscribe the use of corrosives and 
 escarotics, though proper to arrest hemorrhage. If they must be em- 
 ployed, he recommended that the mildest be chosen. 
 
 " If the hemorrhage resists these remedies, he advises that two ligatures 
 be made of the vessel, at the point of injury, and the intervening por- 
 tion be divided. There was only one step to take, between this and the 
 ligatures of the vessel, in amputations ; yet it required centuries to take 
 it. If the ligature was impracticable, he proposes the actual cautery, 
 provided the wound has bled enough, and that there are no nerves or 
 muscles in the wounded part, as on the forehead and top of the head ; 
 parts which they believed destitute of these tissues ; but this application 
 could only afford a doubtful result. It was still the habit to apply cups to 
 an opposite part, in order to determine the flow of blood from the wound ; 
 but it is plain that, under the circumstances, they could be of no utility.f " 
 
 *'Dujarclin, Histoire de la Chirurgie, vol. I, book iti, p. 210. 
 flbid., vol. I, book it, p. 372. 
 
 {
 
 EXTERNAL PATHOLOGY AND THERAPEUTICS. 197 
 
 There is no necessity for me to show in what respect the advice of 
 Celsus. on this occasion, is more detailed, more methodic and rational, 
 than that of the Hippocratic writers. I shall content myself by adding 
 another example. 
 
 ON THE EXTEACnON OF THE DEAB FETUS. 
 
 " If we compare," says the same historian, " the cruel method em- 
 ployed by Hippocrates, to take away the fetus, with the practice of our 
 time, we shall see that, in this respect, surgery has also made much 
 progress. To extract a dead fetus, he introduced his hand, covered with 
 cerate, into the womb, having his thumb armed with a sharp instru- 
 ment, which was termed a claw. He cut off first, the arms, and with- 
 drew them ; the hand was then returned to the womb, and the abdomen 
 of the fetus was opened, and the entrails slowly withdrawn ; lastly, 
 the ribs were broken, in order to reduce the size of the chest, so as to 
 render the extraction easy. He gives another process, quite as terrifying. 
 "When the dead fetus is situated obliquely in the uterus, presenting an 
 arm, he covered the head and chest of the mother, in order to prevent 
 her seeing the operation ; then he seized the arm, drew it without, and 
 amputated it at the shoulder-joint. He next made an opening in its 
 chest, below the clavicle, and several smaller ones in the abdomen, to 
 allow the air to escape. An effort was now made, to get hold of the 
 head, so as to withdraw the fetus entire. If this was unsuccessful, he 
 crushed the head, and brought away the body piecemeal." 
 
 " It remains, now, to detail with Celsus, how the accouchement was 
 terminated, when the infant was presented dead. After placing the 
 woman on her back, across the bed, the thighs were to be held apart, 
 the indicator, greased with oil, was introduced into the uterus, and then, 
 in the interval of the pains, the other fingers, successively, and, finally, 
 the whole hand. There were occasions, he says, when both hands were 
 introduced, which is not easily conceived. Celsus remarks, very pro- 
 perly, that when the hand is introduced into the uterus, it is at once 
 recognized whether the infant presents the head, or the feet, or trans- 
 versely. In this latter situation, the hands or the feet are not very 
 far from the os uteri, and the practitioner should endeavor to make the 
 head or the feet the presenting part ; for it is well known, that next to 
 the head, the feet are the more natural and advantageous presentation 
 for delivery. This plan is a great improvement in obstetrics, since the 
 time of Hippocrates. 
 
 " When the child presents an arm, an effort should be made to deliver 
 
 " Dujardin, Histoire de la Chirurgie. CEuvres d'Hippocrate, De la Superfeta- 
 tion. De I'Extraction du fetus mort. Maladies des femmes.
 
 198 ANATOMICAL PERIOD. 
 
 by the head ; if it was a foot, the other should be sought. In this case, 
 the accouchement can not be suj)posed difficult, even by the hand alone. 
 When the head comes down, a very smooth and short-beaked crotchet is 
 to be fastened in the orbit, or the mouth, or in the ear, and sometimes 
 in the forehead, so as to hasten the delivery. Celsus says, if traction 
 is made while the orifice of the womb is contracted, the crotchet may 
 slip from the part to which it is fastened, fall upon the undilated orifice, 
 excite convulsions, and j^lace the life of the mother in the most immi- 
 nent danger. Consequently, he orders, that traction be made gradually, 
 and only at periods of relaxation, and without violence. While the 
 operator draws upon the instrument with his right hand, the left is to 
 be engaged in directing the crotchet, and the position of the child." 
 
 " If version can not be effected, when the fetus is in the transverse 
 position, the crotchet must be fastened in the axilla, and traction be 
 made gradually. As the head is carried backward, it is to be separated 
 from the trunk, and then the separated portions are to be removed suc- 
 cessively. To do this, a crotchet similar to the first was employed, 
 excepting that its internal edge was sharp. The head was first with- 
 drawn, because it was thought that if the trunk, which is the most vol- 
 uminous, was first delivered, the head could not afterwards be taken 
 away without extreme danger ; nevertheless, if the operator must finish 
 with the head, he commenced by laying on the abdomen of the woman 
 a piece of linen, folded double ; then, an intelligent and strong man 
 must be placed at the left side of the woman, and apply both his hands 
 to the abdomen, one placed on the other, and press the head toward the 
 orifice of the womb, which the surgeon must seize with the crotchet, 
 and withdraw, in the manner prescribed. Though this procedure is 
 unnatural, it can not be denied that, in general, this manual of diffi- 
 cult labor, described by Celsus, is more rational and methodic than that 
 of Hippocrates ; notwithstanding the few occasions in which men were 
 called upon to act, in the important function of maternity." ■•■= 
 
 I should have been willing to abridge these quotations, and many 
 others that are passed, as well as those that are to come ; but after 
 deliberate reflection, I have concluded to present the thoughts of authors 
 in their own style, rather than abridge them by incomplete quotations; 
 or alter them by analysis ; I employ this last means, only when I can 
 not do otherwise. It has appeared to me, that one of the principa 
 objects of the history being to offer the reader a succinct narration, as 
 exact as possible, of the vicissitudes of medical science, it would be 
 better to furnish him, often, with the means of judging for himself, by 
 
 « Histoire de la CMrurgie, T. I, liv. iv, p. 496. Celae, liv. vii, chap. xxix.
 
 CLINICS. 199 
 
 placing before him, in some sort, the various documents on the subject, 
 than to present him a ready formed opinion. The advantages of this 
 method seem to me so clear, that I do not think it necessary to argue it 
 at length. 
 
 CHAPTER VIII. 
 CLmiCS. 
 
 Clinics, as before remarked, is not a particular branch of medical 
 science ; it is the science itself, in its practical application ; it is 
 the battle-field of the physician ; the theater where he displays not 
 only all the resources of his art, but, also, of his genius, as well as the 
 qualities of his soul. A high intellectual capacity is doubtless the 
 first condition that constitutes the great practitioner ; but this is not 
 sufficient ; there are, also, necessary, constant watchfulness, and pres- 
 ence of mind, which will enable him to seize passing indications ; firm- 
 ness of character, that prevents him being troubled under the most 
 painful circumstances, and which gives him courage to take a resolu- 
 tion, without being disturbed by unjust and calumnious conversation — 
 fearlessly risking his reputation for the salvation of his patients. 
 
 A great practitioner must show himself, in all his acts, a constant 
 advocate of truth. He must not palliate his reverses, or his faults, 
 nor exagerate his success, for he is not ignorant that both serve as 
 lessons ; and that, in his elevated position, to hide the truth, or speak 
 falsely, is to pave the way for future homicides. 
 
 Such are the qualities that shine in the clinical histories unanimously 
 attributed to Hippocrates, in the first and third books on Epidemics. 
 In no other part of his writings are they so conspicuous as in these 
 books. The anatomic period, during which the Art made such great 
 progress, has not transmitted to us any collection of clinical observations 
 worthy to be compared with these ; whether the works of the illustrious 
 practitioners of this period perished in the destruction of the great 
 libraries, or whether, during this long period, there did not exist any 
 man who united in himself, in so eminent a degree as the old man of 
 Cos, all the qualities which constitute the great practitioner, I do not 
 pretend to say. Galen, who alone, among the physicians of this period, 
 can sustain advantageously a comparison with Hippocrates, by the gen- 
 eral character of his acquirements, and the multitude of his writings, 
 has left us no collection of clinical observations. He reports, now and 
 then, the history of some diseases, but for the evident purpose of showing
 
 200 ANATOMICAL PERIOD. 
 
 the superiority of his diagnosis, and the excellency of his theory. We 
 do not see in his recitals, as in Hippocrates' lively pictures of epidemical 
 constitutions, the naive and impartial historian, who gives his facts 
 without comment ; but we everywhere find, on the contrary, the prolix and 
 subtle dialectician, who lets no phenomenon escape him, without inter- 
 preting and discussing it, in a lengthy manner. 
 
 APHORISMS. 
 
 Many writers of this period, and Galen among the rest, commented 
 upon the Hippocratic aphorisms, but no one attempted to construct new 
 ones. The greater part were doubtless maintained, from the respect 
 which was held for the ancient oracles, whose reputation was colossal ; 
 it may be, too, they feared the abuse to which this kind of literature in 
 Medicine, more pretentious than solid, would lead. Be this as it may, 
 we shall not reproach the authors in this period, for having abandoned 
 them. 
 
 CHAPTER IX. 
 
 THEORIES AND SYSTEMS.- 
 
 GENERAL CONSIDERATIONS. 
 
 In proportion as the physical science of man was cleared up by the 
 researches in experimental anatomy and physiology, or, the diagnosis of 
 
 * The words them-y, system, and doctrine, have been many times already placed 
 before the eyes of my readers ; nevertheless, there is nothing more vague than 
 the various acceptations that authors attach to them — especially the first two. 
 If, to clear up this uncertainty, we have recourse to the most modern and best 
 esteemed lexicons, we find nothing in them satisfactory. No one gives a rational 
 explanation of the synonymy of these terms, and the shades of difference between 
 them, (a) Some of the more recent writers have attempted to introduce the fol- 
 lowing distinction : " A theory," say they, " is the production of a genius who 
 sees nature as it is ; a system is a product of the imagination, which bends every 
 thing in nature to its taste." But it is evident that such a definition rests on an 
 uncertain and arbitrary base ; for each author and his partisans being inclined to 
 consider their opinions the only true ones, will attribute to those of their adversa- 
 ries such qualifications as give them an erroneous character, as is clearly shown 
 by M. Raige-Delorme, in the Dictionary of Medicine, in 21 volumes, at the word 
 Doctrine. 
 
 M. Bouillaud complains very bitterly of the want of accuracy and precision in 
 philosophical terminology, and more especially of the ambiguity of the words 
 
 {a) Consult, on this subject, Dictionaire de VAcademie. — Dictionalre de Laveaux. — Dictionaire 
 de M. Napoleon Landais.— Dictionaire des Sciences Medicalos, in 60 volumes. — Dictionaire des 
 Synonymcs, by Boinvilliers.
 
 CLINICS. 201 
 
 diseases became more perfect, as the conquests in natural history multi- 
 plied the resources of therapeutics, it became more and more necessary 
 to classify the material acquisitions of science, in a methodical order, 
 that could be recalled easily by the memory ; and to unite by a theory, 
 more or less reasonable, the multitude of old and new facts, that made 
 up the treasure of Medicine. 
 
 A great number of philosophic writers, holding different views, 
 attempted this difficult enterprise ; some, in fact, endeavored to unite 
 the traditions of the past with the conquests of the present, without 
 changing at all the fundamental principles of the accredited doctrine, and 
 by the aid only of a few modifications of details. Others, on the contrary, 
 judging these principles to be erroneous or insufficient, aspired to nothing 
 less than the overthrow of the ancient edifice of science, in order to 
 reconstruct it on new foundations. 
 
 If the historian should attempt to record the particular opinions 
 emitted, on each of the phenomena of the animal economy, he would 
 find nearly as many different theories as there exist authors in Medi- 
 cine ; for there is not a single physician who has not modified, in some 
 point, by his own experience, the doctrine which he has received from 
 his masters. But if regard be had only to the capital differences — 
 to the divergence in principles — the theories which most divided physi- 
 cians of this period may be ranged under four heads, namely: Dogma- 
 tism, Empiricism, Methodism, and Eclecticism or Syncretism. 
 
 theory, system, doctrine, etc. ; but he has not remedied it. (6) M. Coutanceau is 
 the only one in my knowledge, who has given a clear and logical definition of the 
 theory and system. A theory, he says, indicates the relation of facts among 
 themselves ; it marks their order of succession and dependence. A system (in 
 medicine) is a general theory of the laws and mechanism of life, by means of 
 which we endeavor to reduce to a small number of principles, sometimes even, 
 to one alone, all the phenomena of health and disease, (c) 
 
 Though M. Coutanceau has limited to medicine his definition of system, whilst 
 his definition of theory is applicable to all sciences, he has nevertheless appre- 
 ciated and expressed, more happily tlian any other writer, the shade of difi"erence 
 between the two expressions, and the similitude which unites them, in saying that 
 a system is a general theory. Such is the sense which we have ourselves attached 
 to these words, when we would make a distinction ; thus we say, the theory of 
 inflammation and of fever; the system of Hippocrates, of Themison and Stahl. 
 Lastly, the word doctrine has a still more extended signification ; for it signifies 
 all that one believes or teaches, on any matter whatever. It embraces, in its 
 scope, theoretical and practical notions, systems, facts, and hypotheses ; it is what 
 must be understood by the following expressions, which recur so often in medical 
 language : the doctrine of Cos, of Montpelier, of Leyden, etc. 
 
 (6) See hi3 Essai de Pliilosophie Mr;dicale, Paris, 183C, page 176, note. 
 (c) See Diet. Med., in 21 vols., words Theory, System. 
 
 13
 
 202 ANATOMICAL PERIOD. 
 
 ART. I. ON DOGMATISM. 
 
 We know, already, the principles of Dogmatism, its origin, its authors, 
 and its most illustrious partisans. We know that this doctrine, taught 
 in the school of Cos, and sustained by Plato and Aristotle, had reigned 
 in the medical world for several centuries before the school of Alexan- 
 dria was established. The earliest, and the most celebrated professors 
 of that school, brought up in the tenets of Dogmatism, made few changes 
 in it. Herophilus admitted the sentiments of Hippocrates, and Praxa- 
 goras, his master, on the effect of the mingling of humors, in health or 
 disease, and followed nearly their rules in the practice. Besides great 
 discoveries in anatomy, he made many experiments with medicines. 
 which he termed the hands of the gods when properly employed, but 
 useless, and even injurious instruments, if a practitioner is ignorant of 
 their appropriate use.''"' 
 
 Erasistratus, though adopting the greater part of the Hippocratic 
 dogmas, thought that fever and inflammation proceeded from the pas- 
 sage of the blood from the veins to the arteries. According to him, 
 these last vessels contained, naturally, only air, or spirits ; " but," said 
 he, " when there is an excess in the veins, extravasation takes place, 
 into the arteries, and creates all the inflammatory and febrile symptoms." 
 The sanguineous plethora appeared to him to be the most frequent cause 
 of diseases ; nevertheless, to combat it, he rarely employed bleeding. 
 
 He preferred abstinence or fasting, dieting, mild injections, vomits, 
 exercise, and baths. He was not very partial to purgatives, and did 
 not believe, with Hippocrates, that certain of these remedies had the 
 property of eradicating some particular humor, exclusively. He said, 
 that the thinnest, and most subtile humors, were first carried off"; 
 then the more tenacious followed. According to him, the mildest pur- 
 gatives produce only slight, watery evacuations ; those which are a 
 little stronger, carry off" the bile ; and the strongest of all, the atrabile. 
 
 But of all the sectators of Dogmatism, the most fruitful, the most 
 skillful, and the most powerful, was Claudius Galen. He was a native 
 of Pergamos, a city of Asia-Minor, celebrated for its temple dedicated 
 to Esculapius, its school of Medicine, and its library — which in rich- 
 ness was only second to that of Alexandria. His father was his first 
 master, who placed him, also, under professors very distinguished in all 
 the sciences. The young Galen profited by their instructions, with 
 extraordinary success. He was already in a state to dispute with the 
 most erudite, on grammar, history, mathematics, and philosophy, when, 
 
 '■ Galen, De Compos. Medicam. local., lib. vi, cap. iii, (Luler, p. 322.)
 
 THEORIES AND SYSTEMS. 203 
 
 on the express advice of the gods, he decided to study Medicine. He 
 recounts with complacency, how this counsel was twice given to him in 
 a dream, by Apollo, and that he could not resist the divine will, s« 
 clearly manifested. But his numerous and learned writings justify 
 much better his medical vocation, than all these mysterious reminis- 
 cences. 
 
 He undertook several voyages, for instruction, and visited, among 
 other cities, the capital of Egypt, where he remained some time. On 
 his return to his country, he was charged by the Pontiff, to dress the 
 wounded in tlie circus, which furnished him an opportunity to display 
 his anatomical knowledge and surgical skill. Very soon afterward he 
 left again his native city, to go and exhibit himself in a much grander 
 theater. He went to Eome, preceded by his great renown, and where his 
 easy and brilliant elocution, his profound and varied erudition, and prac- 
 tical skill, secured him the esteem of the highest personages ; but his 
 rapid success, his boasting, his disdain for his confreres, which he took 
 no pains to disguise, and his natural jealousy, raised up against him a 
 crowd of enemies, who rendered his stay at Eome very disagreeable. A 
 conception of this may be had, by the following picture, which he draws of 
 the physicians of that capital, in his work on Prenotions •' He accuses 
 them of base jealousy, and stupid ignorance, and pours out upon them 
 such epithets as thieves, and poisoners, and closes by saying, that after 
 having unmasked them, he would shield himself from their hidden and 
 evil designs, by abandoning the great and populous city — where a man 
 has consideration only in proportion to the luxury he displays ; where 
 a shameless charlatanism usurps the confidence of a stupid and frivolous 
 public — to seek a home in some smaller city, where the citizens are 
 mutually acquainted, and therefore know the birth, education, fortune, 
 and private life of each other. 
 
 He left Eome, but very soon returned, on the invitation of the emperors 
 Marcus Aurelius and Lucius Verus. He had also the confidence of 
 their successors, Commodus and Septimus Severus. It is supposed that 
 he died in the seventy-first year of his age, toward the close of the 
 second century of the Christian era, either at Eome or Pergamos, or on 
 the passage from one city to the other. A monk has imagined that he 
 finished his days during a pilgrimage to the Holy Land. 
 
 Galen asserts, that he was not attached to any of the sects that 
 divided the physicians of his time. He treats as slaves those who took 
 the title of Hippocratists, Praxagoreans, Herophilians, etc. ; but he is 
 not to be credited, when he affects to hold an equal balance among the 
 
 -' De Proenotione ad Posthumum, edition of Chartier, Tom. VIII, page 836.
 
 204 ANATOMIC PERIOD. 
 
 various doctrines. It is probably only an absence of mind, very pardon- 
 able in a man wbo has written so much ; or an oratorical artifice, to show 
 d"n air of independence and impartiality. His predilection in favor of 
 the doctrine of Hippocrates is well marked: he explains, comments upon, 
 and amplifies it at length ; he refutes the objections of its adversaries, 
 and strives to give it the ascendancy over all others. " No one," he 
 says, " before me, has given the true method of treating diseases. Hip- 
 pocrates, I confess, has heretofore shown the path, but as he was the 
 first to enter it, he was not able to go as far as he wished. The order 
 he adopted is bad ; he omits certain important indications, and has not 
 made all the distinctions necessary. Often, he is obscure, as is usually 
 the case with the ancients, when they attempt to be concise. He says 
 but very little of complicated diseases ; in a word, he has only sketched 
 what another was to complete ; he has opened the path, but has left it 
 for a successor to enlarge and make it plain."'-' 
 
 This short quotation shows the point assumed by Galen, and how 
 slightly he regards the labors of the physicians, who lived between 
 Hippocrates and himself. Let us now see how he has acquitted himself 
 of the task he so arrogantly undertakes. 
 
 There are, according to him, three sorts of principles in man, viz., 
 spirits, humors, and solids, which he also named parts. 
 
 Among the solids, some are simple, or similar ; that is to say, if they 
 are divided, each fraction is homogeneous with the rest. Such are the 
 bones, flesh, nerves, membranes, etc. These structures have, in vain, 
 been divided into as many fractions as were desired, but there always re- 
 main in each, pieces of bone, flesh, or membrane, similar to the entire bone, 
 flesh, or membrane, that has been broken up. Other parts are called 
 organic, or compound, as the arm, leg. head, or eye ; because they exe- 
 cute the most striking and perfect acts, and because they are formed of 
 several similar parts. 
 
 There are some simple parts that take their origin from the semen ; 
 such as nerves, membranes, bones, and veins. These are not very sus- 
 ceptible to corruption, and are not regenerated after they have been 
 destroyed. There are other simple parts which degenerate easily, and 
 are reproduced with the same facility. They are those that come from 
 the blood, as the fleshes. f 
 
 Galen refutes, with Hippocrates, and by the same arguments, the 
 opinion of those philosophers who recognize but one element ; neither 
 does he share the advice of those who, in admitting several elements, 
 
 ■' Method Medencli. lib. ix, cliap. viii. 
 
 •{• De Constitutione Artis Medicie. Also, De semine. 
 
 A
 
 THEORIES AND SYSTEMS. 205 
 
 regard the corpuscles as incommunicable in their essence. When the 
 tissues are divided, he says, both pain and heat are excited ; now, both 
 of these results would not transpire if they were composed of one ele- 
 ment alone, or if the elements that enter into their constitution were 
 unalterable. Nothing more would be realized, in such a case, than 
 when one finger is separated from another, which excites not the 
 slightest pain or heat. In consequence of this reasoning, Galen ranges 
 himself on the side of Hippocrates and Aristotle, who admitted, as we 
 know, four elements or primordial qualities, heat, cold, dryness, and 
 moisture. He thought that all the changes which occur in the body are 
 due to one of these elements ; but he regards heat as the most active of 
 all, and cold next to it. The natural bodies, he says, in which the 
 primitive qualities show themselves in the highest degree, are fire, air, 
 earth, and water. These are called elementary, because the others are 
 derived from them.-' 
 
 We perceive, therefore, that Galen reproduces and amplifies the Hip- 
 pocratic Dogmatism. What follows is a continuation of the same sub- 
 ject ; but the reader who is cm fait in the doctrine of Cos, will discern, 
 without my pointing them out, expressly, the additions and pretended 
 improvements which the physician of Pergamos makes to this doctrine. 
 I proceed, then, without interruption to exhibit the system of Galen. 
 
 There exists between the elementary or similar parts of the human 
 body, four simple variations : that is to say, one part may be hotter than 
 the other, or colder, or dryer, or moister. There exists, also, or may 
 exist, between these same parts, four compound variations, namely, one 
 may have more heat and dryness than another, or more heat and mois- 
 ture, etc. The exact proportion and mixture of these qualities produce 
 the best constitution, or perfect health. But this perfection is rather 
 an ideal type than a reality ; the most healthy men are always a little 
 removed from it. 
 
 Between perfect health and disease there are, according to Galen, 
 eight kinds of temperaments or imperfect mixtures, compatible with the 
 free exercise of the functions of life. Four of these elements are sim- 
 ple, and four compound. If a man has in every part of his body, or in 
 some one part, an excess of heat, it may be said that his temperament 
 is simply hot; or if the excess be in moisture, his temperament is 
 humid, and so on for the rest. But if there exist an excess of heat and 
 moisture at the same time, in the body of an individual, or in any por- 
 tion of his system, then that individual would have a hot and moist or 
 
 ° De Constitutione Artis Medicae — Introductio sen Medicus — De Elementis ex 
 Hippocrate.
 
 206 ANATOMICAL PERIOD. 
 
 a compound temperament. Disease, says Galen, is not a temperament, 
 but an intemperament.'' 
 
 After this somewhat subtle and arbitrary classification of tempera- 
 ments, Galen designates the signs that characterize each of them. 
 Here, for example, are those that indicate a cold brain : the natural 
 emunctories of this Viscus, viz., the palate, ears, nose, and eyes pour out 
 excretions too freely. The hair is straight, red, rather stiff, thin, and 
 poorly nourished ; it grows slowly. Persons in this condition are very 
 sensible to refrigerant influences, and very subject to catarrhs and heavi- 
 ness of the head. The skin about the cranium is neither hot nor 
 flushed. The veins of the eyes are scarcely visible : in short, these 
 persons have a remarkable propensity to sleep. f Our physiologist 
 passes in review in this manner all the principal organs of the human 
 body, and describes the signs of their various temperaments. 
 
 Then he describes the temperaments of the natural humors of the 
 body, and those of certain substances foreign to the animal economy. 
 In these descriptions we still see, as in all that precedes them, the 
 evident traces of the Hippocratic Dogmatism. Thus, according to the 
 opinions of the physician of Pergamos, the blood, air, and the spring 
 season are hot and humid; the yellow bile, summer, and fire are hot 
 and dry; the earth and autumn are dry and cold; the phlegm, water, 
 and winter are cold and wet. It is indispensable that the humors of 
 the body be reciprocally transmutable — -just as are all the primitive 
 elements ; for, though they exist in all parts mingled together, and 
 mutually temper each other, there is nevertheless an organ, a period of 
 life, and a season in which some one of them more particularly abounds. 
 The blood, for instance, predominates in the heart among the adolescent 
 and in the spring ; the yellow bile in the liver, in middle life and in 
 summer. I 
 
 Beside the structures and humors, there is, also, in the animal econ- 
 omy, a third principle, which is called spirits. These spirits are of 
 three kinds, namely, natural spirits, which Galen compares to a subtile 
 vapor that arises from the venous blood. They originate in the liver, 
 which is also the source of the blood ; thence they proceed to the heart, 
 where they mix with the air which that viscus attracts from the lungs, 
 and unite with it to form the vital spirits. These last are thrust by 
 
 '■' De Constitutione Artis Medicce, chap, ix ; Ars Medica, cap. iv ; De Tempera- 
 mentis, lib. i, chap, vm ; De Optima Nostri Corporis Constitutione ; De Sanita 
 Tuenda. 
 
 ■j- Ars Medica, cap. vm ; De Temperamentis, lib. i, ii, iii. 
 
 I De Humoribus Introductis seu Medicus, cap. xii ; De Placitis Hippocratis et 
 Platonis.
 
 THEORIES AND SYSTEMS. 207 
 
 the arteries into all parts of the system, but chiefly into the brain, where 
 they are converted into animal spirits. 
 
 The spirits are the instruments or servants of the soul, which governs 
 the animal economy. 
 
 Galen thought, with Plato and Aristotle, that the human soul is com- 
 posed of three faculties, or, rather, of three parts : the vegetative, which 
 resides in the liver ; the irascible, which has its seat in the heart ; and 
 the rational, which dwells in the brain." 
 
 Each faculty of the soul has in its service, according to Galen, inde- 
 pendently of the spirits, a certain number of secondary faculties. Thus, 
 the vegetative soul held in its department, the generative, growing, and 
 nutritive faculties. These secondary faculties, in their turn, fulfilled 
 their functions, aided by faculties of a third order. The nutritive, for 
 example, which has its principal locality in the stomach, is assisted by 
 attractive, retentive, assimilative, and expulsive faculties. f 
 
 Aided by this hierarchy of souls, spirits, and faculties, Galen and his 
 sectators had no difficulty in giving an account of all the functions of the 
 animal economy. If the question was asked of one of them, how nutrition 
 is performed, the answer was : nutrition is a natural function, to which 
 four faculties concur, namely : the attractive, which draws the food ; the 
 retentive, which keeps it for a sufficient time, for coction to take place ; 
 the assimilative, which transforms it into particles analogous to the sub- 
 stance of our bodies ; the expulsive, which eliminates their excrementi- 
 tial residuums. When, I say, the candidate had made this response, pro- 
 fessors and assistants must show themselves equally satisfied, for he had 
 explained, according to the language of the times, what was supposed to 
 constitute the essence of the nutritive function. 
 
 Pathology ofi'ers us the same assemblage of imaginary or abstract 
 entities, to which attributes were ascribed, as to real beings. We find 
 accounts of diseases that had their seats in the solids, humors, and 
 spirits. 
 
 Diseases of the solids were divided into three orders : the first com- 
 prises afi'ections of similar parts, and also named distempers. There 
 are two species of distempers, namely: the simple distemper, which 
 proceeds from the excess of a single element, whether heat, cold, dryness, 
 or moisture ; the double, or complex distemper, which results from an 
 excess of two of these elements at the same time, as an excess of heat 
 and dryness, or an excess of heat and moisture, etc. The second order 
 comprises aflfections of organic parts, which consist in irregularities of 
 
 ' De Facultatibus Naturalibus, lib. i., n., in, 
 t De Facultatibus Naturalibus.
 
 208 ANATOMICAL PERIOD. 
 
 conformation, errors in number, size, or situation. Finally, the third 
 order, which is common to similar parts, and organic parts. It includes 
 all the accidents connected with the solution of continuity. Galen dis- 
 tinguishes, also, among the diseases of the solids, various complications, 
 which constitute so many new species.'-'^ 
 
 The essence of fever consists in an unnatural heat, which sometimes 
 is kindled in the tissue, even, of the heart ; again, in the humors of this 
 viscus ; and, lastly, occasionally in the spirits. The latter are most 
 promptly inflamed ; next, the humors ; lastly, the solids. Fevers of 
 the shortest duration have their seat in the first; those of medium 
 duration, in the second ; and those that are longest continued, in the 
 parenchyma.! 
 
 Ardent fevers degenerate into the hectic, or consumptive, in two ways ; 
 first, when they are prolonged to such an extent as to consume all the 
 humidity of the heart, and then seize upon the tissue, even, of the 
 organ ; second, when they invade the substance of the heart, before all 
 its humidity is consumed. Hectic fevers are recognized by the tem- 
 perature of the body of the arteries, which is more elevated than the con- 
 tiguous parts. This diiference is especially marked, at the moment of 
 the diastole of the artery. J 
 
 Among the fevers which proceed from the humors, Galen distinguishes 
 three orders, viz : the continent, continued, and intermittent. Each of 
 these orders he divided into many species. Of intermittent fevers, the 
 most common are the quotidian, the tertian, and the quartan. The 
 first is produced by the phlegm ; the second, by the yellow bile ; the 
 third, by the atrabile. Galen admits, besides these, many other species 
 of fevers, both simple and compound. 
 
 In regard to the progress of these febrile affections, our pathologist 
 recognizes, with Hippocrates, four periods, which he names invasion, 
 augmentation, stasis, and decline. He compares these periods to the 
 four ages of man, in the following order : the first age, or that of gene- 
 ration ; the second, or that of growth ; the third, or that of force and 
 vigor ; the fourth, or age of decline. When the patient succumbs, it is 
 always in one of the first three phases ; never in the last.[| 
 
 In other respects, in regard to coction, crises, and critical days, our 
 author concurs in the pure doctrines of Cos. 
 
 He divides the action of remedies into primitive, and consecutive. 
 The primitive action depends on one or two qualities, which exist in the 
 
 •' De Morborum DifFerentiis liber. — ^De Morborum Causis, liber. 
 ■j-De Differentiis Februm, lib. i, cap. i. 
 
 I De Differentiis Februm, lib i, cap. x., xiii. 
 
 II De Morborum Temporibus, etc., lib. ii.
 
 THEORIES AND SYSTEMS. 209 
 
 medicine. Thus, one substance will excite heat or warmth, because the 
 element of fire predominates in it ; another is cooling, because it has the 
 cold element in excess. There are also substances that produce heat 
 and dryness at the same time ; others which excite heat and moisture. 
 Among therapeutic agents endowed with the same property, for example, 
 that of heating, some have it in. an eminent, and others in an inferior 
 degree. Thus, bitter substances are extremely heating ; the sweet are 
 only moderately so, their heat but little surpassing ours. The saline 
 taste proceeds from the excess of the igneous and terrestrial principle.'"' 
 There are substances which produce their effects immediately ; for exam- 
 ple, fire heats at once ; and ice cools in like manner. The effect of others 
 is not so prompt, such as the anthemis pyrethrum and castor, which pro- 
 duce a sensation of heat only after some time has elapsed ; and hyosci- 
 amus and mandragore cool, also, slowly. A thing may be said to possess 
 a quality, naturally, or accidentally, accordingly as it is a natural or 
 accessory attribute. Water, for example, which is naturally cold, may 
 become hot, accidentally, but its acquired heat is not long retained, 
 while its natural coldness persists, habitually. After other distinctions, 
 still more subtile, on the various ways in which we may observe the 
 primitive effects of medicaments, Galen traces the rules to be followed 
 in order to recognize their effects ; he indicates the precautions to be 
 observed, so as not to be deceived by false appearances. Passing then 
 from precept to example, he demonstrates by a series of experiments and 
 arguments, that water has a cold and humid temperament ; vinegar a 
 cold temperament, with a certain mixture of heat proceeding from its 
 acridness.f 
 
 The consecutive action of medicines is so called, because it is manifest 
 after the primitive effect, and as a consequence of it. This action is 
 very varied ; thus, there are medicines that open the pores, others which 
 close them ; some harden, others soften the tissues ; some purge the hu- 
 mors, others alter them ; some hasten their maturation and the formation 
 of pus ; others give relief to pain, etc. There are, also, remedies whose 
 consecutive action is especially related to certain organs, or certain func- 
 tions ; such as diuretics, vomits, drastics, emmenagogues, etc. Galen 
 sought to establish the connection which exists between the primitive 
 and secondary action of remedies ; for example, he supposed, that reme- 
 dies which harden the tissues, are of a cold and moist temperament ; 
 those which increase the flow of urine, are hot and dry ; and those that 
 increase the secretion of milk and semen, are moderately hot and humid.| 
 
 **De Simplicium Medicamentorum, Temperamentis Facultatibus, lib. i, ir, ra, iv. 
 t Ibid., lib. I, n, in, it. | Ibid,, lib. v.
 
 210 ANATOMICAL PERIOD. 
 
 As to the principles which should guide the practitioner in the choice 
 of therapeutic means applicable to each disease, the physician of Per- 
 gamos adopted fully the axiom proclaimed by the school of Cos, which 
 says, that diseases are cured by their contraries. Consequently, all 
 researches and pathological dissertations aimed to penetrate the essence 
 of diseases, to make it evident, and distinct from all accessory accidents ; 
 in short to apply to this essence a treatment whose action would be 
 diametrically opposite to its mode of existence. Now, he considered 
 this essence to be, sometimes, the excess of one or two elementary quali- 
 ties of the diseased part ; again, the re-action of the vital principle, the 
 efl&cient and primary cause of all the symptoms. In this respect his 
 doctrine is confounded with the Dogmatists ; it is nothing else than Dog- 
 matism itself, amplified, explained, and pushed to its last consequences. 
 Occasionally, however, he had regard to the constriction and relaxation 
 of the pores, which approaches the views of the Methodists. Finally, he 
 professes, in many passages, a great consideration for the pure concourse 
 of symptoms and experience ; fundamental principles, which the Empi- 
 rists placed above every thing. Notwithstanding these rare and slight 
 digressions, Galen has been, and must be regarded as one of the pillars 
 of the Hippocratic Dogmatism, 
 
 Though he has written a great number of treatises on pathology and 
 therapeutics, it would be difficult, if not to say impossible, to treat a 
 single disease by his directions, so bad is the method he has adopted, 
 and so defective was his manner of studying each case. I except, always, 
 from this proscription, the last four books of the treatise on Local Affec- 
 tions {de Locis Affectis) , where he gives excellent counsel how to ascer- 
 tain the anatomical seat of diseases, particularly of a mental and nervous 
 character. This treatise, joined to his writings on anatomy and physi- 
 ology, of which notice has already been taken, constitute for the physician 
 of Pergamos imperishable titles of glory, and justify and excuse the 
 infatuation of which he was the object during more than twelve cen- 
 turies. 
 
 In an historical sense, this encyclopedic writer has rendered immense 
 services ; for he has preserved the opinions of a great number of physi- 
 cians whose writings have perished, and especially of the chiefs of the 
 sects. Thanks to him, we are able to raise a corner of the veil that 
 covers the great contests between the Dogmatists, Empirics, and Meth- 
 odists. If the numerous works he has published are not now a trea- 
 sure, easy for the practitioner to explore, they are an arsenal from which 
 the erudite, and the dialectician, may draw arguments, on all kinds of 
 medical questions. Now, we approach an epoch in "Which physicians 
 showed themselves more anxious to shine by the subtilties of dialectics, 
 
 1
 
 THEOKIES AND SYSTEMS. 211 
 
 and the glitter of a vain erudition, than by the wisdom of their prac- 
 tice ; so much so, that the defects, even of this author, shall contribute 
 yet, to maintain in his hands the scepter of Medicine ; because, for 
 erudition, subtility of reasoning, and universal knowledge, he was 
 second only to Aristotle, and excelled even him, in elegance, purity, and 
 strength of style."-' 
 
 ART. II. ON EMPIRICISM. 
 
 The epoch in which the school at Alexandria was founded, was, as 
 we have seen, one of the most brilliant in the history of the human 
 mind. The love of letters, art, and philosophy, generally diffused 
 throughout Greece, had endowed her with chefs (Tceuvre of every kind. 
 The companions of Alexander had carried the lights of her young and 
 vigorous civilization to the center of Asia, the first cradle of a decrepid 
 civilization. In short, the radiant and communicative science of the 
 Greeks, eclipsed, on the shores of the Nile, the pale and shadowy rays 
 of antique Egyptian wisdom. "While the successors of Plato and Aris- 
 totle continued to teach the doctrines of their great masters, other philo- 
 sophers elevated rival schools, and strove to propagate diverse views. 
 Epicurus revived and embellished the system of Leucippus and Demo- 
 critus, on atoms, vacuum, and perpetual motion. Pyrrho developed the 
 maxims of Parmenides and Zeno, on the uncertainty of our knowledge 
 and judgment. He founded the sect of Skeptics, or Zatetics, who have 
 been styled the indifferent, in matters of science, as the Epicurians were 
 indifi"erent in mattei'S of morals. On the other hand, Euclid invented 
 the useless art of embroiling all questions, and silencing his antago- 
 nists, by captious and odd arguments. His sect, which was named con- 
 tentious, sought victories only in public debates, at that time very much 
 in fashion ; and they put in vogue a prating and cavilling dialectic, 
 which gradually infected the other schools. 
 
 Medicine, as usual, followed in the track of philosophy, and was 
 divided into several opposing camps. Herophilus and Erasistratus, 
 though dissenting from some of the points of the Hippocratic doctrine, 
 respected it as a whole ; but their disciples, Philinus of Cos, Scrapie 
 of Alexandria, and others, did not maintain the same veneration for 
 it ; they attacked even the principles of that doctrine, and asserted 
 that all which it affirms touching the elements, and elementary quali- 
 ties, cardinal humors, coction, crisis and critical days, the occult, or 
 
 '' It is said that he composed more than five hundred volumes on Medicine, and 
 nearly half that number on other subjects. But it must be observed, that among 
 these volumes there are counted many little manuscripts of a few pages only.
 
 212 ANATOMICAL PERIOD. 
 
 proximate causes, and the essence of disease, was altogether false, or 
 hypothetical. They rejected, as doubtful, hazardous, and useless, the 
 famous therapeutic axiom that forms the basis of Dogmatism, (diseases 
 must be cured by their contraries) and dared to reconstruct the Art on 
 new foundations. 
 
 This medical reform, or rather revolution, made rapid progress, and 
 the names of a number of physicians of high standing, are cited as 
 supporting it ; but the most celebrated, after the two coryphei, whom 
 we have named, was Heraclidus of Tarentum, who lived cotemporary 
 with them, or a few years later. The Methodist, Coelius Aurelianus, 
 who, following the expression of the historian, Daniel Leclerc, was accus- 
 tomed to maltreat the physicians of other sects, speaks of Heraclidus, 
 only in most honorable terms, giving him the epithets of noble and 
 famous ; calling him the last, and the most estimable of the Empirics.'-- 
 Galen's opinion in relation to him is nearly the same : " Heraclidus 
 never speaks contrary to truth to defend the interests of his sect — he 
 announces only his own experience ; and he practiced Medicine as well 
 as any other physician of the time.f 
 
 The Empirics composed a great number of books, which are lost. It 
 is only from the reports of writers of other sects, that we are acquainted 
 with their doctrines. It is probable, therefore, that they have not been 
 exhibited in the most favorable light. The Empirics go back to the 
 infancy of the Art ; they recount how the first sick were treated, and 
 they deduce from this the rules for the perfection of medical science. 
 
 The following argument of theirs is copied from Celsus: " Among the 
 sick, who, in the commencement, were without physicians, some, tor- 
 mented by hunger, could eat from the first days of their illness ; others. 
 on the contrary, disgusted with food, could eat nothing, and recovered 
 much sooner than the former. Again, some ate, even during a fever ; 
 others, a little in advance of its accession ; others again, after it had 
 ceased ; and these did better than the first or second. Also, those who 
 had eaten largely at the beginning of their disease, were in a much more 
 dangerous condition than those who had eaten but little. As these 
 things occurred every day, attentive persons soon observed what was 
 best suited to the sick, and thereafter prescribed it. Thus medicine 
 originated, which, from the essays that have been made, sometimes to 
 the advantage, and again to the detriment, of the sick, has been the 
 means of establishing a judgment between what was good, and what 
 
 '' Acutorum, lib. i, cap. xvii. Ibid., lib. ii, cap. ix. 
 
 f Galen, in lib. Hippocr. des Articcul. Comment. 3. Ibid., De Composit. Medical., 
 per genera, lib. iv, cap. vn.
 
 THEORIES AND SYSTEMS. 213 
 
 was evil. It was only then, after men had found remedies, that they 
 commenced to reason on the manner of employing them." " If, now, we 
 compare this passage with those taken from the work on Ancient Medi- 
 cine, it will be seen that, between them, there is perfect conformity ; but 
 I shall have occasion, hereafter, to show other analogies between the 
 doctrines of the Hippocratic works and the system of the Empirics. 
 
 They ranged under three heads the method of acquisition adapted to 
 Medicine : first was personal observation on autopsy ; second, the study 
 of the observations collected by others — or history ; third, the induc- 
 tions drawn from autopsy and history, which would serve to discover 
 things, for the moment concealed, but which had been before observed. 
 The last method was termed epilogism, or, in other words, consecutive 
 reasoning, to indicate that it was deduced from anterior observations ; 
 at other times, it was called analogism, because it rested on a similarity 
 of features. These three sources of medical instruction : autopsy, his- 
 tory and epilogism, formed the base, or what was termed the tripod of 
 Empiricism. 
 
 AUTOPSY. 
 
 The Empirics realized fully the maxim of Hippocrates, "experience is 
 deceptive ;'' for they took the most minute precaution, to avoid the causes 
 of error to which this mode of acquisition is subject ; though it is the first 
 of all, and the true foundation of the Art. They thought, for example, 
 that a disease should be studied a great number of times, from its 
 accession to its end ; in a simple, and in a complicate state ; in indi- 
 viduals of different temperaments, ages, and sexes ; and the knowledge 
 attained, of what conditions favored or prevented its development, etc., 
 before any one could pretend to have made its autopsy. They thought, 
 also, that the same treatment should have been employed a great number 
 of times, in the same disease, and under different circumstances, before 
 it could be affirmed that it would be efficacious in similar cases. 
 
 They did not confound symptoms with the disease : they called a symp- 
 tom an isolated phenomenon, or separate consideration, for example : 
 pain, swelling, redness, cough, and difficult respiration. They gave the 
 name disease to an assemblage of morbid phenomena, or, in other terms, 
 to a concourse of pathological occurrences, which were not fortuitous, 
 but which were nearly always developed in the same form. 
 
 Though they banished from their pathology the research of what the 
 Dogmatists named essential, or consecutive phenomena, they believed, 
 nevertheless, that all the symptoms were not of equal value. They 
 estimated the importance of a pathological phenomenon, not on its 
 
 *Celsus, Trad, de Ninnin, liv. i, chap i.
 
 214 ANATOMICAL PERIOD. 
 
 pretended essence, wliicli nothing, they said, revealed, but on the mani- 
 fest or sensible circumstances, which every one could appreciate. Thus, a 
 symptom that persisted throughout a disease, appeared to them to merit 
 more attention than one whose duration was much shorter. A symptom 
 related to the functions of an organ essential to life, or which announced 
 a grave alteration of an essential organ, was, in their eyes, more serious 
 than one which involved a secondary function, or indicated a superficial 
 derangement. 
 
 But, however grave a symptom, they were not willing to accord to it 
 an exclusive consideration ; they directed their attention to the general 
 state of the patient, or the concourse of symptoms. Thus, while some 
 physicians attached an exaggerated importance to the character of the 
 pulse, urine, or other dejections, or to the state of the skin, etc., for the 
 diagnosis of certain diseases, they asserted that, as far as possible, no 
 circumstance should be neglected, and an exploration be made, in every 
 case, not only of the organ or function specially affected, but also of all 
 the functions and organs, or at least the principal ones. They taught, 
 also, that an observation should be made of the accession and disappear- 
 ance of the different symptoms, their order, course, and, in short, of all 
 their relations to age, sex, habit, complexion, climate, season, etc. 
 
 An individual who had observed, frequently, the same disease from its 
 origin to its close, and who preserved a faithful memory of its symptoms, 
 course, and most ordinary complications, and the means to combat them, 
 possessed a theorem. Any one, then, who had thus stored in his mem- 
 ory a considerable number of theorems, possessed experience or practical 
 skill. Thus, autopsy, or clinical observation often repeated, established a 
 theorem, and the reunion of a number of theorems constituted experience. 
 
 An Empirical theorem, then, was nothing else than an exact tableau 
 of all the known phenomena of a disease, arranged according to their 
 importance and accustomed order, with the specification of their varie- 
 ties, and of the appropriate treatment, either separately or conjointly 
 considered. Each theorem, or each morbid concourse, in Empiricism, 
 was designated by a particular name, which was the symbol or abridged 
 expression of all the phenomena which made up the theorem. This 
 name was derived, sometimes, from the part principally affected ; thus, 
 the word pneumonia designated a concourse of symptoms, whose prin- 
 cipal seat was the lung ; gastritis, a collection of symptoms, relatino' 
 principally to the stomach ; thus avoiding all prejudice as to the nature 
 of the symptoms, and the cause of the disease. Sometimes, the name 
 of the theorem, or morbid assemblage, was derived from a dominant 
 symptom, as icterus, mania ; again, from the resemblance to a forei^^n 
 object, as cancer, elephantiasis, etc.
 
 THEORIES AND SYSTEMS. 215 
 
 The Empirics, we thus observe, attached but a secondary importance 
 to the name of a disease, for that did not indicate to them its essence, 
 but only an assemblage of morbid symptoms. The essential matter, 
 with them, was, that each concourse be traced with great exactness, 
 following, at first, its habitual march, then its irregularities and 
 complications. 
 
 HISTORY. 
 
 If it were necessary for a man to have seen, with his own eyes, most 
 diseases, with all their varieties and almost infinite shades of difference, 
 and to have directed the remedies employed in each case, and to keep 
 faithfully in his mind, or in his note book, the account of all these mat- 
 ters, he must have reached a very advanced age before commencing the 
 practice of Medicine. Few men could have been found, endowed with 
 patience, sagacity, and memory sufficient to finish so long and complicated 
 an undertaking. Moreover, the experience of preceding generations, and 
 thatof our cotemporaries, would be almost lost to us. The scientific edi- 
 fice of jNIedicine, in place of being extended and perfected from age to age, 
 would have remained stationary, or made but little progress. To supply 
 the insufficiency of autopsy, the Empirics had recourse to historj^ that 
 is to say, to clinical relations and theorems, committed to writing. By 
 the aid of history, we participate in the experience of all other men ; 
 we correct our own observations ; we are able, in a word, in a few years, 
 to acquire more knowledge and practical skill than if we had passed all 
 our lives in collecting notes at the bedside. 
 
 But to be able to appreciate the value of this source of instruction, 
 we must know how to make a judicious use of it, and besides, must 
 only confide in such histories as present sufficient characteristics of 
 truth, some of which we will mention. 1 . The reputation of an author 
 is an essential thing to consider. Faith is much more readily given to 
 the recitals of a man like Hippocrates, who has the reputation of an 
 attentive observer and truthful writer, to whatever sect he may belong, 
 than to the narration of one like Andrews, who has the character of 
 being an inexact 'observer and an insincere writer. 2. When several 
 histories, of different epochs and countries, recount the same fact, with 
 analogous circumstances, it ■ is a powerful motive to confidence. 3. A 
 still surer guarantee of the correctness of a history is, that it accords 
 with our own observations. It is necessaiy, then, before receiving the 
 statements of a writer, to submit his narration to a critical and severe 
 examination, and to accept it only in proportion to the degree of certainty 
 it presents. Thus illuminated, history becomes a sure guide, and an 
 extremely useful repertory for a practitioner.
 
 216 ANATOMICAL PERIOD. 
 
 EPILOGISM on ANAX0GI8M. 
 
 It may happen, that a new disease is presented to the practitioner, 
 which has not before been described. In that case, neither autopsy nor 
 history can offer examples as a guide. It may happen, also, that in 
 treating a well-known affection, the ordinary remedies indicated are not 
 at our disposal; here, again, history and autopsy do not aid us. In 
 both these cases, one is obliged to have recourse to reason, and be 
 guided by analogy. For example, a physician has a case not before 
 seen, nor described by authors. Search, say the Empirics, among the 
 historical relations, or in your own experience, what there is that 
 approaches nearest to the present disease, then treat it with those reme- 
 dies which have succeeded with the former. Thus, the treatment which 
 has been employed successfully in erysipelas, may be tried in certain 
 skin affections which strongly resemble that disease. So, also, a rem- 
 edy which had cured a rheumatism of the leg, would very probably 
 cure it in the arm. If it is desirable to replace a remedy whose efficacy 
 is known, but which is not to be had, by an equivalent remedy, seek, say 
 they, among the medicines at your disposal, that which is most similar 
 to the one you lack. Thus, you may substitute the juice of the per- 
 simmon for that of the quince, on account of the astringent taste which 
 is common to both of these fruits, in the treatment of a diarrhea, the 
 result of mei'e relaxation ; and a decoction of flaxseed may well replace, 
 in certain eases, that of the root of the althea. 
 
 To illustrate epilogism or analogism still further, suppose a patient 
 is attacked with pain in the hypogastric region, which is sometimes very 
 acute, again less so ; returning irregularly, and then sometimes entirely 
 disappearing. If these pains are increased by walking, and especially 
 by riding on horseback; if the emission of urine is occasionally inter- 
 rupted suddenly, to commence again after an irregular interval ; if a 
 metallic sound introduced through the urethra into the bladder, comes 
 in contact with a body that creates a sensation of rubbing against a 
 rough and solid substance, this concourse of circumstances would autho- 
 rize the physician to think that a vesicular calculus is the probable 
 cause of these symptoms. Likewise, if the cranium of an individual 
 who has accidentally lost his reason, presents cicatrices, and a depi'ession 
 of bone, it would be permitted to conjecture that a wound of the head 
 is the cause of this mania. Finally, if an individual has been bitten 
 by a strange dog, though the wound may present nothing peculiar in its 
 character, it would be prudent to treat it as an envenomed wound, because 
 observation teaches that the bite of a mad dog resembles entirely that 
 of any other dog, and when there is doubt, it is best to take the surest 
 method for the prevention of hydrophobia.
 
 THEORIES AND SYSTEMS. 217 
 
 DEFINITIONS OF THE EMPIRICS. 
 
 As these physicians rejected, absolutely, the latent causes, and the 
 so called essential elementary or primitive properties of disease, they 
 could not admit the definitions of the Dogmatists, which are based, for 
 the most part, on the pretended essence of things, or on their proximate 
 or occult cause. They replaced them, therefore, by a simple description, 
 called hypotyposis, which consists in an abridged enumeration of the 
 sensible phenomena. Thus, instead of defining fever, like Galen, to be 
 an unnatural fire fixed in the heart ; or, with Asclepiades, an accelerated 
 movement of the blood, occasioned by the obstruction of the pores ; or, 
 with Erasistratus, an affection proceeding from the passage of the blood 
 from the veins into the arteries, they say, fever is an affection which 
 manifests itself by an acceleration of the pulse, the augmentation of 
 heat, accompanied often by thirst. While Galen made health consist 
 in the normal temperament of the heat, cold, dryness, or moisture, of 
 the different parts ; in the exact proportion, number, and. situation of 
 compound parts, and in the perfect mixture of the humors, the Empirics 
 said, very simply, that a man was supposed to be in good health, when 
 he enjoyed the complete exercise of all his functions. 
 
 EXTLANATION. 
 
 I must remark, apropos to the definitions, that the doctrine of the 
 ancient Empirics is very singularly related to that of modern Sensualists. 
 The Empirics rejected occult causes, and the properties called essen- 
 tial, or primitive ; they denied that we are able to know the intimate 
 nature of things, that is to say, what things are, in themselves. They 
 assumed, that we are able to seize only the i-elation of things to us, and 
 among themselves, because these relations are due to our sensations, and 
 all our knowledge comes through the organs of sense. They insist that 
 our judgment and reason, in the facts of Medicine, can never pass the 
 limits of the capacity of our senses. In fine, they replace definitions 
 by simple descriptions, which accords with thepractice of modern Sen- 
 sualists.^"' 
 
 ANATOMY AND PHYSIOLOGY, 
 
 The Empirics are reproached with having neglected anatomy and 
 physiology. This is supposed by some, however, to be exaggerated ; they 
 did not deny, absolutely, the utility of these two branches of medical 
 science, but regarded them as accessory ; yet they placed clinical obser- 
 vation before all. It is difficult to know the truth, on this point, while 
 we only know the opinions of the Empirics through their adversaries. 
 
 *^ See Art de Penser, de Condillac, part. 1, chap, viii and x. 
 
 13
 
 218 ANATOMICAL PERIOD. 
 
 It does not appear reasonable, that the disciples of the greatest anato- 
 mists of antiquity could have denied the importance of the discoveries 
 of their masters. However this may he, if the coryphei of Empiricism 
 Lave committed this medical heresy, they are so much the more culpa- 
 ble, as it is in flagrant contradiction to the fundamental principle of 
 their doctrine. How could the philosophers, who supposed all ideas 
 derived from sensations, depreciate anatomy — tiie only one of the depart- 
 ments of Medicine which owes almost nothing to reasoning, and which 
 obtains, on the contrary, all its light from observation? Besides, is it not 
 evident, that a knowledge of anatomy is necessary for the practice of 
 surgery? As to physiology, the ancient Empirics are somewhat excusa- 
 ble for having despised it : because, in their time, the science was, in 
 general, made up of long dissertations on the principle of life, the ele- 
 ments of the body, the primary cause of generation, and a crowd of 
 other mysteries, just as impenetrable. But by the side of this tran- 
 scendental and empty physiology, they reared another, less ambitious, 
 which following anatomy, step by step, was limited to the description 
 of the functions of organs of which anatomy showed the form, situa- 
 tion, and structure. This last physiology, which I call organic, to 
 distinguish it from the other, is eminently useful, and, I will say. 
 indispensable, to the pathologist and practitioner. 
 
 THERAPEUTICS. 
 
 In the remote ages, as we have heretofore said, there was no thera- 
 peutic axiom. When a treatment was successful in one affection, and 
 there occurred afterward other analogous cases, or that appeared as such, 
 the same treatment was employed, without inquiring whether it acted 
 in virtue of one principle or another. The conduct of those who practiced 
 Medicine in those primitive times, was purely instinctive ; but proper 
 reflection will show, that that instinct had for a basis an infallible 
 axiom, which we have announced heretofore, and which it will be well 
 to repeat now : Those remedies which have cured one case of disease, 
 will cure all cases analogous to it." 
 
 This axiom has no need of demonstration ; its truth strikes us like 
 an axiom in mathematics. Nevertheless, Hippocrates and his disciples 
 believed it their duty to substitute another in its place ; not surer, 
 but which they believed of more easy application in Medicine, to wit : 
 Diseases are cured hy their contraries ; which was adopted almost 
 unanimously, and is now invoked by most physicians. 
 
 We have, it is true, heretofore, pointed out two books of the Hippo- 
 cratic collection, whose authors, without contradicting the axiom, deny 
 
 * See Mystical period.
 
 THEORIES AND SYSTEMS. 21ft 
 
 that it is applicable to the cure of all cases. These authors affirm that 
 certain aflFections have been cured by similars, while others again have 
 been cured by remedies which appear neither to be similar nor contrary 
 to the nature of the disease.'"' 
 
 The Empirics went much farther ; they assumed that the intimate 
 nature of diseases, as well as their proximate or essential causes, being 
 impenetrable, we can not hope to discover the species of relation that 
 exists between this nature, or these causes and the action of any remedy. 
 Bleeding, they said, cures certain inflammations and exasperates others. 
 Experience teaches us this ; but who would be able to foresee the result ? 
 What connection is there between the subtraction of a liquid necessary 
 to life, and the resolution of a phlogosis ? A small dose of opium often 
 produces sleep, while a stronger dose causes insomnia. Is there, then. 
 an opposition between two unequal quantities of the same substance, that 
 it should produce two contrary effects '? Wine, taken immoderately, 
 plunges certain individuals into a lethargic sleep ; but in others it 
 excites a furious delirium. Is it similar to the nature of the first, and 
 contrary to that of the second, or vice versa ? 
 
 Those who maintain that it is necessary to know the essence of a dis- 
 ease, before treating it, should at least agree on what the essence is. 
 But if you ask some of them, in what consists the nature of a phlegmon, 
 one will respond, that it is a tumor, caused by the excessive heat of the 
 blood ; others, by the acridity of the bile ; a third, by the closing of the 
 pores; a fourth, by the extravasation of the blood, etc. But, while 
 waiting for the dispute to terminate, if ever, what guide shall we take, 
 to treat properly a tumor of this kind ? Certainly there is none other 
 than experience. Experience, alone, has taught us what we must do in 
 such a case. 
 
 All that may be affirmed for a treatment which has been successful 
 in disease, is, that it will procure the same success afterward, if it be 
 employed against the same concourse of pathological phenomena. Thus, 
 therefore, the important and essential matter in order to make the cura- 
 tive indications as precise as possible, is to observe carefully, and define 
 well, the pathological phenomena. 
 
 As the practitioners of the same epoch employed very nearly the 
 same means of cure, notwithstanding the divergence in their theories, 
 the Empirics concluded that in reality all were influenced to do so by 
 experience, which varies but little, while theoretical explanations con- 
 tradict themselves incessantly. 
 
 * ffiuvres d'Hippocrate, trad, par Littre, T. I : Traite de I'Ancienne Medicine, 
 from § 10 to 20, inclusive. Traite' des Lieux dans rHomme, !?§ 67, 6-^, 69, 70. 
 Note. — Every physician knows the aphorism : A vomit will often cure vomiting.
 
 220 ANATOMICAL PERIOD. 
 
 COROLLARY. 
 
 Moreover, the question which we now discuss is one of the most inter- 
 esting and intricate. It constitutes the basis of therapeutics, or of the 
 Art, properly speaking. It has been, at various epochs, the subject of 
 long debates, and must, therefore, be presented more than once in the 
 course of this history, and particularly apropos to modern theories. 
 It is not yet, therefore, the proper time to discuss it in full. I will only 
 say, in anticipation, that a disease is never the result of a unique 
 influence. 
 
 Take, for example, several individuals wounded by a sharp instru- 
 ment, in the same manner, and in the same region of the body. Here 
 is a very simple aff"ection ; nevertheless it is probable that it would not 
 run the same course in all, on account of individual peculiarities, which 
 are so different. Thus, in the most simple cases, the disease is always 
 subjected to several simultaneous, or successive influences, so that it may 
 be regarded as the result of several forces. Now, to neutralize the bad 
 ■ effects of this result, and to destroy it, it is not always necessary to 
 oppose to it an influence directly contrary, and of an equal or superior 
 energy. Ordinarily, we may suppose that it will suffice to change the 
 direction of this result, or moderate its intensity, by modifying one 
 alone, or a few of its component forces. 
 
 ORIGIN OF PHILOSOPHIC, OR RATIONAL EMPIRICISM. 
 
 Some authors think that Empiricism is a deduction from the Skeptical, 
 or Pyrrhonean doctrine. Galen seems to be of this opinion, when he 
 advises an Empiric to imitate the modest conduct of a Pyrrhonean phi- 
 losopher, to prove himself as simple, sincere, exempt from all ambition, 
 and seeking to prove the excellency of his doctrine, by a skillful and 
 happy practice, rather than by a long discourse.'--' 
 
 Kurt Sprengel adopts the above sentiments of Galen, and asserts 
 that medical Empiricism is a consequence and ofi'-shoot of philosophic 
 Skepticism. f Xeverthcless, Sextus Empiricus, a medical philosopher 
 who lived at the commencement of the third century of the Christian 
 era, and who has left an apologetic explication of the Pyrrhonean phi- 
 losophy, denies that there is, between that doctrine and Empiricism, the 
 analogy that many persons have supposed they have seen. J 
 
 This diflerence of opinion obliges me to throw a comparative coup 
 d'ceil on the two systems. 1. The Pyrrhonean philosophy rests in 
 doubt in regard to every thing, because there exist, according to it, 
 
 " De Subfiguratione Empirica, cap. xiii. 
 
 f Histoire de la Medicine, Paris 1815, T. I, p. 4G9, et suiv. 
 
 I Text. Empir. Pyrrhon. Hypotyp. lib. i, cap. xxxiv.
 
 THEORIES AND SYSTEMS. 221 
 
 equal reasons for affirmation and negation, in all questions. The 
 Empiric rejects the opinions which are not immediately derived from the 
 senses, but admits the certainty of facts, and truth of observations. 
 
 2. The Pyrrhonian philosopher says, that there are sensations which are 
 pleasant, and others that are disagreeable ; it offers as an example, that 
 honey is sweet to the taste — that pain is distressing ; but if asked, iu 
 what consists the essence of the sweet taste, and the suffering of pain, 
 be ingenuously acknowledges his ignorance, and replies, that he knows 
 nothing about it. The Empiric accords with the Pyrrhonean in this : he 
 confesses that he is completely ignorant of the essence of things, and 
 affirms, moreover, that the question is impenetrable, because it is inap- 
 preciable to the senses. The Dogmatist on the contrary does not hesi- 
 tate to give an explanation of the essence ; he will tell you that pain 
 proceeds from a disjunction of the elements, and that the sweet taste is 
 derived from the temperate mixture of heat, cold, dryness, and moisture.''- 
 
 3. The Pyrrhonean is naturally inclined to inaction, never feeling a 
 positive motive to take a part. In medicine he will follow, from predi- 
 lection, the expectant plan. The Empiric employs, on the contrary, an 
 active medication. Convinced of the truth of the rules of his art, which 
 he believes deduced from exact and repeated observation, he does not 
 hesitate to put them in practice. 
 
 This parallel between the two doctrines proves that, while there is 
 between them some similitude, there exist, also, capital differences, 
 which prevent us regarding them as proceeding from a common source. 
 On the other hand, in following attentively the phases of this history, it 
 is easy to see that Empiricism has an origin purely medical. AVe have 
 seen, in the first place, that physicians of primitive times followed by 
 instinct the Empirical method ; much later, Acron of Agrigcntum, cotem- 
 porary of Pythagoras, affirms, that experience is the only true founda- 
 tion of the Healing Art. Hippocrates, himself, although endeavoring to 
 attach his medical doctrine to the Pythagorean dogmas does not less 
 proclaim, in many cases, the superiority of observation to theory ; and 
 in his clinical observations he shows himself more careful to report, 
 faithfully, the facts, than to justify his theoretical views. 
 
 The surprising progress of anatomy and physiology, during the first 
 ages of the Alexandrian Institute having confounded several points of 
 the Hippocratic doctrine, the confidence which it inspired began to 
 diminish. Then a thousand new speculations were hazarded, to explain 
 the functions of the animal economy, which nullified each other. In 
 the midst of this anarchy, wise practitioners, to whom experience 
 
 ° See Galen and Hippocrates.
 
 222 ANATOMICAL PERIOD. 
 
 demonstrated every day the utility of certain remedies, continued, 
 naturally, to seek in experience alone, a refuge from the incessant 
 variations of Dogmatism, and the sterile incertitude of the Skeptics. 
 
 If, now, the question be asked : to what philosophical doctrine Medical 
 Empiricism is attached, there is not one of my readers who is not in a 
 state to respond, that it is intimately united to the sensual philosophy ; a 
 philosophy, of which the foundations were laid by Aristotle, but who 
 abandoned it almost immediately, to trace the rules of metaphysics, and 
 the logic of rationalism. In short, that philosopher, deceived by superfi- 
 cial observation, asserts that general ideas are the first that are formed 
 in our minds, by the aid of the senses, and that they constitute the prin- 
 ciples — the beginning of the sciences. Now. modern metaphysicians have 
 demonstrated, that the sensations give us only individual ideas ; and that 
 general ideas, being the result of an operation of the understanding, 
 called abstraction, are the last formed ; whence it follows, that, so far 
 from being the foundation stone of the scientific edifice, they, are the 
 key stone of the arch. 
 
 The Empirics adopted the basis laid down by the chief of the Peri- 
 patecians ;'■■= but, instead of engaging, as he, in seeking at first the gene- 
 ralities of science, malapropos termed principles, they confined them- 
 selves to a careful collection of facts, and an exact narration of them, 
 in order to deduce therefrom rules of practice. We see that, in this 
 way, they laid the true basis of the Art ; but by not attempting to ele- 
 vate themselves to the most abstract generalities, and universal axioms, 
 they left their work incomplete, not indicating, even to their successors, 
 the final end to which they should direct their labors. 
 
 PnOGRESS OP EMPIRICISM. 
 
 The Empirical doctrine took, at first, a rapid extension ; we have 
 already cited the names of three celebrated authors, who taught it 
 towards the epoch of its foundation. Galen cites a much greater num- 
 ber, of whom several wrote much, but whose works are entirely lost to 
 us. It appears that in the time, even, of that author, the term Empiric 
 was not yet a disgrace, and that men of high public estimation were 
 attached to it. Galen, who was not accustomed to flatter his adversa- 
 ries, and who covered with contempt the Methodists, speaks of the 
 Empirics with much regard ; he avows, more than once, in combating 
 their system, that their arguments unsettled him.f We have seen that 
 
 " In a passage heretofore cited, Aristotle says, formally, that the sensations 
 beget ideas and remembrance, from which flows, subsequently, experience, the 
 common origin of the sciences and the arts. 
 
 f Galen, De Subfiguratione Empirica, cap. xin., et passim.
 
 THEORIES AND SYSTEMS. 223 
 
 the Methodist, Aurelianus, spoke of some of them in very honorable 
 terms. Finally, the Eclectic, Celsiis, judges them still more advan- 
 tageously. 
 
 The moderns who have given themselves the trouble of studying the 
 ancient doctrines, have nearly all admired the wise and ingenious 
 economy of the system of the Empirics. I will cite, among others. 
 the historians Daniel LeClerc and Kurt Sprengle. The last expresses 
 himself thus, in one of the passages where he eulogises Empiricism: "I 
 see, in all these principles, the most evident proof of the great sagacity 
 and sound judgment of the ancient Empirics. Certainly, they were 
 more inspired by the true genius of medicine, than most of their prede- 
 cessors (the Dogmatists), who gave themselves up to vague theories."-' 
 
 The circumstances in the midst of which Empiricism was pro- 
 claimed, were most favorable for its propagation. Medical theories 
 had fallen, as we have seen, into confusion. All the principles, meth- 
 ods, and opinions, were questionable. The recent discoveries in anat- 
 omy; the introduction of a considerable quantity of new medicines, 
 whose properties were yet undetermined ; the furor of the philosophic 
 disputes, which increased, all disturbed the antique dogmas, without 
 substituting anything better in their place, or, nothing which obtained 
 general favor. In the midst of such conjectures, a doctrine which pro- 
 posed to put an end to the perpetual variations of Dogmatism, and avert 
 the sterile incertitude of Skepticism, by resting solely on the evidence 
 of facts, ought to have been received with enthusiasm, especially by those 
 practitioners, to whom daily experience demonstrated the uselessness of 
 dialectics to advance medicine. 
 
 DECADENCE OP THE SYSTEM OP THE EMPIRICS. 
 
 Although Empiricism was founded on pure observation, we can not 
 hesitate to perceive that it did not put an end to differences of opinion, 
 nor incertitude ; for if rationalism, which proceeds from generals to 
 particulars, is subject to deception, the experimental method, or sensi- 
 tiveism, which proceeds from particulars to generals, has also its grop- 
 ings. Moreover, the ancient Empirics, by stopping at secondary gene- 
 ralities, without striving to go up to first principles, or, better still, to 
 definite axioms, resemble workmen who stop in the middle of the erec- 
 tion of an edifice. Finally, the greatest wrong of Empiricism, in the 
 eyes of antiquity, was, in not attaching itself to any philsophic theory 
 then known. Such a doctrine, though able to captivate practitioners 
 by its simplicity, could not satisfy speculative minds. It had not, then, 
 the elements of life required by the learned world at that epoch ; so ita 
 
 =* Hist de la Med., T. i, p. 476.
 
 224 ANATOMICAL PERIOD. 
 
 fall was complete. Empiricism has been in disgrace for many ages, and 
 its name has become synonymous with ignorance. Nevertheless, we shall 
 see it revive from this long humiliation, and aspire, even rashly, under 
 the name of the Experimental method, to universal dominion in the 
 sciences, after the labors of Bacon, Locke and Cordillac shall have 
 cleared up, somewhat, its metaphysics. 
 
 AET. III. ON METHODISM. 
 
 The doctrine of Empiricism had been proclaimed about a century and 
 a half, and in that time a great number of celebrated physicians 
 endeavored to establish the Healing Art on its principles. They col- 
 lected clinical observations with as much care as possible, and made 
 from them, model descriptions of each species of disease, with the indi- 
 cation of those remedies that had produced the most advantageous 
 effects. But they had vainly multiplied these model descriptions or 
 paradigms ; cases were incessantly appearing, in practice, that presented 
 different features from those that had been observed, which required 
 the construction of new theorems ; for, according to this doctrine, every 
 concourse of symptoms not before described by authors, was thought to 
 represent a new disease. In this way, there was a tendency to an 
 indefinite multiplication of morbid species, and the Empirics fell into 
 the same defect of which Hippocrates had reproached the Cnidians ; a 
 defect which must inevitably lead to confusion, so long as similar kinds 
 were not united in a common species, and analogous species into other 
 groups of a superior order ; in short, so long as they did not rise from 
 secondary generalities to more elevated ones. Thus, pure Empiricism, 
 such as its founders had conceived, had reached its limit, and could 
 render no further services to science, and though it had laid the true 
 foundation of the edifice, was incapable of continuing and completing 
 perfectly the structure. 
 
 In the meanwhile, a man endowed with rare intelligence, and a 
 remarkable faculty of elocution, but better versed in the doctrines of 
 the philosophers and grammarians than in the practice of ]\Iedicine, 
 Asclepiades, of Bythinia, came to Eome with the intention of teaching 
 rhetoric. The charms of his mind, his talents, and his address, gave 
 him, immediately, access to the most illustrious persons of the Eepub- 
 lic. He taught eloquence, for a time, with great eclat, and as early 
 as the one hundred and fiftieth year before Christ, enjoyed a high 
 reputation as a rhetorician, for Cicero honored him with his intimacy. 
 Notwithstanding this, he abandoned the career of letters, to under-
 
 THEORIES AND SYSTEMS. 225 
 
 take the practice of Medicine ; but, being unwilling to follow in the 
 tracks of his predecessors, he took upon himself to create a new sys- 
 tem. Imbued with the philosophy of Epicurus, then in high repute 
 among the higher classes of Eoman society, he deduced from it a theory 
 which united to its merit as a novelty, that of being in harmony with 
 the philosophic ideas most in vogue. 
 
 Asclepiades taught, as a consequence of the dogmas of Democritus 
 and Epicurus, that the elements of the body existed from all eternity ; 
 that they are incommutable in their essence, indivisible, impalpable, 
 and perceptible to reason only. These elements, which he named atoms, 
 possessed no quality, per se, but were of various shapes, and animated 
 by a perpetual motion ; and that from their frequent encounters and 
 fortuitous combinations, all sensible things, all the phenomena of the 
 universe, were supposed to result. "When any one asked this innova- 
 tor, how it was that the body could be endowed with properties, when 
 its constituent parts had none, he replied, that compounds and aggre- 
 gates differ very much from their elements ; that the order and num- 
 ber in which the atoms became united, the shape and size of bodies 
 which resulted from their aggregations, were the sole causes of the 
 properties observed in them. Solid silver, he said, is white, but reduced 
 to powder, it appears black ; the horn of the goat, on the contrary, is 
 black, but if it be rasped, the particles are white. 
 
 Passing from general physics to physiology, Asclepiades affirmed that 
 the human body is formed of tissues every way permeable, that is, 
 pierced with invisible holes, which he named pores, through which 
 passed and repassed, continually, atoms of various shapes and sizes. 
 He pretended to explain all the physiological and pathological functions, 
 the secretions, sensibility, pain, etc., by the spontaneous movements of 
 the atoms, and their continual passage through the pores of the body. 
 Health depended on the extent of the exact symmetry of the pores with 
 the atomic molecules. Besides, he repelled, with derision, the hypothe- 
 sis of a motive principle in the animal economy, endowed with instinct, 
 and watching over the preservation of the entire body or any of its 
 parts. He ridiculed the theory of Hippocrates, on coction, crisis and 
 critical days, for he did not expect any beneficial action from the efforts 
 of nature, and relied entirely, for the cure of the sick, upon the skill of 
 the physician. He called the circumspect therapeutics of the venerable 
 man of Cos, a meditation on death. 
 
 If the physiological explanations of Asclepiades were but little cal- 
 culated to deceive a thoughtful mind, and especially physicians, who 
 were accustomed to watch the progress of diseases, his therapeutical 
 maxims were eminently calculated to secure to him the confidence of
 
 226 ' ANATOMICAL PERIOD. 
 
 the sick. He proposed no other aim in his treatment, than to enlarge 
 the pores when they were too contracted, as the result of the constric- 
 tion of tissues, and to close them when they were too open. To attain 
 this end, he said, only certain, prompt, and agreeable means should be 
 employed. Consequently, he rejected all violent remedies, such as 
 vomits, drastics, incisions, and the cautery. He employed blood- 
 letting rarely, and recognized only a small number of surgical 
 operations. His favorite remedies were generally taken from hygiene, 
 such as walking and other physical exercises, riding on horseback, 
 in carriage, and in boat- rowing ; frictions executed in various man- 
 ners, and wine, which he administered frequently, either pure or med- 
 icated, etc. 
 
 Unquestionably, these means are useful in many cases ; employed 
 appropriately, and concurrently with others, they render great service, 
 especially in chronic affections, and during convalescence ; but to limit 
 medical counsel to their use alone, and to abstain voluntarily from many 
 other resources, more powerful, is to exhibit a desire to please patients, 
 and obtain their good will, rather than to be desirous of restoring them 
 to health. Thus, Asclepiades, aiming at a circumstantial success, rather 
 than at solid reputation, obtained, notwithstanding all his talents, but 
 an ephemeral celebrity. 
 
 Themison of Laodicea, a disciple of Asclepiades, was led by the teach- 
 ings of his master, to lay the true foundation of Methodism. After 
 having divided, like him, all diseases into two great classes, under the 
 title of acute and chronic affections, he separated each class into three 
 species, viz : the constrictive or contracted ; the fluxionai'y or relaxed ; 
 and the mixed. Then he established the distinction of these species, 
 not on the occult qualities of the Dogmatists, nor on the consideration, 
 no less hypothetical; of the state of the pores, but on the sensible char- 
 acters drawn from medical observation. He called these characters, 
 sometimes, communities, because they were common to diseases of the 
 same species, and again similitudes, because they indicated certain like- 
 nesses or similitudes in diseases. 
 
 The communities of the constrictive species, are swelling, tension, and 
 hardening of structures, the partial or complete suppression of some 
 natural evacuation, all the signs, in short, that indicate the constric- 
 tion of tissues. The communities of the relaxed species are softening 
 of tissues, the diminution of the entire volume of the body, or some of 
 its structures ; the increase of ordinary evacuations, or the appearance of 
 some abnormal evacuation. Lastly, the communities of the mixed 
 species consisted in a mixture, a coincidence of signs that indicated 
 both constriction and relaxation.
 
 THEORIES AND SYSTEMS. 227 
 
 Themison had attained an advanced age when he published his plan 
 of reform, and we are ignorant to what degree of perfection he carried 
 it. We know, simply, that Thesalus of Tralles, and Soranus of Ephesus, 
 made changes in, and additions to it ; but it is impossible to say pre- 
 cisely, what part each of these authors took in the creation of the sys- 
 tem of the Methodists, now when all their works have been lost. There 
 exist none of the writings of this sect, but the treatise of Ccelius Aure- 
 lianus, of whom I have already spoken ; and it is the work, from which 
 we have extracted, almost entirely, what we have said concerning the 
 doctrine of Methodism. The following will show the arrangement of 
 diseases : first, the constrictive of the acute variety ; apoplexy, angina, 
 lethargy, convulsions, ileus, madness, etc. ; of chronic affections, cepha- 
 lalgia, vertigo, epilepsy, mania, jaundice, amennorrhea, obesity, etc. ; 
 secondly, the relaxed species : cardialgia or gastralgia, cholera, hema- 
 temesis, and other hemorrhages, including the hemorrhoidal flux ; thirdly, 
 and lastly, of the mixed species : peripneumonia, pleurisy, colic, disen- 
 tery, etc., asthma, paralysis, catarrhs, phthisis, etc. 
 
 It is plain that there is much that is arbitrary in the above classifi- 
 cation. Besides, the Methodists were not agreed amongst themselves, on 
 the class in which several of these should be placed : some, for instance, 
 insisting that hydropsy belonged to the constrictive class, others to the 
 relaxed ; some thought asthma should be enrolled among the mixed, 
 others, that it belonged to the fluxionary species, and so forth. But the 
 greatest reproach that can be brought against the classification of the 
 Methodist, is the union of very differeiit diseases, in one community, 
 and the separation of analogous ones. However this may be, this 
 attempt at a pathological classification, founded on the evident characters 
 of diseases, and not on occult causes, or imaginary qualities, was a great 
 progress. 
 
 It followed from this division of diseases, that with the ^Methodists 
 there were only two kinds of therapeutical indications to fulfill, viz. : to 
 relax when there was constriction, and to constrict where there was a 
 flux or relaxation. Also, they admitted but two modes of treatment, 
 which they named curative communities. All therapeutic agents were 
 comprised in one or the other of these communities. Blood letting, for 
 example, cups, emollient cataplasms, warm and laxative drinks, sudo- 
 rifics, warm air, sleep, exercise carried to fatigue, etc., form a part of 
 the community of relaxants. Darkness, fresh air, cold and acidulated 
 drinks, decoction of the quince, red wine, or vinegar, solution of alum, 
 etc., were ranked in the community of astringents. 
 
 Some Methodists admitted a third curative resource, which they 
 named prophylactic. It comprised all the special means in use, to
 
 228 ANATOMICAL PERIOD. 
 
 prevent or arrest tlie toxic cfiFects of poisons and venemous substances. 
 But the pure Methodists, such as Aurelianus, rejected this community, 
 and wouhl not admit specific remedies, any more than specific diseases. 
 They erased from their materia medica, purgatives, diuretics, emmena- 
 gogues, anodynes, somnifera, etc., excepting from this general proscrip- 
 tion vomits only, which they gave, not with a view of evacuating the 
 bile or phlegm, like the Dogmatists and Empirics, but to give the 
 economy a shock which would open its pores, and change the general 
 disposition of things. 
 
 In the progress of diseases, the Methodists distinguish three periods, 
 or temporary conditions, viz. : the periods of development, stasis and 
 decline. Each of these temporary conditions required particular care, 
 and became the source of the curative indications. 
 
 Lastly, there was added a fourth or last community, called chirurgical, 
 that embraced all the operations of surgery. It consisted in removing 
 from the body the things which were foreign to it, and unnatural. This 
 lass was subdivided into several others, accordingly as the foreign or 
 unnatural things were of external origin, as a thorn, an arrow, etc., or, 
 as they were from within, as a tumor, an abscess, an excrescence, an 
 ulcer, or hair-lip, etc. 
 
 By the help of these summary considerations, touching the common 
 symptoms of diseases, and their curative indications, the Methodists 
 believed they might dispense with all ulterior research. They did not 
 inquire for the causes, whether occasional or proximate, because they 
 said from the moment that the disease is developed, it is necessary to 
 cure it. The indications in diseases were to be drawn from its nature, 
 characters and progress, and not from anterior circumstances, which 
 exert no influence. Now, the nature of diseases consisted, uniquely, 
 according to them, in the conditions or communities of which I have 
 spoken. Neither did they attach much value to the precise knowledge 
 of the seat of the disease, or affected parts ; nor to the consideration of 
 the age of the patient — his habits — the general state of his forces — nor 
 to climate and season. They assumed that these details were superflu- 
 ous, and could not affect any notable modification of the treatment. 
 For, according to their system, an affection of the constrictive species, 
 such, for example, as an inflammatory tumor, always requires the same 
 kind of treatment, whatever may be its locality, or the age of the 
 patient, the climate or the season. If, sometimes, they gave attention 
 to the region particularly aff'ected, it was only for the purpose of apply- 
 ing the topical treatment indicated, more exactly at the seat of the 
 disease. 
 
 The Empirics, anxious to secure themselves from the error into which
 
 THEORIES AND SYSTEMS. 229 
 
 the search for proximate causes, first principles and elements, had drawn 
 their predecessors, the Dogmatists, could think of nothing better than 
 to banish from science all transcendent generalities. Finally, then, to 
 keep as near as possible to the truth, based on observation, they estab- 
 lished as many morbid species as they had encountered diiferent assem- 
 blages of symptoms. This resulted, at length, in such a multitude of 
 species, that it became extremely difiicult to recognize them, separately, 
 especially as some among them were only separated from each other by 
 light shades of difference. To obviate this embarrassment, it was neces- 
 sary, as we have already said, to unite together all the analogous morbid 
 species, and form them into genera, which being few in number, and dis- 
 tinguished from each other in a marked manner, could easily be recog- 
 nized; then, with a knowledge of the genus, the mind could easily 
 descend to a determination of the species. In this way, a philosophic 
 method serves as a lever to the feebleness of our understanding. 
 
 But the Methodists misconceived the true use of the groups of the 
 second order, i. e., the genera which they had established. Instead of 
 making use of them to arrive more conveniently at the determination 
 of the species, they rejected them as useless, and preferred to rely exclu- 
 sively upon their general principles ; so that they would treat by the 
 same means, mania, jaundice, amenorrhea, etc., which are chronic affec- 
 tions of the constrictive genus ; and, on the other hand, peripneumonia, 
 colic, dysentery, etc., acute affections of the mixed order, were also all 
 treated alike. They had no regard, either to the natural tendency of 
 the vital forces, or to coction or crisis, or a multitude of other essential 
 circumstances which we have lately enumerated. Lastly, they had 
 much less regard for anatomy and physiology than the Empirics. Their 
 desire to simplify the practice of medicine was so great, that they sub- 
 mitted all their patients to a uniform regimen. They were all required 
 to fast for the first two or three days. During the second ternary, they 
 allowed them a small quantity of food, and so OU; increasing their nour- 
 ishment gradually, every three days. Their mania for uniformity is 
 nowhere revealed more sensibly, than in the mode of treatment called 
 the metasyncritic circle, or, more simply, metasyna-isis, which they 
 employed in very obstinate affections, after having exhausted their ordi- 
 nary means. The following is a description of the famous metasyncritic 
 circle, as given by Coelius Aurelianus, in his treatise on chronic diseases, 
 Book first, chapter first : 
 
 " The first day, the patient must fast; the next day, after being car- 
 ried into the open air for a short time, he is to be anointed, and even 
 bathed, if his pain permit ; then he is to receive one-third the quantity 
 of bread which he was in the habit of usinsr in health. He is also
 
 230 ANATOMICAL PERIOD. 
 
 allowed to eat salted and roasted meats, dressed with mustard, green 
 olives preserved in salt, and other things of the same nature ; but he 
 must abstain from pork, from garlic, onions, and other herbs which excite 
 the brain. As a beverage, he shall have wine ; and this diet is to be 
 continued for two or three days, if he can support it : and sometimes 
 fish and brain are to be added to the above mentioned meats. After 
 this, the second third of the bread of which he was deprived may be 
 allowed, with brain and fish, and herbs, for two or three days. Finally, 
 his full amount of bread is to be given to him, and the former meats 
 exchanged for that of fowls ; which latter is to be continued as long as 
 the preceding ; and, lastly, is to be followed by the uhe of pork. 
 
 " If it is desirable to change more frequently, the bread may be 
 divided into four parts — so that one part may be given at each change 
 of the meats — thus, the first part is given with the middle diet, another 
 with fowl, a third with game, and the fourth with pork ; but, to prevent 
 the patient becoming disgusted by eating, for so many days, the same 
 sort of meats, it is necessary to vary as much as possible, each kind of 
 food. The first day, for example, when he uses salt meats, he should 
 make the meal with a sardine, and a little sea-fish. When he uses 
 middle diet, which is composed of fowl, he must use sometimes a thrush, 
 and, at others, the titlark, or snow-birds, or young pigeons. Apples 
 may also be given, in small quantities, so as not to produce flatulency. 
 When pork is used, vegetables must be added, taking care not to allow 
 too many nor too rich articles. In changing from one sort of diet to 
 another, frictions, and water as an excl'nsive beverage, are to be used : 
 but, on the following days, wine may be given, and a bath be taken. It 
 is unnecessary, nevertheless, to bathe every day ; because too frequent 
 bathing may renew the headache. The movements of the body must 
 be augmented and diminished b}'^ turns. 
 
 " This first part of the metasyncritic circle being achieved, we come 
 to the second, in which no other treatment than vomiting is to be pur- 
 sued. During the intervals, the nutrition drawn from salt meats and 
 sour substances shall be suspended. The first day, the patient, after 
 being exercised a little, shall endeavor to procure vomiting by the use 
 of horse-radish, or with other medicines, if that fail. It is to be pro- 
 cured as follows : one pound of the bark of the root is taken, which, 
 being cut up very fine, is soaked in honeyed water, called hydromel, to 
 which is added a little vinegar, or vinegar of squills. The bark being 
 thus prepared, it is all eaten a little before meal-time, and the liquor in 
 which it was infused, drunk in small quantities at a time. Afterward, 
 he must walk slowly, and then rest when he feels a sour and hot sensa- 
 tion, which takes place in about an hour. Then, he must take two 
 
 .1
 
 THEORIES AND SYSTEMS. 231 
 
 glasses of lukewarm water — not more, for fear of weakening the medi- 
 cine — and put two fingers down his throat, so as to excite vomiting. 
 This is to be continued, until every thing is thrown up that has been 
 taken. Then a large quantity of water is to be drunk, to wash the 
 stomach, and extinguish the remains of fire that the horse-radish may 
 have kindled there. After this, vomiting must be excited afresh ; and 
 thus the water and vomiting must be repeated three or four times con- 
 secutively, until the water is thrown up as clear as it is swallowed. 
 
 "The vomiting being ended, the head is to be fomented, and the 
 mouth rinsed with warm water. After awhile, a gentle promenade 
 should be taken, to relieve the head from the agitation and excitement 
 which has been brought about by the shock of the vomiting ; or, what 
 will have the same effect, anointing the body and rubbing it with the 
 hands, from above downward, exciting everywhere an easy and equal 
 perspiration. After this, two glasses of warm water are to be drunk, 
 and the patient put to bed ; where he rests in great repose of body and 
 mind, without eating, or drinking, or sleeping, for some time, or until 
 the agitation caused by the remedy ceases. If the patient be allowed 
 to sleep, while the brain is excited from the effect of the treatment, the 
 effect of the sleep being to produce contraction of the head, it would 
 effect the contrary of what is desired. It is necessary, also, to abstain 
 from meats, for fear of its decomposition by the heat and irritation of 
 the stomach, resulting from the vomitings, as well as the remains of 
 the horse-radish sometimes left behind, which, mingling with the food. 
 corrupts it, and gives rise to flatulency ; which, rising toward the head, 
 increases the danger instead of diminishing it. 
 
 " The following day, the patient must bathe, and live on the middle 
 diet, and after two or three days, he should complete the other parts of 
 the circle commenced. If it is observed that the patient is sensibly 
 better, and that he has intervals of perfect calm, after having gone 
 through again the resumptive circle, the vomiting should be resumed, 
 joined with drimyphagy or the use of salt food. In fine, the rest of 
 the metasyncritic circle must be boldh" achieved." 
 
 I terminate here this very long quotation, though I have not half fin- 
 ished the metasyncritic circle ; those who wish to know it in full, will 
 find it by consulting the original, or History of Medicine, by Daniel 
 Leclerc, (2 part, liv. iv, sect. 1, chap. XI,) what I have reported will 
 suffice to convince the reader that this series of proofs, somewhat severe, 
 through which the patient is made to pass, is, at bottom, only a system- 
 atized perturbating method. 
 
 The founders of Methodism mistook the true use of the generali- 
 ties that they established. Instead of regarding them as a progress, a
 
 232 ANATOMICAL PERIOD. 
 
 perfection of Empiricism, as a means of retaining and classing in the 
 memory the numerous and precise details furnished by that sect, they 
 rejected their details ; they did not consider each genus as a collection 
 of distinct species, necessary to be distinguished from each other, but 
 believed, rather, that the knowledge of the genus dispensed with that 
 of the distinction of species. They were ignorant, that the more an 
 idea is general, the more it is separated from objective tnith and phe- 
 nomenal reality ; and how could it be otherwise, when the greatest meta- 
 physician of antiquity, Aristotle, had said that the first ideas formed 
 in our minds by the intermediation of the senses, are general ones, 
 while it was demonstrated, two thousand years later, that our first 
 ideas are particular ones, always relating to individual objects ? 
 
 The Methodist doctrine abridged, singularly, the study of Medicine, 
 and to such an extent, that one of the coryphei of the doctrine, Thes- 
 salus, of Tralles, could say, without too much exaggeration, that he 
 felt able to teach the whole Medical Science in six months. It is true, 
 that inculcating solely in the minds of his adepts some superficial 
 notions on the general characters of diseases, and the virtues of reme- 
 dies, he placed them, without scruple, in the ranks of the profession, 
 but not without frequently committing blunders. Unfortunate were 
 those who imprudently placed themselves in the hands of these ofi"-hand 
 doctors ; for they, not knowing how to discern the delicate shades which 
 separate many morbid species, overlooked a multitude of precious indi- 
 cations, and prolonged the sufi"erings of their patients, or sent them 
 into the other world, without supposing for a moment that it was the 
 fault of their treatment. 
 
 t Methodism made a rapid progress, from its advent in the medical 
 world. It had, in the first place, as its admirers, the numerous vulgar 
 herd of neophytes, who were anxious to finish their apprenticeship, to 
 rush into practice. Secondly, it satisfied a natural penchant of the 
 human mind, the love of generalizations, particularly felt at that epoch, 
 and which Empiricism had not gratified. In short, it rested between 
 Dogmatism and Empiricism, as a mediator, combining the advan- 
 tages of both doctrines, without having any of their inconveniences. 
 The Methodist said to the Dogmatist : I adopt, like you, rational truths 
 only ; I deduce them from sensible phenomena, and not from circum- 
 stances insusceptible to observation. 
 
 He said to the Empirics, like you I take observations for a guide ; 
 but I do not embarrass the Art with a multitude of precepts difficult to 
 retain, and more difficult still, to put in practice. I deduce from expe- 
 rience a small number of rules, based on evident signs. 
 
 The above is, without contradiction, a fine programme, as are all the
 
 THEORIES AND SYSTEMS. 233 
 
 programmes of system-makers ; but we know very well how little its pro- 
 mises have been fulfilled. Galen was not duped by this reasoning. He 
 demolished the sophisms of the Methodists, and demonstrated the insuflB- 
 ciency of their doctrine, and the dangers of their practice ; he over- 
 whelmed them with strokes of his satire, calling them the asses of 
 Thessaly, alluding to the want of literary and medical instruction in 
 a great number of them. 
 
 ART. IV. ON ECLECTICISM. 
 
 If we now take a retrospective glance of the systems we have detailed, 
 we shall see that in all of them there are some valuable truths, 
 confirmed by the reason and experience of all ages, while all arc at the 
 same time tarnished by some exaggeration or error. 
 
 The first of all and the most ancient, Dogmatism, directs our atten- 
 tion especially to the animal economy, in health as well as disease ; it 
 describes admirably the union of the vital forces, sympathies of the 
 organism, and natural efi'orts, to repel both internal and external dele- 
 terious influences. One of the most characteristic and one of the most 
 striking traits of these phenomena of life, is their combined tendency 
 toward a common end, which seems to be premeditated, for the preser- 
 vation of the individual, for a certain period of time. This nearly 
 providential tendency manifests itself, particularly, in certain acute dis- 
 eases, and those who first studied the progress of these aflPections, applied 
 themselves, with a praiseworthy perseverance, to discover the laws which 
 control the vital principal, or the organic forces, in each disease. This 
 is the fair side of Dogmatism ; the one which has resisted the caprice 
 of opinion, and the progress of light. 
 
 But beside the organic force, there exist other forces which modify the 
 action of the first — sometimes deranging and even masking and destroy- 
 ing it. These latter ones, which are named inorganic or physico-chemi- 
 cal, act sometimes in an obvious manner, as when a man is killed or 
 wounded by a mechanical agent or a violent poison : again, in a latent 
 form, as when there is developed in the human body a chronic disease, 
 by the influence of regimen, air, or some similar cause. The Dogma- 
 tists divided the external forces acting on the animal economy, into four 
 species, viz.: heat, cold, dryness, and moisture, which correspond to the 
 four general forms of matter acknowledged by the physicians of those 
 times — fire, air, earth, and water. Then, to maintain uniformity or 
 harmony, they imagined in the living body the continual presence of four 
 humors ; blood, bile, atra-bile, and pituite, each one characterized by a 
 predominance of one of the elementary q^ualities. Now, this classification 
 15
 
 234 ANATOMICAL PERIOD. 
 
 of elementary qualities or organic forces, their presumed analogy with 
 the humors of the body, their mode of action on the economy, was 
 entirely founded on imaginary hypotheses or presumptions. How- 
 ever, the causes of diseases being supposed to consist in the excess of 
 some one of these qualities or humors, the treatment was directed 
 against these supposed causes. That was the weak side of Dogmatism, 
 and on which its enemies attacked it. 
 
 The Empirics were right in opposing the idea of inaccessible and 
 occult causes becoming the basis of a rational treatment. They said, 
 that the nature of diseases existed in the totality of their appreciable 
 phemomena ; or, in other terms, in the concourse of these symptoms. 
 They affirmed that there was no constant relation of antagonism or 
 similitude between a disease and the remedy which cures it. 
 
 The Methodists added a remarkable improvement to Empiricism, by 
 forming secondary groups, destined to unite the primitive groups or the 
 species of the Empirics. I will not recapitulate here the defects of 
 these systems, because they must yet l)e fresh in the memory of the 
 reader. I have sufficiently well proved, I presume, what I advanced at 
 the commencement of this chapter, that, in each one of the three great 
 systems of Medicine which prevailed during this historic period, there 
 were excellent things, mingled with defects and errors. 
 
 Many physicians of antiquity held the same view: they compre- 
 hended vaguely, that the entire truth of Medicine did not exist in any 
 one of these systems ; but they could not precisely state, as we have 
 done, that there was both good and evil in each, for the philosophic 
 principles that guide us in our choice were yet unknown. These physi- 
 cians, not being able to establish any general rule, which could serve as 
 a basis for their judgments, decided each particular question according 
 to their taste, fancy, or reason. They assumed the name of Eclectics or 
 Episynthetics, to convey the idea that they adopted no system exclu- 
 sively, but took from each whatever was best in it. 
 
 The Eclectics do not form a sect, since they had no precise dogma or 
 theory of practice which was common to each and all who were con- 
 nected with them. They professed to follow, on every occasion, the 
 lights of reason and experience only ; but that is a common idea which 
 all the sects invoke, and which is not characteristic of any one in par- 
 ticular. The habitual state of an Eclectic is that of doubt and incer- 
 titude, so that they may be confounded with the Pyrrhonians at first 
 sight ; but reflection will show, that the doubt of the latter was abso- 
 lute and universal, being the result of the principle they held, while the 
 doubt of the Eclectic had no foundation in principle, but was only the 
 eflFect of uncertainty.
 
 THEORIES AND SYSTEMS. 235 
 
 Eclecticism, in Medicine, is the absence of all fixed principle, or, as 
 I have said in my introduction, it is individualism erected into a dogma. 
 Like the Proteus of the fable, it can not be seized, because it has no 
 regular form ; it escapes refutation, because it is entirely deficient in 
 principles. Many practitioners were, or called themselves. Eclectics, to 
 avoid the discussion of principles, to which they were little inclined or 
 apt. Besides, with this profession they had the greatest possible lati- 
 tude, on any particular occasion, to adopt the sentiments which they 
 thought best. In fine, an Eclectic is a man destitute of any profound 
 conviction, like a citizen who, in the midst of internal dissentions, sides 
 with no party, weai-s no colors, is committed to no pex'son, and who, on 
 account of his indiflFerence even, is perhaps, the better prepared to 
 judge with impartiality the acts and arguments of each faction. - 
 
 RESUME OF THE ANATOMICAL PERIOD. 
 
 We have now seen that medical studies, which were already flourish- 
 ing in the isle of Cos, under the successors of Hippocrates, received 
 a new impulse by the foundation of the school at Alexandria, and sud- 
 denly attained in that city a degree of prosperity unheard of before. 
 We have pointed out some of the circumstances which concurred to 
 this happy revolution ; such as the formation of a great library, and a 
 museum of natural history, open, if not to the public, at least to all 
 professional men who fixed their residence in the capital of Egypt ; 
 the influence of the learned, drawn to that capital by the honors, 
 rewards, and especially the perspective of an easy and secure life; 
 finally, the dissection of the kuman body, which could nowhere else 
 be practiced openly without peril, was not only authorized, but even 
 encouraged by the sovereigns, who were above the prejudices of the a^e. 
 By this union of circumstances, the school of Alexandria became the 
 most famous in the world, for natural and medical sciences ; and though 
 the Roman invasion cut ofi^ a part of the advantages which it enjoyed, 
 it still held the first rank. 
 
 During the historic period that we have just passed over, anatomy 
 and physiology made the most progress ; next followed internal and 
 external nosography ; lastly, medical and surgical therapeutics accjuired 
 great perfection. Two works on Internal Nosography, that of Aret£eus,t 
 
 ^ Whatever yet remains of vague and indecisive, in the expression of our 
 thoughts concerning the ancient systems of Medicine, will completely disappear, 
 when we shall have exhibited the modern systems which are derived from them : 
 because, then, we shall better know the real origin of the ideas and the mode of 
 formation of the physical sciences. 
 
 t Aretaei Cappadocis, De Causis et Signis Acutorum et Diuturnorum libri. 
 nova editio, Graece et Latine cum notis Kuhn, Lipsite, 1828, in 8vo.
 
 236 ANATOMICAL PERIOD. 
 
 and that of Coelius Aurelianus,--' have left far in the rear all that the 
 preceding period has transmitted to us on this branch of science ; never- 
 theless, the medical fame of no one of that period has reached the hight 
 of that of Hippocrates ; no man united in himself, perhaps, in the same 
 degree as he, all those qualities that constitute the great practitioner — 
 intelligence, sincerity, disinterestedness, the love of his Art, and of 
 humanity. 
 
 In regard to theory, Medicine made also remarkable progress. Instead 
 of a few general considerations, and a few incomplete essays at system- 
 ization, met with in the Hippocratic writings, the present period offers us 
 complete systems, whose parts, closely co-ordinated, are more or less well 
 adapted to the various forms of diseases, and practical details. Dog- 
 matism, enlarged and improved, represents, as exactly as possible, the 
 combined influence of the vital principle, or organic forces, with the 
 properties of the physico-chemical elements, or general forces. Empi- 
 ricism laid the foundation of a new scientific edifice ; an edifice which 
 it not only left unfinished, but of which, also, it did not perceive 
 the definite end. Methodism, which should have been contented with 
 indicating this end, in accepting the experimental contributions fur 
 nished by Empiricism, rejected these, and flattered itself to be able to 
 construct a medical edifice by commencing at the summit — that is to 
 say, with the general properties of matter. It seduces, by an appear- 
 ance of simplicity and rigorous exactness, but in fact constitutes only 
 an ideal monument, which falls before the result of daily observation 
 and practice. The Eclectic, not perceiving in any of these systems the 
 truth in full, and seeing that none of them embraced the plenitude of 
 science, but only a part — one aspect — refused to all his adhesion, and 
 boasted of choosing from each what he considered best. Nevertheless, 
 he does not define in what this consists ; he gives no rule by which it 
 can be known ; he refers to the reason and experience of each one, i. e., 
 he proclaimed individualism, doubt, and isolation. In the midst of this 
 conflict, Dogmatism, resting on the highest philosophical and medical 
 illustrations, developed and sustained by the immense erudition and 
 subtile dialectics of Galen, offers the most extended and reasonable 
 explanation of the phenomena of the living economy. It thus must 
 triumph, as in fact it did, its errors even contributing to establish it ; 
 for they were in harmony with the prejudices of the dominant philo- 
 sophy. 
 
 " Coelius Aurelianus, De Morbis Acutia et Chronicis, nova editio, Amst., 
 1709, in 4to.
 
 BOOK II. 
 AGE OF TRANSITION. 
 
 J0M:MEN€ING at the death of GALEN, DURING THE REIGN OF 
 THE EMPEROR SEPTIMUS SEVERUS, A. D. 201, AND ENDING AT 
 THE REVIVAL OF LETTERS IN EUROPE, ABOUT THE YEAR 1400. 
 
 V. GREEK PERIOD. 
 
 SNCLUBING THE PERIOD OP TIME BETWEEN THE DEATH OF GA.LEN AND THE 
 DESTRUCTION OF THE ALEXANDRIAN LIBRARY, WHICH OCCURRED IN THE 
 YEAR 64a 
 
 GENERAL CONSIDERATIONS. 
 
 At the time when this historic period oommences, all the known 
 parte of the ancient world were under the dominion of a single 
 man. The empire of Septimus Severus had more extent than that of 
 Alexander the Greai, and inspired the hope of a much longer existr- 
 ence. The Eoman dominion, cemented by seven hundred years of a 
 skillful, bold, and persevering government, appeared seated on immov- 
 able foundations. The people of the adjoining frontiers troubled yet, 
 occasionally, the peace of this vast territory, but none were strong enough 
 to penetrate as far as its center, and place this gigantic power in any 
 real peril. 
 
 The great civil wars had ceased, or had changed their object. The 
 people and the Senate, those two eternal competitors, no longer contended 
 for supreme power ; they had both given over the struggle. The monar- 
 chical form was now accepted, not only ss a fact, but as a habit and a 
 necessity. The citizens no longer took up arms to change the form of 
 government, but only for the choice of a master. 
 
 A revolution is progressing in the domain of the mind, analogous to 
 tihat which had changed the political world. The discussions of the 
 philosophers, so interesting in the schools of Greece, where the most
 
 238 GREEK PERIOD. 
 
 difficult questions in physics, morals, and metaphysics were discussed in 
 full liberty, have already lost much of their interest, and very soon will 
 cease entirely. The supremacy of one tends to be established in the 
 whole intellectual world. The disputes relate but little to principles, 
 but rather to the true meaning of the language of the teacher. In 
 morals, Plato, Epicurus, and Zeno are followed, until a purer and 
 more sublime morality, that of Jesus, son of Mary, takes the place of 
 all the rest. In physics and metaphysics, Aristotle soon reigned des- 
 potic, and the authority of Galen is unrivaled in Medicine. 
 
 History, which should be the faithful image of society, becomes con- 
 tracted, also, during this age, justly called the age of transition, because 
 it serves as a transition from one social state to another. In place of 
 offering the scene of great contests and movements, it is summed up in 
 some sort in the biographies of individuals — in interior manifestations ; 
 and, to keep to our special subject, we will say, that the history of 
 Medicine will no longer be taken up with discussion among various 
 sects, and of choice between different methods ; for there is now, and 
 will be for ages, but one sect and one sole method. The progress of 
 medical science, slowly retrograding, will no more be thwarted by any 
 remarkable revolution ; only, the scientific scepter will pass from the 
 hands of one nation to that of another, and the language of Hippocra- 
 tes and Galen will be replaced by that of Avicenna and Albucasis. 
 
 The first period of the age of transition offers for our consideration, 
 Dnly the lives and writings of four Greek physicians, all of whom had 
 studied in the school of Alexandria, and whose reputations were sus- 
 tained until the time of the invasion of the Arabs. Though these 
 writers had made, for the most part, only a compilation of the works 
 of Galen and other authors, they have rendered, nevertheless, a signal 
 service in presenting science under an abridged and more commodious 
 form, and in enriching it with several new particulars, and especially 
 in preventing its torch being extinguished among their indolent 
 cotemporaries. 
 
 CHAPTEK I. 
 CELEBRATED COMMENTATORS. 
 
 Oribasius is the first author of any importance in the history of 
 Medicine, after Galen. He was also born at Pergamos, and lived in 
 the fourth century. He attached himself, early, to the fortunes of 
 Julian, surnamed the Apostate, and followed him into Gaul, when that
 
 CELEBRATED COMMENTATORS. 239 
 
 prince was named its governor. He recalls, himself, this circumstance, 
 in the preface to one of his works. The young Caesar appreciated the 
 great qualities of Oribasius, and became very intimate with him, and 
 after he was made emperor, appointed him Questor at Constantinople. 
 After the premature death of that philosophic ruler, Oribasius remained 
 faithful to his memory, but those who were envious of him, falsely rep- 
 resented his fidelity. He was disgraced, spoiled of his office and his 
 property, and banished among a barbarous people. The courage which 
 he displayed on that occasion, the extraordinary cures that he effected, 
 the eloquence of his discourses, attached to him very soon the love and 
 respect of semi-savage men, who wished to honor him as a god. The 
 fame of the homage he received reached the ears of the emperors Valens 
 and Yalentinianus. They saw their error, recalled Oribasius, reimbursed 
 him for his losses in his property and dignities, and permitted him to 
 enjoy peaceably to the end of his days, his high reputation and fortune. 
 Eunapius, a cotemporary of Oribasius, and a physician, gives a very flat- 
 tering account of him. He was, he says, the wisest man of his time ; 
 the most skillful in Medicine, and the most amiable in conversation. 
 
 Oribasius has written several works, of which the most important, 
 entitled Collections Medicinales, was dedicated to Julian, when he was 
 only as yet Csesar. It includes seventy books, of which seventeen only 
 have reached us. The following passages, forming the preface, exhibit 
 for what end, and in what spirit the work was undertaken. 
 
 " I have finished long since, divine Csesar, the abridgement of the 
 books of Galen, which you charged me to make, during our residence in 
 the nearer Gaul. You deigned to express your satisfaction on the sub- 
 ject, and you enjoined upon me, at the same time, another work — that 
 of reducing to a single volume, all that the most illustrious physicians 
 have taught, of utility, on the Healing Art. I have, there^^re, resolved 
 to gratify you according to my abilities. I shall be careful to omit 
 nothing of what Galen had said, because he is, of all those who have 
 written on these matters, the one who has treated his subject with most 
 clearness, reason, and method. He shows himself, besides, the faithful 
 interpreter of the principles and sentiments of Hippocrates." 
 
 Oribasius edited, at a later period, an abridgment of his great work, 
 for the benefit of his son. This abridgment, divided into nineteen books, 
 has reached us complete, as well as another compendium, on the prepa- 
 ration of remedies and the cure of diseases, undertaken at the solicita- 
 tion of his friend Eunapius. 
 
 This writer, as is seen, does not hesitate to avow that he borrows 
 from the authors that have preceded him, and particularly from Galen, 
 the greater part of his materials. Nevertheless, there are in his books.
 
 240 GREEK PERIOD. 
 
 certain fragments which are no where else found ; but we are ignorant, 
 whether they are his own, or borrowed from some authors whose works 
 are lost ; for he cites several, whose works are entirely lost, such as 
 Herodotus, chief of the pneumatic sect, Archigenes, Posidonius, and 
 Antyllus. However this may be, his principal merit consists in repro- 
 ducing the ideas of others with so much clearness, order, and precision, 
 that the summaries he has given of them are often preferable to the 
 originals themselves. What he has said of px'egnant women, nurses, and 
 the earliest education of the child, has appeared so perfect to the writers 
 that have followed him, that the most of them have copied him literally, 
 to the beginning of fifteenth century. We shall quote an example of 
 this in speaking of Paulus J^gineta. 
 
 Oribasius has written very little concerning surgery, but he is much 
 more extended on anatomy, on which he follows Galen exclusively. His 
 prepossession in favor of the latter is so great, and he makes of it so 
 little concealment — he adopts so servilely, his theoretic idea, even to his 
 expressions — that he has been surnamed the ape of Galen. 
 
 §11. 
 
 Aetius flourished towards the close of the fifth century, and in the 
 commencement of the sixth. He was born in the city of Amida, in 
 Mesopotamia, and studied medicine at Alexandria, as we learn from 
 him. He went afterwards to Constantinople, where he was attached to 
 the court, with the grade of Count of the Palace, or chamberlain. 
 Aetius appears to have been the first physician of any note, who pro- 
 fessed Christianity. The following passages leave no doubt as to his 
 religion, but they show, at the same time, that his faith was more 
 enthusiastic than enlightened. In stating the composition of a certain 
 ointment, he recommends that the following words be repeated in a low 
 voice : " may the God of Abraham, the God of Isaac, and the God of 
 Jacob, deign to bestow upon this medicament, such and such virtues." 
 
 In another place, he recommends, that to extract a bone from the 
 throat the following words be pronounced : " bone, as Jesus Christ caused 
 Lazarus to come forth from the sepulchre, as Jonah came out of the 
 whale's belly, come out of the throat;" or in this form: "bone, I con- 
 jure you, by Blaises, martyr and servant of Jesus Christ, come forth, or 
 go down." He exhibits the same credulity in not doubting the miracu- 
 lous virtues attributed by the charlatans of his age, to a mass of their 
 remedies. 
 
 Nevertheless, this author recommends himself to us in the same way 
 as Oribasius. Like him, he has collected all that he has found remark- 
 able in the writings of his predecessors, and has instituted a body of
 
 CELEBRATED COMMENTATORS. 241 
 
 doctrines, in such a way as to omit nothing essential. We are indebted 
 to him, for the preservation of several fragments of antiquity, which 
 otherwise would have been entirely lost. His work, divided into four 
 sections, of four books each, formed a complete manual of medicine and 
 surgery, except that it lacked anatomical descriptions, and what relates 
 to luxations and fractures. His surgery consisted of external applica- 
 tions only. He points out the composition of a multitude of plasters 
 and ointments, and recommends the frequent use of the cautei'y, both 
 actual and potential. In his materia medica, the remedies are arranged 
 according to the kingdom to which they belong, and in alphabetical 
 order; but he does not describe, like Dioscorides, the natural characters 
 of the substances ; having been content to enumerate their medicinal 
 properties, in which he adopts the ideas of Galen. 
 
 §ni. 
 
 Alexander was of Tralles, a city of Lydia, where the Greek language 
 was very correctly spoken. His father Stephen, like himself, a physi- 
 cian, had five sons, whom he carefully educated, and who were all dis- 
 tinguished for their learning ; but Alexander was the most celebrated 
 of his family. After having traveled in many parts of Asia, Egypt, 
 Spain, Gaul, and Italy, he fixed his residence at Eome, where he imme- 
 diately acquired a brilliant reputation. Living to a very advanced age, 
 and being no longer able to sustain the fatigues of practice, he was still 
 willing to be useful by giving to the public the fruits of his long expe- 
 rience. To this end, he composed a treatise in twelve books, exclusively 
 devoted to afiections that do not require the aid of surgery. The first 
 ten books treat of diseases of a special seat, commencing with those 
 of the head, and finishing with those of the abdomen. The eleventh 
 treats of gout alone, and the twelfth of fevers. It seems, nevertheless, 
 the last should be placed the first, and such was the intention of the 
 author, as expressed in his preface. 
 
 " Since you desire," says he, "dear Cosme, that I inform you of the 
 remedies whose efficacy I have frequently proved in diseases, I feel 
 impressed to acquiesce in your request, on remembering the kindness 
 with which you and your father have honored me. I feel myself happy 
 in having, in my old age, this occasion to gratify you, and since I can 
 no longer support its fatigues, I have resolved to embody here, succinctly, 
 the knowledge I have acquired in a long practice. I hope that those 
 who shall read this book without prejudice, will be charmed by the exact- 
 ness of my teachings, and the clearness and conciseness of my style. I 
 have studied to employ, as much as possible, common and usual terms, 
 so as to have ray diction comprehended by the vulgar even. We shall
 
 242 GREEK PERIOD. 
 
 commence with ephemeral fevers, following the method of the divine 
 Galen, to whom we shall endeavor to conform in this, as in everything 
 else." 
 
 We see by the above that he professes, after the example of his pre- 
 decessors, a great veneration for Galen ; but he does not adopt, like 
 them, his opinions blindly, at least in regard to practice. He allows him- 
 self, at times, to take an opposite view, not, he says, from a desire to 
 contradict so great a man, but with a wish to present things in their 
 true light; and though he makes no innovation, in a theoretical point 
 of view, yet we place him in the same category as the two compilers of 
 whom we have just spoken. From the manner in which he describes 
 diseases and directs the treatment, we regard him as a good observer. He 
 speaks of several, of which no one before him has made mention. Such, 
 among others, is the case of a woman tormented by excessive hunger, 
 called bulimia — a perpetual gnawing in the stomach, accompanied with 
 a violent pain in the head. This woman was cured by taking iera, 
 which caused her to pass a worm twelve cubits in length. This is the 
 first time that a condition of this kind was attributed to intestinal 
 worms. He advised bleeding in the foot in hemoptysis, and he says 
 that he found it more efficacious than at the arm ; because, he adds, 
 performed thus distinct from the diseased part, it acts as a powerful 
 revulsive. No better reason could be offered now, even, for a similar 
 course. In tertian fevers, more particularly than in the quartan, he 
 was accustomed to procure vomiting before the accession, and affirms 
 that he obtained great success in this way. We conceive that it must 
 have been one of the most efficacious remedies, before the discovery of 
 the febrifuge par excellence. But what is most difficult to conceive, and 
 which at the same time astonishes and afflicts us, is, that a man of 
 judgment so sound, and a mind so enlightened, had faith in the virtue 
 of amulets and talismans, the use of which he recommends on various 
 occasions. Such was the universal prejudice of his age, that it was 
 necessary for every man to pay tribute to the errors of his cotempora- 
 ries. Alexander has at least this excuse, that the whole world in his 
 time was plunged in the same superstition ; and we shall see, that up 
 to an epoch very near our own, physicians of reputation, and learned 
 men, partook of this weakness without having the same excuse. 
 
 Without pretending to place this author in parallel with Aretoeus of 
 Cappadocia, there exist, nevertheless, some traits of resemblance, which 
 unite them. In the first place, they have both treated of a small num- 
 ber of diseases, only about sixty, which proves that they were only will- 
 ing to speak of those they had seen and studied. Their plan of arrange- 
 ment is similar, and is the most natural that could have been adopted
 
 CELEBRATED COMMENTATORS. 243 
 
 in their times. They were equally exact in describing the symptoms 
 of diseases, and in tracing out the characteristic signs of those which 
 are most likely to be confounded, on account of their similarity. Though 
 the style of Alexander is much less elegant and pure than that of the 
 physician of Cappadocia, it closely resembles it in clearness, concise- 
 ness, and energy. There is also this diflPerence between them : Alex- 
 ander does not give an anatomical description of the affected parts in 
 each disease. But the reader himself shall be able to make the com- 
 parison, by placing the following description in comparison with that 
 which has been given on a previous page. 
 
 " I do not give the name pleurisy," says Alexander, " to every species 
 of pain in the side, for true pleurisy is the inflammation of the mem- 
 brane which lines the chest. It is accompanied with an acute fever, 
 which is owing to the proximity of the heart, which suffers sympatheti- 
 cally. If, then, you observe in a sick person, a difficult respiration, 
 with acute fever, cough, and pungent pain, you may be sure that he is 
 a true pleuritic. Those who are affected with an inflammation of the 
 liver have also a fever, and breathe with pain ; their side is also tender 
 and painful, and they have a sympathetic cough ; but the stitch in the 
 side, and the hardness of pulse are absent. 
 
 " The following is the rule by which to distinguish pleurisy from 
 hepatitis: they are distinguished, particularly, in the nature of the 
 pain, and the character of the pulse. The pleuritics have a hard pulse, 
 which gives to the touch the sensation of a saw ; it is not the same in 
 persons affected with hepatitis, nor do pulmonics experience anything 
 similar, on account of the softness of the affected organ. The cough is 
 also different in pleurisy from that in hepatitis. In the former, it is 
 more violent, and is promptly followed with expectoration. During the 
 progress of the disease the color of the expectorated substance indicates 
 what humor it is which has given rise to the inflammation. Eed matter 
 shows that it comes from the blood ; yellow, from the bile ; that which 
 is white and viscid announces the phlegm ; dark, the atrabile. In 
 hepatitis, there is cough, but no expectoration. Eemember, though- 
 that in pleurisy, sometimes, there is no expectoration ; from which it 
 follows, that it would be wi'ong to consider as a hepatitic, every indi- 
 vidual who coughs without expectorating ; for there are obstinate pleu- 
 risies, of difficult coction, and these are the most dangerous. The inflam- 
 mation may also be seated below the false ribs, without extending into 
 the chest ; it may also be exterior. In these cases there can be no 
 expectoration ; but, then, the humors which cause the inflammation 
 form an abscess, unless it is discussed, which rarely happens. Give, 
 then, attention to all these signs, as well as to the color of the face.
 
 244 GREEK PERIOD. 
 
 Patients attacked with hepatitis are usually pale ; it is the opposite 
 with those who have pleurisy. In this way you may discern the 
 
 latter."- 
 
 §IV. 
 
 Paul, surnamed iEgineta, because he was a native of the isle of Mgina., 
 is the last Greek physician who will interest us. Though the time in 
 which he lived is somewhat uncertain, the most probable opinion places 
 it toward the end of the sixth century, and the first half of the seventh. 
 He travelled much, and doubtless spent some time in Alexandria, either 
 to gain instruction in his Art, or to teach it. His skill in surgery, and 
 especially in obstetrics, rendered him celebrated, even among the Arabs, 
 whose midwives sent for him in consultation, it is said, from great dis- 
 tances, in difficult cases. On this account their writers frequently give 
 him the surname of accoucheur ; which does not signify that he limited 
 himself to that branch specially, in surgery, but that he had acquired 
 in it a great reputation, and rendered himself celebrated. 
 
 Paul of iEgina composed a compendium of Medicine, divided into 
 seven books ; after the example of others, he does not hesitate to borrow 
 from his predecessors, or even to copy them literally. A number of 
 chapters can be cited, taken entirely from Oribasius, and especially 
 those that concern pregnant women, and the earliest life of infants. I 
 will content myself by placing an example of this before the eyes of the 
 reader, so that he may judge for himself the manner in which authors 
 of those times plundered their predecessors. 
 
 -ORIBASII SYNOPSEOS. PAULI iEGINET^. 
 
 LIBER QUINTUS. LIBER PRIMUS. 
 
 CAP. V. CAP. V. 
 
 Educatio pueruli. Educatio pueri. 
 
 Puer nuper in lucem editus xnelle Priraum alimentum recens nato in- 
 
 primiim nutriator; deinde lacte bis in fanti mel exhibere oportet ; posteavero 
 
 die, aut ter ad summum. Quiimque id lac praebere bis in die, aut ad summum 
 
 alacriter puer assumit, spesque est cum ter. Quuiii autem et ipse promptus 
 
 esse concocturum, turn cibus jam offeri fuerit ad accipiendum, et spem exhib- 
 
 potest qui ipsum non impleat: si vero ueritconcoctionis, tunc jam etiam cibus 
 
 nobis ignaris impleatur, turn ad som- dandus est qui non impleat. Si vero 
 
 num proclivior et segnior efficitur, ven- nobis non advertentibus repleti fuerint, 
 
 terque intumescit et inflatur, et urina somnolentiores statim et segniores 
 
 redditur aquosior : quibus notis per- fiunt, et tumor in ventre adest et fla- 
 
 spectis, nihil dandum est priusquam tus, et urina3 sunt aquosiores. Ex qui- 
 
 quod in ventre habet consumpserit. bussignisrepletionedcpreliensa, nutrix 
 
 Satis erit biennium lacte nutrire ; de- nibil exhibere debet, donee fuerit con- 
 
 inde vero ad cibos transeundudum est. sumpta. Sufficit autem biennium lacte 
 
 nutrire ; deinde ad cibos transgredi. 
 
 "' De Arte Medica, lib. vi, cap. i.
 
 MEDICAL ORGANIZATION. 245 
 
 But Paul of JEginn makes no secret of this course, which saves him 
 from the reproach of plagiarism. "While it would be extremely diffi- 
 cult, not to say impossible, to retain in the memory the general principles 
 of the Healing Art, and all the particular means advised by the ancients 
 I have made this abridgement of what there is best of their writings. 
 They are not my own conceptions which I propose, if exception be made 
 of some details of observation noted in my practice ; but, being versed 
 in the reading of a number of excellent authors, and principally Oriba- 
 sius, I have attempted, in imitation of him, to collect the cream of what 
 others have said concerning the means of preserving health." 
 
 Notwithstanding this modest avowal, Paul is not deficient in origin- 
 ality. The surgical part of his book includes a quantity of observations 
 which are his own, and which prove that he had performed many opera- 
 tions ; and so far from following, always, the rules of others, he knew 
 how to modify them according to circumstances, and to extend even the 
 narrow limits of his art. He is often more explicit than Celsus, whether 
 in the description of diseases and the curative indications, or in the 
 exposition of a plan of operations. I will refer, among others, to the 
 chapters relative to hydrocephalus, paracentecis of the thorax and abdo- 
 men, the extraction of vesicular calculi, and aneurisms. He is the first 
 who pointed out and described varicose aneurisms ; the excision of hyper- 
 tophied mammse in men, etc. He appears also to have been the first to 
 perform the operation of bronchotomy, after a method which he borrowed 
 from Antyllus, of which he has transmitted us a very detailed account. 
 I will close what concerns this author, by the single remark, that Fabri- 
 cius of Aquapendente, the famous surgeon of the sixteenth century, 
 draws from him and Celsus the basis of his doctrines. 
 
 CHAPTER II. 
 
 MEDICAL ORGANIZATION. 
 
 I have already said a few words on the medical organization of the 
 most celebrated people of antiquity. I now proceed to examine this 
 organization in a more special manner. I shall describe the principal 
 changes to which the profession of Medicine was subjected, in proportion 
 as civilization progressed, from the infancy of society to the ruin of the 
 Alexandrian school. I shall speak of the few laws that regulated its 
 teaching and practice in remote ages, and I shall show the origin of 
 some institutions destined to extend the benefits of the Healing Art to 
 the inferior classes of society.
 
 246 GRSEK PERIOD. 
 
 I have put off, to the end of this period, what I have to say on this 
 subject, so as to bring together, in a single view, everything that relates 
 to it. By the aid of this concentration, the reader will be able, at one 
 glance, to compare among themselves the various phases of the medical 
 profession, throughout antiquity ; for the extinction of the Greek domi- 
 nation in Egypt constitutes, in the history of Medicine, the separation 
 of ancient from modern times. At that epoch, a new language and new 
 authors made their appearance in the medical world — the scepter of 
 letters and arts passed from the Greeks to the Arabs — and then com- 
 menced a new era. 
 
 If a general view be taken of the organization of medicine among the 
 ancients, four distinct phases may be recognized ; each of which corres- 
 ponds to a form and particular state of civilization. 
 
 FIRST PHASE. 
 
 At the origin of society, among the wandering tribes and small set- 
 tlements, before the existence of great cities, and especially before 
 the invention of writing, the treasury of human knowledge was very 
 limited, and the memory of one man sufficed to contain it. It was 
 composed of a few simple notions which wei'e transmitted, verbally, 
 from father to son — from the master to the disciple — and formed, often, 
 the patrimony of a family. At this epoch, the same person often united 
 in himself the authority of sovereign, priest and man of science. 
 
 Such were the patriarch Jews, Abraham, Isaac, and Jacob, and those 
 whom Homer paints as the heroes of Greece — Kercules, Theseus, Jason, 
 Achilles, Ulysses, etc. We see them after the combat, sometimes, dress- 
 ing the wounds of their companions in arms, or preparing them a 
 repast, or a sacrifice, or a funeral ceremony. We have before remarked 
 that Machaon and Podalirius, surnamed the sons of Esculapius, on 
 account of their surgical skill, were at the same time distinguished 
 captains, and that most of the generals who served at the siege of 
 Troy, boasted of having been the pupils of the centaur Chiron, renowned 
 for his great skill in Medicine. 
 
 We know, also, that the Egyptians attributed the invention of the 
 Healing Art, and all other arts, to several of their kings ; but chiefly 
 to Hermes, who was regarded as the author of several books that inclosed 
 the secrets of Medicine. The Chaldeans attributed the honor of the 
 same discovery to Zoroaster ; the Chinese to Cinningo and Hohanti. 
 In a word, we find the same tradition, with but slight variations, among 
 all the famous nations of antiquity, which proves, evidently, that the 
 chiefs of the people were nearly all, at the same time, priests and physi- 
 cians. We shall give to this first phase of the medical profession, the
 
 MEDICAL ORGANIZATION. 247 
 
 name of patriarchal, because the practice of Medicine constitutes a 
 species of patronage and protection. 
 
 SECOND PHASE. 
 
 When the tribes or settlements had become nations, industry had 
 made progress, and intellectual riches were increased by the aid, espe- 
 cially, of the admirable artifice which enables us to fix thought, and 
 to give a visible body to the passing word ; then the treasure of human 
 knowledge could no longer be contained in the memory of a single man, 
 and the highest function of society could no longer be executed by one 
 individual ; then a division was made, varying according to numerous 
 circumstances, but which presented this remarkable peculiarity, that 
 the priesthood and the practice of Medicine remained a long time united 
 in many countries. 
 
 It was so in Egypt, when the priests of the time of Moses practiced 
 Medicine, and all the learned professions. They were divided into 
 several orders, of which each received only the species of instruction 
 appropriate to the functions he professed to fulfil. The legislator of 
 the Hebrews, reared among the priests, introduced the greater part of 
 their institutions among the Jews. We have seen, that he confided to 
 the Levites the duties of religious worship, and sanitary police or public 
 Medicine, the only kind that is alluded to in his laws. In Greece, from 
 the ruin of Troy to the dispersion of the Pythagorean society, the Ascle- 
 piadae, or priests of Esculapius, appear to have been the only physicians 
 of any public consideration. Their temples were transformed into dis- 
 pensaries, where patients from the most distant countries came to receive 
 counsel and treatment. The same phenomenon is reproduced in nearly 
 all countries of the earth, at a certain epoch in civilization ; we find it 
 in the history of the ancient Greeks and of the inhabitants of the 
 Brittanic Isles, in China and Japan, among the Tartars, in Africa, and 
 in the New World ; we see the same in Europe, in modern times, when 
 feudal anarchy replaced Roman civilization. 
 
 This coincidence, which may be said to be universal, could not have 
 been the result of accident ; and it is easy to explain, by a little reflec- 
 tion, that in the ages of ignorance, credulity, and superstition, diseases 
 were regarded as a celestial chastisement, an evidence of the divine 
 wrath, or as the result of some malign influence, rather than as the 
 effect of natural causes ; and therefore, it was deemed more advisa- 
 ble to resort to prayers, expiations, sacrifices, exorcisms, etc. — as much, 
 at least, as to the natural resources of Medicine. In this condition of 
 the public mind, it was almost inevitable for the priests to take hold of 
 the practice of Medicine ; for they shared, also, the common opinion,
 
 248 
 
 GREEK PERIOD. 
 
 and supposed the cure of diseases a part of their attribute. I will 
 therefore, designate this phase of the profession by the epithet of 
 sacerdotal. 
 
 THIRD PHASE. 
 
 Nevertheless, the clergy did not always, in certain countries, remain 
 in exclusive possession of the secrets of Medicine. There came a time 
 when the Art was no longer taught in an occult manner, and when its 
 practice was accessible to every citizen. That revolution, we have seen, 
 first took place in Greece, about the commencement of the fifth century 
 before Christ, after the dispersion of the Pythagoreans. We have 
 appreciated a few of the circumstances that accompanied it ; among 
 others the promulgation of the medical doctrines of Cnidus and Cos. 
 We have shown how the families that had the direction of these institu- 
 tions, and who assumed to be descendants of Esculapius, acceding, either 
 willingly or unwillingly, to this general movement of mind, divulged the 
 secrets of their practice, and opened the schools to the profane. 
 
 It is probable that long before this epoch there were in Greece, as 
 well as elsewhere, individuals not adjuncts to the priesthood, who pre- 
 tended to practice Medicine. These were medicasters of a low grade, 
 herbalists, holders of some panacea or family recipes ; but these were not 
 the true depositories of the medical science of their time. The Asclepiadae 
 alone were such, and they made no communications to the uninitiated. 
 It was not so after the revolution referred to ; then medical science fell 
 within the public domain, and to be admitted to the profession required 
 only leisure, and the means to pay for books or teachers. Science 
 gained very much by this transformation ; but the profession was much 
 lowered in the minds of the people, who now only saw it in the light of 
 a lucrative occupation. 
 
 From Greece this revolution was extended into Asia and Egypt ; it 
 penetrated Eome about the time of the second Punic war, but made 
 little progress there until at a later period, by the talents and address 
 of Asclepiades of Bithynia. Until that time Medicine had been prac- 
 ticed at Eome under the patriarchal form. The oldest and best 
 instructed of the relatives treated the diseases of his family, as he 
 understood them ; and it does not appear that the priests, more than 
 others, assumed this function. Cato, the censor, was much engrossed 
 with this domestic Medicine. He wrote a book on the subject, in which 
 he recommends cabbage as a sovereign remedy in many cases. He 
 venerated the number three, after the fashion of the Pythagoreans, and 
 disdained not to transmit to posterity the magical words which he 
 believed were useful to repeat for the reduction of luxations and 
 fractures.
 
 MEDICAL ORGANIZATION. 249 
 
 If this practice is not usually the most enlightened, or the most 
 efficacious, it is in general the mildest and most disinterested. Besides, 
 the old Censor carried to the end of his life a profound hatred against 
 the men of the medical profession. Let us see in what terms he 
 endeavors, by his familiar correspondence, to inculcate this hatred to 
 his son Marcus. '• I will tell you," he writes, "when 1 have an 
 opportunity, what I think of these G-reeks, and what I esteem most of 
 what there is in Athens. It is good to study, to some extent, their 
 letters and sciences, but it is not necessary to learn them fully. I shall 
 be done with this wicked and proud race ; nevertheless, be assured, as 
 if a prophet had told you, that as soon as this nation shall have com- 
 municated to us its literature, it will spoil and corrupt everything, and 
 this will be so much more easily eflFected if it sends us also its physi- 
 cians. They have sworn among themselves, to kill all barbarians by 
 means of medicine, and yet they require pay from those whom they 
 treat, in order to gain their confidence, and thus ruin them more easily. 
 They are insolent enough to call us barbarians, as well as others, and 
 they treat us even more disdainfully, by calling us opiques. In short, 
 remember that I have forbidden you to employ physicians." =•' 
 
 If the hatred of Cato appears to be blind and ridiculous, like every- 
 thing which is exaggerated, it must be borne in mind that the Greek 
 physicians who came to Eome merited, in part, these invectives. The 
 greater number were only intriguants, without instruction or manners, 
 having no other aim than to make a fortune, and capable of every 
 baseness tc attain it. Such is the picture that Galen has drawn of 
 them, as we have shown elsewhere. Asclepiades himself, whose superior 
 talents did not require for success the vile deceits of charlatanism, had 
 recourse to these shameful means. We have seen that he promised all 
 his patients an easy, prompt, and perfect cure, and I now add another 
 proposition attributed to him : " whoever understands Medicine thor- 
 oughly is never sick." Fortune, it is said, seemed to confirm this 
 aphorism on his own person, for he reached a great old age, and died 
 from an accident. Such an example never lacks imitators, and long after 
 Asclepiades, Thessalus, who was much inferior to him in merit, exhibited 
 a much greater amount of impudence. He would only appear in public 
 accompanied by a troop of bakers, boys, butchers, weavers, carders, and 
 other artisans of the lowest classes of society, to whom he gave the 
 title of pupils, whose vulgar language, it is said, he used. We can 
 conceive the stir that such a suit must have made, and how much it 
 served to increase his reputation among the ignorant. He carried his 
 
 Cato, De re rustica. 
 
 16
 
 250 GREEK PERIOD. 
 
 audacity so far as to write to the Emperor Nero, that previous to 
 himself, no physician had found anything certain for the preservation 
 of health and the cure of diseases, and that he alone had discovered 
 the true method of treatment. The chronicle reports that he had 
 extraordinary success ; but in what an age ! and under what a prince ! 
 
 The number of these false physicians was much more considerable at 
 Eome than elsewhere. Galen has indicated the reason of this in the 
 following passage : " In a vast and populous city, like the capital of 
 the Eoman Empire, it is easy for a stranger, and even for a citizen, to 
 conceal his name, his birth, his fortune, and his conduct. A man is 
 only judged by the luxury he displays, and the arrogance he exhibits. 
 If accidentally he is discovered, it will suffice for him to change his 
 location : while in a small town, all the inhabitants know each other ; 
 a man's relatives, education, and manner of life, are so well understood 
 that fraud is impossible." 
 
 In the midst of this overflowing of charlatanism, the health of the 
 citizens was given over to the mercy of the first im2)0ster who called 
 himself a doctor ; for how could the cheat and usurper of the title be 
 ■ distinguished from the man of knowledge and probity, who had acquired 
 it by study ? No examination, no legal proof was imposed on any one 
 who wished to practice Medicine ; there was no security for the sick. 
 Such a disorder could not always exist, and the excess of the evil led 
 to its suppression, which in fact was brought about. Thus finishes the 
 ^third phase of the medical profession, which we shall call the unlicensed 
 ■laity phase. 
 
 FOURTH AND LAST PHASE. 
 
 The abuse to which this indefinite liberty led, in the practice of 
 Medicine, having become intolerable, the legislative power was obliged 
 to interfere. Now commences for the medical profession a new phase, 
 which I shall call the legal or organized laity jj/tase. 
 
 The Emperor Anthony the Pious, was the first who occupied himself 
 with this subject. He made mention, in several of his rescripts, of the 
 immunities to which those physicians had a right, who were employed in 
 the public service, whether civil or military ; but there is no evidence 
 yet of examinations or proofs of qualifications, and we can only suppose 
 their existence.-- It is necessary to go as far back as the Christian 
 Emperors to discover the traces of a regular medical organization. It 
 ■was then, only, that the title of Archiater received a legal sense, and 
 that certain functions were attached to it ; while it docs not appear to have 
 
 ^ Justiniani Codocis, lib. x. tit. m. De Professoribus et Medicis, i. Digestorum, 
 lib. xxvii, tit. I. De Excusationibus, vi, §1, 2.
 
 MEDICAL ORGANIZATION. 251 
 
 been, ever before, more than an honorary title — an ambitious distinction, 
 excited by vanity, and often usurped. Andromachus, physician to Nero, 
 was decorated with it ; but Galen, physician to Marcus Aurelius, never 
 bore it. From the time of Constantine the Great, the name of Archiater 
 is frequently met with in the edicts of the Emperors. It served to 
 designate, sometimes, the physicians attached to the person of the sov- 
 ereign, sometimes physicians fulfilling certain public functions in cities. 
 
 There were, consequently, two sorts of Archiaters ; one named Palatine, 
 who belonged to the household of the prince, holding rank amongst the 
 officers of the court, and having at their h^d a count or duke, who was 
 a peer with the higher dignitaries of the Empire. He bore the title of 
 Count Archiater, or Count of the Archiaters, for historians differ in 
 opinion in regard to these two denominations. '■■' The others, called 
 Popular Archiaters, formed in each town a kind of college, charged with 
 the supervision of everything that related to salubrity. No one could 
 practice medicine in their jurisdiction without having been examined by 
 them, and recognized as sufficiently instructed. Whoever transgressed 
 this regulation, was punished with a fine of two thousand drachms. 
 These Archiaters were honorably pensioned by the State, and enjoyed 
 various privileges. In return for these advantages, they were obliged to 
 wait upon the poor gratuitously ; but they had the right to charge those 
 who were rich or in easy circumstances. The practitioners who were not 
 members of the College of Archiaters, had no immunity, and lived upon 
 the product of their practice. 
 
 The Popular Archiaters amounted to ten in the metropolis ; seven, in 
 cities of the second order, and five in those below. They were not chosen 
 by the Governor, but elected by the citizens, from among the candidates 
 who had given proof of their capacity before the College, and obtained 
 its approbation.! Such was the first medical organization destined to 
 remedy the frightful evils of anarchy. It subsisted until the dismem- 
 berment of the Empire by the barbarians. 
 
 It was during this period, about the year 400 of our era, that we see 
 designated for the first time in medical books a class of citizens to whom 
 was confided the duty of preparing the drugs ordered by physicians.} 
 Their functions had some analogy with those of our apothecaries, though 
 in knowledge and social position no comparison can be made between 
 the pharmaceutists of our day and their obscure predecessors. Before 
 this epoch the physicians prepared, themselves, or caused their students 
 
 "Histoire de la Chirurgie, T. II, lib. vi, p. 715. 
 ■j-Degest, T. IX, lib. l. De decretis ab ordine faciendis. 
 I Oribas. In prcemio Euporistorum, ad Eunapium,
 
 252 GREEK PERIOD. 
 
 or servants to prepare, the remedies which they needed in their practice, 
 as- is shown from various passages in Hipprocrates and Galen. The 
 Pharmacopolists who were mentioned by writers anterior to the fourth 
 century, were only druggists, or herbalists, to whom the physicians went 
 to obtain simple substances, necessary for the confection of compound 
 remedies. Perhaps, also, some of these pharmacopolists kept always 
 ready some remedies of frequent and daily use, such as the theriacS' 
 
 CHAPTEE III. 
 
 INSTITUTIONS ACCESSORY TO MEDICINE. 
 
 I comprehend under this title the hospitals and hospices, the dispen- 
 saries and all the establishments which enable the necessitous classes to 
 participate in the relief afforded by medicine. Pagan antiquity has 
 transmitted us no model of institutions of this order, unless one of the 
 gymnasia of Athens, called Cynosarge, be called such, in which aban- 
 doned children were nurtured and brought up at the public expense, until 
 they reached an age to be able to serve the Piepublic ; or also those 
 retreats which were established by several cities of Greece for the relief 
 of meritorious citizens. Eome never had, either under the Eepublic or 
 under her idolatrous Emperors, similar establishments. She effected the 
 same thing by frequent distributions of provisions or lands, by the 
 remission of unpaid taxes or some special duties, by the permission 
 accorded to parents to destroy newly-born children whom they were 
 unable to maintain, by the bond of patronage which united patrician to 
 plebian families, and made it a duty of both to succor each other in 
 times of their distress. As to the slaves, they were cared for by their 
 masters as his property, like his cattle or his flocks. The rights of 
 hospitality established between families, cities, and provinces, and 
 religiously observed, assured to travellers subsistence and shelter ; but 
 none of these institutions resemble our modern hospitals — nothing of all 
 this bears the character of an establishment destined to receive the 
 afflicted poor. 
 
 *Dujardin et Peyrilhe, Histoire de la Chirurgie, liv. v, T. w, p. 61, et sui. 
 According to this author, the first attempt at medical organization in the Roman 
 Empire goes back to the fourth or even the third century of our era ; while Cu- 
 vier says it only commenced in the fourth century, on the model of the scientific 
 establishment founded in Persia by the Nestorians. Hist, des Scienc. Natur., by 
 Cuvier, edited by M. Magdeleine de Saint-Agy, Paris, 1841, T. i, p. 409.
 
 INSTITUTIONS ACCESSORY TO MEDICINE. 253 
 
 It is to Christian charity that we owe the foundation of the first 
 alms-houses and asylums.'" Modern researches teach us that at the end 
 of the fourth century, Saint Pauline, a Eoman lady of illustrious birth, 
 after exhibiting the spectacle of the rarest virtue in the midst of worldly 
 pomp, resolved to retire from society, in order to continue, more uninter- 
 ruptedly, a'life entirely devoted to charity and self-denial. She went to 
 Jerusalem, first cradle of the faith, and theater of the greatest wonders, 
 where she united with other Christian women of the same mind, and 
 formed with them, under the direction of St. Jerome, a pious congrega- 
 tion, who divided their time between the reading of sacred books and 
 the practice of good works. 
 
 The faithful, who came in crowds to visit these venerated places, 
 actuated by pious motives, and had established there their residences, 
 were often exposed to severe privations, and though they supported them 
 with stoic fortitude, or rather with the resignation of martyrs, their 
 sufierings could not fail to touch the hearts of their brethren in Jesus 
 Christ. Their lot appeared particularly to excite pity, in regard to their 
 diseases or infirmities. To oflFer them, in these severe circumstances, 
 an asylum, where they would receive the attention of the kindest charity, 
 united to the counsels of art, was to fulfil for them the ofiices of Provi- 
 dence ; it was, also, in the opinion of those who discharged them, the 
 best means in the eyes of God, of redeeming all the imperfections and 
 weaknesses of human nature. Such a thought was well calculated to 
 excite instinctive compassion in a sex eminently sympathetic. These 
 holy women agreed to execute the project of founding a hospice for the 
 benefit of the indigent sick ; and for the purpose of putting the last 
 seal to this work of mercy, they bought a house out of the city, to which 
 they sent the convalescent, to breathe a pure air, and rejoice in the 
 charms of the country, so salutary for persons who are recovering from 
 disease. 
 
 In the end, the Emperors, Kings and Califs signalized their zeal in 
 the erection of sumptuous edifices for the relief of human misery, and in 
 bestowing upon them rich legacies. Then dispensaries and benevolent 
 societies were instituted, to complete the work of public charity. In 
 fine, these establishments, which had, at first, only a philanthropic end, 
 turned to the advantage of the Art, and contributed admirably to the 
 progress of the science. 
 
 ^^ Consult, on this subject, Percy et Willaume's Memoir on this question: "Had 
 the ancients public establishments for the benefit of the indigent orphan, or aban- 
 doned children, or for sick and wounded soldiers ? If they had not, what supplied 
 their place?" Paris, 181.3, in 8 vo.
 
 254 GREEK PERIOD. 
 
 RESUME OF TUB GREEK PERIOD. 
 
 In the times of Galen, animals were still dissected, and this professor 
 tells us that he made his anatomical demonstrations on monkeys, whose 
 conformation so closely resembles that of man. Sometimes the physi- 
 cians who followed the armies obtained permission to open the corpse 
 of some barbarian taken from the field of battle ; but, ultimately, the 
 practice of dissection entirely ceased, and the conformation of the human 
 body was only studied in books, as the horror of the early Christians 
 against cadaveric researches was more decided even than that of 
 Pagans ; and the fathers of the primitive church launched their anathe- 
 mas against the violation of the mortal remains of man. 
 
 This abandonment of anatomy contributed, doubtless, to the decadence 
 of the healing Art ; but other causes concurred no less powerfully. In 
 the first rank must be placed the rapid extension of Christianity, which 
 disorganized the Pagan schools, discredited the profane sciences, and 
 ruined their teachers. It engendered in every mind the passion for 
 religious controversy, which excited so much trouble in the rising 
 Church, and hastened, as is known, the fall of the Empire of the 
 East. 
 
 In the second place, the limited number of those who continued at- 
 tached to the culture of the Natural Sciences, enchained by a vicious 
 method, only sought the explanation of the phenomena of Nature in the 
 writings of the ancients ; and not daring to advocate any change in 
 regard to the received doctrines, dragged heavily in the rut of the past. 
 Two men, only, Alexander, of Tralles, and Paul, of JEgina, in the lapse 
 of more than four centuries, showed the least originality ; the one 
 enriched intei-nal pathology and therapeutics with a few observations — 
 the other added moi-e marked improvements to surgery. 
 
 But if the period we have passsed over was unfruitful in scientific 
 progress, it was not so in social amelioration. The commencement of 
 organization that the teaching and practice of medicine received was 
 probably more profitable to humanity than might have been discoveries 
 in the science ; for we have seen that charlatanism had reached its acme. 
 A law destined to keep it in check, by requiring certain conditions of 
 capability and good character on the part of the aspirant to the medical 
 profession, responded then, under the circumstances, to an urgent 
 necessity, and such a law is at all times a benefit to society. In fine^ 
 the charitable institutions of which this epoch offered to the world the 
 first model, prepared for the future valuable means of medical instruc- 
 tion. The first period, then, of the age of transition, was not entirely 
 lost to the future of science, and especially to that of humanity.
 
 GENERAL CONSIDERATIONS. 255 
 
 VI. AEABIC PERIOD. 
 
 COMMENCING AT THE DESTRUCTION OF THE ALEXANDRIAN LIBRARY. IN THE 
 YEAR 640 OF THE CHRISTIAN ERA, AND ENDING AT THE CLOSE OP THE FOUR- 
 TEENTH CENTURY. 
 
 GENERAL CONSIDERATIONS. 
 
 At the epocli when this period commences, the Empire of the West no 
 longer existed. The finest provinces which composed it had been over- 
 run and subdued by barbarous tribes from the forests of Germany. From 
 its ruins had already arisen several independent kingdoms, of which the 
 most considerable were those of the Francs in Gallia, of the Visigoths 
 in Spain, and that of the Lombards in Italy. Justinian, who reigned a: 
 century previously, was the last of the Eoman Emperors whose arms 
 threw a passing glory over Italy, Sicily, Africa, and Spain, thanks to 
 the skill of some of his generals, and especially to the genius and heroic 
 devotion of Belisarius. 
 
 The Empire of the East, attacked at all points, still sustained itself 
 with vigor, though losing daily some one of its supports, similar to a 
 fortress reputed to be impregnable, which, encircled by its enemies, sees 
 fall one after another, the works destined to defend their approach. The 
 Turks had begun to show themselves on the banks of the Danube. The 
 Persians, those eternal enemies of the Eoman name, made incessant war 
 upon it, sometimes openly, again covertly. At last, a more redoubtable 
 enemy, and who at this time made greatest havoo of the Empire, had just 
 sprung up in the deserts of Arabia. There a man arose, who was at the 
 same time legislator, prophet, and conqueror, having united under one 
 domination and one worship the tribes heretofore divided and rivals ; 
 forming of them a powei'ful and enthusiastic nation, animated by a 
 thirst of conquest and an ardor of proselytism. Finally, century had not 
 passed since the first preaching of Mahomet, and already Arabia entire, 
 India, Syria, and Egypt, were in the hands of his followers. In G-IO or 
 641, Amrou achieved the con(|uest of this latter kingdom by seizing 
 Alexandria, its capital. The library of that city, composed of 500,000 
 volumes, was delivered to the flames, by the order of Omar the Second, 
 successor of Mahomet , and these books, says the historian Abulpharage,.
 
 256 ARABIC PERIOD. 
 
 served to heat, for six months, the public haths, which numbered nearly 
 four thousand. Such were the first fruits of the establishment of 
 Islamism /•'•■' 
 
 Happily the fervor of proselytism abated somewhat among the Mussul- 
 man princes, and policy more frequently guided their conduct than relig- 
 ious zeal. The Arab Califs showed themselves, in general, the protectors 
 of the Arts, Sciences and Commerce. Several among them endeavored 
 to collect the debris of the scientific treasures of antiquity, which had 
 escaped the ignorant fanaticism of their predecessors. More tolerant in 
 matters of religion than the Christian Princes of their times, they 
 received, without distinction of country or religion, all the men of merit 
 who took refuge in their States, gave them employment, and recompensed 
 them for their services. On this account, the philosophers and perse- 
 cuted heretics often sought an asylum among the Infidels, and carried 
 to them, in return, the light of Greek civilization. 
 
 Among the sovereigns of this nation, who distinguished themselves by 
 an enlightened love of letters, I will cite, in first rank, Haroun-al-Ea- 
 schid, the Charlemagne of the East — cotemporary and emulator of the 
 glory of the Emperor of the Francs — the hero of so many Arabic tales 
 and poems, and whose dominion extended over Asia, Africa and Europe, 
 from the borders of the Indus to the heart of the Spanish Peninsula. 
 He embellished, considerably, the city of Bagdad, his capital, and estab- 
 lished there public schools, mosques and hospitals. Almamon, his son 
 and successor, made still greater efibrts than he, in favor of the Arts 
 and Sciences. He founded the academy of Bagdad, which was one of 
 the most celebrated of the middle ages ; and spared no eflforts to attract 
 there the most illustrious savans of all countries. He enjoined on his 
 embassadors to buy all the writings of the philosophers and physicians 
 that could be found, and as fast as they were forwarded to him he 
 caused them to be translated into Arabic. The interpreter Honain, who 
 was a Christian, was emploped in this work for forty years, and for each 
 book he translated, he was paid, literally, its weight in gold. 
 
 The eclat that the dominion of the Moorish Kings shed upon Spain, 
 from the tenth to the thirteenth centuries, is well known. Several 
 cities possessed schools, public libraries and academies. Those of Cor- 
 dova, Toledo, Seville and Murcia were celebrated in all the West, and 
 students went to them, from all parts of Europe, to be instructed in what 
 were termed at that epoch, the Arts and Sciences of the Saracens. The 
 
 " Some modern critics have questioned the burning of the Alexandrian 
 Library by the Arabs ; but M. Matter has established that fact on incontestible 
 proofs.
 
 MEDICINE OF THE ARABS. 257 
 
 library of Cordova, the capital of the kingdom, embraced more than 
 224,000 volumes. Thus the literary and scientific scepter passed from 
 the hands of the Greeks and Eomans into those of the Arabs. AVe now 
 proceed to see what became of Medicine, among them. 
 
 CHAPTEK I. 
 MEDICINE OF THE ARABS. 
 
 §!• 
 
 Ehazes, or Easis, is the first physician of any eminence, who wrote 
 in the Arabian language. He was of Persian origin, and flourished 
 toward the end of the ninth century and the beginning of the tenth. 
 If we may believe the histoiians of his nation, who are naturally 
 inclined to exaggeration and the marvelous, he was a universal genius, 
 who had acquainted himself with music, astronomy, mathematics, 
 chemistry, medicine, etc. It is certain that at the age of thirty years 
 he was one of the most distinguished professors of the academy of Bag- 
 dad, and that students came from a great distance to hear his lectures. 
 Chosen from among a hundred of the most skillful physicians, to direct 
 the grand hospital of that capital, he displayed in the exercise of his 
 functions an indefatigable zeal, even to his old age. He had attained 
 his eightieth year when the loss of sight compelled him to quit his prac- 
 tice. His reputation was then at its height. It is easily conceived that 
 a man of his acquirements, nurtured in the writings of the ancients, and 
 placed for so many years in a post so favorable for medical observation, 
 must have acquired rare skill in the knowledge and treatment of dis- 
 eases. He was surnamed the Experienced, on account of his great 
 experience. 
 
 Ehazes wrote much on philosophy, medicine, history and chemistry; 
 but the greater part of his works are lost, or are buried in the depth of 
 of some library. We have, from him, two treatises on medicine, the 
 briefest of which, dedicated to the Calif Almanzor, contains excellent 
 counsel on the choice of a good physician. Here are some of the recom- 
 mendations he has given on the subject: "Study, carefully, the ante- 
 cedents of the man to whose care you propose confiding all you have 
 most dear in the world ; that is to say, your health, your life, and the 
 health and lives of your wife and children. If the man is dissipating 
 his time in frivolous pleasures ; if he cultivates with too much zeal the
 
 258 ARABIC PERIOD. 
 
 arts that ai-e foreign to his profession, such as music and poetry ; still 
 more, if he is addicted to wine and debauchery, refrain from committing 
 into such hands a trust so precious. He merits your confidence, who, 
 having early applied himself to the study of medicine, has sought skill- 
 ful instructors and seen much disease; who has united to the assiduous 
 reading of good authors, his personal observations ; for it is impossible 
 to see everything and try everything in one's own practice ; and the 
 knowledge and experience of a single individual, compared to the 
 knowledge and skill of all men, of all ages, resembles a slender brook 
 of water that flows by the side of a great river." 
 
 i The greatest work of Ehazes, entitled " Continens," is a collection of 
 extracts, which he compiled from all authors, for his own use. It is 
 divided into two parts, which comprise, together, thirty-seven books, 
 and form an abridgment, somewhat confused, of Medicine and Surgery 
 entire. The first part treats of diseases which attack a particular organ, 
 and commences with the head and finishes with the inferior members. 
 The second part treats of diseases whose seat is sometimes in one part 
 of the body and then in another, as phlegm, erysipelas, wounds, etc., 
 as well as those which afi"ect, or seem to affect, all the economy at once, 
 such as fever, the plague, etc. 
 
 The books which make up the Continens, though arranged after a 
 certain order, do not constitute a work fixed upon any uniform plan, 
 whose parts follow each other regularly, but is rather like a collection 
 of notes, extracts and souvenirs, which were probably not designed to be 
 published, or, at least, not in the state in which we possess them. This 
 collection, rich in facts and erudite quotations, is more interesting in a 
 historical than a scientific point of view ; for it embraces nothing, or 
 next to nothing, which is not found in Greek authors, unless we except 
 the indications for some remedies, introduced by the Arabs into the 
 materia medica, and a special mention of eruptive fevers, comprised 
 under the name of variola. These diseases having been described for the 
 first time by the Arabian physicians, it has necessarily been concluded 
 that they originated in Arabia, and had not been seen by the Greek 
 and Latin physicians of the previous age. This opinion is certainly 
 easy to sustain, but before admitting it in an absolute manner, let us 
 see what the most ancient authentic documents that we possess, say 
 concerning these diseases. Ehazes expresses himself as follows, in the 
 thirtieth book of the Continens : 
 
 "Galen says, in his fourth book, on Habits, that the ancients called 
 a phlegmon a disease in which heat caused an efi'ervescence, as in 
 erysipelas and variola. These afi"ections are caused by the bile. He 
 repeats the same in his treatise on the pulse, and in the ninth book, on
 
 MEDICINE OF THE ARABS. 259 
 
 Internal Diseases, in these terms : ' Superfluous matters, -wliicli are not 
 converted into blood, become putrefied, and at length attenuate, giving 
 rise to erysipelas and variola.' 
 
 '' He says again, in his fourth book, on the Pulse : ' The blood becomes 
 so much putrefied in apostema, variola, and eruptions, as to burn the 
 skin.' I affirm, also, that Galen has designated variola by its name, has 
 laid down its special treatment, and it may be inferred from his expres- 
 sions, that he considered its pustules as indicating a species of crisis." 
 
 It is evident from the above, that Ehazes did not consider variola as 
 a new disease, nor peculiar to his country. His testimony is of great 
 weight in the question under consideration ; but it would have more, if 
 the passages he has cited from Galen existed in the editions that we 
 possess. I avow that I have not been able to find them, which should 
 not, however, invalidate what he advances ; because, the copies which 
 the Arabian physician possessed, differed, probably, very much from 
 ours. Besides, I will add, with Doctor Bruno, a learned Hellenist of 
 the seventeenth century : " This question does not appear to me to have 
 as much importance as it formerly was supposed to possess, and it is 
 not improbable, that the ancients may have designated these diseases by 
 the names of pustules and exanthemata, (^zxd'Jfj.o.Tcou, vel siavdr^iiazcov,) 
 which are so frequently met with in their books." ■■■' 
 
 The Continens, notwithstanding the imperfect state in which it exists, 
 has been held in great esteem among the Orientals, and even among the 
 Latins. The Arabian writers, posterior to Ehazes, have drawn from 
 this collection as from a common fund of knowledge. For the most 
 part, they have only disposed in a better order, or edited with more 
 elegance and correctness, the abundant material which they found in it.f 
 
 §11. 
 Haly-Abas, also a Persian, flourished toward the close of the tenth 
 century, about fifty years after Ehazes. He wrote under the title of 
 Almaleki {opus regium) a treatise in twenty books, which forms a 
 complete system of the theory and practice of Medicine, and which is 
 extracted, in a great measure, from the " Continens." It is generally 
 argued, in regard to this composition, that it is the best which has 
 proceeded from the pens of the Arabian writers. It has the preference, 
 even now, over the "Canon" of Avicenna, of which we shall speak 
 presently, though the latter had much greater vogue during the middle 
 ages, among the Occidentals. 
 
 - Lexicon Medicum Graeco-Latinum. Vide Morbilli. 
 
 ■]• G. Cuvier thinks that the Continens was not written by Rhazes, but is a 
 collection of his oral lectures, published by some one of his pupils.
 
 260 AEABIC PERIOD. 
 
 §111. 
 
 Avicenna, surnamed the Prince of Physicians, was born at Bokhara, 
 a considerable city of Khorassan, in the year of grace 980. He mani- 
 fested, from the most tender age, an extraordinary disposition for the 
 sciences. His ardor for study was so great that he devoted to it entire 
 days, and the greater part of his nights. Having gone to study philo- 
 sophy and medicine in the university of Bagdad, his talents were soon 
 exhibited. He was received at court, loaded with favors, and elevated 
 to the dignity even of a Vizier. Then, suddenly, he fell into disgrace, 
 was stripped of all his property, cast into prison, and menaced with the 
 loss of his life. After two years detention, he recovered his liberty, 
 acquired anew the consideration of the public and the court, and 
 travelled in various countries. But he did not long enjoy this return 
 of fortune. Excessive labors, and the intemperance to which he 
 surrendered himself, gradually undermined his robust constitution ; he 
 died of dysentery, at the age of fifty-six. 
 
 Avicenna composed several works, of which the principal is called 
 the *' Canon,"'-' from a Greek word which signifies rule, law. The Canon 
 was, indeed, for five or six centuries, a classic book, and may be said 
 to have been the medical code of Asia and Europe. The professors of 
 the faculties confined their teachings for a long time, to reading it from 
 their desks, explaining, translating, and making extracts or compen- 
 diums from it. No author, after Galen, enjoyed so wide and durable 
 an authority in the medical world. Although now dethroned from this 
 high position, my readers will not object, I think, to acquire some 
 knowledge of an author so renowned in former times. 
 
 His entire book is divided into five volumes, of which the first two 
 embrace the general principles of physiology, pathology, hygiene, and 
 therapeutics, arranged in conformity with the doctrines of Aristotle 
 and Galen, and may be termed the philosophic part of the science. 
 The third and fourth books contain the description and treatment of 
 all the diseases then known ; the last treats of the composition and 
 preparation of remedies. The entire work, from one end to the other, 
 as all other works of this period, is a compilation, neither better nor 
 worse than the Almaleki. This may be inferred from the following 
 fragments. 
 
 DEFIXITION OF MEDICINE. 
 
 " I say that ^Medicine is a science which gives the knowledge of the 
 conformation of the human body, and its susceptibility of being amended 
 
 * Canon Medicinge.
 
 MEDICDTE OF THE AEABS. 261 
 
 or modified for the preservation or restoration of health." This 
 definition is somewhat obscure and refined, but it is nothing in com- 
 parison to the commentary which the author makes upon it. 
 
 " Some one may say," he continues, " that Medicine being divided 
 into theory and practice, I am wrong in calling it a science, which indi- 
 cates that it is in the same rank of purely speculative knowledge. I 
 reply that if there are arts exclusively theoretical and others exclusively 
 practical, Medicine, the same as philosophy, is at once theoretical and 
 practical. 
 
 " When we admit into a science two branches, the one theoretical and 
 the other practical, we attach to the words theory and practice a difi'er- 
 ent signification from the vulgar acceptation of the terms, which it is 
 proper to explain. We are not willing to say, for example, that one 
 branch of Medicine is devoted to demonstration and the other to opera- 
 tion ; but we wish to have it understood that there are two parts in 
 Medical Science — one which treats of principles without having in view 
 their application, and the other which sets forth the rules according to 
 which we should operate. Thus, when it is said that there are three 
 sorts of fevers, and nine temperaments or complexions, the science is ren- 
 dered speculative ; on the contrary, when it is said that we must employ 
 repercussives, refrigerants and incrassants in the onset of an inflamed 
 tumor, then repercussives concurrently with the emollients, and finally, 
 toward the close of the disease, emollients united with resolvents, then 
 we treat of the practical part of the science. "••■^ 
 
 I avow, that after having read and re-read, with the most scrupulous 
 attention, this passage in the Latin translation, it has appeared to me 
 difficult, if not impossible, to attach to it any clear and precise sense. 
 Avicenna here seems to play upon words ; he surpasses, in subtilty, 
 Aristotle and Galen, whom he takes for models, even exaggerating their 
 defects. Besides, the philosophic teachings of the schools consisted at 
 that time only in the subtilties of language. The book, or the author 
 whom they took for a guide, was tortured in a thousand ways ; they 
 exhausted themselves in seeking the thoughts of others, in place ot 
 thinking for themselves ; the struggle consisted in who should refine 
 most a word or a phrase. In this disposition of their minds, they were 
 frequently disposed to regard as sublime and transcendent what was 
 obscure and even unintelligible ; so that the philosophic part of the 
 Canon of Avicenna, that which treats of the generalities of science, and 
 which now appears the most defective, seems to have been most admired 
 then, and has contributed most to the prodigious success of the work. 
 
 ^ Canonis, lib. i, fen i, doctrina 1 ; Venetiis apud Juntas, lo62.
 
 I 
 
 262 ARABIC PERIOD. 
 
 In the second part, which is devoted to the exposition of practical 
 knowledge, the author strays farther still into the labyrinth of theory, 
 which renders the reading of his work difficult and fatiguing ; but there 
 are some chapters relative to eruptive fevers, that all judges agree in 
 regarding as the best, and which throw some light on the history of these 
 diseases, in showing the views held in regard to them at the time of 
 their first appearance. I will now give a few extracts about them. 
 
 ON VARIOLA. 
 
 " The blood manifests, occasionally, an ebullition similar to that which 
 is seen in vegetable juices, producing the disaggregation of their par- 
 ticles. The natural cause of this ebullition is nothing else than the 
 residue of the menstrual blood, which remains in the womb at the 
 moment of impregnation, or a residuum subsequently engendered from 
 food of a bad quality, and deposited there — that kind of food which 
 rarefies the blood, causing its ebullition, until its sound parts predomi- 
 nate, as occurs naturally in the juice of the grape, in a state of ferment- 
 ation, by which it is converted into a liquor of uniform composition. 
 after having expelled the thick froth and earthy dregs."* 
 
 This analogy must appear very gross and ridiculous to many young 
 physicians of the present time, so much is it unlike the doctrine now 
 accredited in the schools; but, after an unprejudiced examination, it 
 will be found to give a very good account of the principal phenomena 
 which characterise eruptive fevers, and particularly variola. These 
 aifections, as is well known, attack so universally the human race, as to 
 lead to the belief that they were inherent to our nature ; and that each 
 individual contracted the germ of it in the womb of his mother. In the 
 second place, would not the regularity and violence of the febrile symp- 
 toms, and the enormous quantity of excrementitial matter ejected from 
 the economy by the eruption, taken all together, seem to prove a depu- 
 rative effort — a synurgy of the vital forces, for the purpose of eliminat- 
 ing a mischievous humor or element ? 
 
 This hypothesis, clear, simple, and natural, has been admitted almost 
 without contradiction even down to our day ; and so profoundly was the 
 public mind imbued with it, that doctors in theology proscribed innocu- 
 lation and vaccination as a derogation of the order of things established 
 by Providence ; and doctors in medicine repulsed the same means, as 
 tending to retain in the economy a venom whose expulsion it was impor- 
 tant to favor. But, even if the above views had been much more 
 rational than was supposed, they did not authorize the consequences 
 
 *Canonis, lib. vr, fen. i, tractatus iv, chap. vi.
 
 MEDICINE OF THE ARABS. 263 
 
 deduced from them. Indeed, even if it were true that we contain, on 
 coming into the world, the germ of certain diseases, or a proximate dis- 
 position to contract them, it need not follow that the germ or the ten- 
 dency must be left to develops themselves to the point of giving origin 
 to such formidable phenomena, if we have a milder and surer means of 
 destroying such a bad predisposition. 
 
 SIGNS OF THE APPEARANCE OP VARIOLA; 
 
 " The precursory symptoms of variola are, ordinarily, pain in the 
 back, itching of the nose, fright during sleep, a pricking sensation 
 all over the face, and general lassitude. The face and the eyes 
 become red, the latter being constantly suffused with tears ; and nu- 
 merous inflamed spots appear on the skin. The patient yawns fre- 
 quently, and respiration is difl&cult; the voice is hoarse, and a thick 
 saliva is expectorated. The head feels heavy and aches, while the 
 mouth is very dry. The patient realizes, in the throat and chest, a 
 painful constriction ; the feet tremble and fall backward. All this 
 morbid train is accompanied by fever." 
 
 This graphic tableau does not approach the perfection of those that 
 Aretseus and Alexander of Tralles have left us. No distinction is made 
 here, either in regard to the gravity or the frequency of the symptoms, 
 or of the manner in which they succeed each other. The author does 
 not tell us whether it is necessary for all of them to appear united, or 
 if the apparition of a few of them only is necessary, to prognosticate 
 the imminence of variola. He indicates, no better, the march, charac- 
 ters, and duration of the eruption ; nor the phases, so remarkable, of 
 the fever, which attracted particularly the attention of the ancients. 
 
 ON THE MORBILLI. 
 
 The writers of the middle ages comprised under this term all the 
 febrile exanthemata, such as rubeola, scarlatina, and roseola. " The 
 morbilli," says Avicenna, "are a species of bilious variola. There is 
 scarcely any difference between these two classes of affections, unless 
 that morbilli, jDroceeding from the bile and a smaller quantity of mor- 
 bid matter, do not, so to say, affect more than the surface of the skin, 
 nor produce, in general, any elevations which require particular treat- 
 ment ; while variola produces, from its beginning, elevations and pus- 
 tules. The morbilli are less grave and less apparent than variola; 
 but the signs of their invasion are pretty much the same. However, 
 the irritation of the stomach, difBcult respiration, and general inflam- 
 mation have more intensity in morbilli, while the pain in the bones is 
 less severe. This pain, in variola, is caused by the abundance of the
 
 264 ARABIC PERIOD. 
 
 blood, whicli distends the vein that runs the whole length of the spinal 
 column, for variola depends upon the quantity of corrupt blood, while 
 the morbilli depend on the quality of it. The variola irruption is 
 gradually developed, while that of morbilli occurs, ordinarily, in a 
 sudden manner." 
 
 We see, by the above, that the physicians of those times divided 
 eruptive fevers into two classes only. The first class comprehended' 
 under the denomination of variola, all the eruptions which consist in 
 pimples, more or less prominent, filling up with any liquid — such as 
 pustules, bullae, and vesicles. The second embraces, under the title of 
 morbilli, eruptions in which the skin is covered with spots, large patches. 
 or pimples, barely salient, and containing no liquid. That was, un- 
 questionably, a very philosophic division, and it still remains in our 
 science. The second species received the name of morbilli, which sig- 
 nifies a little disease or little pest, because the affections which they 
 represent were regarded as less grave, and as engendered by a smaller 
 quantity of morbific matter, than the affections of the first order. 
 Finally, it is to be remarked, that all the authors of that period 
 range eruptive fevers in the class of pests, or epidemic pestilential 
 fevers. 
 
 In going back to antiquity, the history of diseases seems to me to 
 offer three distinct phases : in the first, no allusion is made to erup- 
 tions ; they were considered as epi-phenomena of little importance — a 
 sort of crisis, according to Ehazes ; whereas the febrile symptoms, which 
 indicate the state of the vital forces and the intensity of the danger, 
 attracted all the attention of observers. The Asclepiadse, who even 
 made no account of tetters, lepra, or other infirmities 3f that kind, 
 might well neglect transient eruptions, which generally leave no trace, 
 or of which the cicatrices constitute, at most, a mere disfiguration. In 
 the second phase, whether eruptive fevei's had suddenly taken an 
 extraordinary development, or that they passed for the first time the 
 limits of Arabia, the attention of physicians was more directed to the 
 characters of the eruption, and they distinguished, consequently, two 
 species of it. Finally, the third phase, which extends down to us, in 
 which each genus is divided into several species, founded upon the 
 
 nature of the eruption. 
 
 §IV. 
 
 Albucasis, or Alsaharavius, a native of Cordova, lived in the beginning 
 
 of the twelfth century. He wrote an abridgment of the theory and 
 
 practice of Medicine, a mere compilation, in which is found, absolutely, 
 
 nothing new, unless it be a little treatis3 on surgery, which terminates 
 
 the work, as a kind of supplement, and which does him more credit than
 
 MEDICINE OF THE ARABS. 265 
 
 all the rest of the work. This last fragment, one of the most curious 
 monuments of Arabian Medicine, includes, among other interesting 
 matter, a description of the instruments then employed in surgical 
 operations, with explanatory figures. The reasons which decided 
 Albucasis to write this treatise on operative Medicine, are worthy of 
 being known. He gives them himself, in the following language : 
 
 " After having terminated, happily enough, the work on Medicine 
 which I undertook for your instruction, my sons, I have thought it 
 proper to add to it a small treatise ou manual operations, seeing that 
 this part of our science is so much neglected in our country at the 
 present time, that there remain scarcely any vestiges of it. We can 
 only find a few short descriptions of operations in the books of the 
 ancients ; they are, however, disfigured by the ignorance of the book- 
 makers ; the manuscripts are so faulty, that at every step we are in 
 such doubt as to the sense of the authors, that no one dare enter into 
 the study of surgery. I have, therefore, undertaken this little treatise 
 for the purpose of reviving this most important and useful branch of 
 our Art. I have detailed briefl5^ the methods of operation, I have 
 described all the necessary instruments, and I present their forms, by 
 means of drawings ; in a word, I have omitted nothing of what can 
 shed light on the practice. But one of the principal reasons why it 
 is so rare to meet a skillful surgeon is, that the apprenticeship to this 
 branch is very long, and he that devotes himself to it must be versed 
 in the science of anatomy, of which Galen has transmitted us the 
 knowledge. He should know the functions of organs, their shape, and 
 their relations ; the number of the bones, and their modes of union ; 
 the origin and termination of the muscles, the nerves, the arteries, and 
 the veins. In fine, no one should permit himself to attempt this diffi- 
 cult art without having a perfect knowledge of anatomy, and the action 
 of remedies." •■' 
 
 Observe, that Albucasis, who felt so much the necessity of acquiring 
 extended and precise notions touching the structure of the human body, 
 contents himself, by referring those who desire to instruct themselves in 
 this branch, to the descriptions of the physician of Pergamos. He 
 says not one word about dissections, which leads us to conclude that 
 they were not tolerated in his time, and that he never practiced them 
 himself — at least in an ostensible manner. 
 
 He divides his treatise on surgery into three books. In the first, he 
 shows the diseases that require the cautery, the various methods of 
 
 * Albucasis, lib. i. The best edition of this work has for a title, Albucasis, 
 De Chirurgia : Arabice et Latine, cur. .J. Channiag. Oxonii, 1778, 2 vol. quarto. 
 
 17
 
 266 ARABIC PERIOD. 
 
 applying it by fire and escarotics, the instruments whicli were used, and the 
 cautions that must be taken. Enthusiastic partisan of this medication. 
 he counsels it in a multitude of cases : among others, in spontaneous 
 luxations, and in the commencement of curvatures of the spine. The 
 second book is devoted to the operations which are performed by 
 cutting instruments. The author describes a great number of these, 
 and even some of the most formidable. But among the chapters which 
 have appeared to me the most interesting, I will cite in particular those 
 relative to forcible delivery and the extraction of the afterbirth, the 
 mode of administering clysters, and blood letting. A fact worthy of 
 remark, and which the reading of the book confirms, is, that whenever 
 it became necessaiy to explore the genitals of the female, the physician 
 must never proceed himself in that research, but always employ the 
 ministry of a sage-femme — an uncertain course, which the excessive 
 modesty of one sex, and the unbridled jealousy of the other, imposed 
 on the man of art. The third book treats of the methodic cure of 
 luxations and fractures. The author remarks that this part of surgery 
 was abandoned to men of vulgar ancl uncultivated minds, and for that 
 reason had fallen into the deepest contempt. 
 
 Though he assures us that he had seen with his own eyes all that he 
 reports, it is difficult to believe what he recounts of multiplied concep- 
 tions, in his chapter on abortion. He speaks of several women who 
 threw ofi" more than ten embryos in a single fausse couche, and of one 
 among the rest, who cast oif seventeen ! It seems probable that our 
 surgeon, being obliged, under the circumstances, to believe the account 
 of the matrons, shows himself a little too credulous in regard to their 
 statements. I will terminate what I have to say relating to this author, 
 by the following statement of Fabricius of Aquapendente : " Celsus," 
 hie says, " among the Latins, Paul ^Egineta, among the Greeks, and 
 Albucasis, among the Arabs, form a triumvirate to which I confess I am 
 under great obligations." 
 
 § v. reteospectrve considerations of the scientific progress of 
 Medicine among the Arabs. 
 
 During this period the Arabs embraced with much ardor the study 
 of Medicine : they endeavored to translate into their language all the 
 treasures that Greece had amassed on this science, and we owe to 
 them the conservation of some fragments of Greek authors, which have 
 not in any other way come down to us ; nevertheless, we possess a much 
 greater number of them, of which the former were entirely ignorant ; 
 such, for example, as the writings of Aretoeus and several books of
 
 MEDICINE OF THE GKEEKS. 267 
 
 Galen. On the other hand, the Arabs neglected entii'ely the Latin 
 authors — they did not know Celsus, nor Coelius Aurelianus — so that 
 thej had, on the antiquity of Medicine, less complete notions than we, 
 though placed much nearer the sources of antique knowledge. 
 
 Anatomy and physiology, far from making any conquests under 
 Arabian rule, followed, on the contrary, a retrograde movement. As 
 those physicians never devoted themselves to dissections, they were 
 under the necessity of conforming entirely to the accounts of Galen ; 
 consequently, they translated his descriptions in the most faithful 
 manner possible. Xow, in a work of this kind, the inexactitudes of 
 the translation are always added to those of the original, if the 
 translator does not correct and prevent them by his own direct obser- 
 vations on the subject. It is thus easily seen, how much the anatomy 
 of the Arabs must have been inferior to that of the Greeks, which 
 served them as a model. 
 
 Pathology was enriched in the Arabian writings by some new obser- 
 vations, the most important of which we have pointed out. The 
 physicians of this nation were the first, as we have already said, who 
 began to distinguish eruptive fevers by the exterior characters of the 
 eruption, while the Greeks paid but little attention to these signs. 
 
 Therapeutics made also some interesting acquisitions under the Arab 
 physicians. It owes to them, among other thinjrs, the introduction of 
 mild purgatives, such as cassia, senna, and manna, which replaced 
 advantageously, in many cases, the drastics employed by the ancients ; 
 it is indebted to them, also, for several chemical and pharmaceutical 
 improvements, as the confection of syrups, tinctures, and distilled 
 waters, which are very frequently and usefully employed. Finally, 
 external therapeutics, or surgery, received some minor additions, such as 
 pomades, plasters, and new ointments ; but t^ese additions were verj- 
 far from compensating for the considerable losses which it suffered by 
 their abandoning a multitude of operations in use among the Greeks. 
 
 CHAP TEE II. 
 
 MEDICINE OF THE GREEKS DURING THE ARABIC PERIOD. 
 
 While the Arabian nation was elevated to the summit of the social 
 scale, by power, intelligence, and renown, the Greek nation declined 
 from day to day. Its genius, its courage, all its antique virtues, became 
 gradually weaker, and seemed on the, point of extinction. The historian
 
 268 ARABIC PERIOD. 
 
 of Medicine can find only one single name to cite, during a period of 
 nearly seven hundred years, and he is not an original author, and is 
 out of the regular line ; but he is an elegant writer, and skillful 
 compiler. 
 
 Actuarius, whose true name is John, son of Zacharia, lived at the 
 close of the thirteenth, or beginning of the fourteenth century. He 
 was employed at the court of Constantinople, as his surname, Actuarius, 
 by which he is designated, proves, it being only the honorary title of 
 the physicians of the palace. We have no details of his life, but we 
 know that he has written much, and that several of his works have 
 not come down to us. The most considerable of these, extant, is an 
 abridgment of Medicine, in six volumes, entitled, "On the Cure of 
 Diseases," =' in which is found, absolutely, the doctrines of G-alen, 
 presented in a compact manner, and in perfect order. The theory of 
 critical days is explained there in the most lucid manner, and sustained 
 by astronomical hypotheses, very ingeniously combined. It is the first 
 Greek work in which mention is made of the new remedies introduced 
 by the Arabs, such as mild purgatives, syrups, juleps, and distilled 
 liquors. The author, however, says not one word of variola, the 
 morbilli, spina ventosa, and other affections described by the physicians 
 of that nation. 
 
 His treatise on animal spirits, divided into two books, is remarkable 
 for the connection of its ideas ; it oiFers the quintescence of the theory 
 of Galen on that subject. After having established the principle that 
 man is formed by the union of two contrary substances, the soul and 
 the body, he demonstrates that the human soul dififers from the soul of 
 brutes ; that it is an emanation of the Divinity, a simple substance 
 endowed with various immortal and intelligent faculties, insensible in 
 its nature, though capable of realizing pain and pleasure, by the inter- 
 mediation of spirits, which connect it closely to the body. 
 
 These spirits being supposed to be the bond that places the soul in 
 communication with the body, it became very important to acquire exact 
 notions on their nature, origin, and the changes to which they are sub- 
 ject, and the means to prevent or combat their degeneration. Our physi- 
 ologist explains their formation as follows : the purest juice of the food 
 digested by the stomach is transported to the liver, where it serves for 
 the composition of natural spirits, which are the instruments of the 
 concupiscible faculty of the soul. These are carried by the blood into 
 the lambdoidal vein, one branch of which descends toward the inferior 
 regions, and the other mounts upward to the right ventricle of the heart. 
 
 '^ De Methodo Medendi, lib vi.
 
 MEDICINE OF THE LATINS. 269 
 
 There the spirits and the Wood pass into the left ventricle, to be elabo- 
 rated and changed into vital spirits, which the arteries distribute to all 
 parts of the body. Xow, there exists at the base of the brain, an 
 extremely minute plexus of arterial and venous vessels, which is called 
 the plexus reticidaire. It is there that the vital spirits contained in 
 the blood, undergo a third alteration, which transforms them into animal 
 spirits. These last are in immediate I'clation to the soul ; by their aid, 
 that immaterial substance perceives the sensations of exterior objects, 
 and executes the most elevated functions." '••' 
 
 I shall not show the anatomical and physiological errors of this theory. 
 I will simply observe, that the admirable plexus in which were elaborated 
 the animal spirits, does not exist in man. But if we admit the hypoth- 
 esis of Actuarius, which is that of Galen, and nearly all the physiolo- 
 gists of antiquity, we are forced to admit that no one has explained 
 more methodically than he, the functions of the animal economy, and 
 the generation of diseases. He says that health may become affected 
 in two ways : first, when the humors of the body, being too abundant 
 or vitiated in their composition, permit the exhalation of confused 
 vapors, which trouble the lucidity of the spirits, obscure the sensations 
 of the soul, and cause disorder in its operations ; secondly, when one of 
 the elementary qualities, heat, cold, di-yness, or moisture, is in excess in 
 any part, and causes derangement. It is in this manner that our physi- 
 ologist appi'eciates successively the influence of various kinds of food, sleep, 
 watchings, exercise, repose, the passions, remedies, and, in one word, of all 
 hygienic and therapeutic agents. The precepts which he gives, have for 
 their end to conserve the clearness of the spirits, to favor the coction of 
 the humors, and prevent their alteration or superabundance, and to re-es- 
 tablish the equilibrium of elementary qualities. In short, we see that 
 his system is perfectly co-ordinated according to logical rules, but that 
 it is based on gratuitous hypotheses and material errors. 
 
 CHAPTER III. 
 
 MEDICINE OF THE LATIXS DURING THE SAME PERIOD. 
 GENE HAL CONSIDERATIONS. 
 
 At the commencement of this period, the provinces of the Empire of 
 the West present a most painful spectacle. Swarms of barbarians from 
 the forests of Germania and Scandina\4a sweep successively over it, 
 pillaging, and killing many of the inhabitants, and reducing the rest to 
 
 "De Spiritu Animali, lib. i, chap. vi.
 
 270 ARABIC PERIOD. 
 
 a state of slavery. Everything in southern Europe is changed ; laws, 
 manners, customs, language, institutions, monuments! Each genera- 
 tion sees break forth some new and unknown horde of invaders, which 
 comes to demand its share of the booty and renown, leaving a more or less 
 deep trace of its passage over the countries, lately so flourishing, but 
 now ruined. Eor a moment the genius of Charlemagne, reuniting under 
 the same dominion these diverse races, seemed to resuscitate the Empire 
 of the West, but scarcely had he breathed his last sigh, when the ele- 
 ments of this incongruous empire, having no affinity among each other, 
 became separated. The great vassals of the crown, no longer being held 
 by so vigorous an arm, united at first against it, then against each other ; 
 so that for several ages there was nothing but an uninterrupted succes- 
 sion of wars and invasions, without definite results. A species of organ- 
 ization gave some sort of legitimacy to this military anarchy, under the 
 name of feudalism. There was, at that time, neither repose nor secu- 
 rity for any one ; the weak were trampled under foot, the great were 
 constantly under arms for defense or attack. With difficulty, a few 
 men found, in the pale of the Church, a little calmness and leisure to 
 devote themselves to the study of theology and ecclosiastical law. Pro- 
 fane letters, as well as the natural sciences, had fallen into the most 
 complete neglect. 
 
 However, toward the end of the eleventh century, the enthusiasm of 
 the Crusades offered a new aliment to the turbulent ambition of the 
 Christian Barons. But while the higher and inferior lords of western 
 Europe carried their bellicose humor to the East, the people, though 
 always oppressed, began to breath freer ; a few States recovered their 
 independence ; the reign of law was slowly established ; municipal insti- 
 tutions were organized and consolidated, and establishments consecrated 
 to public instruction Avere multiplied and acquired importance. Finally, 
 in the course of the thirteenth and fourteenth centuries, the darkness 
 which covered the face of Roman Catholic Europe, began to give way ; 
 a few men of talent, and even genius, appeared on the horizon of letters 
 and science, though all is in obscurity around them — they shone in the 
 midst of their ignorant cotemporaries, like the stars that glow in the 
 firmament before the appearance of Aurora. Such, in letters, were 
 Dante, Petrarch, Boccacio, whose writings recall the good taste and purity 
 of the happiest ages ; such, in mathematics, was Leonard of Pisa, who 
 was the first in Europe to understand and employ the Arabic figures and 
 algebraic characters.'-' 
 
 " Cuvier attributes the honor of this importation to Gerbert, a learned Benedic- 
 tine of the tenth century, who wore the tiara under the name of Sylvester II. — 
 His. des Scien. Nation.; Paris, 1841, t. i, pp. 396.
 
 MEDICINE OP THE LATINS. 271 
 
 The physical sciences, also, had representatives at that epoch, when 
 the questions of scholastic philosophy and theology had, almost alone, 
 the privilege of engaging the human mind.f Koger Bacon, by the 
 force of his genius, was in advance of the scientific reform which was 
 accomplished three centuries later. He attempted to introduce the 
 experimental philosophy ; and he succeeded so well in communicating to 
 his auditors the convictions with which he was penetrated, that they 
 subscribed, in equal shares, the sum of two thousand pounds sterling, to 
 provide for the expenses of his experiments. It was, unquestionably, 
 money well employed, and served to make a prodigious number of dis- 
 coveries for such an age. Thus, it is said, that Bacon knew the prop- 
 erties of convex and concave glasses, and was the first to conceive the 
 idea of making microscopes and telescopes. His astronomical observa- 
 tions led him to demand a reform of the calender, which was executed 
 three centuries later, under Gregory XIII, He had, also, some knowl- 
 edge of gunpowder and its effects ; in short, he rejected the physics of 
 Aristotle. So much boldness and superiority could not fail to draw 
 down upon him persecution ; he was condemned to imprisonment for life, 
 by the chief of the Grey Friars, and to live on bread and water ; but he 
 was brought forth in 1266, on the demand of Pope Clement IV. He left 
 a large number of works, of which several still exist, but only in manu- 
 script, the friars having always forbidden their publication, because they 
 believed them to be tainted with magic and sorcery. 
 
 ART. I. THE MEDICAL ORGANISATION OF THE WEST. 
 
 We have seen what was the medical organisation of the Boman 
 Empire, down to the seventh century. The palatine archiaters, attached 
 to the palace of the prince ; the popular archiaters, forming in each city 
 a college, charged with the sanitary police, and the instruction and 
 and examination of aspirants to the practice of medicine, and required 
 to give gratuitous attention to the afflicted poor ; such is the sum of 
 the positive knowledge we possess on the subject, down to the destruction 
 
 t The philosophers were at that time divided into two camps, under the names 
 of Realists and Nominals. The first believed with Plato, that ideas are self-existent 
 and independent of the mind — that they are veritable entities ; the second, on the 
 contrary, affirmed with Aristotle, that general ideas are pure abstractions, which 
 our minds form by the aid of sensations, and which, without these, could never 
 exist. These two sects kept up a very active war ; and as they called to their aid 
 the civil and ecclesiastical authority, the result was persecution against each 
 other, according as either party had momentarily the power.
 
 272 ARABIC PERIOD. 
 
 of the school of Alexandria. It is probable that after the ruin of this 
 celebrated school, the same medical organisation subsisted in those 
 provinces which continued to form a part of the Greek Empire of 
 Constantinople. 
 
 In those countries subjected to Arab sway, we are ignorant of what 
 rules existed regulating the practice of Medicine. We know, only, that 
 schools and academies were founded in several cities, for the teaching and 
 perfection of the art ; but we have nothing positive on the interior regi- 
 men of the schools and academies, or the degrees that were conferred by 
 them, and the manner in which they ascertained the capacity of the 
 aspirants to academical titles. These countries, as we have already 
 said, did not long enjoy an enlightened and liberal government. From 
 the moment that they fell under the yoke of the Turks, they lost the 
 greater part of their scientific institutions, which have not since been 
 resuscitated; and, if one may judge by what still exists to-day in those 
 unfortunate countries consumed by the leprosy of ignorance and despot- 
 ism, the most complete medical anarchy followed the old organization. 
 
 In Europe, things took a difierent course. At first, the invasion of 
 the barbarian threw every thing into disorder and confusion. The 
 Christian states of the west presented, during three or four centuries, a 
 chaotic condition. The sovereigns of these states, constantly occupied 
 with the care of self-defense, or the desire of usurping the heritage of 
 their neighbors and relatives, scarcely dreamed of bestowing upon the 
 people useful laws and institutions ; or, if any among them wished to 
 labor for the happiness of their subjects, all their plans were paralyzed 
 by a multitude of obstacles that prevailed within as well as without. 
 In the midst of these circumstances, the ecclesiastic schools, placed under 
 protection of the bishops, preserved, alone, a course of literary and sci- 
 entific instruction. In the time of Charlemagne, the colleges of the 
 cathedrals and some monasteries taught Medicine, in a limited way, 
 under the name of physics. In this way, all the liberal professions, and 
 the practice of Medicine in particular, fell into the hands of the clergy. 
 We see priests, abbots, and bishops become the physicians of kings. 
 The monks of Mount Cassin, of the order of St. Benoit, enjoyed, for a 
 long time, a great reputation for skill in Medicine. Among others are 
 cited Berthier, abbot of this convent, in the ninth century ; Didier, who 
 wore the tiara toward the close of the eleventh century, under the name of 
 Victor III.; and Constantine, called the African, of whom I shall speak 
 presently, when on the subject of the school at Salerno. Among the num- 
 ber of ecclesiastics who distinguished themselves by their knowledge of 
 Medicine, from the ninth to the eleventh centuries, must be mentioned 
 Hugues, abbot of St. Dennis, who was physician to the king of France ;
 
 MEDICINE OF THE LATINS. 273 
 
 Didon, abbot of Sens; Sigoal, abbot of Epernay; Mile, archbishop of 
 Benevent, and others. Finally, several religious orders of women in- 
 gratiated themselves, also, in the practice of Medicine, and Hildegarde, 
 abbess of the convent of Eupertsburgh, near Bingen, is mentioned as 
 the authoress of a treatise on materia medica.'--' 
 
 From the ninth to the thirteenth century, the Jews shared with the 
 clergy the monopoly of the healing art. The knowledge that several of 
 them had acquired of the Arabic tongue, by the commerce they held 
 with the Saracens, facilitated their study of the medical works of that 
 nation, which stood, at that time, at the head of civilization ; also, not- 
 withstanding the canons of the church which forbade the Israelites from 
 prescribing or administering remedies to a Christian, they were obliged 
 to call upon them in time of need, and the Jew had access not only to 
 the courts, but also to the palace of the Pioman pontiiFs. 
 
 The education of these Christian or Jewish medicasters, clergy and 
 laiety, embraced generally but a very few things ; it consisted, often, in 
 the possession of some recipes and the knowledge of a few symptoms. 
 The extreme rarity of books, and the absence of capable professors, ren- 
 dered a good medical education entirely impossible. We may form an 
 idea of what was, at that epoch, the teaching of Medicine, when we 
 learn that, in the thirteenth century, John of Gaddesden, the author of 
 the Rosa Anglicana, an informal collection of odd formulse, was the 
 oracle of the University of Oxford, the doctor a la mode of the court of 
 England ; and that, about the same time, Bernard de Gordon, the author 
 of Lilium Medicince, a work of the same character of the Rosa Angli- 
 cana, shone in the first rank among the professors of Montpelier. Guy 
 de Chauliac thus speaks of the work of Gaddesden ; " Finally appeared 
 a pale English rose, which was sent to me, and I perused it. I did 
 hope to find in it sweetness of perfume ; but I only found the fables of 
 the Spaniard Gilbert and of Theodorus."f M. Malgaigne esteems this 
 critic too severe ; but he does not show himself very indulgent in regard 
 to a man who dishonored his ecclesiastical character, and his character 
 of physician, by the juggleries of the most impudent charlatanism ; of 
 a man who took pleasure in displaying the shame of his most illicit 
 gains. The following among his acts is one that will excite most 
 hilarity : he speaks of having sold, at a high price, to the barber-sur- 
 geons, a recipe for a preparation of green frogs, and boasted of having 
 duped them. I What confidence could this vender of secret remedies 
 
 '- See Histoire de la Medicine, by Sprengle, translated by Jourdan, T. II, p. 351' 
 et 8uiv. 
 
 t La Grande Chirurgie de Guy de Chauliac, restored by Laurent Joubert, Rouen, 
 1632, p. 10. 
 
 J Freind, Hist. Med., Paris, 1728, quarto ed.
 
 274 ARABIC PERIOD. 
 
 inspire ? — this constant puflPcr of a multitude ofridiculous proceedings, 
 to whom all means of gaining money appeared equally good. 
 
 No law, no rule of public administration, had for its object to insure 
 the capacity of individuals who aspired to the medical profession. Each 
 one at liis risk and peril, entered upon the cure of diseases ; also, besides 
 the priests and the Jews, who stood at the top of the scale, there was still 
 a multitude of healers and practitioners of the lowest order, such as bath 
 keepers, barbers, and resuscitators, and even a few women. The morality 
 of this vulgar medical mass was on a level with its knowledge, as is 
 proven by a law of Theodoric, king of the Visi-Goths, which code was 
 in force in the greater part of the West, from the sixth to the twelfth 
 century. This law says that no physician could bleed a woman, or a 
 daughter of noble birth, without the assistance of a relative or a domes- 
 tic, and in case of contravention, he should pay a penalty of ten sous, 
 quia difficilUmum non est ut in tali occasione ludihrium interduvi adhce- 
 rescat. When a physician is called to treat a disease or dress a wound, 
 it is necessary, immediately after having seen the patient, to give secu- 
 rity and agree upon the price of his attention. If he happen to harm a 
 gentleman, he must pay a forfeit of one hundred sous, and if the patient 
 died from the eifects of his operations, he should be handed over to the 
 relatives of the deceased, who could do with him whatever they pleased. 
 If in any way he crippled a serf, or caused his death, he was held account- 
 able for the restoration of another to the lord." 
 
 We see by the above guarantees of knowledge and morality which 
 were required of the aspirant to the medical profession, that the legisla- 
 tor held in constant suspicion all who devoted themselves to its practice. 
 It is possible, as M. Malgaigne observes, that these severe restraints 
 were only applicable to surgical cases, the practice of which was at that 
 time abandoned to individuals of the lowest conditions, against whom 
 the law might and should show itself suspicious ; while the practice of 
 internal medicine formed part of the privileges of the clergy, who alone 
 were the depositories of letters and science, and enjoyed the highest 
 consideration. It is not probable that the secular power ever dreamed 
 of handing over to the relatives of the dead, a man protected by the title 
 of clergyman.! 
 
 It is probable that it was from this time, i. e., from the seventh cen- 
 tury, that Medicine was separated from Surgery. This change, which 
 was contrary to the views of the greatest masters, and which in itself 
 
 '■'Lindenbrog, Cod. Leg. Antiq. Wisigoth, lib. xi, tit. i. Sprengel Hist, de la 
 Med., translated by Jourdm. Paris, 181-5, t. II, p. 49. 
 
 tCEuvres completes d'Ambrose Pare, Paris, 1840, t. I, introduction, § 1.
 
 MEDICINE OF THE LATINS. 275 
 
 is not very rational, was not the effect of any civil law, but the gradual 
 result of custom caused by the general prohibition against the spilling of 
 blood by ecclesiastics. Nevertheless, it appears that the practice of Medi- 
 cine, though thus separated from the practice of surgery, led to such 
 irregularities in the manners and discipline of the clergy, that from the 
 twelfth century, we observe the councils and popes interdict its practice 
 under the most severe menaces, by men in holy orders and bound by 
 monastic vows, and yet this prohibition was often violated, as is attested 
 by the frequent reiteration of this law.-' 
 
 In the course of the twelfth century, the secular authority began also 
 to be moved by the abuses which had entered into the practice of Medi- 
 cine. Eoger, founder of the kingdom of Sicily, and one of the greatest 
 men of his time, seems to have been the first among Christian princes of 
 the Middle Ages, who occupied himself with this subject. In 1140, he 
 published an ordinance, by which every man who wished to devote him- 
 self to the practice of Medicine in his State, was obliged to present 
 himself before the magistrate, to obtain their authorization, under pain 
 of imprisonment and the confiscation of all his goods. From this time, 
 many other sovereigns followed his example, and established ordinances 
 to regulate the practice of Medicine. In the end, the medical organiza- 
 tion was completed by the institution of faculties and university degrees. 
 
 ART. II. SCHOOL OF SALERNO. 
 
 The origin of this school, so celebrated in the Middle Ages, is some- 
 what obscure. The common opinion carries it back to the epoch of the 
 destruction of the library of Alexandria, by the Arabs. It is pretended 
 that after this mournful event for the sciences, the professors and phy- 
 cians. who were very numerous in that city, were scattered in different 
 countries ; that some sought refuge at Salerno, where they laid the 
 foundation of a medical school, which grew rapidly. It had already a 
 reputation, as early as the eighth century, but the epoch of its great- 
 est splendor was from the tenth to the thirteenth century. 
 
 Several circumstances concurred, at this time, to secure to it extra- 
 ordinary eclat : first, the number and skill of its professors, who were 
 unquestionably the most capable in all Christendom ; in the second 
 place, the unexceptional situation of the city of Salerno, lying in the 
 route which travelers had almost necessarily to follow in passing from 
 Europe to Asia, and of the fleets that transported the armies of the 
 
 "Sprengel, Hist. Med., by Jourd., t. II, p. 350.
 
 276 ARABIC PERIOD. 
 
 Crusaders. This city offered to pilgrims and warriors a safe haven ; a 
 delicious and salubrious climate ; all the means and recreations which 
 most contribute to the establishment of health and the oblivion of every 
 species of fatigue and suffering which they had encountered. 
 
 The reputation of its medical school attracted those who had diseases 
 or wounds difficult of cure, from all parts of Europe. Robert, Duke of 
 Normandy, the son of William the Conqueror, stopped there on his 
 return from the Crusades, to be treated for a wound of the arm. John 
 of Milan composed for his benefit a summary of the hygienic aphorism 
 of the school, which was published in 1100, with the title of " Dietetic 
 Precepts of the School of Salerno," and made much noise in the world. 
 This compilation was honored by several commentaries, the most famous 
 of which is that of d'Arnaud de Villeneuve. It begins as follows : 
 
 " The faculty of Salerno wrote to the king of England as fol- 
 lows: If you wish good health, banish despondency and avoid 
 anger. Drink but little wine ; eat light suppers, and do not disdain to 
 take some exercise after meals. Do not sleep during the day. Do not 
 retain too long the urine and evacuations from the bowels. By observing 
 these precepts, your life will be prolonged. "=•' , 
 
 Among the professors of the school of Salerno, the most illustrious was 
 Constantino of Carthage, surnamed the African. He flourished during the 
 latter half of the eleventh century. While yet young, the desire for 
 knowledge urged him to travel. He passed through Arabia, Persia, India, 
 Egypt, Ethiopia, and all the countries where any knowledge could be 
 gained. On his return to his country, in place of the honors he had a 
 right to expect, he found only persecutions ; he was looked upon as a 
 magician, and came near being put to death, but escaped and took refuge 
 at Apulia, near the Duke Robert Guiscard. who made him his secretary. 
 Afterward, he was adjunct professor in the College of Salerno, and taught 
 Medicine for some time in that capacity. Finally, disgusted with the 
 world, he retired to the monastery of Mount Cassin, where he found a 
 safe retreat, where he could indulge, without distraction, in his penchant 
 for study. While there, he translated and compiled a great number of 
 the medical works of the Greeks and Arabs, compilations extremely 
 useful at an epoch when the originals could not be read, and which 
 
 "•' Anglorum regi scripsit schola tota Salerni : 
 Si vis incolumen, si vis te reddere sanum, 
 Curas toUe graves ; irrasci crede profanuin. 
 Parce mero ; cenato parum ; non sit tibi vanum 
 Surgere post epulas. Somnuni fuge meridianum. 
 Non mictum retine, nee comprime fortitei" anum. 
 Haec bene si servas, tu longo tempore vives. 
 
 Regimen Sanitatis Salerni, Paris, 1493.
 
 MEDICINE OF THE LATINS. 277 
 
 contributed powerfully to popularize, in Europe, the letters and science 
 of the East. Though written in barbarous Latin, the translations of 
 Constantino served, in a very efficacious manner, for the propagation of 
 medical knowledge in those ignorant times. 
 
 In the course of the thirteenth century, the Emperor Frederic II., 
 grandson of Eoger, issued an edict, in virtue of which no individual 
 could practice Medicine, in the Kingdom of Xaples, who had not been 
 examined previously, and created a master, by the College of Salerno. 
 To effect this, he must study logic three years, and pursue a course in 
 Medicine which must continue — (including surgery, which made a part 
 of Medicine) — five years, according to the interpretation of Sprengel, 
 and two years only according to that of Malgaigne." However this 
 may be, to have been admitted to an examination at the end of term, 
 the student must furnish a ce»tificate of his legitimate birth, and that 
 he had attained his twenty-fifth year, or his twenty-first according to 
 another version ; after which he was examined, publicly, on the thera- 
 peutics of Galen, the first book of Avicenna, and the aphorisms of Hip- 
 pocrates. These proofs being satisfactorily fulfilled, he took an oath to 
 be faithful to good conduct, to submit to the rules of the profession, to 
 give gratuitous attention to the poor, and not to share in the profits of 
 the apothecaries. His diploma was afterward to be confirmed or legal- 
 ized by an officer of state ; still he could not enter fully into practice, 
 but was obliged to continue a year longer under an experienced physician. 
 
 He, who wished to devote himself exclusively to surgery, was obliged to 
 follow the teachings of the faculty for one year only ; but he must devote 
 himself, above all, to acquiring anatomy, without which, said the act, he 
 could not safely perform any surgical operation, nor direct the subsequent 
 treatment. Afterward, he underwent an examination which gave him 
 authority to practice, and take the title of master. Thus, says M. Mal- 
 gaigne, there were two masterships : one, which gave the right to prac- 
 tice medicine and surgery ; and the other, which conferred the right 
 to practice surgery only. 
 
 ART. III. ON THE ORIGIN AND GROWTH OF UNIVERSITIES. 
 
 §1. 
 
 In the times of Charlemagne, as before observed, each cathedral pos- 
 sessed a school, where writing, arithmetic, singing, theology, and some- 
 times, also Medicine, were taught. The Episcopal College, of Paris, had 
 
 - Lindenbrog, Constit. de Naples et de Sicile, liv. iii, chap, xxxrv. — Sprengel, 
 Histoire de la Medicine, sec. 7, chap, u, T. II, p. 363. — M. Malgaigne, (EuvreB 
 d'A. Pare, introduc, § 4, p. 30.
 
 278 ARABIC PERIOD. 
 
 medical teachers, who gave advice and dressed wounds before the portals 
 of Notre Dame, or even in the interior of the church. The same thing 
 was done in several other cities ; but when the medical profession had 
 been declared incompatible with the sacerdotal office, by a series of 
 councils, the popes, in order to preserve the high jurisdiction which they 
 had exercised from time immemorial over the medical corps and the bar, 
 erected certain Episcopal schools into universities, combining at once 
 instruction in philosophy, theology, law, and medicine, or only some one 
 of these faculties. Thus were created during the thirteenth century, 
 the most of the great universities of Christian Europe ; among others, 
 those of Bologna, Padua, and Naples, in Italy ; those of Paris, Mont- 
 pelier, and Toulouse, in France ; those of Valencia and Tortosa, in 
 Spain, and that of Oxford, in England. Pope Innocent III., issued a 
 bull which guarantied the professors and students of Paris from all 
 excommunication which should not proceed directly from the Holy See. 
 Other bulls confirmed and extended these immunities. The kings of 
 France, themselves, assumed the honor of conferring special privileges 
 ujion the universities of their capital, to such an extent that very soon 
 the members of the university formed in the midst of Paris a second 
 city, having laws, customs, police, inhabitants, and magistrates, differ- 
 ing from those of the rest of the city. " All science," says M. Mal- 
 gaigne, " appertained to the clergy, and teaching, though removed from 
 the cloister, did not become less Roman Catholic. These new clergy- 
 men, connected to the Chief of the Church by their oaths and privileges. 
 were unto him a numerous and powerful militia, and while by the 
 clergy proper the popes reigned over the consciences of the people, by 
 the clergy of the universities they reigned over their minds. Who 
 can be astonished, then, that they bore impatientl}^ the fact of not being 
 able to concentrate, also, all other powers in their hands ?"* Neverthe- 
 less, we must do justice to the pope, the monks, and the Catholic clergy 
 in general, who prepared the intellectual movement of modern Europe. 
 The universities, by associating together studious men, offered them the 
 opportunities and means of mutual instruction, excited their emulation 
 by the prospect of honors and rewards — concurred, in short, in a very 
 efficacious manner to elevate Christian civilization, above all others. 
 
 . The great eflfects of these liberal institutions were not immediately 
 realized, it is true ; it required several generations to develop their 
 results, and ripen their fruits. On this account, the end of this his- 
 toric period, though less barbarous than its beginning, has transmit- 
 ted to us but very few writers worthy to arrest our attention. The men 
 
 ffiuvres d'A. Pare, introduction, p. 28,
 
 MEDICINE OF THE LATINS. 279 
 
 who made themselves a reputation in the sciences, and especially in 
 Medicine, shone less by the merit of their works, than by the love for 
 instruction, and by the zeal which they displayed in its research and 
 propagation. To-day, when literary riches abound, we can with diffi- 
 culty form an idea of the price they cost our ancestors. We are aston- 
 ished to see them undertaking expensive, as well as wearisome voyages, 
 without any encouragement or hope of remuneration, to obtain some 
 manuscript, or hear some renowned professor. Such was the devotion 
 and zeal of the greater part of the authors of whose lives and labors 
 we now proceed succinctly to speak. 
 
 §n 
 
 The first who presents himself is Gerard de Cremona, in Lombardy. 
 " You will seek in vain," says M. Malgaigne, "the name of Gerard in 
 the historical medical dictionaries ; he has been rejected even by many 
 others, and yet there are few sciences which do not owe him some grati- 
 tude. A man of study and piety, he had ardently perused all that the 
 Latin authors could teach him, but not having been able, in Italy, to 
 procure the Almageste of Ptolomy, he determined to go in search of an 
 Arabian translation, at Toledo. He was not acquainted with the Arabic, 
 but he learned it, and armed with this powerful resource, which none of 
 the Occidentals since Constantino the African had possessed, he could 
 not see before him so many Arabic works on all the sciences, without 
 feeling an intense desire to transmit them to the Latins, as to a cherished 
 heiress, says his naive biography, and the rest of his life was occupied 
 in translations. Among a mass of his translations are found those of 
 some of the treatises of Hippocrates and Galen; the work of Serapion, 
 the books of Ehazes to Almansor, the immense canon of Avicenna, and 
 the treatise on surgery, by Albucasis. He died at Cremona, in 1187, 
 at the age of seventy-three, and left all his books to the convent of 
 Saint Lucy, in which he was buried. "••■^ 
 
 William of Salicet had a less wandering life. Born at Plaisance, 
 in the first years of the thirteenth century, he was professor, at first at 
 Bologna, afterward at Verona. It does not appear that he ever quitted 
 Italy. Though he has written on Medicine and Surgery, it is especially 
 as a surgeon that he is worthy of the recollection of posterity. He is 
 the first, in that period of ignorance, who wrote on that branch of our 
 Art from his personal experience, and who has not always followed. 
 blindly, the opinions of his masters. He died in 1277 or 1280. 
 
 Arnold de Villeneuve was a man passionately fond of the sciences. 
 He studied ten years at Montpellier, twenty years at Paris, and visited 
 
 '^ CEuvres of d'A. Pare. p. 27.
 
 280 ARABIC PERIOD. 
 
 all the universities in Italy. He passed into Spain, to be instructed in 
 the Arab works. He wrote on medicine, theology and chemistry, and 
 enjoyed considerable reputation among several sovereigns and popes. 
 He was especially renowned as a chemist. " We owe to him," says M. 
 Dezeimeris, " the discovery of the spirits of wine, of the oil of turpen- 
 tine, aromatic waters, and some other preparations. He introduced into 
 medicine the use of chemical remedies. His death is stated to have 
 occurred in several ways ; but it is generally believed to have taken 
 place in 1313, when he went from Sicily to Avignon, to attend upon 
 Clement V., who was sick."" 
 
 Lanfranc was from Milan, and studied under William de Sali- 
 cet. All that we know of the early years of his life, is, that he 
 practiced surgery in that city at the time of the greatest dissensions of 
 the Guelfcs and the Gibelins. The party to which he was attached was 
 the weaker. Matthew de Vincenti, chief of the other party, exiled our 
 surgeon. He went to seek an asylum in France, and stopped first at 
 Lyons, where he remained several years, and where he wrote his Minor 
 Surgery. In 1295 he went to Paris, and, at the instance of John Passa- 
 rant, dean of the faculty of Medicine, he opened a course on Surgery, 
 which had great success. It was then that he achieved his Great 
 Surgery, which was published in the following year. We do not know 
 the period of his death, but from the way Henry de Mandeville speaks 
 of him in 1306, we suppose he was not then alive. 
 
 " We are, unhappily, compelled to add," observes M. Malgaigne, "that 
 in the hands of I^anfranc, and much less, doubtless, from his fault than 
 by that of his age. Surgery began to decline. We have seen that from 
 the times of Brunus (who practiced in Padua in 1250), the barbers did 
 the scarrifying and bleeding ; from the times of Lanfranc there were 
 others who applied leeches, and what is much more serious, even caute- 
 ries. The women, who meddled themselves with surgery, in all these 
 operations competed with the barbers. On the other hand, the lay- 
 surgeons held themselves as the rivals of the clergy. Lanfranc, who 
 had inherited for them all the aversion of his master, had more than one 
 contest to sustain with them in his practice, and if they had less success, 
 they had more boldness. The clinical surgeons began to regard the 
 operations as too much beneath them ; Lanfranc, who deplored these 
 whims, and who declared that he sometimes bled with his own hands, 
 never, however, operated for ascitis, hernia, cataract or stone."'-' 
 
 t M. Hoefer denies all the chemical discoveries attributed te this physician, and 
 proves that they were anterior to him. Hist, de laChimie ; Paris, 1842. 
 -' OJuvres de A. Pare; Paris, 1840, Introduc, § G, pp. 46.
 
 MEDICINE OF THE LATINS. 281 
 
 John Pitard was, in 130G, surgeon of the King of France, Phillip 
 le Bel, and, also, the sworn surgeon of Chatelet. He has left no 
 writings on his art ; but he is regarded as the founder of the surgical 
 school of St. Come and St. Damien, which occupies so eminent a position 
 in the surgical annals of France. This college, which was, in 1311, 
 only a little brotherhood of lay-surgeons, insensibly increased in impor- 
 tance, as the result of the obstinate struggle which they sustained, on 
 one hand against the faculty of medicine — on the other against the 
 barber-surgeons. M. Malgaigne, who has unravelled, with the patience of 
 an erudite, the origin and title of this community, proves that at first 
 its importance was greatly exaggerated by its historians.-' Afterwards, 
 on another occasion, looking especially on the facetious side of its long 
 quarrels, he has traced their various turns of fortune in the comic 
 vein of Aristophanes, or of the chorister of Lutrin.f 
 
 Guy de Chauliac, the most famous of the physicians and surgeons in 
 Christendom, during the Arabic Period, was born in a village of the diocese 
 of Mende, in Gevaudan. " He was already clerk," says M. Dezeimeris, 
 •' and at least twenty-five years of age, in 1325. In this way we fix the 
 epoch of his birth at the end of the thirteenth century. It is supposed 
 that he studied the humanities in the College of the Cathedral, at 
 Mende, which enjoyed, at that time, a great celebrity. He studied 
 medicine at Montpellier. Among the masters he heard, he cites with 
 gratitude Eaimond de Molieres, Pierre de Toulouse, Pierre d'Horlac or 
 d'Aurillac, and Master Barthelemy, or Barthomieu, called, also, Bertru- 
 cius or Bertrand, in the copies printed of the surgery of other authors." 
 It is probable that Guy followed the course of the faculty of Paris ; for he 
 recounts, himself, how a shoemaker of that city removed a corn from his 
 foot. He studied, also, at Bologne, where he saw several dissections made. 
 
 " Little satisfied with the science drawn from the schools," adds his 
 biographer, " Guy de Chauliac made himself familiar with the writings 
 of the ancients, and acquired an erudition infinitely more extended than 
 any of his cotemporaries. He practiced in various cities, but fixed his 
 residence for a longer time at Lyons than elsewhere. He entered the 
 service of Pope Clement YI., at Avignon, where the Holy See was trans- 
 ferred — at latest in 1348. We have reason to believe that he enjoyed 
 the same honor under Innocent V., at the death of whom Guy de Chauliac 
 was welcomed by Urban Y., his compatriot, who was crowned Pope in 1362; 
 he became his chaplain, commencal or reader in his chapel. We know 
 not the length of time he enjoyed that dignity. All our knowledge on 
 
 '* (Euvres d'A. Pare, § 16, pp. 120. 
 
 t See his eleventh letter on the History of Surgery. 
 
 18
 
 282 ARABIC PERIOD. 
 
 this subject comes from himself; and it does not appear that he wrote 
 anything after 1363, at which time he published his Surgery. '■■' 
 
 He composed several works, which are enumerated by M. Malgaigne. 
 but the only one which requires our attention now, is his Great Surgery, 
 which he calls Inventory, to signify, as he explains, that it contains the 
 succinct exposition of all that was essential, that had been taught up to 
 that time, on each branch of the art. In his singular chapter — capitu- 
 lum singulare — which seems as an introductory, he glances at the pro- 
 gress of surgery since Hippocrates. He names a great number of Greek, 
 Arabian, and Latin authors, and of all those whose writings have reached 
 us, he omits only Celsus and Aetius. He cites some Arabian physicians 
 of whom we have no knowledge at present. No one has known better 
 than he, how to unite respect for the ancients with justice toward 
 moderns. " The sciences," he remarks, " are created by successive 
 additions ; the same man can not lay the foundation, and perfect the 
 superstructure. We are as children carried on the neck of a giant ; 
 aided by the labors of our predecessors we see all that they have seen, 
 and something besides." In the same chapter, in tracing the character 
 of a surgeon, he recommends that he be learned, expert, ingenious, and 
 bien morigene, that is to say, following the interpretation that be gives 
 himself of the last word : that he be bold where he is sure, and timid 
 when in doubt ; that he avoid bad cures and practices ; be gracious to 
 the sick ; generous to his companions ; wise in predictions ; chaste, 
 sober, pitiful, and merciful ; not covetous, nor an extortionate of money, 
 but receive a moderate fee, according to his labor, the abilities of his 
 patient, the character of the issue or event, and his own dignity. 
 " Never, since Hij^pocrates," exclaims M. Malgaigne, " has Medicine 
 heard a language stamped with such nobility, and in so few words." 
 
 The entire work is divided into seven treatises or books. The first 
 is devoted to anatomy, but contains nothing new ; the description he 
 has given of the body is drawn entirely from Galen, or some other 
 nearer and less pure source. But he insists on the necessity of 
 dissections, and states that the practice had been introduced for some 
 time, in the school at Montpellicr, of making anatomical demonstrations 
 on animals. He proposes, also, to make use of the corpses of executed 
 criminals. He speaks of drawings representing parts of the human 
 body, which had been drawn by the direction of Henri d'Hermoudaville, 
 or Mondeville. As to his surgery proper, he extracted it from Galen, 
 Oribasius, Paul dVEgina, Ehazes, Avicenna, Albucasis, Roger. Roland, 
 and other writers, but he selects from them with discretion ; he discusses, 
 
 ' M Dezeimeris Dictiooinaire de Medicine, article Guy de Chauliac.
 
 MEDICINE OF THE LATINS. 283 
 
 judges, chooses, and makes summaries of their opinions and methods. 
 '•At that period,"' says M. Dezeimeris, " an inventor would have rendered 
 less important services than a judicious compiler. Books were of an 
 extreme rarity, and from their price within the reach of but few sur- 
 geons ; to unite them nearly all in one, to collect all that there was 
 useful, so as to form but one small volume, was to place the science 
 within the reach of all fortunes, to give facility for learning to him 
 who was doomed to ignorance by the scarcity of books, and to create, not 
 surgery, it is true, but surgeons.*' 
 
 In the second book^ which treats of abscess, our author gives the 
 word a more extensive meaning than it has at this time. He designates 
 by it every species of tumor, excressence, and swelling, partial or 
 general. " The great abscesses," he remarks, "are, according to Galen, 
 considerable tumors, which are developed in fleshy parts. The little 
 abscesses are, according to Avicenna, eminences, pustules, and pimples, 
 which appear on the surface of the skin.'" He divides abscesses into hot 
 and cold. The hot are caused by too much blood, such as the phlegmon, 
 anthrax, gangrene, and pustules : sometimes from the bile, as erysipelas, 
 vessicles, and effervescences. Amon^- cold abscesses he classed oedema, 
 tympanitis, dropsies, scrofula, scirrhus, and cancer. 
 
 The practice of Guy de Chauliac, though timid, was more active than 
 that of Lanfranc. He never cut for stone ; he left to the travelling 
 surgeons that operation, which he desribes according to the Arabic 
 writers, and as he had seen it performed ; but he incised the abdomen, 
 in ascitis, and did not hesitate to attempt the radical cure of hernia ; 
 he speaks of cataract like a man thoroughly acquainted with it, and 
 who had operated." 
 
 The plague which raged during the fourteenth century in all parts of 
 the known world, and which depopulated the globe, according to his- 
 torians, of a fourth of its inhabitants, appeared twice in the city of Avig- 
 non, at the time Guy resided there. He acknowledges, ingenuously, 
 that he desired to fly, like others, that theater of death; but was 
 prevented by the shame of the thing. Et ego, he says, propter infa- 
 miam, non fui ausus recedere. He remained at his post, continuing to 
 visit the sick, and giving them consolations as well as counsels, notwith- 
 standing the uselessness of remedies. Being attacked himself, he saw 
 all abandon him and leave him for dead. In this frightful position, he 
 preserved enough presence of mind, to follow the progress of his disease, 
 analyze his suff'erings, and give a description of them, worthy of Hippo- 
 crates. 
 
 * M. Malgaigne, (Euvres d'A. Pare.
 
 284 ARABIC PERIOD. 
 
 Here finishes the list of men rendered eminent by services to medical 
 science during the Arabic period. The work of Guy de Chauliac became 
 very soon the surgical code of Europe ; translated and commented upon 
 in all tongues, and reproduced under different forms, it was for a long 
 time classic, and still preserves its interest, as representing the state of 
 science at the close of the middle ages. He has written, moreover, in a 
 clear, concise, and even picturesque style, very superior to the barbarous 
 Latin of most of the writers of his time. 
 
 CHAPTER IV. 
 ACCESSORY INSTITUTIONS. 
 
 Charitable institutions were astonishingly multiplied during this 
 period, as well among the sectators of Mahomet as in the Christian 
 states. By the side of each mosque, the same as by each cathedral, 
 there were usually a school and a hospital, endowed with more or less 
 munificence by emperors, califs, kings, bishops, or the opulent, who hoped 
 to buy a redemption from their sins by pious liberality, and secure an 
 eternity of happiness. A great number of religious communities were 
 established during the middle ages, to give succor to the necessitous 
 sick. The most consideralile were the orders of St. Mary, St. Lazarus, 
 the Knights of St. John of Jerusalem, and the Daughters of God. In 
 the end, some of these orders departed from their primitive undertak- 
 ings, and became so rich as to excite the covetousness of sovereigns, and 
 so powerful as to resist their authority. More than once, the laxity of 
 morals and the spirit of discord entering into these religious societies, 
 rendered their reform or even their suppression necessary ; but in their 
 origin all had an aim for charity and sanctifieation. 
 
 The charitable zeal for the sick was never more fervent than at this 
 epoch; we see princes, bishops, and popes give an example of heroic 
 devotion, in dressing, with their own hands, the ulcers of the leprous, of 
 which no one at that time had doubted the contagious properties ; never, 
 besides, were the occasions for their exercise more frequent. The leprosy 
 that the crusaders had contracted in the Orient, spread with frightful 
 rapidity ; misery, uncleanness, and the want of hygienic care had multi- 
 plied, to the last degree, cutaneous diseases of every species; ignorance 
 and fear aggravated still more the evil, by confounding with the leprosy 
 affections of a nature less formidable ; so that, in the thirteenth century,
 
 ACCESSORY INSTITUTIONS. 285 
 
 it was estimated that there were not less than two thousand leprous per- 
 sons in France, and nineteen thousand in Europe entire. 
 
 The excessive severity of a mass of ordinances enacted against the 
 leprous, proves how great was the terror which that hideous disease in- 
 spired. They were forbidden to enter the cities ; if they encountered 
 any one in their walks, they were compelled to turn aside, so that their 
 breath should not taint them. If a healthy person was convicted of 
 having touched a leper, or any thing which they had been using, he 
 was immediately separated from society. Lastly, the least infraction of 
 any of these rules entailed severe punishment, often even that of death. 
 What superhuman courage, what abnegation did it not require in those 
 who devoted themselves to the service of these unfortunates ! 
 
 Another institution, which would tend more effectually than coercive 
 measures to the diminution of these cutaneous diseases, was that of pub- 
 lic baths. They were established in nearly every city, and the number 
 increased to such an extent that, in the fifteenth century, the bathers 
 formed in Paris a powerful brotherhood. •■•^ Jaques Despars, physician 
 to Charles VII., and one of the most renowned professors of the faculty, 
 having spoken too openly against the abuses of public baths, was obliged 
 to quit the capital to avoid the persecutions of that brotherhood. 
 
 RESUME OF THE ARABIC PEPJOD. 
 
 Three grand facts predominate in the history of this period, and 
 reflect, to some extent, the progress of the human mind. 
 
 1. The Arab nation, until that time obscure, and almost a stranger 
 to the progress of civilization, passed rapidly from a demi-sivage to the 
 first rank of polished nations. After having, for several years, carried 
 over the conquered countries the fury of a religious vandalism, they 
 embraced, with enthusiasm, the culture of the muses, and endeavored to 
 repair their early ' ravages, by collecting the debris of the literary and 
 scientific movements of Greece. Medicine is one of the sciences which 
 they cultivated with most zeal and success, though they added but little 
 to the treasures amassed by the genius of the Greeks. Very soon a 
 people more barbarous and unknown, issued from the deserts of Tartary 
 and subjugated, in their turn, the Arab nation, in all parts of the world 
 where they had established themselves, enervated them under a brutal 
 despotism, and degraded them to a state akin to their primitive igno- 
 rance. Thus, wherever the Turk dominates, humanity retrogrades. 
 
 "Sse P. S. G(5rard, Recherches sur les etablissraents de Bains Publics a Paris, 
 from the fourth century to the present time. (Annales d'Hygiene Publique 
 et de Me'dicine Legale, Paris, 1832, T. VII, p. 5, ct suiv.)
 
 286 ARABIC PEEIOD. 
 
 2. The Greek nation, which marched for so many ages at the head 
 of civilized nations, is stripped, one by one, of the gems of its antique 
 crown — power, virtue, courage, glory, independence, all successively 
 pass away. It descends by a slow, but continued degradation, to 
 the lowest rank of modern nations. In the course of this period, but a 
 single physician merits a historic mention on account of his writings, 
 and we find in these nothing new, with the exception of a few remedies 
 borrowed from the Arabians, and without giving credit for them. 
 
 3. 1 he western part of the Roman Empire, subjugated by the barba- 
 rians who issued from the forests of Germany and Scandinavia, fell 
 into the the thickest darknes from the first tiges of this period ; but the 
 inhabitants of these unhappy countries, though loosing the independence, 
 order, and security which they enjoyed under the Eoman institutions, 
 preserved, at least, their manly courage. Their blood received new life 
 by being mingled with that of the rude children of the North. They 
 repulsed, in the first place, the Saracens, who poured upon them like a 
 torrent from the South of Spain. Tranquil on that side, they turn 
 their arms against each other, and bring ruin upon themselves for sev- 
 eral centuries: then, excite! by religious fanaticism, as were formerly 
 the Mohamedans, they rushed by thousands to the plains of Asia Minor, 
 Syria, and Egypt, which had been occupied for several centuries by the 
 Saracens. These distant and adventurous enterprises, the aspect of an 
 entirely new civilization, inspired the Erancs with a taste for poetry and 
 works of imagination, then in great honor among the Arabs. During 
 the twelfth and thirteenth centuries, the governments of Europe become 
 regulated and stable, liberal institutions are created, the mind of the 
 people of the West shakes off, gradually, the rust of ignorance, and at 
 the end of the Arabic period, we already see some brilliant streaks of 
 light in the horizon of European nations. Medicine participated in 
 this progressive movement. Erom the fourteenth century, we see it 
 worthily represented in Italy, in Paris, and especially in 3Iontpclier. 
 Nevertheless, physicians as yet only knew how to follow, timidly, the 
 track of the Arabs ; scarcely any of them had approached their lips to 
 the purer sources of Greek medicine. 
 
 Here I close the Age of Transition, or the middle ages, and now opens 
 before us an era more glorious, which we may salute by exclaiming with 
 the poet, " Already commences a new order of famous ages." 
 
 Magnus ab integro saeclorum nascitur ordo. 
 
 ViRQ. Edog.
 
 BOOK III. 
 . AGE OF RENOVATION. 
 
 EXTENDING FROM THE COMMENCEMENT OF THE FIFTEENTH CENTURY 
 TO THE PRESENT TIME. 
 
 VII. ERUDITE PERIOD, 
 
 INCLUDING THE FIFTEENTH AND SIXTEENTH CENTURIES. 
 GENERAL CONSIDERATIONS. 
 
 This age, which includes a space of a little more than four hundred 
 years, or only about one-third of the duration of the preceding age, 
 offer's, nevertheless, to the history of science in general, and that of 
 Medicine in particular, much more abundant, varied, and interesting 
 materials. The mind of Occidental Europe, long plunged into a species 
 of torpor, gi-adually awoke, and seemed to have acquired by the repose 
 an extraordinary vigor. Soon breaking its Gothic bonds, it launched 
 forth, in every direction, with youthful ardor; some remounting the 
 chain of ages to seek the debris of antique science, in order to restore 
 and offer to it a species of worship ; others endeavored to associate an- 
 cient with modern ideas, and elevate on this double base the edifice of 
 human knowledge ; others, finally, bolder and more precipitate, cut loose 
 from the past, rejected its traditions, and assumed to build the scientific 
 structure with new materials entirely. 
 
 1 have already announced some of the circumstances that contributed 
 to the awakening of the mind of Europe ; such as the diminution of the 
 internal conflicts between the princes and their vassals, a better social 
 organization, the creation of establishments calculated to disseminate 
 knowledge, etc.; and, I must add here, that this awakening was consid- 
 erably favored by some industrial discoveries of capital importance.
 
 288 ERUDITE PERIOD. 
 
 The invention of the compass, for example, rendering long maritime 
 voyages less dangerous and more frequent, opened to cosmography and 
 many other sciences a vaster field. By the aid of the telescope, astron- 
 omy was able to seize some of the most scattered rays in the immensity 
 of the skies ; to calculate more exactly the revolutions of celestial 
 bodies ; to assign to our globe its true form, and to the sun its gigantic 
 dimensions and legitimate p/lace, in the center of our planetary system. 
 The eye of the naturalist, armed with the microscope, penetrated into 
 the domain of the infinitely minute, and perceived there a multitude of 
 phenomena which the ancients had not even suspected. Engraving on 
 copper, multiplying almost at pleasure the chefs-d' ceuvre of painting and 
 drawing, united to the verbal description of objects, their graphic, and. 
 if we may say so, living representation, whenever that appeared neces- 
 sary, as in the works on natural history and anatomy. 
 
 But of all the discoveries that inaugurated this modem age, and 
 illustrated its commencement, no one has thrown such eclat or has ex- 
 ercised so great an influence on the development of ideas, as the art of 
 printing. After writing, nothing has been found to the present time so- 
 favorable to the transmission of thought, as the typographical art. This 
 art, in which the first attempts were made between the years 1435 and 
 1440, was carried from its origin to a degree of notable perfection by 
 the united efforts of three industrious men, Guttenberg, Faust, and 
 Shoeffer. Thanks to their ingenious combinations, language, repeated 
 an infinite number of times, was able to carry ideas and light even to 
 the most obscure ranks in society. Thence the triunsphs of intelligence 
 and reason were secured ; thence might be seen, in the future, more or 
 less distant, the end of the dominion of brute force ; for, by means of 
 this happy artifice, thought was thereafter to be as imperishable as 
 its source. 
 
 At the beginning of the erudite period, the Arabic literature was still 
 predominant in the school of Medicine. The only authorities that were 
 then invoked and explained, were Bhazes, Haly-Abbas,^ and Avicenna. 
 Jacques Despars, one of the most distinguished professors of the faculty 
 in Paris, in the first half of the fifteenth century, distinguished himself 
 by his compilations of the books of Avicenna an^ Mesue. The taste 
 for Greek literature began, however, to prevail in the universities of 
 Italy, and finally grew so as to be extended into other parts of Europe, 
 after the taking of Constantinojde, in 1483, by Mahomet II., emperor 
 of the Turks. This mournful event, which seemed to be a mortal blow 
 to the Greek language and literature, hastened, on the contrary, their 
 resurrection in the Occident. This city having been given over to pill- 
 age, a large number of learned men expatriated themselves, carrying
 
 HUMANIST PHYSICIANS. 289 
 
 away all the manuscripts tbey were able to save. The most of them 
 sought refuge in Italy, where they found enlightened protectors in the 
 all-powerful princes of the house Medici, in Florence, in the Koman 
 pontiffs, and Alphonso d'Aragon, sovereign of Naples and Sicily. These 
 fugitives made their hosts acquaiuted with chefs-d'oeuvre of Greek anti- 
 quity, so long forgotten ; and paid thus their adopted country, for the 
 hospitality that was accorded to them, by disseminating the models of 
 a good literature. Among these strangers, who contributed the most to 
 popularize Greek works, history gratefully cites the names of Theodore 
 Gaza, Agryrophile, and Lascaiis. 
 
 Thence the taste for books, libraries, and sound erudition was diffused 
 throughout Europe. The monuments of Greek and Latin anti(j[uity 
 were hunted up and published with indefatigable patience and ardor ; 
 A mass of ancient works were edited, translated, and commented 
 upon, with extreme care, and a great number of these translations and 
 commentaries are still most estimable. The authenticity of manuscripts 
 and purity of texts were discussed with sagacity ; and efforts were made 
 to free the new editions from faults, omissions, and interpolations, which 
 had glided into the manuscript copies in the lapse of time, by the igno- 
 rance or cupidity of the copyists. Scholars of the first merit devoted 
 themselves to this wearisome and thankless, though eminently useful, 
 task ; and they opened for their successors the pathway of science, and 
 removed the obstacles that encumbered it. Let thanks be rendered to 
 them. 
 
 For a short time, now, we will glance at the labors of some of those 
 laborious critics who have elucidated for us the memorials of antique 
 Medicine. 
 
 CHAP TEE I. 
 HUMANIST PHYSICIANS. 
 
 1. The first who presents himself to us in chronological order, is 
 Nicholas Leonicenus, who was born at Lonigo, near Vincenza, in the 
 year 1428. He studied Medicine at Padua, and taught it for more than 
 sixty years at Ferrara. His lectures and his numerous writings contrib- 
 uted effectually to propagate a taste for a sound literature. He was 
 the first to translate directly from Greek into Latin the Aphorisms of 
 Hippocrates, and several books of Galen. He enjoyed, during his long 
 career, unalterable health and vigor of mind, which failed not for an 
 instant — rare and precious advantages, due to his temperance, purity of
 
 290 ERUDITE PERIOD. 
 
 manners, and serenity of soul. He died at the age of ninety-six, regret- 
 ted by tlie learned and by the people. 
 
 Leonicenus combated peiscveringly the infatuation of his cotem- 
 porarics for the Arabs and Arabists ; and he had the satisfaction to see 
 them gradually return to the study of the Greek and Latin models. 
 His letters on the errors of Pliny, the naturalist, and those of some 
 other physicians, are written with an elegance and purity unknown 
 before him ; they offer the first example in this age of an impartial 
 critic of the ancients. He demonstrates that the lioman encyclopedist, 
 for whom he testified otherwise a profound veneration, fell into errors 
 and manifest contradictions, for want of understanding well the Greek 
 authors whom he compiled, and attaches the same reproach, but with 
 more severity, to the Arabian writers. '• These men," he says, in speak- 
 ing of the latter, '• never knew the plants which they described ; they 
 obtained their description from authors who had preceded them, and whom 
 they have badly translated. On this account, there exists a chaos of 
 various denominations and descriptions, more and more erroneous. 
 Unfortunate the patient for whom the physician should order remedies 
 on the faith of Mesne or Serapion !"=■■' 
 
 This wise critic maintained always a tone of perfect urbanity and 
 kindness against his cotemporaries, whose scientific opinions he combats. 
 Here is what he wrote to Politien, in the letter we have just cited : "I 
 had proposed to respond, by simple missive, not by a book, to the rea- 
 sons that j^ou allcdge to justify Pliny in having confounded the ivy with 
 the rock-rose, not being willing to make public my literary discussions 
 with a man who is my intimate friend, and whom I honor from the bot- 
 tom of my heart ; but the matter requires more ample developments 
 than I had sujDposed." 
 
 II. Thomas Linacre, of Canterbury, was the cotemjiorary of Leoni- 
 cenus, though somewhat younger. After having made his first studies 
 at the University of Oxford, he sailed for Italy, in 1484, for the pur- 
 pose of perfecting his university instruction. He followed, at Florence, 
 the lectures of Demetrius Chalcondylus, one of the Greek refugees of 
 whom I have spoken, where his happy disposition, joined to his modesty, 
 gained him the notice of Lorenzo de JMedicis. That prince proposed 
 to him to become the companion of his children in their studies, whose 
 preceptor was Angel Politien, the same to whom Leonicenus addressed 
 the afi'ectionate expressions that we have given above. The young Eng- 
 lishman accepted with joy an ofi'er so honorable to him, and which gave 
 him an opportunity to satisfy his penchant for study, and he profited so 
 
 * Letter to Politier.
 
 HUMANIST PHYSICIANS. 291 
 
 well by the lessons of his masters, that in a short time he became as 
 learned as themselves. 
 
 After being thus nurtured on the cream of the finest literature of his 
 time, he returned to his native country, where his talents were worthily 
 appreciated and remunerated. Having become physician in ordinary to 
 Henry YII., and the princess Mary, who afterward mounted the throne 
 of England, Linacre showed himself worthy of his high fortune, by the 
 zeal he displayed all his life in favor of sound education. He was the 
 first of his nation who spoke purely, the language of the Eomans. He 
 translated several treatises of Galen, and his translations are still 
 esteemed. These caused the erection of two chairs, one at Oxford, and 
 the other at Cambridge, the incumbents of which had to explain the 
 works of Hippocrates and Galen ; but what entitles him most to the 
 gratitude of his countrymen, is the foundation of the College of London. 
 
 To appreciate properly the importance of such a creation, and the 
 merit of its author, we must reflect on the circumstances that sur- 
 rounded this rising institution, and take into consideration the obstacles 
 that had to be surmounted. At that epoch, the bjshops alone had the 
 right to give in their dioceses the permission to practice medicine, 
 whence it resulted that the practice of the Healing Art was abandoned 
 entirely into the hands of monks and illiterate empirics. Linacre had 
 need of all his credit at court to obtain the reform of such abuses ; but 
 his persevering and enlightened zeal triumphed over all opposition. He 
 obtained the issue of letters patent, which prohibited the practice of 
 Medicine by any one who had not received his degrees in one of the two 
 universities in the kingdom, and who had not been examined by the 
 President of the College at London, assisted by three physicians dele- 
 gated especially for that purpose. Behold by what a series of intelli- 
 gent and generous eiForts this estimable man merited and obtained the 
 title of the restorer of Medicine in England.' ■' 
 
 The two personages whose works and influence on the minds of their 
 compatriots we have just succinctly traced, belong to the commence- 
 ment of the Erudite Period. They merit particular attention, not only 
 on account of the importance of their literary labors, but also because 
 they were the first among physicians who embraced the culture of the 
 Greek classics, and contributed efl&ciently to propagate it. Many others 
 afterward followed the same course, and distinguished themselves in the 
 same career, such as Gontier d'Andernach, Jac({ucs Houlier, Louis 
 Buret, and others ; but I can not enumerate here the titles of all the 
 men of talent who devoted their lives to restoring the monuments of 
 
 '•" Hist. Med., by Freind; article Linacre.
 
 292 ERUDITE PERIOD. 
 
 ancient Medicine ; it is sufficient to have signalized the general ten- 
 dency of the mind for bibliographic researches at the epoch of intellec- 
 tual regeneration — a tendency which denotes a want profoundly felt, 
 and which resulted from the new direction their studies began to take. 
 
 Indeed, from the moment that they began to realize the superiority of 
 Greek models over their prolix Arab commentators, they were anxious 
 to go back to the source of excellence, and sought with avidity the 
 originals, which had till then remained covered up in the rubbish and 
 dust of libraries. But at this time the copies of Greek authors were 
 few in number, and in a deplorable state, owing to the neglect they had 
 suffered during so many ages. It then became necessary and urgent to 
 draw them from obscurity, to purify, co-ordinate, and multiply them, 
 especially by the aid of printing. This work, too little appreciated 
 to-day, required very extensive and varied knowledge, rare sagacity, and 
 admirable disinterestedness and patience. The most eminent men in 
 science did not disdain to be thus occupied. On this account, the epi- 
 thet, erudite, seems to me to be very characteristic of this period, in 
 which the grammarians enjoyed such great and worthy consideration. 
 
 Among the jiublications in medical literature, belonging to this epoch, 
 is one which is out of the ordinary line of enterprises of this nature, 
 and therefore merits special notice. I allude to the complete edition of 
 the Hippocratic writings, with a Latin translation of Anuce Foes. 
 " In the midst of the dearth of correct manuscripts," says a modern 
 historian,* " defective texts, and numerous alterations introduced suc- 
 cessively by the copyists, an exact and complete Greek edition of the 
 works of Hippocrates was as earnestly desired as vainly expected for a 
 long time. At last, the press groaned, and there was seen issuing from 
 Frankfort on the Main, in 1595, a volume much less frightful by its 
 mass, than by the idea of the time, application, and sacrifices of ever}"^ 
 kind, that its composition must have cost its learned and laborious 
 author." Foes was a distinguished practitioner, whom fortune had not 
 much favored. He lived on the product of his business, and on his 
 income as pensioned physician of the city of Metz. He had consecra- 
 ted to this immense work, the leisure and labors of forty years of his 
 life. His name is henceforth immortal, by its association with that of 
 Hippocrates, as the ivy shares in the strength of the oak to which it 
 is attached. 
 
 I can not pass in silence another publication which dates, also, from 
 the last half of the sixteenth century, less capital than the preceding, in 
 a medical point of view, but in which the author has displayed an 
 
 -' M. Dezeimeris.
 
 ANATOMY AND PHYSIOLOGY. 293 
 
 erudition scarcely credible ; it is the treatise on the gymnastics of the 
 ancients, by Jerome Mercurialis, a classic work, not less precious to the 
 historian than the antiquarian. 
 
 After having thus rendered a just homage to the bibliographic labors 
 which concurred to the restoration of a good taste in Europe, it is time 
 to examine, in detail, what became of each of tbe branches of medical 
 science during this period. 
 
 CHAPTER II. 
 
 ANATOMY AND PHYSIOLOGY. 
 
 About the year 1315, Mondini, professor at Bologna, dissected the 
 bodies of two women. Shortly after, he published an Epitome of Anat- 
 omy, illustrated with wood cuts, which obtained general success, and 
 served for more than two centuries, concurrently with the writings of 
 Gralen and the Arabs, for anatomical demonstrations. But this abridg- 
 ment contained nothing new : the parts wei-e indicated only, rather than 
 described. Lauth expresses himself about this author, as follows : 
 *■ Mondini may be considered an anatomist who has examined, with dis- 
 cernment, the corpses that he has dissected, but we must stop at splanch- 
 nology, if we would not lose this good opinion. Let us see how he 
 proceeds to reach the deep muscles of the extremities. ' Beneath the 
 veins of the fore-arm,' he remarks, ' we see many muscles, and many large 
 and strong cords, (tendons) ; of which it is not necessary to attempt the 
 anatomy on such a corpse (a recent one) , but on one dried in the sun 
 for three years, as I have shown otherwise, in developing the number 
 and the anatomy of those of the superior and inferior extremity.' He 
 takes an opposite and unauatomical course to discover the nerves, advis- 
 ing maceration in running water." ■■= At that era, and still for a long 
 time after, it was the custom to demonstrate anatomy on hogs and other 
 animals, and it was great boldness on the part of Mondini to apply the 
 knife to the human body. The prejudice against dissection of the 
 human body was so general, for more than a century afterward, no one 
 dared renew, at least ostensibly, the undertaking of the Bologuesc pro- 
 fessor. His own conscience did not seem to be well satisfied by the ope- 
 ration, since he was not willing to open the head, for fear of committing 
 a mortal sin. To comprehend his scruples, and those of his cotemporaries, 
 
 '"' Hist, de I'Anat., Strasbourg, 1815, t. I., liv. v, par. iv, sec. 2, p. 303.
 
 294 ERUDITE PERIOD. 
 
 it will suffice to add that Pope Boniface VIII. issued a Lull in 1300, 
 which forbade the evisceration and anatomical cooking preparation of 
 the dead. This prohibition, it is true, says Holfinx, Avas only designed 
 to abolish the absurd custom introduced by the crusaders, of cutting 
 up and boiling the bodies of their relatives, deceased in infidel countries, 
 so as to send them to their families to give them a burial in holy ground ; 
 but it is certain that the same bull was interpreted, whether right or 
 wrong, as prohibiting anatomical dissection, for, in 1482, the university 
 of Tubingen had recourse to the authority of Pope Sixtus IV. to obtain 
 permission for dissection. ••= 
 
 It was only toward the close of the fifteenth century, and in the early 
 years of the sixteenth, that this prejudice began to abate. The popes 
 themselves, who stood then at the head of scientific movements, with- 
 drew their interdictions, and the universities of Italy gave the first ex- 
 amples of public dissections. Achillini, Benedetti, and, perhaps also, 
 Jacques Berenger, dissected previously to the year 1500, at Bologna, Pa- 
 dua, and Pavia. Soon after, their example was followed in many other 
 places. Toward the close of the sixteenth century, Dubois, called Syl- 
 vius, following the fashion of the times, demonstrated anatomy at Paris, 
 on the dead body. He gave for forty years, vei-y frequently, special 
 courses, and contributed very much to popularize the taste for this 
 science. He dissected a great number of animals, and as many dead 
 bodies as he could procure, which was no easy matter at that time, as 
 we shall presently sec. He subordinated, however, all his researches 
 to the authority of Galen : so much so, that he would not admit any 
 remark contrary to the statements of this author, unless that which 
 contradicted him was considered as a freak of nature, or a result of the 
 degeneration of the human species. 
 
 In like manner, all the other anatomists followed this vicious course ; 
 no one would permit himself to contradict the assertions of the oracle 
 of Pergamos ; until, at last, a man of genius and courage, prepared for 
 literary discussion by severe study — a true reformer — appeared. He was 
 Andrew Vesalius. Born at Brussels, in 1514, of a family for a long 
 period illustrious in ]\[edicine, he studied the humanities at Louvain. 
 under Guinther, or Gonthier d'Andernach, who was there professor of 
 the Greek language. Already the inclination of the young scholar, for 
 anatomy, revealed itself in his pastimes ; he amused himself in dis- 
 secting, during the recreations, rats, moles, dogs, etc. He made a con- 
 quest, literally, of his first skeleton, on the place of execution near 
 Louvain. Having observed the body of a criminal, of which the birds 
 
 =^Hist. de I'Anat., t. I., lib. v, part iv, sect. 2, p. 303.
 
 ANATOMY AND PHYSIOLOGY. 295 
 
 had so perfectly cleaned away the soft parts, that there remained of it 
 only the bones and ligaments, he detached successively the extremities ; 
 but when he attempted to carry off the trunk, he found it so strongly 
 bound to the stake by the iron chains, that he was comjjelled to work 
 all night to get it loose. 
 
 Afterward, he went to Paris, attracted by the course of Sylvius, which, 
 as we have remarked, had acquired great reputation. While there, he 
 was not content with the lessons of his master, but wished to observe 
 nature himself; to accomplish which he had, more than once, to dispute 
 with the dogs and vultures at the hill of Montfaucon, for the remains of 
 criminals, or to introduce himself stealthily into the cemeteries, to dis- 
 inter a body, at the risk of incurring the accusation of the capital crime of 
 sacrilege. His progress was as rapid as his ardor, for his application was 
 great. From his twentieth year, he gave instructions at Paris, to his 
 fellow students, and exhibited to them the semi-lunar valves of the 
 aorta, which Sylvius had not found. At the age of twent^'-three, he 
 was nominated to the chair of anatomy in the faculty at Padua, by the 
 senate of Venice ; at twenty-nine, he published his great work, in which 
 this science is placed in a new light, and with a completeness which left 
 far in the rear all that antiquity had transmitted on the subject. ■' The 
 year following, Yesalius, no less renowned as a practitioner than as an 
 anatomist, was called by the Emperor Charles V.. to the court of Mad- 
 rid, then the most brilliant in Europe, in the character of first physi- 
 cian. From this time he abandoned his anatomical labors, to resume 
 them no more. 
 
 Vesalius dared subordinate the authority of Galen to anatomical in- 
 spection. He refuted many errors in his anatomy, and asserted that 
 the greater part of his descriptions, having been made from monkeys, 
 did not correctly represent the human structure. This audacity raised 
 up against him numerous opponents, among whom his old master, Syl- 
 vius, showed himself the most animated and the least reasonable ; but 
 the young reformer vigorously made head against the storm, and as 
 truth was on his side, at last triumphed. He was not, however, him- 
 self free from censure, notwithstanding the multiplied dissections which 
 had served as the basis of his anatomy. He was amenable to the reproach 
 brought against him by Columbus and Eustachius, that his descriptions 
 of the eyes, muscles of the larynx, and tongue are not in accordance 
 with nature. But, as said Lauth on this subject, " these iri-egularities 
 and defects in his work do not destroy his glory ; there results from it, 
 
 '^De Humani Corporis Fabrica, libri septem., Basle, 1843, with wood cuts.
 
 296 ERUDITE PERIOD. 
 
 simply, that the route which he had traced was the true one, and wae 
 still open to conduct other learned investigators to celebrity. "■■■= 
 
 The minds of men generally, were ripe for the revolution of which 
 Vesalius gave the signal ; what proves it is, that scarcely had he 
 appealed from the decision of Galen to the observations of nature, than 
 a crowd of anatomists struggled to follow his method. We have already 
 cited Columbus, who was his pupil — his co-laborer, and successor to the 
 chair in Padua; B. Eustachius, professor at Eome, who shared with 
 Vesalius the honor of having founded human anatomy, and of having 
 made astonishing progress in it. We place on the same line, Fallopius, 
 disciple and friend of Vesalius, who was professor, successively, at 
 Ferrara, Pisa and Padua. He died prematurely for the science which 
 he had cultivated with so much ardor and success ; and his name must 
 rest united to that of Vesalius in the history of modern anatomy, as 
 those of Herophilus and Erasistratus are in the history of ancient 
 anatomy. Lauth gives the following opinion of bis labors : ' ' Fallopius is as 
 much distinguished for the delicacy of his language as for his anatomical 
 talents. Under the modest title of " Observations," he has published a 
 treasury of discoveries on all parts of the human structure ; and when 
 he sees himself obliged to correct Vesalius, he always softens the style of 
 his criticism, though he does not abate its depth ; so that the work of 
 Fallopius is an excellent commentary on that of Vesalius." 
 
 The researches of Jerome Fabricius. on the formation of the egg 
 and of the fetus — on the valves of the veins and the viscera, have 
 equally a capital importance. They were designed for a treatise on 
 human and comparative anatomy, which the author had not time to 
 complete. But here I feel that I must pause ; very many other names, 
 and many other works, have a right to be mentioned, but I am forced to 
 pass them in silence, and refer the reader to the special histories of 
 Anatomy for them. 
 
 At this epoch, many modifications were introduced in the regulation*- 
 of the Faculties of Medicine ; permanent amphitheaters for dissection 
 began to be established — for till then, the anatomists had dissected 
 either in their chambers or in some provisional hall. Anatomical 
 chairs were created, and the salaries paid out of the public treasury. In 
 some cities the supply of material was not limited to the bodies of crim- 
 inals, but permission was also given to dissect the dead at the hospitals. 
 The Koman Pontiifs seem to have taken the initiative in this respect, 
 which explains the great number of subjects with which Eustachius was 
 supplied, compared with Vesalius, who obtained only two or three in a 
 
 *» Hist, de I'Anat., p. 373.
 
 ANATOMY AND PHYSIOLOGY. 297 
 
 year. The razor, a very incommodious instrument, was also replaced in 
 dissection by the pointed scalpel, which has remained in use till now. 
 
 This concourse of circumstances elevatsd anatomy very promptly, to 
 a degree of psrfection it had never attained under the Greeks. Plates, 
 designed by skillful artists after very careful anatomical preparations, 
 represented our organs with more exactness and detail than had been 
 supposed possible. The nerves were entirely separated from the tendons 
 and ligaments. They were traced as far as possible, from their origin 
 to their finest ramifications: and the anatomists assured themselves that 
 the muscular fibre was not produced by an expansion of the nervous 
 fiber. A glimpse was also obtained of the lymphatic vessels. 
 
 Capital discoveries were also made in the vascular apparatus. It 
 was discovered that there was no bony structure in the tissue of the 
 heart, as the ancients believed ; that the partition which separates the 
 cavities of that viscus, was not at all porous, so that the blood could not 
 pass from one cavity to another, through the septum. The attentive 
 examination of the valves led, finally, to the discovery of the pulmonary 
 circulation. Michael Servetus, the same whom Calvin burned at the 
 stake, was the first to discover this important phenomenon. He saw that 
 the sanguinary fluid could not penetrate, directly, the left, from the right 
 cavities of the heart, owing to the impermeability of the partition, so that 
 it was necessary for the whole mass of the liquid to pass through the lung, 
 where it became impregnated with the vital spirit contained in the atmos- 
 phere, and reached, afterward, the left auricle. The disposition of the 
 valves of the pulmonary artery and veins, plainly confirmed this conjec- 
 ture. Besides, the caliber of the pulmonary artery appeared enor- 
 mously disproportioned to the quantity of blood necessary for the 
 nutrition of the lungs ; which seemed to prove that such was not, as had 
 been believed true till then, the unique purpose of that vessel. About the 
 same period Fabricius d"Aquapendente, pointed out the valves in the 
 veins of various parts of the body : and shortly after, Columbus and 
 Andrew Cesalpine explained in a more explicit manner the mechanism 
 of the pulmonary circulation. 
 
 All these discoveries were an immense progress made toward the dis- 
 covery of the great circulation. It seemed that there remained only a 
 small step, to arrive at it ; and we feel astonished that those great 
 anatomists of the sixteenth century should have paused in so plain a 
 path. Andrew Cesalpine so closely approached this conception that 
 some have thought that he attained it ; but the passage on which they 
 sustain themselves does not authorise that opinion. The following is 
 his statement: " The openings of the heart are disposed in such a man- 
 ner that the passage is free from the vena cava into the right ventricle 
 19
 
 298 ERUDITE PERIOD. 
 
 and from that cavity into the lung ; further, there exists a communica- 
 tion from the lung to the left ventricle, and from this last into the 
 aorta. Membranes are placed at the orifices of the various conduits, in 
 such a way that a retrogade flux of the liquid column is impossible. In 
 this way is effected, continually, the passage of the blood from the vena 
 cava into the right cavities of the heart, and from these into the lungs, 
 and thence into the aorta by the intermediation of the left ventricle, as 
 we have explained in the Peripitecian questions. Now while awake, 
 the movement of the innate heat is from within outward, and during 
 sleep it is the reverse ; hence it follows, that while awake a great 
 quantity of the vital spirit and blood are carried to the arteries, which 
 transmit them to the nerves ; and, during sleep, the same heat returns 
 to the heart, not by the arteries, but by the vena cava, which alone com- 
 municates with this organ. 
 
 " The proof of this is drawn from the arterial pulsations, which are 
 large, vehement, prompt and frequent, with a species of vibration at the 
 moment of awaking, while they are small, languishing and slow during 
 sleep — for at this time the natural heat is carried less to the arteries : 
 but it flows freely there, as soon as we are aroused. 
 
 " The veins act entirely different ; they enlarge during sleep, and 
 diminish when we are awake, which is easily seen in those on the 
 hands. This occurs, because during sleep the natural heat passes from 
 the arteries into the veins, by means of their anastomases, and in that 
 way returns to the heart. In the same manner the flux and reflux of 
 the blood toward the superior and inferior parts, like the waves of Eu- 
 ripus, manifest themselves during sleep, and when we are awake also. 
 The same species of movement is manifested either by applying a liga- 
 ture around some part of the body, or by pressure on the veins in any 
 other way. For when the course of a stream is interrupted, it swells 
 above the obstacle. Perhaps in this case the blood returns back to its 
 source (son principe), so that this interruption may not (ne Veteigne) 
 destroy it."" 
 
 * This passage is of extreme importance, because upon it is founded the right 
 of Cesalpine to the greatest discovery of modern physiology. I have, therefore, 
 thought it proper to transcribe here the text, even, of the author, so that each one 
 may judge for himself, having the passage in his hands : 
 
 " Ilud sciendum est : cordis meatus ita a natura paratos esse, ut ex vend cava 
 intromissio hat in cordis ventriculum dextrum, unde patet exitus in pulmo- 
 nem: ex pulmone prretereli alium ingressum esse in cordis ventriculum sinis- 
 trum, ex quo tandem patet exitus in arteriam aortam, membranis quibusdam ad 
 ostia vasorum appositis, ut impediant retrocessum : sic enim perpetuus quidam 
 motus ex vena cava per cor et pulmones in arteriam aortam, ut in qunestionibus 
 peripateticis explicavimus. Ciim autem in vigilia motus caloris nativi fiat extra,
 
 HYGIENE. 299 
 
 Observe first, that this passage includes all the elements necessary to 
 arrive at the knowledge of the circulation of the blood. The author 
 says, positively, that the blood cannot flow backward, through the arte- 
 ries, toward the heart, on account of the membranes which close the 
 orifice of the aorta ; and he adds that the vena cava is the only vessel 
 which permits its entrance into that viscus. He speaks, also, of the 
 anastamoses of the arteries and veins. He remarks, that if a band is 
 applied around a member, the veins tumefy below the ligature. Does it 
 not seem that the author needed only to pronounce the word circulation, 
 to have resolved the problem ? But this word fell not once from his 
 pen ; but he compares it to the flux and reflux of Euripus, as Aristotle 
 had done. It is evident that he tortured his mind to conciliate two 
 irreconcilable theories, viz.: the opinions of the ancients on the move- 
 ment of the blood, with the recent discoveries of anatomy. Thus, the 
 glory of Harvey is untouched by this discussion, as will appear more 
 evident still, in its place. 
 
 CHAPTER III. 
 HYGIENE. 
 
 Next to anatomy, hygiene was one of the branches of Medicine least 
 cultivated in the middle ages. The governments being entirely occu- 
 pied with the care of maintaining and extending their dominions, never, 
 
 scilicet ad sensoria : in somno autem intra, scilicet ad cor : putandum est in 
 vigilia multum spiritiis et sanguinis ferri ad arterias, inde enini in nervos est 
 iter. In somno autem eumdem calorem revcrti ad cor, non per arterias: ingres- 
 sus enim naturalis per venam cavam datur in cor, non per arteriam. Indicio 
 sunt pulsus, qui expergiscentibus fiunt magni, veliementes, celereres et crebri 
 cum quadam vibratione: in somno autem parvi, languidi, tardi et rari (3 De 
 cans, pul., 2 &t \0) . Nam in somno calor nativs minus vergit in artei-ias: in 
 easdem erumpit veliementiiis, cum expergiscuntur. 
 
 " Venae autem contrario se modo habent : nam in somno fiunt tumidiores in 
 vigilia exiliores, ut patet intuenti eas quce in manu sunt. Transit enim in 
 somno calor nativus ex arteriis in venas per osculorum communionem, quam anas- 
 tomosin vocant, et inde in cor. Ut autem sanguinis exundatio in superiora, et 
 retrocessus in inferioria, instar Euripi, manifesta est in somno et vigilia, sic non 
 obscurus est bujusmodi motus, in quacumque parte corporis vinculum adhibear 
 tur, aut alia ratione occludantur vena;. Cum enim tollitur permeatio, intu- 
 mescunt rivuli qua parte fluere solent. Forte recurrit eo tempore sanguis ad 
 principium, ne intercisus extinguatur." (Andreae Cassalpini, Quaefdonum medica- 
 rum, lib. (8c.') qusestio xvii. Venetiis, apud Juntas, 1571.
 
 300 ERUDITE PERIOD. 
 
 or very rarely, inquired into what concerned public health. In the capi- 
 tals even of European states, no measure of police, no administrative 
 rule, existed for keeping the streets and houses clean, the free circula- 
 tion of air, the soundness of the food employed by the people, and the 
 propagation of hygienic habits. Those who founded or endowed hospi- 
 tals, asylums, and monasteries were not moved by any thoughts of social 
 amelioration, but by a pure sentiment of Christian charity — or the fear 
 of hell. In the establishments for public instruction, nothing was fore- 
 seen or ordered, in view of the physical perfection of man ; none but 
 the most ordinary and urgent cares were bestowed upon the health of 
 the pupils. There was, moreover, an opinion universally diffused, and 
 received almost as an article of faith, that there was no better means 
 for increasing the intelligence and enlarging the empire of the soul, 
 than to mortify the body. The statutes of most of the religious orders 
 had no other object. The clergy, placed at the head of instruction and 
 of the liberal professions, were profoundly imbued with this prejudice, 
 which explains their indifference to the physical education of youth. 
 During the lapse of several ages, no other hygienic code was in vogue 
 than the dietetic maxims of the school of Salerno, in which there was 
 nothing to justify its high reputation." 
 
 On the revival of letters, the attention of physicians was early turned 
 toward the means of preserving health and preventing diseases. But. 
 at first, they only compiled, with more or less erudition, the teachings 
 of the ancients on this matter. The earliest writings, at all original on 
 this subject, belong to the second half of the sixteenth century, and 
 appertain to a man unconnected with Medicine. 
 
 Louis Cornaro, a Venetian noble, had never enjoyed robust health, and 
 at the age of thirty-five he saw that his health was growing worse. He 
 was a prey to pains in the stomach, with loss of appetite, and attacks 
 
 ' My manuscript was finished, and already in the hands of the printer, when 
 I saw the work of iM. Levj, in which I find a just and elevated appreciation of 
 the Saleruian Sentences. I think I can not do better than copy them for the 
 reader : " If we place ourselves in the perspective of the progress accomplished 
 during the last four or five hundred years, to judge of this book, which is a sum- 
 mary of the spirit of that celebrated school, we perceive only an undigested 
 mass of Medicine and dietetics : a fragment of Galenism, united to the recipes 
 of the Arabian polypharmacy ; the maxims of antique wisdom, and the accred- 
 ited echoes of the popular superstitions. But let us not judge the works of past 
 centuries by the light of our day. The Medical Testament of Salerno is a his- 
 torical document, and not a work to study, in regard to the present state of 
 science. Nevertheless, we find, on several of its pages, distinct reflections of the 
 Hellenic school, and more than one sound hygienic maxim strikes us as being of 
 Hippocratic origin."
 
 HYGIENE. 301 
 
 of gout more and more frequent. Besides, he felt himself slowly con- 
 sumed by a slight continued fever, and was a prey to a thirst which he 
 could not satisfy. For five consecutive years, he employed all sorts of 
 remedies without obtaining any relief; on the contrary, his condition 
 became worse every day, and he saw in prospect only an untimely death, 
 preceded by long sufferings. Finally, his physicians told him that there 
 was only one re.-^ource left, and that was, to renounce his habits of in- 
 temperance, and adopt a course of life extremely sober, from which he 
 must never vary. Cornaro took a firm resolution, and held it. In the 
 first place, he studied to know the various species of aliment which 
 suited his stomach, and the quantity to take, in order not to be incom- 
 moded. After some experiments, he fixed on twelve ounces of solid 
 food, composed of bread, yolk of eggs, meat, fish, etc., and fourteen 
 ounces of liquid. Every morning, he weighed out his rations for the 
 day. This regimen suited him so well that, at the end of a year, he 
 was freed from all his afflictions. At the same time, his appetite 
 returned: he recovered his former gaiety, equanimity of humor, apti- 
 tude for mental efforts, and bodily exercises. In short, he lived without 
 infirmities to the age of one hundred years. 
 
 The whole life of Cornaro oBFers us a striking example of the salutary 
 effects of sobriety; but there is one trait in it which shows the power 
 of habit. At the age of seventy-eight, overcome by the solicitations of 
 his friends and kinsfolk, who pressed him to relax a little the severity 
 of his diet, he consented to add to it, two ounces of solids, and two of 
 liquids, each day. His stomach was very soon deranged ; he lost, 
 gradually, his appetite, and his manner became taciturn ; in fine, he 
 soon fell into a severe fever, which lasted thirty days and nearly de- 
 stroyed him. He was not re-established until he had resumed his 
 former way of living. In his account of the advantages of sobriety, 
 Cornaro takes pleasure in enumerating all the happy effects which he 
 realized from his manner of living. He states, that he composed, in his 
 eightieth year, a comedy, characterized hy refined and pointed wit, and 
 written in a lively style. At this age, he mounted his horse easily, and 
 climbed the steepest hills, and was always in a good humor. In his old 
 age, nevertheless, he endured some severe trials ; but he overcame them 
 well, thanks to the happy disposition of mind and body with which his 
 regimen endowed him. On one occasion, among others, he was obliged 
 to sustain a severe law-suit, which caused the death of his brother from 
 chagrin ; but, though the suit concerned himself especially, his health 
 was not altered nor his courage shaken, and he came out of it victo- 
 rious in every respect. Nevertheless, the enthusiasm of the old man 
 did not go so far as to believe that the same diet would suit everybody :
 
 302 ERUDITE PERIOD. 
 
 he only asserted that if men never went beyond the limit of need, in 
 eating and drinking, they would avoid a great many infirmities, and pro- 
 long their days much beyond the period usually attained.'-'-' 
 
 The history of Cornaro, say Halle and Nysten, may be placed with 
 the number of fine experiments which have been made in hygiene ; and, 
 consetj^uently, which have contributed to fix its principles, and concur to 
 the progress of the art.f 
 
 I shall say nothing of the memoir of the Jesuit Lessius, on the same 
 subject, because it is only a paraphrase of the treatise of Cornaro ; but 
 I must mention here the treatise, on Gymnastics, by Mercurialis. This 
 work, whose literary merit I have already appreciated, does not develop 
 any new notion, it is true, but directs the attention of men of the Pro- 
 fession, and the public at large, to hygienic considerations, so long aban- 
 doned and forgotten. It must, therefore, contribute to the restoration 
 of hygiene. 
 
 CHAPTER IV. 
 
 GENERAL PATHOLOGY. 
 
 We now return to the ancient divisions of Medical science, such as 
 Galen and Celsus adopted : that is to say, that after having studied man 
 in the normal state, in anatomy, physiology, and hygiene, we proceed to 
 study him in the abnormal state, in pathology and therapeutics. These 
 last two departments will be divided, as heretofore, into internal and 
 external. However irregular may appear this distribution of diseases, 
 we are forced to follow it, because it was adopted by all the authors of 
 that period. Pathology is a subject so vast, so complex, and so change- 
 able, that it is impossible to establish an irreproachable classification ; 
 we must, therefore, content ourselves with an exactness more or less 
 approximative. But let it be remembered, that a classification even 
 vicious, is much better than none at all, for this latter state is nothing 
 less than chaos — the negation of all general ideas, of all science. The 
 distinction of diseases into acute and chronic, existed then as at pres- 
 ent ; but in their treatises, no separation was made of the first from the 
 second, as the ancient Methodists had done ; the acute and chronic 
 states were considered as two forms of the same morbid entity, not as 
 
 '' On Sobriety and its Advantages, by Lessius and Cornaro ; new translation, 
 by M. de la Bonardiere, Paris, 1701. 
 f Dictionaire des Sciences Medicales, in sixty vols.; art.. Hygiene.
 
 INTERNAL PATHOLOGY. 303 
 
 two different species. Etiology was treated with much more subtiltj, 
 in conformity with the Peripitecian doctrine, as we shall show in the 
 chapter on theories. In short, we see commenced in this period the 
 rudiments of a new branch of pathology, which is styled pathological 
 anatomy, and which is destined to acquire a capital importance in mod- 
 ern times. 
 
 CHAPTEE V. 
 INTERNAL PATHOLOGY. 
 
 § I. Semeiotics. 
 
 The section of pathology which is devoted to the interpretation of 
 symptoms, considered in a general and abstract manner, made but few 
 acquisitions after Gralen. The Arabs added to the science only a small 
 number of observations, the most interesting of which belong to erup- 
 tive fevers ; and the Greeks and Latins of the middle ages did little 
 more than copy each other. At the epoch of the revival of letters, 
 writers occupied themselves in collecting the discoveries of anterior ages, 
 to withdraw them from the oblivion into which most of them had fallen, 
 to elucidate and put them in order. They made, to use the expression 
 of Guy de Chauliac, an inventory of all the acquisitions of the past, and 
 this was the best which at that time could be done ; for, before inno- 
 vating and reforming, it is necessary to know what exists, and to be 
 acquainted with the actual state of science. 
 
 The savans of the fifteenth and sixteenth centuries acquitted them- 
 selves perfectly of this task, as we have already shown. If they did 
 not make many discoveries, they prepared the way for their successors, 
 for the rejuvenation of ancient ideas so long forgotten. Can not this, 
 to some extent, be called an invention ? Among those whose writings 
 contributed to elucidate semeiotics, may be cited Vallesius, Prosper 
 Alpin, Lommius, Thomas Fyens, and especially, J. Fernel. The latter 
 offers us, in the second and third books of his pathology, the most suc- 
 cinct and lucid summary of the notions and ideas that composed the 
 science of symptoms among the ancients. After having defined what 
 he understands by signs and by symptoms, and how these phenomena 
 must be distinguished from the disease itself, he exposes the signs of 
 various species of plethora, namely, the sanguineous, bilious, melan- 
 cholic, pituitous, and serous ; then he devotes the whole of the third 
 volume to an examination of the pulse and the urine. In this we find 
 sphygmology and uriscopy forming the basis of prognosis and of curative
 
 304 ERUDITE PERIOD. 
 
 indications ; further, that they did not hold to the plan of grouping 
 symptoms to form tableaux, according to the synthetic method, of which 
 Hippocrates has given so fine an example in his treatise on Prognosis, 
 but that a separate examination was made of each phenomenon, which 
 was isolated, and an eflFort made to go back to its cause, so as to deduce 
 all the indications it could furnish, according to the analytic method 
 introduced by Aristotle and continued by Galen. 
 
 " The pulse and the urine," remarks Fernel, " furnish the surest indi- 
 cations concerning the force of diseases ; the first, by i-evealing 
 the state of the heart and the arteries ; the second, by indicating the 
 state of the liver and the veins ; for these organs hold under their 
 dominion the whole economy. The pulse shows clearly the energy pos- 
 sessed by the vital faculty, as well as the whole body, and shows the 
 present condition of the heart and arteries. The urine reveals the 
 qualities of the humors and the state of the liver in a very ( istinct 
 manner, it enlightens us on the diseases derived from them, but it fur- 
 nishes but little light as to the vigor of the vital movements, and of the 
 body in general. "=•■= The whole of the third book is only the develop- 
 ment of the proposition just quoted, namely, the theory of the pulse 
 and the urine. 
 
 § n. Pathological Anatomy. 
 
 Toward the end of the Erudite Period, pathology was enriched from a 
 new source, and one destined to shed great light on the dijjgnosis of dis- 
 eases, and which establishes a line of demarcation between ancient and 
 modern Medicine ; this is pathological anatomy. The idea of studying 
 the sensible traces that disease leaves in our organs after death, began to 
 germinate in the minds of physicians at the close of the fifteenth century. 
 Anthony Benivieni, a physician of Florence, appears to have been the first, 
 or at least one among the first, who conceived of the knowledge that might 
 be attained by opening bodies with the view of ascertaining the location and 
 causes of diseases. M. Malgaigne remarks as follows about this author: 
 " A eulogy which he merits without reserve, which he shares with no other 
 person, and which has not been accorded to him, up to this time, by 
 the many historians of surgery who have superficially searched in these 
 precious sources, is, that he was the first who had the habit, and felt 
 the need, and set the useful example which he transmitted to his 
 successors, of searching on the cadaver, according to the title of his 
 
 " Fernel's Patliologiaj, lib. iii, cap. 1 
 
 J De Abditis Nonnullis ac Mii-andis ]Morborum et Sanationum Causis, a work 
 printed after the death of Benivieni, under the care of his brother Jerome. 
 Florence, lo07.
 
 INTERNAL PATHOLOGY. 305 
 
 book, for the concealed causes of diseases." f Benivieni did not limit 
 himself to opening the bodies of his own cases ; he sought occasions 
 for autopsy with the same ardor that c'aracterizes the anatomists of 
 our times. In fine, he explored the bodies of those who had been hung, 
 without any hope of attaching anatomical lesions to the symptoms he 
 had not been able to see, but always thinking to find on them something 
 of interest, so as to be able to turn his researches to t' e profit of descrip- 
 tive anatomy and physiology." - After him, Bartholomew Eustachius 
 was one of those who showed most zeal in anatomical researches. "We owe 
 to him precious observations on the structure, functions, and diseases, 
 of the kidneys. He shed on these subjects a clear and new light. He 
 was also the first in modern times, who attempted to clear up the 
 anatomy and physiology of man, by comparing them with that of the 
 animals. 
 
 After Eustachius, we must mention, as at the head of the physicians 
 who cultivated pathological anatomy in the sixteenth century, Eembert 
 Dodoens and Marcellus Donatus. The latter refutes the prejudice 
 which in his time, in many localities, still opposed autopsies, in the 
 following terms : " Let those who interdict the opening of bodies well 
 understand their errors. When the cause of a disease is obscure, in 
 opposing the dissection of a corpse which must soon become the food 
 of worms, they do no good to the inanimate mass, and they cause a grave 
 damage to the rest of mankind ; for they prevent the physicians from 
 acquiring a knowledge which may afford the means of great relief, 
 eventually, to individuals attacked by a similar disease. No less blame 
 is applicable to those delicate physicians, who, from laziness or repug- 
 nance, love better to remain in the darkness of ignorance, than to 
 scrutinize, laboriously, the truth ; not reflecting that by such conduct 
 they render themselves culpable toward God, toward themselves, and 
 toward society at large." f 
 
 Nevertheless, pathological anatomy had no considerable extension 
 during this period. Few men cultivated it in a regular manner, and 
 the totality of their discoveries do not constitute the elements of a 
 doctrine ; but their labors merit the attention of the historian, as 
 indicating a new tendency which makes an epoch in science. 
 
 § III. NOSOGRAPHY. 
 
 Of all the treatises that appeared during the period we have named 
 Erudite, that of Fernel obtained the most universal and durable success. 
 
 "' Introfluction to the works of Pare, p. 119. 
 J Marcellus Donatus, Medica Historia, lib. vi.
 
 306 ERUDITE PERIOD. 
 
 It became classic throughout Europe. It is, in fact, the complete and 
 lucid resume of the Galeuo-Arabic doctrine, at that time taught 
 exclusively, in the schools of Medicine. In reading the work of Fernel, 
 we can form a correct idea of the manner in which diseases were studied, 
 at that epoch, and the general state of the science. On this account it 
 merits a special attention on our part, and we proceed to present a short 
 analysis of it. 
 
 Fernel has included pathology entire in seven books. The first 
 three are devoted to the most abstruse generalities concerning the 
 essence of diseases, their causes, signs, and symptoms. The author 
 explains each of these with much subtility ; he traces the rules which 
 he believes infallible, in order to arrive at a knowledge of them in 
 every instance. The material contained in these three books embraces 
 all the questions relative to etiology and semeiotics, and forms a 
 treatise on general pathology. We will recur to it in speaking of 
 theories. 
 
 The last four books include particular descriptions of all diseases then 
 known, and their methodic classification, which constitutes nosography 
 proper. The diseases to which men are subject are therein classified as 
 general and special; the former includes those whose locality is unde- 
 termined, (morbi incertae sedis) and the latter, those which appertain 
 to a part, or to an organ, exclusively. 
 
 The first class, then, or general diseases, only comprehends fevers, of 
 which Fernel admitted three genera, viz : simple, putrid, and pesti- 
 lential. Each of these genera was subdivided into a small number of 
 species or types, to the description of which the fourth book on patho- 
 logy is devoted. 
 
 The second class, or special diseases, is also divided into three orders, 
 viz.: First, diseases which afi"ect a part, situated above the diaphragm. 
 Secondly, those aff'ecting parts below that partition. Lastly, external 
 or surgical diseases. The description of morbid species, comprised in 
 these three orders, fill the last three books on pathology, viz.: the fifth, 
 sixth, and seventh. 
 
 Notwithstanding its defects, the nosological classification, at which 
 we have just glanced, was very superior to all those which had preceded 
 it. It possessed, in a very high degree, the merit of clearness and pre- 
 cision, which is an essential quality in a work of this kind. At that 
 time, considered in regard to cotemporaneous science, it included, easily, 
 all the derangements of health. Such a division of diseases sufiiced for 
 the epoch in which it was proposed ; but science has greatly enlarged 
 since that time, so that now the nosography of Fernel is extremely 
 defective. I shall not attempt to point out its numerous imperfections.
 
 INTERNAL PATHOLOGY. 307 
 
 but will signalize one only, extremely grave, whicli the author might 
 have avoided. 
 
 In all nosography the important capital condition consists in portray- 
 ing, exactly, the morbid species, and tracing the characters of each of 
 them so faithfully, that the practitioner can not confound them with 
 each other. Kow, the work of the Trench nosologist is especially de- 
 fective, in this respect ; his descriptions are insufficient, too short, and 
 sometimes worthless. He makes no special mention of eruptive fevers, 
 nor of other affections then newly observed; such as scurvy, hooping- 
 cough, raphania, or cereal convulsions, etc. He names, among new 
 affections, nothing but syphilis, of which he gives a sufficiently exact 
 description, though rather too succinct. In regard to the known ancient 
 diseases, instead of taking for models the tableaux of Aretgeus, Ca4ius 
 Aurelianus, and Alexander of Tralles, he adopts, a little too servilely, 
 the ideas and method of Galen ; besides, his descriptions are generally 
 inferior to the authors we have just named, as may be judged by the fol- 
 lowing example: 
 
 "Peripneumonia," says Fernel, '-is a phlegmasia of the lungs, which 
 is related sometimes to phlegmon, and sometimes to erysipelas. There is 
 great difficulty in respiration ; the cheeks are a bright red ; the eyes 
 appear swollen and prominent. If the inflammation is phlegmonous, 
 the patient spits blood, according to Hippocrates, unless the expectora- 
 tion is extremely crude. He feels a constriction under the hypochon- 
 dria and throughout the chest, a great weight beneath the sternum, and 
 in the back ; the fever, however, is moderate. AVhen the inflammation 
 is erysipelatous, the cough brings up yellow matter, mingled with a 
 little blood ; the tightness of the chest and the sensation of weight are 
 less, but there is more fever. 
 
 " These two forms of fever arise sometimes primitively, and, again, 
 succeed an acute angina, or a pleurisy, when the humor is thrown sud- 
 denly from the throat or the side upon the lungs. According to 
 Hippocrates, a peripneumonia which proceeds from an inflamed side is 
 bad ; for if, in a violent pleurisy, the pain in the side ceases suddenly, or 
 diminishes considerably, it makes, ordinarily, a metastasis to the lungs ; 
 the cough and suffocation augment, or peripneumonia, accompanied by 
 a bloody expectoration, appears ; and but few patients recover. "VMien 
 peripneumonia does not succeed another affection, but is an original 
 affection, it is caused by thinness and biliousness of the blood, which the 
 right ventricle of the heart throws vehemently, and in too large quan- 
 tities, into the lungs. The blood fills up not only the veins and arte- 
 ries of the organ, but, also, it invades the parenchyma itself; it distends 
 it too much, coagulates, putrefies, and lights up an inflammation, which
 
 308 ERUDITE PERIOD. 
 
 is not limited, as in other circumstances, but is diffused throughout the 
 viscus. True peripneumonia is, however, extremely rare. Hippocrates 
 attributes it, especially, to drunkenness ; the use of fish whose sticky 
 flesh is contrary to the nature of man, such as the mullet and eel ; or 
 to the habit of eating too much ; or to a change of water. Sometimes 
 a thin and acrid humor flows abundantly from the brain into the lungs, 
 assumes an unnatural character, and produces heat with fever. Many 
 persons give the name of peripneumonia to that species of disease in which 
 the cough, the difiicult respiration, and a slow fever consume the patient, 
 without ulceration of the lungs, or sanguineous expectoration. If this 
 be called peripneumonia, it must be borne in mind that it diff'ers very 
 much from legitimate peripneumonia, in the nature of the cause and the 
 extent of symptoms. "=■•' This tableau, it is plain, is inferior to that 
 drawn by Aretseus of the same disease, which was heretofore given. 
 
 About the end of the sixteenth, or the commencement of the seven- 
 teenth century, a Swiss physician, named Felix Plater, a very distin- 
 guished practitioner and professor at Basle, published an abridgment of 
 Medicine,! in which diseases are classified in an entirely new manner. 
 He treats, in the first place, of lesions of functions, which he divides 
 into lesions of sensation and lesions of motion ; secondly, he speaks of 
 pains, of which he admits only one kind ; finally, he treats of vices, 
 which he distinguishes into vices of the body and vices of excretions. 
 This, it is seen, is an entirely new and very defective classification. AYe 
 have alluded to this book, less on account of its intrinsic value, than as 
 a first step in an unexplored route, where a new era in nosography begins. 
 The author does not class pathological affections according to the pre- 
 sumed state of the interior of the body, i. e., according the intimate 
 phenomena which are fulfilled, or are supposed to be fulfilled in the 
 structure of the organs, but according to the totality of their apparent 
 symptoms. 
 
 CHAPTEE VI. 
 
 INTERNAL THERAPEUTICS. 
 
 Everything in Medicine is connected, or should be connected with 
 therapeutics. Ars medica est id quod est propter thernpeuticen : such 
 is the maxim that should never be lost sight of by men who write on 
 
 *"' J. Fernelli, Pathologiae, lib. v, cap. x. 
 
 f Praxeos sen de Cognoscendis, Curandis Affectibus Humani Incommodantibus 
 Tractatus, Basilce, 1602.
 
 INTERNAL THERAPEUTICS. 309 
 
 any branch of the Healing Art. Anatomy, physiology, pathology, etc., 
 must all converge toward therapeutics as a common center. Each of 
 these has an eifective value only in proportion to the succor it gives in 
 the treatment of diseases. This is a truth which needs no demonstra- 
 tion — it is barely necessary to announce it ; nevertheless, it has been 
 forgotten or mistaken sometimes, by eminent minds. We see the ultra 
 sectarians of the autocratism of nature, or animism, make the perfection 
 of the Art consist in the knowing in advance and predicting the course, 
 crisis, and probable issue of a disease, limiting, to some extent, the 
 duties of the physician to the idle contemplation of the sufferings of 
 the patient. We see the blind partizans of another school attach such 
 a high interest to the determination of the anatomical lesions whose 
 traces are seen after death, that they lose sight of the treatment, or say 
 a word about it, for form's sake, and occupy themselves exclusively 
 with the alterations observed in the dead body. It is to the zealots of 
 this school that the sentence of Asclepiades may be justly addressed : 
 " Your Medicine is oaly meditation on death." 
 
 What are, in the eyes of men matured by practice, and undeluded by 
 the pompous promises of anatomism, what are, 1 say, diagnosis and 
 prognosis, if their light does not serve to improve treatment and render 
 it more efficacious '? For the true practitioner, as well as for the patient. 
 therapeutics is the cap-stone of the Science, the criterion of the real 
 progress of the Art. On this point it merits a very particular atten- 
 tion, and the details into which I proceed to enter on this subject, will 
 interest, I presume, those readers who seek in this history something 
 more than the vain satisfaction of curiosity. 
 
 The epoch of the revival of letters forms, as is shown, the limit 
 between the middle ages and modern times. The physicians of that 
 famous epoch attempted less to create new methods of treatment, than 
 to restore the ancient ones ; they attempted to conciliate the Greeks 
 with the Arabs ; Galen with Avicenna, and to study their writings is 
 to converse still with the classics of antiquity. It will be, then, a last 
 glance which we proceed to take of the doctrines of the fathers of Med- 
 icine — a definite judgment which we shall render on the rules they have 
 transmitted to us, before passing to the changes that the moderns have 
 thought it their duty to make. 
 
 Among the writers of the Erudite Period who have shown themselves 
 zealous partisans of the Greek theories, no one has better penetrated 
 their spirit than John Fern el, no one has succeeded better than he, to 
 attach to them the practical facts of his times ; no one, in fine, has con- 
 nected with as much art as he the ancient theories with modern dis- 
 coveries, so as to form a complete body of doctrines, and develop clearly
 
 310 ERUDITE PERIOD. 
 
 the principles for the guidance of his cotemporaries in the treatment of 
 diseases. It will be, then, in his writings that we obtain the knowledge 
 of these principles, and the consequences that were deduced from them. 
 
 Fernel has divided his therapeutics into seven books, the same as his 
 pathology, following in the two treatises an analogous if not uniform 
 plan. He explains, in the first place, the generalities, or as was said 
 then, the principles ; afterward, he passes to the particular rules of 
 practice, and he shows how each of them is comprised in the principles 
 he has established. Ee proceeds constantly from generals to particu- 
 lars, according to the method of Aristotle and Galen, to which he 
 strictly conforms, true Peripatecian as he was. 
 
 Fernel commences by laying down the fundamental axioms of thera- 
 peutics, the pivot around which must turn all the particular rules of 
 treatment, which axiom was nothing else than the famous law of con- 
 trarieties, which we have already brought before our readers and dis- 
 cussed, but which we have promised to submit anew to a more thorough 
 examination. The time has now arrived to devote ourselves to this 
 examination, because no author, ancient or modern, has supported this 
 great axiom with as numerous, subtile, and specious arguments as ker- 
 nel. He opens the subject as follows: '' Every disease must be com- 
 batted hj contrary remedies — for a remedy is that which can drive out a 
 disease ; now, that which drives, acts violently — that which uses vio- 
 lence, is in opposition : therefoi-e, the remedy is always opposed to the 
 disease, and no healing can take place except in virtue of the law of 
 contraries."" 
 
 This argument, notwithstanding its apparent precision and its scho- 
 lastic form, is evidently a begging of the (juestion. It amounts to this : 
 diseases must be combatted by their contraries, since all that cures a 
 disease is contrary to it. But is it not plain that he offers as a reason, 
 and alleges as proof, the veiy thing itself which he undertakes to prove ? 
 It is affirmed that all that cures a disease is contrary to it, and that is 
 really what should be proved. This reasoning reminds us very much of 
 that which a celebrated comic poet puts sometimes in the mouths of his 
 characters, as, for example, when he makes one of them say, " your 
 daughter is dumb because she does not speak. '"f Such is the sophism 
 with which one of the loftiest intelligences of the sixteenth century 
 deceived himself, and imposed on the whole Medical world I 
 
 Fernel, however, did not content himself with the subtile and arid 
 
 'Joanis Feruelii, Theraj^euticus Universalis, sen Method! Medendi, lib. i. 
 cap. HI. 
 
 f Moliere, dans la Comedie du Medecin malgre lui.
 
 INTERNAL THERAPEUTICS. 311 
 
 argumentation which we have given above. He knew too well, that a 
 rule of medicine must be verified, especially, by practice, consequently, 
 he essayed to demonstrate that each particular case of healing enters, 
 necessarily, into the law of contraries. Let us follow him as he devel- 
 opes this law. We call contraries, he says, not only those things which 
 are endowed with opposite elementary qualities, as heat and cold, dry 
 and wet, but also, all things which differ among themselves in any way, 
 whether as to quantity, number, situation, figure, etc. Thus, the hard 
 and the soft ; the dense and the difi"use ; the great and the small ; that 
 which is in excess, and that which is deficient ; the high and the low ; 
 the full and the empty ; what is pure, and what is impure ; that which 
 is entire, and that which is broken ; such as these are what Fernel 
 understands as contraries. 
 
 The above is an example of the puerile subtilties into which a supe- 
 rior mind is forced to descend, when it proceeds upon a false principle. 
 According to the language of Fernel, a drop of water would be the oppo- 
 site of a lake; a giant the opposite of a dwarf; a pitcher empty, the 
 opposite of a full one ; a mountain the opposite of a valley, etc. Who 
 does not see, at the first glance, that these are the opposites of the 
 painter, the poet, or the rhetorician, or, in other terms, contrasts ; but 
 not at all real opposites, founded on the antagonisms of forces, or ele- 
 mentary properties, according to the understanding of physicians, phi- 
 losophers, and mathematicians ? In the language of these, the term 
 contrary is applied either to qualities which neutralize each other, 
 such as heat and cold, dry and moist, or to forces which act in a manner 
 diametrically opposite, such as the south and north wind, and the cen- 
 tripetal and centrifugal forces. 
 
 In giving to the word contrary, the unlimited extension of our thera- 
 peutist, we make it the synonym of the word different, but then the 
 famous precept to treat diseases by contrary remedies, signifies nothing 
 else than to treat them by remedies which differ from the disease itself, 
 or its cause, which amounts almost to nonsense. Such an axiom is not 
 worth the trouble of being laid down, and certainly this is not the sense 
 which the early writers, such as Hippocrates, Galen, and their innu- 
 merable ancient and modern sectators attach to it. When these advised 
 to give in each affection remedies contrary to the disease, they meant 
 remedies whose properties or curative virtues would be in opposition, 
 real or direct, with the hidden cause or principle of the disease. It 
 results from this, that Fernel, in order to justify his fundamental dogma 
 of medical practice, is obliged to torture the sense of words, after hav- 
 ing tortured logic. 
 
 Moreover, notwithstanding the exorbitant extension which was given
 
 313 ERUDITE PERIOD. 
 
 to the word contrary, this author still fearing that his therapeutical 
 axiom did not embrace every possible case of cure, hastens to go beyond 
 all the doubts and objections that could be given to it by the following 
 interpretation: " Many men conceive that this sovereign principle is 
 annulled, when it is said, that there are diseases which are cured by 
 similars : but these persons do not reflect that such remedies, though 
 apparently similar in their effects, to the symptoms of the disease, are 
 opposed to the causes which produced it, so that they destroy the disease 
 by removing its cause ; thus, rhubarb, though heating, extinguishes 
 fever by purging the matter which feeds the fire. Exercise fatigues us 
 by aiding the elimination of the humors efi"used into the muscle. A 
 purgative arrests a dysentery by evacuating the peccant matter, which 
 causes, and sustains it.'- 
 
 Certainly, Fernol has interpreted the axiom of contraries in a way 
 so wide and flexible, that it is impossible to suppose a case of cure which 
 is not comprised in it. Order whatever remedy you please ; employ any 
 curative procedure of which you may get an idea ; if the remedy or pro- 
 cedure is successful, according to Fernel, it will be always on the prin- 
 ciple of contraries, even if there should be identity between the cause 
 of a disease and the means of cure ; as when we cause the pain in a 
 small burn to cease, by heating the burnt part for an instant at the fire ; 
 or when the frozen fingers are warmed by rubbing them with snow. 
 
 But let us leave these vain artifices, which have not caused ancient 
 science to advance an iota, and let us explain how it happened that so 
 many eminent men, with their light, could content themselves with it, 
 during a long series of ages. In clearing up this psychological phe- 
 nomenon in one single individual, we do it for all. Feruel possessed a 
 mind essentially logical. Before embracing the profession of medicine, 
 he was distinguished by his discoveries in mathematics and astronomy. 
 When he emitted a principle which he believed well founded, he pushed 
 it to its last consequences, as do all minds of his stamp. Now, in his 
 philosophical and medical education he had acquired a great veneration 
 for the ancients ; he could not persuade himself that a principle adopted 
 almost unanimously by the most sublime geniuses of antiquity — by 
 Hippocrates, Aristotle, Galen, and so many others — as the basis of phy- 
 sics and medicines could be false. To doubt the infallibility of the 
 axiom of contraries, was to sap the foundation of the elementary theory 
 of Plato and Aristotle, as well as the thereapsutics of Galen. A single 
 man was not capable of so grand an effort : it required generations for 
 that, as the result of this history shall show. Fernel admitted, then, 
 
 '^ Method! Medendi, lib. i, cap. ii.
 
 INTERNAL THERAPEUTICS. 313 
 
 the principle of contraries, as an article of faith ; in place of discussing 
 it with complete independence of mind, he exerted himself, only, to seek 
 arguments to convince himself and others of its reality. Could he 
 foresee that before an age this famous law of contraries, by which 
 physicians and natural philosophers explained at that time the phe- 
 nomena of nature, would be banished from the domain of physics and 
 chemistry, and replaced by the law of affinities ; in other words, that 
 thereafter the composition and decomposition of bodies, their formation 
 and their destruction, would only be explained by the affinities more or 
 less great of their material elements ? Could he presume that experi- 
 mental analysis would be substituted by the chemists, at a future time, 
 for the mental analysis of the philosophers ; that the number of elements 
 would increase in a manner indefinitely, and the qualities of the ele- 
 ments would no longer present the pretended antagonism imagined by 
 the ancients ? Fernel, then, had only to believe and repeat an old error 
 which time had sanctioned, and which seemed to preclude all discussion ; 
 but he had the advantage over most of those who professed the same 
 faith with him in medicine, of endeavoring to sound to the bottom of 
 science, and of seeking to strengthen his faith by proofs, which, in 
 their turn, have furnished us the occasion to refute him. 
 
 OBJECTION. 
 
 If you overturn, say some, the fundamental dogma of ancient thera- 
 peutics, if you pretend that remedies do not cure diseases by properties 
 contrary to them, then say by what virtue do they cure: is it by prop- 
 erties similar to those of the morbific cause, or solely diverse? For 
 remedies can only act in three ways — by antipathy, homoeopathy, or by 
 some virtue which may be neither antipathic nor homoeopathic, but only 
 different, that is to say, allopathic. Which one then, of these three 
 modes of action, must we choose, in the treatment of diseases ? 
 
 An ancient author, whose authority I have often invoked, answers for 
 me this question. We read in the Hippocratic treatise on Ancient 
 Medicine: "diseases are cured sometimes by contraries, sometimes by 
 similars, and sometimes by remedies the action of which is neither con- 
 trary nor similar, but operate in an inexplicable manner. There is no 
 fixed rule on this subject." 
 
 The author of the treatise " On Diseases," professes the same opinion 
 as the above: "there is," he says, "no manifest principle of cure that 
 may be properly termed a universal principle for every case to which 
 our Art is applicable." - 
 
 If there is no fixed rule, then, replies our censor. Medicine is not an 
 
 ^ Traite de 1' Ancienne Medecine, liv. i. § ii, translation of Gardeil. 
 
 20
 
 314 ERUDITE PERIOD. 
 
 Art, and the treatment of diseases is subject to the caprices of the phy- 
 sician ; and their cure depends entirely on chance, not on the observation 
 of rules. 
 
 This is a grave accusation, and one which has rested for a long time 
 against Medicine. My confreres, I presume, will not be angry, if I make 
 a peremptory response to it. Before there were any physicians, and 
 before any discoveries had been made of the properties of any medica- 
 ment, how were the sick treated ? Every one treated them according to 
 his fancy or instinct, or they had the counsel of some neighbor or passer 
 by, who knew no more about it than they, not having, himself, any other 
 guide than a very questionable experience. But when the efficacy of 
 certain remedies had been established by repeated trials in certain dis- 
 eases, thereafter they did not fail to administer the same remedies when- 
 ever the same diseases were presented. The number of known diseases 
 and remedies then experimentally ascertained, being very much increased 
 in the course of ages, men made a particular study of them, and col- 
 lected their knowledge in a body of doctrines. Then Science and Art 
 were constituted, and then only they began to reason on the essence of 
 diseases, and the mode of action of remedies. This reasoning might 
 possibly contribute to the perfection of the science, but it did not consti- 
 tute it, nor form its base. The true foundation of practical j\Iedicine 
 was, and still is, observations, collected from age to age, from which it 
 results, that such a mode of treatment cures, or relieves, such a species 
 of disease more efficaciously than any other known means. If, now, it 
 is asked, in virtue of what rational principle the practitioner is sup- 
 posed to act, when he rejects the action of contraries, and the action of 
 similars, it will be easy to respond — in virtue of that incoutestible and 
 incontested principle, that diseases must he treated hy remedies which 
 have heen experimentally recognised as the most e^cacious. 
 
 What more can be required of a physician who is called to see a 
 patient, than that he discern clearly the affection before him, and bring 
 to bear all the light that commemorative and present circumstances can 
 furnish him, and that he then employ the curative means which the 
 observation of all ages, deposited in the writings of the masters, and 
 confirmed on suitable occasions by his own experience, demonstrates to 
 possess the most efficacy in such a case. This is all that can be 
 demanded of a physician, and it is of little import to the patient whether 
 he is cured by antipathy, homoeopathy, or allopathy : the essential thing 
 for him is, to be treated by the method which experience has proved to 
 be the best. 
 
 Thus, then, in reversing the dogma of co7itraries, we do not sap the 
 scientific edifice of Medicine, nor do we bi'eak the chain of tradition ; but
 
 INTERNAL THERAPEUTICS. 315 
 
 we restore tlie practice of medicine to its real basis, experience, and iu 
 this way go back to the primitive traditions, whicb the fictions of the 
 philosophers had obscured. In this system — for Empiricism is one, and 
 even the most rational, as will appear more and more, in proportion as 
 we shall advance in this history — in this system, I say, we do not com- 
 mence the science with Hippocrates, Diodes, Hcrophilus, Serapion, or 
 any other celebrated physician, but we begin with the origin of time. 
 Neither does this system conduct us to the following conclusion of a 
 distinguished professor of the school of Paris, which I have read with 
 alarm, and which he has let fall from his pen, doubtless, by inadvertence : 
 " Bichat has very well established," says this professor, " that all the 
 systems of pathologj- have influenced therapeutics, and as these systems 
 were often tarnished with error, the therapeutics, which were only a con- 
 sequence, and, as we may say the conclusion of them, must be equally 
 false, bad or injurious. It is a great misfortune, certainly, but it was 
 inevitable, and it will recur unceasingly, until the time when we shall 
 have ideas that are perfectly correct, on the nature of diseases ; and not 
 treat diseases without having regard to their nature, which is as absurd 
 as it is impossible."" Empiricism conducts, logically and historically, 
 to the following conclusion, which is less absolute and more consoling 
 and true : The knowledge of physicians in former times was very imper- 
 fect, yet they knew how to cure certain diseases, Now, we know a 
 greater number less imperfectly, and we have still more extended knowl- 
 edge of the means for their cure ; and those who shall succeed us will 
 have still more extended and sure means than ours. According to this 
 doctrine, we do not say oui- predecessors had only false ideas on the 
 nature of diseases, that is to say on the totality and corelation of their 
 phenomena ; but we say, our predecessors had notions more limited 
 than ours, on the nature of diseases ; and in proportion as the human 
 race shall improve, it is probable that the notions acquired will be 
 extended and perfected more and more, for each day we discover new 
 phenomena in the diseases already observed, and new means of curing 
 them, or to prevent some of their symptoms. 
 
 There exist, then, and there have existed from time immemorial, 
 rules of medical practice, founded on the pure and simple observation 
 of phenomena, independent of all interpretation, true or false, judicious 
 or extravagant, of those phenomena ; in other words, free from all specu- 
 lation on the essence of diseases, and on the intimate action of remedies. 
 These rules are not unchangeable, but they change and improve in pro- 
 portion as, by more careful and delicate observation, new objects are 
 
 Bouillaud, Essai de Philosopliie Medicale, 3e partie, chap, vi, art. 1.
 
 316 ERUDITE PERIOD. 
 
 discovered, iinperceived or neglected heretofore. Nor are rules arbi- 
 trary, for they must have been sanctioned by experience. Those who 
 conform to them cannot be accused of acting in a hazardous manner, 
 because they know, in advance, the probabilities of success they offer, 
 and their therapeutics cannot be charged with being bad or injurious, 
 because it is the best and the most successful known at the time. 
 
 I had terminated my refutation of the axiom of contraries, when I 
 read in the translation of the works of Hippocrates by M. Littre, an 
 extract from a work published in Germany, on the same subject. As 
 we cannot have too much light on these subjects, when it is a cjuestion 
 of condemnation of an opinion almost universally embraced by antiquity, 
 and sustained to our day by respectable authorities, I have been 
 charmed with the reading of this work, which arrives at the same con- 
 clusion as my own, though elaborated in a different way, and presented 
 under another color. I give the remarkable fragment as M. Littre has 
 reproduced it, and I hope it will afford the same pleasure to my readers 
 as to myself: "We think we are able to sustain," says M. F. "W. 
 Becker, " that the hypcnantiose, or the principle contraria contrariis 
 curantur, does not rest on experience, free from hypothesis — that it 
 originated in the mechanico-chemical manner, in which life was sup- 
 posed to exist, and thus it falls with this view. When an opposition 
 seems to exist between a disease and the remedy, it is only in appear- 
 ance, and not in reality. We propose to establish this by examples 
 drawn from the different methods : 
 
 " We observe that an indisposition produced by a surcharge of the 
 stomach is cured by dieting ; that a disease of the skin produced by 
 uncleanliness, is cured by bathing ; that a man fatigued by excessive 
 efforts, is refreshed by repose. At the first glance it certainly seems, 
 that there is, here, an opposition between the disease and the treat- 
 ment ; but, in fact, the cure is the result, not of a veritable opposi- 
 tion, but of the removal of the cause which produced the evil, or 
 aggravated it, and of the restoration of the organism to a condition 
 favorable to the exercise of its recuperative powers. 
 
 " We see, also, that the end of the treatment is obtained by arousing 
 or re-exciting, by external means, the diminished or suspended function : 
 constipation is cured by evacuants ; atonic ulcers are put in the way of 
 cure by exciting ointments ; a fever, with a small pulse, is cured by the 
 use of wine, which excites a fullness of the pulse. These are some of 
 the phenomena which have been brought forward to prove the principle, 
 contraria contrariis curantur. But it is easy to prove that in any one 
 of these cases, or in others to which the method termed excitant is 
 applied, the vital activity is not absolutely augmented. All these
 
 \ 
 
 INTERNAL THERAPEUTICS. 317 
 
 modes of treatment are not founded on tlie opposition of the medica- 
 ment to the disease, but on the result of experience — particular and 
 very important physiological results, namely, that the organism, when 
 an action is excited in it, produces, at the same time with this action, 
 and on account of it, similar or identical actions. It seems, that when a 
 function is morbidly increased, the cure must be sought in the diminu- 
 tion of that activity ; and it is pretended that there is hypenantiose in 
 such a case. But the functions, in such a morbid state, are the objects 
 of a depressing, sedative treatment, not because they vary from the 
 laws of health, but simply because they become the occasion of other 
 morbid states, which menace the organ, or the organism. We do not 
 arrest a diarrhea with opium because the intestinal evacuations are 
 more frequent or more abundant than in a state of health, (for many 
 diarrheas may be left to the control of nature, and some are even 
 treated by purgatives,) but we give opium in the case when we have 
 reason to fear the prolonged evacuations may determine an inanition, or 
 the exhaustion of the entire organism. We do not prescribe digitalis, 
 which reduces the pulse, because the pulse is frequent, (for in every 
 accession of fever, when the pulse is no less frequent, we do nothing for 
 the symptom,) but simply in cases where the shock of the blood excites 
 the fear of a derangement in the movements of the li(|^uid, or in the 
 texture of the heart, vessels, or lungs. 
 
 " Besides the three classes of curative methods indicated thus far — 
 dietetic, excitant, and sedative — all of which have a direct relation to 
 vital activity, there are still two others, namely, those which act 
 immediately on the mass and the movement of the blood, (as emission, 
 infusion, transfusion, haemostasis, ligation, etc.,) and those which 
 change the form of the solid parts, as surgical operations. To these 
 two classes, the principle contraria, etc., is as little applicable as to 
 the preceding ones, and we have always particular ends in view, which 
 are attained by the immediate action, on the liquid or solid substances 
 of the organism. 
 
 " If, then, contraria contrarns curantur is not founded on pure 
 experience — if it has the appearance of truth only in the eyes of those 
 who mistake the true connection between a disease and its cure — how 
 is it, that this principle, which has been so universally recognized, from 
 the ancients down to Paracelsus, has, notwithstanding its victorious 
 refutation by reformers of past times, assumed again an authority so 
 general ? We think the reason may be found in the necessary connec- 
 tion in which hypenantiose stands, as a therapeutic principle, with the 
 mechanical and chemical manner in which most objects in physiology 
 and pathology are represented. This mode of representation, though
 
 318 ERUDITE PERIOD. 
 
 refuted in different ways, in its primary and grosser forms, and replaced 
 by organic Medicine, is still frecjuently reproduced in medical history, 
 in other forms, less definite, and, it appears, more scientific. The h pen- 
 antiose which constantly accompanies it must maintain an extraordinary 
 influence, and we are led to think, that this influence will be abolished, 
 only when it shall have been understood what is the subordinate rank 
 which mechanics and chemistry hold in physiology." '■■■■ 
 
 Another reason why the principle, contraria contrariis curantur, 
 preserved, and still preserves much of its authority, notwithstanding 
 its more or less victorious refutation at different times, arises from the 
 fact that its adversaries have substituted nothing which can take its 
 place. Now, in a science of daily and urgent application, like Medi- 
 cine, it does not suffice to prove that a doctrine is doubtful, or false, or 
 incomplete ; it is necessary at once to present in its stead one surer, 
 truer, and more general ; this is what no one has yet done, not even the 
 author of the extract I have just quoted, who thinks that the hypenan- 
 tiose will not lose its influence until it shall be in accordance with the 
 subordinate rank that mechanics and chemistry hold in physiology, 
 which is probably to await the coming of the Greek Kalends. The 
 animists, vitalists or modern Hippocratists, have attempted to substi- 
 tute for the axiom of contraries that of coction and crisis, or the auto- 
 cratism of nature ; but we shall demonstrate, in the next period, that 
 the theory of the autocratism of nature is very far from embracing all 
 cases of cures, all modes of treatment, and we shall then propose 
 another therapeutic axiom, more sure, more evident, and more general 
 than any of those that have been proposed up to this time. 
 
 After this somewhat long, but necessary digression, in view of the 
 importance of the subject, I return to the examination of the therapeu- 
 tic doctrine of Fernel. The second precept which this author gives, 
 relates to expectorant medicine, which seems to me is worthy of all 
 approbation, as it circumscribes the employment of that method within 
 just limits. When a disease, he says, is not well known to you, and 
 you do not see clearly its nature, do not be in haste to apply remedies ; 
 let nature conduct the case for a season if there be no urgency, for 
 nature, aided by a suitable regimen, will cure the affection, or declare 
 its true character. A doubtful and vain medication is nearly always 
 injurious. In fine, if you are forced to attempt something, do it with 
 circumspection, in such a way as not to cause a grave prejudice to the 
 patient. 
 
 '■' Berliner Med. Zeitung, 1834:, p. 15. CEuvres Hippocratiques, T. IV, de M 
 Littre, p. 520. Aphorismes, Argument, § 13.
 
 INTERNAL THERAPEUTICS. 319 
 
 Another recommendation on which Fernel insists very much, is, to 
 endeavor to destroy the cause or causes of any disease, before attacking 
 the disease itself. This recommendation forms one of the capital 
 points of his therapeutic doctrine, and he sustains it by considerations 
 that may be thus summed up : While the cause of a disease exists, the 
 affection derived from it can not be completely uprooted — it recurs 
 unceasingly ; on the other hand, after the extirpation of the cause, the 
 disease will often cease of itself, unless it be too inveterate. Again, it 
 must be remarked that there is, in certain affections, not a single cause, 
 but a series of causes, which it is necessary to destroy successively, 
 according to the order of their development, that is, to commence with 
 the first, or oldest, and finish with the last, or most recent. This, 
 exclaims Fernel, is what is termed a methodic cure, a cure which does 
 not consist simply in the employment of such or such a remedy, but 
 also in the manner and order of proceeding." 
 
 He quotes, in the same chapter, several examples of this curative 
 method, from among which I extract the following, which is one of the 
 most simple. Suppose that by prolonged use of a diet too heating, 
 there should be formed in the stomach an acrid chyle, which, carried to 
 the liver, creates there an excessive quantity of bile and vicious humors. 
 These, after having passed from the great veins into the less, are easily 
 vitiated, and give rise to all the symptoms of fever. Now it is certain 
 that we can not calm the symptoms of this fever without having previ- 
 ously evacuated the putrid matter which gives rise to it. To eliminate 
 properly the putrid matter, it is necessary to commence by drying up 
 the source whence it flows ; that is to say, the excess of bile and vicious 
 humors engendered by the liver. Finally, this excess of humors being 
 due to an impure chyle formed in the stomach, it follows : first, that we 
 must suppress the evident causes that give rise to the formation of bad 
 chyle, in other words, change the heating diet ; second, purge the mass 
 of vicious humors arising from the putrid matter; third, evacuate 
 this ; fourth, and lastly, suppress the excess of unnatural heat, if it 
 still remains, whether in the liquids or solids. 
 
 AVhat a chain of causes to follow, and how many indications to ful- 
 fill in the cure of a simple fever ! What would it be when one had to 
 treat a somewhat complex disease, or a complication of several diseases ? 
 How could we untangle the inextricable interlacement of causes inac- 
 cessible to observation ? To return to the example cited by Fernel, I 
 will ask, by what kind of investigation is he assured that the symptoms 
 of a simple fever are due to that series of intimate causes or phenomena 
 
 ^ Method! Medendi, lib. i, cap. iv.
 
 320 ERUDITE PERIOD. 
 
 which he paints as if he had seen them ? Did he follow the course and 
 development of these phenomena in the interior of the living economy, 
 or at least, did he find the incontestable traces of them on the cadaver ? 
 Not at all. Some ancient physiologists had figured to themselves that 
 these things occurred thus, and those who followed them were contented 
 with this explanation, having none better to offer. In this way has the 
 doctrine of occult causes and the essence of things been sustained. 
 This doctrine was generally admitted, because it emanated from the 
 reigning philosophy, as we have already shown, and because it flattered 
 the pride of the human mind. Indeed, it seems to initiate us into the 
 most intimate mysteries of the animal economy ; but in reality, it offers 
 us nothing but fictions. 
 
 In the above example Fernel considers only a single order of causes, 
 while in his pathology he admits, truly, a frightful number of them. 
 There are, he says, according to the philosophers, four sorts of causes, 
 viz: the material, the formal, the efiicient, and the final. The human 
 body is the material cause of all diseases ; that is to say, the subject in 
 which our diseases necessarily reside. The appearance under which a 
 morbid afifection presents itself, the form with which it is clothed and 
 which determines its species, is its formal cause ; the end towards which 
 it tends is its final cause, and this end can only be suffering or death. 
 Finally, the efficient cause of a disease, that which it most imports the 
 physician to understand, is nothing else than the force which modifies 
 the body and causes it to pass from the state of health to that of dis- 
 ease. The author afterwards divides the causes in several other ways, 
 which would be too long for me to enumerate, and I shall only report the 
 subdivisions of the most important of all — the efficient cause : 
 
 1. The efficient cause is divided into congenital and accidental. 
 
 2. The congenital is either natural or unnatural. 
 
 3. The accidental may be exterior or interior. 
 
 4. The interior accidental is divided into antecedent and continent. 
 
 5. The efficient cause produces its effect sometimes immediately, that 
 is to say, by itself; sometimes in a consecutive manner or by accident. 
 
 6. Finally, the efficient cause is divided into the principal, adjuvant 
 and indispensable. For example, when we administer a drastic, the 
 principal efficient cause of the purgation is the purgative virtue of the 
 medicament ; the adjuvant are the various substances that are added to 
 the principal medicament — the preparation to which it is submitted ; the 
 indispensable is only the natural heat of the body, without which the 
 virtue of the remedy is inoperative." 
 
 * PatliologiEe, lib. i., cap. xi. et xn.
 
 INTERNAL THERAPEUTICS. 321 
 
 What a rigmarole ! Does it not seem as if they had undertaken the task 
 of surcharging science with idle considerations, so as to render it unintel- 
 ligible and ridiculous ? Unfortunate were those patients, who fell into 
 the hands of recent graduates, from whose minds clinical experience had 
 not yet removed the jargon of the schools ! What may be said most 
 favorable of the physicians of those times is, that they soon unburdened 
 themselves in the presence of their patients, of their theoretic baggage, 
 and contented themselves with treating each case of disease with reme- 
 dies that had succeeded best in analogous cases, without troubling them- 
 selves with abstruse questions in regard to their pathogeny. They 
 reserved this pretended scientific lumber for the official dissertations of 
 the schools or for books. In short, we can only justify the medical prac- 
 tice of past ages in the eyes of the present generation, by admitting that 
 these physicians followed, in their treatment of diseases, not the illusory 
 indications of physiological theories, but the positive facts of a rational 
 empiricism. 
 
 Fernel reduced to three genera all methods of medication ; namely : 
 first, evacuate the excedent of the humors ; second, purge, or in other 
 words, purify the humors ; third, alter, that is, restore to the normal 
 state, the parts which have been vitiated in their temperament or their 
 composition. He examines in detail the efi'ects of each of these plans of 
 treatment, and the various modes of instituting them. 
 
 ON EVACUATING MEDICATION. 
 
 There are two modes of evacuation, says Fernel, the one general, the 
 other particular. The first mode draws the humors from all parts of 
 the body, as the sweat, sanguineous emissions, vomitings, and alvine 
 dejections. Vomiting, for example, discharges first the stomach, then 
 the larger veins, afterwards the veins of small calibre, finally, the whole 
 body. The sanguine emission empties at first the veins and the arteries, 
 which anastamose with them ; lastly, the mass of the body and the vis- 
 cera. Perspiration evacuates first the mass of the body ; next, the great 
 veins and arteries ; finally, the viscera and deep-seated parts.'-- 
 
 A particular evacuation is that which relates to a special region or 
 organ. Thus, the excretions of the nose and palate relieve the brain 
 only ; cough and expectoration, the lungs and chest. So the rectum is 
 relieved by a hemorrhoidal flux ; the uterus, by the menses ; the kidneys, 
 by the sand or the pus mingled with the urine ; the belly, by a clyster 
 or a supository ; the whole superfices of the body, by a cutaneous erup- 
 tion. An artificial issue may be placed in any region whatever.f 
 
 '•' Method! Medendi, lib. ii., cap. ii. f Loc. cit.
 
 322 ERUDITE PERIOD. 
 
 Of all artificial evacuations, that of phlebotomy is the most powerful, 
 according to Femel, because it withdraws the venous blood, which con- 
 tains the four principal humors — the bile, pituite, atrabile, and the 
 pure or impure blood. It is applicable in all cases of plethora, either 
 simple, or accompanied by cacochymy. The author raises apropos to 
 blood-letting, the following questions: What are the immediate and 
 secondary cfi"ects of blood-letting ? How does it operate — by revulsion, 
 or derivation? What are the diseases which claim its employment? 
 Is it more advantageous before or after the invasion ? What vein is it 
 best to choose in a given case ? What is the utility of a spontaneous 
 sanguineous discharge ? What are the indications for blood-letting, and 
 of the quantity to be drawn ? At what period of the disease, or on what 
 day, and at what hour, is it best to practice phlebotomy ? How shall 
 the patient be prepared for it ? How must the physician act, before and 
 after the operation ? 
 
 DEErVATION AND REVULSION. 
 
 The question of derivative and revulsive bleedings has been a matter 
 of controversy, for a long time, among physicians, but it has lost much 
 of its interest since the discovery of the circulation of the blood. At 
 this time the words derivation and revulsion are indifferently employed, 
 or rather, between the two there is only an insignificant shade of difier- 
 ence. The veritable demarkation between derivative and revulsive blood- 
 letting, says M. Guersant, Sr., is a scholastic subtilty, which originated, at 
 first, among the Dogmatists, who departed more and more from the obser- 
 vation of nature. A little further on he adds, "these distinctions 
 between derivation and revulsion, are purely systematic and abstract, 
 and do not rest on any positive differences. We cannot even admit an 
 essential difference between words which, having the same etymology, 
 must be regarded as synonymous. "••' The ancients, on the contrary, 
 attached to these words very distinct significations, founded on the 
 errors in anatomical and physiological science, which time has since 
 corrected, but of which it is necessary to have a notion, in order to 
 conceive of the importance which they put on the distinction of these 
 two things, and the history of their long disputes on the subject. 
 
 Hippocrates and Galen had given the precept to bleed largely from 
 the arm, on the diseased side, in pleurisy and peripneumonia. They 
 directed, even, that the blood be permitted to flow till syncope was pro- 
 duced. That practice was gradually abandoned, when the sound tra- 
 ditions of Greek Medicine began to be lost sight of ; finally, the Arabs 
 substituted for it one entirely opposite ; they prescribed pricking slightly 
 
 * Dictionnaire de Mcdecine, in 21st vol., at the word Derivatiox.
 
 INTERNAL THERAPEUTICS. 323 
 
 the vein of the foot, to let the blood flow drop by drop. Their method 
 prevailed throughout Europe, until the commencement of the sixteenth 
 century ; then, a pleuritic epidemic having appeared several times in the 
 capital of France, a physician of Paris, named Pierre Brissot, distressed 
 to see the most of his patients perish, and encouraged also by reading 
 the Greek authors, dared to revive their practice. The success he 
 obtained filled him with enthusiasm ; he hastened to publish it, and 
 proclaimed boldly the superiority of the method of Hippocrates to that 
 of Avicenna.="= 
 
 This created a great uproar in the medical world. The innovation 
 found partisans and adversaries, equally bitter. The dispute grew 
 warm ; on both sides learned papers appeared, which gave no new light, 
 and persuaded no one. The Arabists clamored that they were slan- 
 dered, and that the other side was heretical, so that but little was 
 wanting in Spain, to invoke the auto-da-fe for the defence of the Arabic 
 method. Nevertheless, the contrary method triumphed, less, perhaps, 
 because clinical observation sustained it, than because the fashion 
 changed from Arabia to Greece. However this may have been, the 
 question was nearly settled at the epoch when J. Fernel wrote ; but it 
 was not extinct, and preserved something still of its vitality. On this 
 account he discusses it very thoroughly, and conformably to the ideas of 
 the times. I will now give the substance of what he says on the subject : 
 "When the blood makes an irruption on any part, the promptest means 
 to repress its impetuosity consists in evacuating it in an opposite direc- 
 tion, from the most distant point possible ; in other words we must ope- 
 rate by revulsion ; for the most natural course of the humors is in a 
 direct line, especially in the veins, whose longitudinal fibers have the 
 property of attracting the liquids. jSFow, the veins of all the right side 
 of the trunk are continued into the right arm, and the veins of the left 
 side into the left arm. Thus, then, in pleurisy and pneumonia, we must 
 open the vein in the diseased side, as taught by Hippocrates, as well as 
 by reason. In hepatitis the bleeding is always from the right arm. 
 
 It is not the same for the pelvic members ; they, being in direct com- 
 munication with each other by their veins, when there is an inflamma- 
 tion in the right leg, the revulsion must be made by bleeding in the left 
 foot and vice versa. 
 
 Derivation is effected by attracting the humor toward a point near the 
 affected part. To accomplish it, that vein is opened which communicates 
 
 •' Apologia qua docetur per quae loca sanguis mitti clebeat in viscerum inflam- 
 mationibus, praef. in pleuritide. Paris, 1525, 4to.
 
 324 ERUDITE PERIOD. 
 
 with the point itself, and we thus direct to the orifice sometimes 
 the nutritious juice, and sometimes the bad humor that keeps up the 
 disease. Then the excess of humor, running off at the opening estab- 
 lished, relieves very much the diseased part, especially if care be taken, 
 previously, to moderate the impetuosity of the fluxion by a revulsive 
 bleeding. But if the engorgement is such that the humor can no longer 
 flow, which happens in inveterate inflammations that turn into scirrhus, 
 derivation must be attempted, not by phlebotomy, but by fomentations, 
 emollient plasters, and digestives. ■■■= 
 
 From the errors, obscurity, and anatomical nonsense disseminated in 
 this chapter of Fernel, we can judge that the question of revulsive and 
 derivative bleedings was far from being clear at an epoch when it was 
 thought to have been entirely resolved. We see here, also, an example 
 of the facility with which the most sagacious minds satisfied themselves 
 with explanations where they knew absolutely nothing. 
 
 Fernel speaks, in the same book, of the efi'ects of local blood-letting, 
 which is effected by leeches or scarifications, either with or without the 
 aid of cups ; he explains, also, succinctly, the physiological efi'ects of diet, 
 exercise, baths, sweating-rooms, anointings, and frictions ; for such are 
 the means which, according to him, evacuate insensibly all the humors 
 of the body. 
 
 II. PUEGATIVE MEDICATION. 
 
 The third book is devoted to the explanation of this sort of medica- 
 tion. Now, we know that by purgative medication is understood. all the 
 means proper to provoke the evacuation of a peccant humor through any 
 channel. Thus, vomits, cathartics, drastics, sialagogues, errhines, ex- 
 pectorants, etc., were comprised in the number of purgative medica- 
 ments. In this sense, to purge signifies, as we have said, to purify the 
 economy — to relieve it from any injurious humor. 
 
 We can conceive how much importance this kind of treatment had in 
 a pathological system, where nearly all diseases were supposed to origi- 
 nate by the excess or vitiation of some of the humors of the body. We 
 are not astonished, then, that our therapeutist speaks of it with so 
 much detail. He professes, in regard to this class of remedies, the 
 opinion of Hippocrates and Galen, who assumed, as has been heretofore 
 shown, that certain substances have the property of attracting such and 
 such humors : some, the bile ; others, the atrabile ; others, the phlegm, 
 etc. He unfolds, very skillfully, this theory, and supports it by argu- 
 ments more subtile than solid. 
 
 ■ Methodi Medendi, lib. ii, cap. v.
 
 INTERNAL THERAPEUTICS. 325 
 
 III. ALTERANT MEDICATION. 
 
 The fourth book treats of alterant medication ; that is, of a medica- 
 tion destined to modify the state or temperament of parts. That is 
 termed a medicament, says our author, which has the faculty of chang- 
 ing the natural constitution of the body in any way whatever. Now, 
 there are, in medical substances, three sorts of faculties, which are con- 
 sidered as primitive, secondary, and tertiary. The primitive qualities 
 depend upon the preponderance of one or two elements. The substances, 
 for example, in which the igneous element predominates alone, are sim- 
 ply hot ; those in which fire and moisture exceed, are hot and humid, 
 and so on. These primitive qualities constitute what was formerly 
 named the temperament of substances. 
 
 The secondary qualities result from the union of the primitive quali- 
 ties with the greater or less density of substances. In regard to 
 density, a substance may be tenuous or thin, thick or gluey, or medium — 
 that is, between the two extremes. The combinations of various de- 
 grees of density with the temperament or primitive qualities of sub- 
 stances, form the secondary qualities, of which, according to Fernel, 
 the following are the chief: the incisive or attenuant and the incras- 
 sant, detersive and inviscant or emplastic, the exasperative and demul- 
 cent, the aperient and obturative, dilatant and constrictive, rarcfiant and 
 condensing, laxative and tonic or confortant, the attractive, digestive, 
 dissolvent, repulsive, emollient, astringent, maturative or supurative, 
 septic, agglutinative and exulcerant or vesicant, sarcotic and corrod- 
 ing, epulotic, escarrotic or caustic. 
 
 The savory, having the same origin as the secondary qualities, are the 
 best indicators for these. There are nine sorts of this kind that are 
 distinguished by the taste, namely, the pungent, the acid, the greasy or 
 mucilaginous, the saline, the astringent, the sweet, the bitter, the acrid, 
 and the insipid. The pungent taste, for example, which is remarkable in 
 pepper, pillitory, and euphorbia, indicate the tenuity of matter, united 
 to a dry and hot temperament, for all that is acrid and biting partakes 
 of the nature of fire. Fernel explains, in the same manner, the con- 
 nections which he believes to exist between the taste of the above 
 named articles, and the corresponding secondary qualities ; but we shall 
 not follow him in the details of this more curious than useful theory. 
 
 The tertiary qualities of medicaments proceed neither from the tem- 
 perament, nor the density of the substance, but from its mass and form. 
 For this reason, these qualities are denominated the occult properties of 
 the entire substance. Properties of this class are not manifested either 
 by the taste or any sensible quality, but by experimenting. Thus, it is 
 by experiment alone, that certain medicaments are ascertained to have
 
 226 ERUDITE PERIOD. 
 
 tlie property of attracting and evacuating from the body a particular 
 liumor, such as diuretics, Vt'hich provoke the emission of urine, chola- 
 gogues, which increase the flow of bile — hydragogues, errhines, emmena- 
 gogues, emetics, drastics, etc. Others neutralize and expel animal and 
 vegetable poisons, such as alexiteric or alexipharmics. These various 
 agents produce the effects that we have just enumerated, in virtue of 
 an occult principle, depending upon their substance and form, which 
 principle, clinical observation only can reveal. 
 
 If we wished to establish a species of comparison between antique 
 and modern science, we could say that the primitive qualities of the 
 ancients respond, in some sort, to our chemical properties ; their secon- 
 dary qualities to our physical ones, and their tertiary to our specific 
 medical properties. But the existence of most of the primitive and 
 secondary qualities of the ancients, is purely fictitious and nominal ; 
 their classification is confused, their origin imaginary : for it all rests 
 on the mental analysis of the philosophers, and not on an experimental 
 or empirical analysis, like that of our modern chemists. 
 
 As regards the faculties which are named tertiary, they have generally 
 more reality, and their denominations have been, for the most part, pre- 
 served in medical language ; because they are founded on clinical 
 observation. It is not questionable that there are remedies which 
 excite alvine evacuations, others that increase the flow of urine, others 
 that excite the menstrual flux, others the saliva, etc. These substances, 
 it is true, do not produce their effects in an absolute and necessary man- 
 ner, but only under given circumstances, that is to say, when the indi- 
 vidual to whom they are administered combines certain favorable 
 conditions. It is the same with other medicinal properties ; they are 
 nearly all conditional, which, however, does not prevent us from classing 
 and giving them names; so that, whatever may be the phy so-pathologi- 
 cal theories in vogue, we shall always have substances which are cathar- 
 tics, diuretics, emmenagogucs, sialagogues, errhines, etc. 
 
 The ancients, by abstaining from giving any explanation touching the 
 nature and origin of this order of faculties, and by saying that expe- 
 rience alone could determine them, showed themselves more than usually 
 wise and circumspect. They have emitted, on this point in the science. 
 a reasonable doctrine which no scientific revolution has yet overturned. 
 They may be reproached only for not having been sufliciently critical in 
 their clinical experiments — for having too carelessly attributed to a 
 mass of substances, admirable virtues, which the observations of succeed- 
 ing ages have not confirmed : so that, before inscribing in their formu- 
 laries that a given substance was endowed of certain properties, they 
 should have submitted it to repeated and varied experiments — they
 
 I 
 
 INTERNAL THERAPEUTICS. 327 
 
 should have, in a word, conformed themselves to the excellent precepts 
 given by the Empirical physicians of the school at Alexandria. 
 
 Fernel shows, in the same hook, the reasons which may justify, in many 
 cases, the employment of compound remedies, and he lays down the rules 
 which must be observed in the process of mingling various substances. 
 He enumerates the pharmaceutical and magisterial forms, in which they 
 were accustomed to administer medicaments, as well as the particular 
 advantages attached to each of these forms. He speaks, among other 
 preparations of distilled waters, essential oils, infusions, decoctions, 
 extracts, syrups, powders, conserves — in short, of nearly all the prepara- 
 tions now used in pharmacy and medicine. The last three books of the 
 same work, namely, the fifth, sixth, and seventh, embrace materia 
 medica proper, and a small formulary. The medicamental substances 
 are there classed according to their mode of action on the animal 
 economy, that is, according to the physiological effects they produce in 
 the organism. This basis of classification would have been excellent, 
 if the action of remedies had been established on careful clinical obser- 
 vation ; but we have seen that of the three orders of faculties, the first 
 two were imaginary or hypothetical, and the third only was founded on 
 medical observation. Unhappily, yet, the observations which had 
 served to establish the third class of faculties were not always made 
 with proper care. Thus, therefore, among the virtues attributed to 
 medicamental substances in the ancient formularies, the greater part 
 should be regarded as hypothetical, exaggerated, or false. 
 
 The judicious Ternel had well felt this defect, and he alludes to it in 
 the preface of his fifth book, where he says that he will admit into his 
 materia medica only such substances as are well proved by long expe- 
 rience ; preferring a small number of well known and well studied 
 remedies, to a great number of doubtful ones. Nevertheless, he assigns 
 to many of the substances, properties which are entirely imaginary ; 
 because, to avoid this defect, he would have found it necessary to have 
 reconstructed science, which is the work of ages, and not of one man 
 alone. He does not mention some substances from the mineral king- 
 dom, newly introduced into medicine, such as certain salts of antimony, 
 mercury, gold and copper. The effects of these energetic agents, which 
 now render such signal service in medicine, were at that time but little 
 known. They were scarcely employed, except in the hands of charlatans, 
 barbers and alchymists, who administered them, right or wrong, without 
 precise indications or in proper doses, so that their use did more harm 
 than good. We must, then, approve the circumspection of Fernel, 
 which led him to exclude from his formulary these powerful remedies, 
 yet too little tested, when we reflect that he was placed at the head of
 
 328 ERUDITE PERIOD. 
 
 medical teaching — that his book, destined for the instruction of young 
 men, became classic throughout Europe, from its first appearance — and 
 that these heroic remedies, which may be employed by a skillful hand 
 without danger, produced, at that epoch, effects nearly as formidable as 
 those of the disease against which they were administered, as the result 
 of the ignorance and temerity of the medicasters who proclaimed them 
 to be panaceas. 
 
 CHAPTEK VII. 
 EXTERNAL PATHOLOGY AND THERAPEUTICS. 
 
 In all time, external pathology and therapeutics have surpassed in 
 progress, the career of internal pathology and therapeutics. It is a law 
 that holds to the nature of things. External diseases are more easily 
 discerned than internal ; they may be better observed from the com- 
 mencement, with their progress, phases, and various modifications. The 
 remedies can be applied immediately to the parts affected, and their 
 effects be observed with exactness. All these advantages in favor of 
 surgery render it more permanent than Medicine, so that its progress 
 is more constant and certain. 
 
 Nevertheless, this law appears inverted during the middle ages. In 
 the midst of the general decadence of the sciences in Europe, surgery 
 fell yet lower than medicine, for the reason that the latter was in the 
 hands of the priests, the only men who had, at that time, a tincture of 
 a liberal education ; while the practice of surgery was abandoned to a 
 class of ignorant barbers, bathers and bone-setters. I will mention 
 one fact, which will give some idea of the extreme contempt in which 
 this class of operators was held. " No artisan," says Sprengel, " could 
 take a young man as an apprentice, without an attestation showing that 
 he was born of honest parents, the fruit of a legitimate marriage, and 
 the issue of a family in which there were neither barbers, bath-keepers, 
 shepherds nor butchers; nevertheless," says this historian, " these men 
 were, to the middle of the fifteenth century, the surgeons of most of the 
 cities in Germany. The other countries of Europe were but little more 
 advanced than Germany, with the exception of Italy, where, as we have 
 seen, from the thirteenth and fourteenth centuries, several physicians did 
 not disdain, entirely, surgical operations ; and France, where Lan- 
 franc and Guy de Chauliac gave it a temporary eclat towards the close 
 of the Arabic period. But these rare exceptions did not prevent
 
 EXTERNAL THERAPEUTIS. 329 
 
 surgery in France, and even in Italy, as in Germany and the rest of 
 Europe, from being abandoned completely by the clergy, who devoted 
 themselves to the practice of Medicine. 
 
 If it be now asked how it was that an art as useful as the surgeon's — 
 the practice of which requires extended and various knowledge, as well 
 as sagacity, courage and address — an art, the necessity of which must 
 have been so frequently felt in those calamitous times of continual war and 
 combat, and the services of which are so much more manifest than 
 those of internal therapeutics — was so neglected by men who could 
 best comprehend its utility, namely, the doctors in medicine, the re- 
 sponse is easy, and our readers can make it themselves, by recalling 
 what we have said of the constitution of society in general, and the 
 medical profession in particular, during the middle ages. The Chris- 
 tian nations of the West were at that time divided into three very dis- 
 tinct orders, namely : the noblesse, unceasingly at war ; the clergy, 
 filling all the liberal professions ; the populace, in all the lowest occu- 
 pations, supporting all the rest, but having no privileges. In this 
 division, the practice of the Healing Art was a clerical right ; but, as 
 we have before observed, a canon of the Church prohibited them from 
 drawing blood, under pain of excommunication ; consequently the most 
 of them abandoned the practice of surgery to the ignorant and vulgar 
 laity, who acquitted themselves in it as a pure mechanical work, without 
 any idea of the art or its progress. 
 
 Another reason, no less powerful, also removed the clerical doctors 
 from the practice of surgery ; it was the lack of all detailed and precise 
 anatomical notions, which are as indispensable to the physician as the 
 surgeon, but the defect of which is more sensible and opprobrious in the 
 latter. The absence of anatomical knowledge was, it is true, common to 
 both the clerical doctor and lay operator, but the latter, being less en- 
 lightened, did not feel so much its need ; being also less elevated in the 
 social hierarchy, he had less fear of compromising himself. Moreover, 
 a great number of the operators had no fixed residence ; they went fr^m 
 city to city, and stopped in each place as long as they had any cases 
 submitted to them, or until some reverses forced them to depart. The 
 most of them limited themselves to one or two sorts of operations ; some 
 operated for cataract, others for stone, others for hernia, etc., according 
 to methods which they kept secret, and which they transmitted to their 
 children as an heritage. The History of Medicine has preserved the 
 names of some of those families of itinerant operators, such as the 
 Branca, the Norsini in Italy, and the Colot in France. 
 
 In hands so unskillful the art could not grow, and the profession must 
 be mean. Neither began to revive until the prejudice which opposed 
 21
 
 330 ERUDITE PERIOD. 
 
 anatomical dissections, and which prevented physicians from practis- 
 ing surgeiy, began to abate. But this revolution was effected very 
 slowly. The dawn of it began from the thirteenth to the fourteenth 
 centuries, during which a very few of the clergy dared, in a timid man- 
 ner, to perform surgical operations. The number increased in the course 
 of the fifteenth century, and at last became considerable, in the sixteenth. 
 The most of the great anatomists of that period were at the same time 
 distinguished surgeons, such as Benivieni, Berenger de Carpi, Vesalius, 
 Fallopius, Fabricius d'Aquapendente, and others. 
 
 While the clerical physicians were willing to descend to the rank of 
 operators, the lay surgeons aspired to the level of doctors in medicine. 
 This latter transformation took place especially in France, the only 
 country where at that epoch there existed a special college of surgeons. 
 This college was no other than the small brotherhood of St. Come, which, 
 always contending against the faculty on one hand, and the barber-sur- 
 geons on the other, sometimes defeated, sometimes triumphant, but never 
 submissive, asked at last a peace with the university, and was benignly 
 received by it among the number of its scholars, and enjoyed thereafter 
 without molestation the privileges and immunities attached to this title. 
 This took place in 1515. "From that moment," says M. Malgaigne, 
 " a new state of things commenced for surgery in Paris. The Faculty 
 reigned over the surgeons and barbers, who were admitted together to their 
 lectures. The barbers followed the course on anatomy and surgery, which 
 gradually drew them nearer to the surgeons of St. Come, and prepared 
 them to wear worthily their new title of barber-surgeons. But they did 
 not obtain these unexpected results without giving up some of their 
 former rights. Thus, besides their initiation by a proper tribunal, to 
 the privilege of barbering, they had to pass an examination before the 
 physician and the two surgeons of the king, at Chatelet, for the right to 
 practice surgery. The surgeons, as the price of their submission to the 
 faculty, had, then, besides the university privileges, acquired a sort of 
 supremacy over the barbers ; also, their daily association in study and 
 hierarchy, dissipating the memory of old divisions, prepared for the 
 new epoch results which perhaps never before took place ; the barbers 
 were admitted to the rank of surgeons of St. Come, and the surgeons 
 of St. Come were admitted as doctors regents of the Faculty of 
 Medicine." 
 
 Thus surgery offers during this period a double upward movement , 
 on one hand it approaches as a profession medicine proper, from which 
 it should never have been separated ; on the other, it received as an art 
 
 ''Introduction to the works of A. Pare, 1. 1., p. 153.
 
 EXTERNAL THERAPEUTICS. 331 
 
 numerous improvements. Among the men who contributed to extend 
 it, we have already cited the names of some celebrated anatomists ; to 
 these we will add those of John de Vigo, Fabricius of Hiklen, Maggi 
 Peter Franco, Felix Wurtz, Jacques Guillemeau, and above all, that of 
 Ambrose Pare, who from a sim^^le journeyman barber, elevated himself 
 by obstinate labor and his genius to the rank of the first surgeon of his 
 age. 
 
 The life of Ambrose Pare is so closely related to the progress of sur- 
 gery during that epoch, that by tracing it we give, in some sort, the 
 history of its progress. On this account I do not think I am leaving 
 my subject, by extracting from his biography the passages which con- 
 nect him most directly to the history of the art itself. Ambrose, born 
 at Laval, of parents not in easy circumstances, did not receive a univer- 
 sity education, having never learned the Latin, the only language at that 
 time in the books and schools of Medicine. The date of his birth, though 
 uncertain, must have been between the years 1510 and 1517. His first 
 apprenticeship was to a provincial barber- surgeon, after which the desire 
 for improvement led him to Paris, about the year 1532 or 1533. He 
 studied for three years at the Hotel Dieu in that city, and it appears 
 that he obtained so fully the confidence of his masters, that they some- 
 times made him perform their operations. Pare loved to recall his 
 sojourn in that hospital; he counted it among his highest honors, which 
 permits us to presume that these functions were coincident only with 
 important duties, and even not a common right nor an ordinary favor. 
 " Be it known," he says in his Preface, to the reader, " that for the space of 
 three years I resided at the Hotel Dieu of Paris, where I had an oppor- 
 tunity to see and know (owing to the great diversity of patients goino- 
 there) everything that concerns operations and diseases pertaining to the 
 human body ; and besides, I learned there, on an infinite number of 
 bodies, all that can be said and considered on anatomy ; also, that often 
 I made very satisfactory proofs of it, and that very publicly, in Paris at 
 the schools of medicine." And in his Apology, when a physician of 
 Milan seemed astonished at the young man's knowledge, he remarked, 
 not without some pride, ''But tlie good man did not know that I had 
 been house-surgeon for three years at the Hotel Dieu of Paris." •- 
 
 In regard to the functions of these barber apprentices in the hospitals, 
 and the kind of instruction they received there, we have no positive 
 knowledge, but it is probable that they made the dressings, bleedings 
 and post mortems ordered by the master surgeon — that they assisted him 
 in his operations, and perhaps took his place in cases of urgency, about 
 
 'Introduction to the works of A. Pare, t. I., p. 232.
 
 332 ERUDITE PERIOD. 
 
 as commonly as the Internes do in our hospitals at present. They 
 learned by watching the operations of their chief — by listening when 
 they deigned to converse with them, and by carefully studying the pa- 
 tients. They found there, also, opportunities, precious and rare at that 
 time, for anatomical dissection ; but it does not appear that they had 
 any regular instructions in clinics — the communications between the 
 master and his pupils being optional, depending absolutely on the plea- 
 sure of the former. 
 
 It was not long after his leaving the Hotel Dieu, in the year 1536, that 
 Ambrose made his first campaign. He held the position of surgeon to 
 the Marshall de Monte-Jan, colonel-general of the French infantry, of 
 the army which Francis I. assembled in Provence to repulse the invasion 
 of Charles Y. " He had never seen war, nor recent gun-shot wounds, 
 and only knew of them by what he had read in John de Vigo. 1 shall 
 not repeat what he has so well recounted himself; it should be read both 
 in his first discourse, in the book on Arquebuse Wounds, and in his great 
 apology, how, after the aflfair of the Pas-de-Suze, he watched the other 
 surgeons, dreaming of nothing else but to imitate them as far as he 
 could ; how the boiling oil giving out, with which all wounds were cau- 
 terised, anxiety about it prevented him from sleeping soundly, and how, 
 to his great admiration, he found that the wounded who had been sub- 
 mitted to the operation, suficred more than the others. This accident 
 put him in the way of his first discovery : but the rap/idity and depth 
 of his judgment, and the boldness of resolution which led him, a young 
 man, without name or authority, and moreover, without letters or philo- 
 sophical studies, at once to observe, to point out, and combat a doctrine 
 universally admitted and sustained by the highest surgical renown of 
 the epoch, was not an accident." 
 
 The earliest authors who had spoken of gun-shot wounds, considered 
 them as poisoned, and complicated with burning. Consecjuently, they 
 gave the precept to cauterise them with boiling oil, or red hot iron, and 
 administer internally at the same time alexipharmics, for the purpose of 
 arresting the progress of the poison. John de Vigo, who was physician 
 of Pope Julius II., assures us that the danger of these wounds results 
 from the round form of the balls, their degree of heat, and the poison- 
 ous qualities that the powder communicates to them. His theory, and 
 the method, doubly incendiary, which was its necessary consequence, 
 had been adopted without contradiction, till the day that Ambrose Pare 
 dared protest against them. 
 
 After a campaign of three years, having lost his master, he returned 
 to Paris, where he married the daughter of the valet-chaufFe-cire of the 
 Chancery of France. In 15-13, we find him with the army of Perpignan,
 
 i 
 
 EXTERNAL THERAPEUTICS. 333 
 
 ia the service of M. de Eohan, grand lord of Brittany, and lie gave 
 proofs there, on several occasions, of his sagacity. " I presume," con- 
 tinues M. Malgaigne, " it was after this campaign that his reputation, 
 so well established among wan-iors and great lords, inspired Sylvius 
 with the desire of seeing him. In fact. Pare recounts that in the con- 
 versation they had together, he insisted on the special and entirely new 
 precept, of which he made so happy an application on M. Brissas, that 
 of placing the wounded in order to extract balls, in the position they 
 were at the moment they were shot. This interview was honorable in 
 all respects to both. Sylvius, whose teachings attracted more auditors 
 than those of Fernel, even invited the young surgeon to dinner, and 
 heard, with great attention, the observations and experiments on which 
 Pare had established his doctrines on gun-shot wounds, and was so much 
 struck with them, that he besought him with great warmth, to write 
 them out, and make them public. Pare felt, sensibly, this encourage- 
 ment coming from so high a source, and prepared his text, drew the 
 figures, and in the year 1545, at Vivant Gaulterot's, sworn bookseller in 
 the University of Paris, that little work, which mai'ked in a manner so 
 glorious the revival of French Surgery was published, with the following 
 title: The Manner of Treating Wounds made hy Arquebuses and other 
 Fire Arms, and those made by Arrows, Darts, and the like ; and also of 
 Burns made especially by gunpowder : Composed by Ambrose Pare. 
 Master barber- Surgeon, Paris.'--' 
 
 "In a few months Pare published his second edition, in which he 
 recommends still, the actual cautery in hemorrhage ; but each day 
 he made it a subject of meditation, and on one occasion he discussed 
 the subject with Stephen de la Pdviere and Francis Basse, both surgeons 
 of Saint-Come, and submitted to them the idea, so simple and so lumi- 
 nous, that since ligatures were applied to veins and arteries in recsnt 
 wounds, there was nothing to prevent their being equally applied after 
 amputation. Both agreed with him, and he only needed the opportunity, 
 which soon presented itself at the siege"'of Damvilliers. A gentleman 
 of M. de Eohan had his leg crushed by a shot from the fortress. Pare 
 made an amputation, and for the first time did not apply the cautery. 
 He had the happiness to save his patient, who, full of joy at having 
 escaped the red-hot iron, said that he had got clear of his leg on very 
 good terms. This last discovery was not less fortunate than the former. 
 of which it was, if I may say so, the complement. By the first step 
 the young surgeon saved from cauterization all who had simple gun-shot 
 wounds ; by the second, he spared all subjects of amputation dreadful 
 
 ^ Introduction to the works of A. Pare, p- 236.
 
 334 ERUDITE PERIOD- 
 
 suffering. Military surgery, -whicli till that time had been a torture, 
 became a blessed art, and it was a barber-surgeon who produced the 
 double marvel." =•' 
 
 This took place in 1552. In the month of October, in the same 
 year, one of the most eminent of the generals of Charles V. having 
 besieged Metz, the Emperor came in person to join the army, on the 
 twentieth of the following month. " The city, defended by the Duke 
 de Guise, with seven princes under his orders, and a number of gentle- 
 men, had to suffer at the same time the attacks of the enemy, the 
 fatigues of the siege, and the rigors of a frightful winter. The Duke 
 had established two hospitals for the soldiers. He had put in requi- 
 sition the barber-surgeons of the city, and had even advanced to them 
 the money to get supplies of ointments and drugs ; but the ignorance 
 of the surgeons unfitted them to struggle against a combination of cir- 
 cumstances so unfavorable, and nearly all the wounded perished, which 
 caused a suspicion among the troops that they were poisoned. The 
 Duke de Guise dispatched one of his captains, named Thomas Delveche, 
 to the king, to say, that the place could hold out for ten months, but 
 asked, at the same time, for fresh medicines. The king sent for Pare, 
 handed him one hundred crowns, and directed him to take all the 
 medicine he thought necessary, and gave him also a letter to Marshal 
 St. Andre, who commanded in Yerduu. The Marshal and M. de 
 Vieille-Yille bribed an Italian captain, who engaged, for fifteen hundred 
 crowns, to introduce into the besieged city, A. Pare, his valet, or his 
 man, and the captain of the Duke de Guise. The expedition was 
 perilous, and, to tell the truth, says our naive author, he would very 
 willingly have remained in Paris. He passed, however, without acci- 
 dent, and the little caravan entered Metz the eighth of December, at 
 midnight, by the Moselle gate. He was known to the chiefs and 
 common soldiers, for he had already passed sixteen years in war, and 
 enjoyed the highest renown in military surgery. The next day after 
 his arrival, the cluke, who knew how to strike the imagination, presented 
 him on the rampart to all the princes, lords, and captains, who embraced 
 and received him with acclamations. On the same day he began to 
 treat the leg of M. de Magnane, who for four days had been in charge 
 of a charlatan, and had suffered horrible tortures. The next day he 
 decided to trephine M. de Bugueno, who had been struck by a fragment 
 of stone on the head, and had laid insensible for fourteen days. He 
 cured them both. His success, which the surgery of our period must 
 pronounce extraordinary, appears to me as a strong testimony of the 
 
 ^° Introduction to the works of Ambrose Pare.
 
 EXTERNAL THEEAPEUTICS. 335 
 
 confidence "witli which Pare inspired the wounded, and which facilitates 
 such cures." 
 
 The little brotherhood of Surgeons of St. Come, recently erected into 
 a college, ready to seize on every circumstance which could redound to 
 their advantage, desiring to possess in its community a man who enjoyed 
 such great renown, and of such high standing at the Court, decided to 
 admit him to an examination, in despite of the statute which required 
 that the candidate should understand Latin ; and besides, what was 
 unheard of before, they awarded him the honor of a gratuitous recep- 
 tion. In the course of the year 1554, Ambrose Pare submitted to all 
 the examinations, and obtained successively the grades of bachelor, 
 licentiate, and master in surgery. 
 
 Notwithstanding the correctness and firmness of his character, of 
 which he gave a thousand proofs, his favor at the Court never dimin- 
 ished. He was surgeon in ordinary to Henry II., and Francis II., first 
 surgeon of Charles IX., and of Henry III., which caused the witty and 
 true remark, that the kings of France transmitted him to their succes- 
 sors as a legacy of the crown. In the midst of the excitement of 
 camps, and a very extended private practice, he found time to read all 
 that had been published on his Art, and to compose a great number of 
 works himself. He enriched nearly all the branches of surgery with 
 some discovery or improvement ; but instead of making a secret of his 
 inventions, as was very much the custom at that time, he thougbt it his 
 conscientious duty to give the public the benefit of them. " For my 
 part," he says, in the preface of his large work on Surgery, "I have 
 dispensed liberally to every body the gifts that God has conferred upon 
 me, and I am none the worse for it, just as the light of the candle does 
 not diminish, however many may come to light their torches by it." 
 
 The doctrine of A. Pare, on gun-shot wounds, was rapidly dissemina- 
 ted. From the year 1550 Bartholomew Maggi, a physician of Bologna, 
 advocated it without naming its author, and sustained it by decisive 
 experiments. He observed that none of the wounded by arqucbuse shots 
 felt any heat, and that their clothing did not present any trace of burn- 
 ing. He shot balls through packets of powder, without setting them on 
 fire. John Lange made these views known in Germany. Leonard Botal, 
 a celebrated physician of Turin, was also one of the first to take it up, 
 but like those I have named, kept back the true author's name."'-' 
 
 I have dwelt somewhat at length on the theory and the treatment of 
 gun-shot wounds, because this class of lesions, unknown to the ancients, 
 had at that time acquired a major importance, to increase from day to 
 
 "' (Euvres d' A. Pare.
 
 336 ERUDITE PERIOD. 
 
 day, as a result of the incessant employment of t^iat species of weapon. 
 I shall not enter into a detail of the additions and improvements that 
 the other branches of surgery received at that epoch ; these details will 
 be more in place in the following period, when we shall give a retrospec- 
 tive glance at the history of each of the principal surgical operations. 
 
 Obstetetcs. 
 
 I have already said, but it may not be improper to repeat it, that 
 obstetrics is a branch o." surgery which, from its importance, merits to be 
 examined separately ; there, as before observed, the life of two individuals 
 depends on a skillful maneuver, or on an indication clearly understood. 
 The great surgeons of the sixteenth century felt this truth, and did not 
 neglect the art of accouchement ; but none of them occupied themselves 
 with it in so special a manner as Jacob Guillemeau, pupil and friend of 
 Ambrose Pare. We owe to him the first improvements that the moderns 
 made in this art. I will cite, as one of the most capital, the formal pre- 
 cept, to terminate the accouchement artificially, in the case of consider- 
 able hemorrhage, or when the woman is taken with convulsions, during 
 labor. Guillemeau supports the precept on the authority of Hippocrates, 
 and what is much better, on a great number of facts which prove the 
 value of the practice, and how great the danger of its neglect, when it 
 is indicated. 
 
 The Cesarian operation was known to the ancient Greeks and Eomans, 
 but during the middle ages, like many others, it had been abandoned. 
 Some of the surgeons of the sixteenth century attempted to re-establish 
 it ; among others Francis Eousset, physician to the duke of Savoy, who 
 recommends it very warmly. He reports several cases, where it had a 
 happy issue, both for the mother and the child. The most remarkable 
 of all is that of a woman of Milly, who was delivered six times by this 
 operation, and perished in her seventh confinement, because, according 
 to Eousset, the surgeon who had been accustomed to operate upon her 
 was absent. Unhappily, these facts are not well established. 
 
 CHAPTEE VIII. 
 
 CLINICS. 
 
 Clinics, as has been said, is not a branch of medical science : it is 
 the science in totality, taught or put in practice at the bedside ; it is 
 there that theory is put face to face with reality. In vain will we have 
 stored our minds with the precepts of the greatest masters, in vain shall
 
 EXTERNAL THERAPEUTICS. 337 
 
 we Lave beard for years together, the most learned professors, and gra- 
 ven their lectures in our memory : if we have not followed them to the 
 bedside, if we have not seen them make a test of their methods upon 
 the living, we shall know very imperfectly their doctrine. You may 
 possess very extensive general or theoretical notions, but you will be 
 ignorant of a crowd of details which language can not describe, and 
 which sight alone can supply. You may be capable, perhaps, to dis- 
 course on the most difficult questions in science, and excite the applause 
 and admiration of an auditory, but you may still be an ordinary or 
 feeble practitioner. Let you be placed in the presence of a grave and 
 complicated disease, and you are required to point out, from the midst 
 of a crowd of symptoms, those which shall form the bases of a curative 
 indication, and you will be embarrassed and troubled. When, in a peri- 
 lous and urgent case, it is necessary to make a prompt decision, on 
 which depends the life of the patient, you will have neither that correct 
 judgment, that prompt appreciation of the case at a glance, nor that 
 firmness of resolution necessary for the emergency ; all this is acquired 
 by practice, and it is clinical teaching alone that lays the foundation of 
 this practice. By this, though the pupil does not practice himself, he 
 at least sees practice, and mingles with it ; he participates in the prac- 
 tice of the teachers, and acquires experience, without any danger to the 
 patient. Clinical teaching is, in a word, the indispensable complement 
 of all medical education. 
 
 In primitive times, when the science was only composed of a few 
 notions, easy to seize and retain in the memory, and which were perpetu- 
 ated by tradition, without the aid of books, there was no other mode 
 of transmission in medicine than by clinical teaching. Then the lessons 
 consisted more in example than precepts. The pupil attached himself 
 to his master, in the character of an aid, servant, or adjunct. He 
 became accustomed, under his directions, to discern diseases, and pre- 
 pare and administer medicine. At a later period, when Medicine became 
 the exclusive domain of some sacerdotal families, this mode of teaching 
 was continued in the Asclepidian schools. The Hippocratic collection 
 offers, under the title of Epidemics, admirable clinical narrations, for the 
 time when they were written. 
 
 But after the foundation of the school at Alexandria, there is no 
 further mention made in the history of Medicine, of instructions being 
 given at the bed-side. Collections of clinical relations, traced after the 
 model of the Epidemics of Hippocrates, became more and more rare, 
 because less value was attached to direct observations. The professors 
 loved better to descant on the nature of man, the essense of diseases, the 
 elementary action of medicines, than patiently to observe the phenomena,
 
 338 ERUDITE PERIOD. 
 
 and describe tliem with simplicity, accordingly as they were presented 
 to the senses. 
 
 The invasion of the philosophers into the domain of Medicine, was 
 one of the principal causes of the abatement of clinical observations. 
 These men, strangers to the practice of the Art, imagined themselves, 
 and persuaded others, that it was not necessary, in the study of nature, 
 to pause at the phenomena ; but that the mind must penetrate 
 beyond these sensible things, and seek the internal constitution of 
 entities — their elementary and invariable principles, on which depended, 
 they said, the forms and actions apparent to our senses. This was, if 
 we may believe them, the unique means of placing science on a solid 
 and immovable basis ; while the phenomena, they added, offer only a 
 shifting ground, on which nothing stable can be erected. The physi- 
 cians, misled by these sophisms, attempted to go back, by the aid of 
 some anatomical and physiological notions, to the principle of life ; 
 they hoped to unravel the mechanism of the most internal acts of the 
 animal economy ; and pretended to determine the primitive mode of 
 formation of diseases, or their latent causes, and to direct the action of 
 therapeutic agents against the primary affection. They substituted 
 transcendental hypotheses for the simple results of observation, and 
 believed that they had raised the edifice of Medicine on an immovable 
 foundation, because they had established it on a basis inaccessible to the 
 appreciation of the senses, and consequently, they said, secure from 
 their illusions and instability. 
 
 By this doctrine, clinical observation lost much of its importance ; it 
 was no longer a torch which could illuminate every step in science, 
 and supervise, constantly, its progress ; it was only a feeble and uncer- 
 tain light, which, after having enlightened the cradle of human reason, 
 and served as a basis to the mind, on which to elevate itself to greater 
 truths, could henceforth be useful only to direct the artist in the appli- 
 cation of immutable rules which the mind had discovered. 
 
 In vain some sages, undeluded, from experience, by the fictions of theory, 
 strove to recall the medical world to the study of phenomena, by pro- 
 claiming that our light on the nature of things does not go beyond the 
 perception of the senses ; in vain they affirmed that the only means 
 of enlarging our knowledge consists in adding, unceasingly, new to ante- 
 rior observations ; their voice was not heard, for the human mind does 
 not willingly accede to a slow pace, and the imagination loves better to 
 anticipate the march of time. To the laborious, incessant and exhaust- 
 ing study of phenomena, they prefered a science fully made, having 
 invariable dogmas, which were supposed to be founded on the essense of
 
 EXTERNAL THERAPEUTICS. 339 
 
 things. Idleness and vanity found much more satisfaction in this last 
 doctrine. 
 
 Nevertheless, the habit of observing and describing facts as they were 
 developed, was not entirely lost. The coryphii of the Empirical sect 
 always remained faithful to it ; and tradition says that they had col- 
 lected in the earliest years of the Alexandrian school, a considerable 
 number of historical clinics, after which the later nosographers, Aretseus, 
 Coelius Aurelianus, and others drew the portraits of a number of dis- 
 eases so well that but little has been added to them since. 
 
 After the death of Galen, during the lapse of time which we have 
 named the Second Age of Medicine, and which extends from the eleventh 
 to the fifteenth century, the princes of the science, in the midst of their 
 habitual sterility have transmitted to us but a small number of inter- 
 esting clinical facts, some of which have been pointed out. It should 
 be remembered that we owe to the writers of that stationary epoch, 
 among other acquirements, the knowledge of certain eruptive fevers, of 
 which they have given the first description ; but they are justly 
 censurable for reporting none but extraordinary cases, and for having 
 omitted, in the most of their clinical relations, important details. 
 
 Long after the revival of letters, clinical teaching, so useful to the 
 progress of science, and so indispensable j^to young practitioners, was 
 still in oblivion, and this fact led Ph. Pinel to make the following 
 reflections, which may be thought too severe: "It seems," says the 
 learned professor, " that the first editions of the ancient works of 
 the Greek physicians, published at the commencement of the fifteenth 
 century, should have led to the restoration of clinical studies as the sole 
 guarantee of solid instruction, and of the ulterior progress of medical 
 observation ; but this happy impulse of the mind was still retarded for 
 more than two centuries ; they plunged into all the subtilties of an 
 indigested erudition — that is to say, they were occupied solely with 
 commentaries and disputes and controversies, as in the other physical 
 sciences ; and they left the sole method of settling all uncertainties, and 
 repressing the wanderings of a deranged imagination, viz.: the historic 
 description and progress of diseases in the hospitals." 
 
 I believe that in the above passage our celebrated nosologist did not 
 fully appreciate the services rendered to science during the Erudite 
 Period. In fact, these physicians had not the happy idea of founding 
 clinical teaching, such as it now exists in a great number of hospitals ; it 
 is also true, that they occupied themselves more with philological 
 researches than with the observation of nature ; but what better could 
 they have done in order to free the human mind from the rust which a
 
 340 ERUDITE PERIOD. 
 
 long course of years had heaped upou it, thau restore the Greek 
 science in its original purity ? This was a painful and ungrateful, but 
 necessary task, and which must precede the labors of reformation. 
 
 Nevertheless, they did not neglect entirely, as is affirmed above, the 
 study of phenomena, and the historic description of diseases. They 
 began, from the fifteenth century, to make relations of epidemics, on the 
 model of those of Hippocrates ; they observed a mass of new pathological 
 states, and attempted means of cure unheard of by the ancients. In 
 fine, in the course of the sixteenth century, the spirit of innovation 
 made progress, and some physicians carried it even to the point of abuse, 
 as we shall see in the next chapter. But among those who remained 
 faithful to the worship of tradition, enriching, nevertheless, the science 
 by valuable clinical observation, I will cite particularly, Nicholas 
 Massa of Venice, John Crato of Craftheim, Rembert Dodoens, John 
 Schenck, Felix Plater, Peter Forcest, or Forestus, Marcellus Donatus, 
 Louis Duret, and finally William Baillou, worthy by his great character 
 and his high intelligence and talent for observation, to be the precursor 
 of the medical reform that commenced in the following century. 
 
 Nothing proves better how much the art of observation and descrip- 
 tion of pathological phenomena made progress at the epoch of the revival 
 of letters, than the great number of new diseases of which the authors 
 of that period make mention. We read in their writings for the first 
 time, the names of whooping-cough, milliaria, scurvy, plica polonalis, 
 syphilis and raphania. Is it credible that all these diseases, some of 
 which modify the economy profoundly, fell upon Europe at the same 
 time ? Is it reasonable that the changes occurring in the political and 
 commercial relations of the people — the discovery of the new world, 
 giving rise to long voyages at sea — in a word, the modifications intro- 
 duced in public and private hygiene, resulting from so many events 
 which marked that epoch, could have suddenly given birth to this flood 
 of new diseases '? No one, I think, dare sustain it. It is more probable, 
 I might almost say certain, that the most of these diseases had an 
 ancient existence ; but they were not recognized before, by attentive 
 observers who could discern their true characters, and there were no 
 exact historians to describe them. 
 
 Medical men in our days, are divided in opinion on the origin of only 
 one of these aflfections — syphilis ; some inclining to believe that it was 
 developed spontaneously in Europe, toward the close of the fifteenth 
 century ; others think that it was imported from the new world ; others, 
 and the greater number, see in the venereal diseases only a degeneration, 
 or one of the numerous ramifications of leprosy. We now proceed to
 
 EXTERNAL THERAPEUTICS. 341 
 
 discuss each of these opinions, and will endeavor to make a choice 
 of one of them : t 
 
 I. The first view accords with the opinions of the most ancient his- 
 toriographers of syphilis. Indeed, the most of the authors tliat have 
 first made mention of this disease, have considered it as a sort of pest 
 (lues venerea), developed under the influence of a particular epidemic 
 constitution. They agree in saying that it appeared nearly simulta- 
 neously in all parts of Europe — at Berlin, Halle, Brunswick, inLombardy, 
 Apulia, Auvergne, etc. They regard it as impossible that the conta- 
 gion could be propagated in so short a time, and at such widely separated 
 points, as the sole result of impure sexual commerce, consequently they 
 are forced to admit the influence of an epidemic constitution. 
 
 But they differ very much among themselves on the causes that could 
 have given rise to the development of such a constitution. Some, like 
 Leonicenus, attributed it entirely to natural causes. He thought that 
 it was the result of the extraordinary inundation that occurred in all 
 parts of Italy toward the close of the fourteenth century — the sun 
 having heated by his rays the soil soaked by the pools of stagnant 
 water that covered the low ground, there resulted unhealthy exhalations, 
 which gave rise, he said, to the variolus epidemic. He supported his 
 views on the authority of Hippocrates and Galen. These authors say, 
 indeed, that in damp seasons, when the south wind blows, or when no 
 wind disturbs the air, there are developed a running from the eyes and 
 ears, ulcerations of the mouth, pustules, and suppurations of the genital 
 organs. 
 
 Others attributed the appearance of the pest to astrological influences, 
 such as, for example, the meeting of Saturn in the sign of the Bull, or 
 the union of Jupiter, Mars, Mercury, and the sun, in the gign of the 
 Balance, etc. A large number rejected all these learned explanations, 
 and saw in the propagation of this new plague only the finger of God, 
 who laid it on men, to punish them, and turn them away from unbridled 
 libertinism. Tan Helmont regarded syphilis as the result of the con- 
 nection of a man with a mare aff"ected with farcin. Andrew Gesalpine, 
 as the product of the mixture that the Spaniards had made of the blood 
 of a leprous person with wine. Gabriel Fallopius thought the venereal 
 vice was engendered by a poison which the perfidious Xeapolitans had 
 thrown into the wells whence the French drew their water. These 
 reveries would not be worth mentioning, if they did not indicate 
 admirably the spirit of the age, and show to what a degree of aberration 
 a love of the marvelous may draw the most clear-sighted men. 
 
 II. Gonzalvo Ferdinand of Oviedo, Inteudant-General of the commei'ce 
 of the Xew "World, under Charles V., and author of a History of the
 
 342 ' ERUDITE PERIOD. 
 
 East Indies, printed in 1545, was the first writer who said, positively, 
 that syphilis originated in America. He says that Christopher Columbus 
 having returned from his second expedition to the new hemisphere, in 
 1496, the sailors and soldiers of his suit enlisted, for the most part, 
 under the flag of Gonsalvo de Cordova, to go and fight the French, who 
 had invaded the kingdom of Naples. They communicated, he adds, 
 to the French and Neapolitans the affection they had brought from 
 St. Domingo, where, he asserts, the disease is endemic among the 
 natives of the country. The statement of Oviedo was admitted almost 
 without examination, by most of the physicians of the sixteenth and 
 seventeenth centuries ; but in the early part of the eighteenth, Astruc 
 sustained it by very erudite reseai-ches, which gave it for a time the 
 authority of a settled decision. 
 
 Unhappily for the veracity of the Spanish historian, it is certain, from 
 authentic testimony, that the pox broke out in Naples toward the close 
 of the year 1493, or in the beginning of the following year, that is, two 
 years before the arrival of the Spanish fleet. We read, in a decree of 
 the parliament of Paris, relative to venereals, as follows : " This day, 
 the sixth of March, (1496 or 1497) because in this city of Paris there 
 are several persons afilicted with a contageous disease, called big pox, 
 which for two years has made great progress in this kingdom, as well 
 in the city of Paris as in other places, etc." If there were needed 
 other proofs to invalidate the narative of Oviedo, we might add, that 
 he exhibits in many places a manifest prejudice against the inhabitants 
 of the New World. He likens them to the Canaanites, and the Spaniards 
 to the people of God, so as to give a color of justice to the atrocities 
 which he inflicted upon the unhappy Indians during his government. 
 
 Other later writers have pretended that it was on the first return of 
 Christopher Columbus, that his sailors and soldiers carried into Europe 
 the syphilitic infection ; but this assertion falls to the ground, like the 
 preceding, before a serious examination. In fact, it is known, that on 
 his return in his first voyage, this bold navigator was assailed by a 
 tempest that forced him to put into Lisbon, where King John II. retained 
 him seven days in the midst of continual festivals. Thence he made sail 
 forPalos, where he landed in the course of the month of ilarch, 1493. 
 From this city he went by land to Barcelona, with eighty-two men of 
 his equipage, and nine Indians. There he met King Ferdinand, with 
 Isabella and the whole court. After remaining some weeks at Barcelona 
 he started for Cadiz, to prepare for a second expedition. Now, at none 
 of the points where he touched during his route, in none of the cities 
 where he stopped with his retinue, did the slightest symptom of the 
 venereal poison manifest itself for several years, while from the year,
 
 EXTERNAL THERAPEUTICS. 343 
 
 even, of his arrival in Europe, or the year following, numerous attacks 
 of a venereal nature were observed in many and very distant places 
 in Italy, France, and Germany. 
 
 The authors of this epoch, who assumed that syphilis originated in 
 America, insist very much on the following consideration, which they 
 think of great value. The Supreme Intelligence, they say, is accustomed 
 to place the antidote hy the side of the poison ; now, guaiacum wood, 
 which may be considered as the most precious specific against venereal 
 accidents, is indigenous to the West Indies, and it follows, therefore, that 
 the affection it was destined to combat must have originated in the same 
 regions. This argument has lost so much of its force in its progress 
 down to us, that there is to-day no necessity for refuting it. 
 
 III. The opinion that syphilis is a degeneration of leprosy, or one of 
 the numerous forms of this affection, seems not to be as old as the two 
 preceding ones ; but it has not ceased to make progress in the course of 
 time, and now it reigns almost exclusively in the medical world. In 
 order to appreciate to what extent this is probable, it is necessary to 
 place in comparison the principal symptoms attributed foi-merly to the 
 two diseases under consideration. 
 
 The writers who wrote first on the venereal disease say, that it com- 
 monly commenced with large pustules on the genital parts, invading 
 subsequently the entire body, and hence obtained the vulgar name of 
 big-pox. The pustules were not accompanied by fever, as are those in 
 small-pox ; they never came to perfect maturity, but were converted into 
 pustules adhering to the skin, or phagedenic ulcers. Very soon pains 
 were felt in the extremities, which increased by the heat of the bed. 
 Then there supervened, after a period more or less long, a formidable 
 cortege of consecutive developments: such as bubos, chancres in the 
 mouth, nose, eyes, and vegetations or excrescences of every form, alope- 
 cia, macules, exostosis, necrosis, etc. 
 
 Blennorrhagia (les ecoulements) now so common, and which constitutes 
 often in itself the whole disease, was not observed till twenty 3-ears 
 later as a symptom of the syphilitic infection. It was also remarked, 
 that the greater part of the developments called consecutive or constitu- 
 tional, might, in rare cases, show themselves from the commencement : 
 that is, without having been preceded by any other symptom of the 
 infection. 
 
 Some observers, struck with the rapidity with which this epidemic was 
 propagated at its first appearance, believed that the contagion could be 
 communicated by the breath, even, of the diseased. However, gi'cater 
 numbers were of the opinion that it required the immediate contact of 
 the ulcerated parts, or of the running matter, and this view soon became
 
 344 ERUDITE PERIOD. 
 
 universal. Sucli are, in substance, the characters that were presented 
 at the first appearance of the syphilitic disease. 
 
 Now, let us see some of those which the ancient writers attributed to 
 lepra. We read in the sacred books of the Jews: " The man on whose 
 skin or flesh a diversity of color shall appear, or a pustule or any bright 
 spot which seems to be the sore of leprosy, shall be taken to the priest 
 Aaron, or to some one of his sons," etc. " The man who suffers with 
 that which should only happen in the marriage relation, shall be impure. 
 And it shall be judged that he suffers this accident when there is a 
 constant accumulation of an impure humor which adheres to his person. 
 Every bed in which he sleeps, every place on which he sits shall be 
 impure. "'••■■ 
 
 Hippocrates, Aretfeus, Galen, Celsus, and the Arabian physicians 
 make mention of gonorrheas or issues, of the semen ; they speak of 
 pustules, ulcers, phlegmons, excrescences and crusts located on the 
 genitals and neighboring structures. The Latin satirists, Horace, Juve- 
 nal, and others, describe some symptoms of this kind as being the fruit 
 of a shameful lubricity. 
 
 The writers of the middle ages are more explicit than those of 
 antiquity. AVilliam de Salicet, who lived in the thirteenth century, 
 which is about two hundred years before the outbreak of the syphilitic 
 epidemic, says bubos often occurred after an impure coition — quum 
 accidet homini in virgd corriiptio, ^propter concuhituni cum fcedd mii- 
 liere, aut oh aliam causam. Lanfranc expresses himself more clearly 
 still: "The ulcers of the penis," he says, "proceed either from hot 
 pustules which burst, or acrid humors, or from commerce with a woman 
 who has been previously aifected in the same manner. If one wishes to 
 preserve himself from all infection, it is necessary immediately after 
 connection with a suspected person, to wash himself in a basin of water 
 mingled with vinegar."! John Ardern makes mention of scalding 
 urine, vulgarly called chaude-pisses, which was caused by ulceration of 
 the canal, or by gonorrhea. 
 
 " It can not be dissimulated," says a modern writer of great weight 
 on this subject, " that the resemblance is such in the different varieties 
 of cutaneous diseases of the present time, when compared with those of 
 remote times, that it is impossible in many cases to decide if an affection 
 is venereal or not ; the only thing that can be alleged against the iden- 
 tity is, that the ancients did not represent these diseases as contagious, 
 if we except some tetters, corroding ulcers, and the leprosy. 
 
 '■' Leviticus, chap, xiii, verse 2 ; xv, 2, 3, 4 — translation of Le Maistre de Sacy. 
 See, also, in the Traite d'Hygiene of M. Levy, Paris, 1844, T. I, note to page 7. 
 fLiv. III. chap. ii.
 
 EXTERNAL THERAPEUTICS. 345 
 
 " Moreover, one disease can succeed another without presenting the 
 same symptoms : it suffices if the last has some resemblance to the 
 preceding, if it controls and displaces the other. Did not this occur at 
 the end of the fifteenth century and at the commencement of the six- 
 teenth ? In those times leprosy and elephantiasis were frequent, and 
 there were special hospitals for these diseases ; but gradually these hos- 
 pitals were deserted, and were employed for other purposes. "•■= 
 
 The sudden appearance of syphilis in nearly all parts of Europe at 
 the same time, which the first observers have reported as an extraordi- 
 nary, and nearly miraculous thing, being persuaded that the disease was 
 new — this species of sudden ubiquity for which they could not account, 
 is explained very naturally, when the venereal aflPection is regarded as a 
 degeneration or modification of leprosy, a disease extremely common at 
 that epoch. "VVe can conceive that from the moment physicians began 
 to establish a line of demarkation between the symptoms of leprosy and 
 those of syphilis, the first must diminish in proportion as the latter 
 increased. 
 
 All the authors of the times signalize the marked similitude between 
 the two diseases ; they even say that one may be converted into the 
 other. Analogous precautions were taken to prevent the extension of 
 syphilis, as had been employed against leprosy. The regulations for the 
 leprous hospitals served as a model for those of the lupanars, for in the 
 commencement, the pox inspired a horror nearly equal to that of leprosy, 
 and this horror did not diminish until increasingly efficacious means 
 were found to cure it. Therefore the opinion which assumes that vene- 
 real diseases have always existed, is sustained by the greatest probabili- 
 ties, and if it was not the first one embraced, it is to be accounted for 
 in the fact that it flattered less the taste of an age passionately fond of 
 the marvelous. 
 
 Sanchez, a Portugese physician, was one of the first to oppose the idea 
 of the American origin of syphilis, and collected a number of passages 
 which would authorize us to think that this affection commenced in 
 Italy, as an epidemic, whence it rapidly spread throughout Europe.f 
 
 He submits the work of Astruc to a luminous and severe criticism, 
 and refutes, triumphantly, his conclusions. But this cfi'ort was fruitless, 
 and almost forgotten, when Hensler took it up nearly ten years later, 
 
 '' CuUerier, Dictionnaire des Sciences Me Jicales, on Syphilis. — Dictionnaire de 
 Medicine et de Chirurgio Pratiques, art. Syphilis, T. XV, p. 176. — M. Lagneau 
 holds the same opinion on this point. — See Dictionnaire de Medicine, in 21 vol., 
 at the word Syphilis. 
 
 t Dissertation sur I'origin de la Maladie Vene'rienne. Pai-is, 1752: Examen 
 historique sur I'apparition de la Maladie vene'rienne en Europe. Lisbonne, 1774. 
 
 22
 
 346 EEUDITE PERIOD. 
 
 and supported it hy new researches, wliicli attracted the attention of 
 all Europe, and created doubts in many minds.'' 
 
 M. Jourdanf having examined, scrupulously, all the opinions emitted 
 up to that time, on the origin of these diseases, concludes with Hensler, 
 that all the symptoms which it had been usual to connect with syphilis, 
 have been known and described from the remotest antiquity, but they 
 were not supposed to proceed from a common source, (an impure 
 coition) and as being attached to the same cause, until after the close of 
 the fifteenth century. This last opinion, we have said, is the most gene- 
 rally received at present, nevertheless, all the syphiligraphs are not 
 united in this view, and we must cite among those who oppose it, M. 
 Gibert, whose authority is of so much more weight, because he has 
 •made on this subject very erudite researches.! 
 
 CHAP TEE IX. 
 THEORIES AND SYMPTOMS. 
 
 The prevailing theory during this period, as we have already observed, 
 was a mixture of Galenism and Arabism. Nothing else was taught in 
 the university schools of Italy, France, Germany, England, and Spain. 
 Men standing at the head either of science or teaching, employed all 
 their sagacity to unite together the ancient doctrines — to put in agree- 
 ment, Plato and Aristotle, Hippocrates and Galen, Ehazes and Avicenna. 
 They can all be ranked in the class of the conciliators, with a few excep- 
 tions, of whom I shall speak in the next chapter. But among them, 
 Eerncl occupies the first place, and merits special notice on our part. 
 
 John Fcrnel, surnamed the modern Galen, was born at Clermont, in 
 Beauvoisis. He exhibited, from an early age, an extraordinary aptitude. 
 and application above his years. He had made himself a reputation in 
 letters, philosophy, and mathematics, when he began the study of medi- 
 cine. Eeceived as doctor in 1530, says his biographer, G. Plancy, with 
 the unanimous applause of all the faculty of Paris, yet he did not feel 
 
 *' Geschichte der Lustseuche clie zu Ende des XV. .Jalirhunderts in Europa 
 ausbrach. Altona, I7S3, 1791, 2 vol., Svo. 
 
 f Traite complet de la Maladie vdne'rienne. Paris, 1826, 2 vol., Svo. 
 
 J See the commencement of his memoir on tlie Syphilidcs, inserted in the 3Ie- 
 moires de VAcademie de Medicine. Paris, 1843, T. X., p. 503, et als., and liis Re- 
 marques Ilistoriques sur la Le'pre, inserted in the Revue Medicate, in the July 
 tind August numbers, 1840.
 
 THEORIES AND SYMPTOMS. 347 
 
 that his precocious success dispensed with the future study of authors, 
 as is the practice of so many laureates, inflated by their juvenile erudi- 
 tion. On the contrary, he commenced reading with new zeal the mas- 
 ters in the Art, stealing from the hours of sleep and repose, every moment 
 he could, and when his friends, alarmed for his health, represented to 
 him his excesses in study, and persuaded him to take repose, he was 
 accustomed to reply : 
 
 Longa quiescendi tempora fata dahimt : Destiny reserves for us repose 
 enough. 
 
 The king of France, Henry II., was desirous of attaching him to his 
 person, in the quality of first physician ; but the philosopher refused 
 that honor, saying that it belonged, by right of succession, to Bourgeois, 
 who had been physician to the late king, Francis I. But after the death 
 of Bourgeois, he had no further excuse to make, and was constrained to 
 accept the eminent post, the object of so much solicitation. 
 
 It was in the midst of a very extensive private practice, and the duties 
 of his new charge, that he undertook to collect all the medical knowl- 
 edge scattered in the Greek, Latin and Arab books, and to form from it 
 a body of doctrines, all parts of which would be united together, as 
 branches are to the same trunk. To this end, he collected in each 
 author whatever he found most substantial, then making a judicious 
 choice of the materials he had collected, he gave them a form appropri- 
 ate to the taste of the age, and composed from the mass a work perfectly 
 regular in its arrangements, and which was regarded by his cotempo- 
 raries as the most complete and just expression of medical science, as it 
 was at that time understood. His work, written with a Ciceronean 
 purity and elegance, offers an extremely able fusion of the most accred- 
 ited ancient dogmas. We have already exhibited some parts of that 
 doctrine, and there remains but little more for us to do, in order to 
 obtain a complete idea of the work, and the relations of its parts. 
 
 Fernel emits, in the first place, his opinion on the source of our attain- 
 ments, and on the best method t» follow in the study and teaching of 
 Medicine. He unites, on this subject, the doctrines of Plato and Aris- 
 totle, which appear to be irreconcilable : the first affirming that ideas 
 come to us by recollection, the second that they originate in our minds 
 as the effect of sensations. He attempts to show each of them correct, 
 as follows : 
 
 " Before the mind." he says, "is united to the body, it enjoys its full 
 liberty ; it perceives distinctly the essence of things, aad possesses an 
 instinctive knowledge of their nature ; but as long as it is retained in its 
 material prison, the body, oblivion obscures its view, like a thick cloud, 
 and plunges it into profound ignorance. Nevertheless, it still retains a
 
 348 EEUDITE PERIOD. 
 
 slight remembrance of its divinity ; and this pleasant reminiscence of 
 celestial things becomes a ray which inflames it ■with an insatiable 
 desire to learn and to know. Hence that ardent zeal and constant appli- 
 cation, with which it struggles to recover, by means of sensitive impres- 
 sions, the mass of its knowledge. It commences, at first, with the 
 observation of sensible objects ; then it seizes, by its thought, those 
 which are accessible to the intelligence only. This, then, is the process 
 by which have been established, with the aid of the senses, the princi- 
 ples from which human sciences have been deduced, and carried to a 
 very high degree of perfection. "=■■' 
 
 What an agreeable mixture of truth and fiction, which the progress 
 of light dissipated, as we shall see in the commencement of the follow- 
 ing period. The philosophical theory, whose essential and fundamental 
 dogma we have just read, was eminently appropriate, to kindle in young 
 hearts a love for study, and to console the learned for the fatigues and 
 privations that it imposed. 
 
 " The philosophers," continues the same author, " desirous to rest 
 their doctrines on a lucid chain of rigorous proofs, have employed analy- 
 sis. Such was the method adopted by Euclid, in the exposition of 
 geometry and arithmetic ; of Ptolemy in astronomy ; such, also, the one 
 which Aristotle adopted, in order to transmit to posterity his philosophy, 
 and lay the solid foundations of so many truths, incomprehensible to the 
 vulgar, and which produce astonishment like prodigies or fables." 
 
 What would the metaphysician Condillac have said, if this passage 
 had been shown him ; he who believed analysis a scientific method of 
 modern invention ? We have already seen, that this writer was deceived 
 in regard to Aristotle — the effect of not having read, or badly com- 
 prehended him. We shall sec, further on, that the description he gives 
 of the analytic method, is imperfect, according to Barthez, one of the 
 most competent judges of our epoch. 
 
 Fernel adds, in another book. " Seeing that the knowledge of those 
 individual objects is not science, for the purpose of following a sure and 
 rational method, I shall commence by general considerations."! This 
 method, we see, is in perfect conformity to the doctrine of Aristotle, 
 which we have already set forth, and the artificial sophistry of which we 
 have unraveled. Here is the judgment that a sage of our century gives 
 upon it: "how happy we would be, said Laromiguiere, if these general 
 propositions, whose extent of application seems unlimited, and which 
 have been placed with so much confidence at the portals of science, 
 were as valuable as they arc confidently announced to be. It would 
 
 "Phjsiol. lib. I, cap. i. f Pathol., lib. i, cap. i.
 
 THEORIES AND SYMPTOMS. 349 
 
 then suffice to understand well a few axioms, to be able to comprehend, 
 thoroughly, all that it is possible to know. But, I ask if it is for those 
 who already possess the sciences, or for those who are ignorant of them, 
 that they are embraced in a few hasty formula ? Certainly these are 
 not for the ignorant ; who will dare maintain this ? Now, if they are 
 only the abridged expression of acquired ideas, they are only results, 
 and not principles."" 
 
 Our philosopher concludes, from these reflections, that the general 
 propositions, and the axioms, which it had been customary to place at the 
 commencement of most treatises, would have been more properly placed 
 at their end. But that was not the gravest inconvenience of this bad 
 method ; it has another, much more capital, which we have already 
 pointed out, but to which it is important to recur. This consists in 
 what the axioms of physics and of medicine of the ancients proclaimed. 
 These pretended principles, on which they were willing to rest the edi- 
 fice of our acquirements, instead of being the result of repeated observ- 
 ations, are the fruits of preconceived opinions, and of hastily formed 
 judgments on things imperceptible to the senses. It is on this account, 
 that when we come to compare their principles with particular facts, or 
 reality, we often find the former in opposition to the latter. Whence it 
 follows, that their principles would be defective or insufiicient guides in 
 practice, which has been proven by the ancients themselves. Fernel 
 was compelled to avow it, notwithstanding his prejudice in favor of 
 principles, that "no one could accomplish any thing great by the simple 
 knowledge of generalities, without the habit of studying particular 
 cases."j An old adage establishes, in a very explicit manner, the 
 antagonism of this philosophic method, to observation, for it says, posi- 
 tively, '' good theorist, had practitioner." Here, unquestionably, is a for- 
 mal condemnation of the theoretic principles of antiquity ! 
 
 Fernel divides medical science into three great sections, namely, phy- 
 siology, which comprehends the anatomical description of the parts, 
 pathology, and therapeutics. Each of these divisions contains seven 
 books : — 
 
 1. In the first section we find again the doctrine of Galen on the ele- 
 ments, humors, temperaments, innate heat, radical moisture ; on the 
 formation of natural, vital, and animal spirits ; in a word, on all the 
 functions of the animal economy, as they were understood by the physi- 
 cian of Pergamos. In it is given the explanation of the most impene- 
 trable mysteries of the organism, in conformity with the ideas of the age. 
 and with a firm conviction of their truth. Would you know on what 
 
 ''Lef;ons de Philosophic, 1826. First part, § 5. f Pathol, lib. iv., Praefatio.
 
 350 ERUDITE PERIOD. 
 
 depends the sex of infants ? Fernel replies, in the faith of the ancients, 
 that it depends on the quality of the semen of the father and the 
 mother. If heat and dryness, he says, predominate in the two liquids, 
 a male will be generated ; if coldness and moisture predominate, it will 
 be a female.' Ask whence proceeds the resemblance and want of resem- 
 blance between the parents and their offspring? Our physiologist 
 answers you that it appertains chiefly to the imagination of the mother. 
 
 2. The second section, that is, the treatise on pathology, offers us, in 
 the first place, abstract dissertations on the essence, the causes, and 
 symptoms of diseases. We shall not recur to this point, which has here- 
 tofore been alluded to. Afterwards the author exposes the specific and 
 individual differences that distinguish morbid affections from each other, 
 and on this subject he proposes a programme very difl&cult to fill up. 
 " As for myself," he says, "I shall never believe I have profound knowl- 
 edge of any affection if I do not know positively, just as if I could see 
 with my eyes, in what part of the human body is its primitive seat, 
 what species of organic lesion constitutes it, whence it proceeds, if it 
 exists idiopathically or by sympathy, or if it is kept up by the presence 
 of some exterior cause. He who pretends to be a rational physician must 
 sound each of these subjects, and discern them by certain signs."" 
 
 Where is the pathologist who would now dare to promise himself the 
 solution of such a problem, in most diseases ? Fernel regarded it solved 
 for a long time, and aspired only to the glory of thoroughly compre- 
 hending the sense of the solution which had been given by the founders 
 of the doctrine, and faithfully reporting it. Here are some propositions 
 from his pathology, which might be said to be extracted from the writings 
 of Galen : 
 
 " Fever is an unnatural heat, which is propagated from the heart into 
 all parts of the body. The febrile essence exists in the heart, and being 
 opposed to the innate heat, falls furiously upon the organ, like an enemy 
 changing and troubling all its functions.f 
 
 " Ephemeral fever resides especially in the vital spirit, of which the 
 heart is the great reservoir. Now, this spirit being extremely subtile, 
 it results from that that this fever is the most transient of all. 
 
 " Synocha, or continued fever, is seated in the humors of the heart 
 and great veins. 
 
 " Hectic is fixed in the substance itself of the heart." 
 
 These propositions, which now appear so strange to us, passed for fixed 
 truths in the days of Fernel. Skepticism was at that epoch as rare in 
 philosophy and medicine as in religion. They believed as much in the v 
 
 -Pathol., lib. V. flbid.
 
 THEORIES AND SYMPTOMS. 351 
 
 infallibility of Aristotle, Hippocrates, Galen, and Avicenna, as in that 
 of St. Paul or St. i\.ugustine. When an axiom in philosophy or an 
 aphorism in medicine had obtained the assent of the great geniuses of 
 antiquity, faith was given to them, without examination, as to a dogma 
 of theology consecrated by the sanction of a Council. This shows us how 
 so many errors were taught and defended with entire conviction, by men 
 of lofty intelligence. 
 
 3. In regard to therapeutics, I have exposed sufficiently at length the 
 principles on which it was founded, and the manner of their application. 
 I shall content myself by adding here some examples of cure, which can- 
 not be explained either by the rule of contraries or similars, and which 
 completes the refutation already given of these two rules, and proves 
 more and more the necessity of banishing them from therapeutical 
 language. 
 
 First example. — A man having swallowed, by mistake or design, a 
 concentrated solution of corrosive sublimate, the physician called at the 
 moment hastens to obtain the whites of eggs, and gives them to the pa- 
 tient to drink. How could a chemist explain the anti-venomous action 
 of the remedy ? Shall he say that the force of the albumen, being op- 
 posed to that of the poison, formed an equilibrium and neutralized it ? 
 Xo. He will say that the mercurial is decomposed by the albumen and 
 brought into a state of protochloride, a substance insoluble and much 
 less deleterious than the sublimate. There is not, as we see in this ex- 
 planation, any idea of antagonism or similitude between the poison and 
 the antidote. 
 
 Second example. — A young woman is afflicted with chlorosis ; her 
 blood contains less fibrin and less red globules than in the normal state ; 
 the menstruation is effected imperfectly or not at all. Feruginous 
 preparations are ordered, and exercise on horseback, with a nutrition 
 composed mostly of meats. At the end of some months, on this regi- 
 men, the patient recovers her health. What relation of similitude or 
 opposition is there between the pathological state of this person and the 
 treatment employed ? It would need very keen eyes to perceive between 
 these things, so separate, any analogy or antagonism. All that can be 
 said is, that the diseased organs have been put in contact with new 
 modifiers, by the aid of which they have returned to their normal state.. 
 
 Third example. — A traveler, overcome by cold, is carried into an inn. 
 He is very cautiously kept from the fire, and is rubbed with snow. In 
 this case the remedy has much similitude with the morbific cause. The 
 examples of this order are rare, yet they have sufficed to suggest the 
 strange system of Homoeopathy — so much is the spirit of man inclined 
 to generalize even the most exceptionable facts.
 
 352 EEUDITE PERIOD. 
 
 Fourth example. — Let an individual suffer a luxation of the femur, 
 by any accident whatever. To restore the bone to its natural position, 
 the surgeon must act in a contrary sense to that of the forces vyhich 
 produced the displacement. In this maneuver there is a manifest oppo- 
 sition between the morbid cause and the remedial process. 
 
 These examples suffice to demonstrate materially, that neither the 
 law of contraries nor the law of similars can be rationally elevated into 
 a general therapeutic axiom. If it be desirable to establish an axiom 
 which embraces every case of curing, we must seek it in another class 
 of ideas, as we have already insinuated on more than one occasion, and 
 which we shall formally demonstrate in the next period. 
 
 CHAPTER X . 
 
 OCCULT SCIENCES. 
 
 The doctrine which we have developed in the last chapters reigned 
 almost universally in the medical world, during the fifteenth and the 
 sixteenth centuries. Nothing else was taught in the schools, so that it 
 may be regarded as the orthodox doctrine of those times. Nevertheless, 
 a few voices protested against it, and attempted to overturn the ancient 
 edifice of Philosophy and Medicine. But these voices had only a pass- 
 ing echo ; they could not arouse the mass of minds, because they pro- 
 posed nothing, in the place of a doctrine which had the sanction of ages 
 and genius, but informal essays and undigested lucubrations. The most 
 of the partisans of the occult sciences were restless minds, such as are 
 found in all ages, who bear impatiently the yoke of authority, and who, 
 full of confidence in their own abilities, will receive a law from no other 
 person. Some of these did not lack sagacity, imagination, or audacity ; 
 but most of them lacked connection of ideas, propriety of language, 
 and dignity of conduct. Prophets or demons, they had among them- 
 selves no community of principles — living most of the time isolated 
 from each other and the rest of the world. They became remarkable by 
 their oddities, their adventures, and even their misfortunes. Instead 
 of setting up again the car of reason, the sectators of the occult sciences 
 who gave the first signal of revolt against the accredited doctrines, 
 would have caused the world to deviate still more, if it had followed 
 their foolish direction. Nevertheless, we meet in their writings some 
 useful truths, mingled with a mass of reveries. They have founded no
 
 OCCULT SCIENCES. 353 
 
 doctrine worthy of a pliilosopliic regard ; but, by their declamation, they 
 forced the true savans to leave the track of the past, and revise the ele- 
 ments of our knowledge, which led to the dawn, in the following period, 
 of an admirable scientific reform." 
 
 I. The first promoter of the occult sciences who is mentioned in the 
 history of Medicine, is Cornelius Agrippa. Issue of a noble family of 
 Cologne, he received a distinguished education, and possessed varied and 
 extensive attainments ; but his natural inconstancy and caustic humor 
 raised up enemies every where against him, and prevented him from 
 becoming permanent in any locality. He led a wandering life, some- 
 times honored with the favor of the great, and again plunged into 
 extreme misery. Entering early into the service of the Emperor Maxi- 
 milian I., he obtained at first the post of secretary, and followed that 
 monarch in the array, where he distinguished himself by his bravery on 
 several occasions, and merited the title of knight. Disgusted very 
 soon with the profession of arms, he quit it to devote himself to the 
 study of jurisprudence and medicine, between which he divided his 
 time. His intemperate and bold pen soon drew him into quarrels and 
 persecutions. At Dole, he fell out with the monks ; at Paris and 
 Turin, he compromitted himself with the theologians ; at Metz, he 
 drew upon himself the formidable animosity of the Jacobins, for having 
 attacked, imprudently, the prevailing opinion at that time, which gave 
 three husbands to Saint Ann. His oddities and incessant controversies 
 obliged him to fly from country to country. He was a vagabond, and 
 almost a mendicant, in Germany, England, and Switzerland. Thence 
 he went to Lyons, where at that time resided Louisa de Savoy, mother 
 of Francis I., and regent of the kingdom, who honored him with the 
 title of her physician. But Agrippa found these functions beneath his 
 merits and birth, and he did not fulfill them long. Having dared to 
 predict to the superstitious princess the reverses which he believed 
 announced by the course of the stars, he was disgraced and banished 
 from the court of France. From thence his evil star led him to the 
 Low Countries, where he was cast into prison on account of his treatise 
 on the Vanity of the Sciejices, and on Occult Philosophy. Afterward 
 he dared return to Lyons, and was there incarcerated anew for a libel 
 which he had published against his old protectrice, Louisa de Savoy. 
 Finally, his adventurous life was terminated in a hospital of Grenoble, 
 in 1535, at the age of nearly fifty years. 
 
 Among the works proceeding from his satiric pen, the most considera- 
 ble, the one in which the bitterness of his spirit, and the caustic 
 
 " Eusebe Salverte, Des Sciences Occultes, or Essai sur la Magie, les Trodiges et 
 les Miracles, Paris, 1843.
 
 354 ERUDECE PERIOD. 
 
 character of liis genius is most liberally displayed, is his treatise on the 
 Uncertainty and Vanity of the Sciences, in which he proposes to demon- 
 strate, " that there is nothing more pernicious and injurious to common 
 life, and nothing more pestilential to the salvation of souls, than the 
 arts and sciences" — a paradox renewed and sustained with much more 
 eloquence in the last century, by J. J. Eousseau. Agrippa approached 
 his subject in a manner more extended than the philosopher of Geneva. 
 He commenced, according to the custom of the times, by establishing 
 his proposition on scriptural authority ; then he supported it by testi- 
 mony drawn from profane authors. Afterward, he passed in review the 
 various departments of human knowledge, the diverse occupations and pro- 
 fessions, and concludes from this detailed examination, that each of them 
 does man more harm than good. Courtiers, warriors, magistrates, 
 churchmen, proletarians, ail, are cited to his tribunal, where they are 
 judged and condemned. He only acknowledges the value of laborers 
 and shepherds, who, he says, have produced the necessaries of life, since 
 the fall of Adam. 
 
 He speaks as follows of alchymy, which he had practiced a good deal : 
 " In fine, having lost the time and the money which you have devoted to 
 it, you will find yourself old, ragged, hated, famished, always smelling 
 the sulphur, soiled with sweat and charcoal, paralytic by frequent mani- 
 pulation of quicksilver, and gaining nothing but a running nose ; in a 
 word, so unhappy, that you will be willing to sell your body, and even 
 your soul.* 
 
 As to lawyers and physicians, we may judge how he treated them, by 
 the following facetiousness : " Some jurisconsuls and physicians were 
 disputing once for preeminence : the suit was heard by a magistrate, who 
 examined both parties, and noted their answers. ' AVhat is the custum,' 
 asked the judge, ' when criminals are led to punishment; in what order 
 do the hangman and the thief march to the scaffold "?' They having 
 answered, that the thief went first, and the executioner followed ; the 
 judge founded upon this report, his sentence: Let the lawyers, then, 
 proceed, and the physicians follow next ; showing in this way, his views 
 of the grand larcenies of the former, and the bold homicides of the 
 latter."! 
 
 He did not show himself more gallant towards the fair sex. " The 
 court women," he says, " have also their particular vices. We see some of 
 them handsome in person, gracious, agreeable, genteel, and besides well 
 
 '■' Paradoxe, or the Uncertainty, Vanity, and Abuse of the Sciences, by Agrippa. 
 French translation, 1603, chap. xc. 
 tibid., c, 83.
 
 OCCULT SCIENCES. 355 
 
 dressed, ornamented, and enriched with gold rings and precious stones. 
 But it is not easy for every one to jDenetrate with the eye, under those 
 fine veils, which cover often hideous monsters. On this account, Lucian 
 has justly compared them to Egyptian temples, which are beautiful and 
 rich externally, constructed of elegant stones, and adorned with sump- 
 tuous works; but if the gods were asked what was within, to which 
 these superb edifices were dedicated and consecrated, they would answer 
 a stork, a monkey, a stag, a cat, or some other ridiculous animal." 
 
 We will terminate the extracts from this martyrologist, by the follow- 
 ing passage, relative to monastic sects. " They are joined," says our 
 sarcastic writer, " like all free receptacles for wanton sinners, by all those 
 who, afii'ighted by their evil consequence, fear the rigor of the laws, 
 and who can find no other safe retreat ; and by those who have led infa- 
 mous and dishonest lives, and are reduced to want and beggary, after 
 having wantonly dissipated their goods in brothels and taverns, and 
 become hopelessly in debt to all of them. Behold the great sea in which 
 live, with other fish. Behemoth and Leviathan, enormous monsters and 
 strange reptiles, whose number is infinite. '"=•' 
 
 Let us now look at the morality of the work, and we shall find it, I 
 think, worthy of an adept of the occult philosophy. " If you desire to 
 obtain wisdom from the tree of life, and not that from the tree of know- 
 ledge of good and evil, reject all human doctrines, all the curiosities 
 and discourses on the flesh and the blood, re-enter into yourselves, and 
 there you will learn every thing ; but if you cannot perceive them by 
 clear and manifest intelligence, as well as the saints, it is necessary to 
 have recourse to Moses, to the prophets, to Solomon, to the evangelists, 
 to the apostles — for all the secrets of God and nature, the reason and 
 basis of all laws and customs — the kuowledge of all things present, 
 past and future, are contained in the holy writings of the Bible." 
 
 The definite conclusion that Agi'ippa drew from this book was not as 
 strange to the eyes of his cotemporaries as it appears to us now. Long 
 before him, erudite men of the first order, such as Bessarion, Pic de la 
 Mirandole, Angel Politien, Marcellus Ficin, had attempted to introduce 
 the ideas of Plato into physics. They thought, with that philosopher, 
 the best means of acquiring science and mastering the truth, consisted 
 in mental reflection and in isolation as much as possible from all exter- 
 nal sensation ; besides, they admitted a correspondence, sympathetic and 
 antipathetic, between the celestial bodies and the beings of our sublunary 
 
 *Paradoxe, or the Uncertainty, Vanity, and Abuse of the Sciences, by Agrippa. 
 French translation, 1G08, chap. cm.
 
 356 ERUDITE PERIOD. 
 
 globe. They were persuaded that a great number of phenoraena and 
 events in this world have their origin in astral influences. 
 
 From this system to the extravagances of the Cabal there is but one 
 step, and which was easy to take in times of superstitious prejudice and 
 religious excitement. The ascetic Christians have, in fact, a belief that 
 approaches very much the system of the Platoneans. They attribute a 
 great number of events and phenomena, not to the influence of the stars, 
 but to the direct intervention of the Divinity or the demon. According 
 to them, also, the surest way to acquire science and wisdom consists in 
 uniting the soul to God by meditation, prayer, and the renunciation 
 of all exterior distractions. 
 
 The following is a summary of the Cabalistic theory : — All the events 
 of life and all the phenomena of nature proceed from the immediate in- 
 fluence which God, or demons, or the stars exercised on the archetype, 
 that is to say, on the essential spirit of substances. He who is able to 
 withdraw this spirit, and knows how to ally it to other bodies, possesses 
 the faculty of creating new beings ; he can fabricate gold at pleasure. 
 The day and the hour of our birthplaces are under the domination of a 
 particular star. Besides, each one of our principal members corresponds 
 to some planet and shai'cs its constitution. 
 
 Such is the foundation of the occult philosophy which is divided into 
 four branches, namely, theurgy or theosophy, to which a man raises him- 
 self by prayer, meditation, and extasy, and which gives the faculty of 
 producing, like the saints, supernatural phenomena by the intervention 
 of God ; magic, or the art of controlling demons, and imitating by their 
 intermediation true miracles ; astrology, or the art of reading future 
 events in the stars, and predicting the fate of nations, the destiny of 
 men, and the issue of diseases ; lastly, alchymy, which teaches the secret 
 of exti acting the quintessence or the archetype of substances, otherwise 
 called the philosopher's stone, by means of which the metals can be trans- 
 muted, gold fabricated, and many diseases cured. 
 
 Thus the errors of science, superstitious prejudices, religious excite- 
 ment, and the thirst for riches, concurred at the same time to propagate 
 the follies of the Cabal at the close of the middle ages. Never were 
 there seen so many sorcerers, demoniacs, astrologers, and alchymists. 
 Never were prophecies, visions, and prodigies of all sorts, so common. 
 Not one remarkable event occurred, but immediately it was pretended 
 that it had been announced by some previous sign or token. How many 
 times was the ond of the world predicted as very close at hand, putting 
 in great agitatnn entire communities — not only the inmates of cottages, 
 but even of palaces. 
 
 i
 
 OCCULT SCIENCES. 357 
 
 But in no country were the Cabalistic reveries as universally adopted 
 as in Germany, where mysticism maintained them longer than elsewhere. 
 Luther himself seemed to share the vulgar prejudices of superstition, 
 and contributed much to spread them. He spoke often of struggles 
 with the devil. He said that the evil spirit was accustomed to appear 
 unto him in the figure of a monk, opposing him with captious syllogisms. 
 He blames the physicians for attributing to natural causes many diseases 
 of which the demon alone was the author. 
 
 The history of this period offers us everywhere the spectacle of the 
 reign of darkness struggling, with forces nearly equal, and with balanced 
 successes, against the reign of light and of truth. 
 
 II. The second propagator of cabalistic Medicine was Jerome Cardan, 
 who was born at Pavia, the first year of the sixteenth century. His 
 life, like that of Agrippa, was full of vicissitudes, his character full of 
 oddities. His mother attempted, vainly, during his uterine life, to 
 produce abortion, by the use of certain drinks. After his birth she 
 took an affection for him, and devoted to him all the care that his 
 delicate health required. But his father never loved him ; he treated 
 him like a beast during his childhood, imposing upon him painful labor, 
 above his strength. However, at the solicitation of his mother, he con- 
 sented, rather late, to send him to a gymnasium, where the young 
 Cardan learned the first elements of the Latin language, grammar, and 
 dialectics. Afterward he embraced with very great ardor the study of 
 mathematics, philosophy and medicine. He made such rapid progi'ess 
 that at twenty-two years he was capable to discuss publicly, all ques- 
 tions. Two years after he received the doctor's hat. He practiced 
 medicine in various places till the age of thirty -three years, when he 
 was named professor of mathematics at Milan. He kept this place 
 only two years, after which he traveled in Grermany, France, and 
 England, and returned to Italy. He was imprisoned six months at 
 Bologna, for debt, and went at last to Eome, where he obtained a pension 
 from the Pope, and where he died, in the year 1576. 
 
 The following is the opinion of M. Dezeimeris respecting him : " His 
 immense acquirements, extraordinary sagacity, gTcat liberty in thought, 
 his style, in general manly and elevated, would have placed him at the 
 head of the most celebrated writers of the sixteenth century, if he had 
 not united to so many qualities a taste for paradoxes and the marvelous — 
 an infantile credulity and superstition hardly conceivable, an insup- 
 ptrtable vanity, and endless boasting."-' Leibnitz, a good critic in 
 regard to talents and merit, judges him still more advantageously ; he 
 
 ** Dictionaire Hist. Med., at the word Cardan.
 
 358 ' ERUDITE PERIOD. 
 
 says, " Notwithstanding his faults, Cardan was a great man, and without 
 his defects would have been incomparable." 
 
 He wrote a great number of works on i^hilosophy, mathematics, and 
 Medicine." Sometimes he admits without any criticism the most absurd 
 stories, visions, dreams, sorceries of all sorts, and explains them by the 
 theories of the Cabal. Again, he affirms that he had never devoted 
 himself to the cabalistic art ; he blames those who practiced them, and 
 jeers at those who have faith in them ; he ridicules those persons who 
 believe in apparitions, charms, and prodigies. 
 
 The following principles on Chiromancy are extracted from one of his 
 works : " The indications of strength, of valor, and voluptuousness, are 
 revealed by the thumb, which is under the influence of Mars ; those of 
 honorable positions, civil or ecclesiastical dignities, are located in the 
 forefinger, which is controlled by Jupiter. The middle finger, which -is 
 under Saturn, indicates capacity for the Magical art ; it also indicates 
 melancholy, poverty, care, quartan fevers, and captivity. The ring 
 finger submits to the reign of the sun, and presages friendship, honor, 
 and power. The little finger, which is influenced by Venus, designates 
 children, handsome women, and sensual pleasures. Mercury reigns over 
 the triangle on the middle of the hand, where are found indications of 
 erudition, cunning, robbery, etc." | 
 
 The history he has written of his life is no less curious than his 
 works, and no less strange from the freedom, somewhat cynical, with 
 which he confesses his errors and even his vices. It is true that 
 he attributes his faults, as well as all the misfortunes of his life, to the 
 influence of the stars. Moreover, he loves to speak of himself so much, 
 that he omits no particular ; he gives the size of his inkstand, the cost 
 of his knife, the color of his hair at birth, the age at which he lost his 
 teeth, and other trifling minutise. Nevertheless, neither the great num- 
 ber of his writings nor the versatility of his humor, would suffice to 
 explain his tcdiousucss, his numerous repetitions, and frequent contra- 
 dictions, if we did not know that he composed most of his works under 
 the pressure of want; that in his haste to finish them, he often let his 
 pen run at hazard, without any other desire than to increase his volume 
 so as to obtain a better price. 
 
 III. Paracelsus, native of Marien-Einsiedeln, a village of Switzer- 
 land, twenty miles from Zuerich, had no cause, like the preceding two, 
 to complain of his lot, or of men. He made more noise in the world 
 while he lived than many savans of superior merit, and after his death 
 he obtained a celebrity which his writings are far from justifying. His 
 
 " Hier. Cardani Opera, Cura Car. Sponii. Lugduni, 1663. Ten vol. in fol. 
 ■j- Cardan, De Rerum Varietate, lib. xv., cap. lxxix.
 
 OCCULT SCIENCES. 359 
 
 father, wlio was a physician, gave laim his preliminary education. After- 
 ward, he made him travel, according to the custom of the scholastics of 
 those times, to visit the universities and hear the most celebrated pro- 
 fessors. But instead of frequenting the schools, young Paracelsus sought 
 the conversation of clever women, barbers, renovators, magicians, alchy- 
 mists, in whose society he boasted he had obtained valuable secrets. 
 A very marked taste led him at once to the chimeras of the Cabal. He 
 declares that he did not open a book for ten years. He neglected to 
 such an extent his academical studies, that he forgot the little gram- 
 mar and literature he had acquired in the paternal mansion, and 
 became incapable of expressing himself in Latin in an intelligible 
 manner. 
 
 From the age of twenty-five years, he contracted the degrading habit 
 of strong drink, and the passion augmenting from day to day, ended by 
 absorbing entirely his reason and virility. It is certain that he never 
 exhibited any inclination for women, whom he continually slandered. 
 In regard to the feebleness of his intellectual faculties, hear what his 
 secretary and faithful disciple, Oporin, says: "During the two yeai's 
 which I passed with him, he was so strongly inclined to drunkenness 
 and constant debauch, that he could scarcely be seen an hour or two in 
 the day without being full of wine, especially after his departure from 
 Basle for Alsace, where that condition did not prevent him being admired 
 by every one as a second Esculapius. Xevertheless, drunk as he was, 
 he did not leave oif dictating to me something of his philosophy, when 
 we had returned to our lodgings. Very often he would get up in the 
 middle of the night and take his sabre, which he boasted had been given 
 to him by an executioner, and whirl it around, striking groat blows 
 upon the walls and the floor, so that I would tremble, expecting every 
 moment that he would split my head open."'-' 
 
 At that time, Paracelsus was between thirty-three and thirty-five 
 years of age, which was the most brilliant period of his life. His wri- 
 tings, in which he gives with great emphasis, accounts of his numerous 
 successful cures, after the fashion of charlatans, and in which he says 
 he is possessed of infallible secrets against the most incurable diseases, 
 had at last drawn on him public notice. He had just been called to 
 Basle to fill the chair of Physic and Surgery. A crowd of curious and 
 idle persons, and of enthusiasts attended his first lectures, which he 
 delivered, not as was customary, in the Latin, but in the vulgar tongue. 
 The thaumaturgist, in order to astonish his auditors, commenced by burning 
 
 "' Oporini de vita et moribus Paracelsi, ad Solenandrum et Wierum epistola, 
 Sennerti libro de consensu et dissensu chimicorum cum Gal. et Arist. inserta.
 
 360 ERUDITE PERIOD. 
 
 the works of Galen and Avicenna ; then he began to read and develope 
 his own writings, breaking off from time to time in declamations of this 
 kind: " Know, ye doctors, that my hat knows more than you — that my 
 beard has more experience than your academies. Greeks, Latins, Arabs 
 French, Italians, Jews, Christians, and Mohammedans, you must follow 
 me ; I shall not follow you, for I am your monarch, and sovereignty 
 belongs to me !" =•■■= 
 
 His vogue as professor was not of long duration ; before two years had 
 expired, no one was willing to listen to him. He was not less under- 
 rated as a practitioner ; so that being obliged to quit Basle, in consequence 
 of some mishaps, his precipitate departure created no sensation. He 
 resumed then the wandering life which he always loved, and continued 
 in it till the end of his days. We find him in Alsace in 1528, at 
 Nuremberg in 1529, at St. Galle in 1531, at Mindelheim in 1540, and 
 the year after at Saltzburg. where he died at the age of forty-eight, in 
 the hospital of St. Stephen. 
 
 There are few medical men of whom so much of good and evil has been 
 said, as Pai'acelsus, and there are few of whom it would be as difficult to 
 form a proper and equitable opinion. If we consult the testimony of his 
 cotcmporaries, we find little agreement among them — they are often in 
 direct opposition ; and if we essay to enlighten ourselves by the writings 
 even of the author himself, we fall into a chaos still more inextricable. 
 Those who have attempted to analyse his doctrines, have abandoned the 
 attempt, after efforts more or less obstinate and superfluous. " It would 
 be an impossible enterprise," svijs a modern historian, "to arrange the 
 writings of Paracelsus into a systematic form. Ideas without connection, 
 observations which contradict each other, and incoherent phrases, defy 
 the comprehension of the best reader. Fancy a man who in certain 
 moments gives proof of an admirable penetration, and who, in the next, 
 writes the veriest nonsense in the world ; a man who is sometimes 
 devoted to science, proclaiming the absolute authority of experience — 
 launching the most violent anathemas against the theories of the 
 ancients — and who again, as if deranged, seems to converse with demons, 
 and to believe in their omnipotence ; a man, in fine, who, fasting in the 
 morning and drunk at night, yet put down all his ideas in exactly 
 the order they were presented to his mind. Such was Paracelsus, whose 
 name entire, was Aurelius Phillippus Theophrastus Parcelsus Bombas- 
 tus ab Hohenheim. 
 
 " No one can contest the influence that Paracelsus exerted upon his 
 age. That influence was certainly immense. Why? How? Was it 
 
 ^' Preface to the book entitled Paraganum, et alibi.
 
 OCCULT SCIENCES. 361 
 
 because he allied mediciue and chemistry with the mystical doctrines 
 of the Cabal ? Others, wiser than he, had already done this. All the 
 Hermetic philosophers had done it. Was it because, as some think, he 
 was the representative of the alchymists ? It is in the middle ages, and 
 not in the sixteenth century, that we must seek such a representative ; 
 for fi-om the epoch of Paracelsus, alcbymy began to be exposed, and true 
 chemistry to be developed. He should, then, have exercised a retro- 
 grade, instead of the progressive movement which he brought about. 
 Besides, the true alchymists of the sixteenth century did not recognise, 
 in any manner, Paracelsus for their patron ; they do not even allude to 
 him, no more than if he had not even existed. 
 
 "Let us endeavor to solve this question, which will enable us to 
 comprehend all the influences that this man exerted on his age ; and in 
 the first place let us establish, once and for all, that it is to physicians, 
 and not to alchymists, that Paracelsus addresses himself, and with 
 whom he has controversies. As to alchymy, his writings embrace 
 nothing which has not been said, and a thousand times repeated, by 
 the theosophs of Alexandria, by the Arabians, Albert the great, Pioger 
 Bacon, Kaymond Sulle, etc." =•' 
 
 Behold Paracelsus thus disowned by the chemists and alchymists, 
 with whom, however, he was supposed to be connected, whose works he 
 boasted that he possessed, and whose teachings he had followed ; whose 
 doctrines he was incessantly praising, for he disdained the science of 
 Hippocrates, Galen, the Arabs, and the Arabists. He despised the course 
 of instruction given in the universities, but highly valued what was 
 drawn from the writings and experiments of the alchymists. He cites, 
 with ostentation, the names of the latter, whom he had the honor to 
 know, and whose experiments and writings he had followed. "I have 
 diligently studied," he says, "under excellent masters, who were pro- 
 foundly versed in that most abstruse and secret philosophy which they 
 called adept philosophy, Xow, my masters were, first, William Hohen- 
 heim, my father, who instructed me diligently, and several others, who 
 were faithful in their teachings and concealed nothing from me. Addi- 
 tionally, I have studied the writings of several distinguished person- 
 ages, the reading of which has been of great profit to me: namely, 
 those of Scheit, bishop of Settgach, Erard Levantal, of the bishop 
 Nicholas of Yppon, of Matthew Schacht, the suffragan of I'hreisiuo-en. 
 of the abbot Spanheim, and those of several other great chemists. 1 
 have also become enriched with numerous and varied experiences, 
 which I learned from the chemists, among whom I will name the very 
 
 F. Hoefer, Hist, ile la Chimie. Pixris, 184:3 ; T. 11.. epoch o, sect, i., ^ 3 n <) 
 23 ' b . p. .
 
 362 ERUDITE PERIOD. 
 
 noble Sigismund de Fugex' de Scliwats, who has added very much to 
 chemistry, and greatly extended it, having maintained at great expense 
 several servants, whom he kept continually at work.""- 
 
 Since Paracelsus must he erased from the number of men who have 
 contributed to the progress of chemistry, though he boasts on all occa- 
 sions to have improved it, let us see what was his influence on Medicine. 
 Let us take the best, or rather the least exceptionable of his works, the 
 one in which we meet the most sensible things and the least extrava- 
 gance — his " Great Surgery." M. Malgaigne, desirous of extracting 
 the quintescencc of this work, to use a common expression of Paracel- 
 sus, quotes, as an admirable extract, the following passage — the sole 
 one, moreover, in which he has found any traces of a rational philoso- 
 phy : " There are two kinds of ways and paths, or two methods and 
 fashions, by which to arrive at a knowledge of the arts. The one 
 teaches and conducts to the truth ; the other, to illusions. The erring 
 and vagabond discourses on the understanding and reason, are the 
 causes of error, which occurs when they arc permitted to guide us. 
 Experience, and that which is found familiar and in accordance with 
 nature, and which produces like actions, is the cause of truth and 
 certainty, "f 
 
 The entire chapter to which this fragment belongs, is devoted to show 
 that arts in general, and Medicine in particular, are formed and im- 
 proved by experience, and not by reason ; for nature can and wishes to 
 be known by the aid of the senses only, without needing to have recourse 
 to ratiocination ; thus, we do not know, by reason, what is concealed 
 within the bowels of the mountain — but by the senses, only, which are 
 impressed with the things that are seen, and reveal to our minds 
 their nature. f M. Malgaigne is so astonished with the doctrine pro- 
 fessed in this chapter, that he does not hesitate to proclaim Paracel- 
 sus the precursor of Francis Bacon, the great reformer of philosophy 
 and the physical sciences — as if this was the first time that such a 
 doctrine was put forth; as if Aristotle himself had not taught that all 
 our ideas come from the senses, and that the sciences are the result of 
 observation and memory I Even Fernel, so reverential toward the an- 
 cients, teaches also, that our first ideas arise from sensations. 
 
 Yet this doctrine has not prevented Aristotle, nor Fernel, nor Para- 
 celsus, nor Bacon, nor a crowd of others, from departing in their theo- 
 ries from the testimony of the senses, to follow the phantom of their 
 
 " Grande Chirurgie, translated into French by Dariot, liv. ni, part i, chap. i. 
 •j-Ibid, liv. II, tr. ii, chap. i. — Introduction aux Giuvres d'A. Pare, part ii, § v, 
 pa. 225. 
 I Ibid.
 
 OCCULT SCIENCES. 363 
 
 imagination. Who, more than Paracelsus, has falsified experience ? 
 Open his works wherever you may, ami you will not find one chapter, 
 not one page, which is in accordance with it. " He proscribes," says 
 M. Malgaigne. (who endeavors, however, to sustain him), "he banishes 
 from Medicine the doctrine of four humors, upon which, after Galen, all 
 explanations had been founded : but he replaces one hypothesis only by 
 another, and all his theory, resting on a doubtful basis, crumbles in its 
 turn when it is submitted to the test which this supreme judge him- 
 self has invoked — experience. The following is the sum total of it : 
 
 " The human body, like the great world of which it is an image, is 
 composed of four elements — fire, air, earth, and water. The fire, in 
 man, is the soul ; the earth is represented by the dry parts ; the water, 
 by the liquids ; the air, by that which we now-a-days call gas, and 
 which he terms vacuum : now these four elements may cause diseases. 
 But, if we leave this high analysis, to get at the more immediate ele- 
 ments, the body of man is composed of mercury or liquor, of sulphur, 
 and of salt. And now, see how this is demonstrated by alchymy: 
 there are, in the first place, in the body, liquids ; these are the mercury ; 
 then the solids which may be burnt, and the portion which burns is 
 sulphur, while the residue, or the ash, is salt. But this doctrine does 
 not belong to Paracelsus ; it is found before, in the writings of Basile 
 Valentin, and even, it is said, in those of another alchymist, anterior to 
 Paracelsus, Isaac Hollandus."-' 
 
 The above is what may be collected, most rational, on physiology, in 
 the writings of this pretended reformer. As to anatomy, he says not a 
 word about it, and for good reasons, because he was, on this subject, 
 profoundly igTiorant ; besides, he shows for it a sovereign contempt. 
 However, he recommends that great attention be paid to the correspon- 
 dence which exists between certain regions of the great world, or the 
 universe, and certain parts of the little world, or the human body. He 
 insists, that the physician should have at his fingers' ends, the knowl- 
 edge of the regions in man, named (after constellations;, the dragon's 
 tail, the ram, the polar axis, the meridian line, the east, and the 
 west, etc."f 
 
 The pathological doctrine of Paracelsus is distributed in a great num- 
 ber of writings ; but M. Malgaigne having analyzed only the Great 
 Surgery, has extracted only what concerns ulcers, because it is espe- 
 cially in the knowledge of this kind of lesions that the ph3'sician of 
 Zurich passes for an expert. The substance of his doctrine on this 
 
 "(Euvres d'A. Pare; introduction, t. I., p. 215. 
 
 t Paragrani, tract ii, De Origine Morborum, lib. iv, et alibi. See Daniel Le 
 Clerc, Essay on a Plan to serve as continuation of the History of Medicine, p. 806..
 
 364 EKUDITE PEKIOD. 
 
 subject, is as follows: Ulcers all proceed from the corruption of the salt 
 that is in us, and they vary in nature according to the variation of the 
 salt itself. Consequently, Paracelsus proposes to divide ulcers into 
 ulcers from nitre, scrofula ; ulcers from common salt, certain ulcers not 
 painful, whose seat is generally at the bend of the arm, or in the ham ; 
 ulcers from vitriol, corroding ulcers of the legs ; ulcers from alum, gan- 
 grenous and fetid ; ulcers from realgar, malignant ulcers of all species, 
 etc., etc." I put aside, adds M. Malgaigne, after this enumeration, 
 that which treats of ulcers of another sort ; those which are caused by 
 celestial influences, or the corresponding constellation of the parts ; or 
 from special fluxes, comparable to springs which issue from the ground. 
 There ai'e those which originate in chaos, that is, from the air which is 
 in us ; others are produced by enchantment ; in a word, it is a multiple 
 doctrine, odd and difficult to comprehend in its totality, and we may 
 -occasionally doubt if the author understood it all himself."="' 
 
 Since, then, if in considering only a single work of Paracelsus, and 
 that the best of all, it is impossible to deduce from it a pathological 
 theory, at all sensible, what would it be if founded upon all, or the 
 ■greater part of the writings of this prolific author ? We would fall into 
 an inextricable labyrinth, into a mass of unintelligible nonsense. Some- 
 times he says that all diseases arise from two sources, one of which he 
 calls ex Cagastro, the other ex lUastro. The diseases of the order ex 
 Cagastro, come from natural seeds, like apples, pears and other fruits ; 
 these are hydropsy, gout, jaundice, etc. The diseases of the order ex 
 lliastro are formed by the decomposition of something. In this order 
 are comprised, the plague, pleurisy, fever, etc. Sometimes he admits 
 five causes of diseases, to which he gives the odd name of morbific 
 beings. The first of these causes is the Divinity himself, ens Dei ; the 
 second, the influence of the stars, ens astrale ; the third, the forces of 
 nature, ens naturale ; the fourth comprehends the errors of the imagina- 
 tion, evil influences, and enchantments, under the denomination of ens 
 .spirituale, or pagoycum ; the fifth and last, the ens veneni, comprising 
 •venoms and poisons, whether natural or artificial. 
 
 Moreover, he invokes another etiology ; mercury, sulphur, salt, enjoy 
 here the role of universal nosogenic agents. He assures you, for exam- 
 ple, that the mercury which is in the animal body, being in close rela- 
 tionship to ordinary quicksilver, produces, by its volatility, mania, 
 mortification of the ligaments, tremblings, etc. ; that if this volatility 
 ■becomes excessive, or if it is joined to acrimony, mania, phrenzy, mad- 
 ness, etc., occur; if, on the contrary, the mercury is chilled, it causes 
 
 '•■^Introduction aux (Euvres d'A. Pare. Paris, ISiO. t. i., p. 217.
 
 OCCULT SCIENCES. 365 
 
 tremblings of the hands and feet, or of the head alone, lethargy, contor- 
 tions of the mouth, eyes, etc. 
 
 Sulphur produces various kinds of fever, apostema or phlegmons, 
 jaundice, etc. In separating itself from the salt, it causes pleurisy, 
 inflammation of the stomach and liver, megrim, diseases of the eyes, 
 tooth-ache, ear-ache, etc. 
 
 The salt gives the colic, causes stone and gravel, gout of the feet and 
 hands, sciatica, etc. AYhen it becomes dissolved it causes a diarrhea ; 
 if it coagulates, it causes indurations, obstructions ; if it volatilizes too 
 soon, it causes ulcers, the itch, prurites, erysipelas, cancer, herpes, etc.'-' 
 
 I have not shown by far, all the phases of this fantastic nosology ; 
 but I pause for fear of annoying the reader, without being able to oifer 
 him in remuneration, any thing valuable. I pass to his therapeutics, 
 where we shall have, possibly, the happiness to meet with something 
 useful : some ingenious perception ; for this author does not cease to repeat 
 that it is not by vain words that the physician is to make himself 
 known, but by his works in curing the patients who are confided to him ; 
 and on that point, he boasts of having cured a crowd of strange diseases, 
 in persons abandoned by all physicians. Nevertheless, here are some 
 witnesses who diminish considerably the success with which he praises 
 himself. Andrew Libavius, a distinguished physician, and great chemist, 
 and who was director of the gymnasium at Cobourg, and nearly cotem- 
 poraneous with Paracelsus, assures us that the latter injured a multi- 
 tude of people, and did not cure them ; that he killed a good number, 
 or put them in a worse state than he found them ; in short, that he 
 could not cure himself of a cough, the gout, and a muscular contraction 
 with which he was aifected.f Oporinus, his fervent disciple, recounts, 
 that when his master was called any where to treat internal diseases, he 
 could never stay there more than one year, and he was accustomed to 
 say that he should not practice any longer in one place." It aj^pears, 
 indubitably, from these evidences, that if the rash practice of Paracelsus 
 procured some unhoped for cures, it was prejudicial to a much greater 
 number, and that, in short, he did much more harm than good. 
 
 Pretended reformer, who counts as nothing the authority of the most 
 worthy writers, and relies on nothing but his own experience, did he 
 really consult experience when he proposes, as an excellent means to 
 discover the specific virtues of remedies, to observe what he calls the 
 
 * Daniel Leclerc, Essai d'lm plan pour servir a la continuation tie 1' Histoire de 
 la Mcdecine, pp. 809, 810. 
 
 t Neo. Paracelsica inquibiis vetus Medicina defenditur adversus G. Amwald, 
 cujus liber de Panacea excutitur. Francofurti, 1594, 8vo.
 
 366 ERUDITE PERIOD. 
 
 signature of tltiruis 2 The partisans of the occult sciences, designated hy 
 this term certain marks and variations of color or figure which are 
 met with in various substances, and which indicate, according to them, 
 the essential projterties of these substances. Thus, the little yellow spot 
 that is seen on the flowers of the cuphrasia, which they compared to the 
 pupil of the eye. was, according to their system, an indication of the 
 cui'ative virtue of this plant, in diseases of the eye. So the seeds 
 of the pomegranate, and various kernels, fi'om tlieir rcsemblace to the 
 teeth, appeared to them as a proper remedy in tooth-ache. The pulmo- 
 nary or lung wort, on account of its spongy tissues, and the dark macu- 
 lae on its leaves, had the credit of being exceedingly efficacious in lung 
 affections. Citrons were supposed to be excellent cordials, because their 
 form represented, rudely, that of the heart, and because their golden 
 colour resembled that of the sun, which corresponds to the heart, in the 
 macrocosm. See, also, in the work of Oswald Croll, entitled Basilica 
 Oltymica, the signatures of a multitude of other substances. 
 
 Paracelsus has been very much praised for having made use of chemi- 
 cal or spagyric remedies. It is true, that though he did not invent 
 them, since they were known before him, he has at least contributed 
 powerfully to vulgarise their use, and this is the sole merit which no 
 one can contest with him. But was this merit very great and very 
 profitable to humanity? I will briefly examine this question. 
 
 In the first place, it will be admitted, that the more a remedy is 
 energetic, the more the circumspection and discernment which is requii-ed 
 in its employment. In the second place, every one knows that the 
 chemical preparations recommended by Paracelsus, such as the salts of 
 gold, antimony, mercury, etc., have in general very great energy. If, 
 then, we demonstrate that he administered these remedies with a blind 
 rashness, it will be at (mce conceded, that in his hands, and those of his 
 disciples, they would produce infinitely more harm than good. Now, 
 it is an agreed fact, the proof of which may be seen in the writings of 
 this author, that he advised a crowd of very energetic medicaments, 
 without any decided indication, without prescribing the doses in which 
 they should be administered, or the manner of preparing them — an 
 omission so much the more reprehensible, as he erai»loyed remedies but 
 little known. Each one of his recipes, as he says, is nothing less than 
 an admirable secret, which cures all diseases, or nearly all, and he alone 
 possessed the knowledge of its preparation, which he describes, for the 
 most part, in an unintelligible manner. Let us see how he describes 
 the philosophers' tincture, the tincture of antimony, of corals, of potable 
 gold, etc. A single example will suffice to show how little care he 
 exorcised in pointing out their curative indications. " It should be
 
 OCCULT SCIENCES. 367 
 
 known," lie says, " that as antimony purges gold only, and consumes 
 all othei* metals, it is the proper agent to purge the human body, and 
 no others ; for in regard to foi'ccs and perfection, man has a great 
 similitude to gold ; whence it follows, that antimony only brings man 
 and gold to a supreme degree of perfection and purity, while it destroys, 
 consumes, and corrupts, everything else. The nature, then, of antimony, 
 is purgative ; yet it does not produce evacuation of feces, and other 
 excremeuts. but above all other remedies which act insensibly, it drives 
 out that which renders man impure, and having purged the cause of 
 diseases and ulcers, it brings man to a supreme degree of health. Now, 
 the most eminent philosophers have labored hard to prepare it, but in 
 vain ; nevertheless, it was finally perfectly elaborated, but I must say 
 by my own efforts. This, then, is the great remedy with which we 
 must commence all cures, because the ruin and destruction of many 
 patients, caused by the errors and obstinacy of physicians, would thus 
 be prevented." ■■■' He describes, immediately afterward, the manner of 
 extracting the ve)y nohle, very precious, and most divine essence of the 
 jioioer of antimony, which cures all diseases. 
 
 When we reflect on the energy of a great number of spagyric com- 
 positions, when we think that several of them are violent poisons, 
 instead of blaming the wise circumspection with which most physicians 
 have admitted them into practice, they are entitled to our praise for 
 this prudence, especially at an epoch when the process for obtaining 
 them in a uniform and pure state was not known. We are frightened 
 at the idea of the ravages which the reckless and exaggerated adminis- 
 tration of these heroic remedies must have produced. Xow that their 
 effects are much better known, and when we know how to obtain them 
 in a uniform and pure state, where is the man who dares gerrci^'ali-ze 
 their use ? Who would dare proclaim a salt of gold, or antimony, or 
 other preparation, as an infallible remedy in all diseases ? None but a 
 shameless charlatan, or a physician of tlie lowest degree of ignorance, 
 would pretend to do it. Thus, then, the extravagant eulogies which 
 the Paracelsists offer to certain chemical preparations, the blind and 
 abusive emplo3-ment which they made of them, the frequent and 
 formidable accidents of which they were then the source, far from hav- 
 ing recommended such remedies to rational i)ractitioners, must have, on 
 the contrary, discredited them, and would doubtless have retarded their 
 introiluction into the materia medica, if more sensible experimenters 
 had not not been found — men more patient and skillful, to connect ^ith 
 veritable indications these heroic but dangerous agents. Thus, then, 
 
 ' Grande Chirurgie, lib. iii., part 1, chap. v.
 
 368 ERUDITE PERIOD. 
 
 from whatever point of view we regard the influence of Paracelsus, in 
 physiology, pathology, and therapeutics, we find it injurious, and even 
 retrograding, when submitted to the test of a severe analysis. 
 
 Nevertheless, we ask ourselves how it is that in an age eminently 
 erudite, a man of scarcely any learning, whose skill in practice was very 
 questionable, whose successes were mingled with many reverses, was 
 able to exert on his cotemporaries so remarkable an influence, and fill the 
 world with the echo of his renown ? A historian who has made a par- 
 ticular study of the doctrine of Paracelsus, to which he has devoted the 
 half of a volume, shall answer this question for us. 
 
 •' A revolution," says Sprengel, " which is based upon mysticism, finds 
 access much more easily to the common people, than one which is ef- 
 fected by good sense ; because the chimeras of the imagination always 
 present themselves under the liveliest colors, and excite the mind to 
 much more activity than the severe conclusions of cold reason. In the 
 sixteenth century Germany had enlightened entire Europe by her spirit 
 of reformation. The mighty genius of Luther rendered to his cotempo- 
 raries, and to the latest posterity, the inestimable service of giving so 
 heavy a blow to mysticism, that Catholicism and scholastic theology 
 were forever put down.* Paracelsus adopted the same plan, but the fol- 
 lowing circumstances prevented his system finding as favorable and as 
 general a reception as that of the reformer in theology. 
 
 "First, Medicine is a science of experience, and to possess it, it must 
 be learned. It rests on reasonable principles drawn from observation ; 
 consequently, a doctrine which rejects the testimony of reason, and which 
 represents experience as a useless thing, could not have much success 
 among physicians. Secondly, the system of Paracelsus was based not only 
 on mysticism, but also on the grossest fanaticism. In fact, superstition 
 reigned despotically throughout the whole course of the sixteenth cen- 
 tury ; but to give to these same prejudices the appearance of a scientific 
 doctrine, was an idea that shocked good sense too much to be generally 
 received. Finally, Paracelsus was not the man to insure success to 
 his system ; he was a barbarian, an ignoramus, who despised all the 
 sciences, for the sole reason that he was ignorant of them all. Though 
 he speaks much of divine light as the source of universal knowledge, his 
 manners and his vagabond life certainly did not prove that he enjoyed 
 much of its blessed influence. 
 
 " Nevertheless, his doctrine found in Germany, especially, more par- 
 tisans than could have been reasonably supposed. From the calculation 
 which I have made of the known successors of Paracelsus, it results that 
 
 ■'It must not be forgotten tliat these are the views of a Protestant.
 
 OCCULT SCIENCES. 369 
 
 three-fourths of them were German born, but, for the most part, men 
 without education, and without any knowledge of the sciences, who threw 
 themselves, soul and body, into the arms of his mystic system, because 
 they found there amply what could supply their lack of instruction, and 
 incompetency. Others held to the medicaments and secrets of Paracel- 
 sus, seeking to reconcile his theory with the system of Galen, or at least 
 to purify, perfect, and render it more plausible." =••= Finally, the Society 
 of the Eose of the Cross applied his theories much more logically than 
 had ever been done before, to theology and philosophy. 
 
 Thus this pretended reformer, though feigning to invoke reason and 
 experience, addressed himself to the imagination, to superstitious preju- 
 dices, and mysticism. His system, if we can so name an informal assem- 
 blage of incongruous propositions, by dispensing with all university 
 studies, favored idleness and ignorance, and tended to replunge the hu- 
 man mind into the darkness of barbarism, from which it had with so 
 much difficulty extricated itself The school which he founded or prop- 
 agated is nothing else than a school of ignorance, deception, and boast- 
 ing — in a word, of medical dishonesty ; a school of which Thessalus of 
 Tralles had been the corypheus in antiquity, which John de Gaddesden 
 revived in the middle ages, and to which Paracelsus gave a new 
 development.! 
 
 CONCLrSION OP THE WHOLE CHAPTER. 
 
 The men whose portraits we have just sketched, formed, with their 
 numerous sectators, a separate class of physicians, who, abandoning the 
 slow march of observation and reason, flattered themselves with having, 
 at a stroke, attained omniscience without having made scarcely any 
 effort at study, by the direct inspiration of the Divinity, or by commerce 
 with demons, or by the discovery of the secrets of magic and alchjony. 
 The importance of the part which they played for several centuries, 
 required of us to say something of them ; but we think that we would 
 be far from our aim if we accorded any more space to the exposition of 
 their errors, which seem to belong to the history of mental diseases, as 
 much, at least, as to the history of the transformation of science. If 
 some of these fanatics were impostors and tricksters, the greater num- 
 ber were miserable hypochondriacs of the monomanial species — dupes of 
 
 '' Hist, de la Medecine, sec. ix., chap, ni., t. in., p. 333. 
 
 f See the portrait of Paracelsus drawn by Francis Bacon, cited by Tourtelle in 
 his Histoire Philosephique de la Mc'decine ; Paris, ISOi, t. II., p. 313. See also my 
 pamphlet on Charlatanism en Medecine, inserted in the Revue Medicalc, April 
 number, 1839.
 
 370 ERUDITE PERIOD. 
 
 their own hallucinations. History shows ns that snch pretended sor- 
 cerers, alehyinists or astrologers — such self-styled inspired of God or 
 possessed of the devil, were so fully convinced of the reality their vis- 
 ions as to contend for them in the midst of tortures, to their latest 
 breath. 
 
 CHAPTEE XI. 
 PARTIAL EFFORTS FORREFORM. 
 
 While the partisans of the Occult sciences strove to overturn, com- 
 pletely, the scientific edifice of antiquity, other reformers, less hold and 
 more sensible, without attacking in its whole the old monuments, the 
 ohject of veneration for so many ages, disclosed partially its defects, and 
 so opened the way to a radical reform. Without repudiating in toto, 
 like preceding ones, all the traditions of antique science, they desired 
 that they should not be blindly received but after subjecting each one 
 to a serious examination, those only should be accepted which appeared 
 in conformity with reason and experience, while the rest should be 
 rejected, or subjected to such modifications as were deemed necessary. 
 These were generally enlightened men, and, at the same time, free 
 thinkers — friends of regular progress, and not of destruction, whi'jh has 
 always, a momentary retrograde effect. They were few in number dur- 
 ing the sixteenth century, and did not produce any capital work ; but 
 history must take note of their efforts, because they were the first to 
 foresee the new route in which succeeding generations must enter, and 
 which would lead to a complete renovation of science. 
 
 I. I place at the head of the reform physicians c>f the sixteenth centui'y, 
 John Argentier of Castel-Nuovo, in Ticdinont. He taught successivelj' in 
 Naples, Pisa, aiid Turin. In his i.troductory discourse, pronounced in the 
 University of Naples, he divides physicians into two classes. " The first, 
 persuaded," he says, " that no improvement can be made on the writings 
 and doctrines of the ancients, limit themselves to their study, and to 
 ascertain their true sense, without permitting themselves to add or 
 retract anything ; the other are equally convinced of the necessity of 
 reading and meditating on these great authors of antiquity, yet do not 
 think that all which they advance is to be received without discus- 
 sion, but that it is proper to modify, change and improve them as far 
 as possible."" 
 
 *' In Artem IMcdicinalem Galeni Commentarii.
 
 PARTIAL EFFORTS FOR REFORM. 371 
 
 He does hesitate to pronounce against various jioints of the theory of 
 Galen, and contends with those who have adopted them too servilely, 
 like J. Fernel, and others. He assumes, for example, that all parts of 
 the body take their nourishment from the blood, and denies that there 
 is any part which is nourished by tlie semen. He proves that the secon- 
 dary ([ualities of the body, such as hardness, softness, asperity, etc., 
 do not depend on primitive or elementary (jualities. He rejects the 
 multiplicity of spirits with which the Galeuiftts peopled the human ma- 
 chine, and recognises only one kind, and especially treats of the class of 
 animal spirits as chimerical, for the reason that the reticular tissue, 
 which is supposed to prepare them, does not exist in man.-' Unhajpily, 
 these few new and sound ideas are overwhelmed in long and futile dis- 
 sertations. After having displayed very great subtilty, and expended 
 a quantity of words to refute a definition of Galen, the author proposes 
 for it another, which is neither clearer nor more correct. He devotes 
 seven large folio pages to a discussion on the fiist aphorism of Hippo- 
 crates: " Life is short." In fine, though styled a reformer, Argcntier 
 clings too much to the ideas of Hippocrates, Aristotle and Galen ; which 
 he explains, comments iipon, and discusses, with great prolixity, limiting 
 his reform to changing a few definitions and divisons, without making 
 any remarkable innovation in the practice. 
 
 II. Such was not Leonard Botal, who, without pretending to revolu- 
 tionize science, like the former, introduced into the practice very impor- 
 tant and bold innovations. Before him, the employment of blood-letting 
 was excessively restrained. "NVe have seen that Brissot, after a long 
 struggle, only succeeded in establi:>hing it a little oftener in pleurisy: 
 Botal undertook to generalize it, or, at least, to extend it to numerous 
 aflPections in which it had not been employed. He advised abundant 
 andnpeated sanguineous emi.^sio)is, not oidy in plcuris}-. peripneumonia, 
 apoplexy, and angina, but also in gout, dysentery and putrid fevers ; 
 not only among subjects vigorous and in the strength of age, but also 
 among children, old persons, pregnant women, and cacochymic individu- 
 als. He carried the paradox so far as to sustain that an infirm old 
 man should be bled from four to six times a year, and that it was a 
 good custom to open a vein every six months, in healthy individuals. 
 
 Botal, native of Astia, in Piedmont, served at first in the character of 
 surgeon in the French army. Later, he became successively physician 
 to the kings Charles IX. and Henry III. His position, as we see. must 
 have given weight to his assertions, which, however, did not prevent 
 the Faculty of Paris from condemning his method as heretical and 
 
 " In Artem Mcdiciualem.
 
 372 ERUDITE PERIOD. 
 
 dangerous. He composed several works, the most remarkable of which 
 is a memoir entitled, On the cure of Diseases by Blood- Lettimj. In this 
 book he develops his paradoxical ideas on the utility of frequent vene- 
 sections. " The blood," he says, " being destined to nourish and sustain 
 the body, not to injure and clog it, can only fulfil its destination in pro- 
 portion to its purity and proper quantity. If, then, it surpasses the 
 just quantity, and if it oflFends in any of its qualities, so as to be incon- 
 venient, it is necessary to correct it ; now, this is done efficaciously by 
 blood-letting, according to the testimony of Hippocrates, Galen, and 
 especially as is demonstrated by the happy results of this practice." 
 
 If the theory of Botal is very contestable, the numerous facts on 
 which he supports it are very much less so. It can not be denied that 
 he obtained extraordinary success by emissions of blood ; but as he cites 
 only his successes, it is reasonable to suppose that he does not cite all 
 the cases in hi^practice. In the second place, it is necessary to remem- 
 ber, that this physician having collected his earliest observations in 
 camp, on young and vigorous subjects in the full strength of age, it is 
 probable that he was influenced afterward by the recollection of the 
 happy results which his^method produced for him in the beginning. 
 Finally, it may be said in his defense, that if he exaggerated the employ- 
 ment of sanguineous emissions, his cotemporaries made use of it too 
 timidly, whence it follows that, all things considered, his practice would 
 be as advantageous, and even more so, than that of his rivals. 
 
 The memoir of Botal goes out of the line of ordinary compositions of 
 this epoch, as well in regard to its form as to its matter. We do not find 
 in it, as in the others, subtile arguments and long theoretical digressions. 
 This author says scarcely anything on theory, but, on the other hand, 
 mentions many facts. Without disdaining the authority of the ancients, 
 on which he sometimes depends, he invokes, especially, observation. In 
 fine, he unites independence and energy of thought to elegance and 
 purity of style. 
 
 III. Laurence Joubert, Chancellor of the University of Montpelier, 
 and consulting physician of the king of France, Henry III., was also a 
 liberal thinker. In his annotations on the books of Galen, he some- 
 times approves, and again he condemns the doctrine of this author. 
 Among other new opinions, he emits the following: " That the humors 
 never putrify in the living body, that there is only an effervescence in 
 them, in fevers called putrid." His treatise on Popular Errors had an 
 unheard of success for the epoch when it was published. In less than 
 six months, there were retailed 4600 copies, which must appear prodi- 
 digious, when we consider the small number of persons who were at that 
 time able to read. Some of the circumstances that contributed to this
 
 PARTIAL EFFORTS FOR REFORM. 373 
 
 popularity, may be summed up as follows : First, the Look was written 
 in the common language, which was a new thing in works treating of 
 subjects connected with Medicine, and which placed it within reach of 
 a crowd of new readers of all classes. In the second place, it was 
 diversified with jovial and vulgar anecdotes. In short, it includes, on 
 the subject of generation and parturition, certain technical details, for 
 which men of the world, unused to these matters, are always greedy. 
 The author, moreover, though affecting a light, paradoxical and wanton 
 manner, respects, at heart, religion and good manners. He justifies as 
 much as possible, in his preface, the nudity of some of his illustrations, 
 and to shelter it from too severe censures, he dedicates his book to the 
 very high, very excellent, and studious Marguerite de France, the very 
 illustrious Queen of Navarre, daughter, sister, and wife of kings. 
 
 I shall not essay to analyze a work which treats of a multitude of 
 disconnected and often unsuited subjects ; but I will detach some frag- 
 ments, by which the style and spirit in which it was written ma}^ be 
 judged. The author commences by a question of high philosophy, 
 which he discusses with independence and discernment. " There is," 
 he says, " a great contest between the princes of philosophy, Plato and 
 Aristotle, on the condition of the rational soul, which they both agree 
 to be celestial, divine, immortal, and separable from the body. But 
 Plato thinks that it does in itself know all things, which become effaced 
 from its memory and are lost the moment it is submerged and, so to 
 say, mired in our humid and soft bodies. Then, in proportion as the 
 body gradually dries, the soul becoming again clearer and more bril- 
 liant, is restored, and gradually recognizes everything, as if it learned it 
 anew ; for, according to the views of Plato, what we call learning is, 
 really, only remembering. 
 
 " On the contrary, Aristotle afiirms that our soul unites with the 
 body in entire ignorance of all things, but is capable, and very promptly, 
 of conceiving of all things, being at first a simple spirit, but capalile of 
 all things by degrees. He compares it to a polished tablet on which 
 nothing has been drawn, but ready to receive every color and figure 
 which may be put upon it. This opinion has had more partisans than 
 the former, and is conceived to be true, by the best philosophers. For 
 if we become wise by the mere dessication of the body, it follows that 
 we should have no need of doctrines, or in other words, of instruction ; 
 and the mind could commit no error, (provided that the exterior 
 8ens3S were entire and sound,) both of which conclusions arc notoriously 
 absurd." 
 
 *' Erreurs Populaires au fait de la Medecine et Regime de Santc, par Laurent 
 Joubert. Paris, 1587. Preface to the first part.
 
 374 ERUDITE PERIOD. 
 
 We shall not follow farther this author, in the development of his })hi- 
 losophic thesis. We will only observe that he did not seek, as l\niel, 
 to conciliate the opinions of Plato with those of Aristotle, but that he 
 clearly pronounces himself in favor of those of the two which seem to 
 him the best. We see here already a free and clear thinker, who pro- 
 fesses for the ancients neither an idolatrous worship nor a blind contempt, 
 but who chooses according to his knowledge and taste. After having 
 sustained the conclusion just stated, Laurence Joubert explains the mo- 
 tives which have induced him to undertake the work, and the end he 
 proposes to attain. 
 
 " Madam," he says, " I leave, for the present, to the theologians the 
 instruction of the soul in the Christian faith, to engrave this early upon 
 it, to color it with piety, to feed it with sound doctrine, and to perfume 
 it with odors agreeable to God and profitable to our neighbor, by a holy 
 and exemplary life, conforming to doctrine and proceeding from piety, 
 having its strength in faith of the highest character. I hold to what is 
 my vocation, that is, the care of the human body, to preserve its health 
 and restore it when deranged, by the help of the grace of Almighty God, 
 who has created Medicine and established the physician for the necessi- 
 ties of man. In this vocation I have for a long time (for at least twenty- 
 five years) labored, for a double aim — the one, to instruct the youth in 
 the said science, as well by writing as by verbal teaching, sincerely and 
 diligently giving them the first traits, watering it with good precepts, 
 making them acijuainted with the most secret remedies, and exercising 
 them in discussion and practice ; the other, to extinguish and annul 
 several false opinions and errors (offsprings of ignorance) which have 
 long been valued and in fashion in Medicine, Surgery, and Pharmacy — I 
 say, among the professors of the three departments of our Art, from 
 which has resulted many abuses and nullities. 
 
 " But all this is trifling, compared with the popular errors in Medi- 
 cine and the regimen of health, which for the most part are so stujiid 
 and vulgar as to merit much more ridicule than reprehension. Never- 
 theless, because they are very prejudicial to the life of man, it seems to 
 me that we must neither despise nor dissimulate them, but rather remon- 
 strate with the ignorant vulgar in regard to what and how they err and 
 go astray, trying to lead them in a better path. For they do not act 
 maliciously or with an intention to injure, but for the best, according to 
 their opinion. It belongs, then, to physicians to i-emcdy this evil, to 
 corr: ct which I have taken great pains for a long time, and remonstrated 
 with many. But that has been of little moment, as long as the greater 
 number are incapable of reason and discussion. Finally, 1 have deter- 
 mined to remonstrate with the people, showing up their en-ors by writing,
 
 PARTIAL EFFORTS FOR REFORM. 375 
 
 and in order to set up a judge wholly unsuspected l)y them, yet, never- 
 theless, capable of correcting such abuses. 
 
 " Now, having long reflected who this judge should be, the excellency 
 of your majesty, madam, has seemed to me the most proper one in the 
 world, by the rare virtues which every one admires in you, your most 
 angelic spirit, your exquisite judgment, your honest curiosity and stu- 
 elious desire to know all things, and also on account of the leisure you 
 possess for such a pastime, which will serve you as a gi-eat recreation for 
 several hours a day, to understand and examine the reasons I have 
 deduced against popular errors, in order to overturn them. I shall, how- 
 ever, fear the venomous and envious tongues who will endeavor to find 
 something unbecoming in what 1 jiropose to your majesty on this subject; 
 for I am constrained frequently to say things which appear too filthy and 
 lascivious ; but knowing that one may honestly speak, as I have done, 
 on all the natural functions, as well as on all, even the most secret and 
 hidden parts of the human bod}', which chaste eyes do not fear to see 
 represented in public by drawings and sculpture ; rememberiug, too, 
 what Dion recounts of the virtuous Roman princess Livia, wife of the 
 emperor Augustus, who saved the lives of men condemned to death be- 
 cause they had exposed themselves before her entirely naked — she say- 
 ing, that to the observation of a virtuous woman they differed in nothing 
 from statues, I consider myself fortified by such reasons, as by defen- 
 sive arguments, against which the poison of slanderers can avail nothing 
 with you."' • 
 
 We see by these citations — first, that Joubert, in writing the book we 
 have mentioned, proposed for himself a serious and useful end — that of 
 combating prejudices no less injurious than ridiculous ; secondly, that he 
 justifies very adroitly the licenses of expression in which he has in- 
 dulged, as well as the odd idea he had, of dedicating such a book to a 
 woman. Besides, it appears that the very studious queen of Navarre 
 does not show herself on this occasion more severe than the Eoman em- 
 press, and that she deigned to accept the dedication of the Chancellor of 
 the University of Medicine at Montpclier. We may judge, by the fol- 
 lowing announcement of several of the questions agitated in this work, 
 if it was not calculated to excite the curiosity, I will not say of a 
 princess, but of the generality of readers. 
 
 The entire work is divided into two parts, at the close of which, is 
 added a mixture and collection of other (questions and popular errors, 
 collected by him and his friends. The following are some of the propo- 
 sitions, each of which forms the title of a chapter. "Why are there 
 
 ^'Erreurs Populaires au fait de la Medecine et regime dc sante.
 
 376 ERUDITE PERIOD. 
 
 more jiliysicians than other sorts of people ?' ' It is not profitable to sick 
 persons to have several physicians, but one alone, who should be very 
 assiduous.' ' Can a woman conceive without having her courses ; in 
 other words, without her natural purgatives V ' Against those who keep 
 up sexual intercourse, with a view of having children, and of those who 
 indulge but seldom, in order to have less.' ' If thei-e is any certain know- 
 lege whether the child will be male or female, and whether there will be 
 one or two ?' ' Why is a pregnant woman advised to put her hand on her 
 posteriors, if she cannot satisfy her desires ?' ' Is it good to make a 
 woman sit on the bottom of a hot kettle, or put on her belly the cap of 
 her husband, in order to have a better delivery ; and what are the best 
 means for accouchement ?' ' Is it true that a woman delivered in full 
 moon, will afterwards have a boy, and if in new moon, a girl ?' ' An 
 exhortation to all mothers, to nurse their own children.' ' Is there a cer- 
 tain sign of the maidenhood of a girl ?' ' On the superstitious and false 
 opinions of women, who believe that the milk of a woman will dry up 
 in her breast, if some of it be heated.' ' Is it true that truffles, arti- 
 chokes, and oj^sters render men more keen for venereal pleasures?' &c." 
 The author treats these delicate matters in a manner worthy of the 
 subject, mingling, as we have said, his serious dissertations with amusing 
 anecdotes. Thus, after having shown the ridiculous presumption of so 
 many men assuming to act as physicians without understanding any 
 thing about it, and that too, in the presence of physicians, he narrates 
 the following adventure : " It is said that the duke of Ferrara, Alphonso 
 d'Este, at one time proposed, in a familiar way, the question, in what 
 calling are most men engaged : One said shoemakers, another tailors, a 
 third carpenters, mariners, pettifogers. and laborers. Gonelle, his 
 famous buffoon, said there were more physicians than any other class of 
 men, and made a bet with the duke, who denied it, that he would prove 
 it in twenty-four hours. The next morning Gonelle left his lodgings, 
 wearing a great night-cap, and a cravat tied around his chin, then a hat 
 over all, and his mantle drawn up over his shoulders. In this attire, 
 he took a route leading to the palace of his excellency, through Angel 
 street. The first one he met asked him what was the matter ; he replied 
 that he had a raging tooth-ache. Ha ! my friend, said the other, I 
 know the best recipe in the world against it, and told it to him. Gon- 
 elle inscribed his name on his tablets, pretending that he was writing 
 down his recipe. A step further on he found two or three together, who 
 all asked the same question, and each one gave him a remedy. He 
 inscribed their names as the first ; and thus he pursued his course very 
 gingerly to the end of the street, not meeting a single person who did 
 not offer him a recipe different from the rest, each one saying that his
 
 PARTIAL EFFORTS FOR REFORM. 377 
 
 was well established, certain, and nearly infallible. He wrote down the 
 names of all. Coming to the lower court of the palace, he found him- 
 self surrounded with gentlemen, (for they all knew him,) who, after 
 having learned his affliction, compelled him to take their recipes, which 
 each one said was the best in the world. He thanked them all, and 
 wrote down their names. "When he entered into the chamber of the 
 duke, his excellency cried out, 'Eh ! what have you got Gonelle?' He 
 replied very piteously and complainingly, ' tooth-ache, the worst that 
 ever was.' To which his excellency replied, ' ha ! Gonelle, I know a thing 
 which will drive off the pain at once, without touching the tooth. Mr. 
 Antonio Musa Brussavola has never employed a better one. Do so and 
 so, and incontinently you will be healed.' Suddenly, Gonelle threw down 
 his head dress, and his attire, crying out, ' and you also, my lord, are a 
 physician ! Look at my list, and see how many others I have found, 
 between my lodgings and your palace. Here are nearly two hundred, 
 and I have only passed through one street. I will engage to find ten 
 thousand in this city, if I go every where. Find me as many persons 
 in any other business.' This is an appropriate story ; in fact, every one 
 meddles with medicine, and there are few men who do not think that 
 they know a great deal about it, and even more than physicians th em- 
 selves. "=■■' 
 
 I have dwelt somewhat at length on this work because, under its light 
 form and without affecting any pretension to scientific depth, it has, 
 nevertheless, an end eminently useful, namely, to dissipate a multitude 
 of errors which, when practiced, produce bad results ; and in attempting 
 to enlighten the vulgar, was he not laboring for the propagation of sound 
 doctrine ? However, I must say that we find in the book of Joubert 
 the sanction of certain erroneous theories which then reigned supreme 
 in science ; but this was an inevitable defect, for an author would not 
 be able to combat vulgar prejudices with other lights than those of his 
 own age. 
 
 '' Erreurs Populaires, part., liv. i., chap. ix. 
 
 24
 
 378 erijDite period. 
 
 OHATTEE XII. 
 MEDICAL ORGANIZATION AND ACCESSORY INSTITUTIONS. 
 
 The separation of Medicine from the priesthood, which hegan to take- 
 place at the close of the preceding period, was completed during this, to 
 the great advantage of both professions, for though the Pagan priest 
 could practice the Healing Art without derogation to the rules of his 
 order, the Catholic priest could not, without defilement and a violation 
 of the canons of the church, descend into a mass of sensual details 
 which the study and practice of Medicine required. From the sixteenth 
 century, celibacy ceased to be obligatory on physicians in the kingdom 
 of France, and they no longer obtained ecclesiastical benefices. At the 
 same time. Surgery, which had long been separated from Medicine, reap- 
 proached it, and this approach, as we have seen, turned to the profit 
 of science. 
 
 From this date, the professors of the Surgical College of St. Come 
 were put on the same level with the professors of the University, and 
 enjoyed equal privileges. 
 
 In fine, the establishments destined to propagate medical instruction, 
 faculties and schools of Medicine, increased, and those which already 
 existed were developed. Amphitheaters for dissection were opened in 
 every State in Eui'ope. The hospitals and dispensaries — in a word, all 
 the institutians devoted to the comfort of the afflicted poor, followed the 
 upward march. The governments turned more of their solicitude 
 toward the regulation of medical police and hygiene, and then com- 
 menced an amelioration in the sanitary state of the people. 
 
 RESUME OF THE ERUDITE PERIOD. 
 
 The historical period whose state we have just sketched, offers a most 
 interesting spectacle. We have seen the human mind, long buried in a 
 lethargic sleep, gradually awake, and mark its first steps by discoveries 
 of the highest importance ; the love of letters became general, as the 
 means of instruction multiplied ; science, enclosed in the cloisters during 
 the middle ages, became secularized as in the times of Hippocrates, 
 Plato, and Aristotle, but with the means of propagation more numerous 
 and efficient. The first effect of this expansive movement of the mind 
 was, to re-direct the attention of the learned world toward the primitive 
 sources of the beautiful and the true ; the debris of Greek literature 
 was exhumed from the dust of the libraries of the convents, and it 
 gradually took the place of the Arabic literature, its degenerate daughter.
 
 MEDICAL ORGANIZATION. 379 
 
 Soon the monuments of antique science were insufficient for the expand- 
 ing human mind. They were submitted to a criticism more clairvoyant 
 and severe, which revealed many defects, and weakened very much the 
 respect in which these precious relics had been held. Then adventurous 
 and impatient minds attempted to overturn the entire edifice of human 
 acquirements, and rebuild it in a day ; but their work — fruit of a mor- 
 bidly excited imagination, having neither reason nor experience to sus- 
 tain it — fell before the light of discussion, as the dreams of an unquiet 
 night fly at the approach of day. A few men, however, succeeded in 
 uniting the worship of antique traditions with the love of novelties ; 
 they comprehended that to reform was better than to destroy, and that 
 all change is justifiable only as it includes a progress and an ameliora- 
 tion. Consequently, they contented themselves with proposing partial 
 modifications of the ancient doctrines, with a view to improve, not to 
 <lestroy them.
 
 380 REFORM PERIOD. 
 
 VIII. REFOEM PERIOD. 
 
 COMPEISING THE SEVENTEENTH AND THE EIGHTEENTH CENTURIES. 
 GENERAL CONSIDERATIONS. 
 
 We have just seen the systems of Aristotle and Galen resist the 
 premature attacks of the partisans of the occult sciences, and gather 
 around them the great majority of minds, by means of some partial 
 modifications claimed by the less bold though more sensible innovators. 
 The long duration of these systems, the almost unanimous accord of the 
 great men of antiquity and of the middle ages, in their favor, formed a 
 precedent so respectable that a general disposition to disdain them had 
 not yet been learned. It is not then astonishing that the most eminent 
 men in science should prefer them to the eccentric and mal-elaborated 
 theories of the founders of the occult doctrines — to those of restless, 
 capricious, and haughty minds, who pretended to arrogate to themselves 
 the sceptre of knowledge, without taking the trouble to prepare a scien- 
 tific reform whose wisdom and greatness would justify, in the eyes of 
 enlightened men, so high a pretension. 
 
 In the meantime the domain of natural sciences enlarged from day to 
 day ; observation had enriched it with a multitude of new facts which 
 harmonized with, or discredited prevailing doctrines. The moment 
 approached when the need of a radical reform was felt in nearly every 
 branch of human science. Men whose knowledge equaled their genius, 
 began to appear and take the direction of the intellectual movement, 
 and substitute for the decrepid theories of the schools, those which were 
 younger, stronger, and harmonized better with the totality of known 
 phenomena. The worship of the ancients is succeeded by an immode- 
 rate desire to shake off their yoke, and to revenge in some sort their 
 ■long tyranny. On this account I have given to this the name of Eeform 
 Period, which characterizes perfectly, if I am not mistaken, the gene- 
 ral tendency of minds, the predominant thought and culminating fact 
 'Of the epoch. 
 
 i
 
 GENERAL CONSIDERATIONS. 381 
 
 At the beginning of this period a Florentine nobleman, one of the 
 fioest geniuses of modern times, Vincent Galileo, carried the torch of 
 regeneration in physics. Without other guide than his intelligence he 
 abandoned the route of subtile speculation to follow that of observation 
 only. In this way he reaped an ample harvest of surprising truths, one 
 of which would suffice to immortalize his name. He first calculated the 
 law of gravity; he discovered the weight of the atmosphere, and he 
 asserted the movement of the earth on its own axis and around the sun. 
 Nothing was wanting to his glory, not even the seal of persecution. He 
 was cast into the dungeons of the holy inquisition, for creating too daz- 
 zling a light before the eyes of his cotemporaries. At the same time 
 Kepler traced the course of the heavens for Newton, by his bold and 
 happy hypotheses. 
 
 While the astronomers, extending the limits of the universe, and with- 
 out pretending to read in the stars, as the astrologists, the destiny of 
 kings and of nations, determined with a marvelous exactitude the laws 
 which maintain harmony in the movements of these sublime bodies, the 
 naturalists discovered by the aid of the microscope, a new world close 
 by us, under our hands, which the ancients had not even suspected. 
 Their eye perceived in a drop of liquid myriads of organised beings, 
 living and moving in the narrow space, as in the midst of an immense 
 lake. The chemists, abandoning the vain and darkened researches of 
 alchymy, reaped on their part an ample harvest of useful and unheard of 
 discoveries. In place of reasoning theoretically, after the manner of the 
 philosophers, on the nature, form and combinations of the material ele- 
 ments, they studied every thing experimentally ; they learned to modify 
 and overcome them at pleasure — in short they endowed man in some 
 degree with a secondary creative power. The ancient philosophers had 
 no more rude adversaries than they, and their labors contributed more 
 to destroy their dogmas than those of any other class of savans. Bernard 
 Palissy,'-'- a simple potter of Agen, and Andrew I.ibavius, doctor in medi- 
 cine, native of Halle, in Saxony, were, during the sixteenth century, the 
 true princes of chemistry, the precursors of the experimental doctrine of 
 Chancellor Bacon. 
 
 Medicine made also, at the same time, numerous and great conquests, 
 which led to frequent revolutions in its theory. The truth of that 
 aphorism, '' experience is decej)tive, and judgment difficidt,''^ was never 
 more evident than during this period, in which we see melt away, not 
 only Galenism, but also several other newly hatched systems, all of 
 which had had the pretention of being founded in experience, and 
 
 "See (Euvres de Bernard Palissy, by M. Cap, Paris 184:3, 12mo.
 
 382 REFORM PERIOD. 
 
 had been emitted and extolled by men of superior merit. "But, as will 
 appear in the course of this history, all these systems had the defect of 
 considering the phenomena of the animal economy in one aspect only, 
 and neglecting others not less important. All committed the no less 
 grave error of passing, in their abstractions, beyond the limits of sensible 
 phenomena. For this reason they have all vanished, or suffered great 
 modifications, after an existence more or less ephemeral. 
 
 We proceed now, according to our custom, to expose, in the first 
 place, the material progress in each principal branch of the science, and 
 then the varieties of the most important doctrines. Nevertheless, it 
 will happen more than once, as has already frequently occurred, that 
 after having reported a fact, or an observation, we shall join it at once 
 to some theory ; because it is sometimes impossible, or at least very 
 inconvenient, to separate from a phenomenon its theoretical explanation. 
 
 CHAP TEE I, 
 
 ANATOMY AND PHYSIOLOGY. 
 
 The anatomists of the sixteenth century had described the apparent 
 and easily accessible parts of the human body with such scrupulous exact- 
 ness, that they had left little for their successors to do in this particu- 
 lar ; consequently, the latter turned their attention in another direction. 
 Minute and comparative anatomy, and experimental physiology, offered 
 a vast field of new truths, till now but little explored. They directed 
 their observations toward these objects, and their efforts, as we shall 
 see, were crowned more than once with brilliant success. 
 
 OmCULATION OF THE BLOOD. 
 
 Before describing the researches which have immortalized the name 
 of William Harvey, it will be proper to recall, succinctly, what were 
 the acquisitions of his predecessors, on this function of the animal 
 economy. 
 
 The liver was considered, from time immemorial, as the organ of 
 sanguification. It was supposed that the veins took their origin in this 
 viscus, and that they were the sole order of vessels that contained, 
 naturally, the blood. It was imagined that the fluid flowed from its 
 principal reservoir to all parts of the body, and returned to its source 
 through the same canals, by an undulating movement, similar to the 
 flux and reflux of the sea. The arteries were supposed to contain, in
 
 ANATOMY AND PHYSIOLOGY. 383 
 
 their normal state, vital spirits only, of which the heart was the great 
 reservoir ; but it was admitted that in certain diseases, the blood could 
 make an irruption into the arterial channels. Such was the doctrine 
 of the Asclepiada?, and particularly of Erasistratus. 
 
 Galen modified it by demonstrating that the arteries contained blood, 
 at every period of life. Neither was he ignorant that this li(£uid is 
 poured into the right cavities of the heart by the great veins ; but he 
 believed that only a small quantity passed from the right ventricle 
 into the lungs, by means of the pulmonary artery, while the major 
 part came directly, according to him, to the left ventricle, by passing 
 through the porosities of the interventricular septum. This opinion of 
 Galen was uncontested till the middle of the sixteenth century. 
 
 At that epoch the theologian Michael Servetus, the same who perished 
 a victim of the jealousy of Calvin, dared to deny the passage of the 
 blood through the septum of the ventricles. He contended that the 
 blood which comes into the right cavities of the heart, passed by the 
 pulmonaiy artery to be distributed in the lung, whence it returned into 
 the left ventricle, by the pulmonary veins. This was a luminous 
 thought, and a great step, in fact, toward the truth. Shortly after. 
 li. Columbus demonstrated, anatomically, the conjecture of Servetus, 
 by showing the real use of the valves of the heart. 
 
 A. Cesalpin approached still nearer the truth. He explained, in the 
 game manner as Columbus, the course of the blood through the lungs, 
 and added, that the last arterial ramifications communicated with the 
 veins — that the blood and vital spirits passed from the arteries into the 
 veins during sleep, which seems to him j^roven by the swelling of the 
 veins and the diminution of the pulse, at that time. 
 
 They knew, also, the existence of valves in the veins. It was dem- 
 onstrated by experiment, that if an artery is tied, on a living animal, the 
 blood ceases to flow, and pulse stops below the ligature ; but if, on the 
 contrary, a vein was tied, it shrunk above the ligature, and tumefied 
 below it. Such was the state of science at the beginning of the seven- 
 teenth century. There was only one step to take to find the true course 
 of the blood, but that step was difficult, as we may now readily 
 understand. 
 
 William Harvey, native of Folkstone, in the county of Kent, made 
 his first studies in his own country. Afterward, he traveled for his 
 instruction, in France, Germany, and Italy, and remained at Padua 
 during four years, to hear the lectures of Fabricius d'Aquapendente. 
 He returned to his country with the title of Doctor, in 1602, and estab- 
 lished himself in London, and was elected sometime afterward, a mem- 
 ber of the College of Medicine. Named regent in 1013, he commenced
 
 384 REFORM PERIOD. 
 
 to make known his doctrine on the circulation of the blood, in his public 
 lectures, but he did not publish the result of his researches till 1G28, 
 after having submitted them for fifteen years to proofs and counter 
 proofs of every kind. 
 
 Here is his own story, in which he depicts the obstacles he met with 
 in his efforts to discover the truth : "Devoting myself to discern the 
 use and utility of the movements of the heart in animals, in a great 
 number of vivisections, I found at first the subject so full of difficulties 
 that I thought, for a long time, with Fracastor, that the secret was 
 known to God alone. I could distinguish, neither, in what manner the 
 systole and dioistole took place, nor at what moment the dilatation and 
 constriction occurred, owing to the celerity of the movements of the 
 heart, which, in most animals, is executed in the twinkling of an eye, 
 or like the flash of lightning. I floated, undecided, without knowing on 
 what opinion to rest. Finally, from redoubled care and attention, by 
 multiplying and varying my experiments, and by comparing the various 
 results, I believed I had put my finger on the truth, and commenced 
 unraveling the labyrinth. I believed I had seized the correct idea of 
 the movement of the heart and arteries, as well as their true use. 
 From that time I did not cease to communicate my views either to my 
 friends, or to the public in my academical course."'-' 
 
 M. Dezeimeris appreciates as follows the discovery of the English 
 physiologist: " To its intrinsic merits, the work of Harvey on the cir- 
 culation of blood has, besides, the merit of arrangement. The author first 
 clears up his course, by removing the errors of antiquity ; he describes, 
 next, the movements of the heart in the living animal, he shows its 
 muscular structure, the alternate contractions of the auricles and ven- 
 tricles, the influence they must exert to drive the blood with force into 
 the arteries, determined in that direction by the mechanism of the 
 valves ; in fine, he establishes the whole system of the circulation. He 
 terminates the treatise by original observations on the difierence of its 
 structure, in different animals, at different periods in life."f 
 
 So much care and circumspection in the research for truth, so much 
 modesty and firmness in his demonstration, so much clearness and 
 method in the development of his ideas, should have prepossessed every 
 one to favor the theory of Harvey ; but, on the contrary, it caused a 
 general stupefaction in the medical world, and gave rise to much oppo- 
 sition. This theory, which appears to us to-day so natural that we con- 
 ceive with difficulty why it was not found much sooner, was nothing 
 
 '"'Guillelmi Harvey, Exercitatio Anatomica de Cordis et Sanguinis mo tu, cap. i. 
 f Dictionaire Historique de Medicine, at the word Haevey.
 
 ANATOMY AND PHYSIOLOGY. 385 
 
 less than a revolution in physiology. I shall not pause to describe all 
 the phases of the controversy it excited ; it will be sufficient to say that 
 it continued no less than twenty-five years, and that there was not a 
 man at the time who made any pretension to a knowledge of anatomy 
 and physiology, who did not take an active part in it. Even the natu- 
 ralists and philosophers themselves, did not remain indifferent. Eene 
 Descartes was one of the first to declare himself in favor of the new 
 doctrine of the circulation, and supported it by some experiments, but 
 especially by the authority of his name. John Waloeus, a celebrated 
 anatomist, and professor in the University of Leyden, confirmed it by 
 new observations. Finally, Plempius, of Louvaine, one of the most 
 fiery adversaries of this theory, gave way to the force of truth, and 
 passed with a free will and publicly over to the ranks of its defenders, 
 in 1652. This was a great triumph for Harvey, and brought so much 
 additional support to his doctrine as nearly to silence all 02)position. 
 
 During these long debates the conduct of Harvey was always digni- 
 fied and firm. He mingled in the polemic which his discoveries had 
 excited, only to add new proofs and new experiments to those he had 
 already published. One, only, of his adversaries obtained a direct re- 
 sponse from him. This was John Eiolan, professor in the faculty of 
 Paris, and one of the greatest anatomists of his age. Harvey attached 
 much value to his support. In seeking to convince him, he spoke 
 always with the greatest deference, giving him, several times, the epi- 
 thet of prince of the Science. The opinion of J. Ptiolan was, in fact, 
 of immense weight among his cotemporaries ; but whether from excess 
 of respect for the ancients, or from envy against moderns, he combatted, 
 with as much violence as obstinacy, the two finest discoveries of the age, 
 namely, that of Harvey, and that of Pecquet, which we shall soon 
 consider.-' 
 
 Harvey had the satisfaction before his death, to see his theory of the 
 movements of the heart and of the blood universally adopted. He left, 
 besides, interesting observations on generation, in man and in animals — 
 on midwifery — and on the structure and diseases of the uterus. 
 
 The further progress of science only confirmed the doctrine of the circu- 
 lation of the blood. In 1 G 6 1 , Malpighi, professor at Bologna, demonstrated 
 for the first time, by the aid of the microscope, the progression of the 
 blood globules in the small vessels. He confirmed the reality of the 
 communication which had been said to exist between the arteries and 
 the veins, and gave a clear demonstration of their last branches. In 
 1690, Anthony de Leeuwenhoek, naturalist of Delft, was enabled to see, 
 
 ^ See Lettres de Gui Patin, new edition, with notes by M. Reveille. Paris.
 
 386 REFORM PERIOD. 
 
 with bis perfected microscope, the movements of the blood in the small- 
 est vessels, and gave to several persons important testimony of his 
 observations. 
 
 Leaving far in the rear his precursors, E. Lower and J. M. Lancisi, 
 J. Senac published in 1749, his great work on the Structure of the 
 Heart, its Actions and Diseases. The author puts forth, in his preface, 
 some maxims of medical philosophy stamped with wisdom, among which 
 we find the following : " Theory reduced to consequences drawn from 
 facts alone, is the light of practice. But in following the track of 
 nature by the light of experiments and observation, we soon arrive at the 
 barriers where the mind is abandoned to itself. In going beyond 
 these limits, it can rest only on conjectures, where error is inevitable." 
 *' While some elevated the force of the heart to a weight of three mil- 
 lions of pounds, others reduced it to the weight of eight ounces. A rival 
 of Newton and Leibnitz (M. d'Alembert), was more wise, who said that 
 none but the foolish attempted to estimate the force of the heart's 
 action."" Notwithstanding this severe criticism given against those 
 who attempted to calculate the vital forces, Senac, in the course of his 
 work, gives a conjecture on this subject. Having remarked that a 
 weight of fifty pounds, attached to the foot, was raised by the pulsation 
 of the artery, he estimated, approximately, the force of the heart at two 
 hundred pounds. 
 
 He describes with much care, the structure of the heart, and the 
 direction of its fibres, of which the external appeared to him oblique, 
 and the internal arranged in spiral. These latter take their origin, 
 according to him, from the fleshy columns of the aortic ventricle. He 
 placed among the remote causes of the movements of the heart, the 
 animal spirit, which is transmitted from the brain and the spinal marrow, 
 to the muscle, by the intermediation of the nerves. This spirit, he 
 thought, was a fluid extremely elastic, which the impression of the blood 
 on the delicate tissue of the parietes and columns, put in action. In 
 the first place, the vena cava, by these alternate constructions, caused 
 the blood to enter into the auricles, which, stimulated by the presence 
 of that liquid, contract, in their turn, and push it into the ventricles. 
 These last commence at once to act, and drive forward the blood which 
 they contain. Thus, these three machines, by the aid of the fluid 
 which they enclose, act successively, while the vital spirit subsists in 
 the tissue of the brain and nerves. The heart is only the prime mover, 
 or determining and conditional cause of the movement of the blood, but 
 
 * Traite de la Structure de Cceur, de son Action de ses Malacies, 11. edition ; 
 published by A. Portal, Paris, 1774, T, I., preface, p. 32.
 
 ANATOMY AND PHYSIOLOGY. 387 
 
 its force is insufficient to produce it alone ; we must add to it the elas- 
 ticity of the arterial coats, and above all the action of their muscular 
 fibres and their nerves. In regard to the pathology of the central organ 
 of the circulation, which forms the last part of the treatise, we will say 
 simply, that diagnosis, in it, is carried to as high a degree of perfection 
 as could be attained prior to the discovery of percussion and ausculta- 
 tion.-' This work, in which analysis was pushed to its utmost limits, 
 made a sensation in the medical world. His cotemporaries spoke of it 
 only in terms of admiration. Morgagni, when refering to it, applies to 
 the author the epithet of great ; but it has become much out of date 
 since the perfection of auscultation and percussion has carried the 
 diagnosis in thoracic diseases to an unhoped for success. Senac was 
 physician to Louis XIV., after Chicoyneau, and he had the entire confi- 
 dence of his sovereign. 
 
 ON EESPIRATION. 
 
 If the researches concerning the mechanism and end of respiration, 
 ^ve not results as prompt and decisive as those relative to the circula- 
 tion of the blood, they were not, however, unfruitful, as is very plain in 
 comparing the notions which antiquity has transmitted to us on this sub- 
 ject, with those that were possessed at the close of the last century. 
 
 The ancient anatomists described, summarily, the exterior form of the 
 lungs, their situation in the thoracic cavity, their spongy consistency, as 
 well as the cartilagino-membranous structure of the trachea, and the 
 first divisions of the bronchia ; they did not carry farther their dissec- 
 tions, but they thought that the extremities of the bronchia anasta- 
 mised with the radicals of the pulmonary veins, which they named on 
 that account, arterial veins : that is to say, veins conducting the atmos- 
 pheric fluid of the lungs into the heart. 
 
 On these vague and partly erroneous anatomical data, they built the 
 following theory : The air drawn into the lungs by the heat of the heart, 
 the reservoir of the vital spirits, enters by the trachea and bronchia. 
 In penetrating into the last bronchial ramifications, it is rarified : the 
 thinnest part passes into the pulmonary veins, to be carried to the heart, 
 where it serves as material for the fabrication of the vital spirit : its 
 grosser parts were exhaled with the fuliginosities of the heart, during 
 expiration. According to this theory, respiration had two purposes — 
 one to refresh the lung, which being of a porous and inflamablc nature, 
 would be in danger, without it, of taking fire by the contact of the 
 heart — the focus of animal heat ; the other to furnish the pneuma or 
 
 * As it is no part of my plan to enter into any account of these important dis- 
 coveries in science, I refer the reader to the treatisis of Laaennec and Bouillaud.
 
 388 REFORM PERIOD. 
 
 ether, whicTi was employed by the heart in the fabrication of animal 
 spirits. Such were the ideas formed on the mechanism and end of the 
 respiratory function — ideas which reigned, without submitting to any 
 important modification, down to the seventeenth century. 
 
 The discovery of the small and great circulation sapped one of the 
 bases of this theory, for they showed that the pulmonary veins carried 
 to the heart no other li({uid than the blood, and that no substance, 
 liquid or gaseous, could re-flow from the aortic cavities into the lung. 
 In 1661, Malpighi demonstrated the cellular structure of this viscus. 
 He announced that the bronchial ramifications terminated in vesicules 
 lined by a vascular rete, and communicated with each other. 
 
 About this time much more careful examinations were instituted than 
 bad ever been before, in regard to the manner in and forces by which the 
 movements of the chest are efi'ected. J. A. Borelli, Adrian Helvetius, 
 and many others, among whom the indefatigable A. Haller holds the 
 first rank, made, on the same subject, interesting experiments, which 
 may be summed up as follows : First, during inspiration the thoracic 
 cavity is enlarged in all respects, by the action of the diaphragm and 
 intercostal muscles, aided occasionally by the action of the muscles 
 which extend the neck, the shoulders, and the head — in short, of the 
 superior regions of the chest. Secondly, in expiration, this same cavity 
 diminishes by the simple relaxation of the inspiratory muscles. Ordi- 
 narily this relaxation is sufficient to enable the thorax to diminish, and 
 return upon itself. In other cases, the triangular muscle of the sternum, 
 the abdominal, the dorso-lumbar, in a word, all the muscles that connect 
 the parietes of the thorax to the inferior regions of the trunk, excepting 
 the diaphragm, concur to produce the expiratory movement. Thirdly, 
 there never exists an empty space between the lungs and the side of 
 the chest. The pulmonary organ follows the cavity which incloses it — 
 it dilitates when it expands, and diminishes when it contracts. Fourthly, 
 the air is not drawn into the chest by the heat of the parts, but by 
 the tendency of all gaseous fluids, to maintain an equilibrium. When 
 the thoracic cavity is expanded by the action of the inspiratory muscles, 
 the air which it contains becomes rarified, and is no longer in equi- 
 librium with the external air. which rushes in through the opening of 
 the trachea. This is the mechanism of respiration. 
 
 That being settled, difi'erent pneumatic theories were, by turns, adopted 
 and abandoned. Here is one of the most remarkable : the latro- 
 mechanicians assumed, that in respiration no particle of air penetrates 
 into the blood, but that the alternate movements of the expansion and 
 contraction of the chest have the efl^ect of l)reaking and attenuating the 
 molecules of the venous fluid, and mingling them with the lymph and
 
 ANATOMY AND PHYSIOLOGY. 389 
 
 the chyle, and changing thus the venous into arterial blood. Besides, 
 they thought that the unfolding of the pulmonary vessels, during 
 inspiration, favors the passage of the blood through the lungs. 
 
 Some physicians renewed the theory of the ancients, in modifying it ; 
 they thought that the air inspired, being colder than that which is 
 expired, serves to moderate the heat of the heart, and the effervescence 
 of the constituent parts of the blood ; that the impression of the cold 
 air against the parietes of the pulmonary vessels serves to condense 
 the venous blood, and changes it into red blood, without the addition of 
 any new principle. 
 
 All these theories had to give way before the exact knowledge of the 
 changes that occur in the atmosphere during respiration. It was 
 ascertained by rigorous experiments, that the air which enters into the 
 che.st has lost, when it passes out, a portion of its oxygen, which is 
 replaced by a nearly equal quantity of carbonic acid and aqueous 
 vapor. These phenomena, which had been conceived by Mayow, in 
 1668, were perfect!}^ established by subsequent observations. It had 
 always been observed that the blood which appears black in issuing 
 from the vein, in phlebotomy, becomes red in contact with the air. In 
 fine, direct observation proved that a similar change of color takes place 
 in the blood, in its passage through the pulmonary vessels during life. 
 Goodwin was the first, who, having opened the thorax of a frog, saw the 
 sanguineous fluid, which came black, and in appearance venous, to the 
 lung, acquire a fine red color in traversing the tissue of the organ. 
 Hessenfratz filled a soaked bladder with venous blood, and plunging 
 this membranous pouch into an atmosphere of oxygen gas, saw the blood 
 change from black to red.-' 
 
 Toward the close of the eighteenth century, Lavoisier, resting on the 
 facts we have just named, proposed a pneumatic theory of seducing 
 simplicity: "When the atmospheric fluid," says the celebrated chemist, 
 "has reached the pulmonary vesicles, a poi'tion of its oxygen passes the 
 extremely delicate walls of these vesicles and combines with the excess 
 of carbon and hydrogen of the venous blood, to form the carbonic acid 
 and acqueous vapors which are found in the expired air. The venous 
 fluid, thus freed from its excess of carbon and hydrogen, acquires, 
 instantly, that fine red tint which characterises the arterial blood, and 
 constitutes, according to the views of many physiologists, hsematosis. 
 
 The respiratory function was assimilated, by this theory, to the com- 
 bustion of a lamp, in which the carbon and hydrogen of the oil, by 
 
 '-■ I say nothing yet of the experiments of Bichat, which belong to the nineteenth 
 century, by the date of their publication.
 
 390 REFORM PERIOD. 
 
 combining witli the oxygen of the air, produce carbonic acid and vaj3or. 
 During this double combination, there is evolved a great quantity of 
 caloric, which Lavoisier regarded as the source of animal heat. A some- 
 what general law in zoology seemed to confirm this interpretation. It 
 had been observed that among animals provided with lungs, the natural 
 temperature is so much the more elevated as the respiratory apparatus has 
 extent, and as they absorb a greater quantity of air. 
 
 The purely chemical theory of Lavoisier was received with enthusiasm 
 by the learned world. It seemed to shed a clear light on two great 
 phenomena of the animal economy — hsematosis and calorification — of 
 which no one had before given any satisfactory explanation. Xeverthe- 
 less, it was soon perceived that it was subjected to very grave objections, 
 two of which, for the present, we will give. If it is true, said one, 
 that the lung is the focus of all the animal heat, its temperature should 
 be much more elevated than that of the other viscera, which observation 
 does not show ; on the contrary, all experiments show that the tempera- 
 ture of the lungs does not difi'er sensibly from that of other organs ; 
 secondly, in this theory are set aside both the action of the lung proper, 
 and of the nervous influence — an influence which might have been 
 inferred, a priori, and whose existence was put beyond doubt by subse- 
 quent and conclusive experiments.-' 
 
 LYMPHATIC SYSTEMS. 
 
 The discovery of the lymphatic vessels and their functions, was no 
 less remarkable than that of the circulation of tlie blood. If it had less 
 eclat, it is because it was not, as the former, the work of one man, but 
 its complete development took place only by a slow gradation. Our 
 mind, like our eye, is strikingly impressed only when the light reaches 
 it suddenly. 
 
 It appears that Herophilus and Erasistratus had perceived in the 
 mesentery of some animals, white vessels, which were connected with 
 the mesenteric glands. They took them to be arteries, full of air. 
 G-alen, who had an opportunity of seeing them, treated their remarks as 
 chimerical. He believed that the veins of the mesentery absorbed the 
 chyle in the intestines, and carried it to the liver, where it was trans- 
 formed into blood. This opinion reigned until the middle of the 
 seventeenth century. However, as early as the year 1563, Eustachius 
 had described the thoracic duct of a horse, but did not suspect its use. 
 In 1622, Gaspard Aselli, professor of anatomy at Milan, discovered the 
 
 " See researches of Dupuytren, Ch. Dumas, M. Blainville, and others, on the 
 effects of the section of the pneumogastric nerves.
 
 ANATOMY AND PHYSIOLOGY. 391 
 
 lacteal, or chyliferous vessels, on a dog which was killed immediately 
 after eating, for purposes of dissection. Accident led him to this 
 discovery, according to his own account, which is as follows: "I per- 
 ceived," he says, " on the walls of the intestines and in the folds of the 
 mesentery, very fine white filaments, which I took at first to be nervous 
 filaments ; but having pricked one by mistake, I saw issue from it a 
 white, creamy liquid. Struck with astonishment, I took pains to estab- 
 lish this unexpected phenomenon before the eyes of spectators, among 
 whom there were two very distinguished physicians, Louis Settala and 
 Alexander Taddini." 
 
 On the following days, Aselli repeated the same experiment on other 
 dogs, with equal success, and acquired the certainty that the white 
 threads were vessels which drew the chyle from the intestines. He 
 observed the valves with which they are supplied, but supposed that 
 they all met in the pancreas, to be continued to the liver, which has 
 always been regarded as the organ of sanguification. 
 
 finally, in 1647, John Pecquet, being still a student at Montpelier, 
 discovered the reservoir that bears his name, and which is formed by 
 the union of all the lymphatic trunks of the inferior members, and 
 those of the organs contained in the abdominal cavity. ••■^ This reservoir, 
 situated between the second and third lumbar vertebrge, is the beginning 
 of the thoracic canal, which is varied in structure, sometimes straight, 
 again flexed, sometimes single, and sometimes double, lying along the 
 anterior face of the dorsal column, and empties itself into the left sub- 
 clavian vein. Pecquet followed the canal to its termination. Having 
 ligated it, he saw it swell below and empty itself above the ligature. 
 He studied with closer attention than any who had preceded him, the 
 course of the lacteal vessels, and convinced himself that none of them 
 were connected with the liver, but that all, on the contrary, emptied 
 themselves into the common reservoir of which we have spoken. 
 
 The discovery of Pecquet gave the last blow to the ancient theory 
 which attributed to the liver the function of hsematosis, and it confirmed 
 the doctrine of Harvey on the circulation of the blood, but, like that, 
 was strongly opposed. If we were astonished to find at the head of 
 its opponents the celebrated detractor of moderns, John Piiolan, we are 
 much more astonished to see the illustrious W. Harvey make, on this 
 occasion, common cause with the Dean of the Faculty at Paris. 
 
 From that time the lymphatic vessels and glands became objects of 
 research by a great number of anatomists. Among those whose labors 
 contributed most to develop the disposition and uses of this order of 
 
 '^ J. Pecquet! Experimenta nova anatomica. Paris, 1654, iro.
 
 392 REFORM PERIOD. 
 
 organs, we must name John Vesling, professor in the University at 
 Padua, who discovered the thoracic canal about the same time as Pec- 
 quet, the celebrated Th. Bartholin, Euy.sch, Olaiis Rudbeck, W. and J. 
 Hunter, Hewson. Cruikshank, and above all, Mascagai, who was the 
 first to give a graphic description of this whole apparatus.'"' A cer- 
 tainty was now acquired that the lymphatics, disseminated in infinite 
 number in all parts of the body, in a very variable and irregular form, 
 were arranged generally in two layers, the one superficial, the other deep- 
 seated ; that they w^re frequently interrupted in their course by small, 
 rounded, oblong bodies, called conglobate glands, or better, ganglions, 
 and that their functions consisted in carrying into the torrent of circu- 
 lation, first, the chyle, which they draw from the surface of the intes- 
 tines ; secondly, a transparent, colorless, or slightly pink-colored humor, 
 nearly tasteless and inodorous, called lymph, which they collect from all 
 parts of the body. 
 
 NERVOUS SYSTEM. 
 
 We have seen that Hippocrates and his successors in the school of 
 Cos, had no precise notion of the nervous system ; they confounded, 
 under the term of veupa, nerves, tendons, ligaments, membranes, and 
 true nerves. Aristotle was but little in advance of the Asclepiadoe in 
 this matter ; he regarded the brain as an inert mass, without sensation, 
 and supposed that the nerves originated in the heart. According to 
 him, they strengthen the articulation and aid the movements. Spren- 
 gel attributes then, wrongfully, a knowledge of these organs to the 
 philosopher of Stagyrus,f but more correctly, further on, gives the honor 
 of the same discovery to Herophilus.J 
 
 It appears, in fact, according to the most certain traditions, that the 
 physician of Chalcedonia was the first to unravel a little, the functions 
 of the nervous system. Piufus, the Ephesian, who lived under Trajan, 
 says that Herophilus distinguished three sorts of nerves: the first, 
 which serve for sensations and voluntary movements, proceed from the 
 brain and spinal marrow, as ramuscles ; the second and the third are 
 destined to unite the bones, and the muscles to the bones. We see, by 
 this passage, that Herophilus had not yet entirely shaken ofi" the pre- 
 judice which confounded tendons, ligaments, and membranes with the 
 nerves. 
 
 * Vasorum lymphaticorum Corporis Humani Historia et Icomographia, Senis, 
 1787, 4vo. 
 
 t Ihiil, t. I, p. 384. X Ibid. t. II, p. 435.
 
 ANATOMY AND PHYSIOLOGY. 393 
 
 Galen himself was not exempt from this error, as any one may be 
 convinced by the following glance of the description which he gives of 
 the nervous system. After having spoken of the two membranes that 
 envelop the encephalon, which we know as the dura-mater and the arach- 
 noid, he points out the great division of the encephalic mass into cerebrum 
 and cerebellum ; he describes each of these parts, their respective posi- 
 tion, volume, consistency, the two substances that enter into their com- 
 position — the one white, the other gray — the depressions and convolu- 
 tions on their surfaces, the ventricles, etc. He regards the cerebrum as 
 the seat of the rational soul and the origin of the sensitive nerves, while 
 the cerebellum, as well as the spinal m.arrow which proceeds from it, 
 give rise, according to him, to the nerves of motion, which he thought 
 had more consistency than the others. To prove that the nerves are 
 the primary agents of sensibility and mobility, Galen cites the following 
 experiment: "If we cut a nervous cord, or place a ligature around it, 
 immediately the parts situated below the section or ligature lose the 
 faculty of feeling and motion." The alternate movements of expansion 
 and contraction of the encephalon, did not escape him, and he regarded 
 them as a species of respiration of the brain. He gives to the great 
 sympathetic nerve the name of intercostal, and says it is derived from 
 the vagus nerves, which form the sixth pair in his classification. He 
 observed the ganglions that are met with on their track, but he never 
 suspected their use. Does it not seem, from this, that Galen distin- 
 guished perfectly the nerves from the tendons and the ligaments ? Never- 
 theless, he says, in another place, that the extremities of nervous ramifi- 
 cations are spread out into membranes, ligaments, and tendons. He 
 places the sense of touch in the membranes which envelop the muscles, 
 and to which he gave the name of aponuroses, on account of their 
 supposed nervous origin. 
 
 The anatomists of the sixteenth century described with more exact- 
 ness than Galen the various branches of the nervous system. They dis- 
 tinguished better each part, followed farther the distribution of vessels 
 and nerves, and corrected some material errors of antit^uity on this 
 branch of anatomy. They assured themselves, for example, that the 
 nerves of the cerebrum, cerebellum, and spinal marrow, served equally 
 for sensation and motion. Nevertheless, the most of the ancient preju- 
 dices concerning the organs of sensibility and mobility, as well as the 
 manner in which they executed their functions, still existed. A suffi- 
 cient number of experiments had not yet been made, to establish a rational 
 opinion on this subject, consequently only more or less plausible con- 
 jectures could be formed. There was so much uncertainty on this sub- 
 ject, that a Cesalpinus could, without a too great paradox, renew the 
 25
 
 394 REFORM PERIOD. 
 
 theory of Aristotle which made the heart the origin of sensation and the 
 seat of the soul. Very much later, toward the end of the seventeenth 
 century, Baglivi published a theory which referred the vital movements 
 to two structures — the heart and the dura mater. He supposed that 
 the latter is agitated by a continual oscillation, which is transmitted 
 from the membranous envelope of the nerves and thence to all parts.* 
 
 There remained, therefore, at the commencement of the Keform Period, 
 an ample harvest of discoveries to be made on the texture and functions of 
 the nervous system in general, as well as in each of its divisions, in par- 
 ticular. The progress of comparative anatomy, and experiments on living 
 animals, during this period, cast vast light on neurology. At the close 
 of the last century, the vascular organization of the gi'ay substance of 
 the brain was known ; it was no longer a question, that the encephalon 
 was the organ of sensation and voluntary motion, and the seat of the 
 mind. The splendid researches of E. Vieussens, Haller, J. I'. Meckel, 
 Yicq d' Azyr, A. Scarpa, Th. Soemmerring, and of a great number of 
 other physiologists, had put this fact beyond question. They had de- 
 monstrated that the dura-mater receives no nerves, and that it is desti- 
 tute of all sensibility and could not be the source of any movement. It 
 was shown, also, by rigorous observations, that all the nerves coincide 
 and are united at the base of the brain, in that part termed the protube- 
 rance annulare, from which it was inferred with some probability, that 
 this was the sensitive center of the animal — the place where all the sen- 
 sations centered, and from which go forth all voluntary and reflex actions. 
 Nevertheless, other obsei'vations, of which we shall speak farther on, led 
 to the belief that the encephalon is a complex oi-gan, each division of 
 which fulfils a special function. At this time Xavier Bichat proposed 
 to divide the nervous system into two very distinct departments, though 
 united by numerous communications. One of these departments, com- 
 posed of the encephalon, the spinal marrow, and their annexes, subserv- 
 ing, according to him, the operations of the understanding and the will, 
 is the principal organ of the life of relation or animal life ; the other, 
 including the great sympathetic, its ganglions and plexuses, gives im- 
 pulse to the acts of organic or individual life — to those functions in vir- 
 tue of which an individual transforms into his own structure nutritive 
 molecules, and casts off those which are effete, or worn out, and injurious 
 to the system. This division, which has been an object of deep criti- 
 cism, offered to its author opportunities to develop many interesting 
 observations. 
 
 During this period the ancient supposition, that the membranes were 
 
 ^Baglivi, Opera Omnia, Lugduni, 1745, page 241.
 
 ANATOMY AND PHYSIOLOGY. 395 
 
 entirely derived from nervous ramifications, completely disappeared. 
 Very delicate dissections proved that the nerves, far from terminating 
 in aponeuroses, separate from their neurilema, and preserve only their 
 medullary pulp at their termination. Hence it was concluded, that 
 it is in this last condition that the nerve receives the immediate 
 impression of objects, and transmits it to the brain, by the intermedia- 
 tion of the nervous filaments. In this way, exploration was made of 
 all the functions of sensation — sight, hearing, smell, taste, and touch. 
 
 How difierent is this explanation, so simple, based on the anatomical 
 disposition of parts, and separated from the imaginary hypotheses 
 believed by the a.ncients, and accepted by the moderns until the begin- 
 ning of the seventeenth century! Empedocles appears to have been 
 the first who, to render an account of the sensitive impressions, supposed 
 an elementary affinity between exterior objects and the organs of sense. 
 He thought that there exists in each of our organs a force which governs 
 and attracts from other bodies the molecules similar to its own. The 
 eye, for example, being of a resplendent nature, attracts, he said, the 
 luminous molecules from bodies ; the ear, which is of an airy nature, 
 must attract sonorous particles. The nose has a vaporous, the tongue a 
 humid, and the organ of touch, an earthy constitution. Aristotle, 
 Galen, and their successors, did not make any special modifications in 
 this theory. They added only to the hypothesis of Empedocles the 
 consideration of spirits, of which they made as many species as we- 
 have difierent senses. These spirits, invisible and impalpable, were 
 secreted by the brain, and transmitted to the external organs of sense 
 by the nerves. The visual spirits connected themselves with the organ 
 of sight, where they put themselves in communication with the luminous 
 particles of bodies ; the auditive spirits were connected with the ear, 
 where they were associated into sonorous particles, and so on for the 
 other senses. 
 
 From the beginning of the seventeenth century, the celebrated mathe- 
 matician Kepler, announced that the crystalline lens is not, as had 
 been supposed till that time, the seat of vision, but that its function 
 is to refract the rays of light. He observed that the image of objects 
 is painted on the retina. The Jesuit Scheiner confirmed these observa- 
 tions, and extended them, and demonstrated that the expansion of the 
 optic nerve is the essential part in the organ of sight. Many other 
 learned men, and especially physicians, submitted the various membranes 
 and humors of the eye to an attentive examination, so that this organ, 
 30 marvellous and complicated in structure, is one of the best understood 
 in the organism. The researches of the great Newton, on light and 
 colors, Contributed also to perfect the theory of the visual function.
 
 396 REFORM PERIOD. 
 
 At the same time, Casserius and other anatomists studied the organ 
 of hearing. The osselets and the small muscles of the internal ear, and 
 the semi-circular canals, were described. The acoustic nerve was fol- 
 lowed in its windings and ramifications. Duverney published a remark- 
 able monograph, in which, by the aid of comparative anatomy, he 
 corrects several errors which had escaped his predecessors, and adds new 
 details to what was already known. E. Vieussens established the true 
 seat of audition in the membrane which lines the drum and labyrinth. 
 Lastly, Cassebohm, Valsalva, Morgagni, Geoffroy, Lecat, Comparetti, 
 Scarpa, and others, added several improvements to the notions of their 
 predecessors, on the organs of sense." 
 
 ]\Iany conjectures have been emitted, and many researches and experi- 
 ments attempted by moderns to explain the functions of the nervous 
 system. Some have regarded the nerves as tubes of extreme delicacy, 
 containing a subtle fluid, which receives the impression of objects and 
 transmits them to a central point, situated in some portion of the brain. 
 Others represent the nervous fibrillar as cords, all ending at a common 
 center. Charles Bonnet renewed the hypothesis of Hartley, according 
 to which each nerve is supposed to contain as many distinct fibers as it 
 receives varied sensations. For example, the organ of sight must be 
 composed, according to the naturalist of Geneva, of as many kinds of nerv- 
 ous filaments as there are colors ; that the organ of taste must have as 
 many varieties as there are dififerent flavors ; and so for the rest. 
 
 Thomas Willis was one of the first to consider the brain as an assem- 
 blage of various apparatuses, and assigned special functions to some of its 
 divisions. He placed the seat of common sensation in the corpora striata 
 — the imagination in the corpus callosum — the memory in the cortical 
 substance, etc. Cabanis, to explain the influence of the physical on the 
 moral man, compared the functions of the encephalon to those of some 
 other viscera. He said that the brain effects all the operations of the 
 understanding, as the stomach and intestines accomplish the digestion of 
 food — as the liver secretes bile, the kidneys urine, '•■■' etc.: but is not this an 
 abuse of induction ? and can one establish a perfect similitude between 
 a material effort exercised on visible and palpable substances, as the 
 alimentary bolus, which we may follow in its successive transformations, 
 and the elaboration of thought — the abstract and immaterial result 
 of a function whose mechanism is unrevealed by our senses ? 
 
 '•' Besides these several authors, great interest -will be excited by consulting the 
 fine researches made in our times by G. Breschet, on the organ of hearing and 
 :auditioninman, and the mamifers, birds and fishes. 
 
 f Rapports du Physique et du Morale, de I'Homme, par M. L. Pcisse.
 
 ANATOMY AND PHYSIOLOGY. 397 
 
 Thus far we have given only hypotheses ; the following opinions 
 
 II appear less conjectural, and are the result of more attentive observations : 
 
 ; P. Camper, having compared a great number of heads of men and ani- 
 
 \ mals, remarked that, in proportion as we descend from the higher classes 
 
 i to those that are inferior in the animal scale, the forehead recedes more 
 
 and more, and the jaws become more elongated. So he thought that 
 the facial angle is the most certain index of the development of the 
 intellectual faculties. Was it from a similar observation that the Greek 
 artists gave to the heads of their divinities an elevated and prominent 
 forehead '? =•••= 
 
 Pinel and other pathologists had already observed that in various 
 states of mania, delirium, or partial insanity, certain mental faculties, 
 such as the memory, attention, judgment, imagination, will, etc., were 
 abolished or suspended, while others preserved their free exercise, or 
 even acquired more energy ; and they inferred from this, that each of 
 the faculties must have, in the brain, its own seat, or, in other words 
 belong to a special section of that organ. 
 
 After a series of patient and ingenious observations, Grail thought he 
 might emit the following propositions : First, the development of the 
 mental faculties is in constant proportion to the volume of the brain, 
 other things being equal ; second, each part of this viscus is the instru- 
 ment of a distinct and independent faculty ; third, the cranium being 
 molded in nearly an exact manner upon the encephalic mass, it can be 
 determined, by the inspection of the bony box, what is the volume of 
 certain portions of the encephalon, and from this determine what facul- 
 ties are predominant, or are defective, in an individual submitted to an 
 examination. At the same time. Gall introduced an entirely new classifi- 
 cation of the faculties of the understanding ; but though he commenced 
 publishing his discoveries before the close of the eighteenth century, 
 their complete manifestation and propagation belong to the nineteenth cen- 
 tury, and for this reason we shall carry no farther our exposition of his 
 system, f 
 
 ON GENEEATION. 
 
 The generative functions in viviparous animals, such as man, may be 
 divided into three periods, namely, impregnation, pregnancy, and 
 accouchement. We shall speak here only of the first, the other two 
 being referred to the chapter on obstetrics. This subject always occu- 
 pied the reflections of philosophers and physicians, who, in default of 
 positive data, did not fail to erect hypotheses, more or less ingenious. 
 
 " See the work of Camper, published at Utrecht in 1791-92. 
 
 t Anatomic et Physiologic du System Nerveux; Paris, 1810-1819.
 
 398 REFORM PERIOD. 
 
 Galen describes with sufficient exactness the genital parts of man. 
 He very justly observed that the artery and spermatic vein of the right 
 side took their origin, one from the aorta, and the other from the vena 
 cava, while the artery and spermatic vein of the left side emanated from 
 the renal artery and vein. The same disposition is met with in women, 
 in regard to the ovarian arteries and veins. Moreover, this anatomist 
 believed that there existed a perfect analogy between the genital organs 
 of the two sexes, with this sole difference, that in the male these organs 
 have been pushed outward by the heat of his temperament, while in the 
 female they are retained within the body, owing to her natural coldness- 
 He called the ovaries the testicles of the female, and supposed that in copu- 
 lation they secreted a spermatic liquor analogous to that in man. He 
 believed, also, that the womb was divided into two cavities, which proves 
 that he had only examined that viscus in the females of animals. 
 
 On these anatomical data, partially true, he founded the following 
 explanation of the act of generation: "The womb," he said, "having 
 received, at the time of coition, the seminal fluid of the man and of the 
 woman, the two are mingled. But that of the woman only serves to 
 nourish the other, and to produce one of the envelopes of the fetus. 
 The semen of the male, almost as soon as it is received into the womb, 
 is changed into membranes. Some of these membranous textures 
 remain always in the same condition, otliers become gradually thickened 
 and hardened, and are transformed into cartilages, these into bones, 
 which serve as the framework of the body. Others are folded or hol- 
 lowed, and elongated in a way to form the tubes which are called arte- 
 ries or veins. Others, in fine, are extended into filaments, and produce 
 fibers or nerves. The body of the animal being thus arranged, each 
 part afterward attracts that which is necessary to it." 
 
 In relation to the procreation of the sexes, Galen shared the opinion 
 of Hippocrates, who taught that the right testicle in man furnishes the 
 seed for males, the left for females ; that the male embryo was always 
 developed in the right cavity of the uterus, while the female occupied 
 the left. 
 
 Such is a summary of the knowledge that antiquity transmitted to 
 the middle ages, on the reproductive function, and which came down, 
 without any modification, to the sixteenth century. Then only were 
 efforts made to rectify some of the material errors of Galen, on the con- 
 formation of the genital organs of women. It was demonstrated, for 
 example, that the womb had but one cavity. Fabricius d'Aquapendente 
 made the first experiments, in order to ascertain the particular part 
 that each portion of the sexual organ played in the act of reproduction. 
 He killed pullets after coition, and saw that among the little yellow
 
 ANATOMY AND PHYSIOLOGY. 399 
 
 round grains, disposed like a bunch of grapes, which constituted the 
 ovaries, that there was one which enlarged, in which vessels were devel- 
 oped, and which at length became detached and traversed the oviduct, or 
 the cloaca, to be thrown off in the form of an egg. 
 
 At a later period, Harvey repeated the same researches, on bitches, 
 and obtained analogous results. He states positively, that the matter 
 furnished by the female, in the generative function, is a germ. He 
 emits the premature and too general opinion, that every animal pro- 
 ceeds from an egg. DeGraaf expsrimentsd on rabbits, and made still 
 more precise observations. In explaining the texture of the genital 
 organs of women, he substituted the word ovaries for the inconvenient 
 term of female testicles. 
 
 In order to ascertain if what Hippocrates and Galen had said, was 
 true, touching the function of the right testicle, which they said always 
 generates males, and the left one females, he made the following experi- 
 ments : first, he took away the right testicle of a rabbit, and afterward 
 coupled it with a female ; she brought forth, in due time, young of both 
 sexes. Then he took away the left testicle of another rabbit, with the 
 same results. In order to find out, also, if each ovary furnished ovules 
 of both sexes, or of one only, he ligated, in one female rabbit, the right 
 ovarian duct, and in another one the left. Each one bore young of both 
 sexes : whence it is permitted to conclude that the theory of Hippocra- 
 tes on this subject, which had been confirmed by Galen, and adopted by 
 all antiquity, must be classed among fictions. 
 
 A mass of hypotheses were conceived, to explain the mysterious acts 
 of generation, but it is not our purpose to mention them here. AVe 
 shall simply say that they may be reduced to two great classes, namely, 
 epigenesis and evolution. 
 
 In the first, it is assumed that the new being is formed, in all its 
 parts, by the aggregation of molecules possessing reciprocal affinity, 
 and which arrange themselves in a certain order, nearly as occurs in the 
 phenomenon of crystilization. A special force, to which were given in 
 turn the names of nature, pneuma, soul, archeus, plastic force, essential 
 force, formative force, etc., presides over the union and co-ordination of 
 these particles, and impresses on the new being its form, character, and 
 properties. 
 
 The second class admits that the embryo pre-existed under some form, 
 and being vivified by the act of fecundation, it then commences a scries 
 of developments, which must lead to the construction of an individual 
 similar to the one whence it proceeded. The partisans of this system 
 were divided into two sects — the ovarists and the animalculists. 
 
 The ovarists contended that the matter furnished by the female is an
 
 400 REFORM PERIOD. 
 
 egg, containing the germ of the new being, and besides, a substance 
 which serves for the nutrition and earliest development of the embryo. 
 This system was founded on the observation of oviparous animals. 
 In these, indeed, the female furnishes, evidently, an egg, which even 
 in a large number of cases, is laid, before the connection of the sexes, 
 and is fecundated externally. 
 
 The animalculists contend that the new individual proceeds from an 
 animalcule contained in the sperm of the male. Leeuwenhoek was the 
 first who, by the aid of the microscope, remarked in the semen of 
 animals a prodigious quantity of small bodies, executing spontaneous 
 movements. Later observations have proved that these animals, termed 
 spermatazoa, always exist in recently ejaculated sperm, and that similar 
 ones are not found in any other humor of the body — that they are 
 different in different species of animals, but are not identical in the 
 same species. They are not seen in the sperm of an animal, except at an 
 age capable of reproduction, and are absent before, as well as after, that 
 period. Their number is so prodigious that fifty thousand have been 
 estimated in a single drop of the sperm of a cock, the volume of which 
 is scarcely equal to that of a grain of sand. If in any way, as by 
 electricity, distillation, etc., these animalcules are destroyed, or if they 
 be withdrawn from the sperm, that liquor loses immediately its prolific 
 virtues. Such are, in resume, the facts on which the animalculists 
 support their system. The great Buffon adopted this system, after 
 modifying it, and popularized it by the charms of his eloquence. For 
 ourselves, to explain in two words our sentiments on the subject of the 
 various systems of generation, imagined up to this time, we say, in the 
 language of Horace: The philosophers have disputed on this subject 
 from the beginning of the world, and the question is still undecided, 
 Grammatiei certant, et adhuc subjudice lis est. 
 
 ON VITAL OR ORGANIC PROPERTIES. 
 
 We have seen that the ancients admitted that there are in crude 
 matter two kinds of properties — one, which they termed elementary, 
 agrees with our chemical properties, and was supposed to proceed from 
 the elements which entered into the composition of all material sub- 
 stances. These elements, as is known, were four in number — fire, air, 
 earth, and water. The qualities which bodies assumed, from their 
 relative proportions, amounted to eight : thus, a body could be simply 
 hot, cold, dry, or moist ; or hot and dry, hot and moist, cold and dry, 
 or cold and moist. 
 
 The second order of properties, recognized by the ancients, compre- 
 hended hardness, elasticity, porosity, etc. — in a word, what we term
 
 ANATOMY AND PHYSIOLOGY. 401 
 
 physical properties. These were supposed to depend on the figure, the 
 number, and arrangement, of the atoms, or unalterable particles ■which 
 constitute bodies. I3y means of these two orders of properties the 
 ancients flattered themselves to be able to explain all the phenomena of 
 inanimate nature. 
 
 But in regard to living beings — man, for example — it was impossible 
 to see, in the exercise of his functions, such as generation, nutrition, 
 locomotion, intelligence, etc., anything but the simple play of elementary 
 and physical qualities. Moreover, the greatest philosophers and physio- 
 logists in all time, agreed to regard each individual of this class as 
 endowed with an intrinsic, primitive force, named by diff'erent writers, 
 essence, nature, soul, spirit, pneuma, etc., which superintended, with 
 admirable instinct, the regular accomplishment of all the functions, 
 unless interfered with by some material obstacle. 
 
 Among physicians some were especially attentive to the efiects of this 
 intrinsic force ; they studied carefully its tendencies and followed most 
 scrupulously all its indications : they were called Hippocratists. Others 
 had regard, principally, to the elementary qualities of the humors ; these 
 were the Humoralists, of whom Galen was the highest representative. 
 Others, in fine, who regarded chiefly the physical properties of the 
 solids, and in particular, porosity, attributing to the tisssues only the 
 qualities of expansion and contraction. These were named Methodists. 
 As to the Empirics, they disdained physiological considerations, in which 
 they were wrong : in a science as complicated and as difficult as that 
 of pathology, we must borrow light from all the other sciences. But 
 they would have been right, if they had said to the other sects: you are 
 not ignorant that the phenomena of the animal economy are produced 
 by three orders of forces ; nevertheless, each of you considers only one 
 of those orders and regards the rest as of little or no value : each one 
 of you is therefore in error. Take for example any function, say the 
 secretion of saliva. Is it not evident that in this function, the vital 
 forces, the physical forces and the forces or properties elementary, 
 namely the chemical, concur simultaneously? Now who can tell the 
 part played by each of these three orders of forces in the act of salivary 
 secretion ? No one. It is therefore impossible to form an exact idea 
 of this function, as long as an eff"ort is made to separate, by a mental 
 analysis, the forces which concur to produce it. The function itself 
 must be studied, as it is presented to our observation, that is to say, 
 synthetically and experimentally. 
 
 At the restoration of the sciences the ancient physiological systems were 
 reproduced under difi'erent forms : the iatro-mathematieians, versed in 
 the calculations of the physical forces, assumed to explain the functions
 
 402 BEFORM PERIOD. 
 
 of the animal economy by the laws of mechanics. They could see in 
 the secretions, the circulation, and the nutrition, nothing but the effect 
 of the elasticity of tissues, of the calibre of vessels, of the friction of 
 liquids, etc. The chemical physicians took into consideration, exclu- 
 sively, the mixture of chemical elements ; they spoke only of alkaline 
 or acid humors, gases, salts and fermentations. The Hippocratists 
 had especial regard to the influence of the intrinsic force of living 
 bodies, a force which they named archeus, soul, or vital principle. 
 Up to this time as is seen, the physiologists made no distinction between 
 the properties of organic and inorganic matter ; to explain certain 
 acts of the animal economy they had recourse to the intervention of an 
 immaterial or quasi immaterial substance, as the soul, the archeus or 
 vital spirits ; they knew nothing of vital forces properly called. 
 
 About the middle of the seventeenth century Francis Glisson, pro- 
 fessor in the University of Oxford, recognized in the living solid tissues 
 a particular force which he termed irritahility, and which he regarded 
 as a sufficient cause for all the phenomena of life. He said that all the 
 tissues are endowed with this force in different degrees, and proposed 
 to divide it into natural, vital, and animal, accordingly as it is mani- 
 fested by movements more or less apparent, with or without the con- 
 currence of the will. 
 
 These ideas made but little impression on the medical world ; they 
 were even forgotten for more than sixty years, when John de Goester, a 
 Dutch anatomist, brought them again to light. He however did not 
 well distinguish irritability from elasticity ; the difference between 
 these two forces had not yet been established by demonstrative ex- 
 periments. Albert von Haller was the first who directed his investiga- 
 tions towards this end, and who, by a series of extremely ingenious 
 experiments, elevated the hypothesis of Glisson to a demonstrated fact. 
 He published in 1747 the result of his immense researches, with the 
 modest title of Primce Linece Physiologice, a work in which are traced 
 for the first time the true characters which distinguish living tissues 
 from dead substances. The author gives, in it, his opinion on the 
 vital contractility of tissues, which he distinguishes perfectly from 
 contractility or elasticity. He proves that the latter is seen in all the 
 structures, in tendons, in membranes, as well as in muscles, and that it 
 continues for a short time after death ; while vital contractility is only 
 found in muscles and becomes extinct with the life. He thinks that 
 the latter proceeds from nervous influence, for the nerves of the spinal 
 marrow being irritated, he says, the muscles, which receive their nerves 
 from these parts, are violently convulsed, even on dead animals. The 
 nerve of a muscle being tied or cut, it relaxes, and cannot in any way
 
 ANATOMY AND PHYSIOLOGY. 403 
 
 excite vital movement; if the ligature is taken off, it recovers its 
 vital contractility. In fine, the weight that a muscle can elevate during 
 life is sufficient to separate and tear it after death." 
 
 Ten years later, in 1757, Haller published the first volume of his 
 great physiology, with the title of Elementa Physiologice Corporis 
 Humani, the whole of which was not given to the world till 1766, two 
 years before the death of its author. It was, if I may be permitted 
 the poetical expression, the song of the swan, the crowning labor of an 
 existence entirely consecrated to the profit of science and humanity. 
 Haller proceeded in the entire work with his usual circumspection, advanc- 
 ing nothing but what was supported on well established facts, and giving 
 the least possible influence to hypothesis. Eich in a multitude of obser- 
 vations, which were his own, and in a vast erudition, he elevated to the 
 science of life an imperishable monument. From this time physiology 
 had an existence, independent of physics or chemistry. It was demon- 
 strated that life has its laws and its special forces, which must be 
 studied after a particular method. 
 
 These new truths, which were proclaimed by Haller, excited, in a 
 lively manner, the attention of the learned world. On all sides, men 
 hastened to repeat his experiments, and to try new ones, in order to 
 confirm or refute his assertions. The celebrated naturalist, Felix Fon- 
 tana, was one of the most zealous and able advocates of the doctrine of 
 irritability. Haller, trying to ascertain to what mode of structure 
 muscular contractility was inherent, thought that this vital princi- 
 ple depended upon gelatine, combined with an earthy principle. He 
 remarked, also, that there are stimulants which act on certain organs, 
 but not on others. Antimony, for example, which irritates the stomach, 
 even in small doses, so as to provoke vomiting, does not appear to have 
 any influence on the heart ; hence originated the idea of specific 
 irritability. 
 
 Theophilus Bordeu applied this idea to the theory of secretions. In 
 his treatise on the position of the glands, and their functions, he com- 
 bats all the chemical and mechanical explanations with which writers 
 had been satisfied up till that time, and attributes the various sorts of 
 secretions to the proper action of the glands, all of which, he says, 
 have their specific tone and sensibility. He emits a conjecture, which 
 was possibly the point of departure for the researches of Gall, on th e 
 philosophy of the brain. He says that all the functions commence at 
 this viscus, which is divided into as many departments as there are 
 organs of the body. The brain communicates its impulse to the organs 
 
 * Haller's Elements of Physiology, French translation.
 
 404 REFORM PERIOD. 
 
 by the intermediation of the nerves ; nevertheless, he adds, this matter 
 is very obscure, and it is necessary to multiply experiments, to know 
 the brain, and the uses of its different parts.'"'^= 
 
 Peter Anthony Fabre, professor in the Faculty at Paris, was the first 
 one to apply the doctrine of irritability to pathology. He refuted the 
 mechanical theory of Boerhave, on inflammation, and proved that this 
 proceeds, not from the obstruction of the capillary vessels, but from the 
 exaltation of their irritability. In his microscopical observations on 
 frogs, he perceived that the blood moves in all directions in the capil- 
 lary vessels, whence he concluded that in these vessels the motion of 
 the fluids is no longer under the impulse of the heart, but under the 
 influence of irritablity. f 
 
 Haller had demonstrated the existence of irritability in the muscular 
 fiber. His disciples assumed it also for other tissues, as we have just 
 seen, but it remained to be proved by experiments, and a severe analysis, 
 that it does exist in all the tissues. It was necessary to show to what 
 degree, and under what circumstances, it manifests itself in each of 
 them ; in a word, it was necessary to systematize the theory of vital 
 properties, to extend it to all the functions : this work was undertaken 
 and executed with much genius and boldness, by the celebrated Bichat. 
 
 This man, whose career was so short and so complete, commences by 
 tracing clearly the characters that distinguish vital fi'om physical forces. 
 " The one," he says, "varies unceasingly in its intensity, energy, and 
 development, passing often with rapidity from the last degree of pros- 
 tration to the highest point of exaltation ; accumulating and wasting, by 
 turns, in the organs, and assuming under the influence of the slightest 
 causes a thousand various modifications. Sleep, wakefulness, exercise, 
 rest, digestion, hunger, the passions, the action of bodies surrounding 
 the animal, etc., — all expose them each moment to numerous changes. 
 The others, on the contrary, fixed and invariable, are the source of a 
 series of always uniform phenomena. Compare the vital faculty of feel- 
 ing with the physical faculty of attraction ; you perceive that the attrac- 
 tion is always in proportion to the mass in which it is observed, while 
 sensibility changes constantly its intensity in the same organic part and 
 in the same mass of matter," J 
 
 '■'Bordeu, Recherches Anatomiques sur la Position des Glandes et sur leur 
 Action. Paris, 1751. 
 
 t Reclierches sur diiferents Points de Physiologie, de Pathologic et de The'ra- 
 peutique. Paris, 1784. 
 
 J Bichat, Recherches Phjsioligiques, sur la vie et sur la raort, pi*e. partie, 
 art. VII., § 1,
 
 ANATOMY AND PHYSIOLOGY, 405 
 
 Bichat reduced the vital faculties to two species, namely, the faculty 
 of feeling and the faculty of contraction ; but in each of these he admits 
 different degrees ; thus, sensibility is divided, according to him, into 
 organic and animal. The first consists in the faculty of receiving an 
 impression ; it is common to the plant and to the animal ; the zoophyte 
 possesses it, as well as the quadruped. The second consists in the 
 faculty of receiving an impression and transmitting it to a common 
 center ; animals provided with a nervous system are only endowed with 
 this. As to contractility, Bichat divides it also into organic and animal ; 
 accordingly as it is independent of the brain, as in the heart, intestines, 
 secretory organs, etc., or as it is controlled by the will, as in the muscles 
 of locomotion, of the voice, etc. 
 
 In a later work the same physiologist admits that the vital properties 
 are susceptible, not only of exaltation and diminution, but also that 
 they may be modified and rendered unnatural ; and he bases on this con- 
 sideration the utility of specific remedies. In fine, he recognizes a spe- 
 cies of vitality in the fluids of the animal economy, but he avows, at the 
 same time, his inability to determine in what this vitality consists. 
 " Its existence," he says, " is no less real on that account, and the 
 chemist who analyzes the fluids, has before him only their cadaver, just 
 as the anatomist has but that in the solids which he dissects." " 
 
 We must not forget that at this epoch numerous and beautiful re- 
 searches were already made, by a celebrated surgeon of London, in order 
 to determine the vital properties of one of the most essential liquids in 
 the animal economy. The treatise of John Hunter, on the Blood and on 
 Inflammation, had placed beyond question the truth that the blood, while 
 it circulates in a living body, enjoys certain properties which it loses when 
 it issues from the vessels, or when the animal is deprived of life. One of 
 the vital properties of the blood, on which the author insists the most,, 
 and which he regards as the principle of most of the phenomena of in- 
 flammation, is the aptitude of that fluid to coagulate spontaneously, 
 that is to say, without the addition of any chemical agent. In fine, to 
 the authors whom I have cited as having contributed to the progress of 
 anatomy and physiology, during this period, I must add the names of 
 Winslow, Bernard, Sigefroy, Albinus, the two Alexander Monroes, James 
 Douglass, Vicq d'Azyr, and others. 
 
 " Anatomie Gene'rale, Considerations Gene'rale.
 
 406 REFORM PERIOD. 
 
 CHAPTEK II. 
 HYGIENE. 
 
 This branch of Medicine was, during the last historical period, con- 
 siderably extended. It became the object of meditation, not only of 
 physicians, but also of philosophers and learned men of all classes, and 
 governors and statesmen, who endeavored to ameliorate the condition of 
 the physical life of the nations, and teach them more salutary habits. 
 Considered from the most elevated point of view, hygiene embraces all 
 the objects of nature, and all the productions of art ; for there is nothing 
 in the universe which may not be beneficial or injurious to the health 
 of man. But the limits of this work and of our knowledge, force us to 
 confine it to a circle infinitely more restrained. It is customary now-a- 
 days to divide hygiene into two great sections, accordingly as it refers to 
 man living in society, or as an isolated individual. We shall conform 
 to this arrangement. 
 
 § I. On Public Hygiene. 
 
 We have already seen in the commencement of our history, with 
 what foresight the legislator of the Hebrews mingled with moral 
 precepts a great number of hygienic prescriptions, appropriate to the 
 people, and the climate in which they lived. The first sovereigns of 
 Egypt had given this example, before him. The founders of the Greek 
 cities drew from that source a part of their religious rites, and their 
 hygienic customs, to which they added improvements. Among others, 
 they instituted the gymnasium, and carried the gymnastic art to a 
 degree of perfection that has not been since equaled. Their exercises 
 had not only the purpose of imparting strength, but also grace, supple- 
 ness and agility. We know that the athletic temperament was not 
 ranked by them among the good temperaments. In Sparta, where the 
 only object was to make soldiers, the exercises had only the purpose of 
 hardening the body against the fatigues of war. 
 
 In Rome, gymnastics took a worse direction still, for it was aban- 
 doned to the gladiators and slaves, who alone combattcd in the circuses. 
 The baths became, also, under the emperors, objects of luxury and 
 eflFeminacy rather than salubrity. But the construction of aqueducts, 
 fountains and sewers, the maintenance of cleanliness in cities, the atten- 
 tion to the location of cemeteries without the limits of towns, and the
 
 HYGIENE. 407 
 
 importance which was attached to the duties of magistrates, all attest 
 that the earliest legislators of that sage people did not neglect the care 
 of public health. Vitruvius, architect to the emperor Augustus, is 
 worthy of being consulted, not only as regards the perfection of edifices, 
 but also in regard to their salubrity. He gives, next to Hippocrates, 
 the best precepts on the location of cities. He recommends that cellars 
 and public granaries be constructed on the northern side, because a 
 southern exposure is unfavorable to the preservation of stores. He tells 
 us that the ancients consulted the livers of animals to judge of the 
 nature of the water of a country, and the salubrity of its alimentary pro- 
 ductions ; so that the inspection of the entrails of the victims of the 
 priests, instead of appearing to our eyes as a ridicilous superstition, was 
 really a rational means to discover the influence of the waters, airs, and 
 locality, on living beings. 
 
 Among modern nations, the Turks, alone, mix with their religious 
 practices some hygienic observances, such as legal ablutions, abstinence 
 from certain aliments, and particularly wine ; but this last prohibition, 
 which was designed to protect the sectators of the Koran from the vice 
 of drunkenness, has created among them a custom more fatal still — the 
 the use of opium. The Lent of Mussulmen must not be counted among 
 the number of well ordered hj'gienic institutions, any more than that of 
 Christians, for the results seem to me contrary to the true aim of 
 hygiene. Doctor Bruyer sets forth, as follows, the effects of the first, 
 upon health : " Knowing," he says, " the repugnance of every Mussul- 
 man to be out of his house at night, I made it my pleasure, as far as 
 possible, to avoid being late in my return at the close of the day. But 
 I was most careful during Ramazan, a month in which all the faithful 
 take no nutriments from the rising to the setting of the sua — not even 
 a pipe of tobacco, or a cup of coffee, or a drop of water. This fast — 
 always painful to a lodger — is truly intolerable for a laborer, especially 
 when its observance takes place, as I have known it, during the longest 
 days of the year ; so to economize their strength, the boatmen row us 
 as slowly as possible. How often have I encountered, at the dif- 
 ferent quays of Constantinople, those who, fresh and active at the com- 
 mencement of the fast, were, at its close, so dried up, thin and wrinkled 
 that, without my dragoman, I could not have recognized them."* 
 
 In the Christian church, which proposes to elevate man to the highest 
 degree of moral perfection, and free him from the bondage of his pas- 
 sions, we must not search for hygienic rules embodied in ecclesiastic 
 
 * Neuf annees a Constantinople. Paris, 1836, T. I, p. 149, cliap. I, sixieme ex- 
 cursion.
 
 408 REFORM PERIOD. 
 
 ordinances, but, owing to the intimate union which exists between 
 hygiene and morals, it often happens that the maxims of the Church are 
 excellent hygienic precepts. As to the European governments of the 
 middle ages, the sole general measures of salubrity of which their history 
 has transmitted to us the account, are the regulations concerning the 
 sequestration of the leprous, and the establishment of free baths for the 
 poor. Also, it must be said that the attention to the cleanliness of these 
 was so badly observed that the baths, themselves, often became a focus 
 for the propagation of contagious diseases. AVhen syphilis took the place 
 of leprosy, a part of the ordinances relative to leprosy were applied to 
 syphilitics, as has been heretofore remarked. 
 
 It was but a short time before the beginning of the seventeenth cen- 
 tury that the governments of Europe occupied themselves with the state 
 of public health. The lazaretto at Marseilles, was the first estab- 
 lishment founded to prevent the communication of the plague from the 
 East. Wise and strict regulations were promulgated on that occasion, 
 and they have served as a model for all lazarettos founded successively 
 in the other ports of the Mediterranean. 
 
 The idea of a lazaretto was first conceived by French merchants who 
 resided at Cairo and Alexandria. These merchants, observing that the 
 Coptic monks, isolated in their convents, seemed to be secure from the 
 pest, confined themselves also to their houses in the times of the epidemic, 
 and communicated with their neighbors only from the windows or from 
 the tops of the terraces that crown most of the edifices in the Orient. 
 The advantages which they reaped from this custom were such, that it 
 is maintained perfectly as a custom to this day. The Frank quarter, in 
 Constantinople, is generally preserved from the plague by a careful 
 sequestration, while the Turks, imbued with the dogma of predestination, 
 neo-lect all prudent measures, and perish, victims to their blindness. 
 
 At present, commerce earnestly protests against the rigor, and espe- 
 cially against the duration of quarantines. The opinion of a majority 
 of physicians is favorable to a reform in this respect, and there are men 
 who go so far as to discredit the utility of these establishments and 
 demand their suppression. Nevertheless, if we compare the small 
 ravai"es that the plague has made in Christian Europe since their estab- 
 lishment, with the frequency of its invasion before that epoch, it will be 
 difficult to deny the importance and efficacy of these preventive measures. 
 From 1476 to 1649 — that is to say, in a space of less than two hundred 
 years — the plague prevailed sixteen times in the city of Marseilles. 
 Now, it was only in the first part of the seventeenth century that any 
 one seriously thought of it as a contagion, and employed any means to 
 prevent it. Up to that time pestilential epidemics had been generally
 
 HYGIENE. 409 
 
 regarded as a scourge from heaven, whose progress no human barrier 
 could arrest, and no more efforts were made to preserve the people from 
 its ravages than are made among Musselmen. But aftpr 1649, i. e. 
 after the establishment of lazarettos and the rigorous observation of 
 sanitary rules, the plague has prevailed but once in Marseilles during 
 the space of nearly two hundred years.- It is possible, and very proba- 
 ble, that in the institution of quarantines, the measure of strict neces- 
 sity may have been passed, but it does not seem to me logical from this 
 to argue their inutility.f 
 
 It would be too long to enumerate all that has been done or under- 
 taken within two centuries to render cities, camps, districts of country, 
 vessels, barracks, workshops, hospitals, prisons, etc., more salubrious. I 
 should be compelled to refer to the works, not only of physicians, but 
 also of chemists, philosophers, magistrates, generals, navigators, etc. ; 
 for public hygiene is connected with all the sciences and arts, either to 
 profit by their light or in turn to benefit them by its own, so as to make 
 all converge to the well-being of the people. The abundance of mate- 
 rials, therefore, becomes an obstacle to their just appreciation. Ho'vt 
 could we discern fi-om among so many writings, discoveries, and improve- 
 ments, those which merit the preference ? It would be impossible for 
 me to avoid omitting some works, worthy as much to be mentioned, and 
 possibly more so, than certain of those of which I should speak. How 
 shall I depict all the efforts attempted in the last centuries by govern- 
 ments, municipal authorities, learned societies in particular, in order to 
 ameliorate the physical condition of man ? The enlarging and opening 
 of streets, the draining of stagnant waters, the removal of filth, the re- 
 location of cemeteries and insalubrious manufactories from the centers of 
 population, the draining of marshes, the chemical analysis of the air, 
 drinks, and alimentary substances, so as to determine of their elements 
 those which are advantageous or injurious to health, the research of 
 means proper to preserve food, and the regulations of a sanitary police, — 
 these are some of the objects which have occupied learned men and 
 statesmen. 
 
 The Royal Society of Medicine gave a strong impulse to the labors 
 concerning public hygiene, by the questions put in the public concours 
 
 •^The plague of 1720 was the last that existed in that city, although it has fre- 
 quently been met with at its lazaretto, where it was arrested. 
 
 t See the Dictionnaire des Scienc. Medicales, art. Hy«iene, by ITalle' and Nysten ; 
 art. Lazaret, by Fode're. See also the remarkable and important report made to 
 the Royal Academy of Medicine, on the Plague and Quarantine ; Bulletin de 
 I'Acad^mie Royale de Me'decine, Paris, 1846, t. xi. 
 
 26
 
 410 REFORM PERIOD. 
 
 by the reports of its committees, and by the correspondence it main- 
 tained with physicians of all countries, who furnished them their 
 observations on epidemics, topography, and in general, on everything 
 that concerned public health. John Howard ofiFered to the world the 
 first example, perhaps, of a man who traveled neither for his own 
 pleasure or health, nor for any advantage or personal interest, but solely 
 for the love of humanity. Hospitals, prisons, and lazarettos, attracted 
 his attention ; he devoted his fortune and his existence to the ameliora- 
 tion of the condition of the unfortunate, who were shut up in them. 
 A. A. Parmentier signalized, also, his zeal for the poor, by occupying 
 himself, successfully, in regard to means to increase their alimentation. 
 Thompson, Count Eumford, illustrated and made dear his paternal 
 administration, in Bavaria, by the establishment he founded for the 
 purpose of procuring labor and bread for necessitous classes. Guyton- 
 Morveau proposed excellent means of disinfection, which are still 
 employed in many cases. The health of soldiers and seamen attracted 
 the attention of many observers, and gave rise to numerous publications, 
 among which we distinguish those of Eouppe, Lind, Poissonnier des 
 Perrieres, Pringle, Donald Monro, Van Swieten, Colombier, Gilbert and 
 Desgenettes. 
 
 But of all the conquests which public hygiene has made in these 
 latter times, there is one which merits a special mention. Variola pre- 
 vailed, periodically, in both worlds ; it took from the population of Eu- 
 rope an annual tribute which is estimated to have amounted to not less 
 than four hundred thousand souls, and mutilated and disfigured nearly 
 as many more. A woman of great spirit and character. Lady Wortley 
 Montague, had, indeed, imported from Constantinople the practice of 
 inoculation, which has much merit, but is not free from reproach, 
 because it exposes its subjects to almost as much danger as the spon- 
 taneous contagion. 
 
 A physician of Barkley, a city of the county of Gloucester, having 
 heard it said, or having remarked, that the disease known in the western 
 provinces of England under the name of cow-pox, was communicated to 
 those who kept or milked cows habitually, and that this afifection, which 
 was very slight, protected completely those who had passed through it, 
 from the variolic affection, meditated on this strange fact, verified it, 
 and c6nceived the happy idea of inoculating children, directly, with 
 the virus taken from the udder of the cow. At the end of three, four, 
 or five days, he saw pustules developed, at all the points of the skin 
 which he had pricked, similar to those of cow-pox ; then the pustules 
 broke, the pus dried and formed a small crust, which in falling left a 
 cicatrice. Besides, there was little or no fever, the children continuing
 
 HYGIENE. 411 
 
 to eat and play as usual without realizing any bad symptoms. Not one 
 of those children was ever attacked by variola. 
 
 Jenuer, after having repeated his experiments for a number of years, 
 and being assured of the inocuous character of the virus, and its 
 prophylactic virtue, convinced, finally, of the reality and grandeur of 
 his discovery, decided to make it public, and consigned all the details 
 of the subject to a volume printed at London, in the year 1798." Great 
 was the stupefaction in the medical world at the announcement of such 
 an astonishing marvel. It seemed impossible to imagine that a pest as 
 ancient and as formidable as variola, could be expelled forever by a pro- 
 cess so simple and benign as vaccination. The discovery of Jenner met, 
 at first, with much opposition. The incredulous raised against it many 
 objections of every kind, and it gave rise to a very spirited polemic 
 between its defenders and opponents ; but I shall not retrace the phases 
 of this contest now terminated, and whose ultimate result has been the 
 adoption of the new specific, in every country into which European civili- 
 zation has penetrated. I will only observe that after the victory, there 
 was a disposition to contest with Jenner the honors of his triumph ; 
 some ambiguous passages from old books were uncovered from the dust 
 of libraries, and certain popular traditions were recalled, that had pre- 
 vailed in some obscure province, to find in them the germ of the admi- 
 rable discovery of the English physician, as if all ideas, all new inven- 
 tions, are not the consequences of some anterior idea or invention ! But 
 even this does not diminish the glory of the discoverer, for the develop- 
 ment given by him to those ancient ideas is great in itself, and emi- 
 nently useful in its results. Xow when I consider the sagacity, patience, 
 and exquisite judgment of which Jenner gave proof in his long experi- 
 ments, when I consider the immense benefit of his discovery, I no longer 
 discuss his genius, I have language only to praise and bless him ! 
 
 § n. Private Hygiene. 
 Among the original and important writings with which this department 
 of hygiene was enriched during this period, I will cite, in the first place, 
 that of Sanctorius, entitled, Aphorisms on Static Medicine. It was com- 
 posed under the following circumstances : Being desirous to estimate the 
 quantity of insensible humor that was exhaled each day from the human 
 body, and to determine the relations which connect this function with 
 the various actions of the different states of the economy, such as diges- 
 tion, exercise, repose, health, disease, age, season, etc., this physician 
 
 ■^ .Jenner, An Inquiry into the Causes and Effects of the Variolae Vaccinas. 
 London, 1798.
 
 41-2 REFORM PERIOD. 
 
 had the idea of arranging a seat on the platform of a balance, in such 
 a way as to be able to take the weight of the body at every hour of the 
 day, if he desired it, both before and after sleep, meals, the emission of 
 urine and feces, in a word, before and after each function whose opera- 
 tion is important to life. He continued, for thirty years, his daily 
 experiments; then he consigned the general results which he had 
 obtained, in a small collection of aphoristic sentences, of which the fol-g 
 lowing are specimens : 
 
 " All diseases proceed from an excess or defect of transpiration. If 
 a physician who has the care of a man's health, has regard only to the 
 nutrition and sensible evacuations, without knowing how much trans- 
 pires each day from those who are confided to him, he is ignorant of 
 their true condition, and is unworthy of the title of doctor in Medicine. "'~' 
 
 "To evacuate very much by stools, urine, or sweat, and but little by 
 transpiration, shows a state of disease. "f 
 
 " Why is swooning of great utility in high fevers ? Because it dis- 
 poses the body to sweat freely."| 
 
 " A man in health loses in a day, by transpiration, as much as he 
 passes in fifteen days by the bowels, though he have a stool of perfect 
 fecal matter every day."§ 
 
 " If a person drinks to excess during the night, and the body returns, 
 neither by coction nor indigestion, the next day, to its naturalstate, the 
 following verses are applicable to his state : 
 
 Si Ton est malade au matin, 
 D'avoir passe la nuit a hoire, 
 II faut envoyer chez Gre'goire, 
 Et se guerir avec du vin."|| 
 
 If 3'ou find yourself sick in the morning, 
 Having passed the night in debauch. 
 The wine of Gregory will cure you. 
 Send quickly to him for a draught. 
 
 "He who sleeps transpires double as much as when he is awake. 
 Hence the following axiom : Two hours rest when awake, are not worth 
 much more than one hour of sleep. "=•■■" 
 
 The publication of Sanctorius was hailed as a revelation from the 
 god of Medicine, a true code of hygienic laws. Their author was 
 saluted with the title of second Hippocrates, and his sanatory maxims 
 put on a level, or above those of the old man of Cos. His salary as 
 professor in the University of Padua, was continued to him by a decree 
 
 "' 1st section, Aphor. 2d, translation of Lebreton. Paris, 1722. 
 1[Ibid. Aphor. 14. JAphor. 98. §Sec. 3d Aph.lO. l|Aph.78. «»4th sec, Aph. 18.
 
 k 
 
 I 
 
 HYGIENE. 413 
 
 of the Senate, and Venice, where he finished his days, in 1636, erected 
 a statute to his memory. 
 
 Nevertheless, if we submit to a severe critic the work of Sanctorius, 
 we find it reprehensible in several respects. In the first place his con- 
 clusions are too general and too absolute, for from experiments made 
 upon one individual in one climate, he makes inductions for every body 
 and for all climates. In the second place, several inevitable causes of 
 error entered into his calculations, among others, the two following : he 
 took no account of the pulmonary exhalation and absorption, nor of 
 cutaneous absorption. In fine, several observers have repeated in 
 various countries the experiments of Sanctorius, and all obtained 
 extremely variable results. From this it appears that there is nothing 
 more changeable than cutaneous transpiration, and that to determine 
 its quantity would be as impossible, says Bichat, as to pretend to specify 
 the volumes of water that are vaporised each hour, by a heat whose in- 
 tensity varies each moment. The only general conclusion which may 
 be drawn from these numei'ous experiments is, that in a state of health 
 this excretion is ordinarily very abundant — that it is less when we are 
 awake, and that in every case it merits the attention of the physician 
 as well as the physiologist. If then these aphorisms of Static medicine 
 do not justify the enthusiasm which their appearance excited, they do 
 no more merit the neglect into which they have fallen in our days. 
 H. Boerhaave, whose judgment has had justly much weight, says that 
 no other book in medicine has been written with so much care, and 
 Lorry has added to it commentaries worthy of being meditated upon in 
 all time to come/-'^ 
 
 Cheyney, a physician in London, had very much impaired his health 
 by excess of pleasure and good living. He became excessively cor- 
 pulent, and sufiered all the inconveniences of that state, such as 
 dyspepsia, lethargy, indolence and other evils. He devoted several 
 years to the care of his health, and had the happiness to re-establish 
 it perfectly, by means of a country-life, milk and vegetable diet, exercise 
 
 '' De Medicina Statica, Aphorismi, Parisiis, 1770, 12mo. Sanctorius has esti- 
 mated the quantity of transpiration, compared with that of the urine and feces 
 taken together, in the proportion of 5 to 3. Denis Dodard a physician in Paris, 
 found that the transpiration is to all other excretions as 12 is to 15. Sauvages, 
 in the south of France, and Gorter in Holland, obtained results similar to the 
 latter. James Keill, who experimented in England, assumes that the quantity 
 of urine surpasses that of the transpiration at the rate of 38 to 31. Linning, 
 who observed this matter in South Carolina, says, that the transpiration exceeds 
 the urine for five months of the year, and that the opposite occurs during the 
 other seven months. We see therefore that there are as various results as there 
 are observers, which makes the reflection of Bichat entirely true.
 
 414 REFORM PERIOD. 
 
 and the Bath waters ; so that he was enabled to resume his very active 
 occupation and continue in it, to the cose of his life which took place 
 at the age of seventy-two. Cheyney enjoyed a great reputation as a 
 practitioner. He has left several works, of which the most estimable 
 is a monograph on the art of preserving health and prolonging the lives 
 of valetudinarians. He gives in it precepts which are still profitably 
 read. He exalts above all, the regimen suited to his condition, as did 
 Carnaro, whose history we have already given. 
 
 Among the other writings which contributed to improve hygiene 
 during the last century, I will cite the following monographs : that of 
 J. B. Fisher, and of M. J. Eoberts, on Old Age and its Diseases ; that 
 of Eamazini, on the Diseases of Artisans, which Fourcroy enriched by 
 interesting notes ; the writings of Lorry, Junckcr, Bebdoes, J. Arbuthnot, 
 Halle ; those of Tissot, which have enjoyed so much popularity ; in 
 fine, the general treatises of Tourtelle, Moreau de la Sarthe ; the 
 Treatise on Medical Police, by J. P. Frank ; the Code of Health, by 
 John Sinclair, etc.'"' 
 
 CHAPTER III. 
 
 GENERAL PATHOLOGY. 
 
 Pathology was studied, during this period, under various aspects, 
 which we shall here content ourselves with indicating, very summarily ; 
 but will speak of it much more explicitly in other places, particularly 
 in the chapters devoted to the exposition of theories and systems. 
 Some gave the principal credit to humors, in the generation of diseases, 
 conformably to the modified Galenic doctrine, or followed the pi'inciples 
 of the new chemistry ; others saw in every morbid disorder only an 
 error or trouble in the governing principle of the economy, which they 
 named archeus, soul, nature, or vital principle ; others considered dis- 
 eases as a mechanical or dynamical derangement of the action of the 
 solids ; others, in fine, banished from pathology the consideration of 
 the causes and phenomena which were not manifest to the senses, and 
 insisted on the results to be obtained from pure observations only. 
 From these dificrent modes of regarding diseases, there followed very 
 different pathological classifications, and, in definitive, a more profound 
 and complete knowledge of the morbid state. 
 
 '"' A new edition of the Traite des Maladies des Artisans, with considerable 
 additions, was published by Doctor Ph. Patissier. Paris, 1822, 8vo.
 
 INTERNAL PATHOLOGY. 415 
 
 CHAPTEE IV. 
 INTERNAL PATHOLOGY. 
 
 § L Semeiotics. 
 
 A great number of physicians devoted themselves, during this period, 
 to the study of symptoms, abstractly considered, and endeavored to 
 establish more precisely their value. They were persuaded that each 
 symptom has its own signification, independent of the concourse of other 
 accidents, and they strove to determine that signification. We have 
 seen Sanctorius seeking the indications of good and bad health, in the 
 variable quantity of insensible perspiration which exhales from our 
 bodies at diff'erent hours of the day. Others flattered themselves to be 
 able to find, in modifications of the pulse, signs more certain, concerning 
 the seat of diseases, their cause, gravity, and probable issue. 
 
 A Spaniard, named Solano de Luque, was the first who, devoting 
 himself to these researches, studied the pulse. He studied medicine 
 at Cordova, under Joseph de Pablo. During his studies he observed 
 the dicrotic or rebounding pulse, so called when two rapid pulsations are 
 felt, followed by a short pause. Astonished at this phenomenon, he asked 
 his master what interior condition of the body agreed with that sort of 
 pulse, and he received the odd reply, that all these insignificant modi- 
 fications are produced by the sooty vapors contained in the arteries. 
 The student, but little satisfied with such an explanation, redoubled his 
 care in researches, and came to the conclusion, that the dicrotic pulse 
 is a constant indication of epistaxis. 
 
 He observed, also, that a modification no less remarkable, in the pulse, 
 usually precedes a critical sweat. This modification is a first pulsation, 
 followed by three others, which increase to the last, somewhat like the 
 billows of the sea that roll upon the shore ; then commences another 
 series of four pulsations, of which the first is always the feeblest, and 
 which gradually augment in force. He named this pulse the inciduus, 
 because the fourth pulsation, which is the strongest of the series, is 
 succeeded by the first or the feeblest pulsation of the following series, 
 so that the pulse seems to fall in passing from one quartenary series 
 to another. Besides, it is ordinarily compressible, soft, and in that 
 case it announces, as we have remarked, a sweat ; but if it exhibits 
 itself accompanied with very much hardness, it is the precursor of 
 jaundice. 
 
 The intermittent pulse is that in which a certain number of pulsa- 
 tions are observed, followed by a longer interval than is usual. According
 
 416 REFORM PERIOD. 
 
 to Solano, this kind of pulse habitually announces a critical 
 diarrhea. If it is soft, also, it indicates abundant urine ; if, on the 
 contrary, it is hard, we may expect vomiting. These are the only 
 species of pulse on which Solano made his observations. He consigned 
 them to a large folio, where they are, as it were, drowned in the midst 
 of an ocean of subtilties. They produced no sensation in the Medical 
 world until they were drawn from obscurity by an English physician, 
 James Kihell, who gave a summary of them, to which were added the 
 results of his own experience. 
 
 Sphygmics acquired a very different importance from the researches of 
 Theophilus Bordeu. This observer, whose sagacity we have already 
 appreciated, undertook to connect all shades of health and disease to 
 certain variations of the pulse. He took, in the first place, the pulse of 
 a good-conditioned adult, for a type of a natural and perfect pulse, the 
 character of which he traced as follows: "This pulse is regular, and 
 is pulsations are perfectly identical, and occur at equal intervals. It 
 is soft, supple, free, neither fi-equent nor slow — vigorous without being 
 laborious. "•■^ 
 
 Taking this as a type, the author points out an incredible number of 
 species and varieties, which are more or less removed from each other. 
 He distinguishes, for example, a particular pulse for each organ ; among 
 others, he has a nasal, gutteral, pectoral, stomachal, intestinal, hepatic, 
 splenic, renal, menstrual pulse, etc. He allows a specific difference 
 between the pulse of organs situated above, and those situated below the 
 diaphragm, and another between those of the right and left half of the 
 body. Then he gives, also, the infinite varieties of the pulse produced 
 by the passions and diseases, as well as by certain medicines. 
 
 We shall not attempt to follow this author into the labyrinth of 
 distinctions, more subtile than real, into which he enters. If it were 
 true that each physiological, pathological, and even psychical act 
 is revealed by the different shades in the pulse, what tact, sufficiently 
 exercised or refined, would be able to seize these shades, often as imper- 
 ceptible and instantaneous as those of thought ? "What light could be 
 obtained from the extremely delicate and fugitive variations of the pulse, 
 when its most remarkable permanent modifications have only an equivo- 
 cal signification, and are connected with very varied states of the health ? 
 Thus the intermittence of pulsation is sometimes a symptom of no 
 importance, while at other times it is one of the most grave. Analysis, 
 as a method of research, has been very much and properly praised in 
 our times, but every method has its faults, and we shall have, on more 
 
 * Bordeu, Recherches sur le pouls par rapport au crises, chap. ni.
 
 INTERNAL PATHOLOGY. 417 
 
 than one occasion, to observe that analysis, pushed to its utmost limits, 
 degenerates into deceptive subtilties. A great number of physicians 
 repeated the observations of Bordeu, either to confirm or amend his 
 doctrine, and their united labors carried sphygmics, toward the 
 middle of the last century, to a very high degree of perfection. At the 
 same epoch, a modest German practitioner gave to semeiotics a new 
 means of investigation, destined to acquire, at a later j^eriod, a major 
 importance. Leopold Avenbrugger published at Vienna, in 17G1, the 
 result of his experience, with the title of New Method to Recognise 
 Internal Diseases of the Chest, hy the Percussion of that Cavity fi This 
 discovery was not much noticed, even in Germany, though Stoll em- 
 ployed it and eulogised it. Sprengel, who wrote his history toward the 
 close of the last century, speaks of it as follows: " 1 must also mention 
 another sign, which was discovered by Leopold Avenbrugger, and which 
 he asserts to be the most important of all those that compose semeiotic 
 pathology ; it is the sound which the chest gives when it is struck. It 
 is impossible to deny that the thorax, struck with the palm of the hand, 
 resounds diflFerently when the lungs are free and sound, than when they 
 are adherent, engorged, or ulcerated. Avenbrugger has developed, very 
 well, this fact, in a particular treatise ; but he does it with a little too 
 much subtilty, for it is scarcely credible that he could have recognised 
 the various diseases of the lungs and chest by the sole percussion of that 
 cavity. Xevertheless, his observations merit to be read, and they have 
 been, in part, confirmed by Isenflamm.f 
 
 The work of Avenbrugger was translated into French by Eosiere de la 
 Chassagne ; but his method of exploration was almost unknown in 
 France until it had been vulgarised by the lectures, translations and 
 learned commentaries of Corvisart.| We shall see it in the end receive 
 an extraordinary extension and perfection by the addition of another 
 proceedure not less ingenious, designated by the name of auscultation. 
 
 We find in the Hippocratic books a proceedure which has some rela- 
 tion to percussion. It consists in giving the shoulders of the patient a 
 shake, by means of which the sound of a liquid effused into the thoracic 
 cavity may be heard. This gross proceeding, termed succussion, appears 
 to have been abandoned by the successors of the Asclepiadse, because of 
 its uncertainty and the great inconvenience of its employment. 
 
 '■^ Inventur novum ex percussione thoracis humani ut signo abstrusos interni 
 pectoris morbos detegendi. Vienne, 17G1. 
 
 f Hist, de la Med., sec. xv., cap in., art. v. 
 
 I See translation of Avenbrugger's work, from Latin into Frencli by Corvisart. 
 Paris, 1808.
 
 418 REFORM PERIOD. 
 
 § n. Pathological Anatomy. 
 
 Pathological Anatomy, whicli was created towards the middle of the 
 preceding period, rapidly grew, and formed very soon a considerable 
 branch of pathology. From the beginning of the seventeenth century 
 a great number of physicians devoted themselves, assiduously, to necro- 
 scopy, and by their labors a considerable quantity of materials was 
 collected. Among the collections of the necroscopic observations of this 
 epoch, we distinguish those of Thomas Bartholin, Nicholas Tulpius, 
 Dominic Panaroli, John James Wepfer, Frederick Ruysch, John Conrad 
 Peyer and Stephen Blancaerd. These materials were capable of shed- 
 ding a bright light on the seat and nature of a certain number of 
 diseases ; but they were lost in a multitude of volumes. In order to be- 
 come beneficial to science it was necessary to collect, examine, and classify 
 them, according to their analogies, to deduce from them the consequences 
 relative to the diagnosis of diseases, and the practice of medicine ; — an 
 immense task, which did not, however, check the patient zeal of The- 
 ophilus Bonet. 
 
 This writer did not dissimulate the difficulties of his project, nor the 
 numerous causes of imperfection, inherent to a first effort of the kind. 
 He appreciates them, on the contrary, with very great justness, when he 
 says : " this work has cost me as much fatigue and care as the reader 
 will draw advantage from it ; for 1 hazard myself without a guide on 
 an unknown path, where there is no perceptible trace of man : I tread 
 with fear this long, rude and difficult path. I know, he continues, how 
 far I shall fall short of my aim ; but I hope that I shall receive thanks 
 for having taken the first step in a career so eminently useful.* 
 
 Bonet divides his general repertory of pathological anatomy into 
 four books. In the first he collects all the diseases of the head : in the 
 S3Cond those of the chest ; in the third those of the abdominal organs : 
 lastly, the fourth contains observations relative to diseases whose seat 
 is unknown, or which may attack indifferently all parts of the body, 
 such as fevers, gout, syphilis, tumors, wounds, etc. 
 
 To give an idea of the quantity of matter contained in this work, I 
 shall only cite one example. The eighth section of the second book is 
 devoted to the exposition of the causes of the palpitations and pains of 
 the heart. The following is an enumeration of these causes according 
 to necroscopic observations reported in this chapter: a tubercle, an 
 abscess, excessive heat, sanguineous plethora occasioning obstruction, 
 worms, sudden evacuation, pregnancy, inflammation, a pouch filled with 
 
 * Sepulchretum sive anatomia Practica. Genevae, 1700.
 
 i 
 
 INTERNAL PATHOLOGY. 419 
 
 water or some putrid liquid, a miasmatic infection whether from the 
 exterior or interior, and certain unnatural adhesions. These causes 
 exist sometimes in the cavities, or in the substance even of the heart, 
 or in the pericardium, or in the arteries ; again, they are in more 
 distant parts, as the uterus, liver, spleen, or stomach. For each of these 
 cases the author reports one or several clinical observations, accompanied 
 with the opening of the corpse. There are at least forty, relating to 
 pains and palpitations of the heart. 
 
 These observations have been complained of for their want of sufficient 
 detail ; some of them for not being sufficiently authentic, and others yet 
 for presenting, as causes of diseases, certain results occurring after death. 
 These reproaches are well founded, and it must be agreed that this 
 enormous compilation shone more for the labor and patience of its pre- 
 paration, than for its invention and method ; but such as it is, it con- 
 stitutes, nevertheless, an era in the history of pathological anatomy — 
 it served as a point of departure for ulterior researches, and principally 
 for those of which the immortal Morgagni published the results, nearly 
 a century later. 
 
 The latter indeed did not propose, in composing his anatomo-patholo- 
 gical letters, more than to amend, and reconstruct in some sort, the work 
 of Thcophilus Bonet. Profiting by the riches which the science had 
 acquired in this interval, and especially by those which his master 
 Valsalva had collected; joining to a very extensive erudition a severely 
 critical habit, he established order and clearness where the author of 
 the Sepulchretwn had left obscurity and confusion reigning. He showed 
 himself original, without making any pretension to it ; in contrast with 
 so many others who make much pretension, without doing any thing of 
 value. He does not disguise what he borrows from others, either dead 
 or living ; but what is his own, is the choice and judicious employment 
 of materials, and his wise and luminous discussion of facts. Persuaded 
 that medical science cannot go forward except in the light of observa- 
 tion, he avoids scrupulously, turning aside into the vagueness of inter- 
 pretations, so that no one could apply to him that remark of Homer, 
 which he himself recalls in his preface, " he has told many lies in 
 speaking of probabilities." Odyss. lib. xix. 
 
 The following selection will show his wise and circumspect manner of 
 discussion : " The great Senac, it is said in the twenty-third letter, 
 denies the absence of the pericardium ; on the other hand, he confirms 
 by multiplied observations, its adhesion to the heart ; but he teaches the 
 nature of this adhesion, and its locality when it causes or prevents pal- 
 pitations. Nor does he any more conceal how much care must be taken, 
 when it occurs at the same time with other causes, if, above all, they
 
 420 REFORM PERIOD. 
 
 are grave, not to attribute hastily the palpitation to adhesion ; and he 
 asserts, in general, that when several causes are united at once, 
 the particular effect of each cannot be distinguished, and even then, all 
 united can produce certain phenomena to which no one in particular 
 could give rise."'-'' 
 
 The work of Morgagni appeared in 1762. From that time to the end of 
 the eighteenth century, a great number of physicians occupied themselves 
 with anatomo-pathological researches, and added new observations to 
 those already known. Among these I must cite, more particularly, Th. 
 Walter, P. Barrere, Santorini, Edward Sandifort, Andrew Bonn, Gr. 
 Hunter, John Ernest Greding, John Baptiste Palletta, Joseph Lieutaud, 
 Anthony Portal, and, above all, Xavier Bichat, who, uniting to a genius 
 eminently generalising, an admirable talent for analysis and observation, 
 shed, not only on pathological anatomy, but on the whole of pathology, 
 a clear light, whose rays have directed the labors of most of his suc- 
 cessors. The idea of separating the human body into elementary 
 tissues, which present, in all parts wheie they are found, the same 
 properties, and are subject to the same alterations, was a mother idea, 
 which has now for fifty years served as the basis of the researches 
 of all pathologists. Bichat comprehended well all these results, and he 
 presents them clearly and justly: 
 
 " Chemistry," he says, " has its simple bodies ; these, by the various 
 combinations of which they are susceptible, form compound bodies ; such 
 are caloric, light, hydrogen, oxygen, carbon, azote, etc. So, also, anato- 
 my has its simple tissues, which by their combination — four to four, six to 
 six, eight to eight, etc. — form the organs. These tissues are : first, the 
 cellular ; second, the nervous system of animal life ; third, the nervous 
 system of organic life ; fourth, the arterial system, etc. Here are seen 
 the veritable organised elements of our parts. Wherever they are met 
 with, their nature is constantly the same, just as, in chemistry, the simple 
 bodies do not vary, whatever may be the compound into which they 
 enter. 
 
 " The idea, too, of considering thus abstractly the different tissues of 
 our organs, is not an imaginary conception, it rests on real foundations, 
 and I believe will have a powerful influence on physiology and medical 
 practice. In fact, from whatever point of view these tissues are studied, 
 they do not at all resemble each other. It is nature, and not science, 
 which has drawn the line of demarkation between them." f 
 
 " Twenty-third Lettre Anat.-Med., translated by Doctor Destonet. Paris, 1820. 
 
 f Anatomie Generale, edition of Beclard and Blandin. — Paris, 1881. Compare 
 
 J. Henle, Traite d' Anatomie Generale, translated by J. L. Jourdan. — Paris, 1843,
 
 IjH INTERNAL PATHOLOGY. 421 
 
 A little farther on he cadds : " I divide pathological anatomy into 
 two great parts. The first includes the history of the alterations com- 
 mon to each system, whatever may be the organ or region in which this 
 structure is found. It is necessary to show, in the first place, the 
 various alterations of cellular, arterial, venous, osseous, nervous, mus- 
 cular, and other tissues ; to examine the mode of inflammation, suppu- 
 ration, gangrene, etc., proper to each of them ; to speak of the various 
 tumors of which they are susceptible, the changes in structure which 
 they realise, etc. After having thus indicated the alterations proper to 
 each system, in whatever organ they are found, it is necessary to re- 
 sume the examination of the diseases appertaining to each region — to 
 examine those of the head, the chest, the abdomen, and the members 
 following their ordinary course. This progress is incontestibly the most 
 natural, although, as in all the divisions by which man tries to bring 
 nature within his conceptions, there are many points to which they do 
 not apply." 
 
 We thus see that in setting forth the advantages of the innovations 
 which he proposes, Bichat neither disguises the difficulties nor the abuses 
 to which it may lead. "Do not esagerate," he said, previously, "this 
 independent relation which the tissues of an organ hold to each other 
 in regard to diseases ; practice would contradict us. We now often see 
 that the cellular tissue is the means of communication, not only between 
 two tissues of the same organ, but also between different organs. Thus, 
 in many chronic diseases, are the tissues of the same organ gradually 
 altered, and, at the opening of the body, the totality of the organ ap- 
 pears to be affected, although a single tissue was originally diseased. 
 In cancer of the breast a small tumor is moveable, at first, under the 
 finger ; in the end the whole glandular, cellular, and even cutaneous 
 tissues, are confounded in a common and cancerous mass. The cancer 
 of the stomach, intestines, etc., presents the same condition."" I have 
 permitted myself to quote thus much on these points, because it shows 
 the true route pathological anatomy must follow, and because it proves, 
 at the same time, that this branch of the science can not be separated 
 from clinical observation without losing much of its importance and 
 utility. 
 
 § in. NOSOGRAPHT. 
 
 It is impossible to construct a descriptive table of all diseases, or 
 even of a small number, without adopting some order — some species of 
 
 ** Anatomic Gcnerale, §vii.
 
 422 REFORM PERIOD. 
 
 nosological classification. We have shown that the outlines of such a 
 plan are to be seen in the works of the Asclepiadse. In that collection, 
 diseases are sometimes divided into sporadic, epidemic, and endemic, 
 and sometimes into acute and chronic ; but the authors who first made 
 these divisions did not adhere to them strictly, at least from what we 
 may judge from the fragments that form the Hippocratic collection. It 
 was only after the foundation of the school at Alexandria, and as the 
 result of the influence of the Peripatecian philosophy, that the savaus 
 in general, and physicians in particular, devoted themselves to arrang- 
 ing, in a more systematic manner, the subjects they had to treat. 
 
 The order most generally adopted by the ancient nosographers, was 
 called the anatomical, and consists in classifying diseases according to 
 the portions of the body afiecte(il Thus, it was customary to divide all 
 the morbid afifections into internal or external, or which follows the 
 same plan, into medical and chirurgical — a bad distribution, which every 
 one blames, but which exists still in most of the treatises, and we have 
 consequently been obliged to preserve it. Then, internal diseases were 
 divided into general and special. The first class comprised diseases 
 which seem to affect the whole system, not having any particular seat, 
 such as essential fevers, gout, syphilis, poisons, etc. The second class 
 comprised affections whose seat is in one of the three splanchnic cavities, 
 the head, chest, or abdomen. There exists still another classification, 
 famous in antiquity — that of the Methodists, which we have explained 
 at length, and which we will, therefore, not repeat. Lastly, some 
 authors have divided diseases according to the age, sex, climate, etc., 
 but their divisions have only been adopted in special treatises, and for 
 particular views, with which, at present, we can not occupy ourselves. 
 It will be only required here to give such classifications as were adopted 
 in the general treatises, embracing the totality, or greater part of known 
 diseases. 
 
 We have said a word on the classification proposed by Felix Plater, 
 at the end of the sixteenth century. It does not appear that it exercised 
 a great influence, for we see a long time after, such medical authors as 
 Sennet, Eiviere, Morgagni, and others, follow the old method. Never- 
 theless, toward the close of the seventeenth century, an illustrious 
 practitioner of England, Thomas Sydenham, expressed a desire to see 
 composed a history of diseases, which would be free from all hypothesis, in 
 which the sole effort should be made to trace with exactness the sensible 
 phenomena, and to distinguish the morbid species by their essential and 
 constant symptoms. At that epoch, all the branches of natural history 
 had gained high ground, and acquired a precision till that time un- 
 known, thanks to the perfection of systematic classifications introduced
 
 INTERNAL PATHOLOGY. 423 
 
 into science. The naturalists had attained such skill as to distribute 
 all beings which were the objects of their study, into classes, orders, 
 genera, and sj^ecies, separated from each other by well-marked and 
 invariable characters, by means of which, it was easy to distinguish the 
 different species, notwithstanding their multitude. Medical men flat- 
 tered themselves, that if they employed an analogous method, they 
 would be able to diagnosticate diseases with the same precision and cer- 
 tainty, as a botanist recognises and names a vegetable. 
 
 Boissier Sauvages, a physician of Montpelier, scarcely twenty-four 
 years of age, conceived a plan of nosography formed on this model. He 
 conferred with the great Boerhaave, who approved of it, without con- 
 cealing from him, however, the extreme difficulties of its execution. 
 But the young man, more emboldened by such suffrage than frightened 
 by the obstacles which were presented, pursued his project, and a few 
 years after, in 1732, he published a first rough draft, with the title of 
 " Xew Classes of Diseases, arranged in an order similar to those of the 
 Botanist." This essay produced only a moderate sensation ; but thirty 
 years later, when the author published the same work, with the title of 
 NosoLOGiE Methodique, but entirely remodeled, and considerably aug- 
 mented, the attention of all Europe was keenly excited. The renown 
 of Sauvages, already great, was carried to its height, and what proves 
 best the extraordinary vogue, as well as esteem, which the Nosologic 
 Methodique enjoyed, is, that the learned Linnaeus used no other work in 
 his course at the University of Upsal, for the space of twenty years. 
 
 Whatever may be the discredit into which has now fallen that spe- 
 cies of composition, the Xosologie Methodique of Sauvages will always 
 be worthy of the regard of whoever loves to follow the march and 
 development of a science as difficult as pathology. Besides that, it 
 offers, as the first link of a series of interesting productions, the most 
 complete collection of diseases described up to that time, and of obser- 
 vations collected from all parts. I will now give an extract from it ; 
 according to Chaussier, Pinel, and Bricheteau/-' 
 
 Diseases were divided by Sauvages into ten classes, forty-four orders, 
 three hundred and fifteen genera, and nearly two thousand four hundred 
 species. 
 
 1st Class. Imperfections, (Vices) ; Superficial or cutaneous affec- 
 tions, the most of which are susceptible of being cured by local and 
 mechanical means. 
 
 2d Class. Fevers; Commencing with shivering, followed by heat 
 
 ^Dictionaire des Sciences Medicales, at the word Nosography; also the Table 
 des M^thodes Nosologiques, of Chaussier.
 
 424 REFORM PERIOD. 
 
 and sweat, with a frequent pulse, general pains, feebleness, prostration, 
 and oppression of tlae forces. 
 
 3d Class. Inflammations; Local phlegmasia with .symptomatic fever. 
 
 4th Class. Spasms ; Convulsive diseases, permanent or periodical 
 contraction of the muscles of locomotion. 
 
 5th Class. Anhelations ; Difficult respiration, spasm of the chest, 
 without acute fever. 
 
 6th Class. Dehility ; Inability to feel distinctly, to act or execute 
 the movements or functions with the accustomed energy. 
 
 7th Class. Pains; General or local, uneasiness, not caused by 
 phlegmasias. 
 
 8th Class. Vesania, or Insanity ; Lesions, more or less profound, of 
 the faculties of the mind. 
 
 9th Class. Flux ; Accidental excretion, more or less considerable, of 
 fluids variously colored. 
 
 10th Class. Cachexias; Depravation or alteration in the form, 
 color, and volume of parts. 
 
 Notwithstanding the veneration that Sauvages professed for Syden- 
 ham, whom he names the. glory of England, and the Light of our Art. 
 he has not strictly followed the counsel given by that physician, to 
 write the history of diseases without mingling with it any theoretic 
 explanation or hypothesis. The theory which Sauvages wished to estab- 
 lish was a mixture of the ideas of Boerhaave with those of Stahl, of 
 which we shall speak hereafter. What I wish to remark at this time 
 is, the inclination of medical writers to decry, in the outset, all theories, 
 to demonstrate their falsity and danger, and immediately propose one of 
 their own, as being alone founded in reason. 
 
 " There has not existed," says Sauvages, " up to the present, any con- 
 nection between theory and practice ; the latter is acquired by tradi- 
 tion, and no one has confidence enough in his theoretical principles to 
 follow them blindly, when the life of a man is at stake. The three 
 principal laws of nosology, dictated by wisdom itself, are : First, make 
 an exact and purely historical division of the species and genera of dis- 
 eases ; second, distinguish philosophic theory or hypothesis from history ; 
 third, establish the characters of diseases, on their constant symptoms." 
 
 A little further on, after having shown the diflFerence that exists 
 between the philosophic knowledge, which he names also etiology, and 
 the purely historical and descriptive knowledge, he gives the preference 
 to the first, in these terms : " Philosophic knowledge aids the historical, 
 opens the way to mathematical knowledge, and fills the mind with 
 
 " Nosol. Method.
 
 INTERNAL PATHOLOGY. 425 
 
 agreeable sensations. Happy he who understands the origin of things ! 
 Philosophic nosology, therefore, is useful to physicians, and preferable to 
 the historic. It distinguishes the Dogmatists from the Empirics, with 
 whom all science consists in the historic knowledge of diseases. But 
 where philosophic nosology is eiToneous, and founded on false principles, 
 we must give preference to simple historic nosology ; for it is much 
 better to have no etiology than to accept a false one, which would only 
 serve to lead physicians into grievous errors."" 
 
 How strange, that, after having so clearly set forth the temerity there 
 is in engaging in a search for the proximate causes of diseases, this author 
 yet dares adventure in the pursuit of this chimera ! Such is, never- 
 theless, the inconsistency of Sauvages, and of nearly every writer in 
 Medicine. Whatever there is of interest, to-day, in the work of the 
 first of nosologists ( and there is much ) it is certainly not applicable to 
 the department of etiology, which has so much changed since his time ; 
 but much rather to the descriptive part, which has but slightly changed, 
 notwithstanding the progress of science. 
 
 AVhen the enthusiasm and astonishment excited by the novelty of 
 this production, were somewhat cooled down, criticism had its turn. It 
 was shown that the genera and species were too gi-eatly multiplied, 
 throwing diagnosis into confusion, and so much the more, as they were 
 not always separated from each other, by symptoms sufficiently well 
 defined and constant. Other faults were also pointed out, more or less 
 real. Then a great number of physicians exerted themselves to trace 
 other nosological classifications, which they believed to be more perfect, 
 because they had not yet submitted them to criticism. Each professor 
 was anxious to have his own, and to attach to it his name ; but as the 
 greater number of these productions only differed from each other in a 
 few variations, I shall dispense with reporting them ; and, I therefore, 
 pass at once to that of CuUen, which appeared in 1772, and which con- 
 stitutes a veritable progress. 
 
 The nosology of William Cullen, professor in the University of Edin- 
 burgh, embraces four classes; nineteen orders; two hundred and thirty 
 genera ; and, less than six hundred species : 
 
 1st class. Pyrexice: Frequent pulse, shivering, augmentation of heat, 
 debility of the animal functions. 
 
 2nd class. Neuroses : Nervous affections, lesions of sensation and 
 motion, without pyrexia, or local disease. 
 
 3rd class. Cachexice: Depravation of the natural state of the 
 
 «» Nosol. Method. 
 27
 
 426 REFORM PERIOD. 
 
 system, or of a considerable portion of it; without primitive pyrexiae 
 or neuroses. 
 
 4th class. Locales : Affections of a part of the body, the organic 
 affections of authors. This last is, according to the framer, the most 
 irregular of all, and purely surgical. 
 
 In this classification, as we see, the orders, genera and species, arc 
 considerably reduced ; they are besides, distinguished from each other 
 by characters better defined and less variable. It presents, then, a real 
 improvement on that of Sauvages ; it also obtained a universal vogue, 
 which it maintained till the publication of the Nosographie Philoso- 
 phique, of Ph. Pinel, in 1798, 
 
 This eclipsed all others, and became classic throughout Europe. Six 
 successive editions, in the space of twenty years, shows the confidence 
 it enjoyed. During this long period, it underwent some revisals, of 
 which I shall say but little, because it belongs to the history of the 
 nineteenth century, and I shall, therefore, refer to the first edition only. 
 
 All the preceding nosologists had embraced, in their classifications, 
 internal and external diseases ; but they included the last for mere 
 form only, and gave them but a very succinct and very insufficient 
 description, to which the Surgeons paid no attention. Pinel did not 
 follow this plan, and was unwilling to comprise, in his classification, only 
 the internal aff"ections or those from internal causes, though he does not 
 dissimulate how vague and inexact the line of demarkation is, which is 
 pretended to be drawn between diseases from an internal or external 
 cause. He avows, that there exist numerous intermediary species 
 which may be called medico-chirurgical, the position of which it is 
 excessively difficult, if not impossible, to determine. iS'otwithstand- 
 ing these defects, he believed it right to preserve the division of 
 pathology into internal and external. 
 
 Consequently, he divided diseases which he regarded as internal, into 
 six classes, twenty-one orders, and eighty-four genera, as follows : 
 
 1st class — Fevers : Frequent pulse, increase of heat, lesions in most 
 of the pulsations, fixed duration, etc. 
 
 2d class — Phlegmasice: Local pain, heat, and redness, with or 
 without the febrile state, terminating by resolution, suppuration, gan- 
 grene, or induration. 
 
 3d class — Active Hemorrhages : Effusions of blood fi'om the surface 
 of mucous membranes, and other tissues. 
 
 4th class — Neuroses : Lesions of sensation and motion, without 
 inflammation or alteration of structure. 
 
 5th class — Diseases of the Lymphatic and Dermoid Systems.
 
 rNTERNAL PATHOLOGY. 427 
 
 6th class — Undetermined Diseases : Comprising the genera which 
 are not e':ough rehited to each other to form general orders.--^ 
 
 The historian Kurt Sprengcl, who wrote at the commencement of the 
 ninteenth century, speaks of the Philosophic Nosography, and its author, 
 in the following terms: " Faithful to nature and experience, like Hippo- 
 crates, whom he took constantly for a model, and cultivated by the pro- 
 found study of the best medical works published in all time, Pinel ranks 
 among the most skillful and learned physicians of our day. His book is 
 a veritable chef d'ceuvre, both on account of the excellent plan he has 
 adojjted, and by reason of the depth and impartiality of his judgment." 
 
 The Nosography of Pinel oiFers numerous differences to that of Cullen. 
 of which the following are the most important : The Scotch nosologist 
 has united in the same class, under the head of pyrexiae, fevers, inflam- 
 mations, and hemorrhage, while the French nosographer has divided these 
 affections into three classes. The first distinguishes fevers either after 
 their type or proximate cause ; the second considers the totality of their 
 symptoms, and the organs which they seem principally to affect. ConsC' 
 quently he admits an order of angiotenic or inflammatory fevers, which 
 he believes derived from the primitive excitation of the organic forces of 
 the vascular system — an order of meningo-gastric or bilious fevers, pro- 
 ceeding from a primitive affection of the membranous system of the 
 primce vice, etc. In regard to phlegmasia and hemorrhage, Pinel distin- 
 guishes them, also, according to the tissues where they are seated. This 
 was an important innovation and happy thought, which has been made 
 more fruitful, as before said, by the genius of Bichat, in his Anatomic 
 Generale, and has shed upon pathology a clear light, and introduced a 
 new order of things. 
 
 Among the uosologists who appeared before the close of the eighteenth 
 century, and of whom we have not yet made account, we shall cite, as a 
 memoir only, and following their chronological order, first, the classifica- 
 tion of Linnaeus, which closely resembles that of Sauvages, and was 
 published twenty years later ; second, the Prcelectiones de Cognoscendis 
 et Curandis Morbis Prcecipius corporis Hiimani Affectibus, of E. A. 
 Vogel, professor at Gottingen ; third, the classification proposed by David 
 Macbride, an Irish physician, in his Methodic Introduction to the 
 Theory and Practice of Medicine ; fourth, that of Melchior Sagar, 
 based almost entirely on that of Sauvages ; fifth, the Xosological Table 
 of Louis Vitet, which may be found in his Treatise on Materia Medica ; 
 
 ^ la the sixth edition, these two classes have been reduced to one, under the 
 title of Organic Lesions.
 
 428 REFORM PERIOD. 
 
 sixth, that of Erasmus Darwin, published under the title of Zoonomia, 
 and remarkable for its originality, and the poetical imagination of its 
 author, much more than for its severity of anal^'sis and exactness of 
 observation ; seventh, and lastly, the essay of a general classification of 
 diseases, presented by Selle at the end of his Pyrethologie Methodique ; 
 an essay which does not respond to the reputation of its author, and 
 which he did not finish. 
 
 Sauvages after having examined at length, in his Prolegomena, what 
 should be the basis of a good nosology, concluded with Sydenham, that 
 it should be based only upon the constant phenomena and sensible 
 characters of diseases. Nevertheless he did not unite example to pre- 
 cept, as we have before said, for he does not fail to seek the principles 
 or causes which constitute the essence of each disease. Let us see, for 
 example, what he says on the subject of fevers: "the cause of fever is 
 the distribution of the nervous fluid or forces, greater in the nerves of 
 the heart, than in the nerves of the members. This unequal distribu- 
 tion is made to destroy the obstacles which oppose the circulation of 
 the blood in the capillary vessels, to disembarrass the sanguineous ves- 
 sels, and re-open a passage for the blood. The heart and the arteries 
 are the principal agents in fever." All the other nosologists, not 
 excepting the sage Pinel, have fallen into the same contradiction, that 
 is to say, after having blamed loudly, the research after occult causes — 
 are themselves subsequently, insensibly led into this research, under 
 some pretext or other. 
 
 One, alone, perhaps, forms an exception to this general statement. 
 This was Joseph Lieutaud, physician of Louis XYL, and author of an 
 anatomo-pathological compilation, which we have before mentioned. 
 M. Dezeimeris expresses himself as follows, on the subject of his treatise 
 on Practical Medicine : " this is the best work of the last century, and 
 nearly the only one, up to a period very near our own, in which we find 
 an author untrammeled by any system, consulting more the phenomena 
 furnished by observation, at the bed side and in the amphitheatre, than 
 the oft repeated opinions of books ; and not seeking to fill by hypotheses 
 the vacancies which experience has permitted to exist in the science. 
 Most of the defects of this remarkable work may be refcred to its 
 brevity ; the author, from having sought to be short, is often too con- 
 densed, incomplete, and obscure for a reader who is not sufficiently 
 instructed. These same defects are carried to a still higher degree, and 
 have destroyed the utility of another work of Lieutaud, of which the 
 object was certainly the most important which could have been chosen 
 during the last century : I mean the treatise on pathological anatomy, 
 in which Lieutaud undertakes to comprise all that had been learned up
 
 INTERNAL PATHOLOGY. 429 
 
 that time, on the seat and causes of diseases, by autopsy. The object 
 is missed for the most part, because the history of the symptoms of 
 diseases is nearly always cut short — the description of the alteration 
 of the organs often insufficient ; and because one can only with great 
 difficulty fill its vacancies, owing to the absence of all references to the 
 sources whence the facts were drawn. "••- 
 
 In his Precis de Medicine, Lieutaud has followed the anatomical 
 order as much as he possibly could ; for he says there are many diseases, 
 on which the opening of the body teaches us nothing, and it is good 
 not to loose sight of this fact, in order not to regard as an omission the 
 silence which I maintain on this subject, in several articles. As to the 
 research of occult causes, he was sensible enough not to engage in them, 
 and gives the following excellent reason; " as I have not been willing 
 to bring into this collection any hypotheses, 1 have not paused to con- 
 sider the immediate and proximcite causes exposed with so much vanity 
 and presumption in books, though always impenetrable ; but I have 
 mentioned those that are termed evident and remote, which may unveil 
 with much less ambiguity the character of diseases." 
 
 These are sentiments worthy of all approbation, and we can not too 
 much praise those authors who have remained faithful to them. But it 
 does not suffice to avoid hypotheses in a nosology: it is also necessary, 
 and this is capital, to give exact and detailed descriptions of each mor- 
 bid species. Too much brevity in the description of diseases causes 
 obscurity, which is, after error, the greatest defect in a work of this 
 kind. The classifications may vary infinitely, because they depend on 
 the manner in which an author surveys his subject, and as diseases are 
 very complicated subjects, they may be considered in a great number of 
 aspects, but the description of each morbid species, when well made, 
 preserves its value, independent of all changes of classification and sys- 
 tem. This is seen in some of the description of Hippocrates, Aretaeus, 
 Alexander de Tralles, and all great observers.f 
 
 ^ Dietionnaire Histor. de Med. Art. Lieutaud. 
 
 fAt the moment of correcting this leaf, I am put in possession of the new 
 work of Professor Bouillaud, entitled. Traits de Nosographe 3fedicale, Paris, 1846, 
 5 vol. 8vo. A work of this importance, by a clinical teacher, and a profound 
 observer, like M. Bouillaud, can not fail to fix the attention of the medical world; 
 besides, I think I ought to exhibit the plan adopted by the author in his nosolog- 
 ical treatise. This work is divided into Twelve Classes of Diseases, viz. ; — Class I, 
 fevers and inflammations, or pyrexiae. — Class II, affections consisting in a want 
 of vital excitation ; appendix, excess and defect of hajmatosis. — Class III, ataxias 
 of the nervous centers. — Class IV, miasmatic and virulent diseases. — Class V, 
 heterotrophic.heterocrinic, and heterogenctic diseases, not originating from inflam 
 mation. — Class VI, effusions in general, and effusions of blood or hemorrhage, in
 
 430 REFORM PERIOD. 
 
 CHAPTER V. 
 INTERNAL THERAPEUTICS. 
 
 I EXAMINED, in the preceding period, the ancient therapeutical axiom, 
 diseases are cured by their contraries, and the result at which we 
 arrived was, that this axiom neither clears up nor explains anything in 
 many cases, and that in others, it is in flagrant contradiction to the 
 facts. I concluded, therefore, that it should be erased from therapeutics, 
 at least as a general axiom, if we wished to rest this science on a solid 
 basis, whose certainty no one could contest. During the present period, 
 the same principle appears under new forms ; at the same time other 
 axioms will be proclaimed, concurrently with it, some of which are con- 
 nected with the ancient doctrines, others with those that are entirely 
 modern ; but as all the general principles of therapeutics are derived, 
 without exception, from some cotemporary physico-pathological system, 
 we shall exhibit them conjointly with those systems, and submit them 
 to a thorough examination. Consequently, we shall not discuss them in 
 this chapter, and only speak for the moment of a small number of mate- 
 rial conquests of therapeutics, of some evident ameliorations attained in 
 the treatment of certain diseases, the utility of which is incontestible, 
 and whose merits are independent of all theory. 
 
 TREATMENT OF SYPHILIS. 
 
 We have seen the venereal disease, taking the place of the leprosy of 
 the middle ages, extend its ravages with a frightful rapidity, and throw 
 the people into a terror nearly equal to that which its predecessor had 
 inspired. The learned physicians sought in vain, in the Greek authors, 
 the means to combat this scourge ; such as they found there were perfectly 
 inefiicacious. The surgeons, on the contrary, who had borrowed from 
 the Arabs certain mercurial preparations, which they emj^loyed against 
 tetters, were naturally influenced to make a trial with the same prepa- 
 rations against venereal pustules. The success that they obtained 
 encouraged them to persist in their use. The celebrated anatomist, 
 
 particular. — Class VII, solutions of continuity, and abnormal communications. 
 Class VIII, changes in position and direction, or displacements and deviations. 
 Class IX, adhesions, connections, and abnormal insertions. — Class X, changes in 
 extension, volume, and capacity. — Class XI, foreign and retained bodies. — Class 
 XII, changes in respect to form, number, and existence of organs, and their 
 constituent parts.
 
 INTERJSTAL THERAPEUTICS. 431 
 
 Berenger de Carpi, was the first who prescribed mercurial frictions with 
 discretion, and watched their effects. He effected, by this medication, 
 numerous cures. Before him, Conrad Gilinus had made known, in the 
 year 1499, the composition of an ointment, in which quicksilver formed 
 the fourteenth, and the bi-chloride the twenty-eighth part. Gaspard 
 Torella, physician to the pope Alexander VI., and of his son, Caesar 
 Borgia, to whom he dedicated his work on the pox, in 1499, also makes 
 mention of a mercurial ointment. 
 
 This ointment was the first mercurial preparation used in Medicine, 
 and for a long time no other was known.=-'' An old prejudice opposed 
 the internal administration of any composition of which quicksilver 
 formed a part, because this metal was regarded as a virulent poison. 
 Paracelsus was, perhaps, the first one who had the boldness to admin- 
 ister it in this way. He says that he did not consider mercury as a real, 
 efficacious anti-venereal, and exempt from all danger, only when taken 
 in this way ; and corrosive sublimate was thought to form a part of 
 some of his numerous secret formulae. . 
 
 Besides, under whatever form and by whatever way, mercurial salts 
 are administered, their employment requires precautions that were not 
 then known. On this account, formidable accidents, such as dysente- 
 ries, profuse and obstinate salivations that exhaust the patient, convul- 
 sions, paralyses, and mortal consumptions, were often observed in 
 persons who had used mercurials. Such grave accidents following a 
 mercurial treatment, most physicians abandoned it, and it fell into the 
 hands of greedy charlatans, ignorant medicasters, and alchymists, who 
 employed it without stint or precaution, after the example and faith of 
 Paracelsus, and thus brought it into discredit. 
 
 At the same time, it was supposed that other means of healing, less 
 dangerous, and not less sure, were found. The decoction of the wood 
 of guaiacum produced excellent effects on many patients who had made 
 abuse of hydrargyric preparations. Thus the chevalier Ulric de Hut- 
 ten, after having been in some sort saturated with mercury, found him- 
 self in a deplorable condition ; he employed this decoction, and recovered 
 his health, against all hope. Pull of joy and gratitude, he wrote a 
 book, to recount the marvels of this sovereign specific. Fracastor 
 devoted to its eulogy the major part of the third volume of his poem on 
 syphilis, published in 1530. Practitioners of the first order recom- 
 mended it, such as Nicholas Massa, who was also a skillful anatomist, 
 and Musa Brasavolo, who was decorated with the title of archiater, by 
 
 *Guy de Chauliac gives the formula of an ointment into which mercury 
 entered for a tenth part.
 
 432 REFORM PERIOD. 
 
 four Popes, and with that of consulting physician by Charles V., Francis 
 I., and Henry VIII., king of England. Divine Providence was praised 
 for having created this precious tree in the country even, which was 
 regarded as the cradle of the venereal pest, placing thus the remedy, as 
 was said, by the side of the evil. Shortly after, sarsaparilla and china- 
 root shared the antisyphilitic reputation of the guaiacum. 
 
 But after a half century, the renown of these exotic vegetables fell 
 considerably. The cures effected by their means, became mo?e and 
 more rare, and finally it was ascertained that alone, they had but little 
 efficacy, and that in our climates they only succeeded when used with, 
 or after, mercurial preparations. The chemical physicians had never 
 discontinued their employment of the latter, but they studied to mask 
 them, and prevent dangerous results, by all sorts of combinations. A 
 prejudice, which was derived from the reigning theories, opposed the 
 perfection of treatment by mercury. The prevailing opinion was, that 
 the venereal virus should be expelled either by sweats or salivation, or 
 by some other emunctory, and in no other way was it supposed that a 
 radical cure could be obtained. Eichard Wiseman, surnamed the Pare 
 of England, signalized, among the number of mercurial preparations 
 used in 1G76, corrosive sublimate, dissolved in water, and taken inter- 
 nally, in a dose sufficient to excite vomiting, or produce salivation. 
 
 Nicholas Pechlin, and Erancis Chicoyneau, were the first who stood 
 up against this prejudice, at the beginning of the seventeenth century. 
 This idea became the signal of a great progress. In 1750 Van Swieten, 
 disciple of H. Boerhaave, and physician to the queen of Hungary, directed 
 all physicians of the military and civil hospitals of the Austrian empire, 
 to treat syphilis after a uniform method, whose efficacy and harmless- 
 ness a long experience had revealed to him. It consisted principally in 
 prescribing each day about a third of a grain of corrosive sublimate, 
 dissolved in six ounces of some vehicle. All the reports were favorable 
 to this plan, and the public eulogies bestowed upon it, encouraged very 
 many practitioners to adopt the use of the liquor of Van Swieten. 
 Priugle introduced it into the military hospitals of Great Britain, and 
 the English army-surgeons gave good accounts of it. 
 
 As may be supposed, the formula and the doses prescribed by Van 
 Swieten were modified, in certain circumstances, to satisfy particular 
 indications. Mercury still continued to be associated with the sudor- 
 ifics, sometimes with opium. It was given in pills, solution, friction, etc. 
 Thus, at the date of this epoch, the Healing Art could boast of possess- 
 ing, against the great generality of venereal accidents, an almost 
 infallible specific, which, handled with circumspection, is never, or very 
 rarely, followed with bad results.
 
 INTERNAL THERAPEUTICS. 4E3 
 
 TREATMENT OP PEHIODICAL DISEASES. 
 
 Under this denomiuation Ave now comprise a multitude of diseases 
 extremely common aud varied. They constitute two very distinct 
 genera, accordingly as they present themselves under the form of 
 pyrexia, or apyrexia. The first, which are the most common and the 
 gravest, have been known from all antiquity. They arc described by 
 ancient authors under the title of intermittent and remittent fevers. 
 The second, that is to say, the periodical affections without fever, have 
 only been observed since the middle of the eighteenth century — the 
 time when Casimir JMedicus first assimilated them to intermittent 
 pyrexia. The ancients did not know any specific treatment against 
 periodicity. The following is what Hippocrates prescribed in inter- 
 mittent fevers of various types: "When any one is tormented with 
 bile, he has every day a fever, which arises at midday, and then ceases. 
 In this state a purgative should be given, on the ninth day. If the 
 patient has no evacuation by the mouth, he should be purged ; but if 
 he is feeble, injections of water should be employed, only. When the 
 fever permits, a hydromel should be administered in the morning, before 
 the purgatives. Pure water should be given the following days, and as 
 much as the patient wishes to take, during the whole duration of the 
 fever. As soon as the fever appears to be over, a tisane with cream, a 
 a little milk, followed by good wine, diluted with water. 
 
 2. In the tertian fevers, a purgative should be given after the fourth 
 paroxysm. When it is thought best not to purge, give about two 
 ounces of the juice of the quintifolium, in water ; if this is not bene- 
 ficial, a bath should be given, and immediately the juice of the syl- 
 phium {ferula tingataiia, Lin.), with clover, in equal parts of wine 
 and water. The patient should be kept well covered in bed, to produce 
 perspiration. During the perspiration, if he thirsts he is to drink 
 water whitened with flour. In the evening he should take a little millet 
 cream with some wine in addition. He must use sound food until he is 
 cured. 
 
 3. In the quartan fever, the purgation must begin at the head, after- 
 ward through the bowels. During the two days of intermission, a bath 
 is to be given, and the patient must drink wine, in which some grains 
 of henbane and mandragora have been infused, with a drachm of the 
 juice of sylphium and of clover. When the stomach is full, an emetic 
 is to be given. After the following paroxysm, in coming from the hot 
 bath, he must be kept covered until the perspiration begins, when he 
 must take a second vomit. If the fever does not cease, the head must 
 be purged again, and the patient be placed upon the use of emollient
 
 434 REFORM PERIOD. 
 
 and bitter aliments, and continue to take the hot baths in the days of 
 intermission. =•■' 
 
 No notable amelioration was introduced in the treatment of inter- 
 mittent fevers, from Hippocrates till toward the middle of the seven- 
 teenth century of the Christian era. Those which were of a benign 
 nature and reigned sporadically, were cured well enough after a longer 
 or shorter period ; but those which were developed under the influence 
 of a pernicious epidemic constitution, prevailed with murderous fury, 
 carrying off the patients in the third or fourth paroxysm. A good 
 number even of these, which were not of a malignant nature, after 
 having resisted all remedies, degenerated into visceral obstructions, 
 hydropsies and phthisis, which conducted the patient by slow degrees 
 to the tomb. 
 
 In 1638, the Countess of Cinchon, the wife of the Vice-king of 
 Peru, was a prey to a fever from which nothing would deliver her. A 
 Spaniard, some say that it was the Governor of Loxa, having learned 
 from the natives of the country the secret of the febrifuge qualities of 
 the cinchona, advised the countess to employ it. She, after much hesi- 
 tation, resolved to try it, and recovered her health as by enchantment. 
 Such is, according to the most accredited opinions, the origin of the great 
 reputation of this bark ; nevertheless, M. A. de Humbolt discredits a 
 part of the story. He asserts that the aborigines of the nei.<7hborhood 
 of Loxa, as well as other provinces of South America, where intermit- 
 tent fevers are very common, far from suspecting the febrifuge virtue 
 of the bark, often prefer to die rather than make use of it. They be- 
 lieved, formerly, even, that the Europeans sought this substance with so 
 much earnestness only as dye stuif. Humbolt infers from this, that it 
 is not very probable that the Indians furnished to the Spaniards the 
 first indications of the medical properties of cinchona. However this 
 may be, it is not questionable that in 1639, the Countess of Cinchon 
 and her physician, Juan Lopez de Vega, imported into Spain a certain 
 quantity of this bark, reduced to powder, and distributed it to various 
 persons. But it was not made an article of commerce till ten years 
 later, by the Jesuits of Eome, who had received a considerable mass of 
 it. It was retailed in Spain as the " Countess' Powder," and in Italy 
 as the "Jesuits', or Cardinal's Powder." As it was very dear, it was soon 
 adulterated in so many ways as to make it very difficult in the end to 
 procure it of pure and good quality. 
 
 Accident thus had placed in the possession of Medicine a precious 
 remedy ; but there remained an immense task for science to fullfil. It 
 
 ^ Hippocrates, Treatise oxi Disease.
 
 INTERNAL THERAPEUTICS. 435 
 
 was necessary : First, to determine tlie botanical characters of the plant 
 which furnished it, in order that it might be recognised wherever found; 
 Second, to ascertain the chemical elements of good cinchona, in order to 
 uncover the sophistications of which it was the subject, and to separate, 
 if possible, its activ^e principle from the other elements ; Third, and lastly, 
 to establish its curative properties, to fix the curative indications it 
 should fullfil, the most advantageous modes of administration, suitable 
 doses, etc. 
 
 La Condamine was the first who gave a description sufficiently com- 
 plete, of the tree which produces the cinchona. This illustrious geome- 
 trician having been sent to America to measure several degrees of the 
 meridian of Quito, found himself placed, from the nature of his opera- 
 tions, in the regions where these trees grow. He described several 
 species of them, furnished precise instructions concerning the qualities 
 of the barks, the size and thickness of the trees, the places where they 
 are found, etc. His work, which was printed in the memoirs of the 
 "Academy of Sciences," in the year 1738, served as a guide for Linnseus, 
 to trace the characters of the genus, to which he gave the name of cin- 
 chona, in memory of the lady who first introduced the plant into Europe. 
 
 Many other naturalists endeavored to complete the natural history of 
 the genus cinchona. They discovered a great number of new species, 
 which they found north and south of the equator, and in very different 
 latitudes. Among these, I will cite first, Celestino Mutis, to whom we 
 owe the description of the britannic riches of Xew Grenada, and espe- 
 cially of several species of cinchona, unknown till then ; Euiz and Pavon, 
 authors of the flora of Chili and Peru ; MM. do Humboldt and Bonpland, 
 whose travels in the equinoxial regions have thrown so much light on all 
 the departments of the physical sciences and natural history. 
 
 A great number of chemists have attempted to penetrate the intimate 
 constitution of cinchona.-' Poullctier de la Salle made the first important 
 remark on the alcoholic extract of the substance. Instead of consider- 
 ing it, according to the common opinion of his times, as a resine, he 
 observed that water dissolved it ; and he called it resiniform matter, 
 because its resinous characters appeared to him more marked than the 
 gummy ones. I will cite, also, because it has shed some light on the 
 intimate constitution of the bark of Peru, the analysis of Buquct and 
 Cornette, charged by the Eoyal Society of Medicine, of France, in 1779, 
 to examine two specimens sent from Santa Fe de Bogota ; that of Four- 
 croy in 1791 ; and that of Doctor Westring, consigned in the memoirs of 
 
 *■ Merat et Delens, Dictionnaire Universal of Materia Medica and Therapeutics. 
 Paris, 18.33.
 
 -436 REFORM PERIOD. 
 
 the Academy of Stockholm for 1800-1801. He directed his researches 
 toward an end eminently useful; he proposed to determine, among the 
 constituent principles of cinchona, the one to which its curative virtues 
 belonged. If he had not the glory to attain an end so desirable, he had, 
 at least, the merit of indicating it. Later, we shall see the labors of 
 two French chemists crowned, in this respect, with complete success. 
 
 Nevertheless, the most important and most difficult questions to solve, on 
 the subject of the new medicament, did not lie within the reach of either 
 botany or chemistry, but rather of practical medicine. It is the latter 
 which had to pronounce definitely upon the value of the curative proper- 
 ties attributed to the substance, on the modes of its administration and 
 proper doses, and on the pathological circumstances which may indicate 
 or centra-indicate its employment. 
 
 The first one who wrote on the medicinal virtues of cinchona, was a 
 Spanish physician named Barba. He demonstrated the efficacy of this 
 powder in a tertian fever, and replies to the objections of some physi- 
 cians of his country, who condemned its use. His book was printed at 
 Seville, in 16-12. Morton speaks of a short treatise drawn up in 1651, 
 by the physicians of Eome, which fixed the dose of the powder at two 
 drachms, and recommended the employment of laxatives before adminis- 
 tering it. They advised, after its administration, to await, tranquilly, 
 the sweats it usually provoked, before recurring to any other remedy. 
 
 About the same time, cinchona was introduced into England, but it 
 soon fell into contempt, owing to the ignorance of the true manner of 
 administering it. Several patients perished from its improper use — 
 among others Senator Underwood and Captain Potter — which disgusted 
 many physicians with its use, but instigated others, especially the sage 
 Sydenham, to seek a better method for its administration. 
 
 A charlatan named Talbot, or Talbor, profited by the discredit into 
 which this substance had fallen, to administer it as a secret remedy. 
 After having astonished London by his numerous cures, and amassed a 
 fine fortune, he went to Paris, where he obtained no less brilliant success; 
 among others, he cured the Dauphin of an intermittant fever, which the 
 court physicians had not been able to cure. The king bought his secret 
 for the sum of two thousand louis d'or, and a pension during life of two 
 thousand francs. After the death of Talbot, the French Government 
 published his recipe, the principal ingredient of which was nothing but 
 cinchona, disguised by the addition of other substances. 
 
 At the head of those persons who contributed to propagate the methodic 
 employment of the Peruvian bark, I must name Sebastian Badio, or 
 Baldies, whose dissertation, published in 16G3, had especially for its 
 aim to refute the attacks of Chifflet and Plempius against this remedy ;
 
 INTERNAL THERAPEUTICS. 437 
 
 Eichard Morton, a celebrated practitioner of London, wliose Pyretology, 
 published in 1692, had, for a long time, a distinguished reputation ; and, 
 above all the preceeding, Francis Torti, professor of medicine at the 
 Grymnasium of Modena, and author of a classic treatise on pernicious 
 fevers. •■' No one had before demonstrated with so much force and reason, 
 the superiority of cinchona over all other remedies, in that class of dis- 
 eases, and no one had refuted in so victorious a manner, the objections 
 of its adversaries. He wrote at the beginning of the eighteenth century, 
 from which period we may regard the cause of cinchona as gained. 
 After him, Werlhof published new observations, which fully confirmed 
 those of the professor of Modena. He demonstrated the futility of the 
 arguments founded on theories, and demanded only the proofs of expe- 
 rience. His writings are a model of urbanity, elegance, and sound eru- 
 dition. After having proved how vain were the high controversies on 
 the essence and proximate causes of fevers, he recounts, among others, 
 the following anecdote : " The empiric Talbot was one day called to a 
 patient attacked with a chronic fever. His physician, who had been in 
 attendance a long time without effecting anything, consented to admit 
 Talbot to consultation, with very great repugnance. As soon as they 
 were assempled, the dean of the consultation gravely asked Talbot this 
 question: ' What is a fever?' 'A fever,' responded the latter, very 
 reverently, ' is something which I cannot define, but which I can cure ; 
 while you, perhaps, may be able to define, but cannot cure it.' " f 
 
 In the second half of the eighteenth century, Casimir Medicus assimi- 
 lated, under certain aspects, periodical affections without fever to inter- 
 mittent pyrexias, and applied the same treatment to them vrith great 
 success. This happy employment of cinchona against a new order of 
 diseases, added very much to the importance, already very great, of this 
 exotic medicament. 
 
 TREATMENT OF OTHER, DIVERSE DISEASES. 
 
 We have mentioned the prophylactic treatment of variola, in the 
 chapter on Hygiene, and endeavored to appreciate the extent of the 
 services rendered to humanity by the practice of inoculation, and above 
 all, by the discovery of vaccination, which we shall not dwell upon 
 again. But, besides these capital ameliorations, several others, less 
 striking, which have also their utility, were introduced into the treat- 
 ment of several diseases. Therapeutics essayed to appropriate to its 
 use a quantity of new substances but little known to the ancients ; such 
 
 " Therapcutice specialis ad febres periodicas perniciosas, Mutina;, 1712. Nova 
 editio curantibus Tombeur et Brixlie, Leodi, 1821. 
 t Werlhof, Observations de febribus.
 
 438 ERUDITE PERIOD. 
 
 as the different gases, electricity, galvanism, tartar emetic, proscribed 
 by a decree of the parliament of Paris,'-'' ipecacuanha, belladonna, 
 digitalis, etc. 
 
 In short, the period through which we have just passed has effected 
 in therapeutics ever memorable improvements : the ravages of variola, 
 so to say, annihilated in its source ; those of intermittent fevers, and 
 periodical affections in general, arrested at their beginning ; the repul- 
 sive contamination of syphilis, which menaced the human species with a 
 progressive degradation by its hereditary transmissibility, unmasked and 
 vanquished in the most of its metamorphoses ; in fine, a multitude of 
 secondary ameliorations introduced into the treatment of many other 
 diseases, without counting the improvements so remarkable in surgery 
 and obstetrics, of which account will be taken hereafter : behold, un- 
 questionably, imperishable titles to the gratitude of all generations ; and 
 if the modern tables of mortality do not lead us into error, if the exten- 
 sion of the mean duration of life, established by them, is a reality, as we 
 are all led to believe, what science can claim, in this happy result, a part 
 equal to that of medicine ? 
 
 An important remark on the subject of all these beautiful improve- 
 ments remains still to be made, which is, that they were all accomplished, 
 not in virtue of prevailing theories, but in spite of them ; that the great- 
 est obstacles they had to surmount, to become established, came from these 
 very theories. If mercurial medication was continued, so as to excite 
 salivation, or to the production of those injurious effects which made it 
 formidable, it was in perfect harmony with the Galenic theory, according 
 to which it was not doubted but that the syphilitic virus circulated 
 with the humors of the body ; whence it followed, that it was necessary 
 to provoke some evacuation or other to expel this virus. What was the 
 reproach that the adversaries of cinchona brought against that medica- 
 ment? It was, that it produced no sensible evacuation. Now, in their 
 opinion, founded on the authority of Hippocrates, Galen, and others, the 
 proximate cause of intermittent fevers could be nothing else than vitiated 
 bile or phlegm ; so that a medicament which expelled neither the bile 
 nor the phlegm, could not, according to their doctrine, radically cure an 
 attack of fever. The Stahlites made a more specious objection still, to 
 the employment of cinchona ; they said that fever is a natural and salu- 
 tary effort of the soul, to free itself from an injurious substance, and that 
 to suspend or arrest the accession, was contrary to the tendency of the 
 vital principle, and produced, in reality, more harm than good. If 
 vaccination itself has encountered opponents, was it not especially 
 
 "See Lettres de Gui Patin, with Notes by Reveille Parise; Paris, 1816.
 
 EXTERlSrAL PATHOLOGY AND THERAPEUTICS. 439 
 
 because tbe Arabs, who first described variola, bad at tbe same time prop, 
 agated tbe opinion that tbe principle of tbis disease is innate in man ; 
 wbence it was concluded, that to prevent its spontaneous development, 
 was to oppose tbe proper action of nature — to keep tbe enemy in bis 
 place ? 
 
 In tbe opinion of every one, tbe progress tbat tberapeutics made, and 
 wbicb we bave just pointed out, was due to tbe pure experimental 
 metbod, i. e., to Empiricism ; not to tbat blind and ignorant empiricism 
 of cbarlatans, and medicasters, and pbarmacopolists, wbo content tbem- 
 selves with asking tbe name of a disease, and witbout otber knowledge 
 deliver, witbout hesitation, tbeir drugs, but to tbe enligbtened and 
 methodic Empiricism wbicb calls to its aid all the positive indications 
 of physiology, pathology, and tbe accessory sciences — to the empiricism 
 of Sydenham, Morton, Torti, Werlhof, Berenger de Carpi, Van Swieteu, 
 Lieutaud, Stoll, Jenner, and other practitioners of such merit ; to tbat 
 Empiricism for which Kurt Sprengel offers apologies, in so many 
 instances, and notably, in chapter second and third, of the sixteenth 
 section of bis History of Medicine. 
 
 CHAPTEK VI. 
 
 EXTERNAL PATHOLOGY AND THERAPEUTICS. 
 
 We have seen that surgery, after having been so long disdained and 
 oppressed by the Clinical physicians of tbe middle ages, was gradually 
 elevated from this abasement, and signalised its resurrection in Europe 
 by discoveries and improvements of tbe highest interest. Tbe sixteenth 
 century had produced some surgical reputation out of line, but the 
 first half of the seventeenth was less fruitful in illustrations of this 
 kind. During tbis lapse of time, Severin Pinau and John Bienaise are 
 nearly the sole representatives of French surgery ; Marcus Aurclius 
 Severino and Peter de IMarchetti sustained still, somewhat, the glory of 
 the Italian school, which declined, after them, to flourish again only 
 toward the close of tbe eighteenth century ; German}^ saw arise no 
 worthy successor of Fabricius de Hilden ; in Switzerland, no one replaced 
 Felix Wurz ; Holland possessed only John Van Horn ; and England, 
 until then one of tbe countries most in arrears, in tbe progress of sur- 
 gery, gave birth to a man who revived, and was tbe dawn in her, of the 
 genius of surgery. Pdchard AViseman was the A. Pare of the Brittanic 
 nation ; his collection of treatises has always preserved its interest, as 
 one of the most precious monuments of English surgery.
 
 440 REFORM PERIOD. 
 
 Toward tlie close of the seventeenth century, and during the whole 
 course of the eighteenth, this branch of the Healing Art emerged anew 
 from its state of stagnation, and took a development, of which no other 
 period in its history offers us an example. Among the causes which 
 contributed, in France, to give it a strong impulse, we shall cite, in the 
 first place, the creation of five chairs of demonstrators of anatomy and 
 surgery, instituted in the college of Saint Come, by letters patent, in 
 September, 1724. G-. Mareschal, first surgeon of Louis XV., and 
 La Peyronie, his friend and colleague, who was destined to be his suc- 
 cessor, were the first instigators of that measure. La Peyronie com- 
 pleted it, in adding to the five royal demonstrators, a sixth, for the 
 course on accouchements, and six adjuncts, whose salaries he paid him- 
 self. This enlightened philanthropist did not limit his benefits to the 
 capital ; he obtained for Montpellier the nomination of four professors 
 and four adjuncts, who wcx'e rerjuired to include in their lectures all 
 branches of surgery. But he lacked an amphitheater, and no emolu- 
 ments were attached to the chairs which were just created. La Peyronie 
 removed all these difficulties, and provided everything from his own 
 purse. In fine, he secured the future of these institutions, by leaving 
 in his will provisions for their support. 
 
 It is to him, also, and to Mareschal, that France was indebted for 
 another endowment, which exercised, during more than half a century, 
 a powerful influence on the progress of surgical studies in Europe. 
 The Eoyal Academy of Surgery, instituted in 1731, became, from its 
 origin, a focus toward which converged the labors of a crowd of surgeons 
 of France and foreign nations. It received, among others, communica- 
 tions from John Louis Petit, Ledran, Garengeot, Lafaye, Csesar Verdier, 
 S. Morand, Quesnay, Hevin, Fabre, Lecat, Puzos, Bordenave, Sabatier. 
 and above all from A. Louis. To the Royal Academy of Surger}^ we 
 must attach the names of Lamotte, Eavaton, Friar Come, Master John, 
 Anthony Petit, Poutcau, etc., who shared its fame, and enriched science 
 by their writings. Then succeeded, in the history of this Art, the School 
 of Practical Surgery, {Ecole Pratique de Ghirurgie) established by a 
 decree of council, in 1750. It was here that Chopart taught with so 
 much zeal, and where his intimate friend, P. J. Dcsault, commenced, as 
 clinical professor. That clinic, the first which France offered as a 
 model, soon acquired a European renown, and, to such a hight, that 
 neighboring nations sent to Paris pensioned students, to follow the 
 course of Desault. From this school came forth Anthony Dubois, A. 
 Boyer, and so many others that the enumeration would be too long. 
 
 While, by a happy concourse of circumstances, French surgery shone 
 thus, in the first rank, the neighboring nations advanced in the same
 
 EXTEKNAL PATHOLOGY AND THERAPEUTICS. 441 
 
 career with a praisewortliy emulation. England could enumerate with 
 pride Cheselden, Douglas, the two Monros, Sharp, Cowper, Pott, B. Bell, 
 J. Hunter, etc.; Italy had her Molinelli, Bertrandi, Guattani, Moscati, 
 Scarpa ; Holland possessed Deventer, and P. Camper ; Germany, and 
 the countries farther north, saw flourish L. Heister, John Zacharia 
 Platner, Stein, Eoederer, Brambilla, Acrel, Callisen, Theden, Augustus 
 Kichter, etc. 
 
 From the concourse of all these celebrated men, and a great number 
 of others, external pathology and therapeutics were elevated to an 
 unheard of degree of perfection. Surgery showed itself worthy to march 
 the peer of Medicine, and the inseparable union of those two twin- 
 sisters, was sanctioned in France, at the time of the restoration of its 
 Medical schools, in 1795. To give an idea of the numerous ameliora- 
 tions accomplished in external pathology and therapeutics, during the 
 Eeform Period, we will take a rapid glance over the history of some 
 of the principal Surgical operations. 
 
 ■WOUNDS OP THE HEAD. 
 
 Among the operations to which the wounds of the superior part of 
 the body may give rise, one of the gravest and most delicate, is, beyond 
 contradiction, that of trephining, which is often alluded to in the 
 Hippocratic works. The manner of executing it ; the cases where 
 it is indicated ; the dangers to which it exposes the patient ; the pre- 
 cautions that it requires, are all traced with a correctness which 
 proves, that, for a long time, the Asclepiadge had been in the habit of 
 practicing it. 
 
 The Surgeons of the Alexandrian school, notwithstanding the supe- 
 riority of their anatomical knowledge, added very little to the precepts 
 of the Hippocratists, concerning this operation. Celsus furnishes only 
 a few details on the modes of operation and on the form of the instru- 
 ments.'"' The Greek and Latin physicians of the following ages 
 abandoned the great operations, and limited themselves in the treat- 
 ment of the wounds of the head, to the use of ointments, cataplasms and 
 other extsrnal applications, which they decorated with the title of 
 vulnerary. Among the Arabs, Albucasis alone, seems to have employed 
 the trephine. Among the clergy who monopolized the Healing Art 
 during the middle ages, Guy de Chauliac was the first, to draw from 
 oblivion this instrument, and the operation it recalls. From that 
 period trephining never fell into disuse again. The forms of the 
 instruments employed by the ancients were modified in various ways, 
 
 ~ Liv. viii, chap, iii, editioa of Ameloveen, Amsterdam, 1713. 
 
 28
 
 442 REFOKM PERIOD. 
 
 but efforts were especially made to establish the indications with exact- 
 ness ; but, in short, no capital improvement was introduced by moderns 
 into this branch of Surgery. 
 
 DISEASES OP THE EYE. 
 
 Cataract. — The ancients had only very confused ideas on the nature 
 and seat of this affection. Celsus, who was the first to speak of it, says : 
 " Often as the result of a blow or a disease, the humor contained in the 
 empty space which I have said exists behind the two tunics ( the 
 transparent cornea and the iris ) becomes concrete, gradually hardens, 
 and obstructs the sight; there results from it an infirmity which is 
 sometimes curable and sometimes not.=-' Then the Eoman encyclopedist 
 enumerates the cases in which an operation may be attempted with 
 some hope of success, and those in which it appears formally con- 
 tra-indicated. These last are, according to him, much the most 
 numerous. 
 
 As to the mode of operating, he describes only the one that is known 
 as the method of couching. However, he does not doubt but that the 
 method by extraction was known to the ancient Greeks. Ehazes, who 
 gives a detailed description of it, assures us that it was practiced by 
 Antyllus, a celebrated surgeon, who lived at the commencement of the 
 second century of the Christian era.f 
 
 " Paul of ^gina, and Albucasis, followed the method of Celsus ; the 
 ecclesiastical physicians of the middle ages knew no other; and those of 
 the Erudite Period did not show themselves any more bold, notwith- 
 standing the progress of anatomy. During all this period of time, the 
 method by extraction was completely abandoned by instructed surgeons. 
 A few intinerant operators only, dared practice it ; but the men of 
 the Art rejected it because it occasioned the loss of the humors con- 
 tained in the chambers of the eye, an occurrence which they believed 
 very formidable. 
 
 It was onl}' towards the close of the seventeenth century, that sounder 
 ideas on the nature and seat of cataract began to prevail. It was then 
 ascertained that it did not proceed from a condensed humor, as had been 
 taught by Celsus, nor from a thin pellicle si)read before the pupil, as 
 had been believed in the middle ages; but that it consisted in the 
 opacity of the crystalline lens, or its capsule. This was a great step 
 towards the rational ti-eatment of this disease. From that time two 
 species were distinguished, namely, the crystalline and the capsular; 
 and the signs were established to determine each of them. The certainty 
 
 " Loc. Cit. t Continens, lib. iii., chap. iii.
 
 EXTERNAL PATHOLOGY AND THERAPEUTICS. 443 
 
 of tlie renewal of the humor of the chambers of the eye was also 
 ascertained, which removed all apprehension about any injury from its 
 discharge. Consequently they established much better than ever had 
 been done before, the indications which should determine the surgeon to 
 prefer, in certain cases, such or such a mode of operation. 
 
 On Fistula Lachrymalis. — It is also in the work of Celsus, that we 
 find the first mention of this disease, which the Greeks named cegilops. 
 The ulcer, he says, sometimes attacks the os unguis and penetrates 
 to the nostrils. When it assumes a carcinomatous form, it would be 
 not only useless, but also dangerous to touch it. If on the contrary 
 the disease is recent, and is not too extensive, a cure may be hoped 
 for. To efi"ect this, the superior part of the ulcer should be seized 
 with a crotchet, and incised to the bone. Then the osseous canal 
 should be penetrated with a red hot iron, care having been taken pre- 
 viously, to protect the eye and surrounding parts, so as to guarantee 
 them from the contact of the heat. Some prefer the use of caustics, 
 as the green or blue cojiperas, but these remedies act slowly, and in a 
 variable manner. =-= 
 
 To this method the Arabs added three others, namely, compression, 
 injections, and tents. Ehazes was the first to remark, that a continued 
 pressure, seconded by frictions, sufiices to cure certain fistulce lachry- 
 malia. He speaks also of injections that may be used through cannulse. 
 Avicenna counsels the introduction into the nasal canals, of a thread 
 saturated with depuratives, which must be withdrawn every day, until 
 the passage be entirely free. We see by this the Arabs knew nearly all 
 the methods in use among moderns, in this disease. 
 
 The Latins of the middle ages employed only escharotics and the 
 actual cautery. Those of the Erudite Period employed exactly the same 
 means ; but in the course of the seventeenth, and especially of the 
 eighteenth centuries, all the proceedures known to the Arabs were still 
 honored, and considerably perfected, and a better judgment was formed 
 of their advantages and particular inconveniences. 
 
 On the Synizesis or Synechia. — The pupil is susceptible of a 
 morbid constriction, and even a complete obliteration, which con- 
 stitutes the affection called synizesis. This occlusion is rarely con- 
 genital ; however it may be in the newly born, resulting from the 
 persistence of the pupillary membrane. Such individuals are born 
 blind, though their eyes possess otherwise all the conditions requisite 
 
 * Celsus, lib. -vii. chap. vii. § viii.
 
 444 REFORM PERIOD. 
 
 for seeing. Accidental synizesis is much more common, and occurs 
 from varied causes : sometimes it arises as the result of an opera- 
 tion for cataract, or a violent inflammation of the eye: again, it has 
 been attributed to the repercussion of any morbid vice, such as that 
 of tetter, gout, etc., and it may manifest itself without any apparent 
 cause. 
 
 The ancients did not attempt the treatment of this infirmity, and 
 the unfortunate who were attacked with it, went the rest of their days 
 deprived of sight. In 1732, William Cheselden published the history 
 of a very delicate operation for its relief, which he had successfully 
 performed. This operation consisted in making an opening or artificial 
 pupil, in the center of the iris. The same operation was repeated several 
 times afterwards, but never or rarely ever succeeded ; the process of 
 Cheselden was therefore judged defective. Other surgeons made useful 
 corrections in it, by means of which, they obtained better results. 
 Thenceforth the operation was a therapeutical conquest, and took rank 
 among the discoveries of modern surgery. 
 
 DISEASES OE THE NOSE. 
 
 Nasal Polypus — The Hippocratic works mention four species or varie- 
 ties of this disease, and they indicate a curative method appropriate to 
 the nature of the excrescence in each case. If the polypus is soft and 
 adheres by a small peliclc, it was advised to tear it loose and draw it forth. 
 If it was hard, it was to be cauterised with the actual cautery. If it was 
 soft and adhered by a large pelicle, a ligature was used. If of a stony 
 hardness it was to be excised. In all cases, the cure was terminated by 
 mild caustics and emolients. 
 
 The Greeks of the following ages added very little to these precepts. 
 The Arabs and the Latins of the middle ages adhered to the ligature 
 and caustics only; but at the epoch of the restoration of the sciences in 
 Europe, all the means employed in antiquity, were restored to practice 
 and examined. A closer study of the effects of each of these applica- 
 tions was carefully made. Gabriel Fallopius and Andrew Levret 
 concurred, especially to clear the diagnosis and treatment of this 
 disease. 
 
 Rhinoplasty — This word is intended to designate an operation which 
 is designed to reconstruct the entire, or a considerable part of the nose. 
 Peter Eanzano, Bishop of Lucern, is the first who made mention of it in 
 his Annals of the World. According to the report of this historian, there 
 lived in Sicily, in 1442, a family of the name of Branca, which pos- 
 sessed the art of reconstructing the nose and other parts of the face, 
 from the flesh of the arm. This art passed from Sicily into Calabria,
 
 » 
 
 EXTERNAL PATHOLOGY AND THERAPEUTICS. 445 
 
 where it was practiced by the family Via' co, or Bojano, at the com- 
 mencement of the sixteenth century. Alexander Benedetti, a celebrated 
 physician of that time, furnishes us exact notions of the mode of opera- 
 ting practiced by the Calabrians." But toward the close of the same 
 century, we find no longer in Calabria any trace of Bojano, or rhino- 
 plasty. Gaspard Tagliacozzi, professor of surgery in the University of 
 Bologna, was then the only man who practiced this operation, whether 
 as his own invention, as he pretends, or as acquired from the descend- 
 ants of the Calabrians. Ambrose Pare recounts the history of a cheva- 
 lier 'of Saint Thoan, who after having for a loug time worn a silver 
 nose, was by the skill of the Italian professor, furnished with a well- 
 formed nose of flesh. In 1597, Tagliacozzi published a treatise on the 
 art of restoring the nose and ears, which had been destroyed or muti- 
 lated, f Thomas Fyens, who made an extract from this work, assures 
 us that he had seen several persons upon whom the author had very 
 happily operated. | Fabricius of Hilden, reports that a surgeon of 
 Lausanne, named Griffon, having possessed the knowledge of the pro- 
 cess of Tagliacozzi, repaired so well the nose of a young girl, that 
 twelve years after, the cicatrice was scarcely perceptible. In fine, John 
 Baptist Cortesi, a cotemporary of Tagliacozzi, and his colleague at the 
 University of Bologna, gave a detailed description of rhinoplasty, which 
 he assures us he had himself practiced. 
 
 Xotwithstanding these undoubted proofs, the art of restoring the 
 nose, fell again into oblivion, for nearly two hundred years, and to such 
 a point, that at the close of the last century some physicians considered 
 it doubtful whether it had ever existed, when a journal of Madras pub- 
 lished, in 1794, an observation of rhinoplasty executed with success on 
 an Indian, after a method formerly known in the country. This pro- 
 cedure consisted in detaching from the skin of the forehead, a flap, out 
 of which the nose was to be formed, while the Tagliacotian operation 
 consisted in taking the flap from the arm, in the deltoid region. The 
 same operation was afterwards repeated in Prance, England, Germany, 
 and other places, with various modifications and results, so that a doubt 
 about its reality was no longer permitted. 
 
 DISEASES OF THE MOUTH. 
 
 Harelip, or split-lip, an infirmity ordinarily congenital and some- 
 times accidental, is not described in any Greek author. Celsus, who 
 is the first to mention it, speaks of it and its treatment, only in a very 
 succinct manner. The Arabian writers are not more explicit, with the 
 
 '^ De Remedica Opus Basil 1539. f ^^ Curtorum Chirurgia, Venice, 1597. 
 I De Praecipuis Artis Chirurgiae Controversiis.
 
 446 REFORM PERIOD. 
 
 exception of Albucasls, who expresses himself about it with more 
 exactness and detail than all his predecessors. He advises sometimes 
 that the separated borders of the lip be cauterised, to excite suppuration; 
 sometimes to excise them, so as to sew them together, and to cover the 
 wound with an ointment of dates. After him, A. Pare was the first 
 who described the hare-lip and its :pcration. He employed, to join the 
 freshened edges of the lip, steel needles, around which he wrapped a 
 waxed thread, in the form of the figure oo • Peter Dionis proved that 
 the resection is always- more prompt and sure than cauterisation. His 
 idea was generally adopted and still prevails. He performed the exci- 
 sion with scissors ; others preferred the bistoui-y, but this difi'erence is 
 of but little importance. The steel needles have been replaced, on 
 account of their rusting, by needles of silver or gold, which are with- 
 drawn more easily, without tearing the flesh. 
 
 DISEASES OP THE TEETH. 
 
 The Art of Dentistry formed among the Egyptians, as it does yet in 
 many countries, a particular branch of Surgery, and was practiced by 
 men more or less ignorant of the rest of the science. Nevertheless, phy- 
 sicians have also occupied themselves with it, from the earliest times. 
 Erasistratus speaks of an odontagogue of lead, which was suspended in 
 the temple of Delphos, to indicate that only such teeth as were greatly 
 decayed, should be extracted. Hippocrates gives the same precept • 
 " Extract," he says, " the carious teeth ; but when they are neither rot- 
 ten nor movable, and yet cause various pains, it is proper to apply fire." 
 Celsus shares the same opinion, but he enters into much more detail, on 
 the subject of the operations usually performed on the teeth. " Some- 
 times," he says, "the teeth are movable because the roots have little or 
 no hold, and the gums are soft and fungous ; in either case the surface 
 of the gum should be touched lightly with the hot iron, whenever the 
 tooth is carious. Do not determine too quickly to extract a tooth, unless 
 it be utterly necessary. It will be better to add to the remedies pre- 
 scribed above, more efficacious compositions still, to calm the teeth, such 
 as opium, pepper, and sory, rubbed up together, and incorporated with 
 galbanum, which is to be applied to the tooth. If medicaments can not 
 appease the pain, and it is thought best to extract the tooth, it must be 
 laid bare, and moved about so as to make its removal easy, for there is 
 extreme danger in attempting to draw a tooth which is firmly fixed in 
 its alveolus. When the teeth are black, and covered with tartar, the 
 dark spots must be removed with a rasp, and the teeth rubbed with 
 an opiate composed, in part, of bruised rose-leaves, and one-fourth of 
 nut-galls and myrrh." Celsus recommends, also, to attach the loose
 
 f 
 
 1 
 
 EXTERNAL PATHOLOGY AND THERAPEUTICS. 447 
 
 teeth to the adjoining sound ones by a gold thread. When in children the 
 permanent tooth begins to press upon the deciduous one, before it has 
 dropped out, the latter one must be extracted, and pressure be made upon 
 the new one every day, so as to constrain it to take the place of the other. 
 
 Albucasis is the first who spoke of dental prothesis ; he substituted for 
 a lost tooth another, either natural or artificial, which he fixed to its 
 place by means of a thread of gold or silver. 
 
 The ecclesiastic physicians of the middle ages, neglected this part of 
 the art. Guy de Chauliac complains loudly, that these operations had 
 been abandoned to the barbers, bath-keepers, and other artizans, deficient 
 in the technical knowledge of the evolution of the teeth ; operations of 
 such importance that no physician should disdain to undertake, or at 
 least to assist in them. A. Pare adds to the laboratory of the dentist 
 several instruments, some of which very much resemble those that are 
 now employed. He is the first one who reports an authentic example of 
 an extracted tooth being immediately returned to its place; and become 
 consolidated. 
 
 In the course of the eighteenth century the Dentist's Art reached a 
 degree of perfection it had never before approached. Several surgeons 
 of Paris, Pierre Fauchard, Anselme Jourdain, Bunon, and Bourdet, 
 contributed especially to its advancement, as well by their practical 
 skill as by their writings. They conferred upon the hygiene of the 
 mouth, and Dental Surgery, numerous sage precepts and useful inven- 
 tions. 
 
 DISEASES OP THE TOXGUE, PAluiTE, AND TONSILS. 
 
 The operations that these diseases require, sometimes consist in scari- 
 fications, excisions, and cauterizations. We find them mentioned, more 
 or less explicitly, in the Hippocratic works. Celsus describes them 
 with more or less details ; he speaks, the first, of the resection of the 
 frenum, and the treatment of ranula. Paul of iEgina adds something 
 to the precepts given before his time ; but the Arabs only copied the 
 Greeks on this branch of the Art. 
 
 The moderns have contributed additions and improvements to the 
 above, which render these diseases less dangerous and more easily cured. 
 They have also signalized some diseases of which the ancients have 
 not spoken, such as salivary fistula?, which are frequently met with in 
 practice. That of the duct of Steno, which is the most frequent, was 
 described for the first time, by Bartholomew Saviard, and also the opera- 
 tive proceeding which he made use of for its cure. He recounts that a 
 man named De Pioy. having pierced his cheek, from without inwards, 
 with a red hot iron, at the point of the fistula, the external opening 
 cicatrised, while the internal remained open.
 
 448 REFORM PERIOD. 
 
 DISEASES OP THE EAR. 
 
 Among the affections which cause a loss, more or less considerable, of 
 the faculty of hearing, and are susceptible of being relieved by the aid 
 of surgery, the ancients knew only the occlusion of the external meatus, 
 whether congenital or accidental. Paul of iEgina is the only one of all 
 the old writers, who furnishes on this subject the most circumstantial 
 and rational instruction. Those who followed him changed none of his 
 prescriptions, up to the epoch when the discoveries of Valsalva, on the 
 structure of the internal ear, gave a new direction to the therapeutics of 
 the affections of this organ. That illustrious anatomist was the first to 
 recognise that deafness proceeds, often, from the obstruction of the 
 Eustachian tube. He perceived, also, that the cavity of the tympanum 
 communicates with the cellules of the mastoid apophysis. This dis- 
 covery was accidentally made. While injecting a carious condition of 
 that bony eminence, he ascertained that the lic^nid passed into the eso- 
 phagus. Cheselden several times observed that the hearing was but 
 little, or not at all affected by the perforation of the tympanum. 
 
 These various observations led to the discovery of several ingenious 
 processes, for the cure of deafness arising from some affection of the 
 internal ear. The first effort made to this end, was by injection through 
 the Eustachian tube. Anthony Petit, John Douglass, and other sur- 
 geons of the eighteenth century, recommend very highly this means. 
 Jasser, a surgeon of the Prussian army, attempted to cure the deafness 
 arising from the occlusion of the Eustachian tube, by trephining the 
 mastoid process, and pushing injections through the cells, in which he 
 succeeded perfectly. In fine. Sir Astley Cooper conceived the idea of 
 perforating the tympanum, to replace the opening of the obliterated 
 Eustachian tube ; and he performed the operation, successfully, three 
 times. 
 
 OBTURATION OF THE AIR PASSAGES. 
 
 When the air passage is stopped by any obstacle, the anguish is 
 extreme, the suffocation iminent, and the patient speedily dies, unless 
 promptly succored. This accident has sometimes occurred in a violent 
 quinsey, but more frequently in the fibrinous effusion in children, called 
 croup. The Hippocratic works indicate as the only resource in this 
 extremity, to pass a leek leaf, or any elastic tube, into the throat of the 
 patient ; but this agent is very difficult of application, and I doubt 
 whether it was ever done advantageously. Asclepiades of Bythinia, had 
 the idea of opening a passage for the air, by making an incission into the 
 larynx or trachea ; but the authors who report this fact do not describe
 
 EXTERNAL PATHOLOGY AND THERAPEUTICS. 449 
 
 the operation he adopted. After him, no one dared attempt tracheotomy 
 until Antyllus, who practiced it several times, and described his mode 
 of operating. "We owe to Paul of ^gina the preservation of this 
 precious fragment. The Arabs, and the Latins of the middle ages had 
 so little anatomical knowledge that they very much exaggerated the 
 dangers of the operation, and, without condemning it absolutely in 
 theory, abstained from its practice. 
 
 Anthony Benivieni, a physician of Florence, who lived at the end of 
 the fifteenth century, saved the life of a patient by opening the trachea* 
 and giving issue to the pus of an abscess that was formed within it. 
 This is the first account we have of a tracheotomy, after an interruption 
 of twelve hundred years ; but its author does not state the manner in 
 which he performed it, and it does not appear that he employed this 
 method in other cases. Fabricius d'Aquapendente is the first among 
 moderns who gives a detailed description of this operation. He proves 
 that it may be executed without injury to any other important organ ; 
 and that by it, we may often save a patient from impending death. 
 The invention of the canula has been attributed to him, which has 
 usually been left for some time in the artificial opening thus made. 
 
 DISEASES OF THE CHEST. 
 
 Empyema. — According to its etymology, the word signifies a collec- 
 tion of pus, formed in any part of the body. Many authors have 
 employed it in this extended sense ; thus they have spoken of empyema 
 of the brain — the maxillary sinus, joints, etc. But a greater number, 
 especially among moderns, use the word empyema, in a more restricted 
 sense, only employing it to designate a purulent or aqueous collection, 
 enclosed in a part of the thoracic cavity. This is the signification, also, 
 which we give to the words. Thus we understand by the operation for 
 empyema, an opening practiced through the parieties of the chest, 
 to give passage to a liquid contained in one of its cavities. 
 
 We are astonished, in reading the Hippocratic Works, at the 
 assurance with which they frequently repeat the advice to open the 
 throracic cavity, to give issue to the empyema. It seems, from these 
 works, that nothing was easier than to recognize the presence and seat 
 of a liquid contained in the chest. Nevertheless, they do not always 
 agree among themselves on the symptoms of that affection : thus, the 
 author of the treatise on the Eegions in Man, declares, that a patient 
 affected with empyema expectorates purulent matter ; while the author 
 of the treatise on Internal xiffections, asserts that there is no pus either 
 in the substances expectorated or vomited. It is said in a passage of 
 the second book on Diseases, that the patient cannot lie on the painful
 
 450 REFORM PERIOD. 
 
 side; and, in another passage of the same book, that he cannot lie 
 on the sound side. 
 
 Apart from these small contradictions which may be blamed upon the 
 copyist, the following are some of the signs given of thoracic effusion : 
 when at the termination of a pleuro-pneumonia, which has existed for 
 some time, or a penetrating wound of the chest, or a fluxion, the fever 
 persists, with cough, expectoration, and oppression — and the patient 
 feels pain in the side or flanks, and realizes an extreme lassitude — 
 sweats on all parts of the body, with alternations of heat and cold, 
 swelling of the feet, and hooked nails, there is every sign of the 
 formation of an empyema. To assure yourself better and to know 
 the precise point of collection, require the patient to be seated on a solid 
 chair, and direct an assistant to hold his hands, then seize yourself both 
 shoulders, and shake him, and listen, attentively, to ascertain from 
 which side comes the sound of fluctuation. You will realize the same 
 sensation as when you agitate a leather bottle containing liquid. 
 When this sign is absent, which happens often, on account, either of 
 the quantity or viscidity of the liquid, an examination must be made, to 
 ascertain if one side of the chest is not more swollen than the other ; 
 and, in that case, the opening should be made a little below or 
 in the rear of the tumor, as low as possible, without wounding the 
 diaphragm. In fine, if we have to guide us neither fluctuation nor 
 tumor, and, nevertheless, the symptoms of empyema exist, it is neces- 
 sary to spread, on a cloth, potter's-clay, softened with warm water, and 
 apply it to the chest ; then, with a brush, dipped in some coloring 
 liquid, mark the portion of the skin where the clay dries the soonest ; 
 this will mai'k the point where the pucture should be made. 
 
 Thoracic paracentesis is performed as follows : after having incised 
 the skin with a scalpel, take a lancet having the blade wrapped nearly 
 to the point, or a red hot iron, and plunge the instrument into the 
 collection of pus, and let it flow in a small quantity. The opening must 
 be closed with a tampon of charpie, fastened to a thread, which will 
 serve to draw it out ; the whole is to be supported by a bandage around 
 the body. Twice a day the dressing is withdrawn, giving issue, each 
 time, to a small quantity of liquid. When it is sensibly diminished, 
 an injection is to be made of warm wine and oil, to prevent the lung, 
 which is accustomed to humidity, from drying too quickly. The dress- 
 ing is thus to be continued, twice a day, allowing the injection of the 
 morning to flow out in the evening, and that of the evening to flow out 
 in the morning. When the cavity furnishes but a very small quantity 
 of humor, a curved metallic sound should be introduced every day, to
 
 EXTEKNAL PATHOLOGY AND THERAPEUTICS. 451 
 
 draw off what is collected. Sometimes, instead of incising an inter- 
 costal space, a rib may be perforated, with a trephine, which will allow, 
 afterwards, greater facility for the use of the tampon. Galen cites the 
 history of a child whose sternum he had trephined, to give issue to an 
 abscess. 
 
 After him the operation for empyema was more and more neglected ; 
 neither the Greek physicians of the following ages, nor the Arabs, nor 
 the Latins of the middle ages practiced it, except in extremely rare 
 cases. But it began to be revived in the course of the sixteenth cen- 
 tury. Fabricius d'Aquapendente recommends it as the sole resource 
 that the art possesses against pleuritic inflammations with effusion — in- 
 ternal abscesses, penetrating wounds — hydro-thorax — in a word, against 
 every species of liquid collection which cannot be evacuated directly by 
 expectoration, the urine, or the stools. Being an enthusiastic partisan 
 of the ancients, he complains that in his time thoracic paracentesis was 
 not practiced as frequently as it had been under the Asclepiadffi. But 
 perhaps they may be reproached for having practised it too often ! The 
 progress of surgery is not measured by the multiplicity of its opera- 
 tions ; on the contrary, its greatest improvement consists in avoiding 
 those which are useless or very dangerous. Xow, that the diagnosis of 
 empyema is carried to a degree of perfection much higher than among 
 the ancients, as the result of the recent discoveries of auscultation and 
 percussion, thoracic paracentesis is much less practiced than in the age 
 of Hippocrates. 
 
 DISEASES OP THE ABDOMINAL OEGAXS. 
 
 Wounds of the Abdomen and Intestines. — Celsus is the first who traces 
 the rules for the suture of the abdominal parieties and the intestines. 
 He remarks as follows : When a wound has opened the abdominal walls, 
 it often happens that the intestines escape. It is necessary in the 
 first place to examine if the gut has been injured, and preserves its 
 natural colour. If the" small gut is wounded, there is no resource ; 
 but we may attempt to cure a wound of the large intestine by sewing 
 together the lips of the wound." He also indicates a very complicated 
 method to execute a suture on the abdominal walls, and like Galen, 
 describes two others which differ from his, which in all make three 
 methods of gastroraphy which have been transmitted to us by the 
 ancients. 
 
 During the middle ages no improvement was made in the cure of 
 abdominal and intestinal wounds. Some physicians conceived the idea 
 of introducing into the wounded intestine, before uniting the edges of 
 the wound, a tube of elder pith, in order to prevent the escape of the 
 feces between the points of suture ; but this odd procedure, and others
 
 452 REFORM PERIOD. 
 
 still more incredible, sucli as the Lites of ants, were justly abandoned 
 at the restoration of great surgery. There was a return to the plans 
 of the ancients, which were modified in an advantageous manner, while 
 at the same time new additions were made. Thus Stalpaart van der 
 Wiel invented the method of establishing an artificial anus, and for the 
 cure of wounds of the large intestine, and Peter Dionis generalised 
 this plan. 
 
 PARACENTESIS ABDOMINAXIS. 
 
 While the Asclepiad^e showed themselves empressed and bold to 
 advise thoracic paracentesis, they on the other hand appeared to have 
 a repugnance of paracentesis abdominalis. It is only recommended in 
 a single passage of the Hippocratic writings, and in a very succint 
 manner, the author simply says that a puncture of the abdomen must 
 be made near the umbilicus, or in the rear, in the region of the flanks. 
 An aphorism directed that but a small amount should be permitted to 
 flow at a time, when an opening was made, either with the knife, or the 
 actual cautery, in dropsy, or an internal abscess. This is all that is 
 found in that antique collection, relative to abdominal paracentesis. 
 It is shown, on the contrary, by a great number of physicians, that 
 ascitis was regarded by the physicians of that epoch, as an affection 
 entirely beyond the resources of art, and nearly always mortal, which is 
 doubtless the reason why they so rarely had recourse to an operation, 
 which they judged to be more injurious than useful, in such cases. 
 
 As to the other species of dropsy, anasarca, tumors of the liver and 
 spleen, they advised in general to treat them by scarifications and cau- 
 terizations. 
 
 Celsus is much more explicit in what regards the diagnosis, or treat- 
 ment of dropsies, of which he distinguishes three kinds, namely, tym- 
 panitic, leucophlegmatic or anasarca, and ascitis. After having described 
 the characters, and the means of cure proper to each of these species, he 
 says, on the subject of the last, that if the remedies employed to dry the 
 bowels, and arrest the humor, do not produce the desired effect, it is 
 necessary to evacuate the fluid in a shorter way, by making a punc- 
 ture. Then, in another book, he describes in detail the method of 
 making the puncture. He directs that the abdomen be incised at the 
 umbilicus, even, or at four fingers width from the left side, with a nar- 
 row bistoury, and then, that a cannula, with a projecting and reversed 
 edge, be introduced at the opening. That being done, a good part of the 
 water is permitted to run out; then the cannula is plugged with a 
 tampon, and is kept in its place by a bandage around the body. The next 
 day the remaining water is gradually evacuated. There are surgeons, 
 he adds, who withdraw the cannula on the first day, and who fix
 
 EXTERNAL PATHOLOGY AND THERAPEUTICS. 453 
 
 in the opening a piece of sponge saturated with vinegar, or water. The 
 next day the cannula is re-introduced, and the evacuation is completed. 
 During the centuries after Galen, not only were no improvements 
 made on the rules given by Celsus, but rather a retrograde movement 
 took place toward the practices of the Asclepiad^e, viz : they preferred 
 cauterizations and scarifications to the paracentesis. This latter method 
 did not come into vogue again till the fourteenth century. Mondini 
 objected to its being practiced at the llnea alba, because, he says, the 
 tendinous nature of the structure here, makes the cicatrization more 
 difficult, and often provokes spasmodic accidents. Fabricius d'Aqua- 
 pendente believed that it could be executed at the umbilicus with less 
 danger than at any other point. John Palfyn chose the middle of a line 
 drawn from the navel to the left anterior superior process of the ilium, 
 and this is to-day the point selected, when any particular circumstance 
 does not require some other one to be chosen. At the same time much 
 attention was paid to the improvement of the instruments employed in 
 the operation. Sanctorius invented one which made much noise, because 
 he kept it secret for a long time. It consisted in a round needle, con- 
 tained io a cannula. It was in fact almost the same as our trochar. In 
 short, we owe to two modern surgeons, and particularly to those of the 
 last century, the knowledge of encysted dropsy, which had escaped the 
 attention of the ancients. H. F. Ledran was the first to trace, in a pre- 
 cise manner, the diagnosis and treatment of this affection. 
 
 This word, in its vulgar and primitive acceptation, and it is that 
 which we adpot here, signifies nothing more than a tumor formed by the 
 displacement of some of the viscera of the bowels. Though the tumors 
 of that sort may show themselves on nearly all parts of the abdominal 
 surface, the ancients have only signalized those that appear at the groin, 
 or umbilicus. They studied particularly the former, because they were 
 most frequent, their diagnosis often obscure, and their treatment very 
 difficult. 
 
 Celsus, who was the first to describe inguinal hernia, expresses him- 
 self in the following terms. " The peritoneum, which separates the 
 intestines from the parts above the groin, is subject to be torn, either as 
 the result of inflammation, or the effect of a violent blow : then the 
 epiploon, or intestine, being drawn down Ly its own weight, becomes 
 engaged in the opening, separating gradually the nervous tunics that 
 envelope the testicle." In this manner the Eoman encyclopedists 
 explained the formation of inguinal hernia. Ihe other writers of anti- 
 quity and of the middle ages, made no change in this explanation, and
 
 454 REFOKM PERIOD. 
 
 it was only at an epoch very close to our own that the error was discov- 
 ered and demonstrated, as we shall show presentl3\ 
 
 In regard to its cure, Celsus advised to attempt it without using the 
 bistoury, but he laid down no rule for the practice of the taxis. He 
 contents himself by saying, after having returned the intestine, that it 
 was necessary to retain it by means of a truss, which often provokes the 
 adhesion of the membranes, especially in very young children. When 
 it is necessary to use a sharp instrument, let it be done as follows : 
 after having incised the first tegument of the tumor, the envelopes of 
 the testicle must be dissected as carefully as possible, so as not to injure 
 that organ ; the herniated viscus is freed from its envelopes and returned 
 to the abdominal cavity, through the peritoneal opening, which is enlarged 
 as much as is needed. As the incision of the tissues goes on, it is neces- 
 sary to tie the larger vessels. At the close of the operation the borders 
 of the wound are brought together by some points of suture, and the 
 threads are left to fall ofi" of themselves, which takes place as soon as 
 suppuration is established. 
 
 Celsus, as is seen, gives directions to have as much care of the testi- 
 cle as possible. Paul d' J2gina confirms the precept of Celsus, and the 
 Arabian writers only copy the Greeks on this subject ; but they abstain 
 from practicing the operation themselves ; their natural repugnance to 
 the employment of cutting instruments being fortified on this occasion 
 by a misplaced modesty. They limit themselves, in the cure of this 
 infirmity, to the use of agglutinative and astringent plasters. The sur- 
 geons of the middle ages established the absurd rule of tying, in these 
 cases, the spermatic cord, and taking away the testicle. 
 
 Ambrose Pare brings back the treatment of inguinal hernia to 
 sounder ideas. He proscribes the removal of the testicle, except in 
 cases of gangrene or sarcocele only. Pierre Franco refutes the errors 
 of the ancients, relative to the rupture of the peritoneum; he shows 
 that ordinarily that membrane accompanies the viscera, when they 
 emerge from tlie abdominal cavit}", without rupturing it. From that 
 time, the diagnosis and therapeutics of hernia acquired a precision 
 which they had never before approached, thanks to the labors of a great 
 number of surgeons, of the seventeenth and eighteenth centuries, 
 among whom we may cite Jean-Louis Petit, Leblanc, P. Camper, Samuel 
 Sharp, A. Louis, Percival Pott, Auguste Eichter, Antoine Gimbernat, 
 and A. Bonn. 
 
 DISEASES OP URINARY ORGANS. 
 
 Among the very varied operations to which these diseases have given 
 rise, up to this period, the gravest, undoubtedly, are nephrotomy and 
 
 I
 
 EXTERNAL PATHOLOGY AND THERAPEUTICS, 455 
 
 cystotomy. The first is recommended in the Hippocratic writings, but 
 the manner of executing it is nowhere described. The second, though 
 less dangerous, is mentioned in only one of the works of that collection, 
 and only to proscribe it. We read in the oath of Hippocrates, " I swear 
 not to cut any person attacked with stone. I will abandon that prac- 
 tice to the mercenaries who devote themselves to it." ^Vhy did the 
 Asclepiadae, who did not hesitate to recommend the cutting into the 
 kidney, show so much repugTaance for cutting into the bladder, an opera- 
 tion less difficult and less fatal than the other ? However this may be, 
 the prejudice that excluded cystotomy from the domain of the Art, 
 became extinct, or was very much abated in the school at Alexandria, 
 since Celsus names two distinguished lithotomists of that school, Ammo- 
 nius and Meges, whose methods of operation, as well as their intentions 
 and curative views, he does not disdain to mention. 
 
 " We are sometimes obliged," he says, " to employ the aid of the 
 hand, not only among men, but also in women, to press out the urine 
 which is retained, either because the urinary conduit is diminished by 
 reason of advanced age, or because there is some stone or clot of blood 
 which stops the passage, or a slight inflammation, which often occurs, 
 and stops the natural flow of the urine. To efi'ect this, sounds, made 
 of brass, are employed, and the surgeon must never have less than 
 three for men and two for women, so as to be able to assist all persons, 
 great or small. Since we have mentioned the bladder and stone, it 
 would appear that this is the place to speak of the operation which we 
 are obliged to practice on those who are attacked with stone, when a 
 cure can not otherwise be eff'ected : for no haste must ever be made to 
 perform this dangerous operation, neither must it be executed at all 
 seasons or ages, nor in all kinds of cases, but only in the spring, and 
 on children from nine to fourteen years of age, and when the suff'ering 
 is so great that, not yielding to other remedies, the patient is continually 
 in danger of perishing." 
 
 After having thus presented the indications which establish the 
 necessity of operating, Celsus describes, with great detail, the sole opera- 
 ive proceeding known in his time, and designated by moderns under 
 the name of minor operation, j^^tit appareil. His description has 
 remained as a model, which the writers who followed him, whether 
 Greeks, Arabs, or Latins, did in no respect change until within a period 
 not far removed from ours. During the middle ages, cystotomy left the 
 domain of the regular practice, and fell into the hands of men, stran- 
 gers to medical science, who went from city to city, according to the 
 expression of the times, to cut the calculous, (couper les calculeiix.) 
 (xuy de Chauliac appears to have been the sole surgeon of that age who
 
 456 KEFORM PERIOD. 
 
 dared attempt or advise such an operation, and he followed, literally, 
 the method of the Eoman encyclopedist. 
 
 About the commencement of the sixteenth century, John de Eomani, 
 surgeon of Cremona, and the Neapolitan, Mariano Santo de Barletta, 
 made some changes in the old method ; they added several instruments 
 of their invention to those which had been employed up to that time. 
 Mariano, having made known his changes in a memoir, ex-professo, the 
 new method of operation was termed the method of Mariano, from the 
 name of its author, or great operation, grand appareil, on account 
 of its complication, and of the number of instruments that were 
 employed in it. The family of Colot has given to France several 
 lithotomists who became celebrated by the employment of the grand 
 appareil. 
 
 About the time that Mariano published the details of his operation, 
 another surgeon, a native of France, and residing at Lausanne, was 
 led by necessity to the discovery of another procedure, more important 
 still, and named, afterward, the high operation. We will let him tell 
 himself the circumstances which led him, very much against his will, 
 to open a new route. " I will recite," he says, " what happened to me 
 once. Desiring to take a stone from a child of about two years of age, 
 but finding a stone nearly of the size of a pullet's egg, I did all I could 
 to withdraw it downward, and seeing that I could not advance it with 
 all my efforts, and that the patient was excessively tormented, and also 
 that the parents, wishing that he might die, rather than live in such a 
 condition, joined, also, to the feeling that I was not willing to bear the 
 reproach of not being able to take it away, (which was very foolish in 
 me) I deliberated, with the importunity of the father, mother, and 
 friends, to cut the child above the os pubis, inasmuch as the stone 
 could not descend downward. He was cut over the pubis, a little to 
 one side, for I held the stone there with my fingers, which were in the 
 fundament, and it was also held on the other side by the hands of an 
 assistant, who compressed the little belly, above the stone. I then 
 extracted it, and the patient was cured, though he was very ill. and 
 the wound consolidated." 
 
 Notwithstanding this result, the method imagined with so much 
 success by Peter Franco, remained in obscurity until in the year 1580, 
 when Francis Rousset attempted to revive it, and argued that it pre- 
 sented no more inconveniences than the others, and had several advan- 
 tages above them. Nevertheless, his argument did not succeed in 
 establishing the operation above the pubis, as the common operation, 
 but only as one that might be employed in rare cases. John Douglass, 
 a celebrated surgeon of the eighteenth century, was the first who
 
 EXTERNAL PATHOLOGY AND THERAPEUTICS. 457 
 
 employed, habitually, the Itigh operation, in preference to the other 
 methods. 
 
 A man, whose complete defect of anatomical knowledge would exclude 
 him from the practice of surgery in an enlightened age, named Baulot, 
 or Beaulieu, better known under the name of Friar James, enriched 
 science with a process of cystotomy which is not behind any of the 
 preceding, and is designated as the lateralized method. The Hollander, 
 Eaw, being initiated by him into this method, employed it with extra- 
 ordinary success ; but he dishonored himself in not communicating it 
 to any one, and carried the secret to his grave. After his death, a 
 crowd of surgeons, desirous of discovering the lost secret, devoted 
 themselves to researches which were not fruitless. On one hand, Wil- 
 liam Chcselden resuscitated the lateral method, and after having added 
 several improvements, gave it a perpetual existence, by the description 
 which he published ; ••' on the other hand, Peter Foubert invented a new 
 method, which has taken rank in science under the name of the lateral 
 method, and which Thomas, surgeon-in-chief of Bicetre, adopted the 
 first, and modified it. 
 
 Thus, to a single method, which the ancients transmitted to us, the 
 moderns have added, before the close of the last century, four others, 
 each of which presents particular advantages and disadvantages ; so 
 that the man of art may accord his preference to either, according to 
 circumstances and the occasion. 
 
 DISEASES OF THE GENITAL ORGANS IN MAN. 
 
 Hydrocele. — Celsus was the first who treated of this disease, which 
 he described very imperfectly^ under the name of aqueous hernia. He 
 advised the excision of the organs, in order to evacuate the liquid, and 
 to wash the wound afterward in a salt of nitre. Galen employed the 
 seton to cure the same disease, the diagnosis of which he did not estab- 
 lish in a manner more explicit than Celsus. Leonidas of Alexandria 
 described hydrocele with more exactness ; he endeavored to fix the 
 characters which separate it from sarcocele, enterocele, and epiplocele. 
 Paul of ^gina first distinguished dropsy of the tunica vaginalis, from 
 infiltration of the cellular tissue. He treated both, either by excision 
 or cauterisation. Albucasis preferred the actual cautery to excision ; 
 nevertheless, he also taught the manner of evacuating the water with 
 a trochar, or to excise the sack, when there was one. 
 
 Thus, at the epoch of the revival of letters, four methods of treating 
 hydrocele were known, namely, excision, the seton, cauterization, and 
 
 " Treatise on the High Operation for Stone. London, 1723. 
 
 29
 
 458 REFORM PERIOD. 
 
 puncture. The modems have added a fifth, stimulating injection after 
 paracentesis, the first mention of which was made by Alexander j^lonro. 
 Besides, they have determined much better its seat, and the various 
 characters and species of the disease. 
 
 Sarcocele, or cancer of the testicle, is the only disease which requires 
 the sacrifice of the organ of virility ; but this terrible operation was for- 
 merly much more employed. Celsus, who first names it, enumerates 
 three species of tumors which require its employment, namely: circocele, 
 or the varicose dilatation of the spermatic cord, sarcocele, and violent 
 inflammation of the testicles. In the course of time, the supposed 
 necessity for the operation was not even thus limited ; it was extended, 
 as before said, to hernia ; recourse was also had to it in the treatment of 
 elephantiasis, leprosy, gout, and even mental alienations. There was a 
 time when ignorance and cupidity, united, seemed to have determined on 
 the destruction of the reproductive organs in man. These pretended 
 curers overspread the countr}^ and, for a moderate sum, castrated chil- 
 dren, under the pretext of curing them of hernias which they did not 
 have, or which they might have been rid of without this odious 
 mutilation. The abuse was carried to such an extent that the Eoyal 
 Society of Medicine became excited. In 1776 it named a committee to 
 make a report on the subject, and devise means to put a stop to this 
 prodigality of mutilations. It was shown that in the diocese of Saint 
 Papoul alone, more than five hundred little boys were cut by the auda- 
 cious charlatans, who received thirty-five livres for every operation of 
 that nature. Haller assures us that in the Swiss cantons, there existed, 
 in his time, a number of men deprived of testicles for the same cause. 
 Let us felicitate modern surgei-y for having reduced the necessity of cas- 
 tration to excessively rare cases. 
 
 Though we have limited ourselves to present the history of this opera- 
 tion in a medical point of view, it is proper to say that long before science 
 had dared avail herself of this extreme resource, in diseases deemed 
 incurable, human passions, polities, jealousy and vengeance, had invented 
 this cruel means, and had not hesitated to exercise it on a grand scale. 
 Eunuchs were common in Egypt, Assyria, and other countries of the 
 East, even before Moses, while castration, as a therapeutic resource, was 
 not employed till after Hippocrates. But do the passions count the suf- 
 ferings, or even the lives of men as anything, when they wish to gratify 
 their ends ? The custom of mutilating young boys to preserve their 
 tone and extent of voice, which is lost at puberty, was kept up in Italy 
 to a recent period, notwithstanding the denunciation of both religion and 
 the laws ; and avaricious parents have been known to ofier their children 
 to this degradation.
 
 EXTERNAL PATHOLOGY AND THERAPEUTICS. 459 
 
 DISEASES or THE ANUS. 
 
 A single one of these diseases, tlie anal fistula, demands special aid 
 from surgery. We are astonished in reading the little Hippocratic 
 treatise relative to this affection, at the exactness with which the treat- 
 ment it requires is there traced. The most of the curative means now 
 advised in such circumstances, are there already enumerated ; and the 
 writers of later periods, until the period of the revival of learning, added 
 very little to the details furnished in this monograph, which is one of 
 the most precious treatises of Hippocratic surgery. 
 
 DISEASES OF THE MEMBERS. 
 
 External Aneurisms. — Aneurisms may exist in all parts of the body, 
 but they are not susceptible of surgical treatment except when seated in 
 the members ; and it is on this supposition only that we take it up. 
 Before the anatomical discoveries of the Alexandrian school, only inexact 
 and erroneous ideas could be held on the subject of aneurisms. At that 
 time the arteries and veins were confounded together ; and when they 
 were known to be distinct, the arteries were supposed to contain air, 
 and not blood. Celsus was not ignorant that the arteries contained 
 blood, for he affrms that a wounded artery does not cicatrise, and some- 
 times allows the blood to escape with great violence ; but he makes no 
 mention of the morbid dilatation of that order of vessels. Philagrius 
 is the first who has spoken of it, and who has indicated the means to 
 remedy this accident. That bold surgeon passed a ligature above and 
 below the tumor ; then he excised it and filled the wound with medica- 
 ments, to establish supuration. Antyllus employed, equally, the double 
 ligature ; but instead of excising the tumor he was contented with 
 emptying it of the clot of blood which it contained, and filling up the 
 cavity with materials to promote supuration. In fine, in the fifteenth 
 century John de Vigo conceived the plan of treating aneurismal tumors 
 by gradual compression and styptics. Xothing has been added since, to 
 the modes of treatment we have just enumerated ; on the contrary 
 excision has been abandoned as always useless, and often dangerous ; 
 but great improvements have been made in the manner of executing the 
 ligature and compression, as well as everything that belongs to the diag- 
 nosis of the disease. 
 
 ON AMPUT.iTION OF MEMBERS. 
 
 A multitude of circumstances may demand the necessity of having 
 recourse to this melancholy resource — the last of all, but sometimes the 
 only one to save the life of the patient ; nevertheless, there is only one 
 allusion made to it in the Hippocratic writings, which is in the following
 
 460 REFORM PERIOD. 
 
 terms: "When, as the result of a fracture, gangrene with discolora- 
 tion supervene suddenly, the whole body perishes. If the bone has been 
 taken off, the flesh which must fall is promptly separated ; but if the 
 bone remains sound, though the flesh quickly falls, it exfoliates slowly 
 where it has been left uncovered by the gangrene. Everything must 
 be removed from the articulation, above the gangrene, having care not to 
 touch any living part ; for if the operator touches that which is sensible, 
 in cutting a part which is not entirely dead, the patient is exposed to 
 pains which produce sometimes their death." It is easy to see by this 
 passage, even, that the complete amputation of a member, of both flesh 
 and bone, was rarely, if ever, practised among the Asclepiadse : for they 
 were not ignorant that it was less the pain than the hemorrhage or 
 inflammation that causes patients to perish. But what most proves 
 liow little skillful they were to practice amputation, is, that they make 
 no mention of this surgical means even where it would be most indi- 
 cated. It was jirobably the surgeons of Alexandria who dared the first 
 to attempt this grave operation. Celsus counseled it in cases where 
 gangrene attacks a member without having also attacked the trunk, 
 though he avows that there is extreme peril in doing it. "But," he 
 .adds, " when it is the only resource, there must be no hesitation about 
 employing it, whatever uncertainty may accompany it." He also recom- 
 mends that the amputation be made between the dead and the sound 
 parts, in such a manner as to affect much more the latter, and alwaj'S 
 keeping as far as possible from the articulation. When the bone was 
 reached, he advised to saw the bone as high as possible, so that more 
 flesh would remain to cover the stump. 
 
 The method of great amputations received but few modifications in the 
 centuries of decadence which followed. As the most immediate danger 
 in all these cases is always from hemorrhage, it was conceived best, in 
 order to avoid it, to cauterize the stump with a red-hot iron, with boil- 
 ing pitch, or other escharotic substances. But there resulted from 
 these methods, as may well be supposed, atrocious pains and fearful in- 
 flammations, which must have carried off most of the patients, and 
 disgusted, likewise, the operators. It was on this account that Guy de 
 Chauliac recommended to let the part full off itself, rather than recur 
 to the operation. 
 
 A new era dawned on this capital branch of surgery, when A. Pare 
 substituted the ligature of the arteries for cauterization, in the first 
 dressing. From that epoch successive improvements were introduced 
 both in the mode of operation, as well as in the consecutive treatment. 
 There was much discussion, also, on the dangers and advantages of im- 
 Tnediate or deferred amputations. At the head of the surgeons who
 
 EXTERNAL PATHOLOaY AND THERAPEUTICS. 461 
 
 concurred in these improvements, and took an honorable part in those great 
 discussions, I will cite D. Anel, .Teau Louis Petit, H. F. Ledran, Anthony 
 Louis, Ulric Bilguer, Brasdor, Benjamin Bell, Peter Joseph Desault, and 
 John Hunter. 
 
 ON O R T H O P ^K II I A . 
 
 The first who wrote a special treatise on this branch of surgery was 
 Xicholas Audry, who defined it an art to correct the deformities of 
 the body, in young subjects. That definition is clear, conformable to 
 etymology, and seems to us to indicate well the end that is proposed in 
 this branch of the Art, and we therefore think we cannot do better than 
 retain it. We find in the most ancient books of Medicine some traces 
 of orthopgedia, and notably in the Hippocratic treatise on Articulations, 
 where we read, among othei'S, the following passage : " There are also 
 some congenital luxations which, if the displacement is small, are sus- 
 ceptible of being reduced, especially those that affect the articulations 
 of the feet. The natural club-foot of birth is curable, in most cases, 
 when the deviation is not very great, and the child is not too old. The 
 best way is to treat the deformity as speedily as possible — before the 
 bones are greatly diminished and the flesh is greatly reduced. There is 
 not only a single species of club-foot — there are several of them ; but the 
 greater part are not complete luxations, but deviations of the foot in- 
 ward, and retained by some means in a constant position. The following 
 points are necessary to observe in the treatment." '••' The author then 
 traces, with much detail, the curative method in these deformities. 
 
 All the surgical works which have been written since, include some 
 fragments relative to the same subject; but these documents disseminated 
 in the midst of other subjects, in various chapters, do not form, in any 
 respect, a body of doctrine. Before the last century, no one had dreamed 
 of extracting them and uniting them, with special reference to ortho- 
 piedia ; it was then a rare and happy idea to call the attention of prac- 
 titioners to this special object, which must sooner or later contribute to 
 the physical perfection of the human species. Though the work of M. 
 Andry, which was the most important that was published in the course 
 of the eighteenth century, contains the usual imperfections of a first 
 essay, it is not without merit at the present time ; for it contains judi- 
 cious precepts — observations full of sagacity, though occasionally in 
 contact with prejudices and errors, often ridiculous. We will also point 
 out, as worthy of being consulted, the works of Levacher de la Feutrie, 
 J. Venel, Anth. Portal, etc. 
 
 ■' OEuvres d'Hippocrate, by Littre — on Articulations.
 
 462 REFORM PERIOD. 
 
 CHAP TEE VII. 
 OBSTETRICS. 
 
 We have seen that the art of accouchement remained very much in the 
 rear of other branches of surgery, notwithstanding the very estimable 
 efforts of some surgeons, to draw it fx'om the state of abjection in which 
 it vegetated. But a very particular cause was an obstacle to its pro- 
 gress. The most of the women employed in childbed, were ignorant old 
 matrons, who, attached to their old routine, which had been followed 
 from time immemorial, repelled all innoTation. Accoucheurs were 
 called in extraordinary cases only, where, from the grave and urgent 
 circumstances, they could not acquii'e, except with difficulty, the expe- 
 perience that inspires useful reforms. However, the prejudices that 
 excluded them from the pi-acticc of midwifery, gradually gave way, and 
 a new era opened for obstetrics. 
 
 In the beginning of the seventeenth century a sage-femme, Louisa 
 Bourgeois, called Boursier, sage-femme of 'Marie de Medicis, made an 
 exception to the common rule, by publishing a collection of observations,'--' 
 in which we meet with several new idcas.f Tinally, the art of accouche- 
 ments came forth from its beaten path, to assume a reform truly scientific, 
 based on rational principles, when Francis Mauriceau, accoucheur-in- 
 chief of the Hotel Dieu, in Paris, published his treatise on the diseases 
 of pregnant women, and those in childbed, which was a complete and 
 methodic collection of the observations derived from those who had pre- 
 ceded him, with those which his own extended practice had furnished. 
 The first edition of this work appeared in 1GG8. It was translated 
 into nearly all the languages of Europe, and powerfully contributed to 
 vulgarise sound obstetrical doctrines. The way once opened, a crowd of 
 competitors came forth, and by their labors enlarged it very much. In 
 that number we particularly distinguish Paul Portal, Deventer, Pen, 
 Amand, and Delamotte, who were cotemporaries, and formed the transi- 
 tion from the seventeenth to the eighteenth centuries. 
 
 * Observations diverses sur la Sterility, Perte de Fruit, Fe'condite', Accouchement, 
 et Maladies des Femmes, et Eufants nouveau — ne's. Paris, 1G09 or 1626. 
 
 •(■ We will mention, also, as forming an exception to the common rule in these 
 latter times, two women, whose -works are marked by sound observations: Madame 
 Lachapelle, sage-femme in chief of the Maison d' Accouchement of Paris [Pra- 
 tisqne des Accoiichemmts, Paris, 1825;) Madame Boivin, sage-femme in chief of the 
 Maison Royale de Sante. [Memorial de Part des Accouehements, Paris 183G, 4th Ed. 
 Trait e des Maladies de VUteru,s, Paris, 1833).
 
 OBSTETRICS. 463 
 
 About this time, the Chamberlaius, a family of English practitionei's, 
 who devoted themselves exclusively to the practice of accouchements, 
 invented an instrument to facilitate the extraction of the head, when it 
 was arrested in its passage. One of them, Hughes, came to Paris to 
 try his instrument, but not succeeding in a difficult case, he passed on 
 to Holland, where he obtained more success. Two accoucheurs of that 
 country, Eoonhuyson and Euysch, bought his secret, which they kept 
 too faithfully for the sake of their own memory and humanity. But in 
 1721, a surgeon of Gand, named John Palfyn, in seeking to discover 
 the secret of the Chamberlains, conceived the idea of contriving a tire- 
 tete (literally, a head-drawer,) composed of two steel spoons. He 
 hastened to publish it, and merits, by this very praiseworthy act, the 
 title of first inventor of the forceps. His tire-tete, advantageously 
 modified by Smellie, of England, and Levret, of France, has taken rank 
 under the name of forceps, among the most useful discoveries of modern 
 surgery. It has rendered much less frequeat the emj^loymeut of crochets, 
 and murderous instruments, and although it has not come into common 
 use, only within a hundred years, we can say, without exageration, that 
 it has already saved the lives of a multitude of women and children. 
 
 During the eighteenth century obstetrics advanced in several respects 
 to a degree of perfection similar to that of the exact sciences, by the con- 
 course of a great number of distinguished surgeons, who occupied them- 
 selves in its study, in a special manner. It is impossible to mention 
 here the names and titles of all those who rendered some service to this 
 branch of art; we shall mention in first rank, Levret and Smellie ; then, 
 Puzos, Burton, Ptoederer, Denman, Stein, Deleurye, Saxtorph, Solayres, 
 and his disciple J. L. Baudelocque, the most celebrated among the 
 last mentioned.'-' While the art became more perfect, establishments 
 
 * Baudelocque was not only the most renowned accoucheur of the close of the 
 last century ; but he recommends himself to us, also, by his grateful recognition 
 of the instruction received from his medical preceptor, as follows : " if a large 
 number of men, in perpetuating by their writings the art of Midwifery, have 
 rendered great services to the race, there is also a large number of others whose 
 knowledge, so to say, has been buried with them, and to whom society -would 
 have been no less indebted, if their incessant labors or premature death, had not 
 prevented them from publishing the fruit of their toil and experience. There is 
 one of these latter, of whom the recollection will perpetuate unceasingly our 
 regrets, and to whose memory we shall always pay with pleasure the tribute of 
 gratitude we justly owe him : I mean Solayres. It is less the man, whom we 
 esteemed, and whose death we regret, than the loss of that profound knowledge 
 of the art which he cultivated, and which he taught among us with the greatest 
 distinction. What I have been able to collect of his doctrines, will not compen- 
 sate for his loss, because a man cannot transmit his genius with the knowledge 
 he had acquired." L'Art des Accouchements, p. 10. 3d edit. 1796.
 
 464 REFORM PERIOD. 
 
 destined to propagate its lights and benefits, were multiplied. There 
 were erected in all the capitals of Europe, and in other cities, practical 
 schools of accouchements, where a crowd of pupils of both sexes entered, 
 to receive from skilful masters sound obstetrical doctrines. These 
 young accoucheurs — these new sage femmes — spread afterwards in 
 the most remote provinces the excellent precepts which they had 
 acquired, and combatted with success the time-honored prejudices of 
 ignorance. 
 
 To better appreciate the progress effected in obsti-etrical science 
 during the Reformative Period, we will examine successively some of the 
 capital points of the science. 
 
 PREGNANCY. 
 
 In order to recognize a state of pregnancy, the ancients had admitted 
 a mass of insignificant signs and ridiculous practices, in the midst of 
 which we find symptoms of a real value, such as the augmentation of the 
 volume of the uterus, the movements realized by women, in the womb, 
 the cessation of the menses, the developement of the mammae, and the 
 secretion of the milk. This collection of signs constitutes, doubtless, 
 a strong presumption of pregnancy, if not a certainty : but it is rare to 
 find them all associated in the same person, so that in the greater number 
 of cases, the ancients could only arrive at a probability, more or less 
 great. Moderns have added to the preceding symptoms, other signs, 
 by means of which we may reach much sooner, and more certainly, the 
 recognition of the state of pregnancy : these signs are, first, those ob- 
 tained by the vaginal touch, which have a great value ; secondly, 
 those furnished by auscultation, which has been recently applied to 
 this subject. 
 
 NATURAL LABOK. 
 
 The ancients were entirely ignorant of the relation that must exist 
 between the dimensions of the head of the infant, and the pelvis of the 
 mother, so that the labor might terminate by the sole forces of nature ; 
 neither had they any but false and vague ideas on the mechanism of this 
 function, and the true agencies that concur to effect it. They believed 
 for example, that the expulsion of the fetus was due to its own efforts, 
 which it made in order to get clear of its envelopes : while it is now 
 well known that in the act of parturition the fetus is entirely passive, 
 and that its expulsion from the womb of its mother is determined 
 principally, by the contractive action of the uterus and abdominal 
 muscles. The ancients also imagined that the head engages in the 
 pelvis in a transverse position : when the most simple inspection of the 
 parts suffices to show that this is not the case. In fact it is necessary 
 that the head, as it advances in the pelvic excavation, execute a spiral
 
 OBSTETRICS. 465 
 
 movement of nearly a quarter of a circle, so that its smaller diameters 
 shall constantly correspond to the least ones of the osteo-membranous 
 canal. The knowledge of these particulars, and a multitude of others, 
 is not, as may be supposed by those who are strangers to the art of 
 accouchements, a pure speculative knowledge ; so far from it, it is on the 
 contrary an indispensable knowledge, to enable the accoucheur to keep 
 himself unceasingly acquainted with the progress of the parturition ; 
 that he may be able at each phase of labor to appreciate with exactness 
 the nature of the obstacles which retard or arrest the accomplishment 
 of this function. 
 
 DIFFICULT LASOB. 
 
 The death of the infant in the womb of its mother, or its extreme 
 feebleness, constituted, in the eyes of the ancients, a very grave acci- 
 dent, which they regarded as an insurmountable obstacle to the natural 
 termination of the accouchement, as the result of the opinion they 
 entertained, that parturition depended on the efforts of the fetus. 
 Consequently, they did not hesitate, in this juncture, to employ crotchets 
 to extract the infant, an operation always fatal to it, in case it still 
 retains vital manifestations, and which is not without danger to the 
 mother. Experience, and a better theory of the mechanism of partu- 
 rition, have demonstrated that the death of the fetus opposes no great 
 obstacle to the accomplisliment of this act — that it obstructs it only a 
 little, and this circumstance by itself could never justify the employ- 
 ment of murderous instruments. 
 
 Hippocrates considered the presentation of the feet, also, as excess- 
 ively dangerous, and he advised recourse, in such a case, to various 
 maneuvers which would have a tendency to bring the head again to 
 the straight — maneuvers nearly always fruitless, and very often injuri- 
 ous. Moschion, a celebrated accoucheur of the second century of the 
 Christian era, Celsus, and Paul of iEgina;, appreciated better the incon- 
 vencies of this position ; they regarded it, truly, as much less advantageous 
 than that of the head, but not as opposing an insurmountable obstacle 
 to the spontaneous termination of the accouchement. In the presenta- 
 tions of the shoulder, and other parts of the trunk, the same accouch- 
 eurs established the principle, that it was necessary, in the first place, 
 to endeavor to bring the head to the passage, and if that could 
 not be done, to search for the feet, and take away the fetus by that 
 extremity.-- 
 
 *Paul. JEgin., lib. iii, cap. Lxxvr.— Aeteus, Tetr. IV, serm. 4, cap. xxni. — Gels. 
 lib. VII, cap. XXIX.
 
 466 REFORM PERIOD, 
 
 The moderns, fiucling that the efforts made with the view of bringing 
 the head again to the straight, are scarcely ever successful, and that 
 they were not without danger, both to the mother and the fetus, have 
 given the formal precept to get hold of the feet in all the presentations 
 of the trunk, and terminate the accouchement by the hand. They pre- 
 scribe the same plan whenever a hemorrhage or convulsions impose the 
 necessity of hastening the labor. 
 
 When the head, engaged in the excavation of the pelvis, no longer 
 advances or recedes, on account of the inertia of the uterus, or the gen- 
 eral exhaustion of the forces of the mother, the forceps now offers a 
 precious means for her delivery, without compromising the life of the 
 child ; while, before the invention of that instrument, the accoucheur 
 was compelled to pierce the cranium, and afterward make extraction 
 with a crotchet. Eecourse, however, in such a case, could be had to 
 symphyseotomy, if the narrowness of the inferior straight would not 
 permit to act efficaciously with the forceps. 
 
 Lastly, though the Cesarian operation had been known from the 
 remotest antiquity, it does not appear that it was practiced on the liv- 
 ing, in the earliest times. It was an extreme resource, which was only 
 resorted to on women who died in the act of labor ; in fact, a Eoman 
 law, attributed to Numa Pompilius {lex regia,) prescribed that all 
 women should be opened who died while pregnant, so as to save the 
 infant if possible. The first authentic example of hj'sterotomy execu- 
 ted on a living woman does not go fui'ther back than the fifteenth cen- 
 tury of our era, as we have before remarked. When a vice of 
 malformation of the pelvis, or an extraordinary volume in the fetus, 
 rendered its passage impossible through the natural passages, the 
 ancients knew no other expedient than to cut the infant in pieces in 
 the womb of its mother, and withdraw it in sections. The moderns 
 have dared, in such cases, to attempt the Cesarian operation, and have 
 sometimes succeeded in saving the lives of both mother and child." 
 
 THE PLACENTA. 
 
 The Asclepiadge had very well felt the importance of this last period 
 of the accouchement; their books allude to it in more than one place, 
 but in the midst of a crowd of useless or odd remedies, which they 
 recommend as proper to procure the evacuation of the after-birth ; the 
 following proceeding only, is worthy of notice. Place, they say, the 
 
 " See observations of MM. Professors Stoltz, (Memoires de I'Acade'uiic Eoyale 
 de Me'dicine. Paris, 1836) ; P. Dubois, (Bull, de I'Academie Royale de Me'dicine, 
 vol. Ill, p. G91, vol. V. p. 2o.)
 
 LEGAL MEDICINE. 467 
 
 woman on a chair witli a liole in it, or if slie is too feeble, lay her in 
 a bed very much inclined : then place the child, which is still connected 
 with the umbilical cord, on recently carded and very soft wool, so that 
 its weight shall draw gently, and without a jerk ; or better still, have 
 two leather bottles full of water, tied together, cover them with wool, 
 and lay the child upon them ; then pierce each with a small instru- 
 ment, so that the water shall slowly run out, and the weight of the 
 child be thus gradually made to draw upon the after-birth/-' 
 
 Celsus, to fulfil the same indication, gives much more simple and 
 rational directions. " The physician," he says, " should give the infant 
 in charge of an assistant ; then he should make moderate traction on the 
 umbilical cord, with the left hand, so as not to break it. If that does 
 not suffice, he must carry the right hand along the iimbilical cord to 
 the after-birth, detach the vascular and membranous connections which 
 unite it to the body of the womb, and then withdraw it entire, as well 
 as the clots of blood which may have accumulated in the uterine cavity." f 
 
 The accoucheurs who followed Celsus have all repeated the precept 
 which we have just transcribed ; but the moderns only have completed 
 it, in pointing out the cases in which it is necessary to hasten the deliv- 
 ery of the after-birth, and those where it is proper to delay ; and in 
 indicating the course to be pursued when there is an hour-glass con- 
 traction, or the umbilical cord is ruptured. 
 
 CHAPTER VIII. 
 
 LEGAL MEDICINE. 
 
 If, with Fodere, legal Medicine be defined, the rational application of 
 all physical, natural, and medical knowledge, to the execution of the 
 laws, and the conservation of public health, there is no doubt but that 
 the history of the ancients would ofi'er us numerous examples of this 
 species of Medicine, We have already signalized remarkable examples 
 of it in the legislation of the Egyptians, the Hebrews, and other cele- 
 brated nations of anticjuity. The old lioman laws, attributed to Xuma 
 Pompilius, and designated by the title. Leges Regice, contained also a 
 very judicious application of the physical knowledge of the times, in 
 
 ~ Traitc de la Superfetation. Also, De la Nature de la Ferume. Maladies des 
 Femmes. 
 
 t Lib. II., cap. XXIX.
 
 468 REFORM PERIOD. 
 
 several of tlicir cuactments relative to testaments, to the separation of 
 the spouse, to the nullity of marriages, to abortion, to the presumption 
 of survivorship, etc. But it seems to me that such a definition embraces 
 too many objects, and that medical science, considered, as has just been 
 said, in all the application that can be made of it, by governments, to 
 the public health, has been better denominated by recent vrriters, 
 political Medicine. Consequently, we shall define legal Medicine, with 
 some jurist physicians of great reputation, the xoliole of medical and phy- 
 sical knowledge proiyer to enlighten magistrates in the administration of 
 justice.'-' 
 
 The custom of summoning physicians into the sanctuary of justice, to 
 enlighten the magistrate on certain questions which require special no- 
 tions in physics and in medicine, does not go back to a very ancient 
 epoch. I'odere, from whom we borrow nearly all the substance of this 
 cbapter, says that it commenced under the first Christian emperors, and 
 that it owes its origin to ecclesiastical authority. Charlemagne con- 
 firmed afterwards what Justinian had prescribed. He ordered, in his 
 Capitularies, that in the questions that pertain to man, the jvdges shall 
 support themselves on the advice of physicians, and that tlie visits, as 
 well as the reports, be made by men recognized as masters in the Art. and 
 of hi g] I moral character, by intelligent jurors acquainted xoith matters 
 belonging to the case. The tribunal of Chatelet appears to have been 
 the first which comprehended the utility of consulting with expert phy- 
 sicians, whose knowledge they could invoke whenever they felt its need. 
 An edict of Philippe le Bel, of 1311, qualified Master John Potard with 
 the title of sworn surgeon of Chatelet. 
 
 Nevertheless, legal medicine was not yet, at that epoch, but in a 
 rudimentary state. It was composed only of a small number of princi- 
 ples, disseminated in the general treatises of medicine or surgery, and 
 obscured by many prejudices. There were connected with the tribunals 
 sworn sage femmes, as well as sworn physicians. Laurent Joubert cites, 
 in his Recuil des Erreurs Poptdaires, three reports of sage femmes, rela- 
 tive to accusations of violation and defloration. The reports — one pre- 
 pai*ed at Paris, another at Beam, the third at Carcassone — agree among 
 themselves in pointing out certain lesions, as indicating violent attempts 
 upon chastity. The author concludes that the opinions of the experts of 
 his time was unanimous on these points ; but he does not hesitate to 
 combat that opinion in discussing in succession the pretended signs 
 
 " See Prunelle's Discourse before the Faculty at Montpelier, 1811 ; OrfiUa, Lefons 
 de Me'decine Le'gale, t. I., lee. i. Diet, de Medecine., in 21 vols., art. Me'decine 
 Politique.
 
 LEGAL MEDICINE. 469 
 
 alleged in the reports, and he demonstrates, from the most respectable 
 authorities in Medicine, that they are superficial or false. The follow- 
 ing is one of the reports alluded to, by which we may judge of the value 
 of the others. ■•' 
 
 The constitution published by the Emperor Charles Y., in 1552, gave 
 great importance to Legal Medifine, by extending, and determining 
 much better than had been done before, its attributes ; that legislator, 
 treated, in detail, questions of infanticide, wounds, poisoning, abortion, 
 and he mentions the means proper to be employed, to establish these 
 sorts of crimes. He requested that medical men commence to establish, 
 in a positive manner, what was the sum of the offense ; and he 
 traced the rules for drawing up reports of cases tried in the courts. 
 The one hundred and forty-seventh article of that constitution pre- 
 scribes a public examination when a questionable hurt is followed by 
 death, if the death was really the necessary effect of the wound ; or, 
 if it proceeded from some other cause, as, for instance, negligence, or 
 bad treatment, etc. Several ordinances of the Kings of France contain 
 analagous sections ; notably, that of Henry III, dated 1570. 
 
 At the beginning of the seventeenth century, Fortunatus Fidelis, 
 having drawn together all that had been written on this matter, pub- 
 lished the first special treatise on Legal Medicine. From .that time 
 this branch of science had a separate and distinct existence, and 
 rapidly increased. Paul Zacchias, physician to Pope Innocent X., 
 contributed very much to its extension, by making public his Medico- 
 legal questions, which enjoyed, for more than a half century, a universal 
 reputation, and still preserve, notwithstanding the incessant progress 
 of physico-natural sciences, a part of their intercst.f 
 
 '- " Nous Marion Teste, Jane de Meaux, Jane de la Guigans, et Magdeleine de la 
 Lippue, matrones jure'es de la ville de Paris, certifions a tous qii'il appartiendra 
 que, le lie jour de juin lo32, par orJonnance de M. le prc'vost de Paris, ou son 
 lieutenant en ladite ville, nous somnies transporte'es en la rue de Fre'paut, oii 
 pend pour enseigne la Pantoufle, ou nous avons vu et visite Henriette Peliciere, 
 jeune fille de quinze ans ou environ, sur la plainte par elle faite a justice, contre 
 Simon le Bragard, duquel elle a dit avoir ete force'e et defloree. Le tout vu et 
 visite au doigt et a I'oeil, nous trouvons qu'elle a : 1. les barres froissees, 2. le 
 baleron demis, 3. la dame du milieu retire'e, 4. le ponnant deTaiflFe', 5. les toutons 
 devoyes, G. I'enchenart re'tourne', 7. la babolle abattue, 8. I'entrepont ride, 9. 1'ar- 
 riere-fosse ouverte, 10. le guilloquet fendu, 11. le lippon recoquillc, 12. le barbi- 
 dant tout e'corche', 13. tout le lipandis pele', l-t. le quillevard elargi, les balunans 
 pendans: le tout vu et visite feuillet par feuillet, avons trouve' qu'il y avait trace 
 de v.. Ainsi nous dites matrones, certifions etre vrai, a vous, M. le prevost, au 
 serment qu'avons a ladite ville." (Ire partie, liv. v. chap, iv.) 
 
 t Qu;estiones medico-legales. Ire Ed., Amsterdam, 1651. This work had a 
 great numb2r of Editions.
 
 470 REFORM PERIOD. 
 
 Legal Medicine does not constitute, rigorously speaking, a particular 
 branch of science ; it is nothing else than the special application of the 
 light furnished by it, to the clearing up of certain judicial questions. 
 But this special application requires to be well directed, a tact and 
 skill -which all practitioners cannot possibly acquire ; and, even a 
 knowledge of laws, to which they are often strangers. On that account, 
 several ,Kings of France, Henry IV, and Louis XIY. among others, 
 established, in all the communes and principal cities, royal sworn physi- 
 cians, charged to make the report in legal trials. " This establishment," 
 says Fodere, " did not do all the good that it promised, because it was 
 stricken, from its birth, with a mortal disease, the venality of officers !" 
 Nevertheless, this philosophic writer does not hesitate to express a 
 desire to see re-established in our days, a similar institution ; but, free 
 from the original vice that reproached it. 
 
 Among the legal physicians of the eighteenth century, whose writings 
 have contributed most to advance science. I will particularly mention 
 John Bohn, professor at Leipsic ; Michael-Bernard Valentin, professor in 
 the University at Halle, and one of the most distinguished sectators of 
 Stahlism ; Herman Frederic Teichmeyer, professor in the LTniversity at 
 Jena, who had A. Haller for a pupil and a son-in-law ; Oliver Mahon, 
 professor in the School of Paris ; John Daniel Metzger, professor in the 
 University at Koenigsburgh, J. P. Frank, and many others ; but, above 
 all, the Savan from whom we have borrowed the greater part of the 
 ideas emitted in this chapter. 
 
 CHAPTER IX. 
 
 CLINICS. 
 
 We have heretofore said, that two modes of clinical instruction may 
 be pointed out, namely, oral and written. In the first, the patients are 
 put under the observation of the students, who observe, for themselves, 
 the symptoms, the course and termination of the diseases, as well as the 
 effect of the remedies prescribed by the professor. This is clinical 
 instruction properly said, such as was practiced in the sacerdotal 
 families of Egypt and Greece, who were devoted to the worship of 
 Esculapius and such as it exists now, in all the faculties and schools of 
 Medicine. The second method of clinical instruction consists in the 
 observation, or the histories of diseases, gathered at the bed-side of the
 
 CLINICS. 471 
 
 sick, witli all the details of treatment, and published afterward, 
 both for the instruction of pupils and the advancement of science. 
 These kind of clinical repertories are, indeed, of great utility. The 
 nosologist may, and must draw from them the natural characters of the 
 morbid species he describes ; the therapeutist finds there, also, models 
 of treatment for each disease, which enables him to deduce the general 
 and particular rules of his art. Thus the facts of daily practice, 
 observed with attention, and traced with fidelity, serve to constitute 
 and develope science: science, in its turn, presents, in abridged for- 
 mula?, the summary of the experience of all ages — directs the prac- 
 titioner with greatest certainty, from day to day — spares him infinite 
 gropings, and deplorable errors. 
 
 §1. Or.\l Clinical Teaching. 
 We have alread}' stated why this mode of instruction, the most effica- 
 cious of all, and the best to form excellent practitioners, was maintained in 
 the Asclepidean families, particularly in that of Cos, till the foundation 
 of the school at Alexandria, and why it was afterward abandoned, to be 
 revived only at an epoch very close to our own. Some crudites have 
 thought that they have discovered traces of cliuical teaching in the 
 histories of the Arabian Universities, and cite, in support of this opin- 
 ion, a passage of Ali-Abbas, in which that author assumes to have col- 
 lected at the bedside the most of the descriptions of diseases which he 
 reports ; and in another passage, where he recommends young physicians 
 to frec[uent the hospitals. But the presence of a few pu2)ils during the 
 visitations and consultations of the physicians of a hospital, constitutes 
 no more clinical teaching, than the practice adopted by some practi- 
 tioners of antique Eome, to train after them in the streets, and in the 
 houses of their clients, a group of men of every class, whom they deco- 
 rated with the title of disciples. 
 
 The first essay in clinical teaching, of which the historj^ of medicine 
 makes mention, since the dissolution of the Asclepidean schools, 
 occurred in 1578, at the hospital of St. Francis, in Padua. The pro- 
 fessors, Albert Bottoni and Mark Oddo, had charge of it : one had the 
 female, the other the male ward." We are ignorant whether this mode 
 of instruction was continued, after them, but we are led to think it was 
 discontinued, from the fact that none are named as their immediate 
 successors. About the commencement of the seventeenth century. Otto 
 de Heurn, professor of practical medicine in the Universit3^ of Leyden, 
 introduced the practice of giving bedside instruction. Francis of Lebo, 
 
 * Comparetti Saggio dclla Scuola Cliiiica nello spedale di Padova. p. 6. Thoma- 
 8iu8, DeGymnasio Patorino, lib. iv., p. 420.
 
 472 REFORM PERIOD. 
 
 called Silvius, who succeeded him, adopted the same plan ; his clinical 
 lessons had great reiiute, and drew a numerous concourse of auditors 
 from the year 1658 to 1672, which has caused him to be regarded as 
 the founder or restorer of this mode of teaching. 
 
 Notwithstanding the eclat of this innovation, and its well recognised 
 utility, the successors of Sylvius let it fall into disuse. Clinical instruc- 
 tion ceased to exist for more than forty years, till the epoch when Her- 
 mann Boerhaave, already invested with several functions in the Uni- 
 versity of Leyden, was charged also with the duties of the chair of 
 practical medicine. The illustrious professor conceived at once what 
 advantage must accrue to the students, if the teacher made an applica- 
 tion, in their presence, of the principles he had inculcated. Though 
 the hospital at Leyden offered few resources for clinical teaching, on 
 account of the small numher of beds it contained, Boerhaave made such 
 good use of them, that very soon auditors came to his course from all 
 parts of Europe. His renown, which was already great, for he had pub- 
 lished his two principal works, the Institutes, and Aphorisms, became 
 immense. Persons came to consult him, from the most distant countries. 
 He was in correspondence with several sovereigns, and even with the 
 Pope, though he was a Protestant. Finally, he received, on a memo- 
 rable occasion, a very touching testimonial of the regard of his fellow- 
 citizens. A disease having forced him to interrrupt his teaching for 
 six months, the first day of his convalescence was celebrated by a gene- 
 ral and spontaneous illumination. 
 
 Now, if we seek to ascertain the real merits that recommend this illus- 
 trious man to the admiration of posterity, we shall find them clearly 
 deduced in the following passage from one of his biographers. " Boer- 
 haave," he says, " exercised during his life, and long afterward, an 
 immense influence in medicine. Inferior in genius to his cotemporaries, 
 Frederick Hoffman and Stahl, he had a reputation more universally dif- 
 fused, and his doctrines have long prevailed over those of his rivals. 
 He owed this advantage to the eclat of his teachings, and the brilliant 
 qualities of his mind. Endowed with activity and rare facility, he 
 acquired the most varied and extended knowledge. He formed from 
 this a system, united in all its parts with infinite art ; presented in his 
 lectures and in his works with method, clearness, precision, and embel- 
 lished with an uncommon grace of elocution, it acquired, as may easily 
 be conceived, universal commendation. This system, which may be 
 considered as a veritable Eclecticism, is made up of some ideas of Them- 
 ison and the ancient Methodists, of those of the medico-chemist Lebo, 
 and especially of the mechanical theories of the iatro-mathomaticians, 
 toward whom his taste, and his studies in the mathematical sciences,
 
 CLINICS. 473 
 
 naturally carried him. The latter theories arc predominant, which have 
 justly caused Boerhaave to be ranked among mechanic physicians. It 
 is to be regretted that with such happy faculties for observation, Boer- 
 haave allows himself to be drawn, against his principles even, into the 
 vortex of systems and hypotheses. He commences by preaching, enthu- 
 siastically, the method of Hippocrates, and ends hy following the bril- 
 liant but unsafe example of Galen."-' 
 
 The prodigious success of the clinic at Leyden, was decisive in favor of 
 that mode of teaching. From the following year, 1715, the sovereign pon- 
 tiff established, at Eome, a similar institution, directed by the cele- 
 brated Lancisi. Soon, Edinburgh, in Scotland, Vienna, in Austria, 
 Pavia, and other cities in Italy, as well as in England and Germany, 
 were endowed with clinical chairs. France followed a little later these 
 examples. In 1795, was established, at Paris, the first chair of clinical 
 medicine which the school of that city ever possessed. Corvisart, who 
 occupied it at first, with J. J. Leroux, elevated his teaching to a level 
 with those of the highest reputation. In fine, the close of the eighteenth 
 century saw clinical instruction established in all the schools of Europe, 
 and even in some of those of the New World. 
 
 After the death of Boerhaave, the faculty of Leyden, which had been 
 elevated to the highest degree of splendor, rapidly declined. That of 
 Edinburgh, and above all, that of Vienna, occupied thereafter the first 
 rank, and so existed, without rivals, during more than half a century. 
 The clinical chair of Vienna, founded in 1733, by Van Swieten, under 
 the auspices of the Empress Maria Theresa, was occupied successively 
 by Anthony de Haen, Maximillian Stoll, and John Peter Frank, who 
 still occupied it at the commencement of the present century, after 
 having been one of the glories of the school of Pavia. Thus, after an 
 interruption of more than two thousand years, clinical teaching was 
 revive 1 more brilliant than it ever had been.j 
 
 '^' Diet. Hist, de Med. by M. Dezeimeris, art. Boerhaave. 
 
 fWe have sketched in this section the history of public and official clinical 
 instruction. As to private and free instruction, everything leads us to believe 
 that it never entirely ceased; but it can not be traced with certainty. It is more 
 than probable that in all time, physicians attached one or more young men to 
 their business, who accompanied them in their visits, both in private and hospital 
 practice, whom they trained in the healing art, both by their example and their 
 counsels. In this way the popular archiaters, created by the edict of the Emperor 
 of Rome, were charged to instruct and examine the aspirants to the practice of 
 medicine. In this way also were instituted temporarily, several clinics in Persia 
 and other countries under Arab dominion, and so, also, in 1780, L. Desbois de 
 Rochefort (born in Paris, October 9, 17.50, died 26th of January, 1786), gave at 
 La Charite Hospital, Paris, clinical medical instruction, which attracted anumer. 
 ous assemblage of auditors. 
 
 30
 
 474 REFORM PERIOD. 
 
 § II. Collection of Clinical Observations. 
 
 We have seen that the physicians of the Erudite Period, having 
 observed and described diseases with more care than physicians of the 
 middle ages, discovered a great number of morbid species, which had 
 escaped their predecessors, such as syphilis, scurvy, raphania, etc. 
 During the Keformative Period, the number of medical observers 
 still increased, but they devoted themselves less to attempts to discover 
 new species, than to determine well the characters of those which already 
 existed, to the formation of more exact and methodic descriptions and 
 classifications, as before remarked, in the section on nosology. Studies 
 were especially directed during this period, to the influence of climates, 
 seasons, regimen, and epidemic constitutions. On these subjects obser- 
 vations had long been neglected, and they promised an ample harvest of 
 discoveries, for the progress of physics and chemistry offered to men 
 of Art the means of establishing, with a precision unknown to the 
 ancients, the variations in temperature, the qualities of the air, of food 
 and drinks, in a word, the influence of all hygienic agents. It is then 
 principally under this aspect, that we proceed to consider the results of 
 clinical observations collected during the last two centuries. 
 
 Hippocrates had left to his successors a brilliant outline of medical 
 topography, in his treatise on Airs, Waters and Places. So, also, he 
 left them, in his first and third book on Epidemics, some tableaux of 
 epidemic constitutions, worthy of serving as models in the epoch when 
 they were traced. But the physicians of succeeding ages occupied 
 themselves but little with these objects, notwithstanding their recog- 
 nized utility, because they required continued observations during a long 
 coui"se of years, and a patience, abnegation and stability, which became 
 more and more rare among physicians after the decadence of the Ascle- 
 pidean schools. 
 
 § III. Epikemic Constitutions. 
 
 It was only at the end of the sixteenth century, when the Hippocratic 
 method began to obtain a preference over Galenism, that men devoted 
 themselves to the study of the influence of the air, regimen, and epi- 
 demic constitutions. William Baillou was the first among moderns, 
 who was distinguished for his researches on this subject. By his educa- 
 tion, writings, and genius, as well as by the times in which he lived, 
 this physician forms the transition from the Erudite to the Eeform 
 Period, and presents the insensible passage from the Galenism of J. 
 Fernel, to the Hippocratism of Sydenham and Stoll. Profoundly versed
 
 CLINICS. 475 
 
 in the Greek and Latin classics, prompt at repartee, subtile and eloquent 
 
 [ . in ai'gument, he was surnamed, iu his youth, the Plague of the Bachelors. 
 
 i By these qualities, he belongs to the class of philosophic, or erudite 
 
 r physicians, who followed in the tracks of Galen ; but what is extraor- 
 
 ' dinary, he joined to this accuteness and vivacity of spirit, a gentleness 
 
 and modesty of character which excited the love of his colleagues as 
 
 much as his talents excited their respect. They gave him an irrefutable 
 
 proof of esteem and affection, by conferring on him twice, unanimously, 
 
 the title of Dean. A lover of independence, but much more of 
 
 humanity, while he refused positions at court, the poor always found 
 
 him ready to give them, prodigally, his time, his attention, and succor of 
 
 every kind. At the expiration of his deanship, Baillou devoted himself 
 
 entirely to the practice of his profession, in which he displayed a talent 
 
 for observation, and a sincerity and exactness in his epidemic tableaux,. 
 
 of which there had been no example since Hippocrates. It was as a 
 
 practitioner that he acquired his finest titles to glory, and became 
 
 worthy to be placed at the head of modern Hippocratists.- 
 
 Baillou observed and described the epidemic constitutions that reigned, 
 in Paris from the year 1570 to 1580. The following is the tableau he 
 traced, of one of these constitutions: "The year of Grace 1573, the 
 weather was extremely variable during the whole course of the year, 
 during which a great many abnormal diseases were seen — particularly 
 quartan fevers ; and what was more astonishing is, that these fevers 
 assumed this type from the very first. The old physicians stated that 
 twenty years before thei-e had existed a similar temperature, and that a 
 considerable number of persons had died of quartan fevers. After death, 
 the spleen was found soft and shrunken, the bile evaporated, and con- 
 creted in the gall bladder. Those who were attacked with double 
 quartans, or complicated fevers, or who attempted to cure themselves 
 with remedies, nearly all succumbed. In the beginning of January, the 
 fever changed in character, and became, in some cases a double tertian, 
 and in others a benign, continued fever. Afterward, an infinite num- 
 ber of persons were tormented with itching, inflamed pustules, redness, 
 and articular pains — chiefly those whom the fever had wasted and dried 
 up. Did the perspiration which was observed in these sufferers from 
 fever, proceed from the dryness of the liver, or the general condition of 
 the body?" 
 
 He joined to the general sketch of each epidemic, the particular history 
 
 '^ He was born in Paris in 1538, and died in IGIG, aged 78 years. The best 
 edition of his works has been published under the title of OjKra Mediea 
 Omnia. Geneva, 1762.
 
 476 REFORM PERIOD. 
 
 of some diseases, and commentaries, whicli develop, confirm, and explain, 
 the principal traits of the general description. The following is one of 
 these histories, which I have purposely chosen among the briefest : The 
 spouse of the Consul Lysseus was taken, in the seventh month of preg- 
 nancy, with a flux like a dysentery, accompanied with tenesmus. Very 
 soon a continued fever lighted up. She went to stool thirty times, 
 during the night, and only made ineffectual efforts. An abortion was 
 feared. The disease was sustained especially by an abundance of 
 humors, which seemed to proceed from the region of the liver. Ehubarb 
 and cassia were administered successively, as well as clysters variously 
 composed. A vein was opened twice. Injections into rectum were 
 administered, and anodynes were given in every form, a day and a 
 night, to prevent abortion. The patient was re-established." This 
 clinical observation, like the one which precedes it, is conspicuous, as 
 is seen, by the clearness and conciseness which distinguish the legitimate 
 writings of Hippocrates. Possibly, we have a right to reproach Baillou, 
 as well as his model, for the absence of sufficient details, but it is 
 necessary to recall that the French Hij^pocrates was accustomed to add 
 to his particular histories an explanatory commentary. 
 
 A curious remark to make, in the course of this historic period, is, 
 *that in proportion as the authority of Hippocrates increased, that of 
 Galen declined ; nevertheless, until the end of the sixteenth century, 
 these two princes in medicine were confounded in a common worship, 
 and Baillou himself quotes both indifferently, in his commentaries. 
 But, after him, the reaction against G-alenism became general ; very 
 soon no one dared invoke the authority of the Pergamian, while, until 
 the latest times, men of the highest reputation — the Baglivi, the 
 Sydenhams, the Stahls, and the Pinels — boasted for themselves the title 
 •of Hippocratists. What, then, is the difference between the Galenism, 
 or the Dogmatism of Galen, Oribasis, Avicenna, and J. Fernel, and modern 
 Hippocratism ? No writer has taken the trouble to show us ; no one, 
 perhaps, has stated it in a well-defined manner. We will undertake to 
 supply their silence, and trace the line of demarkation which separates 
 these two doctrines. 
 
 Por this purpose we recall here what as said in the Anatomical 
 Period on the subject of the ancient Dogmatism : that it is composed 
 of two distinct theories, namely, the theory of coction and crisis, and 
 the theory of four elements, or four primordial humors. Galen and 
 his successors embraced this doctrine in its totality ; they enlarged, 
 commented upon, and endeavored to explain by it, all the }ihenomeua of 
 animated nature. But the progress of physics and chemistry, in the 
 .-sixteenth century having demonstrated the errors of the theory of four
 
 CLINICS. 477 
 
 elements, it was irresistably necessary to renounce that part of the 
 ancient Dogmatism, and cling only to the first. It was then that the 
 sect of modern Hippocratists was formed, which preserved of the doctrine 
 of Hippocrates only the dogma of coction and crisis, founded on the 
 existence of a principle, or intrinsic force, inherent in every living 
 being, and presiding over, or at least co-operating in, all the phenomena, 
 whether physiological or pathological, that are developed in it. The 
 consequence of this theory is, to consider every derangement of the 
 health as an effort of nature, or the vital principle, tending to remove 
 the obstacles which oppose themselves to the free exercise of its func- 
 tions : hence the aphorism, that the physician is the minister of nature — 
 that he must study its tendencies, and respect them, insomuch as they 
 are not evidently bad, and, in short, to interfere with remedies only 
 when the vital forces appear iuefl&cient, or sur-excited, or deviated. One 
 is a Hippoeratist, in the modern sense, from the moment he admits the 
 autocratism of nature, or the vital forces, no matter otherwise how much 
 he tend, with Sydenham, toward humoralism, with Stahl, to animism, 
 or with Pinel, to solidism, etc. There is, as is seen in our days, great 
 latitude in the qualification of Hippocratists, and many physicians to 
 whom it is applied, and who themselves profess it, have advocated 
 doctrines extremely diverse. 
 
 However this may be, we have not to examine here the value of the 
 fundamental axiom of modern Hippocratism. That examination will 
 be more appropriate in the chapter on theories and systems. It has 
 sufiiced for the moment to show in what modern Hippocratism differs 
 from the ancient Dogmatism — that is, from Galenism. 
 
 Thomas Sydenham, who flourished during the second half of the 
 seventeenth century, merits the surname of the English Hippocrates, as 
 much on account of his medical doctrine, as of the profound study he 
 made on the influence of epidemic constitutions. Partisan of the phi- 
 losophy of Locke, of whom he was the cotemporary and friend, he was 
 one of the first who strove to bring physicians back to the observation 
 of pure and simple pathological phenomena, of which Hippocrates had 
 given the example in some of his writings. 
 
 We give here some maxims extracted from the works of Sydenham, 
 which seem to us to comprise the medical philosophy of that author : 
 "In the first place," he says, "it is necessary to reduce all diseases to 
 precise and determined species, with the same care and the same exact- 
 ness that the botanists have displayed in their treatises on plants. In 
 the second place, whoever desires to give a history of a disease, should 
 renounce every philosophic system and hypothesis, and mark exactly 
 the smallest morbid phenomena which are clear and natural ; imitating
 
 478 REFORM PERIOD. 
 
 thus, the painter?, who, in their portraits, have great care to express 
 even the slightest marks of the persons whom they desire to represent. 
 In the third phxce, it is necessary, in the description of a disease, to 
 expose separately the proper or essential, and the accidental and foreign 
 symptoms. In fine, the seasons that favor most each order of symp- 
 toms must be carefully marked. These are not the only things neces- 
 sary to observe in writing the history of diseases, but they are the 
 principal."" Such are, in regard to pathology, the general principles of 
 Sydenham. 
 
 In regard to therapeutics, he expresses himself in these terms: " The 
 great Hippocrates, after having established as a solid basis of his Art, 
 this incontestible axiom, namely : nature cures diseases ; has exposed, 
 clearly, the symptoms of each of them, without having recourse to any 
 hypothesis or system, as may be seen in his works. He has, also, given 
 rules for treatment, founded on the course which nature takes in the pro- 
 duction and cure of diseases. This is very nearly in what consists the 
 theory of the father of Medicine, and all he demands of a physician is, 
 to succor nature when she is overcome, to correct her when she errs, and 
 to bring herback into the circle which she has just abandoned. It is 
 absolutely impossible for a physician to know the morbific causes which 
 have no relation to the senses; neither is it necessary."! 
 
 It is easy to recognize in this expose of principles, the doctrine of a 
 modern Hippocratist. but we find there, also, some maxims borrowed 
 from the ancient Empirics ; such as the following: "It is necessary to 
 describe the pathological symptoms as they manifest themselves, with- 
 out the aid of any hypothesis, and to reduce diseases to precise and 
 determined species, like the vegetable species formed by the botanist. 
 It is absolutely impossible for a physician to know the morbific causes 
 which are not all appreciable to the senses." The first of these projio- 
 sitions recalls, evidently, the symptomatic groups, or the theorems of 
 the ancient Empirics; the second excludes the research of the so-called 
 occult or essential causes against which those philosophic physicians 
 constantly protested. It it on this account doubtless, that some writers, 
 among others, Kurt, Sprcngel, have ranked Sydenham among the secta- 
 tors of Empiricism. But he is distinct from them in several respects, 
 principally in that he does not conform to his own sage maxims which 
 we have just (juoted, but, on the contrary, he transgresses and contra- 
 dicts them at every step. I might quote a crowd of these contradic- 
 tions, but shall content myself with the two following : " Every specific 
 
 ' (Euvres tie Medicine Pratique, preface, sec. 7 to 12. Translation of Janet. 
 t Ibid., 10 to 15.
 
 CLINICS. 479 
 
 disease," he says, "is an affection which proceeds from an exaltation or 
 specific alteration of some of the humors of the body.""' Again, wish- 
 ing to explain the generation of spring-fevers, he reasons as follows : 
 '• In winter, the spirits being concentrated by the cold, become strong j 
 afterward, the hea: of the spring puts them in motion, and as they find 
 themselves mixed among the viscous humors which nature, during the 
 winter, has accum ilated in the mass of the blaod, (though these humors 
 may be still less tenacious than those which, dried by the heat of sum- 
 mer, cause autumnal fevers,) the spirits, I say, finding themselves 
 embarrassed and overwhelmed by these viscous humors, make an effort 
 to disencumber themselves, and by this effort produce the ebulition 
 which occurs in spring fevers. In like manner, if bottles full of beer, 
 which have been long kept in a cool cellar, be brought close to a fire, 
 the liquor soon bubbles and seeks to escape."! I have no need to 
 remark, I think, how far the pathogenetic explication which we have 
 quoted, passes the limits of sensible phenomena to enter into the laby- 
 rinth of hypotheses — how much they are opposed to the sage maxims 
 proclaimed above, which the author has borrowed, possibly without sus- 
 pecting it, from the Empirical doctrines. 
 
 Sydenham, after having studied with admirable patience for fifteen 
 consecutive years, the influence of epidemic constitutions, thought he 
 could emit, on that subject, the following theory: "There are various 
 constitutions of the year, which come neither from heat, cold, drouth 
 nor humidity, but rather from a concealed and inexplicable alteration, 
 which occurs in the bowels of the earth. Then the air is found affected 
 with pernicious exhalations, which cause special diseases, as long 
 as the same constitution is predominant. In fine, at the end of a few 
 years this constitution ceases, and gives place to another. Each general 
 constitution produces a fever which is proper to it, and which, outside of 
 that, never appears. For this reason, I call these sorts of fevers stationary, 
 or fixed." | 
 
 "What appears to me especially difficult," he says, further on, "is to 
 know, in the commencement of a constitution, the species of fever which 
 is going to prevail, since, until then, no specimen of it has been seen. 
 o o o g^t though it may be difficult to foresee, certainly, the new 
 species of fever which is about to commence — and when even that must 
 be supposed entirely impossible, we have, at least, always the resource 
 of directing the treatment upon general principles. By this means we 
 
 '' Preface to (Euvres de Medicine Pratique. Translation of Janet. 
 f History and Curation of Acute Diseases. Sec. i, chap. 5. 
 jlbid.
 
 480 REFORM PERIOD. 
 
 are enabled to place our patient out of danger, provided we proceed cau- 
 tiously, without too much haste — for there is nothing, according to my 
 view, more pernicious than precipitation, nor anything which causes the 
 death of more persons who are attacked with fevers."'-' 
 
 There is no question but that we see epidemics frequently developed, 
 the production of which, possibly, can be attributed neither to variations 
 in the atmosphere, nor to the qualities of the regimen, nor to any other 
 known cause. It is equally evident from common experience, that 
 when an epidemic reigns with a high degree of intensity, it impresses on 
 all intercurrent diseases a particular character, which requires a modi- 
 fication of th€ treatment, according to the nature of the epidemic. This 
 is what all attentive practitioners have observed, and which did not 
 escape the notice of any physician in Paris during the cholera epidemic 
 in 1832. But to pretend that there exists all the time, an epidemic 
 constitution, or stationary fever, independent of the influence of the 
 regimen and atmospheric vicissitudes, a constitution that would change 
 the natural character of diseases and necessitate grave modifications in 
 their treatment, is to generalise a particular observation — is to erect an 
 exceptional fact into a rule. A similar theory, if it could be admitted, 
 would take from therapeutical precepts all stability, and would trans- 
 form medical practice into a continual groping — a consequence that 
 Sydenham himself did not disown in the last quotation, and which is 
 in itself sufficient to cause the rejection of his doctrine. 
 
 This doctrine has, however, a great number of sectators of the highest 
 merit, among whom we must place in the first rank, Maximillian Stoll 
 and Philip Pinel. The celebrated professor of Vienna, whose talents 
 for observation cannot be questioned, strives, with a zeal more merito- 
 rious than fortunate, to unravel the theory of epidemic constitutions ; 
 but though he expresses himself, on this subject, with more precision 
 than any other, he has not been able to dispel the obscurity that rests 
 upon it ; because he has himself extended beyond measure, the idea of 
 stationary fevers, as is easy to be seen by the following passage : 
 
 " The stationary," he says, " is embraced in a certain number of 
 years ; it gradually increases till it attains its hight, then declines, 
 giving place to another stationary, which succeeds it. Do these same 
 stationaries return in a fixed and certain order, after a certain number 
 of years ? Are they limited in number? Or do they produce, sometimes, 
 new ones? These questions cannot be determined, on account of the 
 absence of observations made during a long course of years by skillful 
 physicians in one locality, and compared with similar observations made 
 
 Hist, et Cur. Maladis Aiguiis, sec. iv., chap. vi.
 
 CLINICS. 481 
 
 by others. Thus we arc ignorant, up to this time, of the nature, num- 
 ber, extent, and period of stationary fevers : Solely it is established 
 after the observations of Sydenham and my own, that a stationary fever 
 extends its influence on all absolutely febrile diseases, and that it con- 
 trolls them, whether they are independent of the changes of the season, 
 or proceed from any isolated cause. It is no less certain that the 
 stationary fever exercises a great influence on chronic diseases, whether 
 febrile or not." " 
 
 Independently of the stationary fever, a species of protean, present in 
 all places, in all time, associated with all diseases, clothed in all forms, 
 without having any of its own, the same authors admit other fevers, 
 which they name, sometimes sporadic, or intercurrent, and again, 
 annual, or cardinal.! There are, according to Stoll, four sorts of annual 
 fevers, namely : the injiammatory, which prevails most in the winter, 
 and at the commencement of spring ; the bilious, which predominates in 
 the heat of summer, and at the beginning of autumn ; the pituitous, 
 which shows itself in the passage of autumn into winter, and of winter 
 into spring ; finally, the intermittent, which appears in the spring and 
 autumn. Annual fevers take, often, their vulgar name from some 
 dominant symptom ; thus they are called pleuritic, miliare, petechial, 
 rheumatic, morbilous, variolic, etc., when they are accompanied with 
 pleurisy, miliary, or petechial eruptions, rheumatism, etc. \ 
 
 Xotwithstanding my respect for such observers as Sydenham, Stoll, 
 and Pinel, I can regard their stationary fevers only as an allusion, a 
 Utopia, which resembles the quid divinum, zc Osiov, of the ancients, 
 an expression by which they were accustomed to designate the unknown 
 cause of all strange and inexplicable phenomena. In regard to annual 
 or sporadic fevers, no one doubts their reality, for each of them 
 manifests itself by evident and palpable signs that are appropriate 
 to it. Thus the pathological state which is designated under the name 
 of inflammatory fever, is very distinct from that which is named bilious 
 fever, whatever opinion, otherwise, one may have on the origin and 
 reciprocal relations of the two states ; so, pleuritic fever, or pleurisy, is 
 perfectly distinct from miliary eruption, rheumatism, variola, etc., when 
 however these divers affections do not co-exist, nor are complicated in 
 the same subject. 
 
 " Aphiorisms on the Knowledge and Cure of diseases. Translated by Corvisart. 
 
 t " The stationary fever," says Stoll, "is disguised frequently, and in various 
 •ways. It imitates different diseases, though at bottom, its character may be 
 everywhere the same, and the method of treatment the same in every case." 
 (Apho. .391.) t Aphor. 39, 41.
 
 482 REFORM PERIOD. 
 
 § IV. Medicvl TorOGEATHY. 
 
 The study of ]\redical Topography is intimately united with that of 
 epidemic constitutions; these two branches of science should go together; 
 they mutually enlighten and complement each other. The cultiva- 
 tion of both commenced about the same epoch, namely, during the 
 second half of the sixteenth century. Prosper Alpin was one of the 
 first to occupy himself with topography, in a medical point of view. 
 He wrote a book on the natural history of Egypt, the diseases of its 
 inhabitants, the ancient and modern medicine of the country — full of 
 judicious and erudite reflections, in which the good taste of the author 
 is prominent. James Bontius collected interesting observations on 
 the natural productions of the West Indies, and on the diseases which 
 habitually prevail there. William Pison wrote a similar work on 
 Brazil, and united afterwards, in the same edition, his work with that 
 of Bontius, under the title of Historia Naturalis et Medica Indies 
 Orientalis. The celebrated traveler Koempfer, collected a mass of 
 excellent observations on medicine and botany, during the ten years he 
 employed in travels in Persia. Armenia, Japan, the Kingdom of Siam, 
 and other parts of Eastern Asia. 
 
 In his history of the diseases of St. Domingo, J. B. Poupe Desportes, 
 arranged the medical topography of the island, and described the 
 epidemic constitutions which he had observed there, from 1732 to 
 1747. George Cleghorn studied, with much care and sagacity, for 
 thirteen years, the endemic and epidemic aifections of the island of 
 Minorca, the manners of the people, the qualities of its atmosphere, and 
 the nature of the soil and its productions. He remarked a great 
 analogy between the diseases of that country, and those described by 
 the ancients, Avhich he attributed to the conformity of the climate of 
 Greece, with that of the above mentioned islands.'-' J. Lind wrote an 
 excellent treatise on the Diseases of Europeans in hot climates, and on 
 the means of preserving the health of sea-faring men during long 
 voyages. William Hillary, made meteorological and medical observa- 
 tions in the island of Barbadoes.f Lionel Chalmers, wrote on the 
 
 ''■ Observations on the Epidemical Diseases in Minorca, from 1741 — 1749. Lon- 
 don. 1779, in-8. 
 
 •f Observations on the change of the air, and the concomitant epidemical 
 diseases, in the Island of Barbadoes. London, 1759, in-8. — Comparez J. Hendy. 
 Memoire sur la maladie glandulaire de Barbade ( Memoires de la Societe Me'di- 
 cale d'e'mulation, Paris, an ix, T. IV, p. 44,1 et Alard. De I'inflammation des 
 Vaisseaux absorbants, lymphatiques, dermoides et sous-cutanes, etc. Paris, 
 1824, in-8, fig.
 
 CLINICS. 483- 
 
 climate and diseases of South Carolina. Bajon, addressed to the 
 Academy of Xatural Sciences of Paris, several memoirs,-' which 
 obtained the approbation of that learned association, concerning the 
 medical topography of Cayenne, and of French Guiana, the mal rouge 
 of Cayenne, and the effects of the climate on newly arrived Euro- 
 peans, etc. 
 
 In Europe a strong impulse was given to the study of topography : 
 a multitude of researches were undertaken with this object. Learned 
 societies often put, in conconrs, questions relative to the medical 
 topography of the places in which they were held ; many physicians 
 published spontaneously the result of their observations in the countries 
 where they practised; asjnrants to the doctorate often took as a subject 
 for their theses, the description of localities where they designed to 
 locate for the practice of their profession. There was not a province 
 or a city of considerable size, which did not become the subject of one 
 or several topographical monographs. f 
 
 Finally, an effort was made to collect all the observations that had 
 been published on this subject, in every part of the world, and to 
 compose from them a general geography for the use of physicians, in 
 which all the diseases proper to each climate, and each country, should 
 be clearly defined, with the probable causes of their development and 
 the method of treating them. William Falconer was the first who 
 published a work of this character, entitled, Eemarks on the Influence 
 of Climate, Geographical Situation, Xature of the Soil, Inhabitants, 
 Quality of Food, and Mode of Living ; Dispositions, Temperaments, 
 Manners of the People, Intelligence, Laws and Customs, Forms of 
 Government, and Picligion of the Human Pace. But the execution of 
 the work so pompously announced, was far from responding to the 
 promises of the title. Some years after, Leonard Louis Finke published 
 a general geography of practical medicine — an incomplete and undigested 
 compilation, but richer in facts, and exact observations, than the 
 preceding. 
 
 To give an idea of the multitude of objects included in the medical 
 topography of a country, I will here transcribe the programme which 
 was summed up by the Eoyal Society of Medicine, of Paris, in proposing 
 for a prize essay, the examination of the geographical situation of that 
 capital, and its environs : 
 
 ^ Memoires pour servir a 1' Histoire Naturelle de Cayenne et de la Guiane 
 Francaise. Paris, 1777, 2 vol. in-S. 
 
 t Several Medical Topographe's worthy to be consulted, are published in the 
 Memoires de' la Societe' Royal de Med. Paris, 1776-1790, 10 vol. 4vo, See also 
 Recueil d'Observations de Medicine des Hospitaux Militaire, etc.
 
 484 REFORM PERIOD. 
 
 '' Determine what are the mountains or hills that concur in the 
 formation of the Paris basin, and that are found in its environs. "What 
 is their extent, their form, and their elevation above the ordinary level 
 of the Seine ? What is their position relative to the four cardinal 
 points of the horizon, their respective distance, their connections among 
 themselves, by their projecting and receding angles, their situation and 
 direction in relation to the city ? What is their internal composition, 
 the nature of their soil, and of that of the valleys formed by them, 
 and lastly, what is the extent and direction of these valleys ? What 
 arc the position and extent of the forests planted in the environs, their 
 distance from the city, the quality of their soil, the species and average 
 hight of their trees ? 
 
 " What are the running or stagnant waters that are found in the 
 neighborhood, either constantly or only at certain times of the year ? 
 What is, independently of the river water, the quality of drinking 
 water, and the changes it undergoes at different seasons ? What are 
 the courses of the usual winds, and what obstacles, what deviations and 
 modifications, do they undergo from the forests, the mountains, and 
 valleys ? Lastly, what are the different productions for the use of men 
 and animals, furnished by the surrounding country." 
 
 This programme, as is seen, includes only a part of the documents 
 which compose medical topography ; to complete itj it would be neces- 
 sary to add a general view of the city, its streets, squares, and the 
 public and private edifices of the population ; to describe the physical 
 constitution of the inhabitants, their tastes, inclinations, manners, 
 nutrition, clothing, civil and political state, etc. ; lastly, to give an 
 account of their endemic and epidemic diseases. 
 
 A scheme so vast is not easy to fill, for a city like Paris, and much 
 less still for a great province or a kingdom. It requires extended and 
 varied knowledge, an immense number of positive observations, a spirit 
 of analysis to decompose the facts, and to ascertain their elements, a 
 synthetical genius, to connect them according to their analogies, and 
 deduce from them general consequences. How would it be if one 
 wished, in work of this kind, to comprehend one of the four great 
 divisions of the terrestrial globe, or of the entire globe itself? The 
 life of a man would not be sufficient for it, whatever might be his capa- 
 city, and we feel that an enterprise of this importance can not be 
 attempted except by a learned society, and executed in the period of a 
 great number of years, with the concurrence of savans and physicians 
 disseminated over all parts of the earth.'-' 
 
 *■' The late lamented and eminent Prof. Daniel Drake, M. D., made a contribution 
 to Jledical Science on this subject, that has no parallel in medical literature. See
 
 THEORIES AND SYSTEMS. 485 
 
 C H A P T E Pt X . 
 
 THEORIES AND SYSTEMS. 
 
 PRELIMINARY REFLECTIONS. 
 
 The philosopliic system of Aristotle, and the medical system of Galen, 
 had resisted the attacks, more violent than skillful, of the innovators of 
 the sixteenth century. By the help of some modifications in details, 
 these systems had appeared sufficient to the majority of minds to explain 
 the rationale of observed phenomena in the mental, moral, and physical 
 world. Those, even, vpho found them insufficient or defective in some 
 respects, still preferred them to most of the hypotheses, more brilliant 
 than solid, of the modern Platoneans, and to the crude lucubrations of 
 the propagators of the Occult Sciences. Thus, the doctrines of the 
 schools sustained themselves less, perhaps, by their intrinsic merits than 
 by the feebleness of their adversaries, because these had up to that 
 time proposed nothing better, or that was even comparable to them. It 
 may be said, perhaps, that under this state of things it was wiser to 
 rest in doubt and waiting, without pronouncing in favor of any party. 
 To this counsel I shall offer only this objection : it was impracticable. 
 Indeed, of speculative truths we may certainly rest in doubt and wait- 
 ing ; thus, we may doubt all our lives if there are several sorts of spirits 
 in the animal economy, as indicated by Galen, or if there is only one 
 sort, as is asserted by Laurent Joubert ; but in regard to practical 
 truths, doubt and waiting are impossible. For example, let a physician 
 be called to a patient : he must necessarily prescribe something or 
 nothing. Xow, if he order nothing, he takes a position, just as much as 
 if he had ordered something. "We thus see that the practitioner can 
 not remain indifferent in regard to therapeutical methods, and that, 
 from taste or compulsion, with or without conviction, he is obliged, 
 every day and at each moment, to adopt one of them. It is, therefore, 
 important that he study and compare them well beforehand, in order to 
 adopt the best, or, if you please, the least defective — the one which offers 
 the best guarantee of success. To defer this examination, to take no 
 thought in each circumstance, except from the inspiration of the 
 moment, is to exhibit ourselves unworthy of the medical priesthood — is 
 to play odd and even with the lives of our fellows. 
 
 his Systematic Treatise, Historical, Etiological, and Practical, on the Principal 
 Diseases of the Interior Vallej' of North America, as they appear in the Caucas- 
 ian, African, Indian, and Esquimaux varieties of its population. Vol. I. Cin- 
 cinnati, 18-50.— Tr.
 
 486 REFORM PERIOD. 
 
 But tlic time approached when men more powerful in genius and sci- 
 ence, began to demolish the antique edifice of human knowledge, in order 
 to reconstruct it on new foundations. Already Martin Luther, the 
 boldest of the innovators of the sixteenth century, having proclaimed 
 the liberty of investigation in matters of religion, drew after him a 
 notable part of Europe. Copernicus and Galileo had opened the route 
 in which Newton afterward immortalized himself by almost fabulous 
 conceptions. Natural history, Physics, Chemistry, and Medicine were 
 enriched, every day, by facts that were in manifest contradiction to 
 received theories. The necessity of a general recast of the sciences 
 was more and more felt; the ancient philosophic doctrine could not sus- 
 tain itself in the midst of the crumbling ideas which had served to build 
 it up. 
 
 Thus the Reform Period witnessed the appearance no longer of 
 mere simple outlines, such as we have signalized in the preceding period, 
 but complete systems of philosophy, wisely elaborated by minds of the 
 first order : systems which have exercised a marked influence on the 
 march of the human mind, and on that of Medicine in particular ; sys- 
 tems of which it is indispensable to have a summary idea, in order to 
 comprehend and appreciate modern medical theories. 
 
 A.RT. I. HISTORIC SKETCH OF PHILOSOPHY DURINtI THE SEVENTEENTH AND 
 EIGHTEENTH CENTURIES. 
 
 § I. Retrospective Constderatioxs. 
 
 The magi of the East, the priests of Egypt, and the most ancient 
 philosophers of Greece, were persuaded that to make a grand jirogress 
 in science, as well as in wisdom, there were no better means than to 
 separate from the crowd and the noise of life, become isolated from all 
 external sensations, and meditate deeply on the great truths which 
 constitute real knowledge and lead to true happiness. Such was the 
 aim of the institutions which Pythagoras founded in Italy — imposing 
 silence on his disciples ; and such was the advice that Plato, heir of 
 the doctrine of Socrates, gave to his scholars. It is necessary, he says, 
 in order to arrive at a knowledge of the truth, to retire within one's 
 self, and be freed, as much as possible, from all outward impressions, so 
 that the soul, disengaged by thought from the bonds of the body, may rise 
 in full liberty, toward the eternal essence whence it emanated ; for 
 there is the source of all light ; it is there only that our spirit will 
 find science, and repose in recalling its celestial origin.
 
 THEORIES AND SYSTEMS. 487 
 
 This mettod, which we name intuitive, or reflective, led the earliest 
 sages to the discovery of the moral and religious truths which are the 
 base of the social order. By it, they elevated themselves to the idea of 
 one God, eternal and infinite — Sovereign Arbiter of the destinies of 
 the world ; to the idea of the immortality and spirituality of the soul ; 
 to the ideas of justice, virtue, future rewards, etc. It is also by this 
 intuitive method that mathematical axioms are discovered; axioms 
 which charm us by their infallibility, and from which are deduced, by 
 reasoning from irresistible evidence, an infinity of theorems, more and 
 more admirable. It was especially this infallibility of mathematical 
 reasoning that led the philosophers to introduce the same method into 
 all the sciences. They flattered themselves that by following exactly 
 the same course for every class of ideas, they could advance with the 
 same certainty. Was it not natural, indeed, to desire to generalize a 
 mode of acquisition which had produced such satisfactory results in so 
 many respects ; and must we not excuse Plato when he seeks in ideas, 
 purely abstract, the secret of the creation of the world, and the explana- 
 tion of natural phenomena ; when he essays to establish a system of 
 cosmogony on geometric abstractions, by supposing, for example, the 
 number of primitive triangles that should compose each of the material 
 elements. 
 
 Nevertheless, the men who made a particular study of the physical 
 world, such as Democritus, Hippocrates, and Aristotle, did not fail to 
 perceive that, in order to arrive at a knowledge of the properties of 
 matter in general, and of bodies in particular, mental reflection, apart 
 from all impressions on the senses, was not sufficient ; but that we 
 must, on the contrary, give great weight to these impressions, and make 
 them the basis of our judgment in what relates to the order of sensible 
 things. Hippocrates was one of the first who proclaimed the necessity 
 of observation in medicine, and the impossibility of discovering the 
 causes of diseases, their nature, their course and their efi"ects, by any 
 other plan. Aristotle generalised to excess, perhaps, the thoughts of 
 Hippocrates, when he affirmed that all our knowledge is derived from 
 sensation — ''Nihil est iji intellectu quod non prius fuerit in sensu." But 
 he did not mean to say by this that we acquire ideas by the senses only ; 
 he meant, merely, that the first ideas that arise within us, and which are 
 the foundation of all the rest, are derived from the senses. 
 
 Aristotle, though having an opinion diametrically opposite to that of 
 Plato, on the origin of our acquirements, agreed with him in saying that 
 the first notions that are formed in our minds are very general ones — 
 mother ideas — principles. Now, as we have demonstrated in a former 
 section, this is a very grave philosophic heresy, and it drew these two
 
 488 REFORM PERIOD 
 
 philosophers and tteir successors into an inextricable labyrinth of 
 subtilties and contradictions. For more than two thousand years it 
 was the established rule to place at the head of all treatises, general 
 axioms, which were very improperly named principles ; and efforts were 
 subseipently made to deduce from these principles a series of proposi- 
 tions, more or less logically connected. Observation, when one deigned to 
 consult it, served only to lay the first foundation of the scientific edifice ; 
 reasoning must do the rest. Such was, with some exceptions, the mode 
 of proceeding of all the authors and philosophers, particularly till 
 toward the close of the sixteenth century of the Christian era. 
 
 At that epoch the method of pure observation had partially pene- 
 trated into some branches of human knowledge, such as physics, 
 chemistry, and astronomy, and bad produced admirable results, which 
 had greatly shaken the scholastic philosophy. It now needed only the 
 the advent of a generalizing and profound mind, who would dare 
 penetrate to the base of our ideas, and succeed in finding a form of 
 reasoning less defective than that generally adopted. Now, two men 
 of a character and genius very different, appeared nearly at the same 
 time, both attempting this great enterprize. The first was Francis 
 Bacon — the second Rene Descartes. 
 
 § II. Ox Modern- Sensualism and Reasoning by Induction. 
 
 Bacon, versed early in the management of men and affairs, endowed 
 with a fine and positive mind ; cultivating by predilection the natural 
 sciences, physios and chemistry, was one of the first to feel and point 
 out clearly the defect of the method adopted till then, of placing at the 
 foundation of the sciences, the most general axioms. '• There are and 
 can exist but two ways of investigating and discovering truth. The 
 one hurries on rapidly from the senses and particulars, to the most 
 general axioms, and from them, as principles, and their supposed indis- 
 putable truth, derives and discovers intermediate axioms. This is the 
 way now in use. The other constructs its axioms from the senses and 
 particulars, by ascending continually and gradually, till it finally 
 arrives at the most general axioms, which is the true but unattempted 
 way." * 
 
 This is a very important passage, and merits to fix our attention ; 
 for it lays down in the clearest manner the difference that exists between 
 modern sensualism and the sensualism of Aristotle. Let us recall, 
 
 " Novum Organum, Book i., chap, i., Aphorism xix.
 
 THEORIES AND SYSTEMS. 489 
 
 indeed, the extremely subtile sophisms by which the Macedonian philo- 
 sopher proved that the first ideas which are formed in our minds 
 through the instrumentality of the senses, are very general ideas ; 
 whence he concludes, that in all sciences we should commence by the 
 most universal axioms/--' Bacon, without seeking to unravel the knot 
 of this sophism, contents himself with establishing a rule entirely 
 contrary, which consists in passing from sensations to particular facts, 
 then from these to more extended notions, and so on, rising by grada- 
 tion from individual facts to notions more and more general, up to the 
 most universal axioms, which form the crown, and not the base, of 
 natural sciences. 
 
 It has been customary to regard Bacon as the restorer of the method 
 of observation, and, in fact, he continually asserts it in his works ; 
 but many others before him have proclaimed it with no less persistence, 
 and have consequently been able to avail themselves of a much better 
 method to reach great discoveries. Whence, then, the exclusive honor 
 attributed to him, of having re-established this method ? Because he 
 gave it a new development, and was the first to teach that particular 
 ideas are the base of the scientific pyramid, and axioms are its summit. 
 This was, indeed, a radical innovation, full of the future, the importance 
 of which was completely realized by Bacon ; for he often speaks of it 
 with enthusiasm, and praises it as an unparalelled discovery. " No 
 one has yet been found possessed of sufficient firmness and severity to 
 resolve upon and undertake the task of entirely abolishing common 
 theories and notions, and applying the mind afresh, when thus cleared 
 and elevated, to particular researches ; hence our human understanding 
 is a mere farrago, and crude mass, made up of a great deal of credulity, 
 and accident, and the puerile notions it originally contracted. But if a 
 man of mature age, unprejudiced senses, and clear mind, would betake 
 himself anew to experience and particulars, we might hope much more 
 from such a one ; in which respect we promise ourselves the fortune of 
 Alexander the Great ! " f 
 
 In another work, the English metaphysician, desiring to signalize 
 more and more his method, and its difference from the ancient one. 
 expresses himself in these terms : " The end of our new logic is to find, 
 not arguments, but arts ; not what agrees with principles, but principles 
 themselves ; not probable reasons, but plans and designs of works — a 
 
 " See his philosophic doctrine : Phil. Period. In this sophism Aristotle con- 
 founds, without knowing it, general ideas with confused ideas, which are very 
 different. Hence his errors, and those of the writers who have followed him. 
 
 t Loo. Cit., Aphorism xcvii. 
 
 31
 
 490 REFORM PERIOD. 
 
 different intention, producing a different effect. -■■' =•■' =■■' The nature 
 and order of the demonstrations agree with this object. For in common 
 logic, almost our whole labor is spent upon the syllogism. Logicians, 
 hitherto, appear scarcely to have noticed induction, passing it over with 
 some slight comment. But we reject the syllogistic method, as being 
 too confused, and allowing nature to escape out of our hands. " ^•■■' '••' 
 We therefore think that induction is the true method which guards 
 our senses against all error, which clearly follows nature, is akin to 
 practice, and is almost practice itself." '••' 
 
 Unfortunately, it is not the form of argument, not the logical method, 
 that secures a man from false reasoning. Bacon himself furnishes us 
 the proof of this in his Organum — in that work, even, which he believed 
 was destined to direct the human mind, with certainty, toward the 
 truth. In fact, after having exposed his method, this philosopher, 
 desiring to show its application, and prove its excellence, by examples, 
 essayed to resolve by it several problems, one of the first of which I 
 will give : What is the nature of heat '? After an infinite number of 
 exclusions and circumlocutions, he arrives at the following conclusion : 
 " Heat is an expansive motion, restrained, and striving to exert itself, 
 in the smaller particles, but with the following modifications : first, by 
 its tendency to rise, though expanding toward the exterior ; second, this 
 effort is modified by its not being sluggish, but active, and somewhat 
 violent." f I leave to more skilful critics the task of explaining this 
 definition, as well as the premises from which it is derived ; but I 
 doubt if one more obscure and puzzling can be found among those 
 transmitted to us from antiquity. 
 
 A little farther on the same author, desiring to determine the nature 
 of tangible bodies, expresses himself thus : " All tangible bodies inclose 
 an invisible and intangible spirit, to which they serve as envelope, and 
 as clothing, whence result three orders, or modes of action, which are 
 the triple source of the powerful effects of the spirits exerted on tangible 
 bodies. When this spirit exhales, the body contracts and dries ; if it 
 is retained, it softens or liquifies it ; finally, if it is neither entirely 
 emitted nor entirely retained, then it is developed, and forms the mem- 
 bers, assimilates, evacuates, and organizes. =•■- =-••= " We may dis- 
 tinguish three species or modes of spirit, namely, the unconnected 
 spirit, the branching spirit, and the branching and cellular spirit, 
 or the one which is ramified and distributed in different cells or little 
 cavities. The first is that of all inanimate bodies ; the second, that of 
 
 " The Dignity and Advancement of Learning. 
 I Nov. Organ.
 
 THEORIES AND SYSTEMS. 491 
 
 vegetables ; the third, that of animals." This is not as obscure, cer- 
 tainly, as the definition of heat, but is it any more conformed to obser- 
 vation '? Does not the author surpass, in his description of the spirit 
 of tangible bodies, the teaching of experience, to which alone he should 
 attach himself? 
 
 Induction, as we see, does not shelter us from error any more than 
 syllogism, and the merit of the change introduced by the English phi- 
 losopher in the manner of cultivating the sciences, does not consist, as 
 he supposed, and as many others after him did, in the substitution of 
 the inductive for the syllogistic form. It consists, above all, in the \ 
 emission and propagation of that fundamental truth above announced, 
 that from sensations and particular facts, our mind must not spring, at 
 one leap, to the most general axioms, but that it must gradually rise 
 from particular notions transmitted by the senses to ideas more and 
 more general. This single proposition contained the germ of the whole 
 philosophic revolution ; for, from the moment it was admitted as a 
 principle, that the first ideas which are formed in our minds are partic- 
 ular ideas, related to individual objects, and not, very general ideas 
 comprising a multitude of things, the whole edifice of ancient philo- 
 sophy began to crumble down, and it was necessary to reconstruct it on 
 a new base, viz. : the careful study of facts. 
 
 Bacon proposed to describe all the forms of experience, as Aristotle 
 had described all the forms of reasoning; but his enterprise has 
 remained more defective and vain, considered as a whole, than that of 
 the Greek philosopher, for no one has ever made use of the logic elab- 
 orated by Bacon, while that of Aristotle was employed exclusively 
 during more than twenty centuries, and is still, occasionally. We may 
 judge of the inextricable confusion which reigns in the work of the 
 English philosopher, by the following fragment, which forms a part of 
 the conclusion: "We must say, in conclusion," he says, "that our 
 Organum is only a simple logic, and not a treatise on positive philoso- 
 phy. The object of this logic is to direct the understanding, and to 
 teach it not to hang upon, if we may so say, vain abstractions, and the 
 pursuit of chimeras, like the vulgar logic, but to grasp nature, and to 
 analyze her — to discover the true properties of bodies, the real and well 
 determined actions in matter ; in a word, to discover a science which 
 results not only from the nature of the mind, but also from the nature 
 of the things themselves. Therefore, the reader must not be astonished 
 to see this work strewed and enriched with observations, experiments, 
 and views which belong to the science of nature, and which, in enlight- 
 ening our precepts, serve as so many models of our philosophic course. 
 Now, these prerogatives of facts or instances, as has been seen, are
 
 492 REFORM PERIOD. 
 
 twenty-seven in number, viz. : soUtanj, migrating, ostensible, clandes- 
 tine, constitutive, similar and singular ; also, instances of deviation, 
 limitation, poioers, agreement, and hostility, and suhjunctions ; instances 
 of alliance, of the cross, of divorce, of the door, citation, carrying for- 
 ward, route or passage, supplement, dissection, radiation, course, 
 doses of nature, of struggle or predominance, of indication, of those 
 generally useful, and, finally, of rnagicJ"'-' Thus Bacon, after having 
 advanced from one degree, the theory of Sensualism, falls into chaos ; 
 but he has. nevertheless, opened t'le route and indicated, though confus- 
 edly, a new theory, which others proceeded to study and elucidate much 
 better than he. 
 
 John Locke, born at Wrington, near Bristol, in 1G32, six years after 
 the death of Bacon, embraced first the study of Medicine ; but the del- 
 icacy of his health did not permit him to practice that profession. The 
 reading of the writings of 11. Descartes awakened in him a taste for 
 philosophy. However, he rejected the Cartesian doctrine on innate 
 ideas, and embraced the reripetecian principles renewed by Bacon — 
 that all our ideas come from the senses and from reflection, that is to 
 say, by operations of the mind, or the comprehension of these sensations. 
 Here, he says, are the only two sources of all our knowledge: the 
 impression that objects make on our senses, and the proper operations 
 of the soul concerning these impressions, on which it reflects as so many 
 veritable objects of contemplation.! Thus proceeding from the simple 
 perception, or, in other words, from the conscience which our mind has 
 of sensitive impressions, this philosopher conducts us, by an uninter- 
 rupted gradation, to the most complex and abstract operations of 
 thought. He shows how the ideas arise, multiply, arrange and connect 
 themselves in our understanding; how we arrive at i-epresenting these 
 ideas by language ; what is the real value of words ; what are the 
 abuses of language, and into what errors we are drawn, by the habit we 
 early contract, of considering the abstractions of our minds as having 
 an existence apart from us. 
 
 Bacon had believed and taught, that, the first ideas which are formed 
 in our minds, through sensation, must be particular ideas, related to 
 the objects or individual facts ; he had protested, energetically, against 
 the plan of approaching the sciences by generalities, or axioms. Locke, 
 analyzing with a rare sagacity the functions of the understanding, from 
 the simplest perception, to the highest abstractions, demonstrated what 
 Bacon had only asserted, and destroyed without attacking it directly, 
 
 "Organ. Nov., liv. IT, partii, sec. ii, chap. 2, § in. 
 
 •j- Philosophic Essay on the Human Understanding, chap, i, § 24.
 
 THEORIES AND SYSTEMS. 493 
 
 the famous sophism of Aristotle, and exhibited in a style as neat as per- 
 suasive, the doctrine of Sensualism or Empiricism. This doctrine made 
 rapid progress in England and in France. The greatest philosophers 
 and naturalists of these two countries, during the eighteenth century, 
 adopted, extended, and drew from it consequences more or less legitimate. 
 Stephen Bonnat, of Condillac, born at Grenoble, the thirtieth of 
 September, 1714, (died near Beaugency, third of August, 1780,) was 
 one of the most distinguished representatives of this philosophy. He 
 contributed more than any other person to vulgarise it, by simplifying it 
 still more, and applying it to all the sciences. He pretended to demon- 
 strate that all our knowledge comes from our sensation ; or, in other 
 words, is nothing else than sensations transformed. He reduced all 
 the rules of reasoning to a single one, identity in propositions, and 
 wished, also, to bring back all modes of acquisition and demonstration 
 to one only, analysis. The writings of this philosopher having become 
 classic, in France, we proceed to extract from them some general 
 maxims, now admitted as incontestable rules in the "sciences devoted 
 to sensible objects, such as physics, chemistry, natural history, and 
 medicine. 
 
 APHORISMS OF PHILOSOPHY, PARTICULARLY APPLICABLE TO THE PHYSICAL 
 
 SCIENCES.- 
 
 I. The ideas we form from sensible objects, are, in their origin, but 
 the consciousness of impressions which these objects make upon our 
 senses: now, as there are in nature only individuals, it necessarily 
 follows, that we have, in principle, only individual ideas — ideas that 
 are related to such and such an object. 
 
 II. We have not imagined names for each individual ; we have 
 only distributed the beings in different classes, which we distinguish by 
 particular names, and those classes are what are termed genera, species. 
 
 III. To form a class of certain objects, is, then, nothing more than 
 to give a common name to all those we judge to be similar. But we 
 would strangely deceive ourselves, if we imagined that there are, in 
 nature, species and genera, because there are species and genera in our 
 manner of viewing her. 
 
 IV. The more our discernment is perfected, the more the classes 
 will be multiplied, because there are no two individuals who do not 
 differ in some particulars. But, if it is important to make distinctions, 
 
 ^The exclusive partisans of the Sensualist doctrine derive from the same source, 
 moral and metaphysical truths ; but the legitimacy of this derivation is warmly 
 contested by other philosophers.
 
 494 REFORM PERIOD. 
 
 it is, perhaps, more important not to make too many of them. Do you 
 desire to know within what limits wc may divide and sub-divide our 
 ideas ? I reply, or rather, nature replies for me, until we have enough 
 classes to guide us in the use of things relative to our wants. 
 
 V. Sensible objects being known to us only by the impressions they 
 make on our senses, our minds perceive nothing in the objects beyond 
 the sensations they excite. Thus, when we are asked what is the 
 nature or essense of a body, we are only able to respond by announcing 
 the sensible qualities of that body. 
 
 VI. All the qualities of a being, considered in itself, are equally 
 essential, for they all appertain to its nature and its essence ; but they 
 are not all equally essential, in relation to us, and the abstract idea 
 which we have formed of that being ; so that, what is termed essential, 
 or non-essential, in any thing, is only so, relatively, to our ideas. 
 
 These aphorisms may, henceforth, be considered immutable ; for they 
 not only flow from the theory of sensualism, but they are also confirmed 
 by the sectators of a philosophic doctrine opposite to this, as we shall 
 see in the following paragraph. But, beforehand, it is necessary that 
 we refute two errors propagated by the authority of Condillac, errors 
 strongly accredited, in the schools of philosophy, and which are only 
 calculated to retard the progress of the science of observation. 
 
 FIRST PARADOX. 
 
 The art of reasoning, says Condillac, may be reduced to a well- 
 formed language ; and, all sciences would be exact if they employed a 
 simple language. 
 
 This celebrated ideologist supports this proposition by a very spe- 
 cious argumentation, founded, principally, on the certainty and facility 
 of reasoning in mathematics ; advantages which he attributes to the 
 perfection of algebraic language. He cites, in point, the following 
 problem: "If a man holding 'counters' in both of his hands, passes 
 one from the right to the left, the number of counters is alike in both ; 
 if, on the contrary, he passes one counter from the left hand to the 
 right, he has double as many counters in the right one ; the question 
 is, how many counters had he, at first, in each hand? Condillac 
 in the first place resolves this problem in common language ; then he 
 shows how much more easy it is to obtain its solution, when the problem 
 is translated into algebraic language. Hence he concludes, that if 
 the sciences are but slightly inexact, it is only because their vocabu- 
 laries are badly formed ; a defect which is not usually perceived, or 
 which we do not know how to correct." " Must we be astonished," he 
 exclaims, " that men cannot reason, when the language of the sciences
 
 THEORIES AND SYSTEMS. 495 
 
 is only a jargon, composed of too many words, some of whicli are 
 common, with no determined meaning, and others are foreign or barba- 
 rous ones, and not well understood ? All sciences would be exact if we 
 knew how to speak their respective languages." 
 
 It seems from this argument that .the exactness of the sciences 
 reduces itself to the work of the grammarian, which is a paradox unsus- 
 tainable, and falls before the investigation of good common sense. Who 
 will dare affirm that the modern progress of physics, chemistry, natural 
 history, etc., are due, entirely, or even principally, to mere modifications 
 introduced into the language of these sciences ? Who does not know, 
 on the contrary, that this progress is almost exclusively the result of ob- 
 servation and of experiment ? Do we not see every day, that men almost, 
 or entirely unlettered, make discoveries that have escaped the learned? 
 
 The proposition of the French metaphysician is false, even in relation 
 to mathematics ; it is not true that algebraic language has given to the 
 reasonings of mathematicians more certainty or conviction ; their 
 reasonings were as infallible before the introduction of algebra as since, 
 only they were less prompt, less easy, and less general. The Komans, 
 with their very defective figures, calculated everything as exactly as the 
 Arabs, whose figures are much move perfect ; but they calculated less 
 rapidly and less conveniently. 
 
 Therefore, if Condillac had limited himself to saying that the per- 
 fection of the language adds much to the clearness, facility and power 
 of reasoning, and consequently notably to the progress of science, he 
 would have been correct ; but he surpasses, evidently, the limits of 
 truth, when he affirms that all the sciences would be exact if they were 
 expressed in appropriate language. He takes, in this respect, the 
 shadow for the substance — the image for the reality ; and, by this 
 mistake, he diverts, so far as he is followed, the human mind from the 
 route which leads to discoveries in the science of observation. The 
 proposition of Condillac would be more exact if it was reversed ; so that 
 it might be said without being paradoxical, that the more a science 
 approaches exactness or truth, the more its language acquires perfec- 
 tion ; which reminds us of this axiom of the legislator of the French 
 Parnassus : 
 
 Ce que I'on concoit bien s'edonce clairement, 
 Et les mots, pour le dire, arrivent aisement." 
 
 Thus, the poet shows himself a more profound thinker than the 
 philosopher. 
 
 ^■' What is well conceived is announced clearly, 
 And the words to utter it flow easily.
 
 496 REFORM PERIOD. 
 
 SECOND PARADOX. 
 
 Analysis is the sole method for the acquisition of knowledge. Such 
 is the proposition of Condillac, developed in several chapters, which he 
 strives to establish by an argument that he believes irrefutable. We 
 will now see how far he has succeeded. 
 
 According to this philosopher, analysis consists in decomposing, in 
 the first place, the object which it is desired to comprehend, in order to 
 study separately each of its parts or qualities, as well as their mutual 
 relations ; afterward, to connect all these qualities or parts in their 
 natural order, so as to contemplate the same object as a whole. He 
 cites, in this view, the following example: "I will suppose," he says, 
 " a castle which overlooks a vast and fertile domain, where nature has 
 been pleased to spread a great variety, and where art has availed itself 
 of these natural advantages, to embellish it still more. We reach the 
 chateau during the night ; the next day the windows are opened, just at 
 the moment when the sun begins to gild the horizon, and in an instant 
 afterward they are closed again. Although the scenery was exhibited 
 to us but for one moment, we have certainly had a view of the whole. 
 But this first sight does not suffice to make us acquainted with it — in 
 other words, to look separately at the objects it contains, and therefore, 
 it would be impossible for us, when the windows are closed, to give an 
 account of what we have seen. This illustrates how we may see many 
 things' without learning anything. 
 
 " Finally the windows are opened again, not to be closed as long as 
 the sun is above the horizon, and we see again, for along time, what we 
 saw before. But if, like men in extacy, we contemplate all at once the 
 great multitude of difi'erent objects before us, we shall know no more 
 when the night comes than we knew after the first glance we obtained 
 of them in the morning. To get a clear knowledge of that scene, it will 
 not suflice, then, to look at every part at once — the parts must be 
 studied in succession ; and, instead of embracing the whole in a single 
 coiip iVoeil, it is necessary to pass successively from one object to 
 another. This is what nature teaches all of us. We commence, then, by 
 the principal objects ; we observe them successively, and compare them, in 
 order to judge of their relations to each other. When, by this means, 
 we have recognised their respective situations, we observe, progressively, 
 all those that fill up the intervals, or compare each one with the nearest 
 principal object, and determine from this, its position. Then, only, we 
 separate all the objects wliose form and situation have been compre- 
 hended, and embrace them all in a single view.
 
 THEORIES AND SYSTEMS. 497 
 
 " If, now, we reflect on the manner in which we acquire knowledge 
 by sight, we remark that any very complicated object, such as a vast 
 landscape, is, so to say, decomposed, since we comprehend it only if its 
 parts have presented themselves one after another, to arrange themselves 
 in regular order in our minds. We have shown in what order this 
 analysis takes place. The principal objects first strike our minds, then 
 the others follow, and arrange themselves according to the relations they 
 bear to the first. We make this mental analysis, only because an 
 instant is not sufficient for the study of all these objects ; but we 
 decompose, merely to reconstruct ; and when the knowledge of the whole 
 is acfjuired, its parts, instead of being successive, have in the mind the 
 same simultaneous order which they possess in reality. In this simul- 
 taneous order, consists the knowledge which we possess of them, for if 
 we could not recall them as a whole, we would never be able to conceive 
 the relations which they have among themselves, and we would have, 
 therefore, but an imperfect knowledge of the objects." 
 
 If analysis consists, as Condillac pretends, in decomposing an object 
 into its elements, and at once recomposing it, what then is synthesis ? 
 The response to this question seems to me difficult ; I seek in vain for it 
 in the writings of that philosopher ; I find nothing there clear and 
 satisfactory. " Synthesis," he says, " is a dubious method, which 
 commences, always, where it ought to end. I cannot give a more precise 
 notion of it, either because I do not comprehend it, or because it is not 
 possible to do so. It escapes examination because it assumes the 
 mental characteristics of all those who emploj^ it, and especially of 
 illogical minds." " 
 
 P. J. Barthez, of whom we shall speak at length hereafter, has 
 better comprehended and defined synthesis ; though he has but briefly 
 alluded to it. He expresses himself on the subject as follows : " Con- 
 dUlac, in what he has said on analysis, in various places in his Art 
 of Thinking, gives what he terms analysis, so extended a sense that it 
 includes, also, synthesis, or the recomposition of analysed objects. The 
 denomination of the analytic method becomes, then, so vague that it 
 may be said that analysis is employed in all the operations by which 
 any discovery is made in natural philosophy. The method which 
 Condillac terms analysis, has nothing in it truly analytic, except the 
 decomposition which is made at first of the cpalities or elements of the 
 object to be studied." f 
 
 ^ Logique, part ii., chap. vi. 
 
 fNouveaux Elements de la Science de I'Homme. Paris, 1806, Preliminary 
 Discourse, sect, i., note iv.
 
 498 REFORM PERIOD. 
 
 This passage of Bartliez is very important ; for it not only sliows 
 us in what synthesis consists, but also why Condillac is embarrassed 
 when speaking of that method. It is clear, that this metaphysician, 
 having comprised under the name of analytical method, both analysis 
 and synthesis, that is to say, the decomposition and reconstruction of 
 the object under consideration, there remains nothing for him to say, 
 when he wishes to define the synthetic method ; for this reason he 
 indulges in pure declamations. 
 
 Synthesis, according to Barthez, and according to the etymology of 
 the word, consists, then, in the reconstruction of the object which has 
 been decomposed by analysis ; it is the necessary complement of analysis, 
 and its proof. Thus, when a chemist has decomposed a substance — a 
 mineral water, for example — and when he has studied all its elements 
 separately, he should afterward reunite them, so as to reconstitute, if 
 possible, the primitive substance, in its natural state. It is only after 
 reproducing, by synthesis, the natural compound, that one is sure of 
 the exactness of his analysis. The following is a brilliant example of 
 the satisfaction received by the mind by the alliance of synthesis with 
 analysis : If a solar ray is permitted to penetrate a darkened room, and 
 is received on a prism of triangular crystal, this ray forms, on the 
 opposite wall, an elongated, finely-colored image, with all shades, from 
 red to violet. Then, if a thin board, pierced with seven holes, be 
 interposed between the prism and the image, termed the solar spec- 
 trum, there appear, behind this diaphragm, seven circular images, 
 presenting the red, the orange, the yellow, the green, the blue, the 
 indigo, and the violet. To be assured that these seven colors, thus 
 obtained, are, in fact, the constituent parts of the luminous ray, all of 
 them may be converged on the same surface, by means of reflecting 
 mirrors, in such a way that white light is produced again. 
 
 I agree with Condillac, that synthesis united to analysis, is the best, 
 yea, the only method, to acquire exact notions of nature ; and this 
 metaphysician was only wrong in confounding, under a single denomi- 
 nation two different things ; but this mistake draws him into more than 
 one error. When he advances, for example, that the ancients, Aristotle 
 among others, did not know analysis, he is strangely deceived ; for not 
 only did Aristotle employ, frequently, the analytic method, but he also 
 greatly abused it. The reproach which, rather, should be made to the 
 philosopher of Stagyrus, and to all the physicians of antiquity, is, not 
 to have verified the results of their analysis by synthesis ; or for having 
 been contented with a mental analysis, where they should have employed 
 a material one. Thus, when they affirmed that all bodies were formed 
 of four elements — fire, air, earth, and water — they should have been
 
 THEORIES AND SYSTEMS. 499 
 
 able to prove, materially, the existence of these four elements in each 
 body, and reconstruct again the body, by bringing together its con- 
 stituent elements/-' 
 
 I have dwelt somewhat at length on the errors of Condillac, in regard 
 to the analytic method, and the influence of language ; because the 
 doctrine of this philosopher reigned almost exclusively, in France, 
 during the last half of the eighteenth century, and the beginning of 
 the nineteenth, and because it is still predominant, and is very seduc- 
 tive, by its clearness, simplicity, and the logic of its deductions ; hence 
 results the necessity of guarding the public against the illusions which 
 it has a tendency to foster. 
 
 § ni. On Rationalism, and Reasoning by Deduction. 
 
 In reasoning by induction our minds associate a quantity of particular 
 facts, united together by certain analogies, and draw from their relation 
 a more or less general conclusion. Example : put carbonate of potassa 
 into water, it is dissolved ; put into the same fluid a sulphate, a nitrate, 
 in a word, any salt, with potash as a base, and all will be dissolved. 
 From the sesuccessive experiments, sufficiently often repeated, you will 
 be right in drawing the general conclusion, that all the salts of potassa 
 are soluble in water. 
 
 In reasoning by deduction, on the contrary, we proceed to draw from 
 one fact, or a simple proposition, a series of propositions, which follow 
 each other so logically that they seem to flow from the first, as a com- 
 mon source. Example : a triangle is a surface bounded by three right 
 lines. From this definition the geometricians are able to deduce a gi'eat 
 number of curious and useful theorems. 
 
 Eeasoning by induction, and reasoning by deduction, or, if you please, 
 the inductive and deductive methods, have each their particular advan- 
 tages and inconveniences, which render them more or less valuable in 
 difi'erent sciences. Natural philosophers, chemists, and physicians pre- 
 fer the inductive method, and draw from it excellent practical rules ; 
 
 " We have seen, in one of the Hippocratic books, a commencement of the 
 material proof of the existence of the four elements. The author of the book 
 cites the example of the results in burning green wood: he saw the igneous 
 element in the flame ; the aerian element in the gas, that sometimes escapes 
 with i\oise ; the aqueous element in the water which stews out, and, lastly, the 
 terrestial element in the ash or residuum. But this gross attempt at chemical 
 analysis lacked the proof of synthesis. Besides this, the author commits the 
 common error of inferring general from particular facts.
 
 500 REFORM PERIOD. 
 
 but they should not forget that a single experiment hadly made, or 
 omitted, suflBces to vitiate a general conclusion. The metaphysicians, 
 moralists and mathematicians reason nearly always by deduction and 
 we are indebted to this method for the finest precepts in morals and 
 natural religion, the base of all society ; we owe to it, also, the inven- 
 tion and perfection of mathematics. But it must not be forgotten that 
 if the primitive proposition is not of incontestable certainty, or if the 
 least error, or the slightest omission occurs in the propositions which 
 follow, the entire structure falls. 
 
 Eene Descartes, born at Hague, in Touraine, in 1596, exhibited in 
 early life an independent and creative genius. He had already dis- 
 tinguished himself by important discoveries in physics, astronomy, and 
 especially in mathematics, when he undertook to effect, by the method 
 of abstract reasoning, in opposition to that of Empiricism, a reform in 
 philosophy, an enterprise whose results were brilliant and immense, and 
 which created, says the historian of philosophy, Tenneman, admiration 
 as well as a very lively opposition. Descartes commenced, like Aris- 
 totle and Bacon, by ignoring all existing knowledge. "To attain the 
 truth," he says, " it is necessary to free ourselves at one time in our 
 lives, from all the opinions which we have previously acquired, and 
 reconstruct anew from the foundation the whole system of knowledge."! 
 This precept, old though it was, appeared as a bold novelty, and made 
 a great noise in the learned world, to such an extent had they lost the 
 habit of the methodic doubt, particularly in philosophy. 
 
 This fearless metaphysician did not limit here his reform in regard to 
 method ; he overthrew, with a single stroke, the whole framework of 
 the Peripatecian logic so subtily elaborated by Aristotle, that pedantic 
 apparatus capable of retarding the advancement of the human mind, 
 but unable to prevent it from falling or going astray. " In my exam- 
 ination," he says, "I observed that logic, its syllogisms, and the 
 greater part of its teachings serve, at most, to explain to others things 
 which they already know, or yet, like the art of E. Lulle, to speak 
 without judgment of those things of which they are ignorant, rather 
 than to teach them."* He replaces this complicated logic by a simple 
 and sure rule, of which the following is the substance : the mind may 
 affirm of a thing all that is embraced in the idea of that thing, or, 
 evidence is the only certainty of the truth of our judgment. 1 
 
 *"' This sentence is repeated in various ways, in numerous passages of his 
 writings. 
 
 f Discours sur la Methode. 
 
 J Condillac has defined this rule more clearly by showing that evidence consists 
 in the identity of the propositions which follow each other.
 
 THEORIES AND SYSTEMS. 501 
 
 Having thus cleared the ground from every species of prejudice, and 
 having created a method easy for the arrangement of the materials of 
 thought, Descartes attempts to rebuild the edifice of human knowledge, 
 by starting from the phenomenon of consciousness : / think, from which 
 he draws, at once, this consequence: therefore, I exist. From this he 
 rises, by a series of deductions, to the most sublime moral truths ; but 
 I shall not follow him in this region, because it does not belong to my 
 subject, and, therefore, I pass, at once, to the physical phenomena, 
 Descartes takes, as the basis of his cosmogony, this proposition of the 
 Pythagorean philosophy : matter is inert, and has, of itself, no form or 
 energy. It is possible, that, at bottom, this principle is true ; but, if 
 we consult observation, which must be the point of departure of all 
 reasoning in physics, we shall agree that it proves the contrary of the 
 Cartesian principle. Up to this time, chemistry has not been able to 
 discover any matter absolutely inert ; that is to say, matter deprived 
 of properties, and susceptible to acquire all those which it might be 
 desirable to give it ; for, this would be the philosopher's stone, the 
 primitive matter so much sought after by the alchymists. 
 
 The illustrious philosopher of Touraine has placed himself, from the 
 first, outside of the real world ; 1 shall not, therefore, follow him in 
 his brilliant fictions, but shall content myself here, in offering to my 
 readers, a small part of his physiology, to show how little it is con- 
 formed to observation: '•! assume," he says, '"that the body is 
 nothing more than a statue or machine of earth, which God forms 
 expressly to make it as similar to us as possible. Thus he gives to it, 
 externally, not only the color and the shape of all our members, but, 
 also, he puts within it all the parts which are re(|uisite, to enable it to 
 move, eat, respire, and, in short, that it be able to imitate all of these 
 functions, which may be imagined to proceed from matter, and to 
 depend only on the disposition of the organs."---' 
 
 Beliold a machine perfectly organized, possessing all the material 
 conditions for the exercise of its functions, but which, nevertheless, 
 according to our physiologist, accomplishes none. This hypothesis is 
 also in opposition to daily observation and common sense. When a 
 child is born, well-formed, that is to say, with all the apparent condi- 
 tions necessary to life, we cannot conceive that it does not live ; and, if 
 by accident it is dead-born, we are always moved to ask, why it is 
 dead, or in other words, what is the material obstacle which prevented 
 it from living? Let us follow, however, the hypothesis of Descartes, 
 to see where it will lead us. 
 
 ^ Partie philosopMque des Traite de 1' Homme.
 
 602 REFORM PERIOD. 
 
 " If you have ever Lad the curiosity to observe the organs in our 
 churches, you know how the bellows forces the air into certain recep- 
 tacles, which, I think, are named air-chambers ; and how this air 
 enters into the different pipes, accordingly as the organist touches the 
 keys of the instrument. Now you are able to conceive, that the heart 
 and arteries, which force the animal spirits into the cavities of the brain 
 of our machine, act like the bellows of the organ, which force the air 
 into the air-chambers ; and, that, exterior objects acting upon the 
 nerves which they excite, cause the spirits contained in these cavities, 
 to pass from them into some of the pores, and thus resemble the fingers 
 of the organist, who, according to the key which he touches, makes the 
 air enter from the air-chambers into some of the pipes. Now, as 
 the harmony of organs does not depend on the arrangement of their 
 pipes which are visible, nor upon the shape of their air-chambers or 
 other parts, but solely upon three things, viz., the air which comes 
 from the bellows, the pipes that give sounds, and the distribution of 
 the air in those pipes : so, also, I assume, that the bodily functions in 
 question, do not at all depend on the external shape of the visible 
 parts which the anatomists distinguish in the substance of the brain, 
 nor upon that of the cavities, but solely upon the spirits which came 
 from the heart, the pores of the brain through which they pass, and 
 the manner in which these spirits are distributed in these pores, so that 
 it is only required of me to explain here, in order, all that there is 
 most important in regard to these three things. "=•••= 
 
 The tendency of our philosopher to throw himself outside of sensible 
 phenomena is here still striking. Three things appear to him only 
 necessary in the study of physical man, namely : the spirits that come 
 from the heart, the pores of the brain which give them passage, and 
 the manner in which these spirits distribute themselves in the pores ; 
 now, not one of these three things is tangible. On the other hand, he 
 annihilates completely the study of anatomy, in affirming that the play 
 of the human organs does not depend at all on their external conforma- 
 tion. I doubt if many naturalists and physicians would subscribe to 
 such a doctrine. This example shows us how dangerous it is to attempt 
 the explanation of physical phenomena by means of pure thought ; for 
 the method preferred by speculative minds conducts us almost inevita- 
 bly into the imaginary world, and causes us to loose sight of observa- 
 tion and reality. To go back to the primordial fact of our existence, 
 and from that fact deduce all the others by a rigorous chain of propo- 
 sitions : such has been, in all times, the utopia of strong imaginations, 
 
 '■•■" Partie philosophique des Traite de V Homme.
 
 THEORIES AND SYSTEMS. 503 
 
 and men of transcendental genius. Many great minds, before and since 
 Descartes, have failed in the enterprise, and many more will yet fail. 
 But Descartes has rendered an eminent service to philosophy iu ridding 
 it of its scholastic apparel, and replacing all the rules, so complicated 
 of Peripatetic logic, by a single safe and easy rule. 
 
 Leibnitz, a universal genius, and eminently a generaliser, who shares 
 with Xewton the glory of having invented the differential calculus, 
 conceived, from his sixteenth year, the project of a universal alphabet, 
 which would represent all possible shades of thought, with the same 
 precision and the same generality as the algebraic characters represent 
 the relations of numbers. "It is only requisite," he says, "to find 
 certain terms or forms with which to announce metaphysical propositions, 
 which terms could serve as a guide in this labyrinth, in order to resolve 
 the most complicated questions by a method similar to that of Euclid, 
 preserving always that clearness, or that distinctness of ideas which 
 the vague and undetermined signs of our common languages do not per- 
 mit." He dreamed all his life of this great problem, and died without 
 having found its solution, though convinced of the possibility of arriving 
 at it." Descartes had, also, this conviction, for he wrote in one of his 
 letters : " Ideological characters might be invented to express all 
 thoughts, as has already been done for arithmetic and music ; but to 
 do this, it would be necessary to analyze all simple ideas, and apply to 
 them signs which would imitate, in their combinations, those of our 
 thoughts." f These two great men then imagined that, by perfecting the 
 language of metaphysics, the same precision could be given to this sci- 
 ence as is given to mathematics. In this they committed an error, 
 which Condillac renewed at a later period, though he adopted a philo- 
 sophic method wholly contrary — an error which we have already suffi- 
 ciently refuted. I 
 
 Leibnitz, knowing the objections which had been raised against the 
 system of Descartes, and the singular consequences which had been 
 deduced from it, by the spiritualist, Malebranche, on one hand, and the 
 materialist, Spinosa, on the other, thought to guard himself from these 
 various difficulties by choosing for the basis of his cosmological theory, 
 
 "''Works of Leibnitz, v. ii, p. 49. Historia et Commendatio Liiiguaa Caracteris- 
 tise Universalis, p. 535. 
 
 f Letter 46. 
 
 T Godfrey William Leibnitz was born at Leipsic, in 1646, or four years after 
 the birth of Newton. He was, incomparably, says Cuvier, the most encyclopedic 
 mind that has appeared since Aristotle.
 
 504 REFORM PERIOD. 
 
 a hypothesis diametrically opposite to that of the French philosopher. 
 This latter had started with the generally received opinion of his time, 
 that matter is homogeneous and completely inert; the German 2)hiloso- 
 pher took, as a point of departure, the observed fact, that there only 
 exist in nature individual baings, and that each individual differs from 
 all others in some particulars. To explain this diversity, he supposes 
 that the germs of all living beings having been created from all eternity, 
 never perish ; that they only enlarge and become visible, when we say 
 that they are born ; and that they only diminish and cease to be appa- 
 rent, when we suppose that they die. He gives to these imperceptible 
 and invisible germs the name of monads. He developes his hypothesis 
 as follows : 
 
 " Very exact experimenters have already perceived in our time, that 
 it may be doubted if an entirely new species of animal is ever produced, 
 and if all animals are not already living in a minute state before con- 
 ception, in the semen of animals, as plants are in their seed. This doc- 
 trine being accepted, it would be reasonable to suppose that what has 
 no commencement of life, has also no ending of it, and that death, like 
 generation, is only the transformation of the same animal, which is 
 sometimes augmented, and sometimes diminished. What oj)ens to us, 
 still, the marvels of the divine artifice which no one has ever supposed 
 is, that the machines of nature, being machines even to their most 
 minute parts, are indestructible, on account of their enclosing a little 
 machine in a greater one, ad infinitum. Thus, we find ourselves obliged 
 to accept, at .the same time, the pre-existence of the soul, like that of 
 the animal, and the subsistence of the animal like that of the soul. In 
 this way we perceive that not only the soul, but also the animal must 
 always subsist in the ordinary course of things."-' 
 
 The reader must have already remarked that there is a resemblance 
 between this system and that of Pythagoras on the transmigration of 
 souls. In vain does Leibnitz deny this similitude ; the subtile distinc- 
 tions by means of which he strives to show the difference, prove, them- 
 selves, that there exists analogy between them, if not identity. The 
 system of Metempsychosis is too little known to us ; it has been too 
 much disfigured by successive traditions for us to be able now to form a 
 decisive judgment on the exact degree of its homogenity with any 
 modern system. But if this homogenity were proven — far from consti- 
 tuting an unfavorable precedent for the system of monads — it would, 
 on the contrary, sustain that doctrine, by showing its origin in the 
 
 " Considerations on the Priaciple of Life.
 
 THEORIES AND SYSTEMS. 505 
 
 remotest periods. The strongest objection to tlie hypothesis of monads 
 is, that it is not founded on any observations, and is offensive to our 
 common sense. 
 
 " Leibnitz," says the historian Tenneman, *' was led to his philosophic 
 system by a profound comparison of the most celebrated systems, placed 
 in relation with the demands of his epoch by an imagination fertile 
 in ingenious hypotheses and full of sense, as well as in means of 
 reformation and concilliation ; finally, by his great learning in mathe- 
 matics. His aim was to rebuild philosophy, so that it might boast of 
 a precision analogous to that of mathematics, and put an end to all the 
 disputes of the various schools, as well as to those of theology, by occu- 
 pying, itself, this ground. He dreamed then, principally, to perfect his 
 method, and to establish some positive principles, in the hope of remov- 
 ing the causes of dissensions among the opposing sects. In short, he 
 thought that philosophy should be treated like mathematics. In this 
 respect he favored the demonstrative method, and the system of ration- 
 alism, as Plato and Descartes had believed it to be. 
 
 " Leibnitz has nowhere given a complete exposition of all parts of 
 his system ; each of his doctrines remained more or less separated from 
 the whole. His ideas are, for the most part, the result of a certain 
 kind of analysis and combination, or of a learned artifice to reconcile 
 the difference between theology and philosophy, and of an exclusive and 
 incomplete examination of the faculty of understanding. Preoccupied 
 with the idea that by thought we may arrive at the knowledge of the 
 reality of things, he addressed himself to the understanding alone, as 
 Locke had addressed himself to sensibility alone — to discover the abso- 
 lute principle of life and knowledge. Thereby, he confounds the 
 logical possibility and reality with positive reality ; he intellectualizes the 
 phenomena, and ignores the part which observation plays in the acqui- 
 sition of knowledge. Nevertheless, his philosophy, full of bold 
 hypotheses and superior views, has made new steps in science ; it has 
 put in circulation a crowd of new ideas, with so much more success as it 
 was published in the French language." '•■■ 
 
 We have I think, sufl&ciently established, by the example of Descartes 
 and of Leibnitz, to whom we may join that of Plato, and many other 
 authors who have been cited in the course of this history — we have, I 
 say, sufficiently established how the deductive method is deceptive in 
 regard to physical sciences, and how it tends to separate us from the 
 material reality of the observation of phenomena. It should be now 
 
 ^ Manuel de I'Histoire de Philosophie, translated from the German by Victor 
 Cousin. Paris, 1839. 
 32
 
 506 REFORM PERIOD. 
 
 demonstrated for us, that this method is not anything like as sure as 
 that of induction, in this particular order of knowledge. 
 
 Kant, rendered circumspect by the shipwreck of so many superior 
 minds turned his speculations toward another object : in place of seeking 
 the origin or essence of things in themselves, he proposed to determine 
 what is the mode of comprehension of the human mind, and what are 
 its natural limits. He devoted himself, for the attainment of this aim, 
 to the most patient and profound examination of which the annals of 
 philosophy have any example, and after forty years of meditations, he 
 published the result he had reached, which is summed up as follows, 
 relative to the knowledge that we are able to acquire of sensible things : 
 Reason was only given to us to form experience ; and our mind, in 
 desiring to pass the limits of sensation, in phenomena of the material 
 order, mistakes its rights, as tvell as its poiversS' 
 
 This result is very remarkable, and merits our fixed attention, for 
 it oflFers, under another form, the confirmation of the aphorisms of the 
 Sensualist philosophy, which we have heretofore announced. Thus, 
 Kant, starting from idealism, that is to say, from the pole opposite to 
 that of Locke, arrives at the same conclusion as the former, relative to 
 the knowledge of sensible objects ; he stops at the same limit, also — 
 the sensations — in the domain of the physical sciences. This was a 
 fact important to establish, and which should give us an entire confi- 
 dence in the aphorisms heretofore stated.f 
 
 § IV. Conclusion. 
 
 This rapid and very incomplete sketch of the history of philosophy, 
 during the last two centuries, shows us two sects of philosophers, seeking 
 the truth by two difi"erent ways. The one, more particularly addicted 
 
 '^ Critique de la Raison Pure. 
 
 f The reform introduced by Kant, in philosophy, relates principally to moral 
 and metaphysical ideas, for which the doctrine of Locke does not offer a solid 
 basis. Emanuel Kant was born in Kiniigsberg, in 1724, and died while pro- 
 fessor in the same city, in 180i. " He was," says Tenneman, " a second Socrates, 
 who, by a new method, reanimated the mind for researches, taught it to know 
 its whereabouts, and led reason into a scientific route, by teaching it to know 
 itself. Possessed of rare talents, cultivated and developed with care, he rendered 
 himself worthy of such a vocation. His moral and religious character prevented 
 him from following pure speculation, and made him the impersonation of his 
 doctrine. A constant love of truth, joined to the purest moral disposition, was 
 the soul of his philosophic genius, which united, in an eminent degree, originality, 
 strength, depth, and sagacity." (Man. de Vllist. de la Philosophic, T. II, p. 225.
 
 THEORIES AND SYSTEMS. 507 
 
 to the study of the physical sciences, connects all our ideas with sensa- 
 tions, assuming to deduce from that source, not only the knowledge of 
 sensible objects, but also that of moral and religious truths, such as 
 the existence of God, the free will of man, etc. Their favorite mode 
 of reasoning is that of induction ; but they also make use of syllo- 
 gisms. They have been called sensualists, because they regard the sensa- 
 tions as the basis of all our acquirements ; empirics, because the rules 
 which they trace have for their object, to direct experience, and take 
 their foundation in observation. Their method is the most favorable for 
 the advancement of the natural sciences, properly said ; it was adopted 
 by the greatest philosophers or naturalists of antiquity and modern 
 times, such as Aristotle, Galileo, Newton, Linnaeus, and Cuvier. It 
 should be preferred in medicine, for it is according to it that the philo- 
 sophic aphorisms, or axioms, were established, which guide us in the 
 appreciation of medical doctrines. 
 
 The other sect, more attentive to the phenomena of pure thought, or 
 consciousness, endeavors to comprehend the material world by the same 
 plan, and desires to explain physical phenomena by the laws of the 
 mind. They have been called idealists, because they pretend to deduce 
 all our knowledge from ideas ; rationalists, because the rules which they 
 trace have for their object the direction of reasoning. They proceed, 
 ordinarily, by the deductive or syllogistic method. Now, we have seen 
 the deceptive nature of this method in the physical sciences ; how it 
 tends to divert our attention from the real world, and carry it to the 
 fictitious world. Xevertheless, the metaphysician of Ktinigsberg attained 
 by this route the confirmation of the aphorisms which the sensualists 
 had formed ; which proves that no method necessarily leads either to 
 error or truth, in any department of knowledge. The deductive method 
 is more favorable than the inductive one, for the discovery and demon- 
 stration of moral and metaphysical truth ; it has generally been pre- 
 ferred by the great moralists and profound thinkers of every age, such 
 as Plato, Descartes, Pascal, Leibnitz, Kant. 
 
 Nearly all the philosophers of both sects, charmed by the infallibility 
 of mathematical propositions, strove to imitate the mathematical mode 
 of reasoning, hoping to reach by it convincing demonstrations, and be 
 sheltered from all controversy. Vain eiforts ! they pursued a chimera 
 which it is permitted to no man to attain ; the essence of things cannot 
 be changed by formula of language or reasoning. If they had well 
 reflected on the nature of mathematical propositions, they would have 
 perceived that their character of certainty does not depend either on the 
 signs or the method which mathematicians employ ; but upon the nature 
 itself of the propositions, which is such that they reach our understandings
 
 508 EEFORM PERIOD. 
 
 by the double way of experiment and pure reason, wbich leads to the 
 conviction of our minds in an irresistible manner, without leaving any 
 open door to doubt or hesitation. Let a geometrician, for example, take 
 the hight of a tower by a trigonometrical process, and afterward mea- 
 sure its hight with a line ; he will find by these two processes nearly 
 identical results, which will confirm in his mind the demonstrability of 
 the theories of trigonometry. For ages the predictions of astronomers, 
 on the appearance and duration of eclipses, are verified with a punc- 
 tuality which must inspire us with full confidence in the exactness of 
 their theories and calculations. Experimental proof, it may be said, 
 adds nothing to the certainty of the theoretic demonstrations of geometry. 
 That is true, but the experimental proof adds to the conviction of the 
 mind ; it strikes the ignorant like the learned — forbids doubt and dissi- 
 pates obscurity. 
 
 It is not the same with the other sciences : in examining them care- 
 fully, we shall see that none of them shares with mathematics -the privi- 
 lege of seizing upon our understanding by the double route of reason and 
 experiment. Moral and metaphysical truths, for example, are not sus- 
 ceptible of any experimental demonstration ; it is only by reason that 
 we prove the existence of God, his infinite attributes, the immortality of 
 the soul, the blessedness of virtue, etc. Physical truths, on the contrary, 
 cannot be demonstrated in any other way than by experiment ; thus, the 
 property possessed by acids, of uniting with alkalies to form salts, has 
 been ascertained and can only be proved by experiment. Thus, obser- 
 vation alone has shown, and proves every day, that the abuse of alcoholic 
 drinks enfeebles the brain ; but our intelligence cannot define any neces- 
 sary connection between these causes and their respective efi"ects. It is 
 the same for all the phenomena of the material universe which are not 
 within the range of mathematics ; these phenomena, as well as the laws 
 which regulate them, can only be demonstrated by experiment. 
 
 I could have wished to spare my readers this digression into the field 
 of philosophy ; but it has appeared to me indispensable, and I hope will 
 not prove unfruitful. It has furnished us, in the first place, with an 
 occasion to make choice of a method with discernment ; then it has 
 shown us the limits where must be arrested our faculty of acquiring 
 knowledge of sensible things ; finally, we have established some aphorisms, 
 which, like guide-posts planted on the route which we are to follow, will 
 direct us in the examination of medical doctrines, and abridge considerably 
 our labor.
 
 THEORIES AND SYSTEMS. 509 
 
 ART. IL SOURCES OF ANIMISM AND CHYMIATRIA.e 
 
 Among the men who contributed the most to discredit the ancient 
 doctrines, and to introduce the taste for novelties in Medicine, we shall 
 cite, in the first phice, John Baptist Van Helmont, Lord of Merode and 
 of several other estates. He distinguished himself early by his applica- 
 tion to study, his piety, and the independence of his opinions. At the 
 age of seventeen years he was offered the degree of master in philosophy, 
 but he refused it ; knowing, he said, that his head was furnished with 
 words only, and he was not willing to be dubbed master in the sciences, 
 when he was scarcely a scholar. Having renounced the academic dig- 
 nities, and the schools where futile matters only were taught, to devote 
 himself, in all the independence of his genius, to researches after truth, 
 he read at first the writings of the pagan philosophers, and acquired 
 some taste for the doctrines of the stoics ; but afterwards the books of 
 Thomas a Kempis and of John I'aulerus falling into his hands, decided 
 his inclination toward mysticism. " I saw," he said, " that all truth 
 and wisdom comes from God, to whom man unites himself by prayer, 
 contemplation, and good works." Henceforth he studied to regulate his 
 conduct by the example of Jesus Christ ; and in order to copy closer this 
 divine model in the relief of human misery, he resolved to study 
 Medicine. 
 
 He embraced this study with the ardor of an enthusiast and the 
 obstinacy of a fanatic ; he consecrated to it thirty consecutive years, 
 and after having read, annotated and extracted from more than six 
 hundred Arab and Latin authors, he found himself in a condition to 
 dispute on all diseases, in a way to excite the admiration of the most 
 skillful. He took, then, the title of Doctor. Afterward, he passed 
 through Italy, France, England and Spain, in short, Europe entire, in 
 order to initiate himself directly in the process of the Healing Art in 
 use in each country, and to collect all the secrets of alchymy. On his 
 return to Brussels, the capital of his country, he divided his time there- 
 after between the practice of medicine and labors in his laboratory, in 
 which he sometimes shut himself up for entire days. His discoveries 
 in chemistry have secured him a distinguished place in the history of 
 that science ; but we can only occupy ourselves at present with his 
 opinions in medicine. 
 
 Van Helmont proscribed blood-letting as injurious in all cases ; and, 
 without rejecting purgatives in an absolute manner, he made a very 
 moderate use of them. His favorite remedies were opium, wine, and 
 
 ■^Doctrines -which assumed, respectively, for all the healthy and morbid phe- 
 nomena of the economy, the influences of a presiding soul and the laws of chemistry.
 
 510 REFORM PERIOD. 
 
 compositions which he prepared himself, into which, like Paracelsus 
 and other chemical physicians, he incorporated substances taken from 
 the mineral kingdom. ■•= He cured, with these preparations, certain 
 diseases which had resisted ordinary means ; but how many individuals 
 found themselves made worse by the improper use of remedies yet too 
 little proven ! 
 
 His writings abound in new words and odd ideas, which render their 
 reading fatiguing. We meet there, entire chapters of impenetrable 
 obscurity, so that they form the natural transition from the ramblings 
 of Paracelsus to the learned theories which we shall soon have to 
 examine. Nevertheless, no one could place Van Helmont in parallel with 
 the Swiss thaumaturg, to whom he was superior in all respects, and for 
 whom he professed a profound contempt. Eich in an uncommon erudi- 
 tion, and his own proper experience, the Belgian physician knew how to 
 avail himself of these to sap the prejudices of the schools ; and he is 
 never so clear and so precise as when he wishes to uncover the naked- 
 ness of the hollow verbiage of the physics of Aristotle, and the physi- 
 ology of Galen. He asks, for example, on what foundation the schools 
 sustain, with their Aristotle, that the air is humid at eight degrees, 
 and hot at four degrees ? By what experiment they prove that condensed 
 air is turned into water, and becomes thus a perpetual food for the 
 springs ? At the same time he cites, in support of a contrary opinion, 
 the experiment by which air is compressed in a gun-barrel without 
 exhibiting the least particle of water, whatever the degree of condensation 
 to which it may haA^e been submitted. 
 
 But when he abandons the role of the critic, and attempts to found, 
 in his turn, a system of natural philosophy, he falls into such a confu- 
 sion of ideas that it would be impossible to analyse his doctrine. All 
 that we are able to do, is to report here some of the propositions which 
 appear to form its basis. Van Helmont admits two material principles 
 for all things ; the one is water, which furnishes matter, the other is 
 the ferment or seminal breath which gives it form. At other times 
 he says, that the two principles of all created beings are air and water, 
 because they cannot be transmuted into each other. In regard to the 
 earth, he believed that it proceeded from water, by a secondary forma- 
 tion. The archens is a spiritual gas, which gives impulsion to the 
 fecundated seed, by means of a ferment. It regulates, like a skillful 
 architect, all the movements with which the natural body is endowed ; 
 and it remains in them until their dissolution. Without it no organized 
 being could acquire the form that is proper to it — everything would be 
 
 * See letter of Guy Patin. Paris, 1846.
 
 THEORIES AND SYSTEMS. 611 
 
 confounded, and tlie universe would re-enter into chaos. Besides the 
 archeus and the ferments, Van Helmont sometimes endows the animal 
 economy with a third motor, which he names hlas. The nature of this 
 is double ; one part produces the natural, and the other the voluntary 
 movements. The stars, also, have a double hlas ; the first moves them 
 in space ; the second excites the special revolutions to which their sub- 
 stance is subject. The bias of the stars and of man agree with each 
 other ; so that we may predict certain atmospheric vicissitudes by the 
 aspect of the infirmities which aiflict the human body, and better still by 
 those which are seen in brutes, because the animals were created before 
 man. 
 
 If from these general notions we descend, with this author, to 
 the particular functions of each part of the body, we shall find that he 
 accords to the stomach and the spleen a sort of omnipotence over the 
 rest of the body, which he characterizes by the picturesque expression 
 of duumvirate. The archeus or conscious soul resides on one or other 
 of these two viscera, and more especially on the pylorus. From this 
 position it directs all the functions of the other organs, watching the 
 integrity of each, and maintaining the harmony of the whole. 
 
 There are six digestions : the first takes place in the stomach, by the 
 aid of an acid ferment which the spleen supplies ; the second, in the 
 duodenum, where the bile, mingling with the alimentary bolus, changes 
 its acidity into a volatile salt ; the third, in the mesenteric veins, where 
 the chyle is transformed into venous blood, otherwise called cruor ; the 
 fourth digestion is eficcted in the heart, by means of heat, agitation, 
 and a particular ferment, which causes the venous blood to become arte- 
 rial ; the fifth digestion takes place in the brain, where the vital spirit 
 is extracted from the arterial blood ; the sixth consists in the work of 
 assimilation, which each part executes in appropriating by virtue of its 
 innate spirit, the aliment that is natural to it. With the number 
 seven, nature keeps a sabbath, in other words, rests. 
 
 Let us now take a glance at the pathology of this author. AVheu 
 the archeus is oiFended by any injurious or disagreeable agent, it becomes 
 furious, or it is seized with fear, which produces disordered movements, 
 and the image which this trouble depicts in it becomes the seminal 
 idea of the disease. There are as many species of diseases as there are 
 morbid seminal ideas of different characters, and the primitive seat of 
 all our affections is in the tunic of the stomach, which is the habitual 
 residence of the archeus. Morbific causes were of two sorts, those 
 from without, as miasms, epidemics, poisons, virus, unsound food and 
 drinks, etc. ; the others are from within, and consist in some excre- 
 mentitial matter not evacuated at the proper time»
 
 512 REFORM PERIOD. 
 
 Fever is the result of extraordiaary efforts made by the archeus to 
 disembarrass itself of the morbid idea which troubles it ; from this 
 struggle proceed those intervals of excitement and agitation that suc- 
 ceed each other. The chill indicates the state of terror or exhaustion 
 of the archeus ; the heat announces the violence of the efforts and 
 struggle which it undertakes. Vesicular calculi are formed by the acci- 
 dental combination of three sorts of spirits which exist in the urine, in 
 the ordinary state of isolation. The first is a salino- volatile spirit ; the 
 second is of a vinous and inflammable character ; the third of an earthy 
 nature. The tophaceous concretions in gouty persons are engendered 
 by the synovia, a species of transparent liquor, destined to lubricate the 
 joints, which, in becoming acid, looses its aqueous part, and becomes 
 dry and hard. 
 
 In regard to therapeutics, Van Helmont laid down the principle that 
 the first condition for the favorable operation of a medicine was, that it 
 comport with and be agreable to the archeus ; then, that it be adminis- 
 tered in proper doses and at proper times. He thought that the actual 
 virtue of remedies resides especially in their odors ; these being, he 
 said, the symbol of the seminal ferment, and the cause of all the trans- 
 mutations that are effected in the human body. Besides, he had faith 
 in the efficacy of certain words, as well as in amulets and talismans. 
 He believed in the efficacy of a universal remedy, which he named 
 alkacst, ens primum, primus viefcdlus, etc. 
 
 Van Helmont had no disciples, properly said ; he founded no sect, 
 but several modern medical sects have borrowed their ideas from him. 
 The chemical school owes to him the idea of ferments ; the animists or 
 vitalist school, that of the sensitive soul or vital principle, formed on 
 the model of the archeus. The thaumaturgs, the Eosicrucians, and the 
 magnetisers regard him as one of their adepts, or pretend, at least, to 
 find in his writings some traces of their doctrines. The partisans of 
 scholastic traditions never had a ruder adversary. " At an epoch when 
 there were still found on all sides those who held to the doctrines of the 
 middle ages, when the forces of nature, interrogated with fear, seemed 
 always to present themselves under a mysterious and supernatural form, 
 it is not astonishing that the mystical spirit of Van Helmont saw in 
 the ecstacies of his soul, and in his dreams, the revelation of the solu- 
 tion of the most embarrassing problems. Xor is it any more astonish- 
 ing, that he substituted hypotheses for hypotheses, and errors for errors. 
 The men of those times were, in regard to a thousand questions now 
 clear to us, in the same condition as we are at present, in regard to the 
 difficulties insoluble by our means of investigation. What theory is 
 sufficient for the cure of intermittents by Peruvian bark, the origin of 
 
 (
 
 THEORIES AND SYSTEMS. 513 
 
 variola, and the destruction of its germ by vaccine ? Who has not 
 made a desperate eiFort to pierce this obscurity, to get a glance beyond 
 this horizon ? Very well, let us turn the eye upon this past, which 
 was their future, or our light, which was darkness to them, and repre- 
 sent to ourselves the false lights, and the gropings of our predecessors — 
 so much easier to go astray, as they had not, like us, a guiding compass, 
 in the method of observation, and as they could scarcely abstain from 
 hypotheses in the absence of facts." " 
 
 ART. III. lATRO-CHYMIA. 
 
 Francis de Lebo, called Sylvius, was the first who pretended to 
 explain all the phenomena of the living economy by the laws of chem- 
 istry alone. He was in his forty-fourth year, and enjoyed the reputation 
 of being the most skillful physician in Amsterdam, when he was called 
 to teach practical medicine in the University of Leyden. Before his 
 time, tlie professors contented themselves by reading from the chair, and 
 commenting upon, before their pupils, the most renowned authors. 
 Lebo had the happy thought of admitting his young auditors to visit 
 the sick in the city hospital, and to choose for the subject of his lectures 
 the diseases they had before them. He was thus one of the originators 
 of clinical teaching, and it is to this day his best claim to distinction. 
 He cultivated, with signal success, anatomy and chemistry, and at the 
 epoch when the discovery of the circulation of the blood excited the 
 whole medical world, he was one of the first to declare himself in favor 
 of the doctrine of W. Harvey, and sustained it by new proofs, drawn 
 from the examination of dead bodies. In short, he was accustomed to 
 recommend anatomy, chemistry, and clinical observation, as the true 
 basis of medical instruction. This celebrated iatro-chemist died in 
 1672, aged fifty-eight years. 
 
 Sylvius declared, in substance, that nothing must be held as true, in 
 medicine, which had not been confirmed by the testimony of the senses — 
 an opinion conformable to ouvjifth philosophic aphorism. We will now 
 proceed to see, if in the development of his physico-pathological theory, 
 he is always true to this wise maxim. 
 
 PHYSIOLOGY. 
 
 He describes the act of digestion as follows : The food, he says, is at 
 first triturated in the mouth, where it is impregnated with saliva, a 
 liquid endowed with great fermenting properties. Thence it descends 
 
 ^ M. Littre, .Journal Hebdomadaire de Medccine, Paris, 1830, T. "VI., p. 413.
 
 §14 REFORM PERIOD. 
 
 into the stomacli, and there encounters the residuum of the preceding 
 digestion, a species of leaven very favorable to stomachal digestion, by 
 means of which it undergoes a second preparation ; after which it passes 
 into the intestine, in the form of a viscid and whitish humor. A little 
 below the pylorus this alimentary humor undergoes a third fermentation, 
 by the united action of the bile, pancreatic juice, and the saliva. Then 
 the purest and most fluid part separates from the thickest and crudest 
 part. The latter, carried on to the large intestine, takes the form and 
 name of feces, while the other, deprived of its excrementitious matter, 
 is termed chyle, and goes through the lacteal veins to the thoracic canal, 
 where it unites with the lymph. The humor resulting from this union 
 is carried to the vena cava superior, where it is mingled with the blood, 
 and communicates to that fluid its nutritive quality. The venous blood, 
 thus restored, reaches the right cavities of the heart, and thence goes to 
 the left cavities, by traversing the lungs. In its passage through the 
 lungs, the blood undergoes a last efi'ervescence, which brings it to its 
 highest degree of perfection.- 
 
 This description of the function of digestion is distinguished from 
 that of Van Helmont by much greater anatomical exactness, and by 
 no intervention of the archeus. The saliva, bile, and pancreatic juice, 
 have in this the active agency — an agency that Sylvius denominates 
 trmmvirale. The bile, he says, which holds the first rank, owes its 
 virtue to an alkaline salt, tempered by an oily, volatile spirit. The 
 saliva obtains its virtue from the acid and volatile spirit that enters with 
 water into its composition. The pancreatic juice owes its activity to an 
 acescent volatile spirit. 
 
 The animal spirits are extracted from the blood, which reaches the 
 cerebrum and cerebellum by the carotid arteries. This liquid in pene- 
 trating into the capillary vessels loses its watery part, which is filtered 
 through the pores, and acquires a character that very much resembles 
 the spirit of wine. 
 
 Thirst arises from the saline exhalations that rise from the small 
 intestines, through the stomach to the throat, where they excite a sen- 
 sation of dryness. These exhalations are the product of efi'ervescence 
 of acid bile mingled with the pancreatic juice. Natural hunger arises 
 at first from the fermentation engendered in the stomach by a mixture 
 of the residue of alimentary residuum with the saliva that we continu- 
 ally swallow. This fermentation developes a halitus of an agreeable 
 acidity, which titillates softly the superior orifice of the stomach, and 
 creates the desire for food.f 
 
 ^ Sylvii Praxeos Medicos Idea Nova, cap. x., §§ 2, 3, 4. f Ibid.
 
 THEORIES AND SYSTEMS. 515 
 
 PATHOLOGY. 
 
 The immediate cause of continued fevers is referred to a vice in the 
 bile or lymph ; a vice which is calculated to excite in the right ventricle 
 of the heart an increase of eflFervescence, from which results the con- 
 tinual vehemence of the pulse. 
 
 The cause of intermittent fevers consists in the excessive acrimony of 
 the pancreatic juice. By its mixture with the bile and pituite, this 
 vitiated juice provokes an abnormal fermentation, which occasions a 
 chill, more or less marked, until the bile, flowing in its turn in abund- 
 ance, causes an increase of caloric in the right cavities of the 
 the heart, and creates a heat to succeed the chill. However, in what- 
 ever way the thing takes place, it appears beyond all doubt, that the 
 algid period in all fevers arises from acidity of the pancreatic juice or 
 lymph, while the hot period is the eiFect of the bile, whose alkaline 
 salt united to oil conserves and developes eminently the element of fire. 
 
 THERAPEUTICS. 
 
 It is on the hypothesis that we have just read, and other similar ones, 
 that Sylvius founded his curative indications ; he opposed purgatives to 
 diseases proceeding from the effervescence of the bile ; he pretended to 
 correct the acridity of that humor by opium and other narcotics ; he was 
 prodigal in volatile salts and diaphoretics, sometimes with the purpose of 
 combatting the acidity of the lymph, or the pancreatic juice ; again, 
 in order to arouse the sluggishness of the vital spirits, and favor the 
 secretions. In a word, he created an incendiary medicine, based on a 
 fictitious theory, which he believed in good faith to be the only pure 
 expression of the truth. 
 
 But if we judge this theory by the light of the philosophic principle 
 which he himself has laid down in the beginning, and which consists, 
 as must be recollected, in holding in Medicine as true only what is 
 attested by the testimony of the senses, we shall find that it is very far 
 from fulfilling such a condition. In fact, of the three humors that con- 
 stitute his physiological triumvirate, one only, the bile, possesses in a 
 very feeble degree the alkaline quality that he attributes to it ; the other 
 two, namely, the saliva and the pancreatic juice, do not at all appear 
 endowed with the acidity that he attributes to them, and by which he 
 assumes their co-operation in the digestive act, as well as in the gen- 
 eration of diseases. It might also be asked, on what direct observation 
 he bases himself, to aflBrm that the animal spirits are distilled in the 
 capillary tubes of the encephalon, like the spirits of wine ; or, for 
 teaching that the acidity of the lymph, or the pancreatic juice produces
 
 516 REFORM PERIOD. 
 
 the fever chill, and that the return of the heat, or reaction, is due to 
 the acridity of the bile. Finally, his whole system is radically wrong, 
 on account of its insufficiency and errors ; and no account is taken in it 
 of the state of the solids, or their action. 
 
 We must believe, for the honor of a practitioner so renowned as Syl- 
 vius, that he departed somewhat from his theoretic prejudices at the 
 bedside of his patients, and that he remembered there that sentence 
 which he had himself emitted: How many of the specious and rea- 
 sonable things, in theory, are known to be vain and faulty in practice ! 
 
 His doctrine made rapid progress in Germany and in England, but it 
 obtained less favor in France and Italy, where the partisans of the 
 ancient Dogmatism opposed it with a lively resistance. The novelty of 
 the phenomena on which he rested, the small number and clearness of his 
 principles — the facility of their application in the treatment of diseases, 
 were all well calculated to seduce enthusiastic minds, anxious for a 
 change. Besides, as we have already remarked, the circumstances were 
 favorable for all attempts at innovation in Medicine ; for the antique 
 edifice of the Healing Art was yielding to the attacks on all sides. 
 
 Thomas Willis, cotemporary of Lebo, and a still more celebrated anato- 
 mist than he, contributed more than any other to the propagation of the 
 taste for chemical explanations among physicians. After having taught 
 natural philosophy for six years, and practiced medicine with distinction 
 at Oxford, he resigned his chair to go and exhibit himself on a much 
 greater theater. He moved to London, and became, in a short time, one 
 of the most distinguished practitioners. Being adjunct to the College of 
 Physicians of that capital, he gained the friendship of his colleagues, 
 by the integrity and gentleness of his character, as he merited their 
 esteem by the extent and variety of his learning. 
 
 The system of this iatro-chimicus differs notably from that of Lebo, 
 though established on the same order of considerations. Willis laid 
 down the principle, that if any substance whatever is submitted to the 
 analysis of fire, it is resolved into spirituous, sulphurous, saline, aqueous 
 and terrestrial particles : from which he concluded that there are five 
 elements, namely: spirits, sulphur, salts, water and earth. He excluded 
 air and fire from the number of elementary bodies, because they are 
 neither visible nor palpable. "For," he adds ironically, "my intelli- 
 gence is obtuse, and my reason cannot penetrate beyond the reach of my 
 senses." We perceive that most of -the physicians of this period 
 accepted, at least in principle, the aphorisms of the Sensual Philosophy ; 
 but they were not in the habit of submitting to them their medical 
 theories; thus the " spirits " which Willis placed at the head of the 
 elements, do not appear to me in any manner more visible or palpable
 
 THEORIES AND SYSTEMS. 517 
 
 than air or fire. Could anyone so soon forget the philosophic maxim that 
 he seemed to take for a motto ? This is what; we now proceed to see. 
 
 The " spirits," according to him, are an ethereal substance, extremely 
 subtile, an emanation of the Divine breath, which a benificent providence 
 had placed in the sublunary world, to impress all things with vital 
 action. Sulphur is au element of a little more consistency ; it evapo- 
 rates less promptly than spirits ; the heat, shape and beauty of bodies, 
 as well as their colors, aroma and taste, depend upon the proportion^of 
 this element. Salt has still more density ; it gives to substauces weight 
 and solidity, and is the element of their duration and reproduction. 
 "Water is the vehicle of spirits and sulphur, and favors their admixture 
 with salt ; deprived of this dissolvent, the other elements could form no 
 union. Earth fills the pores of all solid bodies ; it hinders a too inti- 
 mate contact of the active elements, and prevents them from bruising 
 each other — retains by its viscidity those which are too volatile, in fine, 
 gives to bodies their mass and volume.'---'^ 
 
 Most decidedly, the qualities and functions which Willis ascribes to his 
 elements are not more real than the ancients ascribed to theirs. There 
 is no more reason to believe that heat, beauty, form, colors, aroma and 
 taste come from sulphur, than to admit that air is humid at eight 
 degrees, and cold at four degrees. All is equally fictitious and imag- 
 inary ; but in this respect, Willis appears to me more faulty than the 
 ancients, for he puts himself in manifest contradiction with his philo- 
 sophic principles. 
 
 Let us follow now the application of his theory to the phenomena of 
 organized bodies, and in particular to the animal economy, as fermen- 
 tation enjoys here a great role ; let us in advance see what he means by 
 the term: "Fermentation," says our chemist, "is an internal movement 
 of the particular elements of any body whatever, having for its object 
 the improvement of the body or its transformation to another sub- 
 stance. It occurs in the three kingdoms — among minerals buried 
 in the bosom of the earth, as among vegetables and minerals. It is 
 sometimes the effect of art, as well as a natural result." 
 
 PHYSIOLOGY. 
 
 The mind perceives the first development of life in the heart ; that 
 viscus, whose rapid movements are seen by the eye, offers the represen- 
 tation of a fermenting point — ■punctulum ferinenteseens. The spirit 
 bounds from this rebounding point (punctum saliens) as from a prison ; 
 but the sanguineous liquid, which serves it as a vehicle, prevents it 
 
 •^ De Fermentatione Sive de Motu Corporum Tnorganico, cap. n.
 
 518 REFORM PERIOD. 
 
 from flying off, and constrains it to keep on the track ; so that the spirit 
 going and coming, unceasingly, from the center to the circumference, 
 cuts out and fashions the arteries and veins that subserve the circulation 
 of the blood in all parts of the body. 
 
 The chyle is extracted from the food by coction, -which is eiFected in 
 the stomach by the aid of an acid ferment. " Some pretend," continues 
 Willis, "that this ferment comes from the spleen ; but anatomy has 
 not, up to this time, discovered any direct communication between that 
 viscus and the stomach. However this may be, the chyle acquires a 
 milky color by the coction of the sulphurous and saline parts, mingled 
 with the ferment of which I have just spoken." 
 
 It was also by the intermediation of a ferment that the animal 
 spirits were separated from the purest sulphurous portion of the blood, 
 in the cortical substance of the brain and the cerebellum. But though 
 the process by means of which this operation was effected was a little 
 obscure it appeared nevertheless demonstrated, that in this circum- 
 stance, the cncephalon, covered by its bony case, and furnished with its 
 nervous appendages, fulfilled an office similar to that of the upper part 
 of an alembic of glass, enclosing a sponge, for the rectification of the 
 spirit of wine. 
 
 In short, each apparatus of the organic body possessed a particular 
 ferment, indispensable to the exercise of its functions, so that it might 
 be said that our life commenced and was sustained by ferments.'-' 
 
 PATHOLOGY. 
 
 If ferments are the source and sustenance of life, they are equally 
 the cause of our death, for they harbor, after Willis, the germs of all 
 diseases. Sometimes, he says, the sulphurous and spirituous parts of 
 the blood are exhaled in excess, producing an ebullition in the vessels 
 like the fermentation of wine, and giving rise to febrile afiiections of all 
 species ; again, the saline part effervesces, communicating to the blood 
 an acid, austere, or bitter quality, which causes it to coagulate in vari- 
 ous ways; from this proceed most of the chronic diseases, such as 
 scorbutis, dropsies, lepra, etc. 
 
 All the intermittents were due to a superabundance of the non- 
 assimilated digestive juice, which, in circulating with the blood, excites 
 an ebullition which continues until all the morbific matter has been 
 expelled ; then only is a calm re-established — an intermission more 
 or less long succeeds the febrile agitation. 
 
 Continued fevers are engendered in the following manner ; the 
 
 ^ De Fermentatione Sive de Motu. Oorporum Inorganico chap. v.
 
 THEORIES AND SYSTEMS. 519 
 
 spirituous portion of the blood being agitated or heated, produces an 
 ephemeral fever, or a legitimate synocha. If the fermentation extends 
 to the sulphurous particles, a putrid fever results. In fine, ■when a 
 poisonous miasm enters into the circulating fluid, it provokes not only 
 the efi"ervescence of the spirituous and sulphurous molecules, hut also 
 separates the elements of the blood, giving rise to putridities and 
 strange coagulations, and those alarming and extraordinary symptoms 
 supervene that mark extreme peril, and which characterize malignant 
 fevers — the plague, small pox, etc. 
 
 Phrensy consists in the irritation by the spirits of the brain, which, 
 abandoning themselves to confused and disordered movements, derange 
 all the functions of the soul. But when the spirits realize another 
 order of alteration, when, for example, their substance changes its 
 nature and becomes ascesent, sour, or insipid, instead of its former 
 salino-spirituous condition, then, I say, they engender other sorts of 
 madness, such as melancholy, dementia, idiocy, etc. 
 
 THERAPEUTICS. 
 
 It was also by the aid of ferments that all diseases were cured, and 
 the office of the physician, says AYillis, resembles very much that of the 
 butler, who watches that the fermentation of the wine takes place 
 regularly, and removes every foreign substance that would be calculated 
 to trouble it. They act at first on the spirits or their humors ; they 
 appease, excite, or change in a thousand ways their fermentative move- 
 ment ; in this way they produce all sorts of efi"eets on the body, the 
 solids of which they modify secondarily. 
 
 Such are the principal traits in the medical doctrine of Willis. The 
 reader must have remarked what I announced in the commencement, 
 that they resemble very much those of Lebo, in certain connections, 
 and diifer from them in others. The system of AVillis was more vast, 
 complicated and subtile than the preceding, was less comprehensive to 
 the vulgar, and, therefore, pleased better, minds accustomed to abstract 
 speculation ; but there are at bottom the same defects, and it merits the 
 same reproaches. The English nosologist made no more account of the 
 form and constitution of the solid parts, than did the nosologist of 
 Leyden. Nor did he keep any better the promise he made not to go 
 beyond, in his speculations, the limits of sensible phenomena : he pre- 
 sents to us, on the contrary, a series of deductions purely fictitious, 
 resting on materials, placed, for the most part, beyond our senses. I 
 am then, compelled, in order to justify, in the eyes of posterity, the 
 reputation of this great practitioner, to repeat what I have said in 
 favor of Sylvius and so many others, namely : that they laid aside their
 
 520 REFORM PERIOD. 
 
 fictitious theories when visiting the sick, and consulted their experience 
 only. I have the more reason to think that Willis acted in this way 
 from what he says on the subject of Peruvian bark, whose eiFects con- 
 tradict his theory — that it is better in every case to be guided by 
 observation. 
 
 The disciples of these two celebrated men made some secondary mod- 
 ifications in their systems, of which it would be useless here to give a 
 sketch ; I therefore pass at once to another class of theoreticians. 
 
 ART. IV. lATRO-MECHANICS. 
 
 The progress of chemistry had given rise to the idea of explaining 
 the functions of organized beings by the laws which regulate the inti- 
 mate and elementary combinations of crude bodies ; so, also, the pro- 
 gress of experimental physics, mechanics, and mathematics, suggested 
 the thought of applying mathematical calculations to the phenomena of 
 the living economy. They were vainly filled with the hope, that they could 
 arrive to the determination, with mathematical precision, of the least 
 vicissitudes in health, as well as the means to remedy them ; and to this 
 purpose they devoted themselves to patient and ingenious researches. 
 
 Sanctorious was the first who entered upon this path, in essaying to 
 estimate by exact experiments the quantity of insensible perspiration 
 that exhales from the body in a given time. As all the functions of the 
 organism are so bound together that no one can be deranged without the 
 others becoming afiected, he thought that each variation in the quantity 
 of exhaled vapor would indicate a sha<le of change in the general state 
 of the body. This opinion had nothing in itself very unreasonable or 
 unreal ; nevertheless, the researches attempted in this sense, by Sanc- 
 torious, and by many other observers of the greatest merit, only pro- 
 duced results more curious than useful, and consequently have been 
 abandoned on account of the little benefit which has accrued to the 
 Healing Art. 
 
 Alphonso Borelli, professor of Mathematics in the University of Pisa, 
 member of the Academy del Cuiiento, instituted in 1657, by Leopold, 
 prince of Tuscany, for the purpose of propagating the doctrine and method 
 of Galileo, is the veritable founder of the sect of latro-mathematicians. It 
 was in the halls of that academy that he read his first essays on the 
 mechanics of animals. Soon after he quitted Pisa, from some particular 
 discontent, and went at first to Messina, where he did not long remain, on 
 account of the political troubles that agitated Sicily ; lastly, he went 
 to Pkome, where he was welcomed and protected by Christina, ex-queen
 
 THEORIES AND SYSTEMS. 521 
 
 of Sweden, to whom he dedicated his famous treatise on Animal 
 Mechanics. 
 
 Fruit of patience and genius, this work created a new department in 
 Medicine. Until then, in fact, only vague and erroneous ideas were 
 held, on the sum of the forces expended hj animals in their movements, 
 and on the mode of employment of the same forces. Proceeding from 
 the principle that nature attains her ends by the most direct route and 
 the most simple means, it had always been thought that men and ani- 
 mals are constituted in a way to be able to execute great movements 
 and carry heavy burdens by employing the least possible force. Borelli 
 refuted this idea by convincing arguments, founded on anatomy and the 
 laws of statics. Comparing the bones put in play by the muscles, to 
 levers moved by cords, he proved that man expends an enormous 
 quantity of power in his movements. If, for example, there be attached 
 a weight of twenty-six pounds to the extremity of the hand, the arm 
 being extended horizontally, and then be brought to a state of flexion, 
 the biceps muscles must employ, he says, to execute this movement, a 
 power which will not be less than eleven hundred and sixty pounds.* 
 The street porter, having on his shoulders a package of one hundred 
 and twenty-nine pounds weight, consumes, according to the calculations 
 of the same author, a sum of forces equal to 17,266 pounds, when he 
 sustains himself on one foot alone. 
 
 However it may be in regard to the exactness of these calculations, 
 which must be accepted only as a very elastic approximation, it is 
 unquestionable that a man developes, in his movements, a muscular 
 energy incomparably greater than the weight he sustains ; a truth 
 which was not supposed before the publication of the discoveries of 
 Borelli. His work embraces, besides, a prodigious quantity of fine and 
 new observations on the various modes of rest and locomotion of animals, 
 such diiferent attitudes as standing, sitting, or lying down, walking, 
 running, leaping, swimming, flying, etc. To give only one example in 
 a thousand, he presents a very ingenious explanation of the process by 
 means of which a bird sustains itself while sleeping, resting on one foot 
 only, and supported by a frail branch moved by the wind. 
 
 It was, then, not without reason that this author writes at the head 
 of his preface: "I undertake to speak on the mechanism of animals, 
 an arduous subject, which a great number of ancients and moderns have 
 attempted, but which they merely touched. Not one of them has as 
 yet suspected the numerous and interesting problems that belong to 
 it, much less resolved them by rigorous demonstrations." He developes 
 
 "DeMotu Animalium, chap, x, prop. 35.
 
 522 REFORM PERIOD. 
 
 then the plan of his work in these words: "This treatise will be 
 divided into two parts ; in the first, we shall examine the visible move- 
 ments of animals, which are affected by the alternate flexion and exten- 
 sion of the exterior parts. =••■' '••' " In the second, we 
 shall search for the cause of muscular movements, and all internal 
 movements, such, for example, as the progression of liquids in the ves- 
 sels and viscera." 
 
 The first part, as may be judged by the above compte-rendu, has all 
 the perfection that comports with the lights of the age, and merits 
 eulogy. The second has not obtained as unanimous an approval, though 
 it was, in the eyes of the author, the most essential, and had cost him 
 more pains, more calculations and researches than the preceding.* It 
 includes a complete physiological theory, a summary of which we now 
 proceed to give. 
 
 One of the fundamental theorems of this theory is that by which 
 Borclli explains the intimate or immediate cause of muscular contrac- 
 tion. There occurs, he says, a continual flux of the nervous fluid, and 
 of the blood, into the spongy cellules of the muscles. Now, when the 
 sensitive soul, which resides in the brain, wishes to employ the motive 
 faculty, it communicates a simple excitement to the nerves, or rather, it 
 pr jects throughout the nervous tubes a subtile fluid, called animal 
 spirits. In an instant, the mixture of the nervous juice and the san- 
 guineous liquid which impregnates the muscular vescicles is put in ebul- 
 lition, and in expanding distends the muscular mass, the extremities of 
 which are forced to approach each other. Our author devotes three long 
 chapters to the development of this theorem, which is the corner stone 
 of his physo-pathic edifice. He compares the efi'ect of the animal spirit 
 on the mixture of the nervous juice and blood which fills the muscular 
 areolge, sometimes to the spark that flies when the steel strikes the flint ; 
 again, the flame excited by friction ; or the vapor which escapes when 
 water is thrown on quick-lime ; or the effervescence produced when cer- 
 tain acids are poured into alkaline solutions, etc.f 
 
 But in vain does he accumulate subtilties and metaphors ; all the 
 artifices of language could not change a hypothesis into a veritable fact. 
 Now, no observation has established that any humor flows through the 
 extremities of the nervous fibrilloe, nor, for a much stronger reason, 
 that this humor mingles with the blood in the muscular interstices, or 
 
 '' This subject has been studied anew, first by the illustrious P. J. Barthez, in 
 his work, Nouvelle Mecanique des Movements deFHomme etdcs Animaux; then 
 Iby G. and E. Weber, intheirTraitc dela Mecanique des Organs de la Locomotion, 
 .translated from the German, by Jourdan. 
 
 f Le Motu Animalium.
 
 THEORIES AND SYSTEMS. 523 
 
 of an effervescence, instigated by the animal spirit. What shall we 
 think, now, of the calculation which this author pretends to establish, of 
 the expansive force of the nervo-sanguineous molecules, which, are 
 supposed to fill the muscular interstices V Need we be astonished, that 
 proceeding from this fictitious idea, he arrives at such ridiculous and 
 exaggerated results as the following, viz : that the heart overcomes, at 
 each contraction, a total resistance equivalent to the weight of 180,000 
 pounds ! 
 
 He regards stomachal digestion as a simple trituration, which is 
 sometimes facilitated by the concurrence of a corrosive ferment. He 
 explains, in a manner entirely mechanical, the nutrition of parts, or 
 assimilation. The humors, he says, as well as the solids, allow portions 
 of their substance to escape, which evaporate by transpiration, and form 
 little spaces at the points from which the particles are detached. The 
 sanguineous globules, pressed with violence by the heart and arteries, 
 become engaged in these little lacunjB. But all the globules do not enter 
 indiscriminately into all the interstices ; each globule insinuates itself 
 into a vacuole, whose configuration is analogous to its own ; thus, the 
 osseous globules penetrate the pores of the bones only ; the fleshy 
 globules, into those of the flesh ; the membraneous, into the pores of 
 the membranes, etc., so that each tissue, receiving the aliment which is 
 appropriate to it, is nourished, and repairs its losses. 
 
 All the secretions are explained, in this system, in the same way as 
 as the nutrition. See, for instance, how he represents the formation of 
 the urine. The blood being projected with force through the emiilgent 
 arteries, comes, on one hand, in contact with the orifices of the san- 
 guineous capillary tubes, on the other, with the orifices of the urinary 
 canals : suddenly its molecules, united by simple apposition, separate, as 
 in passing through a sieve — the aqueous globules of the urine passed 
 into the proper renal tubes, whose configuration is analogous to theirs, 
 the sanguineous globules insinuate themselves into the veins that are 
 conveniently disposed to receive them, and can not give passage to the 
 urinary globules. " Certainly," exclaims our mechanical physiologist, 
 " as well have faith in dreams and delusions, as to imagine that there 
 exists a magnetic virtue, and particular ferment, endowed with a very 
 subtile discernment, and placed there expressly in the kidney, to separate 
 the urinary from the sanguineous molecules, and dispose each of them 
 in their appropriate reservoirs ! " 
 
 According to him, respiration is not for the purpose of introducing a 
 new principle into the blood, but to moderate the raging passion of the 
 vital spirit, in about the same way as the balance wheel of a clock 
 regulates the movement of all the wheels by its alternate oscillations.
 
 524 KEFORM PERIOD. 
 
 Kespiration has also for an object, to give to the sanguineous globules, 
 which have been changed during their passage through the various parts 
 of the body, their primitive and normal form. 
 
 PATHOLOGY AND THERAPEUTICS. 
 
 These two branches, so important for medical science, have a very 
 small consideration in the work of Borelli ; they are merely mentioned, 
 en passant. 
 
 This writer attributes all the painful sensations to the itching or 
 irritation of the fibrillated extremities of the nerves. He assures us 
 that fever is produced by the acridity, or by the fermentation of the 
 nervous juice which is diffused in the cellules of the tissue of the heart, 
 and he adds, that this acridity of the nervous juice proceeds either from 
 irritation, or from obstruction of the radicles of the nerves, which arc 
 distributed in the glands, and principally in those of the mesentery. 
 
 The fever decreases and becomes calm, according to him, when the 
 blood, projected with force into the glandular organs, has sufficiently 
 washed and carried off the viscid or corrosive matters which obstruct 
 the nervous radicles. But after an indefinite time, the excrementitial 
 residue, deposited in the glandular cavities, occasions a new development 
 of viscous and acrid matter, which excites a second paroxysm ; such is 
 the cause of the periodical return of the febrile accessions. 
 
 The definite cure depends on the complete elimination of the febrigin- 
 ous ferment ; this elimination is efi"ected by insensible transpii'ation, or 
 by the sweat or urine on some other emunctory. If the fever is of a 
 benign nature, it is equally cured, whatever may be the method of cure 
 employed ; if it is of a malignant character, every species of treatment 
 will fail ; thus, then, the surest part, in all cases, is to attempt nothing 
 without an urgent necessity. If, however, we judge it proper to do 
 something, it should be remembered that during the fever the principal 
 indication consists in dissipating the obstruction of the excretory vessels. 
 and in tempering the acrimony of the febrifacient ferment, by the intro- 
 duction of a salt of an opposite nature. 
 
 If we did not know ali'eady what to think of a medical doctrine based 
 on a theorem so hypothetical, it would be sufficient, by considering the 
 poverty of the curative indications which were deduced from it, to declare 
 it insufficient and erroneous. Without attempting to make apparent all 
 the nonsense and contradictions it embraces, I shall content myself with 
 asking : By what experiment has any one established the obstruction of 
 the venous radicles, which was supposed to be the cause of so many 
 diseases ? How is it that Borelli, after ridiculing those who admitted 
 the presence of a particular ferment in each secretory gland, had recourse
 
 THEORIES AND SYSTEMS. 525 
 
 to the intervention of a febrifacient ferment to explain the generation of 
 fever? etc., etc. 
 
 This theory, although as little founded in reason, as that of the iatro- 
 chemists, presents itself under a much more attractive and scientific 
 dress. It rests on extremely delicate considerations in anatomy and 
 hydraulics — on calculations which it would be extremely difficult to 
 verify, and still more, to contradict, which lends to it an air of mathe- 
 matical precision, to which no other system of medicine could aj)proach. 
 It renewed the ingenious idea of Asclepiades of Bythinia, on the atoms, 
 their shapes, their continued passage through the pores, and the obsta- 
 cles that accidentally arrest them ; but it drew these ideas from recent 
 microscopic observations, which resembled demonstrations. In fine, it 
 gave rise to the hope that it would be possible, some day, to represent by 
 algebraic formulae, all the combinations of the vital forces, and all the 
 rules of the Healing Art. 
 
 Vain illusion, which was calculated to, and did seduce many eminent 
 minds, among whom I will mention for Italy, Laurent Bellini, a cotem- 
 porary of Borelli, and member, like him, of the society del Cimento ; 
 George Baglivi, surnamed the Pioman Hippocrates ; Joseph Dauzellini : 
 for France, Bossier de Sauvages, the first of nosologists ; J. Senac, whom 
 Morgagni scarcely ever mentioned without giving to him the epithet the 
 great ; for Germany and Holland, Herman Boerhaave, the propagator of 
 clinical teaching ; John Bernouilli, who shares with Xewton and 
 Leibnitz the glory of the invention of the differential calculus ; in 
 Great Britain, Archibald Pitcairn, who proposed nothing less than the 
 solution of this vast problem : " A disease being given, find the remedy ; 
 James Keill, who joined the Newtonian attraction to the mechanical prin- 
 ciples of Borelli ; John Freind, who continued the history of Daniel 
 Leclerc ; Eichard Mead, celebrated by the nobility of his character, as 
 well as by the variety of his learning. 
 
 The limits of this work do not permit me to indicate all the changes 
 which the iatro-mechanical doctrine underwent by the pens of so many 
 distinguished men. Besides, those details have lost very much of their 
 interest since the doctrine has fallen into complete discredit. It will 
 sufiice to notice the principal phases through which it passed during its 
 short and brilliant career. 
 
 George Baglivi, a native of Eagusa, being left an orphan at an early 
 age, was adopted by one of his relatives, who was a physician, and 
 gave him his first instructions. He received the doctor's hat at the 
 University of Salerno, or Padua ; afterward, he traveled throughout 
 Italy to hear the most famous professors. At Bologna, he followed the 
 anatomical course of the illustrious Malpighi. Finally, he located at
 
 526 REFORM PERIOD. 
 
 Eome, wliere he devoted himself to the practice of Medicine, and very- 
 soon acquired a great reputation for skill. The pope, Clement XL, 
 immediately conferred upon him the chair of Theoretic Medicine in the 
 college of Sapientia ; afterward, that of Anatomy and Surgery, which 
 Lancisi had just left for a more elevated station. Though young, Bag- 
 livi showed himself worthy to succeed such a predecessor, and sustained 
 the eclat of the chair. His renown, already European, increased every 
 day, when he was arrested in the middle of his career by a long and 
 painful disease, by which he was lost to science on the 17th of June, 
 1707, in the thirty-eighth year of his age. 
 
 Baglivi endeavored to complete the theory of Borelli, by applying 
 it to pathology and therapeutics, which the latter had barely touched. 
 He comprehended very well that the physicians of his time, whether 
 Galenists or latro-chemists, were so entirely occupied with the study of 
 humors as to neglect very greatly the examination of the solids ; con- 
 sequently, he proposed to redirect his cotemporaries to the study of the 
 latter, by demonstrating that the solids have a great preponderance over 
 the humors in all the organic functions, whether in health or disease. 
 " Full of this opinion," he says, " I devoted myself entirely to the 
 observation of the symptoms during life, and to the study of the ana- 
 tomical lesions after death, and I have been convinced by my own eyes, 
 that the influence of the solids is greater than that of the li(|uids, even 
 in the generation of diseases."'-' 
 
 He admits for the simple or primitive fiber, only two orders of affec- 
 tions: one proceeding from an excess of relaxation or softening, the 
 other from an excess of tension or rigidity. This hypothesis was 
 renewed by Themison, and is, in short, that on which all the Solidist 
 theories rest, which pretend to go beyond the sensible phenomena. He dis- 
 tinguishes two orders of fibers, namely : the fleshy fiber, which has its 
 origin in the heart, and constitutes the muscles, tendons, bones, and lig- 
 aments ; second, the membraneous fiber which is derived from the men- 
 inges of the brain, and serves to form the membranes, vessels, glands, 
 and other tissues. Consequently, he recognized also two motor princi- 
 ples in the animal economy, namely : the heart, which gives impulsion 
 to fleshy parts, by sending to them a liquid without which their fibers 
 could not be nourished or act, and the brain, whose envelopes give 
 impulse to the movement and life of all the membranes and viscera. 
 
 The manner in which Baglivi conceived the influence of the encepha- 
 lic meninges has, according to my view, no merit for originality, and is 
 
 *■' Specimen quntuor Libroruui dc Fibra JNIotrice et Morbosa. Auimadversiones 
 in Theoricem Veterem, sec. ii.
 
 THEORIES AND SYSTEMS. 527 
 
 not worth tlie trouble of contesting with him its invention. This phy- 
 siologist, in comparing the structure and functions of the dura mater 
 with the structure and functions of the heart, finds between them a per- 
 fect analogy. He further says, that as the central organ of circulation 
 projects the blood into all parts of the body, through the arterial canals, 
 so also the dura mater embraces closely the brain in its movements of 
 systole and diastole, and expresses a fluid which it causes to flow to the 
 utmost extremities of the nerves. He gives next an explanation no 
 less odd, of sympathetic phenomena ; according to him, the oscillations 
 of the dura mater extend by continuity of tissue to the nerves, 
 to the membranes and viscera in general, and to the heart itself : in 
 their turn, the particular movement of each organ tending the same 
 way, reflects itself in some sort upon the brain; hence the manifestation 
 of a universal sympathy, a constant undulation from the encephalic cen- 
 ter to the periphery of the b Ay, and from the periphery to the center. 
 A simple observation destroys this whole scafiblding : it has been avered 
 that the dura mater has no sensible movement in itself; those that are 
 seen, proceed either from the impulsion of the heart and arteries, or from 
 ■ the influence of respiration on the venous circulation of the brain. 
 Moreover, the pretended continuity of tissue of the meninges with the 
 other membranes, vessels, and viscera, is purely visionary. 
 
 If Baglivi merits our remembrance by his theoretic dissertations only, 
 we should not, perhaps, occupy our time with this notice ; but he has 
 more solid titles to our attention. His treatise on Practical Medicine 
 was remarkable for qualities not common at that epoch. The author 
 gives in it unceasing counsel to be guided by observation, to sacrifice 
 the arguments of theory to the prescriptions of experience. Here we 
 see a man whom the prejudices of his medical education sometimes led 
 astray, but who, by the strength of reason and the depth of his genius, 
 was often led to return to the path of truth. 
 
 He does not show himself in this work an exclusive partisan of Solid- 
 icm he was willing to acknowledge that chronic afi'ections might pro- 
 ceed from a cachochymy, or vice of the humors. He was also led to 
 think that the fevers which prevailed in Home during the summer, 
 originated in an alkaline excess, as they are frequentlyjugulated in the 
 outset by acidulous drinks. He protested against the custom of many 
 physicians of his time, who prescribed alkaline solutions, tinctures, and 
 volatile salts in acute inflammatory diseases. All that class of anti- 
 acids augments, as he thought, the acridity and impetuosity of the 
 blood, the dryness of the tongue, thirst, insomnia, headaches, general 
 heat, and, in a word, exasperated all the symptomatic features of 
 inflammation.
 
 528 REFORM PERIOD. 
 
 He pronounced a very wise judgment on the manner in which we 
 should appreciate the ancients and moderns. " I have seen," he says. 
 "in some academies, men so prejudiced against the ancients, that they 
 feared it would degrade their intelligence to devote a little time and 
 trouble to read the works of the Galenist writers. They preferred to 
 torment their minds miserably, in order to imagine something new and 
 unheard of; and if by accident they encountered something of the kind, 
 they think they have great claims upon science — enough for their glory. 
 Others, on the conti-ary, were so religiously attached to the opinions of 
 antiquity, that they unceasingly criticised modern discoveries, however 
 fine or useful they may be."* 
 
 Again he says: "Medicine is not a production bursting suddenly 
 from the genius of man, but is the child of time. In old times it was 
 believed to be an inspiration from the gods, but it can be said with 
 more truth, that it is the fruit of observations collected from age to age, 
 for a great number of centuries. Those who pretend that experience 
 and reason are opposed to each other, seem to me to be rambling ration- 
 alists and Empirics." This last sentence is a trait of genius, a ray of 
 light which the author himself very soon abandons, but which we must 
 keep in view; no, reason and experience are not two opposing authori- 
 ties which condemn each other, and all medical doctrines which do not 
 satisfy, at the same time, both of these modes of acquisition, are mani- 
 festly defective. 
 
 Baglivi, despairing of being able to resolve such a problem, that is to 
 say, to put practice and theory in agreement, essayed to draw between 
 them a line of demarkation, by assigning to each its department — an 
 enterprise inconsistent on the part of a man who had declared that 
 reason and experience, or in other words, theory and practice, should 
 always go together. " It is proper," he says, " for the theorist to give 
 reasons for the apparent phenomena of diseases — to compare past 
 circumstances with the present — to scrutinize the hidden causes of 
 morbid accidents, and the true origin of the causes themselves — to 
 develop, in fine, all that relates to the subject, so that the physician 
 may appreciate clearly, and with precision, the curative indications ; 
 but it belongs to the practitioner to arrange the history of diseases — to 
 pronounce on the appropriateness of remedies, and the indications to 
 fulfil, and to judge by the light of experience all that relates to the 
 cure of diseases. Whoever shall act differently, and pretend to submit 
 the rules of practice to the principles of theory, will obtain no success 
 in the treatment of diseases." 
 
 * Opera Omnia Medica. Pref.
 
 THEORIES AND SYSTEMS. 529 
 
 No one could contradict himself more openly than Baglivi has done, 
 in the passages we have just quoted ; but this must not astonish us — 
 on the contrary, we must expect to see these contradictions frequently 
 renewed, for as soon as an eminent logician leaves the true route, he 
 has more difficulty than any other to re-enter it — the chain of his ideas 
 leads him always straight forward in the track on which he has entered. 
 Here is another remarkable example of the contradictions of this author, 
 in the portrait he has drawn of the Empiric sect : " This sect," he 
 says, in one place, " banishes from medicine all theories, and even every 
 species of reasoning, and follows experience only, in the cure of diseases ; 
 not an experience guided by reason, and multiplied proofs, but a stupid 
 experience, guided by accident, and worthy of market houses only. 
 This sect introduced so many absurdities into medicine, that the Art 
 would have been destroyed if Galen, about the first century of the 
 Christian era, had not raised a dyke to oppose that torrent of errors, 
 and founded, with as much courage as prudence, the Eational sect, on 
 an immovable basis." 
 
 Farther on, this same author holds a very difi^ercnt language : " The 
 Rational sect," he says, " persecuted with hatred the Empirics, describ- 
 ing them as vile, and unworthy of cultivated minds, and fit only for 
 the populace in market places. I should approve of their conduct if 
 by Empiricism they meant the method of stupid and blind experimen- 
 tation, not subjected to repeated tests — not matured by reflection, in 
 sKort, serving only as a basis of false inductions and monstrous precepts. 
 But I can not agree with them, if they had in view a rational or learned 
 Empiricism, the fruit of method, not of hazard, directed and fructified by 
 intelligence, and aspiring to the highest truths by the attentive and per- 
 severing observation of sensible phenomena. Such an Empiricism has 
 obtained in all time the approbation of enlightened men, who strove to 
 increase it, as a mode of acquisition conformable to our nature." 
 
 In many other passages still, the Pvoman Hippocrates emits an opinion 
 favorable to Empiricism, only one more of which I will give : "Accord- 
 ing to Pliny, we are ignorant of what makes us live ; but, if I dare 
 give my opinion, we are much more ignorant of what makes us sick ; 
 for the infinitessimal substance that gives the first and immediate 
 impulse to disease, is entirely incomprehensible. How, then, in the 
 midst of so much obscurity, can we deduce the therapeutical indica- 
 tions ? I avow, that in so much embarrassment, the testimony of the 
 senses is our only refuge ; in other terms, it is necessary to have observed 
 long and patiently, by what process nature engenders disease — how she 
 effects the coction and separation of the peccant humor — then establish, 
 on this base, a curative method, which, following nature step by step,
 
 530 KEFORM PERIOD. 
 
 never loses sight of the injurious or useful effects of the remedies. 
 Now, it is important in this task that reason, so much vaunted by 
 physicians, submit itself to Empiricism — to that Empiricism which 
 letters have polished, which several series of observations have con- 
 firmed, and which intelligence vivifies by its light ; for the aid which 
 theory alone promises us, swells at first our hopes, und then leaves us 
 in perplexity." 
 
 Hermann Boerhaave was endowed with a comprehensive and subtile 
 mind. Profoundly versed in the writings of the ancients, and no less 
 familiar with all the works of moderns, he undertook to unite in one 
 body, the doctrines of all the branches of medical science, and to con- 
 ciliate among them the reigning theories of his times. He was eclectic, 
 after the manner of Galen and Fernel ; but as the mechanical explana- 
 tions predominate in his writings, he has been classed among the latro- 
 mechanics, the same as Galen and Fernel are classed among the Dog- 
 matists. After the example of these he divided his entire course on 
 Medicine, or his Institutes, into five parts, which are, physiology, pathol- 
 ogy, semeiotics, hygiene, and therapeutics. The first part forms, alone, 
 two-thirds of the work ; so that the four following occupy, each, but a 
 small space, and embrace only a general view of the matters of which 
 they treat. 
 
 Physiology being then the most complete part of this course on medi- 
 cine, we proceed to take a rapid view of it. He represents the action 
 of the stomach or food as follows: "If you consider that the food»is 
 continually diluted by a great quantity of saliva which flows, unceas- 
 ingly, from the mouth and the esophagus, into the stomach, and by the 
 humor which transudes the coats of the stomach itself ; that these are 
 mingled and agitated with the rest of the food, which has been previ- 
 ously taken — that their most intimate parts are moved by the action of 
 the air, which is ground up, if I may say so, with it, and that all this 
 is augmented by the heat of the organ : you can conceive that the eftect 
 of the concave part of the velvet tunic, is to dilute, macerate, swell, 
 attenuate, and produce the commencement of fermentation, putrefaction, 
 rancidity, and the solution of food, and fit them for a change into a 
 nature similar to that of the humors of our body. You do not yet com- 
 prehend by this how the stomach can digest the solid food which has 
 been but slightly masticated. But to find the cause which we seek, cast 
 your eyes on the muscular structure of the stomach and see what action 
 depends on it. " •■■' In several animals the digestion is almost 
 
 wholly accomplished by the sole contractile movement of the stomach — 
 a movement which is so considerable that it is heard and felt." 
 
 We see here a very skillful amalgam of ideas drawn from anatomy, 
 
 I
 
 THEORIES AND SYSTEMS. 561 
 
 physics, and chemistry. The rest of the doctrine of Boerhaave offers 
 throughout the same assemblage of ideas, and for that reason I shall 
 not multiply the quotations. I will add only the following, to show 
 how much the greatest minds are liable to be deluded in regard to 
 theories, and to take for demonstrated truths the simplest conjectures. 
 "The fluid which has been filtered," he says, "through the corticle sub- 
 stance of the brain and cerebellum is pressed continually by the action 
 of the heart and arteries into the nerves, and by means of the nervous 
 canals into all parts of the body, forming a circulation as real and as 
 constant as that of the blood and the lymph. This humor is so simple, 
 so mobile, and so perfectly volatile, that it has been called the nervous 
 spirit, and is sub-divided into natural, vital, and animal. But as the 
 secretion of these spirits is never interrupted, as it is constantly sup- 
 plied anew, in order to repair what is lost or consumed, it appears that 
 those which have fulfilled, entirely, their purposes, pass from the last 
 filaments of the nerves into the small lymphatic veins, by which they 
 are carried into other veins a little larger, then into the common lym- 
 phatic vessels, whence they flow to the heart by the sanguiferous veins, 
 and thus this subtile fluid circulates, incessantly, in its vessels, like the 
 other humors."" 
 
 In his writings on practical Medicine, Baglivi abandons theories, or 
 pays but little attention to them, and advises to rely entirely upon 
 experience. Boerhaave, on the contrary, does not appear to doubt for a 
 single instant the exactness of his theoretic speculations, and endeavors 
 to base upon them all the phenomena of diseases, and all the rules of 
 Art. Herein he shows himself a more I'efined dialectitian, but a poorer 
 observer than the Eoman Hippocrates. The latter appears to me to 
 have more depth and genius ; he rises, often, above the prejudices of his 
 medical education and of his age ; he sheds frequently brilliant light 
 in the midst of his contradictions. The other had a larger mind and 
 more extended erudition ; he adopts the teachings of his masters as 
 infallible dogmas, and appears to have no other ambition than to co-or- 
 dinate and conciliate, and to unite them into a complete system. He 
 says in one of his first aphorisms, that the study of pathology must be 
 commenced in the most simple affections, those of which we have the 
 clearest idea, which are the easiest to heal, and the knowledge of which 
 is indispensable for the understanding of other diseases. Xow, accord- 
 ing to him, the diseases of the primitive fiber are those which fullfil 
 these conditions in the highest degree, as may be seen in the following 
 passage : 
 
 * Instit. Med.
 
 532 REFORM PERIOD. 
 
 " The primitive fiber," he says, " is comiDOsed of small simple teiTes- 
 trial particles, separated from the fluid contained in the vessels. They 
 are reciprocally applied to each other by the forces of life, in such a 
 way that the perturbating causes which exist in the living body are 
 scared}' able to change or alter their nature. On this account, each 
 molecule in particular is not subject to any disease that physicians have 
 seen or treated ; but the smallest fiber which results from the reunion 
 of these molecules is subject to the following diseases: excess of soft- 
 ening or relaxation, excess of tension or elasticity. "'••■^ 
 
 Thus the professor of Leydea favors us with the afi'ections of the 
 microscopic molecules of which the pi-imitive fiber is composed, while 
 no physician up to this moment has seen or treated any aifection of this 
 order. In regard to diseases of the fiber itself, he shows thera to us in 
 their smallest details, so well that we could scarcely doubt that lie had 
 seen them and followed them in all their phases. Now, as no one 
 before or since has pointed out this class of diseases, it must be thought 
 that Boerhaave has seen the marvellous things which he recounts above, 
 with a particular microscope, or rather with the eyes of faith. 
 
 Let us then turn away from these microscopic diseases, on which it 
 is impossible to establish any reasoning, and come to diseases more cog- 
 nizable — inflammation, for example. If we define inflammation, with 
 the surgeons, an affection characterized by heat, pain, and redness, 
 accompanied often with tumefaction, and followed nearly always by an 
 abnormal secretion, there is no one who may not in a moment form a 
 clear idea of this disease ; and who, in seeing scurvy, or erysipelas, or 
 phlegmon, or erythema, or a simple labial herpes, could not say, from 
 the preceding definitions, that they are inflammations. It would not 
 ref|uire, afterward, a great effbrt of the imagination to suppose that this 
 ensemble of phenomena, to which we give the name of inflammation, 
 phlogosis, or phlegmasia, may take place internally as well as externally. 
 This conjecture becomes a probability, if in certain diseases of internal 
 organs, such as the stomach or intestines, the patient realizes a sensa- 
 tion of heat and pain, similar to that felt in external phlegmasia. The 
 probability augments still more, if the natural secretion of the suffer- 
 ing organs is altered, augmented, or diminished, etc., etc. In this way, 
 it seems to me, we may proceed from the known to the unknown, from 
 perfectly apparent phenomena to those which are only partially so, or 
 which manifest themselves only by their connection with other sensible 
 phenomena. 
 
 Boerhaave did not proceed in this way, as is plain from the extracts 
 
 " Aphorisms.
 
 THEORIES AND SYSTEMS. 533 
 
 we have already given fi-om his writings, and also hy those which we 
 now proceed to add. Phlogosis, he says, consists in the stagnation of 
 the arterial blood in the smaller vessels, is agitated and pressed by the 
 rest of the blood, whose force and quickness are increased by the fever. 
 It may be developed in the extremities of the sanguineous arteries, or 
 in the sero-lymphatic vessels, or in other arterioles more attenuated still ; 
 which, not being able to transmit the red globules or other grosser parts 
 of the fluids which have penetrated into their cavities by the dilatation 
 of their orifices. '•' " The capillary vessels, which 
 
 are barely visible, augment in volume and are distended with blood, and 
 form a red tumor. Their parieties, formed of small fibrillre, are on the 
 point of rupture, which causes the severe pain. The solids and liquids 
 acting and reacting on each other, produce the hardness and resistance. 
 Finally, the liquid globules flowing through the now obstructed vessels, 
 break against the tumor, and it is this mutual attrition of the liquids 
 and solids that causes the heat and the itching. Who can comprehend 
 these transcendental explanations ? For myself, I avow that I under- 
 stand nothing that is said there, or rather, I see that friction, on which 
 every one may think and write what he pleases. 
 
 If from phlogosis, considered in general, that is, from an abstraction 
 made from the tissue in which it is developed, we pass to the examina- 
 tion of phlogosis in particular, that of the lungs, for example, we shall 
 always find the same defects in the descriptions of this author. He 
 carries us constantly from observation into the field of hypothesis. 
 " When the vessels of the lung are attacked with inflammation, it is 
 called peripneumonia. Those of the vessels which may bo invaded by the 
 phlogosis are the bronchial and pulmonary arteries, and their lymphatic 
 collaterals. Thus, we may conceive of two species of peripneumonia ; 
 one of which is located in the pulmonary arteries, the other in the 
 extremities of the bronchial arteries." 
 
 Doubtless we may, in our minds, distinguish these two si)ecies of 
 peripneumonia, and others also ; but where is the observer who has ever 
 discerned them on the living, or even the dead ; and, therefore, I ask, of 
 what practical value is a purely ideal division, which none of our senses 
 can apprehend? Let us recall our fourth philosophic axiom, which, 
 among other things, says that, if it is important to make distinctions, it 
 is, perhaps, still more important not to make too many ; and that we 
 must not multiply divisions any further than is necessary to regulate us 
 in the use of the things relative to our wants. Xow it is clear that the 
 distinction of these two pneumonias, sidmitted by Boerhaave, is not only 
 useless, but also inappreciable in practice. 
 
 After the death of the celebrated professor of Leyden, the iatro-
 
 S34 REFORM PERIOD. 
 
 mechanical doctrine rapidly fell. At this time it exists only in history, 
 and in some parts of physiology. Others succeeded it, to disappear, also, 
 soon after, or submit to considerable modifications, so rapid was the 
 movement of ideas during the historic period which we have just 
 reviewed. 
 
 ART. V . ANIMISM A X D VITALISM. 
 
 "While the teaching of the professor of Leyden shed such a glaring 
 light over the medical world, and disseminated widely his mechanico- 
 chemical doctrine, two other professors, less celebrated than he, and less 
 profound, but more attentive and faithful observers of nature, laid the 
 foundation of new theories, destined to take the place of his brilliant 
 system. One was Frederic Hoffman — the other George Ernest Stahl. 
 Both had been fellow students in the University of Jena, and now found 
 themselves colleagues in the risiDg school of Halle, on which they drew, 
 for half a century, the attention of the learned world. 
 
 Stahl, of whom we shall speak in the first place, belongs not less to 
 the history of chemistry than to that of Medicine, by his discoveries 
 and his writings ; but in this work we can only occupy ourselves with 
 his medical opinions. He was physician to the court of Weimar in 
 1694, when he was called to the University of Halle, on the recommen- 
 dation of his old fellow student, Hoffman, who showed by this circum- 
 stance, all the generosity of his soul ; for he was not ignorant that he 
 made himself a rival, whose doctrine differed much from his own, and 
 whose renown might cast him in the shade. 
 
 The new professor responded fully to the opinion that had been formed 
 of him, by acquitting himself with a zeal and exactitude that never belie 
 the arduous functions of a professorship. More inclined to observe and to 
 meditate than to read, he showed a somewhat affected disdain for classic 
 erudition, though he attempted to cover his defect of literary culture by 
 some quotations from ancient authors, and by the insertion of a quan- 
 tity of Greek words in his Latin periods. He may be excused for 
 having often presented the ideas of others as his own, by alledging 
 his slight erudition ; but nothing can justify the epithets of contempt 
 which he lavishes on his scientific adversaries. His principal title to 
 glory in Medicine, is for having recalled the attention of his cotempora- 
 ries to the natural tendencies of the animal economy — to the reaction of 
 the vital forces — or the soul — in diseases — a reaction and tendencies 
 which the physico-chemical doctrines too much lost sight of. 
 
 In the first place, he says, it should be understood what life is — in
 
 THEORIES AND SYSTEMS. 535 
 
 what it consists, essentially — what is its principal seat — what end it sub- 
 serves, and its final destination. Afterward, it should be well understood 
 what constitutes health, and the signs by which it may be recognized, in 
 order to know under what circumstances the practice of the Art is useful 
 or necessary.'-' Now life, according to Stahl, is nothing else than the 
 conservation of the humors of the body in a state of integrity and per- 
 fect mixture, notwithstanding their very marked tendency to putri- 
 faction — a tendency which is rapidly developed as soon as they are 
 withdrawn from the influence of the vital force. It is in this respect 
 that the living body is distinguished from inanimate bodies, or simple 
 compounds. " We must never," he exclaims, a little farther on, "loose 
 sight of that disposition according to which the mixtures of the liquids 
 precede the structure of the parts ; so that there is not, in the animal 
 economy, any organ or tissue, which does not presuppose the fluid mole- 
 cules, the reunion of which has served to form them." 
 
 We have seen the latro-chemists present fermentation as the essen- 
 tial and primitive phenomenon of life, — the latro-mechanics attribute 
 that prerogative to muscular contraction ; but now we see another 
 physiologist who regards the pi*eservation of the humors in a state of 
 integrity and perfect mixture as the primordial and characteristic act of 
 a living being. Others will come still, who, proceeding from a new 
 point of view, will accord preeminence to other phenomena. They all 
 forget that sentence of Hippocrates, confirmed by G-. Baglivi : " The 
 human body has no determined commencement. Each of its integral 
 , parts may be regarded equally, as the first or the last ; for in a described 
 circle, it is impossible to find either beginning or end."f Neither do 
 they remember better that sentence which forms our sixth philosophic 
 aphorism. " What is called essential or non essential is related strictly 
 to our ideas and our wants. All the qualities of each individual, con- 
 sidered in itself, are equally essential, in the sense that they all proceed 
 from its essence and its nature, and it is not therefore exact to say that 
 certain of its attributes are more essential than others."| 
 
 After having defined in his way the essence of life, by saying that it 
 consists in the preservation of the mixtures of the humors, the professor 
 of Halle asks what is the primitive agent or principle of this funda- 
 mental act ■? and endeavors to prove that it cannot be anything else 
 than the immaterial and rational soul. He forms from this view two 
 arguments : the first is drawn from the final destination of the human 
 body, which has only been created, according to him, as an instrument 
 
 ° Doctrinse Medicae Theoricte part i., PhjsiologitB de Vita et Sanitate. 
 "j" Hippocrates on K-egions in Man. — Baglivi de Fibra Motrice. 
 J Locke's Essay on the Human Understanding, Book III, cli. iv.
 
 536 REFORM PERIOD. 
 
 for the soul. " It must be remembered," he says, " the human mind 
 could do nothing in this world without the intermediation of the body, 
 for which it is intended. Its functions consist in the acquisition of 
 knowledge, and the exercise of voluntary acts. It cannot put itself in 
 relation with sensible things, nor have, consequently, any idea but by 
 the aid of material organs. It cannot, either, manifest and execute its 
 purposes except by the same organs. It is also very evident, that the 
 body is subjected to the soul, since it employs it both in acquiring know- 
 ledge and accomplishing its purposes." 
 
 The second argument that Stahl proposes is still more subtile. " The 
 act," he says, "by means of which life is sustained, and the soul fulfils 
 its functions, is absolutely repugnant to matter, and agrees well with 
 the nature of the mind. That act, as observation shows, is motion : by 
 it the mixture of the humors is preserved in integrity ; the soul acts on 
 the body and in the body ; compares, reasons, and moves from one object 
 to another ; in a word, it is in perpetual motion. Now, all motion is an 
 immaterial act, which can only have for a principle an immaterial sub- 
 stance itself." On this our physiologist rested without knowing it, or 
 at least without saying so, on an axiom of Descartes, who accords to 
 matter no other essential property than extension, and who requires for 
 the production of any motion, the direct or indirect impulsion of a spir- 
 itual agent. 
 
 Stahl, in supposing, with Descartes, that all motion requires the aid 
 of a spiritual motive agency, affirms a thing which our common obser- 
 vation contradicts, every moment. In fact, we see constantly produced 
 around us and in us, movements which no one is tempted to attribute to 
 a spiritual agency. Besides, it is well demonstrated that our informa- 
 tion, in regard to physical things, cannot go beyond our sensations, and 
 our sensations can learn nothing concerning the presence or absence of a 
 spiritual being. 
 
 Thus considered, the opinion of Stahl on the first motor influences of 
 the animal economy, has only the value of an hypothesis ; but compared 
 with the opinions emitted in advance of him, on the same subject, this 
 hypothesis has the advantage of being more simple and less unrcasona- 
 able. It may be therefore said, literally, that the physiologist of Halle 
 triumphs, when he puts his hypotheses in comparison with those of his 
 predecessors. 
 
 " Those who first assigned to the human heart other active principles 
 besides the rational soul, imagined two more souls, each endowed 
 with a certain degree of discernment, by means of which they were sup- 
 posed to execute their functions with order, measure and propriety. 
 They named the one vegetative, and the other sensitive."
 
 
 THEORIES AND SYSTEMS. 537 
 
 •* Those who hold to the opinion, more ancient still, which allows in man 
 only a single intelligent and rational soul, of a nature superior to that 
 of brute, charged with inferior as well as with the most exalted func- 
 tions, from the plausible reason that what accomplished the highest, can 
 perform the lowest things, disfigure that doctrine, otherwise very sen- 
 sible, by the addition of numerous energies or abstract faculties, which 
 they transform by a figurative language into so many real entities, which 
 execute certain special functions under the direction of the soul. Such 
 is the origin of digestive attraction, plastic assimilation, and other 
 faculties which play so important a part in Galenic physiology." 
 
 " It was much worse, when, deluded by that absurd axiom, that there 
 can exist no connection between an immaterial substance and matter, 
 the physicians invented a host of spirits, a species of beings extremely 
 subtile, serving as intermediaries between the soul and the body. Although 
 so gross a fiction that children now could not be imposed upon by it, it 
 received so much favor, that the spirits were regarded as the servants 
 or emissaries of the soul ; their rapidity was compared to light, and 
 realizing more and more this fiction, they ended by saying, that a spirit 
 was a luminous substance. Van Helmont replaced these spirits 
 by the archeus, or archei ; but while the soul was denied to have 
 effective power, they accorded to the spirits, or archei, the knowledge of 
 the functions which devolved upon them, and the power to fulfil them." 
 
 After having proved that neither chemical ferments, nor the shape of 
 liquid molecules, nor the configuration of vascular orifices, are sufficient 
 to explain the secretions and excretions, he adds, " We must say 
 as much of this invention of some moderns, who assume that particles 
 destined to be secreted exert a special irritation on the secretory organs, 
 in such a way that each of these, by contracting itself, expresses and 
 rejects the humor which is appropriate to it. But, besides the oddity 
 of this fiction, which represents to us mechanical instruments, suscep- 
 tible of irritation, experience contradicts such an hypothesis. Thus, the 
 urine, after much drinking, is passed more frequently, freely and abun- 
 dantly, and at the same time is less dense and more watery ; when, 
 on the other hand, it is more charged with salts, or in other words, more 
 irritant, it is passed less frequently, and in a smaller quantity, 
 which is contrary to the supposition above stated." 
 
 Others have better developed, than Stahl, the influence of the physical 
 upon the moral man, but no one has made so sensible the influence of 
 the moral upon the physical man. He gives some very curious exam- 
 ples concerning the effects of the passions and habits on the vital 
 acts. He explains, very naturally, the birth-marks on children 
 {ncevi malerni), by the sympathy which exists between the soul, or the 
 34
 
 538 REFORM PERIOD. 
 
 imagination, of the mother, and the soul of the fetus. In fine, he 
 concludes, from all these physiological considerations, whether general 
 or particular, that it is the soul which presides directly, and without 
 any intermediary agency, over the organization of the body, from the 
 moment of the fecundation of the germ, and it continues to direct all 
 its functions until death. 
 
 Let us hasten to repeat a sentence which we have already proclaimed, 
 that all these transcendental speculations of ancient and modern physi- 
 ologists, on the final destination of the human body, or on its first 
 movement, or on the primordial phenomena that commence the circle of 
 animal life — all these speculations, I say, appertain rather to philoso- 
 phy than to medicine — they have not advanced a single line the Healing 
 Art. I repeat, there is not a single one of the hypotheses emitted on 
 such subjects, which are not connected with absurd or injurious prac- 
 tical consequences, which is the cause of the legitimate repugnance 
 which practitioners feel for all the physiological systems that rest upon 
 assumptions, without the pale of observation, and loads them to refuse to 
 discuss them, otherwise than by the practical conclusions that flow from 
 them ; imitating in this way the mode of reasoning of the mathemati- 
 cians, who, when the data of a problem conduct them necessarily to an 
 absurd conclusion, conclude from this that they are insufficient, or 
 badly laid down. 
 
 Let us see, then, what are the practical consequences of Animism. 
 The author of the system, himself, deduces them from it, in these terms : 
 " if the movements of the animal economy depart, in any respect, from 
 the normal mode, then the physician should understand that it is his 
 duty to calm them, or to excite them, or to restrain them, in a word, to 
 act upon them conformably to the natural indications. It is of the 
 highest importance to him, to have constantly in view the natural 
 synergy of the soul, in order to show himself the minister, rather than 
 the governor: in other words, the physician should study to follow the 
 movements and tendencies of nature, rather than to believe himself 
 ruthorised to dare attempt something, without having due regard to 
 her tendencies." 
 
 Such a maxim made a fundamental rule of therapeutics, and, rigor- 
 ously observed, is nothing else than the absolute negation of the active 
 concurrence of the physician in the treatment of diseases ; it is to limit 
 the functions of the man of the Art to a lazy contemplation of the 
 sufferings of the patient. If it was true as Stahl taught, that every 
 pathological affection was the result of the reaction of the soul against 
 the morbific agent : if the totality of the symptoms of a disease only 
 represent the succession of vital movements, designedly put in action
 
 * 
 
 THEORIES AND SYSTEMS. 539 
 
 by a rational agent, for the purpose of effecting a cure, could he do bet- 
 ter in any case than remain a spectator of the struggle in which he 
 could take no part, without running the reasonable risk of deranging 
 the wise combinations of the supreme regulator of the economy ? 
 
 Let no one accuse me of exaggerating the consequences of the tliera- 
 peutical axiom of Stahlism. Many philosophers and physicians before 
 me have deduced them in equivalent terms ; they have likewise advised 
 that nothing be done in most diseases ; to await patiently till nature 
 surmounts the difficulty, which advice is easier to give than to follow^ and 
 which fejv physicians put in practice, even of those who proclaim its 
 excellency. The only active succor that the physicians and the assist- 
 ants may attempt, according to tliis doctrine, consists in giving to the 
 patient what he may desire, and furnishing him the means, as much as 
 possible, of satisfying his instinctive appetites, which are supposed to 
 indicate the tendencies of the organism, or to be the appeal of nature. 
 Those who reason thus forget that art was invented only on account of 
 defects and frequent errors of instinct, and to bring aid to this insuffi- 
 cienc3\ This is a fact that has been established by all medical histo- 
 rians, and that I have sufficiently amply discussed in the first volume 
 to make it evermore an element of the science.'--' Nevertheless, there 
 are many diseases that are cured by the natural forces only. Then the 
 functions of the physician are limited, effectively, to the prevention of 
 imprudences, so that nothing be done rashly. Now the latro-chymici 
 had too greatly lost sight of this truth, which Stahlism reminded them 
 of by exaggerating it. 
 
 The doctrine of pure Animism spread rapidly, particularly in Ger- 
 many, but beyond that region it made very little progress ; the theory of 
 the vital principal which is very analogous to it was generally preferred, 
 especially in France, but it differed from it in several important 
 respects ; for the vital principle of the moderns resembles much more 
 the sensitive soul of the ancients or the archeus of Van Helmont, than 
 the immaterial soul of the Stahlians. Barthez, the founder, or at least 
 the eloquent defender of the doctrine of the vital principle, carries it 
 back to the plilosophy of Plato, and even to the dogmas of Pythagoras. 
 He recognises it in the writings of Francis Bacon, and more distinctly 
 still, in those of Van Helmont. The latter, according to him, is among 
 all moderns the one who has indicated the greatest number of phe- 
 nomena which announce in man a vital principle, distinct from the 
 body and the mind, and yet endowned with sensation and perception.f 
 
 '' See the Primitive Period in this History. 
 
 t Nouveaiix Elements de la Science de rHomme. Second Ed. Paris, 1806.
 
 540 REFOKM PERIOD. 
 
 Now if we demand of Barthez what is tlie nature of that vital prin- 
 ciple, he responds: it is neither an extremely subtile matter, interme- 
 diate between the soul and the body, nor a pure spirit, nor a simple 
 modality of organized matter. " Frederic Hoffman," he says, " and 
 other celebrated authors, have pretended that the principle of life which 
 animates a man is of a medium nature between the soul and the body ; 
 but this middle being is one of reason, for we cannot pass by gradations 
 from the body to the immaterial soul, and the essential nature of these 
 two substances causes them, necessarily, to exclude each other. The 
 principle of life whose functions are exercised in the human body, must 
 be conceived by means of ideas entirely distinct from those by which we 
 apprehend the nature of the body and the thinking soul." 
 
 It appears, nevertheless, very difficult to admit the existence of an 
 active principle, which may be neither a spirit, nor a body, nor a subtile 
 fluid intermediate between the soul and the body, nor a simple attri- 
 bute, or property of matter. The vital principle of Barthez, if we may 
 believe him, is none of these things, but is somewhat related tu each ; 
 it is an inconceivable amphibological being, something less than an 
 hypothesis, for it is a doubt. Hear, now, the celebrated professor of 
 Montpellier develop this singular doctrine. " We can only give," he 
 says, " negative assertions, doubts, and conjectures, on the nature of 
 the vital principle of man. It is useful to develop the skepticism of 
 these considerations, in order to study more surely the forces and affec- 
 tions of this principle." A little farther on he adds, " I observe, espe- 
 cially, that it is useless to discuss, as may be done in following ordinary 
 ideas, whether the vital principle in man is, or is not, a substance ; 
 because it seems to me impossible to give a clear sense to the word 
 substance, though this term is commonly employed in metaphysics. The 
 question which I should ask myself in this section is, then, solely, 
 whether the principle of life in man has its proper and individual 
 existence, or whether it is only a mode inherent to the human body, to 
 which it gives life ? " 
 
 " It may be possible, doubtless, that, according to a general law, 
 established by the author of nature, a vital faculty, endowed with 
 motior and sensitive forces, supervises, necessarily, (in an indefinable 
 manner) the construction of matter, of which each animal body is 
 formed, and which, in consideration of this faculty originates subsequent 
 movements, necessary to animal life, in all its duration. But it may 
 be, also, that God unites to the combination of matter which is given 
 to each animal, a vital principle, which subsists hj itself, and which 
 differs, in man, from his mind." 
 
 I say it with regret, more absurdities could not be crammed into so
 
 THEORIES AND SYSTEMS. 54 1 
 
 small a space. What ! you announce that you will not discuss whether 
 the vital principle in man is a substance, or not, hut that you are 
 willing to inquire whether it has a proper and individual existence, or 
 if it is only a mode of existence inherent to the human body ! Ah ! 
 do 3'ou not see, that it is the same question, in different terms ? And 
 then, how strangely you resolve the question ! You say that this vital 
 principle might be only a modality of the organic body ; or that it 
 might also have its proper existence. Here is a solution that resolves 
 absolutely nothing. Nevertheless, Barthez soon quits his character, as 
 skeptic, to entertain us, throughout two volumes, with the faculties, 
 acts, and lesions, of the vitil principle. He speaks of it no longer as 
 of an equivocal and hypothetical being, but as of a real and very active 
 being, endowed with proper forces, and susceptible of modifications 
 distinct from those of the soul and the body. 
 
 He attempts in vain, in the conclusion, to return a little to the 
 skepticism he announced in the onset ; his penchant for the realization 
 of the vital principle is observed in his dubitable phrases. " The results 
 on the death of men are as follows; first, the dissolution of the 
 body ; second, the extinction of the forces of the vital principle ; lastly, the 
 separation of the soul. =•■' =■•' « As is sensible, on the one hand, the 
 metamorphosis of the terrestial part of man, so is doubtful, on the other 
 hand, the fate of the vital principle after death. If this principle is 
 only a faculty united to the living body, it is certain that at the destruc- 
 tion of the body, it returns into the system of forces of universal 
 nature. If it is a being distinct from the body and the soul, it ma}"" 
 perish with the extinction of its forces in the body which it animatea ; 
 but it may also pass into other human bodies, and vivify them by a 
 sort of metamorphosis. ■•' * When a man dies, his body is resolved 
 into its elements ; his principle of life reunites with that of the uni- 
 verse, and his soul returns to God who gave it, and who secures it an 
 immortal existence." 
 
 If, setting aside the radical fault with which the system of 
 Barthez is stamped from its origin, we follow the development of the 
 system into the particular applications which the author has made of it. 
 we shall easily convince ourselves that no other has furnished, to this 
 day, as reasonable explanations on most of the phenomena of the ani- 
 mal economy, whether in a state of health or disease. N"o one, for 
 example, has explained as naturally the physiological or pathological 
 sympathies which arc manifested in a multitude of individuals ; sym- 
 pathies which are often very strange, very surprising, and always a 
 useful study for the physician. 
 
 But it is especially in therapeutics, that touchstone of medical
 
 542 REFORM PERIOD. 
 
 doctrines, where Barthez shows himself superior to all the theorists of 
 antiquity and modern times. Before him, only the two following axioms 
 were known in medical practice : " Diseases arc cured by their contra- 
 ries;" " The physician is the minister of nature, and should study. 
 only, to follow her indications and tendencies." 
 
 In virtue of the first of these axioms, the latro-chemists employed 
 acidulated drinks to correct the alkaline acretions of our humors, and 
 they gave alkaline or spirituous drinks to correct the acid accretions. 
 The latro-mechanics made use of incisives and operatives to unload the 
 vessels or their obstructed pores. In accordance with the second axiom, 
 the Hippocratists and Animists observed the crisis, and extolled the 
 expectant method. For these two axioms, one of which is false, as we 
 have heretofore demonstrated, and the other of which is susceptible of 
 a multitude of diverse interpretations, the physiologist of Montpellier 
 substituted a more precise and philosophic language. 
 
 M. Lordat, the depository and skillful interpreter of the thera- 
 peutical doctrine of Barthez, expresses himself as follows on this sub- 
 ject ; " We may include in three classes all of known therapeutical meth- 
 ods: the first comprises the natural method, the second the analytical, 
 and the third the empirical." 
 
 " I. The natural methods are those which aim to favor, to accelerate, 
 or to regulate the course of diseases which tend toward a favorable solu- 
 tion. The name indicates the end proposed, viz : to aid nature, and 
 render her operations surer, either by retarding, hastening, or changing 
 the proportion of the elementary acts which she employs. 
 
 " II. The analytical methods are thohc in which, after having decom- 
 posed a disease into the essential affections of which it is the product, or 
 into the simple diseases which compose it, the physician attacks directly 
 these elements of disease by means proportioned to their relations of 
 force and influence. 
 
 " These methods, as well as those which will be discussed in the fol- 
 lowing article, are employed : First, when nature makes no Salutary 
 effort ; secondly, when she acts feebly and tardily, so that her efforts 
 are exhausting ; and lastly, when the natural movements add still more 
 to the gravity of the disease. 
 
 " Thus, to give an example of the decomposition of a disease, in 
 most catarrhs, particularly in those which return periodically, Barthez 
 finds : first, a superabundance of serous humors ; second, a fluxionary 
 movement which directs them especiall}' toward the mucous membranes 
 of the nose or the lungs ; third, a modification of the vital actions of 
 those membranes, which puts them in harmony with the other elemen- 
 tary acts, and leads them to concur to the same end, namely : to the
 
 THEOKIES AND SYSTEMS. 543 
 
 excretion of redundant humors, but which may degenerate into exces- 
 sive irritation or into atony. 
 
 " By the anal_) tical method, all the symptoms are not attacked at 
 once, and when it is used, equally energetic means must not be 
 employed against them all. The great art is to choose those elements 
 which it is the most important to combat, and to determine the order in 
 which they are to be attacked. 
 
 " III. \Ye now come to the empirical methods. To conceive their 
 spirit, we have only to oppose them to those of w'hich we have first spo- 
 ken thus far. lu the natural and analytical methods, we perceive the 
 mode of utility of tlie means employed, i. e., the relation of the indica- 
 tions to fulfill, with the afl:"ections and the immediate results 
 brought about by these means. We see, for example, that an artificial 
 flux, occasioned by a venesection, or by other attractives, resolves an 
 inflammation completely, by destroying the natural flux, which enters 
 into the constitution of that disease. " ^ "^ The empirical methods 
 are those whose efficacy has been established by experience, but whose 
 immediate and primitive efi'ects have, in regard to the cure of the dis- 
 ease, no connection that our minds can appreciate. Barthez recognises 
 three sorts of empirical methods, which he distinguishes as imitative, 
 perturbative, and specific. "=••' 
 
 The following method of considering the operation of therapeutics is 
 as new as it is luminous and fruitful. We may say that it lays the 
 true basis of the philosophy of this science, and includes the germ of a 
 revolution in its ideas and its language. The new methods of treat- 
 ment which Barthez has described are of too high importance to be 
 admitted by us before haviug proved them in the crucible of severe crit- 
 icism. We now proceed, therefore, to examine them in succession, with 
 the most serious attention. 
 
 NATURAL METHOD. 
 
 This method aims, says one, to favor, accelerate, or regulate the pro- 
 gress of diseases which have a favorable tendency. When the physician 
 observes that a disease has a favorable tendency, he can do nothing bet- 
 ter than to watch its progress, in order to obv'iate the untoward changes 
 that may ensue, and to prevent the imprudences that the patient or his 
 friends are liable to commit. The epithet natural, given to this 
 method exclusively, seems to me inexact, for it conveys the idea, that 
 we follow better in it the indications of nature than in the others, which 
 the author, doubtless, docs not mean to say, for it would be erroneous. 
 
 '^M. Lordat, Exposition de la Doctrine Medicale de Barthez. raris, 1818,
 
 544 REFOKM PERIOD. 
 
 There exists, in fact, no metliod of treatment which does not rest, or 
 pretend to, at least, on the natural indications of disease — on the 
 knowledge of their symptoms, course and tendencies. The particular 
 method which is now in question, would be much better designated by 
 the epithet expectant, which many writers give to it. This last expres- 
 sion characterises much better the position the physician assumes in 
 this method, and creates no unfavorable prejudices against the other 
 curative methods which he believes it proper to employ, where diflFerent 
 indications require it. The expectant method is convenient, first, when 
 the aflfections tend, spontaneously, to a happy termination ; second, in 
 new aflPections, not well understood. It has been recommended, particu- 
 larly by the Hippocratists and Animists. 
 
 ANALYTIC METHOD. 
 
 This method is perfectly defined and developed by M. Lordat. " It 
 consists," says this writer, "in decomposing a disease into the elemen- 
 tary affections, of which it is the product — or into the more simple dis- 
 eases of which it is composed, in order to attack separately each of these 
 elements, by means proportionate to their relations of force and influence. 
 We have recourse to such a method in diseases which have no tendencies 
 in themselves to a happy termination, and which we cannot cure by any 
 direct specific medication." 
 
 I will add to these statements, that the analytic method is the most 
 difl&cult in application, because it requires more investigation than all 
 the rest ; namely, the decomposition of a disease under treatment. But, 
 as by this decomposition our minds seem to get a more intimate knowl- 
 edge of the circumstancss of the disease, and to penetrate farther into 
 the secret operations of nature, it has happened that several writers 
 have called the analytic method, exclusively, the rational — a very 
 improper designation, because it conveys the idea that reasoning is 
 excluded from the other curative methods, or that there is less reasoning 
 in them than in this. These writers measure the exactness of our judg- 
 ments by the labor which they have cost us ; they resemble a mathema- 
 tician, who supposes that one reasons more justly in transcendental 
 geometry than in arithmetic. 
 
 The third method which this author describes, is designated by the 
 term empirical — but it must be granted that all that is said on this 
 subject is inexact — even its name. In fact, the word empiric, joined to 
 the substantive, method, signifies a manner of treating diseases in con- 
 formity with experience. Now, I ask, is there any method of treatment 
 which must not be established both on experience and on reason ? Let 
 us recall that sentence of Baglivi, which we have heretofore quoted :
 
 I 
 
 THEORIES AND SYSTEMS. 545 
 
 " Those lolio suppose that reason and experience are opposed to each 
 other, are deceived ;" and we must conclude from this that nothing is 
 less sensible than to attempt to distinguish one curative method from 
 others, either by the term rational or empirical. M. Lordat himself has 
 felt the impropriety of this denomination, for he adds, a little further 
 on: "Eigorously, all the modes of treatment, considered in their imme- 
 diate effects on the elementary affections, are empirical, because the 
 results of their action could never have been anticipated." But instead 
 of rejecting an improjier expression, which leads to a confusion of ideas, 
 he endeavors to justify it by a sophism. 
 
 How has it happened that Barthez, having discovered a curative 
 method founded upon analysis, or the decomposition of a disease into 
 elementary affections, did not conceive of another, founded on synthesis, 
 that is, on the consideration of the totality of the morbid phenomena? 
 It was, too, a natural consequence, to whicli it would seem that the most 
 simple reflexion would conduct him: but genius sometimes sleeps, 
 aliquando bonus dormitat Homerus. It suffices by giving a little attention 
 to what passes in our minds, when we have to treat certain diseases, to 
 be convinced tliat after having examined, separately, each symptom, we 
 re-unite them all together, to form the idea of a single disease. For 
 example, let an individual present himself, who has small ulcers on the 
 prepuce, with a dirty greenish base ; also having a small tumor in the 
 groin, of an oblong form, without any red color, but hard, and slightly 
 painful : let such an individual recall that he has had, fifteen days 
 before, connection with a suspected woman. From all these circum- 
 stances united, aud there might be many more, I should form, in my 
 mind, an idea of a single affection, termed syphilis ; and I would direct 
 against it a treatment which would attack all the symptoms together, 
 and which, on that account, 1 should call a7ifi-syphilitic. I am ignorant 
 how a small quantity of a salt of mercury removes all the accidents of 
 syphilis, as by enchantment, in a multitude of cases: but what does 
 this import ? The essential for me and the patient is, that I know that 
 this result will take place, and under what conditions it will be pro- 
 duced. I know no more in regard to any other therapeutical phenome- 
 non, though many authors have given vis, for three thousand years past, 
 very wise explanations on most of these phenomena. It is true that 
 nearly all their explanations have the inconvenience of differing from 
 each other, and of contradicting themselves even. On this accoiint it is 
 prudent to suspend a judgment, until the parties are put in agreement, 
 and hold on to the crude fact, without interpretations. To the physicians 
 who seek the explanation of therapeutical facts, and to those who pre- 
 tend to have found them, for a certain number of cases, I will content
 
 546 REFORM PERIOD. 
 
 myself by citing the following words of Barthez : " Hume has justly said : 
 it does not appear that any corporeal operation, nor any action of the soul 
 on its proper faculties or on its ideas, can make us conceive the production 
 of causes, or the necessary relation which they sustain to their ejBPects. In 
 the succession of natural phenomena, nothing presents to us the idea of 
 causality, or the necessary connection between cause and effect; but 
 when the succession of one phenomenon after another is constant, the 
 human mind which observes it assiduously, and which can frequently 
 even foresee it, is led to believe that these phenomena succeed each other 
 because they are bound together."" 
 
 Thus, then, without seeking to understand why mercury removes 
 venereal accidents, or why vaccine prevents the variolic infection, why 
 bark cures the intermittent fever, etc., I shall employ these agents in 
 cases where they are indicated, with as much certainty and reason as I 
 would employ blood-letting against an inflammation. I call the method 
 of treatment used in such cases, the synthetic method. I shall not say, with 
 a crowd of theorists, that such a method is not ratioi^al, but will say, on 
 the contrary, that it is very rational, or rather that it is, as the preceding, ' 
 both rational and empirical. In the first place I maintain it is rational, 
 for the best reason that one can give for the use of a remedy is the cer- 
 tainty of its success ; now, every one will consent, that Medicine possesses 
 no remedies whose efficacy is more constant than those which I have 
 enumerated above. In the second place, the method is empirical, because 
 it is founded on experience. No one can contest this quality. 
 
 But what is most singular is, that in giving to this method the epi- 
 thet, empirical, there is a design to tarnish it, and exclude it from the 
 class of means acknowledged by science. Is it possible that the theorists 
 pretend to banish from the domains of art, the most precious, the most 
 efficacious, in a word, that which is the true glory of the Art ? When 
 a doctrine leads to such a conclusion, it is done for ; in the eyes of prac- 
 titioners, and of all men of good sense, it is judged and condemned. 
 
 Would to God that medicine possessed a greater number of remedies 
 called specific, which are employed in the mode of treatment which we 
 shall hereafter name synthetic. Then it would not be so often impotent. 
 But well established specifics are very rare, and on this account we 
 have recourse the more frequently to the expectant method, or to the 
 analytic method, the results of which are much less certain. It too 
 often happens, also, that none of these methods succeed. Then the 
 practitioner is reduced to experimentation, — he must attempt some 
 exploration ; but in these cases even, he does not go by chance, but is 
 
 * Preliminary Discourse.
 
 THEORIES AND SYSTEMS. 547 
 
 always guided by certain analogies more or less remote. His conduct 
 does not then cease to be rational, and on this account we denominate 
 this way of proceeding, the perturhative or explorative method. This 
 latter method is doubtless the least satisfactory and the most defective 
 of all. The aim of science should be to restrain its employment more 
 and more, and to enlarge, on the other hand, the domain of the other 
 methods, and, principally, of the one we have called synthetic. 
 
 " Barthez," says one of his biographers, "possessed, in a very high 
 degree, all the faculties of the mind, especially those which constitute 
 a genius for sciences, viz : a prodigious memory, a vast capacity 
 for facts, an inconceivable patience to consider all their aspects, 
 the strength of mind necessary to seize all their relations, and a great 
 aptitude to form and follow the connections of abstract ideas. He 
 understood whatever he studied. His immense reading, and the know- 
 ledge which he had of numerous languages, had rendered him familiar 
 with the philosophers and wise men of all time and every country. 
 The works of Barthez should have exercised an influence on the whole 
 medical world, but they were scarcely felt beyond the school in which 
 he taught. Besides, many have confined themselves simply to condemn- 
 ing them, and sometimes, even, without knowing them."" 
 
 If the influence of Barthez on the medical world has not been as 
 general as might have boen expected, it is owing to some of the follow- 
 ing circumstances : first, his system rests, as we have shown, on an 
 amphibological base : and nothing is less proper than doubt, to excite 
 the imagination, and make a con(|ucst of prosel3'tes. Secondly, he 
 affects a little too much in his demonstrations, an abstract form, which 
 is not within the comprehension of every mind. Thirdly, and lastly, 
 the epoch of his greatest renown corresponds with that of our revolu- 
 tionary troubles, — with the terrible catastrophes that overwhelmed 
 France, and excited entire Europe, — an epoch most unfavorable for the 
 propagation of a scientific System. 
 
 ART. VI. ORGANIC DYNAMISM. 
 
 "While Stahl, the severe logician and bold reformer, pushed his analy- 
 sis to the last limits, and pretended not only to determine the essential 
 and fundamental function of life, but also to go back to the primitive 
 agent of that function, which he affirmed to be nothing else than the 
 rational and immaterial soul, Frederick Hoffman, a less renowned 
 reasoner and more timid reformer, confined himself to seeking what is 
 
 "Dezeimeris' Diet. Hist, de Medecine, Art. Barthez.
 
 548 REFORM PERIOD. 
 
 the essential and fundamental phenomenon of life, without explain- 
 ing himself on its motor nature. This was, as is seen, to simi:)lify 
 the question, or lower the problem a degree. But, reduced to these 
 terms, the problem is still insoluble, as is proven from our philosophic 
 aphorisms — the certainty of which is seen in the fruitless efforts made 
 to that end up to this time. 
 
 The latro-chemists and the latro-mechanics had attempted in vain to 
 explain the functions of organized bodies b}" the general laws of matter. 
 Their theories, more or less subtile and brilliant, had captivated only a 
 part of the medical public ; a certain number of judicious and attentive 
 observers had always rejected them. They recognized that organized 
 bodies are endowed with particular forces distinct from the general 
 forces of crude matter: from which they concluded, justly, that physi- 
 ologists should deduce the laws of living or organic forces from the direct 
 observation of vital phenomena, in the same manner as the philosophers 
 and chemists deduce the laws of the general or inorganic forces, from 
 the observation of the phenomena in crude matter. 
 
 The school of Cos, the Hippocratists, the Animists, the Vitalists, had 
 already proclaimed this truth ; but they had all supposed the existence of 
 a principle, distinct from the organs, and giving an impulsion to the 
 organism, and directing its acts towards an end, and according to a pre- 
 conceived plan. This principle was called by some, nature ; by others, 
 the soul, or archeus, or vital principle ; but always the same idea 
 reproduced under different forms. 
 
 A class of modern physiologists have thought that we should consider 
 the vital forces as inherent to the organs, and study the action of these 
 forces, in order to discover their laws, without engaging in the considera- 
 tion of the organizing principle — just as the philosophers and chemists 
 regard the general forces of crude matter as inhei'ent to that matter, and 
 seek to determine the laws which regulate the action of these forces. 
 Setting aside the idea of the primary motor force, I give to this class 
 of physiologists the name of organo-dynamists, to indicate that they 
 do not separate the active power or force (di/namis) from the organ in 
 which it resides. 
 
 Frederic Hoffman lopped off from philosophy the ferments and acridities 
 of the chemists, the considerations of the mechanicians on the contractile 
 force of the heart, the capacities of the vascular orifices, and the form 
 of liquid molecules ; also the conjectures of the Animists, toucliing the 
 essence of the soul, or the vital principle. By all these retrenchments, 
 his doctrine acquired a simplicity which is its principal merit. Besides 
 it is presented with an elegance and clearness that renders its perusal 
 both easy and agreeable. Unhappily, the translation which I have been
 
 THEORIES AND SYSTEMS. 549 
 
 obliged to use is not marked by these same qualities, as may be seen by 
 the following extracts. 
 
 " I will give," says this author, " as a basis to my reasoning on the 
 whole theory and practice of medicine, the definition of life. Now, this 
 is what I understand by this word : life is the movement of circula- 
 tion of the blood, and other humors, produced by the systole and diastole 
 of the heart and arteries, or, to speak more properly, of all the vessels, 
 and all the fibers^ maintained by the contact of the blood and the spirits, 
 and which, by means of the secretions and excretions, preserves the 
 body from all corruption, and sustains the functions of every organ. 
 The circulation is, indeed, a vital movement, that preserves the blood 
 from putrefaction, to which it is extremely subject. The heat, forces, 
 elasticity, firmness, and tension, depend on it ; and so, also, the different 
 inclinations of men, the traits and characteristics of the mind, and even 
 wisdom and folly. 
 
 " To guarantee, then, the human body from disease, pain and melan- 
 choly, requires nothing more than to give to the blood the necessary 
 aid and succor, and especially to prescribe a regimen appropriate to main- 
 tain the circulation and the excretions in a normal state. To treat 
 disease is nothing else than to cause to return to their naturiil condition 
 the blood and liquids which have become deranged. 
 
 The advantages of the circulation being so evident, and as nothing 
 is able to move of itself, is it not natural to seek its cause ? This research 
 is not from pure curiosity, for he who knows the causes of the circula- 
 tion, can see much more easily what can promote or retard it, or what 
 would be salutary or injurious to the health — two points, the knowledge 
 of which constitute, principally, medicine. 
 
 "After having seen that the causes of the circulation are the con- 
 traction and dilatation of the solid parts of the body, and that all the 
 movements of the fluids depend on these, we can not avoid going back 
 to the study of the causes of this contraction and dilatation. Xow, I 
 can see none other than the blood ; for it is not only composed of solid 
 and humid principles, but also of a sulphurous matter, susceptible of 
 a very active movement, of air, and of the ethereal matter, which is 
 secreted in part in the brain, with an extremely tenuous lymph, which 
 serves it as a vehicle. 
 
 " Let us examine, now, how the concourse of the blood, and the 
 nervous juice, in the organic parts, produce in them the vital movement 
 of contraction and dilatation. All the fibers of which the organic 
 parts are composed have naturally very much elasticity, and being 
 stretched by the influx of the liquors, not only contract and relax, 
 but even return from a point of too great contraction to their natural
 
 550 REFORM PERIOD. 
 
 state. The diastole is, then, always the cause of the systole, and vice 
 versa. Thus, the machinery of the heart is the perpetual motion, 
 sought unsuccessfully for a long time ; for the blood excites the heart, 
 which gives motion to the blood, and by this mechanism the cause 
 produces an effect, from which arises the reproduction of the cause 
 itself." * 
 
 This physiological theory is, as I have said, one of the most simple, 
 but it must be seen, also, that it is not remarkable for strength of 
 reason. I shall not attempt to uncover, in detail, the errors that it 
 includes ; I will only call the attention of the reader to the final pro- 
 position, which is the top stone of the whole doctrine : the blood excites 
 the heart, which in its turn gives motion to the blood ; and behold, 
 exclaims the author, with artless admiration, the perpetual motion 
 found ! But the reader has easily seen that the explanations of Hoff- 
 man turn in a vicious circle, and that, in short, they explain nothing. 
 
 Let us see, now, some practical consequences of this theory : " Dis- 
 eases of every species being only a union of the natural movements^ 
 may then, as all the vital movements, be associated in two classes : the 
 systole and diastole ; in other words, contraction and dilatation ; for if 
 the contraction is too strong, or too long, it is called spasm ; if the dila- 
 tation err in excess or duration, it is called atony. Now, what serious 
 trouble do both these defects produce in the circulation ! In one, its 
 equality is broken, in the other its free course is greatly interrupted.! 
 
 " Since the movements can err only by augmentation or diminution, 
 we must conclude, from this, that there is only need of two classes of 
 remedies, namely : one capable of calming the convulsive movements, 
 called in the schools, sedative and anti-spasmodic remedies ; the other, 
 called confortatives or tonics, which are appropriate to give to the flabby 
 and relaxed parts their natural tension. "| 
 
 Thus the illustrious Dean of the University of Halle leads us, by a 
 circuit, to the pathological and therapeutical dichotomy of the ancient 
 Methodists ; a dichotomy which considered diseases and remedies from 
 two points of view only, and is entirely insufficient in the practice of 
 the Art, since it rests on a hypothesis contrary to observation ; that is 
 to say, that there are only two sorts of modifications in the animal 
 economy. 
 
 The argument of Hoffman is weak, and lacks depth ; it is very super- 
 ficial, and never carries a principle to its extreme censequences, which 
 denotes a mind more observing than logical. This judgment, which we 
 
 * Medecine Raisonnee d'Hoffman, translated by Bruhier. Paris, 1739. 
 J Ibid. ' I Ibid. 
 
 II
 
 THEORIES AND SYSTEMS. 551 
 
 should form a j^^iori, in reading the " Eational Medicine " of this 
 author, is confirmed by his biographers. Hoffman, they say, enjoyed 
 during his life the reputation of the greatest physician in Europe. 
 Boerhaave himself seems to have rendered him this testimony on a 
 memorable occasion. Having been consulted by the king of Prussia, 
 William I., he replied to that sovereign that the best counsel that he 
 could give him was, to apply to Hoff"man. 
 
 A practitioner so eminent should have made theory subordinate to 
 practice ; that is to say, estimate the first only in regard to the services 
 it could render the second, and judge of the truth of a doctrine by its 
 accordance with pathological and therapeutical facts. Such is, indeed, 
 the rule that F. Hoffman establishes to appreciate the value of a med- 
 ical doctrine. " The character," he says, " of a true and solid theory 
 in Medicine consists in its appositeness to the practice, or, in other 
 words, in its ability to explain all the circumstances in the histories of 
 diseases, in the succession in which they have appeared, and to draw 
 from them useful conse<|uences in the practice, in order to give rational 
 and advantageous counsels." 
 
 But none of the theories professed in his time could fill these condi- 
 tions in a complete and absolute manner, and he could do nothing bet- 
 ter than to take, in each one of them, what appeared to him to be the 
 most useful and rational, without being able to account perfectly for the 
 motives of these determinations, and justify them by a solid argument, 
 acting, in that respect, like those whose choice would result from instinct 
 rather than reason ; in a word, he was eclectic, as he also declares him- 
 self in his eulogy of that ambiguous doctrine. Still, he inclines to 
 Solidism, which he had freed from the calculations with which the iatro- 
 raechanics had loaded it. "We must admire," he says, "a physician 
 free from all bondage to all sects or hypotheses, who puts everything in 
 the balance, and adopts only what is conformable to reason and experi- 
 ence, and rejects, carefully, that which is opinion only." Very well ! 
 nothing is better than to adopt for guides, reason and experience ; but 
 the difficulty is, never to be separated from either. Now, up to this 
 time, none of the medical theories that we have announced, without even 
 excepting that of Hoffman, has resisted the test of this double light. 
 
 Perhaps we shall be more successful in the future ; possibly we shall 
 encounter, at last, a physiological doctrine which will account perfectly 
 for the phenomena of the animal economy, both in a pathological and 
 normal state. AVe proceed now to enter into an order of new ideas, of 
 which antiquity offers us no model, and to which the theory which we 
 have just studied serves in some sort for an introduction. Up to this 
 time, no one had considered the movements of the organized solids but
 
 552 REFORM PERIOD. 
 
 as the cflFect of elasticity. Hoffman himself represents them to us in 
 no other manner, in the passages which we lately quoted. But when 
 the great Haller had demonstrated, by a series of experiments, that the 
 contractility of muscular fibers, and other tissues, is a special property 
 of living solids, essentially distinct from elasticity — from that moment, 
 it began to be suspected that this property recently discovered, which 
 was named irritability, might well be considered as the characteristic 
 sign of organization, the source of all the phenomena of life. 
 
 Cullen, author of a very remarkable nosological classification, of 
 which we have already spoken, attempted the first to establish a medical 
 doctrine on the development of the phenomena of irritability. Pos- 
 sessed of a cool and observing mind, he comprehended, in the onset, 
 that if he would assume this property as the base of the functions 
 of the animal economy, he must not push his researches farther, but 
 admit it as a primitive fact, whose causes escape our investigations ; 
 else he might fall into the vicious circle into which Hoffman and so many 
 others had been drawn, who, after having taken the circulation of the 
 blood, or any other phenomenon, as a starting point, were obliged after- 
 ward, to make this primordial phenomenon depend upon some other func- 
 tion. Nevertheless, he could not avoid these contradictions ; for when 
 we have adopted a false principle, it is impossible for us to escape the 
 consequences that flow naturally from it. We are thus drawn from 
 deduction into deduction, in spite of ourselves, by a current stronger 
 than our will. 
 
 Cullen may tell us as much as he pleases, that irritability, being a 
 primitive fact, there is no necessity for seeking its cause ; nevertheless, 
 an instant after, he violates, himself, this injunction, in affirming that 
 irritability is aroused and put in play by an extremely subtile fluid 
 which the brain secretes, and which is distributed everywhere by the 
 nerves. If you, then, demand whence comes this nervous fluid, this 
 physiologist will respond that it originates in the most subtile portions 
 of the blood and lymph, which are carried to the brain by means of the 
 contraction of the heart and arteries. In short, according to this system 
 the irritability of the heart is sustained by the nervous fluid, which fluid 
 is itself a consequence of the irritability of the heart. Eeaching this 
 result, and perceiving that he had fallen into a vicious circle, which 
 he had hoped to avoid, Cullen ends by avowing, as all the great physi- 
 ologists before him had done, that the phenomena of life forming a 
 circle, it was a matter of no importance where we begin or end in their 
 study. It is not, therefore, to be wondered at, that sometimes the cir- 
 culation of the blood was supposed to be the principle on which depended 
 all the functions of the animal economy ; and again, that the nervous
 
 i 
 
 THEORIES AND SYSTEMS. 553 
 
 system is the most important of all the organic aparatus — the one that 
 first feels the impression of excitants, and transmits it to others ; in 
 a word, that gives impulsion to all the movements of the organism. 
 " We adopt," he says, at the commencement of his " Treatise on Materia 
 Medica." " this maxim: Remedies do not act upon a dead body, because 
 their action depends neither on the laws of matter nor those of motion, 
 but on the principles of life. • These are, then, the principles which 
 should be the object of our researches, and they form a circle in such a 
 way as to leave us in uncertainty as to what point we should commence 
 or end. The circulation of the blood appears to be, nevertheless, the 
 principle of vitality on which all others depend." Cullen did not take 
 the trouble to prove in what the circulation of the blood appeared to 
 him to have priority over the other principles of life ; he contented him- 
 self with recalling the opinions of Boerhaave on that subject. How- 
 ever, we shall find him, further on, giving the priority to the nervous 
 system. 
 
 Let us leave, for the present, this discussion of general principles, 
 and pass to the application which the author makes of them to pathology 
 and therapeutics. He commences by declaring that the autocracy of 
 nature, adopted under whatever form, by different sects, has been preju- 
 dicial to the practice of many physicians, from Hippocrates down to 
 Stahl. He avows himself, also, the adversary of the empirical method, 
 and of all specific remed'es, the number of which he thinks every one 
 ought to diminish as much as possible. "I would go," he says, " much 
 further, and show how much the autocracy of nature, adopted under 
 whatever form by the different sects, has been prejudicial to the practice 
 of all physicians, from Hippocrates to Stahl." In his Institutes of 
 Medicine he proscribes, rigorously, the employment of specifics ; how- 
 ever, he is forced to admit them in his treatise on materia medica, and 
 makes the following avowal, which is worthy of being transcribed : 
 " I have testified elsewhere my repugnance for specific medicines ; 
 but we shall, perhaps, be forced to retain many of them still, though we 
 should make efi"ort3 to diminish their number as much as possible." 
 
 Thus Cullen repelled the expectant method, the only one that we could 
 or should employ on many occasions, and the synthetical method, 
 vulgarly named the empii'ical, the most efficacious of all. He declares 
 that the cure of diseases should be particularly and nearly unirpely 
 founded on the knowledge of their proximate causes, or, in other words, 
 he rejects all methods of treatment as irrational, except the analytic — a 
 method often defective, but which seduces us by an illusory appearance 
 of profundity. Besides, this author makes use of analysis with admir- 
 able sagacity, whether he attempts to explain the generation of morbid 
 35
 
 554 REFORM PERIOD. 
 
 phenomena, or to justify the employment of remedies. The following 
 are examples of the application of this method to two of the most 
 important and difficult cases in pathology : 
 
 I. " Our doctrine of fevers," says Cullen, " is reduced to the fol- 
 lowing principles : The remote causes are certain sedative influences act- 
 ing on the nervous system, which, diminishing the energy of the brain, 
 produce, necessarily, debility in all the functions, and particularly those 
 of the minute vessels of the surface. Nevertheless, such is at the same 
 time the nature of the animal economy, that this debility or atony (the 
 proximate cause of the fever) becomes an indirect stimulant to the vas- 
 cular system. This stimulant, aided by the accession of the chill and of 
 the spasm which accompanies it, augments the action of the heart and 
 great arteries, and continues thus until it is able to re-establish the energy 
 of the brain, and communicate this energy to the small vessels, and 
 re-animate their action, and especially, by this means, destroy their 
 spasms. The latter being relieved, the sweat, and all the other signs of 
 relaxation of the excretory conduits, take place." 
 
 II. " All the phenomena of inflammation concur to prove that the 
 impetuosity of the circulation of the blood is accelerated in the afi"ected 
 part ; but, in this case, the action of the heart is not always augmented ; 
 we may therefore, presume that the acceleration of the circulation of the 
 blood in the affected part is due especially to the augmented action 
 of the vessels of the affected part itself. '•' " =••■= The spasm 
 of the extremities of the arteries that sustain the increased action of 
 the blood, which is pushed into them, must then be regarded as the 
 proximate cause of inflammation, at least in all cases where the inflam- 
 mation is not produced by the direct action of stimulants, and even 
 under such circumstances we may suppose that these occasion a spasm 
 in the extremities of the vessels." 
 
 I have no need to remark how much this doctrine agrees with that of 
 f . Hoffman ; in one, as in the other, only two general causes of diseases 
 are admitted : spasm, or the augmentation of tension, and atony, or 
 relaxation. Only the Scotch pathologist places the point of departure 
 of morbid phenomena in the nervous fibrillae, which are always supposed 
 to receive the first impressions of morbific agents, and communicate 
 them at once to the last arterial ramifications, while the German pathol- 
 ogist considers the excessive afflux of the blood as the first motor of 
 abnormal movements in the parts, as the primitive cause of the alter- 
 nate tension and relaxation of the fibers. 
 
 Cullen, like Hoffman, was a circumspect practitioner and skillful 
 observer, rather than a profound dialectician. He did not hesitate to 
 abandon his theory whenever it appeared to disagree with his
 
 f 
 
 1 
 
 THEORIES AND SYSTEMS. 565 
 
 experience. So, notwithstanding his repugnance for specifics, he readily 
 admitted a goodly number into his Materia Medica ; and notwithstand- 
 ing his inclination for Solidism, he admits remedies which are supposed 
 to act on the humors, such as alternants, anti-acids, anti-alkalies, etc. 
 We do not bring against him any reproach for this ; we praise him, on the 
 contrary, for having stated, in many cases with great precision, the cura- 
 tive indications from the apparent phenomena of the diseases, without 
 stopping to inquire whether they conformed or not to his theoretical 
 explanations. In continued fevers, for example, he recognizes threejgen- 
 eral indications to be fulfilled : First, to moderate the violence of the reac- 
 tion ; second, to remove the causes, and prevent the cff"ects of debility ; 
 third, to arrest or correct the tendency of the fiuids to putrefaction. 
 In intermittents, he points out three curative indications : First, during 
 the period of intermission, to provide against the return of the parox- 
 isms ; second, during the paroxisms to take such steps as would procure 
 a perfect crisis of the disease ; third, to remove obstacles which might 
 might prevent the fulfillment of the first two indications. If we consult 
 the most recent treatises of Medicine, we shall see that the curative 
 indications laid down in them are almost the same for these same 
 classes of diseases ; so that in regard to therapeutics, the general views 
 have changed but little since Cullen. Besides, to carry out these views. 
 he employed nearly the same means as ourselves, though his manner of 
 studying diseases and the action of remedies was very difierent from 
 ours ; which proves that the greater part of the rules of practice are 
 founded on pure observation, and independent of all theoretical inter- 
 pretation, or comply equally with a variety of difi^erent interpreta- 
 tions. This is a consoling fact that history alone could make evident, 
 and Avhich justifies in our eyes the practice of past ages, notwithstand- 
 ing the incessant variations of theories, as it will justify in the eyes of 
 our successors, our present practice. Cullen had the pain to see spring 
 up at his side, in his own home, a doctrine which, though hardly hatched, 
 became a menacing rival of his own. 
 
 John Brown, born of obscure parents in a village of Berwick, in Scot- 
 land, was remarkable, from his early youth, for an extraordinary apti- 
 tude for acquiring languages, a decided inclination for scholastic dispute, 
 a pedantic tone and manner, and somewhat irregular conduct. Having 
 abandoned theology for medicine, he fixed his residence in Edinburgh, 
 where he assiduously followed the lectures of the professors. He after- 
 wards repeated and explained them to other students for a compensa- 
 tion. He also translated into Latin the theses of those who were not 
 sufficiently familiar with the language, and wrote in it on every subject, 
 for those who preferred paying for such labor, rather than perform it 
 
 1
 
 556 REFORM PERIOD. 
 
 themselves. He was particularly entertained and countenanced Ly Cul- 
 len, who even took him into his family in the character of preceptor of his 
 children. This agreeable relation subsisted during twelve consecutive 
 years between these two men, whose characters and minds were so differ- 
 ent. The protege was grateful for the countenance of his preceptor, 
 aided him in his labors, and unceasingly praised him. But some tri- 
 fling matters of mutual discontent grew at length into coldness, 
 and changed the old friendship which had united them into an irrecon- 
 cilable hatred. 
 
 Their rupture broke out about the year 1778, and in a short time 
 after, Brown published his Elements of Medicine. The eulogies which 
 he received on that occasion, and the encouragement of some friends, 
 determined him to make this work the foundation of a public course of 
 lectures, in which he gave his theory every possible development. 
 Then commenced between the master and the pupil an obstinate conflict, 
 which agitated the University of Edinburgh for several years ; a con- 
 flict but little interesting to posterity, on account of the personal vanity 
 and interests, which are much more conspicuous there than its scientific 
 interest. Brown, whose pride, inflated by partial success, made him 
 indifferent to every one — whose impassioned eloquence overwhelmed 
 with satiric strokes whoever shared not his opinions, was in the end 
 alienated from the whole Faculty, who endeavored, henceforth, to inter- 
 fere with his teaching, In vain, though sustained by the zeal of some 
 enthusiastic partisans, and by his natural pride, he essayed to make 
 head against the storm ; he was compelled to give way before the con- 
 tinual increase of his enemies. In 1786 he put in execution the project 
 which he had meditated for some time, of going to exhibit himself in a 
 greater theater. He embarked for London, where he died in 1788, aged 
 fifty-two years, a victim to his intemperance and medical delusions. 
 
 Brown employed some of the ideas of his master to develop a doc- 
 trine much more simple in appearance, but founded entirely on abstract 
 considerations ; a doctrine in which every provision seems to be made 
 for discussion, but none for practice. Cullen had said that the nervous 
 system receives the first impression of excitants, and transmits it after- 
 wards to the other organs endowed with motion and vitality. Brown 
 explains thus, the same thought : " Life is only sustained by incita- 
 tion. It is only the result of the action of incitants on the incitability 
 of organs." =■' Cullen regarded the atony of the small vessels as the 
 proximate cause of fever. Brown, improving on this hypothesis, admits, 
 with hardly any exceptions, only hyposthenic diseases. These are the 
 
 ■' Elements of Medicine, Part I, cliap. ii.
 
 THEORIES AND SYSTEMS. 557 
 
 only relations that exist between tliese congenerous doctrines. On all 
 other points they dilBFer, or are in opposition. One is the work of a 
 skillful practitioner, who departs as little as possible from observation, 
 or who hastens to return when his arguments have carried him away 
 from it — loving much better to renounce, for the moment, his theory, 
 than the testimony of his senses. The other is the conception of a 
 mind essentially logical, and possessing a strong imagination, but of an 
 observer preoccupied or distracted, who sees objects only through the 
 prism of his ideas, 
 
 '■We do not know," says Brown, " what incitability is, nor how it is 
 affected by inciting agencies; but whatever it may be, every being which 
 begins to live, is provided with it to a certain degree. Our ignorance 
 on the nature of this faculty, the poverty of ordinary language, and the 
 novelty of the doctrine, obliges me to employ peculiar expressions. 1 
 will say, that commonly, incitability abounds, when we apply a slight 
 stimulus ; that at other times it fails — is crushed or consumed, when 
 the stimulus is too violent. Here, as elsewhere, we must hold to the 
 truth. Avoid carefully, since the}- are nearly incomprehensible, the dan- 
 gerous question of causes, that venomous serpent of philosophy. Let 
 no one, then, believe, from what I have just said in regard to the 
 nature of incitability, that I pretend to decide, if it is a substance, and 
 therefore sometimes augments and again diminishes, or if it is a faculty 
 inherent in matter which is sometimes excited and again languishes ; 
 nor that I wish to resolve in any manner a question so abstract. These 
 researches have nearly always done much injury to science." 
 
 Brown employs here the same artifice as Barthez. To evade the 
 objections that might be brought against it, if he should affirm that 
 incitability is a substance, or if he affirmed that it is a faculty inherent 
 only to the organs, he shelters himself behind the doubt. By this arti- 
 fice, he reserves to himself the advantage of being able to consider this 
 equivocal being, sometimes, as distinct from all parts of the body, hav- 
 ing its own proper existence, and again, as united to the organs in an 
 inseparable manner. But the doubt of Brown is only the ruse of the 
 sophist. In every other part of his work we do not find the least appear- 
 ance of skepticism; everywhere its tone is dogmatic and affirmative. 
 The author considers so well incitability as a being distinct from the 
 organism, that he even goes so far as to attribute to it the formation of 
 the organs. " The first cause," he says, " of the formation of the sol- 
 ids, and the sole means of their subsequent sustenance is incitatiou."" 
 
 This is rapid progress in a little time. This timorous philosopher, 
 who dared advance nothing touching the nature of incitability, who 
 would banish from his doctrine the venomous serpent of causes, does not
 
 558 REFORM PERIOD. 
 
 hesitate now to say, that incitability is the first cause of the formation 
 of solids, that it is what creates and what determines the state of the 
 simple solids and the humors. The skepticism which he afi'ected at the 
 commencement is but an oratorical artifice, made use of to introduce his 
 physiological principles without discussion. In fact, this principle 
 could not resist a serious examination, for in the onset, an impassable 
 objection could be made to it, for it might be said: If the first cause of 
 the formation of the solids is incitation, on what does it exercise itself 
 anterior to their existence ? There is no response possible to such a 
 question, in Brown's entirely Solidist system. 
 
 Now, as we have shown the weakness and nothingness of the basis 
 on which this whole system rests, let us follow a little its developement. 
 The Scotch physiologist distinguished only two pathological states — one 
 consisting in an excess of incitability, which he names the sthenic dia- 
 thesis ; the other, constituted by a want, more or less notable, of the 
 the same faculty, which he designates as the asthenic diathesis. 
 Besides, Brown considers these two state as affecting the entire economy, 
 rather than any organ in particular. A local affection rarely appears 
 to him to be worthy the attention of a practitioner : he gives but little 
 attention except to the general state of the body, sustaining this method of 
 the study of disease by a singular calculation, 
 
 " Let the principal affection," he says " be as six, and the minor 
 one of each part as three : the number of parts but slightly affected 
 as one thousand ; the partial affection will be to the general affection 
 of the rest of the body, in the ratio of six to three thousand." 
 He concludes from this, that in general disease, each local affection, 
 however redoubtable it may be otherwise, must be considered as a part 
 of the first, and therefore the remedies must l)e directed, not to the part 
 chiefly affected, but to the whole organism. This strange calculation is 
 not the result of observation — it had no foundation but in his imagina- 
 tion, and is in flagrant contradiction to the results of daily observation. 
 After having reduced all diseases to two genera, and withdrawn from 
 pathology the study of local lesions. Brown arrives, by a subtile argu- 
 mentation, to consider the affections of the sthenic order as prevailing 
 in a very small number of instances, so that the diseases of the asthenic 
 type comprehend nearly the totality of affections. According to this 
 theory, a physician is rarely ever mistaken if he orders, in all his cases, 
 remedies of an exciting nature. When I say always, I exaggerate, for 
 he would err three times in a hundred, which is sufficiently accurate in 
 medical practice." '■■' 
 
 ** The following explanation is thus given by one of the fervent expounders of 
 the Brunonian doctrine : " However this may be, as in general, the diseases in
 
 THEORIES AND SYSTEMS. 559 
 
 Never since the days of Thessalus (of charlatan memory) had any 
 one simplified to such a point the study and practice of medicine. 
 We may even say that in this respect the Scotch pathologist left far in 
 the rear the physician of Nero. To this attraction, well calculated to 
 tempt students and practitioners, the doctrine of Brown joined the 
 advantage of beiii-^ presented in an energetic and captivating style, full 
 of imagery, which suffices to explain its rapid progress. But this doc- 
 trine, so seductive in its exposition, so easy in its application, is one of 
 the most disastrous that man has been able to imagine, for it tends to 
 propagate the abuse of diffusible stimulants, of which spirituous liquors 
 make a part, an abuse excessively injurious to health in general, and the 
 intellectual faculties in particular — an abuse to which man is too much 
 inclined, naturally, and which the sophisms of Brown may have contrib- 
 uted to spread in all classes of English society." 
 
 One is frightened in reading the long list of diseases against which 
 the Scotch pathologist does not hesitate to prescribe the most energetic 
 stimulants. Here is a sample of this list, extracted from the table 
 of Linch : plague, confluent variola, apoplexy, paralysis, gangrenous 
 angina, synocha. typhus, hydrothorax, phthisis, dysentery, etc.; such 
 are the affections which this bold theorist advises to be treated by 
 electricity, opium, ether, spirit of wine, and other stimulants of this 
 nature, to be employed in increasing doses, in proportion as the diseases 
 progress. " No other systematic author," says M. Cotanceau, " has 
 less known the totality and the details of medicine, and one has reason 
 to be astonished, on each page of his book, at the imperturbable assur- 
 ance with which he accommodates the particular facts of pathology to 
 the consequences of his theory. As a nosographer, he is below all ; and 
 I know no treatise on popular medicine, that does not include a history 
 of diseases very superior to his. Though he continually pleads, as is 
 usual, the increased number of facts in favor of his doctrine, we recog- 
 nize every moment the absolute want of observation, and the most 
 superficial judgment. Neither is there anything in his work to lead 
 you to suppose that he has studied authors any more than nature ; or 
 if he has read any, it was without meditating upon them, for he never 
 quotes any, scarcely, nor combats any theory — he believes that he has 
 extinguished all by the exposition of his own. He advises his students, 
 
 which stimulants are useful, are, from the number of those that require evacua- 
 tions, in the proportion of ninety-seven to three. It is very probable that the 
 alexipharmic was universally more useful than the antiphlogistic or evacuant 
 method." Nouvelle Doctrine de Brown, translated from the Italian bj' Lafont 
 Gonzi, introduction, p. 125. Paris, 1807. 
 
 ' Journal Hebdomadaire de Med., 27 Feb., 1830.
 
 560 REFORM PERIOD. 
 
 nevertheless, to learn what is necessary in anatomy, to open dead bodies, 
 and study the illustrious Morgagni. If he had done this himself he 
 would have seen himself refuted on every page." ••■^ 
 
 Notwithstanding its defects, the system of Brown made rapid pro- 
 gress, principally in Grermany and Italy ; but it is not difficult to 
 understand this success, when we think that this system favored, 
 remarkably, the indolence of physicians, in reducing the science and 
 the art to an extreme simplicity, and which was not less agreeable to 
 the patient, as it countenanced intemperance. Joined to this, the 
 attraction of novelty, the charms of a passionate language which 
 indicates conviction, and you will comprehend that nothing more was 
 needed, or even as much, to obtain numerous and enthusiastic proselytes. 
 In Italy, Brunonism was soon modified in an important manner, which 
 changed entirely its economy. Rasori, while admitting two orders of 
 diseases, founded on the excess or want of incitation, reversed their 
 numerical proportions. According to him, the asthenic affisctions arc 
 rare, and the sthenic much more common. According to Brown, we must 
 stimulate unceasingly, but with liasori contra-stimulants were much 
 more frequently used, viz : antiphlogistics and sedatives. Moreover, 
 the Italian school did not judge the value of remedies from pure 
 theoretical considerations, but from experiments, undertaken with the 
 view to determine their value. 
 
 Brunonism did not find as easy access into France, which was 
 doubtless owing to the anatomical dii'ection of studies in the school at 
 Paris, and the influence of the Vitalism of Barthez in the school at 
 Montpellier. Nevertheless, it had commenced a progress there, and had 
 gained some ground, when it encountered an impassioned and powerful 
 adversary, who, employing by turns the lights of observation, and the 
 weapons of dialectics, assaulted it, piece by piece, and gave it no quarter 
 imtil he had laid bare, and fully exposed, its vices and its dangers. 
 Brown stopped to consider, at this superficial and common observation, 
 that in the greater number of diseases there is a diminution of the 
 general forces ; and without troubling himself about the condition of 
 the organs, he hastened to conclude that it is necessary in nearly every 
 case to administer tonics and stimulants. Broussais, penetrating further 
 in his observations of morbid phenomena, demonstrated that the general 
 debility of the sick coincides more frequently with an exaltation of the 
 sensibility of organs ; whence he concludes, that far from attacking 
 these organs with stimulants stronger than usual, it is necessary, on 
 the contrary, to diminish the energy of the habitual stimulation — that 
 
 " Biographic Medicale, art. Brown. Paris, 1820.
 
 THEORIES AND SYSTEMS. 561 
 
 is to say, employ debilitants and sedatives.-' If we may reproacli the 
 French pathologist for having maintained the narrow base of Brunonism 
 in establishing his nosological classification on the want or excess of 
 irritation, it is no less true that he has rendered an eminent service to 
 science and humanity, in giving the precept, to proportion the degree of 
 stimulation to the receptive condition of the organs, rather than to the 
 general state of the forces, because, in the greatest number of cases, 
 extreme prostration is accompanied with great irritability ; in other 
 words, a very slight tolerance for stimulants. 
 
 ART. VII. EMPIRICISM. 
 
 From Galen to an epoch very close to ours, the Empirical doctrine was 
 not professed openly by any physician of reputation. This doctrine, 
 which threw so much eclat over the school at Alexandria, had fallen 
 into such discredit that not a single writer of the middle ages, or on 
 the revival of letters, had dared declare himself in its favor. Its name 
 became the synonym of folly and charlatanism, and implied, then, the 
 absence of all rational notions in the Healing Art. An empiric was a 
 man who ordered remedies without any appreciation of their therapeu- 
 tical effects, without any discernment of the diseases for which he 
 employed them. 
 
 We have developed, heretofore, the causes of the fall of Empiricism, 
 and the contempt which was attached to its name. We have demon- 
 strated that the principal of these causes consisted in the opposition 
 that existed between this medical system and the philosophical theories 
 then prevailing. All the ancient philosophers, in fact, to whatever sect 
 they belonged, agreed in saying that the study and exposition of any 
 science whatever, must commence at its principles. Xow, the word 
 principle signified, sometimes, a general proposition, from which might 
 be drawn a certain number of particular properties, as a source, afonte. 
 For example, the proposition, tioo quantities equal to a third, are equal 
 to each other, is a principle, or an axiom of mathematics whence are 
 deduced a crowd of theorems. Sometimes the same word designated a 
 simple substance, indivisible, or so considered, and concurring to the 
 formation of compound substances; thus, fire, air, earth, and water 
 were thought to be the elements or principles of all bodies. In philo- 
 sophy, the word principle designated, sometimes, the first rudiment of an 
 organized body, the elementary fiber, or, also, the intriusic and natural 
 
 •^ See his Examen des Doctrines Medicales. Paris, ISIG et 1829.
 
 562 KEFORM PERIOD. 
 
 force whicli resides in living beings, and concurs witli exterior circum- 
 stances to the production of all the phenomena of their existence. In 
 fine, from etymology, and common use, principle is the synonym of 
 commencement. 
 
 Consequently, it would have been supposed as directly opposite to 
 common sense, if any one had commenced the study of a science by any 
 thing else than its principles ; thus, the study of physics was begun by 
 the examination of the theory of the elements, of that of the atoms, 
 etc. ; in a word, by the examination of all the cosmogenic theories pos- 
 sible ; that is to say, he must engage, from the onset, in insoluble ques- 
 tions, the source of interminable discussions. In physiology, he must 
 attend, in the first place, to the research for the principle of life, and 
 the elements of the human body ; in pathology, he must, before every- 
 thing else, determine the essence, the proximate cause, otherwise called 
 the principle of diseases. 
 
 The Empirics came and declared all these researches chimerical, and 
 insoluble, and regarded as mere dreaming all the speculations of the 
 philosophers and physicians in this respect. Bold reformers, they 
 attempted to overturn entirely the established dialectic order, and com- 
 menced the study of the sciences, by the examination of facts, by 
 means of observation and pure experience ! They assumed that rea- 
 soning should not surpass the limit of sensible phenomena. This 
 was, as is seen, to sap the scientific edifice at its base and overturn all 
 received ideas. The minds of men were not ready for a reform so rad- 
 ical, and they therefore must fail. The philosophers, menaced by Empi- 
 ricism in regard to what they held most dear, their theories and their 
 systems, in which was constituted the major part of their scientific lum- 
 ber, repelled the new doctrine as an enemy of all knowledge ; they 
 loaded it with their disdain, denied it the title of rational, and banished 
 it to the domain of stupidity. Such is the history, summarily, of 
 Empiricism, up to the seventeenth century of the Christian era, when 
 our Keform Period begins. 
 
 At this epoch, a sect of modern philosophers started up, who demol- 
 ished the Platonico-peripatetic philosophy, and rebuilt the scientific edi- 
 fice on new foundations. Taking the sensations as the point of departure 
 of our knowledge, they demonstrated that the first ideas which are formed 
 in our minds by impressions upon the senses, are particular ideas, relating 
 to individual objects; they proved, at hast for the physical sciences, that 
 general ideas and axioms, instead of being the commencement, the base 
 of the scientific pyramid, are its termination, its summit. They assumed 
 that our understanding can not surpass, in its conceptions, the limit of 
 observed facts, without falling into the emptiness of hypothesis. This
 
 THEORIES AND SYSTEMS. 563 
 
 was to run full sail into Empiricism. Thus the new philosophy was 
 called experimental, which signifies the same thing as empirical, and 
 those who cultivated it were named sensualists, or better, sensitists, 
 because they referred all our ideas to sensations. These philosophers 
 proceeded, in all their reasonings, from particulars to generals, that is to 
 say, by induction. 
 
 On the other hand, the partisans of an opposite doctrine, those who 
 are now called rationalists, or spiritualists, because they admit either 
 innate ideas, or modes of acquisition proper to the mind and innate to 
 it, held to the ancient method, that which goes from generals to partic- 
 ulars, or deduction ; but they modified their doctrine in the sense that 
 they agreed that in the order of sensible things, reason can not pass the 
 limits of experience, without mistaking its rights and its powers. 
 
 A change so profound in philosophy, and at the same time so favora- 
 ble to Empiricism, should have opened the eyes of physicians, and 
 caused them to give up their prejudices against this system. But ^led- 
 icine is a science so abstruse, the truths of which are so diflicult to 
 discern, and experience itself is so deceptive, that their prejudices 
 resisted for a long time the progress of light, and they could not be 
 eradicated but with great pain. Thus we see the most eminent physi- 
 cians of the Keform Period embarrassed on the subject of Empiricism, 
 sometimes branding this doctrine and its advocates with the most oppro- 
 bious epithets ; again representing them under much more favorable 
 colors, and even advantageously ; sometimes repelling their maxims 
 with disdain, again accepting and eulogising them. This subject was, 
 for the writers of the two last centuries, a source of perpetual 
 contradictions. 
 
 We have already quoted passages in which Baglivi condemned, 
 entirely, the Empirical sect ; a little farther on he changes his opinion 
 and speaks of them in an entirely different manner. Let us recall only 
 the last reflection which he has made on this subject. " I should not 
 think thus," he says, " of rational and learned Empiricism, the fruit of 
 method, not of accident, directed and sustained by intelligence, elevat- 
 ing itself to the highest truths by the attention and persevering obser- 
 vation of phenomena. Such an Empiricism has always obtained the 
 approbation of enlightened men, who have endeavored to enlarge it, as 
 a mode of acquisition conformed to our nature." What other species of 
 Empiricism could have been had in view by those learned physicians of 
 Alexandria, to whom Galen renders so honorable a testimony, who dis- 
 daining the titles of Hippocratists, Herophilians, Erasistratians, and 
 every other denomination borrowed from a proper name, called themselves
 
 564 REFORM PERIOD. 
 
 simply, experimenters. It was certainly not the Empiricism of market 
 houses and street corners that such a class of men avowed. 
 
 Zimmerman, that eloquent though somewhat prolix apologist of the 
 experimental method, does not show himself more equitable nor more 
 consequent in regard to the Empirical sect, of whom he draws two por- 
 traits, which no one could ever believe to have been drawn by the same 
 hand. Here is the first: " An empiric in Medicine is one who, without 
 dreaming ever of the operations of nature, such as signs, causes of dis- 
 eases, indications, methods, and especially discoveries of different ages, 
 asks, simply, the name of a disease, and administers drugs at hazard, or 
 distributes them at random, following his routine and recognizing no 
 art. The experience of such an Empiric is always false, because he 
 practices his art without knowing it — he follows the recipes of others 
 without examining their causes, their spirit, and aim."" 
 
 Here, now, is his second portrait, which resembles but very little the 
 preceding one : " Serapion and his successors opposed the research for 
 hidden causes and only paused to consider those that strike the senses. 
 In this they were right ; it was reserved to anatomy to uncover these 
 secret causes, but anatomy was still in its infancy in the times of 
 Serapion : moreover, causes at that time were only sought in philosophy, 
 so that, necessarily, they must fall from one error into another, in the 
 midst of so much obscurity. We see, therefore, that the authors of the 
 Empirical sect had a design praiseworthy only in itself. 
 They accepted only what is appreciable by the senses, and consequently, 
 they thought that the senses and memory were alone necessary for the 
 practice of Medicine. If they admitted some reasoning, it was so sim- 
 ple that it was not possible to be misled by it, and so natural that it 
 seemed to be self-evident. They did not proscribe reasoning then, 
 except when it was based on false principles, and when nature was 
 judged by false reasoning. Philinus and Serapion, therefore, are not 
 to be blamed if their sectators or successors have turned away from 
 their manner of thinking, and if they have condemned erudition, anat- 
 omy, physiology, and philosophy which is the soul of Medicine. The 
 founders of Empiricism sought true experience and their stupid suc- 
 cessors content themselves with that which is false." 
 
 It would be easy for me to establish, by a crowd of other examples 
 that the same contradictions in regard to the Empirics and Empiricism 
 are met with among the greater part of the most celebrated practitioners 
 and most renowned nosologists of the Reform Period. To do this I 
 
 " Traite de I'Experience, translation of Lefebre, Montpellier. 182-i.
 
 THEORIES AND SYSTEMS. 565 
 
 would only have to open the writings of Torti, Sydenham, Stoll, Mor- 
 gagni, Sauvages, Cullen, Borsieri, Barthez, Ph. Pinel. I. P. Frank, and 
 others ; in all I could show the maxims of the experimental philosophy 
 adopted, proclaimed, and the name of Empiric repulsed and falsified. 
 
 The tendency of physicians toward Empiricism, became more and 
 more marked toward the end of the eighteenth century. It did not 
 escape the historian Sprengel, who signalized it as having had birth in 
 Gi-eat Britain, and assigned for it, as principal causes, on one hand the 
 propagation of the philosophic principles of Bacon, Locke and Hume; 
 on the other, the discovery of several new medicaments, the employment 
 of which contradicted all the systems adopted till to that time, and 
 whose mode of operation could not be reconciled with any of the reign- 
 ing theories. ='•' He shows, afterward, the same tendency toward 
 Empiricism in other countries ; first France, then G-ermany, and extend- 
 ing finally into all parts of Europe. " In general," he says, "all the 
 physicians who wrote during the last ten years of the eighteenth cen- 
 tury seemed to be in favor of Empiricism. They inclined not toward 
 a blind routine, but endeavored unceasingly to have their opinions 
 accord with experience, and never outstripped in their reasonino- 
 the limits assigned by the observation of nature. Xo one invented any 
 new theories on the nature of the vital force, or the essence of diseases • 
 and if a few did appear, they were received with indifference.'-- iS^ever- 
 theless, the return toward Empiricism was only partial, as I have 
 already remarked. The greater part of the writers in Medicine con- 
 trived to mingle with their maxims of EmjDirical philosophy, researches 
 either on the vital principle, or the fundamental and primitive quality 
 of living beings ; on the proximate cause of diseases, their nature or 
 their essence — in a word, on a crowd of subjects that are inappreciable 
 to the senses. While they criticise the explanations of their predeces- 
 sors touching these abstruse matters, they do not hesitate to emit their 
 own opinions on the same matters, without appearing to suspect that 
 they only substitute a new hypothesis for older ones. 
 
 Thus Borsieri de Kanifeld, professor of Practical Medicine in the 
 University of Pavia from 1770 to 1785, a learned writer and excellent 
 observer, wishing to give an idea of inflammation, commences by describ- 
 ing it in these terms: " When one realizes in a portion of the body an 
 unnatural heat, and the part is red, tense, painful, with unpleasant pul- 
 sations, there is said to exist an inflammation or pJdogosis, because 
 something similar to the effects of a burn is felt. If all these accidents, 
 
 '^Hist. Med., section vi, chap, ii, T. V et VI. 
 t Ibid. Sec. xxii, chap, i, T. VI.
 
 566 REFORM PERIOD. 
 
 or the most of them, concur together, they constitute a disease named 
 by us inflammation, and by the Greeks phlogosis, — a disease whose 
 proximate cause is extremely obscure, not to say occult, as is shown by 
 the varieties and diflference in the opinions emitted on this subject."" 
 
 The above description is clear to every mind. There is no student 
 who. after having read and engraved it on his memory, if he possess 
 some skill in clinical observation, may not be in a state to discern an 
 external inflammation from any other disease in a certain phase of its 
 existence ; for it is evident that phlogosis, as well as every other species 
 of disease of the organism, does not preserve the same morbid charac- 
 ters in all the phases of its existence. The botanist does not describe 
 otherwise a plant, or the chemist a salt or a mineral. Why then physi- 
 cians ? When they wish to explain a disease, do they not content them- 
 selves, in like manner, with depicting the symptoms, the march, the 
 termination — in a word, all the sensible and known phenomena as they 
 present themselves at various stages ? Why do they continually pass 
 in their speculations beyond the limits of pure observation ? It is 
 because they are not sufficiently penetrated by this axiom which reigns 
 in all the philosophy of the physical sciences : Reason was only given 
 to us to guide experience ; and our minds, in trying to pass the lim- 
 its of sensations, mistake their rights as well as their jjoiver. 
 
 Borsieri, after having thus described inflammation, and stated that 
 the proximate cause of disease is nearly impenetrable, shows over twenty 
 diff'erent, and sometimes contradictory theories emitted by the most emi- 
 nent authors, from Hippocrates to Boerhaave and Haller, on the proxi- 
 mate cause of inflammation. It would seem, as a natural conse- 
 quence of this exposition, that Borsieri would avoid all new theories on the 
 same subject. Such is, nevertheless, not the conclusion to which he 
 comes ; he has not failed to propose, in his turn, an explanation more or 
 less different from the rest, not only on phlogosis, but on each of its 
 symptoms. He falls into a similar and more striking inconsistency still, 
 on the subject of fevers ; for having at first affirmed, in proper terms, 
 that it is impossible to determine the proximate cause of this affection, 
 he has not hesitated to form, a little farther on, conjectures on the cause 
 and mode of generation of each of the febrile phenomena. Borsieri 
 was, nevertheless, neither a transccndentalist nor an enthusiast ; he was, 
 on the contrary, a wise practitioner and very circumspect theorist, who 
 adopted no exclusive system, but who would choose from each of the 
 
 *■' Institutiones Medicinoe, De Inflammatione, Lipsiae, 1826, t. I., p. 2. Com- 
 pare this work with that of J. Rasori, Theorie de la Phlogose, translated from 
 the Italian by S. Pirondi, Paris, 1839.
 
 THEORIES AND SYSTEMS. 567 
 
 prevailing opinions of liis time tliat which appeared to him most con- 
 formed to reason and experience ; in a word, he was eclectic. We see 
 by this example, and by a thousand others which have been, or might 
 be cited, that there is scarcely a writer in Medicine who did not surpass, 
 in his speculations, the limits of sensible phenomena ; that is to say 
 who did not fall into the vagueness of hypothesis ; but in no department 
 has the tendency of physicians for arbitrary interpretations been more 
 striking and more injurious than in therapeutics. See in what terms a 
 cotemporaneous author has depicted the ridiculousness of this mania : 
 *' Intermittent fevers," he says, " are cured with cinchona. Several 
 hundred volumes have been written to explain the modus operandi of 
 this marvellous remedy. This whole enormous aggregation of science 
 is not worth the following line, and does not go beyond it : for inter- 
 mittent fever, give cinchona. Opium procures sleep. A multitude of 
 very learned writers have explained the action of this precious drug. 
 Moliere, in this respect, knew as much as can know to-day those who 
 have studied all these beautiful works : Opimn facit dormire, quia in 
 eo est virtus dormitiva. Let no one consider this a detraction of Medi- 
 cine, for it is the art of curing, and not the art of explaining cures. A 
 practical notion, well established, possesses no less dignity than a scien- 
 tific principle."" 
 
 Nevertheless, toward the end of the last century some men made 
 praiseworthy efi"orts to banish from practical Medicine every species of 
 hypothesis. Of this number were Werlhof, first physician to the king 
 of England, at the court of Hanover, and Lieutaud, first physician to 
 Louis XV. The former has left a great many writings, which are 
 remarkable foi a spirit of pure observation, judicious principles, and an 
 elegant and pure style. He professes, on the modification of remedies, 
 on the proximate cause of fever and its various symptoms, a prudent 
 skepticism, and recounts, in this respect, an anecdote which wc have 
 already given. f 
 
 The second has already been mentioned advantageously in this Histor3% 
 for his Historia Anatomico-Medica, one of the good works which the 
 close of the last century produced, and for his Precis de Medecine Pra- 
 tique, an interesting composition in several respects, but above all, by 
 the care which the author has taken to avoid all hypotheses, and sub- 
 tile and arbitrary interpretations. His care is so great in this respect, 
 
 *^' Vues Pratiques sur les Ameliorations Agricoles, '^ ''' par M. Dezeiraeris, 
 inserees dans le Journal d'Agriculture Pratique, numero de juin, 184-"), tirage a 
 part, 1st Memoire, p. 3. 
 
 f See chap, v, of this Period.
 
 568 REFORM PERIOD. 
 
 that not only he abstains from all conjecture on the proximate cause of 
 diseases, but also, he avoids giving any definition, any general descrip- 
 tion, either of fever or inflammation. This work was written, evi- 
 dently, under the influence and according to the spirit of the philosophy 
 of Condillac, but the absence of definitions and generalities does not 
 prevent the existence of a little confusion and obscurity in the totality 
 of the subjects which he presents ; so that the judgment which Cullcn 
 gives of it, though severe and even partially inexact, is not without some 
 foundation. " It is," he says, "a collection of facts gathered without 
 permitting himself to reason on their causes. Confusion and indecision 
 are the results of its arrangement. This work, moreover, is not exempt 
 from the reasonings that the author pretends to avoid."* 
 
 Cullen is mistaken when he accuses Lieutaud of being willing to 
 avoid every kind of reasoning. Lieutaud has pretended only to avoid 
 the discussions which turn upon objects impenetrable to the senses, such 
 as the proximate cause of diseases, the primordial properties of bodies, 
 the vital principle, etc. ; but otherwise, far from abstaining from rea- 
 soning, he reasons very much, and even too much ; whence it results 
 that his book is rather critical than didactic. In this he has, perhaps, 
 made a mistake, and missed the end which he wished to attain, as may 
 be judged by the following extract from his work, f 
 
 Thus, parting from the seventeenth century, that is to say, from the 
 commencement of the philosophic reform, we see Empiricism making 
 progress in Medicine, though always hidden under various names. 
 
 •■' Cullen, Elements of Mediciue. 
 
 f Horror quern excipit febris ; dolor alterutrius lateris, et plurimum tamen 
 einistri, sterni, dorsi, etc. ; sputa cruenta, et spirandi difficultas sunt notissima 
 peripneumonite, signa. Sedulo animadvertenduni quod in quibusdam peripneu- 
 monia decumbentibus nulla erumpant sputa cruenta, licet pulmones vera phlo- 
 gosi corripiantur ; cur fit ut plurcs clinici, duce Sydenham, Lunc aifectum pro 
 peripnevimouia notha liabeant; num recte e mox narrandis patebit. Illudetiam 
 notandum incumbit quod pulmonum phlogosis baud semper tussi, dolore et spi- 
 randi difficultate stipetur ; uti grassaute constitutione epidemica 175-1, baud raro 
 inter rimanda cadavera corum quorum cura mihi demandata fuerat, observavi. 
 Peripneumoniam non numguam prseeunt ventris tormina, defluxio anginosa, 
 sliusve morbus inflammatorius : nee infida in quibusdam epidemiis censentur 
 hiBC prnenuntia-, in alia tempestate plane silentia. De erysipelate pulmonum post 
 Hippocratum et Galenum, meutionem subjecerunt Lomnius et BoerhaaTius ; 
 sed meris conjecturis suifulta est h^ec opino; cum erysipelas solam cutem 
 respicere videatur: cujus retrogressu, materia morbosa in quod vis viscos per 
 metastasim ingruente, alter emergit aifectus, ob partis fabricam ab erysipelatis 
 indole profecto dispar : Quod pace tantorum virorum per transennam annotasse 
 sufficiat. (S!/?iopsis univcrsoi yraxeos mediccc, lib. I, sect. 2, InJIammat to pectoris, 1. 1, 
 p. 168. Auistelodami, 1725)
 
 THEORIES AND SYSTEMS. 569 
 
 Some call it, with Sydenham, the natural method, others the method of 
 observation, experimental, eclectic, etc.. Some even dare call it 
 by its true name, yet adding some corrective, to take from the word the 
 idea of contempt which physicians commonly attach to it. Thus it is 
 called by some, for this end, rational Empiricism, the learned Empiricism 
 of Baglivi, Sydenham, Stoll, Van Swieten, and Ph. I'inel, when they 
 wished to have it understood that in many circumstances these great 
 physicians made an abnegation of their theories, in order to follow expe- 
 rience only. If we cast our eyes over the history of Medicine during 
 the first half of the nineteenth century, we shall see Empiricism gaining 
 more and more ground, notwithstanding the propagation of Brunonism 
 and other new systems, among which the system of irritation holds a 
 proper rank. We shall see, for example, medical statistics invoked by 
 the coryphei of all the sects, as the supreme criterion of therapeutic 
 methods. Now statistics is pure Empiricism ; it is the negation of all 
 preconceived theory. The mathematicians have never invoked this mode 
 of demonstration for their theorems, because by reasoning they make 
 them evident ; but in therapeutics, where the evidence of reason does 
 not exist, one is obliged to have recourse to statistics to judge what is 
 the best mode of treatment applicable to such or such a morbid species. 
 The most determined adversaries of the employment of calculation in 
 Medicine, agree however, that it is legitimate and even necessary, in 
 order to obtain a judgment on therapeutical methods ; they insist, solely, 
 on the numerous sources of error, and the extreme difficulty of its 
 application.'"' 
 
 Yes, Empii'icism, under whatever aspect it is viewed, is excessively 
 difficult, wc may say even the most difficult of all the systems of Medi- 
 cine, in its rational application, which will be made clear by the devel- 
 opment which we shall presently give it. Whence it results that far 
 from favoring idleness and ignorance, as some have believed, and others 
 have feigned to believe, it requires, on the contrary, the most extended 
 acquirements and most constant attention. It is, for the most part, to 
 avoid the difficulties which it presents, that a crowd of other systems 
 
 " F. .7. Double who exhibits so well these difficulties and causes of error, does 
 not deny that statistics is definitively the best and even the sole means to judge 
 the relative value of different modes of treatment used against such and such dis- 
 eases. See his work TraiM de Med. Pratique, of J. P. Frank, translated into 
 French by Gonderau. Paris, 1842. — In fine, I would formulate aphoristically 
 my opinion on tkis subject. I would not say with a cotemporaneous author : 
 Non soliim numerandse, sed etiam perpondendoe sunt observations ; but I would 
 say : Primum perpendendte sunt observationes, deinde perpendendw et iterum 
 perpeudendae : demum numerandse. 
 
 36
 
 570 REFORM PERIOD. 
 
 have been imagined, and by turn abandoned, then resumed again with 
 certain modifications, to be abandoned anew as false and insufficient. 
 The Empirical doctrine, alone, has never varied in its fundamental dog- 
 mas : it has marked, from its origin, the true limits to which the mind 
 can attain : it has traced the route which it must follow in the physical 
 sciences. It is the most comprehensive of all medical doctrines, for it 
 embraces every case in the practice ; it makes use of notions suggested 
 by anatomy, physiology, chemistry, physics, the various departments of 
 pathology, etc., more largely and more surely than any other doctrine — 
 as any one may be convinced by reading the following chapter. 
 
 CHAPTER XI. 
 
 EMPIRI- METHODISM; OR THE ALLIANCE OF EMPIRICISM WITH THE 
 PHILOSOPHIC METHOD. 
 
 There is an axiom which reigns over the philosophy of causalities, 
 which presides over all the determinations of the human will, whether 
 with or without our apprehension, to which we give our assent willingly 
 or not, as to a mathematical truth. It is the following: The same 
 cause, acting under identical circumstances, produces, always, the satne 
 effect. If, in order to make an application of this axiom to Medicine, 
 we attempt to translate it into therapeutic language, it is presented in 
 the following proposition, which I have before announced : A treatment 
 which has procured the cure of any disease whatever, will cure, also, all 
 diseases identical, or rather homogeneous to the first. 
 
 I have demonstrated that the physicians of primitive times had no 
 other therapeutic rule, and that they followed it either from instinct, or 
 were led to adopt it by their reason ; and I have cited, among other 
 proofs, the established custom among several nations of antiquity, to 
 expose the sick in front of their houses, so as to attract the attention of 
 those who passed by, that they might suggest the remedies which they 
 had seen successfully employed in similar cases. I have also shown 
 that the application of this rule, the only one in therapeutics which has 
 an absolute generality, offers extreme difficulties, which has led to the 
 creation, successively, of the several branches of medical science, their 
 numerous ramifications and infinite details.--^ I now resume the subject 
 
 ' See remarks at close of Mystic Period.
 
 EMPIRI - METHODISM. 571 
 
 and deduce from it, by a series of evident propositions, all the develope- 
 ments of the Empirical doctrine. 
 
 I pray the reader, in the onset, to observe carefully that the applica- 
 tion of our fundamental axiom in therapeutic rests on three rigorous 
 conditions, namely : homogeneousness of diseases, identity of curative 
 means, and the knotvledye of a treatment applicable to each morbid 
 species. Now to attain, if not absolutely, which is impossible, but 
 proximately, these three conditions, all the resources of science are indis- 
 pensable, as we now proceed to show. 
 
 FIRST COXDIl'ION — HO.MOGr.N'EOUSNESS OF DISEASES. 
 
 Xo practitioner has ever encountered two morbid states absolutely 
 identical, and nature, perhaps, does never produce such. It is neces- 
 sary, then, for the practitioner to content himself, from this circum- 
 stance, with a more or less accurate approximation. But at what degree 
 of approximation dare the physician rest, or, in other terms, by what 
 signs shall he recognise that there is enough resemblance between two 
 diseases, one of which is before him and the other has been previously 
 observed, in order to treat the case in hand with the same remedies 
 employed in the former. In the beginning, they were contented with a 
 very superficial similitude ; it sufficed that a patient present one or two 
 symptoms similar to those of another, to whom the same treatment had 
 been applied. It is, thus, under this gross resemblance, that ordinary 
 men dare, every day, advise the use of a crowd of remedies, and criticise 
 very often, even, those that a physician has ordered. But men habitu- 
 ated to the observation of diseases, cannot hesitate to see how much this 
 manner of judging is false and dangerous ; consequently they endeav* 
 to establish with more precision the distinctive characteristics of the mor- 
 bid species. 
 
 At first it was thought, and not without reason, that two diseases 
 approach so much nearer identity as they present the greatest number 
 of similar phenomena. Consequently, those only were considered homo- 
 geneous which offered a multitude of analogous symptoms ; while, on 
 the other hand, it required but few differences to consider two affections 
 as heterogeneous. This method, very simple and sure in appearance,, 
 did not, however, produce excellent results ; the physicians of Cnidus 
 had adopted it, and were led as Hippocrates said reproachfullj', to mul- 
 tiply the morbid species beyond measure. Their pathology was con- 
 fused and their therapeutics uncertain. 
 
 It will be understood that it does not suffice to enumerate the symp- 
 toms of disease to obtain an exact tableau ; but that it is necessary to 
 make a choice in order to bring into the first sketch, in imitation of
 
 572 REFORM PERIOD. 
 
 painters, the most characteristic traits, that is to say, the greatest 
 phenomena ; secondly, to lay down the less important symptoms and 
 keep back, or neglect even entirely, the slight ones, or those without 
 apparent value ; such was the method of which Hippocrates offers the 
 first model in his Epidemic Histories. 
 
 This manner of describing diseases was preferable to that of the 
 Cnideans ; it prevailed universally. From that time all the difficulty, 
 or at least the greatest difficulty in nosography consisted in the choice of 
 symptoms, in the classification of morbid phenomena. Which among 
 these phenomena are those that should be considered in the first, 
 second, and third rank, and so on for the rest ? Which those that 
 should be neglected ? Such was the great problem that the Hippocratic 
 method proposed for solution : up to that time science had marched 
 slowly, noiselessly, and with centenary steps. But at this epoch the 
 philosophers having taken possession of the mind, disputed, boisterously, 
 for the sceptre of the intellectual empire ; they divided themselves into 
 rival sects, each of which pretended to explain the enigma of the 
 universe, and pronounced definitely on the true method of interpreting 
 the phenomena of nature. Physicians, also, after the example of phi- 
 losophers in order to give the explanation of the phenomena of the 
 animal economy — went back to the sources of life, to determine the 
 proximate cause, the principle of the phenomena of morbid affections, 
 and deduce from them an invariable method of treatment. They also 
 wished to make science complete. 
 
 Nevertheless, observation does reveal to us neither the primitive 
 causes nor principles of phenomena : it shows everywhere a circular con- 
 fiection of phenomena, which are all, by turns, both effects and causes ; 
 but it nowhere exhibits the first link. Nature, as had said Baglivi, and 
 before him Hippocrates, and many others — nature is a circle, of which 
 the eye of man can discover neither the beginning nor the end. There- 
 fore, the research for this beginning or the end, is a vain and super- 
 fluous undertaking, in which it is unreasonable to persist. This is the 
 place to say with Meibomius and Werlhof : " Seek not to know what the 
 Supreme Master has been willing to conceal ; it is but learned ignorance." 
 But most of the philosophers and physicians did not possess this wise 
 resignation. The physicians, for example, not being able to determine 
 by direct observation, the proximate cause or the initial phenomenon of 
 diseases, abandoned, like the philosophers, the route of pure experience, 
 and flattered themselves with being able to resolve the gi-eat problem 
 which they pursued by the aid of speculative considerations. They were 
 ignorant at that time, that in regard to physics the human intelligence 
 
 I
 
 I 
 
 EMPIRI - METHODISM. 573 
 
 can never surpass the limited borizon of tlie senses ; that bejond this 
 horizon, there exists nothing but fiction and hypothesis. 
 
 It required no less than two thousand years for the human mind to 
 be convinced of this truth, and to consent to restrain itself within the 
 limits which the Sovereign Creator has imposed to it; limits which 
 humilitate its pride, and put a rein on its ambition for knowledge. It 
 is only after having essayed by all imaginable hypotheses, and after 
 ramblinu in every possible direction, that philosophers and physicians 
 have returned to their true sphere, that is to say, that they have recog- 
 nized that the intelligence should not and is not able to pass the sensations, 
 in things of the material order. But young, inexperienced, and enthusi- 
 astic imaginations, are always ready to clear this circle, which seems to 
 them too narrow, in order to wander in the fields of infinity, as if it was 
 not enough to leave to this faculty (imagination), which we call folle dv 
 logis, the sovereign reign over arts of amusement and the caprices of 
 fashion, but that it should not be permitted to usurp the place of good 
 sense and experience, in the search of means proper to solace pain and 
 preserve health. What errors has it not accredited in pathology ! Not 
 to recall the principal and most recent ones, have we not had diseases 
 of the archeus, or the soul, or vital principal ; those proceeding from an 
 excess of eifervessence in the blood, or an acid or alkaline acridness ; 
 those consisting in an obstruction of the capillary vessels, or a deformity 
 of the liquid molecules ? Has it not been pretended that all the morbid 
 species, however numerous or various they appear, may be reduced to an 
 excess or want of incitation? Is it not possible, lastly, that ulterior 
 discoveries in the composition of the liquids or properties of the solids, 
 will yet give rise to other hypotheses on the essence of diseases ? 
 
 But while a crowd of theorists gave themselves up to the pursuit of that 
 chimera called, sometimes, proximate cause, sometimes, essence, again, 
 principle of morbid phenomena, and did nothing more, really, than pass 
 from one fiction to another, practitioners, guided by simple good sense, 
 and grounded in experience, limited themselves to describe the apjiarent 
 symptoms, with the evident causes of each morbid affection, and estab- 
 lished on these sensible characteristics the distinction of species and 
 nosologic genera. Such was the course followed, not without deviation, 
 by the most celebrated nosographers of antiquity and modern times ; a 
 course which Torti, Werlhof, and Lieutaud endeavored to re-establish in 
 all its purity, following in this the track of Philinus, Serapion, and 
 other famous Empirics of the school of Alexandria. These, as should be 
 remembered, did not make the homogeneousness of diseases consist in 
 the ideal conformity of unique phenomena, placed beyond the reach
 
 574 REFORM PERIOD. 
 
 of the senses, and called proximate cause, essense, intimate nature, 
 primitive phenomena, etc., but on an evident conformity, that is to say. 
 in the uniform concurrence of the greatest number possible of sensible 
 circumstances, anterior circumstances, concomitant symptoms, and con- 
 secutive phenomena. They demanded that nothing of all this should bo 
 neglected — nothing which had been or might become an object of obser- 
 vation — because for them the totality of all these things constituted the 
 true essence of diseases. 
 
 However, it is impossible, as we have already said, in the examina- 
 tion or the description of a morbid state, that an account be made of 
 all the circumstances, for in that case we should fall into the confusion 
 with which Hippocrates reproached the Cnidians. Xosography would 
 then no longer offer a methodic succession of more or less faithful and 
 recognizable pictures, but an irregular assemblage of colors and traits, 
 drawn at hazard on the canvas, leaving no more trace in the memory 
 than the clouds which traverse the foggy sky of our climate, during the 
 variable weather of spring and autumn. The homoeopathic pathology is 
 an incomparable model of this kind ; the obscurity, chaos and extrava- 
 gance of Paracelsus have been surpassed very far by Samuel Hahne- 
 mann, which, however, has not prevented the inventor of the spiritual- 
 ized poioder of gold from finding, in our age, advocates and enthusiasts, 
 just as the fabricator of potable gold found such in his. But let us 
 leave, now, these souvenirs, which are already ancient history for our 
 forgetful epoch, and see after what rules we may judge the importance 
 and gravity of a morbid accident, setting aside all ideas of the vital 
 principle and primitive or exclusively essential phenomena. 
 
 The ancient Empirics estimated the value of a symptom, or patho- 
 logical circumstance, according to various considerations. Sometimes 
 they had regard to the character and intensity of the symptom ; thus, 
 a permanent delirium appeared to them more grave than a passing 
 one ; a pain which nothing could assuage, seemed to them more unprom- 
 ising than one which could be easily calmed by some sedative. Some- 
 times they had regard to the importance of the organs whose functions 
 were deranged ; thus, difficult respiration appeared to merit more atten- 
 tion than a difficulty in the movement of the arm ; a rheumatism of 
 the head more than one of the foot, things being otherwise equal. 
 Sometimes they took into consideration the occasional or determining 
 cause of a disease, when the specific influence of this cause had been 
 an object of observation ; if, for example, they had to treat a person 
 bitten by a serpent, they believed it very necessary to ascertain whether 
 the reptile was of the venomous species, or not, because experience had 
 demonstrated that this circumstance affected very greatly a wound of
 
 EMPIRI-METHODISM. 575 
 
 this kind. In short, they were persuaded that the value of a symptom 
 could vary from one stage to another, as the result of the increase of 
 knowledge, and change of views. The history of medicine offers several 
 very remarkable examples of this kind of variation, of which 1 shall 
 cite only the following : before the discovery of cinchona, and even 
 for a long time afterward, periodicity had attracted the attention of 
 observers in fevers only, because in these it is extremely well marked. 
 Nevertheless, very little account was made of it, even in them, because 
 this circumstance was not the source of any special curative indication. 
 Thus, Pinel has not separated, in his classification, intermittent from 
 continued fevers, because he regarded periodicity as a secondary symp- 
 tom, which does not change the nature of the disease ! Where is, to 
 day, the pathologist who does not arrange, in a separate classification, 
 periodic affections.'-- 
 
 The following were, at the end of our Eeform Period, the principal 
 characters which constituted the nature of a disease, and according to 
 which one morbid species was distinguished from another, by taking 
 account only of the phenomena appreciable by the senses : first, the 
 anterior circumstances, which comprise the predisposition, or diathesis, 
 and the determining or occasional causes, such as contagion, miasmatic 
 
 '"' Pinel would not have committed this philosophic heresy, if he had been imbued 
 with the sj^irit of our fifth aphorism, an extract from the doctrine of Locke and 
 Condillac: "Sensible objects being known to us only by the impressions they 
 make upon our senses, our minds can perceive nothing in these objects beyond 
 the sensations they excite in us. Thus, when any one asks what is the nature 
 ^ or essence of a body, we can only reply by announcing its sensible qualities." 
 According to this axiom, if W3 are asked what is the nature or essence of a 
 disease, we can only reply by announcing its known symptoms. How, then 
 could it be said that a symptom as important as periodicity, a symptom which is 
 the source of an entirely special kind of medication, does not belong to the 
 nature of the disease ? 
 
 Thus, also, a few years ago, but little attention was paid to the quality of the 
 blood, in diseases, or at least no one drew from it a curative indication ; while 
 now, these qualities, being better studied, furnish precious signs for the diagnosis 
 of several very remarkable pathological states — states that are designated, in the 
 most recent writings, by the words hyperemia, polytemia, hypasmia, antemia, 
 hydremia, which were formerly designated by the terms sanguineous plethora, 
 chlorosis, poverty of the blood, etc. (See Essai d' Hematologic Pathologiquc, of M. 
 Professor Andral, and the Traits de Nbsographic MMicaJa, of M. Professor Bouillaud, 
 in the chapter entitled, Appendice aux deux. Premieres Classes des Maladies.) Among 
 learned men of France, and other countries, whose researches have contributed 
 greatly to clear up the pathology and physiology of the blood, we must mention 
 Prevost and Dumas, Berzelius, Denis, Scudamore, Schultz, Nasse, Huenefeld, 
 Lecanu, Gavarret and Delafond collaborators with Andral, Donne, Becquerel, and 
 Bodier.
 
 576 REFORM PERIOD. 
 
 or poisonous infection, etc.; second, the anatomical seat of the disease, 
 or the designation of the organ or the tissue principally affected, and 
 sometimes, but rarely, the indicatiuu of a vitiated state of the humors ; 
 third, the mode and degree of alteration of these organs in the living ; 
 fourth, the idiopathic and sympathetic functional troubles, their regular 
 or irregular, continued or intermittent course ; fifth, lastly, the anatomical 
 lesions, found in those who had succumbed to diseases of the same species. 
 
 We see by this summary enumeration of circumstances, what this 
 Empiri-Methodic, or Empirico-liatioual doctrine takes into consideration 
 in the classification of diseases ; we see, I say, that far from neglecting, 
 as has been pretended, the light of anatomy, physiology, pathological 
 anatomy, and other necessary sciences furnished to pathology, it liiakes, 
 on the coutraiy, a continual and very appropriate use of these lights, 
 only taking from anatomy the researches on the elementary fiber, and 
 primitive elements of bodies ; from physiology, speculations on the vital 
 principle, proximate cause, and the initial phenomena of life ; in a word, 
 rejecting from each science, whose aid it invoked, only the assertions 
 which are not sufficiently justified by the testimony of the senses. 
 
 According to Empirico-Eational doctrine, the essence of disease 
 consists in the totality of . their known phenomena : two diseases are 
 considered homogeneous, in other words, of the same species, and require the 
 same treatment, when they present a great similitude in the whole of 
 their appreciable symptoms. Thus, the nature or essence of inflamma- 
 tion consists, according to this doctrine, in the union, in the same 
 locality, of these four symptoms : heat, pain, redness, and swelling ; it 
 being understood that these four symptoms constitute only one phase of 
 the disease, which may present other symptoms at other stages of its 
 existence. The Dogmatists, on the contrary, to whatever sect they 
 belong, whether they are Galenists, latro-chemists, Animists, latro- 
 mechanicians, Dynamists, etc., tlie Dogmatists, I say, make the essence 
 ,of disease consist in a primitive force, proximate cause, or initial 
 phenomenon, from which they imagine all these consecutive accidents, 
 all these apparent forms to proceed. The essence of inflammation 
 consists, according to the latro-chemist, in the acid or alkaline acridness. 
 which irritates the aff'ected part ; according to the Animist, in the 
 reaction of the vital principle against the morbiginous cause ; with the 
 latro-mechanician, in the obstruction of the vessels ; with the Dyuamist, 
 in the reaction of the organic fiber against an irritant principle, or 
 mechanical obstacle. 
 
 AVe can comprehend by this presentation of views, why the Empirical 
 nosology always appeared superficial and changeable : superficial, because 
 it stopped at simple appearances, or at sensations ; changeable because,
 
 EMPIRI-METHOmSM. 577 
 
 embracing but known phenomena, it must change as they increase. 
 While the Dogmatic nosology, in whatever form of dogmatism it is 
 studied, has always seemed to be more profound, because it surpassed, 
 by reasoning, the limits of the sensations, and more stable, because, as 
 it pretended to go back to the initial force, or phenomenon, there seemed 
 to be nothing more essential to seek after. But the apparent super- 
 ficiality of Empiricism was wisdom, erudita inscitia — the specious 
 profundity of Dogmatism, an illusion, an optical error. The mobility 
 of Empiricism has been, also, in reality, much less great, much less 
 striking, than that of Dogmatism ; for the Empirical nosography has 
 varied only in details, while the Dogmatic nosography, on the contrary, 
 has been overthrown, from age to age, in its very foundations. ■■ 
 
 SECOND CONDITION — IDENTITY OF CVRATIVE MEANS. 
 
 This condition, though in general less difficult to fulfil than the first, 
 still presents in certain cases grave difficulties : first, because its accom- 
 plishment does not depend alone on the skill of the physician, but on the 
 docility of the patient, or the exactness and fidelity of the persons who 
 concur in any manner whatever in the execution of the treatment: 
 second, because it is not always possible to place the patient in the same 
 favorable hygienic condition. Notwithstanding these obstacles, art is 
 here much more powerful, and it is enabled to obtain, in the most of cases, 
 a sufficient approximation. Nevertheless, to attain this result, it is 
 necessary that the man of art possess sufficiently extended notions on 
 natural history, physics, chemistry, materia medica and pharmacology. 
 
 Thus, the more we advance in the development of the Empiri-meth- 
 odic doctrine, the more we are convinced that the rational application of 
 
 " We can represent the general idea that physicians have had of disease, by 
 an algebraic formula, in the following manner ; Let A represent the sum of 
 acquired notions on any disease by direct observation ; let E represent the proxi- 
 mate cause, or the primitive phenomenon, which, according to the Dogmatists, 
 constitutes the morbid essence — a sort of germ, whose successive evolutions are 
 supposed to give rise to all the apparent phenomena. 
 
 For the Dogmatists of any epoch or sect, the idea of the disease, M, is con- 
 posed of the sum, A, of the notions furnished by the senses, plus the essential 
 phenomenon, E, which the mind should perceive by the aid of reasoning. The 
 general pathological formula of this doctrine will be, then, M, the idea of the 
 disease, equals A, the sum of the notions furnished by the senses, plus E, the 
 essential phenomenon or essence : 
 
 M=A-1-E 
 For the Empirics of all times, the general idea of the disease, M, is composed 
 of the sum, A, of the notions obtained by direct observation, which sum is the 
 same for the Empirics and the enlightened Dogmatists of the same epoch, plus
 
 578 REFORM PERIOD. 
 
 this doctrine requires extremely varied knowledge, constant attention and 
 great perspicacity. 
 
 THIRD CONDITION — KNOWLEDGE OP A TUEATMENT Arpr.lCAP.LE TO EACH SPECIES OF DISEASE. 
 
 It does not suffice to discern one morbid species from another, nor to 
 have at our disposal excellent remedies : it is necessary still, and it is in 
 this that practical skill consists, to know how to use them appropriately. 
 It is not so much the remedy that procures the cure, as the opportunity 
 of its application. This last condition is the supreme end of Medicine — 
 the crowning glory of the Art. To arrive at the knowledge of curative 
 indications, or the opportunity of such or such a mode of treatment, is the 
 principal object of all therapeutical researches. Now it must he avowed 
 that the fundamental axiom of Empiricism does not furnish any light to 
 direct us in such researches ; it does not at all indicate the route to fol- 
 low for the discovery of curative means ; it presupposes a knowledge of 
 these means, and limits itself to tracing the manner of their application. 
 Administer in each case, say the Empirics, the remedies that have best 
 succeeded in analagous cases. Those philcsophic physicians who were 
 not willing to be guided by anything else than rational experience, 
 could not have contented themselves with an axiom so vague ; they must 
 have felt the necessity of adding to this axiom some rules proper to direct 
 
 the essential phenomenon, or proximate cause, which the Empirics regard as 
 inacessible to the penetration of man, and which consequently is, in their eyes, 
 an unknown quantity, X. We shall have, then, for the general pathological 
 formula of this doctrine, M, or the idea of the disease, equals A, the sum of the 
 notions furnished by the senses, plus X, the essential phenomenon : 
 
 M^A-f-X 
 
 These two formula difiFer only in the value of E, which the Dogmatists professed 
 to know ; but which the Empirics considered as inaccessible to the understand 
 ing, as well as to the senses. Now, up to this time, the Dogmatists have not been 
 able to agree among themselves on the value of the essential or primordial phe - 
 nomenon, which they suppose that they understand. Moreover, it is evident 
 that they will never know its value, if we can put some confidence in the following 
 great axiom of modern philosophy : Reason has been given to vian only to guide expe- 
 rien.ce; and the mind, in wishing to surpass the limits of sensations in physical tilings, 
 mistakes its rights as well as its powers. 
 
 We conclude from the above that the pathological formula of Empiricism, 
 though in appearance less complete and less profound than that of the Dogmatists, 
 is, in reality, and always will be, truer and more exact. I do not say with Con- 
 dillac, that the rendering of our reasoning into algebraic language gives to it 
 more certainty, but I say, simply, that it must appear clearer and more precise 
 in the eyes of those to whom this language is familiar.
 
 EMPIRI - METHODISM. 57^ 
 
 them iu experimentation with remedies. History teaches us that they 
 traced, indeed, very wise rules in this respect. But before exhibiting 
 these rules, let us examine, somewhat, the value of the axiom in itself. 
 
 This axiom has been the object of the most bitter criticism on the part 
 of the most renowned philosophers and theorists of antiquity, and of the 
 middle ages. They charge it not with falsity or error — that were impos- 
 sible — but with stupidity. In their view, to use a remedy for the sole 
 motive that it had cured in analagous cases, was to act without reason. 
 It was necessary, according to them, to be able to say, also, by what 
 property — by what concealed virtue this remedy cured. For myself, I 
 am transported with admiration and astonishment when I consider with 
 what precision the corj'jihie of antique Empiricism have marked the 
 limits where our minds must pause in researches touching the action of 
 remedies. They were in advance, by two thousand years, of the discov- 
 eries of modern philosophy. It was too great a diplay of genius : their 
 cotemporaries were not able to comprehend them, therefore they calum- 
 niated them. The Dogmatists and Methodists are not obnoxious, on the 
 other hand, to the reproaches that have been made to the Empirics ; 
 they have attempted to explain the intimate action of remedies, and they 
 have fallen in this respect into such ridiculous aberrations that their 
 pretentious babbling has been compared to the filthy condition of the 
 Augean stables. Let us see how one of the most famous of modern 
 theorists, Bichat, has depicted the obscurity, disorder, and incoherence of 
 the therapeutical language of the schools: " Into what errors he says, 
 " are we not drawn in the employment and the denomination of medica- 
 ments ? Deobstruents were created when the theory of obstruction was 
 in vogue. Incisives sprung up w^hcn the viscidity of the humors was 
 held ; the expressions of dilutants and attenuauts, when the ideas 
 attached to these terms were put forward, at the same epoch. When it 
 was necessary to obtund the acrids, inviscauts or incrassants were 
 created, etc. Those who saw iu diseases nothing but the relaxation and 
 tension of the fibers — the laxum and strictum, as they called it — 
 employed astringents and relaxants. The cooling and the heating reme- 
 dies were employed, especially by those who had particular regard, in 
 diseases, to the excess or want of caloric, etc. 
 
 " Identical means have had, often, different names, following the 
 manner in which it was supposed they acted. Deobstruents with one, 
 relaxants with another, refrigerants with a third. The same medica 
 ment has been by turns employed with different, and even opposite 
 views; so true is it, that the mind of man prodeeds at hazard, when he 
 is led by vague opinions. =■■' =■' Except the medicaments whose
 
 580 KEFORM PERIOD. 
 
 effects are established by strict ohservation, as evacuants, diuretics, siala- 
 gogues, antispasmodics, etc., those consequently that act on a specific 
 function, and what is our knowledge of the rest?"* 
 
 Into what strange ramblings the desire to explain the intimate action 
 of remedies led ancient medicine ! But what the genius of Bichat did 
 not perceive (doubtless because a sufficiently long experience had not 
 ripened it) is, that all these ramblings have for a principle and final 
 resume, the axiom of therapeutics generally admitted still in his time : 
 diseases are cured by their contraries, contraria contrariis curantur. 
 From the moment, indeed, that this axiom was admitted, it became 
 indispensable to determine the mode of action of the morbific cause, and 
 the mode of action of the remedy, in order to establish the pretended 
 antagonism that was supposed to exist between these two powers — 
 forces. 
 
 I have demonstrated elsewhere, in a peremptory manner, the falsity 
 of such a maxim, and the impossibility of its application. Henceforth 
 this is a fact, accepted in science, to which 1 think it unneccessary to 
 recur. But we have seen set up, in our day, another axiom which 
 aspired to take its place, the falsity of which is still more evident — 
 more palpable. Indeed, all the arguments which we have employed 
 against tlie rule of contraries, are equally applicable to the doctrine of 
 similars — of which mention is made in the Hippocratic works, and 
 which a German physician has attempted to generalize. This physician, 
 having recognized by experience, as attentive and unprejudiced observ- 
 ers have done at all times, the error of the axiom which says that dis- 
 eases are cured by their contraries, imagined, that in order to be right, 
 he had only to take the opposite of this maxim. Consequently, he pro- 
 claimed that the supreme law of all cures was this : diseases are cured 
 by their similars. A small number of particular facts, badly observed 
 and badly interpi-eted, appeared to him as a beginning of demonstra- 
 tion. There needed nothing more to excite his enthusiasm, and lead 
 him to undertake researches and experiments, followed with admirable 
 patience, worthy of a better cause. 
 
 Nevertheless, it was imjjossible that experiments made in good faith 
 should not have demonstrated to a sensible mind the falsity of the law 
 of similars. Such appears to have been, in fact, the result of the first 
 homoeopathic experiments. But the author held on to his pretended 
 discovery like a sovereign holds on to his crown, a poet to his verses, a 
 miser to his treasure. He speaks of it with religious admiration ; he 
 puts the rule of similars above all ancient and modern discoveries; he 
 
 '■* Anatomie Generale, Considerations Generales.
 
 EMPIRI-METHODISM. 581 
 
 regards himself already as the object of grateful veneration by posterity. 
 When such an illusion has once entered into the head of a man, it is 
 very rare for it to leave it. Kather than renounce it, such a man will 
 shut his eyes to all evidence ; he will even become a martyr, if necessary. 
 Hahnemann, who appeals unceavsingly to pure experience when he 
 wishes to convince us of the falsity of the axiom of contraries, — this 
 same Hahnemann, rejects the proofs of experience, or what amounts to 
 the same, he annuls it, when the effects of his doctrine are in question ; 
 for, is it not annulling observation, to apply it to objects inappreciable 
 to the senses. ^Yhe^e is the man who can verify the observations of a 
 homoeopath ? When Hahnemann assures us, for example, that the 
 quadrillionth of a grain of the powder of gold, mixed with one hundred 
 grains of an inert powder, has sufficed, after being triturated several 
 moments, to calm at once the furors of a maniac, who can assure him- 
 self whether it is true or not '■■■=? Xo one. Would you reiterate the 
 experiment of the apostle of homoeopathy ? If you obtain a different 
 result, as must be the case, he will respond to you, that you have not 
 employed the exact dose of a quadrillionth of a grain. How will you 
 prove that there is just a quadrillionth of a grain of the powder of gold 
 mixed with a hundred grains of the powder of sugar, in the flask that 
 you have made him smell? That is an impossibility. 
 
 It is, then, physically impossible, as I have just said, to verify the 
 exactness of a homoeopathic experiment. This truth has been confirmed 
 in proper terms by Hahnemann himself. It is diflicult, he says, to 
 comply with the request that many persons have made to me, to place 
 before the eyes of the public some examples of homoeopathic cui-es ; if 
 we should do so, the mere reading of them would be of very little utility.f 
 Hahnemann has been charged with empiricism ; but nothing is less 
 founded than this qualification ; for he entertains us unceasingly on 
 the intimate nature of diseases — the atomic or spiritual action of reme- 
 dies. He shows the medicamental atoms attaching themselves by elec- 
 tion, to the molecules of the diseased part. In a word, he transports us 
 continually beyond the phenomena which are appreciable by the senses ; 
 that is to say, into the region of chimeras. This is clearly pure Dog- 
 matism, 1)ut a dogmatism which differs from the ancient one. as the 
 homoeopath attributes to the similitude of action of the disease and the 
 remedy, the curative result which the others attributed to their antago- 
 nism. What deceives superficial readers, and leads them to believe that 
 
 '* See the Traite de Matiere Medicale ou de I'Action pure des MedicamentB 
 Homoeopathiques, by S. Hahnemann, Paris, 1834. Vol. I, p. 79. 
 tibid.
 
 682 REFORM PERIOD. 
 
 homceopathy is related to empiricism, is the eulogy that Hahnemann 
 ceases not to bestow upon pui-e experiment ; for he continually alludes 
 to it. But this appeal is only formal. We know now how little impor- 
 tance he attaches to the decisions of experience, and how hard he tried 
 to annihilate them. 
 
 If there should remain still a shadow of doubt in the minds of my read- 
 ers concerning the falsity and the nullity, whether of the axiom of contra- 
 ries or the axiom of similars, it will suffice to convince them irresistibly, 
 by reminding them of this sentence of Hume, which I have already 
 quoted after Barthez, and upon which all the philosophers now agree: 
 " It does not appear that any corporeal action, nor any action of the soul 
 upon its own faculties or ideas, can enable us to conceive the acting 
 force of causes, or the necessary relation which they sustain to their 
 effects. In the succession of natural phenomena, nothing presents to us 
 the idea of causality, or the connection of cause and effect. But when 
 the succession of one phenomenon to another is constant, the human 
 mind, which observes this assiduously, and which often even can fore- 
 see it, is led to believe that these phenomena succeed each other because 
 they are linked together." 
 
 Thus, then, when the employment of a therapeutical agent is followed 
 constantly, or very frequently, by the cure of a given disease, we are led 
 to believe that the treatment employed is the cause of the cure ; but 
 our mind cannot seize the bond which unites these two facts together. 
 It cannot, therefore, affirm that the cure has taken place in virtue of the 
 similarity or antagonism of the curative and the morbigenous principle ; 
 or in virtue of any other appreciable connection between the remedy and 
 the disease. All that we can know certainly — all that assiduous obser- 
 vation can teach us, is, that the cure of such a disease succeeds more 
 or less constantly, the administration of such a remedy. 
 
 Besides, is not this the most important thing for us to know ; and the 
 best reason which can be given fur the employment of a therapeutical 
 agent ? Have we not, in this, certainty, or, at least, very great proba- 
 bility that it will cure ? In truth, the theorists who ask more than 
 this, are very exacting, and somewhat unreasonable ; and Empirics, 
 both ancient and modern, have done well not to seek any farther in 
 what consists the curative virtue of remedies, but to concern themselves, 
 with all possible care, if a remedy cures often, or seldom, or never — in 
 what circumstances it cures, and in what it does not cure. They have 
 marked the veritable limit which our mind can attain, and where it 
 must stop in therapeutics, as well as in pathology. Ihey foresaw, as I 
 have said above, the discoveries of modern philosophy, and thus pro- 
 nounced in advance, a condemnation of such strange expressions as 
 
 .1
 
 EMPIRI-METHODISM. 583 
 
 homceopathy, antipathy, allopathy — expressions as opposite to the genius 
 of good medicine as sound etymology. 
 
 x\.ccording to the doctrine of Empiricism, no one should inquire why 
 opium causes sleep, nor why cinchona breaks a fever, but it should be 
 ascertained if it is really true that opium produces sleep — if it constantly 
 has this eifect — in what state of health it procures sleep, and in what 
 doses it is to be administered to cause this result. It should be ascer- 
 tained if cinchona really breaks a fever — the kind of fever it thus cures, 
 and in what doses it is a febrifuge. If the authors in Medicine w^ere 
 only occupied with questions of this kind, the only ones which are effec- 
 tually useful, the sole ones susceptible of a rational solution, they would 
 not be lead away into a labyrinth of learned interpretations, which have 
 become very ridiculous ; they would not have furnished so many avail- 
 able points for the humor of our great Comic ; they would not have 
 opposed their sottish theoretic prejudices to the admission of the most 
 efficacious remedies, such as cinchona, mercury, vaccination, etc. For 
 the doctrine of Empiricism does not exclude in an absolute manner, any 
 curative proceedure — it repels only the means recognized as ineffica- 
 cious, and postpones the admission of those whose efficac}' appears 
 doubtful or contestable. To the Empiri-methodic physician all means 
 that cure are rational, and those which cure the best are most so. He 
 would not reject even the globules, more or less infinitessimal, of 
 Homoeopathy, nor the manipulations of the magnetiser, if it could be 
 shown by observations worthy of faith, that these globules or these 
 passes cured frequently enough any given class of diseases. 
 
 The Empirics, trusting to experience only in the appreciation of the 
 value of remedies (and, as we have just seen, there exists in therapeu- 
 tics no more rational means of appreciating them), they were obliged to 
 devote themselves, with greatest care, to the perfection of this means. 
 And this is what they did. indeed, as we have reported in the Anatom- 
 ical Period, when exhibiting their antique doctrine. The following 
 is a resume of the rules which they drew up on this subject : The 
 same medicament must have been tried a great number of times in per- 
 fectly analogous cases, by different persons, capable of discovering the 
 homogeneousness of morbid affections, and who were worthy of confi- 
 dence. When a treatment had offered these proofs, and was found to 
 be constantly efficacious, then the description of the treatment, and the 
 disease to which applied, formed a theorem. The collection of these 
 theorems thus verified, constituted the Healing Art, and he only 
 possessed Empiricism who kept faithfully in his memory the totality of 
 its theorems.
 
 684 REFORM PERIOD. 
 
 For two thousand years these rules have existed, and no notable 
 change has been made in them, up to the epoch when Barthez proposed 
 his famous classification of curative methods. This classification, it 
 must be confessed, penetrated much farther than had been done before 
 into the mechanism of the operations of the mind in therapeutics ; but 
 it was neither complete nor free from error, as I have before shown. 
 Barthez only had a glimpse of the truth — but he did not seize nor make 
 himself master of it ; he let it escape almost immediately, because he 
 was misled by a false theory. By modifying his therapeutic classifi- 
 cation, as I have already done, he had rendered it neai'ly irreproachable 
 for the epoch when it appeared. This classification, modified in that 
 way, is still, to-day, if 1 am not mistaken, the best one that has been 
 proposed on this subject. It enters, perfectly, into the Empirico- 
 rational doctrine ; it is the direct consequence, the natural develope- 
 ment of the therapeutic axiom of this doctrine — for this reason it must 
 find its place here. 
 
 ON METHOD IX THERAPEUTICS ; OR CLASSIFICATION OF THE GENERAL MODES 
 
 OF TREATMENT. 
 
 There are, in the present state of science, four general modes of treat- 
 ment, namely : the synthetic, analytic, expectant, and explorative or 
 perturbative. 
 
 SYNTHETIC MODE. 
 
 In this mode the mind looks at all the phenomena of a disease, as 
 forming an indivisible concourse of symptoms — a single morbid entity — 
 and it directs against this entity, considered thus en masse, a medica- 
 tion termed specific. This mode of treatment, when it is administered 
 apropos, is the most efficacious — the most benefical of all. But science, 
 unfortunately, possesses very few well established specifics, such as 
 vaccine, mercury, and cinchona, which can be opposed to a determined 
 class of diseases. It possesses a greater number of specifics for the func- 
 tions, such as various eccropotics, sialagogues, diuretics, emenagogues, 
 etc., which, without being endowed with a specificity as admirable as 
 the preceding nevertheless render important service in Medicine when 
 they are employed with discernment, an indispensable condition, after 
 all, for every species of medication. 
 
 The synthetic mode is not only the most efficacious of the modes of 
 treatment, but is also the most natural, the one to which we are most 
 instinctively led. In the first periods of the history of Medicine, none
 
 EMPIRI-METHODISM. 585 
 
 but specific medicaments, or those held as such, were employed. As 
 soon as a substance or a medical preparation appeared useful in a dis- 
 ease, it was designated by a name which recalled these properties ; 
 hence were derived the denominations, vulnerary, scabious, pulmonary 
 therica, etc. However, more attentive and enlightened observation not 
 having confirmed eventually the correctness of these denominations, all 
 confidence was gradually lost in them, and by an exaggeration very 
 natural, the curative method to which it had given rise was included in 
 the same proscription. The treatment by specifics was banished from 
 science, in favor of a false theory, which pronounced the former irra- 
 tional ; but it could not be ecjually excluded from practice, because, in 
 reality, it was the most efficacious and the most natural. It is time. 
 then, that we restore it by means of a better theory to the honorable 
 rank to which it is entitled, from the services which art and humanity 
 receive daily at its hands. 
 
 ANALYTICAL MODE. 
 
 This mode of treatment is the only one which has been well described 
 and well denominated by Barthez. It consists in decomposing a disease 
 or concourse of symptoms into its elements, that is to say, into seve- 
 ral secondary groups, to each of which an appropriate treatment is 
 applied, either simultaneously or successively. For example, in con- 
 vulsive bronchitis or whooping cough, one may combat the sanguineous 
 congestion, if it is marked, by an application of leeches ; the mucous 
 congestion, by mild emeto-cathartics in broken doses ; finally, the nervous 
 element may be attacked by means of some narcotic like belladonna, 
 digitalis, or opium. 
 
 This manner of treating diseases is much less sure than the preceding, 
 and recourse is had to it only in aflfections for which there is no known 
 specific remedy. It is, moreover, of more difficult application, because 
 it requires, on the part of the practitioner, one operation more than the 
 former, viz : the analysis of the symptoms of a disease, which opera- 
 tion presents sometimes serious difficulties, and countenances always 
 arbitrariness. Thus, in the example referred to, it may happen 
 that one physician gives priority to the sanguineous element, another 
 to the serous, a third to the nervous. Owing to the fact that the analy- 
 sis of the morbid concourse is merely mental, it is ordinarily very 
 difficult to decide which of these elements has over the others a prepon- 
 derating influence. Under these circumstances, the practitioner too 
 often suffers himself to be guided in his choice by preconceived ideas, 
 and the prejudices of systems. The Animist, for example, sees in every 
 thing a derangement of the soul, or vital principle, and nothing else ; 
 37
 
 586 REFORM PERIOD. 
 
 the Chemist perceives nothing but the predominance of some acridness ; 
 the Mechanician, a mechanical obstacle to the circulation of the fluids ; 
 and the Vitalist, some changes in the vital forces. It results from this, 
 that analysis is not only of difficult application in therapeutics, but also 
 that it leads strongly toward arbitrariness, to hypotheses."' 
 
 EXPECTANT MODE. 
 
 "When a disease has a fixed and rapid course, as an ephemeral fever, 
 or benign roseola, a varioloid, a simple wound not involving any impor- 
 tant part, etc. ; when a disease, though graver, offers no alarming symp- 
 tom, and seems to tend toward a happy termination by the simple forces 
 of nature, as an inflammatory fever without any apparent phlegmasia of 
 
 * We have frequently had occasion in the" course of this history, to show that 
 analysis is a falacious method, and has been the source of a crowd of errors in 
 Medicine, when it is separated from synthesis. Permit me to add en passant, that 
 the same method applied to morals, has given rise to errors a hvmdred times more 
 grievous still. If we are not on our guard against the illusions with which it 
 fills our minds, under the guise of exactness, truth, and profundity, it will soon 
 dry up our hearts, and smother in our souls every germ of virtue, every impulse 
 of courage, magnanimity, and devotion ; to substitute for them coldness, arid 
 egotism, melancholy, contempt for others and one's self. See in the romance of 
 Alfred de Vigny, entitled: Cinq Mars, ou ime Conjuration sous Louis XlII. ; see 
 Isay, the conversation of Friar Joseph, a man condemned by Richelieu, with Cinq 
 Mars, detained in prison and awaiting execution, in vol. II, p. 352, of the fifth 
 edition. Read from one end to the other the delightful creation of Xaintaine, 
 entitled, Pecciola, of which the following is a fragment : 
 
 "A profound sadness took possession of the Count de Charney. Philosophic analy- 
 sis, notwithstanding all his efforts to shake it ofi", reigned over his mind, controlled 
 all his aiFections, tarnished, contracted, and extinguished the pleasures and luxu- 
 ries in the midst of which he lived. The eulogies of his friends, the caresses of 
 his mistresses, were no more to him than the current money with which they 
 paid for the part they took, of his fortune, and were only a testimony of their 
 necessity to live at his expense. Decomposing and reducing every thing to its 
 first elements, by this same spirit of analysis, he was attacked with a singular 
 disease. In the tissue of the fine cloth of his dress, he thought he detected the 
 odor of the animal which furnished the wool ; on the silk of rich hanging?, he 
 thought he saw crawl the disgusting worm which had spun it; on his elegant 
 furniture, his carpets, the bindings of his books, toys of pearl and ivory, he saw 
 nothing but spoils of death — death set off in attractive colors by the sweat of 
 poor artizans. Illusion was destroyed, and the imagination paralyzed.^' 
 
 Must we conclude from these abuses of analysis that we should proscribe this 
 mode of acquisition, to which the human mind is indebted for so many discov- 
 eries? No, certainly not. Such is not our intention; we have presented the 
 dangers and deceptions of analysis, in order that it may not be embraced with 
 blind faith; just as the ancient Empirics assigned limits to reason, not to pro- 
 scribe it, as they have been accused, but to prevent its abuse.
 
 EMPIRI-METHODISM. 587 
 
 an organ ; when a disease presents itself in an obscure manner, and 
 there is besides nothing urgent in the case, and, in a multitude of other 
 cases which it would take too long to specify, it suffices, in order to 
 obtain a cure, to place the patient in favorable hygienic conditions, pre- 
 vent the commission of any imprudence, and direct the use of a proper 
 regimen. 
 
 Nature, in these cases, seems to take upon herself the work of medi- 
 cation ; the physician has only to observe and hold himself in expecta- 
 tion, to repress, if need be, the deviations of medicating nature, to 
 excite or moderate her movements, to sustain her forces, and to aid her. 
 in a word, by following the indications which she furnishes. The prac- 
 titioner has been compared, in such a case, sometimes to a servant or 
 minister who waits for his actions, only the signal of the master ; again . 
 to an idle spectator ; but it is evident that in this case the listlessness 
 of the physician is only apparent, aud the denomination of inactive 
 medicine, employed to designate the treatment, appears to me improper. 
 
 The disease, or the concourse of symptoms is here considered as a reg- 
 ular chain of phenomena, which nature excites for a curativ^e purpose. 
 and it is important not to interfere with the spontaneous tendency with- 
 out absolute necessity. This manner of philosophizing having been put 
 in vogue by Hippocrates, those who adopted it were named Hippocratists. 
 or Naturalists. It suited especially in the infancy of the Art, at an 
 epoch when few or no ti'ue specifics were known, and when an enlight- 
 ened use of analysis had not yet been made. It renders the practitioner 
 circumspect and attentive, which must be to the advantage of the pa- 
 tient ; and it is applicable in a multitude of cases, both acute and 
 chronic. 
 
 But it is evident that the expectant method does not constitute all of 
 the Healing Art : that the synthetic is much more prompt and sure 
 whenever it can be employed, and that the analytic merits also in many 
 cases the preference. Generalizing the Expectant method to excess, 
 under the title of Hippocratic or Natural method, is to mistake the 
 progress of light, aud to chain the genius of Medicine to the bed of 
 Procrustes, 
 
 EXPLOEING OR PEETURBATING MOPE. 
 
 Ambiguous or doubtful cases often occur in practice, which our minds 
 can not associate in a precise way to any of the known morbid species ; 
 then the physician prescribes often, not at hazard, but from choice, a 
 medication calculated to develop the characters of the disease and clear 
 up his diagnosis. His conduct, under these circumstances, may be
 
 588 REFORM PERIOD. 
 
 compared to that of the chemist who employs a re-agent to recognize the 
 nature of a saline solution. 
 
 In other cases, unhappily too numerous, the man of Art, after 
 having exhausted all the rational means which science has put 
 at his disposal, without obtaining any satisfactory result, owing to 
 some idiosyncracy, or other inexplicable circumstance, has recourse 
 to an indirect treatment, by which he proposes to give a shock to the 
 entire economy, or only to the part affected, in order to produce an 
 advantageous and curative perturbation. Such was the object had in 
 view by the ancient Methodists in inventing the metasyncritic circle ; 
 such is also now our aim when we order sea-bathing, voyages, mineral 
 waters, hydropathy, etc. In these cases, the physician is not acting 
 blindly, nor does he prescribe at hazard, but is guided by certain anal- 
 ogies; he has regard to the habitudes, age, and temperament of the 
 patient. On this account, we give also to this mode of treatment the 
 title of rational ; we class it in the rank of therapeutic methods 
 acknowledged by science. But it occupies the lowest rank among these 
 methods, and the progress of knowledge will more and more restrain its 
 application. 
 
 The explorative and the perturbative method, though united here, 
 respond to two different views of our minds, and should have formed 
 two separate paragraphs. I have thought it proper to unite them 
 because they both constitute a sort of groping, and both also prove that 
 there is in the mind of him who employs either, about the same degree 
 of uncertainty and hesitation. 
 
 R £ M A E K 3 . 
 
 It often happens that in the same disease, we are obliged to 
 employ several modes of treatment, or even all, either collectively or 
 successively. Example : I attended, some twelve years ago, a man 
 thirty-five years of age, small and fat, and of a somewhat sanguineous 
 appearance, whose trade was shoemaking. The first time I saw him, he 
 complained of a want of appetite without increase of thirst, a general 
 debility and insurmountable sleepiness. His tongue, his excretions, 
 alvine and urinary, his digestion, his pulse, his respiration and his cere- 
 bral functions presented nothing abnormal. I ordered some mustard 
 foot-baths, a middle diet, a mild purgative and a promenade after meals. 
 Three or four days passed by without any modification in the state of 
 my patient being visible, unless there was a slight increase of the debil- 
 ity and sleepiness. I took from his arm eighteen to twenty ounces of 
 blood, continued the foot-baths, the middle diet and mild cathartic every 
 other day. At the end of some days there was no amelioration; on the
 
 EMPIRI-METHODISM. 689 
 
 contrary, the debility had increased. I questioned him anew, and he 
 told me among a mass of useless circumlocution, that his greatest drowsi- 
 ness was about three o'clock in the day. I called to see him on the 
 next day at that hour. He was in bed. His color was a little more 
 than usual, but there was no frequency of the pulse or extraordinary 
 heat of skin. AVhen I shook him he opened his eyes, replied slowly but 
 correctly to m}- questions, and fell off with sleep in an instant. I 
 learned that the propensity to sleep came on every day between eleven 
 and twelve o'clock, and ceased towards six or seven in the evening, and 
 that it had never been preceded by shivering or followed by a sweat. I 
 prescribed six grains of the sulphate of quinine to be taken in the 
 evening, and a similar dose to be taken at nine in the morning. The 
 next day the somnolency was much less urgent, and the prostration less 
 sensible. The continuation of the remedy for several days prevented 
 completely the return of the soporific accession and the debility. 
 
 If any one now wishes to SiTi<djze my conduct in the management of 
 this case, he will discover three distinct periods. In the first I employed 
 the expectant method. Then I decomposed the concourse of symptoms 
 conformably to the analytic method, and I treated the symptom of cere- 
 bral congestion which appeared to me to be the most predominant. 
 Finally, I considered the ensemble of the symptoms as a unit, and 
 treated him according to the synthetic method. 
 
 If any one wishes to make the analysis in the same manner of any 
 other treatment whatever, whether simple or complicated, medical or 
 surgical, it is easy to see that each part of the treatment conforms to 
 one of the general modes explained above. Suppose, for example, that 
 it relates to an abdominal tumor, whose extirpation is judged to be pos- 
 sible. It is clear that in this case the synthetic method is first employed, 
 for the disease is attacked en masse, as constituting a unit. Thon the 
 wound is closed by sticking plasters, a simple dressing applied, and the 
 patient is directed to be kept quiet and on proper diet. This is the 
 expectant division of the treatment ; the case is left to nature. But 
 during the course of the cicatrization, various accidents maybe developed: 
 an inflammatory fever, for example, may be lighted up. Then recourse 
 is had to the analytic mode in attacking the sanguineous element by 
 blood-letting, and by withdrawing a portion of the nutrition, which 
 diminishes, of course, the mass of liquids, and by combatting the thirst 
 and excess of caloric by abundant acidulated or mucilaginous drinks. 
 If hospital gangrene supervene, it is treated by topical applications of 
 acids or caustics, with a view to change an ulceration of a malignant
 
 590 REFORM PERIOD. 
 
 nature into a simple ulcer ; in other words, use is made of the pertur- 
 bative method, because no safer means is known yet to arrest this griev- 
 ous complication. 
 
 Thus, however varied may be the means employed in therapeutics — 
 however diverse may be the views of practitioners, it is evident that 
 their views and their means are all related naturally to some one of the 
 methods referred to in bur category above given. Moreover, our thera- 
 peutic classification presents a regular gradation of the general modes 
 of treatment, from the one which offers the least chances of success to 
 the one whose success is nearly infallible. It indicates more clearly 
 than has been done heretofore the end that science proposes, which con- 
 sists in elevating the treatment of each disease to the most perfect and 
 surest mode, that is to say, to the synthetic mode, contrary to the opin- 
 ion of so many theorists, who falsified the art, and diverted the minds 
 of practitioners from the true path by tarnishing with an opprobious 
 epithet this curative method, which they believed to be injurious. 
 
 CONCLUSIO N. 
 
 Finally, the Empiri-methodic or Empirico-rational system, whose 
 economy we have jiist summarily unfolded, includes all branches of 
 medical science and unites them by a natural tie, supported by reason 
 and history. All, or nearly all the authors of systems of Medicine have 
 sought their foundation in physiology, whence they deduced first their 
 pathological theories, and lastly, their rules of treatment. This was, it 
 must be avowed, following an inverse march to what nature and reason 
 indicate. It is therefore not astonishing, however great was the intel- 
 ligence of these authors, that they were led astray. Indeed, if we con- 
 sult history, we see that the first medical researches related to thera- 
 peutics. Even before the existence of the Art, therapeutics was instinct- 
 ively applied. If we interrogate reason, we find that therapeutics is the 
 most important branch of medicine, the center to which should converge 
 the luminous rays that emanate from the other branches of the science. 
 It was, then, natural and reasonable to seek in therapeutics the true 
 basis of a medical system. This is what was done so happily and per- 
 spicuously by the philosophic physicians of Alexandria, who were the 
 first to take the name of Empirics. It is what I have also undertaken 
 to bring about with the aid of the few remains of their doctrine, the 
 lights of history and of those which modern philosophy and medical 
 practice have furnished me. It has been seen how, from this axiom, so 
 natural and so incontestible — each disease must be treated hy those reme- 
 dies which have succeeded best in similar cases — we have deduced the 
 necessity of all the branches of pathology, anatomy, physiology, etc.
 
 GENERAL RESUME. 591 
 
 Would it be too much to afl&rm that the system Empiri-methodic is the 
 only true and complete one which has been proposed in medicine ? So 
 many men of mind and genius have been shown in the course of this 
 history to have been in error for having made a similar assertion in 
 honor of other systems, it would be temerity in me to affirm it, whatever 
 may be my convictions in this respect. I affirm nothing then, but I await 
 with confidence the judgment of my confreres, and in particular that of 
 the practitioners, to whom it appertains, at last, to pronounce on the value 
 of all medical systems. 
 
 CHAPTEE XII. 
 
 GENERAL RESUME. 
 
 The History of Medicine, considered in its totality from the com- 
 mencement of society to the present epoch, offers us three principal 
 phases, which we have designated by the names of Age of Foundation, 
 Age of Transition and Age of Eenovation. 
 
 During the first phase, which terminated at the death of Galen, 
 toward the end of the second century of the Christian era, we have 
 seen the Healing Art commence among all nations in nearly the same 
 manner. We have recognized that it was not a pure invention of the 
 genius of man, but that it owed its origin on one hand to the invincible 
 instinct which leads us to fly from pain and seek means for its relief: 
 on the other, to that inclination, eminently social, called sympathy, 
 which impels us to succor our fellows in their sufferings. 
 
 The discovery of the earliest remedies was due to accident, instinct 
 and experience. But as soon as a knowledge of a certain number of 
 medicaments applicable to some determined diseases had been acquired, 
 it became necessary to arrange this knowledge in an order which wouhl 
 render its application more easy and sure. From that time reason or 
 philosophy united with experience to give perfection to the art. Thus 
 instinct, accident and observation laid the first foundations of the scien- 
 tific edifice, or rather furnished the first materials ; reason came next, 
 to polish, cull and arrange these materials in a suitable manner, and 
 direct observation in the search for new facts. 
 
 Thus far, reason had marched in the rear of experience, or by its 
 side, performing the offices of censor or architect ; but it did not 
 precede it, it did not pretend, especially, to create itself the material 
 which should serve in the construction of the monument of Medicine. But 
 philosophy soon allowed itself to creep upon the steps of observation.
 
 I 
 
 592 REFORM PERIOD. 
 
 which furnished it but too slowly, with vague, limited and ver}^ variable 
 information. The philosophers abandoned the long and tortuous path 
 of experience, believing they could reach their aim more speedily and ■ 
 directly on the wings of intelligence, free from the weight of the 
 senses. The certainty and invariableness of mathematical propositions, 
 the grandeur and beauty of the maxims in morals and natural religion, 
 admirable discoveries, the foundation of all social order, which were 
 regarded as the fruit of the pure perceptions of the mind — these were 
 the motives, very excusable doubtless, on which they rested, to turn 
 from observation, and seek by the aid of pure mental intuition, the laws 
 which regulate physical phenomena. 
 
 From that time, physicians proposed nothing less than to determine 
 the proximate cause, the principle, the essence of life and diseases, and 
 the intimate action of remedies. They assumed to build upon this 
 basis the scientific monument of Medicine. The more, then, objects 
 appeared to them removed from the grasp of the senses, the more they 
 judged them proper to become a solid foundation for science — one that 
 would be undisturbed by the fluctuations of experience, a mode of 
 acquisition which Hippocrates had qualified as uncertain, experientia 
 fallax. Thence sprung up a crowd of hypotheses and systems, which 
 struggled for supremacy in Medicine, from Hippocrates to Galen. Their 
 founders flattered themselves to be able to avoid the uncertainty and 
 gropings of experience, but they fell into a labyrinth of imaginary 
 speculations, and opened an illimitable field to controversy. Physicians 
 were divided, like the philosophers, into rival sects, whose disputes only 
 ceased in consequence of political events, and social revolutions. It 
 was during these conjunctures that the physician of Pergamos, having 
 collected what he found best in the writings of his predecessors, com- 
 posed from them a body of doctrine, conformed to the reigning philosophic 
 ideas, in which we meet, in some degree, all the opinions that had been 
 in vogue, but over all of which Hippocratic Dogmatism predominates. 
 
 The scientific monument of Medicine, thus constituted, traversed the 
 Second Age without undergoing any notable change. The theories of 
 Galen were authority during all this lapse of time ; his successors 
 aspired only to the glory of interpreting them, and to add some 
 particular facts, some observations of detail, to the heritage that 
 antiquity had left to them. There was established, we do not know at 
 what epoch, a strange but salutary opinion, which formed a line of de- 
 markation, a species of antagonism between theory and practice, between 
 rsason and experience. The theorist, it was said, must proceed accord- 
 ing to logic, and the practitioner must be guided by observation. By 
 means of this singular expedient or this fiction, false theories, and a
 
 GENERAL RESUME. 593 
 
 deceptive science, were preserved for centuries without misleading prac- 
 tice too mucli ; the physician could reason badly, without much injury 
 to his patient, and without depriving himself of the lights of experience. 
 
 Such is the aspect which medical doctrine presents at the commence- 
 ment of the Age of Eenovation, and even for a long time afterward. 
 We have seen that at this epoch the human mind awoke from its long 
 torpor, and signalized its revival by num-erous discoveries and improve- 
 ments. Astronomy, physics, chemistry, and natural history, underwent 
 a complete revolution, for which they were indebted to the direct observa- 
 tion of phenomena, and the adoption of a logical method, formerly 
 scarcely used, called induction. The mathematicians, who were never 
 kd astray in their abstract speculations, and who had made such 
 beautiful discoveries, reasoning by deduction, preserved this logical 
 method, always dearer to meditative minds than to observers. 
 
 The philosophers were divided into two classes — one, including Des- 
 cartes, Leibnitz, Kant, and their disciples, considered, above all, the 
 activity of the soul in the acquisition of knowledge, and the production 
 of moral acts ; they were called spiritualists, and remained faithful to 
 the ancient form of reasoning, deduction, after freeing it from the 
 pedantic dress of the schools. The other, including Bacon, Locke, 
 Condillac, and their followers, rather regarded the soul as passive, and 
 assumed that all its faculties, and all its acts, are derived from sensi- 
 tive impressions ; they were called, on this account, sensitists, and 
 adopted, for their general method of reasoning, induction, which they 
 strove to introduce into all the sciences. If I dare express an opinion 
 on a subject so delicats, I would say that the first, — that is, the spirit- 
 ualists — seem to me to have better demonstrated moral and intellectual 
 truths, while the second, or the sensitists, appear to me to have traced 
 with more exactness the phenomena of matter, either organic or inorganic, 
 and to have better com2:)rehended its laws. 
 
 However this may be, the greatest number of physicians adopted the 
 sensitive philosophy. They all pretended to take the sensations, or the 
 sensible phenomena, for the basis of their systems, but all, or nearly all, 
 surpassed, in their theoretic speculations, the horizon of these pheno- 
 mena, in which they violated that axiom of modern philosophy, common 
 to Sensualism and Spiritualism — reason has only been given to us to 
 guide experience, and the mind, in attempting to pass the limits of the 
 sensations, mistakes its right and its poiver. Hence the chimeras and 
 instability of recent medical theories ; hence, also, the necessity of 
 prolonging, indefinitely, the divorce of theory and practice, of reason 
 and experience — a divorce wliich the greatest practitioners of the last 
 centuries have often proclaimed — a divorce whose inconveniences Baglivi
 
 594 REFORM PERIOD. 
 
 was the first to signalize — which Weiihof, Morgagni, and Lieutaud, 
 with a small number of other writers, attempted to break, but which 
 will only completely cease when all physicians shall be penetrated with 
 this truth : that beyond rational Empiricism there is for science nothing 
 but illusion or hypothesis. 
 
 We have demonstrated that all systems of Medicine should be based 
 on therapeutics, which is contrary to the common opinion ; for all authors 
 who have been authority, from the successors of Hippocrates to the 
 present epoch, all, I say, excepting the Empirics, have endeavored to 
 found their systems on the laws of physiology. The last, even, among 
 them, Broussais, was willing to characterize his doctrine by the term 
 physiological — a title which we are in no wise inclined to refuse to it, 
 no more than that of many others which have preceded it. Yes, the 
 theory of irritation is a reflection of the physological ideas of its author ; 
 the theory of incitation offers us an image of the ideas of Brown on 
 the functions of the animal economy ; the theory of Animism is a 
 consequence of the manner in which Stahl conceived life to exist ; the 
 theory of four elements and four humors, represents the intimate play 
 of the organs of the living body, as men figured them to exist in the 
 times of Galen. It is the same with all other medical theories — each 
 one of them is a deduction of some physiological idea. 
 
 The authors of these theories have reasoned as follows : To treat a 
 disease properly, we must know its nature. Now the disease being 
 nothing else than a derangement of health, or the physiological state of 
 the body, it is necessary to know in what health consists, in order to 
 appreciate the derangements which take place — that is to say, the 
 diverse pathological states. This reasoning, which appears so just and 
 so natural at first sight, is at bottom only an extremely subtile sophism, 
 which clinical experience contradicts at every step. There is a crowd 
 of diseases whose nature, or mode of formation, escapes entirely our 
 researches, yet which we know very well how to cure — there are others, 
 whose mode of formation is much better known to us, on whose nature 
 we have more exact data, whose treatment is, nevertheless, but little 
 improved thereby. 
 
 If, on the other hand, we go back to the infancy of the Art, we shall 
 perceive that a great many remedies were found before reason had been 
 invoked, either on the intimate nature of diseases, or on the principles 
 or primordial properties of living beings. Finally, if we follow the 
 history of science from its origin to our times, we shall see the physio- 
 logical systems vary infinitely, and often contradict each other, while 
 the manner of treating diseases has undergone much fewer changes. 
 From these facts we have concluded, experimentally, that therapeutics
 
 GENERAL EESUME. 595 
 
 cannot be deduced directly from physiology ; but that the precepts of 
 the first are, and should remain, independent of the speculations of the 
 latter. 
 
 To those who pretend to deduce the general rules of treatment from 
 some opinion, or physiological experiment, we would recall the axiom of 
 philosophy already invoked by us more than once : In the succession of 
 natural phenomena, nothing presents to us the idea of causality, or the 
 necessary relation of cause and effect. But when the succession of one 
 phenomenon after another is constant, the human mind, which observes 
 it assiduously, and which often can foresee it even, is lead to believe 
 that these phenomena succeed each other because they are linked together. 
 Thus, when the cure of an order of diseases follows constantly the em- 
 ployment of a medication, we are lead to regard this medication as the 
 cause of the cure which follows its use ; but it is impossible for us to 
 perceive the physiological reason of this result, and it is, consequently, 
 useless to seek it. 
 
 The physiologist must limit himself to describe the functions of the 
 organism, without pretending to seize the proximate cause of these func- 
 tions. While he does not content himself with depicting the phenomena 
 of the animal economy as they are shown to us by observation, but 
 flatters himself to be able to determine by analysis the principle, or 
 essential phenomenon of living beings, he mistakes his rights as well as 
 his powers. He resembles the dog in the fable, which dropped the sub- 
 stance to seize the shadow. He forgets that life is a finished circle, in 
 which, consequently, there is neither commencement nor end — He, alone, 
 who traced this circle, is able to tell us where it commences and 
 where it ends. The man who struggles to resolve this problem, makes 
 greater proof of folly and unmeasured ambition, than depth of mind. 
 Far from being able to determine the principle or essential phenomenon, 
 the object of so many vain speculations and researches, the physiologists 
 have not even been able to assure themselves, by the most delicate obser- 
 vations, if life commences in the solids or liquids ; for wherever life 
 exists, we find a combination of liquids and solids, an assemblage of 
 containing parts and parts contained — we cannot even conceive of life 
 without this union." 
 
 Thus, therefore, the physiologist must limit himself to the description 
 of the normal phenomena of the living economy — the pathologist to 
 abnormal ones, without either of them aspiring to penetrate the prim- 
 itive mechanism of these phenomena. So, also, the therapeutist should 
 
 " See, among other works, in the Manual of Physiology, of J. Muller, para- 
 graphs relative to the forms of organic matter, and organic properties of the blood.
 
 596 REFORM PERIOD. 
 
 base the choice of the curative means he employs, not on the analogies 
 perceptible to the understanding only, but on the material and sensible 
 analogies. Such is the resume of the Empiri-Methodic doctrine, toward 
 which the present generation manifestly inclines, notwithstanding some 
 divergencies. It does not require a great prophet to foresee that before 
 a long time shall have elapsed, all medical opinions will unite upon this 
 doctrine. Do we not see researches on specific medications everywhere 
 multiplied ? Does not our age owe to this order of researches the discovery 
 of some precious remedies for diseases, and the improvement of several 
 others ? To recall but the principal ones, we will cite the extension of 
 the application of the febrifuge, par excellence, to all periodic affections ; 
 the propagation of vaccination in spite of all physiological theories ; the 
 introduction of iodine and its compounds in the treatment of scrofula 
 and constitutional syphilis ; the employment of ergot in inertia of the 
 uterus and hemorrhages that follow accouchement ; the use of tarter 
 emetic in certain forms of pneumonia, etc., etc. Are these not results 
 which speak stronger in favor of the specificity of certain remedies 
 than the sophisms and eloquence of writers who strive to lead the mind 
 in another direction, by taxing as irrational a mode of treatment unani- 
 mously recognized as the most efficacious and beneficial ? The research 
 for occasional and predisposing causes, that is to say, causes called 
 evident, by the ancient Empirics — is it not prefered in some recent books 
 to the research of causes called intimate, constitutive, physiological and 
 essential ? From all these signs, it is easy to foresee that the definite 
 triumph of Empiri-Methodism, otherwise called rational or philosophic 
 Empiricism, approaches. 
 
 But let happen what will, the first among moderns, I have endeavored 
 to revive the name of the grand Empirical school of Alexandria. 1 
 have endeavored to resuscitate and cause to shine in greatest brilliancy 
 its claims to glory, forgotten or mistaken for two thousand years. I 
 have not been content to reproduce this doctrine, I have sought its 
 enlargement and consolidation, by basing it on new philosophic dogmas 
 of incontestible evidence, sustaining it by historic proofs sufficient to 
 fasten conviction upon the most resisting minds. Thus comprehended 
 and developed, Empiricism is, of all the systems, the only one which 
 furnishes a sufficient reason for the rules of the Healing Art observed 
 in all past and present time ; the only one which is applicable to all 
 branches of Medicine and its accessory sciences ; the only one, in fine, 
 which gives a solution of this capital problem, sought in vain by Bag- 
 livi, and so many other illustrious physicians : the agreement of theory 
 with practice, of reason with experience. This system, it is true, takes 
 from the mind numerous illusions which flatter our vanity, and which
 
 GENERAL RESUME. 597 
 
 become obstacles to its rapid propagation, for although the world grows 
 older, man always remains a child, whom fictions amuse. But in a sci- 
 ence like Medicine, fictions are never innocent ; they have always caused 
 much evil, they retard the progress of light much more than doubt and 
 ignorance. 
 
 In a professional point of view, the history of Medicine has offered 
 us four distinct phases : 
 
 First, a patriarchal phase, which corresponds to the origin of society, 
 to an epoch when the chief of a family united in himself all power, and 
 was the depository of all traditions ; 
 
 Second, a sacerdotal phase, which reigned long in Egypt, and flour- 
 ished in Greece from the Trojan war to Hippocrates, and which reap- 
 peared in Europe during the Middle Ages ; 
 
 Third, an unlicensed lay phase, the worst of all in regard to the dig- 
 nity and morality of the profession ; 
 
 Fourth, a licensed, or organized lay phase, the most perfect of all 
 known professional forms, the most appropriate to the present state 
 of Europe, and the most favorable to the progress of science and art. 
 
 THE END.
 
 A.FPENDIX:. 
 
 PHILOSOPHICAL LETTERS 
 
 MEDICINE IN THE NINETEENTH CENTUEY. 
 
 FIRST LETTER. 
 
 MEDICINE JUDGED BY PHYSICIANS. 
 
 You are aware, my dear and worthy colleague," and it is universally 
 known, that Medicine and physicians have always furnished ample 
 material to the wits ; poets, philosophers, novelists, and writers of all 
 descriptions have rivaled each other in the exercise of their satirical 
 humor on this inexhaustible subject. But what is not so generally 
 known, what most persons have always overlooked, and what must seem 
 most singular is, that the bitterest criticisms which have ever been made 
 upon medical science, and upon those who cultivate it, have flown from 
 the pens of physicians. 
 
 To prove my assertion, I need not to go back to the dark picture 
 which Galen traced of the quackery, ignorance, and avidity of his col- 
 leagues at Eome ; neither need I recall the vulgar wit of a Cornelius 
 Agrippa, nor the sarcasms of Guy-Patin. We who are disciples of 
 Esculapius attach, in general, but little importance to the opinions and 
 labors of our predecessors. The sharp and ridiculous pictures of Moliere, 
 of the physicians of his time, touch us but little, persuaded, as we are, 
 that we resemble the originals in no respect. Although only two centu- 
 ries separate us from that epoch, we believe ourselves to be at an infinite 
 
 ' This series of Letters was addressed to the editor of I' Onion Medicale in 
 1850.
 
 600 APPENDIX. 
 
 distance above the errors and the ridiculous practices which the great 
 Comedian pursued with his shafts, so much progress does it seem to 
 us that science and Medicine have since made. 
 
 I shall, therefore, not seek the proofs of the fact above asserted, in 
 the ancient authors, whose authority might be questioned. I shall take 
 them from the most recent writings, in order to establish the evidence 
 of the truth of my proposition, that in our days, as well as formerly, the 
 most severe critics of the practice and the science of Medicine, have 
 been physicians themselves. 
 
 I . School of P a k i s . 
 
 At the commencement of our century, Bichat wrote as follows : 
 " We h^ve yet had in Materia Medica no general systems ; but this 
 science has until now been influenced successively by those who were 
 leaders in the profession, and each one of these has, if I may say so, 
 forced upon it his own views. Hence the vagueness and uncertainty 
 which it presents to us to-day. An incoherent assemblage of incoherent 
 opinions, it is perhaps, of all the physiological sciences, the one which 
 shows plainest the contradictions and wanderings of the human mind. 
 In fact, it is no science at all for a methodical mind, but is a shapeless 
 conglomerate of inexact ideas, of observations often piTcrile, of illusory 
 remedies, and of formulas as oddly conceived as fastiduously arranged. 
 It is said that the practice of Medicine is repulsive. I say more than 
 this : it is, in respect to its principles, taken from most of our Materia 
 Medicas, impracticable for a sensible man. Except the medicaments 
 whose effects are fully established by strict observation, such as evacu- 
 ants, diuretics, sialagogucs, anti-spasmodics, etc., that is, those which act 
 upon a determined function, and to what does our knowledge of the 
 other articles amount ?"'■■■= 
 
 I have quoted this passage entire, notwithstanding its length : First, 
 because it contains the opinion of a man of genius, and of an able 
 experimenter, whose ideas and discoveries have exercised a capital influ- 
 ence upon medical studies in France ; second, because it indicates with 
 precision the original, radical defect of our therapeutical denomina- 
 tions ; third, finally, because it points out, although somewhat indis- 
 tinctly, the path which must be chosen to arrive at a better nomencla- 
 ture and sounder notions in therapeutics. Except the medicaments 
 
 *^' Bichat, General Anatomy, General Considerations. Paris, 1818.
 
 FIRST LETTEK. 601 
 
 whose effect is fully established by strict observation, such as evacu- 
 ants, diuretics, sialagogues, etc., that is, those which act upon a specific 
 function, and what is the amount of our knowledge of the other articles ?" 
 A few years later, a physician nurtured in the physiological ideas of 
 Bichat, and the philosophy of Condillac and Cabanis, and strengthened 
 also by the observation of diseases, and by a large practice in armies 
 and hospitals, traced the following picture of the effects of Medi- 
 cine: "Look back," he says, " and recall what we have said in regard 
 to the vices of medical practice ; imagine, in all parts of the civilized 
 world, legions of physicians who do not even suspect the existence of 
 gastric inflammation, nor the influence which this phlegmasia exercises 
 upon the other organs ; see them pouring floods of vomits, purgatives, 
 heating remedies, as wine, alcohol, liquors impregnated with bituminous 
 substances and with phosphorus, upon the sensitive coats of the phlogosed 
 stomach ; contemplate the consequences of this medical torture, the 
 agitation, trembling, convulsions, andphrenitic delirium, the cries of pain, 
 tortured expression of face, and the burning breath of all these unfor- 
 tunate ones who beg for a drop of water to allay the thirst which 
 devours them, and then receiving as answer but a new dose of the poi- 
 son which has reduced them to that horrible state ; '•■■■ 
 and then decide whether Medicine has, until now, been more useful, 
 than injurious to mankind. I agree that it has rendered suffering 
 humanity the service of offering it consolations, by lulling it continu- 
 ally with illusory hopes ; but you must also agree that such a utility is 
 far from being sufiicient to elevate Medicine to the came rank with other 
 natural sciences, but it seems to reduce it to a level with astrology, 
 superstition, and all sorts of quackery."-' 
 
 " Thank me, kind reader, for I have shown you but one-third of this pic- 
 ture, whose colors grow constantly darker and darker. What I have 
 given suffices to prove that the epigrams of philosophers and poets, upon 
 the faults of physicians and the pernicious effects of their Art, are but fee- 
 ble sketches by the side of this picture, at once so animated and so fright- 
 ful. It would fill every honest and sensible heart with disgust for the 
 practice of such a profession, if the author of this description had not 
 placed the remedy by the side of the evil he paints. This remedy, as 
 you will understand, is nothing else than his own doctrine, in favor of 
 which, he says, the statistics of mortality have already declared, and 
 which must in a short time have an influence upon population more 
 marked even than the discovery of vaccination.' ^■\ 
 
 We shall see, a little farther on, how these doctrines of the Val de 
 
 " Brouasaig, Examen dea Doctrine Medicales. f Ibid. 
 
 38
 
 602 APPENDIX. 
 
 Grace were appreciated and are appreciated yet, by other schools. But 
 first permit me to quote here the opinion of one of the most eminent 
 partisans of this doctrine, now a distinguished professor of the faculty 
 of Paris. He, after giving the opinions of Pinel, Bichat, and others, on 
 the practice of medicine, adds : " Considered in general, and absolutely, 
 these sentences are too severe ; indeed, there are a certain number of 
 diseases in whose treatment therapeutics has attained, long since, a high 
 degree of certainty and precision. But it is also true that these 
 reproaches apply themselves in all their severity to several points of our 
 therapeutics."" 
 
 Mr. Bouillaud is not at all an optimist in his judgment upon the ideas 
 and the practices of his predecessors ; still we must praise him for 
 having avoided the exaggerations of his master in this respect. He is 
 astonished to meet a great many laymen, and even a few colleagues, 
 who ask him privately and in good faith, if he believes in Medicine. 
 " In their opinion," he says, " Medicine should, to a certain point, be 
 assimilated to the science of those Augurs who could not look each other 
 in the face without laughing." M. Bouillaud should rather be aston- 
 ished that, after the declaration of so many illustrious physicians against 
 this science, there are still persons credulous enough to believe in it, and 
 bold enough to invoke its aid. Should not the instinct which leads men 
 to trust in the prescriptions of an Art which has been so much derided 
 by its own adepts, be a safer and surer guide than the reasoning of its 
 detractors ? This is a very grave and very difficult question, whose solu- 
 tion we cannot yet attempt. 
 
 Let us pass on to other medical schools, or rather to other medical 
 sects. Toward the end of the last century, Pinel, in the first edition of his 
 nosography, declares that he does not propose any other problem than the 
 following: " A disease being given, determine its true character and the 
 rank it must take in a nosological table." Thus he leaves all consider- 
 ations in regard to treatment, so to say, in the rear. He dare not lay 
 down one single general proposition of therapeutics ; not because he is 
 unaware of the extreme importance of this branch of science, but because 
 he considers it too little advanced yet to be comprehended in generali- 
 ties. The proof that this was really his thought, is, that twenty years 
 later, in a note to the sixth edition of the same work, he declares that 
 therapeutics, or the methodical treatment of diseases, is one of those parts 
 of Medicine which must undergo a general reform, and upon which the 
 attention of true observers cannot be too often invited, as a serious sub- 
 ject of their researches." 
 
 * M. Bouillaud, Essai sur la Philosophic Medicale.
 
 FIRST LETTER. 603 
 
 M. Louis does not accuse therapeutics alone of being still in infancy, 
 but also all other branches of IMedical science. " The physicians of 
 antiquity have given us," he says, "very incomplete descriptions of the 
 diseases which they observed. They have left us numerous therapeut- 
 ical precepts, but they are deprived of proof. " * The 
 modern physicians have scarcely been more successful. ='' '■' '^' 
 And still we count among the physicians of antiquity, as well as among 
 their successors down to our days, illustrious men, of rare capacities, who 
 apparently wanted nothing to advance science, especially since patholog- 
 ical anatomy has been allowed to be cultivated without opposition. How, 
 then, is it that science owes them so little in general, and that its his- 
 tory is in many respects only that of their errors or of their systems." •■' 
 
 M. Louis and M. Bouillaud attributed the errors of the ancients to 
 the faults and imperfections of their methods of examining diseases. 
 Consequently each of them traced a formula or a model for clinical obser- 
 vations, to which tbey thought every one should conform, in order to 
 avoid the faults and errors with which they reproached their predeces- 
 sors. They insist, also, in having enumerated all the cases of success 
 or failure, in order to appreciate the value of tbe different modes of treat- 
 ment proposed for each species of diseases. This is a condition very 
 easy to fulfil, and which should never be neglected, although it does not 
 possess all the importance which these gentlemen give it. In fine, they 
 are both convinced that in following the rules which they prescribe, we 
 shall march henceforth, with a firm step, in the path of progress. 
 
 This seems, nevertheless, to be an opinion contrary to that of the 
 authors of a Treatise on Therapeutics, published a few years later; for 
 we read in its preface the following paragraph : '-We do not believe that 
 by a work of the nature of the present one, we should or can set right an 
 entire generation, which, according to our opinion, turns its back on 
 truth, and which will have to march, perhaps for some time yet, in error, 
 until that shall fall by its own consequences." f 
 
 Thus, according to these latter, we have not only been in error until 
 now, but we are so yet, and are obliged to remain so for an indefinite lapse 
 of time. What, after this, shall the mass of practitioners and students 
 do and believe, if the teachers themselves agree so little with each other 
 that every new work which appears contains a more or less explicit con- 
 demnation of all those that have preceded it ? Does not this popular 
 
 ''Memoires de la Societe d'Observationes Me'dicales. Year 1837. 
 
 fMM. Trousseau et Pidoux, Traite de Therapeutique et de Matiere Medicale, 
 1841. In the third edition of their work, the authors give a resume' of their 
 doctrine. We shall spaak of this philosophical conception in the following 
 letter.
 
 604 APPENDIX. 
 
 medical saying, which is a parody on the verses of a cotemporaneous 
 poet, correctly say : 
 
 ''Driven thus from system to system, shall tve never be able to throw 
 out our anchorV 
 
 Now, this want of union which 1 have pointed out as existing among 
 the masters of this science, does not relate to details only : no, it is 
 mostly upon the very principles which form the foundation of medical 
 science that they disagree. Each one of these medical legislators 
 aspires to nothing less than to build his ideal monument upon the ruins 
 of all others. They all commence by destroying what exists, leaving 
 to others to build up again when and how they can. 
 
 §11. School of Montpelmee. 
 
 There exist, however, medical Faculties in France as well as else- 
 where, among which the worship of the ancients is held in higher honor 
 than it is in Paris, and where the respect for the doctrines of the great 
 masters is transmitted from generation to generation. In Montpellier, 
 for example, the physiological idea of Hippocrates, illuminated and ex- 
 tended by Barthez forms to this day the foundation of their medical 
 instruction ; and M. Lordat, one of the most distinguished professors of 
 that school, has lately published a work consecrated to the development 
 and the demonstration of this same Hippocratic idea.=--= 
 
 Not that from time to time some discordant voice is not heard amid 
 this harmony ; but if some heresy does show itself there, it does not 
 ostensibly destroy the orthodox doctrine, but rather softens and hides its 
 opposition under reverential forms. Thus the historian of the medical 
 doctrine of Montpellier, after having enumerated the works of Barthez, 
 and paid a just tribute of praise to his genius, gives an excellent critique 
 of his system. f 
 
 He goes still farther. He announces in different places a maxim, 
 which, if true, overthrows completely the medical doctrine of Barthez, 
 and of all those who have followed or may yet follow the same route. 
 It is as follows : " Physiology can not serve as a basis for practical 
 medicine." 
 
 Such a proposition, I repeat it, does i-uin not only the system, of Bar- 
 thez, but also many other ancient and modern systems. But M. 
 Berard has contented himself with announcing it, without supporting it 
 
 '•'Mt. Lordat, Preuves de I'Insenescence du Sens intime de PHomme. Mont- 
 pellier, 1844. 
 
 f F. B^ard, Doctrine medicale de Montpellier.— Paris, 1836.
 
 FIRST LETTER. 605 
 
 by a single direct proof ,* on this account this bold proposition, which 
 contains the germ of an entire medical revolution, has passed by, so to 
 say, un perceived. So far as I know, no one has even taken the pains either 
 to contradict it or demonstrate it formally. I shall endeavor to fill this 
 vacuum. I shall discuss, and in another letter will try to solve the 
 following difficult question, which should be the preliminary of every 
 medical doctrine : " Can physiology form the base of the practice of 
 Medicine ?" In the meantime let us continue our review of the opin- 
 ions of physicians in regard to the theory and practice of their Art. 
 For this purpose we will take a look out of France, in order to see if in 
 other countries there exist as deep dissensions on this subject as there are 
 in our own. We shall, as we have done thus far, consider only the cap- 
 ital points of disagreement, i. e. those which have a bearing upon the 
 entire science, or upon its fundamental principles. 
 
 § Til. Italian School. 
 
 At the end of the last century the doctrine of Brown was introduced 
 into Italy, and was received there with enthusiasm. Easori, who had 
 studied it in England, contributed much to its extension. This doctrine, 
 as you well know, recognizes as the cause of nearly all diseases, too 
 great force or weakness (sthenia and asthenia). Out of one hundred 
 species of diseases there are scarcely three, according to the tables of 
 Linch, which can be regarded as being caused by an excess of vitality 
 or incitability. Therefore, nearly all medicaments, most all modifiers of 
 the human economy, are considered to be stimulants, and according to 
 this system, the art of the physician consist simply in proportioning the 
 force of stimulation to the degree of asthenia of the patient. Medical 
 science and practice are both reduced by it to their utmost degree of 
 simplicity, which fact explains the rapid propagation of such a system. 
 
 Still, Easori himself perceived, or thought he perceived, after a few 
 years of practice, that certain modifiers did not act by stimulation, but 
 rather by sedation, or contra-stimulation, and that a large number of dis- 
 eases were based, not upon depression of vital forces, but upon their exal- 
 tation. From that time he became a reformer himself, and henceforth 
 Italy, as well as France and England, had each her own indigenous 
 medical system founded upon the ruins, and to the exclusion of all 
 others. 
 
 " When we think," says one of the most enlightened partizans of 
 the Easorian doctrine, " from what sources the ancients obtained their 
 notions of materia medica, we can not be astonished that Stahl has 
 called the pharmacology of his time a stable full of offal, and that
 
 606 APPENDIX. 
 
 Bichat has judged so unfavorably of that of his epoch. ••' In this we have 
 the condemnation en ynasse of ancient Medicine." 
 
 In speaking of cotemporaneous Medicine he says: " While the art of 
 diagnosis has made immense progress in France, that of the application 
 of medicaments has been entirely neglected. The special doctrine of re- 
 vulsion plays a considerable part in the French schools. Formerly all 
 was sympathy, consensus, in diseases ; now every thing is antagonism 
 or revulsion." 
 
 This is as much as to say, Frenchmen understand diseases very well 
 but cannot cure them — that we treat them irrationally. What great 
 advantage ! to be able to explain to a patient the nature of his disease, 
 to discuss with more or less skill the origin, the seat, the progress, and 
 the probable consequences of the affection of which he suffers, but to be 
 unable to relieve him? What would the irritable Broussais have said 
 of such a judgment on his doctrine ; he who believed to see already in 
 the diminution of mortality the happy results of its propagation ; he 
 who exalted its blessings as being far above those of vaccination ? He 
 would, doubtless, have cried out against ignorance, blindness, and 
 injustice ; but that would not have prevented strangers from exercising 
 their judgment on our Medicine in the same manner as we judge theirs. 
 i. e. from a special, exclusive, and unfavorable point of view. 
 
 § IV. Parallel between the English, French, and Italian Doctrines. 
 
 While in the native country of Brown most diseases are considered as 
 proceeding from a certain degree of feebleness, a diminution of vitality, 
 and are combatted by an increase of excitation, in France the disciples 
 of Broussais considered most pathological alterations as the product of 
 an excess of excitability or irritation ; and they have nothing so much 
 at heart as to calm this irritation, to extinguish this phlogosis by means 
 of sedatives or antiphlogistics. 
 
 In Italy they agree with the French in regard to the nature of the 
 morbid affections, which are generally considered as connected with a 
 sthenic diathesis, but the former differ widely from the latter in regard 
 to the appreciation and the use of therapeutic agents. The same arti- 
 cles which pass on the north side of the Alps as energetic excitants and 
 powerful tonics, pass on the other side as sedatives, or hyposfchenics. 
 Thus the quinine, which, in the eyes of the French and the English, is 
 
 '" Giacomini, Traite philosophique et experimental de Matiere Medicale, et de 
 Therapeutique. French translation, hy M. Rognetta and M. Monjon. Paris, 1845
 
 FIRST LETTER. 607 
 
 an excellent tonic, has in the eyes of an Italian only a depressive 
 hyposthenic action ; cautharides, mercurials, iodides, etc., which in 
 France are classed among the acrid poisons and irritants, are ranged by 
 the Kasorians among the contra-stimulants and sedatives. 
 
 Thus, then, we may say that there exists in Medicine, as in theology, 
 an Anglican, a Grallican, and an Ultramontane doctrine ; and these 
 medical doctrines are not distinct from each other by mere shades of dif- 
 ference, but they differ in their essentials — they exclude each other 
 mutually, and contradict each other reciprocally. 
 
 §V. Gee MAN School. 
 
 Germany could not remain behind the other countries in medical 
 inventions. She felt the need, also, of having her own national doc- 
 trine for the nineteenth century, stamped with colors truly Germanic. 
 This was thoroughly understood by Dr. Hahnemann ; consequently 
 he commenced dreaming, meditating, and experimenting, but espe- 
 cially dreaming, until at last a ray from on high illuminated his 
 mind ; the true law of past, present, and future cures appeared to him 
 like a revelation, as a pure action of divine love. Great physicians of 
 antiquity and of modern times, whose collective works of thirty centu- 
 ries have served to raise the scientific monument of the Healing Art — 
 illustrious men, living and dead, bow before this medical messiah ! Your 
 lights were but darkness, your teachings pure deception, your practice 
 a series of blunders and homicides ! 
 
 The same would be the case yet, if the pious, the modest Hahnemann 
 had kept to himself his great discovery. But he did not wish to deprive 
 his fellow men of such immense blessings ; he hastened to propagate it 
 every where; and if the entire human species does not enjoy these bless- 
 ings to-day, it is not from want of good will on his part. 
 
 Do not imagine, dear reader, that I am jesting, or exaggerating the 
 mistico-emphatic language of the German thaumaturge, in order to 
 render him ridiculous. Hear him speak, himself. After having 
 recounted how he had succeeded in finding the only true way of 
 obtaining veritable, easy, prompt, and certain cures, he exclaims: " For 
 truth is eternal, like divinity itself. Man may neglect it for a long. 
 time, but the moment comes at last when, in the fulfillment of the 
 decrees of Providence, its rays pierce the cloud of prejudices, and 
 throw over mankind a beneficent light, which henceforth nothing can 
 extinguish."* 
 
 ' Hahnemann. Organon. Paris, 1845.
 
 608 APPENDIX. 
 
 " If I did not know that I am placed in this world in order to 
 improve myself as much as possible, and to do to others all the good of 
 which I am capable, I should consider myself very foolish in making 
 the public acquainted, before my death, with an Art of Healing which 
 I alone possess, and whose advantages I might consequently have 
 enjoyed alone, by concealing this Art."" 
 
 The inventor of Homeopathy and infinitisimal doses might have been 
 asked — If you had kept your secret until you descended into the grave, 
 who could guarantee you that it would not have been buried with you ? 
 And even if it should not have fallen into oblivion after your death, 
 you would not have enjoyed during your life such notoriety ; you would 
 have passed away in some obscure corner of the world, and your exit 
 would not have caused the least sensation. You had therefore a great 
 and immediate interest in divulging as early as possible your discovery, 
 independently of the satisfaction which every man, every Christian 
 must feel in fulfilling a duty toward humanity. For nothing equals, if 
 we believe you, the frightful evils which were inflicted upon mankind by 
 former Medicine — this fatal Art, as you call it, which for centuries 
 has enjoyed the power to decide, arbitrarily, on life and death, which 
 destroys ten times more than do the most murderous wars, and which 
 makes millions of others infinitely greater sufferers than they were at 
 first.! 
 
 §VI. Conclusion. 
 
 I will limit here my citations. I believe that I have superabundantly 
 proved what I said at the commencement of this letter, that there exist 
 no more violent detractors of Medicine than physicians themselves. 
 Can we be astonished, after this, that we find among them so many who 
 are incredulous, so many sceptics, who exercise their Art without hav- 
 ing faith in it ? But I know of no more revolting position for a con- 
 scientious man, nor a more ridiculous one, than that of a physician who 
 has no confidence in the means he employs. Such a man can not possi- 
 bly pursue the study and the practice of his Art with the zeal, applica- 
 tion, and assiduity which alone can secure him real, honest success. 
 For, in order to study and practice Medicine well, says a wise man of 
 our time, we must give it great importance, and to be able to do this, 
 we must believe in it.J 
 
 *■' Hahnemauu. Traite des Maladies Chroniques. 
 
 f Organon. 
 
 I Cabanis. Du degrc de Certitude de la Medicine. 
 
 J
 
 FIRST LETTER. 
 
 609 
 
 It is therefore essentially necessary that the physician, as well as the 
 public, have a reasonable opinion on the degree of confidence which may 
 be placed in Medicine. But where shall we find motives of conviction 
 in favor of this science, when its most renowned masters are so bold and 
 so loud in discrediting it ? When every new medical generation accuses 
 all preceding ones of gross and fatal errors ? Who can assure us that 
 the teachings of to-day will not be treated as vain deceptions to-mor- 
 row, in a few years, or a century hence ? Is there in this matter any 
 certain sign, any criterion by means of which we may infallibly discern 
 the true from the false, the certain from the mere hypothetical ? This 
 we shall examine in our next letter.
 
 610 APPENDIX. 
 
 SECOND LETTER 
 
 IS THERE IN MEDICINE ANY MEANS OF DISCERNING THE TRUE FROM THE 
 FALSE, THE CERTAIN FROM THE HYPOTHETICAL? 
 
 §1. Importance of this Question. 
 
 It wants only one moment's reflection to be convinced of the extreme 
 importance of such a question, upon whose solution depends, if I do not 
 deceive myself, the whole future of the science. Indeed, if there exists 
 a criterion by the aid of which we can surely recognize truth in Medicine, 
 if this criterion is within reach of every mind, and is applicable to 
 every part of medical science, then we understand at once that this 
 science is possible, and those who devote themselves to its erection may 
 hope not to work in vain. 
 
 But if such a criterion does not exist, or has not been found, this 
 science is impossible ; then all our knowledge of medicine is conjecture, 
 hypothesis, and opinions, more or less probable. It is, therefore, of the 
 very greatest importance, before we lay the foundation of the scientific 
 monument of Medicine, that we examine if we possess a rule, a fixed 
 standard, accepted by all, by means of which we may judge with 
 certainty the value of the facts and ideas which shall in future consti- 
 tute this monument. 
 
 As a skillful architect, before he proceeds to the construction of an 
 edifice, reduces all his measures, and all his calculations to a known 
 and invariable quantity, called unit, so also must physicians choose a 
 fixed, uniform, and sure criterion, in order to estimate the degree of 
 certainty, adaptation, and utility, of the different propositions which 
 form the materials of their science. Without this precaution they will 
 never be able to agree upon any subject. Their discussions will con- 
 tinually degenerate into mere verbiage, as has been the case too frequently, 
 until now, and they will continue to offer to the world a ridiculous 
 spectacle, like individuals who, desirous of appreciating a common object, 
 as for example, the hight of a steeple, or of a mountain, still persist, each 
 one according to his own caprice, in taking a different standard as unit, 
 bearing no relation whatever to the other measures. Such surveyors 
 would most certainly never arrive at identical or even comparable results.
 
 SECOND LETTER. 611 
 
 It is, therefore, essentially necessary, if we wish to put an end to this 
 continued and profound conflict of medical opinions — a conflict so 
 injurious to the progress of science, and to the standing of those who 
 cultivate it — it is necessary, I say, to choose a mode of appreciation which 
 belongs to all times, and all places, embracing all facts, and all ideas, 
 that compose, or may yet compose, the science of Medicine ; which will 
 bring them all back to a unique, universal, invariable standard, known 
 and accepted by all. Now, in order to find such a mode of appreciation, 
 which is perfectly appropriate to medical researches, we must know their 
 final aim — just as a traveller must have fixed the point which he desires 
 to reach, before he decides which route to take, without which he travels 
 at hazard, like a fool. 
 
 Let us examine, therefore, first of all, what is the final aim of the 
 science of Medicine. 
 
 §^11. Final Aim of Medical Science. 
 
 In the primitive ages Medicine was defined to be the Art of Healing ; 
 at that time therapeutics was evidently the final aim of that science. 
 Later, when the field of observation had been widened, it was seen that 
 it was often much easier, and always more advantageous, to prevent 
 diseases, than to combat them after they were developed. Consequently, 
 the tree of medical science brought forth another branch, called hygiene, 
 or prophylaxy, whose special object consists in preserving health, or 
 preventing the development of diseases. Properly speaking, this new 
 branch is an offspring of therapeutics, and was so considered by many 
 ancient as well as modern authors, and thus this science has not 
 changed its aim by this accession, but has been enlarged and extended 
 by it. 
 
 For some time past. Medicine has occupied itself in a more eflacacious 
 manner, with two very important orders of morbid affections, which 
 formerly were entirely overlooked, or at least much neglected — I allude 
 to the deformities which are the objects of orthopedia, and mental 
 affections, which constitute at this time one of our most interesting 
 specialities. In view of these additions. Medicine can now be defined : 
 a science whose object is the preservation of health, the cure of diseases, 
 and the physical perfection of man. Eemark, I beseech you, that in 
 these successive evolutions the aim of the science does not change, and 
 it never leaves the sphere of therapeutics. Therefore, it may be said 
 for all epochs with equal truth : 
 
 Ars medica est id quod est propter therapeuLicen. 
 Everything in Medicine is related, or should relate, to therapeutics.
 
 612 APPENDIX. 
 
 § ni. Answer to the Question placed at the Head of this Lettee. 
 
 Now, as the aim of the science of Medicine is fully known to us, 
 nothing is easier than to determine the route which leads us to it, or, in 
 other words, than to find a sure method for the discovery and the founda- 
 tion of truth in Medicine. We can, from this moment, establish the 
 following general proposition : Every notion, every idea, every hypothesis, 
 every system, which is useless to therapeutics, must be banished from 
 Medicine, as useless and superfluous ; every notion, every idea, every 
 hypothesis, every system, which leads to false or hurtful conseq^uences 
 in therapeutics, must be rejected as tainted with error. 
 
 Then, if we ask by what means, in what way, we can assure ourselves 
 that any doctrine is either advantageous, or barren, or prejudicial to 
 therapeutics, I acknowledge that I know of none better, or more direct, 
 than experience. Thus, in my eyes, the universal criterion of truth in 
 Medicine, the supreme test of the value of all ideas and discoveries 
 which belong to this science, is none other than therapeutical proof . It 
 seems to me that I see the reader smile at this word, and hear him say : 
 This is certainly no new maxim I There is no one who does not agree 
 that therapeutical proof is the best and surest mode of verification which 
 we possess in Medicine — the ultima ratio of all medical doctrine. 
 Every day the founders of new systems appeal, themselves, to this defini- 
 tive tribunal. But this does not prevent and never has prevented the 
 most absurd theories, the most ridiculous errors, from invading the 
 domain of this science ; and there reigns to-day still the most complete 
 want of harmony among physicians upon the most fundamental ques- 
 tions of the Art. This objection, therefore, is serious, and should be 
 closer examined ; but I do not believe it insoluble, and I will endeavor 
 to reply to it. It is not sufficient to proclaim in a vague and general 
 manner that therapeutical proof is the best criterion in medicine ; it is 
 also necessary to know how to make a rational and methodical use of 
 this universally admitted criterion ; just as it does not suffice to possess 
 an excellent musical instrument in order to obtain pure and harmonious 
 sounds ; but we must also understand a good method of playing, and 
 have practised on it. 
 
 Now, I ask, does there at this time exist in our science a general sys- 
 tem of therapeutics, — a system which embraces as a whole, logically 
 arranged, all plans of treatment ? Is it not, on the contrary, an opinion 
 universally accredited in all the schools, that the time has not come yet 
 for a rational systematizing of this branch of Medicine ? You have 
 read in my First Letter (§1) what some of our cotcmporaries think
 
 SECOND LETTER. 613 
 
 upon this subject. You may appeal to any otlier of our modern classics — 
 you will not find in one of them a different opinion. All agree in 
 admitting rational and irrational modes of medication, which latter 
 they call also empirical. But what is oddest in this classification, is 
 that the modes of medication called irrational are generally the most 
 efficacious. 
 
 It is therefore a new idea, which possesses at least the merit of origi- 
 nality, to try to construct logically the entire field of therapeutics — to 
 unite in one plan and under the guidance of a unique principle all 
 modes of internal and external medication, without regard to any 
 pathological system. Such an idea must appear certainly very paradoxi- 
 cal to those who profess with M. Bouillaud that " therapeutics is neces- 
 sarily but a deduction, a corollary from the ideas which are formed on 
 the nature of diseases," and that it cannot be anything else. 
 
 § IV. Inquiry after the FuxDAiiENTAL and Uktveesal Principle of Thera- 
 peutics. 
 
 If the question were asked, what has taught men to provide for the 
 indispensable things of life, to prepare their food and clothing, to con- 
 struct habitations to shelter them against the rigor of the seasons, etc. etc., 
 no one would be at loss for an answer. It is want, necessity, the instinct 
 of self preservation. If we now ask, what has inspired these same men 
 with aversion to pain, the fear of disease and death, the desire to defend 
 not only themselves but also those who are dear to them, against these 
 afflictions ? we can answer with the same assurance : It is a natural, 
 irresistible instinct, which is felt alike by the savage on the desert and 
 the inhabitant of the city, by the poor and the rich, by the philosophic 
 and the illiterate. 
 
 Xow, experience early taught the inhabitants of the earth that nature 
 alone is insufficient to aid them, in many instances. As for example, an 
 individual breaks a limb: nature is incapable of bringing and keeping 
 together the two ends of the broken bone. Another dislocates an arm 
 or a leg. If he expects from nature the reparation of this accident, he 
 will be deprived for his whole life of the full use of his limb. A third 
 ruptures a large vein or an artery ; nature, powerless in this case, will 
 suffer this individual, full of health and life, to succumb from the loss 
 of his blood. Let a woman in labor be seized with couvulsioiis or vio- 
 lent hemorrhage, or let her child present itself in an unfavorable posi- 
 tion, and what will mother nature do in presence of such accidents ? 
 Nothing. She will allow both victims to perish. In fine, there
 
 614 APPENDIX. 
 
 happen every day in the natural course of life, a number of accidents 
 which nature alone is incapable of repairing. Hence men very early 
 acquired the conviction that they could only expect aid from Providence 
 when trying to aid themselves by every means at their command. Con- 
 sequently, as soon as one of them received a wound or was attacked by a 
 disease, those who had witnessed similar cases were invited to see it, that 
 they might indicate the remedies which they had seen employed in simi- 
 lar cases. Soon there were found men, especially old men, who distin- 
 guished themselves by their skill and experience in these kinds of acci- 
 dents, and who transmitted to others the fruits of their observations. 
 Such was, among many nations, the origin of medical science, as is 
 attested by tradition and authentic monuments." Afterward, the art of 
 writing having been invented, it became possible, with the aid of this 
 admirable art, to preserve indefinitely the remembrance of diseases, and 
 the means used for their cure. Henceforth they began to form nosologi- 
 cal collections, i. c. collections containing more or less detailed descrip- 
 tions of the morbid affections which were observed, and of the treat- 
 ment which was employed against them. These collections became the 
 first codes of the Healing Art, and the men who devoted themselves 
 especially to the care of the sick studied them no doubt as rules for 
 their conduct. Gradually these collections were enlarged by successive 
 additions of new observations ; so that When they had attained a con- 
 siderable volume, it became necessary to arrange the materials of which 
 they were formed, in a certain order, which made it easy to find at 
 pleasure the instructions that were wanted. This was the origin of 
 pathological classifications. The idea of it was suggested by the desire 
 to aid the memory and facilitate researches. 
 
 At that epoch very little was done in the study of the intimate 
 nature of diseases and the physiological action of medicaments. They 
 were satisfied to observe and to describe the morbid phenomena as 
 they showed themselves, and to note the apparent effects of the remedies. 
 And this is done yet by all persons ignorant of the science of Medicine, 
 when they undertake to give their advice to the sick. These persons 
 have no other way of expressing themselves than the following : I have 
 seen precisely the same disease cured by such or such remedy. 
 
 At first sight the medical practice of those primitive times seems to 
 us gross and scarcely reasonal)le ; but when we consider it nearer — when 
 we examine with unprejudiced eyes the motives which directed it, we 
 find that, far from being unreasonable, this practice was based upon a 
 principle of incontestible evidence, which may be stated in the following 
 
 ^ Primitive Period ; Medicine among the Egyptians.
 
 SECOND LETTER. 615 
 
 words: Every kind of medication tvhich has cured one disease 
 must also cure analogous diseases. No objection can be made to this 
 principle. It possesses all the clearness and infallibility of a mathe- 
 matical problem ; it corresponds with the following metaphysical axiom : 
 The same cause, the same force or the same combination of forces, acting 
 in identical conditions, will always produce the same effect. 
 
 We see also by a little reflection, that the above announced principle 
 embraces all the operations of internal and external Medicine, as well 
 as all the precepts of prophylaxy. Thus there has existed at all times 
 a fundamental and universal principle for the practice of Medicine ; a 
 principle by which the physicians of the most remote times were guided 
 without knowing it, and which is followed yet, though ignorantly, by 
 all persons without medical knowledge, when they undertake to give 
 advice to the sick. 
 
 But if it may be permitted, as Moliere says, to write prose without 
 knowiug it, it is still better to do so knowingly, because it is then done 
 much better. So if there are now persons who employ this fundamental 
 principle of therapeutics without understanding it, it is still better to 
 employ it understandingly. This is, besides, more worthy of a practi- 
 tioner who loves to understand the motives of his conduct, and it is also 
 more satisfactory for the patient. Let us see, therefore, how we can 
 make a logical application of the above proclaimed principle. 
 
 § V. Ratioxal Application of the Universal Axiom of Therapeutics. 
 
 I have said it was a new idea to try to bring therapeutics under the 
 dominion of a single principle, disconnected from all pathological sys- 
 tems. This is true only in regard to modern times, for there existed in 
 antiquity a sect of medical philosophers who conceived the same project 
 and attempted its execution. But their doctrine did not prevail, 
 because they did not develop it fully, or did not defend it well, or it 
 may be that their cotemporaries did not understand and appreciate it. 
 At all events, their labors and their system have been almost completely 
 lost, and their name has in many instances become a word of reproach. ="- 
 
 In reflecting a little upon this axiom, Each remedy ivhich has cured 
 one disease, must also cure analogous diseases, we can not fail to perceive 
 that its practical application depends upon three conditions, viz : the 
 homogeneousness of the diseases, identity of the curative means, and 
 knowledge of the best possible treatment for every morbid species. Let 
 
 ■ See Philosophic Period.
 
 616 * APPENDIX. 
 
 US see, therefore, how we can fullfil these three conditions, if not in a 
 perfectly exact manner, at least proximately. 
 
 riK3T CONDITION. — H O M O O E N E O U S N E S 8 OP DISEASES. 
 
 No practitioner during his whole life has ever met two identical mor- 
 bid cases, and nature perhaps never produces them exactly alike. We 
 must therefore be contented with a greater or less similarity. But on 
 what degree of approximation must the physician rest, or, in other 
 words, in what symptoms will he recognize similitude enough iu two 
 diseases, one of which is under his eye and the other has been observed 
 formerly, in order to treat the second by the same remedies as the first ? 
 
 We are touching here the most knotty question in pathology, the 
 question which has been the object of the most assiduous researches 
 and the most profound meditations, the question which has excited the 
 most discussions, given birth to the greatest number of systems, and 
 engendered the most errors : W/taf are the characteristic signs of the 
 homogeneonsness of diseases^ Interrogate the physicians of all sects 
 and of all times upon this subject, and they will all give you different 
 and even contradictory answers. 
 
 In the beginning, they were satisfied with a mere superficial resem- 
 blance ; it sufficed that a patient presented one or two symptoms similar 
 to those which had been observed in another, to authorize the applica- 
 tion of the same treatment. It is upon this same gross appearance that 
 quacks and charlatans judge yet, daily, of the similarity of diseases, on 
 which they advise certain kinds of medication. Let a child, for exam- 
 ple, be attacked with a slight impetigo of the face or head, and a quack 
 (pharmacopole) will not fail to prescribe bitters, depuratives, and setons, 
 without even examining the state of the digestive organs or the nervous 
 susceptibility of the little patient. Let an old man cough up some 
 mucus, and at once they administer a variety of cough mixtures. 
 
 Men accustomed to the observation of diseases dare not prescribe 
 remedies so thoughtlessly. They know how faulty and dangerous is 
 this manner of diagnosticating and determining a pathological state. 
 " I have always felt it acutely," says Pinel, "and I feel it yet daily, 
 how important it is for us to cultivate, after the example of naturalists, 
 the science of signs, to become accustomed to understand well the exter- 
 nal characteristics of diseases, and to be constantly guarded against 
 illusion and errors in difficult cases." 
 
 " Notwithstanding the immortal works of Morgagni," says M. Bouil- 
 laud, "notwithstanding the anatomo-pathological impulse which Bichat 
 and his school had given to Medicine, and which Pinel has the credit of 
 following in several parts of his nosography, notwithstanding all this,
 
 SECOND LETTER. 617 
 
 the time had not yet come when diseases were, so to say, personified, by 
 attaching them to the organs ; in a word, localizing them. This great 
 era, for which preparations had long been made, shone only in all its 
 splendor at the epoch when the author of Chronic Phlegmasia took the 
 scepter of Medicine, which the old I'inel had borne so long with honor, 
 but whose weight he could no longer bear. This new era dates from 
 the year 1816, when appeared the famous Examen dela doctrine Medi- 
 cate genrralement adoptee, with the following epigraph, taken from 
 Bichat : What is observation ivorth, if we are ignorant of the seat of the 
 disease ? 
 
 Thus the nosological formula of Pinel which had, at the commence- 
 ment of the nineteenth century appeared to be so exact, is judged as 
 insufficient by Broussais but a few years later ; and the formula of 
 Broussais, so highly praised by M. Bouillaud, appears to-day as incom- 
 plete in many instances, so true is it, that the diagnosis of diseases 
 changes in proportion to the progress of science, and offers at all times 
 difficulties which the vulgar do not even suspect. 
 
 It is frightful what immense and minute details M. Louis demands 
 for the true appreciation of pathological facts ; still, after serious reflec- 
 tion, we are obliged to agree with him that these details are necessary in 
 researches after truth. 
 
 Here is the abridged table of the principal characteristics which con- 
 stitute to-day the diagnosis of diseases, and by which we are able to 
 discern the different morbid species, or the homogeneousness of each, of 
 them : First, the circumstances anterior to the invasion of the disease, 
 which comprise the predispositions or diathesis, the occasional or deter- 
 mining causes, contagious infections, etc. ; " second, the anatomical seat 
 of the disease, i. e., the designation of the organ or tissue principally 
 affected, and sometimes the indication of a vitiated humor ; third, the 
 mode and degree of alteration of the organs ; fourth, the idiopathic and 
 sympathetic functional derangements, their regular or irregular, contin- 
 ued or intermitting course ; finally, the cadaveric lesions found in those 
 who have succumbed to the same morbid species. 
 
 We see by this enumeration of the principal objects which constitut-e 
 the diagnosis of a disease, that in order to be able to fulfill this condi- 
 tion well, we must unite to a most precise knowledge of nosography 
 and pathology, the lights of anatomy, physiology, chemical analysis, 
 pathological anatomy, etc., etc. 
 
 This immense difficulty of diagnosis is, without contradiction, one of 
 
 " Memoire sur I'Examcn des Malades et la Recherche des Faits generaux, by 
 M. Louis. Paris, 1846. 
 
 39
 
 618 APPENDIX. 
 
 the greatest obstacles whicli we meet with in the study and practice of 
 Medicine. There are no systems, no combinations which pathologists 
 have not imagined, with the view of overcoming or facilitating it. All 
 have endeavored to unite the infinite number of varieties of diseases 
 into a small number of types, distinguished from each other by appre- 
 ciable characteristics. 
 
 Hahnemann alone, wishing to spare himself and his disciples the labors 
 of diagnosis, has given the singular precept to note one after another, 
 without choice, without discernment, in the mere order in which they 
 make their appearance, all the symptoms observed during the course of 
 a disease, either by the patient himself or the physician. But this 
 method, apparently so natural and exact, is in reality extremely defec- 
 tive and even impracticable, as will be evident by the following table : 
 
 First, Such a method is extremely defective, for it makes the capital 
 error of ascribing the same value to all morbid phenomena, while there 
 exist immense diiFcrences among them, as the most superficial clinical 
 •observation proves. What shall we think of a pathologist who considers 
 as signs of the same disease, and as possessing equal value, the follow- 
 ing symptoms : 
 
 Insatiable thirst, 
 
 Palor of face, 
 
 Scrofula, 
 
 Sweating of the head after sleep. 
 
 Burning in the palms of the hands, 
 
 Frequent attacks of suffocation, 
 
 Furuncles, 
 
 Vomiting of blood. 
 
 Hiccough after eating or drinking, 
 
 Cutting pain in the rectum while at stools, 
 
 Absence of venereal desires, 
 
 Unbridled lusts. 
 
 Somnolency during the day, after meals, 
 
 Paroxysms of anger bordering on mental alienation. 
 
 Tears, frequently, at the slightest causes, etc., etc." 
 
 Thousands of phenomena, thus thrown together without order, consti- 
 tute no more clinical observation, and give no better idea of a disease, 
 than a number of stones piled up without plan constitute the Pantheon, 
 or than lines drawn capriciously on paper present the image of a regular 
 monument. This is certainly no method at all ; it is the absence, the 
 negation of all method in pathology. It is chaos. 
 
 '' See Treatise of Chronic Diseases by this author.
 
 SECOND LETTER, gJQ 
 
 Second, a peremptory motive opposes the adoption of such a proceed- 
 ing. This motive consists, as we have said above, in the impossibility 
 of its being put into execution. Indeed, let one try to note down all 
 the slight and grave, passing and permanent accidents which arise in 
 the course of a morbid affection, and take account of all the chano-es, 
 all the impressions, moral as well as physical, which the patient experi- 
 ences every day, every hour, yea, every minute. It would be just as 
 reasonable to try to count all the grains of sand driven before a storm, 
 or the atoms which a ray of light falling into a dark room, causes to 
 glitter in the air. Both the undertakings are equally impracticable and 
 futile. 
 
 We are therefore led by the natui^ connection of ideas, and the ir- 
 resistible force of things, to make a choice among the symptoms 
 which present themselves in the course of a disease. We are obliged 
 to ask ourselves the question : which are among the pathological symp- 
 toms, those which are of greatest importance, those which are less grave, 
 and those which are of so little value that they may without inconven- 
 ience, be entirely overlooked ? 
 
 SECOND CONDITION. — IDENTITY OP CURATIVE MEANS. 
 
 Hygiene and materia medica being the two sources from which Medi- 
 cine draws its means for combatting disease, it is evident that the prac- 
 titioner must be fully acquainted with the resources which these sci- 
 ences offer him. Xow, hygiene receives its light principally from physics, 
 chemistry, etc.; materia medica cannot be understood without a knowl- 
 edge of pharmacology, natural history, etc. Thus the practitioner dare 
 not remain a stranger to any of these branches of human knowledge, in 
 order that he may be able to choose, prepare and superintend the use of 
 curative agents with the greatest possible discernment and exactness. 
 It is furthermore indispensable that he obtain on the part of the patient 
 himself, entire obedience, and faithfulness on the part of the attendants. 
 
 THIRD CONDITION. — KXOWLED&E OP THE BEST POSSIBLE TREATMENT OF 
 EVERY MORBID SPECIES. 
 
 The aptitude to fulfil this last condition, that is, to discern the treat- 
 ment best adapted to each pathological case, constitutes alone the true 
 practitioner. This distinguishes him from the mere erudite ; it forms 
 the cap stone of all medical education. But nothing is more rarely 
 found than such an aptitude ; and nothing is more difficult to acquire. 
 It can only be attained by combining the scientific knowledge of the 
 century, with a large practice, directed by a wise method, and con- 
 ducted by a sincere desire to be useful to his fellow man, and by a rea. 
 sonable faith in the eflBcacy of the Art.
 
 620 APPENDIX. 
 
 It is a truth proclaimed by all the masters of science, that it does not 
 suifice to see a great number of patients, in order to become a good medi- 
 cal practitioner ; but that it is also necessary to examine every case 
 with a care and a zeal which cannot be sliaken by the fatigue or disgust 
 to which the practice of Medicine is subject. Now, he alone is able to 
 overcome such obstacles, who devotes himself to the study as well as to 
 the practice of his Art, with a real love for mankind, and a reasonable 
 confidence in the means he employs. Even popular instinct knows very 
 well how to distinguish the practitioner who observes his patients with 
 attention and interest, from him who scarcely examines them at all, lis- 
 tens to them inattentively, and prescribes for them with indiiFerence. 
 
 But let us suppose a physician to be provided with the necessary 
 knowledge, and animated by sentiments worthy of his profession, what 
 method must he follow to arrive at the determination of the treatment 
 best adapted to each morbid species ? 
 
 We have already said that the first experimenters did not reason at 
 ail upon the intimate action of remedies, but that they contented them- 
 selves to observe their most apparent efifects, and to note those which 
 had cured, or seemed to have cured certain diseases, in order to employ 
 them again in similar cases. The first materia medicas were so 
 arranged that curative means were classed according to their most 
 usual and evident efifects. Blood letting for example, must have 
 been classed among the depletives of the blood vessels ; hellebore 
 with the eccoprotics, because it produces, generally, alvine evacuations : 
 opium with the upnotics or anodynes, because it often produces sleep. 
 and allays or cures pain. This classification, and these denominations, 
 were irreproachable, for they were founded upon a real and incontestible 
 action of the curative agents. Besides, if imperfections or errors had 
 entered into the first collections in consef[uence of superficial or too 
 hasty observations, a riper, more attentive observation, would lead to 
 their expulsion. Thus, for example, after having classed opium with 
 the upnotics, nothing forbade to add that this substance sometimes pro- 
 duces agitation instead of sleep ; whence it follows that it is to be ad- 
 ministered with great circumspection, and only after determining fully 
 under what circumstances and in what doses it produces or augments 
 agitation. 
 
 We see by these examples that therapeutics, which from the begin- 
 ning had been founded upon the simple results of experience, should 
 have been enlarged and perfected by the same method, that is, by con- 
 tinuing to take into account only the pure results of experience, without 
 seeking to explain them. Such is, indeed, the method to which Bichat
 
 SECOND LETTER. 621 
 
 seems to allude in the followiug sentence : " Except the medicines whose 
 effects are established by strict observation, such as the evacuants, diu- 
 retics, sicdagogues, etc., and to xohat does our knowledge of the rest 
 amount ? " 
 
 But there arrived a time when tliis manner of studying the action of 
 therapeutic agents appeared to be too simple, too superficial, too much 
 subject to error. Physicians wished to penetrate deeper into the secret 
 of the modifications which eacb medicament produces upon the human 
 economy. They reasoned thus : The sensible eff"ects vary frequently, 
 according to a great number of circumstances, often difficult to appreciate. 
 As these consecutive effects all depend upon the intimate molecular im- 
 pressions which each therapeutical substance exercises constantly in the 
 organism, if we can only arrive at determining the nature of this impres- 
 sion, we shall, by this means, know the secondary efi'ects which depend 
 upon them — we shall be able to foresee and explain them logicOjlly. 
 
 This new method was considered the most rational, the shortest and 
 most direct. It prevailed, at length, almost universally in science, and 
 is yet followed by most of our medical writers. Still it has produced 
 but very unsatisfactory results, as we can judge from the great want of 
 harmony which reigns to day upon this subject in the profession, as I 
 have proved in my First Letter, and which Bichat has painted in such 
 energetic colors. 
 
 " Into what errors in the use and denomination of medicines have we 
 not been lead "? When the theory of obstruction was in vogue, desobstru- 
 ants were created. Incisives sprang up when the theory of the thick- 
 ening of the blood became the favorite idea. The expressions. 
 dilutants and attenuants, and the ideas which were attached to them, 
 arose at the same epoch. AVhen it was necessary to obtund acridity, 
 inviscants, incrassants, etc., were created. Identical means have often 
 had different names, according to the manner in which they were sup- 
 posed to act — desobstruant with one, relaxant with another, refrigerant 
 with a third — the same medicament has been employed in turn, with 
 different and even opposite views, so true is it that the human mind 
 marches at hazard where the vagueness of mere opinions guide it." =•' 
 
 This would be the place to speak of the therapeutical methods — that 
 is, of the general plans of treatment which might be formed in the actual 
 state of science, independently of all pathological systems. But I can- 
 not treat at the end of a letter, so important a subject, upon which I 
 have to say so many things which differ from the ideas received in our 
 
 '- Anatomie Generale.
 
 622 APPENDIX. 
 
 schools. I shall reserve it, therefore, for another occasion, when it will 
 be possible for me to ti-eat it as widely and as much in detail as the 
 subject demands. 
 
 §VI. COXCLUSIOX. 
 
 We have proved that in the eyes of the learned, as well as the ignor- 
 ant, those well versed in the science and practice of Medicine, as well 
 as in those who are strangers to the Healing Art, the best criterion of 
 truth in Medicine is nothing else than therapeutical proof ; conse- 
 quently we have endeavored to establish this proof on a fixed, evident, 
 and incontestible principle, not subject to the vicissitudes of pathological 
 theories — and we have found that this principle may be expressed as 
 follows : That medication which has cured one disease, must cure 
 equally, all analogous diseases. Whence is derived this universal and 
 absolute precept : Treat each disease by the means whose efficacy expe- 
 rience has demonstrated in homogeneous cases. 
 
 Then we have shown that the rational application of this axiom 
 rests on three conditions, whose fulfillment demand that the practitioner 
 possess, with the scientific knowledge of his time, a consummate experi- 
 ence — in other words, that its rational application necessarily requires 
 the indefinite developement of all intrinsic, as well as accessory branches 
 of medical science. Under the impulse of such a principle, science has 
 grown from its origin, and must continue to grow in the future. 
 
 For this reason one of our most ancient authors could say with 
 deeply felt truth : " Medicine has long been in possession of a principle 
 and a method, both of which it has found. AYith these guides, numer- 
 ous and valuable discoveries have been made in the course of centuries, 
 and the rest will be ascertained when capable men, acquainted with the 
 discoveries of the ancients, take these as a starting point for their 
 researches. But he who, rejecting and disdaining the past, attempts 
 other methods and other paths, and then pretends to have found some- 
 thing, deceives himself, and will deceive others." ■■■' 
 
 These prophetic words have not prevented a great number of poste- 
 rior authors from seeking other paths, and from proclaiming new prin- 
 ciples. What have been the causes of this scientific revolution '? What 
 are even to-day its consequences ? These are questions which I pro- 
 pose to examine in my next letter. 
 
 ■" Hippocratic works, Treatise on Ancient Medicine.
 
 THIRD LETTER. 623 
 
 THIRD LETTER. 
 
 § I. Causes which ikduced the Physicians to leave the Primitive Route of 
 PuEE Observation. 
 
 Ai't is long, life is short, expei-ience deceptive, and judgment dijfficidt, 
 said Hippocrates, when he was about to give to the public his Aphor- 
 orisms, that summary of the medical science of his time, collected by 
 him and his associates in the temples of Esculapius during a series of 
 centuries. This sentence, which we must regard as the scientific testa- 
 ment of the greatest physician of ancient times, contains the entire 
 secret of the intellectual revolution which we are going to trace. Phy- 
 sicians abandoned henceforth the path of pure and simple observation, 
 hoping to find a surer guide in physio-pathological observations, and 
 with the view of hastening the too slow progress of the Healing Art, 
 of avoiding the interminable and dangerous gropings of experience, and 
 of overcoming the difiiculties of diagnosis. 
 
 Indeed, the universal precept of therapeutics, given at the end of the 
 preceding letter in these terms : Treat every case of disease hy the rem- 
 edies whose efficaciousness in similar or homogeneous cases has been 
 joroved hy experience ; this precept, I say, which the physicians of the 
 primitive period had followed instinctively, presupposes the knowledge 
 of a treatment for every morbid species, and the capacity of discovering 
 fully the homogeneousness or similarity of diseases. Now science is 
 yet far distant from this degree of perfection, notwithstanding the 
 incontestible progress it has made since the time of Hippocrates. "We 
 meet in practice, almost daily, diseases for which experience has until 
 now discovered no sure remedy. Again, it is often the case that a rem- 
 edy which formerly was remarkably efiicacious in certain affections, 
 now fails in cases considered as entirely analogous to them. 
 
 In all these unfortunately too frecjuent circumstances, the above pre- 
 cept leaves the physician in embarrassment ; it indicates to him in no 
 way the conduct he should pursue. The physicians of the Empirical 
 school of Alexandria recognized this void, and they endeavored to fill it 
 by adding to their general rule of therapeutics a corollary, under the 
 name of analogism or epilogism. This corollary was as follows :
 
 624 APPENDIX. 
 
 EXAMPLES OF EMPIRICAL ANALOGY. 
 
 If you meet, said these physicians, with a morbid condition for which 
 neither your own nor others' experience furnishes any therapeutical indi- 
 cation, you can do nothing else in such a case than experiment. You 
 must seek with what known affection this new one may have any analogy. 
 and try in this case the remedies which succeeded in the former. Thus 
 the treatment which has been employed successfully in erysipelas, might 
 also be tried in certain tetters ; so the remedy which cured a rheuma- 
 tism of the arm, will, in all probability, cure a rheumatism of the leg. 
 
 They adopted the same manner of reasoning when seeking curative 
 agents which we call succedaneous or supplementary, when the known 
 means were not sufficient. Thus, experience having shown that the juice 
 of the quince was useful in diarrhea, if they could not procure them- 
 selves that substance, they tried to replace it by another which had a 
 sensible analogy to the first ; for example, the juice of the medlar plant, 
 which is analogous to the above by its sharpness, appeared to them as 
 proper to fullfil the same indication. 
 
 The analogies of the Empirics were all founded on sensible and appa- 
 rent qualities, whether they applied themselves to diagnosis or to the 
 choice of curative agents. 'J'hese analogies appeared too superficial and 
 unsafe to the Dogmatists. These preferred seeking more radical analo- 
 gies, that is to say, those founded on less superficial and more stable 
 (qualities, which they honored with the names elementary, constitutional 
 essential, or occult qualities, etc. 
 
 EXAMPLES OF EMPIRICAL EPILOCISM. 
 
 If a patient feels in the hypogastric region intermitting and violent 
 pains, which are exasperated in walking or riding, but are, on the con- 
 trary, quieted by repose, if in this patient the emission of urine is 
 sometimes suddenly interrupted for a longer or shorter period, it may 
 be conjectured that the presence of a calculus in the bladder is the 
 cause of all these symptoms. 
 
 Finally, if a metal ic sound introduced through the urethra into this 
 membraneous reservoir, causes the hand which directs it to feel a sen- 
 sation of rubbing against a solid and ragged body, your conjecture 
 becomes certainty, for cadaveric researches and the operation of lithon- 
 tripsy have taught us that a vesicular calculus gives rise, ordinarily, to 
 such a concourse of symptoms. Let a man bitten by a strange dog, 
 which has immediately run away, present a few days afterward symp- 
 toms of hydrophobia, we are authorized to think that the animal was 
 mad, although he exhibited no signs of hydrophobia at the time.
 
 THIRD LETTER. 625 
 
 Thus we see by what use of reason the Empirics attempt to go back 
 to morbid causes, for the moment concealed, but susceptible of falling 
 under the senses. They named them the occasional or evident causes. 
 
 The Dogmatists were not content with the knowledge of this order of 
 causes. They wished to penetrate the intimate mechanism of the phe- 
 nomena of nature : they sought there the causes called immediate, or 
 integral, or essential, etc. ; and they pretended to establish upon these 
 their curative indications. 
 
 The analogism of the Empirics stopped at those qualities, which are 
 regarded as superficial, unimportant, or too mobile ; their epilogism 
 tended only to the discovery of causes foreign to the organism, whose 
 action they did not all attempt to determine. However, these theorists 
 rejected too absolutely the lights of anatomy and physiology. They 
 did not comprehend that without them, diagnosis must fail in preci- 
 sion, in a crowd of cases ; that is to say, that there is danger of consid- 
 ering, as homogeneous, very dissimilar diseases, and as heterogeneous 
 affections, those which have the greatest analogies. 
 
 The Empirical system, such as it has been transmitted to us by histo- 
 rians, confines the human mind in a too narrow circle. Xow the mind 
 is so constituted, that it prefers to go astray in attempting to pass the 
 limits which have been imposed to it by the Creator, rather than to 
 remain thus contracted. In an epoch when the jjhilosophers pretended 
 to explain the enigma of the universe, or macrocosm, by speculations on 
 the atoms, or elements, or the harmonizing forces, how could the physio- 
 logists be prevented from speculating on the motor principal of the 
 animal economy, on the elementary humors of the human body, on the 
 primordial causes, and the phenomena constituting diseases, on the inti- 
 mate action of remedies, etc. ? 
 
 This system was therefore rejected because it stopped only at gross 
 appearances, rested on the changing ground of experience, gave no satis- 
 faction to our natural desire to understand causes, and offered to the 
 Healing Art no fixed and solid basis. Consequently, the primitive way 
 of pure observation was abandoned, and they sought another route, and 
 other principles, which seemed to guide more directly to the final aim of 
 medical science, namely : the preservation of health, and the cure of 
 diseases. They reasoned as follows : In order to find the best means of 
 preserving the health and life of the body, it is necessary to know the 
 parts of which it is composed, what elements constitute it, what forces 
 sustain it, and what laws regulate the action of these forces; so, also, 
 to be prepared to cure, certainly, diseases, they must be known in 
 their mode of formation, their generating causes, and their essential
 
 626 APPENDIX. 
 
 phenomena. This was the unique source, according to them, whence could 
 be drawn the rational indications of treatment. Without this know- 
 ledge, the physician was likened to a blind man armed with a club, who 
 strikes at hazard the disease or the patient. 
 
 Such is the argumentation, unceasingly presented, under a thousand 
 forms, since Hippocrates, and on which physicians have based their 
 ideas for advancing physiology and pathology to the first rank of the 
 branches of medical science, and for placing therapeutics as secondary, 
 as being only a deduction or corrollary fi-om the preceding. Consult the 
 most famous theorists of antiquity and modern times — all, or nearly all, 
 reproduce the same arguments in terms more or less explicit. 
 
 §11. Consequences of this Scientific Revolution. 
 
 From the moment that it was admitted as a principle, that physiology 
 and pathology are the basis of therapeutics — that the treatment of any 
 disease whatever ought to be deduced logically from the idea we form of 
 its nature, of its intimate phenomena, and of its causes — from that 
 moment, all the researches of physicians had for their chief end, to 
 determine the laws of life, and the nature and mode of generation of 
 morbid affections. From that time, also, all medication whose effects 
 could be explained according to the physio-pathological ideas of the day, 
 was esteemed rational. All medication, on the contrary, whose effects 
 could not be in any way explained by such reasoning, was deemed irra- 
 tional or illogical, whatever might be its efficacy. 
 
 In this order of ideas, as is seen, therapeutic proof ceased to be the 
 highest criterion of truth in Medicine, the ultima ratio, that may be 
 given as a justification in the choice of a treatment. Indeed, according 
 to these views, in practical medicine, the physiological explanation of the 
 curative action of medicines becomes the ultima ratio. Such is the 
 plan, such is the philosophy, from which have been constructed all of the 
 ancient and modern systems of Medicine, with the exception only of 
 Empiricism — Hippocratists, Methodists, Eclectics, Mechanists, Chymiater, 
 Solidists, Humoralists, Animists, etc. All these medical sects, so divided 
 among themselves, agree so far as to subordinate their curative methods 
 to some physio-pathological idea or notion. If we pass by the extin- 
 guished theories before the end of the last century, and cast a rapid 
 glance upon those of our age, we will be easily convinced of the truth of 
 what I advance.
 
 THIRD LETTER. 627 
 
 ORGA NO-DYNAMISM. 
 
 Haller had published his great system of physiology ; his experiments 
 upon irritability had filled the learned world with admiration. Brown, 
 as profound a logician as he was a superficial observer, having directed his 
 mind upon this physiological property, believed that he could explain by 
 it, all the phenomena of life, and establish on this basis, a complete sys- 
 tem of Medicine. He afiirmed that life itself, in health as well as in 
 disease, is an efiect of stimulation, and of stimulation only ; that every 
 morbid affection consists in an excess or a deficiency of stimulus ; that 
 the result of every curative action reduces itself to an increase or dimi- 
 nution of excitement.'-' 
 
 The Easorians, adopting the same idea, did not see in any disease, but 
 an excess or deficiency of vital force, a hypersthenia or a hyposthenia ; 
 and, in the action of therapeutical remedies, either an increase or a dimi- 
 nution of this force. 
 
 But they differed from the Brunonians, in considering excitability as 
 uniformly diffused in the animal economy ; whilst the disciples of Ea^'ori 
 considered it unequally distributed in the various tissues and organs. 
 The first admitted only general diseases and general excitants ; the latter 
 recognised special affections, either in regard to their seat or their nature, 
 and remedies, whose actions are manifested by preference, upon this or 
 that organ. 
 
 Broussais, also, changed nothing in the physiological idea of Brown ; 
 he expressly acknowledges it himself. " Brown," he says, " held as an 
 essential principle, that life is only supported by stimulants, and that 
 to live is nothing else than to be excited. Thus far this is true. It is 
 very evident that everything which sustains life has no other percepti- 
 ble effect, to the sense of the observer, than to reanimate the phenomena 
 to which we attach the idea of life, when they are gTowing feebler, and 
 seem to tend to their extinction. 
 
 " But to draw advantage from this principle, it is necessary to study 
 all the parts of the body in connection with the external excitants — to 
 seek in what manner the organs excite each other reciprocally — to 
 study attentively the effects of external and internal excitants in each 
 of the tissues of which the organs are composed. Now this is what 
 Brown did not do : for this mode of studying excitement is nothing else 
 than the French doctrine, which bears the name of physiological doc- 
 trine, or, if it is prefered, physiological method." f 
 
 ^Elements of Medicine by Brown, chap, m, § 22, 23. 
 f De Plrritation et de la Folic, ch. ii, p. 47.
 
 628 APPENDIX. 
 
 In this passage Broussais characterises with great clearness, the theory 
 of Brown and that of his own. We see that he adopts, without any 
 restriction, the physiological principle of the Scotchman ; but that he 
 studies the effects of excitation, not in the economy as a whole, but in 
 each tissue — in each particular organ, after the manner of the Easorians. 
 
 Perhaps you will inquire in what do they differ? In this that 
 the latter consider the special action of most of external modifying 
 agents on every part of the organism as ab-irritative or hyposthenic — 
 while the French pathologist considers this same action as hypersthenic 
 or irritative. Here, then, we have three logicians, each possessing extra- 
 ordinary strength, who deduce three systems from the same physiolog- 
 ical idea — whose practical conclusions are antagonistic or widely different 
 — a curious and instructive spectacle, well calculated to render us cir- 
 cumspect in the application of physiology to therapeutics. Thus the 
 French reformer attributed to his doctrine the exclusive epithet, physi- 
 ological ; this artifice of language can deceive no one. It is very evident 
 that his doctrine does not derive more from physiology than the two 
 preceding, nor more than those which we are about to consider. The 
 only difference is that each one these systematists pretended to under- 
 stand physiology better than his predecessors and adversaries. 
 
 Toward the end of the last century and the beginning of the present, 
 one of the most vast and profound minds which has honored French 
 Medicine, Barthez, proposed, likewise, to establish medical practice upon 
 physiology, in a work intitled " Xew Elements of the Science of Man." 
 He declares in his preface that such is his aim and hope. '• Indepen- 
 dently of its utility in metaphysics and morals, the physical science of 
 man presents to curiosity as great an attraction as any other science ; 
 and it acquires the highest degree of interest when we see that it forms 
 the foundation of knowledge necessary to the art of curing." =■•■' He writes, 
 in several other passages, on the necessary union which exists between 
 physiology and practical medicine, and he terminates with indignant 
 expressions against those who do not partake of his convictions on this 
 point. 
 
 Barthez admitted in the human body three orders of forces, or three 
 dynamisms : First, a material aggregate, which obeys physico-chemical 
 laws ; second, a harmonizing force, which he calls vital principle — a 
 force which, spread out in all parts, and residing in no one exclusively, 
 
 ■*New Elements of the Science of Man. Paris, 1806.
 
 THIRD LETTER. 629 
 
 makes them sympathize with each other, coordinates movements to a 
 common end — the preservation of life, and acts in all things automatic- 
 ally under particular laws, without having conscience either of its 
 existence or its. acts ; third, and finally, an immaterial principle, called 
 soul, endowed with spontaneousness of conscience and perception, capa- 
 ble of influencing, accidentally, all the vital functions. The following 
 passage may be cited among many others, where this triple dynamism 
 is plainly indicated. 
 
 •' The order of the phenomena of death in man is as follows : first, the 
 separation of the soul from the body ; second, the extinction of the forces 
 of the vital principle ; lastly, the chemical dissolution of the body. =••■ '■-■ 
 The metamorphosis of the terrestrial part of it is fully known, but the 
 fate of the vital principle after death is a mystery. If this principle 
 is but a faculty united to the living body, it is certain that in the destruc- 
 tion of this body, it reenters the system of forces of universal nature. 
 If it is a being distinct from the body and the soul, it may possibly 
 perish by the extinction of the forces of the body which it animates, 
 or it may pass into other human bodies and vivify them by a kind 
 of metempsychosis." " 
 
 Barthez doubted the independent existence of the vital principle, dis- 
 tinct from that of the body and the soul, or whether it be but a modality 
 of organized matter, a faculty endowed with motor forces, which are 
 the necessary consequences of the material combination of which each 
 animal body is formed. 
 
 M. Lordat, the inheritor and perpetuator of this doctrine, does not 
 hesitate to raise this doubt. He afilrms that the mysterious principle 
 which gives impulse to the animal economy enjoys an independent exist- 
 ence, separated from that of the body and the soul. He consecrates to 
 the demonstration of this opinion an entire book, under the title of 
 Insenescence Du Sens Litinie. 
 
 I must confess, that the school of Montpellicr appears to me to be in 
 possession of a physiological truth of high importance, which it is right 
 not to abandon. Its doctrine on the vital principle or the harmonizing 
 force of organized bodies, is very justly named Hippocratic. It is 
 indeed stated in several of the writings attributed to the physician of 
 Cos, who gives to the harmonizing force of the living organism divers 
 names. He calls this force, according to the aspect under which he 
 regards it, either motor euopfxov, or nature (^'O^c;;, etc. We read, among 
 other things in the Treatise on Aliment : '• Nature is equal to and 
 sufficient for all things. * = ■= There is in the interior an unknown 
 
 ' Ibidem. Last chap., cccxvi and cccxvit, book II.
 
 630 APPENDIX. 
 
 agent who works for the whole and for the parts; sometimes for certain 
 ones and not for others. =•' Nature is one in all, but infinitely 
 
 varied. •' " There is but one end ; there is but one effort. The 
 
 entire body participates in it ; it is a universal sympathy." '^"- 
 
 This opinion, derived from the philosophy of Pythagoras, renewed by 
 Leibnitz, has been adopted by a large number of naturalists and physi- 
 cians of all countries and all times. It appears to be generally followed 
 in Germany. M. Miiller, Professor in the University of Berlin, after 
 having discussed it with great depth and impartiality, concludes by 
 inclining to it. f But we do not intend to examine here how far such a 
 doctrine is founded in physiology. We have to occupy ourselves only 
 in regard to its consequences upon practical medicine. 
 
 Now, from the moment that we recognize in human nature a triple 
 dynamism, to-wit : an aggregate material, a vital harmonizing force, 
 and an immaterial essence whose determinations react sometimes on the 
 living organism, we must admit that each one of these dynamisms 
 reveals itself to the eyes of the observer by special functions which may 
 be injured either separately or simultaneously. Thence result three 
 general classes of diseases. The first class comprises the physico-chem- 
 ical alterations of the solids and fluids ; the second, the lesions of the 
 vital force or properties ; the third, the affections of the soul. Such 
 is, indeed, the nosological classification indicated by M. Barthez. \ I 
 do not intend to consider here the grave objections which might be 
 raised against this classification of diseases. I pass immediately to 
 the practical consequences which result from it, according to its author, 
 who expresses himself in the following language: " My new doctrine on 
 the faculties and functions of the vital principle being rigorously 
 deduced from facts, and independent of all the systems of the differ- 
 ent sects in the Science of Man, does not exclude any of the views 
 which are essential to recognize, to perfect and to multiply all the meth- 
 ods, natural, analytical and empirical, which the art of curing may 
 embrace in the treatment of the divers kinds of disease." 
 
 But let us now permit M. Lordat to explain to us what are the thera- 
 peutic methods to which he makes allusion : " The Natural methods are 
 those whose object is to favor, to accelerate or to regulate the course 
 of diseases which tend to a happy solution. * =■■' =•■•= The Analytic 
 methods are those in which, after having decomposed a disease into its 
 essential affections which produced it. or into the more simple diseases 
 
 " Works of Hippocrates. Treatise on Aliments, §§ 3 and 4. 
 
 f Manual of Physiology. 
 
 X New Elements of the Science of Man. Preliminary Discourse.
 
 THIRD LETTER. 631 
 
 ■which complicate it, we then attack directly these elements of disease, by 
 means proportioned to their relations of force and of influence. '■•' * ^■■* 
 The Empirical methods are those whose efficacy have been established by 
 experience, but whose immediate and primitive efi"ects have no connec- 
 tion with the cure of the disease, intelligible to our minds." " 
 
 This classification of therai)eutical methods is very important, and 
 merits a profound discussion, upon which I shall not again enter here, as 
 I have treated it fully already in the Article on Animism and Vitalism. 
 I will add to what I have said there, but a simple reflection : How is it 
 that Barthez, who pretends to found therapeutics on physiology, did not 
 see that there does not exist any rational connection, any coiTclation 
 which the human mind may appreciate, between his triple dynamism or 
 his physiological ternary, and the three modes or general plans of curing 
 above given ? However, far from blaming him for having tried to ren- 
 der practical medicine independent of all systems of physiology and 
 pathology, I praise him, on the contrary, highly for it. What I blame 
 him for is, not to have been able not to render it independent of his own 
 system, as well as those of others. He could then have established 
 a true and lasting doctrine of therapeutics, instead of which he has 
 only shed a ray of light on this important and difficult branch of medi- 
 cal science. Nevertheless, this ray of light is a service rendered to pos- 
 terity, which has accepted it, and by freeing it from the shadows and 
 errors with which it is still enveloped, will cause it to shed forth a clear 
 and vivifying light. 
 
 HOMEOPATHY. 
 
 No one has raised himself with more force and perseverance against 
 all physiological and pathological systems than the author of the home- 
 opathic doctrine. He wars against them from the beginning, in all his 
 writings, but particularly in a pamphlet entitled, " Value of Medical 
 Si/stems ;" and in the paragraph of his Materia Medica, entitled, A 
 Souvenir, he declares emphatically that Medicine is and only can be 
 but an empirical science, the same as physics and chemistry. f He 
 charges the pathologist, sometimes with creating imaginary morbid 
 entities, purely nominal, by means of symptoms grouped arbitrarily, and 
 sometimes with seeking the cause of the ills which afflict man in the 
 
 "^ Explanation of the doctrine of Barthez, by M. Lordat. 
 
 f True, Medicine is, from its nature, simply an empirical science, and can only 
 be based upon pure facts and sensible phenomena belonging to its sphere. ^' "' 
 In the purely empirical sciences, as Physics, Chemistry, and Medicine, the purely 
 speculative mind must not be allowed any decisive influence. — Organoji,thc Art 
 of Curing.
 
 632 APPENDIX. 
 
 depths of physiological abstractions, such as the diverse degrees of 
 lesions which sensibility, irritability, and nutrition may undergo. He 
 attacks them with the weapons of reason and ridicule. He adjures them, 
 in the name of conscience and religion, to renounce such errors. 
 
 Who would not expect, after so many declamations, that the founder of 
 Homeopathy, the inventor of infinitesimal doses, would abstain entirely 
 from all physiological explanation ? that he would invoke in favor of 
 his doctrine experience only, pure experience, as he incessantly repeats ? 
 Well, undeceive yourself. The whole explanation of his system is, from 
 beginning to end, but a physio-pathological theory, a long dissertation 
 on the essence of disease, and the intimate action of medicines. He 
 says, for example, that diseases are but the immaterial alterations of an 
 imp>alpahle vital principle ; hence he concludes that we must attack them 
 by forces of the same kind, that is to sa}", by spiritual virtues of 
 medicines." 
 
 He asserts, for example, that two affections alike in their symptoms, 
 but different in their essence, destroy each other when they meet in the 
 same organism ; he proves this, not by observation, but by the most 
 subtile argument, and one of the most arbitrary hypotheses, f I will 
 not dwell longer on this doctrine, which I propose to submit hereafter 
 to a special examination. It is sufficient for the moment to have dem- 
 onstrated by striking proofs that Samuel Hahnemann, after having stu- 
 pidly reprimanded the theorists who pretend to base therapeutics on 
 considerations drawn from physiology and pathology, falls himself into 
 the same fault with which he reproaches others. Besides, a much more 
 eminent physiologist, Bichat, has committed quite the same inadver- 
 tence. After having charged the influence of the physio-pathological 
 theories as being the cause of the instability of the denominations of 
 the Materia Medica, and of the vagueness and incoherence of therapeu- 
 tics, he throws us back into the same path, by affirming that the action 
 of curative agents reduces itself to restoring the vital forces to their 
 natural type, from which they were diverted by disease.; 
 
 ECLECTICISM. 
 
 I have but two words to say here upon this doctrine, of which I shall 
 speak elsewhere at more length. I wish to observe only, that it aspires, 
 like the preceding, to establish its curative indications on physio-patho- 
 logical views and facts. The eclectic does not accept entirely any one 
 of the physio-pathological interpretations proclaimed by the diverse 
 
 " Organon, sec. 53, etc. f Ibidem, § 40. 
 
 X General Anatomy — General Considerations, § u.
 
 THIRD LETTER. 633 
 
 systems, but neither does he deny any one in an absolute manner. He 
 pretends to draw from each one of them what is suitable to him, with- 
 out subjecting himself to any fixed rule, and puts experience and rea- 
 son in the scale in order to decide on each particular case. 
 
 But within what limits does he interrogate these two faculties, or 
 these two modes of act|uisition ? This is what the Eclectic never tells 
 us ; thus he gives us no assurance that we shall not make choice of 
 error rather than truth, of deceptive fiction rather than reality. 
 
 Medical Eclecticism escapes all general description by the absence of 
 a common formula and a fixed symbol. The eclectics have among them- 
 selves very often nothing else in common but their names, and a decided 
 aversion for the discussion of principles. But it is true, that far from 
 denying the physio-pathological theories, they seek them, and endeavor 
 to deduce therefrom their methods of treatment. 
 
 III. CONCLUSION. 
 
 We have seen that at an undetermined epoch in the history of Medi- 
 cine a capital revolution took place in this science ; that the method of 
 pure observation had been abandoned, to follow another route, in appear- 
 ance shorter, surer, and more rational ; thinking that the study of the 
 elements of the body and their properties, of the laws which govern the 
 functions of the animal economy, and of the causes and production of 
 diseases, would establish the Art of Curing upon a firmer basis than 
 crude results of experience. Henceforth, there was established among 
 physicians a general opinion, which considered therapeutics as a deduc- 
 tion, a corollary form the laws of physiology and pathology. 
 
 A single sect in antiquity resisted this idea, and tried to trace another 
 plan of studies, and other rules of practice ; but it perished after a 
 short popularity ; its name and its memory were for a long time held 
 in dishonor by medical posterity. However, since the revival of letters 
 in Europe, more than one philosopher, more than one physician of high 
 reputation, has dared to judge this doctrine less severely. 
 
 The testimonials in favor of rational Empiricism are not wanting 
 among the writings of the two last centuries, and these evidences become 
 more and more numerous and imposing as we approach the present epoch. 
 In our day a multitude of authors are animated with the spirit of Em- 
 piricism, and proclaim its maxims without rallying openly under its 
 flag. Those who oppose it most warmly in their books, in theory, do not 
 hesitate to take it for a guide in their practice at the bed side. There 
 exists even in Paris an entire class of Physicians, united under the 
 name of the " Society of Medical Observation," which has emitted 
 40
 
 634 APPENDIX. 
 
 principles and metliod, evidently empirical, whose doctrine, though still in 
 the embryonic state, includes in France, as well as in foreign countries, 
 numerous adherents.' ■ Upon the whole, there prevail at this time in 
 Medicine, three opinions, three general methods. One pretends to 
 deduce all therapeutical indications from the laws of physiology and 
 pathology. We will designate it by the term physio-pathologism. The 
 other affirms that no mode of treatment can be derived from physio- 
 pathological notions in a direct and immediate manner, and draws all of 
 its practical rules from the pure results of experience ; this is the old 
 Empiricism, which we name rational Empiricism, or Empiri-methodism. 
 
 The third, which derives its curative indications, sometimes from 
 physio-pathological ideas, and sometimes from crude facts of experience 
 is medical Eclecticism. 
 
 These three opinions, these three methods, are contradictory, as it is 
 easy to see ; one of them being true, the other two must necessarily be 
 false. It is then of the greatest importance to make correct choice, for 
 on this choice depends all the future of medical practice. To remain in 
 doubt is impossible, at least in practice ; to decide by chance in a matter 
 which interests to such a degree the health and life of mankind, would 
 be the act neither of a philosopher, nor of an honest man. We proceed, 
 consequently to treat, with all the development which it merits, in our 
 next chapter, the following capital question : Can pathological physi- 
 ology, in whole or in part, he the direct and immediate foundation of 
 therapeutics. 
 
 ■'- See first Memoir of Medical Society of Observation, 1837.
 
 FOURTH LETTER. 63-' 
 
 FOURT.H LETTER. 
 
 CAN' PATHOLOGICAL PIIi'SIOLOGr BE, IX WHOLE OR IX PART, THE DIRECT AND 
 IMMEDIATE FOUNDATION OP THERAPEUTICS. 
 
 § I. Presext state of Science relative to this Question. 
 
 I said, in terminating my preceding Letter, that three contradictorj 
 opinions are exhibited on the suhject of the above announced question-. 
 The one which has for supporters the most famous modern systematists, 
 such as Stahl, Barthez, Brown, Razori, Bichat, Broussais, and other nu- 
 merous votaries, affirms that there is no rational therapeutics except 
 what is derived from the exact knowledge of the disease, and the mode 
 of action of curative agents. All those illustrious theorists whose doc- 
 trines have divided the medical world, suppose that pathological physi- 
 ology is the only rational and necessary basis of practical medicine: 
 All pretend to derive from this unique source their methods of treat- 
 ment, and the explanation of the effects which they obtain. I call them 
 pure physio-pathologists. 
 
 The second opinion is that of the less exclusive Vitalists, and of less 
 pure Organics, of all those, in one word, who under divers names, prac- 
 tice more or less openly Eclecticism. These physicians agree with the pro- 
 ceding, that the knowledge of the intimate nature of maladies and the 
 mode of action of remedies constitute, in fact, the best foundation of 
 therapeutics. But they add, that in default of this knowledge, which 
 too often is wanting, the crude observation of the effects of agents, or 
 Empiricism, may serve us as a guide, and furnish us, in certain diseases, 
 surer and more efficacious means of cure than those which are indicated 
 by rational Medicine. They regard the physiological explanation of the 
 action of remedies the last improvement of the Art, the final aim of the 
 science, but they think we are still very far removed from this degree of 
 perfection, in many cases. ^ 
 
 '' See, among others : 
 
 Andral — CUnique Medlcale, second edition, preface, page 6; Course de Pathol- 
 ;jie Interne, preliminary considerations.
 
 636 APPENDIX. 
 
 Thirdly, and finalty, there are some authors who maintain that rude 
 experience, or pure observation of the sensible eiFects of remedies, is the 
 fundamental base of therapeutics. These deny, positively, that the 
 lights of physiology and pathology can ever become the immediate source 
 of curative indications, or furnish a rational explanation of therapeutical 
 effects. I have called this sect of physicians by the name of rational 
 Empirics or Empiri-methodists.* 
 
 A general remark, to be made on all the modern writers of Medicine, 
 to whatever category they belong, is, that they do not hesitate to resolve, 
 or rather to settle, the great question which is the subject of this 
 letter, but they do not bring forward any proof of the solution which 
 they give of it. Each one of them seems to imagine that the opinion 
 which he professes in this regard is so clear and evident that it is suf- 
 ficient simply to announce it ; they dispense, in this belief, with all 
 efforts at seeking its demonstration. 
 
 However, they should all consider that this evidence is not of such a 
 nature as to convince all minds, since there is found among their cotem- 
 porarics, a considerable number of distinguished savans and respectable 
 practitioners, who profess entirely different and even contrary principles. 
 This consideration ought, it seems to me, to shake the faith of each 
 of these sections in their respective doctrine, and cause them to follow 
 us in the examination of the fundamental problem above stated. 
 
 Bouillaud — Nosographie Medceale. 
 
 Forget, Professor at Strasburg — Feuilleton de 1' Union Medecale. 1849. 
 
 Frank (Jos.) — Innere Pathologie. 
 
 Gendrin — Traite' Philosophique de Mede'cine Pratique. This author combats 
 Eclecticism, nevertheless, he must be ranked among the eclectics. 
 
 Guein — ■Memoir sur Eclecticism in Mede'cine. 1831. 
 
 Piorry — Traite Pathologie latrique ou Medicale. 
 
 Requin — Elemens de Pathologie Medicale. 
 
 Reveille — Parise. Etudes dc PHomme, dans I'Elat de Sante et de Maladie. 
 
 Trousseau et Pidoux — Traite de Therapeutique et Matiere Medicale. 
 
 " We cite some authors who have professed, more or less, this doctrine : 
 
 Berard (F.) — Doctrine Medicale, de I'Ecole de Montpellier ; pages 198 to 201, 
 and 423 to 459. 
 
 Becquerel — De I'Empiricism en Medicine. Thesis for the concour of agrege'. 
 Paris, 1844. 
 
 Gibert — Fragments Therapeutique et de Medecine Pratique ; 1846. 
 
 Laennec — Traite de I'Auscultation Mediate, second edition ; preface, pages 2") 
 to 31. 
 
 Louis — Memoires de la societie Medicale d'Observation, vol. I. p. 42. 
 
 Valleix — Guide du Medicin Praticien. We ought to range in the same line : 
 
 Chomel — Pathologie Generale. 
 
 ■Grisolle — Traite Elementaire et Pratique de Pathologie Interne.
 
 FOURTH LETTER. 637 
 
 § n. Philosophical Axioms Aiding tue Solution' of this Problem. 
 
 I. Sensible objects being known to us only by the impressions they 
 make upon our senses, the mind does not perceive anything in these 
 objects beyond the sensations which they excite in us. 
 
 II. Xo corporeal operation, nor any action of the soul on its proper 
 faculties or on its ideas, can make us conceive the acting force of the 
 causes, or the necessary connection they have with their effects. 
 
 COROLLARY. 
 
 In the succession of natural phenomena, there is nothing which pre- 
 sents the idea of causality, or the necessary connection of cause and effect. 
 But, when a succession of phenomena is constant, the human mind, 
 which observes it assiduously, and which often may foresee it, is forced to 
 believe that these phenomena succeed each other because they are linked 
 together. A ball, for example, thrown on a horizontal plane, strikes 
 another ball which was in a state of repose ; this latter moves immedi- 
 ately in its turn. The impulse of the first will be regarded as the cause 
 of the movement of the second ; however, the mind does not perceive 
 any necessary connection between these two phenomena, but their con- 
 stant succession, which is manifested each time that we seek the proof. 
 forces us to believe that these phenomena follow because they are con- 
 nected. This is an empirical truth and certainty. 
 
 The two axioms above, and the corollary which follows them, 
 ought to be regarded as incontestible principles, since they conform 
 to the doctrine of all the modern philosophic schools on this mat- 
 ter. We can easily find its substance in the writings of Bacon, 
 Locke, Hume, and Condillac, for the sensitist or empirical school ;" 
 in those of Thomas Pieid and his disciples, for the Scotch school, 
 called school of common sense ;f in these of Kant, for the spirit- 
 ualist or rationalist school ;| finally, in those of M. Cousin and his 
 numerous followers, for the eclectic school. § To these authorities 
 we must add that of Barthez, whose doctrine, though now half a 
 century old, still prevails in spirit in the University of JNIontpellier ;,! 
 and that of M. Buchez also has put forth very recently, on medical 
 
 * Bacon de Verulam. — Organum Novum, Liber I, chap. 1. Locke, Philos 
 Essay on the Human Understanding, lib. IV, ch. iii, § 16 ami 26. Condillac, 
 Essai sur I'Origine des Connaissances Humaines. 
 
 t Inquiries on the Human Understanding. — Th. Reid. 
 
 -[• Critik der Reinen Vernunft. 
 
 §Cours de I'Histoire de la Philosophie Modern. — Cousin. 
 
 II See different passages of Nouveaux Elemeus de la Science de I'Homme.
 
 638 APPENDIX. 
 
 and historical studies, some new and profound views. According to 
 him, the aim of science is to foresee, and there exist two degrees of 
 foresight : the first consists in the knowledge of the order of succession 
 of phenomena ; the second, in the knowledge of the law of generation 
 (if these phenomena. Two conditions are indispensahle, in order that 
 we may arrive at the knowledge of the order of succession of phenom- 
 na : First, that the phenomena of the same order and same nature fol- 
 loio each other always, according to a constant unknown hut invariable 
 laiv ; second, that the entire succession of these phenomena has been 
 observed once at least in its ivhole extent. This being stated, our philoso- 
 pher examines the degree of foresight which each branch of the human 
 encyclopedia appears to have attained, and he uses the following lan- 
 guage on the subject of physiology: "In the sciences of organized 
 bodies, scientific foresight is reduced every where to the knowledge, yet 
 incomplete, of the order of succession of phenomena. This is espe- 
 cially so in Medicine, for whether you study the development of a path- 
 ological modification, or observe the order in which the phenomena 
 succeed each other, to constitute a morbid affection, or whether, finally, 
 you analyze the successive effects engendered by the introduction into 
 the animal economy of a therapeutical agent, your only aim is always 
 to find out the order in which the phenomena of a determined nature 
 succeed each other, so that in similar successions you may subsequently 
 encounter, you may be able to foresee what is to follow by means of what 
 has already taken place. Scientific foresight will always stop there, 
 until the general formula of the organized bodies shall have been 
 found."- 
 
 In presence of such a mass of eminent testimonials, scepticism 
 becomes, impossible. A doctrine which has obtained the assent of so 
 many philosophers in other respects so divided, could not lead us into 
 error. We may well therefore rely with confidence upon it, in order to 
 resolve the important and difficult problem announced at the head of 
 this letter. 
 
 III. REPLY TO THIS QUESTION : CAN PATHOLOGICAL PHYSIOLOGY BE, IN TOTAL- 
 ITY OR IN PART, THE DIRECT AND IMMEDIATE FOUNDATION OF THERA- 
 PEUTICS? 
 
 It is easy to see that this question amounts to the following: Know- 
 ing the series of phenomena which constitute a morbid affection, can we 
 
 *■■' Introduction a FEtude des Sciences Medicales, premier lecon.
 
 FOURTH LETTER. 639 
 
 deduce from it, a priori, the knowledge of the successive effects which 
 will result from the intervention of a new force (a therapeutic agent) 
 in the midst of these phenomena? Our reply to the question thu?f 
 stated is not doubtful, if we remember our philosophic axioms and the 
 commentary of M. Buchez. No, we say, no, it is not possible that the 
 knowledge of a succession of morbid phenomena can enable us to fore- 
 see the changes which a curative agent will introduce into such suc- 
 cession, before these changes may have been observed at least once. 
 
 The lights of pathological physiology, to whatever degree they may 
 have attained, can never give us the foresight of the effect a therapeu- 
 tic agent must produce in the animal economy, before these effects have 
 been directly observed. From which it follows that the indications 
 which flow from physio-pathological knowledge on the opportunity of a 
 treatment, are reduced to simple conjectures, before that treatment has 
 been tried once at least. It is not until after a first trial that the 
 veritable foresight, or in other words, science begins. Thus the physio- 
 pathology can not he in any case the direct arid immediate foundation of 
 therapeutics. 
 
 There are some examples which will prove and confirm the truth of 
 this answer to the minds of those persons who do not distrust absolute 
 and abstract principles, in consequence of the abuse which has been 
 made of these principles. But in order not to leave in their minds any 
 cloud, or any motive to doubt, I will take these examples from the very 
 authors who are of a contrary opinion to the one I have emitted. I shall 
 liave on this point but the embarrassment of a choice, for it is now the 
 custom among our writers in Medicine to establish the curative indica- 
 tions on physio-pathological facts, rather than upon the crude observa- 
 tion of the sensible effects of medicines. 
 
 Eead most of the treatises on Medicine which have been published in 
 the last half century, and you will find but few in which we can not 
 distinguish two kinds of therapeutics. 
 
 One they call rational, founded on the physio-pathological ideas of 
 the day ; the other they name empirical, or irrational, founded on the 
 common observation of the effects of remedies. The writers who estab- 
 lish such a distinction, announce thereby that the choice of a remedy is 
 in their eyes not sufficiently justified by the experimental notion of its 
 efficacy ; and a treatment merits the title of rational only in propor- 
 tion as it can be shown in virtue of what physiological modification it 
 effects a cure. In a word, it is the knowledge of the intimates modifi- 
 cation produced by the curative agents which constitutes, according to 
 these authors, the rationality of therapeutics, the supreme perfection of 
 the Art.
 
 640 APPENDIX. 
 
 One of our cotemporaries, whose opinions are distinguished by clear- 
 ness and exactness, expresses himself in the following language on this 
 subject: '' Medtcme is rational vrhenever it bases the employment of 
 any remedies on the consideration of their physiological eiFects. The 
 indications of these remedies are found by a process of reasoning in which 
 the physiological effects are the principles, and the therapeutic effects 
 the conclusion. There is a logical connection between the latter and 
 the former." 
 
 " Second. Medicine is empirical, not in the bad sense of the word, 
 but in all the dignity of its etymological sense, whenever the remedies 
 it prescribes have for reason, not a physiological deduction or induction, 
 but clinical experience only. Without doubt, physicians may seek, 
 when the utility of an empirical remedy is well observed, to explain it 
 by physiological theories more or less plausible, as on the other hand 
 they seek to demonstrate by the evidence of experience the value of 
 rational remedies ; for reasoning and experience ought naturally to tend 
 to unite themselves in the precepts of the Art. But, in a last analysis 
 the distinction of therapeutical remedies into rational and empirical is 
 always fundamentally true. 
 
 " But how will the practitioner reply, for example, when he is asked, 
 on the one hand, why he purges a man who is constipated, and on the 
 the other hand, why he purges a man attacked with lead colic ? To 
 the first question he will reply, rationally, I purge to evacuate the 
 fecal matter. To the second question he will reply, empirically, I 
 purge because purgation cures lead colic." 
 
 Such is the argument which I extract literally from a treatise on 
 Medicine which is now being published.-' 
 
 For myself, the more I examine and compare the two answers quoted 
 in the last passage, the more I find them identical, that is to say. 
 equally rational and equally empirical. Indeed, when a person answers, 
 I purge in order to evacuate fecal matter, is it not equivalent to say- 
 ing, I administer such a remedy because experience has taught me that 
 it relieves constipation? And again, when one answers: I purge to 
 cure lead colic, does he not say as much as, I administer such a remedy 
 because experience has taught me that it cures lead colic ? 
 
 In the first case, as in the second, you have nothing else but an 
 experimental notion of the therapeutical effect. How do you know, for 
 example, that the powder of jalap will provoke the evacuation of fecal 
 matter ? By clinical observation. How do you know that the same 
 
 *^ Elemens de Pathologie Medicale ; par M. Requin, 1. 1, p. 250, 121.
 
 FOURTH LETTER. 641 
 
 substance will quiet lead colic? Equally by clinical observation. 
 Why then do you call the knowledge of the first eflPect rational, and 
 that of the second empiricaU To this you cannot answer by subtilties 
 and the quibbles of the sophist ; or rather, your enlightened reason, 
 directed by the philosophic axioms above given, will force you to agree 
 that you have established an erroneous distinction between facts of the 
 same order. 
 
 Let us see other examples of pretended rational Medicine. Perhaps 
 they will sustain an examination better than the preceding: " In clini- 
 cal surgery," says the honorable M. Bouillaud, " cases are not rare where 
 rational therapeutics is employed. Indeed, to reduce a luxated bone by 
 bringing into play muscular action in an inverse direction to that 
 which produced it ; to extract, either by a bloody operation or by lith- 
 otrity, a stone from the bladder ; to dilate strictured canals or to make 
 a substitute for them by artificial means ; to ligate a wounded artery, 
 etc. etc., these are purely rational therapeutical proceedings."" 
 
 In order to judge in what respect the last examples which we have 
 cited merit the title of rational, I beg the reader to remember the corol- 
 lary of our philosophical axioms. It is as follows: "A ball thrown on 
 a horizontal plane, strikes another ball which is in repose ; this latter 
 moves immediately. The impulse of the first will be regarded as the 
 cause of the movement of the second. However, the mind does not per- 
 ceive any necessary connection between the two phenomena ; but their 
 constant succession, which inanifests itself every time that we renew the 
 experiment, leads us to believe that these phenomena succeed each other 
 because they are linked together. This is empirical knowledge and 
 certainty." Well then, I again ask, what difference is there between 
 the proceeding of the player who moves one ball by the other, and that 
 of the surgeon who reduces a luxated bone by bringing into play the 
 muscular forces, in an inverse direction to that of the forces which pro- 
 duced the luxation ? Absolutely none. The processes are the same, 
 and the certainty exists in the same degree. But remember the fright 
 of Ambrose Pare, during an entire night, when he had ligated an artery 
 for the first time in order to arrest hemorrhage after an amputation, 
 and then tell me if this proceeding, which appears to us to-day so 
 rational, was judged so then by that celebrated surgeon ? 
 
 We conclude from this, that the surgeon who reduces a luxation or 
 ligates an artery, conformably to the rules of his art, does not act with 
 
 ^ Essai de Philosophic Medicale, p. 309.
 
 642 APPENDIX. 
 
 more reason than the physician who administers a suitable dose of 
 sulphate of quinine to a person attacked with intermittent fever, or he 
 who vaccinates a child to protect it from small pox. The actions of both 
 are based upon a perfectly rational, methodical Empiricism. If so 
 many men imagine that they perceive with spiritual eyes, or seize 
 mentally the logical connection which unites the act of the surgeon with 
 the effect which results from it, while they avow that they cannot per- 
 ceive any rational connection between the act of the physician and its 
 result, it is because in the first case they are deluded ; they are dupes 
 of that faculty of the human understanding which Mallebranche called 
 folle du logis (imagination) as Barthez explains very well in the following 
 passage: " The principle of motion of which the laws are most simple, 
 is the force of impulse. The action of this force seems easy to under- 
 stand, because the imagination considers motion as a being which may 
 communicate itself to bodies brought into contact by a shock, although 
 it cannot overleap any intermediate space. However, from the moment 
 we set aside this false view of motion, the force of impulse, however 
 simple it may be, i-emains incomprehensible, as well as the forces of 
 nature which follow the most complicated laws." - M. Cousin develops 
 the same doctrine in terms not less explicit, f 
 
 Hence we conclude that physicians who hope to found their curative 
 indications on physio-pathological facts are deceived by illusions of their 
 imagination. There is no connection perceptible to our mind between 
 the idea of a disease, however complete it may be supposed, and the 
 determination of the curative agent applied to this disease. In other 
 words, the series of phenomena which constitute a pathological state 
 cannot in any way enable us to foresee the succession of effects which 
 will result from the employment of this or that mode of treatment, 
 before its effects have been observed at least once. Finally, there exists 
 between physiology and therapeutics a solution of continuity, a hiatus 
 which the human mind can overleap only by the aid of clinical experi- 
 ence, or, in other words, by empiricism. 
 
 However paradoxical this doctrine may appear to a large number of 
 my readers, it is not, however, new. It goes back, on the contrary, to 
 the infancy of the Art. It presided over its first acquisitions. It is 
 clearly designated in two books of the Hippocratic collection, as well as 
 
 '"'Nouveaux Elements de la Science de I'Homme, chap, iii, tome I, page 49. 
 •f Cours de I'Histoire de la Philosophie Moderne. Edition 1846, tome I, pages 
 247, 268.
 
 FOUKTH LETTER. 643 
 
 in other writings, both ancient and modern, from which I have elsewhere 
 quoted extracts. 
 
 But, as in a subject so delicate and important we cannot multiply too 
 much the proofs and explanations, no one will find fault, I think, when 
 I add some other fragments of cotemporary authors. " If by motives, 
 we understand," says M. Louis, " that any remedy whatever ought not to 
 be employed but when we have recognized that a patient is in the situ- 
 ation in which this remedy has already succeeded, I understand, and I 
 agree with this view — it is nothing else than experience applied to 
 therapeutics. But if we understand by motives, as by indications, 
 a priori considerations, this view is quite hypothetical ; it enters into 
 so called rational medicine, experimental medicine, to which we have 
 recourse only when in want of a better system, when experience has 
 not yet spoken ; and I reject it with all my powers. "=•■■= 
 
 Hahnemann, desiring to demonstrate that nosography could not guide 
 us in the choice of remedies, expresses himself thus : "In general, all 
 science whatever can judge only the objects belonging to itself. It is 
 foolish to expect from it instruction on subjects belonging to other sci- 
 ences. =•' =■■' Xo matter how necessary it may be to the agriculturist 
 to know exactly the form of plants, and to know how to distinguish them 
 from each other by their exterior parts, nevertheless, botany, which 
 teaches him these things, can never teach him if any vegetable is fit 
 food for his sheep or hogs ; it will never enable him to know what kind 
 of grain or roots gives most strength to the horse, or fattens cattle best, 
 Neither the systems of Tournefort or of Linnaeus, nor the method of 
 Haller or Jussieu enlightens him on this point. He only acquires the 
 knowledge which he needs, by comparative experiments, made with care, 
 on difi"erent animals, "f 
 
 Again, the historian of the medical doctrine of Montpellier, Berard, 
 says that " Sauvages, frightened by the uncertainty of hypothesis, 
 adopted a paradox which will scandalize, without doubt, the systema- 
 tists of all tmes, but which will appear, nevertheless, incontestible to the 
 physiologists of all sects, whenever their particular opinions are not in 
 question."! Physiology, according to him, connot serve as a primary, 
 fundamental, and unique basis for practical Medicine. 
 
 The same historian, after having exposed at great length the scien- 
 tific economy of Empiricism, sums up his opinion on it as follows : 
 
 ■' Memoires de la Societe Medical d'Observation, tome I, page 42. 
 
 t Traite de Matiere Medicale. Prolegomenes, tome I, page 23, trad de 
 
 Jourdan. 
 
 I Doctrine Medicale de L'Ecole de Montpellier: edition de 18-16, page 47.
 
 644 APPENDIX. 
 
 "■ Empiricism is the most profoundly elaborated system whicli has over 
 appeared in Medicine, and merits the most to be studied with care ; it is 
 the one whose contemplation promises to the philosophic mind the most 
 useful and fruitful results, and can serve best in the research of proper 
 methods to satisfy the future progress of the science." '••■' 
 
 §VI. CoNCLusioy. 
 
 We have now arrived, basing all we have said on philosophic axioms 
 universally admitted, to the demonstration, henceforth immovable, of 
 this great truth : Neither physiology nor pathology, whatever develop- 
 ment they may acquire, can ever serve as a primary and immediate 
 foundation for therapeutics. There is, and there always will be, 
 between the knowledge of a disease and the determination of the appro- 
 priate treatment, an interval, a void, which the human mind can fill but 
 by the aid of experiment. 
 
 By this demonstration we have set aside, not only all the systems of 
 Medicine known until the present time, which ai'c derived from some 
 physio-pathological idea, but all those also, which any one can be 
 tempted in the future to extract from the same source. We have 
 reestablished practical medicine upon a true and primary basis — clinical 
 experience ; not that blind and limited experience of the first age of the 
 science, but an analytical and learned experience, which, collecting with 
 equal care the old traditions and new acquisitions, elucidates them both 
 in the light of a severe critic. 
 
 Nevertheless, it is not sufficient to have recovered and set forth the 
 true foundation of therapeutics ; it is still necessar}' to demonstrate that 
 upon this foundation we can and ought to raise the entire scientific 
 edifice of Medicine. It is necessary to prove that, far from rejecting, as 
 has been believed for a long time, the lights of anatomy, physiology, 
 pathology, physics, chemistry, and, iu a word, all the branches which 
 are connected with the medical encyclopedia, rational Empiricism, or 
 Empiri-methodism is the only one of all the systems which uses them 
 appropriately, and circumscribes them in their legitimate bounds. It is 
 necessary to demonstrate that it is the only system which ofi'ers to the 
 practice of the Healing Art an immovable basis — and yet sufficiently 
 accommodating to receive all ulterior improvements ; that it is the only 
 one which does not reject, a priori, any means of treatment — neither 
 doses excessively small, nor imponderable fluids, from whatever source 
 they may come ; that it demands of the most extraordinary thera- 
 
 *' Doctrine Medicale d'Ecole de Moutpcllicr ; edition 1836, page 424.
 
 FOURTH LETTER. 645 
 
 ':>s peutical processes, in order to open to them the sanctuary of science. 
 
 only the sanction of reiterated proofs, serious and sufficiently con- 
 J •• stant in their results. It is finally necessary to prove that Emperi- 
 rpa ' methodism is the only one of all the systems of Medicine which resolves 
 
 in a satisfactory manner, this great problem, declared insoluble even in 
 
 our times, by men of high reputation : " 7^ he harmony of science ivith 
 
 art — of theory tcith practiced -'^ 
 
 But before undertaking this demonstration, it is useful to refute 
 L- ■ specially some more recent medical doctrines, which might deceive a 
 ^ I \ large number of our readers. 
 
 . [• 
 
 '' Consult, among other writings proclaiming the insolubility of such a prob- 
 lem, the feuilleton of the Union Medicale, from p. 24 to 27. February, 1847.
 
 646 APPENDIX. 
 
 FIFTH LETTER. 
 
 ON ECLECTICISM IN MEDICINE. 
 
 § I. Origin of the New Eclecticism in Medicine — Its Difference from 
 Eclecticism in Philosophy. 
 
 No sooner has a philosophic doctrine ohtained any celebrity than it 
 is reflected in Medicine. This is a fact that the history of our science 
 confirms at each step, and of which the new medical Eclecticism 
 oifers one more sample. It is about thirty-five years since a young pro- 
 fessor of philosophy began his teaching by a kind of protestation against 
 all systems of metaphysics which derive from a single faculty of the 
 human understanding, all the acquisitions of science. He tried to 
 demonstrate, contrary to the general opinion of the French philosophers 
 toward the end of the eighteenth century, that Sensitism or Empiricism 
 show us only one side of things — the material or sensible side — and 
 developes in us but a single order of ideas — the contingent ideas. 
 
 He proved equally, that Spiritualism, or pure Eationalism, shows only 
 another side of things — the immaterial, or the one imperceptible by the 
 senses — and produces in us but a single order of ideas — the necessary 
 and universal ideas. M. Cousin has always continued in this path, and 
 by his influence Eclecticism has become, in France, quite a fashionable 
 doctrine. 
 
 About the same epoch, a professor of Medicine at the military hospital 
 of Val-de-Grace put forth a system in which all diseases are represented 
 as an effect of irritation, as a simple mode or a transformation of phlogosis. 
 This system, owing to the favorable disposition of the minds of the profes- 
 sion, advantageously prepared by the philosophy of Condillac and of 
 Cabanis, who also considered all the acts of the understanding as a result 
 of transformed sensation, took a rapid growth, and in less than ten years 
 became common in France, and spread over Europe. But while the 
 physio-pathological system of Broussais reached with so much prompti- 
 tude the zenith of its renown, a doctrine more modest raised itself 
 slowly by the side of it, and began its ruin.
 
 FIFTH LETTER. 647 
 
 Medical Eclecticism, the emanation of philosophic Eclecticism, had 
 already protested against the pretention of deducing all the morbid 
 phenomena from a single lesion. It collected, by the aid of clinical 
 observation, pathological anatomy, and chemical analysis, a mass of 
 proofs before which fell, very soon, the brilliant edifice of the professor 
 of Val-de-Grrace. This result is now consummated. For some years 
 past the greater part of our writers in Medicine profess an avowed or 
 tacit Eclecticism, as we have seen in the preceding letter. 
 
 All have renounced the idea of connecting the innumerable anomalies 
 of the living organism with a single primitive modification. It is, then, 
 essentially important in the present medical generation, to be fixed on 
 the value of Eclecticism in Medicine. It is for this reason that we have 
 believed it our duty to submit this doctrine to a special examination : 
 and, in the first place, we intend to find out in what Medical Eclecti- 
 cism differs from philosophical Eclecticism, a circumstance which does 
 not appear in anywise to have entered the minds of our Medical 
 Eclectics. 
 
 Philosophy, embracing the entire circle of human acquirements, 
 admits, generally, of two modes of acquisition, known under the names 
 Rationalism and Empiricism. The first consists in establishing evi- 
 dent principles, or axioms, and deducing consequences and particular 
 applications. This is the process of deduction. This mode of acquisi- 
 tion, called very improperly, by certain authors, the synthetical method, 
 is more especially used in mathematics, metaphysics, morals and dia- 
 lectics. The second mode consists in studying at first particular 
 facts, and abstracting what they have in common, in order to form gen- 
 eralities or communities, which are named, also, principles and axioms, 
 because these generalities, once established, guide us in the research or 
 production of other particular facts like the first. This is the method 
 of induction. This mode of acquisition, called, sometimes, wrongly, the 
 analytical system, is employed in preference by naturalists, natural 
 philosophers, chemists, physicians, etc. In Kationalism, the principle 
 governs, is fixed ; the fact is subordinate, variable. In Empiricism, 
 on the contrary, the fact governs, and it must be constant, and well 
 determined ; the principle is subordinate, variable. 
 
 We may conceive, from this succint expose, that the philosopher 
 can, and ought even, to be an Eclectic in respect to methods, that he 
 ought to give the preference sometimes to one, and sometimes to the 
 other, according to the order of facts he contemplates, and that he will 
 do wrong in adopting one exclusively, on all occasions. The physician. 
 on the contrary, cannot be an Eclectic, since he has no choice to make 
 in this respect. The method which he ought to employ habitually, is
 
 648 APPENDIX. 
 
 fully indicated by the order of facts he cultivates. These facts arising 
 from sensation or observation, he ought then to have recourse to the 
 Sensitic method, otherwise called the Empirical or Inductive. Eclecticism 
 in Medicine cannot then consist, as Eclecticism in philosophy, in the 
 choice of this or that mode of acquisition. Eclecticism in Medicine is 
 more confined ; its object is entirely special, as we shall see from the 
 exposition which will be made shortly. But before entering on this 
 exposition, it was necessary to establish the capital diflPerence between 
 philosophic Eclecticism and medical Eclecticism, so that, in the end of 
 our discourse, no one may apply indistinctly to the former, whatever we 
 shall say for or against the latter. 
 
 §11. Ox Eclecticism in PATnoLOGT. 
 
 It has been said many times, and we cannot repeat it too often, that 
 Eclecticism is a doctrine so vague, so undeterminate, and so variable, 
 that no one has dared until the present time, to give a complete dog- 
 matic exposition of it. I do not know of but one serious attempt of 
 this kind ; it was made by one of the most eminent medical writers of 
 the periodical press. M. Jules Guerin addressed, in 1831, to the Koyal 
 Academy of Medicine, a memoir, in which he treated exclusively of 
 Eclecticism in pathology ; at the same time, he promised a second, in 
 which he would treat of Eclecticism in therapeutics ; but this one has 
 never yet appeared, and according to all appearances, it will never see 
 the light of day. 
 
 However this may be, we are happy in possessing the work of M. 
 Guerin, by the aid of which, it will be possible for us to seize this pro- 
 tean and parasitic doctrine, which lives by borrowing, having produced 
 nothing until the present time, in itself, but an individual critic, more 
 or less independent and arbitrary. This is the opinion of the author 
 himself whom we have cited, and it is to put an end to this sterile anar- 
 chy of Electicism, to constitute it dogmatically, that he prepared, he 
 said, his memoir, the first of a series of other works which would have 
 the same aim.-' 
 
 Consecjuently, the first thing that M. Guerin proposes to decide, in 
 order to raise the scientific edifice of Eclecticism, is the instrument or 
 method by means of which the Eclectic can discern the true from the 
 false, the real from the hypothetical, among the facts and opinion? 
 which are furnished by other systems. Now, this writer arrives, by a 
 
 ^ Memoire sur I'Electisisme en Medecine, par J. Guerin, page 2, 23, and 26.
 
 FIFTH LETTER. 649 
 
 series of considerations, to the conclusion, that the supreme criterion of 
 the Eclectic in the selection of his materials, is nothing else than expe- 
 riment. From which it results, according to his avowal, that Eclecti- 
 cism confounds itself with Empiricism, in respect to method. 
 
 Some persons have said, he says, and others may still say, that Eclecti- 
 cism, as thus determined, is only the experimental method, applied to Medi- 
 cine, and might ask, why change the name of this method ? Why call Ec- 
 lecticism by that which could be more clearly designed under the name of 
 Experimentalism ? I have a peremptory answer to make to this objection. 
 
 I will give this answer textually : " Empiricism is, properly speaking, 
 the chaos of science ; I may dispense with showing its insufficiency. 
 Empiricism stops at those facts which are the most material ; it does 
 not regard either the coiJrdination of facts, or the explanation of the 
 laws which produce them ; consequently, it rejects science. Its obser- 
 vation is isolated in the individuality of each disease, no regard being 
 had to what is expressed by its general relations. However, if it does 
 not seek analogies, if it neglects differences, its observation, instead of 
 being analytical, is superficial and general, and although it does not 
 approach facts with preconceived ideas, it sees only an obscure totality, 
 and its experience is of no benefit for the future." 
 
 When did M. G-uerin find that Empiricism does not require either co- 
 ordination of facts, or science ; that it does not seek analogies ; that it 
 neglects differences, etc. ? Is it in the writings of the ancient or mod- 
 ern Empirics, that he has collected such maxims "? 
 
 Have not the ancient Empirics established excellent precepts to dis- 
 cern morbid species? Are not their symptomatic assemblages the most 
 reasonable, so far as pathological descriptions are concerned, which anti- 
 quity has transmitted to us ? Now how could any one range diseases 
 into classes more or less natural, without taking into account their ana- 
 logies and difi"erences — without analysing them ? 
 
 As to the modern Empirics, it sufl&ces to observe, in order to absolve 
 them from the incredible accusations with which they have been charged 
 in the description above, that it is in accordance with their principles, 
 as proclaimed by Sydenham, that most of our nosologies are composed. 
 
 By this portrait of Empiricism who could recognize the learned sys- 
 tem of which Baglivi has spoken : " That it is the fruit of method ele- 
 vating itself to the highest truths by the attentive and persevering ob- 
 servation of phenomena ; that it has obtained in all times the approba- 
 tion of distinguished men, Avho were forced to enlarge it, as a mode of 
 acquisition conformable to our nature."" 
 
 * De Praxi Medica, Lib. i., cap. 11. 
 41
 
 650 APPENDIX. 
 
 Could you recognize it yet as that system which Berard, the historian 
 of the doctrine of Montpellier, regarded as the most profoundly elabo- 
 rated that has ever ajipeared in Medicine. Could you recognize 
 in it the philosophic method which, according to M. Cousin, Bacon, 
 Locke, Hume and Condillac have developed ? '■' No, certainly not. 
 Empiricism, such as is represented above, is neither a system 
 nor a method ; it is, to make use of the language of M. Bouillaud, 
 " I know not what, which has no name and does not merit our atten- 
 tion here." 
 
 M. Guerin is perfectly right in rejecting, with all his powers, an em- 
 piricism so gross, and so anti-methodic as that which he has painted for 
 us. But is it loyal, is it worthy for a mind so elevated as his, to tra- 
 vesty thus the opinions that he wishes to refute ? Such was doubtless, 
 not his intention. He has been led by the habit which we have all con- 
 tracted, in our medical education, of considering empiricism but from 
 its bad side, and in its lowest representatives ; a habit which makes us 
 confound, sometimes, scientific Empiricism or Empiri-methodism, with 
 something which has no rank in science; the charlatanism of the 
 mountebank, ignorance, the denial of all kinds of reasoning, of all the- 
 ory, of all methodic co-ordination. 
 
 What proves that he has acted in this way, is that the author of the 
 memoir in favor of medical Eclecticism, wishing to characterize a little 
 more his method, and to render it unlike those of other systems, ex- 
 presses himself in these terms : " The observation of Eclecticism is sep- 
 erated equally from the passive neutrality of Empiricism and the par- 
 tial activity of systems. It applies the experimental method to each 
 fact ; that is to say, it notes successively all the elements of the 
 facts, accordingly as they are produced, and in the order that they are 
 produced.'' f 
 
 For myself, I confess, the more I study the method counseled and des- 
 cribed by M. Gruerin, the more I find it identical with that of Empiri- 
 cism. I see no difference, absolutely, but in name. 
 
 It remains to ascertain which of the two appellations is the most 
 exact, his or ours. In this respect I believe that M. Guerin has himself 
 decided the question, in giving to his method the epithet Experimental, 
 synonyme of empiric. At the most, I felicitate myself in not disagreeing 
 with him, but in the meaning of a word. When we have reached this 
 point we are not far from understanding each other. 
 
 '^ See our Fourth Letter. 
 
 f Essai sur la Philosophic Medicale.
 
 FIFTH LETTER. 651 
 
 §111. On Eclecticism in Therapeutics. 
 
 Eclecticism in therapeutics consists, as we have said elsewhere : First, 
 in not admitting any universal principle of treatment ; second, in de- 
 ducing the curative indications, either from physio-pathological theo- 
 ries, or from pure experi.acntation. 
 
 Now, we have proved in the preceding letter that it is impossible to 
 deduce any rule of cure directly from pathological physiology. Conse- 
 quently, we might ('ispense with a more ample emamination of Eclecti- 
 cism in therapeutics ; because, whoever has followed our argument must 
 have seen that this doctrine is fundamentally erroneous. But there are so 
 many varieties of eclecticism in Medicine that this refutation en ma&se 
 does not suffice ; because a great many theories, thoroughly eclectic, are 
 produced under other denominations, and every one does not perceive at 
 the first view the connection which exists between the most elevated 
 principles of science, and their remote consequences. Moreover, this 
 doctrine is the most fashionable one of the present day, and in this view 
 merits still on our part a special examination. 
 
 I choose designedly, for the immediate object of this discussion, one 
 of the most recent and most remarkable specimens of modern Eclecti- 
 cism, the introduction to the Treatise on Therapeutics, by MM. Trous- 
 seau and Pidoux, third edition. No one, I hope, will accuse me of con- 
 sidering Eclecticism in its lowest representatives. The fragment of 
 medical philosophy which I have just designated is really an eclectic 
 production, although its authors do not say so ; but I judge it by the 
 maxims which are emitted in it, and the spirit which pervades it from 
 the beginning to the end. 
 
 Indeed, after a rapid description of the revolution that the expe- 
 riments 01 Haller on irritability of the tissues first introduced into 
 physiology, and consecutively into therapeutics, after a succinct 
 discussion of the principal doctrines which have prevailed since the 
 time of Cullen till our day, these authors begin the explanation of 
 their own theory, of which I will give the following resume : There 
 exists a class of diseases arising from a simple exaltation or depression 
 of the vitality of the organs. These diseases have no real specificity. 
 and do not differ from each other but in their seats and degrees of inten- 
 sity. They are not diseases, properly so called, they are Occidents, 
 purely traumatic lesions. In these kinds of affections there is no neces- 
 sity for the resources of the Materia Medica, properly so called ; the 
 resources of hygiene arc sufficient. In this numerous class of diseases, 
 the curative indications ought to be drawn from physio-pathological ideas. 
 
 Thci'e is another class of diseases whose specificity is not doubtful. 
 Each one of these constitutes in the organism a distinct entity, leading
 
 652 APPENDIX. 
 
 in some sort a particular life. These are diseases truly essential, 
 as syphilis, marsh fever, small pox, etc. Against this class of affec- 
 tions the resources of hygiene are insufficient ; we cure them only by the 
 aid of special agents. In these cases, the lights of pathological physi- 
 ology furnish us but imperfect indications ; pure experience or empiri- 
 cism guides us more surely. 
 
 Such is the doctrine comprised in substance in this essay of medical 
 philosophy. We read in it that the principle of general therapeutics, 
 the sovereign law of good practitioners, consists " in the idea of subor- 
 dinating to the medication of the symptom that of the morbid unity, 
 when this latter is not well determined and sufficiently specific to gov- 
 ern all the other indications ; and to subordinate, on the contrary, the 
 medication of the symptoms to that of the nature of the disease, when 
 this latter possesses such unity and such specificity that none of its 
 parts or its symptoms can be detached from it, and each one of them 
 represents and manifests it as well as the whole."* 
 
 All this is not very clear, but by the aid of the antecedents we may 
 ^nevertheless satisfy ourselves that the authors of this article have 
 wished to avail themselves of physio-path ologism and empiricism. They 
 think that we should take from physio-pathology the therapeutics of the 
 first class of diseases, and from common experience the therapeutics of 
 the second class. This is, as any one can see, pure Eclecticism, if any 
 thing ever was. It remains to know how we may know if a morbid 
 case belongs to one or the other of these two nosological classes. It is 
 not easy to solve this question in a large number of affections, even the 
 most simple. Let us take, for example, venereal chancres, situated on 
 the external organs of generation. Before laying down a treatment 
 appropriate to this lesion, it will be necessary to decide if it is of a 
 physiological natui-e, or of a special essence. Now, if you interrogate a 
 partisan of Easori on this point, he will answer by saying that you must 
 treat ulcers with hypostheijia, or, in other words, by lowering vitality. 
 If you consult a follower of Broussais, he will affirm that you have 
 ■nothing before you but a product of ulcerous irritation, or an exaltation 
 of vitality. Another theorist will see in it a particular virus, or an 
 essential affection. By what rule, I demand of the authors of this phi- 
 losophic pamphlet, by what criterion do you make your final choice ? 
 You have nothing else than the therapeutic proof, that is to say. 
 Empiricism, which you have endeavored to avoid, and which you have 
 previously condemned. 
 
 But if your sovereign lata can not guide us in a case so simple as the 
 
 ' "Page 28. 
 
 (
 
 FIFTH LETTER. 653 
 
 preceding, of what aid will it be to us when we have to deal with some 
 of those complex affections which we encounter frequently in practice, 
 such as typhoid fever, cholera, scrofulous affections, etc. V With such 
 a guide, we must stumble at every step against some insoluble difficulty. 
 You have foreseen this, and stated it in formal terms, when you say : 
 " We do not know any disease which may not have a certain unity, and 
 may not be distinguished from every other by something special. 
 •-' =-' =-' « Just as wc know no disease which does not remain 
 subject to the laws of the economy, and which does not consequently 
 present some physiological indications."" 
 
 Thus your sovereign laio of good practitioners, which is based solely 
 on the distinction of diseases of a special nature from diseases of a phy- 
 siological nature, according to your own confession, crumbles to its very 
 foundation. I will not stop to discuss the axiom of contraries, although 
 you assert that it is at the present time better demonstrated than ever 
 before.f It is a subject of which I have disposed elsewhere, in such a 
 manner that I have no need to return to it. But what astonishes me in 
 the last place is, that you declare afterward that no one can base the Mate- 
 ria Medica, in the present state of science, upon a general idea.| Is in 
 your opinion the axiom of contraries no general idea? And your sove- 
 reign laio of good practitioners, is it not, either, a general idea? 
 
 Thus you see the inconvenience of having no fixed, determined prin- 
 ciple ; you are drawn necessarily into contradictions from which all the 
 talent in the world cannot extricate 3'ou. The philosophic medical essay 
 of which I have just given you a short and incomplete analj' sis, offers us a 
 remarkable example of this defect. Xotwithstanding the incontestable 
 sagacity and talent of these authors, and the profound study which they 
 have made of the vicissitudes of therapeutics, within half a century, 
 the absence of a fixed and avowed principle gives vagueness, indecision, 
 and obscurity to the whole of their work. 
 
 IV. Conclusion. 
 Eclecticism in Medicine, whether considered in its foundation or in 
 its details, is a doctrine proven to be sterile, and which, under the pre- 
 text of holding an equal balance among the various systems, acts only 
 as a poor amalgam without fixed proportions. It is an individual criti- 
 cism calculated at most only to destroy some errors, but incapable of 
 establishing anything stable ; unable, in short, to create but doubt and 
 uncertainty ; a doctrine essentially transitory, which must disappear in 
 
 ^ Page 28. f Page 53. J Page 70.
 
 654 APPENDIX. 
 
 the presence of the true theory, as the shadows of twilight arc scattered 
 before the beams of the risinar sun. 
 
 ON HOMEOPATHY. 
 
 PRELIMINARY CON SIDE RATIONS. 
 
 " The time has gone by," truly remarks the translator of the works 
 of Hahnemann, " when the pleasantri'^s relative to the infinitisemal 
 doses can be regarded as good arguments against homeopathy." ••' We 
 are certainly compelled to take this doctrine into serious consideration, 
 since men commendable by their scientific titles and medical position, 
 members of faculties, hospital physicians, and eminent practitioners, 
 have embraced it and become its public defenders ; since journals have 
 been established and societies instituted in different countries to make 
 public its principles and practice. Before this invading propaganda it 
 is not permitted to any man clothed with the medical pri'^sthood, and 
 comprehending the dignity and importance of his ministry, to remain 
 indifferent ; it is necessary for him to take a part for or against it, and 
 how can he take a part in so grave a question without a preliminary and 
 searching examination '? 
 
 I regret that no one of our academical dignitaries or teachers have 
 charged themselves with such a work ; it would have been more perfectly 
 accomplished, and especially more authoritative than my effort. Unhap- 
 pily, none of our distinguished teachers have deigned or dared to enter the 
 list openly for a combat with the partisans of this new gospel. It is 
 true that a long time past, some experiments were made, but these exper- 
 iments, now almost forgotten, should have been resumed on a grander 
 scale by different therapeutists ; for it must be avowed that the negative 
 results published by M. Andral, or any other experimenter, whoever he 
 may have been, can not nullify the mass of positive results that the 
 homeopaths pretend to oppose to them. 
 
 Moreover, what can we answer when they say to us, your so-called 
 rational ]Mcdiciuc only treats more or less subtily on the evils of human- 
 ity, but it does not teach you at all how to relieve them. The most 
 efficacious means possessed by the Healing Art, specifics which accord- 
 ing to common consent pi'ocure the mildest, promptest, and most durable 
 cases, your official medicine proscribes as much as possible ; it excludes 
 them from its theory, if not from its practice. AVe, on the contrary, 
 come to teach you a means to discover, and a method to employ these 
 
 ' .Jourdan. Preface to French translation of the Treatise on Materia Medica.
 
 FIFTH LETTER. 655 
 
 admirable instruments of cure. What have we to respond to such an 
 argumentation ? Nothing, absolutely nothing serious and logical. 
 
 There is not one among the old doctrines, except rational Empiricism, 
 which is not embarrassed by such an objection, because rational Empiri- 
 cism, or Empiri-Methodism, is the only one of all these doctrines which, 
 far from excluding from its theory a treatment by specifics, admits them 
 on the contrary, to the first rank of curative methods, called rational, 
 as may be seen in the article on Therapeutical Methods in the Reform 
 Period, and which will be again referred to in its appropriate place. 
 
 Since our masters have not entered into a struggle with the apostles 
 of Homeopathy, but have left their disciples as well as the public with- 
 out a guide, and without defense against the attractions of this novelty 
 and the deceitful promises of these innovators, I, though an obscure 
 champion, but confident in the principles which I have adopted, will 
 open the conflict, by exploring to its most minute elements, the Homeo- 
 pathic code. 
 
 Philosophicax, Phtsiological, and Pathological Doctrine of Hahnemann. 
 
 PHILOSOPHY. 
 
 "The mind is not able to recognise any thing aj)riori; it cannot 
 form in itself a notion on the essence of things, their causes and 
 their effects. Whenever it has to pronounce truths in regard to real 
 objects, each of its propositions must be founded on sensible observa- 
 tions, on facts and experience. In going a single step from the path of 
 observation, it is at once plunged into the illimitable spaces of imagi- 
 nation and arbitrary hypothesis, parents of false opinions and of noth- 
 ing absolute."-' 
 
 These are maxims which a pupil of Condillac cannot disavow. They 
 are, indeed, only a commentary of the famous axiom of the Sensitist or 
 Empiric school : all our hwwlege comes from the senses ; an axiom which 
 I accept not as of universal application, but limit it to physical sci- 
 ences, of which ^Icdicine is one of the most eminent. Thus, then. I am 
 in harmony with the pontiff of Homeopathy, on the source of our lights 
 in Medicine. 
 
 PH YS lOLOGY. 
 
 •' That which unites the living parts of the human body in such a 
 manner as to make it an admirable organism, that which determines 
 them to harmonize in a manner so directly contrary to their primitive 
 
 "Organon De I'Art de Guerir, preface, 2d edition, French translation of Bra. 
 non, p. 40.
 
 6S6 APPENDIX. 
 
 nature, physical or chemical, that which animates and impels them to 
 such surprising automatic actions, that fundamental force, in fine, cannot 
 be represented as a distinct being ; it can only be understood imper- 
 fectly ; it escapes all investigations, and all our perceptions. No mor- 
 tal can know the substratum of vitality, or the disposition a priori of 
 the living organism. No mortal can sound the depths of such a sub- 
 ject, nor even describe its shadow. I^et them speak in prose or verse, 
 human language, in this respect, can only express chimeras or nonsense. 
 
 " Consequently, all that a physician can know of his subject, the liv- 
 ing organism, is limited to what the sages among us, a Haller, a Blu- 
 menbach, a Wrisberg, have understood by the name of physiology, and 
 what may be termed experimental biology ; that is to say, appreciable 
 phenomena of the human body in health, separately and generally con- 
 sidered. The impossible, that is to say, how these phenomena take 
 place, is totally excluded from the circle of our necessary knowledge in 
 physiology."^;- 
 
 This profession of physiological faith has no need of comment. It is 
 seen that its author only admits, in the science of life, the pure and 
 simple description of phenomena observed during the natural play of the 
 organs, or those excited by experiments. This is still Empiricism, and 
 the most austere Empiricism, I will even say the narrowest. For the 
 Empirical doctrine, well understood, in all the breadth of its principles, 
 does not exclude from physiology a priori consideration, or hypotheses on 
 the organic forces and the substratum of vitality, provided that these 
 hypotheses be given as such, and not for realities ; and especially, pro- 
 vided, that no one pretend to build on those abstract or imaginary enti- 
 ties systems of Medicine and therapeutical rules. 
 
 PATHOLOGY. 
 
 In the same work, Hahnemann expresses himself in these words: " I 
 pass to pathology, in which the same furor for systems which turns the 
 brains of metaphysical physiologists, has given birth to so many hypothe- 
 ses on the intimate essence of diseases, or why diseases are diseases ; in 
 one word, on what is called the proximate or interior cause. No mortal 
 has a clear idea of what is sought here. " •' " * Nevertheless, a 
 crowd of sophists have affected the important airs of men who possess 
 this knowledge.!" 
 
 This is what the author of Homeopathy wrote in 1808, before he had 
 
 * Valeur des Systemes en Medecine, French translation of Jourdan, p. 462. 
 t Ibid. p. 463.
 
 FIFTH LETTER. 657 
 
 promulgated his own system. The following was published in his Organon, 
 in 1819 : " We can easily conceive tliat each disease supposes a change 
 in the interior of the human organism. Nevertheless, this change can 
 be suspected only in an obscure and dubious manner, by the symptoms 
 of the disease ; but it will never be recognised to its full extent, in an 
 infallible manner."-' 
 
 These passages and a groat number of others in which the same views 
 are held, prove that Hahnemann professed in pathology as in physiolog}' 
 and philosophy the most absolute Empiricism or Sensitism ; indeed, 1 
 have said the narrowest and most exaggerated. In fact, he goes so far 
 as to be willing to expunge from medical language those collective 
 expressions which designate a concourse of symptoms or morbid phenom- 
 ena, such as pleurisy, pneumonia, tetanus, diabetes, hydropsy, mania, 
 angina, phlogosis, etc., under the pretext that these words are not 
 applicable to any real entity, to any distinct and always identical 
 individuality.! 
 
 But can any one mistake to such a point the most elementary princi- 
 ples of general grammar as to be willing to banish from scientific lan- 
 guage abstract terms, because these terms give rise often to very differ- 
 ent ideas with those who use and understand them ? Thus the words 
 pleurisy, tetanus, diabetes, inflammation, etc., have extremely varied 
 significations, not only in pathological treatises belonging to difi'erent 
 epochs, but even in those of the same epoch. This is doubtless a fault, 
 an imperfection ; but this fault and imperfection are common to all the 
 sciences and all languages ; they are inevitable. 
 
 Do the names of the classes, orders and families in natural history 
 represent real objects ? Is there any individual in the vegetable king- 
 dom which is termed acotyledon, or leguminous, or labiated ? Do not 
 these several words express an abstract collection of ideas or of proper- 
 ties common to a multitude of different vegetables ? Would you exclude 
 from philosophic language the words substance, body, spirit, virtue, 
 courage, chastity, vice, etc., because these denominations have an appli- 
 cation to nothing material, nothing which may be perceptible to the sen- 
 ses ; because they awaken sometimes in those who understand them 
 very varied ideas; because, in fine, there are ignorant persons who 
 attribute to these abstract expressions an objective reality? 
 
 What will you put in place of the words gastritis, variola, pneumo- 
 nia, etc., which you would exclude from pathological language? The 
 
 ' Organon. The Art of Curing, sec. 5. 
 ' Ibid. Section 83, and explanatory note.
 
 658 APPENDIX. 
 
 enumeration of all the symptoms or accidents realized, by each patient, 
 responds Hahnemann. Thus a pure homeopath must not say, for 
 example, I treat a man attacked with an acute articular rheumatism. 
 He would come greatly short of Hahnemannic orthodoxy ; but he must 
 say, I treat a man who, in consequence of taking cold has been attacked 
 with acute pain in this or that articulation ; the pain is exasperated at 
 certain hours in the morning or evening. There is a certain degree of 
 swelling, coloration, etc, ; a difficulty or complete impossibility of 
 motion ; so many strong, slight or medium pulsations in the morning, 
 at noon or at night, before or after meals, etc. The patient realizes a 
 vertigo when he closes his eyes at five o'clock in the morning ; his head 
 swims when he looks upward after drinking ; there are sour belchings 
 after eating sour-crout, etc, etc. The stools are sometimes green, some- 
 times gray, sometimes of a sour or putrid odor, etc. etc. He has itching 
 of the nose the day after taking a cup of tea, and a violent itching at 
 the anus on awaking on the morning of the fifth day, etc. He is 
 inclined to anger; sometimes he is frightened and troubled without 
 cause, and a thousand similar futilities. 
 
 By these absurdities Hahnemann proposes to replace the usual denomi- 
 nations of diseases and the nosological descriptions of authors. I am 
 ashamed for the enlightened followers of Homeopathy to insist on the 
 refutation of so gross a philosophic heresy, which several of them have 
 disavowed ; but I am forced to do so, because it constitutes one of the 
 foundations of the mother doctrine. 
 
 It may possibly be objected, that Hahnemann does not proscribe the 
 names of diseases in an absolute manner ; that he even tolerates them in 
 common language in the presence of the unprofessional ; that he has 
 even employed them sometimes in his writings. Certainly I lose nothing 
 by making this concession. But what does this prove ? Nothing else 
 but that this author has not been able to change the essence of human 
 language ; that he has been constrained, notwithstanding his obstinacy, 
 to express himself like every one else. It is a law which no man, no 
 Hahnemannic Society whatever, can ever change nor disturb. It is a 
 specimen of folly, or alienation, or obstinate ignorance to have attempted 
 not to conform to it, and so directed his disciples. 
 
 Nevertheless, pathology not being cultivated with any particular care 
 by the founder of Homeopathy, I leave this branch of medical knowledge, 
 to pass to therapeutics — the true battle field of Hahnemann, the special 
 object of his meditations and researches.
 
 FIFTH LETTEK, 659 
 
 THERAPEUTICS OP HAHNgMANN. 
 
 The grand axiom of Homeopathy, the one from which the doctrine 
 takes its name, is this : Cure diseases by remedies xvliich 'produce symp- 
 toms similar to those of the disease/' 
 
 The first question to be asked after reading this axiom, so contrary to 
 the received ideas of every one, the learned as well as the ignorant, is 
 this : Where has the author obtained his therapeutic rule ? On what 
 observations and experiments does he found so paradoxical a proposition ? 
 I have sought throughout the works of Hahnemann for a clinical obser- 
 vation which would justify his famous axiom, and I avow that I have 
 not been able to find a single one. 
 
 Can any one cite as medical observations worthy of any confidence, 
 such remarks as the following : " A diarrhea which had existed for 
 several years, and which threatened an inevitable death, against which 
 all remedies had been employed in vain, was cured by an unprofessional 
 practitioner in a rapid and durable manner by means of a purgative, as 
 Fischer observes, to his great astonishment, but not to mine. " " * 
 Boerhaave, Sydenham and Eadcliif were able to cure a species of dropsy 
 with alder blossoms, simply because the alder, as Haller tells us, pro- 
 duces tumors (oedema) by its external application." 
 
 " How many times does not the small-pox produce deafness and dysp- 
 noea ? These two chronic evils were therefore extinguished by it, when 
 it had attained their highest development, as I. Fr. Closs has remarked. 
 o o o Vaccination, which causes as its proper sign a tumor on the arm, 
 has also cured after its eruption a swelled and nearly paralyzed arm."t 
 
 If it is by observations of this kind that Hahnemann pretends to 
 prove the law of similars, it must be admitted that the partisans of 
 Homeopathy arc not hard to please in regard to proofs. I can furnish 
 them with another, which doubtless escaped the erudition of their 
 patriarch : The son of Hemy I., King of England, having been attacked 
 with small-pox, his physician, a skillful man if there ever was one, 
 ordered with all convenient ceremony that the young prince be enveloped 
 in scarlet; that everything about him b3 red — the hangings of his 
 chamber and the clothes of his servants. " This arrangement cured 
 him so well," he says, " that not a single trace of the disease was left 
 upon his face."! We see that John of Gaddesdcn, — this is the name 
 of the celebrated therapeutist — had a presentiment of Homeopathy I 
 
 Since Hahnemann is contented with as gross analogies as those above 
 
 '^Organon, sec. 1.5. f Organon, § 41. 
 
 ; Freind, History of John de Gaddesden.
 
 660 APPENDIX. 
 
 given, it was not difficult for him to demonstrate, that the cures of all 
 the authors that history has transmitted to us were affected in the 
 homeopathic way. Indeed, where is the remedy, the administration of 
 which may not be followed by one or two symptoms having an analogy 
 more or less remote with certain morbid symptoms, especially if we 
 relate, like Hahnemann, to the action of the remedy all the grave or 
 slight phenomena which manifest themselves for ten, twenty or forty 
 days after its administration ? 
 
 This author affirms that there are but three ways of employing reme- 
 dies specifically, namely: 1, The Allopathic method, which uses reme- 
 dies whose effects are different from the symptoms of the disease. 2, 
 The Homeopathic, which employs remedies whose effects have the closest 
 possible resemblance with the symptoms of the disease. 3, The Anti- 
 pathic method, which employs remedies contrary to the disease. 
 
 This enumeration is not complete, and there should have been added 
 to it, for gi'eater exactness, the Isopathic, which consists in making use 
 of means identical or of the same essence as the disease, such as 
 innoculation, etc. But let us pass over this omission, to which I 
 do not attach much importance. There is another much more capital 
 reproach, which I make to the manner in which the action of curative 
 agents is regarded in the above. I say that this manner of considering 
 therapeutic effects is radically defective, because it turns the human 
 miml from the true object of the Art, to enter upon researches as fruit- 
 less as insoluble. 
 
 AVhat is in fact the true aim of therapeutics? Is it not to cure? 
 What then is essentially important to know in regard to any remedy or 
 treatment ? Is it not first, if it cures ; then if it cures promptly and 
 sui'cly. Finally, in what doses and in what morbid circumstances it 
 shows itself most efficacious. Well then, in what way can one be 
 assured incontestibly of all these things ? Is it not by means of thera- 
 peutic proof ? Is there any testimony that can dispense with this ? 
 The homeopaths, the allopaths, the antipaths and the isopaths, are they 
 not all obliged to appeal to this criterion and submit themselves irrevo- 
 cably to its sovereign decision. 
 
 When therapeutic proof has spoken, what is the use of enquiring 
 if the remedy has acted by homogeneousness or by antagonism, by sim- 
 ilitude or difference ? Is not this a vain research, since it can neither 
 replace nor impair the testimony of the supreme criterion ? Do we not 
 arbitrarily restrict the field of experimental therapeutics when we 
 include it, a jfriori, within this or that category of medicaments, either 
 heterogeneous or homogeneous, homeopathic or allopathic ; or when we 
 circumscribe it within excessively minute, or very large, or medium doses ?
 
 FIFTH LETTER. 661 
 
 Most writers in Medicine resemble the attorneys in the comedy of the 
 Plaideurs, who speak interminably on matters foreign to the case, and 
 say nothing, or next to nothing, on what concerns the litigation. When 
 any one has made experiments with a remedy or a treatment in a cer- 
 tain class of diseases, he describes, as briefly as possible, the character- 
 istic symptoms of the state of the patient, and the manifest results of 
 his experimentation, but dwells at great length on the presumed or 
 pathogenic or essential cause of the morbid phenomena, and on the 
 intimate modification which the treatment is supposed to impress on the 
 organism ; things entirely imperceptible to the senses, and on which our 
 minds can form only ephemeral conjectures. We know, for example, 
 that opium generally causes sleep, but that frequently, also, it produces 
 agitation. This double effect of the same substance has put to torture 
 the minds of the theorists of our age. They have written a thousand 
 dissertations, and imagined numerous theories to explain this apparent 
 anomaly, without advancing the question one iota. Does opium possess 
 sedative or exciting properties ? Notwithstanding our progress, and 
 our pretentious physiology, we know no more on this matter than did 
 Gralen, Avicenna, the Arabists, and the scholastics of the middle ages. 
 If any one now asks why opium produces sleep, we shall not be able to 
 give a better reason than that in Moliere: " Opium facit dormire, quia 
 in eo est virtus dormitiva." Behold ! where all our curious researches 
 on objects inaccessible to our observation lead us, and cause us to 
 neglect the essential and indispensable ? Instead of expatiating learn- 
 edly on the excitant or sedative property of opium, it would be better — 
 it would be infinitely more useful — to seek out. by direct and con- 
 tinued experiments, what are the conditions of health and disease in 
 which this substance produces a sedative effect, and what are the condi- 
 tions in which it produces an opposite one ; what are the doses and the 
 preparations most proper to bring about either result. 
 
 But this way is too simple and too long, and does not give a free rein to 
 the imagination. Hahnemann preferred to follow the beaten path, by sub- 
 stituting in all his writings, transcendental explanations for clear and 
 established experience. In justification, for example, of infinitesimal 
 doses, instead of bringing detailed and authentic facts of curing to the 
 support of his method, he endeavors to persuade you by an inextricable 
 tissue of subtile devices, that diseases being only immaterial alterations 
 of an immaterial vital principle, must be combatted by forces of the 
 same nature — that is to say, by the spiritual virtue of medicaments, 
 developed by means of homeopathic attenuation.-' 
 
 * Organ, sections 53, 66.
 
 662 APPENDIX. 
 
 Another time be will tell you that the general forces of nature, such 
 as attraction, electricity and caloric, whose powers are manifest to every 
 one, are neither ponderable nor coercible ; whence he infers that we are 
 wrong in doubting the efficacy of any infinitesimal doses whatever. '••■^ 
 
 This proves that he has not, then, observed that if the forces of which 
 we have just spoken are imponderable and inaccessible to our senses. 
 their substrata are not at all so. Thus, the force of attraction is in 
 proportion to masses ; electricity is developed in proportion to the fric- 
 tion of surfaces ; caloric to the quantity of combustibles — all of which 
 are material, and appreciable by the senses. 
 
 It is known that Hahnemann has composed a treatise on ^Materia 
 Medica and Chronic Diseases, in which he attributes a multitude of 
 new and unheard-of properties to several substances supposed hitherto 
 to be perfectly inert. He assures us, for example, that the carbonate 
 of lime, administered in doses of the sixtiUionth part of a grain, pro- 
 duces no less than one thousand and ninety symptoms, from among which 
 I select the following : f 
 
 1. In the evening (thirteen days after taking it), on going out. 
 unsteady gait. 
 
 2. Dizziness on walking out (at the end of twenty-six days). 
 14a. Sudden deafness, immediately after dinner. 
 
 147. Itching on the border of the eyelids (after five days). 
 
 572. Itching at the anterior part of the glans penis, after urination 
 (after twenty-eight days). 
 
 583. Ardent venereal desires, especially during a walk before dinner 
 (after seventeen days). 
 
 865, Great heat at the extremity of the big toe (after twenty-one 
 days). I 
 
 Pray tell us how any one can assure himself that an imperceptible 
 atom of the carbonate of lime is, unquestionably, the determining cause 
 of these thousand and ninety symptoms, a great number of Avhich are 
 manifested only at the end of ten, twenty and thirty days after the 
 ingestion of the medicamental atom ? Who can assure us that the most 
 of these strange phenomena that are attributed to the influence of the 
 infinitessimal atom, are not, rather, the effect of a multitude of other 
 forces, quite energetic, on the contrary, which act unceasingly on the 
 economy — some permanently, others accidentally? Is it not absurd, as 
 Hahnemann himself says, elsewhere, to attribute an effect to one force, 
 
 ^ Organon, sect. 305, and note. 
 
 f The figures denote the order in which the symptoms stand. 
 
 \ Treatise on Chronic Diseases.
 
 FIFTH LETTER. 663 
 
 while there are in play, at the same time, other forces which often con- 
 tribute more than it to its production.- 
 
 To these questions, so legitimate and ?o pressing, the author of 
 Homeopathy makes no response. He only opposes affirmations destitute 
 of every species of proof, and his credulous adepts are contented. They 
 accept his strangest assertions as articles of faith. Some, however, have 
 separated themselves from the faithful flock, and attempted to revise the 
 symptomatic categories of Hahnemann. They have submitted each of 
 his propositions to scrupulous examination, and exact experiments ; and 
 what have they found at the foundation of this burlesque frame, pomp- 
 ously announced as a divine revelation "? I will let one of the admirers 
 of Hahnemann make the reply. 
 
 M. Rapou, historian of the Homeopathic doctrine, in summing up. 
 under the title of the " Specific School," the sum of the differences which 
 are exhibited among the partisans of the new method, expresses himself 
 as follows : " The law of similars is positive, but it does not constitute 
 the general law of therapeutics. Medicamental substances may operate 
 by the law of contraries ; enantiopathy is as often in play as homeo- 
 pathy — both are secondary and accessory modes. The great principle 
 is the specificity, and the most important problem is not to seek the 
 similarity between the remedy and the disease, but to find, directly, the 
 specific appropriate to each morbid state. Dynamization does not exist 
 even where by many its importance has been greatly exaggerated. 
 Dilution is incapable of developing a medicamental efficaciousness in 
 most substances which are inert in their natural state, and which 
 Hahnemann has put among the number of active remedies. Infinites- 
 imal doses have no marked action ; it is necessary, ordinarih*, to 
 employ tinctures and powders, and never to extend them beyond the 
 third or fourth divisions. Our medicines may be administered with- 
 out inconvenience in the ordinary pharmaceutical preparations, and 
 the various allopathic remedies may be employed conveniently with 
 them. Clinics must become the principal source of indications, and 
 concur, in the largest degree, to the formation of our pure materia 
 medica. This last part of science is to be reconstructed ; an anatomical 
 and physiological classification of symptoms must be introduced into 
 it. The theory of psora, and its pretended consequences, arc false in 
 all respects. We can and we must seek to combine the specific proceed- 
 ure with the usual indications. It is proper to fall back to the use of 
 pharmaceutical mixtures." f 
 
 ^ Treatise ou Materia Medica. 
 
 ■f Histoire de la Doctrine Homceopathic, 1817 — vol. II, chap. xit.
 
 664 APPENDIX. 
 
 These, then, are the results to which Hahnemann's own disciples have 
 arrived when they endeavored to verity by facts, the astonishing asser- 
 tions of their master. Each one of the fundamental propositions of the 
 new doctrine, receives thereby the most formal denial. What remains 
 of this doctrine after so complete and detailed a refutation ? Nothing, 
 absolutely nothing which is worthy of the attention of a man of sense. 
 
 As to the expose of principles which we have just read, and which 
 forms the programme of emancipated Homeopathists, under the name of 
 the Specific School (Ecole Specijicienne), I do not see what the most 
 severe critic can find to condemn, unless it be the words specificity, spe- 
 cifics, which might be advantageously replaced by the more exact expres- 
 sions synthesis and synthetical. Apart from this slight modification, the 
 programme of the Specific School agrees entirely with the principles which 
 we have, ourselves, proclaimed under the head oi Empiri-Methodic system. 
 
 CONCLUSION. 
 
 The Hahnemannic doctrine, whose defects we have only feebly set forth, 
 ofiers to us the strange assemblage of assertions devoid of proof, auda- 
 cious paradoxes and manifest contradictions. Its author, after hav- 
 ing declared solemnly in numerous passages that " the human mind 
 cannot form of itself a notion of the essence of things, of their cause 
 and their effects ; that every proposition must be founded on sensible 
 observation, on facts and experiments," forgets the maxims of his wise 
 philosophy, when he is laying the foundation of his medical system and 
 laboring for its development. 
 
 From that time he did not hesitate to affirm that all the chronic dis- 
 eases that are observed in Europe, (except syphilis,) are the result of 
 a protean impalpable miasm which he calls the psoric or scabby. If a 
 child passes worms in his alvine dejections or by vomiting, if he is sub- 
 ject to opthalmia, catarrh, convulsions, sore throat ; to furuncular tumors, 
 scrofulous engorgement, etc ; it is, according to Hahnemann a latent 
 psoric miasm which is at work. If a young girl is afi^"ected with chlorosis, 
 or hysteria or chorea ; if she is subject to spitting of blood or threatened 
 with pulmonary tubercles or aneurism of the heart, etc., etc., psora is 
 committing in her these ravages. If an old man has hemorrhoids or 
 tetters, if he is affected with a catarrh, or an asthma, or dropsy, or gout, 
 or rheumatism or paralysis, etc., the psoric virus manifests in him its 
 presence. 
 
 By what series of transcendental observations, of delicate experiment, 
 has Hahnemann been able to grasp and unite so many and so various 
 phenomena with the incoercible and immaterial miasm which he names 
 psoric virus. He is silent upon this subject, which is incomprehensible
 
 SIXTH LETTEK. 665 
 
 and incredible to whoever does not possess homeopatliic faith ; but 
 becomes hicid and indubitable to those who possess this new, pretended 
 divine revelation. 
 
 An orthodox Homeopathist is very careful not to suspect the most 
 unimaginable assertion of his prophet. No one among them, for example, 
 has ever attempted to call in question the following anecdote by which 
 Hahnemann pretends to prove the efficaciousness of his infinitesimal 
 doses : "Let a melancholic patient, disgusted with life, and feeling pressed 
 by an insupportable anguish to commit suicide, smell for several minutes 
 only, a flask containing a quadrillion th of a grain of homeopathic powdered 
 gold, and at the end of half an hour he will be delivered from the demon 
 which seemed to possess him, and his flow of spirits will become again 
 like that of a man of sound mind."-- 
 
 No founder of a medical philosophic sect, since Pythagoras, has pushed 
 as far as the chief of the Homeopathists, the despotism of the word of 
 the master. No one has imposed on his disciples more submissive and 
 blind credulity. In order to demonstrate the reality of homeopathic 
 cures he does not report any well established facts or observations, he 
 contents himself with affirming that the medicamental atoms given to his 
 patient proceed to the imperceptible point of the economy wiich is the 
 seat of the primary lesion, and by acting upon it cause the disease to 
 cease, naturally, by replacing it with a stronger artificial afi'ection, which 
 is subsequently extinguished by the vital force ; and not one of his dis- 
 ciples ask him how he has been able to perceive all these phenomena, 
 inaccessible to the human eye — how he has been able to follow the track 
 of the infinitcssimal atom, the course of which he recounts with so much 
 assurance ! Oh, Messieurs Homeopathists, you merit well the epithet of 
 Hahnemanni servzim pecus ! 
 
 '■' Treatise on the efficaciousness of minute homeopathic doses. 
 
 42
 
 666 APPENDIX. 
 
 SEVENTH IE TTER. 
 
 THERAPEUTICAL METHODS. 
 I. Present State of this Branch of Science. 
 
 This branch of the science is, without contradiction, one of the least 
 advanced ; only a few feeble gleams of light pierce the thick darkness 
 that envelopes it. The classification of the therapeutical methods, by 
 Barthez, which I have previously cited, is yet the best and most rational 
 that we possess." However, it can only be considered a rough draft, 
 because it partakes, with all the other modem therapeutical classifi- 
 cations, of the capital fault of incoherence and inconsistency. Thus the 
 classification of Barthez admits a natural method, having for its object 
 to favor, accelerate, or regulate the progress of diseases which tend to a 
 favorable termination. An analytical method, in which each disease is 
 decomposed into a certain number of elementary afi*ections, which are to 
 be treated separately by appropriate means ; an empirical method, by 
 which certain maladies whose nature is unknown are combatted with 
 remedies whose immediate or primitive action is not understood ; finally, 
 a pcrturbative method, which Messrs. Trousseau and Pidoux replace by 
 the substitative method. Let us consider the incoherency of this 
 classification. The first method is called natural ; the second ought to be 
 called, by way of opposition, nmiatnral. There is a method which is 
 designated by the term analytic ; there should be one called the syn- 
 thetic. The fundamental rule in every classification or division of an}- 
 subject whatever is, that the parts of which it is composed should recip- 
 rocally exclude each other, but this rule has been comparatively forgot- 
 ten, as may be perceived in the classification of Barthez ; each of the 
 methods which have been admitted is founded on considerations of an 
 order foreign to the preceding, instead of flowing from the same princi- 
 ple, as the branches of a tree proceed from the same trunk. What 
 would be said of a naturalist, should he divide bodies into artificial 
 and organic, or of a pathologist who should divide diseases into epi- 
 demic, endemic, and contagious ? It would be alleged that they mix 
 
 '-' See our Third Letter.
 
 SEVENTH LETTER. 667 
 
 and confound all their ideas. Does not a therapeutical classification 
 based upon diflferent principles merit the same reproach ? The incon- 
 sistency of the classification of Barthez is not less palpable than its 
 incoherence. In fact, we find a method distinguished from the others 
 by the title Empiric, which signifies, in the ordinary language of authors, 
 unreasonable and unphysiological. But this method being the one 
 which, by the consent of eveiybody, produces the most brilliant cures, 
 it follows according to its peculiar denomination, that physicians never 
 produce better cures than when they treat diseases without being guided 
 by, or even contrary to their theories. What beautiful logic ! And 
 yet I venture to say, French Medicine has not produced a greater genius 
 than Barthez. But what can you expect ; the most adroit musician can 
 not produce harmonious sounds from a poor instrument. As long as theo- 
 rists shall obstinately designate certain curative methods by titles which 
 are appropriate, or ought to be appropriate, to all of them in general ; as 
 long as they will continue obstinately to call the one rational, the other 
 natural, a third exact, a fourth physiological, another experimental or 
 empirical, etc., never, no, never, will therapeutics escape from the chaos 
 into which it has been plunged ; never shall we succeed in forming a 
 truly rational classification of the different modes of treatment. 
 
 In order to accomplish an object so desirable, it is necessary at first 
 to establish a universal principle of therapeutics, embracing all the ope- 
 rations of internal and external Medicine ; afterward, to deduce from 
 this principle the diflferent curative methods proposed ; finally, to desig- 
 nate each of these methods by a term which is applicable to it alone. 
 
 We have already fulfilled the first of these conditions, in forming the 
 following precept, whose evidence and generality no one will contest ; 
 treat each malady hy those means xvliose efficacy in similar or homologous 
 cases has been demonstrated hy experiences- We shall now attempt to 
 fullfil the other two in the classification which follows. 
 
 §11. Classification of the Therapeutical Methods. 
 
 THE SYXTHETICAL METHOD. 
 
 The most ancient, the most natural, and the most simple mode of cure 
 consists in opposing to each disease which presents itself, one remedy or 
 one combination of curative means, which removes the disease at once. 
 In this mode of treatment our mind considers all the symptoms as forming 
 
 '"' See our Second Letter, § 4 and 5.
 
 
 668 APPENDIX. 
 
 an indivisible concourse, as tlie manifestation of one simple morbid 
 entity, against which he directs a plan of medication which seems to 
 attack the disease in its essence, and to put an end to all the accidents 
 by a virtue which is special and peculiar to it, and is in some sort 
 incomprehensible. I shall give to this method the epithet synthetic ; 
 that is to say, simultaneous, a word which represents very exactly the 
 manner in which our minds consider both the morbid symptoms and the 
 effects of the treatment. 
 
 The ancients, who saw in all cures nothing but the result of antago- 
 nistic foi'ces, designated these kinds of medication by the name of anti- 
 dotes, the moderns called them specifics. By a sort of precipitation very 
 common to the human mind, the first therapeutists were very quick to 
 arrange among the antidotes a larger number of substances whose vir- 
 tues were by no means assured. Thus they designated a large number 
 of plants by the title of vulnerary, because they supposed them to pos- 
 sess especial virtue in the cure of wounds. They called theriacs several 
 very complicated pharmaceutical preparations which, in their imagina- 
 tion, had a marvelous efiicacy against venom and all sorts of poisons. 
 
 It is the same with a multitude of pharmaceutical affections of anti- 
 quity. The moderns have not been less prolific in this respect, but 
 have often been less sincere ; and the pompous denominations by which 
 they designate numerous medicaments are only enticing labels to attract 
 customers. Among this number are to be classed the elixirs of lon- 
 gevity, of immortality, the anti-goutous and anti-mucous nervines, the 
 sedative waters, etc. etc. 
 
 Galen, not knowing how to explain the therapeutical effects of anti- 
 dotes, has said that these remedies act hy their whole substance, and 
 medical posterity has repeated this explanation, which was nothing 
 more than a method of concealing its ignorance : in the same way natu- 
 ral philosophers concealed their ignorance of the cause of the ascension 
 of water in the tube of a suction pump, by saying that the liquid 
 rises in consequence of nature's horror of a vacuum. The moderns, 
 not willing to be satisfied by senseless explications, have fallen into 
 excesses not less ridiculous. Some have denied the existence of specif- 
 ics ; others, without contesting either their existence or admirable effi- 
 cacy, have endeavored to proscribe them, or to restrict their application 
 as much as possible. They have treated these remedies as irrational. 
 They have banished them from their theories, in order to give them 
 over to blind and ignorant practitioners. I have demonstrated the error 
 of this peculiar prejudice, but it cannot be too much denounced for the 
 interests of humanity and for the honor of the Medical Art.
 
 SEVENTH LETTEK. 669 
 
 Too fortunate indeed would be both patients and pliysicians, if the 
 occasion more frequently presented itself in which we could employ those 
 remedies, called specifics, or better, synthetics, which remove a disease in 
 totality as if by a charm, however numerous its symptoms may be, and 
 whatever mask it may wear ! The day is not far distant when men will 
 be astonished at the resistance of my cotemporaries against the restora- 
 tion to the method which I call synthetic, the title of rational, which it 
 should never have lost, and which it merits in the highest degree. We 
 do not ask the natural philosopher or the chemist, why alkali combines 
 with an acid ; why the electric spark converts the mixture of hydrogen 
 and oxygen gases into water. We do not ask the physiologist why the 
 marsh mallow is insipid to the taste; why sugar is sweet, and succory 
 bitter ; why my hand is opened or shut by the act of my will ? And 
 yet you dare ask the therapeutist why quinia cures intermittent fever, 
 mercury syphilis, digitalis idiopathic palpitations of the heart, etc. etc. 
 Are these latter phenomena more easy to explain than the former ? 
 Is it not just the reverse '? Is it not plain that our exactions in regard 
 to the physician are unjust and unreasonable? 
 
 We distinguish two sorts of specifics : the one which acts especially 
 upon certain physiological functions, as emetics, diuretics, emmena- 
 gogues, soporifics, purgatives, etc., were known to the ancients. The 
 other, whose specificity is manifest only in certain morbid conditions, 
 such as febrifuges, anti-syphilitic, anti-scrofulous remedies, etc., have 
 been appreciated only by the moderns. 
 
 It is the greatest pride of modern medicine, and without contradic- 
 tion its best title to the gratitude of mankind, that it has discovered 
 genuine specifics for diseases ; that is to say, remedies as sure and much 
 less painful than the most vaunted surgical proceedings. A physician 
 who vaccinates a child in order to protect it against the variolous infec- 
 tion, or who administers a salt of quinia to arrest the paroxysms of 
 intermitting fever, is he not as certain to obtain a decided cure, as the 
 surgeon who ties an artery afi'ected with an aneurismal tumor, or who 
 attempts to break up a vesicular calculus by the ingenious maneuver of 
 lithotrity ? Why then foolishly call the conduct of the first empirical — 
 which in our language means blind — and that of the second rational ? 
 Is this not in consequence of a pure mental hallucination, as I have 
 elsewhere peremptorily demonstrated? " 
 
 As to myself, firmly convinced that the synthetical method, which 
 removes diseases almost instantaneously by special medications, is the 
 
 " See Fourth Letter, § 3.
 
 670 APPENDIX. 
 
 most rational as well as the most efficacious and sure, I assign to it 
 the first rank among therapeutical methods. I do not hesitate to 
 proclaim loudly, that it accomplishes better than any other, the object of 
 our Art, and shows its power and utility more manifestly than any 
 other, to the eyes of the world. 
 
 §11. Anylitical Method. 
 
 Unfortunately, it is not always possible to attack a malady, that is to 
 say, a collection of symptoms, entirely en masse. The number of spe- 
 cific medicines is still extremely limited. In the must common cases, 
 we are, therefore, obliged to resort to analysis, which consists in decom- 
 posing each pathological condition into a certain number of elements or 
 more simple maladies, and then to direct against each one of these mor- 
 bid elements an appropriate medication. 
 
 I suppose, for an example, that we have to treat a man of middle age 
 and average strength, attacked with pneumonia. Since we possess no 
 specific against this affection, the following is, in the present state of 
 the science, the method generally pursued: During the first two or 
 three days, the patient will be bled, in order to diminish the san- 
 guineous congestion that occurs in the lung ; and all nourishment is 
 withheld for the same purpose. Tepid emolient drinks, which diminish 
 the general tension, dispose to diaphoresis and moderate the internal heat, 
 by which the patient is often incommoded, are given. Finally, certain 
 slightly narcotic drinks are administered, in order to calm the nerv- 
 ous ij-"itation, which the paroxysms of coughing and difficulty of respi- 
 ration incessantly provoke. After continuing this treatment a few 
 days, many practitioners give tartar emetic, either in large doses (from 
 six to ten grains to five ounces of water), or smaller ones (one or two 
 grains to the pint). Experience proves that the use of this medicine in 
 either form, is followed sometimes by alvine dejections, sometimes by 
 vomiting, again by sweats, or also by two or all three of these phenom- 
 ena. But whatever may be its immediate effects, it favors, nearly 
 always, the absorption of the white fluids with which the lung is 
 engorged at this period of the disease, and it is in view of this second- 
 ary result that it is thus given. I designedly omit to mention a num- 
 ber of other means by which we pi'opose to fulfill different indications. 
 These details would be here of no utility Avhatever. AYhat precedes suf- 
 fices abundantly to explain the mechanism of the analytical method at 
 the bed-side, and I must restrict myself to that.
 
 SEVENTH LETTER. 671 
 
 COMPAR SON or THE TWO PRECEDING METHODS. 
 
 It is sufficient to glance at the description of each of these therapeut- 
 ical methods in order to be convinced that the first is the most simple 
 and the most natural, and that its application requires no eifort of the 
 mind ; while the second, more complicated and more artificial, requires 
 in its application more or less thought. This consists, as has already 
 been said, in decomposing a pathological state into its several elemen- 
 tary lesions, or simple aff"ections, and in arranging the treatment which 
 shall respond as much as possible to each one of these morbid elements. 
 
 It is true that by this mental analysis of pathological states, our 
 mind seems to penetrate farther into the intimate nature of the disease, 
 just as, in the combination of a multiple treatment, it appears to enter 
 more into the knowledge of the physiological action of each modifier. 
 In a word, it is evident that the analytic method requires a series of 
 intellectual operations and reasonings, more or less abstract, which 
 the synthetical method spares us. For example, far less labor of the 
 intellect is necessary in order to prescribe a suitable dose of quinia. for 
 an individual attack with intermittent fever, than to decompose pneu- 
 monia, typhoid fever, or Asiatic cholera into a certain nxxmber of 
 elements, and subsequently to direct against each one of these an appro- 
 priate medication. It is therefore not astonishing that the mind, which 
 often judges of the value of things only by the trouble which they have 
 cost it, in comparing the extreme simplicity of the therapeutical syn- 
 thesis with the complications of anah^sis, should have been induced 
 to consider the first process much less wise an I rational than the 
 second. " 
 
 But if, laying aside this gothic prejudice, we estimate things as we 
 ought to do, by their real intrinsic value — if we judge the therapeutical 
 methods by their degree of certainty and efficacy, then, without doubt, 
 we shall give the preference to the synthetical method ; and we shall be 
 much astonished if the title of rational should be denied to this, in order 
 to accord it exclusively to its younger sister, to whom the epithet of 
 arguer, or wrangler, is much more appropriate. 
 
 * There was also a time when the merit of the difficulties overcome was held 
 in high estimation in appreciation of literary works. At that epoch flour- 
 ished the enigmas, words for rhyming, roundelays, and other compositions, 
 ''jwsrlem farinre. The law giver himself of the French Parnassus, made sacrifice to 
 this bad taste when he said : 
 
 " A faultless sonnet is better than a long poem."
 
 672 APPENDIX. 
 
 That which contributes still to perpetuate the common illusion in favor 
 of the Analytical method is the immense service which it has rendered 
 and still continues to render to chemistry ; for at all times this latter 
 science has had the privilege of exercising a considerable influence upon 
 medical theories. But it is not considered that chemical differs essen- 
 tially from therapeutical analj^sis ; the first operates upon palpable 
 objects, and obtains, by decomposing them, fixed and determined ele- 
 ments. The second only acts upon objects purely intellectual ; it decom- 
 poses, not diseases themselves, but the ideas which we form of those 
 diseases ; it does and can only obtain variable, uncertain, and imagin- 
 ary elements. Consider well this capital difference, dear reader, and 
 you will comprehend why the Analytical method, which leads to admi- 
 rable discoveries in chemistry, is in therapeutics an inexhaustible source 
 of eiTors. You will understand why the clinical analysis of Barthez 
 differs so widely from that of Boerhaave, and why that of Broussais 
 does not resemble either of the other two. You will comprehend why 
 it may happen that of two, three, or ten physicians called in consulta- 
 tion each one may have a particular notion of a pathological state, 
 wliich must be decomposed mentally ; while, if they have in hand a 
 disease for which the Science possesses an established specific, they will 
 be nearly unanimous. 
 
 From which I conclude that in therapeutics, synthesis is incomparably 
 more simple, more sure, more efficacious, and more rational than analy- 
 sis ; that the highest aim of this branch of Medicine consists in 
 restoring, as far as possible, the treatment of each morbid state to the 
 synthetical process ; an object that the German specific sect has per- 
 fectly understood, in proposing as an object of research, specific remedies, 
 without troubling themselves whether they act by antipathy, homeo- 
 pathy, isopathy, or allopathy. 
 
 III. Expectant Method. 
 
 Synthesis and analysis are methods common to all the sciences, but 
 tKerapeutics embraces others which are peculiar to it ; thus, when a 
 disease has a determined and rapid course, as an ephemeral fever, simple 
 measles, varioloid, a simple wound that involves no important part, etc.; 
 when a disease, although more grave, offers no alarming symptoms, and 
 seems to tend to a favorable termination by the simple forces of nature, 
 as an inflammatory fever, without any manifest inflammation of an 
 important organ ; when a disease announces itself in an obscure man- 
 ner, and there is nothing urgent in the case ; finally, in a multitude of
 
 SEVENTH LETTER. 673 
 
 other cases wliicli it would be too tedious to specify, it suffices to place 
 the patient in good hygienic conditions, and to prevent his committing 
 any imprudence, in order to obtain a cure. 
 
 In such cases, nature appears to supply all the means for the cure ; 
 the physician has only to look on and hold himself in readiness, in 
 order to correct, when necessary, the digressions of nature, to excite 
 or moderate her, to sustain her forces, to aid her, in a word, 
 according to the indications which she herself furnishes. The part of 
 the medical man in these cases has been compared to that of a servant 
 or agent who only waits, before he acts, for the signal of the master. 
 Medicus minister naturce, is an axiom that has become celebrated in 
 many schools of Medicine, but which is absurd when it is made appli- 
 cable to the entire system of therapeutics.-' 
 
 Some authors, considering the office of the physician in these circum- 
 stances as nearly a nullity, have given to the Expectant method the 
 name of inactive Medicine, but this qualification is evidently inexact, 
 for the inaction of the physician is only apparent. Although he may 
 prescribe nothing energetic, his mind does not cease to be attentive and 
 occupied ; he watches over the progress of the symptoms, prevents 
 imprudences, regulates the regimen, etc. ; none but ignorant persons can 
 regard as nidi this function of the man of science. Those, on the con- 
 trary, who have been desirous to generalize the Expectant method, under 
 the title of Natural or Hippocratic, consider each malady, or each con- 
 course of particular symptoms as a regular concatenation of phenomena, 
 which nature, the soul, or the vital principle developes with the deter- 
 mined aim of curing. Natura Morhorum Mediccdrix. Xature is the 
 sovereign curative agent of all our diseases — this is their universal 
 axiom in therapeutics. But if it is true that nature alone cures cer- 
 tain aifections, it is not less demonstrated by daily observations that 
 she is often impotent, or even injurious, without the intervention of Art. 
 I have already cited very striking examples of this, which saves here 
 the trouble of insisting further upon this point.'-' 
 
 SECONDARY METHODS. 
 
 The three methods which 1 have just described embrace all therapeu- 
 tical acts, whether internal or external. There is not a single medical 
 prescription, nor a single surgical operation which can not be referred to 
 one of the three categories of medication above described. However, 
 
 * If on many occasions a physician is the minister naturce, in how many others 
 is he also mxigiHter naturce. 
 •' See Second Letter, § 4.
 
 674 APPENDIX. 
 
 many authors have given the name of therapeutical methods to modes of 
 treatment of a very much less general application. Thus they have 
 admitted methods called anti-phlogistic, derivative, or perturhative, 
 substitutive, etc., but it is easy to see that each one of those enter into 
 one or the other of the three preceding, and should not consequently be 
 arranged on the same line, in a good classification. 
 
 §111. Application of our Theory of Curative Methods. 
 
 Let us suppose that it is desirable to appreciate and classify the treat- 
 ments so numerous and so variously advised in modern times, in order 
 to combat the cholera, a question replete with present importance, a 
 truly inextricable chaos, according to the poor doctrines of our classics. 
 God forbid that we should wish to pass in review all the means that 
 have been proposed or tried, in order to conjure this terrible plague I 
 It will be sufficient to direct our attention to a few of them, to show 
 how we may seize the prevailing idea, and assign to each one of them 
 the rank which it should occupy in a therapeutical classification, in 
 order that every attentive reader may be able afterward to accomplish 
 the same work in regard to any treatment, and in any disease whatever. 
 
 FIRST CATEOOUY — SYNTHETICAL METHOD. 
 
 There are physicians who, considering all the cholera phenomena 
 as the manifestations of an indivisible morbid entity, have endeav- 
 ored to arrest its development by the aid of one uniform medi- 
 cation, the specific efficacy of which has apj^eared to them suf- 
 ficiently justified by certain observations, or certain analogies more or 
 less well founded. Such are those who have had recourse to the saline 
 medication in the use of chloride of sodium, or to a mercurial treat- 
 ment, or to the nitrate of silver ; those still, who have proposed cin- 
 chona and the salts of quinia, under the title of prophylactics, etc. 
 
 SECOND CATEGORY — ANALYTICAL METHOD. 
 
 Other practitioners, regarding the cholera as a multiple affection, or 
 at least polymorphous, have decomposed it by mental analysis into sev- 
 eral elements, or simple affections, and have first directed their thera- 
 peutical resources against the one of these elements which seem to them 
 to govern and give impulse to the rest. 
 
 We arrange in this category the treatment by diluent drinks, of which 
 the obvient object is to dissolve and evacuate the acrid matters which 
 are supposed to engender the disease ; that by evacuants, emetics, and 
 purgatives, employed in the intention to expel from the economy the
 
 SEVENTH LETTER. 675 
 
 deleterious principle which, corrupting the secreted products, provokes 
 all the morbid accidents ; third, the treatment by anaesthetics and anti- 
 spasmodics, such as opium, ether, chloroform, etc., which affect particu- 
 larly the nervous element ; fourth, the anti-phlogistic treatment, the 
 aim of which is to combat the phlogosis of the alimentary canal, which 
 is considered as the prime motor, the determining cause of all the other 
 phenomena ; fifth, the use of stimulants, such as aromatic waters more 
 or less alcoholic, tinctures, ammonia, galvanism, etc., the ordinary effect 
 of which is to arouse the oppressed vital forces, to arrest the alarming 
 progress of prostration, etc., etc. 
 
 THIRD CATEGORY — EXPECTANT METHOD. 
 
 None of our practitioners have dared essay the expectant practice in 
 this terrible disease ; for the office of the temporizer which has immor- 
 talized the name of Fabius Cunctator, is more difficult to sustain in the 
 midst of the general alarm and trouble menacing all the functions of 
 the organism, than to head an army impatient to measure its strength 
 with the enemy. The value of this method cannot therefore be judged, 
 in epidemic cholera. Xevertheless there arc patients who, not being 
 able to obtain the counsels of a medical man, or being unwilling to fol- 
 low them, like the lunatics in Salpetriere, have been guided by instinct 
 only. May it not be said that in this class of sufferers, in which there 
 were several recoveries, the expectant method was ilkistrated ? 
 
 Does the reader see with what facility the classification of such numer- 
 ous and divergent medications announced above, is effected ? Now let 
 him attempt to perform the same thing by means of therapeutical clas- 
 sifications in common use ; he cannot accomplish it in a satisfactory 
 manner. He could never decide which of the methods of treatment 
 above enumerated merits, to the exclusion of the others, the title of 
 rational, or physiological, or natural, or empirical, or substitutive, etc., 
 for these epithets are nearly equally applicable to all ; whence it follows 
 that they characterize none in a special manner. 
 
 IV. Classificatiox and Denomination of Medicaments. 
 
 This section of therapeutics has been the object of bitter and multi- 
 plied recriminations. There is not a single treatise on Materia Medica 
 published since a half century, in which the instability, confusion and 
 insufficiency of the classifications and pharmaceutical nomenclature are 
 not deplored. Bichat has pointed out to us the principal sources of 
 these defects : " There have been in Materia Medica no general systems,
 
 676 APPENDIX. 
 
 but this science has been iufiuenced by turns, by those who have 
 reigned iu Medicine ; each of ■whose opinions, if I may so say, has been 
 reflected back upon it ; hence the vagueness and the uncertainty that it 
 now presents." " 
 
 Must we, to avoid these causes of error, adopt the classifications of 
 the naturalists, as a recent author in Materia Medica and therapeutics 
 has done ? f I think not, for this reason : all methodical distributions 
 of the materials of a science must be based on the properties which this 
 science entertains. Now, what properties in medicamental agents are 
 considered in therapeutics ? Those which modify the animal economy. 
 It is necessary, then, to name and class these pharmaceutical materials 
 according to the modes of action which they manifest in the living 
 organism. To seek another base, less Variable, as M. Dieu has done, is 
 to change the difficulty, and not resolve it. 
 
 Unhappily the action of the same substance on the animal economy 
 may vary according to numerous circumstances, which it is often diffi- 
 cult to appreciate with certainty. For example, tartar emetic, admin- 
 istered to a series of patients, in different forms and doses, can produce 
 a sweat in one, an increase of bronchial secretions in another, alvine 
 evacuations in a third, and vomiting in a fourth. In others it can 
 arrest vomiting, stools, etc. Applied to the skin, this substance pro- 
 vokes an eruption of pustules, followed by ulcers, the healing of which 
 is tedious. Under what head shall we rank this medicament? Which 
 of its effects can be regarded as the more characteristic and essential ? 
 Answer : the one which is the most sensible and the most constant. 
 
 But if it happens that a remedy produces several effects nearly equally 
 remarkable, to which shall we give pi-cference ? It is not important 
 which is placed in the first rank, provided the othei'S are carefully 
 stated. Thus, I would not hesitate to class tartar emetic among the 
 emetics ; but I should not complain if it is placed among the irritants, 
 provided care be taken to note its property as a vomit. I would class 
 opium, in like manner, among the anodynes or the narcotics, being care- 
 ful at the same time to notice that, instead of calming certain pains, 
 cephalalgia for example, it exasperates them ; that instead of producing 
 sleep, it sometimes produces agitation. I should be particularly careful 
 to indicate the circumstances that influence these various results. 
 
 Finally, it may happen that a medicament changes its position in the 
 pharmaceutical scale, as the result of some newly discovered property. 
 
 **Anatomie Generale. Considerations Generales, § II. 
 
 t M. Dieu, Pharmaceutist-JMnjor and Professor in the Military Hospital of Metz, 
 lias followed fully tlie divisions of the old naturalists, who separated, as is 
 shown, all substances into the three kingdoms. 
 
 I
 
 SEVENTH LETTEK. G77 
 
 Thus ether and chloroform, which two or three years ago were classed 
 exclusively among diffusible stimulants, may now very properly he 
 ranked among the anaesthetics. 
 
 To seek in any order of knowledge more stability and more perfection 
 than comports, even, with the nature of this knowledge, is to lose time 
 in the pursuit of a chimera. Now the Materia Medica, like Chemistry, 
 is a science essentially changeable. The merit of a therapeutic treatise 
 does not consist so much in the nomenclature and classification of cura- 
 tive agents, as in a scrupulous care to specify well the circumstances 
 which cause a variation in the effects of these agents ; not in attribu- 
 ting to them any imaginary virtue in connection with this or that medi- 
 cal doctrine, but in keeping strictly to the results of pure observation. 
 
 §V. Conclusion. 
 
 Up to this time no one has embraced in the same plan and united 
 under one principle, internal and external Medicine. The most famous 
 systematists of modern times have always been careful to exclude from 
 their therajjoutical theories surgical operations; that is to say, the 
 medication whose effects are most evident, because these effects do not 
 aid them in their theoretic explanations. Let a surgeon, for example, 
 extirpate a tumor ; no one could say that he had acted by the principle 
 of contraries or similars, because in this case there is no relation of 
 antagonism or similitude between his operation and the nature of the 
 disease which he treats. But it can be well said that he attacks, syn- 
 thetically, the product of the morbid affection. 
 
 This necessity in systems, other than Empiri-methodism, to exclude 
 from the therapeutic scale external medication, is alone sufficient to 
 prove the imperfection, insufficiency and falseness of these systems, if 
 already I had not demonstrated this falseness in various ways besides. 
 
 It is true that Empiri-methodism does not pretend, like most other 
 systems, to explain the intimate connection which exists between the 
 nature of diseases and the mode of action of remedies. We willingly 
 confess our ignorance on these subjects, which are impenetrable to the 
 senses as well as the mind. We avoid carefully hazarding any conjec- 
 ture in this respect, not being willing to offer to our readers arbitrary 
 interpretations for truth, and ideal fictions for material realities.
 
 678 APPENDIX. 
 
 EIGHTH LETTER. 
 
 KEPLY TO SOME OBJECTIONS CONCERNING THE EMPIEI-METHODIC DOCTRINE. 
 §1. AReteospective View. 
 
 The chief aim of this publication being, as I have auuounccd from the 
 commencement, to establish the practice of Medicine on an immovable 
 base, to protect it from the incessant variations of phj'sio-pathological 
 theories, and to constitute, in a scientific manner, the Healing Art, 
 whose processes, often disjointed or contradictory, seem to have among 
 themselves no logical union, this has, it appears to me, been sufficiently 
 attained in the preceding letters. 
 
 Indeed, after having established the necessity of a universal axiom in 
 therapeutics, of a certain and incontestable evidence, embracing every 
 possible mode of curing, whether internal or external, we have proved 
 that this axiom cannot be other than the following : that medication 
 which has cured a disease, must cure equally all diseases analogous to it. 
 Whence is deduced at once this precept, which allows of no exception : 
 treat each case by means lohose ejfflcacy has been demonstrated by expe- 
 rience in homogeneous casesfi 
 
 Afterward we have shown, that the rational application of the precept 
 can be very well effected by means of three general methods of treatment, 
 which comprise all the operations of Medicine proper, and of Surgery, 
 without any alliance with physio pathological theories.f 
 
 Thus is established a foundation of a therapeutical system which is 
 both rational and progressive: thus is realized the agreement, hereto- 
 fore declared impossible, of science with art, of theory with practice, of 
 reason with experience : thus is constituted what may be called the great 
 medical strategy, si parva magnis componere licet. You know that the 
 part of a physician combatting a disease has often been compared to 
 that of a general in presence of an enemy. Well, if I may be allowed 
 to continue the similitude, I would observe that sometimes the man of 
 war attacks his foe in front, and attempts to overwhelm and destroy him 
 at a blow ; then he employs the synthetic method. At another time, on 
 
 '' See Second Letter. f See Second Letter
 
 EIGHTH LETTER. 679 
 
 the contrary, he seeks to disunite the battalions of the enemy, in order 
 to conquer them separately ; in this case his method of attack is the 
 analytical, finally, it happens sometimes that a skillful general 
 avoids committing himself, awaiting a favorable occasion, or hoping that 
 his adversary will become exhausted by want of provisions or amuni- 
 tion. Has not this tactic much resemblance to our expectant method ? 
 
 Thus you see, that according to the system of rational Empiricism, or 
 Empiri-methodism, as I have exhibited it in these letters and otherwise, 
 the practice of Medicine is scientifically constituted, without any suji- 
 port from physio-pathological theories ; the Art of curing no longer offers 
 the strange anomaly of processes called rational, whose efficacy is more 
 than doubtful, by the side of others called ?io«-rational, whose efficacy is 
 perfectly established ; the practitioner is no longer reduced to the neces- 
 sity of making the humiliating avowal, that he can never cure better 
 than when he treats a patient without knowing why. I might there- 
 fore limit here my task, and leave to others the care of developing the 
 principles which I have established ; to follow their application through 
 all the branches of medical science, and to show how these principles 
 govern, in all their details. But there are still some clouds to be 
 removed, some objections that must be resolved, concerning the ensemble 
 of the empiri-methodic doctrine, and in answering these I shall termin- 
 ate my remarks on this subject. 
 
 §11. First Objectiox. 
 
 We read in the Essay on Medical Philosophy, l)y M. Bouillaud: " We 
 have demonstrated heretofore that diagnosis is the essential foundation 
 of therapeutics, or rather, we have admitted, with all physicians, that 
 this is an axiom that needs no demonstration. How, indeed, can we 
 treat a disease which we do not know ? Therapeutics is really only a 
 deduction or corollary from ideas or doctrines which we form on the 
 nature of diseases."" 
 
 In order to refute victoriously the doctrine emitted in this passage 
 by the celebrated professor of La Charite, it would suffice, doubtless, to 
 refer the reader to the philosophic axioms which I gave in my Fourth 
 Letter, and to the corollary which accompanies them. But I will not 
 content myself with an indirect refutation, especially because there is 
 in the passage which I have just cited a captious sophism, whose artifice 
 it is necessary to reveal. " How treat," he says, " a disease which we 
 
 '- Essai sur la Philosophie Medicale, part ni, cliap. vi, p. 302.
 
 680 APPENDIX. 
 
 do not know ?" The question is urgent, and T do not know tliat M. 
 Louis or M. Cliormel, to whom he seems to address himself personally, 
 has ever made any response to it. I shall endeavor, therefore, to 
 answer it in their place ; hut before doing so, I ask to be permitted to 
 propose a question myself. 
 
 Is not a gardener obliged to know the plants he cultivates ? Must 
 he not be able to distinguish a cabbage from a turnip, a carot from a 
 beet? Certainly no one will question but that this knowledge is 
 necessaiy. Does it follow from this that he can deduce by reason the 
 rule of culture, the character of soil, manure, exposure, etc., which is 
 appropriate to each of thescxvegetables ? Every sensible man will reply 
 in the negative. Take any man you please, learned in botany or veg- 
 etable physiology, chemical analysis, or microscopy; suppose that he 
 combines the knowledge of all the academies, on these various branches 
 of science, yet I defy his capacity to deduce from them directly, the 
 least horticultui'al rule, without some previous experience of his own or 
 of others. Having laid down this proposition, I come to the objection 
 of M. Bouillaud. 
 
 " How treat," you say, " a disease which we do not know ?" Every- 
 body will agree with you that the thing is impossible. Every one will 
 consent, for example, that to treat well a variola, it is essential not to 
 confound it with a syiihilitic pustule, and that to treat properly an 
 inguinal hernia, it must not be taken for a bubo. Thus far you are 
 right, when you insist on the importance and the necessity of diagno- 
 sis ; when you affirm that without an enlighted diagnosis there is no 
 rational, effective medication. 
 
 But because therapeutics can not proceed safely, if it is not guided 
 by the light of diagnosis, does it follow that it needs no other aid ? 
 Does it suffice to diagnosticate well a disease, in order to know how to 
 cure it? In a word, is therapeutics, as you pretend, a deduction, a 
 corollary from our ideas on the nature of disease ? This is exaggera- 
 tion and an error, scarcely conceivable on the part of a elinist so dis- 
 tinguished as the professor by whom it has been emitted ; an error 
 which the following examples will make perfectly plain. 
 
 Nearly a thousand years ago, variola was known to Europe ; it was 
 described by the Arabs and Arabists with such exactness as to leave 
 little for their successors to do. Only about fifty years since was the 
 discovery made for the prevention of this disease by vaccination. Do 
 you believe that this discovery is a deduction, a corollary from the ideas 
 which were then held on the nature of the disease ? You know too 
 much of the history of the propagation of vaccination to sustain such 
 a heresy. You know too well with what relentlessness and obstinacy
 
 EIGHTH LETTER. 681 
 
 this operation was combatted in the name of the most accredited 
 theories. 
 
 Intermittent fevers were known from all antiquity. We find descrip- 
 tions of them in the works of Hippocrates, and it is probable that the 
 Asclepiadre diagnosticated these diseases nearly as surely as ourselves. 
 Nevertheless, we cure them incomparably better than they did. Do we 
 owe the perfection of our therapeutics in this respect to more just ideas 
 on the nature of these diseases ? You well know the contrary ; you 
 know, definitely, that the introduction of the great febrifuge took place 
 in spite of the reigning ideas and theories on this class of aifections. 
 
 Finally, what disease is better known to us than hydrophobia ? We 
 know its origin, how it is communicated to man, the duration of its 
 incubation, its course, symptoms, and infallible termination. It suffices 
 to have seen it once not to confound it with any aifection of another 
 species. Nevertheless, its therapeutics is no more advanced than it was 
 two or three thousand years ago. 
 
 And you dare affirm that " therapeutical indications are evidently 
 derived from the diagnosis of the disease ; that when the nature of the 
 latter is exactly known, it indicates necessarily the remedy. "'•■■= Never 
 was there a more illusory maxim professed in Medicine. Alas, the con- 
 trary is too well proved by the history of our Art. No, the knowledge 
 of the remedy does not flow from the knowledge of the disease, as a 
 conclusion drawn from the premises. Diagnosis constitutes only one of 
 the premises of the Art of curing ; the other premise, no less indispen- 
 sable, is clinical proof. Thus the Asclepiadge understood very well 
 intermittent fevers ; but before clinical proof had sanctioned a mode of 
 treatment, the Art was nearly powerless, science was lame, relatively to 
 this class of affections. Thus, our diagnosis of hydrophobia leaves but 
 little to desire, while our therapeutics is still and will always remain 
 miserable, until clinical proof shall have sanctioned some of the reme- 
 dies employed in this frightful malady. 
 
 According to the opinion of M. Buchez, conformed in this respect to the 
 doctrine of all modern philosophers, you can not foresee the successive 
 effects engendered by the introduction of a therapeutic agent into the 
 animal economy, before the entire succession of these phenomena have 
 been observed once at least, to their full extent. f So much more im- 
 possible is it that the diagnosis of a disease, however exact it may be, 
 can enable us to foresee the series of modifications which any given 
 treatment will produce upon this disease before the entire series of 
 
 "Essai siirla Philos. Med., p. 321. 
 •|- See Fourth Letter. 
 
 43
 
 682 APPENDIX. 
 
 these modifications have been observed at least once, in their whole 
 extent. 
 
 Formerly syphilitic accidents were regarded as the indices of a virus, 
 which must, by all means, be expelled from the economy. Consequently 
 sweating and salivation were induced and continued almost to exhaustion, 
 in the individuals attacked with some of these symptoms ; after all 
 this, they were purged. Latterly, some pathologists have pretended that 
 the venereal symptoms are only the product of an irritation or a phlogosis : 
 consequently, they have advised the application of antiphlogistic medica- 
 tion in all cases of this nature. The Homeopaths regard these same acci- 
 dents as the effects of an impalpable miasm, and feel authorized by this 
 hypothesis to oppose them with spiritualized remedies. Both have 
 deduced, apriori, these rules of treatment from their respective ideas on 
 the nature of the malady. Both have followed an equally false route, 
 based on hypothesis. We must not proceed in this way in practical 
 Medicine, but must reason, and conduct ourselves as follows : 
 
 The venereal disease is manifested by symptoms which are distin- 
 guished now into primitive, secondary and tertiary or constitutional. 
 Experience teaches us that each of these phases requires a different 
 medication. Thus, in the first we employ, sometimes with advantage, 
 astringents or diluant drinks. In the second, the salts of mercury in 
 small doses, aided by opiates or sudorifics, generally succeed best, without 
 producing salivation or any other sensible evacuation. Finally, in the 
 third period, called constitutional, it is proved that the salts of gold and 
 iodine are thus far the most efficacious remedies. Consequently the 
 philosophic physician, who does not exaggerate the limits of our intelli- 
 gence — who does not suffer himself to be imposed upon by the phantoms 
 of his imagination, will employ each of these remedies established by 
 experience, at the appropriate period of the disease, without troubling 
 himself whether the disease is a product of a virus, an irritation, or a 
 miasm, all of which are impenetrable, both to the senses and to the 
 mind. 
 
 §111. Second Objection. 
 
 If all the physio-pathological theories are only illusory hypotheses, 
 calculated solely to mislead the physician, they should, then, be ban- 
 ished entirely from science, as dangerous, or at least useless fictions. 
 Nevertheless, the absolute exclusion of theories and reasoning appears 
 to be impossible, and there is no examjjle of it in any medical treatise ; 
 whence it follows that any doctrine which rests upon such exclusion,
 
 EIGHTH LETTER. 683 
 
 and makes a formal i^recept of it, is based on an impossibility, that is 
 to say, on error. 
 
 Such is the objection unceasingly repeated, under a thousand forms, 
 against Empiricism; and, on this account, this system is not studied 
 thoroughly.'"' It is accused of proscribing reason, because it desires to 
 suppress its abuse ; of rejecting all theories, because it would confine 
 them to natural limits. It is time to make account of this prejudice, 
 the offspring of ignorance and thoughtlessness. 
 
 EESPONBE. 
 
 It is well understood that when I use the word Empiricism, I do not 
 allude to that practiced in market-houses, or in charlatan's shops, nor 
 to that which exhibits a great display of curative facts in advertise- 
 ments. These retailers of drugs and possessors of secret remedies and 
 specific treatments, who are generally denominated Empirics, know 
 Empiricism only by its name. But when duly examined, we perceive 
 at once, that they never fail to entice the credulous public by means 
 of some physio-pathological theory, by which they pretend to explain 
 the marvellous effects of their medication. It is only by antiphrasis. 
 therefore, that they are termed Mnpirics ; because in reality they are 
 in theory physio-pathologists, in their way. 
 
 It is now well understood that we mean rational methodic Empiri- 
 cism, such as was professed by some of philosophic physicians in the 
 ancient school of Alexandria, and such, especially, as I have heretofore 
 developed. Now, I ask all who have formed the least notion of this 
 doctrine: is reason excluded from it? Is it not, on the contrary, 
 founded on very special, if not very true reasoning ? What have I been 
 doing in the whole course of this history, except laying down principles 
 of the highest philosophy, and deducing consequences therefrom ? Let 
 our adversaries contest these principles, or the consequences we have 
 drawn from them ; this is fair, and it is their privilege. But that they 
 should accuse us of banishing reason, passes all imagination. It is 
 equal to denying the light of the sun, and shows a profound ignorance 
 of the history of medical doctrines. 
 
 The reproach that it annihilates the physio-pathological theories, if not 
 entirely true, has at least some claims to truth. Yes, Empiricism does 
 proscribe the intrusion of these theories into thereapeutics ; it declares 
 this intrusion to be injurious and illegitimate. This is a fundamental 
 dogma, which I have demonstrated in my Eourth Letter, in such a man- 
 ner as to leave no doubt in the minds of attentive readers. But rational 
 
 * Broussais, in hia Examination of Medical Doctrines, devotes to this system 
 tnly a paragraph of a few lines. See chap, ii., p. 35, edition 1821.
 
 684 APPENDIX. 
 
 Empiricism, or Empiri-metliodism, does not exclude in any fashion, 
 physiological and pathological theories from their natural domain, that 
 is to say, from physiology and pathology. I am far from sharing the 
 opinion of Laennec, who regards these creations of genius as vain amuse- 
 ments of the mind. I consider them for my part, as eminently useful 
 inventions, and as indispensable auxiliaries to the human understand- 
 ing. These physio-pathological theories have not been injurious to 
 Medicine, except in the abuse that has been made of them by the dog- 
 matists, in transporting them from their legitimate domain into that of 
 therapeutics. Some examples will enlighten us on the use of theories 
 in the sciences, and on the danger of their excessive extension. 
 
 FIKST EXAMPLE. 
 
 An apple becomes detatched spontaneously from its branch and falls 
 to the ground. A pendulum, withdrawn from the vertical line, oscillates 
 for some time. The planets describe around the Sun an ellipsis of which 
 that body is the center. Here are facts which seem to have among 
 themselves no connection, which thus isolated, leave in the memory but 
 a slight trace. But a man of genius conceived the happy idea of con- 
 necting these phenomena to an unique cause: he supposed that the apple 
 is drawn toward the earth by an invisible force which he called attrac- 
 tion ; that the pendulum oscillates from the same cause, and that the 
 planets are retained in their orbits by a similar force. Observations, 
 experiments, and calculations without number, were undertaken to verify 
 this hypothesis ; all seem to confirm it, all lend themselves to this inter- 
 pretation. From that time, a multitude of phenomena which had been 
 before unnoticed, because they had among themselves no apparent con- 
 nection, attracted the attention of the learned, became fixed in their 
 memories by means of this artificial bond, and constitute one of the 
 most beautiful conquests of science. 
 
 But if, quitting the domain of general physics, we wish to carry the 
 theory of attraction into chemistry, if we pretend to explain by it ele- 
 mentary affinities, we fall into chaos, we abuse the hypothesis. Indeed 
 the theory of Newton supposes no difi"erence in the particles of matter, 
 while chemical affinities are based precisely upon these difierences. 
 
 SECONIi EXAMPLE. 
 
 The hypothesis of an interior agent called vital principle, or better, vital 
 force, which, being endowed with an admirable instinct, but not with con- 
 sciousness, giving impulsion to all the movements of the organized body 
 and directing them to a common end, according to a wonderfully combined 
 plan ; this hypothesis, emitted by Hippocrates, exaggerated by Von Hel- 
 mont, brought back to its true terms, and elevated almost to the degree
 
 EIGHTH LETTER. 685 
 
 of demonstrated truth by the moderns, is unquestionably one of the 
 most beautiful creations of physiological science ; without it, a great 
 number of the phenomena of the living economy would remain incom- 
 prehensible and without common bond of union. 
 
 But when an effort is made to introduce this theory into therapeutics, 
 we arrive, if we wish to be logical, to the negation of the Healing Art: 
 the position of the j^hysician is reduced to a simple contemplation of 
 death, as Asclepiades reproached the Hippocratists of his time. If on 
 the contrary it is sometimes desirable for the physician to interfere 
 actively in disease, he is forced, like Stahl, Bavthez and others, to con- 
 tradict himself continual ly.'--' 
 
 THIRD EXAMPLE. 
 
 Pinel ranked intermittent fevers of the tertian type, in the order 
 of bilious fevers, which he also denominated meningo-gastric ; those 
 of the quotidian or quartan, in the order of pituitous or adeno- 
 meningeals ; finally, the pernicious intermittents and remittents were 
 classed by him in the order of ataxise. Hemorrhage, neuroses, and 
 other periodical affections were disseminated in divers sections. Brous- 
 sais attached all these morbid forms to phlogosis and especially to 
 gastritis. 
 
 Nevertheles, both did not hesitate to combat all these affections with the 
 salts of quinia, contrary to their pathological theories, but in order not to 
 renounce these, they qualified this beneficial medication as irrational. 
 Ah, pardon me, illustrious masters, it is not the medication that is 
 irrational under these circumstances, it is yourselves who are so illogi- 
 cal in pretending to unite the disease to the remedy by the bond of 
 induction, while they can be united only by observation and experience. 
 
 rOUKTH EXAMPLE. 
 
 Inflammation, in Latin, inflammatio, in Greek, (pAe'fiiaaca, or 
 (pXayoac:, is a subject which has excited as much discussion among 
 physicians as the real presence, or sufficient grace, has excited among 
 theologians, with this difference, however, that the disputes of the 
 children of Esculapius have not kindled the flames of the stake, nor 
 excited persecution. Apart from that, they have not been less keen, 
 nor less obstinate ; and still, so far from being extinguished, certain 
 authors deny the existence of phlogosis, while others extend this mode 
 of lesion to all pathology. Truth, according to us, is not in any of 
 these extreme opinions. 
 
 * See Second Letter, § 2, also the theory of Barthez, in the body of the work.
 
 686 APPENDIX. 
 
 In fact, if we go back to the origin of science, we see that the words 
 phlegmasia, phlogosis, and inflammation have been employed on account 
 of the similitude which has been thought to exist between the effects of 
 this disease and those of caloric. Now, here is what has been remarked 
 in regard to the latter : if any part of our body is exposed at a moderate 
 distance to a fire, we feel at first an agreeable warmth. Soon this sen- 
 sation grows painful, and the part begins to redden. Next we feel 
 a keen sensation of burning, the color becomes of a deeper red, and 
 tumefaction begins. Later, the skin becomes covered with phlyctaenae or 
 bullse, filled with serosity — tha cellular subcutaneous tissue now feels 
 the action of the caloric. Finally, mortification attacks the superficial 
 layers of the tissues, and advances deeper and deeper, until it attacks 
 the deep-seated layers. But if the action of caloric ceases before it 
 causes the mortification, then the affected part recovers its normal 
 state, with or without suppuration, with or without any loss of sub- 
 stance, according to the severity of the burn. 
 
 Such is an abridged account, omitting many shades in the succession 
 of phenomena produced by the action of external caloric on any part 
 whatever of the body. Now, as the same phenomenal series may be 
 provoked in the organism by other causes, either internal or external, 
 the name of inflammation was primitively given to the assemblage of 
 three or four of the following symptoms : heat, redness, pain, swelling. 
 
 Numerous theories have been emitted on the initial phenomenon, and 
 the mode of generation of the phenomenal series called inflammatory ; 
 and the authors or the partisans of these theories have all had the pre- 
 tention to base on each one of them an anti-phlogistic treatment, which is 
 the cause of the many variations in this treatment. 
 
 Finally, in our times, numerous researches and experiments have been 
 undertaken, with a patience and minuteness above all eulogy, in order 
 to seize the intimate molecular transformations which the tissues and 
 living liquids undergo in their passage from a normal to a phlogosed state. 
 Aided by the microscope, physio-chemical analysis, dissections, etc., a 
 sort of scale of phenomenal gradation has been established from simple 
 irritation to confirmed phlegmasia. The caliber of the capillary vessels 
 has been seen to contract at first under the influence of chemical or 
 physical irritants, and dilate again ; the movements of the liquids in 
 the same vessels, after a momentary accelleration, move slower, then stop 
 entirely. The serum of the blood transudes the parieties of the vessels, 
 carrying with it the coloring matter in a state of solution, and the 
 globules themselves have been seen to be deformed. The generation of 
 the pus has been observed from its very beginning. 
 
 But when we wish to pass from this pathogeny to therapeutics, it is
 
 EIGHTH LETTER. 687 
 
 plain that no rational tie, perceptible to our understanding, unites the 
 facts which make up these two departments of Medicine, We are con- 
 vinced that the most exact and profound knowledge of the series of 
 pathological phenomena can not furnish directly the indication of the 
 most suitable and efficacious remedies, nor can it, in a word, take the 
 place of therapeutical proof. The following is an avowal which the 
 most skillful observers do not hesitate to make when they are not 
 blinded by some preconceived theory : " We can not yet, unhappily,'" 
 says M, Lebert, " construct therapeutics on the basis of scientific Medi- 
 cine, and with the best intentions in the world, we can regard the 
 greater part of its precepts but as the result of Empiricism. "=^' 
 
 I would observe, in connection with this passage, that henceforth the- 
 rapeutics is established scientifically, not on pathological physiology, 
 according to the desire of M. Hebert, but on another base, more sure 
 and larger, the only one on which all its precepts can rest, namely : 
 experience or rational Empiricism, otherwise called Empiri-methodism. 
 There is not a single rule of therapeutics that can be justified otherwise 
 than by the results of experiment. The precept of reuniting divided 
 parts has been cited as an example of rational therapeutics, Xow this 
 precept is neither more nor less rational than that which directs the 
 use of cinchona in intermittent fever. Why has it been advised to 
 unite divided parts ? Because it is known by observation, that in cer- 
 tain cases the divided parts are susceptible of reunion. But there arc 
 also cases, unhappily but too numerous, which observation also has 
 made known to us, in which the divided parts can not again be united. 
 Would in this case, the precept to bring them together, be rationaV'. 
 N"o, certainly not, for experience has proven otherwise. 
 
 IV. Third Objection. 
 
 "Empiricism," says Broussais, "consists in finding a remedy appropriate 
 to the disease, without taking the trouble to explain the latter, nor the 
 manner in which it is modified. " " Anorexia is cured 
 
 sometimes with water, sometimes with wine, sometimes by purging, at 
 others by fasting, and again by eating food more freely, or of a more 
 exciting character than ordinary, etc. What do then ? If we do not 
 wish to reason or form a theory in order to discover which of the means 
 should be employed, it only remains to try first one then the other, "f 
 
 '= Physiol. Pathol., vol. I, p. 103. Paris, 1846. 
 f De I'Irritation et de la Folie, p. b'o.
 
 688 APPENDIX. 
 
 I would not have quoted this objection, so trifling does it appear, if 
 it had not emanated from a man who has exercised an incontestable 
 influence on cotemporaneous Medicine; the name of Broussais im- 
 poses upon me the obligation not to pass it silently. Nevertheless, I 
 shall be short in my refutation, not being willing to avail myself of all 
 the advantages which the feebleness of the attack afibrds me. 
 
 RESPONSE. 
 
 You say that a want of appetite is cured sometimes with water, some- 
 times with wine, etc. I ask how you have learned that this afi'ection. 
 or if you like it better, this symptom, may be treated by means so 
 diverse, and often so opposite ? Is it not by observation, and observation 
 alone ? AVhat physio-pathological theoi-y could have suggested such a 
 great variety of treatments, applicable to a disease always the same 
 in appearance ? None ; it is clinical observation only which has 
 furnished us with this notion. 
 
 You add, if we do not wish to reason or form a theory, in order to 
 discover which of these means should be adopted, it only remains to try 
 them successively. I pass the common accusation of want of reasoning. 
 with which the partisans of Empiricism are charged — an accusation 
 unworthy of Broussais, who knew, definitely, that the Empirics do not 
 neglect reasoning — an accusation which has already been sufiiciently 
 refuted, and I come to his conclusion, that we are compelled to try all 
 methods of treatment successively, if we have no physio-pathological 
 theory to guide us, and reply : 
 
 Yes, certainly, we are obliged to attempt successively all medications, 
 if after the example of certain reformers we take no account of the 
 observations of our predecessors — if it be pretended to form science 
 anew, from its base to its top stone ; but such has never been the 
 pretension of the Empiri-methodists, and the first physicians who 
 assumed the title of Empirics in the school of Alexandria, have left 
 us very wise rules by which to discern the degree of confidence which 
 should be accorded to the observations of others — which proves that 
 they did not disdain to make use of them. 
 
 Thus, then, from whatever point of view we study therapeutics, in 
 generalities or in details, always and everywhere, induction must be 
 subordinate to experience ; the rules of treatment must have received 
 the sanction of clinical proof, before obtaining citizenship in the 
 science.
 
 NINTH LETTER. 689 
 
 NINTH LETTER. 
 
 ON THE EANE THAT MEDICINE SHOULD OCCUPY IN A GENEEAL SYSTEM OF 
 HUMAN KNOWLEDGE, AND THE DEGREE OF CERTAINTY WHICH IT CAN 
 ATTAIN. 
 
 § I. Propriety of this Inquiry. 
 
 After having assigned to each of the branches of Medicine its 
 proper place, having had regard to the importance of its influence for 
 the realization of the final aim of this science — the curing of maladies ; 
 after having demonstrated, contrary to the opinion of a great number 
 of theorists, that, in this respect, therapeutics holds the first rank, and 
 that pathology, anatomy, physiology, etc., follow as auxiliaries ; after 
 having, in short, brought forth medical practice from the chaos into 
 which it was plunged, by re-establishing the true theory of the Healing 
 Art, misunderstood and misrepresented for twenty centuries, I think it 
 will not be improper to examine what place Medicine should occupy in 
 a systematic classification 'Of all the sciences, and what degree of cer- 
 tainty it is susceptible of attaining. This research constitutes, it seems 
 to me, the supreme complement of all medical doctrine and should close 
 properly this epistolary series. 
 
 Nevertheless, I am not ignorant how little the present epoch is 
 favorable to philosophic dissertations ; that in the midst of a society 
 disturbed like ours, and menaced in its foundations, physicians can 
 only lend a distracted ear to questions of pure theory, the examination 
 of which requires calmness, security, and leisure. Moreover, I will not 
 abuse the patience of my readers ; I shall attempt to say only what is 
 absolutely indispensable for the solution of the problems announced at 
 the head of this letter. In this manner I pretend to recognize the 
 kind reception which has been given to my philosophic lucubrations, and 
 to testify my gratitute in particular to the honorable confrere who 
 directs with so much impartiality and discernment the publication of 
 this estimable journal.'- 
 
 Being obliged to glance at the diverse opinions of philosophy, concern- 
 ing the origin of our acquirements, their degree of certainty, and the 
 
 * L'Union Medicale.
 
 690 APPENDIX. 
 
 various modes of acquisition of our understanding, I shall divide my 
 subject into two parts — one historical, the other critical and dogmatical. 
 
 Part First. — A Historical Resume of the Opinions which have been emitted on the 
 Origin of Ideas, and their Modes of Development. 
 
 § II. Antique Period. 
 
 RATIO KALISM. 
 
 The first philosopher whose writings have come down to us in a suffi- 
 cient state of entirety to give a just idea of his doctrine is Plato, the 
 elegant disciple of the sage Socrates, who from the charms of his con- 
 versation and the gracefulness of his style, was surnamed the Swan of the 
 Academy. He thought that the knowledge which we acquire in this 
 world is only the feeble rays of the light that our soul possessed before 
 its union with the body, and he was persuaded that the best means to 
 find truth consists in isolating ourselves as much as possible by medita- 
 tion, from the influence of the senses and exterior objects, in order to put 
 ourselves in direct communication with the intimate nature of things 
 by mental intuition. " The soul," he says, " never thinks better than 
 when it is undisturbed by sight, pain, or voluptuousness, and when, shut 
 up within itself, disdaining as much as possible all commerce with the 
 body, it grasps directly what it desires to know. '■' =-■■= Indeed, 
 
 the body involves us in a thousand embarrassments, owing to the neces- 
 sity of our cares for it. Added to this, diseases which spring up obstruct 
 our researches. They fill us with passions, desires, fears, a thousand 
 chimeras and follies, to such an extent that in fact they leave us, as has 
 been said, not one hour for wisdom. =••'= " * '' It is thus demon- 
 strated that in order to know a thing thoroughly we must, so to say. 
 separate ourselves from the body, that the soul may examine them in 
 themselves.'"' " 
 
 ON SENSITISM. 
 
 Aristotle, cotemporary with Plato, was one of his most assiduous 
 auditors during twenty years ; after which he became the chief of a 
 school. Now, he professed an opinion entirely contrary to that of his 
 master, on the origin of our ideas. According to him, all animals have 
 received from nature the faculty of feeling and judging; but after the 
 sensation has been produced some preserve the remembrance of it, while 
 others do not. Those whose souls retain some trace of the received 
 
 ** Phedon. French translation, of Cousin, p. 202-204.
 
 NINTH LETTER. 691 
 
 impressions, can in the course of a great number of sensations, reason 
 Trom the recollection of them which remains. This explains how the 
 memory arises from the faculty of feeling. The memory of the same 
 thing often repeated, produces experience ; and experience, that is to say, 
 every general notion which is fixed in the soul, relatively to what is 
 common to several things, is the principle of Science and Art. The first 
 ideas which the sensations create in our minds are always ideas of 
 totality, or very general ideas. Subsequently, in proportion as the same 
 sensations are reiterated, they become more distinct, and more and 
 more special." 
 
 Aristotle insists very much on this proposition, that the first ideas 
 which arise in our minds by the intervention of the senses, are always 
 very general ideas. They form a fundamental basis for his scientific 
 method ; and he supports this by examjDles and reasoning which he thinks 
 invulnerable. If a man, he says in one place, perceives an object at a 
 distance, he will have at first the idea of a body in general. If the 
 object gradually approaches him, and he sees it advance with an autom- 
 atical motion, his general idea of a body will change to the less general 
 one of an animal ; subsequently, to that of an animal of some particular 
 species ; then finally, the object coming very close, he will distinguish it 
 from all others, he will in short, obtain an individual idea. Elsewhere 
 he cites the example of a little child, who calls, at first, every man papa, 
 and every woman mama ; afterward, as he grows older, his ideas become 
 special, he learns to discern his father and his mother from all other 
 persons. 
 
 Such is, according to this philosopher, the gradation of our ideas, and 
 on this basis he establishes a scientific method, which all antiquity 
 adopted ; a method which consists in commencing the study and the 
 teaching of any science whatever by generalities, which are also called 
 principles, or elements. 
 
 It must be borne in mind, that the argumentations of the chief of 
 the Peripatetics, and the examples with which he sustains them, are 
 extremely captious. It would be very difficult for us to-day to show 
 its artifice, if Locke and Condillac had not demonstrated, absolutely, 
 that the first ideas excited in us by the sensations are always individual 
 in their character : if they had not taught us by their learned analyses 
 of the operations of the understanding, how our mind rises from indi- 
 vidual to general ideas, and in what respect these differ from vague and 
 indistinct ideas, with which Aristotle confounds them in the examples 
 
 * Aristotelis Opera Omnia quae extant Grasce et Latine. Autlaore Guillemo 
 Duval. Analyticorum Posteriorum, lib. II., cap. xrx. De Principibus Naturali- 
 bus, lib. I., cap. i. Metaphysicorum, lib. I., cap. i.; et alibi passim.
 
 692 APPENDIX. 
 
 above given. But the ancients, deprivad of the lights of modern 
 metaphysics, could not shake oiF the yoke of the Peripatetic method, 
 whose prestige was maintained down to an epoch very near our own. 
 
 In Peripateticism, the sensations, though forming the point of depart- 
 ure of our acquirements, are not considered as our only instruments in 
 intellectual progress ; they constitute only the materials of thought, and 
 reason maintains there her supremacy over the other faculties of the 
 soul. She has the task of elaborating and setting in order the materials 
 for the construction of the scientific edifice. 
 
 It is not entirely the same in the system of Epicurus, if we may 
 credit his elegant Latin interpreter. According to him, the sensations 
 are all produced by images or shadows, extremely delicate, which, detached 
 from the surfaces of bodies, or spontaneously formed, float in space, and 
 impress our senses. The senses never mislead us ; truth has no surer 
 foundation than their authority, and our existence depends on the exact- 
 ness of their impressions. When we form false judgments, it is reason 
 alone which is misled in its operations." Here, as is plain, the theory 
 of Sensitism is pushed to its extreme limits, and forms the most com- 
 plete antagonism with the doctrine of Plato. 
 
 ON KCLECTICISM. 
 
 Potamo, who lived at Alexandria about the first century of the Chris- 
 tian era, that is to say, at an epoch when philosophic disputes were very 
 animated, having recognised, or supposed that he recognised, that none 
 of the systems proclaimed with so much warmth by the contending sects 
 were entirely true, though each contained a portion of truth mingled with 
 many errors, thought that wisdom consisted in not attaching himself 
 exclusively to any of the prevailing doctrines, but to extract from each 
 one what he judged most conformable to experience and reason. History 
 does not say whether he reduced this manner of philosophizing to a 
 system, nor that he gained disciples. However this may be, he was 
 considered as the founder of Eclecticism, or Syncretism, a method which 
 had among the ancients many partizaus, but whose sectators never 
 formed a school, properly said, because they never adopted a precise 
 formula, or common symbol of doctrine. 
 
 SKEPTICISM. 
 
 I shall not pause to examine Skepticism, because absolute and uni- 
 versal doubt appears to me less a scientific doctrine than the negation of 
 any species of knowledge. The reasoning of the Pyrrhoneans does not 
 merit, in my opinion, any serious refutation ; because it oflFers, according 
 
 ^ Lucretius, Poeme de Natura Rerum, chant IV.
 
 NINTH LETTEK. 693 
 
 to the avowal of its own philosophers, no character of certainty. I will 
 content myself, then, with repeating with Lucretius, 
 
 Denique, nil sciri si quis putat, id quoque nescit 
 An sciri possit; qiioniam nil scire fatetur. 
 
 §111. Middle Period. 
 
 SUPERNATUEALISM. 
 
 To the two modes of intellectual acquisition admitted by philosophers, 
 the fathers of the Christian Church have added a third, which they con- 
 sidered as the surest and the only infallible one. This mode which is 
 called revelation or supernaturalism, consists in the direct communica- 
 tion which God has made to man, of certain truths, which could not 
 have been discovered by the mere lights of reason. Nevertheless, 
 philosophy does not abdicate entirely its rights to examine these lofty 
 truths ; for while their celestial origin is proclaimed, they present several 
 points which were evidently the offspring of human reason; thus it 
 might be, and has been asked indeed, by what signs are we to recog- 
 nise that aDy revelation is really divine ; how can we assure ourselves 
 that a given proposition comes from a supernatural source, etc. Xow, 
 it is evident that all these questions are within the competency of phi- 
 losophy. Thus many ancient fathers of the Church studied the Greek 
 philosophers, and endeavored to conciliate, at least in part, the doctrines 
 of these philosophers with the dogmas of religion. Of this number 
 were Justin the Martyr, Saint Clement of Alexandria, Saint Origen, 
 and Saint Augustine. Others, however, such as Quintillian, Arnobus, 
 and Lactantius, did not consent to this plan, and regarded the study 
 of philosophy as superfluous and dangerous. 
 
 ox SCHOLASTICS. 
 
 In the ages of barbarism and ignorance which followed the establish- 
 ment of the Christian religion, in the midst of the long perturbations 
 kept up by the dismembering of the Grseco-Eoman Empire, and the 
 establishment of new states, the taste for letters and philosophy sensibly 
 declined ; the writings of the philosophers, buried under the dust of 
 libraries, remained there unknown even to their owners ; and when 
 Charlemagne instituted those numerous schools which became after- 
 ward universities, the only remains of ancient philosophy which had 
 not been entirely forgotten were the metaphysics and logic of iVristotle. 
 During that indefinite lapse of centuries, which is called the Middle 
 Ages, the ecclesiastics, who were the sole depositories of the treasures
 
 694 APPENDIX. 
 
 of human knowledge, employed at first Peripatetic dialectics, in their 
 essays on moral truths and the dogmas of religion. Subsequently they 
 supposed they could reach by the same way, that is to say, by pure dis- 
 cussion and reason, the discovery of natural laws and the solution of all 
 the problems of the physical sciences. 
 
 They usually proceeded as follows : they laid down some axioms or 
 universal principles of metaphysics, whence they drew by a series of 
 arguments, the explanation of all the phenomena of nature. This 
 method of philosophizing was called scholastic, from the name of the 
 schools where it originated and where it was employed until very 
 recently. 
 
 It ref|uired many years, many eiforts, and many contests, before the 
 human mind could disengage itself from the shackles of this vicious 
 method, which was still so much credited at the close of the sixteenth 
 century, that Eamus, or La Eamee, professor in the University of Paris, 
 exposed himself to the rudest persecutions for having dared criticise it. 
 
 §IV. Third Period. 
 
 REVIVAL OF PHILOSOPHY. 
 
 I will not attempt to retrace even succintly, the admirable concourse 
 of circumstances which prepared the freedom of thought ; the discoveries 
 in the sciences and arts, the restoration of the literary monuments of 
 antiquity by the art of printing, the uprising of public opinion against 
 the abuse of the power of the clergy and the feudal nobles, etc.; 
 all this would require, even to be sketched only, much more space 
 than I have at my disposal. I come then, without preamble, to the 
 revival of philosophy, which includes in it the whole progress of the 
 human mind. 
 
 In the first half of the seventeenth century, two men of a character 
 and genius quite different, started from opposite points, the one from 
 sensation, the other from mental intuition, to rebuild the entire edifice 
 of science. They agreed, however, in this, that each one should reject 
 equually the lumber of the scholastic method, and create his own 
 method. The first, replete in the knowledge of statesmanship, having 
 filled the highest places in the state, substituted induction for syllogism 
 as the habitual form of reasoning, and proclaimed the sovereignty of 
 experience as the scientific criterion and the true means of discoveries. 
 The second, on the contrary, withdrawing from the world and its honors. 
 a friend of solitude and meditation, a mind eminently generalizing, 
 who, though still young, had acquired great renown by his discoveries in
 
 NINTH LETTER. , 695 
 
 mathematics, replaced all the complicated rules of the Peripatetic 
 dialectics by a single one, admitting as characteristic of truth, evidence 
 alone. The reader has already anticipated the names of Francis Bacon 
 i and Bene Descartes, the two restorers of the philosophy of modern times. 
 
 ON SENSITI3M. 
 
 Bacon, like Aristotle, placed the source of our knowledge in the 
 faculty of feeling ; but he maintained contrarily to the latter, that the 
 sensitive impressions give rise at first to particular ideas, and not to 
 general ones. Thus, though adopting the scientific basis of the philo- 
 sopher of Stagyrus, he separates at once from him, to follow another 
 route, entirely different. The chief of the Peripatetics wished to begin 
 science by the most general and abstract notions, named therefore by him 
 principles or elements. The English philosopher protested on the con- 
 trary, with all his might, against this course; he assumed that our minds 
 can never suddenly rise at a single bound from individual ideas, excited 
 by the senses, to axioms or general principles. He insists that progress 
 should be gradual, and not by leaps ; that we should pass from a par- 
 ticular idea to one that is somewhat general ; from this to another, more 
 general, and so on, till we reach the universal axioms, which should be, 
 he says, the last ones laid down. Bacon insists obstinately on this 
 method ; he recommends it constantly ; he renews its exposition in 
 various ways, in various terms, in several portions of his books, for fear 
 that it might not be sufficiently comprehended or appreciated ; he exalts 
 its value much above all particular discoveries. 
 
 Posterity has confirmed the judgment of Bacon on the excellency of 
 his method, which has been adopted and improved by learned men and 
 thinkers of the first order, and which has contributed much to the pro- 
 gress of the human understanding, especially in the physical sciences. 
 
 John Locke enlarged and cleared the route, which Bacon has merely 
 indicated by land marks. He showed by what series of acts the mind 
 rises from a sensation, which furnishes it a simjjle or individual idea, to 
 complex or compound ideas ; how we form, by abstraction, general 
 ideas, ideas of species, genera, or classes. He made excellent observa- 
 tions on the nature, formation, and errors of language, refuted the Pla- 
 tonic doctrine of innate ideas, and admitted with Aristotle and Bacon, 
 sensitive impressions as the only basis of our knowledge. He endeav- 
 ored to demonstrate empirically, that is to say by the testimony of the 
 senses, the existence of God, His attributes, the immortality of the 
 soul, in a word, all the truths of natural religion and morals. 
 
 Stephen Bonnot de Condillac was, in France, the extreme representa- 
 tive of Sensitism ; he supposed that all the faculties of the soul, and all
 
 696 APPENDIX. 
 
 its determinations are derived from the faculty of feeling. According 
 to this metaphysician, attention is nothing more than a prolonged sen- 
 sation, which effaces all others for the moment ; that comparison and 
 judgment consist in two sensations, which are realized simultaneously, 
 or are united in the memory as if they were really simultaneous ; 
 and so on for the other intellectual faculties. The acts of the will he 
 represented as proceeding from the same origin. Thus the sensations, 
 which, considered as representations of objects, are the source of ideas, 
 become the source of all the acts of the will, accordingly as they effect 
 us agreeably or disagreeably. Hence arise, following this theory, our 
 diseases, our habitudes, our vices and our virtues. 
 
 No one in France has contributed as much as Condillac to popularize 
 the taste for philosophic studies, by his clearness and connection of 
 ideas. But does he not turn these studies from their true object in 
 making the supreme perfection of the sciences to consist in the mere 
 perfection of the signs of language ? Is it not evident that he mistakes 
 the effect for the cause, when he attributes the exactness of reasoning in 
 mathematics to the exactness of algebraic language ? This grave mis- 
 take has not a little contributed to perpetuate in the schools, and among 
 the learned societies, those vain disputes on words, which he had him- 
 self so much blamed. 
 
 Condillac, like Locke, endeavors to derive moral and religions ideas 
 from sensation ; but other philosophers deduced from these, no less suc- 
 cessfully, the destruction of these same ideas. Thomas Hobbs, David 
 Hume, Charles Bonnet, Claude Adrian Ilelvetius, and others, have 
 proved victoriously, that the theory of sensations is not unfavorable to 
 skepticism, materialism, and atheism. 
 
 ox RATIONALISM. 
 
 Descartes perceived, early, that the instruction he had received in the 
 schools or drawn from books, under the name of philosophy, was nothing 
 more than a scaffolding of words, or an art of speaking without judgment, 
 as he said, on things of which we are ignorant. His mind, habituated 
 to the exact researches of mathematics, could not be contented with a 
 science so visionary ; consequently he resolved to reconstruct it from 
 top to bottom. To this end, he commenced by erasing everything which 
 he had learned, excepting from his philosophic doubt, but the practical 
 truths whose application, he said, could not be dispensed with. 
 
 Then he laid down, as the basis of his scientific edifice, this fact, 
 incontestable to every reflective mind: " I think ;" that is to say, I 
 have conscience of my thought ; from which he drew at once this con- 
 clusion, no less incontestable: -'therefore 1 exist.'' This is as much
 
 NINTH LETTER. 697 
 
 as to say : there is in me a thinking substance, which I call soul ; a 
 substance essentially distinct from matter ; a substance, in fine, the 
 reality of which is clearer and more evident to my mind than that of my 
 body, and all exterior objects. This soul, whose essence consists in 
 thought, finds in itself the innate idea of a being or a spirit, absolute, 
 unlimited in its attributes — on the infallibility of which, the certainty of 
 all our knowledge rests. 
 
 As long as this philosopher did not go beyond the sphere of pschycho- 
 logical phenomena, his propositions are linked, naturally ; but when he 
 endeavors to pass into the domain of natural phenomena, it seems as if the 
 route was closed to him — he is obliged to have recourse to hypotheses 
 which are entirely arbitrary. Thus he supposes, in physics, that matter 
 is not endowed with any activity, which is contrary to all observations. 
 In physiology, after saying that the soul is present in all parts of the 
 body, he assigns to it, for a special seat, the pineal gland ; he puts at 
 its disposal a host of animal spirits — a species of intelligent messengers 
 — who go and come from one extremity of its organic empire to the 
 other, either to carry its orders or to bring back intelligence of what is 
 going on.="' 
 
 Xotwithstanding his errors, Descartes influenced in a powerful man- 
 ner the progress of the human understanding ; he gave, as was said, the 
 death-blow to the scholastics. The clearness of his conceptions, the 
 boldness of his hypotheses, excited the mind to think for itself, and cast 
 off the prejudices of a scholastic education. A great number of learned 
 men studied his doctrine, either to develop and defend it, as Nicole, 
 Pascal, Spinosa, Malebranche, or to combat it, as Gasscndi, Hobbes, and 
 others. 
 
 Godfried Wilhelm Leibnitz, one of the most universal geniuses of 
 modem times, attempted to put an end to the disputes of the yarious 
 philosophic schools, by uniting all their doctrines into one, which should 
 retain what was true in all, and reject what was false or hypothetical. 
 He proceeded to the execution of his vast project by the speculative 
 method of Descartes, whose philosophy he called the antechamber of 
 truth, while he had little regard for the empirical method of Locke. 
 Like the French philosopher, he placed in God the foundation of all reality, 
 all knowledge, and all certainty. He admits innate ideas, not as present 
 to consciousness from birth, but as allied to our intellectual constitution 
 by a necessary relationship. He accords to matter only the force of 
 inertia, or resistance, and to explain the active forces with which bodies 
 appear endowed, he supposes that each of them is only the natural 
 
 ___^ £ 
 
 ' (Euvres de Philosophique. 
 
 44
 
 698 APPENDIX. 
 
 evolution of a monad, or a simple, indivisible, imperishable, and, in 
 some sort, spiritual molecule, which is the motor of all the spontaneous 
 developments of tangible bodies — the source of all active properties, 
 and which reflects in miniature the entire universe. 
 
 The philosophy of Leibnitz, though more comprehensive than that of 
 Descartes, is not less hypothetical, as is seen, nor less distant from the 
 results of daily observation. 
 
 Emanuel Kant, before engaging in the researches of ontology, endeav- 
 ored to determine the laws and the limits of our faculty to acquire, in 
 order to avoid the principal cause of error of human reason, whiuh cause 
 resides in the almost irresistible inclination which we have to pass, con- 
 tinually, the limits within which the Author of nature has confined our 
 understanding. Consequently he applied himself with rare sagacity 
 and perseverence to discern knowledge rational, or a priori, and knowl- 
 edge empirical, or a posteriori. Here is a resume of his doctrine on 
 this subject: 
 
 Observation teaches us with certainty that a thing exists in such or 
 such a manner ; but it does not teach us that it could not possibly exist 
 otherwise. Its judgments are never strictly universal ; they possess but 
 a conditional generality ; which means that no one has remarked to the 
 present, an exception to a given law of nature, as, for example, to the 
 following: all bodies have weight. On the contrary, a judgment 
 applied with rigorous universality, that is to say, in a manner which , 
 admits of no exception, cannot come from experience, but is absolutely 
 a priori. Such are the following propositions: Two quantities equal to 
 a third, are equal to each other. Nothing happens without a cause. 
 Thus necessity and universality are the characteristics of all rational 
 or a priori knowledge. Contingency and limitation form the essential 
 character of all empirical or a posteriori knowledge. 
 
 Fichte and Schelling, who have followed Kant in the speculative 
 route, appear to have had as a principal aim, to found ontology on an 
 immutable basis by demonstrating the objective reality of the concep- 
 tions of the understanding. Have they succeeded in this great enter- 
 prize ? This is a question which I shall not undertake to examine here, 
 for it is much more pertinent to metaphysics and morals than to the 
 physical sciences, of which Medicine forms a part. Besides, the response 
 to such a question surpasses very much my abilities : Non iiostrum 
 iantam componere litem. 
 
 ON COMMON SENSE AND SENTIMENT, CONSIDERED AS A MEANS OP KNOWtEDOE. 
 
 Neither the exclusive Sensitists, nor the pure Eationalists having 
 been able to construct an entire system of knowledge which would
 
 NINTH LETTER, 699 
 
 satisfy equally observation and reason, some philosophers flattered them- 
 selves to have found in common sense, or universal sentiment, a surer 
 guide, an infallible criterion of truth. The Irishman Hutcheson, was 
 one of the first who emitted this opinion, but it owes its principal lus- 
 ter and the notice of the learned world, to the labors of several Scotch 
 philosophers, at the head of whom it has been usual to place Thomas 
 Eeid, which has given to the doctrine itself the name of Scotch School. 
 These learned men, seeing that the most common truths in morals and 
 experience were shaken by the speculations of certain philosophers, and 
 desiring to establish them on an unapproachable base, supposed man to 
 be endowed with a moral sense, a sort of spiritual instinct, which leads 
 him naturally to truth and to correct action, which inspires him only 
 with sound judgments, when he does not choke this interior voice by 
 prejudices and bad passions. According to this theory, the common sense 
 of humanity, that is to say, instinct, considered in its most general and 
 most irresistible manifestations, is a certain principle of knowledge, an 
 infallible criterion of truth. Among the writers who in other countries 
 have contributed to popularize this doctrine, we must name J. J. Rous- 
 seau, in France, and Henry Jacobi, in Germany. 
 
 ECLECTICISM. 
 
 There have always been Eclectics, that is to say, learned men who, 
 instead of endeavoring to distinguish themselves by the inventio" of 
 some new system, have been content to extract from each of the cotem- 
 poraneous systems as much truth as in their eyes was contained in them, 
 and to stitch together these various pieces, in order to form a body of 
 doctrine which would represent as exactly as possible the sum of the 
 acquisitions of the human understanding at a given epoch. In this 
 way Fernel, at the commencement of the sixteenth century, united with 
 much skill the theory of Plato to that of Aristotle ; thus also, in our 
 days, a professor in the Univei-s-ity of Paris ^has offered to his auditors 
 the resume of modern philosophic opinions in a highly critical work, of 
 which the following is the substance, as condensed by himself: 
 
 " The eighteenth century," he says, " has left us a heritage of three 
 grand schools, which remain to this time : the French and English 
 school, of which Locke is the chief, and of which Condillac is among us 
 the most accredited representative ; the Scotch school, which presents so 
 many illustrious names, Hutcheson, Smith, Reid, and Dugald Stewart ; 
 the German school, or rather the school of Kant, for of all the philoso- 
 phers beyond the Rhine, he of Kcenigsberg is about the only one who 
 appertains to history.
 
 700 APPENDIX. 
 
 " But this is only an ethnographical enumeration of the schools of the 
 eighteenth century. It is especially necessary to consider them in their 
 analogous or opposite characters. The Anglo-French school represents 
 particularly Empiricism or Sensualism ; that is to say, an almost exclu- 
 sive importance is attributed in all departments of human knowledge to 
 experience in general, and especially the experience of the senses. The 
 Scotch school and the German school represent a spiritualism more or 
 less developed. Finally, there are philosophers who, denying the 
 supremacy of the senses and reason, seek in the sentiment the true 
 guide and light of intellectual and moral life ; for example, Eousseau, 
 in France, Smith and Hutcheson, in Scotland, and Jacobi, in Germany. 
 Such are the philosophic schools which prevailed in the eighteenth 
 century. 
 
 " Is the truth to be found in either of these schools exclusively ? 
 We are compelled to say that neither of them contains, in our eyes, 
 truth in full. We are convinced that a considerable part of knowledge 
 escapes the sensations, and we believe sentiment is not a basis firm 
 enough or large enough to sustain human science. We are then rather 
 the adversaries than the partisans of the school of Locke and Condillac, 
 and of that of Hutcheson and Jacobi. 
 
 " In general, in the history of philosophy, we are in favor of all 
 those systems which favor reason ; thus, for antiquity, we hold to Plato 
 rather than to Aristotle ; among moderns, we are for Descartes against 
 Locke ; and in the eighteenth century, for Eeid against Hume, for Kant 
 against Condillac and Jacobi. But at the same time, while we recog- 
 nize reason as a force superior to sensation and sentiment, as being par 
 excellence the faculty of knowing, the faculty of truth, and beauty, and 
 all good, we are persuaded that reason can not develop itself under 
 conditions which are foreign to it, nor suffice for the government of man, 
 without another power ; this power, which is not reason itself, and which 
 it can not reject, is sentiment ; the conditions without which reason can 
 not develop itself, are the senses. We now see how important to us are 
 sensations and sentiment ; how, consequently, it is impossible for us to 
 condemn, absolutely, either the philosophy of sensation or that of 
 sentiment. "=■•' 
 
 I pray the reader to excuse me for the extent of this quotation. Never- 
 theless, I am persuaded, that after having read it, he will thank me for 
 not having abridged it ; for it offers, as briefly as possible, an expose, 
 nearly complete, of the philosophic doctrine called Eclecticism. 
 
 * Cousin : — Cours de I'Histoire de la Philosopliie Moderne, vol. ir, p. 366, ed. 
 1836.
 
 NINTH LETTER. 701 
 
 Pakt Second. — A Critical and Dogmatical Examinadoyi of the various Systems of 
 Philosophy abovementioned. 
 
 § V. 
 
 The fragment whicli I have just reported, simplifies and will abridge 
 singularly the second part of this letter. The appreciation which is 
 found there, of modern systems of philosophy, appears to me perfectly 
 just, and I would give to it my full assent, if the author had better 
 explained the nature and special destination of each of these faculties of 
 the understanding which he presents as a principle of knowledge, 
 namely: common sense, or the sentiment, sensation, and pure reason. 
 
 OS INSTINC T — T HE PEINCIPLE OF SENTIMENT AND COMMON SENSE. 
 
 When we reflect on the manifestations of this faculty which the phi- 
 losophers of the Scotch school name common sense, and which others 
 name sentiment, we find that it has no other source than instinct, that is 
 to say, that innate light, that natural aptitude for certain acts, which 
 develops itself spontaneously among animals as well as among men, from 
 the first moment of their birth, or at determined periods of their exist- 
 ence. Instinct suffices for the common needs of life ; it is the principle 
 of the most natural sentiments, it guides us before experience and reason 
 are yet formed, it furnishes us sometimes the promptest inspirations, 
 surer even than the teachings of experience and reason. It is not sus- 
 ceptible either of memory or education, according to physiologists, and 
 should not be consequently ranked among the number of the philosophic 
 faculties, that is to say, those which are perfectible. 
 
 "A complete opposition," says M. Flourons, the interpreter of Frederic 
 Cuvier, " separates instinct from intelligence. In instinct all is blind, 
 necessary and invariable : in intelligence all is elective, conditional and 
 modifiable. The beaver who builds his cabin, the bird who constructs 
 her nest, act only from instinct. The dog and the horse, who learn even 
 the signification of many of our words, and who obey us, do so by intel- 
 ligence. All in instinct is innate : the beaver builds without having 
 learned it ; all in him is fated ; he builds in a masterly manner, from a 
 constantly irresistible impulse. In intelligence, all results from experi- 
 ence and observation : the dog obeys only because he has been taught ; 
 all this is free ; he obeys only because he wills it. There are, then, in 
 animals, two distinct and primitive forces: instinct and intelligence.^'--' 
 
 *De 1' Instinct et de 1' Intelligence des Animaux. Resume of the observations 
 of F. Cuvier on this subject, by M. Flourons: 2 ed., p. 46.
 
 702 APPENDIX. 
 
 ON SENSATION, THE PRINCIPLE OP EXPERIENCE. 
 
 We have seen how Aristotle supposed experience to be derived from 
 sensation. He thought that the first ideas which the senses awaken in 
 us are very general ideas. We have seen afterward how Bacon, Locke, 
 and other modern sensitists, refuted this opinion, and showed the true 
 gradation of sensible ideas, the real developement of the experimental or 
 empirical method. 
 
 But, when these attempted to elevate themselves by this way to supra- 
 sensible things ; when they would establish on this base the demonstra- 
 tion of universal and necessary truths, the existence of natural religion 
 and morals, they were not able to do it on a solid basis. Their proofs 
 and their arguments vanished in the light of vigorous argumentation, as 
 the cloudy vapor disappears under the rays of the sun. By endeavoring to 
 establish morals on sensible ideas exclusively, they disturbed them, they 
 opened the door, unknowingly, to skepticism, materialism, and atheism. 
 
 The domain of knowledge which is derived from sensation, is vast 
 enough, without any one attempting to extend it beyond its natural 
 limits ; for it embraces all the sciences which are occupied with the laws 
 of matter, whether organized or unorganized ; it comprehends physics, 
 properly said, natural history, chemistry, medicine, etc.; all the arts and 
 trades arc in its dependence. These are the sciences whose principle 
 lies in the faculty of sensation, which grow by observation or experience, 
 and must be cultivated by the empirical method. 
 
 ON REFLECTION OR CONSCIOUSNESS, THE PRINCIPLE OP PURE REASON. 
 
 The human mind possesses the faculty of isolating itself from all exte- 
 rior sensation, to fall back upon itself and contemplate its own functions. 
 This faculty, which is named rejtectioti or consciousness, is the source of 
 the most^sublime knowledge ; for it is by this that man rises to ideas of 
 the absolute, the necessary, the universal, the infinite, the good, or the 
 evil ; in a word, to all the notions which constitute the exclusive domain 
 of pure reason. The sciences which are derived directly from it, arc, logic, 
 metapln-sics, and morals. This faculty alone puts an immeasurable 
 distance between the human species and the animal species nearest in 
 the scale to man, in the language of the physiologist, the most competent: 
 
 " Animals," say F. Cuvier and Flourons, " receive by their senses 
 impressions similar to those which we receive by ours ; they preserve, 
 like us, the trace of these impressions ; these preserved impressions form 
 for them, as for us, numerous and varied associations ; they combine 
 and deduce relations and judgment from them; they possess, therefore, 
 intelligence. But all their intelligence is reduced to what is said of it
 
 NINTH LETTER. 703 
 
 above. The intelligence which they possess does not consider itself, does 
 not see itself, dses not know itself. They possess, therefore, no reflection. 
 that faculty which the human mind possesses, with which to study itself. 
 Keflection, thus defined, is therefore the limit which separates the intel- 
 ligence of man from that of animals. '•' '-' Man is the only one of 
 created beings to whom the power has been given to feel that he feels, 
 to know that he knows, and to think that he thinks." =■•' 
 
 The philosophers who have endeavored to study the material world 
 by the speculative method, or pure reason, without the aid of experi- 
 ence — such as Plato, Descartes, Malebranche, Leibnitz, and others — have 
 only succeeded in making a fantastic and imaginary world, on the model 
 of their supra-sensible ideas. Sometimes they have refused to matter 
 every species of force or activity ; sometimes they have despoiled it of its 
 existence even ; they have pushed on blindly to the denial of the reality 
 of bodies ; in a word, they have found nothing reasonable, concerning 
 the objects which fall under the senses. As a compensation, they are 
 sublime and admirable, when speaking of supra-sensible things ; they 
 have developed with a superior logic the soundest ideas touching religion 
 and morals. 
 
 ECLECTIC DOGMATISM. 
 
 We see from what has already been stated that certain philosophers 
 were led astray by endeavoring to rise, by ideas derived from sensations. 
 to the most abstract thoughts of the human mind, and others by attempt- 
 ing to deduce the laws and properties of matter from pure perceptions 
 of the mind. Eationalists and Sensitists have all committed the same 
 fault ; all have interrogated a faculty of the soul on objects with which 
 this faculty is not connected. Is it astonishing, then, that they have 
 both fallen into palpable errors — errors which shock common sense ? 
 
 May we not represent sensation and reflection as two windows, one of 
 which opens on the natural or sensible world, and the other on the 
 immaterial or supra-sensible world. As long as our minds abstain from 
 looking through but one of these windows, it sees necessarily but one 
 world ; it acquires only one kind of ideas, and it is led naturally to 
 doubt the reality of the other world, to deny the existence of the other 
 order of ideas. Wisdom consists, then, when we wish to make dis- 
 coveries in a science, in examining without prejudice what order of 
 ideas this science developes, in order to make choice of the method which 
 is best adapted to it. 
 
 By a unique privilege mathematics includes the two grand orders of 
 ideas which divide the intellectual sphere of man. It realizes, in some 
 
 " Pages 49 and 50.
 
 704 APPENDIX. 
 
 sort, the union of spirit with matter ; on this account they may be studied 
 either by the speculative or by the sensitist method. The mathematician 
 can at his pleasure materialize his abstract conceptions, by the aid of 
 signs, or idealize sensible results, and generalize particular observations, 
 by means of formula. On this account mathematical propositions have 
 a character of certainty which is not found in any other science, and for 
 this reason they irresistibly convince the mind. Taking hold of it by 
 the way of speculation and experience, they leave no door open to doubt 
 or uncertainty. 
 
 § VI, Classification of Medicink in a General System of Sciences. 
 
 From what has been said nothing is easier than to determine to what 
 order of ideas medical science belongs, and what method of study is 
 most appropriate to its advancement. No one, I presume, will attempt 
 to class it with sciences purely rational, as metaphysics ; but every 
 body will agree to rank it among the sciences which treat of sensible 
 objects, as physics, chemistry, etc. Now the method which succeeds 
 best in this order of knowledge, the one which the great observers of 
 all times have followed, according to common opinion and the testimony 
 of history, is that which is called by modern philosophers, indifFer^ 
 ently, experimental or empirical, and consists, as we have already 
 said, in abstracting by thought what belongs in common to the par- 
 ticular facts furnished by observation, in order to form at first generali- 
 ties of a limited kind, then rising afterward by gradations to other 
 generalities, more and more vast and more and more abstract. 
 
 The other method, on the contrary, that is, the one which proceeds 
 from generalities to particulars, from axioms to consequences, may find 
 its application in the teaching of Medicine, whenever the question is 
 not one of discoveries to be made, but of pure and simple exposition of 
 knowledge already acquired. 
 
 ON HYPOTHESK 
 
 We have admitted hypothesis in physiology and in pathology as a 
 means of uniting and co-ordinating phenomena among themselves, which 
 without some artificial bond of union would remain isolated from each 
 other, and would have no connection perceptible by our senses or reason, 
 and therefore would escape too easily from the memory. But we have 
 added, and cannot too often repeat, that a physio-pathological hypothesis 
 should never be the basis of treatment. It can, at most, be tolerated 
 as a provisional motive of a therapeutical essay, before experience has 
 spoken ; even then, however, it is not without danger, though limited
 
 NINTH LETTER. 705 
 
 to this transitory use ; it would be better to experiment without any 
 preconceived idea. Thus comprehended, hypothesis conforms to the 
 analogism of the ancient Empirics ; but in no case should it form any 
 part of therapeutics, constituted as a science. 
 
 I am reproached for pulling down medical practice and reducing it to 
 a state of pure empiricism ; my brethren who have offered this objection 
 deceive themselves, because they attach to the word empiricism a trival 
 and abusive sense, which is not that of philosophic language. Should 
 I, from a regard to a vulgar prejudice, abstain from an exact and 
 established expression, and replace it by some one of the common 
 epithets with which so many writers clothe their medical theories ? I 
 have not thought so ; I think I have made enough concession to this 
 prejudice in adding to the word empiricism the epithet methodic, to dis- 
 tinguish it from that ignorant and blind empiricism with which a careless 
 reader might have confounded it. 
 
 §VII. Ox Certaixty in Medicine. 
 
 Philosophers distinguish two species of certainty, metaphysical cer- 
 tainty and empirical or experimental certainty. The first admits not 
 even the possibility of an exception ; thus, the following propositions 
 have a metaphysical certainty : tico quantities equal to a third are equal 
 to each other ; a straight line is the shortest distance between two 
 points ; nothing happens without a cause. Empirical certainty exists 
 wherever the terms of a proposition express an idea to which there is no 
 known exception. Thus, all bodies have iveight — the earth turns inces- 
 santly around the sun — are propositions which oflFer an example of 
 empirical certainty. 
 
 We see by these examples, that the word certainty, taken in its rigor- 
 ous philosophic acceptation, does not admit of degrees. A thing is cer- 
 tain or it is not — this is all ; but we cannot say that it may be more or 
 less certain, little certain, or very certain. On the contrary, in common 
 language, the word certainty, being synonymous with probability, admits 
 of numerous degrees and shades, and it is in this last sense that we in- 
 quire into the degree of certainty of Medicine. 
 
 Cabanis, who felt how much it is necessary for the success of prac- 
 tical medicine that the physician and the patient have a reasonable 
 faith in the efficacy of the Art ; in order that the former embrace the 
 study and practice of his profession with that conscientious zeal which 
 can alone enable him to surmount the difficulties ; and that the latter 
 execute the prescriptions of science with that confident submission and
 
 706 APPENDIX. 
 
 exactness which procures most frequently success ; Cahanis, I say, has 
 devoted a long memoir to the discussion of the question of certainty in 
 Medicine ; and Broussais, following in his track, has treated the same 
 subject in nearly the same manner. The plan adopted by these authors 
 would carry us too far; I am obliged to restrain myself in much 
 narrower limits — but I hope I reach the same end by a much shorter 
 way, by looking only on the practical side of the question. 
 
 In what respect is it important both to physician and patient, to know 
 the degree of certainty in Medicine ? Is it not in order to be assured 
 whether it would be better to abandon diseases to the sole resources of 
 nature, or to treat them conformably to the rules of Art ? Every one 
 will agree that this is the only useful side of this discussion, and the 
 writers who have agitated it, have not treated it from any other point 
 of view, whether they have decided in favor of or against science. 
 
 Eeduced to these terms, the question of the certainty of Medicine 
 seems to me easy to resolve ; indeed, if I consult history, I find that no 
 nation, civilized or savage, has ever been without some kind of Medicine 
 either learned or ignorant, natural or superstitious. If I interrogate 
 common sense and the intimate sentiment, I find that it is impossible for a 
 man who suflers, to keep himself perfectly quiet, without asking any 
 relief of the experience of his fellows, as has been advised by certain 
 very stoical philosophers. The most obstinate skeptics, the most violent 
 detractors of the Healing Art, if they dislocate an arm or break a leg, 
 do not hesitate to call in the assistance of the surgeon, or even a bone- 
 setter. Where is the man, who, seeing an infant attacked with convul- 
 sions, or an old man fall down paralysed, would not call a physician ? 
 Did Montaigne and J. J. Eousseau, those two lovers of paradox, who 
 were both afl3icted with the gravel, deprive themselves of the aid of 
 surgery when they could not urinate ? 
 
 FIRST OBJECTION. 
 
 But, reply those who are very incredulous in regard to medicine, if 
 there are cases where the intervention of art is indispensable, and truly 
 eflicacious, in how many other cases has not this intervention been more 
 injurious than useful ? How can we definitely establish the balance 
 between the good, and the evil which results from it ? 
 
 Since you are forced to admit that the intervention of art is some- 
 times useful and necessary, who shall decide properly on the opportunity 
 or inopportunity of this intervention '? The man who is most familiar 
 with the resources of art, or he who is completely ignorant of them ?
 
 NINTH LETTER. 707 
 
 Would you call a mason to decide whether a luxation is reducible, or 
 if a fracture of the cranium requires the operation of trephining? 
 Would you ask an engineer if it is proper zo bleed a man attacked with 
 imminent suffocation, or if it would bo better to vomit him, or apply an 
 irritating foot-bath? You see that the question of opportunity or 
 inopportunity of the aid of medicine can be properly resolved only by 
 him who is in possession of medical science. 
 
 BECOND OBJECTION. 
 
 It is insisted, that if the practitioner is really more apt than any one 
 else of judging the cases in which science should interfere, he has often 
 an interest opposed to that of the patient, and it is to be feared at least, 
 that in this conjuncture his zeal may be somewhat abated. 
 
 It can not be denied that, in the present state of society, the interest 
 of the physician is not unfrequently in opposition to that of his patient, 
 especially when the latter is very rich. But this is no longer a ques- 
 tion of science, but one of probity and of social organization ; it is for 
 the legislator to devise the means to harmonize these two opposite 
 interests, to arrange them in such a manner that both shall concur to 
 the same end — the prompt cure of the patient. In the meantime, the 
 wisest part consists in making choice of an honorable as well as a skillful 
 physician ; to inquire into the morality of the man to whom is confided 
 the care of health and life, with as much solicitude as we inquire into 
 the morality of the notary or advocate to whom we commit the charge 
 of our fortunes. We must not hesitate on any occasion to prefer a 
 practitioner of limited knowledge but known probity, to one of high 
 scientific renown but of suspected morality ; for if the case is difficult 
 or doubtful, the first will not hesitate to ask for a consultation with a 
 more skillful colleague than himself, and the patient will thus have the 
 advantage of probity directed by science. Fortunate is the patient who 
 encounters these two qualities united in the same physician ; the best 
 plan, then, is to abandon himself with confidence to the counsels of such 
 a director ; he has put his life and his health under the most favorable 
 chances, as far as the limited wisdom of man can determine.
 
 TAELE OF CONTENTS 
 
 Introduction, ._. ....9 
 
 Synoptic Table of the Ages and Periods in Medicine, 24 
 
 BOOK FIRST— AGE OF FOUNDATION. 
 
 Extending from the Origin of Society to the end of the Second Century of the Christian Era. 
 
 I. PRIMITIVE PEPtlOD, of variable length among different nations, - - 25 
 
 General Considerations, 25 
 
 Chap. I. Medicine of the Antique Nations, - - 26 
 
 § I. Medicine of the Egyptians, 26 
 
 § IL Medicine of the Hebrews, - 32 
 
 § in. Medicine of the Oriental Indians, 36 
 
 § IV. Medicine of the Chinese, ...-...- 38 
 
 § V. Medicine of the Greeks, during the Primitive Period, - - 45 
 
 Chap. II. Medicine of some other nations of the Old and New World, - - 53 
 
 Chap. HI. Origin of Medicine, --------- 53 
 
 Chap. IV. The Utility of Medicine during the Primitive Period, - - - 55 
 
 Resume of the Primitive Period, 59 
 
 II. MYSTICAL PERIOD, comprising a space of time extending from the 
 
 Trojan War, B. C, 1184, to the dissolution of the Pythagorean So- 
 ciety, B. C, 500, - - - - Gl 
 
 General Considerations, ---Gl 
 
 Chap. I. The Practice of Medicine in the Temples, ----- 62 
 
 Chap. II. On Dreams, 64 
 
 Chap. III. Medical Teaching in the Temples, 66 
 
 Chap. IV. The Origin of Classifications in Pathology, . - - . 68 
 
 Chap. V. Therapeutics, 70 
 
 Chap. VI. Origin of Systems, - - - - 73 
 
 Resume of the Mystical Period, 75 
 
 III. PHILOSOPHIC PERIOD, comprising the period of time between the 
 
 dispersion of the Pythagorean Societies, in the year B. C, 500, and the 
 
 foundation of the Alexandrian Library, in the year B. C, 320, - 78 
 
 General Considerations, 78 
 
 Pythagoras, 78 
 
 Chap. I. Doctrine of Pythagoras, 83 
 
 Chap. II. Periodic Physicians, 88 
 
 Chap. III. The Practice of Medicine in the Gymnasia, - - - - 89
 
 710 TABLE OF CONTENTS. 
 
 Chap. IV. Schools of the Asclepiadse, - 90 
 
 Art. I. Hippocrates, --91 
 
 Art. II. The Hippocratic Collection, - - 94 
 
 § I. Anatomy and Physiology, 94 
 
 § n. Hygiene. 96 
 
 § in. Pathology and Therapeutics, .---..- 97 
 § IV. Semeiotics. ----.-..-. 93 
 
 § V. Internal Nosography, 102 
 
 On Pneumonia,- 103 
 
 On Pleurisy, - - 105 
 
 § VI. Therapeutics, 106 
 
 Treatment of Pleurisy and Pneumonia, . - - - 107 
 
 § VII. External Nosography and Therapeutics, or Surgery, - - 108 
 
 § VIII. Obstetrics, --.----.-. 109 
 
 § IX. Clinics, 110 
 
 First Constitution, 113 
 
 First Case, • - - 114 
 
 § X. Aphorisms, - 115 
 
 Art. III. Theories and Systems, 117 
 
 § I. Theory of Coction and Crisis, 118 
 
 § II. Theory of Four Elements and Four Humors, - - - - 123 
 
 § III. Theory of Fluxions, 129 
 
 § IV. Theories founded on the consideration of Two Elements, - - 132 
 
 § V. Theory of a Single Element, 136 
 
 § VI. Theory of any Excedent, -------- 138 
 
 § Vn. Resume of the Hippocratic Theories, 144 
 
 Chap. V. The Medical School of Cos after Hippocrates, - - . - 145 
 
 Art. I. Plato, - 147 
 
 Art. II. Aristotle, 153 
 
 Resume of the Primitive Period, 164 
 
 IV. ANATOMICAL PERIOD, comprising the i)eriod of time which extends 
 from the Foundation of the Alexandrian Library, some three hundred 
 and twenty years before Christ, to the death of Galen, in the 3'ear two 
 
 hundred, of the Chi-istian Ei-a, 166 
 
 General Considerations, 166 
 
 Chap. I. The School of Alexandria, 168 
 
 Chap. H- Anatomy and Physiology, 171 
 
 Chap. HI. Hygiene, 180 
 
 Chap. IV. General Pathology, - 183 
 
 Chap. V. Internal Pathology, - . 184 
 
 § I. Semeiotics, 184 
 
 § II. Nosography, 186 
 
 On Pneumonia, -.-.---.-- 188 
 
 Chap. VI. Internal Therapeutics, - - 190 
 
 Cure of Peripneumonia, - -- 192 
 
 Chap. VH. External Pathology and Therapeutics, 194 
 
 Chap. VIII. Clinics, 199 
 
 Chap. IX. Theories and Systems, ----..-- 200 
 General Considerations, 200
 
 TABLE OF CONTENTS. 711 
 
 Art. I. On Dogmatism, -.-.'---- 202 
 
 Art. n. On Empiricism, 211 
 
 Art. m. On Methodism, - - - 224 
 
 Art. rV. On Eclecticism, 233 
 
 Resume' of the Anatomical Period, 236 
 
 BOOK SECOND.— AGE OF TRANSITION. 
 
 Commencing at the death of Galen, during the reign of the Emperor Septimus Severus, A. D. 
 201, and ending at the revival of Letters in Europe, about the year 1400. 
 
 V. GREEK PERIOD, including the period of time between the death of Galen, 
 and the destruction of the Alexandrian Library, ■which occurred in the 
 
 year 640, 237 
 
 General Considerations, ... ..-._ 237 
 
 Chap. I. Celebrated Commentators, - 238 
 
 § L Oribasius, 238 
 
 § n. Aetius, 240 
 
 § m. Alexander of Tralles, - • 241 
 
 § IV. Paul .Egineta, 244 
 
 Chap. TT. ^Medical Organization, 245 
 
 Chap. III. Institutions accessory to Medicine, - 252 
 
 Resume of the Greek Period, 254 
 
 VL ARABIC PERIOD, commencing at the destruction of the Alexandrian 
 Library, in the year G40 of the Christian era, and ending at the close 
 of fourteenth century, ......... 255 
 
 General Considerations, - 255 
 
 Chap. I. Medicine of the Arabs, ._...... 257 
 
 § L Rhazes 257 
 
 § n. Hally-Abas, 259 
 
 §m. Avicenna, - - - - . 260 
 
 § IV. Albucasis, . - 264 
 
 § V. Retrospective considerations on the progress of Medicine among 
 
 the Arabs, - - 266 
 
 Chap. II. Medicine of the Greeks during the Arabic Period, - - - 267 
 Chap. IIL Medicine of the Latins during the same Period, . - - - 269 
 
 General Considerations, 269 
 
 Art. I. Medical Organization of the West, - 271 
 
 Art. n. School of Salermo, 275 
 
 Art. ni. On the Origin and Growth of Universities, 277 
 
 § I. From Charlemagne to the fifteenth Century, .... 277 
 § n. Efforts of some Physicians to restore the Science, ... 279 
 
 Chap. IV. Accessory Institutions, - 284 
 
 Resume of the Arabic Period, . - 285 
 
 BOOK THIRD.— AGE OF RENOVATION. 
 
 Extending from the commencement of the Fifteenth Century to the Present Time. 
 
 Vn. ERUDITE PERIOD, including the fifteenth and sixteenth Centuries, - 287 
 
 General Considerations, 287 
 
 Chap. I, Humanist Physicians, -- 289
 
 712 TABLE OF CONTENTS. 
 
 Chap. II, Anatomy aud Physiology, 293 
 
 Chap. III. Hygiene, Mondini, Berenger, Vesalius, Servetus, R. Columbus, 
 
 Cesalpine, Louis Carnaro, 299 
 
 Chap. IV. General Pathology, - - - 302 
 
 Chap. V. Internal Pathology, ---..-.-- 303 
 
 § I. Semeiotics, - - 303 
 
 § II. Pathological Anatomy, 304 
 
 § m. Nosography, 305 
 
 Chap. VI. Internal Therapeutics, Doctrine of Contraries, - - - - 308 
 
 § I. On Evacuating Medication, 321 
 
 Derivation and Revulsion, 322 
 
 § II. Purgative Medication, 324 
 
 § III. Alterant Medication, 325 
 
 Chap. VII. External Pathology and Therapeutics, 328 
 
 Barber Surgeons, - - 330 
 
 Ambrose Pare, 331 
 
 Obstetrics, 336 
 
 Chap. VIII. Clinics, 336 
 
 § I. Syphilis, considered as a new Disease, 341 
 
 § II. Its origin in America considered, 341 
 
 § in. A degeneration of Leprosy, ... ... 343 
 
 Chap. IX. Theories and Systems, 346 
 
 General Considerations, .---..-- 346 
 
 John Fernel, - 346 
 
 § I. Doctrine of Galen on the Elements, Humors, etc., ... 349 
 § II. Dissertation on the Essence, Causes, and Symptoms of Diseases, 350 
 § III. Therapeutics, Examples of Cures, .-,-.. 351 
 
 Chap. X. Occult Sciences, - 352 
 
 § I. Cornelius Agrippa, 353 
 
 § II. .Jerome Cardan, 357 
 
 § m. Paracelsus, ----- 358 
 
 Conclusion of Chapter X, 369 
 
 Chap. XI. Partial efforts for Reform, 370 
 
 § I. John Argentier, 370 
 
 § II. Leonard Botal, 371 
 
 § III. Laurence Joubert, 372 
 
 Chap. XII. Medical Organization and Accessory Institutions, - - - 378 
 Resume of the Erudite Period, ---.-. 378 
 
 Vni. REFORM PERIOD, comprising the seventeenth and eighteenth Cen- 
 turies, - - - - 380 
 
 General Considerations, - 380 
 
 Chap. I. Anatomy and Physiology, - - 382 
 
 Circulation of the Blood, 382 
 
 William Harvey, 383 
 
 Malpighi, 385 
 
 Senac, 386 
 
 Respiration, ----.---.. 387 
 
 Lymphatic System, 390 
 
 Nervous System, 392
 
 TABLE OF CONTENTS. 713 
 
 Generation, 397 
 
 Vital or Organic Properties, 400 
 
 Francis Glisson, ...- 402 
 
 Albert Von Haller, 402 
 
 John Hunter, 405 
 
 Chap. n. Hygiene, 406 
 
 § I. Public Hygiene, 406 
 
 Among the Ancients, -- 406 
 
 Fasting among Turks and Christians, 407 
 
 Lazarettos, 408 
 
 General attention to Hygiene, ----.-. 409 
 
 Inoculation, 410 
 
 Jenner, - 410 
 
 Vaccination, - - 411 
 
 Private Hygiene, 411 
 
 Sanctorius, 411 
 
 Cheyney, 413 
 
 Chap. HE. General Pathology, 414 
 
 Chap. TV. Internal Pathology, 415 
 
 § I. Semeiotics, ..- 415 
 
 Sphygmics, -...-....- 416 
 Percussion, ....- ..... 417 
 
 Avenbrugger, 417 
 
 § n. Pathological Anatomy, ' 418 
 
 Bonet, - - 418 
 
 Morgagni, 419 
 
 Bichat, 420 
 
 § HL Nosography, 421 
 
 System of Sauvages, 423 
 
 System of CuUen, 425 
 
 System of Pinel, 426 
 
 Systems of Linnasus and others, -.--.- 427 
 
 System of Bouillaud. Note, 429 ■ 
 
 Chap. V. Internal Therapeutics, 430 
 
 Treatment of Syphilis, 430 
 
 Treatment of Periodical Diseases, 433 
 
 Introduction of Cinchona, 434 
 
 Treatment of other diverse Diseases, 437 
 
 Chap. VI. External Pathology and Therapeutics, 439 
 
 General Remarks, 440 
 
 Wounds of the Head, .....--- 441 
 
 Diseases of the Eye, - - 442 
 
 Cataract, 442 
 
 Fistula Lachrymalis, 443 
 
 Synizesis, .--. 443 
 
 Diseases of the nose, --...--- 444 
 
 Nasal Polypus, 444 
 
 Rhinoplasty, 444 
 
 Diseases of the Mouth, 446 
 
 45
 
 714 TABLE OF CONTENTS. 
 
 Hare Lip, -- - 445 
 
 Aflfections of the Teeth, — Dentistry, ... - 446 
 Affections of the Tongue, Palate, and Tonsils, - - 447 
 
 Diseases of the Ear, 448 
 
 Obturation of the Air Passages, 448 
 
 Diseases of the Chest, 449 
 
 Empyema, - 449 
 
 Diseases of Abdominal Organs, .... . 451 
 
 Wounds of Abdomen and Intestines, - - - . 451 
 
 Paracentesis Abdominalis, 452 
 
 Hernia, 453 
 
 Diseases of Urinary Organs, 454 
 
 Cystotomy, --. 455 
 
 Diseases of the Genital Organs in Man, 457 
 
 Hydrocele, 457 
 
 Sarcocele, 458 
 
 Diseases of the Anus, ..--.... 459 
 
 Diseases of the Members, 469 
 
 External Aneurisms, ....... 459 
 
 Amputation of Members, ...... 459 
 
 Orthoptedia, ........ 461 
 
 Chap. VIL Obstetrics, - 462 
 
 Pregnancy, 464 
 
 Natural Labor, 464 
 
 Difficult Labor, ... - 465 
 
 The Placenta, 466 
 
 Chap. VIII. Legal Medicine, 467 
 
 Chap. IX. Clinics, 470 
 
 § I. Oral Clinical Teaching, 471 
 
 Bottoni, Oddo, De Huern, Sylvius, Boerhaave, .... 471 
 § II. Collection of Clinical Observations, .... - 474 
 
 I HI. Epidemic Constitutions, ..--.-.. 474 
 
 Baillou, ... - . 474 
 
 Difference between Galenism and modern Hippocratism, . . 476 
 
 Sydenham, 477 
 
 Stoll, 480 
 
 § IV. Medical Topography, 482 
 
 Alpin, Bontius, Pison, Koempfer, -...-. 432 
 
 Desportes, Cleghorn, Lind, Hillory, 483 
 
 Chalmers, Bajon, Falconer, 483 
 
 Daniel Drake, -- - 484 
 
 Ch/Vp. X. Theories and Systems, --.-.... 435 
 
 Pi'eliminary Reflections, -- 485 
 
 Art. I. Historic Sketch of Philosophy during the Seventeenth and Eight- 
 eenth Centuries, 4SG 
 
 § I. Retrospective Considerations, -...--- 486 
 § II. On Modern Sensualism and Reasoning by Induction, - - 488 
 
 Francis Bacon, 488 
 
 John Locke, 492 
 
 Stephen Bonuat de Condillac, 493
 
 TABLE OF CONTENTS. 715 
 
 Aphorism of Philosophy, particularly applicable to the Physi- 
 cal Sciences,- ----- 493 
 
 First Paradox of Condillac : The Art of Reasoning may be re- 
 duced to a ■well formed Language, ------ 494 
 
 Second Paradox : Analysis is the sole ]\Iethod for the Acquisi- 
 tion of Knowledge, .-...-.- 496 
 § in. On Rationalism, or Reasoning by Deduction, - - - - 499 
 
 Descartes, 500 
 
 Leibnitz, 503 
 
 Kant, 506 
 
 § IV. Conclusion, - - - 606 
 
 Art. n. Sources of Animism and Chymiatria, 509 
 
 Van Helmont, 509 
 
 Art. m. latro-Chymia, 513 
 
 Sylvius, 513 
 
 Willis, 516 
 
 Art. IV. latro-Mechanics, 520 
 
 Borelli, 620 
 
 Baglivi, 625 
 
 Boerhaave, --- 630 
 
 Art. V. Animism and Vitalism, 634 
 
 Stahl, 634 
 
 Barthez, - - - 639 
 
 Art. VI. Organic Dynamism, 547 
 
 Hoffman, 547 
 
 CuUen, 552 
 
 Brown, 555 
 
 Art. VII. Empiricism, -.. 561 
 
 Werlhof, 567 
 
 Lieutaud, 567 
 
 Chap. XI. Empiri-Methodism, or the Alliance of Empiricism with the 
 
 Philosophic JSIethod, -------- 670 
 
 Universal Axiom of Therapeutics, 570 
 
 First Condition required for the Application of this Axiom, - 571 
 
 Second Condition, 577 
 
 Third Condition, 578 
 
 On Method in Therapeutics, or Classification of the General 
 
 Modes of Treatment, 584 
 
 Synthetic Mode, 584 
 
 Analytic Mode, ..- 585 
 
 Expectant Mode, 586 
 
 Exploring or Perturbating Mode, 587 
 
 Char XII. General Resume, -.. 591 
 
 Phases in Medical History. - - 591
 
 CONTENTS OF APPENDIX. 
 
 FIRST LETTER. 
 
 Medicine Judged by Physicians. 
 
 School of Paeis — Scliool of Montpelier — Italian School — Comparison of the 
 English, French, and Italian doctrines — German School — Conclusion : it is not 
 astonishing that there are so many skeptics in regard to Medicine, when the 
 masters themselves declaim so against it, 599 
 
 SECOND LETTER, 
 
 Is there in Medicine a sure means of discovering the true from the false — the certain from tlie 
 
 hypothetical ? 
 
 Importance of the question — ^Final aim of Aledicine : every thing in this science is 
 or ought to be related to Therai)eutics — The supreme and infallible criterion in 
 the Healing Art is Therapeutical pi*oof — Universal Axiom: all medication which 
 has cured one disease, must cure, equally, diseases which are analagous to it — 
 The rational application of this axiom rests on three indispensable conditions : 
 homogeneousness of the diseases, identity of curative means, and the knowl- 
 edge of the treatment most appropriate to each morbid species — Conclusion : 
 Medicine has always been in possession of a sure principle and method for its 
 development, • 610 
 
 THIRD LETTER. 
 
 On the causes which have lead physicians to leave the primitive route of pure observation. 
 They are included in this aphorism : Art is long, life is short, experience defec- 
 tive, and judgment difficult — Consequences of this scientific revolution — Origin 
 of Physio-Pathological Systems — Conclusion : on this account, the various sects 
 in Medicine, -- 623 
 
 FOURTH LETTER. 
 
 Can pathological physiology, in whole or in part, be the direct or immediate foundation of 
 
 therapeutics ? 
 
 Present state of Science in relation to this question — Differences in opinion among 
 ancient and modern authors — Philosophic axioms which aid in the solu- 
 tion of this problem — Negative reply to the question placed at the head of the 
 letter : can pathological physiology be in any case the direct and immediate 
 foundation of therapeutics ? — Examples and proofs to support this response — 
 Conclusion: confirmation of this axiom in our Second Letter, clinical proof is 
 the supi-eme criterion of truth in Medicine, --.-.. 635
 
 718 CONTENTS OF APPENDIX. 
 
 FIFTH LETTER. 
 
 On Eclecticism in Medicine. 
 Origin of the New Eclecticism in Medicine, which must not be confounded with 
 Eclecticism in Philosophy — Eclecticism in Pathology — Eclecticism in Therapeu- 
 tics — Conclusion : Eclecticism in Medicine is a doctrine essentially vague, 
 shifting, and destitute of foundation, 646 
 
 SIXTH LETTER. 
 
 On Homeopathy. 
 The progress of this doctrine imposes upon us the obli ration to consider it seri- 
 ously — The philosophy of Hahnemann is the most absolute Sensitism ; his 
 physiology and his pathology conduct us to the grossest and narrowest Empiri- 
 cism ; his universal principle of Therapeutics, the law of similars, is founded 
 on the most remote and false analogies — The author continually promises 
 therapeutical observations, but furnishes none which are avithentic — The Spe- 
 cific School, having submitted the theorems of Hahnemann to experimental 
 proof, find them to be false or accidental — Conclusion : the Homeopathic doc- 
 trine oifers the strangest assemblage of assertions devoid of all truth, auda^ 
 cious paradoxes, and flagrant contradictions ; in a word, is a challenge to the 
 credulity of mankind, 664 
 
 SEVENTH LETTER. 
 
 On Therapeutical Methods. 
 Present condition of this branch of the Science — New Classification of Therapeu- 
 tical Methods — The Synthetic Method, the most perfect of all, is blindly denom- 
 inated Irrational — Analytic Method — Comparison of the two methods — Expec- 
 tant Method called, improperly, Natural — Secondary Methods — Ai^plication of 
 our Theory of Curative Methods — Various Methods — Classification and Denom- 
 ination of Medicaments — Conclusion — Empiri-SIethodism is the only one of all 
 the Systems in Medicine that unites under one Principle, and embraces in 
 its scheme all Internal and External Therapeutics, - - - - 666 
 
 EIGHTH LETTER. 
 
 Kesponse to some Olijections concerning the Empiri-Methodic Doctrines. 673 
 
 NINTH LETTER. 
 
 On the Rank tliat Medicine should occupy in a general System of the Sciences, and the Degree of 
 Certainty wliich it can attain. 
 
 Value of this inquiry — Division of the subject of the Letter into two parts, 689 
 
 FIRST PART. 
 
 Historical resume of the opinions emitted by philosophers on the Origin of Ideas, aud their 
 various modes of development. 
 
 Antique Period — Middle Period — Modern Period — Revival of Philosophy — Sen- 
 sitism of Bacon, Locke, Condillac, and others — Rationalism of Descartes, Leib- 
 nitz, Kant, Fichte, and Schelling — Common Sense and Sentiment considered 
 as a means of Knowledge — The Scotch School — Philosophic Eclecticism of our 
 TimeB, 690
 
 CONTENTS OF APPENDIX. 719 
 
 SECOND PART. 
 
 Critical and Dogmatical Examination of tlie various Systems just mentioned. 
 Instinct, the principle of Sentiment or Common Sense, is not a philosophic fac- 
 ulty, that is to say, perfectible — Sensation the principle of experience, is the 
 source of all Physical Sciences, of all the Arts and Trades — Reflection or Con- 
 sciousness, is the principle of pure Reason, and is characteristic of the Human 
 Species, the source of all supra-sensible, or a priori knowledge — Eclectic Dog- 
 matism — Why mathematical theorems take hold of our convictions with an 
 
 irresistible force — Classification of Medicine in a complete system of science 
 
 Value of hypotheses in Medicine — Certainty in Medicine, - - - 701
 
 iiiiiiiiii