■ijn 
 
 
 
 m:^M 
 
 ^!M 
 
 Ki 
 
 f -'>^ 
 
 

 
 p. WILSON 
 
 10. 
 
 UNIVER?^ITY OF CALIFORNIA 
 CALIFORNIA "E OF MEDICINE 
 
 IRVINE, CALffORWfA Wm
 
 1 / '^ >v

 
 HISTORY OF MEDICINE 
 
 ■WITH THE 
 
 CODE OF MEDICAL ETHICS 
 
 NATHAN SMITH DAVIS, A. M., M. D., LL.D. 
 
 Emeritus Dean and Professor of Medicine, Nortliwestern University 
 Medical School, Chicago. 
 
 CLEVELAND PRESS 
 CHICAGO
 
 Copyright 1903 
 
 BY THE 
 
 CLEVELAND PRESS 
 (All Righti Reserved.)
 
 PREFACE. 
 
 From 1892 to 1897, both years included, I gave to the 
 senior class of the Northwestern University Medical School 
 each year a course of fourteen or fifteen lectures on the 
 history of medicine from the earliest periods of which we 
 have any records, to the end of the nineteenth century of 
 the Christian era. My object was to trace with as much 
 clearness and accuracy as possible the origin and pro- 
 gressive development of the various branches of medical 
 science and practice, and their intimate connection with 
 the progress of all other departments of human knowledge. 
 
 The following chapters, constituting this book, have 
 been written and revised from the notes used in the lecture 
 room ; each chapter representing a lecture in the order in 
 which it was given. 
 
 I have consented to their publication in a neat, but 
 inexpensive volume, in the hope that they might attract 
 the attention of a large proportion of both students and 
 practitioners of medicine ; and thereby diffuse a better 
 knowledge of the origin, progress, and present status of 
 the true science and art of medicine. 
 
 NATHAN S. DAVIS.
 
 HISTORY OF MEDICINE. 
 
 CHAPTER I. 
 
 THE CONDITION OF MEDICINE PRIOR TO THE TIME OF HIPPO- 
 CRATES THE GREAT, 460 B. C. 
 
 It was said by Hippocrates that "The physician must 
 know what others have known or he is constantly liable 
 to deceive both himself and others." Consequently, if 
 the physician would know what others have known, he 
 must study, not only the present text-books and litera- 
 ture of the profession, but he must also patiently review 
 its past history from the earliest ages through its suc- 
 cessive stages of development and the relations of that 
 development to the progress of man in all other depart- 
 ments of human knowledge. 
 
 For every important branch of knowledge bears some 
 relation to every other branch, and in prosecuting our 
 study of the history of medicine, we shall find that in 
 every stage, and in every^ country, its condition and prog- 
 ress has been intimately connected with the coincident 
 condition and progress in philosophy, religion and science. 
 
 The earliest indications of progress in civilization have 
 been traced in Egypt and southern and central western 
 Asia, occupied by the Egyptians, Hindoos, Chinese, Baby- 
 lonians, Assyrians, Phoenicians, Medes, Persians, Jews 
 and Greeks ; and in time extending to 5,000 or 6,000 years 
 before the commencement of the Christian era. 
 
 During the 6,000 years just mentioned all these an- 
 cient nations, except the Greeks, had been either de- 
 stroyed, scattered or reduced to a dormant or non-progres- 
 sive condition, leaving at present, as the chief evidences 
 of their once prosperous and semi-civilized condition, the 
 fragments of broken monuments ; the remains of ruined 
 cities, some of them long since buried, but found to con-
 
 tain statues, images, implements and inscriptions ; and in 
 Egypt the pyramids with their mummified inhabitants. 
 From all these fragmentary sources of information, suf- 
 ficient has been gathered to show that all these nations 
 had made much progress in the mechanical arts and math- 
 ematics, while their ideas of philosophy and religion were 
 inseparably mixed. Their philosophy consisted in the 
 belief that the world was made of four elements — fire, 
 air, water and earth — all pervaded by spiritual qualities, 
 and the first named most refined, possessed of intelli- 
 gence, and identical with the soul or spirit of man. Their 
 religion, except that of the Jews, consisted in the recog- 
 nition and worship of deities almost without number, and 
 generally represented by some material image or statue. 
 Everything pertaining to human life and destiny was 
 thought to be controlled by good or evil spirits, and in 
 consequence a God or Goddess was supposed to rule over 
 every line of blessings and curses or evils that visited them. 
 As a logical necessity, they attributed all forms of sickness, 
 or mental and bodily suffering, to the displeasure of some 
 one of their deities, and of course to such deities they 
 turned with petitions, prayers and sacrifices, for relief. 
 
 From the numerous but imperfect data furnished by 
 the researches of antiquarians and historians, it has been 
 inferred that the ancient kingdom of Egypt was founded 
 as early as 6,000 B. C, and its people reached the climax 
 of their progress towards what we call civilization between 
 4000 B. C. and 3000 B. C., when the most famous pyramid 
 and the noted Sphinx were constructed, during the reign of 
 Chufu or Cheops. 
 
 The most ancient and renowned of the medical divin- 
 ities of that country was Isis, said to have been both 
 sister and wife of Osiris, for it was not uncommon in 
 those days for brothers to marry their own sisters. The 
 divine honors of Isis were founded on the great medical 
 skill she displayed in recalling to life her son Horus. If 
 we may credit this legend it will be perceived that the 
 practice of medicine by the female sex is by no means of 
 modern origin.
 
 Among the other medical divinities were Imhotep, 
 sometimes called the Egyptian ^sculapius, whose tem- 
 ple was at Memphis; Pacht, who was represented with 
 the head of the cat, and was regarded as the special deity 
 of parturient women ; and Thout or Taaut, who was some- 
 times represented with the head of the dog, and was hon- 
 ored as the inventor of the healing art, and of all other 
 arts. To him has been attributed the authorship of the 
 oldest Egyptian medical works, said to have been origi- 
 nally inscribed on pillars of stone. At a later period the 
 inscriptions were copied on papyrus, and made to consti- 
 tute a part of the so-called sacred "Hermetic Books". Ac- 
 cording to the medical historian, Baas, the prescriptions in 
 these books were regarded as derived directly from the 
 Gods, and from them no one might deviate without be- 
 coming liable to severe penalties. Probably all that now 
 remains of these books may be found in two papyri, one at 
 Leipzig and the other at Berlin. The fact that they con- 
 tain remedies for the treatment of each part of the body, 
 suggests that the medical men were then as much devoted 
 to specialties as at the present day. 
 
 The universal belief that both diseases and their rem- 
 edies were derived from and controlled by their deities, 
 necessarily caused the office of priest and physician to be 
 united in the same person, and the temples for worship be- 
 came the chief places of resort for the sick. The most 
 noted of these temples in Egypt were at Thebes, Mem- 
 phis, and Heliopolis. The names of four physicians, who 
 are represented as practising medicine between 5,000 B. 
 C. and 4,000 B. C, have been preserved and are Teta, 
 Tseshorta, Nebsuchet and Chui. The first two were also 
 kings, and the last was an oculist. 
 
 There are indications that considerable progress had 
 been made in the practice of surgery, especially during the 
 reign of the Pharaohs, who were much engaged in war. 
 Their surgeons are credited with having performed ampu- 
 tations, lithotomy, the removal of cataract, the extraction 
 of foreign bodies and the dressing of wounds. Their med- 
 ical practice consisted largely in conjurations, prayers and
 
 8 
 
 soothsaying, but they sometimes administered both emet- 
 ics and purgatives. 
 
 The ancient Babylonians, Assyrians, Phcenicians, Medes, 
 Persians and Jews occupied the central portion of West- 
 ern Asia, between the Caspian Sea and the Persian Gulf, 
 and were in their most prosperous condition from 4,000 
 B. C. to 1,000 B. C. They are supposed to have succeeded 
 a more ancient people called Accadians, or descendants of 
 Accad, and were all of Semitic origin. All these nations 
 had more or less commercial intercourse with the Egyp- 
 tians, and as far as can be determined by such scanty rem- 
 nants of their work as have been preserved, their ideas of 
 philosophy, reUgion and medicine were similar. Like the 
 Egyptians they invented a multiplicity of deities to whom 
 they attributed all the events of life, whether good or evil. 
 
 By the Assyrians and Persians the chief God of healing 
 was called Ainyama, and Thrita was the God of physicians. 
 
 With the Phoenicians the chief medical deity was Es- 
 mun, the eighth of the Cabiri ; and as a people they appear 
 to have been more enterprising and intellectually pro- 
 gressive than any of their contemporaries except the 
 Greeks; for the Phoenicians were not only commercially 
 active and given to colonizing, but to them we owe the 
 art of writing with letters, instead of the cuneiform marks 
 of the Assyrians and the hieroglyphics of the Eg>'ptians. 
 To them we also owe the invention of the Zodiac, with 
 its division into signs, degrees and minutes, and the divis- 
 ion of the day into twelve equal hours. Their most im- 
 portant temples, both for learning and worship, are said 
 to have been located on the islands, Tyros, Arados and 
 Dilmoun, near the mouth of the Tigris, more than 2,000 
 years B. C. But almost the only fragment left to indi- 
 cate anything concerning their progress in medicine is 
 one chapter of the Papyrus Ebers at Leipzig, contributed by 
 a physician of Byblos. The medical historian, Baas repre- 
 sents their supreme deity, called Baal-Zebul (the Beelzebub 
 of the Bible) as a God of Medicine. 
 
 The Jews or Hebrews, constituting a distinct division 
 of the Semitic race, are first made known to us as a no-
 
 madic people, inhabiting the country bordering on the 
 middle Euphrates and Tigris called Palestine. At an 
 early period they visited Egypt, but soon returned to Pal- 
 estine. At a later period, probably not far from 2,000 B. 
 C, they emigrated again into Egypt, where they remained 
 about 400 years, when they were led back to Palestine by 
 Moses (the Egyptian Mesu) between 1,500 B. C. and 1,600 
 B. C. Their leader and great law-giver, Moses, had been 
 educated in all the learning of Egypt as a member of the 
 royal family, and was consequently familiar with the re- 
 ligion, arts and medicine of that country. But he chose 
 to cast his lot with his own people, and in the Code of 
 Laws he framed for their government he made one im- 
 portant provision dififering from the laws of all the other 
 nations of that time. It consisted in the proclamation of 
 one God as the creator and preserver of all things, accom- 
 panied by the injunction that Him, and Him only, should 
 the people worship. All other divinities or deities were 
 declared to be false and their worship forbidden under the 
 severest penalties. But he recognized the existence and 
 influence of evil spirits, or demons, the chief of which was 
 Satan, or the Devil. Yet, like the people of all the other 
 countries, the Hebrews regarded the prevalence of dis- 
 eases, and especially of important epidemics, as punish- 
 ments inflicted by their Deity on account of their sins. 
 Consequently, for relief, they resorted to repentance, 
 prayer, and the interposition of the priests officiating in 
 their places of worship, rather than to the administration 
 of medicines. They thereby combined the functions of 
 priest and physician in the same persons, even more than 
 did the Egyptians or Assyrians. 
 
 While we find a remarkable absence of any mention of 
 either surgical or strictly medical practice among the early 
 Hebrew people, their great lawgiver, Moses, gave them 
 the earliest elementary code of public hygiene of which we 
 have any record. It contained specific directions in regard 
 to the kind and preparation of food; the slaughtering of 
 animals ; the burial of the dead ; the regulation of marriage 
 and sexual relations; the diagnosis and isolation of cases
 
 10 
 
 of leprosy, and some other contagious or infectious dis- 
 eases, and the strict prohibition of artificial abortion. The 
 only surgical procedure included was that of circumcision, 
 which was to be performed by the priests of the tribe of 
 Levi. After this people had been repeatedly conquered 
 and compelled to mingle, as captives, with the neighbor- 
 ing nations, they adopted many medical and surgical prac- 
 tices derived from both Egyptians and Assyrians, as may be 
 seen in the book of the Talmud, written during the third 
 century before the Christian era. 
 
 Of the condition of medicine among the people orig- 
 inally occupying that part of Asia now called India and 
 China, we really have no knowledge, Alax Mueller claims 
 that the progress of the inhabitants of those countries in 
 religion, philosophy and medicine was earlier than in either 
 those of Egypt or Greece. The present inhabitants of 
 India, however, are supposed to have immigrated from the 
 north and settled in Bengal about the year 2000 B. C. 
 According to the traditional mythology of these people, 
 their supreme God of Medicine, called Dhanvantari, was 
 sent to the earth by Indra when the world was sick. He is 
 supposed to have educated many physicians, among whom 
 was Susruta, the son of the fakir-king, Visvamithra and 
 Charaka, and to whom is attributed a remarkable work 
 called the Yayurveda, in which, we are told by Baas, all 
 diseases are divided into "natural and supernatural", and 
 "are ascribed to an unequal or perverted action of the five 
 common elements, ether, air, fire, water and earth. These, 
 however, in the first place, through the influence of food, 
 season, conditions of the atmosphere and the climate, form 
 proximate causes of disease, while corruption of the three 
 elementary fluids, bile, mucus and air, is looked upon as 
 the remote cause". 
 
 The Yayurveda of Susruta and the Atharvaveda con- 
 stitute the medical part of the Vedas or sacred books of 
 India. They are supposed to have originated from 1000 
 B. C. to 1500 B. C, and are the earliest writings belong- 
 ing to that country of which we have any positive knowl- 
 edge.
 
 II 
 
 Max Mueller contends that all the writings constituting 
 the Vedas existed and were transmitted only by oral tra- 
 ditions until the reign of Azoka, 259 B. C. to 222 B. C, or 
 more than a century later than the time of Hippocrates 
 in Greece. The beginning of the book attributed to Char- 
 aka-Susruta, now being translated into English, has the 
 form of Aphorisms, of which the following may serve as 
 specimens : 
 
 "Mind, Soul and Body, this trinity, called person, rest- 
 eth on union like three sticks (standing against each other). 
 Upon that trinity everything rests". 
 
 "Of all diseases, physical and mental, the causes in 
 brief are of three kinds, viz : Adverse or excessive corre- 
 lation, or want of correlation of time, mind, and the objects 
 of the senses". 
 
 "Body and mind are regarded as the subjects in which 
 health and disease co-inhere; parity of correlation being 
 the cause of health". 
 
 "The Soul is immutable and eternal; faculties, the at- 
 tributes of matter, and the senses, are the causes of con- 
 sciousness. The Soul is the eternal witness, for it views 
 all actions, without being itself affected by any of them". 
 
 "Wind, bile and phlegm have been said to be the causes 
 of all bodily diseases. The qualities of passion and darkness 
 have again been indicated to be the causes of mental dis- 
 eases". (See translation of Charaka-Samhita, published by 
 Abinash Chandra Kaviratua.) 
 
 Baas says that the oldest of the Veda books called the 
 Rigveda, contains simple charms, of which he quotes the 
 following : 
 
 "Ye breezes, healing blow, and waft his pain away; 
 The Gods have sent you forth with stores of healing 
 
 drugs." 
 Again : 
 "Healing are the watery billows, water cools the fever's 
 
 glow ; 
 Healing against every plague, health to thee brings 
 
 water's flow."
 
 12 
 
 The last two lines may be taken as forestalling our 
 modem hydrotherapy or bath treatment of fevers. 
 
 The general adoption of the religious doctrines of 
 Brahma, with its division of the people in castes, and the 
 complete rule of the priests about 800 B. C, seems to have 
 arrested all further progress in either medicine or general 
 science. 
 
 The introduction of the Buddhistic doctrines four cen- 
 turies later, and considerable commercial intercourse with 
 Greece, evidently caused some modifications ; but, notwith- 
 standing these, the native people of both India and China 
 have remained in a remarkably non-progressive condition 
 for the last 4,000 years. 
 
 The Chinese are even more fanciful than the Hindoos, 
 and yet more fatalistic in both religion and medicine than 
 the followers of ]\Iahomet. They appear to attribute all 
 diseases of an epidemic character to the influence of spir- 
 its, aided by cold or warm winds. In their pharmacology, 
 as compiled by Lee-Sheo-Tshin, are included "elephants' 
 bile, dried spiders, bugs, toads, lizards, snakes, claws, ears, 
 tongues, hearts and livers of numerous animals, excrement, 
 dragon-bone, cotton, ivory, musk, rheubarb, gentian, 
 camphor, etc." (Baas.) A summary of their ideas of 
 anatomy and physiology as given by Baas, is as follows: 
 "The Chinese assume the existence of six chief organs in 
 which the 'moisture' is located, viz: The heart, liver, two 
 kidneys, spleen and lungs; six others in which is the 
 seat of 'warmth,' viz: The small and large intestine, the 
 gall-bladder, the stomach and the urinary apparatus. They 
 enumerate 365 bones, including 8 for the male and 6 for 
 the female cranium; 12 ribs in men and 14 in women". 
 Instead of the fire and earth of the other contemporary na- 
 tions, the Chinese regard wood and metal as elements, 
 and heat and moisture as fundamental qualities. 
 
 Did our time permit, traces of the same theurgic ideas 
 and practices in relation to medical matters could be found 
 among all the other ancient inhabitants of Asia, Africa, 
 the islands of the Pacific and of the Indian oceans, as well
 
 13 
 
 as among all the aboriginal tribes and nations of North 
 and South America, 
 
 Everywhere, in the early ages, diseases were attributed 
 to supernatural agencies, as either the work of demons or 
 evil spirits, or inflictions of the Gods as punishments for 
 the sins of the people; and as a consequence the priests 
 were the chief physicians. Indeed it might be said that 
 their medicine was only a part of their religion; and 
 whether they worshipped one deity or many, they all per- 
 sistently claimed that the human body, dead, was more 
 sacred than while living, and that the study of human 
 anatomy by dissections was sacrilege. In consequence of 
 that doctrine and the absence of a knowledge of analytical 
 chemistry, the science and art of medicine remained 
 substantially stationary during all the past seven or eight 
 thousand years among all the early or aboriginal inhabi- 
 tants of Asia, Africa and North and South America. And 
 it is to be regretted that we still have some among us who, 
 notwithstanding all our progress in science, philosophy 
 and art, still regard medicine as a part of their religion, and 
 consequently when sick they call for prayers instead of 
 physic — the priest instead of the physician. Such people 
 appear to be incapable of comprehending the fact that the 
 God they worship — the Creator of the universe — himself 
 works with materials and in accordance with laws, and 
 that the true office of prayer is for His guidance in the 
 choice of materials and for wisdom in their application. 
 
 The earliest traces of medical history in Europe have 
 been found among the ruins of the buried cities, the broken 
 monuments and works of art, and the historical poems of 
 Homer, belonging to the people called Hellenes of ancient 
 Greece. They unmistakably point to a period of time coin- 
 cident with the period of greatest prosperity in Egypt, 
 Assyria and Phoenicia, i. e., from 6000 B. C. to 1000 B. C. 
 
 And the Hellenes, or Greeks, like their contempora- 
 ries in Egypt, assumed the existence of numerous deities, 
 both male and female, or Gods and Goddesses, to whom 
 they attributed the control of nearly all the affairs of life.. 
 Chief among these were Apollo, Pluto, Hercules, Juno,
 
 Artemis and Coronis. According to Homeric mythology, 
 Apollo was the ruler of Pestilence ; Artemis, the Goddess 
 of Parturition ; Pluto, the ruler of Hades ; and Hercules 
 was the discoverer of warm baths. The special God of 
 Medicine, however, was ^sculapius, the mythical son of 
 ' Apollo and Coronis. 
 
 Another fable represents him as having immigrated 
 from ^lemphis in Egypt, and to have received instruction 
 in the healing art by Chiron, who is represented in Greek 
 art as half horse and half man. The very great skill ac- 
 quired by .^sculapius in restoring the sick to health, is 
 said to have so offended Pluto, the keeper of Hades, that he 
 induced Zeus to slay him with a thunderbolt. 
 
 By some writers .^sculapius is represented to have 
 been a real person, living about 1250 B. C, who after 
 death was deified, and the temples erected by his followers, 
 both for the reception of the sick and for worship, were 
 called .(Esclepieia, and those who administered in them 
 were called ^sclepiadae, on whom devolved the double 
 duties of physician and priest. These temples or 
 i^sclepieia were established at Tricca, Epidaurus, Rhodes, 
 Cos, Cnidos, Pergamos, and other places ; but those most 
 celebrated were at Cos, Cnidos and Rhodes. The his- 
 torian, Herodotus, very properly calls Homer the Manu- 
 facturer of Gods ; yet in the poems of Homer, ^sculapius 
 is represented only as a physician of extraordinary skill and 
 the father of Machaon and Podalirius who were the chief 
 army surgeons as well as warriors in the Hellenic wars 
 described by the poet. He also alludes to female physi- 
 cians, especially to Hellen and Agamede, "who all heal- 
 ing herbs well knew." And Paeon is called the divine 
 healer of wounded Gods, as in the following : 
 "Thus he who shakes Olympus with his nod, 
 Then gave to Paeon's care the bleeding God. 
 
 (Ares.) 
 With gentle hand the balm he poured around, 
 And healed the immortal flesh and closed the wound." 
 The medicine of the Greeks prior to, and during, the 
 Homeric period was mostly surgical. He makes very lit-
 
 15 
 
 tie allusion to internal diseases, once only alluding to an 
 epidemic of nine days produced by the darts of Apollo, and 
 to a pestilence in Crete during the siege ^f Troy. The 
 Homeric period proper is supposed to have been the 9th 
 century B. C. Up to that period and for three centuries 
 later, they had no written language, all knowledge being 
 acquired and transmitted by oral instruction from one gen- 
 eration to another. The earliest writing found in Greece 
 was on small pieces of leather executed about 600 B. C, 
 and inscriptions on tablets in the yEsclepieia. 
 
 It was not until the introduction of papyrus from 
 Egypt and the art of writing with letters from Phoenicia 
 that a real literature was commenced in Greece. Hippo- 
 crates, about 450 B. C., is represented to have been the 
 first physician to commit his views concerning diseases 
 and their treatment to writing; and is therefore justly 
 styled the "father of medical literature", as well as the 
 father of medicine. 
 
 While the Greeks, like the other primitive nations, at- 
 tributed all things to the control of invisible spirits, good 
 or evil ; and regarded the world as composed of the four 
 elements, fire, air, water, and earth, they displayed a far 
 greater intellectual activity in studying the relation of 
 these elements to physical changes constantly taking place 
 under their observation. This early gave rise to the ev- 
 olution of theories or so-called schools of philosophy. The 
 earliest of these schools of which we have any account, 
 called the Ionic, was founded by Thales, of Miletus, a pupil 
 of the Egyptian priests, about 600 B. Q. He assumed that 
 reason, spirit or mind and God were one ; and that water 
 and spirit were the first cause of all things, and preserved 
 their identity throughout all the changes in what he called 
 secondary elements — fire, air and earth. Half a century 
 later, Heraclitus, of Ephesus, taught that fire instead of 
 water was the primal matter, and enmity between the par- 
 ticles of matter was the cause of decay, and friendship the 
 cause of their union in all the visible forms of matter. He 
 also regarded the embryo in impregnation to be derived
 
 i6 
 
 wholly from the male semen, and the uterus as the recep- 
 tacle for its development, 
 
 Anaxagoras, of Clasomena, in Asia Minor, about 460 
 B. C, said to have been the teacher of Pericles, in addition 
 to some very advanced views in astronomy, taught that 
 matter and spirit were "the elementary principles of the 
 world"; the first being composed of innumerable atoms 
 which were moulded or transformed by the active creative 
 spirit, into all bodies animate and inanimate. He^repre- 
 sented that the animal body was nourished by appropri- 
 ating to itself materials similar to those of which it was con- 
 stituted ; and that diseases were caused by the penetration 
 of bile into the blood vessels, lungs, and pleura. About 
 the same time Empedocles, of Agrigentum, while admit- 
 ting that fire, air, water and earth were the elements of all 
 things, claimed that no element could be destroyed; that 
 all changes in bodies were only changes in the arrange- 
 ment of elements or atoms, and that all bodies were formed 
 by the friendship (attraction) and destroyed by the enmity 
 (repulsion) of the elements entering into their composi- 
 tion. His medical views are set forth by Baas as follows: 
 "The sex in the embryo was determined by the predom- 
 inance of heat or cold in the parents". He believed the 
 embryo was nourished through the navel, and to him we 
 owe the terms amnion and chorion. Death, however, re- 
 sulted from the extinction of heat, the effect of the separa- 
 tion of the elements. Expiration arose from motion of 
 blood upwards, and consequently of the air upwards; in- 
 spiration in an inverse way. 
 
 Although he referred the cure of diseases to the Gods, 
 nevertheless it is said that he endeavored to banish epi- 
 demics by building bonfires and draining swamps, with- 
 out waiting for his divinities to act ; more rational, certainly, 
 than some at the present day. 
 
 Another coincident, and perhaps more influential 
 school was that of Pythagoras, of Samos, established about 
 550 B. C, and sometimes called the Italian School. Pytha- 
 goras visited Egypt where he became acquainted with the 
 mathematics and other branches of Egyptian learning, and
 
 17 
 
 for a time was a pupil of Onuphis, of Heliopolis. He at- 
 tempted to build a theory of the universe founded on num- 
 bers. Unity, or monad, was the beginning of all things, 
 the symbol of perfection, the Anima Mundi, or God. Duad, 
 or number 2, represented the material world. Visible 
 bodies are formed by combinations of an endless variety 
 of numbers one and two or the monad and the duad. He 
 taught that the Anima Mundi, or God, was the light of 
 the universe and self-created. That the Anima, or mind or 
 soul of man, was an emanation from God and immortal, 
 while his body after death underwent decay, and that the 
 basis of life was heat. Physiologically, he represented new 
 animal life as originating from the semen, a fluid emanat- 
 ing from the brain. A proper regulation of diet and ex- 
 ercise was regarded as necessary for the promotion of 
 health. The application of salves and poultices was rec- 
 ommended, but surgical operations were discouraged. As 
 diseases were attributed to demons or evil spirits their 
 cure was sought by prayer, sacrifices and music. 
 
 He endeavored to form his followers into a club under 
 a pledge to observe certain rules of living. 
 
 Alcmaeon, of Crotona, a pupil of Pythagoras, was one 
 of the earliest to study comparative anatomy by the sys- 
 tematic dissection of animals. To him is attributed the 
 discovery of the optic nerves and Eustachian tubes ; and he 
 explained hearing by claiming that the ear contained a 
 vacuum in which the sounds were produced. When 
 Polycrates banished the Pythagorians from Crotona, many 
 of them became itinerant physicians, and were perhaps the 
 first to visit patients at their homes. 
 
 The Materialistic school, founded chiefly by Democri- 
 tus, of Abdera, about 450 B. C., also exerted considerable 
 influence on the development of medical ideas. The dis- 
 tinctive features of the philosophy of this Sect, or School, 
 were: ist. The denial of all Anima, Spirit, or God, and 
 substituting therefore Necessity, or Fate. 2d. The declar- 
 ation that all things originate in matter composed of in- 
 finitely minute and numerous atoms, in which inhere order, 
 position, form and motion. The atoms diflfer in size and
 
 i8 
 
 weight in consequence of which their combination pro- 
 duce the four elements, fire, air, water and earth. The 
 functions of sensibility and mental phenomena were at- 
 tributed to very small, round, smooth atoms in motion. 
 These were supposed to be particularly active in the heart, 
 causing anger; in the liver, desires; and in the brain, 
 thought. It was claimed that a healthy brain produced 
 mental health, and a diseased brain mental disorder; 
 thereby anticipating by more than 2,000 years some of the 
 cerebral and mental pathology of the present day. 
 
 Besides the foregoing schools of so-called Philosophy 
 and Medicine, there were also the Sophists, founded by 
 Gorgius, of Loentium; the Socratists, founded by Socra- 
 tes, perhaps the greatest of Grecian philosophers and the 
 strongest opponent of the materialistic doctrines of Demo- 
 critus ; and the schools more directly connected with the 
 yEsclepieia, or temples of ^sculapius, to which the greater 
 number resorted for treatment, and which were the chief 
 repositories of the tablets on which were inscribed many 
 facts relating to cases of disease and their remedies. 
 
 I have thus far endeavored to give a brief statement 
 of the condition of learning among all the peoples or na- 
 tions of which we have any authentic records prior to the 
 advent of Hippocrates, about the middle of the fifth century 
 before the Christian era. 
 
 We have seen that among them all the real progress 
 in development was limited to the mechanical arts and 
 mathematics. The construction of implements, houses, 
 cities, images, pictures, statues and monuments was car- 
 ried to a high degree of perfection ; and in the science of 
 numbers they showed no lack of proficiency. But with- 
 out any analytical chemistry, anatomy or biology, they 
 had no means of determining the composition and prop- 
 erties of the visible bodies around them, nor of the com- 
 position and functions of the structures and organs of 
 which their own bodies were composed. Hence, their 
 only conclusion was that the four visible and tangible 
 forms of matter: fire, air, water and earth, were the real 
 elementary materials of which the world was made ; and
 
 19 
 
 that the four visible fluids coming from a living animal 
 body: blood, phlegm, bile and black bile, were the ele- 
 mentary humors which, when natural, constituted health, 
 and when disordered, constituted disease. But the mys- 
 terious evidences of design and incomprehensible wisdom 
 displayed in every department of nature led them instinc- 
 tively or intuitively to refer the authorship of the whole 
 to invisible spirits or Gods. And having accepted the ex- 
 istence and power of spirits or Gods, what more logical 
 than to attribute the good things to good spirits, and the 
 bad things to evil spirits. Equally logical and necessary 
 was the next step, to attribute all diseases either to the evil 
 spirits or demons, or as punishments by the good spirits 
 on account of the sins of the afflicted. And if the dis- 
 eases were inflicted by the Gods, good or evil, of course 
 the chief remedy must consist in prayers, sacrifices and 
 penances for propitiating the offended deities, and for this 
 the priest becomes the physician. Thus, we have, in a 
 few words, the actual development of medicine and its 
 relation to other departments of human knowledge from 
 the beginning of man to the days of Hippocrates.
 
 20 
 
 CHAPTER II. 
 
 HISTORY OF HIPPOCRATES, — HIS WRITINGS, AND THE PROG- 
 RESS OF MEDICINE DURING THE FIV'E SUCCEEDING 
 CENTURIES, OR TO THE TIME OF GALEN, 
 150 A. D. 
 
 The preceding chapter had brought our history of 
 medicine to the middle of the fifth century B. C, a period 
 when Grecian civilization and power had reached their 
 zenith. Greece had victoriously closed her wars with Per- 
 sia, and in statesmanship, in works of art, in history, in 
 schools of philosophy, and in physical culture, she had 
 excelled all her contemporaries. The art of writing had 
 been introduced from Phoenicia, and the use of papyrus 
 from Egypt, thereby greatly facilitating the recording of 
 facts and the history of events of every kind. It was at 
 this auspicious period in human progress that Hippocrates, 
 called the Great, appeared in Greece. He was born in 
 the .(Esculapian Temple, on the Island of Cos, about 460 
 B. C. His father, Heraclides, belonged to the order 
 yEsclepiadae, and is represented to have been the seven- 
 teenth in order of descent from ^sculapius. His mother, 
 Phoenarete, was a midwife, eighteenth in descent from 
 Hercules. 
 
 Hippocrates received his early education under his 
 parents in the Temple, but after their death he went to 
 Athens and made himself familiar with the doctrines of 
 the Sophists under Gorgias, as well as those of Pythagoras 
 and Democritus and their antagonist, Socrates. Thus 
 educated in the best schools of Greece, and thoroughly ac- 
 quainted with whatever records relating to medical topics 
 had accumulated in the ^^sclepion at Cos, which was one 
 of the most celebrated then in existence, he commenced 
 his professional career contemporaneous with the states- 
 men Themistocles, Miltiades, Pericles and Xicias ; the phil- 
 osophers, Anaxagoras, Pythagoras, Democritus, Socrates 
 and Plato ; the dramatists, ..^schylus, Sophocles and Euri-
 
 21 
 
 pides ; the orators Lysias, /Eschines and Demosthenes ; 
 and the historians Thucydides, Herodotus and Zenophon. 
 
 Although, at the time of Hippocrates, the Greeks had 
 reached the cHmax of their civilization, their medical at- 
 tainments and practice were still limited mostly to the 
 -^sculapian Temples with their ^sclepiadas, and the few 
 surgeons attached to their armies and gymnasiums or train- 
 ing schools for the athlete. 
 
 But the fact that Hippocrates, after having been born 
 and educated in one of the Temples, had visited other 
 cities and studied thoroughly the doctrines of the leading 
 schools of philosophy, had prepared him for a wider range 
 of mental vision, and a more independent application of 
 the faculties of observation and reason with which he 
 appears to have been richly endowed. Consequently we 
 find him early separating himself from the order of .^scle- 
 piadae,in which he had been born, and engaging in the work 
 of a general practitioner of medicine. As such he visited 
 and practised in the provinces of Thessaly, Macedonia and 
 Scythia, and everywhere studied with great care the actual 
 phenomena of diseases and their causes. After spending 
 several years in this somewhat itinerant mode of practice, 
 during which he gained a very high reputation for probity, 
 learning and skill he settled at Larissa, in Thessaly, where 
 he continued to practice his profession until his death, 
 about 377 B. C. This would make the duration of his 
 life about eighty-three years. (I use the word of indefinite 
 meaning, about, advisedly, for the reason that neither his- 
 torians nor antiquarians have been able to determine pos- 
 itively either the year of Hippocrates' birth or death.) 
 His professional services were solicited by all classes of 
 the people, including municipal authorities and kings. His 
 reputation is said to have been greatly increased by his 
 successful treatment of the wife of the philosopher, Gor- 
 gias ; by the great and destructive "plague" that prevailed at 
 Athens between 430 B. C. and 425 B. C. ; and the cure of 
 Perdicas, king of Macedonia, who was sorely afiflicted with 
 "lovesickness." It is said that he was offered a large sum 
 of money by the Persian king Artaxerxes, to induce him to
 
 2.2 
 
 become the chief medical advisor of the king and his 
 arm)\ But he patriotically refused to bestow his profes- 
 sional services on the enemies of his own country. 
 
 Hippocrates was a patient and accurate observer and 
 industrious writer. He wrote on papyrus and in the Ionic 
 dialect. The number of books or essays bearing his name 
 have been stated by different writers as forty-two, fifty- 
 three and seventy-two. Many of them, however, were 
 doubtless by other physicians of the same name, of whom 
 there were no less than five later in the same family line, 
 and some of them are plainly fraudulent. Only nine have 
 been unanimously considered genuine works of Hippo- 
 crates the Great. The most important of these are the 
 Aphorisms ; the treatise on Air, Water and Locality ; and 
 the Essays on Prognostics, Epidemics and Diet ; all of 
 which have been preserved by translation and republica- 
 tion in the modern languages of Europe, including the 
 English. 
 
 One of his characteristic precepts is worthy of the' 
 attention of every practitioner of medicine, and I quote 
 it as follows: 
 
 "Life is short, opportunity fleeting, judgment difficult, 
 treatment easy, thought hard ; but treatment after thought 
 is proper and profitable". 
 
 Equally worthy of remembrance are the following max- 
 ims : "The physician is a servant, not a teacher of nature". 
 "Follow nature". "The physician should benefit, or at 
 least not injure". Yet he declares that, "Timidity indi- 
 cates incapacity, rashness want of skill". All these precepts 
 clearly point towards the three great distinguishing mental 
 qualities of Hippocrates, namely, patient observation, log- 
 ical reasoning and faithful recording of both facts and 
 deductions. It was by the diligent exercise of these noble 
 qualities that he was enabled to commence an absolutely 
 new era in medicine, and to leave a literature containing 
 facts, deductions, and practical maxims that are still, after 
 the lapse of more than 2,000 years, worthy of our careful 
 study. 
 
 Like both his predecessors and contemporaries, he was
 
 23 
 
 obliged to accept as cardinal doctrines the assumptions that 
 fire, air, water and earth were the real elementary forms 
 of matter of which the world was constituted ; that the fire 
 was the most refined, possessed of intelligence and identi- 
 cal with the spirit or soul of man ; and that the four fluids, 
 blood, phlegm, bile and black bile, were the cardinal hu- 
 mors of the living body. 
 
 Unlike them, however, instead of referring all dis- 
 eases to the influence of good or evil spirit — gods or god- 
 desses — he concentrated his attention on the patient study 
 of the local causes, symptoms, progress, and terminations 
 of diseases, and made the best possible use of the four 
 supposed elements and four fluids to explain the morbid 
 processes as they were presented for his study. 
 
 From such study he soon assumed as a fundamental 
 proposition that health consisted in the uniform action 
 and reaction of all these elements upon and between them- 
 selves ; and that disease was an irregular, or non-uniform, 
 action and reaction of the same elements. 
 
 He further assumed that heat was the most essential 
 condition of life, and that its loss was the cause of death. 
 (This assumption was revived and made the comer-stone 
 of the Thomsonion School of Medicine, originating in the 
 New England States during the first half of the 19th cen- 
 tury.) He also supposes that the pneuma, or air, circulat- 
 ing in the vessels to be a second force essential to the con- 
 tinuance of life, and that its irregular circulation is a cause 
 of disease. These two forces, heat and pneuma, or air, 
 inherent in the living body and acting in conjunction with 
 the other elements, appear to constitute the vis vitse, or the 
 Nature on which Hippocrates so much depends for the 
 prevention and cure of disease. By strictly clinical ob- 
 servation he learned that these forces, constituting Na- 
 ture, were sufficient under favorable circumstances to 
 effect the cure of a large proportion of the cases of disease. 
 By the same observations he learned that all acute dis- 
 eases, especially, progressed through a succession of three 
 stages in regular order and within limited periods of time. 
 These stages he designated as of crudity, concoction and cri-
 
 24 
 
 sis; the first corresponding with our prodrome or form- 
 ing stage; the second with our stage of active develop- 
 ment; and the third with our stage of dechne. And as 
 he saw in most cases, at the crisis marking the commence- 
 ment of dechne, notable evacuations either from the skin, 
 kidneys or bowels, these were regarded as the morbid 
 products of the concoction of fluids or humors during the 
 second stage. If they failed to appear at the usual period it 
 was regarded as an unfavorable index or prognosis. 
 
 Having thus determined by careful clinical observation, 
 that all acute diseases inherently tend to pass through the 
 three stages named, within a limited period of time; and 
 when they do so with regularity to end in recovery, he 
 logically inferred that the chief object of treatment was 
 to aid the natural processes. Hence his maxims, already 
 quoted, to "follow Nature", and that the physician is the 
 servant or pupil and not the teacher of nature. By true 
 inductive reasoning, when in the stage of concoction, or 
 what we call the stage of active advancement, the heat 
 became too intense, he endeavored to lessen the excess 
 of heat by cooling drinks, bathing, and sometimes venesec- 
 tion, and a restricted diet ; and as the stage of crisis ap- 
 proached he sought to aid in casting out the products of 
 concoction by such evacuants as diuretics, diaphoretics, 
 cathartics and sometimes emetics. 
 
 It was by such long-continued observation, and the 
 practice of as rigid a system of inductive reasoning as any 
 advocated by Bacon 2,000 years later, that Hippocrates was 
 enabled to deduce those practical maxims in regard to the 
 natural stages of diseases, and the therapeutic indications 
 afforded by them, and to record the same in his works un- 
 der the head of Aphorisms, Prognostics, etc., and which 
 are still accepted as estabhshed truths in therapeutics. 
 
 Instead of following the example of all his predecessors, 
 by referring the causes of disease to supernatural agen- 
 cies, he studied with the same diligence and mental acumen 
 the influence of local conditions in producing disease, as is 
 shown in his work on ''Air, Water and Locality", and on 
 "Epidemics", and still more in his work on "Dietetics" in
 
 which he discusses the influence of modes of Hving and 
 diet in both sickness and health. 
 
 The writings of Hippocrates show that he was a gen- 
 eral practitioner, not restricting his practice to one or two 
 departments of the healing art. 
 
 His surgical practice was not extensive. He describes 
 some dislocations and fractures, the operations of tre- 
 phining and paracentesis of both chest and abdomen, and 
 the suppression of haemorrhage by cold applications, com- 
 presses and bandages. But he remarks that, "he who 
 desires to practice surgery must go to war". 
 
 His very limited knowledge of anatomy and physiology 
 led him to express many opinions that would appear very 
 ludicrous at the present time. For instance, he makes no 
 distinction between vessels, nerves and tendons, but re- 
 gards the two last as carrying air, or pneuma. He speaks 
 of the food as "cooked in the stomach aided by heat fur- 
 nished by the liver". The brain he describes as a secret- 
 ing organ condensing into mucus, or phlegm, the ascend- 
 ing vapors of the body and discharging it through the 
 nose. And he ascribes most of the diseases of the eyes 
 to the descent of bad humors into them from the brain. 
 
 Perhaps the best English translation of the writings 
 of Hippocrates is by Adams in two volumes published in 
 London, 1849. 
 
 The great benefits bestowed upon the development and 
 progress of medicine by Hippocrates were threefold, ist. 
 He effectually severed the practice of medicine from sub- 
 serviency to the priesthood, and gave it an independent pro- 
 fessional standing. 2d. He boldly substituted a thoroughly 
 clinical study of the actual symptoms, progress and re- 
 sults of diseases and their causes, and an example of 
 strictly inductive reasoning, for the purely fanciful or 
 metaphysical methods of all his predecessors. 3d. By a 
 faithful record of the results of all his studies in such lan- 
 guage as by ready translation and perpetuation became 
 the actual beginning of a permanent medical literature. 
 And surely these are sufficient to justify his being called 
 "The Father of Rational Medicine".
 
 26 
 
 Notwithstanding the very high reputation gained by- 
 Hippocrates during his life, he left no pupils or followers 
 imbued with the same spirit of investigation as himself. 
 His two sons, one called Thessalus and the other Draco, 
 were both physicians ; the first lived and practised at the 
 court of Archelaus, King of Macedonia, and the second 
 was physician to Queen Roxana. His son-in-law, Polybus, 
 is credited with some investigations regarding the origin 
 and office of the membrane surrounding the egg, and with 
 the authorship of some of the books ascribed to Hippo- 
 crates. But neither of them added anything to the progress 
 of medicine. 
 
 The individual who exerted the most influence directly 
 following Hippocrates from 400 B. C. to 347 B. C, was 
 Plato, who instead of following the rational methods of 
 the former, endeavored to evolve from a mixture of the 
 philosophical doctrines of Pythagoras and Socrates a dog- 
 matic system of both philosophy and medicine as fanci- 
 ful as any that preceded, though clothed in language well 
 calculated to captivate his pupils. Having resided several 
 years at Heliopolis, he became familiar w-ith Egyptian 
 mathematics. 
 
 One may judge of the value, or rather the non-value, 
 of his philosophy by the following : "Absolute intelligence, 
 or God and Matter, constitute the universe. The world is 
 formed of the four elements which are not indivisible, but 
 composed of atoms ; those of fire being pyramidal, those 
 of earth cubical, those of air octagonal, and those of water 
 twenty-sided" (Baas). 
 
 His medical doctrines were of the same dogmatic fan- 
 cies. Thus he teaches that continued fever is caused by 
 fire ; quotidian by air ; tertian by water ; and quartan by 
 earth. Of course medicine derived no real aid from him 
 or his immediate followers. 
 
 Praxagoras, of Cos. during the latter part of the third 
 century B. C, is credited with having discovered the dif- 
 ference between arteries and veins, the latter always car- 
 r}-ing blood, while the former he said carried air except when 
 wounded so as to allow the air to escape. Then they be-
 
 27 
 
 came filled with blood absorbed from adjacent parts. He 
 also studied the variations of the pulse in health and dis- 
 ease. 
 
 The most influential rnan in both philosophy and med- 
 icine during the third century B. C. was Aristotle, the 
 teacher of Alexander the Great, and the founder of the 
 natural sciences, especially botany, zoology and compar- 
 ative anatomy. Being the intimate friend and adviser of 
 the Emperor Alexander, who had established his capital 
 or chief city at Alexandria in Egypt, he received from 
 him all the aid he needed for making botanical and zoolog- 
 ical collections, and prosecuting the dissection of animals. 
 The proceeds of his labor and that of his pupils, were ac- 
 cumulated at Alexandria and paved the way for the estab- 
 lishment of the great Alexandrian University with its re- 
 nowned library and museum. 
 
 Although by the actual dissection of animals Aristotle 
 added many items to the previous knowledge of anatomy 
 and actually remained the chief authority in that depart- 
 ment for eight or ten centuries, his descriptions were very 
 imperfect, and his physiological views fanciful. For in- 
 stance, with reasonable correctness he describes the brain 
 as composed of two lobes and the cerebellum with the 
 ventricles, but fails to distinguish between nerves and ten- 
 dons, and thinks both are derived from the heart. He 
 clearly recognized four general functions of the living ani- 
 mal body, i. e., the nutritive, the sensitive, the motive and 
 the intellectual. The three first he regarded as common 
 to all the structures. The fourth, intellect, he limits to a 
 special seat, but leaves us in some doubt whether he 
 thought that seat was the brain or the heart. 
 
 Alexander, who, with his victorious army, had sub- 
 dued all Greece, Egypt, and nearly all of the southwestern 
 part of Asia, founded n6ar the mouth of the Nile the city 
 of Alexandria as the capital of his vast empire, and with 
 the aid of Aristotle and Plato had also made it the chief 
 center of learning, died at the early age of thirty-three. 
 Directly after his death the empire was divided between 
 two or three of his most successful generals. The King-
 
 28 
 
 dom of Egypt with its new capital city came under the 
 rule of Ptolemy Sotor, who was followed in succession by 
 Ptolemy Pliiladelphus and Ptolemy Euergetes, covering a 
 period of lOO years, or from 323 B. C. to 222 B. C. All 
 these followed the example of Alexander in extending 
 the most liberal aid to those engaged in cultivating 
 science, literature and the arts, and succeeded in elevating 
 Alexandria to the zenith of its greatness, as the emporium 
 of commerce, literature, science and art. During their reign 
 their Greco-Egyptian Kingdom was supposed to contain 
 30,000 towns and more than 7,000,000 of inhabitants. It 
 is claimed that the great library contained 700,000 volumes, 
 which means that number of rolls of papyrus, a dozen of 
 which might not contain as many words as one of our octavo 
 volumes of 250 printed pages. The museum contained a 
 proportionately vast collection of works of art and spec- 
 imens of natural history, particularly in botany, zoology 
 and comparative anatomy, to which was added at least one 
 human skeleton. The great library and museum consti- 
 tuted the basis of the Alexandrian University, which at- 
 tracted not only students of every kind, but also the 
 learned in all departments of human knowledge from all 
 the surrounding countries. It is well to remember, how- 
 ever, that it was to the philosopher and physician, Aris- 
 totle, that Alexander owed the accomplishment of the 
 greater part of his literary and scientific works; and that 
 the Ptolemies were equally indebted to the physicians 
 Herophilus and Erasistratus and their disciples. 
 
 Herophilus was born in Chalcedon about 335 B. C, 
 became a pupil of Praxagoras, of Cos, from whom he im- 
 bibed an earnest desire to prosecute the study of human 
 anatomy, and was the ordinary physician to Ptolemy Sotor 
 when he succeeded Alexander as King of Egypt. Not- 
 withstanding the universal prejudice and extreme penal- 
 ties against all efiforts to dissect the human body, Hero- 
 philus obtained the King's permission to secretly dissect 
 the body of one or more criminals after death. It was 
 doubtless from this source the complete human skeleton 
 came into the Alexandrian Museum, and which remained
 
 29 
 
 for several centuries one of the chief attractions for stu- 
 dents and practitioners of medicine. By the opportunity 
 thus afforded he gained a much better knowledge of the 
 different parts of the body, describing with considerable 
 accuracy the brain and nerves and the connection of the 
 latter with the former, and also their sensory and motor 
 functions. He described the pulmonary artery and vein; 
 the lymphatic and chyliferous vessels ; together with most 
 of the viscera of the abdomen. In diagnosis, prognosis 
 and treatment of diseases he followed Hippocrates more 
 closely than any of his contemporaries. 
 
 Erasistratus, of lulls, who followed Herophilus only 
 twenty-three years later, was a pupil of Chrysippus, of 
 Cnidos, and of Theophrastus, and soon became the ordi- 
 nary physician of King Seleucus. Antiochus, the son of 
 Seleucus, had been sick through ardent love for his step- 
 mother. Erasistratus correctly diagnosed his case by tak- 
 ing notice of his palpitation, trembling and blushing on 
 the approach of the lady, and cured him by prescribing 
 their marriage. For this he gained not only a high repu- 
 tation for skill in diagnosis, but also a large fee, said to 
 have been one hundred talents. Subsequently, he resided 
 in Alexandria where he became the physician and com- 
 panion of Ptolemy Philadelphus as Herophilus had been 
 of Ptolemy Sotor. 
 
 Pergamos was the capital city of another Kingdom, 
 resulting from the division of the Empire of Alexander, and 
 the seat of a noted .^sclepion. For many years she main- 
 tained an active rivalry with Alexandria, especially as a 
 seat of learning and possessed of a library of many thou- 
 sand volumes founded by Eumenes H, about 170 B. C. On 
 account of this rivalry the second Ptolemy thought to crip- 
 ple the work at Pergamos by prohibiting the exportation 
 of papyrus from Egypt. But that only resulted in the dis- 
 covery and use of parchment instead of papyrus at Perga- 
 mos. 
 
 Mithridates, both king and physician, established ex- 
 tensive botanical gardens at Pergamos and cultivated many 
 medicinal and poisonous plants with which he experi-
 
 30 
 
 mented both on himself and others for the purpose of dis- 
 covering an antidote that by use would render him im- 
 mune to all poisons ; for he, like many of the rulers or 
 kings of that period, lived in constant fear of being pois- 
 oned by his enemies. The so-called antidote formed by 
 him, contained a large number of ingredients, and under 
 the name "Mythridaticum", retained a high reputation 
 through many centuries. 
 
 Aside from the works of Aristotle, Herophilus and 
 Erasistratus, real medicine made very little progress in 
 the great Alexandrian School until the city and the whole 
 Greco-Egyptian kingdom fell a prey to the victorious Ro- 
 man armies under Tertullus and Pompey. Until the time 
 of this conquest the Romans had made very little progress 
 m any department of the healing art. What rudimentary 
 efforts were made in the practice of either medicine or 
 surgery were confined mostly to their slaves and conse- 
 quently medicine was in bad social repute. But in ac- 
 cordance with the practice of all the conquerors of their 
 time, the Roman legions took as legitimate booty all the 
 movable works of art and other treasures from the con- 
 quered countries to Rome. In doing this, they also took 
 many Greeks for servants, and among them some who 
 proved much more skilful in medicine and midwifery than 
 any of their own countrymen. Not only this, but as soon 
 as it became manifest that the future metropolis of learn- 
 ing, as well as of commerce, was to be Rome instead of 
 Alexandria, the most learned in art, philosophy and medi- 
 cine began to migrate thither from all the other countries, 
 as they had previously been doing to the Alexandrian Uni- 
 versity. By such transference, in a comparatively brief 
 period of time, the Greek culture had made as complete 
 a conquest of the Roman, as the Roman armies had those 
 of Greece. 
 
 The earliest physician to gain renown in Rome was 
 Asclepiades, born in Prusa in Bithynia, 128 B. C. He was 
 educated at Alexandria, and of course was familiar with 
 the schools of philosophy that had flourished in Greece. 
 He spent a few years practicing medicine in Athens, Pro-
 
 31 
 
 pontis and on the Hellespont, and then went to Rome. 
 At Rome he first taught rhetoric, but soon resumed the 
 practice of medicine and by his superior mental endow- 
 ments, coupled with an abundance of self-assurance, he be- 
 came the personal friend of Cicero, Crassus and other influ- 
 ential Romans, and gained a very high reputation. 
 
 His reputation was caused more by the vehemence of 
 his denunciation of Hippocrates and the advocates of the 
 humoral doctrines founded on the four humors, than by 
 anything that he added to the general stock of medical 
 knowledge. For his own doctrines were only slight mod- 
 ifications of those of Heraclides, Democritus and Epicurus, 
 relating to atoms, promulgated three or four centuries 
 earlier. He regarded all bodies as composed of very nu- 
 merous and minute atoms between which were empty 
 spaces or pores. "If the motion of these particles is quiet 
 and regular it is called health, but if it is irregular, feeble 
 or boisterous, sickness arises. Sickness also originates in 
 the air received in respiration, and in the food, and enters 
 our bodies in respiration and digestion, by both of which 
 it passes through the pores into the heart and the blood, 
 and through this finally into the whole body which it nour- 
 ishes. The pulse originates in an influx of the particles 
 into the .vessels ; animal heat, sensation, secretion, in a 
 similar way ; hunger and thirst, however, originate in 
 emptiness of the pores of the stomach, which, in accordance 
 with our varying conditions, may be either full, empty or 
 contracted". — ( Baas. ) 
 
 Such were the anatomico-physiological ideas of Ascle- 
 piades, the founder of the Roman Medico-Philosophical 
 school called Methodists, or Solidists, which constituted 
 the first serious opposition to the humoral doctrines of 
 all the preceding ages. He gained some surgical reputa- 
 tion by performing tracheotomy for the relief of severe 
 cases of angina. In the general treatment of disease he 
 was conservative, relying much on the regulation of diet, 
 cooling drinks, frequent bathing and friction or massage, 
 but he sometimes resorted to enemas, cathartics, emetics, 
 and blood-letting.
 
 32 
 
 Among the most prominent disciples of Asclepiades 
 was Themison, of Laodicea, 50 B. C. The distinctive fea- 
 ture of his teaching was not that the body was made of 
 atoms and pores simply, but that the pores were capable 
 of expanding and contracting; and he attributed all dis- 
 eases to a want of harmony between the size of the atoms 
 and pores. Hence he arranged all diseases into three 
 classes: ist. Those that caused too great relaxation of 
 the pores, called Laxta; 2d. Those caused by constriction 
 of pores, called Stricta; and 3d. Those with some pores re- 
 laxed and others contracted, called Mixta. 
 
 A much more important practitioner and contributor 
 to medical literature was Soranus, of Ephesus, who prac- 
 tised in Rome during the times of Trajan and Hadrian 
 from 98 A. D. to 138 A. D. He wrote very creditable 
 works on medicine, surgery, midwifery, diseases of wo- 
 men, and on the etymology of the names of the different 
 parts of the human body. His work on midwifery was 
 for the instruction of midwifes, translations of which have 
 been preserved, and show that practical obstetrics was at 
 that time relatively better understood than any other 
 branch of medicine. He wrote in the Greek language, 
 but several of his works were subsequently translated into 
 the Latin. 
 
 Aulus Cornelius Celsus, from 25 B. C. to 45 A. D., was 
 another important Roman medical writer of high author- 
 ity. He wrote in the Latin language, and in a style so 
 pure and elegant that he has been called the Cicero of 
 medicine. He also wrote works on philosophy, oratory, 
 jurisprudence and history. His medical writings are not 
 so valuable for the original matter they contain, as for 
 their full summary of the views of the best authors during 
 the later Greek and Alexandrian periods, which would 
 have been otherwise lost. 
 
 Soon after Celsus and Soranus, the disciples of the school 
 of Methodism became divided into several minor schools, 
 of which only the Pneumatic and Eclectic are worthy of 
 mention. The most important feature of the doctrines of 
 the Pneumatic school, was the engrafting of the pneuma,
 
 -^ 
 
 33 
 
 or world-soul of Zeno, upon the naked SoHdism of the 
 Methodists; and its most prominent supporter was Athe- 
 naeus, of AttaHa, in Cihcia. 
 
 The founder of the Eclectic school was Agathinus, of 
 Sparta, about 90 A. D. His cardinal principle was to 
 avoid theories and metaphysical speculations, and to se- 
 lect from all the preceding schools or teachings, that which 
 was most reasonable and practically beneficial. Among 
 his influential , followers were Archigenes of Apamea ; 
 Aretjeus, of Cappadocia; Herodotus; Philip, of Caesarea; 
 and more important than all the others Claudius Galen, of 
 Pergamos, during the last half of the second century, A. D. 
 It has already been stated that prior to the conquest 
 of Greece the Romans had no medicine worthy of the 
 name, and that the few who made some efforts to practise 
 belonged to a class of servants or slaves, but we have 
 seen that in Greece, Egypt and the countries of Asia, 
 their practice of medicine was so closely connected with 
 their religion, that its practitioners were directly affiliated 
 with priests, kings and even deities, and consequently they 
 occupied a very high social position. At first, the intro- 
 duction of Greek medical practice into Rome was met 
 with bitter opposition and scorn. But when Asclepiades 
 had gained the personal friendship of Cicero and accom- 
 panied Csesar in one of his campaigns where he had an 
 opportunity to show his superior knowledge and skill, the 
 Emperor was soon induced to grant the privileges of citi- 
 zenship to all physicians in Rome. Later the Emperor 
 created court-physicians, as well as city and district phy- 
 sicians, called Archiatri, with fairly liberal salaries; and 
 the profession gained a fair standing among the Romans. 
 But much the larger number of those who gained a 
 high rank were either Greeks, Egyptians or Hebrews, and 
 most of the minor surgery and midwifery remained in 
 the hands of barbers and female slaves. 
 

 
 34 
 
 CHAPTER III. 
 
 HISTORY OF MEDICINE FROM THE TIME OF GALEN, I3I A. D., 
 TO THE END OF THE SEVENTH CENTURY, A. D. 
 
 Claudius Galen was born at Pergamos 131 A. D., and is 
 reported to have died 204 A. D., aged about seventy-three 
 years. He was the son of Nicon, an architect, by whom he 
 was educated until he attained the age of fifteen years. He 
 then commenced the study of the prevailing systems of philos- 
 ophy and of medicine, first at Pergamos and subsequently 
 at Corinth, At the age of twenty-one years he went to 
 Smyrna, and after visiting the most interesting places in 
 Asia Minor and Palestine, he went to Alexandria and spent 
 considerable time in the great Librar}^ and Museum, and 
 was much interested in the study of the complete human 
 skeleton contained in the latter. Having acquired a thor- 
 ough knowledge of the works of the most celebrated phy- 
 sicians and philosophers from the time of Hippocrates to his 
 own day, he returned, at the age of twenty-eight years, to 
 his native city, Pergamos, and engaged in the practice of 
 medicine in connection with the gymnasium, and rapidly ac- 
 quired a high reputation. 
 
 Six years later he changed his residence to Rome, where 
 he not only engaged in general practice, but also in lecturing 
 on anatomy and physiology, and by his unusual attainments 
 and industry he soon attracted general attention. But the 
 indulgence of an inordinate self-complacency in criticising 
 freelv all his contemporaries and nearly all the schools of 
 philosophy and medicine that had prevailed before his day, 
 caused him to be involved in bitter controversies and to be- 
 come so filled with disgust that in a few years he abandoned 
 Rome and returned to Pergamos. One year later, however, 
 he was induced by the Emperor, Marcus Aurelius, to again 
 visit Rome, where he became Physician-in-Ordinar}- to the 
 ruler Commodus, and continued there until the end of his 
 life ; which has been stated by different authors as occurring 
 in 200, 202, 204 and 206, A. D.
 
 35 
 
 He was a very industrious student and prolific writer on 
 a wide range of subjects. His works on grammatical, math- 
 ematical, philosophical and legal subjects numbered one 
 hundred and twenty-five. His independent works on medi- 
 cine were eighty-three ; and his Commentaries on the works 
 of Hippocrates were fifteen, beside which he left a large 
 amount of unpublished manuscript. 
 
 His treatises on medical subjects, called "Canonical" be- 
 cause they remained the chief medical text-books through 
 the Middle Ages, or more than i,ooo years, were his "De Usu 
 Partium Corporis Humani"; "De Pulsibus"; "Ars Parva"; 
 "Methodus Modendi" ; "De Crisibus" ; "De Differentiis Feb- 
 rium"; and his Commentaries on Hippocrates. While he 
 criticised freely the views of his predecessors, and denied af- 
 filiation with any preceding school, he nevertheless adopted 
 nearly all the leading doctrines of Hippocrates and endeav- 
 ored to construct upon them a more complete system of ec- 
 lectic practice than that of Agathinus and Aretius, which he 
 had freely denounced. The four elements, fire, air, water 
 and earth, and the four cardinal humors, phlegm, blood, bile 
 and atrabile, with the pneuma, or spiritus-vitalis, constitute 
 the basis of all his doctrines, as they had of all his prede- 
 cessors, except perhaps Asclepiades and his direct disciples. 
 This could not be otherwise, so long as there was no science 
 of chemistry by which the real elementary composition of 
 bodies could be determined and the relations of such ele- 
 ments to each other. Yet Galen assumed that the spiritus- 
 vitalis, or pneuma, was the primitive vitalizing force or soul, 
 received through respiration and by penetrating everv^ part 
 of the body developed three general faculties designated as 
 "animal", "vital" and "natural", and four special faculties 
 or functions termed "attraction", "propulsion", "retension" 
 and "secretion". To these special faculties, acting in differ- 
 ent organs and structures, he attributed the processes of as- 
 similation, nutrition, secretion and muscular movements. 
 \Mien the several humors and all these faculties or func- 
 tions were in their natural condition it constituted health. 
 Their disturbance or want of harmony constituted disease. 
 He classified diseases under two heads, general and local.
 
 36 
 
 The general diseases he attributed to disorder of the car- 
 dinal humors, and local diseases to disturbance of one or 
 more of the special functions or faculties. He assumed that 
 all general fevers were caused by concoction or putridity of 
 the humors, even specifying that quotidians were caused by 
 disorder of the phlegm, tertians by the yellow bile, and the 
 quartans by the black bile. He also recognized the division 
 of causes of disease into two classes, i. e., predisposing and 
 exciting. And in his general anatomical and physiological 
 views he, more distinctly than any previous writer, recog- 
 nized the human body as the work or product of an intelli- 
 gent, supreme or final cause, by which all its parts had been 
 adjusted in harmony with a definite plan. 
 
 But the most important additions to our knowledge of 
 real value, made by Galen, were in the departments of an- 
 atomy and physiolog}'. Having gained a fair knowledge of 
 the bones of the human skeleton by their study in the Alex- 
 andrian jNIuseum, he recognized distinctly the cavities of 
 the head, chest and abdomen, and by the dissection of ani- 
 mals was enabled to give a better description of the contents 
 •of each cavity than any of his predecessors. By such dissec- 
 tions he was enabled to give fairly correct descriptions of 
 many of the muscles of the upper and lower extremities and 
 of the neck. He distinguished the nerves from tendons and 
 traced many of them to their origin from the brain and spinal 
 cord ; and by intelligent vivisections he demonstrated both 
 the contraction of muscles and the motor function of certain 
 nerves. He represented the motor nerves as hard and orig- 
 inating from the spinal cord, and the sensory nerves as soft 
 and originating from the brain. The lachrymal glands with 
 their ducts were discovered, and their secretion of tears de- 
 scribed by him, such secretion having been previously con- 
 sidered to be an exudation from the aqueous humor of the 
 eye. 
 
 Galen clearly described the three coats of the arteries and 
 their connection with the heart, but still taught that they 
 carried the pneuma or vital spirits, while he thought the 
 veins originated from the liver and carried the blood con- 
 cerned in nutrition. He states correctly that respiration is
 
 37 
 
 effected by the action of the intercostal muscles and dia- 
 phragm, but claims that the air, or pneuma, not only fills 
 the lungs but also passes into the heart and arteries. He rep- 
 resents the food taken into the stomach as passing from 
 thence into the liver, where it becomes converted into blood 
 and is then passed on into the right cavities of the heart, 
 from which it is returned through the veins to all parts of 
 the system and mostly used in the nutrition of the various 
 structures. He devoted much time to the study of the pulse 
 and its variations in health and disease, and wrote several 
 papers concerning it. He also took note of the pulsating 
 movements of the brain, which he regarded as the seat of the 
 rational soul, while courage and the passions he located in 
 the heart. In the domain of pathology he followed closely 
 the views of Hippocrates both as regards the concoction of 
 humors and the observance of critical days, or crises. He 
 also recognized the tendency of acute general diseases to 
 pass through successive stages, which he designated as the 
 stadium initiale, incrementi, acmes and decrementi. These 
 fairly represent the forming stage, the stage of increase, the 
 climax and the stage of decline of modern writers. In the 
 direct treatment of the sick, Galen followed closely in the 
 footsteps of Hippocrates. 
 
 A more independent investigator and writer on the ma- 
 teria medica of that time was Padanius Dioscorides, of An- 
 asarba, and later, of Csesarea, in Cilicia. He visited most of 
 the countries in the southern part of Europe and wrote a 
 work on Materia Medica that was retained as the chief au- 
 thority or text-book in that department for 1,400 years. The 
 time covered by Dioscorides and Galen was that during 
 which the Christian religion as proclaimed by Christ and his 
 Apostles was being actively advocated not only in Palestine, 
 but throughout the greater part of the Roman Empire. The 
 zealous advocacy of the Jewish doctrine of one God as the 
 maker and upholder of the universe, and one mediator be- 
 tween' God and man, with the denunciation of the worship of 
 all other Gods and Goddesses as idolatry, necessarily brought 
 the converts of the newly proclaimed Christianity in direct 
 antagonism to the various contemporary schools of philoso-
 
 38 
 
 phy, and still more so with the methods of treating the sick 
 at the various /Esclepiadse, or so-called schools of medicine. 
 The result of this conflict was little or no real progress in 
 any department of medicine during the third, fourth and the 
 first half of the fifth centuries of the Christian Era. 
 
 Constantine I. was the first of the Roman Emperors to 
 embrace the Christian religion, and he commenced his reign 
 during the last quarter of the third century A. D, In 312 
 A. D. he proclaimed at Rome absolute free toleration in re- 
 ligion. In 330 A. D. he removed his seat of government to 
 Byzantium, which subsequently took the name of Constan- 
 tinople, where the Emperor died in 337 A. D. 
 
 The great museum at Alexandria which had so long at- 
 tracted the students and professional men of all the sur- 
 rounding countries was first burned by one of the ships of 
 Cffisar's fleet during a Roman invasion in 47 B. C. It was 
 subsequently restored to a very great extent by Cleopatra, 
 but was finally utterly destroyed by fire during a domestic 
 revolt in 265 A. D. The great Alexandrian library was like- 
 wise burned, but not until an invasion of the Saracens in 
 640 A. D. 
 
 Fortunately for the preservation of the medical works of 
 greatest value from the time of Hippocrates to Galen, Ori- 
 basius, of Pergamos, who was born 326 A. D., liberally ed- 
 ucated generally, and specially in medicine at Alexandria 
 under Zeno, became the personal friend and physician to the 
 Emperor Julian, called the Apostate. He was appointed by 
 the Emperor, Quaestor of Constantinople, and was requested 
 to make a fair compilation of all the valuable medical works 
 that had been written from the time of Hippocrates to Galen. 
 Oribasius was well qualified for the task and completed it so 
 far as to make a series of seventy books in the Greek lan- 
 guage, in which were included works of Hippocrates, Eras- 
 istratus, Soranus, Archigenes, Dioscorides, Galen and many 
 others. Some of his collations were accompanied by useful 
 comments, and he is credited for good descriptions of both 
 syphilis and gonorrhoea, and with being the first to recom- 
 mend' the use of urethral and vaginal injections in the treat- 
 ment of the last named disease. As this was more than 1,000
 
 39 
 
 years before the discovery of America by Columbus, it af- 
 fords very good evidence that neither of those diseases were 
 imported into Europe from America, as has been claimed by 
 some more modern writers. 
 
 The medical writings of Oribasius furnished but little 
 that was new or original in any of the departments, but was 
 of very great value in preserving the most important part 
 of tlie works of the early Greek and Roman authors in such 
 form as to be transmitted to subsequent generations. And 
 an excellent edition of his works was translated into French 
 and published in Paris, in four volumes, by Bussemaker and 
 Daremberg in 1851-62.' 
 
 After the death of the Emperor Julian, to whose fortunes 
 Oribasius had closely adhered, he was persecuted and ban- 
 ished from Rome to a country of barbarians. But he con- 
 tinued his writing and medical practice with such success 
 that in a few years he was recalled and reinstated not only 
 in favor, but was also recompensed for his losses, and re- 
 tained a high reputation until his death, 403 A. D. 
 
 Cselius Aurelianus, a native of Sicca, in Numidia, was a 
 teacher and practitioner of medicine in Rome during the 
 last part of the fourth and beginning of the fifth centuries 
 A. D, He wrote voluminous works on materia medica, 
 "Chronic Diseases" and on "Diseases of Women", consist- 
 ing largely of translations of the writings of Soranus of 
 Ephesus. He i& credited with having given a good descrip- 
 tion of gout and its treatment, and with having insisted 
 upon the correct therapeutic principle that it was far more 
 important to prevent the recurrence of the paroxysms than 
 to combat the paroxysm itself. He advocated the condensa- 
 tion of milk, and the use of lime to prevent its coagulation. 
 He improved the methods of differential diagnosis in regard 
 to several diseases and even hinted at the practice of auscul- 
 tation. He also opposed the resort to physical restraint and 
 advocated seclusion in the management of nervous and 
 mental diseases. His works gained a high degree of popu- 
 larity and remained much in use during the six or seven 
 succeeding centuries. 
 
 The great Roman Empire having been formally divided
 
 %f 
 
 40 
 
 into Eastern and Western Empires in 395 A. D., the Western 
 rapidly declined in power, population and influence under the 
 repeated invasions of the more barbarous peoples from the 
 north, and the Eastern Empire, with Byzantium (Constan- 
 tinople) for its seat of government, became relatively more 
 important and more attractive for physicians and educated 
 men generally. Consequently during the first half of the 
 sixth century, during the reign of Justinian I., we find 
 ^tius occupying much the same relative position in that city 
 as had been occupied at Rome by Oribasius and Cselius 
 Aurelianus. ^tius was born in Mesopotamia, 502 A. D., 
 educated in medicine at Alexandria, but he returned to By- 
 zantium to practise his profession, where he gained a high 
 T X reputation and lived until 575 A. D. He embraced the doc- 
 " V*"^ trines of the Christian religion and was physician in ordinary 
 to the Emperor Justinian I., wdio endeavored to close or ban- 
 ish all so-called pagan schools throughout the Eastern Em- 
 pire . He devoted much time to the compilation of what- 
 ever he found valuable or remarkable in the writings of his 
 predecessors, whether Egyptian, Greek or Roman. In doing 
 this he produced sixteen books or "Sermones" on different 
 medical subjects, the whole constituting a text-book of gen- 
 eral medicine and surgery, in which he preserved the most 
 valuable part of the works of Archigenes, Leonides, Soranus, 
 Aspasia and many others that would have been otherwise 
 lost. A Latin translation of his whole work was published 
 in the sixteenth century (Basil. 1533-35). He was, how- 
 ever, not a compiler merely, but added many observations of 
 value in both surgery and practical medicine. He recom- 
 mends the use of many salves and plasters in the dressing 
 of wounds ; the irrigation of wounds with cold water, and 
 the suppression of haemorrhage by litigation and torsion. 
 He also mentions the use of setons and the practice of lith- 
 otomy. He practised free venesection in the treatment of 
 cerebral congestion and active inflammation, and recom- 
 mends a decoction of pimperel (Anagallis Phoenicea) for 
 hydrophobia and of pomegranate for the expulsion of 
 worms. He mentions the prevalence of a disease of children,
 
 41 
 
 evidently the same as now called diphtheria, and noticed the 
 occasional occurrence of faucial paralysis following it. 
 
 While /Etius was attracting chief attention in the capital 
 of the Eastern Empire, Alexander of Tralles, in Lydia, at- 
 tained a similar position in Rome. He was born in Tralles, 
 525 A. D., the son of a physician named Stephen. His early 
 education was directed by his father and a friend or patron 
 whom he calls Cosmas. He had four brothers, all of whom 
 were noted for their learning and success in various callings. 
 His father and his brother Dioscurus, who was also a phy- 
 sician, subsequently settled in Constantinople, where they 
 attained to influential positions. Alexander, after complet- 
 ing his home education, traveled and practised in Cyrene, 
 Greece, Italy, Gaul and Spain, and finally settled in Rome, 
 where he enjoyed a high reputation until his death, 605 A. D. 
 After he had attained an age rendering him incapable of 
 active practice, he wrote a highly interesting work on pure- 
 ly practical medicine as distinguished from operative sur- 
 gery. He did not, like Orabasius and Cselius Aurelianus, 
 fill his work with collations from preceding authors, but 
 founded it largely upon his own experience and observations. 
 He commenced with diseases affecting the head and pro- 
 ceeded in order downwards, ending with those affecting the 
 feet. His work was written in Greek and consisted of twelve 
 books or parts, styled "Libri duodecim de re Medica", under 
 which title the whole work was translated into Latin and re- 
 published in 1549. He regards fevers as caused chiefly by 
 irritation or disease of the stomach and intestines ; recom- 
 mends a seton or the establishment of suppuration at the 
 seat of the aura accompanying paroxysms of epilepsy ; and, 
 contrary to the instructions of both Hippocrates and Galen, 
 he declared that venesectiot could be practised properly on 
 either side or in any convenient part, as the veins were all 
 connected with each other. 
 
 In physical diagnosis, he applies pressure of the finger 
 to detect oedema or anasarca; palpation in enlargement of 
 the spleen; percussion in tympanites and succussion in as- 
 cites. He attached much importance to the consideration of 
 the constitution, personal habits and age of his patients. He
 
 42 
 
 cautions against implicitly following "Authorities" ; yet he 
 treats both contemporaries and predecessors with respect, 
 and even eulogizes Galen. 
 
 Paul, or Paulus, of -Hgina, sometimes called .l^ginata, 
 appears to be the last of the Greek physicians who gained a 
 prominent position in medical history. He was born in the 
 Island of JEgms., probably near the end of the sixth cen- 
 tury, received his medical education chiefly at Alexandria, 
 traveled and practised in many countries and enjoyed a high 
 reputation in both surger>' and midwifery, during the reign 
 of the Emperors Heraclius and Constantius, during the mid- 
 dle part of the seventh century A. D. It was during the 
 early part of his career that Alexandria was captured by the 
 Saracens, under the direction of the Caliph Omar, 640 A. D., 
 and the celebrated library finally completely destroyed by 
 fire. Paulus appears to have been strictly an itinerant prac- 
 titioner, with no permanent place of residence, though the 
 greater part of his life was spent in Egypt, Arabia and other 
 parts of Asia Minor. He wrote a general treatise on medi- 
 cine and surgery, composed of seven books or parts, in which 
 he gave freely his own views and methods of practice, inter- 
 spersed with copious extracts from Oribasius, Soranus and 
 others. 
 
 The work was highly esteemed by the Arabians and was 
 translated into their language and became the basis of much 
 of their subsequent progress in the healing art ; and, as a 
 w^hole, it probably aftords the best index of the actual con- 
 dition of practical medicine, surgery and midwifery at the 
 close of Greek and Roman dominance, and the beginning of 
 the Arabian school in the middle of the seventh century A. D. 
 
 The sixth book in his series was devoted to surgery, and 
 shows that much progress had Ijeen made both in devising 
 instruments and in their use. He recommended and prac- 
 tised scarification, venesection and arteriotomy, always bleed- 
 ing as near as possible to the affected organ ; applied the 
 actual cauter}' for the relief of deep-seated abscesses ; washed 
 out the bladder freely in chronic cystitis ; ligated the veins in 
 varicocele and treated hydrocele by incision ; endeavored to 
 reduce dislocations and applied splints to fractures as soon
 
 43 
 
 after the injuries as possible, and forbade frequent changing 
 of dressings. He advised trephining immediately after frac- 
 tures of the skull ; practised paracentesis of both chest and 
 abdomen, also undertook tracheotomy, bronchotomy and 
 lithotomy, and advised punctures of the membranes in hy- 
 drocephalus. He used a variety of forceps for the extrac- 
 tion of teeth, and for the removal of foreign bodies lodged 
 in the flesh, and dilated rectal strictures by bougies. He de- 
 scribed with considerable accuracy syphilitic ulcers on the 
 genital organs of both male and female patients, and also 
 gonorrhoea, but apparently without any knowledge of their 
 specific causes or infectiousness. In diseases of the uterus 
 he used the vaginal speculum freely, by which he was en- 
 abled to recognize fissures, excrescences, polypi and other 
 morbid conditions of the vagina and neck of the uterus. 
 
 In general practice he gave opium in tetanus and other 
 painful affections; practised venesection in apoplexy; used 
 bathing and restricted diet in fevers, and did not deviate 
 much from the rules inculcated by Galen. 
 
 The brief account now given of the leading medical men 
 of the first six centuries A. D., whose writings and modes of 
 practice have come to us sufficiently authenticated, afford a 
 fair view of the progress of medicine during that period. 
 The almost constant wars that were prosecuted during that- 
 time created an equally constant demand for surgeons to 
 care for the wounded and physicians for the sick. This led 
 each successive ruler, whether Christian or pagan, to secure 
 for himself and his soldiers the services of the most emi- 
 nent medical men within the sphere of his influence. This 
 led to a steady advance in practical surgery, especially in the 
 invention of instruments and operative procedures, and the 
 writers of new works aimed largely at the collection of 
 whatever was deemed valuable in the writings of their prede- 
 cessors. The investigations in comparative anatomy and 
 physiology that had been prosecuted with varying activity 
 and success from the time of Aristotle to Galen, had been al- 
 most wholly neglected since. Consequently no advance had 
 been made in these important branches of medical science,
 
 44 
 
 and the whole tenor of medical and surgical practice was de- 
 cidedly eclectic and empirical. 
 
 Notwithstanding the degraded condition of medicine in 
 the Roman Empire prior to the conquest of Greece, and the 
 bitter Roman prejudices against the introduction of Grecian 
 philosophy and medicine, the great superiority of the latter 
 was soon demonstrated by the influx of men educated at 
 Alexandria, which soon caused their services to be required, 
 not only with their armies but also in the cabinets and house- 
 holds of the successive emperors. Educated members of the 
 profession were soon permitted to enjoy all the rights of cit- 
 izenship ; and during the reign of Antonius Pius, in the last 
 half of the fourth century A. D., they were granted many 
 special privileges, and some restrictions were placed upon 
 the custom of allowing anyone to practise who might choose 
 to do so. The physician to the King or Emperor was called 
 Archiater, or royal healer. Popular Archiaters were also 
 appointed, whose duty it was to attend to the poor and to 
 perform many of the duties at present assigned to public 
 health officers. Such were paid moderate salaries from the 
 public treasury, and where such officers existed no persons 
 were alloweed to commence the practice of medicine without 
 an examination and license by the Archiater of the District. 
 
 Notwithstanding this partial organization of the better 
 educated members of the profession and fair recognition of 
 their social standing in the Roman Empire, a large part of 
 medical practice remained in the hands of the more ignorant 
 and superstitious part of the population. The rapid decline 
 and closure of the ^sclepiadae, so long the chief resorts for 
 the sick and centers for medical instruction, following the 
 edict of Constantine against them in 335 A. D., made it nec- 
 essary to provide substitutes both for the care of the sick and 
 for the preservation and increase of medical knowledge. The 
 monasteries under the control of monks and priests became 
 the most ready substitutes, especially as healing of the sick 
 and help for the poor were inculcated as cardinal duties of 
 the Christian life. And as healing of the sick and restoring 
 the dead to life were resorted to by the author of Christian- 
 ity and his immediate disciples as evidence of the truth of
 
 45 
 
 their doctrines and their divine origin, it exerted great influ- 
 ence in again connecting medicine with religious institutions 
 under the control of the priesthood. The same influences 
 created in the minds of the female converts to Christianity 
 great zeal in prosecuting charitable enterprises of various 
 kinds. Consequently, while the Emperor Constantine was 
 enforcing his decree for closing the ^sclepiad^e and all med- 
 ical institutions under what was called pagan control or 
 Greco-Roman philosophy that recognized the worship of 
 many Gods, his mother, Helena, was devoting much of her 
 time and means to the founding of a genuine hospital for 
 the sick and poor in Jerusalem. With the aid of many others 
 another was established at Antioch about 363 A. D., and as 
 early as 373 A. D. a still more noted one was organized at 
 Csesarea. 
 
 Such was the beginning of the modem system of hospi- 
 tals, asylums, and dispensaries for the sick and helpless that 
 are now found in all the countries of Christendom. The 
 founding of these institutions also led to the appointment of 
 some person to prepare and dispense the medicines ordered 
 by the physicians. And this was doubtless one of the chief 
 influences creating the order of pharmacists, or apothecaries, 
 as distinct from that of the physician.
 
 46 
 
 CHAPTER IV. 
 
 HISTORY OF MEDICINE FROM THE SEVENTH TO THE FOUR- 
 TEENTH CENTURY. — THE ARABIAN ERA. 
 
 In the preceding chapter the history of medical progress 
 was traced from the time of Galen, the second century A. D., 
 to the seventh century A. D. During that period the great 
 Roman Empire had culminated in its greatness and divided 
 into Eastern and Western Empires ; and Rome, only a little 
 before mistress of the world, had, under the repeated at-- 
 tacks of so-called Northern barbarians and the effect of in- 
 ternal dissensions, become little more than a heap of ruins. 
 The Eastern Empire, with its capital at Constantinople, was 
 still maintaining a semblance of power, though its downfall 
 was rapidly approaching. During the same period the gen- 
 eral aspect of medicine had undergone an equally radical 
 change. The renowned school of Alexandria, with its li- 
 brar}- and museum, had been destroyed. The rapid spread of 
 Christianity and its dominating influence throughout the 
 Roman Empire had resulted in suppressing nearly all the 
 i^sclepiadae and associated medical schools. By doing so 
 the intimate and long-continued connection of medicine with 
 the ever-varying systems and schools of Grecian and Greco- 
 Roman philosophy was effectually broken up. Alany of the 
 educated members of the medical profession embraced the 
 Christian doctrines, and served as Archiators, and many oth- 
 ers joined the monasteries and the newly organized hospitals 
 for the sick and again reunited the functions of both physi- 
 cian and priest. 
 
 \\'hen the Emperor Justinian, 529 A. D., finally closed the 
 only remaining important /Esclepion at Acropolis, and the 
 Platonic School at Athens, their occupants, together with 
 many of the Greek and Roman scholars, migrated into Svria, 
 Arabia and other parts of Asia. They carried with them 
 copies of the best works of the Greek and Roman authors, 
 from Hippocrates to Galen. They were cordially received by 
 Mahommed and'Chosroes, King of Persia, and by translat-
 
 47 
 
 ing their valuable medical books into the Syriac and Arabic 
 languages they were readily introduced into the schools at 
 Bagdad, Bassora and Damascus. Their work in thus laying 
 the foundation for an Arabian era of medicine was much 
 aided by a schism that had occurred among the Christians 
 in Constantinople. Nestorius, sometimes called Bishop Nes- 
 tor, had been appointed Patriarch of Constantinople, 428 
 A. D., and with his numerous followers controlled an impor- 
 tant school at Edessa. The school was accompanied by a 
 hospital for the sick, in which the medical students received 
 some clinical instruction. After a few years Nestorius was 
 subjected to a charge of heresy, which led to much theo- 
 logical controversy and resulted in his banishment and the 
 closure of the school by the Emperor Zeno, 489 A. D. 
 
 The school was under the charge of an able faculty of 
 teachers who, with most of the followers of Nestorius, fled 
 into Syria and Arabia and soon founded another school at 
 Nisibus, in Mesopotamia. They carried with them copies 
 of many of the best works of Greek and Roman authors in 
 both philosophy and medicine, and Bishop Ibas, aided by 
 Cumas and Probus, attached tp the new school, translated 
 the works of Aristotle into Syriac, and the school was much 
 patronized by Jewish, Syrian and Arabian scholars and stu- 
 dents of medicine. Some historians have credited these 
 Nestorian schools, both at Edessa and Nisibus, with having 
 been the first to require a definite course of study in medi- 
 cine, and to grant certificates authorizing the holders to 
 practise the healing art. And it was also largely through 
 their influence that pharmacies for the preparation and dis- 
 pensing of medicine became a distinct business separate from 
 the practice of medicine. 
 
 It was thus by the influence of the migration of the Nes- 
 torians from Constantinople and Edessa, and the closing of 
 the schools at Acropolis and Athens by Justinian, that the 
 Greek and Roman philosophy and medicine became trans- 
 ferred to, and firmly established in, the schools of Syria, 
 Arabia and Persia, and were fostered by Chosroes, King of 
 Persia, IMahommet and their successors from the sixth to 
 the eleventh century A. D., constituting a distinct era in the
 
 48 
 
 progress of medicine as well as in the progress of nations, 
 an era in wiiich Xisibus, Uagdad, Bassora and Damascus be- 
 came the chief seats of learning instead of Athens, Alexan- 
 dria, Rome and Constantinople. 
 
 The first physicians to gain general reputation in Arabia 
 were from a Nestorian family named Bachtishua (i. e.. Serv- 
 ants of Christ). Bachtishua ben Jurjis is said to have cured 
 the Caliph Haroun el Raschid of headache by venesection, 
 while his son cured the same Caliph of an attack of apo- 
 plexy. Another Nestorian physician, named ]\Iesue, the 
 Elder, gained a high reputation as a translator of valuable 
 Greek and Latin works into the Syriac and Arabian lan- 
 guages, and in the early part of the ninth century was di- 
 rector of the hospital in Bagdad. 
 
 Honain, of Hira, was another prolific translator of med- 
 ical, philosophical and scientific works, for which he received 
 as compensation the weight of the manuscript in gold. He 
 became widely known as a physician and writer on some 
 medical topics. He appears to have adopted many of the 
 more fanciful doctrines of Galen and Plato, but left no ad- 
 ditions to the sum of real medical knowledge. He was born 
 in 809 and died in 873 A. D. 
 
 Rliazes, born at Rai, 850 A. D., was one of the most emi- 
 nent of the Arabian writers and practitioners of both medi- 
 cine and surgery during the last part of the ninth century. 
 He became one of the most eminent teachers of medicine in 
 the school ot Bagdad. He wrote many works on both philos- 
 ophy and medicine, but the two most important were his "El 
 Hawi" or Liber Continens, and his Aphorisms, which were 
 retained in use during several centuries. These works show 
 that he was familiar with many surgical procedures, such as 
 were required in the treatment of trichiasis, entropion, ectro- 
 pion, cataract and fistula lachrymalis, also with tracheotomy, 
 tonsillotomy, and the removal of necrosed and carious bones, 
 the closure of hare-lip and fistulous tracts. His teachings in 
 anatom}-, physiology- and pathology show no advance beyond 
 what had been derived from translation of the works of 
 Galen and other Greek and Roman authors. 
 
 In the treatment of diseases he adheres closely to the
 
 49 
 
 principles inculcated by Hippocrates, but in semeiology and 
 prognosis he makes some valuable additions to our previous 
 knowledge. His excellent descriptions of smallpox and 
 measles are the earliest that have been handed down to us, 
 and justly entitle him to the position of a pioneer in derma- 
 tology. To the materia medica he added, for external use, 
 preparations of arsenic, sulphate of copper, and mercurial 
 ointment. Late in life he became blind and poor, and died 
 in his native city in 923 A. D. 
 
 Closely following Rhazes was Ali Abbas, an Arabian 
 physician who compiled the "Royal Book" or treatise on 
 medicine, which was later translated into Latin by Constan- 
 tius Africanus, who was the first author to introduce the 
 Arabian writings into Europe. 
 
 Perhaps the most eminent of the Arabian physicians was 
 Avicenna, a native of Bokhara, bom in 980 A. D. His 
 Oriental education consisted in a complete knowledge of the 
 Koran before he had passed his tenth year of age. He then 
 rapidly acquired a knowledge of grammar, arithmetic, geom- 
 etry, dialectics and astronomy. He next made a thorough 
 study of the philosophy of Aristotle, and then commenced the 
 study of medicine under Nestorian teachers at Bagdad. Such 
 was his proficiency that at the age of sixteen years he was 
 declared to be qualified to teach and practise his profession. 
 Five years later he had written an encyclopedia entitled by 
 him, "Book of the Sum Total". Later, he became the author 
 of many works and commentaries, the most important of 
 which was the "Canon", in which he gave an excellent colla- 
 tion of the views of many of the most eminent Greek authors. 
 It was translated into both Latin and Hebrew, and was in 
 general use for four or five centuries in Europe as well as in 
 Asia. Early in his career he became Vizier to the Emir of 
 Hamadan, and lectured on both philosophy and medicine, at 
 the close of each lecture indulging in feasting and dancing. 
 After the death of the Prince of Hamadan, Avicenna was 
 suspected of improper correspondence with parties at Ispa- 
 han, and thrown into prison. After being liberated he fled 
 to Ispahan, where he again attained a high reputation, aban- 
 doned the excesses of his earlier years, freed his slaves, gave
 
 50 
 
 much of his fortune to the poor, and died at the age of fifty- 
 eight years. Notwithstanding the high reputation attained 
 by Avicenna and the length of time that his "Canon" was 
 accepted as authority, we find in it but little that is new or in 
 addition to what was previously known. In his comments on 
 materia medica he recommends the internal use of camphor, 
 preparations of iron, cubebs, aloes, manna, amber, sublimate, 
 and gold and silver as blood purifiers, which shows a decided 
 tendency to use more mineral and chemical remedies than 
 any of his predecessors. 
 
 No true science of chemistry had yet been developed, but 
 the alchemistic theory of a philosopher's stone, an elixir of 
 life, and the transmutation of metals, more or less prevalent 
 among the Eg}'ptians, Greeks and Romans as early as the 
 fifth century A. D., found enthusiastic disciples among the 
 Arabians. Many of them experimented actively, especially 
 in efforts to rend-er the metals soluble and thereby transmute 
 the less valuable into gold or silver. Perhaps Jaffar, or 
 Geber, who lived during the last half of the eighth century 
 A. D., became the most eminent, and made some discoveries 
 of importance. Previous to his time the strongest acid known 
 was concentrated vinegar. He, however, succeeded in mak- 
 ing nitric acid by distilling a mixture of blue vitriol, alum 
 and saltpetre ; and he made aqua regia or nitro-muriatic acid 
 by adding to the same mixture sal-ammoniac (ammonia hy- 
 drochlorate). With his aqua regia he was enabled to dis- 
 solve gold, an object long sought in vain by his predecessors. 
 He also described the absorption and evolution of gases by 
 and from liquids and solids, and was familiar with the pro- 
 cesses of filtration, distillation and sublimation. 
 
 Rhazes, while chief physician to the hospital in Bagdad, 
 made sulphuric acid by distilling green vitriol, and also ab- 
 solute alcohol by distilling spirits over quicklime. 
 
 While the Arabian schools were thus conserving all that 
 was valuable in the Greco-Roman medicine and philosophy 
 and making here and there some valuable additions, the fol- 
 lowers of ]^Iahommet had rapidly gained. control over Arabia, 
 Persia and the greater part of Asia Minor, and before the 
 end of the seventh centun^ had defeated the Eastern Roman
 
 51 
 
 government at Constantinople and led their Saracen legions 
 through the whole southern part of Europe. In doing so, 
 they brought back into Europe all that was valuable in Gre- 
 cian and Roman learning, dressed in Arabic language, with 
 such additions as have been indicated, and re-established a 
 school of medicine at Salernum, a former health resort near 
 Naples, and subsequently schools at Montpellier, Cordova 
 and Seville. These schools, as well as those at Bagdad and 
 Damascus in Asia, received the fostering care of the suc- 
 cessive Moorish Caliphs, and constituted the chief seats of 
 learning, including medicine, during the eighth, ninth, tenth 
 and eleventh centuries, which was pre-eminently the era of 
 Arabian medicine. Though not characterized by any great 
 discoveries, it is justly credited with having received and 
 fostered the most valuable part of Egyptian, Grecian and 
 Roman medicine and literature, as they were driven out of 
 Europe, and again in due time re-established them in Italy 
 and Spain, from which they were finally redistributed to all 
 parts of Europe, constituting the period styled in history "the 
 revival of learning" following the dark ages. 
 
 The Arabians are credited w'th not only the addition of 
 several valuable remedies to the materia medica and the dis- 
 covery of the mineral acids, but also the preservation of a 
 distinctly medical profession based on a clinical study of dis- 
 eases, their remedies, and some elements of natural science, 
 with less reference to theology or supernatural agencies. 
 
 The overthrow and final extinction of Arabian leadership 
 or even activity in medicine came when in 1236 A. D. Cor- 
 dova fell under the control of Ferdinand of Castile, and in 
 1258 A. D. Bagdad was taken possession of by the Tartars. 
 Aside from what has been said concerning Nestorian and 
 Arabian schools, very little progress was made in any de- 
 partment of medicine from the end of the seventh to the be- 
 ginning of the fourteenth century. Medical and nearly all 
 other sciences and arts retreated to the monasteries and the 
 care of monks and ecclesiastics, who were far more influ- 
 enced by papal edicts and so-called supernatural agencies 
 than by clinical observation and experimental inquiry. Yet, 
 during all this dark period, influences were visibly prepar-
 
 52 
 
 ing the way for the revival of learning that followed. Im- 
 portant monas'uic schools were founded in England at Ox- 
 ford, 635 A. D., and at Cambridge, 670 A. D., and Charles 
 I., King of France, better known as Charlemagne, who for 
 more than thirty years prosecuted a relentless and successful 
 war, during which he subdued the inhabitants of Saxony, 
 Lombardy, and Bavaria, and compelled them to adopt the 
 Christian faith, as expounded by papal authority, became al- 
 so a zealous patron of learning and the arts. lie invited to 
 his court men of learning from Italy, and established th& 
 "Palatine School," which, like our normal schools, was de- 
 signed to qualify persons to teach arithmetic, grammar, rhet- 
 oric, logic, history, astronomy, theology and medicine, and 
 then had them go into the provinces and keep alive some 
 educational work among the people. After the death of 
 Charlemagne the vast empire constructed by him, extending 
 from the English Channel to the western borders of Asia, 
 underwent rapid disintegration into many petty kingdoms, 
 and all learning, professional and otherwise, remained under 
 the dominating influence of the monks, priests and bishops, 
 among which those of the Order of St. Benoit enjoyed the 
 highest reputation for medical skill. 
 
 Notwithstanding the religious rites of the Jewish Church 
 forbade all attention to the diseases of Christians many Jews 
 studied medicine under Arabian physicians and retained a 
 fair share of medical practice until near the end of the 
 eleventh century, when the preaching of Peter the Hermit 
 began to kindle throughout all Europe the wild fires of the 
 Crusades. 
 
 During all those preceding centuries besides the Monks, 
 Priests and Jews who maintained some semblance of educa- 
 tion, there were large numbers, including barbers, servants 
 and slaves, both male and female, with no education, who en- 
 deavored to administer to the sick and wounded wherever 
 they were met with. There were no courses of study pre- 
 scribed to qualify any person to engage in practice, nor laws 
 forbidding anyone to practice who might desire to do so. 
 For though the Xestorian schools were said to grant certifi- 
 cates to such as had completed certain studies, and Theo-
 
 53 
 
 doric, King of the Visigoths, issued a decree requiring every 
 physician and surgeon to make full restitution for any in- 
 juries suffered by patients while under their treatment, 
 neither forbade any to engage in practice. The medical 
 school that had been founded during the latter part of the 
 seventh century A. D., at Salernum, being directly on the 
 route of the Crusading legions from Europe to Jerusalem 
 or the Holy Land, near the end of the eleventh ceutury re- 
 ceived a great increase of patronage and remained the most 
 important center of medical instruction until the beginning 
 of the fourteenth -century. It was at that institution that 
 Robert, of Normandy, on returning from the siege of Jerusa- 
 lem with a wounded arm, remained until recovery. On leav- 
 ing he was presented with a Latin poem entitled "Regimen 
 Sanitatis Salemi", which was received with great popular 
 favor, and was published in this country by Dr. Ordronaux 
 in 1 87 1. The most important lesson inculcated in the poem 
 is contained in the following lines addressed to England's 
 King : 
 
 "If thou to health and vigor wouldst attain, 
 Shun mighty cares, all anger deem profane ; 
 
 From heavy suppers and much wine abstain ; ^ 
 
 Nor trivial counfit after pompous fare 
 To rise from the table and to take the air. 
 Shun idle noonday slumbers, nor delay 
 The urgent calls of nature to obey. 
 These rules if thou wilt follow to the end. 
 Thy life to greater length thou may'st extend." 
 
 -(Ord.) 
 
 During the first half of the thirteenth century, by the 
 fostering care of Frederick II., King of Naples, the school at 
 Salernum reached the zenith of its prosperity and influence. 
 The "Compendium Salernitanum", the chief medical text- 
 book of the school, was designed to include all the depart- 
 ments of medicine and was the work of six writers each 
 eminent in his department. It was thus the prototype of our 
 modern encyclopedias or works of many authors. The sev- 
 eral writers simply made fairly good compilations from 
 
 •^
 
 54 
 
 Arabian, Grecian and Roman authors, and their work re- 
 mained a popular text-book not only in Salernum but also 
 in the schools at Bologna, Padua, Pavia, Montpellier, Cor- 
 dova and Paris, for the increased demand for accommoda- 
 tions for the sick and wounded during and following the 
 vast military operations of the Crusades led to a rapid in- 
 crease in the number of monasteries, hospitals and medical 
 schools. 
 
 During the first half of the twelfth century Nicholas 
 Prsepositus, President of the school at Salernum, wrote a 
 work on pharmacy called the "Antidotarum" that acquired 
 great popularity. He used in his work the well-known sys- 
 tem of apothecaries' weights and measures, and is said to 
 have given one prescription from St. Paul and others from 
 the Prophet Elias. In none of the works produced by the 
 patrons of this school do we find any really valuable addi- 
 tions in any department of the field of medicine. They gave 
 chief attention to materia medica and practical medicine, gen- 
 erally following closely the doctrines of Hippocrates and 
 Galen, especially in regard to baths, diet, the use of mild lax- 
 atives, and free venesection in the more acute inflammatory 
 aflfections. Anatomy and physiology- appear to have made 
 no progress from the time of Galen to the end of the thir- 
 teenth century, in any of the medical schools of Europe, as 
 both Christians and pagans still regarded any dissection of 
 the human body for the purpose of gaining useful knowledge 
 as sacrilege. 
 
 Yet early in the thirteenth century, Frederick II. pub- 
 lished an edict forbidding any person from practising medi- 
 cine in the Kingdom of Naples until after an examination by 
 the Faculty of the School of Salernum on the Therapeutics 
 of Galen, the first Book of Avicenna and the Aphorisms of 
 Hippocrates, text-books from six to sixteen centuries old. 
 
 One prominent characteristic of medical writers during 
 the twelfth and thirteenth centuries was the adoption of a 
 poetic or versified mode of expression. Thus, ^gidius, of 
 Corbeil, physician to King Philip Augustus, wrote in verse 
 on "De Urinus", "De Pulsibus" and "De Laudibus et Vir- 
 tutibus Compositorium Medicaminum*', and Alcadinus, of
 
 55 
 
 Syracuse, physician to Frederick II., composed a poem on 
 "De Balner's Puteolanis". He was also one of the teachers 
 at Salernum. 
 
 Another marked feature of the same centuries was the 
 unusual number of women who studied and practised the 
 healing art, and in some instances became teachers and writ- 
 ers, thereby again reminding us that women practitioners of 
 medicine are by no means the exclusive product of the last 
 half of the nineteenth century. Perhaps the persistent ex- 
 perimental search for the philosopher's stone and elixir of 
 life by the alchemists, and the religious enthusiasm of the 
 Crusaders, so elevated the mind of man that his ideas on the 
 most common topics had to be expressed in poetry, and that 
 of woman that she was compelled to pass from the family 
 circle to the wider field of medicine. 
 
 It is more probable, however, that the greater tendency of 
 women to study and practise medicine during this dark pe- 
 riod of human history was caused by the interest she felt in 
 the organization and maintenance of hospitals and dispen- 
 saries for the sick and helpless under Christian dispensation, 
 to take the place of what was called pagan or infidel /Esclep- 
 iadese and schools of philosophy previously existing. 
 
 In the preceding chapters of this work very little has been 
 said concerning the character of the epidemic diseases that 
 are known to have prevailed more or less during all the past 
 ages, and especially during the first thirteen centuries A. D. 
 There is sufficient evidence in both the historical and medical 
 writings to show that from the earliest periods of time 
 chronic diseases of the nervous, digestive and vascular sys- 
 tems, with occasional acute inflammatory attacks, and the 
 endemic fevers of malarial or periodical type, were the dis- 
 eases ordinarily met with in all the inhabited countries of 
 which we have any records. That the allusions to fevers 
 should generally indicate those of periodical form was evi- 
 dently dependent upon the fact that the geological, topo- 
 graphical and climatological conditions of Eg}-pt, Greece, 
 Rome and Asia Minor were such as to favor the annual prev- 
 alence of that form of disease. 
 
 In addition, however, to these ordinary diseases there are
 
 56 
 
 in the earliest historical and medical records indications of 
 the prevalence, at irregular intervals of time, of the rapid de- 
 velopment and wide spread of acute febrile diseases, resulting 
 in so great a degree of mortality as to cause the utmost dread 
 or mental anxiety. Such outbreaks of disease are called epi- 
 demics, and from the earliest times they were indicated by the 
 words Pest, Pestilentia or Plague. Prior to the commence- 
 ment of the Christian era, and for several centuries later, the 
 prevalence of such epidemics was very generally attributed 
 to the anger of the Gods and were often thought to be pre- 
 ceded or accompanied by unusual or violent natural disturb- 
 ances, such as earthquakes, volcanic eruptions, the appear- 
 ance of comets, etc. Consequently, very little effort was 
 made to investigate their real causes or to devise any rational 
 modes of treatment, the latter generally consisting of prayers, 
 sacrifices, the kindling of bonfires, etc. 
 
 But the first great epidemic of the Plague, of which we 
 have a reliable history, commenced in lower Eg}-pt in 542 
 A. D. and extended up the Nile and eastward into Asia 
 Minor, and soon reached Constantinople, where it is claimed 
 that more than 5,000 human beings died daily when the dis- 
 ease was most active. The next year it extended westward 
 over Greece and Italy, and in 545 it invaded Gaul and the 
 next year reached the Rhine. It did not cease its activity for 
 twelve or fifteen years, during which time it decimated the 
 population of Paris and London, as well as most of the dense- 
 ly populated parts of Europe, Asia and Northern Africa. 
 As this great and destructive epidemic commenced soon after 
 Justinian I. became Emperor at Constantinople, it has gen- 
 erally been designated as the "Plague of Justinian". The 
 disease continued to recur with varying degrees of intensity 
 at intervals of from fifteen to thirty years, commencing gen- 
 erally in Eg}-pt, Syria or on the eastern borders of the Med- 
 iterranean Sea, and extending over most of the countries of 
 Europe, until the seventeenth century. 
 
 The Plague appears to have been a highly malignant 
 typhus fever, frequently terminating fatally in from one to 
 three days, and when more protracted becoming complicated 
 with inflammation of the lymphatic glands of the groin, arm-
 
 57 
 
 pit and neck, thereby giving it the name of "Bubonic 
 Plague". With the glandular swellings in many cases came 
 also carbuncles on the back, hips and legs, and if the patients 
 lived beyond the first week extensive suppuration generally 
 took place in both glands and carbuncles and the prospect 
 of final recovery was increased. The outbreaks of the plague 
 generally followed closely unusual periods of famine, wheth- 
 er caused by failure of crops or the ravages of war ; the ac- 
 cumulations of stagnant and impure water after floods ; and 
 the overcrowding of population in cities, with neglect of both 
 ventilation and cleanliness. 
 
 In addition to the epidemics of plague, during the sixth 
 and seventh centuries, variola, or smallpox, and measles were 
 introduced into Europe through intercourse with Arabia, and 
 especially through the Saracen invasions. They had doubt- 
 less prevailed in India and China at a much earlier period, 
 but were first clearly described by the Arabian physicians 
 Ahrun and Rhazes in the seventh century. From that time 
 to the introduction of vaccination, near the end of the eight- 
 eenth century, smallpox recurred in epidemic form and 
 spread over the greater part of Europe at such frequent in- 
 tervals that it became the most dreaded scourge of mankind. 
 The best of English medical writers have estimated that the 
 average annual mortality from this disease alone exceeded 
 200,000 for the whole of Europe. This great mortality was 
 often added to by outbreaks of measles, scarlet fever and 
 diphtheria, then called cynanche maligna. The principal rea- 
 son why the whole of Europe was not literally depopulated 
 during the centuries directly considered in this chapter by 
 the combined influence of almost constant wars and pestilen- 
 tial epidemics, was the fact that those who survived one at- 
 tack of either eruptive fevers or plague were generally ren- 
 dered immune or exempt from subsequent attacks of the 
 same disease.
 
 58 
 
 CHAPTER V. 
 
 THE HISTORY OF MEDICAL PROGRESS DURING THE FOURTEENTH, 
 FIFTEENTH AND SIXTEENTH CENTURIES. 
 
 The Origin and Development of Human Anatomy and of 
 Inorganic Chemistry. 
 
 The beginning of the fourteenth century A. D. was 
 especially characterized by renewed attempts to study 
 human anatomy. As shown in the preceding chapters the 
 study of anatomy, even by the dissection of animals, had 
 been almost suspended during the whole of the Arabian 
 era of medicine and the re-establishing of medical schools 
 in Europe under the Christian dispensation ; i. e., from the 
 second to the fourteenth century A. D. But the constant 
 demand for better educated physicians and surgeons to 
 accompany the armies and serve in the hospitals, made 
 necessary by the almost constant wars, as well as by the 
 frequently recurring epidemic diseases, rendered a better 
 knowledge of the anatomy of the human body impera- 
 tive. The leading influence gained by the Italian Schools 
 under the more enlightened policy of Frederick II., and 
 the increasing demand for experimental inquries by the 
 Alchemists, awakened a bolder spirit of inquiry in other 
 directions. In accordance with this spirit Dr. Mondino de 
 Luzzi, Professor of Anatomy in the school at Bologna, 
 boldly caused a human body to be dissected before his 
 class of medical students in 1306. Not possessing quite 
 courage sufficient to handle the knife himself, he is said 
 to have employed a barber to do the dissecting, while he 
 pointed out the different parts with a rod. Two years 
 later, 1308, the Senate of Venice, in defiance of the decrees 
 of Pope Boniface \'IIT., enacted a law allowing one dead 
 human body to be annually used for the study and teach- 
 ing of anatomy. 
 
 This is probably the first act of a legislative body directly 
 authorizing the use of a limited number of human bodies
 
 59 
 
 for the purpose of better qualifying physicians and sur- 
 geons to alleviate the suffering of the living. Such, how- 
 ever, was still the dread of incurring the anathemas of 
 the Ecclesiastics, that we learn of only two more bodies 
 being used by Mondino in the school at Bologna in 131 5, 
 and none in the school at Prague until 1348, in that at 
 Montpellier until 1376, and in the one at Strasbourg until 
 15 17. During all the prosperous years of the school at 
 Salernum they used chiefly the hog for demonstrations in 
 anatomy. 
 
 Mondino de Luzzi, however, industriously wrote de- 
 scriptions of the parts dissected under his direction, and 
 in 1316 published his celebrated work entitled, "Anatome 
 Omnium Humani Corporis Interiorum Membrorum", 
 which served as a text-book on human anatomy in all the 
 medical schools during the next three centuries. Although 
 very incomplete and erroneous in many parts, resulting 
 from the hasty and imperfect method of dissection, it con- 
 stituted the real beginning of human anatomy as one of 
 the fundamental branches of medical science. Mondino was 
 a son of an apothecary of Bologna, and followed the same 
 calling until he became one of the professors in the medical 
 school. He was born in 1276, and died at Naples in 1326, 
 where he was serving as deputy to King Robert. 
 
 After the death of Mondino, very little progress was 
 made in the correction and development of human anatomy 
 until the beginning of the sixteenth century, when An- 
 dreas Vesalius, of Brussels, appeared upon the stage 
 of action. He was born in 15 14. His ancestors for, at 
 least, three generations had been physicians. He received 
 his primary education at Louvain, and studied medicine 
 in both Montpellier and Paris with such success that 
 he returned to his native city at the age of twenty years. 
 At Paris he was under the instruction of Silvius and ac- 
 quired an extraordinary zeal for the study of anatomy. 
 Near Louvain was a noted place for the execution of crim- 
 inals, and it is said that Vesalius boldly and skillfully stole 
 some of his subjects for dissection directly from the gal- 
 lows after their execution. At the age of twenty-three
 
 6o 
 
 years he became Professor of Anatomy at Padua, and sub- 
 sequently gave instruction in both Pisa and Bologna. 
 
 In 1543, he caused to be published his remarkable work, 
 "De Corporis Humani Fabrica Libri Septem"; illustrated 
 by excellent wood cuts, drawn from nature by John Ste- 
 phan, a pupil of Titian the artist. At first the work 
 was met by violent opposition from much the larger number 
 of his contemporaries, chiefly on account of his numerous 
 and bold corrections of the errors in the anatomical writings 
 of all his predecessors from Aristotle to Mondino. His 
 critics were simply challenged to prove their charges by act- 
 ual dissections. So far as they were induced to do this 
 he was not only fully vindicated, but a much better knowl- 
 edge of human anatomy was rapidly developed in all the 
 medical schools of Europe. The same year that his great 
 work on anatomy was published (1543) Vesalius became 
 physician to the Emperor, Charles V., and accompanied 
 Ifim in his campaigns through Belgium and Germany. 
 About 1556, he became physician to Philip II., in Spain. 
 While there he met with so much opposition from the priests 
 that he suddenly left on a pilgrimage to Jerusalem, in 1563. 
 Soon after his arrival in that city, he received notice of 
 appointment to a professorship in the medical school at 
 Padua. In returning he was shipwrecked and he died, on 
 the Island of Zante from injuries received, at the age of 
 fifty years. 
 
 The most noted anatomists after Vesalius during the 
 last half of the sixteenth century were Columbus, a pupil 
 of Vesalius, while at Padua; Eustachius, at Rome, Fallo- 
 pius, of Modena; Fabricius, of Padua; Caesalpinus, also of 
 Padua; and Thomas Vicary, of London, who published a 
 book on the "True Anatomy of jMan's Body" in 1577. 
 
 Columbus, who followed Vesalius at Padua, described 
 the systole and diastole of the heart with the dilatation and 
 contraction of the arteries. He also pointed out the fact 
 that the blood passed from the right side of the heart to 
 the lungs and returned as arterial blood through the pul- 
 monary veins to the left side of the heart, but he failed to 
 comprehend the mechanism of the circulation of the blood.
 
 6i 
 
 Eustachius was an eminent teacher of anatomy in Rome, 
 a defender of the authority of Galen as against VesaUus, 
 and yet he improved our knowledge of the kidneys, the 
 teeth, and discovered the ducts connecting the fauces with 
 the middle ear to which his name is attached. 
 
 Fallopius, a native of Modena, taught anatomy with 
 great success both at Pisa and Padua; and his name has 
 remained attached to the tubes through which the ovum 
 passes from the ovaries into the uterus. 
 
 Fabricius, a native of Aquapendente, was a pupil of 
 Fallopius and succeeded him as teacher of anatomy at 
 Padua. He described more fully the valves in the veins, 
 and by an extensive investigation of the progress of em- 
 bryology in animals he made important additions to the 
 previous knowledge concerning the development of the foe- 
 tus and its membranes, as seen in his work "De Formato 
 Foetu." 
 
 Until the times of Fabricius and Caesalpinus dissections 
 were made with the razor, but that instrument of the bar- 
 ber now gave place to the scalpel and many other improved 
 facilities for making anatomical demonstrations, and skilled 
 artists furnished excellent cuts and engravings to illus- 
 trate their works. 
 
 Thus at the close of the sixteenth century simple de- 
 scriptive anatomy had reached a degree of development 
 entitling it to recognition as a distinct department of med- 
 ical science. 
 
 Chemistry: The origin and progressive development 
 of chemistry as a science presents a most interesting field 
 for study. The name chemistry is supposed to have been 
 derived from Chemia, the original name of Egypt, and was 
 called the "Egyptian Art", on the supposition that it origi- 
 nated in that country. The truth is, however, that all of the 
 ancient nations and tribes were possessed of some chemical 
 facts and processes gained by simple empirical observation 
 and experience. Thus the Egyptians early acquired con- 
 siderable skill in smelting ores, working metals, and in 
 making dyes for coloring. The Hebrews were well ac- 
 quainted with gold, silver, copper, tin, lead and iron, and
 
 62 
 
 many of their uses. And the Phoenicians were skilled in 
 dyeing, making glass, pottery, etc. There is no evidence, 
 however, that any of these people had any knowledge of the 
 elementary composition of the substances they handled, or 
 of the laws governing their combinations. But the same 
 mental tendencies which had caused them to assume that 
 the world was made of the four elements, fire, air, water 
 and earth, led them to assume that all the various metals 
 were made of sulphur and mercury, and as early as the 
 fourth century A. D., the idea of converting the less valuable 
 metals into the more valuable, as silver and gold, began 
 to be discussed by the Eg}'ptians and Greeks. The same 
 problem was communicated to the Arabians during their 
 invasions of Eg}'pt in the seventh century A. D., and from 
 that time its solution became an absorbing passion with the 
 educated classes during all the succeeding eight centuries. 
 
 The theory on which their investigations were based 
 was that mercury was the fixed or undecomposable metal 
 that imparted lustre and malleability to all the other metals ; 
 while sulphur was thought to be decomposable and liable 
 to many adulterations. All the metals were supposed to be 
 composed of these two in different proportions and in differ- 
 ent degrees of purity. This view was doubtless strengthened 
 by the fact that iron, copper, lead, etc., were generally found 
 in their native ores in combination with sulphur. 
 
 As was stated when discussing the Arabian era of med- 
 icine, all those who embraced the foregoing theory were 
 called Alchemists or searchers for the philosopher's stone 
 that was supposed to be capable of converting all the baser 
 metals into silver and gold. A large proportion of them 
 were medical men, among whom, Geber, the Arabian, was 
 one of the most eminent. By his experiments he learned 
 how to convert metals into oxides by heat ; how to purify 
 native sulphur; and how to make alum, saltpetre, sal-am- 
 moniac and green vitriol. He and his pupils also gave a 
 good account of the carbonates of the fixed alkalies ; of 
 sulphuric acid as obtained by distillation of alum ; of nitric 
 acid by distilling saltpetre and green vitriol ; of acetic acid 
 from vinegar ; and of alcohol from wine. With their acids
 
 63 
 
 they made several salts, the most important of which were 
 nitrate of silver and bichloride of mercury. Geber pub- 
 lished a work on the construction of chemical furnaces and 
 other apparatus. 
 
 The Arabians thus made a substantial beginning in 
 chemistry between the eighth and twelfth centuries A. D. 
 Following them in the thirteenth century were such leaders 
 as Albertus Magnus, in Germany, Roger Bacon, in Eng- 
 land, and Raymond Lully, in Italy. They, however, added 
 but little to what had been accomplished by Geber and his 
 followers in Arabia. 
 
 Bacon was popularly known as "Dr. Mirabilis", and 
 Lully as "Dr. Illuminatissimus." The latter finally joined 
 the Franciscan frairs and went as a missionary to Africa, 
 where he was killed by the Saracens. 
 
 During the fourteenth century the doctrines of the Al- 
 chemists became thoroughly diffused throughout Europe, 
 and were embraced by many of the monks and priests not- 
 withstanding the formal edict forbidding it, issued by Pope 
 John XXII., in 1317 A. D. 
 
 Among the most noted of these was Basil Valentine, 
 during the last half of the fifteenth century. He was a 
 Benedictine monk of Erfurt, and is credited with having 
 discovered antimony; of making some qualitative analyses, 
 and of having used some preparation of antimony in the 
 treatment of diseases. He also represented common salt 
 (chloride of sodium) as a third elementary metal. 
 
 Up to the commencement of the sixteenth century all 
 medical teaching in the schools and universities of Europe 
 was conducted in the Latin language, and adhered tena- 
 ciously to the leading doctrines of Hippocrates and Galen. 
 Notwithstanding this, and the repressing influence of the 
 edicts of Popes and Ecclesiastical Councils, a spirit of re- 
 bellion or independence of thought and action became vis- 
 ible during the fourteenth and fifteenth centuries. Early in 
 the sixteenth century that spirit broke forth as a meteor, in 
 the person of Theophrastus Bombast von Hohenheim, usu- 
 ally called Paracelsus. He was born in 1493, near Maria 
 Einsiedeln, in Switzerland. He received his primary edu-
 
 64 
 
 cation under the direction of his father, who was also a prac- 
 tising physician. At the age of sixteen years he entered 
 the University of Basil, where he enjoyed the use of the 
 laboratory of Sigmund. On leaving the University he en- 
 gaged as an army surgeon in the Venetian, Danish and 
 Netherland wars ; and subsequently travelled extensively 
 through Spain, Portugal, Prussia, Denmark, Egypt and 
 the Orient, as he said, '"in order to understand the wonders 
 of nature," for he declared that, "Reading never made a 
 doctor, but practise is what forms the physician." 
 
 At the age of thirty-two years he returned to Germany, 
 and engaged in the general practise of his profession. His 
 success, coupled with an unusual independence of expres- 
 sion, soon gained for him a good reputation, and in 1527 
 he was given a professorship at Basil with a liberal salary. 
 But regardless of the universal custom of teaching in Latin, 
 he gave all his instruction in the language of his own coun- 
 try, the German. 
 
 He also indulged in violent denunciation of the author- 
 ity of Galen and Avicenna, and is represented to have pub- 
 licly made a bonfire of their works. These acts soon in- 
 volved him in controversies so extensive and bitter as to 
 compel him to leave his position in the University. He 
 then became an itinerant practitioner and teacher, and by 
 lecturing and writing in the native language of the coun- 
 try he everywhere attracted followers, and by the energy 
 of his assaults upon all, so-called, established authorities, 
 he compelled even his adversaries to exercise more inde- 
 pendence of thought and expression in their own defence. 
 He also aided much in turning the attention of the Alchem- 
 ists from the transmutation of metals to the discovery of 
 new remedies for the treatment of diseases. He even 
 boasted of having discovered a universal remedy called the 
 "Elixir of Life." Nevertheless he died from the combined 
 effects of poverty, dissipation and disease, at the early age 
 of forty-eight years. 
 
 During the last part of the sixteenth century the ex- 
 treme pretensions of the Alchemists began to be opposed 
 by Libavius and Van Helmont. The former was a phy-
 
 65 
 
 sician of Cobtirg, who improved the processes for making 
 sulphuric acid and made a preparation of bichloride of tin, 
 which is still called the fuming liquor of Libavius. Van 
 Helmont boldly denied the four elements of the ancients, 
 claiming that fire was not a substance. He equally denied 
 that the elements of the Alchemists, sulphur, mercury and 
 salt, were elements of either animal or vegetable bodies, 
 and in their place he put forth the claim that water was 
 the cTiief element of all things. To demonstrate the cor- 
 rectness of this claim he planted a willow, weighing only 
 five pounds, in a pot filled with earth, and for five years 
 gave it nothing but water and air. At the end of ^he time 
 the willow weighed one hundred and sixty-four pounds, 
 while the earth in the pot had only lost two ounces. He 
 described several gases, and appears to have been the first 
 to use the word gas to designate a chemical product. 
 
 The sixteenth century thus closed with some real chem- 
 ical progress, and the adoption of some true methods of 
 investigation, though the bitter controversies between the 
 followers of Paracelsus and the persistent defenders of the 
 ancient Greek and Roman authorities were at the height 
 of their activity. 
 
 Progress in the other departments of medicine, during 
 the three centuries under review, was less than in anatomy 
 and chemistry. But the revival of the study of human 
 anatomy and the constant demand for operative surgery 
 caused by the frequent wars, certainly led to many im- 
 provements in the departments of both surgery and mid- 
 wifery. In the Italian, and indeed all the medical schools 
 of Europe, during these centuries anatomy, surgery and 
 operative midwifery were taught by the same person. Con- 
 sequently, the most eminent anatomists were generally 
 found among the most active surgeons. 
 
 For a long time a warm controversy was maintained 
 concerning the question whether the dressing of surgical 
 and other wounds should be wet, as advised by Hippocrates, 
 or dry, as suggested by Galen. The disciples of the school 
 at Salernum followed the former, and those of the school 
 at Bologna adhered to Galen. The same question was again
 
 66 
 
 persistently discussed in some of the medical journals only 
 a few years since. 
 
 Besides those who used wet, relaxing dressings (poul- 
 tices), there were many who used soothing ointments; and 
 those more directly connected with the armies used wine 
 and oil, aided by a covering of wool. As nearly all the 
 educated physicians were of the order of the Priesthood, 
 and persistently forbidden to shed human blood, practical 
 surgery was so long compelled to remain in the hands of 
 barbers and less educated persons, that, coincident with 
 the revival of anatomy and the multiplication of medical 
 schools, the more intelligent barber surgeons began to de- 
 mand a better recognition in the schools and a more equal 
 standing with physicians. In France, before the close of 
 the thirteenth centurj^ under the leadership of Jean Pitard, 
 royal surgeon to St. Louis, the reigning monarch, an asso- 
 ciation of the better educated surgeons was formed under 
 the name of "College de Saint Como." This organization 
 claimed a board of examiners, and established a respect- 
 able standard of education for admission, including a knowl- 
 edge of Latin, the study of medicine and philosophy in a 
 university two years, and the study of surgery two years 
 more. The College of St. Como, thus organized, was sus- 
 tained until 1713, when it was merged into the "Academie 
 de Chirurgie", and exerted much influence in elevating the 
 condition of surgery, especially in France. 
 
 Early in the fourteenth century the more intelligent 
 barber surgeons of London, England, under the leadership 
 of Thomas Vicary, formed an association or guild for sim- 
 ilar purposes, which became a chartered organization in 
 1461, under the title of "Masters of the Commonality of 
 Barbers of London." 
 
 A similar organization was formed in Hamburg in 1452. 
 
 By all the foregoing influences the practice of surgery 
 was being gradually elevated to a higher educational plane, 
 while the introduction of dissections of the human body 
 for the study of anatomy in nearly all the medical schools 
 compelled greater familiarity with it by physicians, and in- 
 clined a larger number of them to practise surgery as well
 
 ^7 
 
 as medicine. Thus the two classes of medical practitioners 
 were being drawn nearer together. 
 
 During the last years of the thirteenth century Lan- 
 franchi, of Milan, a surgeon well educated in the Italian 
 schools, accepted membership in the College de St. Como" 
 at Paris, and gave lectures that were attended by large num- 
 bers of students. He published a work on both Major and 
 Minor Surgery, in which he advocated the free use of the 
 actual cautery, but showed much timidity in the use of the 
 knife. He was followed, in the early part of the fourteenth 
 century, by Guy de Chauliac, who studied medicine at Paris, 
 IMontpellier, and Bologna, and became chaplain and phy- 
 sician of Pope Urban V. Subsequently he practised many 
 years at Lyons. While Chaplain of the Pope at Avignon, 
 1363, he published an important work known as the "Chi- 
 rurgia Magna", which was accepted as the ruling surgical 
 authority for many years throughout France. This work 
 though containing very little that is new or original, con- 
 tains a very fair statement of surgical views and prac- 
 tices at the time it was written, with less intermixture of 
 purely fanciful dogmas than in previous works. He rec- 
 ommended venesection according to the location and nature 
 of the disease ; opened freely fistulous tracts and deep-seated 
 abscesses ; and applied the actual cautery for caries, an- 
 thrax and open cancerous and leperous cases. He gives 
 very fair directions for the treatment of dislocations, frac- 
 tures, and surgical diseases of the eyes. He relates cases 
 of trepanning, lithotomy, the removal of pharyngeal polypi, 
 and the removal, by amputation, of supernumerary limbs. 
 He endeavors to so adjust wounded surfaces as to favor 
 union by first intention, and arrests haemorrhage by styp- 
 tics and pressure when possible, applying actual cautery only 
 in bad cases. 
 
 During the third quarter of the fourteenth century, 
 John Ardern, an English surgeon, who practised first in 
 Newark and subsequently in London, gained considerable 
 reputation for the treatment of "Fistula in Ano", and left 
 a chapter in manuscript on the subject, which was pub- 
 lished by John Read in 1588.
 
 68 
 
 The man who is credited with having accompUshed most 
 for the advancement of surgery during the sixteenth cen- 
 tury, was Ambroise Pare, bom at Laval, about 1510. He 
 commenced his career as an apprentice to the provincial 
 barber surgeons, but feeling the need of better training, at 
 the age of 22 years, he went to Paris, and studied three 
 years at the Hotel Dieu. He made such progress as 
 to gain the confidence and special commendation of his 
 teachers, and in 1537 he was made surgeon to Colonel 
 Rene de Montijean, and accompanied him in his first cam- 
 paign in Italy. This campaign, which continued three 
 years, furnished the opportunity that enabled him to make 
 one of his most important improvements in practical sur- 
 gery. Until his time, gun-shot wounds had been univer- 
 sally regarded as poisoned and burned by the penetrating 
 ball or missile and burning powder, and were treated by 
 pouring into them boiling oil or by the application of actual 
 cautery, thereby adding immensely to the torture of the 
 patients. Early in the progress of the campaign he found 
 himself in charge of a large number of wounded soldiers, 
 and his supply of boiling oil became exhaused with many 
 wounds still without that dressing. After passing a sleep- 
 less night from anxiety he w^as surprised to find in the morn- 
 ing that the patients who had received no oil in their 
 wounds had suffered much less and were in better condi- 
 tion than those to whose wounds it had been applied. This 
 led him to reflection and further trials ending in his aban- 
 donment of the use of the boiling oil as a dressing, and also 
 the doctrine that such wounds were necessarily either pois- 
 oned or burned. 
 
 After the close of this campaign, he returned to Paris 
 and was married. In 1543 he again entered military ser- 
 vice with the army, in the service of de Rohan, Lord of 
 Brittany, during which he added much to his reputation by 
 boldly resorting to the ligation of arteries for the arrest of 
 haemorrhage instead of the actual cautery. After his re- 
 turn from another active campaign he was appointed one 
 of the twelve royal surgeons, and in 1554 he was elected 
 fellow of the College de St. Como, against their rule re-
 
 69 
 
 quiring a knowledge of Latin; for Pare never acquired a 
 knowledge of the Latin language, but wrote all his works 
 in the language of his own country — France. In 1545, he 
 wrote his first notable work on the treatment of gun-shot 
 and other wounds, and of burns by gun powder. It was a 
 small volume in French, published by Gaulterot, the book- 
 seller of the University of Paris, and soon brought about 
 a most desirable revolution in the treatment of such wounds. 
 
 Subsequently he became surgeon to King Henry II., and 
 directly after this monarch's death, in 1559, he occupied 
 the same relation successively to Francis II., and to Charles 
 IX. 
 
 In 1573 he caused to be published his important work 
 entitled "Deux Livres de Chirurgie", in which is shown the 
 work of a most active and practical mind, constantly striv- 
 ing to make such improvements as would lessen human 
 suffering and prolong human life, and yet keeping nothing 
 secret for private gain as was much the practice in his day. 
 For during those centuries, many went from place to place 
 claiming to have discovered some valuable elixir, or some 
 special mode of operation, and called themselves Herniot- 
 omists, Lithotomists, etc., much like some of the peram- 
 bulating specialists of the present day. 
 
 Pare, though rising from the humble condition of a 
 poor barber surgeon's apprentice to that of chief surgeon 
 of a kingdom, and the honored guest of many kings, ever 
 remained true to his early maxim that : "He who becomes a 
 surgeon for the sake of money, and not for the sake of 
 knowledge, will accomplish nothing." He was not only 
 ever seeking knowledge, but also persistently applying it 
 in improving instruments and modes of operation, the correc- 
 tion of errors, and the abandonment of evil practices though 
 sanctioned by all preceding authorities. Actuated T)y such 
 motives and aided by Lanfranchi, of Milan; Maggi, of 
 Bologna; Lange, of Germany, and others, he lived to see 
 surgery fairly started on a career of independent profes- 
 sional recognition and progress. He died in 1590, aged 
 about 80 years. 
 
 In close connection with the progress of anatomy and
 
 surgen-, during the sixteenth century, came the beginning 
 of pathological anatomy. 
 
 During the last part of the fifteenth century Benivieni, 
 of Florence, commenced searching for the seat and nature 
 of diseases and the causes of death by post-mortem examina- 
 tions of bodies, whenever practicable. The results of his 
 work were published at Florence, in 1507, in a monograph 
 with the title "Concerning Some of the Secret and Strange 
 Causes of Disease" ; in which he describes the gross patho- 
 logical conditions found, and the chief symptoms with which 
 they were connected during life. He was followed in the 
 same field of investigation by Donatus, Grafenberg, Felix 
 Patter, Fernel, Koyster, and others. The descriptions of 
 changes found by the latter in the brain and spinal cord 
 after death from delirium, convulsions and paralysis were 
 remarkable for their minuteness and general accuracy. As 
 the result of the investigations of this class of workers, 
 extending through the whole of the sixteenth century, the 
 profession was made acquainted with a great variety of mor- 
 bid conditions in the internal structures and organs, re- 
 sulting from diseases both acute and chronic. 
 
 Thus was laid the foundation of pathological anatomy 
 by direct personal research, and not a few of the theoretical 
 dogmas of the ancients were corrected and the way pre- 
 pared for entering the field of physiology in the next cen- 
 tury. 
 
 In the surgical part of midwifery the Csesarean section 
 and podalic version were revived and improved by Pare, 
 Guillemeau and Rousset; and in the field of practical med- 
 icine the chief advancements were in the better recognition 
 of syphilitic and gonorrheal affections ; the use of mer- 
 curials externally and internally; the revival and more dis- 
 criminating practice of venesection, especially in acute in- 
 flammatory' diseases ; and a marked increase of independent 
 individual thought and practice. 
 
 The frequent recurrence of epidemics of the plague, 
 small-pox and other diseases mentioned at the close of the 
 preceding chapter, continued with little or no abatement 
 through the fourteenth, fifteenth and sixteenth centuries;
 
 to which were added during the last named century epidemic 
 influenza, or la grippe, petechial or spotted typhus, and 
 pleuro-pneumonia.
 
 72 
 
 CHAPTER VI. 
 
 HISTORY OF PROGRESS IX THE DEVELOPMENT OF THE VARIOUS 
 
 BIL\NCHES OF MEDICAL SCIENCE AND EDUCATION 
 
 DURING THE SEVENTEENTH CENTURY A. D. 
 
 In the preceding chapter chief attention was given to the 
 origin and development of the two fundamental branches of 
 medical science, i. e., human anatomy and chemistry. 
 
 The three centuries of progress reviewed in that chap- 
 ter constituted a transition period of great importance. It 
 marked the emergence of the human mind from the domain 
 of purely speculative fancies, called philosophy, and tena- 
 cious obedience to authority, to the actual study and colla- 
 tion of facts from which to deduce conclusions, and the 
 institution of experimental tests instead of the dictum of 
 authority. It is true the emergence was slow, and char- 
 acterized by mental controversies as bitter and relentless 
 as the coincident political contests and almost continuous 
 wars that devastated the greater part of Europe. 
 
 When schools of medicine and of other branches of 
 learning were re-established in Europe on the decline of 
 the Arabian era they were still founded on essentially the 
 same theoretical dogmas that had pervaded all the systems 
 of Grecian and Roman philosophy. So persistent was this 
 reverence for authority that when, at the commencement 
 of the fourteenth century, Frederick II., King of Naples, re- 
 quired all who would practise medicine in his kingdom to 
 be examined by the Faculty of Salernum, the works on 
 which they were to be examined were those of Hippocrates, 
 Galen and Avicenna. And a century later, when, under 
 the leadership of such men as Nicholas Leonicenus, of 
 Italy, and Thomas Linacre, of England, the study of Greek 
 language and literature had been revived and the best clas- 
 sical authors had been translated into excellent Latin, the 
 last named author, by the authority of King Henr>' VIII., 
 was permitted to establish chairs of Hippocratic and Galen- 
 ical Medicine in the Universities of Oxford and Cambridge,
 
 73 
 
 and ail medical writing and teaching was done in the Latin 
 language. While this persistent submission to the dictum 
 of authority, often sustained by the edicts of kings, popes, 
 and ecclesiastical councils, w^as exhibited on one side; on 
 the other was the inherent principle implanted in the human 
 mind constantly prompting to independence of thought and 
 action, aided by the fundamental doctrine of the Christian 
 religion, i. e., man's individual responsibility to God, as pro- 
 mulgated by its divine author and his immediate followers. 
 It was the promptings of the latter principles and doctrines 
 that led such men as Mondino, Vesalius, and their followers, 
 to study human anatomy in defiance of the highest human 
 authority, when the only apparent benefits to accrue were 
 the personal satisfaction always afforded by increased 
 knowledge and the higher satisfaction of so applying it as 
 to greatly benefit the living. 
 
 It was the same promptings that caused Geber, the 
 Arabian, Basil Valentine and other monks, Paracelsus, and 
 especially Libavius and Van Helmont, to so guide the zeal- 
 ous labors of the alchemists as to develop not only new 
 chemical substances, but also a knowledge of the applica- 
 tion of such substances in the treatment of disease. The 
 persistence of authority in making Latin the language of 
 medicine, both in writing and teaching, was rudely shocked 
 by the rebellious course of Paracelsus in boldly writing and 
 teaching in his native German; and its influence was still 
 more effectually nullified by the quiet and dignified course 
 of Ambroise Pare in his adherence to his native French 
 throughout his long and successful career. 
 
 Renouard and other historical writers have designated 
 the period intervening between the re-establishment of med- 
 ical schools in Europe, and the end of the sixteenth cen- 
 tury, as an "Age of Renovation." Perhaps it might be more 
 properly called a protracted period of mental revolution, 
 durmg which the human mind slowly but successfully 
 emerged from its bonds of authority, both philosophical 
 and ecclesiastical, and asserted its own right to independence 
 of thought and of expression. And the seventeenth cen- 
 tury, instead of being a period of reform (Renouard) was
 
 only a continuance and increase of that independent spirit 
 of investigation which had already begun to manifest itself 
 among the students in every department of human knowl- 
 edge. For it was during the last part of the sixteenth 
 century that Copernicus, Kepler, Galileo, and their co-work- 
 ers, laid the foundations for nearly all the modern physical 
 and natural sciences. And during the seventeenth cen- 
 tury their work was greatly extended by Swammerdam, 
 Hooke, Malpighi, Sir Isaac Newton, Romer, James Greg- 
 ory, and others. 
 
 Human investigations having thus fairly passed from the 
 domain of closet speculation to the broader field of 
 observation, verification by experiment, collection of facts, 
 and logical deductions therefrom, greater advancement was 
 made, not only in medicine but in all the collateral sciences, 
 in a single century than in all the fifteen centuries preced- 
 ing it. 
 
 Notwithstanding the marked advancements made in our 
 knowledge of chemistry, descriptive anatomy, and even 
 pathological anatomy during the sixteenth century, com- 
 paratively little progress was made in physiology, or a 
 knowledge of the functions of the various structures and 
 organs of the human body. Indeed such progress was 
 not practicable so long as the arteries were supposed to 
 carr}- only air or vital spirits, and the whole mechanism of 
 the circulation of the blood was a profound mystery. It is 
 true that in prosecuting the study of the anatomy of the 
 heart and blood-vessels, Fabricius had described the valves 
 in the veins, and Columbus those of the heart, and ]\Iichael 
 Servetus and Caesalpinus had explained the passage of the 
 blood through the lungs, thereby paving the way for the 
 discovery and complete demonstration of the circulation of 
 the blood by William Harvey, early in the seventeenth 
 century. 
 
 William Harvey was born at Folkestone, Kent, Eng- 
 
 \^ land, April i, 1578. His primary education was in the 
 
 ' grammar school of Canterbury, and at the age of fifteen 
 
 he entered Cambridge. After completing his course in 
 
 college he went to Padua, in 1599, where he pursued the
 
 75 
 
 study of medicine five years, as the pupil of Fabricius ab 
 Aquapendente and Casserio, and returned to England at the 
 age of twenty-six years. Soon after his return he married 
 the daughter of Dr. Lancelot Browne, and received his first 
 official appointment as physician to St. Bartholomew's Hos- 
 pital in London, in 1609, and as professor of Anatomy and 
 Surgery in the College of Physicians, in 161 5. He engaged 
 actively in the practise of medicine in London, and annu- 
 ally lectured to a class of students in the College of Phy- 
 sicians, to whom he began to explain his views concerning 
 the functions of the heart and the general circulation as 
 early as 16 16. 
 
 He continued his investigations several years longer, ex- 
 perimenting on both cold and warm blooded animals, dur- 
 ing which time he found neither air nor "vital spirits" either 
 in the arteries or any cavity of the heart. He did, how- 
 ever, clearly prove "that the blood passes through the lungs 
 "and heart by the pulsation of the ventricles, and is sent 
 "for distribution to all parts of the body, where it makes 
 "its way into the veins and pores of the flesh, and then 
 "flows by the veins from the circumference on every side to 
 "the center, from the lesser to the greater veins, and is 
 "by them finally discharged into the vena cava and right 
 "auricle of the heart, and this in such quantity, or in such 
 "a flux and reflux, thither by the arteries, hither by the 
 "veins, as cannot possibly be supplied by the ingesta, and is 
 "much greater than can be required for mere purposes of 
 "nutrition; it is absolutely necessary to conclude that the 
 "blood in the animal body is impelled in a circle." Having 
 thus, with great patience and perseverance, solved the prob- 
 lem of the circulation, both pulmonary and systemic, and 
 the true function of the heart, he gave a full account of 
 his great discovery in his work entitled, "Exercitatio Ana- 
 tomica de IMortu Cordis et Sanguinis in Animalibus", pub- 
 lished at Frankfort-on-the-jMain, 1628; the same having 
 been rejected by the book publishers of London. 
 
 A second treatise on the same subject, written in reply 
 to the criticisms of Riolan, of Paris, was published at Cam- 
 bridge, in 1649. The announcement of a physiological
 
 7(5 
 
 discovery of such paramount importance and so antagonistic 
 to several of the most cherished doctrines of all the past 
 centuries, did not fail to elicit prompt and severe criticism 
 from almost every quarter. This, however, only impelled 
 the more earnest of his opponents, both in England and 
 on the Continent, to actively investigate the subject, and 
 in doing so they were soon compelled to acknowledge the 
 general correctness of his views and to cease their oppo- 
 sition. 
 
 Harvey was made physician extraordinary to King 
 James I., after whose death he became physician in ordi- 
 nary to Charles I., in 1632, and was a faithful adherent to 
 that unfortunate monarch during the war between him and 
 the English Parliament. As a member of the Court he 
 was compelled to move from place to place, and on one occa- 
 sion his house was seized and some valuable manuscripts 
 were destroyed. He was present at the battle of Edge- 
 hill, after which he retired with the King to Oxford, where 
 he was made Warden of Merton College and received the 
 degree of M. D. He remained there until the surrender of 
 the City to the Parliamentary forces, and during this time 
 he resumed his studies and experimentation concerning the 
 process of generation. A few years after his return to 
 London he gave the results of his researches in a work en- 
 titled, "Exercitationes de Generatione Animalium", pub- 
 lished at Cambridge, in 165 1, in which he demonstrated that 
 all animal generation proceeded from ova. The discovery 
 of spermatozoa, however, has been credited to a German 
 student, named Ludvig Von Hammen, at Ley den, in 1677. 
 
 On account of his adherence to the cause of the King, 
 Harvey lost his position as physician to St. Bartholomew's 
 Hospital, but retained his connection with the College of 
 . Physicians and his general practice in the city. Notwith- 
 standing the severe criticisms of his great work, published 
 in 1628, the opposition subsided as rapidly as verifying re- 
 searches or tests could be instituted, and its correctness, to- 
 gether with that of his subsequent work on Generation, was 
 so generally acknowledged, that in 1652, his statue was 
 placed in the Hall of the College, with suitable inscriptions
 
 77 
 
 in honor of his discoveries. Soon after this he built a 
 valuable addition to the Hall and gave his paternal estate 
 as an endowment, accompanied by the condition that annu- 
 ally an oration should be delivered in commemoration of 
 the benefactors of the College, and containing an "exhorta- 
 tion to the members to study and search out the secrets of 
 nature by way of experiment, and for the honor of the 
 profession to continue mutually in love." In 1654 he was 
 elected president of the College of Physicians, but on ac- 
 count of natural modesty and advanced age, he declined the 
 office. He died in June, 1657, and was buried at Hemp- 
 stead, in Essex. His works were written in excellent Latin, 
 the best translation of which is that by Dr. R. Willis, pub- 
 lished under the auspices of the Sydenham Society in 1847, 
 
 Marcello Malpighi, of Crevalnore, and professor in the 
 University of Bologna, in 1661, with the aid of the micro- 
 scope, discovered the movement of blood in the capillaries 
 of the lungs and mesentery of frogs, and, in 1665, he de- 
 scribed the corpuscles of the blood, the cutaneous glands 
 and the pigmentary layer of the skin, which is still called 
 the "rete Malpighii." 
 
 In 1683, William Molyneux, of Dublin, observed the 
 capillary blood currents in the lizard ; and in 1688 Anton 
 Von Loeuwenhoeck commenced his microscopic studies on 
 the larvae and feet of frogs, by which he was enabled to 
 describe the blood corpuscles, both red and white; while 
 William Cowper saw the arterial blood pass into the veins. 
 To demonstrate the capillaries as the connecting link be- 
 tween arteries and veins, Marchetti, of Padua, and sub- 
 sequently Friedrich Ruzsch, of Amsterdam, succeeded in 
 minutely injecting them, and thus completing the circuit of 
 blood vessels that Harvey had declared must exist. 
 
 During the same period of time, the structure, position, 
 and movements of the heart and lungs were studied by 
 Nicholaus Steno, of Copenhagen, Joh. Jac. Harden, of 
 Basel, Borrelli, and others, by whom the mechanism of 
 respiration and the movements of the heart were more fully- 
 explained. 
 
 Following closely the great discovery of Harvey regard-
 
 78 
 
 ing the circulation of the blood, was that of the existence 
 and uses of lymphatic vessels and glands ; not as the work 
 of one man, but as the result of the work of many investi- 
 gators. It is doubtless true that Herophilus and Erasistra- 
 uis, in their study of comparative anatomy, mentioned seeing 
 white vessels in the mesentery of animals, but they thought 
 they were arteries filled with air. And though Galen 
 claimed that the same vessels contained chyle from the in- 
 testine, he supposed they terminated in the liver. Caspar 
 Aselli, of Paris, in 1622, while examining the chyliferous 
 vessels in the mesentery of a dog soon after a full meal, 
 opened one of them by accident, and saw the escape of a 
 white fluid which he recognized as chyle from the intes- 
 tine. On tracing the course of the vessels he discovered 
 their valves, but thought they terminated in the pancreas. 
 
 Twenty-five years later (1647), Jean Picquet, at ]\Iont- 
 pellier, traced the lacteal vessels into the receptaculum 
 chyli, and the thoracic duct to its termination in the left sub- 
 clavian vein, into which its contents were discharged. 
 
 The discoveries of Aselli and Picquet were followed by 
 those of George Jolyff, of Cambridge, in 1650; Jan \''an 
 Home, of Ley den, in 1652, and others, until the whole lym- 
 phatic system and its connection with the general circu- 
 lation was fairly well understood before the end of the 
 seventeenth century. 
 
 While the foregoing investigations were actively pro- 
 gressing, the publication of Harvey's work on Generation, 
 in 1 65 1, did not fail to attract the attention of several inves- 
 tigators, chief among whom were Aubery, of Florence, Jan 
 Van Home, of Leyden, De Graaf, of Schoonhoven, and 
 Walter Xeedham, in regard to the functions of the ovaries 
 and the progress of the active development of the impreg- 
 nated ovum and its appendages. Until the time of Harvey 
 and his followers the ovaries had been described as female 
 testicles. The discovery of spermatozoa in the male semen 
 by Ludvig Von Hammen, (or Joh. Ham, as he has been 
 named by some writers) and their examination by Leuwen- 
 hoeck and others, first caused them to be regarded as the 
 real germ of the new animal and endowed with an immor-
 
 79 
 
 tal soul, while the ovum or egg of the female was looked 
 upon as only consisting of food for the growth of the new 
 being. But after much investigation, and no little contro- 
 versy, the existence of a germinal cell in the ovum was 
 demonstrated, and the co-operation of it with the sperma- 
 tozoa of the semen in commencing the process of genera- 
 tion was fully recognized. 
 
 The investigations necessary for making plain the 
 mechanism of respiration, circulation and generation, led 
 to much additional knowledge of the anatomy of the liver, 
 the pancreas, the mesenteric glands and the organs of gen- 
 eration. Glisson described the structure of the liver and 
 its capsule that took his name. Anton Nuck first injected 
 the lymphatics with quicksilver, and thereby demonstrated 
 their connection with the whole system of lymphatic glands. 
 Thomas Wharton, a professor in Oxford, in studying the 
 glands, discovered the duct of the submaxillary which took 
 his own name; and Stenson and Needham discovered the 
 excretory duct of the parotid glands. 
 
 Johann Conrad Peyer, of Schaffhausen, and Joh. Conrad 
 Brunner, of Regensburg, discovered the intestinal glands 
 still known as the glands of Peyer and Brunner. The excre- 
 tory duct of the pancreas was discovered by George Wir- 
 sung, of Bavaria, while acting as prosector for Vesalius, 
 at Padua. The structure of the testicles, the seminal ducts 
 and epididymis were Avell described by Nathaniel High- 
 more, of London ; and Walter Needham claimed that the 
 foetus in utero was nourished by blood from the placenta, 
 and he clearly described the foetal and maternal parts of 
 that organ. It was near the middle of the seventeenth 
 century that Conrad Victor Schneider, of Saxony, discov- 
 ered the existence and secretory function of the mucous 
 membrane lining the nostrils, by which it became known 
 as the Schneiderian membrane, and a final end was made 
 of the ancient doctrine that discharges from the nostrils 
 were humors percolating through the cribriform plate from 
 the brain. 
 
 It was near the end of the century, when Vieussens, 
 professor at Montpellier, who had previously made valuable
 
 80 
 
 additions to the knowledge of the position and functions 
 of the heart, gave a more complete description of the brain 
 and central portions of the nervous system than had been 
 given before ; and Thomas Willis, of Oxford, ordinary phy- 
 sician to Charles II., first pointed out the separate parts 
 of the brain and assigned distinct functions to each, and 
 added much to the knowledge concerning its ganglia and 
 blood vessels. 
 
 While the foregoing important discoveries in physiology 
 and advancements in anatomy were developing, the science 
 of chemistry, which had only begun to assume a scientific 
 character during the sixteenth century, continued to pro- 
 gress. Joh. Rud. Glauber, a contemporary of Van Hel- 
 mont, early in the seventeenth century, improved the pro- 
 cesses for obtaining mineral acids and salts, and determined 
 the composition of many substances by synthesis. Robert 
 Boyle, a little later, by true inductive methods, showed 
 that a substance could only be considered as elementary 
 when it could no longer be separated into two or more con- 
 stituents, and thereby efifectually disproved the long en- 
 tertained doctrine of the "four elements" of the ancients. 
 He also discovered the elasticity of the air and invented the 
 air pump. During the last part of the century Otto Tacha- 
 nius, of Herford, made the first correct quantitive analysis 
 by demonstrating that lead when converted into red oxide 
 gained one-tenth in weight. About the same time Nicholas 
 Lemery introduced the study of chemistry into Paris, and 
 was the first to demonstrate the existence of iron in the 
 blood. 
 
 J. J. Becher, of Speyer, Germany, professor at Ments, 
 1660, and imperial councillor at Vienna, published an impor- 
 tant work to establish the close relation between chemistry 
 and medical science in 1669. A prominent topic of dis- 
 cussion was that of combustion and oxidation, and it may be 
 regarded as the first distinct treatise on chemistry as a 
 branch of medicine. 
 
 Materia Medica : The marked progress in physiology 
 and chemistry during the seventeenth century was accom- 
 panied by the use of a larger number of chemical prepara-
 
 8i 
 
 tions and some very important vegetables as remedies in 
 the treatment of disease, and of the latter class, several as 
 food. The chemical preparations were newly discovered 
 alkalies, acids, and salts, the most important of which were 
 tartar emetic, oxide of zinc, Glauber's salts, and prepara- 
 tions of mercury and arsenic. 
 
 Of the new vegetable remedies the most important were 
 the cinchona bark and ipecacuanha. The first was originally 
 introduced into Europe from South America, in 1640, by 
 Juan del Vego, ordinary physician to the Count of Cinchon. 
 It was called cinchona or "Countess' bark" in honor of the 
 wife of the Count who had been cured of an attack of fever 
 by the remedy. 
 
 It was obtained from the bark of several species of 
 the cinchona tree, found chiefly in Peru, and consequently 
 was later called Peruvian bark. Its use in Spain was fav- 
 ored by the Catholic clergy, and hence was often called 
 "Jesuits' " bark. Its introduction and use in England was 
 greatly promoted by Sydenham, while Robert Tabor, an 
 apothecary of Cambridge, introduced it as a secret remedy 
 into Paris, and after effecting the cure of the Dauphin, he 
 sold the secret to the government of France for 2,000 Louis 
 d'or. In Germany perhaps the first to use it were Peyer 
 and Professor Valentini, of Giessen. 
 
 The first medical work to recommend the use of the 
 cinchona was the Vera Praxis, of Pietro Barba, published 
 at Seville, in 1642. For many years it was used chiefly 
 in the form of powder, and acquired so much reputation as 
 a remedy for the arrest of malarious fevers that it some- 
 times sold for its own weight in gold. (Henderson.) 
 
 Ipecacuanha is said to have been first described by Guil- 
 laume Le Pois, in 1648; and was . introduced into general 
 practice by Le Gras as a mild emetic and an efificient rem- 
 edy for dystentery, in 1672. Potatoes first became a com- 
 mon article of food in Europe in the seventeenth century ; 
 and tea, coffee and chocolate, though known and used to 
 some extent at an earlier period, rapidly gained wide popu- 
 larity as articles of luxury at this time. 
 
 It was also during this seventeenth century that the
 
 82 
 
 use of tobacco, for both smoking and chewing, increased so 
 rapidly among all classes that several of the leading gov- 
 ernments enacted very severe laws for its suppression. 
 
 During the middle part of the same century the first 
 attempts to gain more accurate knowledge concerning the 
 action of drugs by experiments on living animals were made 
 by Wepfer, Brunner and Harder. 
 
 State Medicine or ]Medical Jurisprudence: This 
 important department first began to attract special atten- 
 tion at the beginning of the seventeenth century. Fortu- 
 natus Fidelis, at Palermo, published his work, "De Rela- 
 tionibus Medicorum", in 1602 ; and Paolo Zacchias, ordinary 
 physician to the Pope, published his work, "Questiones 
 IMedico-Legales", at Rome, in 162 1. The latter work at- 
 tracted much attention, and has been generally regarded as 
 the primary basis of medico-legal science. 
 
 In 1637, the Royal College of Physicians of London pre- 
 sented to the City Council a "Report on all such annoyances 
 as they conceive likely to increase the sickness of this Pop- 
 ulous City." And Ludvig von Hoernigk, of Mayence, in 
 1638, wrote a work "On the duties of the Medical Profes- 
 sion as a whole." 
 
 Swammerdam discovered the fact that human lung tis- 
 sue that had been fully inflated by respiration would not 
 afterwards sink in water, in 1667, and Malachias Thuiston 
 immediately applied it as an important test for deciding 
 whether a child had been born dead or had lived long enough 
 to breathe. The conditions limiting the application of the 
 test were pointed out by Hartmann, and it was first made 
 available during the trial of a case in court by Joh. Schreyer 
 in 1681. It is the well known hydrostatic test of modern 
 works on medical jurisprudence. 
 
 The active progress in a knowledge of all the depart- 
 ments of physics and the natural sciences during the sev- 
 enteenth century was intimately connected with the ad- 
 vancements in the elementary branches of medicine, as 
 illustrated by the application of the microscope, in com- 
 pleting a knowledge of the circulation of the blood through 
 the capillaries and of the corpuscular elements of the blood
 
 83 
 
 itself, and by the application of physical laws in the inven- 
 tion of instruments and appliances of value in the practical 
 branches of the healing art. The trochar for paracentesis 
 abdominis and an ingenious self-injecting apparatus were 
 invented by Sanctorius, of Padua. The tourniquet was in- 
 vented by the French surgeon Morel during the siege of 
 Besancon, in 1674. The obstetric forceps, one of the most 
 important instruments in use, was invented by Peter Cham- 
 berlen, of London, early in the century, but were kept as 
 a family secret many years for private gain. The use of 
 the instrument was restricted to his sons and a few other 
 persons, also pledged to continue the secret. 
 
 Notwithstanding the selfish and unjustifiable policy pur- 
 sued by the Chamberlen family, the instrument became 
 quite well known in England before the end of the century. 
 
 Surgery: The internicene and so-called "religious" 
 wars that prevailed in Europe during the greater part of 
 the seventeenth century, afforded a wide field for practical 
 surgery, and the steady progress in anatomy and physiol- 
 ogy greatly favored coincident progress in surgery in which 
 the English and French took the lead. Perhaps the best 
 representative of English surgery during that period was 
 Richard Wiseman, ordinary surgeon to 'James I. and after- 
 wards in the service of Charles I. and II., and James II. 
 He had an extensive military experience, both in England 
 and on the Continent, and finally settled in London, in 
 1652. He favored primary amputations, especially in gun- 
 shot injuries of the joints; preferred to operate through 
 healthy tissues ; treated aneurisms by compression ; and used 
 the ligature for the control of hemorrhage, except on the 
 field of battle, when he kept the actual cautery ready, be- 
 cause, he said, the ligature required too much time and too 
 many assistants. He is credited with having been the first 
 to accurately describe the white swelling under the name 
 of "tumor albus." He established the indications of herni- 
 otomy more distinctly, and in his treatise "On the ill con- 
 sequences of Gonorrhea", gave the first recorded case of 
 external urethrotomy for stricture, as performed by Edward
 
 84 
 
 Molins, in 1652. His most important work was entitled 
 "Several Surgical Treatises'', published in London, 1676. 
 
 Sir Christopher Wren, who was a learned architect as 
 well as surgeon, in 1657, was one of the first to inject med- 
 icines into the veins, which was soon shown to have the 
 same effect as when taken into the stomach. In France, 
 Jean Baptiste Denis, physician of Louis XIV., aided by the 
 surgeon Emmerez, performed the first transfusion of blood 
 in man, on the 15th of June, 1667. Edward, King of Eng- 
 land, repeated the operation November 23d, and Riva, in 
 another case, in December of the same year. 
 
 In Germany perhaps no surgeon during this century 
 was more distinguished for his learning, or exerted more in- 
 fluence in promoting closer relations between the physiciais 
 and surgeons, than Fabricius Hildanus, of Hilden. He, 
 like many of the surgeons of that period, practised both 
 ophthalmology and otolog}', and not a few also practised 
 dentistry and obstetrics, with their general surgery. 
 
 Medicine : The effectual overthrow of the purely the- 
 oretical doctrines of the ancients founded on the four ele- 
 ments, four humors and their concoctions, and the vital 
 spirits, by the actual development of chemistry, anatomy, 
 physiolog}^ and pathological anatomy, in close connection 
 with the rapid progress in all the collateral sciences dur- 
 ing the sixteenth and early part of the seventeenth centuries, 
 led to many attempts to construct new systems or theories 
 of diseases and their treatment, based on some one of the 
 recently developed sciences. Thus Van Helmont, at the 
 beginning of the last-named centur}-, endeavored to cre- 
 ate a system of medicine by uniting the alchemistic doc- 
 trines of Paracelsus with his own Archeus or dynamic 
 force. This was soon superseded by the latro-chemical 
 system, founded by Francois de la Boe or Sylvius, of Ley- 
 den, and Thomas Willis, of Oxford. They attributed dis- 
 eases chiefly to changes in the saliva, pancreatic juice, and 
 bile, or to fermentation in the blood, and endeavored to 
 explain all the phenomena of both health and disease on 
 chemical principles. 
 
 Somewhat in contrast with this, was the latro-Physical
 
 85 
 
 system, the ablest supporter of which was Sanctorius, a 
 practitioner of Venice and professor at Padua. He prose- 
 cuted investigations concerning the insensible transpira- 
 tions from the skin, the excretion by the kidney, the evacua- 
 tions from the bowels, and the variations of temperature of 
 the body and of the pulse by the aid of instruments of his 
 own invention, with a perseverance and success but little 
 less creditable than those prosecuted by Harvey regarding 
 the circulation of the blood. Both the latro-Chemists and 
 the latro-Physicists retained in their system much of the 
 humoralism of preceding ages. But the latro-Mathematical 
 system, founded by Giovanni Alfonzi Borelli, of Naples, 
 was one of solidism. Borelli and co-workers sought to 
 explain muscular action, circulation, secretion, and both 
 physiological and pathological processes generally on purely 
 mathematical and mechanical principles. They endeavored 
 to explain movements produced by muscular action on the 
 principle of the lever, and computed mathematically the 
 amount of force employed. Thus Borelli estimated the 
 force of the heart's action to be equal to 1,500 kilograms 
 per minute, while others figured it at only a few ounces. 
 
 While these various attempts to construct theoretical 
 systems of medicine founded on the coincident advance- 
 ments in general science were in progress, the greater num- 
 ber of active practitioners, led by Sydenham, were making 
 greater and better progress by a return to the Hippocratic 
 method of patiently observing facts and deducing practical 
 conclusions from them. 
 
 Thomas Sydenham was born at Winford Eagle, in Dor- 
 setshire, in 1624, and died in London, 1689. He entered 
 Magdalen College, University of Oxford, in 1642, but was 
 soon interrupted by enlistment in the Parliamentary Army, 
 in which he held the office of captain ; thus placing him in 
 political antagonism to Harvey who was on the side of the 
 King. He re-entered Oxford in 1645, and took his Bac- 
 calaureate degree in 1648. Subsequently he pursued med- 
 ical studies at Montpellier for a considerable time, and 
 finally took the doctor's degree at Cambridge, was admit- 
 ted to membership in the Royal College of Physicians of
 
 86 
 
 London, and settled in Westminster, London, in 1663. His 
 most important medical work was entitled "Observationes 
 Medica", published in 1666. He early adopted Hippo- 
 crates as his model, and discarding all attempts to con- 
 struct theories or systems of medicine, and adopting the 
 Hippocratic doctrine that disease is a more or less active 
 effort of the natural functions to free the system from dis- 
 turbing influences, he insisted that these efforts of nature 
 were the chief agents for effecting cures. Consequently he 
 insisted that the chief business of the physician is to ob- 
 serve carefully the conditions and circumstances under 
 which diseases arise, and with equal care to note their symp- 
 toms, progress and terminations, that he may adopt rational 
 methods for obviating the first, and such dietetic and thera- 
 peutic measures as would assist the natural tendencies 
 towards a cure. 
 
 He regarded "inflammation of the blood" as the chief 
 pathological condition in acute febrile affections, and of- 
 ten resorted to venesection, cathartics, diaphoretics, cool 
 drinks, and, in the latter stages, more nourishment and 
 tonics, especially the cinchona bark, which he aided much 
 in gaining a favorable introduction to the profession gen- 
 erally. By his strenuous defence of the "healing powers 
 of nature", and his intelligent adherence to the study of 
 facts and the phenomena of disease, through the more than 
 forty years of his professional life, he wielded a greater in- 
 fluence, and did more to advance the real interests of prac- 
 tical medicine, than any other practitioner of the same cen- 
 tury. 
 
 For some needed comments on the social status of the 
 profession, the conditions of the medical schools, and the 
 prevalence of epidemics during this century, I must refer 
 to the first part of the next chapter.
 
 87 
 
 CHAPTER VII. 
 
 THE SOCIAL STATUS OF THE PROFESSION ; THE PROGRESS OF 
 THE MEDICAL COLLEGES, AND THE CHARACTER OF EPIDEM- 
 ICS DURING THE SEVENTEENTH CENTURY; CONTINUED 
 PROGRESS OF CHEMISTRY AND PHYSICS, AND THEIR CON- 
 NECTION WITH THE PROGRESS OF MEDICINE DURING THE 
 EIGHTEENTH CENTURY; ALSO ADVANCEMENTS IN PHYS- 
 IOLOGY AND IN GENERAL AND PATHOLOGICAL ANATOMY, TO 
 THE END OF THE EIGHTEENTH CENTURY. 
 
 The social condition of the medical profession during 
 the seventeenth century was characterized by marked im- 
 provement in its education, its stability and greater unity 
 of purpose, and in its influence in directing the sanitary 
 interests of the people. In proportion as chemistr\', anat- 
 omy, physiology, and pathological anatomy developed from 
 observation, experiment, and induction, in direct connection 
 with the similar advancement of physics and all branches 
 of the natural sciences, in the same proportion did the prac- 
 titioners of both medicine and surgery cease to be itinerant 
 or traveling specialists. From the re-establishment of med- 
 ical schools and other institutions of learning in Europe on 
 the decline of the Arabian era, to the commencement of 
 the sixteenth century, a large proportion of the medical prac- 
 titioners traveled from place to place, and often from one 
 country to another, claiming either superior skill in the per- 
 formance of important operations, or the possession of rem- 
 edies of unusual efficacy in the treatment of diseases. Even 
 the professors in the colleges seldom remained in the same 
 institution many years. Thus we find Vesalius, the anat- 
 omist, teaching successively in Padua, Pisa, Louvain and 
 Basil; and the attendance of students was still more vari- 
 able. 
 
 It is claimed by Baas and other historical writers that 
 a large proportion of the students were not only of a roving 
 and reckless character, changing from one school to an- 
 other without let or hindrance, but often committing depre-
 
 dations upon the rights and property of others. It was 
 during these medieval centuries, that students organized 
 themselves into bands or social clubs, with badges, mot- 
 toes, and sometimes peculiarities of dress. It was during 
 this same period of time that senior classes assumed the 
 most cruel and arbitrary control over their juniors or fresh- 
 men, and exacted from them the most menial service. Un- 
 fortunately these barbarous and wholly unjustifiable stu- 
 dent practices are not yet entirely absent from the colleges 
 and universities of our own time, as the records of "hazing" 
 and initiatory exercises of secret societies annually show. 
 
 During the sixteenth century the Italian Schools began 
 to lose their prestige as those of Germany, France and Eng- 
 land advanced. This change became still more prominent 
 during the seventeenth century, when those of Paris, Mont- 
 pellier, Berlin, Leyden, Heidelberg and Edinburgh had be- 
 come the chief centers for medical education in Europe. 
 
 The final introduction of their study of descriptive anat- 
 omy by dissections of the human body in all the impor- 
 tant medical schools during this century, coupled with the 
 fact that the chief teachers of anatomy were at the same 
 time most prominent as surgeons, aided very much to bring 
 the physicians and surgeons together, both in education and 
 in practice. Coincidently with this came the protracted and 
 relentless religious, or more properly, ecclesiastical, wars 
 that devastated Europe for thirty years, and resulted in ef- 
 fectually destroying the dominating influence of priests and 
 ecclesiastics over medicine and medical institutions, and 
 thereby removed one of the obstacles to the union of phy- 
 sicians and surgeons as one profession. While the College 
 de Come was doing much to elevate the character of sur- 
 gery in France and to separate it from the "barber shop", 
 an equally active influence was being exerted in England 
 bv the incorporation of the barber-surgeons in London no- 
 ticed in a previous chapter. In 15 12 a new charter was 
 granted which forbade any person from practising surgery 
 in London except the members of that corporation. In 1540 
 another act was passed forbidding the barbers who prac- 
 tised shaving and hair dressing from doing any surgical
 
 89 
 
 work except the extraction of teeth. On the other hand, 
 the surgeons were forbidden to practise shaving. The final 
 legal separation of the surgeons and barbers did not take 
 place until 1745, when an act was passed making the Col- 
 lege of Surgeons and the Corporation of Barbers entirely 
 separate bodies and limiting the practise of surgery wholly 
 to the membership of Colleges of Surgeons, Physicians and 
 Apothecaries. 
 
 The Act of Incorporation of the College of Physicians, 
 London, was granted in 15 18 during the reign of Henry 
 VIIL, chiefly through the influence of Thomas Linacre and 
 John Chambers, both physicians to the king. It restricted 
 the privilege of practising medicine in the city of London, 
 or within seven miles of it, to the members of said College. 
 Until this time medical practitioners were required to pro- 
 duce a license from either the bishop of London or the dean 
 of St. Paul's. 
 
 . It was also during the seventeenth century that several 
 scientific societies were organized, having both a direct 
 and indirect influence on the medical profession. In Lon- 
 don the "Invisible Society", at first a secret organization, 
 was founded by Milton and Hartleib, in 1645, but publicly 
 reorganized into the Royal Society of London for the pro- 
 motion of the Sciences in 1662. 
 
 In France the "Academic des Sciences" was founded 
 by Colbert, in 1665 ; and at Schweinfurt, Germany, in 1652, 
 was founded the "Gesellschaft naturforschender Aerzte" 
 Vv'hich was reorganized in 1677, and is still doing good work. 
 
 These and other scientific and literary societies re- 
 ceived many papers, bearing more or less on the progress 
 of medicine, which were published in their transactions, 
 and among their most active supporters were the more 
 eminent members of the medical profession in each coun- 
 try. 
 
 By the co-operation of all the foregoing influences, 
 during the seventeenth century all the departments of 
 medicine advanced ; the medical schools and their faculties 
 became more stable and better organized ; the departments 
 of medicine, surgery, and midwifery acquired greater unity
 
 90 
 
 as one profession ; a much larger proportion of the active 
 practitioners selected permanent locations or fields for 
 practice, while the services of a large number were con- 
 stantly required in the armies, and in municipal and gov- 
 ernment offices. Still there remained both within and 
 without the profession, an abundance of ignorance, bigotry, 
 prejudice and exhibitions of vice and folly in all the coun- 
 tries. 
 
 Epidemics : All the epidemic diseases mentioned in pre- 
 ' ceding chapters continued to recur during this century 
 with little or no abatement of their malignancy. During 
 the "Thirty Years' War," in the first half of the century, 
 epidemics of typhus and typhoid fever, dysentery, and ty- 
 phoid pneumonia, were of frequent occurrence and very 
 fatal. 
 
 From 1657 to 1685 malarious fevers several times ap- 
 peared in a highly malignant and pandemic form, but most 
 severe in England and the Netherlands. Both King James 
 I. and Oliver Cromwell are reported as having died of 
 the ague. In their time the soil around London, in Cam- 
 bridgeshire and Lincolnshire, was neither drained nor cul- 
 tivated. The plague also prevailed in London in 1603 to 
 1608, in Ireland in 1650, and again in London in 1665, 
 when it is reported to have destroyed 69,000 lives. It 
 repeatedly appeared in different parts of France, Germany 
 and Italy. In Alilan, where it is said to have destroyed 
 180,000 lives, its prevalence was attributed to a "Plague 
 Salve" supposed to have been rubbed on the walls of 
 houses by a barber named Mord and the health officer 
 Piazza, who were tried, condemned, cruelly tortured, and 
 then burned to death. 
 
 Limited epidemics of small-pox, scarlet fever, diph- 
 theria and influenza also prevailed at different times both 
 in Europe and America. Cases of undoubted malignant 
 diphtheria occurred in Roxbury, Mass., as early as 1659, 
 when four children of one family died from what was 
 styled "Bladders in the windpipe." But the first full ac- 
 count of a severe epidemic of the disease in America was
 
 91 
 
 published by Dr. Wm. Douglass, of Boston, Mass., in 
 1736, under the name of "Angina Ulcusculoso." 
 
 Clinical Instruction : The chief attempts to illus- 
 trate the progress of disease and the effects of treatment 
 at the bed-side, or true clinical instruction, were made by 
 Dr. William, of Utrecht, in 1636, Dr. Albert Kyper, at 
 Leyden, in 1648, and still more successfully by Sylvius, of 
 Ley den, in 1658. But that important method of instruc- 
 tion was not permanently established until the time 
 of Herman Boerhaave, of Leyden, at the beginning of the 
 eighteenth century. 
 
 Herman Boerhaave was born in 1668, at Voorhout near 
 Leyden, the son of a clergyman, and was educated for the 
 same calling as his father. After studying thoroughly 
 philosophy, history, metaphysics, philology, mathematics 
 and theology, he changed his purposes and with equal zeal 
 studied chemistry, botany, and all other branches of med- 
 icine as the pupil of Drelincourt and Nuck. He gradu- 
 ated in medicine in 1693, and commenced practice in Ley- 
 den. In 1709 he was elected to the chair of Botany, and 
 five years later, on the death of Bidloe, he was given the 
 chair of Practice of Medicine, and in 1718 he acquired also 
 the professorship of Chemistry, in which he gained a very 
 high reputation. From the commencement of his teaching 
 practical medicine, in 1714, he freely connected therewith 
 direct clinical instruction, lecturing extempore with such 
 success that he soon attracted the attention of both pa- 
 tients and students in numbers greater than the hospital 
 and college rooms could accommodate. He persistently 
 avoided attempts to construct any theoretical system of 
 medicine ; placed great reliance on the curative powers of 
 nature ; and insisted that observation and experience at 
 the bed-side of the sick were the safest guides in the 
 treatment of diseases. He was probably the first to give 
 separate lectures on ophthalmology, and to use a magnify- 
 ing glass in examining the eye. He also measured the 
 temperature of his patients by applying the thermometer in 
 the axilla. 
 
 Dtiring the last quarter of the seventeenth century
 
 92 
 
 Nicholas Lemery, of Paris, Becher, of Mayence, George 
 Ernst Stahl, of Halle, and Herman Boerhaave, of Leyden, 
 began active investigations in chemistry. Becher con- 
 tended that all metals and combustible bodies were com- 
 posed of three varieties of earth, i. e., the fusible, combus- 
 tible and mercurial. Stahl accepted the doctrine of 
 Becher, but called his combustible earth phlogiston, the 
 substance supposed to be expelled during the progress of 
 combustion or oxidation and evolvement of heat. The 
 residue left after the expulsion of the supposed phlogiston 
 was regarded as the true elementary body. Boerhaave, 
 without disputing the chemical doctrines of Becher and 
 Stahl, determined to subject the transmutation pretentions 
 of the Alchemists to a crucial test. For that purpose he 
 kept one specimen of mercury moderately hot for fifteen 
 years, another very hot six months, and distilled a third 
 specimen five hundred times; yet all the specimens were 
 only mercury still. 
 
 He was perhaps the first to declare the aflfinity of 
 heterogeneous bodies with the suggestion of some definite 
 law regulating their combination ; and the text-book pub- 
 lished by him aided much in promoting correct methods of 
 studying chemistry. 
 
 As a man of great erudition, close observation and log- 
 ical reasoning, he had few equals among contemporaries ; 
 and as a general practitioner and teacher of medicine he 
 gained a wider reputation and more influence than any 
 other physician of the eighteenth century. His advice was 
 sought by all classes of people, from those highest in au- 
 thority to the common laborer, and he insisted on giving 
 each his turn, regardless of rank or wealth. He died in 
 1738 at the age of seventy years, leaving a large fortune. 
 
 The true nature of combustion and oxidation processes 
 were not understood until the discovery of oxygen gas 
 as an elementary body by K. W. Scheele and Joseph Priest- 
 ley, in 1774, and the demonstration that atmospheric air 
 was composed of a definite mixture of oxygen and nitro- 
 gen by Lavoisier ; and that in combustion the oxygen was 
 added to the combustible body, increasing its weight, in-
 
 93 
 
 stead of the separation of phlogiston as previously taught 
 by Stahl. 
 
 In 1 78 1 water was shown to be a compound body con- 
 sisting of hydrogen and oxygen, as demonstrated by Henry 
 Cavendish and James Watt. During this period arsenic 
 and cobalt were proved to be simple bodies by Brandt; 
 chlorine and fluorine, by Scheele ; platinum and molyb- 
 denum, by Wood; chromium, by Vauquelin ; nickel, by 
 Cronstedt ; uranium and zirconium, by Klaproth ; and the 
 first medico-chemical work was done in analysing organic 
 substances, such as milk, chyle, bile, and other secretions, 
 by Antoine Francois de Fourcroy. 
 
 While these rapid advances were being made in chem- 
 istry, all having more or less bearing on medicine, equally 
 rapid progress was being made in the departments of phys- 
 ics and the other natural sciences; including the discov- 
 ery of electricity and magnetism, by Galvani, Volta, Count 
 Rumford and others, and the identity of electricity with 
 lightning, by Benjamin Franklin. 
 
 Near the close of the eighteenth century both chem- 
 istry and physics and their relations to medicine, were still 
 further advanced by the investigations of Wentzel and 
 Richter, who proposed the theory of chemical equivalents ; 
 Dalton, author of the Atomic theory; Guy Lussac ; Sir 
 Humphrey Davy ; Thenard ; Berzelius ; Faraday and others. 
 
 Physiology: The investigations of William Harvey 
 explaining the circulation of the blood and the animal gen- 
 eration from ova, and the work of his contemporaries and 
 followers in establishing a more complete knowledge of 
 lacteals, lymphatics and capillary vessels and their con- 
 nection with the general circulation, during the last part 
 of the seventeenth century, prepared the way for the equally 
 important work of Albert von Haller, of Berne, Switzer- 
 land, in the field of physiological science. 
 
 Haller v/as born in Berne, in 1708, and at the age 
 of fifteen years he entered the University of Tubingen. 
 Two years later, 1725, he went to Leyden to study medi- 
 cine under Boerhaave and Albinus, and received the degree 
 of M. D. at the age of nineteen years. He then visited
 
 94 
 
 London, Paris and Basil, actively prosecuting investiga- 
 tions in anatomy, physiology, botany and mathematics, 
 and then returned to his native city to practise his profes- 
 sion. In 1/34, at the age of twenty-six years, he was ap- 
 pointed director of the Hospital and professor of Anatomy, 
 and soon established an anatomical theater in which to 
 prosecute his investigations. In 1736 he was called to 
 Gottingen as professor of anatomy, surgery, chemistry and 
 botany, and there became the founder of the Botanical 
 Garden, Anatomical Theater and a Hall of Anatomical 
 Drawing. He was also one of the chief founders of Koni- 
 ^liche Gesellschaft der Wissenschaften, of which he was 
 the first and only president until his death. In 1739 ^^ ^^^^ 
 appointed English Physician-in-ordinary; and in 1749 made 
 English State Councillor, while he had been received into 
 the Council of his native city, in which he served until 
 chosen Landermann of the Canton. All these more pub- 
 lic duties did not deter him from the active and persistent 
 prosecution of physiological and scientific investigations. 
 His work on physiology was published in 1747, and an ac- 
 count of his researches on Irritability in 1752, and sub- 
 sequently his most noted work the Bibliothecae. Haller is 
 said to have executed more than five hundred experiments 
 in establishing the existence of irritability as a property of 
 living muscular structure, imparting to it the capacity to 
 contract independent of nerves, and entirely distinct from 
 sensibility, that being restricted to nerve tissue alone. In 
 prosecuting these numerous experiments he added many 
 new items to our knowledge of the anatomy of the brain, 
 heart, kidneys and sexual organs and their appendages. 
 It is true that Glisson, the successor of Harvey in the pro- 
 fessorship of Anatomy and Surgery in the College of Phy- 
 sicians, about the middle of the seventeenth century, 
 taught a doctrine of irritability deduced from the fact that 
 all living structures were undergoing constant metabolic 
 changes or movements in response to the presence of ex- 
 citors or stimuli. But the word susceptibility, meaning the 
 capability of being acted upon or excited to action, would 
 better express the idea of Glisson. The irritability de-
 
 95 
 
 scribed by Haller as distinct from nerve sensibility and 
 limited to muscular structures only, evidently included the 
 capacity to contract, and might have been better indicated 
 by the word contractility, especially as he regarded^ it as 
 the cause of muscular movements. 
 
 The doctrine of irritability, as taugh by Haller and his 
 numerous experimental investigations, led to a very gen- 
 eral study of the physiological question suggested thereby, 
 by all the leading minds in the profession. Many construed 
 the doctrine as an elementary property belonging to all 
 living organized structures in accordance with the expres- 
 sion of Glisson ; others gave it the more limited range of 
 belonging to fibrous or muscular structures only, as viewed 
 by Haller ; and still others continued to regard it as a man- 
 ifestation of nerve sensibility under the leadership of Wil- 
 liam Cullen, of Edinburgh. All, however, were speedily 
 led to abandon the last remnants of the humoral doctrines 
 of the ancients, together with the vis anima of Stahl and 
 the vital ether of Hoffmann, and to adopt an exclusive 
 solidism both in physiology and pathology. 
 
 In applying the doctrine of irritability to the study of 
 embryology, Haller and his more direct followers agreed 
 with Harvey that the germinal cell of the ovum contained 
 in itself the minute points of all parts of the future mature 
 animal; and that the process of generation was one of 
 simple evolution or growth from previously existing em- 
 bryonic matter in the germinal cell of the ovum. 
 
 On the other hand, Caspar F. Wolff, of St. Petersburg, 
 one of the earliest of the noted Russian investigators, re- 
 vived the ancient theory of epigenesis, i. e., that the pro- 
 cess of generation was an actual new creation. He was 
 also the first to claim that tissue cells contain no true cav- 
 ities within. 
 
 A little later the doctrine of a "nisus formativus", or in- 
 herent impulse of the impregnated germ to preserve and 
 perpetuate from generation to generation its own form 
 and species, was promulgated by the eminent anthropo- 
 logical investigator, J. F. Blumenbach, of Gotha, and pro- 
 fessor in Gottingen. He was also the founder of modern
 
 96 
 
 anthropology and made a remarkable collection of skulls, 
 both human and comparative, called his "Golgotha." 
 
 For nearly fifty years, commencing 1721, Bernhard F. 
 Albinus taught anatomy in the school at Leyden. Aided 
 by the artists W'andelaar and Ladmiral he published fairly 
 accurate descriptions of nearly all parts of the human body, 
 illustrated by admirably colored plates. He was perhaps 
 the first to demonstrate by injections the actual vascular 
 connection between the mother and the foetus through the 
 placenta. 
 
 During the last part of the eighteenth century those 
 who most successfully advanced the departments of anat- 
 omy, physiology and pathology beside those already men- 
 tioned, were Sommerring, of jMayence, and Cassel ; William 
 and John Hunter and John Bell, of London ; G. B. Morgagni, 
 of Forti, Italy ; and ^i. F. X. Bichat, of Paris. 
 
 jMorgagni became a professor in Padua in 1715, and 
 for many years industriously pursued the study of patho- 
 logical anatomy, including the changes and products de- 
 veloped in the progress" of a large number of the most com- 
 mon diseases. He published his great work on Patholog- 
 ical Anatomy, consisting of five books or volumes, in 
 Venice in 1761, which justly entitles him to the honor of 
 being the founder of that branch of medical science. 
 
 William Hunter was born in Long Calderwood, Scot- 
 land, and was first educated for the ministry, but subse- 
 quently turned his attention to medicine and became a 
 pupil of Cullen, in Edinburgh. He went to London in 
 1741, and commenced lecturing on Anatomy and Sur- 
 gery in 1746. He rapidly acquired a high reputation and 
 extensive practice in both surgery and midwifery. He 
 devoted much attention to pathological anatomy, and is 
 said to have spent half a million dollars on his house, 
 library, and collection of normal and pathological anat- 
 omy. The latter have been well preserved and now con- 
 stitute the Hunterian Museum of the University of Glas- 
 gow. 
 
 His most im'portant works were entitled "Aledical
 
 97 
 
 Commentaries", published in 1764, and the "Anatomia 
 Humani Uteri Gravidi'' in 1774 He died in 1783. 
 
 John Hunter, a younger brother of William, was born 
 in 1728 and died in 1793. He commenced work as a 
 ship-carpenter, but in a few years he changed that for 
 the study of medicine as the pupil of his brother William 
 and of Cheselden and Pott, of London ; and commenced the 
 practise of surgery in the last named city in 1763. Five 
 years later he became surgeon to St. George's Hospital, 
 in 1776 surgeon extraordinary to the King, and in 1790 
 he was surgeon general of the English Armies. Though 
 his rapid and high official advancement were thus in the 
 line of surgery, he was an untiring and successful investiga- 
 tor in the departments of anatomy, both normal and path- 
 ological, human and comparative, and in several of the 
 natural sciences. He investigated experimentally patho- 
 logical conditions of the blood in inflammation ; was the 
 first to describe phlebitis ; the different forms of chancre in 
 syphilis, and the constitutional conditions following. His 
 collection of anatomical and pathological specimens were 
 purchased by the government for $75,000 and given to the 
 College of Surgeons, and still constitute a large part of 
 the Hunterian Museum in London. His most valuable 
 publications were "On Venereal Disease", "On the Blood, 
 Inflammation and Gunshot Wounds", and "On the Natural 
 History of Human Teeth". 
 
 The closing years of the eighteenth century were ren- 
 dered notable by the climax reached in the development 
 of anatomical knowledge during the brilliant though brief 
 career of M. F. X. Bichat, the creator of the department 
 of General Anatomy. He was born in Thoirette, France, 
 in 1771, the son of a physician, and commenced his edu- 
 cation at Nantes. He prosecuted his medical studies at 
 Lyons and Montpellier, and subsequently became a pupil 
 and an assistant of the eminent surgeon Desault in Paris, 
 He developed an extraordinary degree of mental activ- 
 ity and some original methods of investigation especially in 
 normal and pathological anatomy. 
 
 After the death of Desault in 1795 Bichat lectured on
 
 98 
 
 surgery and after 1797 he added private courses on anat- 
 omy. He founded the Societe d'Emulation ; was appointed 
 to the Hotel Dieu in 1801, and died the following year from 
 pulmonary tuberculosis, aged only thirty-one years. Yet 
 during the eleven years of his professional career he wrote 
 no less than nine important volumes, the most valued of 
 which were, a Treatise on Membranes in 1800; one on 
 General Anatomy in 1801 ; and one on Pathological Anat- 
 omy, which was published several years after his death. 
 In addition to the ordinary methods of dissection in the 
 study of anatomy he not only studied each membrane, 
 but traced each organized structure wherever it was to 
 be found both in its healthy and diseased conditions. In 
 doing this he is said to have examined seven hundred 
 bodies during a single winter. The results are to be found 
 in his two remarkable volumes on General and Patholog- 
 ical Anatomy. He described twenty-one distinct simple 
 tissues which by their combinations constitute the different 
 organs and parts of the bod>^ as recognized in ordinary de- 
 scriptive anatomy. He not only showed that each primary 
 or simple structure retained the same properties or func- 
 tions wherever found, but was also subject to the same 
 morbid processes or diseases. 
 
 In thus prosecuting his study of anatomy analytically, 
 according to the tissues, both healthy and diseased, Bichat 
 rendered much aid in diagnosis and prepared the way for 
 the brilliant developments in morbid anatomy and differ- 
 ential diagnosis by the French School of the first half of 
 the nineteenth century. He was perhaps the first to 
 demonstrate that the acute morbid condition called peri- 
 pneumonia, was capable of being resolved into a pleurisy, 
 a pneumonia, or a bronchitis, according to the tissues in- 
 volved, and each presenting reliable diagnostic symptoms. 
 He strenuously insisted that the actual study of the patho- 
 logical conditions in internal organs, by post-mortem 
 examinations and comparing them with the symptoms be- 
 fore death, was essential for the establishment of correct 
 methods of diagnosis. He did much to check the purely 
 theoretic tendencies of the profession, and to promote
 
 99 
 
 the careful observation of facts and their comparison as 
 affording the chief basis for legitimate deductions. 
 
 Probably there is the name of no other member of the 
 profession on the pages of Medical History, who accom- 
 plished as much valuable scientific work in the brief period 
 of eleven years, as was done by Bichat in the closing years 
 of the eighteenth century. In 1857 a monument was 
 erected to his memory in the Ecole de Medicine at Paris. 
 
 A review of the more important advancements in the 
 strictly practical branches — surgery, midwifery, practical 
 medicine, and public hygiene or preventive medicine, dur- 
 ing the eighteenth century, is considered in the next chap- 
 ter.
 
 100 
 
 CHAPTER VIII. 
 
 THE HISTORY OF MEDICINE DURING THE EIGHTEENTH CEN- 
 TURY CONTINUED. THE PROGRESS OF SURGERY, MID- 
 WIFERY, PR^\CTICE OF MEDICINE, AND HYGIENE OR PRE- 
 VENTIVE MEDICINE, 
 
 The numerous and important advancements made in 
 the departments of physics, chemistry, physiology, and 
 anatomy, both normal and pathological, during the eigh- 
 teenth century, as shown in the preceding chapter, were 
 accompanied by corresponding progress in all the more 
 practical branches of medicine. 
 
 Surgery : As nearly all those who were active and suc- 
 cessful investigators and teachers of anatomy were at the 
 same time active practitioners of surgery, the latter could 
 not fail to profit more or less by each advance in the for- 
 mer. Early in the century, William Cheselden, who was 
 born in Leicestershire, England, in 1688, commenced lec- 
 turing on anatomy and surgery in 1710, and soon acquired 
 a high reputation and an extensive surgical practice. He 
 w^s perhaps the first to make an artificial pupil by incision 
 of the iris with a needle introduced through the sclera. He 
 was noted for unusual dexterity in operating, especially for 
 the removal of calculi from the urinary bladder. In per- 
 forming the operation of lithotomy he preferred the lateral 
 section, which, it is claimed, he performed in fifty-four 
 seconds of time. His Avork on the "Anatomy of the 
 Human Body" was published in 1713; a "Treatise on the 
 High Operation for Stone" in 1723, and a more noted 
 work on "Osteology, or the Anatomy of the Bones" in 
 1733. He was surgeon to St. Thomas's and Chelsea Hos- 
 pitals, and chief surgeon to Queen Caroline. 
 
 Samuel Sharp, of London, a pupil of Cheselden and a 
 surgeon of Guy's Hospital, also gained a high reputation 
 both as an oculist and general surgeon. Alexander Mon- 
 ro Sen, of Edinburgh, born in 1697, became professor of 
 both Anatomy and Surgery, and by his industry and skill
 
 lOI 
 
 he added much to the reputation of the Edinburgh Medical 
 School. 
 
 Charles White, a surgeon of Manchester, was the 
 pioneer of conservative surgery. He first resected the 
 humerus leaving the periosteum, and thereby gained a 
 complete regeneration of the bone, in 1768. Wainman 
 and Shripton had successfully exsected the elbow joint in 
 1758. Charles White demonstrated the practicability of 
 resecting the hip joint on the cadaver, and he was the 
 first to practise the reduction of dislocation of the shoulder 
 by placing the heel in the axilla. 
 
 Percival Pott, of London, born in 1713, and surgeon to 
 St. Bartholomew's Hospital from 1769 to 1787, did much 
 for the better treatment of diseases of the spine and 
 chronic diseases of the joints generally. He wrote a val- 
 uable essay on the Diseases and Deformities of the Spinal 
 Column, which caused the angular spinal curvatures to be 
 called "Pott's Disease." His complete surgical works 
 were published in London in 1771. 
 
 (The eminent character and valuable works of the Hun- 
 ters, William and John, were mentioned in the preceding 
 chapter in connection with the subjects of normal and 
 pathological anatomy.) 
 
 Benjamin and John Bell, of Edinburgh, were both emi- 
 nent practitioners and teachers of surgery during the last 
 part of the eighteenth century. The first gave much at- 
 tention to the treatment of fractures and dislocations, white 
 swellings of the joints, and ulcers. He wrote a volumi- 
 nous System of Surgery, published in Edinburgh, in six 
 volumes, 1783-87. 
 
 Thomas Bayford established the correct diagnosis be- 
 tween the contagions of gonorrhoea and syphilis ; and 
 Richard Bayley, of New York City, successfully disarticu- 
 lated the shoulder joint in 1782. 
 
 Many of the English surgeons practised also exten- 
 sively as oculists, dentists and obstetricians. 
 
 In France, more than in any other country during the 
 eighteenth century, greater advancements were made, 
 both in surgical practice and in the relative rank of surgical
 
 102 
 
 practitioners, than during any other equal period of time. 
 The "Academic de Chirurgie" was founded in 1731, chiefly- 
 through the influence of Marechal and Francois Gigot de 
 La Peyronie. The latter devoted both his time and his 
 fortune in sustaining the interests of his favorite depart- 
 ment. He was not only an active director of the Academic 
 de Chirurgie, but he secured the establishment of several 
 professorships of Surgery, both in Paris and ]\Iontpellier. 
 He was surgeon to the King, and in 1743 he completed the 
 separation of surgeons from the barbers ; and at his death 
 in 1747, he, by will, devoted the greater part of his remain- 
 ing estate to the further advancement of the same pro- 
 fessional objects for which he labored faithfully during life. 
 Contemporary with Peyronie, and more famous as a 
 practitioner and teacher of all parts of surgery, was Jean 
 Louis Petit, of Paris, born in 1674 and died in 1750. He 
 was one of the early Directors of the Academic de Chir- 
 urgie; improved several surgical instruments; practised 
 herniotomy without opening the sac ; and acquired a very 
 high reputation in both civil and military surgery. 
 
 Later in the century Pierre Joseph Desault became the 
 leading surgeon in Paris. He was the son of a farmer, born 
 in 1744, and obliged to support himself by teaching while 
 pursuing his medical studies in Paris. After commencing 
 practice he acquired reputation rapidly, became professor 
 and chief surgeon to the Hotel Dieu, in which he estab- 
 lished its first surgical clinic. He gave special attention 
 to the study of surgical anatomy and improved many sur- 
 gical operations and instruments. In dressing wounds, 
 he not only insisted on thorough cleanliness, but also such 
 closure as to favor permanent union by first intention or 
 direct adhesion without suppuration. 
 
 Many of the most enterprising surgeons in France, like 
 those of England, gave no little attention to ophthalmol- 
 ogy, otology and dentistr\'. The first formal work on 
 the last named branch was written by Pierre Fauchard, of 
 Paris, entitled "Le Chirurgien Dentiste, ou Traite des 
 Dens", published in 1728. 
 
 The first catheterization of the Eustachian tubes ap-
 
 103 
 
 pears to have been accomplished by Archibald Cleland, 
 an EngHsh surgeon, in 1741. 
 
 Surgery advanced much less rapidly in Germany and 
 Austria than in England and France. During the first 
 half of the century Lorenz Heister, of Frankfort-on-the- 
 Main, was the most noted surgeon of Germany and author 
 of valuable works on anatomy and surgery. He was the 
 first in that country to teach that cataract was caused by 
 opacity or cloudiness of the lens. 
 
 In the last half of the century August Gottlieb Richter, 
 of Zorbig, gained a high reputation as a surgeon and as 
 a professor in Gottingen. Though a general surgeon he 
 devoted much attention to diseases of the eye, and to 
 improvements in operative procedures. 
 
 During the same period of time George Jos. Beer, a 
 professor in the Vienna University, gained a still higher 
 reputation in the department of ophthalmology, on which 
 he gave separate lectures, thereby adding much to the 
 reputation of the Vienna school. He divided inflamma- 
 tory affections of the eye into idiopathic and those excited 
 by local irritants or by sympathy, and studied the patho- 
 logical changes taking place during their progress. He 
 also made important improvements in the operations for 
 cataract and the formation of artificial pupils. 
 
 J. Andr. Venel, of Orbe, Switzerland, was a pioneer 
 orthopedist, who gained considerable reputation for the 
 treatment of club foot and crooked joints. 
 
 It is thus seen that throughout the eighteenth cen- 
 tury, surgery in all its departments made steady advance- 
 ment, pari passu, with the progress of descriptive, general 
 and pathological anatomy ; and chiefly by the same indi- 
 vidual members of the profession. Its separation from the 
 "barber shop" and the domination of ecclesiastics, that 
 had fairly commenced in the seventeenth century, was 
 fully completed during the eighteenth by the establish- 
 ment of well sustained chairs of surgery in all the medical 
 schools, both in Europe and America, and the admission 
 of surgeons to equal professional and social standing with 
 general practitioners of the healing art.
 
 104 
 
 Midwifery : As during all the earlier centuries sur- 
 gery was compelled to remain in the hands of the barbers, 
 so midwifery was equally confined to the management of 
 uneducated midwives or menial servants ; and if help was 
 called for resort was had to the surgeon rather than to 
 the physician, for the reason that the assistance required 
 generally involved mechanical or operative procedures in 
 aid of deliveries. Consequently, as stated in previous 
 chapters, the Cjesarean section was early resorted to, and 
 instruments were invented and used for efifecting craniot- 
 omy and the extraction of the child in pieces. 
 But, as has been previous stated, the invention of 
 the obstetric forceps, by which deliveries could be 
 effected generally without injury to the mother or 
 child, did not occur until the early part of the 
 seventeenth century, and then the inventor, Peter 
 Chamberlen, a member of the Guild of Barber Sur- 
 geons of London, and his descendants, kept a knowledge 
 of the invention so far a secret, for purpose of private gain, 
 that it became known to, and used by, only a limited num- 
 ber of members of the profession, even in England, until 
 the beginning of the eighteenth century. In fact, so little 
 was known on the continent concerning the Chamberlen 
 invention that Jean Palfyn invented an instrument for 
 the same purpose, which he exhibited to the Paris Acad- 
 emic des Sciences in 1721. Though called obstetric for- 
 ceps or "Palfyn's hand", it was composed of three blades 
 without fenestra or lock, and consequently was incapable 
 of efficient use until improved by Duce of Paris in 1735. 
 
 Just prior to this latter date, however, full descriptions 
 of the Chamberlen forceps were published by both William 
 Giflford and Edmund Chapman, of London, the latter hav- 
 ing used them in his practice more than ten years. By 
 these publications, aided by those of William Smellie, of 
 London, a few years later, the instrument soon became 
 known to the profession both in Europe and America. Its 
 form and methods of use were much improved by the last 
 named writer, whose valuable "Treatise on the Theory 
 and Practice of Midwifery" was published in 1752. He
 
 105 
 
 also directed attention to the several conjugate diameters 
 of the pelvis, and gave practical directions for efiecting 
 cephalic version and versions by the breech. The im- 
 provements effected by Smellie and his strong recom- 
 mendation of the use of instruments in many cases of 
 natural labor, led not only to the rapid introduction of his 
 forceps into general use, but caused it to be used in many 
 cases needing no such aid. This abuse, however, was 
 effectually checked by the decided opposition of William 
 Hunter, eminent both as a surgeon and obstetrician. He 
 was followed on the same conservative line by Thomas 
 Denman, whose work entitled "Introduction to the Prac- 
 tice of Midwifery" was published in London, 1787. He 
 described more fully the mechanism of natural labors ; the 
 conditions justifying versions ; and those requiring the use 
 of the forceps. In cases of known great contraction of 
 the pelvis, he recommended the induction of prema- 
 ture labor instead of the Csesarean section at the full pe- 
 riod. In 1736, Sir Richard Manningham established the 
 first private lying-in asylum in London. 
 
 Andre Levret, of Paris, contemporary with Smellie 
 and William Hunter, of London, was perhaps the most 
 eminent teacher and practitioner of midwifery on the con- 
 tient during the middle part of the eighteenth centur}'. 
 His teaching was characterized by good judgment, free 
 from extravagances and attracted pupils from all the neigh- 
 boring countries. In cases of placenta previa, he advised 
 detaching it from the edge, rather than penetrating directly 
 through it. His most important work was a Treatise on 
 Accouchement, published in 1753. 
 
 Later, Jean Louis Baudelocque, of the same city, be- 
 came a leader in the department of obstetrics, and opposed 
 the recommendation of Denman to procure premature 
 labor in cases of great contraction of the pelvis. He also 
 invented an external pelvimeter. 
 
 John Georg Roderer, of Strassburg, became the first 
 professor of midwifery in Germany, at Gottingen, in 175 1. 
 He was well versed in anatomy and physiology, and based 
 on them his science of obstetrics; and also aided greatly
 
 io6 
 
 in diffusing through Germany a more scientific grade of 
 practical obstetrics. He discouraged the prevalent ten- 
 dency to use instruments, especially such as involved injury 
 either to the mother or child. 
 
 But the application of scientific principles, derived from 
 a correct knowledge of anatomy and physiology, in the 
 practice of obstetrics, made slower progress in Germany, 
 Austria, Italy and Spain than in England, France, or 
 America. The English colonies in North America de- 
 rived their medical men partially from immigration from 
 the mother country, and in part from enterprising young 
 men who, born in the colonies, resorted to the medical 
 schools of Europe, and especially to the University of 
 Edinburgh, for their medical education. It was chiefly by 
 men belonging to the last named class that the first medical 
 schools were established in Philadelphia and New York, 
 near the middle of the eighteenth century. Consequently 
 the progress of midwifery and all the other practical 
 branches in the English, French and Dutch colonies of 
 America kept even pace with the same in England and 
 France. 
 
 On the organization of a medical school in connection 
 with King's (now Columbia) College in New York, 1768, 
 full professorships of Anatomy ; Surgery ; Physiology and 
 Pathology ; Chemistry and Materia Medica ; Midwifery and 
 Theory and Practice of Physic were established, and Dr. 
 John V. B. Tennent was appointed to the chair of Mid- 
 wifery, which he filled with credit several years. About the 
 same time Dr. William Shippen gave lectures on mid- 
 wifery, in addition to his chair of Anatomy and Surgery 
 it, the medical school established in Philadelphia, in 1765. 
 As nearly all the important advancements in midwifery 
 during the eighteenth century were the result of coinci- 
 dent improvements in anatomy, physiology and surgery, it 
 was natural that in passing from the hands of the mid- 
 wife it should first find lodgment in the hands of the sur- 
 geon before reaching full recognition as an independent 
 branch of medicine. Therefore we find that through the. 
 greater part of the eightenth century, the teaching of
 
 107 
 
 midwifery in the medical schools was committed to the 
 professor of Anatomy or Surgery, and in many places 
 all the three branches were taught by one and the same 
 professor. But its independent position was very gener- 
 ally admitted before the end of the century, and the works 
 of Smellie, William Hunter and Andre Levret were in gen- 
 eral use both as text-books and for reference. 
 
 Practice of Medicine : Notwithstanding the many at- 
 tempts to construct special systems of medical pathology 
 and practice during the seventeenth century, a large major- 
 ity of the educated practitioners followed the teachings of 
 Sydenham and Boerhaave. The thoroughly eclectic doc- 
 trines of the latter, coupled with the display of unusual 
 practical good sense in their application, caused them to 
 maintain a controlling influence, not only during the last 
 half of the seventeenth, but also during a considerable 
 part of the first half of the eighteenth century. But the 
 coincident discoveries in the department of physiology and 
 pathological anatomy; more especially the demonstration 
 of irritability and contractility in living tissues independent 
 of nerve sensibility, by Haller, led rapidly to the final 
 abandonment of what had remained of the humoral doc- 
 trines of the ancients and also of the vis anima of Stahl and 
 the vital ether of Hoffman. In their stead, the irritability 
 of Glisson and Haller was accepted as an inherent prop- 
 erty of living organized matter, giving it the capacity to 
 respond to the action of stimuli, which led directly to the 
 inference that all vital action, whether normal or abnormal, 
 resulted from the influence of stimuli. If the stimuli were 
 natural, as wholesome food, drink, and air, and in natural 
 proportions, the vital actions resulting were healthy. If 
 they were applied with either too little or too great a de- 
 gree of intensity, or of an unnatural quality, the resulting 
 actions would be unnatural, constituting disease. Conse- 
 quently before the middle of the eighteenth century all 
 diseases came to be regarded as the direct or indirect 
 result of the action of stimuli or irritants on the organic 
 irritability, constituting a system of medicine as exclu- 
 sively solidistic as any of those of the ancients were
 
 io8 
 
 humoral. The soUdism thus generally adopted led to diver- 
 gent views in its practical application. As has been pre- 
 viously stated, not a few continued to claim that the irri- 
 tability of Haller was only nerve sensibility ; and that im- 
 pressions of stimuli were primarily made on sentient nerve 
 matter. 
 
 The more immediate followers of Haller regarded his 
 irritability as a vis vita;, or susceptibility inherent in liv- 
 ing organized matter, but causing motion or active phe- 
 nomena of life only when acted upon by irritants or stim- 
 uli. 
 
 By some of the leading chemists oxygen was thought to 
 be the essential excitor or irritant. Others claimed that 
 it was caloric or free heat. Still others, like Galvani, 
 claimed that galvanism was the true vital force, the positive 
 pole being identical with irritability and the negative with 
 sensibility. 
 
 Those who adhered to the doctrine that ner^-e struc- 
 tures were the exclusive seat of vital susceptibility called 
 it a "nervous force" or "life giving element", and claimed 
 that it originated in the brain and spinal cord, from which 
 it was transmitted to all other parts of the body by the 
 nerve cords and the blood. 
 
 The most eminent and influential advocate of the neu- 
 rologic pathology was William Cullen, professor in the 
 University of Edinburgh. He was born in Lanarkshire, 
 Scotland, in 1712, of ver}- poor parents, and obliged to 
 work his own w-ay to an education and high position in his 
 profession. His occupations were successively those of a 
 barber, apothecary, ship-surgeon, and then the surgeon of 
 a small village. 
 
 He was an intimate friend of William Hunter, and it 
 is said they alternated as practising physicians in Hamil- 
 ton ; one attending to the practice and earning the nec- 
 essary money for their support, w^hile the other attended 
 the University. By such means Cullen was enabled to 
 graduate in 1740, and six years later he was appointed 
 professor of chemistr\' in Glasgow. In 175 1, he was trans- 
 ferred to the chair of Practice, and in 1756, he was called
 
 109 
 
 to corresponding positions in the University of Edinburgh, 
 where he remained until his death, in 1790. 
 
 He embraced fully the doctrine of a "nervous force", 
 or susceptibility, and that all the causes of disease made 
 their primary impression on the nervous system produc- 
 ing either spasm or atony. The more irritant or exciting 
 causes produced direct spasm of the peripheral vessels 
 crowding more blood upon the heart and internal organs, 
 followed by reaction and fever. The more depressing in- 
 fluences caused atony of the vessels primarily and conse- 
 quent retarded circulation, to be followed by reaction as 
 in the other case. 
 
 In 1769 he published his "Synopsis Nosologse Metho- 
 dicae", in which he divided all diseases into four classes, 
 viz: I. Pyrexiae, with five orders; II. Neuroses, with four 
 orders ; III. Cachexiae, with three orders ; and IV. Locales, 
 with seven orders. Fevers, constituting the first order of 
 the first class, he divided into intermittents or periodical, 
 and continued. The latter he divided into Synocha, Syno- 
 chus and typhus. 
 
 His "First Lines of the Practice of Physic" was pub- 
 lished in 1777; and a "Treatise on Materia ^Medica" in 
 1789. Both these works were written in the English lan- 
 guage, and he was one of the first medical professors in 
 Great Britain to give his lectures, both didactic and clin- 
 ical, in his native language, instead of the orthodox Latin. 
 
 The nosology and chief pathological doctrines of Cul- 
 len were approved by a large proportion of the profession 
 in Europe, and by a still larger proportion in the English 
 colonies in America, among whom were many who had 
 ' received their chief medical instruction in Edinburgh and 
 subsequently became the founders of the first medical 
 schools in America. The therapeutic agents relied upon 
 by Cullen and his followers were rest, low diet, cooling 
 drinks, cathartics, and sometimes emetics, opium and ven- 
 esection in the earlier stages, and later, cinchona bark 
 and wine, with more nourishment. IMercury, in the form 
 of mild chloride, was used both as a cathartic and altera-
 
 no 
 
 tive, especially in the more active cases of inflammation 
 and fever. 
 
 Perhaps the most prominent of the direct followers of 
 Cullen were James Gregory, his successor in the Univer- 
 sity of Edinburgh, Samuel Bard, of New York, and John 
 Morgan, of Philadelphia, who were professors of Prac- 
 tice of Medicine in the first two medical schools founded 
 in America. 
 
 Chief among those who were influential in the field of 
 Practical Medicine on the continent of Europe were Ger- 
 hard von Swieten, of Leyden, who later went to Austria ; 
 Anton de Haen, of the Hague, who became a co-laborer 
 with von Swieten in Vienna ; Maximilian Stoll, of Swabia, 
 who devoted much time to the study of epidemics ; Theo- 
 phile de Borden, of Paris, who advocated the doctrine of 
 "vitaUsm" and defended the practice of inoculation ; and 
 J. B. T. Baumes, of Montpellier, who endeavored to con- 
 struct a purely chemical system of medicine and divided 
 all diseases into five classes, i. e., the oxygenized, the calo- 
 rified, the hydrogenized, the nitrogenized, and the phos- 
 phorized. 
 
 But the physician during the last part of the eighteenth 
 century whose medical doctrines attracted the widest at- 
 tention was John Brown, the author of the well known 
 Brunonian system of medicine. He was bom in Ber- 
 wickshire, Scotland, in 1735, and died in 1788. His father 
 was a poor weaver and unable to give the son a liberal 
 education. But young Brown manifested a remarkable 
 degree of intellectual activity at a very early age, and after 
 working his way through the primary and Latin schools 
 he entered upon the study of medicine as a pupil of Cul- 
 len. At the same time he became a friend and comrade 
 of Burns, the poet, and a partaker of some of his vicious 
 habits. Being favored by Cullen he was enabled to pursue 
 his studies in the medical school in Edinburgh, but finally 
 received the degree of M. D. from the University of St. 
 Andrew in 1779. As early as 1770, however, his irregu- 
 lar habits caused an interruption of his friendship with 
 Cullen. and he commenced giving private lectures, set-
 
 Ill 
 
 ting forth doctrines in many respects antagonistic to those 
 cf Cullen. They were attended by many students and 
 members of the profession, and in 1780, was pubhshed his 
 celebrated work entitled "Elementa Medicinse". Eight 
 years later he died from the effects of alcoholic drinks and 
 opium, leaving a wife and children destitute of the neces- 
 saries of life— a striking illustration of the fact that no 
 activity or breadth of intellect without moral integrity, 
 can safeguard the man against the seductive and destruc- 
 tive influence of these anaesthetic and narcotic drugs. 
 
 Brown's whole theory of disease was founded on the 
 assumption that living matter possessed a vital irritabil- 
 ity and all active phenomena of life resulted from the ac- 
 tion of stimuli on this irritability. In other words, life 
 was simply a state of excitation. When from natural stim- 
 uli, as air, water and food in proper quantities, health was 
 the result. When the stimuU were in excess or deficiency, 
 or irritating in quality, disease was the result. If the stim- 
 uli were deficient or depressing the resulting disease was 
 termed asthenic, if in excess or too active the result was 
 sthenic. The resulting changes in structure were termed 
 congestion, irritation and inflammation. His therapeutic 
 principles were equally simple and easily applied. His doc- 
 trines found but few followers in England, but became 
 quite popular on the continent, and found some influen- 
 tial advocates in America. 
 
 Preventive Medicine: The inoculation of young 
 persons in good health with the virus of variola (small- 
 pox) for the purpose of securing mildness, and there- 
 fore safety, in the attack, as well as permanent exemption 
 from future attacks, was practised by the Brahmans of 
 India, and by the Chinese, at least 1,000 years before the 
 Christian era. But it was not known or practised in 
 Europe or this country until the beginning of the eigh- 
 teenth century. The first account of this practice in Asia 
 was given by Emanuel Timoni, a physician residing in 
 Constantinople, in a communication to the Royal Society 
 of London, in 1 714. In 171 7 Lady Mary Wortley Montague, 
 the wife of the English Ambassador to the Porte, had her son
 
 112 
 
 inoculated, and, on her return to London in 1721, she had 
 her daughter, aged six years, inoculated. These proving 
 favorable, a son of Dr. Keith was inoculated the same year, 
 and soon after several members of the royal family. The 
 Rev. Cotton Mather, of New England, having read the 
 published papers of Timoni to the Royal Society of Lon- 
 don in 1714, induced Dr. Zabdiel Boylston, of Boston, to 
 inoculate his own son, thirteen years old, and two colored 
 servants, the 27th of June, 1721, only two months after 
 the inoculation of the daughter of Lady Montague in Lon- 
 don. These cases proving successful. Dr. Boylston the 
 same year inoculated 247 persons of different ages and 
 39 were inoculated by other physicians, making 286, of 
 which 6 died, while of 5,759 who were attacked in the nat- 
 ural way the same year 844 died. From these beginnings 
 in London and Boston the practice of inoculation spread 
 rapidly in both Europe and America, but not without much 
 and sometimes bitter opposition. It was practised espe- 
 cially in the armies of the different countries to prevent the 
 disastrous consequences of a small-pox epidemic in the 
 midst of an active campaign. 
 
 During the American revolution from 1 775-1 781, many 
 of the newly recruited regiments were placed in camps 
 under good hygienic regulations and subjected to inocula- 
 tion generally with a resulting mortality of only one in 
 700 or 800. 
 
 Though this practice greatly lessened the aggregate 
 mortality from small-pox during the last half of the 
 eighteenth century it was destined to be soon superseded 
 by the discovery of the preventive power of vaccination 
 with the cow-pox virus by Edward Jenner, of Berkeley, 
 Gloucestershire, England, and published to the world in 
 
 1798. 
 
 Jenner was born in 1749 and died in 1823. After re- 
 ceiving a good academic education he decided to study 
 medicine, and entered the office of surgeon Ludlow, of 
 Sudbury, near Bristol, as an apprentice. Among the pa- 
 tients visiting the surgeon's office was a milk-maid who 
 had previously had a pustule on her hand caused by
 
 113 
 
 matter from sores on the udder of a cow while milk- 
 ing, and which it was claimed rendered her immune to 
 small-pox. Learning that several such cases had been 
 noticed among milk-maids, the' thought occurred to him 
 that if the sore on the udder of the cow from which 
 the virus was communicated to some abrasion on the 
 finger or hand of the milk-maid could be identified, and 
 a way devised for propagating it in sufficient quantity 
 for use for general vaccination instead of the virus of 
 small-pox, it would be a great boon to the human 
 race. In 1770, he went to London and became a pupil 
 of John Hunter. While studying with him he talked 
 freely about the possibility of discovering and propagating 
 the cow-pox virus and using it for the prevention of small- 
 pox and he was advised by Hunter to investigate the 
 subject more thoroughly. When his term of study had 
 been completed he returned to Berkeley and commenced 
 the practice of his profession, because it was in a dairy 
 district, favorable for the prosecution of the investiga- 
 tion that had been so strongly impressed upon his mind. 
 With untiring perseverance he prosecuted his inquiries 
 and experiments for twenty years, and in 1796 he vaccinated 
 his first human subject, James Phipps, with virus from a 
 cow-pox pustule on the hand of Sarah Nelnies contracted 
 while milking. Subsequently both Phipps and Nelmes 
 were found to be completely immune to inoculations with 
 small-pox virus. With the virus from these cases he con- 
 tinued to vaccinate others until the proofs of the value of 
 his discovery were fully established, when in 1798 he pub- 
 lished to the world a full account of his work in a paper 
 entitled "An Inquiry into the Causes and Effects of the 
 Variola Vaccina". The paper was soon translated into 
 several of the European languages and circulated freely in 
 most of the countries of Europe and in America. 
 
 The first vaccinations in America were made by Ben- 
 jamin Waterhouse, of Boston, Professor of the Practice 
 of Medicine in Harvard College ; who procured virus from 
 Dr. Haygarth, of Bath, England, and vaccinated four of 
 his own children in July, 1800.
 
 114 
 
 * Thus was given to the world with the utmost free- 
 dom and frankness on the part of its author — perhaps the 
 greatest life-saving discovery known in the history of pre- 
 ventive medicine. Its reception, rapid diffusion, and ulti- 
 mate eflects upon its discoverer will belong to the early 
 years of the nineteenth century. 
 
 Another great advance in the prevention of human 
 suffering was commenced by Philippe Pinel in charge of 
 the Hospital Eicetre, in Paris, in 1792, and subsequently 
 by the Salpetriere. It was while in charge of the Bicetre, 
 that he boldly removed the chains from many of the in- 
 sane patients, and instituted that more humane and suc- 
 cessful treatment which has since met with universal ap- 
 proval.
 
 115 
 
 CHAPTER IX. 
 
 HISTORY OF MEDICINE DURING THE FIRST HALF OF THE NINE- 
 TEENTH CENTURY. 
 
 Discoveries in the Physiology of the Nervous System; in 
 Pathological Anatomy; Physical Diagnosis; and Organic 
 Chemistry. The Discovery of Anaesthesia ; and the Prac- 
 tice of Ovariotomy. 
 
 As was shown in the two preceding chapters, the chief 
 important and permanent improvements in the several 
 branches of medicine during the eighteenth century were 
 the rapid advancement of inorganic and analytical chem- 
 istry, with the laws governing chemical combinations and 
 the addition of electricity and galvanism; the addition of 
 general anatomy by Bichat, and minute anatomy by aid of 
 the microscope ; the development, of human physiology un- 
 der the leadership of Albert Von Haller; and the discovery 
 of the protective power of vaccination with cow-pox lymph 
 by Edward Jenner. The last named discovery was announced 
 to the world during the last years of the eighteenth century, 
 (1798) and was met with much adverse criticism and some 
 bitter denunciations. But so complete were the proofs pa- 
 tiently gathered by Jenner, that his work at once command- 
 ed the attention of the more enlightened members of the 
 profession in Europe and America ; and as fast as samples 
 of the cow-pox lymph could be obtained it was put to the 
 test. This resulted in so rapid an establishment of its effi- 
 cacy that before the close of the year 1800 it had been ap- 
 proved and successfully introduced into London, Vienna, 
 Paris, Berlin, Saxony, St. Petersburg, and in Boston, Bal- 
 timore, and several other cities of the United States. So 
 complete was the general approval of this most valuable 
 discovery, that in 1802 the British government awarded Dr. 
 Jenner the sum of $50,000, and four years later the further 
 sum of $100,000; and a few years later still, he received 
 awards from the presidencies of Bengal, Bombay and
 
 ii6 
 
 Madras aggregating $35,000. In 1808 he was elected a cor- 
 responding member of the National Institute; and in 1857 
 a monument was erected to his memory in Trafalgar Square, 
 London. Notwithstanding the general adoption of the Jen- 
 nerian vaccination as a safe and effectual preventive of small- 
 pox by the people and governments of all civilized countries, 
 there still remains a small class of bitter opponents, called 
 anti-vaccinationists. 
 
 Progress of Chemistry. During the firsthalf of the nine- 
 teenth century inorganic chemistry continued its rapid prog- 
 ress by the labors of Barthollet, Thenard, Vauquelin, Proust, 
 Dumas, Magendie and Orfila of France ; Berzelius, in 
 Sweden ; Hofifman, Richter, Gmelin, and Schoenbien, in Ger- 
 many ; Dalton, Davy, Faraday and Graham, in England ; 
 and Benjamin Silliman of the United States. But the crown- 
 ing event in the progress of chemistry during this half cen- 
 tury, was the development of organic and physiological 
 chemistry by Justus Liebig, of Germany, in his monograph, 
 first presented to the British Provincial Medical and Sur- 
 gical Association and published in 1842, under the title, "Or- 
 ganic Chemistry in its Relations to Physiolog}' and Pathol- 
 ogy," One or two years previously he had published a work 
 on "Chemistry in its Relations to Agriculture", which at- 
 tracted much attention both in Europe and America. In 
 these publications he endeavored to explain all the phenom- 
 ena of vegetable and animal life in accordance with purely 
 chemical laws. Analysis having shown that all organized 
 bodies were composed either of four elements, i. e., carbon, 
 hydrogen, oxygen and nitrogen, or of the first three ele- 
 ments named only. He called the first, nitrogenous elements, 
 and the second, non-nitrogenous or carbonaceous. The same 
 analytical examination of the various food substances showed 
 them to be composed of the same two classes of matter. Con- 
 sequently Liebig claimed that the nitrogenous food elements 
 were used for the growth and repair of the organized struc- 
 tures of the body, while the carbonaceous, or hydro-carbons, 
 were oxidized for the production of heat or stored in the 
 form of fat. In the first class of food substances he included 
 the fibrinous and albuminous parts of animals, including
 
 117 ■ 
 
 eggs, the casein of milk, and the gluten in cereals or grain. 
 In the second class he included the fats or oils, the starch, 
 sugar, gum, and the alcohols ; all of which were supposed 
 to unite with the oxygen furnished by respiration, constitut- 
 ing a form of combustion for the maintenance of animal heat 
 and force. When they were consumed too rapidly, evolving 
 heat in excess, fever was produced. If they were taken 
 faster than they could be oxidized or burned up, they were 
 stored in some of the tissues in the form of fat. As proof 
 of the correctness of his theory, he claimed that the inhab- 
 itants of the colder regions of the earth consumed much more 
 of the non-nitrogenous or combustible food than the inhab- 
 itants of the tropical regions. 
 
 These views and classifications of Liebig were so plausi- 
 ble and so easily comprehended that they were very gen- 
 erally adopted, and very soon became incorporated into all 
 our literature, both professional and secular. Their correct- 
 ness, however, was denied by some of his contemporaries, 
 among whom were Lehman, Miescher and Voit, in Germany ; 
 Sandras and Bouchardet, of France ; William Prout, of Eng- 
 land, and myself in this country, as will be seen in the sequel. 
 
 Directly parallel with the progress of both organic and 
 general chemistry, came the brilliant 'discovery of Sir Charles 
 Bell, of London, concerning the distinct sensory and motor 
 functions of the posterior and anterior roots of the spinal 
 nerves and their connections, published in 1824; the experi- 
 ments of James H. Miller, of Baltimore, Md. ; M. Brachet, 
 of France, and Professor Reid, of the British Association of 
 Science, concerning the functions of the great sympathetic 
 or ganglionic system of nerves, between 1809 ^^'^ 1838; the 
 work of Marshall Hall in demonstrating the reflex or excito- 
 motor system of nerves as published in 1838 ; and experi- 
 ments to determine the special function of dififerent parts of 
 the brain and medulla oblongata, by Magendie, Flourens, 
 Reid, H. H. Smith, of Philadelphia, and others. 
 
 The researches of all the foregoing investigators in the 
 field of nerve physiology were well supplemented by the 
 very valuable work of Dr. Samuel George Morton, of Phila- 
 delphia, entitled "Crania Americanae", published in 1839.
 
 ii8 
 
 The experiments of Sir Charles Bell fully demonstrating 
 that the posterior columns of the spinal cord and the nerves 
 proceeding therefrom were sensory in their function, and the 
 anterior columns, and the nerves connected therewith, were 
 motor, were performed in 1816. By subsequent experiments 
 he demonstrated the connection of the nerves controlling res- 
 piration with the medulla oblongata. 
 
 The investigations of James H. Miller, of Baltimore, 
 were commenced in 1809 and prosecuted until he fairly dem- 
 onstrated the important functions of the great sympathetic 
 or abdominal plexuses of nerves, and taught the same in his 
 lectures in Washington Medical College in 1827, a few years 
 previous to the publication of M. Brachet's researches con- 
 cerning the same subject in France. Later Marshall Hall, 
 by additional experimentation, found that not only the 
 nerves of respiration, but also those of the organs of circula- 
 tion, had their center in the medulla oblongata, and claimed 
 these, together with the nerves controlling the sphincter 
 muscles of the body, as constituting a distinct system called 
 "excito-motory". The results of his investigations were pre- 
 sented in a communication to the Royal Society in 1833. 
 
 While the foregoing developments in organic chemistry 
 were taking place in Germany, and the discoveries in the 
 physiology of the nervous system, chiefly in England and 
 America, a no less important evolution of pathological an- 
 atomy and physical diagnosis was in progress, chiefly in 
 France. From the study of the normal tissues of the body by 
 Bichat in the closing years of the eighteenth century, it was 
 a natural step in progress to investigate the same tissues in 
 the different stages of disease. For this purpose the Parisian 
 hospitals La Charite and Hotel Dieu, afforded the best op- 
 portunities, and' the leading physicians engaged in the work 
 were Bayle, Corvisart, Laennec, Chomel, Louis, Andral and 
 Gavarret. 
 
 Jean Nicolas Corvisart was born in 1755, a native of 
 Dricourt in Champagne. He studied medicine in Paris as a 
 pupil of Vicq d'Azyrand Petit; and in 1795 was made Pro- 
 fessor of ^Medicine in the clinic of the Charite Hospital. Sub- 
 sequently he became successively ordinary physician of the
 
 119 
 
 First Consul, and then of the Emperor Napoleon. Notwith- 
 standing these official relations he found time to investigate 
 minutely the pathological changes in different stages of dis- 
 eases of the heart and lungs. In 1808 he translated from the 
 German Auenbrugger's work on percussion as a means for 
 the diagnosis of diseases within the chest, and in his hospital 
 clinics was perhaps the first to apply the ear to the naked 
 chest (immediate auscultation) in studying the sounds of 
 the heart. He published a valuable work on diseases of the 
 heart, and aided Bayle and Laennec in studying pulmonary 
 tuberculosis. He gained a very high reputation for integrity 
 and kindness, which added much to his influence. 
 
 Gaspard Laurent Bayle studied medicine in Montpellier, 
 and after several years of service in connection with the 
 army he became one of the physicians to the Charite Hospital 
 in Paris, where he and Laennec conducted numerous post- 
 mortem examinations of those who had died from pulmonary 
 consumption. Bayle accurately described the gray miliary 
 tubercle, and Laennec described the several stages of tuber- 
 cular infiltration. 
 
 To these were added the results of dissections of no less 
 than 358 bodies dead from pulmonary consumption by M. 
 Louis, from which he obtained descriptions of the tubercular 
 disease in every stage of its progress. But the most im- 
 portant work of both MM. Chomel and Louis was in tracing 
 the structural changes taking place in the abdominal viscera 
 during the progress of continued fevers, which up to their 
 time had been called typhus or adynamic fevers. They soon 
 pointed out with great accuracy the visible changes in the 
 liver, spleen and the glandular structures, in the mucous 
 membrane of the intestines, and those in the mesentery. 
 They found in some cases progressive enlargement and soft- 
 ening of the liver and spleen, tumefaction and softening of 
 the mesenteric glands, and enlargement and ulceration of the 
 glands of Peyer and Brunner, more especially in those of the 
 lower half of the ileum and its connection with the colon, 
 and in the middle and advanced stages much gaseous dis- 
 tension of the intestines. In other cases they found much 
 less change in the glands of the intestines and mesentery,
 
 120 
 
 less abdominal tympanitis, and more softening of the struc- 
 tures of the spleen and heart, with darker color and less 
 coagulability of the blood. Louis, adopting a numerical 
 method, placed all those presenting the first assemblage of 
 pathological events in one series, calling them cases of ab- 
 dominal typhus ; those presenting the symptoms named in 
 the second series he called simply cases of typhus. Both he 
 and his co-workers, however, found a less number of cases 
 in which the pathological changes, both in the viscera and 
 on the cutaneous surface, were so mixed that they were 
 obliged to make a third series called doubtful. 
 
 While these investigations were being prosecuted in 
 Paris, the same methods of clinical and post-mortem study 
 by Gerhard, of Philadelphia, Enoch Hale and J. Jackson, of 
 Boston, and Austin Flint, then of Buffalo, all of whom had 
 been visitors in Paris, were being pursued in the several 
 cities named. The same line of study concerning the patho- 
 logical changes in the cases of continued fever in the Lon- 
 don hospitals was also pursued by Sir William Jenner, and 
 with the same results. An account of the work of Enoch 
 Hale was published in 1833; that of Gerhard in 1835; of 
 M. Louis in 1841 ; of Sir William Jenner in 1850; and of 
 A. Flint in 1852. 
 
 In the meantime, while the foregoing investigators were 
 pursuing their studies concerning the pathological changes 
 that take place in the various organized structures, MM. 
 Andral and Gavarret of Paris were making equally patient 
 investigations chemically concerning the changes in the 
 pathological conditions of the blood, the secretions and ex- 
 cretions in all the more important febrile and inflammatory 
 affections, which resulted in the publication by Andral of 
 his valuable "Essay on the Pathology of the Blood" in 1843. 
 His work showed conclusively that in all acute general dis- 
 eases the blood and other fluids of the body suffered changes 
 both in composition and quality as important as those in the 
 organized structures, and thereby checked the exclusive 
 solidistic doctrine that had followed the discovery of the ir- 
 ritability of Haller and the neurology' of Cullen. 
 
 Physical Diagnosis: During the progress of all the
 
 121 
 
 foregoing pathological investigations, efforts were made to 
 determine the connection of each change with diagnostic 
 symptoms marking the successive stages of the disease. 
 Bayle and Laennec, in their clinics, had not only revived the 
 practice of percussion as first taught by Auenbrugger, but 
 they had also practised immediate auscultation, that is, the 
 direct application of the ear to the chest for detecting the 
 sounds produced by movements of the heart and lungs. To 
 facilitate listening over any and all parts of the chest, Laen- 
 nec constructed a tube of cedar wood, with an ear piece at 
 one end and a funnel-shaped opening at the other, which 
 was called a stethoscope. The invention attracted much at- 
 tention, and greatly increased the practice of auscultation and 
 percussion to aid in the diagnosis of diseases in the chest. 
 In 1819 was published his work, "De I'Auscultation Mediate, 
 ou Traite du Prognostic des Maladies des Poumons et du 
 Coeur, etabli principalment a I'aide de ce nouveau Moyen 
 d'Exploration." This was soon translated into most of the 
 languages of Europe, and rapidly extended the practise of 
 physical exploration as an aid in diagnosis, and added much 
 to his reputation. But the next year his health began to 
 fail and he died from pulmonary tuberculosis in 1826, at the 
 age of forty-five years. 
 
 The pleximeter, for aiding in the practice of percussion, 
 was invented by P. A. Piorry, of Paris, in 1826 ; and he ex- 
 tended its use to the abdomen as well as to the thorax. 
 
 The practice of physical diagnosis of the French was in- 
 troduced into the German states and Austria by Rokitansky 
 and Skoda, of Vienna ; into Great Britain by John Forbes, 
 William Stokes and C. J. B. Williams ; and into America by 
 James Jackson Jr., of Boston, W. W. Gerhard and Samuel 
 George Morton, of Philadelphia, and Austin Flint, Alonzo 
 Clark and G. P. Camman, of New York. 
 
 Both the stethoscope of Laennec and the pleximeter of 
 Piorry underwent many modifications by different parties 
 in different countries ; the most important of which was the 
 completed binaural stethoscope of Dr. Camman of New York 
 in 1852. During my three years of medical study from 1834 
 to 1837 I received no instruction in the practice of ausculta-
 
 122 
 
 tion, but was told by the professor of practical medicine that 
 a stethoscope had been invented by Laennec and he thought 
 it would be found useful. I accordingly, the same year, 
 purchased a plain primitive cedar wood instrument, and a 
 few years later one of Dr. Camman's more perfect binaural 
 stethoscopes. 
 
 Anesthesia : One of the most important discoveries in 
 the history of medicine was made during the last decade of 
 the first half of the nineteenth century by members of the 
 medical profession in the United States of America. During 
 the last three or four centuries narcotics and alcoholic liquors 
 had frequently been administered to patients to lessen the 
 severity of their pains during surgical operations, and Sir 
 Humphrey Davy had vaguely suggested that the inhalation 
 of nitrous oxide gas might be found useful for the same 
 purpose. The first direct experiments for producing com- 
 plete anaesthesia, or unconsciousness of pain for surgical pur- 
 poses, however, were made by Horace Wells, a practitioner 
 of dentistry in Hartford, Connecticut, in 1840. He was a 
 native of that State, born in 181 5. After several times dem- 
 onstrating his ability to render a patient insensible to pain 
 by the inhalation of nitrous oxide gas, he extracted teeth 
 without pain under its influence, in Hartford, Dec. nth, 
 1844. During the next month, January, 1845, he caused the 
 inhalation of sulphuric ether vapor while Dr. Marcy removed 
 a tumor (wen) from the head of a patient without pain or 
 consciousness. During the same month he communicated 
 these facts to the medical and surgical stafif of the Massa- 
 chusetts General Hospital in Boston, and attempted to 
 anaesthetize a patient for an operation before a class in at- 
 tendance. 
 
 From mental trepidation and over-anxiety he failed to 
 effect complete anaesthesia, and was hooted out by the stu- 
 dents as a failure. He, however, continued to extract teeth 
 under the successful anaesthetic effects of both the nitrous 
 oxide and ether, which was well known to both Charles T. 
 Jackson and Dr. W. T. G. Morton, of Boston. The latter 
 had been a student of Dr.. Wells and was a practitioner of 
 dentistr}\ Dr. Jackson was an eminent chemist and well ac-
 
 123 
 
 quainted with the effects of inhaHng ether, though he had 
 made no attempt to apply its use in surgery. In October, 
 1846, Dr. Morton successfully anaesthetized a patient in the 
 Massachusetts General Hospital with ether, while Dr. J. C. 
 Warren performed an operation, a full account of which was 
 published in the Boston Medical and Surgical Journal, No- 
 vember 18, 1846. Jackson and Morton claimed this as the 
 first demonstration of the practicability and safety of surgical 
 anaesthesia, and soon obtained a patent for their an<iesthetic 
 under the fictitious name of "Letheon." This, however, was 
 soon shown to be nothing but a pure specimen of sulphuric 
 ether, and their patent became void. 
 
 Several years later it was satisfactorily shown by Dr. J. 
 Marion Sims, that so early as March 30, 1842, Dr. Crawford 
 W. Long, of Georgia, had safely extirpated a tumor from the 
 neck of a Mr. Venables while profoundly under the anaes- 
 thetic influence of ether. And during the next three years 
 the same surgeon performed several other operations with 
 the patients under the complete influence of the same an- 
 aesthetic. But he published no account of his work un- 
 til 1849. 
 
 Chloroform as a chemical substance was discovered in- 
 dependently, and nearly at the same time, in 1831, by Mr. 
 Samuel Guthrie, of Sackett's Harbor, N. Y., and Soubeiran 
 in France. Its properties were studied by Liebig, and it was 
 named chloroform by Dumas. It was first used by Sir J. Y. 
 Simpson, of Edinburgh, for producing anaesthesia instead 
 of ether, in November, 1847. 
 
 Such is a simple history of the discovery of anaesthesia 
 as a means of temporarily preventing or relieving pain in 
 the practice of medicine, surgery and midwifery, as produced 
 by the three leadmg general anaesthetics, i. e., nitrous oxide, 
 sulphuric ether, and chloroform. When properly used it is 
 one of the most beneficent discoveries in medical history. 
 At first its use met with much opposition, as is usual with 
 all new discoveries of importance. This, however, soon 
 ceased and was .followed by a tendency to abuse, by resort- 
 ing to it on trivial occasions, or prolonging its effects con- 
 tinuously longer than necessary.
 
 124 
 
 Ovariotomy : Another advancement of much impor- 
 tance in the domain of operative surgery, during the first 
 half of the nineteenth century, was the deHberate planning, 
 and the successful execution, of the operation of ovariotomy 
 by Dr. Ephraim McDowell, of Danville, Kentucky, in De- 
 cember, 1809. It is true that the ovary had been several 
 times removed as an incidental or necessary accompaniment 
 of operative procedures for the removal of other parts, but 
 not as an independent operation for ovarian disease. The 
 first patient operated upon by Dr. McDowell was a Mrs. 
 Crawford, who was afflicted by an ovarian tumor, and he 
 proceeded to deliberately remove it without the aid of either 
 anaesthetics or special antiseptics, for at that time neither was 
 used or known to the profession. The patient made a good 
 recover}^ and lived in fair health more than thirty years aft- 
 erwards. He performed the operation in all thirteen times, 
 resulting in eight complete recoveries and five failures. A 
 full account of them was published in the "Eclectic Repos- 
 itor}- and Analytic Review" for April, 18 16. 
 
 Dr. McDowell died in 1830, and a monument was erected 
 to his honor in Danville, Kentucky, in 1879. In 1831, a 
 single ovariotomy was performed by Dr. Nathan Smith, but 
 no one ventured to follow his example by repeating the op- 
 eration until 1843, when Dr. John L. Atlee, of Lancaster, 
 Pennsylvania, successfully removed a very large ovarium. 
 The following year, 1844, the operation was repeated with 
 success by his brother, Dr. Washington L. Atlee, of Phila- 
 delphia, Pennsylvania ; and also by Dr. Alexander Dunlap, 
 of Springfield, Ohio. Edmund Randolph Peaslee, of New 
 York, performed his first ovariotomy in 1850, at which time 
 thirty-six operations, in all, had been performed by eighteen 
 operators, resulting in twenty-one recoveries and fifteen 
 deaths. By this time, however, the use of anaesthetics had 
 received the sanction of leading surgeons, obstetricians and 
 g}'necologists on both sides of the Atlantic, and greatly en- 
 couraged and facilitated the performance of otherwise for- 
 midable surgical operations of all kinds. But at this early 
 period probably no one except the originator, Dr. McDowell, 
 exerted more influence in sustaining the propriety and dem-
 
 125 
 
 onstrating the feasibility of ovariotomy than Washington L. 
 Atlee, of Philadelphia, and his brother John, of Lancaster, 
 Pennsylvania. And, as we shall see in the sequel, it proved 
 the beginning or foundation of the whole system of modern 
 abdominal surgery. 
 
 From the foregoing review of the discoveries in the 
 physiology of the nervous system ; the development of patho- 
 logical anatomy and physical diagnosis ; the evolution of or- 
 ganic chemistry ; the discovery of true anaesthesia and its ap- 
 plication to the prevention or relief from pain in all the prac- 
 tical departments of medicine, all resulting from patient ob- 
 servation, experimental research, and the application of 
 known scientific principles to the construction of new instru- 
 ments and appliances, we see a more rapid, more extensive 
 and more important enlargement of the scientific basis of 
 medicine, during the first half of the nineteenth century, than 
 during any previous period in its history. It was the first 
 period in the history of medicine when strictly scientific in- 
 vestigations and their results gained predominance and gave 
 a decided check to the persistent tendency to construct so- 
 called schools or systems of medicine on theoretical dogmas 
 or general hypotheses. 
 
 One of the earliest and most direct effects of the devel- 
 opment of organic chemistry, was its application to the sep- 
 aration of the active constituents of crude vegetable drugs, 
 and of the pathological changes in the blood and secretions 
 of the human body during the progress of disease. The lat- 
 ter, as we have already seen, was begun and successfully 
 'prosecuted by Andral and Gavarret, in Paris, from 1833 to 
 1843. The chemical research for the active constituents of 
 opium, nux vomica and cinchona bark was commenced in 
 1816, when morphia was separated from opium, and in 1818 
 Pelletier and Caventou obtained strychnia from the nux 
 vomica, and in 1820 the same chemists separated quinia from 
 the cinchona bark. So much interest was excited in this line 
 of investigation, that in 1835 the Society of Pharmacy of 
 Paris offered a prize of 500 francs for the discovery of, and 
 the mode of preparation of, the active constituent in the 
 digitalis purpurea. This was increased in 1840 to 1,000
 
 126 
 
 francs, which was awarded to M. HomoUe and M. Quevenne 
 for the discovery of digitaline in 1846. 
 
 The work thus begun has been continued with such ac- 
 tivity and success as to effectually revolutionize the whole 
 field of pharmacy and bedside prescribing. It has resulted 
 in relegating nearly all crude drugs to the storehouses or 
 laboratories of the wholesale manufacturing pharmacists, 
 giving to the physician a greater variety of active medicines 
 in a simple pocket case than he formerly had in his capa- 
 cious and w^ell-filled saddle-bags, and presenting for the pa- 
 tient to swallow only grains or minims, and those often en- 
 cased in tasteless capsules, instead of spoonful doses of bit- 
 ter powders or bowlfuls of still more bitter infusions or de- 
 coctions. 
 
 In direct connection with the separation of the active 
 constituents of crude drugs, came investigations, both ex- 
 perimental and clinical, by which the actual physiological ac- 
 tion of such constituents on the living system was deter- 
 mined and their application in the treatment of diseases ren- 
 dered more exact and efficient. The important discoveries 
 concerning the functions of different parts of the brain and 
 nervous system opened the way for a more correct knowl- 
 edge of insanity and mental impairments, and thereby im- 
 proved that department of medical jurisprudence, and also 
 led to a better understanding of the nature of many previous- 
 ly obscure nervous affections, as may be seen by reference 
 to the work of John Abercrombie, of Edinburgh ; the Essay 
 on Shaking Palsy, by James Parkinson, 1817 ; and the papers 
 of William and Daniel Griffin, of Limerick, on Spinal Irrita- 
 tion, in 1834. 
 
 Notwithstanding the great activity and rapid progress 
 made in all the lines of original research to which allusion 
 has been made, there were no attempts to create new sys- 
 tems or universal theories of disease during the first half 
 of the ninteenth century. The three leading ones of the 
 latter part of the previous century, i. e., the Cullenian, the 
 Brunonian and Broussaian, culminated in their influence 
 before the end of the first quarter of the nineteenth, and 
 began to decline. As they were all based on the exclusive
 
 127 
 
 doctrine of solidism, with its susceptibility or irritability 
 and stimuli, and making the first step in disease irritation, 
 and the second inflammation with fever, their foundation 
 was being impaired by the rapidly accumulating facts 
 evolved by analytic investigations concerning the pathol- 
 ogy of the blood and secretions by Andral, Gavarret and 
 their followers, and by the microscopic demonstration of 
 living organized cells in the blood and their modification 
 in disease. Though the Brunonian system was sustained 
 by the eminent Benjamin Rush, of Philadelphia, and by 
 Samuel Jackson in his "Principles of Medicine", and by 
 others both in England and on the Continent of Europe, 
 the neurological pathology of Cullen maintained its 
 supremacy, as shown by the Treatise on Fevers, by South- 
 wood Smith in England and by the systematic works on 
 the "Practice of Medicine" by John Eberle, in 1829, and by 
 George B. Wood, in 1847; in all of which it is claimed that 
 the first link in the chain of morbid actions constituting 
 febrile affections is an irritative or morbid impression on 
 the nervous system. Practically, however, it made but lit- 
 tle difference whether attempts were made to trace all 
 morbid actions to primary impressions on the nerves, or 
 on the inherent irritability of all the tissues, the therapeutic 
 inferences led to the adoption of the general antiphlogistic 
 system of treatment for nearly all acute diseases, whether 
 general or local. The system consisted essentially in rest, 
 low diet, cooling applications, venesection or local bleed- 
 ing, cathartics, and sometimes emetics, in the first stage, 
 followed by sedative diaphoretics and diuretics, and mer- 
 curial alteratives, and in the later stages tonics and more 
 nourishing diet. It was at the climax of its popularity 
 during the first half of the nineteenth century, and like 
 all other general therapeutic systems, was carried to un- 
 reasonable extremes, especially in blood-letting, emeto- 
 cathartics and mercurials, by a small proportion of prac- 
 titioners. 
 
 The general adoption of Jennerian vaccination at the 
 beginning of the century effectually limited the destruc- 
 tion of human life by sweeping epidemics of small-pox ;
 
 128 
 
 and the rebuilding of London on a more sanitary basis 
 after its destruction by fire in 1666, and important sani- 
 tary improvements in and around Cairo in Egypt, and 
 most of the great cities of Europe, equally arrested the 
 further destructive prevalence of epidemics of the plague 
 in Europe, and greatly diminished those of typhus fever. 
 
 The most noted epidemic diseases of the first half of the 
 nineteenth century in Europe and America were cholera, in- 
 fluenza, yellow fever, diphtheria, erysipelas, and cerebro- 
 spinal meningitis. Erom 1817 to 1822 cholera prevailed se- 
 verely in India, China and the south parts of Asia. In 
 ■831 it was very severe and fatal throughout Europe, and 
 in 1832 it appeared in Canada and extended rapidly over the 
 United States. During the two following years it prevailed 
 in ]\Iexico and the West India Islands. In 1836-7 it visited 
 Central America and again s«.ourged the southern part of 
 Europe. It then disappeared from both Europe and Amer- 
 ica until in 1848 it revisited almost every country in Europe, 
 and in 1849 ^t was equally severe in America, where it con- 
 tinued to recur nearly every summer until 1854. Both ery- 
 sipelas and cerebro-spinal meningitis have been epidemic 
 in limited localities in many countries. But their most noted 
 and extensive prevalence during the first half of the nine- 
 teenth century was from 1841 to 1846, when they extended 
 over the greater part of the United States and some portions 
 of Europe. Influenza, in its true epidemic form, swept over 
 the greater part of Asia, Europe and America in 1807; 
 1831-3 and in 1847, attacking a greater proportion of the 
 whole population than any other epidemic of modern times, 
 but resulting in a less ratio of mortality. 
 
 Diphtheria prevailed in some parts of Europe from 1818 
 to 1 82 1, as described by Bretonneau, of Tours, and to a lim- 
 ited extent in this country in 1831, as described by Dr. John 
 Bell, of Philadelphia.
 
 129 
 
 CHAPTER X. 
 
 HISTORY OF MEDICINE DURING THE FIRST HALF OF THE NINE- 
 TEENTH CENTURY CONTINUED. 
 
 The Progress of Medical Education; the Organization of 
 Medical Societies, Local, State and National, and their 
 Influence on the Progress of Medical Science and Practice. 
 
 It has been shown in the preceding chapters that not un- 
 til during the last half of the eighteenth century did the three 
 primary divisions of medical practice become so far affiliated 
 and freed from the dominating influence of ecclesiastics, 
 barbers and uneducated midwives, as to be generally rec- 
 ognized as one profession. Consequently it was not until 
 the period just named that the medical schools in various 
 countries began to make adequate provision for full instruc- 
 tion in the Practice of Medicine, Surgery and Midwifery, 
 as well as in Chemistry, Anatomy, Physiology and Materia 
 Medica. And even down to the close of the first quarter 
 of the nineteenth century in a large majority of the medical 
 schools active instruction was given only half or three- 
 quarters of the calendar year. A large majority of students 
 looked for the larger part of their medical knowledge to 
 the books and instruction of private preceptors or practition- 
 ers, to whom many were indentured legally, the same as in 
 learning the mechanical trades. Many resorted to the med- 
 ical schools only for one collegiate year, and not a few 
 attended no medical college, but after serving the al- 
 lotted time as students, they entered upon the general 
 practice of medicine with no other credentials than the cer- 
 tificate of their preceptor. Only a minority of those en- 
 gaging in the study of medicine attended regularly some 
 medical school three or more years and graduated either as 
 bachelors or doctors of medicine. The proportion doing 
 so was greater on the continent of Europe. In Great Britain 
 perhaps as large a proportion of medical students attended 
 medical college instruction in schools connected with the
 
 130 
 
 leading hospitals of London, and with the universities of 
 Cambridge, Edinburgh, Glasgow and Dublin, but instead of 
 taking college or university degrees they were very gen- 
 erally examined and licensed by one of the royal colleges or- 
 ganized for that purpose. 
 
 In the United States of America at the beginning of the 
 nineteenth century only four medical colleges were in ex- 
 istence, i. e., one in Philadelphia ; one in New York ; one in 
 Boston ; and one in Hanover, N. H. They had all been or- 
 ganized as ]\Iedical Departments of Universities or general 
 collegiate institutions, and were known as the Medical 
 Schools of Pennsylvania University, of Columbia College, 
 N. Y., of Harvard College, j\Iass., and Dartmouth College, 
 N. H. The whole country was comparatively new, it hav- 
 ing been recognized as an independent people among the 
 nations of the earth less than twenty-five years. Its 5,000,- 
 000 of inhabitants were sparsely distributed over thirteen 
 states bordering on the Atlantic coast extending from IMaine 
 to Florida, with neither railroads nor even good wagon 
 roads to facilitate intercommunication of one State with 
 another. Consequently at the opening of the century an 
 aggregate of not more than one hundred and fifty medical 
 students were found in attendance at the four medical schools 
 then existing, and not more than thirty or forty graduated, 
 either as bachelors or doctors of medicine in any one year. 
 Yet it would not be correct to imply, as has been done by 
 some writers, that the country was then, or at any previous 
 part of its colonial history, destitute of fairly well educated 
 physicians and surgeons. For some such very generally 
 came with the immigrants both from Great Britain and the 
 continent of Europe, and, as explained in previous chapters, 
 not a few young men resorted to the University of Edin- 
 burgh and to the hospitals and schools of London and Paris. 
 
 Another source of valuable medical and surgical instruc- 
 tion for the American colonists was the almost constant 
 wars waged by Britain and France with each other and with 
 the Indian tribes in their American colonies ; and in which 
 the inhabitants of the colonies were compelled to take part. 
 In doing so they were brought in frequent contact with the
 
 131 
 
 members of the medical and surgical staffs of the English 
 and French armies operating in America. 
 
 Neither is it true that the very large proportion of prac- 
 titioners both in this country and in Europe, who depended 
 for their medical education entirely upon the books and in- 
 struction of their preceptors without ever entering either a 
 medical college or public hospital, were entirely destitute 
 of valuable clinical instruction, as has been often stated. On 
 the contrary such students almost from the beginning be- 
 came the constant assistants of their preceptors in all office 
 work, such as extracting teeth, venesection, dressing wounds, 
 and all varieties of minor surgical operations ; and in the 
 last half of their pupillage frequently accompanied their pre- 
 ceptors in their visits to important cases, or went as sub- 
 stitutes in cases of emergency. 
 
 From all the preceding circumstances and conditions the 
 impartial investigator will find that through all the last half 
 of the eighteenth and the first quarter of the nineteenth cen- 
 turies there was but little difference in the scientific attain- 
 ments, practical skill, and general professional standing of 
 the medical profession in this country and in Europe. It is 
 true that during the time under consideration there were in 
 all the countries many ignorant or only partially educated 
 practitioners ; many charlatans and bombastic pretenders, as 
 well as visionary theorists of every grade. 
 
 And is it not equally true, that now in the early years of 
 the twentieth century of the christian era, all these evils and 
 evil classes still exist throughout all the countries more or 
 less? For there is scarcely a pathy or ism or theoretical 
 dogma of the seventeenth and eighteenth centuries that does 
 not have its followers among us. The anti-vaccinationists, 
 the anti-vivisectionists, the Eddyites, the Dowieites, the Os- 
 teopaths, and those wearing the trade-mark of him who in- 
 vented the two, so-called, universal principles, i. e., "Similia 
 Similibus Curantur", and the greater the attenuation of the 
 dose the greater the curative power, still flourish on both 
 sides of the Atlantic Ocean. 
 
 But all this does not prove that true medical science and 
 art have not been progressing with increasing rapidity in
 
 132 
 
 all their departments ; for there is no garden so rich that it 
 does not have weeds, and no forest so stately that it does not 
 have its shrubs and parasites. 
 
 No sooner, however, had the several departments of med- 
 icine become united, and the medical schools prepared to 
 teach the whole, than an increasing disposition was mani- 
 fested to unite in forming society organizations for friendly 
 intercourse and mutual improvement. Many of these organ- 
 izations embraced not only the branches of medicine proper, 
 but also many of the collateral sciences. Before the begin- 
 ning of the nineteenth century the following societies, in 
 which medical men had more or less interest, had been or- 
 ganized in Europe and America : The Royal Colleges of 
 Physicians, Surgeons and Apothecaries, chiefly for the reg- 
 ulation of medical studies and the examining and licensing 
 of candidates for permission to engage in the practice of 
 medicine; the Royal Society of London for the promotion 
 of Science, in 1662; the Academy of Sciences in France, in 
 1665 ; the German Scientific and Medical Association at 
 Schweinfurst in 1652; the Medical Society of New Jersey 
 organized at New Brunswick, in 1766; the Massachusetts 
 State Medical Society, in 1781 ; the Connecticut State Med- 
 ical Society, (1792) and the New Hampshire Medical So- 
 ciety, in 1791 ; the Philadelphia College of Physicians, in 
 1787; and the Philadelphia Medical Society, in 1789. 
 
 The several societies enumerated were sanctioned by acts 
 of incorporation by the legislative bodies of the several coun- 
 tries or states in which they were located. Their avowed 
 objects were the promotion of friendly intercourse, the ad- 
 vancement of medical science, and the support of the useful- 
 ness and honor of the medical profession. Nearly all of 
 them are still in existence, and have proved true to the ob- 
 jects of their organization. 
 
 Perhaps the first of the society organizations in America 
 to commence the publication of a separate volume of transac- 
 tions was that of Massachusetts prior to 1800. It contained 
 papers by ten of its members, the most important of which 
 were : "An account of the weather and epidemics of Salem, 
 County of Essex, for the year 1786, with a bill of mortality
 
 133 
 
 for the same year," by Edward A. Holyoke, M. D. ; "A case 
 of Empyema successfully treated by an operation" by Dr. 
 Isaac Rand, in 1783; "Observations on Hydrocephalus In- 
 temus by operation" by Dr. Isaac Rand, Jr., in 1789; and 
 "An account of an aneurism of the thigh cured by an op- 
 eration and the use of the limb preserved" by Thomas Kast, 
 M. D., in 1790. Another volume was not published by the 
 same society until 1808. 
 
 In Great Britain the British Royal Society has regularly 
 published its "Philosophical Transactions" since 1665. 
 
 The Royal Medical Society of Edinburgh was founded 
 in 1737, and the Medical Society of London in 1773. 
 
 During the eighteenth century many so-called learned 
 societies were organized in France, Germany, Switzerland 
 and Italy, chiefly devoted to the consideration of strictly 
 scientific and philosophical subjects, but in the membership 
 of which were embraced many physicians. Perhaps the most 
 famous of these societies was the "Konigliche Academie" 
 formed by the union of two preceding societies by Fred- 
 erick the Great in 1744 at Berlin; and the Konigliche Gesell- 
 schaft der Wissenschaften zu Gottingen founded by the in- 
 fluence of Haller in 1751. 
 
 In France there were Societes Royales des Sciences of 
 Montpellier in 1706, of Bordeaux in 1714, of Lyons in 1724, 
 and Dijon in 1725. 
 
 In Switzerland, the "Gesellschaft der Artze und Natur- 
 forscher" of Basil in 1751, and the "Naturforschende 
 Gesellschaft" of Zurich, 1757, exerted much influence, as 
 did also the Imperial Russian Society of St. Petersburg, 
 1724; the Royal Swedish Academy of Stockholm, 1739; and 
 the Royal Danish Society at Copenhagen. 
 
 The formation of medical and scientific societies by which 
 members of the profession were frequently brought together 
 for the reading of papers, and for the discussion of questions 
 pertaining to both the science and practice of medicine, has 
 proved to be one of the most efficient agencies for the de- 
 velopment and diffusion of medical knowledge that we pos- 
 sess. 
 
 Coincident with the formation of scientific and medical
 
 134 
 
 societies and the publication of their transactions, came also 
 the printing of newspapers, magazines, and periodicals. The 
 first were generally published weekly and were devoted to 
 politics and miscellaneous news items ; the second were more 
 generally published monthly and devoted to literature and 
 art ; the third were published monthly or quarterly and were 
 more generally devoted to some departments of science or 
 medicine. The first weekly newspaper of which we have 
 any record was the London Weekly News, first issued May 
 23rd, 1622, and edited by Nathaniel Butters and Nicholas 
 Bourne. The next one to appear was "The Gazette de 
 France", May 30th, 1631. One of the early and most impor- 
 tant journals devoted to both medicine and scientific topics 
 generally was called "Der Arzt", issued in 1759, and was 
 continued twelve years under the management of Joh. Aug. 
 Unzer, an eminent physiologist and practising physician at 
 Hamburg. 
 
 A Journal devoted to Military Medicine and Surgery 
 was published in Paris, from 1782 to 1788. Some trawsla- 
 tions from this were published in New York in 1790. The 
 first original medical journal, however, published in America 
 was The Medical Repository, commenced in 1797 at New 
 York, and issued quarterly until 1824. It was ably edited 
 by Drs. Elihu H. Smith, Edward Miller, and Samuel L. 
 Mitchell. 
 
 No other medical periodical appeared in this country 
 until September, 1804, when the Philadelphia Medical Mu- 
 seum made its appearance, edited by Dr. John Redman 
 Coxe, followed one month later by the Philadelphia Med- 
 ical and Physical Journal, edited by Dr. Benj. Smith Barton. 
 
 These several journals, together with those established 
 in Europe during the last half of the eighteenth century, 
 called forth much talent hitherto dormant, by eliciting es- 
 says and papers from many of the more intelligent members 
 of the profession. in the several countries; by publishing the 
 proceedings of the medical societies ; and by affording a 
 free channel for dignified scientific discussions. Thereby 
 they became efficient auxiliaries to the medical colleges and
 
 '00 
 
 societies in the great work of medical education and ad- 
 vancement. 
 
 With the organization of medical societies and the fair 
 inauguration of a medical periodical press, there came more 
 general discussions concerning the necessity for appropriate 
 and just laws regarding the qualifications of physicians and 
 the preservation of the public health. 
 
 The few and very limited attempts to establish some 
 standard of qualifications for .those who should be permit- 
 ted to engage in the practice of medicine and surgery, made 
 during the Grecian, Roman and Arabian periods of medical 
 history, have been noticed in preceding chapters. But not 
 until the permanent establishment of the Royal College of 
 Physicians and Surgeons in Great Britain during the eight- 
 eenth century, and the more stable condition of the leading 
 Universities on the continent of Europe, did these several 
 institutions become invested with authority to examine all 
 parties desiring to commence the study of medicine, and to 
 grant permission to such only as possessed an academic or 
 good general education, including the natural sciences and 
 the Latin language. The same institutions were also in- 
 vested with authority to adopt a curriculum of medical 
 studies, generally extending over a period of four or five 
 years, with annual examinations in progress, and the final 
 granting of licenses or degrees to such as completed the 
 course satisfactorily. And none but those who received 
 such licenses or degrees were legally authorized to practise 
 medicine and surgery in the countries in which the licensing 
 institutions were located. 
 
 In the American colonies, prior to their declaration of 
 independence of Great Britain in 1776, but few laws were 
 enacted having for their object the regulation of medical ed- 
 ucation and practice. The earliest of such laws of which we 
 have any record related to the practice of midwifery, which 
 was almost exclusively in the hands of uneducated mid- 
 ' wives. In July, 1716, the legal authorities of New York 
 City adopted and proclaimed an ordinance as follows : 'Tt 
 is ordained that no woman within this corporation shall ex- 
 ercise the employment of midwife until she have taken oath
 
 136 
 
 before the mayor, recorder or an alderman to the following 
 effect: That she will be diligent and ready to help any 
 woman in labor, whether poor or rich ; that in time of ne- 
 cessity she will not forsake the poor woman and go to the 
 rich ; that she will not cause or suffer any woman to name 
 or put any other father to the child, but only him which is 
 the true father thereof, indeed, according to the utmost of 
 her power; that she will not suffer any woman to pretend 
 to be delivered of a child who is not, indeed, neither to claim 
 any other woman's child as her own ; that she will not suffer 
 any woman's child to be murdered or hurt ; and as often as 
 she shall see any peril or jeopardy, either in the mother or 
 child, she will call in other midwives for council ; that she 
 will not administer any medicine to produce miscarriage; 
 that she will not enforce a woman to give more for services 
 than is right ; that she will not collude to keep secret the birth 
 of a child; will be of good behavior; and will not conceal 
 the birth of bastards." (Baas.) 
 
 Such an ordinance sufficiently indicates the condition of 
 midwifery practice in the early part of the eighteenth cen- 
 tury. 
 
 So far as is known, the first male physicians known to 
 have engaged in the practice of obstetrics in this country 
 were Dr. John Moultrie, a Scotchman, who settled in 
 Charleston, S. C, in 1733; Dr. John Dupuy, of New York, 
 whose death was announced with regret in the N. Y. Weekly 
 Post Boy, July 22nd, 1745 ; and Dr. James Lloyd, a pupil of 
 William Hunter and Smellie, who commenced practice in 
 Boston in 1752. And as has been stated in a previous chap- 
 ter, Dr. William Shippen, Jr., of Philadelphia, was the first 
 to give a course of lectures on Obstetrics, and Dr. John V. 
 B. Tennant, of New York, the first to receive the appoint- 
 ment of full professor of midwifery, which was in the Med- 
 ical Department of Kings College, N. Y., in 1767. 
 
 The first law for regulating the practice of medicine and 
 surger\' was enacted by the General Assembly of New York 
 in 1760, as follows : "No person whatsoever shall practise 
 as physician or surgeon in the City of New York before he 
 shall have been examined in physic and surgery, and ap-
 
 137 
 
 proved of and admitted by one of his Majesty's Council, 
 the Judges of the Supreme Court, the King's Attorney Gen- 
 eral, and the Mayor of the City of New York for the time 
 being, or by any three or more of them, taking to their as- 
 sistance for such examination such proper person or per- 
 sons, as they in their discretion shall see fit." A penalty of 
 five pounds was prescribed for all violations of the law ; but 
 its operation was limited to the City of New York. In 1772 
 a similar law was enacted by the Colony of New Jersey. 
 
 The law of 1760 in New York remained substantially 
 the same until it was superseded by an Act of Legislature of 
 that State passed in 1797, which prohibited all persons from 
 practising physic or surger}^ in that state without a license 
 from one or more of the officers named in the law of 1760, 
 under a penalty of $25 for each offense. The period re- 
 quired for medical study was made four years, with a de- 
 duction of one year in favor of those who had graduated at 
 a literary college. Each candidate was also required to fur- 
 nish the examining officers with a certificate of the time he 
 had studied, verified by the oath of his preceptor; and his 
 license was to be filed in the office of the Clerk of the County 
 in which he commenced practice. Students who had re- 
 ceived the degree of bachelor or doctor of medicine from 
 a medical college were permitted to practise on filing a copy 
 of their diploma without further examination. 
 
 The medical society that had existed in New Jersey since 
 1766 was incorporated by an Act of the Legislature of that 
 State in 1790, under the name of the Medical Society of the 
 State of New Jersey. By the Act of incorporation that 
 State Society was authorized to appoint censors to examine 
 and license candidates for permission to practise medicine 
 in that state. The terms of study required, and all the reg- 
 ulations adopted, were much the same as those prescribed 
 in the New York law of 1797. The New Jersey law also 
 authorized the formation of district or county societies whose 
 delegates were to constitute the State Society. 
 
 The Medical Society of the State of South Carolina was 
 incorporated by the Legislature in 1797, but no provision 
 was made for examining persons for license to practise.
 
 138 
 
 In 1/99 ^^ "Medical Chirurgical Faculty of the State 
 of Maryland" was incorporated by the State Legislature, 
 and given power to elect by ballot twelve persons of the 
 greatest medical and chirurgical abilities in the State," who 
 shall be styled the ]\Iedical Board of Examiners for the 
 State of Maryland." It was made the duty of said Board 
 "to grant licenses to such medical and chirurgical gentlemen 
 as they either by examination or upon the production of di- 
 plomas from some respectable medical college, may judge 
 adequate to commence the practice of the medical and chirur- 
 gical arts." By a supplementary act of the legislature passed 
 in 1801, the State Board of Examiners required all persons 
 proposing to practise in the State, whether graduates of 
 medical colleges or not, to appply for a license before com- 
 mencing practice; and all who were licensed by the Board 
 were by virtue of such license made members of the State 
 Society. A penalty of fifty dollars was imposed for each 
 violation of the foregoing provisions, to be collected in the 
 County Court where the offender might reside. 
 
 It is thus seen that Maryland was not only one of the 
 earlier states to enact laws for the protection of her citizens 
 against the inroads of ignorance and empiricism, but also 
 that her laws relating to the subject were the most simple 
 and effectual. 
 
 By the foregoing details it appears that six of the orig- 
 inal thirteen states had recognized their right and duty to 
 legislate on the subjects of medical education and practice 
 during the first twenty years after the achievement of their 
 independence. The union of all legitimate branches of med- 
 ical science and practice in one profession with fairly well 
 established medical schools ; the organization of medical so- 
 cieties for mutual improvement arid the free discussion of 
 all medical subjects ; and the initial development of a med- 
 ical periodical press, were the important agencies that at the 
 beginning of the nineteenth century greatly increased the 
 rapidity of progress in all that relates to the advancement 
 of medicine and its application to the various interests of hu- 
 man society. These several agencies having acquired only 
 an initial beginning with the commencement of the nine-
 
 139 
 
 teenth century, have since increased in extent and influence 
 with a rapidity difficult to appreciate. On the 9th of April, 
 1806, the Legislature of the State of New York passed a law 
 authorizing "the legally qualified physicians and surgeons 
 of each county to form themselves into a society, named after 
 the county in which it was formed, with power to choose 
 officers, make all needful rules for the government of its 
 members, and appoint a board of censors to examine and 
 license all the applicants for admission into the profession 
 in their respective counties. But no one could be admitted 
 to an examination until he had given evidence of having 
 studied three years with some practitioner, and had arrived 
 to the age of twenty-one years." (See History of Medical 
 Education, etc., by N. S. Davis, 1851). The law also pro- 
 vided for the formation of a State Medical Society, com- 
 posed of delegates from each County Society, and permanent 
 members not exceeding two each year chosen by the society 
 in annual session in Albany. 
 
 The State Society was required to divide the State into 
 four medical districts, and appoint a board of censors in 
 each, whose duty was to examine all applicants for license to 
 practise medicine and surgery after having studied at least 
 three years. The law forbids any one to enter the medical 
 profession or to practise medicine or surgery without first 
 having procured a license from a County or State Society 
 or a diploma from an organized medical college. County 
 Societies were quickly organized in nearly every county in 
 the State ; and the State Society held its first meeting at the 
 capital in Albany in February, 1807, when its organization 
 was completed. 
 
 Two very important objects were accomplished by the 
 foregoing law, i. e., a thorough organization of the pro- 
 fession throughout the State in a manner most favorable for 
 its advancement; and the examination of all candidates for 
 admission by practitioners of medicine without the interven- 
 tion of any other class. The enactment of the law in New 
 York was largely owing to the influence of Dr. John Stearns, 
 of Saratoga County, Dr. Alexander Sheldon, of Montgom- 
 ery County, and Hon. Wm. W. Van Ness, all of whom were
 
 140 
 
 members of the Legislature at the time. Important amend- 
 ments to the law were enacted in 1818 and in 1827, by which 
 the term of medical study was extended to four years with 
 the privilege of deducting one year in behalf of such stu- 
 dents as had pursued classical studies one year after the age 
 of sixteen years, or had attended one full annual course of 
 medical college instruction. And no person was permitted 
 to receive the degree of doctor of medicine from the Regents 
 of the University of the State, unless he had studied medi- 
 cine at least three years with some respectable practitioner, 
 and had attended two full annual courses of medical college 
 instruction in an incorporated medical college. 
 
 The example of New York was followed by the Legisla- 
 tures of other states until prior to 1850 nearly every state 
 in the Union had laws providing for City, County, District 
 and State Medical Societies, and more or less for the protec- 
 tion of the people from the effects of imposition and igno- 
 rance on the part of those attempting to practise medicine. 
 Though the laws of the several states were very defective in 
 regard to protection of the people against ignorant and il- 
 legal practice, yet the frequent contact of members of the 
 profession with each other in the County and State Societies 
 where they were occupied in the reading of papers, the re- 
 lation of cases, and the discussion of topics connected with 
 the prevalence and treatment of diseases in their own locali- 
 ties, soon led them to a more thorough knowledge of each 
 other, and the adoption of by-laws and correct ethical rules 
 for their mutual government and private intercourse. Many 
 of the papers and public addresses found their way into the 
 m.edical periodicals or into the annual volumes of transac- 
 tions of the State Societies. 
 
 Probably the most important medical society organiza- 
 tion effected in Eyrope during the first half of the nineteenth 
 century, was the "Provincial ^vledical and Surgical Associa- 
 tion", organized at Worcester, England, July, 1832. It was 
 effected by an assembly of about fifty medical men from 
 leading provincial towns in the south part of England under 
 the able leadership of Dr. Charles Hastings, of Worcester. 
 The avowed objects of the Association were the cultivation
 
 141 
 
 of friendly intercourse, mutual improvement and the ad- 
 vancement of medical science. At its second meeting, 1833, 
 its membership numbered one hundred and forty. Its meet- 
 ings were held annually in some one of the provincial towns, 
 and were attended by a steadily increasing membership, giv- 
 ing rise to the publication of an annual volume of transac- 
 tions containing many papers that attracted wide attention. 
 
 It was to the annual meeting of this Association in 1842 
 that Justus Liebig presented his celebrated paper on "Or- 
 ganic Chemistry in its relations to Physiology and Patholo- 
 gy", described in a preceding chapter. Under the judicious 
 leadership of Dr. Hastings (afterwards Sir Charles Hast- 
 ings) the Association continued to prosper until 1856, when 
 its plan of organization was extended by provision for the 
 organization of branches in all parts of the Kingdom, en- 
 titled to representation in the annual meetings, and its name 
 was changed to that of British Medical Association. It was 
 thus changed from a strictly provincial to a national organ- 
 ization, and has since become one of the largest and most 
 influential medical associations in the world. 
 
 By the union of the several American states under a 
 written constitution, making them one nation, all matters 
 pertaining to education were left to the regulation of the in- 
 dividual states. Consequently while the Legislatures of the 
 several states granted acts of incorporation to County and 
 State Medical Societies with power to appoint censors to 
 examine candidates for permission to practise medicine, as 
 has been previously stated, they also granted charters for 
 new medical colleges as often as they were requested by am- 
 bitious members of the profession. Such charters usually 
 placed no restrictions upon the colleges, except the require- 
 ment of three years of medical study and attendance upon 
 two annual terms of college instruction before graduation as 
 doctors of medicine. 
 
 Each medical college was permitted to regulate its own 
 curriculum of studies, the length of its annual courses of in- 
 struction, and its fees. Nearly all of them were without pe- 
 cuniary endowments and consequently dependent upon the 
 fees of students for their support. This led rapidly to an
 
 142 
 
 active competition for students not based on an effort to see 
 which colleges should give the most full and systematic 
 courses of instruction, but rather which could confer the 
 degree of doctor of medicine at the least cost to the students 
 in time and money. 
 
 The college degree of M. D., being almost everywhere 
 accepted as authority to practise without other examina- 
 tions, the college that offered to confer it after attendance 
 on the shortest annual courses of instruction and the lowest 
 college fees could generally draw the largest class. 
 
 Under these conditions and tendencies the annual courses 
 of medical college instruction were progressively shortened 
 from six months as required by the first colleges in Phila- 
 delphia and New York, prior to 1800, to sixteen weeks or 
 less ; all semblance of a requirement of suitable prelim- 
 inary education was omitted ; and before the middle of the 
 century had been reached the number of medical colleges 
 had increased from four to forty, and the annual aggregate 
 number of medical graduates from fifteen to more than one 
 thousand. By nominally studying medicine three years, in- 
 cluding two annual repetitional courses of medical college 
 instruction of less than four months each, the student could 
 obtain a diploma entitling him to practise, which was easier 
 and more economical than to study with a preceptor four 
 years and pass an examination by the censors of a County 
 or State Society. 
 
 The foregoing conditions concerning medical education 
 and institutions in the United States during the first half 
 of the nineteenth century were severely criticised by leading 
 members of the profession both in medical societies and in 
 the medical periodicals. At the annual meeting of the New 
 York State Medical Society in February, 1844, I, then a 
 young delegate from the Broome County Medical Society, 
 presented a series of resolutions "declaring in favor of the 
 adoption of a fair standard of general education for stu- 
 dents before commencing the study of medicine ; of length- 
 ening the annual courses of medical college instruction to at 
 least six months with the grading of the curriculum of 
 studies ; and of having all examinations for license to prac-
 
 143 
 
 tise medicine conducted by State Boards, independent of the 
 colleges." After a brief discussion the resolutions were 
 laid on the table until the next annual meeting of the so- 
 ciety, and copies of them ordered sent to the several County 
 Medical Societies in that State, and to the medical period- 
 icals. At the next annual meeting, 1845, the resolutions 
 were taken from the table and during a free discussion it 
 was urged with much force that the requirements of a fair 
 standard of education before commencing medical studies, 
 a longer annual college term with proper grading of the 
 curriculum, and independent examinations for license to 
 practise in New York State alone, would only cause the stu- 
 dents to abandon her colleges for those of Pennsylvania or 
 the New England states. 
 
 This caused the original mover of the resolutions to 
 offer the following preamble and resolutions : 
 
 "Whereas, it is believed that a National Convention 
 would be conducive to the elevation of the standard of med- 
 ical education in the United States, and 
 
 "Whereas, there is no mode of accomplishing so desirable 
 an object without concert of action on the part of the med- 
 ical societies, colleges^ and institutions of all the states, there- 
 fore 
 
 "Resolved, That the New York State Medical Society 
 earnestly recommends a National Convention of delegates 
 from medical societies and colleges in the whole Union, to 
 convene in the City of New York on the first Tuesday in 
 May, 1846, for the purpose of adopting some concerted ac- 
 tion on the subject set forth in the foregoing preamble. 
 
 "Resolved, That a committee of three be appointed to 
 carry the foregoing resolution into effect." 
 
 The preamble and resolutions were adopted and the 
 committee appointed with the mover for chairman. By dili- 
 gent correspondence and discussions in the medical press, 
 before the time for which the convention had been called ar- 
 rived, a convention of delegates representing a large major- 
 ity of the medical societies and colleges of all the States of 
 the Union assembled in New York, May 5th, 1846. The
 
 144 
 
 duly accredited delegates in attendance numbered about one 
 hundred. 
 
 Dr. Jonathan Knight, of New Haven, Ct., was elected 
 President and Dr. Richard D. Arnold, of Savannah, Ga., 
 and Dr. Alfred Stille, of Philadelphia, Pa., Secretaries. The 
 six following propositions were fairly discussed and adopted 
 during the two days the convention remained in session, 
 viz. : 
 
 1. That it is expedient for the medical profession of 
 the United States to institute a National Medical Association. 
 
 2. That it is desirable that a uniform and elevated stand- 
 ard of requirements for the degree of AI. D. should be adopt- 
 ed by all the medical schools in the United States. 
 
 3. That it is desirable that young men, before being re- 
 ceived as students of medicine, should have acquired a suit- 
 able preliminary education. 
 
 4. That it is expedient that the medical profession of 
 the United States should be governed by the same code of 
 Medical Ethics. 
 
 5. That all licenses to practise medicine should be conr 
 ferred by a single Board of Medical Examiners in each State. 
 
 6. That suitable laws should be enacted in each State 
 for the registration of births, marriages and deaths, and the 
 adoption of a nomenclature of diseases.
 
 145 
 
 CHAPTER XL 
 
 THE PROGRESS AND INFLUENCE OF MEDICAL SOCIETY ORGAN- 
 IZATIONS continued; their influence on the PROG- 
 RESS OF medical education, AND ON THE SUBSTITUTION 
 OF DIRECT CLINICAL AND EXPERIMENTAL INVESTIGATIONS 
 IN ALL DEPARTMENTS OF MEDICINE, INSTEAD OF THEORIZ- 
 ING AND MEDICAL SYSTEM BUILDING, DURING THE LAST 
 HALF OF THE NINETEENTH CENTURY. 
 
 In the closing part of the preceding chapter attention 
 was directed to the origin and formation of the American 
 Medical Association which was completed in May, 1847, 
 at Philadelphia, by a convention of representatives from a 
 large majority of the permanently organized Medical So- 
 cieties, Medical Colleges, Hospitals and Asylums then exist- 
 ing in the United States of America. It was organized as 
 a strictly representative body, admitting one delegate for 
 every ten resident members of the State, County and District 
 Medical Societies, two delegates from each regular Medical 
 College, two from the Medical Corps of the Army and the 
 Navy, and one from the Medical Staff of each permanent 
 Hospital and Asylum in the several States. It was therefore 
 a truly representative national organization of the profes- 
 sion, and the first of its kind in any country. The Pro- 
 vincial Medical and Surgical Association, which was or- 
 ganized at Worcester, England, in July, 1832, as stated in 
 the preceding chapter, was not reorganized on a national 
 basis under the name of British Medical Association until 
 1856. The important purposes for which the American 
 Medical Association was organized were declared to be "for 
 cultivating and advancing medical knowledge ; for elevating 
 the standard of medical education ; for promoting the use- 
 fulness, honor and interests of the medical profession ; for 
 enlightening and directing public opinion in regard to the 
 duties, responsibilities and requirements of medical men; 
 for exciting and encouraging emulation and concert of ac-
 
 146 
 
 tion in the profession; and for facilitating and fostering 
 friendly intercourse between those engaged in it." 
 
 The first President of the Association was Dr. Nathaniel 
 Chapman, of Philadelphia, Professor of Practical Medicine 
 in the Medical Department of the Pennsylvania University. 
 
 The Constitution, By-laws, Code of Ethics and Nomen- 
 clature of Diseases devised by the Convention were adopted 
 by the Association, and in accordance therewith standing 
 committees were appointed to consider and report at the next 
 annual meeting on Medical Sciences ; Practical Medicine ; 
 Surgery; Obstetrics; ]\Iedical Education; and on Medical 
 Literature. 
 
 The next meeting was held in Baltimore, May, 1848, 
 and able reports were made by all the standing committees, 
 which, after discussion, were referred for publication in 
 the annual volume of transactions of the Association. The 
 report on medical education elicited much discussion and 
 ended in the adoption of resolutions earnestly recommend- 
 ing a fair standard of academic or general education before 
 commencing to study medicine ; longer annual courses of 
 medical college instruction, and a systematic grading of the 
 curriculum of medical studies. 
 
 The reports on medical sciences and on practical medi- 
 cine also turned much attention to the investigation of epi- 
 demic diseases and to sanitary measures for their preven- 
 tion. 
 
 The Association continued to hold its annual meetings 
 successively in the larger cities of the different sections of 
 the country with entire regularity, except the two first years 
 of the civil war, 1861 and 1862, resulting in infusing new 
 life and activity into all the state and local medical so- 
 cieties already existing, and promoting the organization of 
 new societies in states and counties where none had ex- 
 isted before. The increased attention given to the subject 
 of aetiology and preventive medicine in a few years led to the 
 organization of the American Public Health Association, 
 and to the formation of a National Association of the Med- 
 ical Superintendents of Asylums for the Insane. 
 
 The persistent demand for a higher standard of medical
 
 147 
 
 education and a more systematic arrangement of studies in 
 the medical schools, at each annual rheeting of the American 
 Medical Association, finally resulted in the holding of a 
 convention of delegates from a large majority of the med- 
 ical colleges in the United States at Cincinnati, Ohio, in 
 1867. After three days of free and friendly discussion, the 
 convention adopted, with considerable unanimity, resolutions 
 declaring that a fair preliminary education equal to a full 
 academic or high school course ought to be required of all 
 students before entering upon the study of medicine ; and 
 that the time of medical study should be four years, in- 
 cluding at least three consecutive annual courses of graded 
 medical college instruction of not less than six months each, 
 with hospital clinical instruction during the last college year. 
 
 Moderate and reasonable as were these requirements 
 only one medical school in the country was actually carry- 
 ing them into efifect at that time. That was the Chicago 
 Medical College, now known as the Northwestern Univer- 
 sity Medical School, which was founded in 1859 o^ the prin- 
 ciples recommended for all medical schools by the college 
 convention of 1867. The next medical school that adopted 
 the more complete system of medical instruction recom- 
 mended by the college convention was that of Harvard, in 
 Boston, 1872. Pennsylvania University soon followed, and 
 the continued discussions in the medical societies, both state 
 and national, and in the medical periodicals, finally developed 
 a public sentiment that caused the establishment of state and 
 local boards of health and examination, both for the better 
 protection of the people against the spread of contagious dis- 
 eases and against the admission of unqualified persons to the 
 practise of medicine in any of its departments. 
 
 So effectual were the foregoing influences that before the 
 close of the nineteenth century the requirement of a fair 
 academic general education before commencing the study of 
 medicine ; four years of medical study, including attendance 
 on four consecutive or graded courses of medical college in- 
 struction of not less than six months each, with ample lab- 
 oratory and clinical work as essential parts of each course.
 
 148 
 
 had become the established system of medical education 
 throughout the United States of America. 
 
 The same influences were also potent in establishing more 
 accurate clinical and experimental investigations concerning 
 the causes of disease and the operation of medicine. The 
 opportunities alTorded for the reading of papers at the meet- 
 ings of medical societies, their discussion and subsequent 
 publication, was a constant stimulus to the more thoughtful 
 and industrious members of the profession, which was often 
 given direction by the offering of prizes for the best essays 
 embodying the results of original investigations, and the 
 appointment of committees to report on the prevailing epi- 
 demic and zymotic diseases, and on the sanitary measures 
 required for the improvement of the public health. 
 
 So manifest were the advantages derived from the more 
 extensive medical organizations, that the successful progress 
 of the British and American Medical Associations was soon 
 followed by the formation of a triennial International Med- 
 ical Congress, which has brought into the most fraternal and 
 scientific relations the members of the medical profession of 
 all countries. 
 
 The rapid and important advancements made during the 
 first half of the nineteenth century in pathological anatomy, 
 physical diagnosis and organic chemistry, as detailed in a 
 previous chapter, and the more perfect construction of micro- 
 scopes in 1832, prepared the way for equally rapid advance- 
 ments in the chemistry of foods and their assimilation or 
 uses in the living body ; in embryology and histology or mi- 
 nute anatomy, both normal and pathological ; and in aetiolo- 
 g}^ especially as connected with bacteriolog>' and the for- 
 mation of toxic and antitoxic products in the progress of 
 diseases. 
 
 The sweeping and plausible classification of all food 
 substances into nitrogenous, or proteid, and non-nitrogenous, 
 or carbonaceous, by Baron Liebig, the chief founder of or- 
 ganic and physiological chemistry, and the division of all 
 animal tissues into nitrogenous and fatty or carbonaceous, 
 gave rise to the purely theoretical assumption that only the 
 nitrogenous food elements were assimilated and used for
 
 149 
 
 the growth and repair of the organized structures, while 
 the carbonaceous were used for the maintenance of animal 
 heat by union with the oxygen furnished by respiration. 
 At first, the union of the carbonaceous food elements with 
 oxygen, resulting in the formation of carbonic acid and 
 water with the evolution of heat, was thought to take place , 
 directly in the pulmonary capillaries. Hence they were 
 called supporters of respiration and of animal heat; and 
 various theories were invented to account for the equal dis- 
 tribution of the heat to all parts of the system. However, 
 more accurate analyses of the blood in different parts of the 
 living body and from both veins and arteries soon demon- 
 strated the fact that instead of combustion or oxidation tak- 
 ing place in the lungs the blood currents passing the pul- 
 monary capillaries simply imbibed the oxygen from the air 
 cells and conveyed it free to the systematic capillaries in the 
 various structures of the body, and the carbonic acid sus- 
 pended in the venous blood passed into the air cells and was 
 exhaled with the expired air. The supposed combustion or 
 union of oxygen with the carbonaceous food elements and 
 evolution of heat was thus transferred from the pulmonary 
 to the systematic capillaries. But this did not diminish the 
 general confidence of the public in the chemical theory that 
 these elements were used in the living body only as support- 
 ers of combustion for the evolution of heat, by uniting with 
 the free oxygen in the arterial blood, and leaving as material 
 products carbonic acid and water. The chief elements com- 
 posing this class of foods, as arranged by Liebig, were 
 starch, sugar or glucose, gum, fat or oils, and alcohol as it 
 exists in fermented and distilled liquors. 
 
 The four first named were well known products of vege- 
 table and animal growth, constituting a large part of the 
 cereal grains, tuberous roots, and many kinds of fruit; but 
 the fifth — alcohol — though composed of the same three ele- 
 ments, carbon, hydrogen and oxygen, instead of being a 
 product of vegetable or animal growth was well known to 
 be a product of destructive fermentation, i. e., a bacteriolog- 
 ical excretion, and capable of producing very different ef- 
 fects on the human body than by any other recognized ele-
 
 150 
 
 ment of food. While the placing of alcohol at the head of 
 
 the class of carbonaceous foods by Liebig greatly encour- 
 aged its popular use in all the countries of Europe and 
 America, its correctness was challenged by several men 
 eminent in the departments of chemistry and physiolog)\ 
 It was soon demonstrated by the experiments of AOI. 
 Tiedemann and Gmelin, Bouchardat and Sandras, John Per- 
 cy, Christison and others, that when alcohol was taken into 
 the stomach diluted as in fermented and distilled liquors, it 
 was directly absorbed by the portal veins unchanged and 
 passing through the liver and lungs was speedily detected 
 in the arterial blood, the liver, lungs and brain, and in the 
 urine and exhaled breath. They found none, however, either 
 in the lacteals, the chyle or in the thoracic duct. 
 
 Sir Benj. Brodie found it was readily absorbed and 
 produced its usual effects after the thoracic duct had been 
 tied; and Dr. Prout, of London, clearly showed that while 
 it was present in the blood the amount of carbonic acid or 
 carbon dioxide in the air exhaled from the lungs was no- 
 tably diminished. And Bocker, of Germany, demonstrated 
 by a patiently executed series of experiments that the pres- 
 ence of alcohol in the living body diminished the sum total 
 of excretions and eliminations therefrom. 
 
 Notwithstanding all these evidences that the behavior 
 of alcohol in the digestive organs was wholly unlike that of 
 any other known food, either carbonaceous or nitrogenous, 
 and that its presence in the blood diminished both the ex- 
 halation of carbon dioxide and tissue metabolism, they were 
 given but little attention, and alcohol was continued at the 
 head of the list of heat and strength producing foods by 
 nearly all contributors to medical and general literature. 
 And almost every family was induced to keep on hand some 
 kind of alcoholic liquor, if not for daily use yet to meet the 
 emergencies of exposures to cold or wet or excessive fa- 
 tigue or special weakness from any cause. Consequently 
 faith in the power of alcohol to warm and strengthen the 
 living body became thoroughly fixed in the popular mind ; 
 and all of its evil effects were attributed to its abuse. In 
 other words, it was claimed by Liebig and his chemiccv-phys-
 
 ^51 
 
 iological folowers, that alcohol in moderate doses was a true 
 strengthening and heat-producing food, and became an an- 
 aesthetic or paralyzing agent only when taken in large doses. 
 The same physiological distinction between the influence 
 of small, or moderate, and large doses was soon extended to 
 nearly all known anaesthetic and narcotic drugs ; thus intro- 
 ducing into all our works on therapeutics and practical med- 
 icine the paradox in drug action, viz., that in moderate doses 
 they were stimulating, supporting and warming and in larger 
 doses, sedative, narcotic and paralyzing. 
 
 Being dissatisfied with this alleged antagonistic action of 
 small and large doses of the same drugs, and wholly unable 
 to reconcile the doctrine of Liebig concerning the entire 
 separate action and uses of the nitrogenous and carbonaceous 
 classes of food, either with the results of investigations al- 
 ready mentioned or with the well known facts that AVhole 
 classes of people in different countries lived almost wholly 
 on carbonaceous foods and yet were robust and strong, and 
 that laboring men who took daily a regular ration of alco- 
 holic drink accomplished less work and suffered more from 
 sickness than total abstainers working side by side with 
 them, (see brick-makers work in British and Foreign Med- 
 ico-Chinirgical Review for Oct., 1847), ^ decided to in- 
 stitute further experimental investigations, for the purpose 
 of determining more reliably the sources of animal heat in 
 conditions of health. 
 
 For this purpose during the years 1849 and 1850 I de- 
 vised and executed five series of experiments. The first was 
 for determining the actual variations in the temperature of 
 the body during the 24 hours while taking an ordi- 
 nary mixed diet and the usual exercise, and the coinci- 
 dent variations in the pulse and amount of exhaled carbon 
 dioxide. During two weeks the temperature, as indicated 
 by a delicately graduated thermometer bulb under the 
 tongue, was recorded six times each day, i. e., at 7 :30 A. j\I., 
 before breakfast; at 10: A. M., two hours after breakfast; 
 at 12:30 P. M., before dinner; at 3. P. M., two and a half 
 hours after dinner; at 5:30 P. M., before supper; and at 
 8. P. M., two hours after supper. At the same hours a rec-
 
 152 
 
 Orel was made of the proportion of carbon dioxide in the 
 exhaled air. The records of each day uniformly showed 
 the lowest temperature at 7 130 A. M., after the long fast of 
 the night, an increase of about 2^ F. during the two hours 
 after breakfast ; then a gradual decline until after dinner, 
 when it increased again, attaining the highest temperature 
 at 3. P. i\I., two hours after dinner; then receding slowly 
 until the supper, when another but less degree of rise took 
 place; thus showing that in a strictly healthy condition, and 
 on an ordinary mixed diet of animal and vegetable food, 
 the temperature of the human body uniformly rises from 
 I"' F. to 2^ F. during the period of active digestion and as- 
 similation of food and returns to the minimum during fast- 
 ing. The same records, however, showed that the varia- 
 tions in the quantity of carbon dioxide exhaled from the 
 lungs were not parallel with the variations of temperature ; 
 the greatest amount exhaled daily being from 3. P. M. to 
 6. P. ]\I., then decreasing slowly until 10 A. M. 
 
 Having thus ascertained the actual temperature and the 
 ratio of carbon dioxide in the exhaled air and their daily 
 variations under an ordinary mixed diet, the same indi- 
 vidual made the same observations and records with the 
 same instruments during three consecutive days on a diet 
 exclusively carbonaceous, consisting of starch and white 
 sugar. Then after living on the usual mixed diet one week, 
 the same observations and records were made with the same 
 appliances during three days on a diet exclusively nitro- 
 genous, consisting of tg% albumen carefully separated from 
 the yolk. 
 
 The records of both these series of observations showed 
 the same increase of temperature during active digestion 
 after each meal as had been recorded under a mixed diet. 
 The only difference was that the temperature rose more 
 rapidly after each meal of starch and sugar, and slower after 
 the meals of albumen, plainly on account of the more rapid 
 digestion of the carbonaceous food, for the average daily 
 temperature under the exclusively carbonaceous diet was 
 .5^ F. lower than under either the mixed or exclusive proteid 
 food.
 
 153 
 
 The fourth series of observations and records were made 
 to determine the effects of alcohol on the temperature, pulse 
 rate, and exhaled carbon dioxide. To prevent the results 
 from being complicated by the coincident action of other 
 food the time chosen for commencing the experiments with 
 alcohol was nine o'clock in the evening, three hours after 
 the evening meal. After noting the temperature, pulse rate, 
 and the ratio of carbon dioxide exhaled, four ounces of 
 brandy were taken at once diluted with water. In less than 
 fifteen minutes a sense of heat was felt in the stomach and 
 face, with a feeling of mental exhilaration and less con- 
 sciousness of external impressions and at the end of one 
 hour the temperature was not" appreciably altered, the pulse 
 had increased five beats per minute, and the amount of car- 
 bon dioxide being exhaled had diminished. At the end of 
 two hours the temperature had diminished .2^ F., the pulse 
 had returned to its natural frequency, and the ratio of carbon 
 exhaled was still less than at the beginning. 
 
 At the end of three hours the temperature had fallen 
 .50 F., while the pulse and ratio of exhaled carbon had re- 
 turned to the natural standard before the brandy was taken, 
 but the benumbing effect on the brain, mental faculties, and 
 voluntary muscular movements was still obvious, 
 
 A few evenings later the experiment was repeated with 
 about the same quantity of alcohol in the form of port wine, 
 and with the same results in all respects. 
 
 The foregoing records, so far as they relate to temporary 
 increased frequency of pulse and diminished exhalation of 
 carbon dioxide, are in strict accord with those previously 
 recorded by Front, Bouchardat and Sandras, but they con- 
 stituted the first clear demonstration that the presence of 
 alcohol in the human body reduced the temperature, and 
 lessened the sensibility of the nervous structures generally; 
 effects entirely different from those obtained from the tak- 
 ing of any other known food, either carbonaceous or proteid. 
 
 The fifth experimental inquiry related to the origin and 
 uses of the fibrin of the blood, which up to that time, 1850, 
 had been universally regarded as the most perfectly assim- 
 ilated constituent and used for the growth and repair of the
 
 154 
 
 fibrous and muscular structures of the body. Yet the nu- 
 merous analyses of blood by Andral, Gavaret, Rodier, Si- 
 mon and others, had shown that the relative proportion of 
 fibrin was greatest during the progress of acute inflamma- 
 tions, when digestion and assimilation were much dimin- 
 ished ; in protracted anaemia ; and even in the advanced stage 
 of pulmonary tuberculosis when emaciation was progressing 
 most rapidly. 
 
 These facts were inconsistent with the claim that the 
 fibrin was a direct product of food assimilation, and sug- 
 gested the inquiry whether it might not be a product of ret- 
 rograde tissue metabolism. Indeed, Simon had suggested 
 that the fibrin was derived from the disintegration of the 
 red corpuscles and in his work on the "Chemistry of Man" 
 page 139, he gives the results of analyses of the blood from 
 the aorta, and from the renal and hepatic veins of a horse, 
 showing very marked diminution of the fibrin in the blood 
 returning from the actively excreting organs. It was stated, 
 however, that the horse was not in a healthy condition and 
 the amount of blood from the renal vein not sufficient for a 
 satisfactory analysis. Regarding the question as important, 
 I secured an ample supply of blood from the iliac artery, the 
 iliac vein, and the renal vein of a healthy dog and subjected 
 each specimen to a careful analysis by which it was shown 
 that the blood in the iliac vein contained notably more fibrin 
 than that from the artery, while that from the renal vein con- 
 tained very much less, thereby showing clearly that the 
 blood while passing through a muscular and non-secreting 
 structure gained in its proportion of fibrin, and the reverse 
 in passing through an actively excreting organ. 
 
 The results of all the foregoing series of experimental 
 investigations were embodied in an essay entitled "An Ex- 
 perimental Inquiry concerning some points in the Vital 
 Processes of Assimilation and Nutrition", and read in the 
 annual meeting of the American Medical Association, at 
 Charleston, S. C, May, 185 1. 
 
 The general conclusions set forth by the essayist were 
 "that the carbonic acid of the respiratory process, like the 
 secretions of the skin and kidneys, is a true product of the
 
 155 
 
 metamorphosis of the structures of the body, while the tem- 
 perature depends directly on those changes which take place 
 in the nutritive and organic actions;" * * * "that all 
 digestible substances, whether carbonaceous or nitrogenous, 
 are assimilated and appropriated with more or less facility 
 to the nourishment of the organized structures of the body ;" 
 * * * "that alcohol produced none of the effects of food, 
 but permeated the blood and tissues like other well known 
 drugs; and that the fibrin of the blood was a product of 
 tissue waste to be eliminated by the kidneys and perhaps oth- 
 er excretory organs." The essay was listened to attentive- 
 ly and a vote of thanks tendered, but its facts and inferences 
 were so directly opposed to the then popular chemico-phys- 
 iological doctrines, that no vote for publication was passed. 
 It was, however, published in full in the Northwestern 
 Medical and Surgical Journal, Chicago, September, 1851, 
 pp. 169-190. 
 
 In the autumn of 1852, aided by Dr. Henry Parker, then 
 a resident of Chicago, I repeated and varied my experiments 
 concerning the effects of alcohol in the form of both wine 
 and brandy, noting more particularly its effects on the func- 
 tions of the cerebro-spinal nervous systems, both voluntary 
 and involuntary, in addition to that of respiration and animal 
 heat. The results obtained fully sustained the correctness 
 of the conclusions stated in the essay of 185 1, and they were 
 used by Dr. Henry Parker as the basis of his "Prize Essay 
 on the Difference between Stimulants and Tonics", presented 
 to the annual meeting of the Illinois State Medical Society, 
 in La Salle, 1854, and published in the volume of transac- 
 tions for that year. At this time an eminent physician of 
 Boston suggested that inasmuch as the moderate use of al- 
 coholic drinks lessened tissue waste and favored the ac- 
 cumulation of fat, their use might be of value in the treat- 
 ment of pulmonary tuberculosis and other wasting diseases. 
 The suggestion was received with favor, and during the 
 first two decades of the last half of the nineteenth century 
 cod-liver oil and Bourbon whiskey were the most popular 
 remedies both for the prevention and cure of pulmonary 
 tuberculosis.
 
 156 
 
 On this account I was led to commence making full rec- 
 ord of every well marked case of pulmonary tuberculosis 
 that came under my care, both in hospital and private prac- 
 tice, of which a reliable account could be obtained concern- 
 ing the use of alcoholic drinks both before and during the 
 progress of the disease. During the four years interv^ening 
 between 1855 and the end of 1859, I had accumulated full 
 notes of 210 cases, of whom 140 were males and 70 females. 
 Of the whole number 68 had used some form of alcoholic 
 drink almost daily from one to twelve years before any 
 symptoms of tuberculosis were observed. Some had drunk 
 only beer at the rate of three or four glasses a day; some 
 had drunk chiefly wine; and a larger number had taken all 
 kinds of liquor. They were all habitual drinkers, yet only 
 15 were recognized as drunkards. Ninety-one were period- 
 ical or irregular drinkers of alcoholic liquors, but rarely 
 became intoxicated; and 53 had been total abstainers from 
 alcohol through life. Many of those belonging to the class 
 of habitual drinkers were in such circumstances, and with 
 such habits as were as favorable for testing the influence of 
 alcohol on the development of tuberculosis as could have 
 been devised. But instead of aflfording evidence of any pre- 
 ventive or retarding influence, the use of alcohol appeared 
 to both favor attacks of the disease and to hasten its prog- 
 ress towards a fatal termination. The cases in all their 
 bearings were included in a paper read in the Medical Sec- 
 tion of the American Medical Association at its annual meet- 
 ing in New Haven, Conn., May, i860, and published in the 
 volume of transactions of the Association for that year. 
 
 At the annual meeting of the American Medical Associa- 
 tion in May, 1857, Dr. \Vm. A. Hammond, then a mem- 
 ber of the [Medical Staff of U. S. Army, presented an essay 
 to which was awarded a prize, and w^hich embraced a full 
 account of the eft'ects of living ten consecutive days ex- 
 clusively on albumen and water, and at another time on noth- 
 ing but starch and water. During the diet of albumen he 
 lost five pounds in body weight but without any loss of tem- 
 perature. During the ten days on starch alone he lost no 
 body weight and gained slightly in temperature. His con-
 
 157 
 
 elusions were "that albumen may be assimilated into the 
 system in such quantity as to affoid a sufficiency of both 
 nitrogen and carbon for the organism;" and "that starch can 
 be assimilated by the absorbents m more than sufficient quan- 
 tity to sustain the respiratory function." In other words 
 that both albumen and starch were capable of assimulation 
 and use as food for the organized structures of the body 
 (see Trans, of Amer. Med. Association, Vol. lo, p. 511, 
 1857). Subsequently Dr. Hammond instituted valuable ex- 
 periments with alcohol, first on the dog, and afterwards on 
 himself. When he introduced alcohol diluted with waiter 
 into the stomach of a dog it was quickly absorbed and 
 readily detected in the blood, the various organized struc- 
 tures of the body, in the urine, and the exhalations from the 
 lungs. 
 
 He executed three series of experiments on himself not 
 by attempting to live on alcohol alone, as in the experiments 
 with albumen and starch, but by taking for five days four 
 drachms of alcohol diluted with an equal quantity of water 
 in connection with each meal of ordinary food. During each 
 of the three experimental series of five days he found the 
 amount of carbon dioxide and water exhaled notably dimin- 
 ished ; the urine decreased both in quantity and in solid con- 
 stituents ; pulse increased in frequency ; decided headache 
 with sense of heat in the surface, and indisposition to exer- 
 tion either physical or mental ; but at the end of each five 
 days he had increased a few ounces in weight. These re- 
 sults showed very plainly that the alcohol, instead of acting 
 as respiratory food, actually diminished the sensibility of all 
 the nervous structures as an anaesthetic, and retarded the 
 metabolic and excretory functions. An account of Dr. Ham- 
 mond's experiments may be found in his Treatise on Hy- 
 giene published in 1863. 
 
 During the years 1865-66, Dr. Benj. Ward Richardson, 
 of London, was led to test by accurate experiments the ef- 
 fects of alcohol on the temperature of the human body, and 
 was surprised to find that it uniformly reduced the same in 
 direct proportion to the quantity used. He embodied the re- 
 sults of his investigation in a paper presented in the meeting
 
 of the British Association for the Advancement of Science, 
 at Birmingham, in 1866. After some discussion the paper 
 was regarded with so much increduhty that it was returned 
 to its author for further investigation ; a fate very similar 
 to that awarded to my own paper by the American Medical 
 Association at Charleston, S. C, fifteen years previous, but 
 concerning which Dr. Richardson evidently had no knowl- 
 edge. His paper, however, was soon published and attracted 
 much attention both in Europe and x^merica ; and a large 
 part of his subsequent life work was devoted to further in- 
 vestigations, public lectures and publications, advocating 
 more correct views concerning the nature and effects of 
 alcohol on the human system in health and in conditions of 
 disease. He gained a very high reputation in both literature 
 and science, and died Nov. 21st, 1896, as Sir Benjamin Ward 
 Richardson, in the 69th year of his age. 
 
 Since the foregoing investigations by myself. Dr. Ham- 
 mond and Dr. Richardson every aspect of the influence of al- 
 cohol on the human system and on both animal and vege- 
 table life, in small doses and large doses, aided by every in- 
 strument and device of modern invention designed to secure 
 accuracy of results, has been thoroughly investigated by 
 Professors Martin, Hammerton, Eagleton and Gibbs of 
 Johns Hopkins University ; Drs. E. T. Reichert, David Cer- 
 na, J. H. Kellogg, Beaumont, Chittendon and Mendel, C. 
 F. Hodge, Berkley and Friedenwald, A. C. Abbott, I. H. 
 Orcutt, H. C. Wood and Prof. Atwater, in this country. 
 And in Europe by Parkes, Anstie, J. J. Ridge, Ringer and 
 Sainsbury, Kraepelin, George Harley, Lauder Brunton, Li- 
 onel Beale, E. Destree, Galzinski, Romanes and Krukenberg, 
 F. W. D'Evelyn, Mohilinski, Charles Fere, Branthwaite, H. 
 Frey, Delcarde, ]\Iax Kassowitz, Laitinen and others. A 
 careful rfeview of the experimental work of all the investi- 
 gators heretofore named, shows with perfect clearness that 
 alcohol as it exists in fermented and distilled liquors, instead 
 of being digested and assimilated in the digestive organs 
 like sugar, starch and fat or other carbonaceous food sub- 
 stances, is absorbed unchanged and is carried in the blood 
 to every part of the living body the same as ether, chloro-
 
 159 
 
 form, morphine, nicotine and other anaesthetic and narcotic 
 drugs. That while present it lowers the temperature ; di- 
 minishes the activity of natural metabolism ; lessens the force 
 and efficiency of the circulation and respiration ; impairs the 
 functions of all nerve structures, both sensory and trans- 
 mitting, and thereby diminishes the acuteness of the special 
 senses and the activity of mental processes in direct propor- 
 tion to the quantity used. Also, that it impairs the corpuscu- 
 lar elements of the blood, lessens the activity of the leuco- 
 cytes, and favors tissue degenerations in the direction of 
 fatty, fibroid and sclerotic changes ; that it diminishes every 
 force or energy known in a living body, i. e., muscular, nerve, 
 mental, heat and vital or protoplasmic force, and thereby di- 
 rectly lessens the natural vital resistance to all toxic and 
 disease producing agents and extends the same from parent 
 to offspring. Like all other general anaesthetic and narcotic 
 drugs in large doses it destroys life by paralyzing the func- 
 tions of respiration and circulation, and in small daily re- 
 peated doses it lessens both mental and physical activity and 
 endurance, and yet deceives the individual by lessening the 
 sensibility of his material seat of consciousness in the brain. 
 The important bearing of the foregoing facts on the 
 public health and morals is only beginning to be appreciated 
 at present, but before the end of the twentieth century the 
 numerous investigations by which they have been established 
 will be regarded as among the most important that have 
 characterized the progress of medicine during the last half 
 of the nineteenth century of the Christian era.
 
 i6o 
 
 CHAPTER XII. 
 
 HISTORY OF MEDICAL PROGRESS DURING THE LAST HALF OF 
 THE NINETEENTH CENTURY COMPLETED. THE PRESENT 
 STATUS OF MEDICAL INVESTIGATIONS AND PROGRESS, AND 
 THE INDICATIONS OF FURTHER ADVANCEMENT. 
 
 The brilliant and important advancements in organic 
 chemistry under the* leadership of Liebig in Germany; in 
 pathological anatomy and physical diagnosis in France; in 
 the physiology of the nervous system in England ; and in 
 anaesthesia in America during the first half of the nineteenth 
 century, were all accomplished by close observation and dili- 
 gent experimental application of chemical and physiological 
 laws, with but little aid from the microscope. But they 
 paved the way and furnished an excellent basis for the 
 no less brilliant achievements of the last half of the same 
 century. The compound microscope was brought to a de- 
 gree of completion in 1832 that enabled other investigators 
 to take the several primary structures of the anatomists and 
 resolve them into the individual cells or organized atoms of 
 which they were composed, thereby showing the manner of 
 their evolution or growth, and developing the interesting 
 departments of histology and embryology. 
 
 Under the leadership of Thomas Schwann, Lionel S. 
 Beale, Louis Agassiz, Sharpey, Hassall, Bastian, Tyndal, 
 Huxley, Virchow, and others, every organized structure of 
 the living body was subjected to microscopic analyses and 
 found to be composed of individual cells, varying in size and 
 shape, and performing a great variety of functions, but all 
 composed essentially of an organizable substance recognized 
 as the physical basis of life, and called by some investigators 
 protoplasm and by others bioplasm. Its most distinctive at- 
 tribute is its vital capacity to grow and multiply or propa- 
 gate itself. Thus they found all living bodies, both animal 
 and vegetable, composed of protoplasm aggregated in mi- 
 nute forms called cells, and united in various ways to con- 
 stitute all the organized matter in the fluids and solids of
 
 i6i 
 
 living bodies, — a beautiful histological demonstration, that 
 may well remind us of the crude theory of atoms and pores 
 taught by Asclepiades and his pupil Themison, one hundred 
 and fifty years before the commencement of the Christian 
 era. 
 
 The modern investigators did not limit their microscop- 
 ic analyses to normal structures, but extended them with 
 equal diligence to all the morbid structures and products 
 brought to light by the studies in morbid anatomy during 
 the first half of the century. This soon resulted in demon- 
 strating that all tumors or morbid growths were cellular in 
 structure, and progressive by constant evolution of new 
 cells; and the so-called inflammatory exudations, whether 
 plastic or aplastic, were also composed of cells derived from 
 the blood and tissues. The plastic exudations were found 
 to consist largely of white corpuscles or leucocytes, formerly 
 called migrating corpuscles. They were seen to attack and 
 apparently consume such offending matter as they met with, 
 and soon after to disappear leaving the structure in its nor- 
 mal condition, or if their accumulation was too great or per- 
 sistent, they united in the formation of adventitious tissue 
 by which thickenings, indurations or adhesions might remain 
 for indefinite periods of time. If the exudations were aplas- 
 tic from the presence of pathogenic bacteria, or their toxic 
 products, the vitality of the accumulated leucocytes was 
 overwhelmed and they, with the cells of the tissues, were de- 
 generated into pus corpuscles with more or less destruction 
 of tissue by ulceration, suppuration or gangrene. 
 
 From all the foregoing investigations the eminent Ger- 
 man pathologist, Rudolph Virchow, was enabled to give to 
 the world his great work on cellular pathology (Cellular 
 Pathologic) published in 1858, which was translated into 
 French by Picard and into English by Frank Chase in i860. 
 
 While one class of investigators was thus successfully 
 using the microscope to enable them to see more clearly the 
 composition and modes of development of living organized 
 structures, both in conditions of health and disease, and 
 thereby creating anew the important departments of normal 
 and pathological histology, another class consisting of J. K.
 
 1 62 
 
 Mitchell, Saulsbury, Sanderson, Beale, Lister, Pasteur, 
 Koch, Sternberg, E. Hallier, and many others, both in Eu- 
 rope and America, were applying the same instrument with 
 equal diligence in the domain of aetiology, searching for 
 long-hidden causes of disease. 
 
 In all the earlier periods of medical history most of the 
 febrile and inflammatory diseases were attributed to the 
 concoction or fermentation of the blood and other so-called 
 humors in the living body. Later, by observation alone, the 
 concoctions causing the active phenomena of diseases were 
 traced in some instances to something emanating from moist 
 soils rich in decomposable vegetable matter and exposed 
 to high temperature. Other cases were traced to the influ- 
 ence of the air in over-crowded and ill-ventilated houses and 
 the use of impure water. By long-continued observations 
 the profession became satisfied that the combined influence 
 of heat, moisture and decomposable vegetable matter in the 
 soil, gave rise to a subtle toxic agent capable of impregnat- 
 ing both air and water, that was called Malaria or Koino- 
 miasm. By similar observations it was made evident that 
 both air and water, when impregnated with the excretions 
 and eliminations from living animal bodies, became toxic 
 and capable of producing a variety of severe and often fatal 
 febrile, diseases. When the science of analytical chemistry 
 had reached a high degree of development, many samples 
 of supposedly impure soil, water and air were subjected to 
 rigid chemical analysis, hoping thereby to isolate and iden- 
 tify the specific toxic agents called miasms, but without suc- 
 cess. But when the same substances were properly placed 
 in the field of the microscope an abundance of living germs, 
 called bacteria, were discovered and found capable of prop- 
 agation on suitable media in the laboratory. Copeland and 
 a few earlier writers under the phras? "contagium vivum" 
 had suggested that the specific causes of some epidemic and 
 contagious fevers consisted of sporules or fungi ; and in 
 1849 ^r- J- ^- Mitchell, of Philadelphia, published a very 
 interesting monograph on the subject. He w^as followed by 
 Dr. Salsbury, of Cleveland, Ohio, in 1866, who published 
 two papers, giving the results of his own investigations con-
 
 i6s 
 
 ceming a vegetable fungus called palmella. Still later Drs. 
 Klebs, and Thomasini Crudelli, of Italy, experimented with 
 a fungoid growth found in the malarious soils near Rome 
 that they called bacillus malaria;, and claimed to have dem- 
 onstrated its causative influence by inoculating rabbits with 
 it. Their conclusions, however, were not sustained by a 
 thorough experimental investigation by Dr. Geo. M. Stern- 
 berg, U. S. A., in a highly malarious district in Louisiana. 
 Laveran and others extended their examinations to the blood 
 of patients during the active progress of malarious fevers, 
 and soon identified the supposed specific cause in the red 
 corpuscles of the blood in the form of the plasmodium ma- 
 larite. 
 
 When, during the decade following i860, it was shown 
 by Huxley, Beale, Bastian and others that microscopic germs 
 or fungi pervaded the atmosphere and were greatly increased 
 both in number and variety in the air of over-crowded and 
 unventilated rooms ; and the process of fermentation was 
 shown by Pasteur to be one of bacteriological development, 
 not a few of the investigators regarded the bacteria as the 
 product of spontaneous growth. Bastian published a large 
 work in support of that doctrine. But all his positions were 
 soon completely refuted by the further investigations of 
 Huxley, Pasteur, Beale^ Virchow, and others, showing that 
 in all instances living germs are developed only from pre- 
 ceding germs. They proved conclusively not only that "like 
 begets like", but also that every living cell and germ, wheth- 
 er vegetable or animal, is evolved from a preceding cell or 
 germ. 
 
 In 1835 Bassi and Belasma discovered the silk worm 
 fungus, and in 1855 Polender discovered the bacillus of ma- 
 lignant pustule. In 1847 Joseph Leidy, of Philadelphia, 
 demonstrated the existence of the trichina spiralis, pre- 
 viously described by Richard Owen, in pork, and its com- 
 municability to man. During the decade following i860, 
 Pasteur demonstrated fully that without the presence of 
 micro-organisms there could be neither fermentation nor de- 
 cay. It was during the same period of time that Devalue 
 proved his previously discovered germ in the blood of an-
 
 164 
 
 imals suffering from anthrax to be the cause of that dis- 
 ease ; and Oertel discovered fungi in the exudations accom- 
 panying diphtheria, which were more accurately described 
 later by Klebs and Loeffler as bacilli. 
 
 Early in the next decade (1873) Obermeier discovered 
 the spirochaete in the blood of recurrent fever patients, and 
 Joseph Lister prosecuted his investigations concerning the 
 micro-organisms of suppurating wounds, erysipelas, and 
 septicaemia, by which he was enabled, in 1878, to propose 
 a system of antiseptic surgical practice that speedily effected 
 a most beneficial revolution in the treatment of all wounds 
 and surgical diseases. 
 
 The decade following 1880 was equally remarkable for 
 the microscopic achievements in the department of aetiology. 
 It was at the beginning of that decade the announcement 
 of the fungus of actinomycosis by Bottinger began to at- 
 tract attention, and Prof. James Law, of Ithaca, N. Y., dem- 
 onstrated its existence in 1883. The following year Drs. 
 W. T. Belfield and J. B. Murphy presented two well-marked 
 cases of the disease in the human subject, before the Chicago 
 IMedical Society, and the specific microbe was identified by 
 Drs. Belfield and Fenger. 
 
 In 1885 Pasteur commenced his inoculations for pre- 
 venting hydrophobia in human subjects. 
 
 In 1886, Koch announced his discovery of the cholera 
 bacillus; in 1887 the bacillus of tuberculosis, and that of 
 tetanus soon followed. The pneumococcus of pneumonia 
 was announced by Friedlander; and before the end of the 
 century the numerous workers in the field of bacteriology 
 had claimed nearly all the diseases in the catalogue of human 
 ailments as resulting from pathogenic germs of some form. 
 
 Apparently the first thought excited by all the foregoing 
 discoveries, both in relation to surgical wounds and to dis- 
 ease-producing bacteria, was the practical application of an- 
 tiseptics and germicides for the destruction of the offending 
 germs. Consequently the shelves of the apothecary shops, both 
 wholesale and retail, speedily became loaded with a great va- 
 riety of antiseptics, germicides and antitoxins, for both exter- 
 nal and internal use. Clinical experience in their use soon dem-
 
 i65 
 
 onstrated that by the external apphcations a much greater 
 degree of cleanUness, of both patients and their surround- 
 ings, was secured, and corresponding improvements in the 
 results of all external dressings and surgical procedures. 
 But the same experience with their internal use, for the pur- 
 pose of destroying either the bacteria or their toxins already 
 existing in the blood or tissues, resulted in only a limited 
 degree of success. As soon as the bacteriologist announced 
 the discovery of a pathogenic germ, or its toxin, as the cause 
 of any acute disease, the clinician began to administer his 
 germicide or antitoxin in all stages of the disease, regardless 
 of the previously well known laws of development, progress, 
 and decline, in all acute diseases. 
 
 Every pathogenic germ or toxin discovered was declared 
 to be a contagious or infectious agent, to be either avoided 
 by isolation or directly combatted by specific germicides or 
 antitoxins. 
 
 And thus the nineteenth century closed with the medical 
 profession throughout Christendom engaged in a deter- 
 mined effort to discover the specific causes of diseases and 
 their specific remedies, aided by all the modern facilities and 
 appliances for ensuring accuracy in the domain of scientific 
 research. 
 
 The results thus far have been a great increase in our 
 knowledge of the causes of disease, both specific or ex- 
 citing and predisposing, and corresponding advancements in 
 the field of sanitary or preventive medicine. For the more 
 extensive and accurate our knowledge of aetiological agents, 
 whether in air, earth, or water, the more successfully can 
 sanitary measures be devised for their avoidance or de- 
 struction. 
 
 But the administration of specific remedies for the pur- 
 pose of arresting the progress of active or acute diseases 
 caused by specific germs or toxins has been attended by only 
 a limited degree of success. This remark applies to the use 
 of both chemical antiseptic drugs and organic extracts or 
 antitoxic sera. In their zeal both laboratory investigators 
 and clinicians apparently overlooked the fact that all acute 
 febrile diseases are characterized by a stage of incubation,
 
 i66 
 
 a prodromic or forming stage, a stage of active progress, 
 and a stage of decline or death. So too, all the well known 
 pathogenic bacteria that cause febrile attacks have a period 
 of incubation after they are introduced into the living body, 
 followed by a period of rapid multiplication, during which 
 they commence the evolvement of a toxic ptomain that be- 
 comes the direct excitor of the active phenomena of disease, 
 and continues the same until overcome by the natural pro- 
 cesses of vital resistance or the life of the patient is extin- 
 guished. A careful review of all the facts thus far recorded 
 shows clearly that the administration of germicides, anti- 
 toxins and immunizing agents has been attended by a fair 
 degree of success when they were used during the stages of 
 incubation and of initial febrile symptoms, but with a rapidly 
 decreasing efifect during the subsequent stages of the dis- 
 ease. So true is this that three-fourths of the life-saving 
 influence attributed to the use of anti-diphtheritic serum has 
 resulted from its administration during the incubative stage 
 and first twenty-four hours of fever. 
 
 So early as 1860-62, Dr. G. Polli, of Milan, demonstrated 
 by a reliable series of experiments that putrid and actively 
 poisonous animal matter, injected into the blood or tissues 
 of healthy animals, could be rendered harmless by injecting 
 at the same time efficient doses of hypo-sulphite of lime or 
 soda. From this many inferred that the same remedies 
 might be used successfully in the treatment of all diseases 
 caused by animal or organic poisons. Consequently the 
 hypo-sulphites were soon tried in all stages of erysipelas, 
 smallpox and other eruptive fevers, but with no decided suc- 
 cess, except in a very few cases in which they were given 
 during the period of incubation. Very similar results fol- 
 lowed the experiments of Dr. Daniel Brainard, of Chicago, 
 from which he was induced to propose the use of iodine as 
 an antidote for the poison of reptiles. 
 
 Indeed, an abundant clinical experience has shown that 
 after bacteriological infection has fully developed in the 
 living body, thereby establishing active febrile phenomena, 
 it is effectually neutralized or expelled only by the natural 
 processes of vital resistance, recognized as oxidation, phag-
 
 i67 
 
 ocytosis, anti-toxic evolution and excretion. Therefore what 
 we now most urgently need is more knowledge concerning 
 these natural processes of vital resistance, and how to aid 
 them in either destroying or expelling each infectious agent 
 after it has multiplied itself and established the active phe- 
 nomena of disease. 
 
 Let the clinical observer and the laboratory investigator 
 unite in the work of ascertaining more fully the changes 
 any given toxin or infectious agent produces in the constitu- 
 ents of the blood, the tissues in which it manifests a disposi- 
 tion to accumulate, the changes it undergoes, if any, by ox- 
 idation, its efi'ect on metabolism, and the excretory channels 
 through which it is finally expelled from the living body. 
 Then will the enlightened practitioner be enabled to so ad- 
 just the use of his remedies during the active progress of 
 disease as to aid the natural processes and render recoveries 
 more certain and more perfect. 
 
 It was in urging substantially the foregoing views that 
 the present writer closed the general Address on Aledicine 
 before the annual meeting of the American Medical Asso- 
 ciation, in 1890, in the following words : — 
 
 "If we would reach the highest degree of success in the 
 treatment of acute general diseases, we must keep distinctly 
 in mind the following propositions : — 
 
 "i. We must as early as practicable separate the patient 
 from the further action of both the specific and the predis- 
 posing causes of his disease by surrounding him with pure 
 air and as perfect sanitary conditions as possible ; and as the 
 living animal system uniformly tends to either destroy or 
 eliminate the specific morbific causes by its own metabolic 
 changes, we should carefully avoid the use of such remedies 
 as either directly or indirectly retard or prevent such normal 
 metabolic processes, even for the repression of one or more 
 prominent symptoms. On the contrary, we must use such 
 general alterative and antiseptic remedies as are known to 
 sustain and correct such processes, and thereby aid in hasten- 
 ing the destruction or elimination of the disturbing materies 
 morbi, whether they consist of living germs, chemical pto-
 
 i68 
 
 maines or leucomaincs, or only excretory matters abnormally 
 retained in the system. 
 
 "2. As the pyrexia or high temperature results mostly 
 from interference with the processes of heat dissipation, es- 
 pecially in the ordinary continued fevers, we must further 
 aid in restoring these processes by gently promoting natural 
 elimination and the direct abstraction of heat by sponge 
 baths, and in excessive cases by wrapping in the cold wet 
 sheet, all of which exert a restorative influence on the vaso- 
 motor, cardiac, and respiratory nerve centres, while, with 
 equal care, we avoid administering such doses of internal 
 antipyretics and alcoholics as diminish heat production by 
 retarding both blood and tissue metabolism, and equally de- 
 press nerve sensibility and force. 
 
 "3. Again, as every specific cause capable of producing 
 the complex assemblage of morbid phenomena that consti- 
 .tute a general fever, has displayed a tendency to induce spe- 
 cial local morbid conditions in some one or more of the im- 
 portant tissues or organs during the progress of the general 
 disease, as in the glands of the ileum, mesentery and spleen 
 in typhoid ; the stomach, duodenum and liver in periodical 
 and yellow fevers, etc., we must early and accurately use 
 such remedies as palliate or modify th^se local developments 
 wherever they may be manifested, and thereby prevent such 
 structural changes in these directions as might otherwise end 
 in fatal exhaustion. 
 
 "4. Finally, as all acute morbid processes, when estab- 
 lished, are progressive through the successive stages of in- 
 crease, culmination and decline or destruction of the pa- 
 tient, we must carefully adjust both our remedial agents and 
 nutrient materials to the actual stage of progress of the dis- 
 ease and the capacity of the patient to receive and appropri- 
 ate the same ; ever remembering that the same remedial 
 agent that might be of great value in the first stage, might 
 be injurious or even destructive if used at the stage of cul- 
 mination, or still more in that of decline. Hence specific 
 remedies for acute general diseases can be rationally or suc- 
 cessfully used only when aimed at the destruction or elim- 
 ination of the specific causes and in the first stage of the
 
 169 
 
 morbid processes. Indeed, the chief benefits thus far de- 
 rived from the use of antiseptics and germicides, have been 
 as preventives in the incubative and prodromic stages, rather 
 than as curatives after active morbid processes have be- 
 come manifest." 
 
 The zealous investigators of morbid anatomy and patho- 
 logical processes during the first half of the nineteenth cen- 
 tury have often been accused of treating the diseases instead 
 of their patients. With equal propriety their successors who 
 emphasize the paramoiuit importance of pyrexia and heart- 
 failure, may be accused of treating symptoms without due 
 regard either to the patient or his disease. And with still 
 greater propriety may the profession of the present time be 
 criticized for treating the specific causes of diseases instead 
 of the patients, their pathological conditions, or even their 
 most important symptoms. Is it not possible to so. educate 
 the medical practitioners of the twentieth century that they 
 will comprehend more clearly the nature of each depart- 
 ment of medical knowledge, and its true relations to every 
 other department; and thereby enable them to avoid the 
 partial, one-sided, extreme, and often contradictory practices 
 that have marred the pages of all past medical history ? 
 
 The all-absorbing investigations in search for the spe- 
 cific causes of diseases that have characterized the last two 
 decades of the nineteenth century, have resulted in many 
 brilliant and important discoveries in the department of 
 aetiology, and have laid the foundation for corresponding im- 
 provements in prophylaxis, immunity and preventive medi- 
 cine. These have already notably diminished the ratio of 
 prevalence of several important diseases, and thereby added 
 to the average duration of life. 
 
 But the very common assumption that each acute disease 
 can have but one pathogenic germ as a specific cause ; and 
 that when the same disease or pathological condition, clin- 
 ically identical, is produced by another germ it must be re- 
 garded as a pseudo, or false, disease, is neither justifiable nor 
 in accordance with well ascertained facts. 
 
 It is well known that from ten to twenty per cent, of 
 all cases of well marked clinical diphtheria exist without
 
 170 
 
 the presence of the Klebs-Loeffler bacilkis. So also many 
 cases of pneumonia occur and run their course without the 
 presence of the specific pneumococcus, and cases of inflam- 
 mation, suppuration, and septicaemia are recognized as 
 caused by several well known pathogenic bacteria. There- 
 fore, instead of multiplying names for the same diseases or 
 pathological conditions by making the presence or absence 
 of some one germ or toxin the sole diagnostic test, it would 
 be productive of far better results if the chemico-physiolo- 
 gists, bacteriologists and sanitarians continued to recognize 
 the various well defined diseases as they were clearly dif- 
 ferentiated with so much labor and accuracy by the patholo- 
 gists and pathological anatomists of the first half of the 
 century, and continued their search, not for one specific 
 germ or toxin for each disease, but for all the germs or 
 toxins that may be found connected with it and their rela- 
 tive importance. Then let them go one step further and 
 show how, by what processes, and through what channels, 
 the germs or toxins already developed and producing dis- 
 ease are finally destroyed or expelled from the system. By 
 so doing they would not only preserve the true relations of 
 aetiology to pathology, but also furnish us the proper basis 
 or reliable indications for the rational treatment of the ac- 
 tive stage of acute diseases. 
 
 In the meantime, the experimental therapeutists should 
 demonstrate, by strictly scientific methods, the action of all 
 drugs and therapeutic agents when introduced into the liv- 
 ing body, and the changes in structure or function they are 
 capable of producing. Then would the practitioner be able 
 to choose the remedies best adapted for relieving the actual 
 pathological conditions at each stage in the progress of the 
 diseases he treats; and he would be able to so adjust them 
 as to aid the natural processes of vital resistance in curing 
 diseases. 
 
 Much has been done in this direction during the last half 
 century, especially in regard to the true action of the nar- 
 cotic and anaesthetic drugs, as detailed in the last preceding 
 chapter. ]Much, however, still remains to be done. And 
 there is much need of applying the same methods of inves-
 
 171 
 
 ligation for determining the efifects of the habitual use of 
 all the important articles of food and drink and of the va- 
 rious occupations in modern life. For while acute diseases 
 may arise chiefly from bacteriological and toxic agents, those 
 chronic, slowly-developed, and structural diseases so prev- 
 alent in civilized communities, have their origin from mod- 
 erate but frequently repeated or persistdnt>4mpressions on 
 the organized elements of the blood and on the protoplasm 
 and metabolism of the tissues, by such agents as tea, coffee, 
 tobacco, fermented and distilled alcoholic drinks, and other 
 anaesthetics, and living or working in close, ill-ventilated 
 rooms, with deficient open air exercise. It has already been 
 fully demonstrated that the habitual use of several of these 
 agents cause impairment of the corpuscular and haemoglobin 
 elements of the blood, and degenerations of structure in the 
 various tissues and organs of the body, and thereby mate- 
 riallly shorten the duration of life. And is it not possible, 
 or even probable, that further investigations would show 
 that the same agents, aided by such modes of living and oc- 
 cupations as rendered the blood habitually less oxygenated 
 and decarbonized than natural, were capable of causing 
 morphological changes in some of the non-pathogenic germs 
 that are always found in the human body, sufficient to con- 
 vert them into pathogenic germs of great importance? If 
 the persistence of bad hygienic and sanitary influences may 
 so modify cell proliferation as to cause either morbid 
 growths or tissue degenerations ; or so modify germinal cells 
 as to cause the transmission of hereditary diseases, why not 
 the same or similar influences change a common colon bacil- 
 lus into a typhoid or tuberculous bacillus ? 
 
 The whole field of what has been vaguely termed pre- 
 disposing causes of disease, though temporarily neglected on 
 account of the zealous search for specific causes and spe- 
 cific remedies, would richly repay a thorough investigation 
 and would effectually bring the profession back to a recogni- 
 tion of the patient as well as of his diseases and the causes 
 that produce them. 
 
 It will be seen by the foregoing observations that not- 
 withstanding the many brilliant discoveries and important
 
 172 
 
 advancements in all departments of medicine and surgery 
 during the nineteenth century, there are still remaining am- 
 ple fields in which the investigators of the twentieth centur}' 
 ma}' gain equal renown and the human race even greater 
 benefits. And it would render such a result much more cer- 
 tain if a study of medical history were added to the curric- 
 ulum of every medical school. For, in the language of 
 Hippocrates, "the physician must know what others have 
 known or he is constantly liable to deceive both himself and 
 others." The very general neglect of this, especially during 
 the last three centuries, has caused the education of each 
 generation of medical men to be limited almost entirely to 
 the popular views and practices of their own time, without 
 any adequate knowledge of those entertained and practised 
 by their predecessors. 
 
 This has led to the unnecessary duplication of work in 
 many directions ; to the complaisant exaggeration of the im- 
 portance of present discoveries and practices compared with 
 those of preceding periods ; and to the very imperfect per- 
 ception of the inter-dependence of medical advancements in 
 all ages with the coincident advancements in all other nat- 
 ural and physical sciences.
 
 173 
 
 CHAPTER XIII. 
 
 MEDICAL EXCRESCENCES OR BRIEF NOTICES OF THE MORE IN- 
 FLUENTIAL MEDICAL SECTARIAN DOGMAS THAT HAVE AT- 
 'TRACTED MORE OR LESS PUBLIC ATTENTION DURING THE 
 EIGHTEENTH AND NINETEENTH CENTURIES. THE ORIGIN 
 OF SO-CALLED '^SCHOOLS OF MEDICINE"— HOMEOPATHY ; 
 THOMSONIANISM ; BOTANICO-MEDICAL ; ECLECTICISM/ 
 CHRISTIAN science; OSTEOPATHY, ETC. 
 
 In the preceding chapter was completed a brief history of 
 the origin, development and progress of the science and art 
 of medicine and its relations to the progress of all other 
 sciences or departments of human knowledge, from the 
 earliest medical records to the close of the nineteenth cen- 
 tury. Such history has shown that prior to the actual study 
 of human anatomy, and the development of analytical chem- 
 istry during the fourteenth and fifteenth centuries, A. D., 
 all medical practice was essentially empirical, though often 
 modified in application by the prevailing systems of so-called 
 philosophy. And as nearly all the more eminent philosophers 
 of the earlier centuries were also physicians, each attracting 
 to himself or his doctrines more or less numerous followers 
 or disciples who regarded him as the founder of a system 
 or school of medicine which they designated by his name. 
 Thus before the Christian era we had prominently the med- 
 ical schools of Hippocrates; Plato; Aristotle; Asclepiades, 
 and Soranus ; and during the ten subsequent centuries, the 
 schools of Galen ; Cselius Aurelianus ; ^tius ; Alexander of 
 Tralles; Paulus of ^gina; and in Arabia, the school of 
 Rhazes, Avicenna and Geber. Each of these schools con- 
 sisted of the observed facts, opinions and theoretical views 
 of the individual teacher or writer and his followers. All of 
 them embraced some items of value, and all of them were 
 more or less influenced by the universal belief in the ele- 
 mentary nature of fire, air, earth, and water, and in the four 
 humors and their concoctions. 
 
 Pre-eminent amiong all these early leaders in medicine
 
 174 
 
 were Hippocrates and Galen, whose wide fields for obser- 
 vation, close adherence to observed facts and the results of 
 experience in the treatment of diseases, gave to their writ- 
 ings unquestioned authority both as text-books and guides 
 in practice for more than one thousand years. 
 
 The development of human anatomy by A''esalius and of 
 analytical chemistry by the alchemists during the fourteenth 
 and fifteenth centuries, aided by the invention of the art of 
 printing, struck the first effectual blow against the reign 
 of personal authority, and laid the chief corner stone for the 
 whole fabric of true medical science and practice, as briefly 
 indicated in the preceding chapters of this volume. Once 
 in possession of a correct knowledge of all parts of the 
 human body constituting descriptive anatomy, the study of 
 the function of each part necessarily followed, thereby de- 
 veloping the department of Physiology. 
 
 As all diseases are departures from physiological condi- 
 tions of function or structure, or of both, the study of such 
 conditions soon added to the expanding field of medical 
 knowledge the departments of Pathology, Pathological An- 
 atomy and Physical Diagnosis. During the same time the 
 application of analytical chemical processes to the study of 
 air, earth, water and inorganic bodies generally, rapidly 
 revealed their actual composition, the laws governing their 
 combination, and the physical forces by which they were in- 
 fluenced, as affinity, attraction, heat, light and electricity. 
 Extension of the same analytical processes to the study of 
 organic bodies soon revealed the composition of . living 
 bodies, both vegetable and animal, by which has been devel- 
 oped the extensive departments of physics and biology. And 
 as the progress of physics brought to our aid the microscope, 
 by the persistent and skillful use of which every department 
 of medicine has been enriched or renovated and the impor- 
 tant fields of ■ minute anatomy and bacteriology have been 
 added, the co-incident discovery of the art of printing not 
 only furnished the needed facilities for recording and pre- 
 serving the facts and results of investigations of every 
 kind, but by the publication of papers and periodicals fur- 
 nished the first efiicient medium for free discussion, and the
 
 175 
 
 rapid diffusion of knowledge in all the countries of Christen- 
 dom. 
 
 By the co-operation of these several influences, during 
 the sixteenth, seventeenth and eighteenth centuries, not only 
 was medicine transformed from an aggregation of fanciful 
 closet speculations and the facts of individual experience, but 
 it, together with all the departments of natural science were 
 developed by strictly scientific investigations and logical de- 
 ductions from carefully observed facts. Consequently, dur- 
 ing the nineteenth century it became impossible longer to 
 build up or maintain any purely theoretical or exclusive in- 
 dividual schools of medicine, founded on some one supposed 
 universal law of disease or equally universal law of cure, 
 within the ranks of educated medical men. Many such at- 
 tempts have been made. But the strictly scientific investiga- 
 tions, clinical experience, and free discussions to which they 
 were subjected soon caused them to be either abandoned or 
 compelled to withdraw from the legitimate channels of med- 
 ical discussion, and appeal to the non-professional public 
 through the ordinary newspapers or to periodicals devoted 
 exclusively to the advocacy of their special dogmas. By 
 such means the idea of the existence of several distinct and 
 rival Schools of Medicine has been perpetuated in the pop- 
 ular mind, and are recognized in the laws of many of our 
 States until the present time. 
 
 The most noted of these is the Homeopathic school, 
 founded by Hahnemann during the last quarter of the eight- 
 eenth century. Samuel Christian Friedrich Hahnemann, of 
 Germany, was born in 1755, A. D., and died in 1843. He 
 commenced the study of medicine in 1775 at Leipsic and 
 after two years changed to Vienna, where he was obliged to 
 spend a part of his time in earning the money necessary for 
 prosecuting his studies. He graduated at Erlangen in 1779. 
 During the next twenty-five years he resided and practised 
 his profession in no less than twelve different cities of Ger- 
 many. 
 
 In 1792 he was Superintendent of the Asylum for the 
 Insane at Georgenthal, in Thuringia, and in 1794 he was in 
 Pyrmont and Brunswick. While at Leipsic he devoted con-
 
 1/6 
 
 siderable attention to chemistry and materia medica, and it 
 is said was requested to test the effects of cinchona upon 
 himself by CuUen, While taking moderate doses of cin- 
 chona for this purpose he claimed that it caused chills and 
 fever closely resembling the symptoms of intermittent fever 
 for which it had come to be regarded as the chief remedy. 
 This directly suggested the theory that the most appropriate 
 and effectual remedy for any disease was the one that when 
 given in health produced symptoms most resembling those 
 of the disease it was capable of curing. Hence his maxim 
 "Similia Similibus Curantur", which is said to have been 
 vaguely hinted at by Hippocrates and more plainly stated by 
 Paracelsus. He soon began to apply his theory in his prac- 
 tice by administering moderate doses of several important 
 drugs either to himself or other persons in good health, and 
 recording minutely all the sensations or symptoms that fol- 
 lowed the taking of each dose not only during the succeed- 
 ing few hours, but for several days. With the aid of his 
 friends, a Materia ^Medica was soon constructed consisting 
 of the proved symptoms of each drug. In like manner dis- 
 eases were studied and their symptoms only recorded in de- 
 tail. Consequently all the physician had to do when called 
 to a patient was to note his symptoms carefully and then 
 select as the proper remedy the drug with symptoms most 
 closely resembling those presented by the patient. 
 
 Questions pertaining to aetiology, pathology and patho- 
 logical anatomy received little or no attention ; the system 
 being founded exclusively on symptomatology. Any one 
 of its most remarkable features was the number of symp- 
 toms attributed to a single dose of each drug. For ex- 
 ample, to chloride of sodium were attributed 1349 symp- 
 toms; to lycopodium, 1608; and to some of the more impor- 
 tant drugs the number of symptoms enumerated was over 
 4,000. 
 
 In 1796 Hahnemann published an "Essay on a New 
 Principle for Ascertaining the Curative Properties of 
 Drugs" in which he not only advocated his law of similia 
 similibus as the tmiversal law of cure, but also the doctrine 
 that by certain dilutions and attenuations the curative power
 
 177 
 
 of drugs could be increased to an unlimited degree. By these 
 processes was evolved his second universal law, i. e., the 
 greater the attenuation of a drug, or the smaller the dose, the 
 greater the curative power. 
 
 He also attached much importance to the method and de- 
 gree of attenuating or diluting medicines for use. If the 
 crude drug was in liquid form, one minim was to be put 
 with one hundred minims of water or alcohol and given a 
 certain number of shakes, which constituted the first dilu- 
 tion. One minim of this was to be mixed with one hundred 
 minims of water for the second dilution. The same process 
 was repeated until the tenth, twentieth or even thirtieth di- 
 lution was reached. It was claimed that each dilution im- 
 parted additional potency or curative power; and the thir- 
 tieth, which would contain only an infinitesimal part of a 
 minim of the drug was regarded by Hahnemann as the most 
 important for use in the treatment of acute diseases. If 
 the crude drug was in the form of powder the same prin- 
 ciple governed in its preparation for use. One grain was 
 triturated with one hundred grains of sugar of milk for the 
 first attenuation. One grain of this was triturated with an- 
 other one hundred grains of sugar of milk, and so on to the 
 tenth, twentieth or thirtieth attenuation and then generally 
 rolled into small pellets or pills. 
 
 The publication of this law of increased potency in direct 
 proportion to the degree of attenuation, or smallness of the 
 dose, was received with so much skepticism and derision by 
 the profession, that in 1802 he abandoned the regular med- 
 ical channels of communication, and began to address his 
 views to the public, both by public lectures and through the 
 secular press. In 1805 while at Torgau he first styled his 
 own system founded on the laws of similars and infinitesimal 
 doses as Homeopathy, and all other medical practice as Allo- 
 pathy. His leading work called "The Organon" was pub- 
 lished in 1810. The next year he settled in Leipsic, where 
 he lectured and practised and succeeded in gaining some 
 medical converts, among whom were Gross, Hornburg, and 
 Wislicanus. As both Hahnemann and his followers pre- 
 pared their own medicines, which brought them in conflict
 
 178 
 
 with the apothecaries, the authorities of Saxony were in- 
 duced to forbid medical practitioners to prepare or dispense 
 their own medicines. This caused him to change his resi- 
 dence to Kothen in 1821, where he became physician-in-or- 
 dinary to the Lord of Anhalt-Kothen and where his wife 
 died in 1825. ^^'hile at Kothen he and his followers began 
 to organize Homeopathic societies, journals and hospitals ; 
 and in 1828 he published his work on Chronic Diseases, in 
 which he contended that all such diseases were caused either 
 by syphilis, sycosis or psora (itch). 
 
 In 1830 he married a young French woman who was 
 possessed of an ample fortune and by whom he was soon 
 persuaded to settle in Pans, where he continued his practice 
 and attracted much public attention until his death in 1843. 
 His fundamental doctrine concerning the nature of diseases 
 was that they were "spirit-like, or dynamic aberrations of 
 our spirit life manifested in sensations and actions." He ad- 
 mitted no morbid anatomy, no material causes of disease, and 
 made no classification, except into acute and chronic. He 
 admitted of but one law of cure, i. e., similia similibus, and 
 but one mode of creating specific remedies, i. e., by the 
 potentizing effects of repeated attenuations or dilutions. 
 
 His earlier disciples, Hermann, Gross and Lutz soon 
 carried his law of similars to the extreme of actual Isopathy, 
 by attempting to cure variola by administering variolus pus ; 
 diarrhoea by giving f^cal matter; tapeworm by eating joints 
 or segments of the worm. This, however, was too disgust- 
 ing to attract many followers. On the other hand, the later 
 and better educated followers of Hahnemann, as early as 
 1850, began to recognize and incorporate into their teaching 
 the results of pathological investigations, and to use in their 
 practice larger doses of medicine. They admitted that some 
 medicines acted on particular organs or tissues. Such was 
 the case particularly with Griessellich, Arnold and Herschel. 
 
 In 1 87 1 Heinigke endeavored to explain the potentizing 
 of drugs by claiming that by the numerous dilutions or tritu- 
 rations the atoms of the drugs were freed from their chem- 
 ical affinities, and only by such molecular freedom did they 
 acquire specific curative power in the treatment of diseases.
 
 179 
 
 Lutze, in his memorial address on Hahnemann in 1872, said : 
 "The poisonous properties are removed from a drug through 
 its dilutions, while its special peculiarities, so to speak, its 
 soul, remained and by rubbing and shaking becomes vivified 
 and strengthened by human magnetism." 
 
 The system of practice of Hahnemann was introduced 
 into England by a Dr. Ouin, in 1827, and gained some atten- 
 tion and patrons chiefly in the larger cities. One hospital 
 containing 100 beds was established in London, in connection 
 with which was organized the only homeopathic college in 
 Great Britain. 
 
 The system was introduced into the United States by 
 Dr. Hans B. Gram, a native of Boston, but who had been ed- 
 ucated in Copenhagen and returned to this country in 1825, 
 settHi^ in. the City of New York where he practised until 
 his death in 1840. 
 
 The novelty of the soMalled law of cure by similars, 
 coupled with the mystery of potentizing drugs by dilution 
 until they became tasteless and infinitesimal in dose, and dis- 
 eases claimed to be only "dynamic aberrations of our spirit 
 life", were well calculated to attract the attention of a few 
 medical men and a large class of non-professional reading 
 persons of both sexes who, so far as relates to medicine, are 
 prone to place the most implicit faith in whatever of theory 
 or practice is most mysterious or incomprehensible. Conse- 
 quently the doctrines of Hahnemann were embraced by a 
 sufficient number of medical men, chiefly in the larger cities 
 of this country, to enable them to commence the publication, 
 in 1834, of a journal called the "American Journal of Hom- 
 eopathia", edited by Drs. J. F. Gray and A. Gerald Hull; 
 and in 1844 they organized the "American Institute of 
 Homeopathy" with between forty and fifty members. 
 
 One of the most active propagators of the homeopathic 
 doctrines in this country was Constantin Hering, a native 
 of Saxony, who cam.e to the United States in 1834. He was 
 the author of the work called the "Domestic Physician", pub- 
 lished in 1858, which in connection with neatly filled cases 
 of ready prepared attenuated medicines in the form of sugar
 
 i8o 
 
 "pellets", greatly facilitated the introduction of the system 
 into family use. 
 
 During the three decades following 1840 the converts to 
 the system increased with considerable rapidity. Homeo- 
 pathic societies were organized in a majority of the States. 
 Homeopathic hospitals, colleges and journals were estab- 
 lished in several of the large cities, and the system reached 
 the climax of its popularity before the end of the third quar- 
 ter of the nineteenth century, when it claimed the existence 
 of 12 or 13 colleges from which about 430 persons 
 were graduated annually, while the regular medical col- 
 leges numbered 124 and the annual number of graduates 
 more than 3,000. Even this very limited degree of develop- 
 ment from an hundred years of strictly sectarian cultivation 
 has been attained only by the practical abandonment of every 
 distinctive principle or doctrine advocated by Hahnemann, 
 except the names he invented, i. e., Homeopathy and Allo- 
 pathy. By following the example of Griesselich, Arnold and 
 Herschel, and incorporating into their works the results of 
 the regular investigations in pathology, pathological anatomy, 
 aetiology, bacteriology and diagnosis ; and into their schools 
 the same text-books on two thirds of the branches taught 
 as are used in all the regular medical schools; and in their 
 practice the use of drugs in any doses required to produce the 
 desired effect, they have preserved before the public the 
 form and machinery of a medical sect called Homeopathic, 
 while the fanciful dogmas of its founder have practically 
 disappeared. And there are abundant evidences indicating 
 that before the middle of the twentieth century even the 
 name will have become as obsolete as the fanciful dogmas 
 it was invented to designate. The Medical Times, formerly 
 an influential homeopathic journal, recently made the follow- 
 ing statement : "The American Homeopathist has changed 
 its name to the American Physician ; and it is a most sensible 
 thing to do. The use of the terms homeopathic and allo- 
 pathic is obsolete, and it would be better if they were never 
 used." 
 
 Thompsonianism : While homeopathy, or the system of 
 Hahnemann, was having its birth and development in Ger-
 
 i8i 
 
 many an equally -fanciful, though far more dangerous, sys- 
 tem of medicine was conceived and promulgated in this coun- 
 try by Benjamin Thompson, who was born in New Hamp- 
 shire in 1769 and died in Boston in 1843. With a very lim- 
 ited degree of education in either literature, science or medi- 
 cine he promulgated through the secular press a system of 
 medicine and commenced prescribing for the sick in 1792. 
 His system and practice were based on the following declara- 
 tions : "Heat is life. Cold is death. Vegetables grow up- 
 ward and sustain life. Minerals sink in the earth and there- 
 fore tend to produce death." Consequently he selected all 
 his remedies from the vegetable kingdom with the exception 
 of hot water or steam. 
 
 As his knowledge of botany was very limited his list of 
 remedies was equally brief, consisting of lobelia inflata, 
 steam, cayenne pepper and a strong tincture of pungent aro- 
 matic herbs called "No. 6", all chosen for their supposed 
 influence in sustaining the temperature of the living body, 
 and increasing the evacuation of all morbid or disease-pro- 
 ducing agents through the stomach by emesis, and the skin 
 by diaphoresis. He discarded the use of all mineral medi- 
 cines, and was especially severe in denouncing the prepara- 
 tions of mercury, and all physicians who prescribed them. 
 He attributed all cases of necrosis, chronic rheumatism, 
 periostitis, and neuralgia to the poisonous effects of calomel 
 and other minerals previously given by regular physicians. 
 His usual mode of treating all acute diseases was to produce 
 free vomiting by full doses of lobelia, followed by steam or 
 vapor baths, and then frequent doses of cayenne pepper or 
 of "Number 6". Even many old chronic diseases were 
 treated by the same active routine for the purpose of ex- 
 pelling from the system mineral poisons alleged to have been 
 taken years previously. 
 
 Thompson prepared and had printed a small book stat- 
 ing his fundamental doctrines and method of treating dis- 
 eases and in 1813 obtained a patent on his system, and be- 
 gan to sell to other parties the right to practise it, with a 
 copy of his book, for $20. A travelling agent for the Ohio 
 Valley and Southern States is reported to have sold no less
 
 I«2 
 
 than 4,000 copies between 1827-30, thereby realizing $80,- 
 000. The simplicity of Thompson's theories and the visible 
 activity of his remedies, coupled with the constant denun- 
 ciation of the regular profession for using poisonous min- 
 erals, caused them to be readily adopted by the less edu- 
 cated and working classes in all parts of the country. A very 
 large majority of those who chose to practise the Thomp- 
 sonian system were devoid of any regular medical education 
 or legal license to practise, and were very generally styled 
 "steam and herb doctors." Their ignorant and reckless ad- 
 ministration of repeated emetic doses of lobelia and pro- 
 tracted vapor baths produced fatal exhaustion in many cases, 
 even in the care of Thompson himself, by which he became 
 involved in several suits for malpractice and lost much of his 
 earlier influence, before his death in 1843. 
 
 As the personal influence of Thompson passed its zenith. 
 Dr. Alva Curtis, of Ohio, became a leader with more knowl- 
 edge of medical botany and more caution in the use of lo- 
 belia and steam, and introduced among his followers a larger 
 number of vegetable remedies, but maintained all the bitter- 
 ness of the original Thompsonians against the use of min- 
 erals. 
 
 He designated his system as Botanico-AIedical, and in 
 1837 commenced the publication of a journal advocating it 
 in Columbus ; and in 1841 he obtained a charter for a Botan- 
 ico-Medical college to be established in Cincinnati. Later 
 he professed to discard the use of all poisons as medicines 
 whether mineral or vegetable, claiming that all remedies to 
 exert a curative influence must act in harmony with physio- 
 logical processes, and therefore changed the name of his sys- 
 tem to "Physio-Medical" instead of Botanico-Medical. 
 
 He succeeded in attracting some followers until 1855 
 when his journal, called the Physio-Medical Recorder, passed 
 under the control of Dr. W. H. Cook, who continued its pub- 
 lication until 1885 when both it and the college in Cincinnati 
 were discontinued. In the meantime a Physio-Medical col- 
 lege had been organized in Indianapolis and another in Chi- 
 cago, from which about twenty students were graduated 
 annually from 1881 to 1890. Since the latter date the num-
 
 i83 
 
 ber of students in attendance has seldom equalled the num- 
 ber of their professors. 
 
 While Dr. Curtis was leading one part of the original 
 followers of Thompsonianism in the direction of the Physio- 
 Medical system, Dr. Wooster Beach was leading the re- 
 mainder in the direction of simple Eclecticism by endeavor- 
 ing to establish a "Reformed Medical College" in New York. 
 Failing in that, another college was organized at Worthing- 
 ton, Ohio, and attracted a few students annually for ten 
 years when it ceased to exist. In 1845 a much more suc- 
 cessful institution was established in Cincinnati, Ohio, called 
 the "Eclectic Medical Institute." Dr. John M. Scudder be- 
 came professor of Practice and Pathology; and Drs. J. B. 
 Jones, William Sherwood and John King were also mem- 
 bers of the faculty. Dr. Scudder added to his eclectic princi- 
 ple of selecting the good from all other systems of practice 
 that of "specific medication." Drs. Jones and Sherwood 
 published a work entitled "American Eclectic Practice of 
 Medicine" in 1857 '> and Dr. King a work on "Chronic Dis- 
 eases" in 1867, and an "American Dispensatory" in 1874. 
 
 The Eclectic Institute in Cincinnati thus became the lead- 
 ing college of Eclecticism in America, and during the first 
 twenty years of its existence graduated not less than 1800 
 students. 
 
 Other Eclectic schools and journals were established in 
 many of the larger cities, and Eclectic Medical Societies were 
 organized in a majority of the states prior to 1880. Since 
 that date, more than half of the schools and journals orig- 
 inally established have been discontinued for lack of sup- 
 port, and the sect appears to be in the same state of decline 
 as the Physio-Medicists. Yet during the most active and ag- 
 gressive stage in the progress of both Eclecticism and Home- 
 opathy, which was during the second quarter of the nine- 
 teenth century, they were enabled to induce the legislatures 
 of several states to repeal the legal restrictions that had been 
 enacted against unlicensed practitioners. And chiefly by the 
 direct political influence of their state society organizations 
 they have succeeded in causing their legal recognition by 
 representation on nearly all the State Boards of Health and
 
 i84 
 
 Examination in the several states, thus presenting the ab- 
 surd position of legally recognizing several distinct and op- 
 posing medical theories, and thereby perpetuating the er- 
 roneous popular idea of competing schools of medicine. 
 
 The true object of establishing State Boards of Exam- 
 iners is, or should be, to see that all persons licensed to prac- 
 tise medicine were possessed of sufficient knowledge of all 
 the branches of medical science and theory to make them 
 safe practitioners of *he healing art. Neither the Home- 
 opathic, Thompsonian, Botanico-AIedical, nor modem Ec- 
 lectic, so-called, systems or schools of medicine have re- 
 ceived legal recognition in any of the countries of Europe. 
 
 Now, with the close of the nineteenth century, the most 
 popular and progressive medical sectarians are the "Chris- 
 tian Scientists", the "faith" or "Divine Healers", and the 
 "Osteopaths", all of whom discard entirely the use of medi- 
 cine. The two first rely entirely on mental influences for 
 the relief of human suffering, and the third add a vigorous 
 system of massage ostensibly for correcting displacements 
 and imperfect adjustments of the bones in the living body, 
 to which they attribute all forms of disease. 
 
 The Christian Scientists, who are the most numerous and 
 most active in winning followers on both sides of the At- 
 lantic, declare all diseases and sufferings to be only morbid 
 mental conditions, to be removed solely by persuading them- 
 selves that they are well, aided by the mental suggestions and 
 will power of others. The founder of the sect, IMrs. Baker 
 Eddy, of jMassacliusetts, claims to have discovered the true 
 method of curing diseases by her own spontaneous recovery 
 from the effects of an internal injury caused by an accident. 
 She first called her system "Divine IMetaphysical Healing." 
 In 1866 she changed the name to "Christian Science" ; and in 
 1876 organized in Boston the first Christian Science Society. 
 Since that time her followers have increased with consider- 
 able rapidity, and Christian Science societies, churches and 
 schools have been formed in many parts of this country, and 
 to some extent in Europe. The system as taught and pub- 
 lished by Airs. Eddy is a blending or union of her ideas of 
 religion and medicine as complete as was the religio-medical
 
 i85 
 
 doctrines of the ^sclepiadae of ancient Greece and Rome. 
 It claims that all suffering or disease is mental, and to be 
 cured only by mental influences. The use of drugs or ma- 
 terial medicines of every kind is persistently refused. The 
 patient or sufferer is given the most positive assurances that 
 if he will persistently endeavor to believe that he has no 
 bodily or physical disease, and will devote a specified time 
 each day to such efforts, and at the same hours have the aid 
 of the will power and suggestion of one or more of those 
 who have acquired confidence and skill in guiding the mental 
 forces, he will find relief. Every intelligent reader will per- 
 ceive that this "Christian Science" is simply an effort to re- 
 lieve all suffering by hypnotism and mental suggestion as 
 recognized by regular physicians and psychologists, with 
 enough reference to Divine aid to justify calling it Chris- 
 tian. 
 
 From the preceding brief history of the more noted spe- 
 cial or exclusive schools of Medicine existing during the 
 nineteenth century, it will be seen that the founders of each 
 voluntarily withdrew with their followers from the ordinary 
 medical periodicals and channels for professional discus- 
 sion, and proclaimed their doctrines through either period- 
 icals exclusively for that purpose or through the secular 
 press. They all claimed to have discovered some one uni- 
 versal law of morbid action or disease, and one general ther- 
 apeutic law of cure, on which their respective systems were 
 based, with little or no reference to progressive pathological 
 changes or the material causes of disease. Consequently 
 they were incapable of improvement by the application of 
 new discoveries in either physics or biology ; and equally in- 
 capable of furnishing a basis for preventive medicine or pub- 
 lic sanitation, without ignoring or nullifying one or more of 
 their fundamental laws, and at every step approximating the 
 scientific field of legitimate medicine, until having only the 
 sectarian name left for a proprietary trademark. 
 
 Such has been the fate of all attempts to establish sec- 
 tarian schools of medicine or special medical systems, founded 
 on some one or more so-called universal laws, either of aetiol- 
 ogy, pathology, or therapeutics, through all the centuries
 
 i86 
 
 past, and such will be their fate to the end of time, for the 
 simple reason that there are no such universal laws govern- 
 ing the development and progress of disease, or of its cure. 
 Man, as a living being, is subject to all the influences, men- 
 tal and physical, that surround him in the air, the water, the 
 earth, the ingesta of food and drink, and the social condi- 
 tions he encounters. And his diseases are as diverse in their 
 origin, progress and results as are the ever varying condi- 
 tions that surround him. Consequently the several depart- 
 ments of legitimate medicine are composed of such facts and 
 materials, gathered from every other field of human knowl- 
 edge, as relate to the causes, tendencies and results of dis- 
 eases, and their remedies. Each of those departments, there- 
 fore, must advance with every new discovery or advance- 
 ment or implement of more accurate research, in the general 
 departments of science to which they relate. Such are the 
 diverse tendencies and results of legitimate medicine, and of 
 medicine founded on exclusive dogmas or so-called universal 
 laws. The one is ever progressive, the other like the good 
 ship stranded upon the rocks.
 
 i87 
 
 CHAPTER XIV. 
 
 THE ORIGIN AND PROGRESS OF MEDICAL ETHICS TO THE END OF 
 THE NINETEENTH CENTURY. 
 
 Medical Ethics is that branch of moral philosophy which 
 treats of the duties, responsibilities and rights of members of 
 the medical profession in relation to the nature of their call- 
 ing, their relation to each other and their relations to the 
 whole community. General ethics or moral philosophy has 
 occupied the attention of the most learned men in all ages 
 past, and has ever been closely connected with the co-incident 
 systems of religion. 
 
 The earliest attempts to formulate definite rules of con- 
 duct for the guidance of physicians, of which we have any 
 reliable account, were made in Greece when both medical 
 teaching and practice were chiefly connected with the As- 
 clepiadse and temples for worship, and had for their chief 
 objects the perpetuation of the doctrines of each school by 
 the pupils, their support of each other, and the prevention of 
 improper persons from entering their ranks. 
 
 Pythagoras, about 550 B. C., endeavored to organize his 
 followers in a club or sect with definite rules for the main- 
 tenance of both high character and judicious modes of liv- 
 ing. The teaching of Socrates was still more ethical, but 
 the earliest attempt to formulate a medical code that has 
 been preserved in writing is known as the Hippocratic Oath, 
 and is as follows : "I swear by Apollo, the physician ; by 
 ^sculapius, by Hygeia, by Panacea, and all of the Gods and 
 Goddesses, that according to my ability and judgment, I will 
 keep this oath and stipulation, to reckon him who teaches 
 me this art equally dear to me as my parents ; to share my 
 substance with him and relieve his necessities if required; 
 to look upon his offspring on the same footing as my own 
 brothers, and to teach them this art if they shall wish to 
 learn it, without fee or stipulation ; and that by precept, lec- 
 ' tufe and every other mode of instruction, I will impart a 
 knowledge of this art to my own sons, to those of my teach-
 
 i88 
 
 ers, and to disciples bound by a stipulation and oath accord- 
 ing to the law of medicine, but to no others. I will follow 
 that system of regimen, which, according to my ability and 
 judgment, I consider for the benefit of my patients; and 
 abstain from whatever is deleterious and mischievous ; I will 
 give no deadly medicine to any one, if asked, nor suggest 
 any such counsel ; and in like manner I will not give a wom- 
 an a pessary to produce an abortion. With purity and with 
 holiness I will pass my life and practise my art. I will not 
 cut persons laboring under the stone, but will leave this to 
 be done by men who are practitioners of this work. Into 
 whatever houses I enter, I will go into them for the benefit 
 of the sick, and will abstain from every voluntary act of 
 mischief and corruption ; and further, from the seduction of 
 females and males, of freemen and slaves. Whatever in 
 connection with my professional practice, or not in connec- 
 tion with it, I see or hear, I will not divulge as reckoning that 
 all such things should be kept secret. While I continue to 
 keep this oath inviolate, may it be granted to me to enjoy life 
 and the practice of my art, respected by all men at all times. 
 But should I trespass and violate this oath, may the reverse 
 be my lot." 
 
 This oath constituted substantially the ethical code of all 
 the Asclepiadae until their suppression by the spread of the 
 Christian religion. Even then the same principles were 
 adopted in the monasteries, hospitals, and medical schools 
 that succeeded under the first ten centuries of the Christian 
 dispensation. An attentive reading of the text as translated 
 from its original Greek shows that its author had four lead- 
 ing objects JTti view. 
 
 First, that every physician should feel a profound re- 
 spect and gratitude for his medical teachers, and be ready at 
 all times to extend to them the same aid as to his own kin- 
 dred. 
 
 Second, that he should teach his own sons and his teach- 
 er's sons, if they desired it, the same art of medicine fully 
 and free of charge, and to no others except such disciples as 
 bound themselves by stipulation and oath to observe the law
 
 189 
 
 of medicine ; thereby fostering a distinct hereditary tendency 
 in the perpetuation of the profession. 
 
 Third, that the paramount objects of all medical prac- 
 tice are to benefit the sick, to relieve human suffering, and 
 to prolong human life ; and not for mere pecuniary gain. 
 
 Fourth, that a life of virtue, temperance and integrity on 
 the part of the physician is essential both for his own suc- 
 cess and for the safety of his patients; thereby indicating 
 that personal example is more influential than precept. 
 
 The foregoing ethical principles and objects were ad- 
 mirably illustrated both in the writing and the conduct of 
 Hippocrates. And their beneficial influence can be easily 
 traced through even the darkest periods of European history, 
 though their practical application was often interfered with 
 by the almost constant wars, and the frequent attempts to 
 enforce ecclesiastical authority. 
 
 It was not until the end of the eigtheenth century that the 
 Hippocratic code was more fully discussed, revised and ex- 
 tended by Sir Thomas Percival, an eminent English physi- 
 cian, born in Warrington, England, September 29th, 1740. 
 He was educated at the Warrington Academy and the Uni- 
 versity of Edinburgh, completed his medical studies and re- 
 ceived the degree of M. D. at Leyden in 1765. Two years 
 later he commenced the practice of his profession in Man- 
 chester, and in 1781 was one of the chief founders of the 
 Manchester literary and philosophical society. He made 
 several valuable contributions to the "Philosophical Trans- 
 actions" of London and of Manchester. 
 
 Later in life, he wrote much on moral and literary topics 
 and enjoyed a high reputation. In 1803 ^e published his 
 work entitled "Medical Ethics, or a Code of Institutes and 
 Precepts adapted to the Professional Conduct of Physicians 
 and Surgeons." He died in Manchester, August 30th, 1804. 
 After his death all his important works were collected and 
 published by his son in four volumes, octavo, in London in 
 1807. His work on Medical Ethics embraced a full and very 
 interesting discussion of the nature of the physician's calling ; 
 the duties of the physician to his patients and the obligations 
 of the patient to his physician ; the duties of physicians to each
 
 190 
 
 other and to the profession at large; and the duties of the 
 profession to the pubUc and the obligations of the public to 
 the profession. It was received with so much favor that it 
 speedily became the standard authority on medical ethics by 
 the profession of Great Britain and her colonies, and has con- 
 tinued such until the present time. 
 
 Dr. John Gregory, when at the head of the medical fac- 
 ulty of the University of Edinburgh, in a series of lectures, 
 discussed very fully the duties of the physician. He was 
 followed on the same subject by Dr. Benjamin Rush, of Phil- 
 adelphia, and as medical societies multiplied during the first 
 half of the nineteenth century, many of them adopted the 
 leading sentiments of Percival's code either in their by-laws 
 or in brief codes of their own compilation. One of the most 
 formal of the latter class was imanimously adopted by the 
 New York State Medical Society in 1823, as reported by a 
 committee of which Dr. J. R. Manley was chairman. It 
 was called a "System of Medical Ethics", and was considered 
 in five divisions, namely : 1st. Personal Character of Phy- 
 sicians. 2nd. Quackery. 3rd. Consultations. 4th. Specifi- 
 cations of Medical Police in Practice. 5th. Forensic IMed- 
 ical Police. At the national Convention of delegates from 
 the local and state medical societies^ medical colleges and 
 hospitals, in the United States, held in New York in May, 
 1846, the following resolution was adopted: 
 
 "Resolved, That it is expedient that the medical pro- 
 fession of the United States should be governed by the same 
 code of medical ethics, and that a committee of seven be ap- 
 pointed to report a code for that purpose, at a meeting to 
 be held at Philadelphia on the first Wednesday of May, 
 1847." The committee appointed for that purpose consisted 
 of Drs. John Bell, Isaac Hays, and G. Emerson, of Phila- 
 delphia ; W. W. Morris, of Dover, in Del. ; T. C. Dunn, 
 Newport, R. I. ; A. Clark, of New York; and R. D. Arnold, 
 of Savannah, Ga. This committee, at the convention in 
 Philadelphia, 1847, made an interesting report, accompanied 
 by a more complete code of medical ethics than any pre- 
 viously devised. It was adopted by unanimous vote of the 
 convention ; and as that body at the same meeting resolved
 
 191 
 
 itself into the permanent American Medical Association, it 
 became the code of that organization, and was fully recog- 
 nized in its constitution and by-laws. Its principles and 
 much of its language were copied from the work of Dr. Per- 
 cival, though some important paragraphs are nearly in the 
 words of Drs. Gregory and Rush ; all of which was fully ac- 
 knowledged by the committee in a note appended to their 
 report. 
 
 The leading purpose prompting the formulation of the 
 code was to obtain a com.mon and just standard of profes- 
 sional rights and duties, to guide the medical men in all 
 the states of the American Union. And as the American 
 Medical Association organized at that time was to be a 
 strictly representative body composed of delegates from the 
 several State, District and County Medical Societies in all 
 the states, it adopted as one of its by-laws the following in 
 1865 : "No State or Local Medical Society, or other organ- 
 ized institution, shall be entitled to representation in this 
 Association that has not adopted its Code of Ethics ; or that 
 has intentionally violated or disregarded any article or clause 
 of the same." 
 
 In accordance with this by-law, nearly all the regular 
 State and Local Medical Societies have adopted the same 
 Code of Ethics, and it remains in full force at the present 
 time ; and is in the following language : 
 
 Art. I. — Duties of physicians to their patients. 
 
 Section i. A physician should not only be ever ready to 
 obey the calls of the sick, but his mind ought also to be im- 
 bued with the greatness of his mission, and the responsibility 
 he habitually incurs in its discharge. These obligations are 
 the more deep and enduring, because there is no tribunal 
 other than his own conscience to adjudge penalties for care- 
 lessness or neglect. Physicians should, therefore, minister 
 to the sick with due impressions of the importance of their 
 office; reflecting that the ease, the health, and the lives of 
 those committed to their charge, depend on their skill, at- 
 tention, and fidelity. They should study, also, in their de- 
 portment, so to unite tenderness with firmness, and conde-
 
 192 
 
 SCension with authority, as to inspire the minds of their pa- 
 tients with gratitude, respect, and confidence. 
 
 Section 2. Every case committed to the charge of a phy- 
 sician should be treated with attention, steadiness and hu- 
 manity. Reasonable indulgence should be granted to the 
 mental imbecility and caprices of the sick. Secrecy and deli- 
 cacy, when required by peculiar circumstances, should be 
 strictly observed ; and the familiar and confidential inter- 
 course to which physicians are admitted in their professional 
 visits, should be used with discretion, and with the most scru- 
 pulous regard to fidelity and honor. The obligation of se- 
 crecy extends beyond the period of professional services ; 
 none of the privacies of personal and domestic life, no in- 
 firmity of disposition or flaw of character observed during 
 professional attendance should ever be divulged by the phy- 
 sician except when he is imperatively required to do so. The 
 force and necessity of this obligation are indeed so great, 
 that professional men have, under certain circumstances, 
 been protected in their observance of secrecy by courts of 
 justice. 
 
 Section 3. Frequent visits to the sick are in general 
 requisite, since they enable the physician to arrive at a more 
 perfect knowledge of the disease — to meet promptly every 
 change which may occur, and also tend to preserve the con- 
 fidence of the patient. But unnecessary visits are to be 
 avoided, as they give useless anxiety to the patient, tend to 
 diminish the authority of the physician, ahd render him lia- 
 ble to be suspected of interested motives. 
 
 Section 4. A physician should not be forward to make 
 gloomy prognostications, because they savor of empiricism, 
 by magnifying the importance of his services in the treat- 
 ment or cure of the disease. But he should not fail, on prop- 
 er occasions, to give to the friends of the patient timely no- 
 tice of. danger when it really occurs; and even to the patient 
 himself, if absolutely necessary. This officce, however, is so 
 peculiarly alarming when executed by him, that it ought to 
 be declined whenever it can be assigned to any other person 
 of sufficient judgment and delicacy. For the physician should 
 be the minister of hope and comfort to the sick ; that, by such
 
 193 
 
 cordials to the drooping spirit, he may soothe the bed of 
 death, revive expiring Ufe, and counteract the depressing 
 influence of those maladies which often disturb the tran- 
 quility of the most resigned in their last moments. The life 
 of a sick person can be shortened not only by the acts, but 
 also by the words or the manner of a physician. It is, there- 
 fore, a sacred duty to guard himself carefully in this respect, 
 and to avoid all things which have a tendency to discourage 
 the patient and to depress his spirits. 
 
 Section 5. A physician ought not to abandon a patient 
 because the case is deemed incurable ; for his attendance may 
 continue to be highly useful to the patient, and comforting to 
 the relatives around him, even in the last period of a fatal 
 malady, by alleviating pain and other symptoms, and by 
 soothing mental anguish. To decline attendance, under such 
 circumstances, would be sacrificing to fanciful delicacy and 
 mistaken liberality, that moral duty which is independent of, 
 and far superior to, all pecuniary consideration. 
 
 Section 6. Consultations should be promoted in difficult 
 or protracted cases, as they give rise to confidence, energy, 
 and more enlarged views in practice. 
 
 Section 7. The opportunity which a physician not unfre- 
 quently enjoys of promoting and strengthening the good res- 
 olutions of his patients, suffering under the consequences of 
 vicious conduct, ought never to be neglected. His counsels, 
 or even remonstrances, will give satisfaction, not ofifense, if 
 they be proffered with politeness, and evince a genuine love 
 of virtue, accompanied by a sincere interest in the welfare of 
 the person to whom they are addressed. 
 
 Art. II. — Obligations of patients to their physicians. 
 
 Section i. The members of the medical profession, upon 
 whom is enjoined the performance of so many important and 
 arduous duties toward the community, and who are required 
 to make so many sacrifices of comfort, ease, and health, for 
 the welfare of those who avail themselves of their services, 
 certainly have a right to expect and require, that their pa- 
 tients should entertain a just sense of the duties which they 
 owe to their medical attendants. 
 
 Section 2. The first duty of a patient is to select as his
 
 194 
 
 medical adviser one who has received a regular professional 
 education. In no trade or occupation do mankind rely on the 
 skill of an untaught artist ; and in medicine, confessedly the 
 most difficult and intricate of the sciences, the world ought 
 not to suppose that knowledge is intuitive. 
 
 Section 3. Patients should prefer a physician whose hab- 
 its of life are regular, and who is not devoted to company, 
 pleasure, or to any pursuit incompatible with his professional 
 obligations. A patient should, also, confide the care of him- 
 self and family, as much as possible, to one physician ; for a 
 medical man who has become acquainted with the peculiari- 
 ties of constitution, habits, and predispositions of those he at- 
 tends, is more likely to be successful in his treatment than 
 one who does not possess that knowledge. 
 
 A patient who has thus selected his physician should al- 
 ways apply for advice in what may appear to him trivial 
 cases, for the most fatal results often super\-ene on the slight- 
 est accidents. It is of still more importance that he should 
 apply for assistance in the forming stage of violent diseases ; 
 it is to a neglect of this precept that medicine owes much of 
 the uncertainty and imperfection with which it has been 
 reproached. 
 
 Section 4. Patients should faithfully and unreservedly 
 communicate to their physician the supposed cause of their 
 disease. This is the more important, as many diseases of a 
 mental origin simulate those depending on external causes, 
 and yet are only to be cured by ministering to the mind dis- 
 eased. A patient should never be afraid of thus making his 
 physician his friend and adviser; he should always bear in 
 mind that a medical man is under the strongest obligations of 
 secrecy. Even the female sex should never allow feelings of 
 shame or delicacy to prevent their disclosing the seat, symp- 
 toms, and causes of complaints peculiar to them. However 
 commendable a modest reserve may be in the common occur- 
 rences of life, its strict observance in medicine is often at- 
 tended with the most serious consequences, and a patient may 
 sink under a painful and loathsome disease, which might 
 have been readily prevented had timely intimation been given 
 to the physician.
 
 195 
 
 Section 5. A patient should never weary his physician 
 with a tedious detail of events or matters not appertaining 
 to his disease. Even as relates to his actual symptoms, he 
 will convey much more real information by giving clear an- 
 swers to interrogatories, than by the most minute account 
 of his own framing. Neither should he obtrude upon his 
 physician the details of his business nor the history of his 
 family concerns. 
 
 Section 6. The obedience of a patient to the prescriptions 
 of his physician should be prompt and implicit. He should 
 never permit his own crude opinions as to their fatness to in- 
 fluence his attention to them. A failure in one particular 
 may render an otherwise judicious treatment dangerous, and 
 even fatal. This remark is equally applicable to diet, drink, 
 and exercise. As patients become convalescent they are very 
 apt to suppose that the rules prescribed for them may be dis- 
 regarded, and the consequence, but too often, is a relapse. 
 Patients should never allow themselves to be persuaded to 
 take any medicine whatever, that may be recommended to 
 them by the self-constituted doctors and doctresses who are 
 so frequently met with, and who pretend to possess infalli- 
 ble remedies for the cure of every disease. However simple 
 some of their prescriptions may appear to be, it often hap- 
 pens that they are productive of much mischief, and in all 
 cases they are injurious, by contravening the plan of treat- 
 ment adopted by the physician. 
 
 Section 7. A patient should, if possible, avoid even the 
 friendly visits of a physician who is not attending him — and 
 when he does receive them, he should never converse on the 
 subject of his disease, as an observation may be made, with- 
 out any intention of interference, which may destroy his con- 
 fidence in the course he is pursuing, and induce him to neg- 
 lect the directions prescribed to him. A patient should never 
 send for a consulting physician without the express consent 
 of his own medical attendant. It is of great importance that 
 physicians should act in concert; for, although their modes 
 of treatment may be attended with equal success when ap- 
 plied singly, yet conjointly they are ver\' likely to be pro- 
 ductive of disastrous results.
 
 196 
 
 Section 8. When a patient wishes to dismiss his physi- 
 cian, justice and common courtesy require that he should de- 
 clare his reasons for so doing. 
 
 Section 9. Patients should always, when practicable, 
 send for their physician in the morning, before his usual hour 
 of going out ; for, by being early aware of the visits he has to 
 pay during the day, the physician is able to apportion his 
 time in such a manner as to prevent an interference of en- 
 gagements. Patients should also avoid calling on their med- 
 ical adviser unnecessarily during the hours devoted to meals 
 or sleep. They should always be in readiness to receive the 
 visits of their physician, as the detention of a few minutes is 
 often of serious inconvenience to him. 
 
 Section 10. A patient should, after his recovery, enter- 
 tain a just and endearing sense of the value of the services 
 rendered him by his physician ; for these are of such a char- 
 acter, that no mere pecuniary acknowledgment can repay or 
 cancel them. 
 
 OF THE DUTIES OF PHYSICIANS TO EACH OTHER, AND TO THE 
 PROFESSION AT LARGE. 
 
 Art. I. — Dvities for the support of professional character. 
 
 Section i. Every individual, on entering the profession, 
 as he becomes thereby entitled to all its privileges and im- 
 munities, incurs an obligation to exert his best abilities to 
 maintain its dignity and honor, to exalt its standing, and to 
 extend the bounds of its usefulness. He should, therefore, 
 observe strictly such laws as are instituted for the govern- 
 ment of its members ; should avoid all contumelious and sar- 
 castic remarks relative to tlie faculty as a body ; and while, 
 by unwearied diligence, he resorts to every honorable means 
 of enriching the science, he should entertain a due respect 
 for his seniors, who have, by their labors, brought it to the 
 elevated condition in which he finds it. 
 
 Section 2. It is not in accord with the interests of the 
 public or the honor of the profession that any physician or 
 medical teacher should examine or sign diplomas or certifi- 
 cates of proficiency for, or otherwise be specially concerned 
 with, the graduation of persons whom they have good rea-
 
 197 
 
 son to believe intend to support and practice any exclusive 
 and irregular system of medicine. 
 
 Section 3. There is no profession from the members of 
 which greater purity of character and a higher standard of 
 moral excellence are required, than the medical ; and to attain 
 such eminence is a duty every physician owes alike to his 
 profession and to his patients. It is due to the latter, as with- 
 out it he cannot command their respect and confidence, and 
 to both, because no scientific attainments can compensate for 
 the want of correct moral principles. It is also incumbent 
 upon the faculty to be temperate in all things, for the prac- 
 tice of physic requires the unremitting exercise of a clear and 
 vigorous understanding; and, on emergencies, for which no 
 professional man should be unprepared, a steady hand, an 
 acute eye, and an unclouded head may be essential to the 
 well-being, and even to the life, of a fellow-creature. 
 
 Section 4. It is derogatory to the dignity of the profes- 
 sion to resort to public advertisements, or private cards, or 
 handbills, inviting the attention of individuals affected with 
 particular diseases — publicly offering advice and medicine 
 to the poor gratis, or promising radical cures ; or to publish 
 cases and operations in the daily prints, or suffer such pub- 
 lications to be made ; to invite laymen to be present at op- 
 erations, to boast of cures and remedies, to adduce certifi- 
 cates of skill and success, or to perform any other similar 
 acts. These are the ordinary practices of empirics and are 
 highly reprehensible in a regular physician. 
 
 Section 5. Equally derogatory to professional character 
 is it for a physician to hold a patent for any surgical instru- 
 ment or medicine ; or to dispense a secret nostrum, whether 
 it be the composition or exclusive property of himself or 
 of others. For, if such nostrum be of real efficacy, any con- 
 cealment regarding it is inconsistent with beneficence and 
 professional liberality ; and if mystery alone give it value and 
 importance, such craft implies either disgraceful ignorance 
 or fraudulent avarice. It is also reprehensible for physicians 
 to give certificates attesting the efiicacy of patent or secret 
 medicines, or in any way to promote the use of them.
 
 198 
 
 Art. 1 1. ^-Professional services of physicians to each other. 
 Section i. All practitioners of medicine, their wives, and 
 their children while under the paternal care, are entitled to 
 the gratuitous services of any one or more of the faculty re- 
 siding near them, whose assistance may be desired. A phy- 
 sician afflicted with disease is usually an incompetent judge of 
 his own case; and the natural anxiety and solicitude which 
 he experiences at the sickness of a wife, a child, or any one 
 who, by ties of consanguinity, is rendered peculiarly dear 
 to him, tend to obscure his judgment, and produce timidity 
 and irresolution in his practice. Under such circumstances, 
 medical men are peculiarly dependent upon each other, and 
 kind offices and professional aid should always be cheerfully 
 and gratuitously afforded. Visits ought not, however, to be 
 obtruded officiously ; as such unasked civility may give rise 
 to embarrassment, or interfere with that choice on which con- 
 fidence depends. But, if a distant member of the faculty, 
 whose circumstances are affluent, request attendance, and an 
 honorarium be offered, it should not be declined ; for no pe- 
 cuniary obligation ought to be imposed, which the party re- 
 ceiving it would wish not to incur. 
 
 Art. III. — Of the duties of physician as respects vicarious 
 
 offices. 
 Section i. The affairs of life, the pursuit of health, and 
 the various accidents and contingencies to which a medical 
 man is peculiarly exposed, sometimes require him temporari- 
 ly to withdraw from his duties to his patients, and to request 
 some of his professional brethren to officiate for him. Compli- 
 ance with this request is an act of courtesy, which should al- 
 ways be performed with the utmost consideration for the 
 interest and character of the family physician, and when ex- 
 ercised for a short period all the pecuniary obligations for 
 such services should be awarded to him. But if a member 
 of the profession neglect his business in quest of pleasure 
 and amusement, he cannot be considered as entitled to the 
 advantages of the frequent and long-continued exercise of 
 this fraternal courtesy without awarding to the physician 
 who officiates the fees arising from the discharge of his pro- 
 fessional duties.
 
 199 
 
 In obstetrical and important surgical cases, which give 
 rise to unusual fatigue, anxiety and responsibility, it is just 
 that the fees accruing therefrom should be awarded to the 
 physician who officiates. 
 
 Art. IV. — Of the duties of physicians in regard to 
 consultations. 
 
 Section i. A regular medical education furnishes the 
 only presumptive evidence of professional abilities and ac- 
 quirements, and ought to be the only acknowledged right of 
 an individual to the exercise and honors of his profession. 
 Nevertheless, as in consultations the good of the patient is 
 the sole object in view, and this is often dependent on per- 
 sonal confidence, no intelligent regular practitioner, who has 
 a license to practice from some medical board of known and 
 acknowledged respectability, recognized by the Association, 
 and who is in good moral and professional standing in the 
 place in which he resides, should be' fastidiously excluded 
 from fellowship, or his aid refused in consultation, when it 
 is requested by the patient. But no one can be considered 
 as a regular practitioner or a fit associate in consultation, 
 whose practice is based on an exclusive dogma, to the re- 
 jection of the accumulated experience of the profession, and 
 of the aids actually furnished by anatomy, physiology, 
 pathology and organic chemistry. 
 
 Section 2. In consultations, no rivalship or jealousy 
 should be indulged; candor, probity, and all due respect 
 should be exercised toward the physician having charge of 
 the case. 
 
 Section 3. In consultation, the attending physician should 
 be the first to propose the necessary questions to the sick; 
 after which the consulting physician should have the oppor- 
 tunity to make such further inquiries of the patient as may 
 be necessary to satisfy him of the true character of the case. 
 Both physicians should then retire to a private place for de- 
 liberation ; and the one first in attendance should communi- 
 cate the directions agreed upon to the patient or his friends, 
 as well as any opinions which it may be thought proper to 
 express. But no statement or discussion of it should take 
 place before the patient or his friends, except in the presence
 
 20O 
 
 of all the faculty attending, and by their common consent; 
 and no opinions or prognostications should be delivered 
 which are not the result of previous deliberation and con- 
 currence. 
 
 Section 4. In consultations, the physician in attendance 
 should deliver his opinion first; and when there are several 
 consulting, they should deliver their opinions in the order in 
 which they have been called. No decision, however, should 
 restrain the attending physician from making such variations 
 in the mode of treatment as any subsequent unexpected 
 change in the character of the case may demand. But such 
 variation, and the reasons for it, ought to be carefully de- 
 tailed at the next meeting in consultation. The same priv- 
 ilege belongs also to the consulting physician if he is sent for 
 in an emergency, when the regular attendant is out of the 
 way, and similar explanations must be made by him at the 
 next consultation. 
 
 Section 5. The utmost punctuality should be observed in 
 the visits of physicians when they are to hold consultations 
 together, and this is generally practicable, for society has 
 been considerate enough to allow the plea of a professional 
 engagement to take precedence of all others, and to be an 
 ample reason for the relinquishment of any present occupa- 
 tion. But as professional engagements may sometimes in- 
 terfere, and delay one of the parties, the physician who first 
 arrives should wait for his associate a reasonable period, 
 after which the consultation should be considered as post- 
 poned to a new appointment. If it be the attending physician 
 who is present, he will, of course, see the patient and pre- 
 scribe; but if it be the consulting one, he shoiWd retire, ex- 
 cept in case of emergency, or when he has been called from 
 a considerable distance, in which latter case he may examine 
 the patient, and give his opinion in writing and under seal, 
 to be delivered to his associate. 
 
 Section 6. In consultations, theoretical discussions should 
 be avoided, as occasioning perplexity and loss of time. For 
 there may be much diversity of opinion concerning specu- 
 lative points, with perfect agreement in those modes of
 
 201 
 
 practice which are founded, not on hypothesis, but on expe- 
 rience and observation. 
 
 Section 7. All discussions in consultation should be held 
 as secret and confidential. Neither by words nor manner 
 should any of the parties to a consultation assert or insinuate 
 that any part of the treatment pursued did not receive his 
 assent. The responsibility must be equally divided between 
 the medical attendants — they must equally share the credit 
 of success as well as the blame of failure. 
 
 Section 8. Should an irreconcilable diversity of opinion 
 occur when several physicians are called upon to consult to- 
 gether, the opinion of the majority should be considered as 
 decisive ; but if the numbers be equal on each side, then the 
 decision should rest with the attending physician. It may, 
 moreover, sometimes happen that two physicians cannot 
 agree in their views of the nature of a case, and the treatment 
 to be pursued. This is a circumstance much to be deplored, 
 and should always be avoided, if possible, by mutual conces- 
 sions, as far as they can be justified by a conscientious re- 
 gard for the dictates of judgment. But in the event of its 
 occurrence, a third physician should, if practicable, be called 
 to act as umpire ; and, if circumstances prevent the adoption 
 of this course, it must be left to the patient to select the phy- 
 sician in which he is most willing to confide. But, as every 
 physician relies upon the rectitude of his judgment, he 
 should, when left in the minority, politely and consistently 
 retire from any further deliberation in the consultation, or 
 participation in the management of the case. 
 
 Section 9. As circumstances sometimes occur to render 
 a special consultation desirable, when the continued attend- 
 ance of two physicians might be objectionable to the patient, 
 the member of the faculty whose assistance is required in 
 such cases should sedulously guard against all future unso- 
 licited attendance. As such consultations require an extraor- 
 dinary portion of both time and attention, at least a double 
 honorarium may be reasonably expected. 
 
 Section 10. A physician who is called upon to consult, 
 should observe the most honorable and scrupulous regard for 
 the character and standing of the practitioner in attendance ;
 
 202 
 
 the practice of the latter, if necessary, should be justified as 
 far as it can be, consistently with a conscientious regard for 
 truth, and no hint or insinuation should be thrown out which 
 could impair the confidence reposed in him, or affect his rep- 
 utation. The consulting physician should also carefully re- 
 frain from any of those extraordinary attentions or assidu- 
 ities which are too often practiced by the dishonest for the 
 base purpose of gaining applause, or ingratiating themselves 
 into the favor of families and individuals. 
 
 Art. V. — Duties of physicians in cases of interference. 
 
 Section i. Medicine is a liberal profession, and those ad- 
 mitted to its ranks should found their expectations of prac- 
 tice upon the extent of their qualifications, not on intrigue or 
 artifice. 
 
 Section 2. A physician, in his intercourse with a patient 
 under the care of another practitioner, should observe the 
 strictest caution and reserve. No meddling inquiries should 
 be made — no disingenuous hints given relative to the nature 
 and treatment of his disorder ; nor any course of conduct pur- 
 sued that may directly or indirectly tend to diminish the trust 
 reposed in the physician employed. 
 
 Section 3. The same circumspection and reserve should 
 be observed when, from motives of business or friendship, a 
 physician is prompted to visit an individual who is under the 
 direction of another practitioner. Indeed, such visits should 
 be avoided, except under peculiar circumstances ; and when 
 they are made, no particular inquiries should be instituted 
 relative to the nature of the disease, or the remedies em- 
 ployed, but the topics of conversation should be as foreign to 
 the case as circumstances will admit. 
 
 Section 4. A physician ought not take charge of or pre- 
 scribe for a patient who has recently been under the care of 
 another member of the faculty in the same illness, except in 
 cases of sudden emergency, or in consultation with the phy- 
 sician previously in attendance, or when the latter has relin- 
 quished the case, or has been regularly notified that his serv- 
 ices are no longer desired. Under such circumstances, no 
 unjust and illiberal insinuations should be thrown out in re- 
 lation to the conduct or practice previously pursued, which
 
 203 
 
 should be justified as far as candor and regard for truth and 
 probity will permit ; for it often happens that patients be- 
 come dissatisfied when they do not experience immediate re- 
 lief, and, as many diseases are naturally protracted, the want 
 of success, in the first stage of treatment, affords no evi- 
 dence of a lack of professional knowledge and skill. 
 
 Section 5. When a physician is called to an urgent case, 
 because the family attendant is not at hand, he ought, unless 
 his assistance in consultation be desired, to resign the care 
 of the patient to the latter immediately on his arrival. 
 
 Section 6. It often happens in case of sudden illness, or 
 of recent accidents and injuries, owing to the alarm and anx- 
 iety of friends, that a number of physicians are simultaneous- 
 ly sent for. Under these circumstances, courtesy should as- 
 sign the patient to the first who arrives, who should select 
 from those present any additional assistance that he may 
 deem necessary. In all such cases, however, the practitioner 
 who officiates should request the family physician, if there 
 be one, to be called, and, unless his further attendance be 
 requested, should resign the case to the latter on his arrival. 
 
 Section 7. When a physician is called to the patient of 
 another practitioner, in consequence of the sickness or ab- 
 sence of the latter, he ought, on the return or recovery of the 
 regular attendant and with the consent of the patient, to sur- 
 render the case. 
 
 [The expression, "patient of another practitioner," is un- 
 derstood to mean a patient who may have been under the 
 charge of another practitioner at the time of the attack of 
 sickness, or departure from home of the latter, or who may 
 have called for his attendance during his absence or sick- 
 ness, or in any other manner given it to be understood that 
 he regarded the said physician as his regular medical at- 
 tendant.] 
 
 Section 8'. A physician, when visiting a sick person in 
 the country, may be desired to see a neighboring patient who 
 is under the regular direction of another physician, in con- 
 sequence of some sudden change or aggravation of symp- 
 toms. The conduct to be pursued on such an occasion is to 
 give advice adapted to present circumstances ; to interfere no
 
 204 
 
 further than is absolutely necessary with the general plan of 
 treatment ; to assume no future direction unless it is ex- 
 pressly desired ; and, in this last case, to request an imme- 
 diate consultation with tlie practitioner previously employed. 
 
 Section 9. A wealthy physician should not give advice 
 gratis to the affluent ; because his doing so is an injury to his 
 professional brethren. The office of a physician can never be 
 supported as an exclusively beneficent one ; and it is defraud- 
 ing, in some degree, the common funds for its support, when 
 fees are dispensed with which might justly be claimed. 
 
 Section 10. When a physician who has been engaged to 
 attend a case of midwifery is absent, and another is sent for, 
 if delivery is accomplished during the attendance of the lat- 
 ter, he is entitled to the fee, but should resign the patient to 
 the practitioner first engaged. 
 
 Art. VI. — Of differences between physicians. 
 
 Section i. Diversity of opinion and opposition of inter- 
 est may, in the medical as in other professions, sometimes oc- 
 casion controversy and even contention. Whenever such 
 cases unfortunately occur, and cannot be immediately termi- 
 nated, they should be referred to the arbitration of a suffi- 
 cient number of physicians or a court-medical. 
 
 Section 2. As peculiar reserve must be maintained by 
 physicians toward the public, in regard to professional mat- 
 ters, and as there exist numerous points in medical ethics 
 and etiquette through which the feelings of medical men may 
 be painfully assailed in their intercourse with each other, and 
 which cannot be understood or appreciated by general so- 
 ciety, neither the subject-matter of such differences nor the 
 adjudication of the arbitrators should be made public, as 
 publicity in a case of this nature may be personally injurious 
 to the individuals concerned, and can hardly fail to bring 
 discredit on the faculty. 
 
 Art. VII. — Of pecuniary acknowledgments. 
 
 Some general rules should be adopted by the faculty, in 
 every town or district, relative to pecuniary acknowledge- 
 ments from their patients ; and it should be deemed a point of 
 honor to adhere to these rules with as much uniformity as 
 varying circumstances will admit.
 
 205 
 
 OF THE DUTIES OF THE PROFESSION TO THE PUBLIC, AND OF 
 
 THE OBLIGATIONS OF THE PUBLIC TO 
 
 THE PROFESSION, 
 
 Art. I. — Duties of the profession to the public. 
 
 Section i. As good citizens, it is the duty of physicians 
 to be ever vigilant for the welfare of the community, and to 
 bear their part in sustaining its institutions and burdens; 
 they should also be ever ready to give counsel to the public 
 in relation to matters especially appertaining to their pro- 
 fession, as on subjects of medical police, public hygiene, and 
 legal medicine. It is their province to enlighten the public 
 in regard to quarantine regulations; the location, arrange- 
 ment, and dietaries of hospitals, asylums, schools, prisons, 
 and similar institutions ; in relation to the medical police of 
 towns, as drainage, ventilation, etc. ; and in regard to meas- 
 ures for the prevention of epidemic and contagious diseases ; 
 and when pestilence prevails, it is their duty to face the dan- 
 ger, and to continue their labors for the alleviation of the 
 suffering, even at the jeopardy of their own lives. 
 
 Section 2. Medical men should also be always ready, 
 when called on by the legally constituted authorities, to en- 
 lighten coroners' inquests and courts of justice on subjects 
 strictly medical — such as involve questions relating to san- 
 ity, legitimacy, murder by poisons or other violent means, 
 and in regard to the various other subjects embraced in the 
 science of Medical Jurisprudence. But in these cases, and 
 especially where they are required to make a post-mortem 
 examination, it is just, in consequence of the time, labor, and 
 skill required, and the responsibility and risk they incur, that 
 the public should award them a proper honorarium. 
 
 Section 3. There is no profession by the members of 
 which elemosynary services are more liberally dispensed than 
 the medical, but justice requires that some limits should be 
 placed on the performance of such good offices. Poverty, 
 professional brotherhood, and certain of the public duties re- 
 ferred to in the first section of this article, should always be 
 recognized as presenting valid claims for gratuitous services ; 
 but neither institutions endowed by the public or by rich in- 
 dividuals, societies for mutual benefit, for the insurance of
 
 206 
 
 lives or for analogous purposes, nor any profession or occu- 
 pation, can be admitted to possess such privilege. Nor can 
 it be justly expected of physicians to furnish certificates of 
 inability to serve on juries, to perform militia duty, or to 
 testify to the state of health of persons wishing to insure 
 their lives, obtain pensions, or the like, without a pecuniary 
 acknowledgement. But to individuals in indigent circum- 
 stances, such professional services should always be cheer- 
 fully and freely accorded. 
 
 Section 4. It is the duty of physicians, who are frequent 
 witnesses of the enormities committed by quackery, and the 
 injury to health and even destruction of life caused by the 
 use of quack medicines, to enlighten the public on these sub- 
 jects, to expose the injuries sustained by the unwary from 
 the devices and pretensions of artful empirics and impostors. 
 Physicians ought to use all the influence which they may pos- 
 sess, as professors in Colleges of Pharmacy, and by exercis- 
 ing their opinion in regard to the shops to which their pre- 
 scriptions shall be sent, to discourage druggists and apothe- 
 caries from vending quack or secret medicines, or from being 
 in any way engaged in their manufacture or sale. 
 
 Art. II. — Obligations of the public to physicians. 
 
 Section i. The benefits accruing to the public, directly 
 and indirectly, from the active and unwearied beneficence of 
 the profession, are so numerous and important, that physi- 
 cians are justly entitled to the utmost consideration and re- 
 spect from the community. The public ought likewise to en- 
 tertain a just appreciation of medical qualifications; to make 
 a proper discrimination between true science and the as- 
 sumptions of ignorance and empiricism ; to alTord every en- 
 couragement and faciHty for the acquisition of medical edu- 
 cation — and no longer allow the statute-books to exhibit the 
 anomaly of exacting knowledge from physicians, under a lia- 
 bility to heavy penalties, and making them obnoxious to 
 punishment for resorting to the only means of obtaining it. 
 
 EXPLANATORY DECLARATIONS. 
 
 Whereas, Persistent misrepresentations have been and 
 still are being made concerning certain provisions of the 
 Code of Ethics of this Association, by which many in the
 
 207 
 
 community, and some even in the ranks of the profession are 
 led to beHeve those provisions exclude persons from profes- 
 sional recognition simply because of differences of opinions 
 or doctrines ; therefore 
 
 1. Resolved, That clause first, of Art. IV., in the Na- 
 tional Code of Medical Ethics, is not to be interpreted as ex- 
 cluding from professional fellowship, on the ground of dif- 
 ferences in doctrine or belief, those who in other respects are 
 entitled to be members of the regular medical profession. 
 Neither is there any other article or clause of the said Code 
 of Ethics that interferes with the exercise of the most per- 
 fect liberty of individual opinion and practice. 
 
 2. Resolved, That it constitutes a voluntary discon- 
 nection or withdrawal from the medical profession proper, 
 to assume a name indicating to the public a sectarian, or ex- 
 clusive system of practice, or to belong to an association or 
 party antagonistic to the general medical profession. 
 
 3. Resolved, That there is no provision in the National 
 Code of Medical Ethics in any wise inconsistent with the 
 broadest dictates of humanity, and that the article of the 
 Code which relates to consultations cannot be correctly 
 interpreted as interdicting, under any circumstances, the ren- 
 dering of professional services whenever there is a pressing 
 or immediate need of them. On the contrary, to meet the 
 emergencies occasioned by disease or accident, and to give 
 a helping hand to the distressed without unnecessary delay, 
 is a duty fully enjoined on every member of the profession, 
 both by the letter and the spirit of the entire Code. 
 
 But no such emergencies or circumstances can make it 
 necessary or proper to enter into formal professional consul- 
 tations with those who have voluntarily disconnected them- 
 selves from the regular medical profession, in the manner 
 indicated by the preceding resolution. 
 
 N. S. Davis, of Chicago, 
 A. Y. P. Garnett, of Washington, 
 H. F. Campbell, of Augusta, Ga., 
 Austin Flint, of New York. 
 J. B. Murdoch, of Pittsburgh.
 
 208 
 
 On motion of Dr. Brodie, the resolutions %yere unani- 
 mously adopted. 
 
 On motion of Dr. Keller, it was unanimously agreed that 
 the resolutions be added as an explanatory addendum in all 
 future publications of the Code. 
 
 Every intelligent and thoughtful reader will perceive 
 that the foregoing code of ethics is not a mere system of by- 
 laws, but a liberal and just recognition of the nature and ob- 
 jects of the physician's calling; the moral principles that 
 should govern his intercourse with his patients, with his pro- 
 fessional brethren, with the community at large ; and in re- 
 turn the principles that should influence the conduct of both 
 the patient and the community towards the profession. 
 
 It properly assumes that injuries, diseases, pains and 
 death are conditions of distress to which the whole human 
 family are more or less liable, and that as it is the paramount 
 object of both physicians and surgeons to prevent or relieve 
 such distress and to prolong human life, it is their duty to 
 promptly and faithfully bestow their services upon all who 
 ask them, whether rich or poor, so far as their own time and 
 health will permit. It also assumes that inasmuch as "the 
 laborer is worthy of his hire" so the physician is justly en- 
 titled to a fair pecuniary compensation for his services from 
 all who are able to pay ; while those who are so unfortunate 
 as to be both sick and destitute, should also be treated with 
 all the kindness and faithfulness that their cases require. 
 
 On the same liberal and humane principles the code 
 makes it the physician's duty to enlighten the public on top- 
 ics connected with the public health, and to enlighten the 
 courts on all medico-legal questions involved in the adminis- 
 tration of justice. 
 
 The two topics that have given rise to nearly all the criti- 
 cisms and controversies are those relating to advertising and 
 consultations. Concerning the first, the code freely permits 
 each member of the profession to place his name, his title, 
 his residence, office and office hours on his cards and in the 
 newspapers and magazines whenever he chooses to do so. 
 It does, however, prohibit him from resorting "to public ad- 
 vertisements, or private cards, or hand bills, inviting the
 
 209 
 
 attention of individuals affected with particular diseases", 
 etc. ; not only because such is the common practice of em- 
 pirics and public impostors, but also because the indulgence 
 in such practice by reputable physicians would soon fill the 
 newspapers with bombastic and pretentious medical adver- 
 tisements with no profit to any one except the newspaper 
 publisher whose chief income is from his advertising col- 
 umns. And it would also make it still more difficult for the 
 young physician to establish himself in practice, because he 
 would have to compete in the advertising line with his older 
 and established competitors when he had no funds to spare 
 for such a purpose. 
 
 Concerning consultations, the code enjoins the widest 
 liberality consistent with the honor of the profession and the 
 welfare of the patient. It assumes that in all consultations 
 "the good of the patient is the sole object in view"; and 
 therefore no intelligent, legally authorized practitioner who 
 is in good moral and professional standing, should be ex- 
 cluded from consultation, except those who base their prac- 
 tice on an "exclusive dogma" or theoretical law of cure, to 
 the exclusion of the accumulated experience of the profes- 
 sion, and indicate the same by a sectarian title, as more fully 
 explained in the resolutions adopted by the American Med- 
 ical Association in 1869, and appended to the preceding copy 
 of the Code of Ethics.
 
 
 DATE DUE 
 
 
 ; ^ -'Q-;- 
 
 I _j 
 
 
 
 
 
 
 d^Mzi^l__ 
 
 
 
 nn^]^ji___ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 1 
 
 
 
 
 
 
 
 
 VLORO 
 
 P'^INTED IN U S A.
 
 ITZUO 
 1)2631'. 
 1903 
 Davis 
 
 Histoid'' of medicine 
 
 D263h 
 
 ^ . 1903 
 
 Davis. 
 
 History of medicine 
 
 CALIFORNIA COLLEGE OF MEDICINE LIBRARY 
 
 UNIVERSITY OF CALIFORNIA, IRVINE 
 
 IRVINE, CALIFORNIA 92664 
 
 PniMTIO M U-«.A*
 
 ^ 
 
 c/> 
 
 I 
 
 22 
 
 o 
 
 C/9 
 
 BO 
 00 
 
 g
 
 I« ''^l 
 
 <»-' 
 
 
 'k'"*!"*'^ 
 
 ;:j^i- 
 
 
 *''>'S^ta 
 
 
 
 
 ' '' ^^H 
 
 
 ' ."L^jfl 
 
 
 '.'T'^'J^^^H 
 
 
 '-'h^H 
 
 
 
 !w'r'.' ; 
 
 'jH^^^^^^^^^H 
 
 ^1