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JOHN HUNTER 
Painted by Sir Joshua Reynolds 



THE HISTORY OF 
MEDICINE 

In its Salient Features 



WALTER LIBBY, M.A., Ph.D. 

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WITH HXUSTRATIONS 




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PREFACE 

In the doeing days of 1917 I was asked to give a 
course of lectures on the history of medicine. This 
book is the outcome of my attempt to comply with 
the request made at that time. The course of lee- 
turesy given in the first place in the early weeks of 
1918, followed the lines of the present table of con* 
tents. My auditors were third-year students in one 
of the American Schools of Medicine, and the plan of 
presentation was more or less consciously dictated^ 
at the start, by the recollection of what had chal* 
lenged my curiosity and aroused my attention about 
the time I had attained a like standing as a student 
of medicine. Questions and class discussions evoked 
by the lectures in 1918 and the three subsequent 
years suggested, however, certain modifications of 
the initial treatment of the subject and indicated 
in what directions additions and elucidations were 
most desirable. 

Even at the outset I felt sure that the course 
would be of greater interest to the men if I could 
trace the development of medicine, however sue- 
dnctly, from the earliest times till the present day. 
I b^an, therefore, with an account of the dawn of 
medical science in Egypt and Babylonia, in spite of 



vi PREFACE 

the imperfect state of the records and their need 
of interpretation. Nor could I refrain — in April, 
191 8 — from saying at least something concerning 
''Medical Science and Modem Warfare," although 
the time had obviously not arrived for setting forth 
adequately the medical aspects of the World War. 
Similarly, the distribution of space as regards an- 
cient and modem medicine, the emphasis of what 
seemed to me the most important stages in the evo- 
lution of medicine, the avoidance of unnecessary de« 
tails and of needlessly abstruse terminology, as well 
as the general style of composition, have their ex- 
planation in the nature of the audience before whom 
and of the circumstances in which the course of lee* 
tures was given. By the use of simple reading lists, 
now represented by the References at the ends of 
the chapters, I hoped so to interest the students 
that they would soon become capable of construct^* 
ing their own bibliographies, and that from the pe- 
rusal of Allbutt, Garrison, Guerini, Hyrtl, Meunier, 
Osier, Singer, SudhoflF, Withington, and other au« 
thorities brought to their particular attention, they 
might pass to an examination of Baas-Handerson, 
Buck, Choulant, Daremberg, Diels, Friend, Haeser, 
HoUtoder, Ideler, Ilberg, Le Clerc, Littr6, Meyer- 
Steineg, Neuburger, Pagel, Puschmann, Schelenz, 
Schwalbe, Sprengel, Wellmann, Wickersheimer, and 
other more or less distinguished writers on the his- 



PREFACE vfi 

tory of mcklicine. GBrriBcm^s Introduction to the His^ 
tary of Medicine (third edition, 192 1) is a compre- 
hensive and up-to-date work almost indispensable 
to the serious student of the subject it treats. I am 
especially conscious of my indebtedness to it, to the 
Histoire de la Midecine of L6on Meunier, to the 
Geschichte der Meditin of Max Neubuiigery and to 
the Medical History of E. T. Withington, of whose 
translations I have made use in the second chapter. 
Through an almost inexplicable oversight I failed 
to mention in the preface of iin Introduction to the 
History of Science the "Science Room" at the Bodle- 
ian Library, Oxford, where that book was written. 
Some of the researches there carried on by Dr. 
Charles Singer and those associated with him have 
been embodied in two handsome volumes — Studies 
in the History and Method of Science {1917 9 1921). I 
take this opportunity of expressing my sense of obli- 
gation to him, as well as to Dr. Geoiige Sarton, of 
the Carnegie Institution, editor of Isis and exponent 
on this continent of the claims of the history of 
science. I wish also to thank Dr. Edna M. Guest, 
of Toronto, for advice in reference to all the chap- 
ters which she read in manucript, and for sub- 
stantial help in the revision of the twentieth chap- 
ter, — help which her military experience in the 
E^t, as well as on the Western front, rendered 
invaluable. All interested in the history of the 



PREFACE 

medical scienoes as well as of sctehoe in general 
will welcome the annowicement of a work by Pro- 
fessor Lynn Thomdike on The History of Magic, and 
of a History of Biology from the pen of Professor 
W. A. Locy. 

Walter Libby 

September t 1923 



CONTENTS 

I. The Priest-Physicians of Egypt and 
Babylonia i 

IL Hippocrates the Father op Medicine 23 

III. Roman Anatomy AND Surgery 46 

IV. The Transmission of Medical Science 

BY THE Arabs 71 

V. The Revivai. of Anatomy and Surgery in 
THE Sixteenth Century 94 

VI. William Harvey and the Revival of 

Physiology 116 

VII. Science and Practice: 

Sydenham, Boerhaave 138 

VIIL Comparative Anatomy: 

John Hunter 160 

IX. Morbid Anatomy, and Histology: 

MORGAGNI, BiCHAT I8I 

' X. Local Diagnosis: 

AUENBRUGGER, LaeNNBC ' 200 

XI. Advances in Physiology 218 

XIL Embryology and Karl Ernst von Baer 238 

XIIL The Cell-Theory and Cellular Path- 
ology 257 

XIV. The Introduction of Anaesthetics 276 

XV. The Theory of Organic Evolution 296 

XVI. The Founders of Bacteriology 316 

XVIL Antiseptic Surgery: Lord Lister 335 



X CONTENTS 

XVIII. The History of Syphilis 354 

XIX. Prevbntivb Mbdicinb in the Tropics 374 

XX. Medical Science and Modern Warfare 396 

' Index 415 



ILLUSTRATIONS 

John Hunter Frontispiece 

From the photogravure in William Stirling*! Some Apostles 
afPhysudoey (London. 190a) of the portrait by Sir Joshua 
Reynolda in the Royal College of Surgeoni» London. 

Facsimiles from the Ebbrs Papyrus in Egyptian 
Hieratic Characters, containing Dental^Prb- 
scriptions 6 

From Guerini't Hisiory of DenHstry. 

Hippocrates 32 

From an engraving by W. Skelton, in Thomas Joseph Petti- 
srew's Medical PortraU Gallery, of the bust found near 
Albano among ruins supposea to have been the villa of 
Marcus Varro. The bust is now in the British Museum. 

Dissection showing the Female Viscera in Situ, 
DRAWN BY Leonardo da Vinci, circa 1510 104 

From Qwidemi d^Analomia. 

Marie-Fran^ois-Xavter Bichat 190 

From William Stirling's Some AposOes ef Physichiy. 

Francois Magendib 190 

From Some AposUes of Physioloiy, 

Sir Charles Bell aaa 

From an engraving by J. Thomson in Pettigrew's Medical 
Portrail GaUery, after the portrait by Ballantyne. 

Lord Lister 346 

From a photogravure in Sir Rickman Godlee's Life of 
LordLisier. 

Plastic Surgery of the Face 413 

From H. D. Gillles*s Plastic Surgery of ike Pau, Oxford, 
1920. 



i 



i 



THE HISTORY OF MEDICINE 
In its Salient Features 






CHAPTER I 

THE PRIEST-PHYSICIANS OF EGYPT AND 

BABYLONIA 

Tbb medical lore of a very remote ps»t was handed 
down from generation to generation by the Egyp- 
tian priests, the overseers of the general welfare of 
the people, to become ultimately known, at least in 
part, to Hippocrates and other Greeks of the Peri- 
clean age. The tendency to perpetuate traditional 
teachings and practices, natural to the priestly 
caste everywhere, was enhanced in Egypt through 
the early development of the hieroglyphic and hi- 
eratic systems of writing from the pictorial, and 
encouraged by the preservative nature of the dry 
Egyptian climate. The written records of the scribes 
and clerics, their incantations, spells, exorcisms, 
prescriptions, and clinical observations, were main- 
tained intact from age to age, and finally embodied 
in compilations, of which a few specimens survive in 
the medical papyri of our libraries and museums. 
At the same time the ease with which the dead 



2 THE HISTORY OF MEDICINE 

could be preserved irom putrefaction in the plateaus 
above the Nile Valley led to improved methods of 
tomb construction, which culminated in the erec- 
tion of the pyramids between the thirtieth and 
twenty-fifth centuries, as well as to the develop- 
ment of the art of embalming, which reached its 
highest perfection about the middle of the sixteenth 
century, B.C. It is natural to find that in these 
circumstances therapeutics and religious supersti- 
tion were not mutually exclusive, and that the 
efforts of the Egyptian priest-physicians to pro- 
mote hygienic living and the attainment of longevity 
were closely associated with a transcendental vision 
(A a material life everlasting* 

In Egypt more clearly than elsewhere can be 
traced a rapid advance from barbarism to a high 
degree of civilization. In the Nile Delta, not far 
from the pyramids, are still to be seen the graves of 
neolithic man containing such evidence of his primi- 
tive industries as stone implements, pottery, frag- 
ments of linen, grains of barley and split wheat. 
These graves are not unlike those of primitive and 
prehistoric men elsewhere, as, for example, the 
graves of some of the aborigines of North America. 
In fact, the early Egyptian, watering his fields by 
a simple system of irrigation, living in huts of 
mud-brick, employing an undeveloped method of 
chronology, and unacquainted with copper or iron, 



THE PRIEST-PHYSICIANS 3 

18 in many respects comparable with the ancient 
Pueblo Indian of New Mexico and Arizona. The 
transition to a more advanced stage of development 
came for the Egyptians when in the fifth millennium 
B.C. they added to the use of gold and the rarer 
silver that of copper, found native or obtained by 
smelting from malachite. This acquisition led in 
turn, about the middle of the thirty-first century, 
to the empIo3rment of prepared stone as building 
material, and, about the beginning of the thirtieth 
century, to the erection of the first pyramid. This 
step-pyramid was de ;igned by Imhotep, the first of 
the priest-physicians whose name is known to us. 
In later centuries his memory was held sacred in 
hundreds of temples, and he became identified in 
the minds of many Egyptians with Thoth, the god 
of healing. 

It is not strange that some resemblance should 
exist between the surgery of Egypt, where, in the 
desert sands, stone tools and flint arrowheads are 
still to be found, and the surgery of primitive and 
prehistoric peoples. Before the dawn of history 
trephining, cupping, circumcision, castration, vene- 
section, the use of the cautery and of splints were 
known in many parts of the earth; though the 
motives that led to the employment of these prac- 
tices were not in each case identical with those of 
modem surgery. Skulls recovered by the archse- 



4 THE HISTORY OF MEDICINE 

olpgist bear witness that trephining was practiced 
among prehistoric peoples in the western as well as 
in the eastern hemisphere. It was performed for a 
variety and mixture of motives — to relieve head- 
ache, to cure epilepsy, to let out the tormenting 
spirit, to obtain amulets, or to propitiate the gods. 
Even among primitive peoples to-day trephining is 
sometimes effected by means of knives of flint or 
obsidian. A slight link is estaUished between the 
surgery of barbarian and that of civilized Egypt 
by some representations of surgical operations of 
2500 B.C. They were discovered on the doorpost of a 
tomb in a necropolis near Memphis. Among the 
pictures are two of circumcisions, in which the 
surgeon is shown in the act of operating with a flint 
knife. The Jews, who learned this adolescent rite 
from the Egyptians, were still in their ceremonies 
using the same sort of neolithic instrument cen- 
turies later, as we know from the fifth chapter of 
the Book of Joshua. \ 

On account of the conservatism of the priest- 
physicians, Egyptian medicine never advanced far 
beyond primitive medicine with its simple faith in 
magic spells and the virtue of a rich pharmacopoeia, 
and its belief that the cause of disease was the 
malice of a demon, the justice of an avenging god, 
the ill-will of an enemy, or the anger of the dead. 
The medicine chest of an early Egyptian queen 



THE PRIEST-PHYSICIANS 5 

(about 2100 B.C.)* with its alabaster bottles coii« 
taining medicinal roots, b typical of the Egjrptiaii 
faith in the efficacy of drugs. In the London papyrus, 
the lesser Berlin papyrus, and the Brugsch papyrus 
the mystical element predominates, though in the 
last-named we read of vermifuges, fumigations, 
treatment of ulcers, of haematuria, of diseases of the 
breast, heart, and ears. The Ebers papyrus, the 
discovery of which was announced in 1873, though 
by no means wanting in charms and incantations, 
is less dominated by the m3rstical element than the 
preceding or succeeding medical papyri. It is a 
compilation of about the middle of the sixteenth 
century B.C. Much of it reflects, however, the 
practice of an earlier epoch, and it may be con- 
sidered as representing the high-water mark of 
Egyptian medicine. 

It is in the main a collection of prescriptions, some 
ci which had been tried frequently, as we learn from 
mai^nal notes, and found good, or excellent. It 
makes mention of some seven hundred remedies, 
evidently accumulated in the course of the ages, and 
put on record and preserved for posterity by the 
priestly scribes. Among the remedies are found 
poppy, castor-oil, gentian, colchicum, squills, aloes, 
cedar, mint, myrrh, crocus, hyoscyamus, caraway, 
elderberries, and many other medicinal herbs, that 
call to mind the therapy of North American In- 



6 THE HISTORY OF MEDICINE 

dians and of all primitive tribes throughout the 
worid. The Egyptian priest-physicians made use 
also of certain inorganic remedies^ such as lead 
oxide, earthy carbonate of lead, galena, meteoric 
iron, blue vitriol, crude carbonate of soda, sodium 
chloride, and sea-salt. Petroleum, bog-water, goose- 
oil, turpentine, ink (made from charcoal and gum), 
honey, probably antimony, possibly mercurials, 
found a place in the Egyptian pharmacopoeia. 
Honey was thought to be terrible to the dead, 
though sweet to man. It may have been on the 
complementary principle that what is abhorrent to 
the patient is pleasant to the perverse demons of 
disease that many disgusting substances were used 
as remedies, such as the dung of the gazelle and the 
crocodile, the fat of a serpent, mammalian entrails, 
and other excreta, tissues, and organs. In some 
cases the object seems to have been to wheedle, in 
other cases to repel, the evil spirits that had taken 
possession of the patient. The various medicines 
were given as foods, potions, pills, plasters, in- 
unctions, inhalations, etc. 

Among the diseases spoken of in the Ebera 
papyrus are ailments of the eyes and ears, stomach 
troubles, worms, dysentery, and other affections 
of the intestines, arthritis deformans, gout, lum- 
bago, ascites, pemphigus, scurvy, leucorrhoea, 
asthma, tumors, and a disease which some would 







■■^^m 






FACSIMILES FROM THE EBERS PAPYRUS IN EGYPTIAN 

HIERATIC CHARACTERS, THE UPPER CONTAINING THREE, 

THE LOWER ELEVEN, DENTAL PRESCRIPTIONS 



K 

01 

di 
ti 
di 
ar 
tfa 
an 
Hi 
of 

OD 

El 
dis 



Q 

hat 

/ 

dta; 
iQd 

the 

cqik 
othe 
Sod 



THE PRIEST-PHYSICIANS 7 

identify as hookworm disease (Egyptian chlorosis), 
others with bilharziasis. Both of these last-named 
diseases are very prevalent in Egypt at the present 
time; both are marked by anaemia and are asso- 
ciated with arrest of mental development; both 
are now known to be caused by parasitic worms, 
the former by Ancylostoma duodenale (and Necator 
americanus)^ the latter by Schistosoma kosmatohiutn. 
Haematuria is one of the most constant symptoms 
of bilharziasis, a fact which may have some bearing 
on the identification of the disease mentioned in the 
Ebers papyrus, for the symbol there used for the 
disease is the phallus. As we shall see in the six- 
teenth chapter, some of the other diseases treated 
in the Egypt of the sixteenth century B.C. have in 
recent times been studied by one of the leading 
bacteriologists. 

A few passages of the Ebers papyrus may bear 
witness to a knowledge of anatomy, surgery, and 
diagnosis somewhat beyond the range of primitive 
and prehistoric peoples. One of these reads: "If 
the physician place his finger on the head, neck, 
hands, arms, feet, or trunk, everywhere he will find 
the heart, for its vessels go to all parts.'' The 
vessels of the body are said to run in pairs, and to 
contain not merely blood, but air, water, milk, and 
other fluids. Another passage says: "When you 
find a man with a stoppage, his face pale and heart 



8 THE HISTORY OF MEDICINE 

palpitating, and you find upon examination that 
his heart is hot and his belly swollen, that is an 
affection caused by irritant food. Treat it with 
something that is cooling and aperient, especially 
with a draught of sweet 'beer, poured upon dry 
nequat fruit. Four times shall he eat or drink/* A 
third passage advises operation following diagnosis 
of fatty tumor: ''If you find disease of fat in any 
part whatsoever of the body of the person, and find 
that it moves hither and thither under your fingers, 
and that it trembles when your hand is at rest, then 
you must say of it, 'It is a fatty tumor; it pains; I 
will treat it.' Treat it with the knife; dress it as one 
dresses open wounds.*' 

The Ebers papyrus is not only the most important 
source of information concerning ancient Egyptian 
medicine, but the most complete book on any sub- 
ject that has come down to us from those remote 
times. The Kahun papyrus consists of two parts, 
the first gynecological, the second veterinary. The 
Hearst papyrus, recovered by the Hearst Egj^tian 
Expedition of the University of California, is in 
content identical with a part of the Ebers papyrus; 
they belong to the same epoch. 

A study of the art of embalming and an examina- 
tion of mummies and other human remains throw* 
light on the medical science of different periods of 
Egyptian history, as well as on the various diseases 



THE PRIEST-PHYSICIANS 9 

to which the ancient Egyptians were subject. At 
the same time we are afforded a glimpse of the in- 
juries to which they were especially liable, and of 
the methods of surgical treatment. Embalming is, 
of course, of particular interest to us because of the 
knowledge of anatomy it involved and because it 
was essentially an antiseptic art. Any brief descrip- 
tion of embalming is likely to prove an imperfect or 
a composite picture, for the procedure was by no 
means uniform. Evisceration of the dead was to 
some extent customary before the sixteenth cen- 
tury B.C., and the fact that the ceremonial flint 
knife was always used to make the incision in the 
abdomen indicates that the practice had a very 

ft 

early origin. After the embalmer's art had reached 
its highest development, the brain was sometimes 
removed by means of an iron or bronze hook, which 
reached the interior of the skull from the nose by 
perforating the cribriform plate of the ethmoid 
bone or by tunneling the sphenoid. The cavity was 
then cleansed with a solution of drugs. This diffi- 
cult operation of removing the brain was as a rule 
quite successful, though the less expert occasionally 
broke through into the orbital cavities, or even 
fractured the frontal bone from within. As already 
implied, the intestines, stomach, liver, and spleen 
were removed generally through an opening made 
in the abdonGdnal wall* This was on the left side, 



10 THE HISTORY OF MEDICINE 

probably to allow free play to the right arm of the 
operator. In some cases the lungs were also re- 
moved by piercing the back part of the diaphragm 
or by removing that muscle. The heart and kidneys 
might be left in situ. After the organs had been 
removed, the body was rinsed out with wine, myrrh, 
cassia, etc. At times, instead of making an incision 
in the abdomen, the embalmer injected a solution 
of cedar-oil, which acted as a solvent on the viscera, 
which then were removed through the anus. The 
body was now kept for seventy days in a saline 
solution, a solution, for example, of crude carbonate 
of soda (natron) found native in different parts of 
Egypt. Finally it was bandaged and wrapped in 
linen smeared with gums or wax. Resin and pitch 
were used extensively, as, indeed, the terms ''em^ 
balm'* and "mummy" imply. 

During the last few years mummies and other 
human remains have been examined with the pur- 
pose of determining, as far as possible, the diseases 
and injuries from which the ancient Egyptians 
suffered. These belated autopsies, numerous as 
they have been, a£Ford no evidence of sjrphilis, 
little or no evidence of rickets (though there are on 
record cases of distortion difficult to ascribe to any 
other cause, as well as a case of achondroplasia), and 
no evidence of tuberculosis except as involved in 
Pott's disease, an extreme form of which is exhibited 



THE PRIEST-PHYSICIANS ii 

in the mummy of a priest of Ammon of about 
looo B.C. Thousands of bodies exhumed in Nubia, 
in the vicinity of the Assuan Dam, show on exami- 
nation that the Egyptians suffered but little from 
pyogenic infections, that the death-rate of children 
was much lower in ancient than in modem Egypt, 
and that in the earlier and less luxurious epochs few 
of the inhabitants of the region suffered from pre- 
mature decay of the teeth. At no period is there any 
sign of filled or of artificial teeth, and even as late as 
the sixteenth century B.C. a large proportion of 
adults in some districts were able to show perfect 
sets of teeth. 

The examination of bodies belonging to all 
periods of Egyptian history shows the prevalence of 
the disease now known as arthritis deformans, of 
which mention has already been made. It is de- 
scribed as the bone disease par excellence of the 
ancient Egyptians. It still afflicts the inhabitants 
along the course of the Nile. Its etiology is uncer- 
tain, but, though the view predominates that it is 
a chronic infection, wet and damp may be among 
the exciting causes. In the Egyptian cases that have 
been examined the vertebrae are sometimes involved, 
as also the shafts of the bones. Cases of vesical 
calculus of the fourth millennium, renal calculus of 
the third millennium, gall-stones of the third millen- 
nium, variolous eruption and calcareous arteries 



M ' THE HISTORY OF MEDICINE 

and atheroma, have also been reported. Pleurisy 
and appendicitis (Byzantine period) and a case of 
true gout (sixth century a.d.) belong to a much 
later time. Bouchard's nodes (indicative of dilata- 
tion of the stomach), the enlarged spleen resulting 
from malarial infection, mastoiditis, and infantile 
paralysis, have also been proved to have occurred 
among the ancient Egyptians. 

Ribs of date-palm leaves were used as splints in 
the early centuries of the third millennium, and 
splints of the same material are still in use in the 
Egypt of to-day. The ancient Nubian remains 
exhibit many cases of fractures that had been per- 
fectly set and had healed satisfactorily. Fractures 
of the ulna near the wrist (as well as of the femur 
and cranium) are quite common. These injuries 
were probably sustained in attempting to ward off 
the blow of the naboot. This weapon was a staff, 
which was grasped, by the person wielding it, in 
both hands. Its use was a favorite pastime of the 
ancient Egyptians, and resembled the old English 
quarterstaff play. Besides the injuries caused by 
the naboot, fatal sword-cuts of the skull and cranial 
ulcerations from carrying water-jars have been 
noted. 

For its skill in medicine Egypt became famous 
among all the surroimding nations. The Odyssey 
refers to it as a land producing an infinite number of 



THE PRIEST-PHYSICIANS 13 

drugs, where each phymdan possessed knowledge 
above all other men. Similarly the Hebrew prophet 
Jeremiah alludes to it as a land of many medicines. 
The Greek historian Herodotus, the contemporary 
of Hippocrates, speaking of the Egyptians of the 
fifth century BX., says: "Medicine is practiced 
among them on a plan of separation ; each physician 
treats a single disorder, and no more; thus the 
country swarms with medical practitioners, some 
undertaking to cure diseases of the eye, others of 
the head, others again of the teeth, others of the 
intestines, and some those which are not local." 
He also takes note of the habits, especially among 
the priestly caste, of personal hygiene, light cloth« 
ing, frequent baths, purgation, and careful diet, for 
they have a persuasion that every disease to which 
men are liable is occasioned by the substances 
whereon they feed. 

It was not till about 3 100 B.C. that the City of 
Babylon, under the leadership of Hammurabi, a 
Semitic (Amorite) king, gained ascendancy over the 
Sumerian cities, which lay along the Tigris and 
Euphrates toward the Gulf of Persia. In the ruins 
of these cities has been discovered the record of a 
civilization analogous in its development to Egyp- 
tian civilization. Long before 3000 B.C. the Sume- 
nans had learned how to control the freshets of the 
Euphrates for purposes of irrigation ; they cultivated 



14 THE HISTORY OF MEDICINE 

barley and split wheat, reared cattle, sheep, and 
goats, made use of the ox and ass in ploughing and 
transportation; they constructed mud-brick dwell- 
ings, as well as enormous stage-towers as places of 
worship and sepulture; they had ornaments of gold 
and silver, and knives of copper and bronze; they 
were skilled in pottery and stone-cutting; they 
developed a phonetic system of writing based on a 
primitive pictorial system, for it was to these early 
inhabitants of the land of Shinar that the East was 
indebted for cuneiform writing. The intellectual 
and professional life of the Sumerians, as of the 
Egyptians, was dominated by the priestly caste. 

The Amorites of 2100 B.C. were not the first nor 
the last of the Semitic races to overrun the cities 
and adopt the system of writing and the general 
culture of the Sumerians. Many centuries after 
Hammurabi, the Assyrians, who had from very 
early times felt the cultural influence of the Sumeri- 
ans, entered upon a career of conquest, and from 
about the middle of the eighth till near the dose of 
the seventh century controlled an e3ctensive empire 
of which Babylonia formed a part. One of the great 
Assyrian kings, Assurbanipal (668-626 B.C.), es- 
tablished in his palace at Nineveh a cuneiform 
library. The Code of Hammurabi, a collection of 
laws inscribed on a large block of black diorite, and 
the clay tablets of the library of Assurbanipal are 



THE PRIEST-PHYSICIANS 15 

the chief sources of information in reference to what 
may be roughly called Babylonian medicine. 

The following sections from thb earliest code of 
laws known to history, the starting-point of medical 
jurisprudence, throw light on the rights and duties 
of the surgeon of 2080 B.C. ; 

**!{ a physician operate on a man for a severe 
wound (or make a severe wound upon a man), with 
a bronze lancet, and save the man's life; or if he 
open an abscess (in the eye) of a man, with a bronze 
lancet, and save that man's eye^ he shall receive ten 
shekels of silver (as his fee)/* 

" If he be a freeman, he shall receive five shekels/' 

"If it be a man's slave, the owner of the slave 
shall give two shekels of silver to the physician." 

"If a physician operate on a man for a severe 
-wound, with a bronze lancet, and cause the man's 
death; or open an abscess (in the eye) of a man, 
with a bronze lancet, and destroy the man's eye, 
they shall cut off his hands." 

" If a physician operate on a slave of a freeman 
for a severe wound, with a bronze lancet, and cause 
his death, he shall restore a slave of equal value." 

" If he open an abscess (in his eye), with a bronze 
lancet, and destroy his eye, he shall pay silver to 
the extent of one half of his price." 



16 THE HISTORY OF MEDICINE 

** If a physidan set a broken bone for a man, or 
cure his diseased bowels, the patient shall give five 
shekels of silver to tlie physician/* 

** If he be a freeman, he shall give three shekels." 

"If it be a man's slave, the owner of the slave 
shall give two shekels of silver to the physician/' 

"If a veterinary physician operate on an ox or 
ass for a severe wound and save its life, the owner of 
the ox or ass shall give to the physician, as his fee, 
one sixth of a shekel of silver/' 

"If he operate on an ox or an ass for a severe 
wound, and cause its death, he shall give to the 
owner of the ox or ass one fourth its value/' 

It is evident that in this translation the term 
"freeman" indicates a rank intermediate between 
that of "man" (or gentleman) and that of "slave," 
and that the term "veterinary" is used in anticipa- 
tion, since the horse was unknown in Babylonia till 
some time after the formulation of the Code of 
HanmiurabL 

As already implied, the medical science of the 
Babylonians was closely associated with their 
religious beliefs and superstitions. Disease was 
considered the seizure or attack of the patient by 
some demon or other, such as the demon of con- 
sumption, the demon of liver complaint, and the 



THE PRIEST-PHYSICIANS 17 

particularly hideous demon that haunted the bed- 
side of women. Cures were to be effected by charms, 
incantations, exorcisms, and other magic rites. 
These led to the use of remedies, like mint, cassia, 
chicory, sesame, honey, and liquorice, or a green 
frog, the foot of a small insect, the daw of a black 
dog, to fortify the patient and to drive or coax out 
the demon of disease. As the Babylonian priests 
sought to foretell the future by the study of the 
heavens, of numbers, and of geometrical forms, so 
they turned to the inspection of the viscera of 
sacrificial animals as a means of divination. They 
believed, like the Jews, that the blood was the vital 
principle, in some sense identical with the soul; 
that the blood was elaborated in the liver, and that 
consequently that organ should be made an object 
of particular attention. They held it possible, since 
the deity passed into all animals offered up in 
sacrifice, to read the disposition of the divine mind 
by observing the markings and anomalies of a 
sheep's liver. Clay models of this organ, dating 
from about 2100 B.C., are as carefully marked off 
into distinct areas as our modem phrenological 
charts. The lobes, ducts, depressions, fissures, gall- 
bladder, etc., on the under side of the liver were 
minutely scrutinized and definitely named. Patho- 
logical conditions were especially studied, because 
all irregularities seemed to foretell unusual events. 



i8 THE HISTORY OF MEDICINE 

The practice of inspecting the liver for purposes 
of divination — hepatoscopy — passed from Baby- 
lonia as far west as Italy and was not without 
significance in the development of anatomy and 
physiology. In a like spirit and with greater results 
for the progress of science, the Babylonian priests 
turned their attention to the study of congenital 
abnormalities in man and animal, and to the inter- 
pretation of pathological symptoms. A monstros- 
ity was an evil omen; hysteria and epilepsy and 
leprosy were special marks of possession or of divine 
condemnation. In the study of birth-omens and 
sickness-omens, the Babylonians developed a knowl- 
edge of the various parts of the body, and learned 
to recognize the symptoms of various diseases. 
Among the latter might be mentioned as finding 
a place in cuneiform medical literature, colds, in- 
digestion, rheumatism, neuralgia, headache, eye 
troubles, heart disease, and jaundice. 

Some of the early Babylonian prescriptions are 
half exorcism and half directions for effecting a 
cure. One cuneiform text, for example, dictates a 
formula for calling down the wrath of the god Ea on 
the worm that causes toothache, but advises that 
while the curse is being uttered thrice, the aching 
tooth should be treated with a mixture of henbane 
and resin. Other prescriptions dispensed altogether 
with the aid of magic: ** If a man is sick of a cold, 



THE PRIEST-PHYSICIANS 19 

which has turned into stomach pains, let him com- 
pound . • • liquorice root . • • these seven drugs let 
him drink as the star rises and in the morning 
without food [that is, evening and morning, fasting], 
and he will recover/' The tendency to rely less and 
less on incantations and more and more on actual 
remedies seems to have been more pronounced in 
the later stages of Babylonian medicine. Of course, 
primitive methods were resorted to in desperate 
cases; as, for example, if ''a man's forehead b 
affected and the demon in a man's body cries out 
and does not depart," the traditional treatments 
may be employed as a last resort. Further evidence 
of the progress of medicine is afforded by letters 
written in the seventh century B.C. to Assurbanipal 
by a doctor called upon to treat the members of 
the royal family for eye trouble, bleeding of the 
nose, and other ailments. They read like the com- 
munications of a rational, sympathetic, and capable 
modem practitioner. One of these sends "Hearty 
greetings to the little chap whose eye causes him 
trouble" and gives reasons for expecting a speedy 
recovery. A second letter with similar greetings to 
the king's son contains excellent directions for 
arresting persistent haemorrhage of the nose. 

In the textbook literature of the library of Assur- 
banipal are found long lists of remedies, which are 
divided into two classes corresponding, it would 



20 THE HISTORY OF MEDICINE 

eeem from the particular Sumerian words used, to 
the distinction of organic and inorganic substances. 
Among the latter are found alkalies and salts, as 
well as a number of stones which had probably been 
thought efficacious as amulets before taking their 
place in the pharmacopoeia. Only a limited number 
of the drugs that enter into cuneiform prescriptions 
have as yet been identified, but in addition to those 
already set down the following might be mentioned ; 
anise, cumin, caraway, colewort, colocynth, cori- 
ander, cynoglossum, figs, dates, jasmine, juniper, 
nard, oleander, willow, and sal ammoniac. Among 
the therapeutic agents relied on by the Babylonian 
priest-physicians are found purgatives, diaphoretics, 
enemata, compresses, salves, poultices, liniments, 
fumigations, diet, and rest. One might be tempted 
to ascribe to them the knowledge of a form of 
massage; but the impression must not be created 
that the medical science of the Babylonians ever 
attained to any considerable development. At its 
best it was obscured by astrology and other super- 
stitious beliefs, and at no time completely emerged 
from the primitive stage. By the fifth century B.C. 
it seems, indeed, to have deteriorated; for according 
to Herodotus no physicians were to be found in the 
Babylon of the Persian regime and patients were 
brought into the streets to receive the suggestions 
of the passers-by. 



THE PRIEST-PHYSICIANS 21 

In Babylonia as in Egypt the conservatism of the 
priests preserved throughout the ages the medical 
knowledge of an immemorial past, but the very 
quality that enabled them to perpetuate traditions 
prevented their making any marked advance to- 
ward a real medical science. Their faith in the 
virtues of drugs and in the influence of the stars 
was detrimental to progress, and the dbtinction of 
making the first great contributions to scientific 
medicine was reserved for another people, among 
whom the healing art was not dominated by the 
priestly caste. 

REFERENCES 

Flnlaynn, James: "Ancient Egyptian Medidne," BHHsk Medicat 

Journal, 1893, vd. i, pp. 748, 1014, 1061. 
Harper, R. F.: The Code of Hammurabi. Chicago, 1904. 
Holmes, B. T., and Kitterman, P. G.: Medicine in Ancient Egypi. 

1914. 
Jastrow, Morris, Jr.: (i) "The Medicine of the Babylonians and 

As^oians," Proc. Roy. Soc. Med., 7*, History of Med. Sec* 

tion, I9I3-I4» Pp. 109-76. 
(2) " Babylonian-Assyrian Medidne,'' Amiab cf Medicat 

History, vol. i (no. 3), 1917, pp. 231-57. 
Joadiini, H.: Papyros Ebers, 1890. (German translation.) 
Moodie, R. L.: "Studies in Paleopadiology," Surg. Oin^ vd. m, 

pp. 481-96. Chicago, 1918. 
Mflller, W. Max: Egyptological Besearckes. Carnegie Institution, 

Washington, 1906. 
Ruffer, Sir M. A.: Studies in the Paleopathology of Egypt. Chi- 
cago, 1921. 
Ruffer, Sir M. A., and Ferguson, A. R.: "Note on an Eruption 

resembling that of Variola in the ^n of a Mummy of the 

Twentieth Dynasty/* Joumat of Path, and BacLt 1910-11, 

vd. I5» pp. 1-3. 



22 THE HISTORY OF MEDICINE 

Shattodr, S. G.: "A Report upon the Pathological G>ndition of 
the Aorta of King Menephtah, traditionally regarded as the 
Pharaoh of the Exodus," Froc. Roy. Soc. Med., vol. u, 
Pathological Section, 1909, pp. 122-27. 

Smith, G. Elliott, and Jones, F. Wood: TU Arckaohgical Sumy 
cj Nubia, Report on Human RanaifUf vol. n. Guro, 1910. 



CHAPTER II 

HIPPOCRATES THE FATHER OF MEDICINE 

Thbee great extraneous influences contributed to 
the development of Greek medicine — theology, 
philosophy, and athletics. And to the institutions 
through which these influences made themselves 
felt, namely, the temple, the school, and the gym- 
nasium. Hippocrates sustained a well-defined rela* 
tion. 

Even in the early stage of Greek culture repre- 
sented in the Iliad and the Odjrssey the priesthood 
played a subordinate part in the healing art. These 
Homeric poems, to be sure, speak of disease as due 
to the anger of the gods, and tell of the efforts of 
the priests to arrest epidemics, as well as of the 
recital of appropriate incantations. But the physi- 
cians, cunning in the use of medicines, are evidently 
distinct from the priests, and form an adjunct of the 
warrior caste rather than of the sacerdotal. 

In the Iliad, iGsculapius, or Asclepios, is a Thes- 
salian chief, who has received from the Centaur 
Chiron instruction in the use of drugs; while his 
two sons are warriors and army surgeons. By the 
beginning of the eighth century B.C., tradition 
had endowed him with supernatural powers. He 



24 THE HISTORY OF MEDICINE 

became an earth god — especially accessible to his 
votaries in sleep — and was portrayed with the 
snake and staff and other attributes of such a deity. 
Not long after, iEsculapius was recognized as the 
god of medicine, the son of Apollo, and the father, 
not only of the surgeon Machaon and the phymdan 
Pod^lirius, but of a younger son, Telesphorus, the 
god of convalescence, as well as of Hygeia and 
Panacea. Eventually himdreds of temples arose 
throughout Hellas, on beautiful and salubrious 
sites overlooking the sea and beside healing foun- 
tains, dedicated to the worship of Asclepios. Among 
the most famous of these were the Asclepieia of 
Epidaurus, Cos, Cnidus, Crotona, and Pergamus. 

In these healthful places, the strongholds ' of 
miraculous medicine, the priests of the temples 
were credited with cures comparable with the faith 
cures duly attested to-day at Lourdes, Sainte Anne 
de Beaupr6, and other Christian shrines. In the 
history of the Greek temples there are some indica- 
tions of the practice of fraud. The priests of iEscu- 
lapius stirred the imaginations and played upon the 
superstitions of the sufferers by sacrificial rites and 
purifications, by the presence of tame snakes, con- 
tact with which brought healing by the power of 
the indwelling god, and, in the third place, by temple 
sleep or incubation. The suppliant, lying down to 
sleep, after due preparation, by the altar of the god, 



THE FATHER OF MEDICINE 25 

was at times granted a vision of iGsculapius himself, 
and was forthwith healed. Sometimes the priest 
condescended to impersonate the god, offering 
equally efficacious treatment, or dictating remedies. 
Again, the suppliant might be permitted to dream 
by proxy. Those that were benefited by the sug« 
gestions, by the remedies, or by the restorative 
power of nature, left tablets telling of their cure, or 
other tokens, such as models of the healed parts in 
marble, or silver, or gold, the priests taking no 
pains to conceal from their patients the therapeutic 
virtue of a substantial fee. 

Epidaurus, as befitted the reputed birthplace of 
iEsculapius, was one of the loudest of the temples 
in prodainfiing the benefits of divine healing, and 
upon the founding of a new temple this mother 
Asclepieion sent the gift of a snake, symbolic of the 
god of medicine. Two pillars inscribed with the 
record of faith cures have been recovered on the 
site of the ancient shrine. The following translations 
will indicate how the temple priests sought to over- 
come the skepticbm of the Greek mind. 

''A man with the fingers of his hand paralysed, 
save one. He came a suppliant to the god, and 
seeing the tablets in the temple he disbelieved the 
cures, and ridiculed the inscriptions, and sleeping 
he saw a vision. He seemed to be playing dice, and, 
as he was about to throw, the god appeared, seized 



26 THE HISTORY OF MEDICINE 

his hand, and stretched out the fingers, then he 
seemed to bend them up and stretch them out one 
by one, and when all were straight the god asked if 
he still disbelieved the inscriptions on the tablets, 
and he said no. Then he said: 'Fear not for thy 
former unbelief, but, that thou mayest believe in 
future, thou shalt obtain what a believer obtains *(?) 
[the sentence is much mutilated]. And when it was 
day he went away whole." 

"Ambrosia of Athens, blind of one eye. She came 
a suppliant to the god, and going round the temple 
ridiculed some of the inscriptions, saying it was 
incredible and impossible that the lame and blind 
should be cured by seeing a dream-vision only. But 
having slept she saw a vision; the god seemed to 
stand by her and say that he would heal her, but 
would demand as payment a silver pig to be set up 
in the temple as a memorial of her stupidity. Hav- 
ing thus spoken he opened her diseased eye and 
poured medicine on it, and when it was day she 
departed cured." 

The temple priests must not be confused with the 
Asclepiads (Asclepiadae), often in attendance at the 
temples, who formed a guild or brotherhood made up, 
at first, of physicians claiming descent from iEscu- 
lapius. At some of the temples the Asclepiads no 
doubt long continued to connive at the theurgy and 
charlatanry of the priests. In other places, however» 



THE FATHER OF MEDICINE 27 

and notably at Cnidus and CoSf they dissociated 
themselves from the practice of mystic healing and 
taught to their sons and disciples medidne as based 
on rational principles. 

Among the philosophers who brought the influ- 
ence of the schools to bear on the development of 
early Greek medicine Pjrthagoras, AlcmaK)ny Em- 
pedodes, and Democritus are especially prominent* 
Bom about 580 B.c. on the island of Samos, Py-* 
thagoras traveled extensively, visiting Egypt and 
probably Babylonia, , and settled at Crotona in 
South Italy. There he founded a sect or society 
which, to its interest in mathematics, ethics, and 
other branches of philosophy, added the teaching 
and practice of medicine aiid politics* He attended 
his followers when they were sick, and advocated 
adherence to a strict diet. In the Pythagorean 
school there developed a mystical number lore, the 
elements of which the master may have learned 
from the Egyptian priests or the Chaldean astrol- 
ogers. It is difficult to comprehend the peculiar 
significance this philosophical school attached to 
certain numbers and number relations. For ex- 
ample, four was of interest to the Pythagorean 
mind as the square of the first even number, and 
still more so as symbolizing the perfection of eter- 
nally flowing nature. Ten was considered a perfect 
number. Something of the sentimental value asso- 



/ 



/ 






28 THE HISTORY OF MEDICINE 

dated with particular numbers by the Pythagoreans, 
as well as by the Babylonians and other Extern 
peoples, still lingers in the attitude of the imagina- 
tive to the sacred number three and the mysterious 
number seven. The number lore of the Pythago- 
reans is important for us because it later conduced to 
the Hippocratic doctrine of critical days. 
y Other schools of philosophy had a more direct 
interest in medical science. Alcmaeon of Crotona, 
philosopher and physician, the first Greek anato- 
mist, introduced abdominal section, by animal dis- 
sections discovered the optic nerve, attempted to 
explain the sense of hearing and the sense of taste, 
and recognized the brain as the seat of mental 
activity. Sleep and waking are due to the ebb and 
flow of the blood, death to its cessation. Health 
depends on the harmony of the material elements 
of the body — cold, warm, moist, dry, bitter, sweet. 
Empedocles of Agrigentum, Sicily, another phil- 
osopher-physician, was the first Greek to think of 
the universe as composed of four elements. 

"Listen, first, while I sing the fourfold root of creation, 
Fire, and water, and earth, and the boundless height of the aether, 
For therefrom is begotten what is, what was, and what shall be." 

Empedocles is said to have freed a town of pestilence 

by diverting a stream and draining the marshes in 

\ its vicinity, and to have improved the climate of his 

native city by blocking up a cleft in the mountains. 



THE FATHER OP MEDICINE 29 

Democritus, a contemporary and friend of Hippo- 
crates, studied the anatomy of animak and the 
physiology of reproduction and of the senses. He 
taught that all things are composed of an infinite 
number of indivisible particles, or atoms, and that 
the impressbns made upon our senses are the source 
of all knowledge and of all thought. 

The influence of athletics on the development of 
Greek medicine was essentially different from that 
of philosophy. The gymnasts were the devotees of^ 
practice, not of theory. Through experience they^ 
acquired skill in the treatment of sprains, disloca- 
tions, fractures, and other injuries. They made use'^ 
of inunctions and fomentations. They controlled / 
the weight and proportions of the athletes by 
means of purgation, emesis, massage, steam baths, 
exercise, and diet. These rude empirics were con- 
sulted by the sick, and the gymnast Herodicus of 
Selymbria, with whom Hippocrates came into con- 
tact, even undertook to reduce fever by methods 
borrowed from the gymnasium. Crotona, as fa- 
mous for athletics as for theurgy and philosophy, 
was the home of the greatest of wrestlers, Milo, six 
times crowned victor at the Olympian, six times at 
the Pjrthian, games. It is probable that Democedes 
of Crotona, the first regular Greek physician of 
whose life we have an account, owed some of his 
surgical skill to the gynmasium of his native city. 



30 THE HISTORY OF MEDICINE 

Leaving home as a young man, Democedes became 
public physician in rapid succession at iGgina, 
Athens, and Samos, his salary as medical officer 
mounting from $1200, to $2030, to $28oo» at a time 
when the incomes of officials were generally very 
low, and the purchasing power of money was very 
high. Later he found himself a slave at the court 
of Darius, whose favor he gained by healing a 
sprained ankle, which had baffled the efforts of the 
Egyptian physicians in attendance on the Persian 
king, as well as by treating the queen successfully 
for abscess of the breast. The one boon of freedom 
was withheld. Finally, however, Darius permitted 
Democedes to accompany a band of Persian ex- 
plorers, the Greek undertaking to guide them in 
their search for points on the coast of Italy most 
favorable for the landing of a Persian army. Ar- 
rived in Calabria, Democedes delivered his com- 
panions into the hands of the king of that region. 
He then hastened to his native Crotona, where, 
shortly after, he married the beautiful daughter of 
Milo the athlete. 

The three influences that affected Greek medicine, 
namely, the theurgic, the theoretic, and the em- 
piric, though logically distinct, were not always 
separated in fact. The Pythagoreans cultivated 
gymnastics as well as dietetics. Milo belonged to 
the political faction of the Pythagoreans without 



THE FATHER OF MEDICINE 31 

necessarily sharing their enthusiasm for pure mathe* 
matics and an abstemious diet. The temple priests, 
as we have seen, worked at times in conjunction 
with the temple physicians, and there is evidence 
that some of the Asclepieia were provided with 
gymnasiums, in which tissue change was effected 
by exercise, diet, and baths. To the combined in- 
fluence of the priests, the philosophers, and the 
gymnasts, it was natural that the genius of the 
greatest physician, bent above all on the successful 
treatment of the individual patient, should in some 
way respond. 

Hippocrates was bom in 460 B.C. at Cos on the 
bland of Cos. His father and grandfather were emi- 
nent physicians; and his descent has been traced 
on the paternal side to iEsculapius, and on the 
maternal side to Hercules. He received his first in- 
struction in the medical art from his father, and 
he may have come under the influence of the 
Asclepiads of the neighboring city of Cnidus, as 
well as of those of his native place. He traveled 
extensively, practicing and teaching, and is known 
to have visited the cities of Thrace, Thessaly, Asia 
Minor, and the island of Thasus; and he may have 
been acquainted with Athens, then at the height of 
its glory, and with Scythia, Egypt, and Libya. He 
gave instruction at the school of the Asclepiadae of 
Cos and trained hb sons and son-in-law in the art. 



32 THE HISTORY OF MEDICINE 

He died at Lariasa, Thessaly, at a very advanced age* 
• An early Hippocratic writing, "The Law," 

' descriptive of the education of an ideal ph]rsician« 
throws light on the training of Hippocrates. " Who- 
ever b to acquire a competent knowledge of medi- 
cine/' it says, "ought to be possessed of the follow- 
ing advantages: a natural disposition; instruction; 
a favorable portion for the study; early tuition; 
/ love cl labor; leisure. First of all, a natural talent 
b required; for, when Nature opposes, everything 
else is vain; but when Nature leads the way to what 
is most excellent, instruction in the art takes place, 
which the student must try to appropriate to him- 
self by reflection, becoming an early pupil in a place 
well adapted for instruction. He must also bring 
to the task love of labor and perseverance, so that 

., the instruction taking root may bring forth proper 
and abundant fruits. 

" Instruction in medicine is like the*culture of the 
productions of the earth. For our natural disposi- 
tion is, as it were, the soil ; the tenets of our teachers, 
as it were, the seed ; instruction in youth is like the 
planting of the seed in the ground at the proper 
season ; the place where the instruction is communi- 
cated is like the nourishment imparted to plants by 
the atmosphere; diligent study is like the cultiva- 
tion of the fields; and it is time which imparts 
strength to all things and brings them to maturity." 




HIPPOCRATES 
The Bust in the British Museum 



THE FATHER OF MEDICINE 33 

The ancient Oath of the Asdepiads of Cos, also 

known to have been written before the time of 

Hippocrates, indicates the source of his professional 

ethics: 

THE OATH 

^'I swear by Apollo the physician, and iGscu- 
lapius, and Hygeia, and Panacea, and all the gods 
and goddesses, that, according to my ability and 
judgment, I will keep this Oath and this stipulation 
— to reckon him who taught me this Art equally 
dear to me as my parents, to share my substance 
with him, and relieve his necessities if required; to 
look upon his offspring in the same light as my own 
brothers, and to teach them this Art, if they should 
wish to learn it, without fee or stipulation; and that 
by precept, discourse, and every other mode of in- 
struction, I will impart a knowledge of the Art 
to my own sons, and those of my teachers, and to 
disciples bound by a stipulation and oath according 
to the law of medicine, but to none others* I will 
follow that system of regimen which, accordii^ 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 to a 
woman a pessary to produce abortion. With purity 
and with holiness I will pass my life and practice my 



34 THE HISTORY OF MEDICINE 

• 

Art. I win 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 mis- 
chief and corruption; and further, from the seduc- 
tion of females or males, of freemen and slaves. 
Whatever, in connection with my professional prac- 
tice, or not in ccmnection with it, I see or hear, in 
the life of men, which ought not to be spoken of 
abroad, I will not divulge, as reckoning that all such 
should be kept secret. While I continue to keep this 
Oath unviolated, may it be granted to me to enjoy 
life and the practice of the Art, respected by all 
men, in all times ! But should I trespass and violate 
this Oath, may the reverse be my lot ! " 

The tendency shown in the Oath to substitute 
benevolence, social duty, and moral law for religious 
superstition is no less marked in the writings €i 
Hippocrates, the contemporary of Socrates. In his 
treatise ''On Airs, Water, and Localities," which 
deals with disease in relation to geographical and 
meteorological conditions, or constitutionst Hippo- 
crates states that the Scythians attribute the pre- 
mature impotence of some of their men to a god, but 
that it appears to him that such affections are just 
as much divine as all others are, and that no one 
disease is either more divine or more human than 



THE FATHER OF MEDICINE 35 

another, but that all are alike divine, for each has 
its own nature, and that no one arises without a 
natural cause. The Hippocratic writing "On the 
Sacred Disease," written by some Huxley among 
the disciples of the master, deals exclusively with 
the claim of epilepsy to be considered divine in its 
origin. If diseases are to be called divine because 
they are wonderful and ill understood, then the 
quotidian, tertian, and quartan fevers seem to the 
author of the treatise no less sacred and divine in 
their origin than epilepsy. Those who first referred 
the latter disease to the gods were probably just 
such people as the conjurors, purificators, mounte- 
banks, and charlatans of his own time. These give 
themselves out, the treatise proceeds, to be ex- 
tremely religious, but it is no homage to the gods to 
see their manifestation in the symptoms of epilepsy 
—outcries, gnashing of the teeth, foaming at the 
mouth, contortions, kicking, fever, delirium, fear, 
and flight. Then, if the epileptics be divinely 
possessed, why must they be submitted to purifica- 
tion? They should rather be taken to the temple and 
presented to the god, if a god be the cause of the 
disease. However, in spite of this vehement con- 
troversy, we must not think of Hippocrates and his 
followers as atheists. While protesting against an 
unworthy conception of divinity, they respected 
the traditions, inculcated lofty ideals of profes- 



36 THE HISTORY OF MEDICINE 

slonal conduct, dignity of deportment, respect for 
patients, devotion to universal charity and to 
medicine. For, as they declared, where love of man* 
kind is, there is also love of the Art. 

The Hippocratic respect for tradition led, at the 
same time, to a just appreciation of the teaching of 
the gynmasium, much of it inherited, no doubt, 
from the remote past. The writings of Hippocrates 
'.^On Fractures" and '^On Dislocations," which have 
been described (by Malgaigne) as the ablest works 
ever written by a physician, as well as his treatise 
'^On Injuries of the Head," and his other surgical 
works, reflect the skill and wisdom resulting from 
long experience. He was bold in the use of the 
trephine and raspatory, employed ink and pitch 
in the manner of the Egyptians, insisted on the 
necessity of cleanliness and dryness in the handling 
of fresh wounds, mentioned healing by first inten- 
tion, referred to exfoliation ct the bone, and to the 
dangers of erysipelas, tetanus, and gangrene, noted 
the occurrence of fracture by cantre<oup and of 
paralysis of the opposite side in cases of lesions 
of the brain, described the treatment of compound 
fractures, as well as various methods of bandaging 
and of reduction with and without apparatus. In 
his ''Aphorisms" Hippocrates remarks that it is 
not well for athletes to develop tissue to the utmost 
limit. Once arrived at the maximum, it is impossible 



THE FATHER OF MEDICINE 37 

to improve or to remain stationary. Instead of 
slowly deteriorating, it b well to reduce rapidly in 
order to begin again the process of repair. It is 
dangerous, however, to carry methods of reduction 
to extremes. In like manner, medicinal evacuations, 
if carried to an extreme, aie dangerous; and, also, 
a restorative course, if in the extreme, b dangerous. 
A slender and restricted diet is always dangerous in 
chronic diseases, and also in acute diseases, where 
it is not requisite. Again, as diet brought to the 
extreme point of attenuation is dangerous, repletion, 
when in the extreme, is likewise dangerous. 

The Hippocratic book "On Ancient Medicine,*' 
which ingeniously traces the origin of the Art to the 
practical study of diet carried on by man from the 
remotest past, suggests to the physician that ad- 
vances are still to be made by continuing the study 
with full knowledge of what has already been 
achieved. " Wherefore those who devote themselves 
to gymnastics and training are always making some 
new discovery by pursuing the same line of inquiry, 
where, by eating and drinking certain things, they 
improve and grow stronger than they were." What 
must be said of those who prosecute their inquiries 
in the Art by hypothesis rather than by the ancient 
method of trial? The former procedure has its 
difficulties. " For if hot, or cold, or moist, or dry, be 
that which proves injurious to man, and if the per- 



38 THE HISTORY OF MEDICINE 

son who would treat him properly must apply oold 
to the hot, hot to the cold, moist to the dry, and dry 
to the moist — let me be presented with a man, not 
indeed one of a strong constitution, but one of the 
weaker, and let him eat wheat, such as it is supplied 
from the thrashing*floor, raw and unprepared, with 
raw meat, and let him drink water. By using such a 
diet I know that he will suffer much and severely, 
for he will experience pains, his body will become 
weak, and his bowels deranged, and he will not 
subsbt long. What remedy, then, is to be provided 
for one so situated? Hot? or cold? or moist? or 
dry?" Thus the treatise "On Ancient Medicine" 
passes from a consideration of the empirics, con- 
demned by Hippocrates only when they went be- 
yond their proper sphere, to a criticism of the 
theorists, or philosophers. 

It has frequently been said that Hippocrates, !n 
addition to repudiating the supernatural as a cause 
of disease, was the first to separate medicine from 
philosophy. That is indeed true if philosophy be 
identified with vain speculation. For the fantastic 
conjectiu'es of Pythagoras and Empedocles, Hip- 
pocrates and his followers substituted a common- 
sense philosophy, still potent in our own time. 
They held that all general views of the nature of 
disease must rest on practice and the use of reason. 
All valid thinking is based on the data supplied by 



THE FATHER OF MEDICINE 39 

the senses, the understanding giving meaning to 
these phenomena, noting the manner of their oc* 
currence, their times, and the relation between 
them of cause and effect. Conclusions must be 
grounded in observation. The physician should, 
therefore, hold to facts, so as to acquire mastery 
in the medical Art. ''Theory b the flower, not the 
root of experience/* The famous opening sentences 
of the '' Aphorisms" attest the power of a philo* 
sophic mind to rise to general conceptions, while 
still mindful of the observations and practice from 
which they were developed. '' Life is short, and the 
Art long; the time is urgent; experiment is danger- 
ous, and decision is difficult. The physician must 
not only be prepared to do what is right himself, 
but also to make the patient, the attendants, and 
externals coSperate.*' 

Dis^^osis furnished a solid basis for his generaliza- 
tions. He observed the color and general state of 
the skin and mucous surfaces, the eyes, the facial 
expression, the movements of the body, the quantity 
and nature of the dejecta and various secretions, 
the temperature, and, to some extent, the pulse, 
respiration, rash, spasm, sore throat, chills and 
fever, localized pains, headache, tenesmus, thirst, 
appetite, nausea, vertigo, lassitude, deafness, dis- 
ordered vision, fear, loquacity, delirium, coma, 
plucking at the bedclothes. He noted the distension 



40 THE HI^ORY OF MEDICINE 

of the abdomen, and by palpation determined the 
enlargement of the liver or the spleen. He took 
account of the form of the chest, the character of 
the voice, and, employing succussion and ausculta- 
tion, detected the signs of pneumohydrothorax or 
of pleuritic friction. Not content with the mere 
determination of symptoms, Hippocrates has left 
us (''Epidemics,*' Books I and m) forty-two case 
histories, which remained without parallel in the 
history of medicine for about two thousand years. 
The following is one of the briefest in the collection : 

''Criton, in Thasus, while still on foot, and going 
about, was seized with a violent pain in the great 
toe; he took to bed the same day, had rigors and 
nausea, recovered his heat slightly, at night was 
delirious. On the second, swelling of the whole foot, 
and about the ankle erythema, with distension, and 
small bullae (phlyctaense) ; acute fever; he became 
furiously deranged; alvine discharges bilious, un- 
mixed, and rather frequent. He died on the second 
day from the commencement.'* 

Hippocrates did not rest satisfied with the record 
of individual cases and their sjntnptoms. In his 
treatise ''On Regimen in Acute Diseases'* he ad- 
mits that the Asclepiads of Cnidus had described 
accurately the symptoms of various diseases, and 
even how certain of them terminate; but they had 
unduly multiplied species. The physician should 



THE FATHER OF MEDICINE 41 

not make the number of species of disease as great 
as that of their manifestations* In another treatise 
{** Prognosdcs^') the Father of Medicine urges upon 
the physician the need of so knowing the various 
diseases in their specific tendencies and in their 
relation to the constitution of the individual patient 
as to be able to foretell their course and outcome. 
"He should observe thus in acute diseases: first, 
the countenance of the patient, if it be like the 
countenances of persons in health, and more so, if 
like itself, for this is the best of all; whereas the 
most opposite to it is the worst, such as the following: 
a sharp nose, hollow eyes, collapsed temples; the 
ears cold, contracted, and their lobes turned out; 
the skin about the forehead being rough, distended 
and parched ; the color of the whole face being green, 
black, livid, or lead-colored.*' This is the fades 
Hippocratica, indicative of approaching dissolution. 
We are, of course, indebted to Hippocrates for the 
terms acute, chronic, endemic, epidemic, in their 
application to disease, for the recognition of the 
tuberculous nature of Pott's disease, for the de- 
scription of the peculiar respiration ''like that of a 
person recollecting himself," for clinical pictures of 
various diseases, including puerperal, intermittent 
and remittent fevers; the latter especially interesting 
since the decline of Hellenic civilization may have 
been owing to the ravages of malaria. But a few 



42 THE HISTORY OF MEDICINE 

quotations from the '^ Aphorisms" will show that, 
true to his own teaching, he advanced to a knowl- 
edge of diseases in their tendencies and outcome. 
''Those cases of epilepsy which come on before 
puberty may undergo a change; but those which 
come on after twenty-five years of age, for the most 
part terminate in death" (v, 7). ''Phthisis most 
commonly occurs between the age of eighteen and 
thirty-five years" (v, 9). "When sleep puts an end 
to delirium, it is a good symptom" (11, 2). In the 
same spirit of generalization he says: "An article 
of food or drink which is slightly worse, but more 
palatable, is to be preferred to such as are better, 
but less palatable" (u, 38). "Acute diseases come 
to a crisis in fourteen days" (n, 23). "A true 
tertian comes to a crisb in seven periods at the 
furthest" (iv, 59). 

As already implied, a traceof Pythagorean doctrine 
can be detected in the Hippocratic theory of critical 
days. And a like concession to the four elements of 
Empedocles is noticeable in the doctrine of the four 
humors. According to this teaching, for the origin 
and complete development of which Hippocrates 
was not responsible, blood is hot and moist like air, 
phlegm is cold and moist like water, yellow bile is 
hot and dry like fire, and black bile is cold and dry 
like earth. As one or other of these humors pre- 
dominated in an individual, he was supposed to be 



THE FATHER OF MEDICINE 43 

of a sanguine^ phlegmatic, choleric, or melancholy 
temperament. This view, which persists in scientific 
and general literature even to the present time, may 
be illustrated from Shakespeare's *' Julius Caesar,'* 
in which play the sanguine Antony, the phlegmatic 
Octavius, the choleric Cassius, and the melancholy 
Brutus represent the four temperamental tjrpes, 
while the ideal character is that in which the four 
humors are naturally and harmoniously mingled. 
Similarly in the Hippocratic physiologyt health 
depended on the crasis, or blending, of the four 
juices of the body. Unless they duly blend, there is a 
state of dyscrasia, or crudity^ the humors, like raw 
food, acting as irritants. Health must be restored 
by a process of coction (or pepsis) wherein the in- 
ternal heat of the body cooks the crude humors. 
Upon this follows a crisis — a separation, or elimi- 
nation — of the superfluous substance. The ele- 
ments may be restored to a state of harmony and 
equilibrium by the remedial power of Nature. It 
was faith in this ms medicalrix naturm which led 
Hippocrates to adopt an expectant attitude in the 
treatment of many of his cases, to abstain at times 
from surgical interference, and to prescribe drugs 
and cooling drinks as auxiliaries of Nature in the 
expulsion of the morbific matter after a fever 
crisis. 
However it may have been with his followers, 



44 THE HISTORY OF MEDICINE 

Hippocrates was carried away by no doctrine or 
theory. Seeing the particular in the general and the 
general in the particular, he bent his comprehensive 
genius to the healing of the individual patient. 
Plato justly compared him to the Athenian sculptor 
Phidias, who beheld the ideal in the real and im- 
pressed upon the rocks of Pentelicus the stamp of 
an eternal beauty. To enjoy the practice of the Art, 
to serve as a model for all true physicians, to be 
respected and honored by all men in all times, was 
and is the reward and destiny of the greatest of the 
Asclepiads. 

REFERENCES 

Adams, Francb: The Genuine Works of Hippocrates. 2 voh^ 
London, 1849, 872 pp. (pagination continuous). 

Allbutt, (Sir) T. C: *' Essay on the Medicine of the Greeks,*' 
MeddctU^Ckkwrpcal Renew, vd. X3cxvin, pp. 483-98. Lon- 
don, i866. 

Caton, Richard: "Hippocrates and the newly-discovered Health 
Temple of Cos," British Medical Journal, 1906, i, pp. 571-74. 
(It is illustrated, and alludes to the supposed connection 
between the worship of iEsculapius and the worship of 
Imhotep.) 

Clifton, Frauds: Hippocrates upon Air, Water, and Situation, etc. 
London, 1734. 389 pp. 

Fihlayson, James: "Hippocrates," Glasgow Medical Journal, 
vol. xxxvu, pp. 253-71. 1892. (Excellent review of the 
sources.) 

Jones, W. H. S.: Malaria, a Neglected Factor in the History of 
Greece and Rome. With Introduction by Major (Sir) R. Ross, 
and a concluding chapter by G. G. EUett. Cambridge, 1907. 
107 pp. 

Jones, W. H. S. : Malaria and Greek History, to which is added the 
History of Greek Therapeutics and the Malaria Theory, by 



THE FATHER OF MEDICINE 45 



E. T. WtChingtoiL Mancfaetter, The Unhmnty FktM» 1909. 

175 PP- 
Witfaington. E. T.: '' The Aaclepiache and the PHesti of Aade- 

piii8»" Studies in ike History and Method of Science^ leooiid 

series, edited by Charles Singeri pp. I9i-20S. Qaiendon 

Fressi igax. 



CHAPTER III 

ROMAN ANATOMY AND SURGERY 

That study of anatomy and practice of surgery 
which within the bounds of the Roman Empire 
reached their culmination in the first and second 
centuries of the Christian era can be traced in their 
development from the medical science of the age 
of Hippocrates. Diodes of Carystus, who stood 
next to the sage of Cos in age and distinction, was a 
dissector of animals, and in a work on zootomy 
described the heart, the large blood-vessels, and a 
greater number of the smaller vessels than had been 
recognized in earlier works. He agreed with his 
contemporary Plato, as well as one of the less 
authentic Hippocratic writings ("On the Heart"), 
in looking upon the heart as the source that sent 
its streams to all parts of the body. Diodes knew 
the oesophagus, the biliary ducts, the caecum, the 
ureters, and the Fallopian tubes. He was the in- 
ventor of a bandage for the head, and of the graph- 
iscus, a spoon-like instrument later used in the 
Roman armies to extract arrows and spears from 
wounds. He made use of opium as an anodyne, and 
distinguished pleurisy from pneumonia. Praxag- 
oras of Cos was the first to differentiate veins and 



ROMAN ANATOMY AND SURGERY 47 

arteries, the former filled with blood, the latter with 
vital air, or pneuma. He recorded the local condi* 
tions of pleurisy, was the first among the Greeks to 
recognize the importance of the pulse in diagnosis, 
and advised laparotomy, as a last resort, in in- 
testinal obstruction, though there b no evidence 
that this operation was actually put in practice in 
his age. Diodes and Praxagoras are classed among 
the Dogmatists, who were under the influence of 
medical speculations concerning the pneuma (which 
in the opinion of Diodes was renewed by respira* 
tion) and concerning the four humors. For example, 
both Diodes and Praxagoras attributed epilepsy to 
a derangement of the humors, as did also the specu- 
lative philosopher Plato and the author of ''On the 
Sacred Disease,'' who was more successful in stating 
what is not than what is the cause of that malady. 
Aristotle of Stagira, the son of the Asdepiad 
Nicomachus and the pupil of Plato, laid the founda- 
tions of comparative anatomy by dissecting about 
fifty spedes of animals, induding the deer, elephant, 
horse, ox, pig, domestic fowl, chamsdeon (which had 
been made a spedal study by Democritus), tortoise, 
frog, sepia, crab, lobster, murex, and sea-urchin. 
He carried into his investigations the experimental 
spirit, which, contrary to the teachings of many 
historians, was never wanting in the medical sdence 
of antiquity. He vivisected some of the lower ani- 



48 THE HISTORY OF MEDICINE 

mals, discovered that the tails of saurians would 
grow again after being cut off, that the chamaeleon 
would continue to breathe for a considerable time 
after being cut open along its entire length, and he 
referred to the movements of the heart of the 
tortoise after the organ had been excised. Aristotle 
must be credited with a knowledge of the rudiments 
of histology, as he recognized the various tissues — 
bone, blood, fat, skin, cartilage, hair, connective 
tissue, and so forth. He studied the embryos of 
various animals, observed the early appearance of 
the chick's heart, its brmn and eyes, the rapid 
growth of the allantois from the fifth day of incuba* 
tion, and the allantoic and vitelline blood-vessels 
on the sixth. He was well acquainted in the adult 
with the liver, spleen, jejunum, colon, sigmoid 
flexure, rectum, the trachea, the brain membranes 
and the network of blood-vessels covering the brain, 
the structure of the lungs and the richness of their 
blood supply. Perhaps his greatest single contribu- 
tion was his study of the heart with its chordae 
tendinese, and his attempt to describe the arrange- 
ment of the blood-vessels, especially the branches 
of the aortat as that vessel is called in the writings 
of this father of science. A brief quotation from the 
''Historia Animalium'* will serve as an example of 
the many passages in which Aristotle anticipated 
the investigations of modem scientists. "The ear,'* 



ROMAN ANATOMY AND SURGERY 49 

he says, ** is constructed internally like the trumpet* 
shell, and the innermost bone is like the ear itself, 
and into it at the end the sound makes its way, as 
into the bottom of a jar. This receptacle does not 
communicate by any passage with the brain, but 
does so with the palate, and a vein extends from the 
brain towards it.'' He failed to understand the 
function of the nerves that lay before him, and em- 
ployed the word neuron to indicate the material of 
the tendons, ligaments, and of the fibrin of the 
blood. 

Luckily the structure and functions of the nerves 
and brain were to a considerable extent elucidated 
by the investigations of Herophilus and Erasistratus 
at the beginning of the third century B.C. They 
were enabled to carry on their investigations at 
Alexandria through the patronage of the Greek 
kings of Egypt, Ptolemy Soter and Ptolemy Phila- 
delphus, who placed at their disposal the bodies of 
condemned criminals for experiment and dissection. 
Herophilus studied the membranes of the brain, the 
sinuses of the dura mater, and noted the dilatation 
of the superior longitudinal sinus now known as the 
wine-press of Herophilus {tarcular HerophUi). He 
examined carefully the ventricles of the brain with 
their choroid plexuses, especially the fourth ventri- 
cle, or ventricle of the cerebellum, which he con- 
sidered as the seat of intelligence, and gave the 



so THE HISTORY OF MEDICINE 

furrow at the floor of the ventricle a name corre- 
sponding to the Latin calamus scriptorius. Hero- 
philus also traced a number of the nerves to their 
connection with the brain and cord, and recognized 
their function as transmitters of will and sensation. 
Erasistratus, in turn, compared the convolutions 
of the cerebrum to the folds of the jejunum, noted 
their greater complexity in man than in the lower 
animals, and ascribed the difference in complexity 
to difference of mental development. He agreed 
with Herophilus in regarding the cerebellum as the 
special seat of intelligencei and remarked that the 
structure of this part of the bnun differs from that 
of the cerebrum. Erasistratus further agreed with 
Herophilus m dividing nerves into nerves of move- 
ment and nerves of sensation. He also taught that 
the nerves arise from the brain substance and are 
filled with marrow. 

Herophilus contributed to other departments of 
anatomy. He taught that the arteries arise from 
the heart, have coats six times as thick as the veins, 
and that they carry blood and pneuma. He called 
the pulmonary artery the arterious vein, named the 
duodenum according to its length, noted the termi- 
nation of the lacteals in gland-like bodies. He de- 
scribed the liver with some care, comparing the 
liver of man with that of the lower animals. He 
examined the salivary glands, the pancreas, the 



ROMAN ANATOMY AND SURGERY 51 

hyoid bdne^ and named the prostate. We also owe 
to Herophilus an early account of the testicles, 
epididymis, vas deferens, seminal vesicles, the 
uterus, the structure of the ovaries, the spermatic 
^ artery, the spermatic vein (even the relation of the 
left spermatic to the renal), as well as the uterine 
vessels. He wrote a treatise on the eye, describing 
the three coats and the vitreous humor, and he im- 
proved the operation for cataract. This pioneer in 
human dissection practiced general surgery and 
wrote a work on obstetrics. Through his teachers 
he was in touch with the traditions of both Cos and 
Cnidus. He developed the diagnostic methods of 
his master Praxagoras, and was the first to describe 
the dicrotic pulse. He held the teachings of Hippo- 
crates in reverence, and did not abandon the doc- 
trine of the four humors. In spite of conservatism 
in this respect, Herophilus preferred observation 
and experience to theory, and was the first to make 
post-mortem examinations. 

Erasistratus, bom about 330 B.C., through his 
master Metrodorus came under the influence of the 
teachings of Aristotle and of the school of Cnidus. 
He was the exponent of a more exact method in 
medical science than had prevailed before his time, 
and as an anatomist and surgeon was not inferior to 
his great contemporary Herophilus. He was more 
exact than Aristotle or the Hippocratic writings in 






52 THE HISTORY OF MEDICINE 

the description of the heart, its chordae tendineas 
and its valves, and named the tricuspid and sig* 
moid. He also gave the trachea its name, and ex- 
plained the {miction of the epiglottis. He observed 
the lacteals in lower animals and in man. By post- 
mortem examination he learned of the hardening 
of the liver in cases of dropsy, as well as of the 
anatomical conditions following pleurisy and a cer- 
tain kind of snake-bite. We are indebted to Erasis- 
tratus for a careful description of the normal liver. 
Though recognizing design in the structure of the 
body, he regarded some parts — the spleen, for 
example — as serving no purpose. He failed also to 
discover the function of the bile, and, rejecting the 
doctrine of the four humors, greatly developed the 
doctrine of the pneuma. like Diodes he taught 
that the pneuma is renewed by respiration. When 
the lungs are expanded, and a vacuum thus is 
created, the air enters by the trachea, bronchi, and 
bronchial tubes. When the heart dilates, the air 
advances from the anastomoses of the bronchial 
tubes to the arterioles, and thence by the pulmonary 
vein (called by him the "venous artery") to the- 
central organ. On the contraction of the heart the 
pneuma is forced through the aorta into the general 
arterial system, that part which feeds the intelli- 
gence passing to the brain. Erasistratus denied, in 
agreement with Praxagoras, the principle of inter- 



ROMAN ANATOMY AND SURGERY 53 

nal heat, and held that the pneuma and the blood 
are the sources of the body's energy. The blood b 
formed from food, and digestion is a trituration 
process, not a coction. Following up his endeavor 
to reduce physiology to mechanical principles, he 
tried to prove by experiments with birds that there 
may occur a loss of body weight other than that due 
to visible excretions. Disease is generally caused by 
plethora, an overfilling of the vessels. Inflamma- 
tion and fever are the result of the plethora of the 
veins; arthritis is the manifestation of plethora in 
the joints. The presence of blood in the arteries is 
pathological, due to the overfilling of the veins or to 
a vacuum in the arteries following the escape of 
pneuma. Naturally Erasistratus was unable to 
anticipate the dbtinction drawn by modem science 
between venous blood and arterial, but it is evident 
that he turned to account the physical science of his 
own times. In spite of his theory of plethora he 
seldom resorted to venesection. He likewise ab- 
stained from tapping the abdomen in dropsy, be- 
cause the operation affected merely a symptom and 
did not strike at the cause of the disease. Era- 
dstratus invented an S-shaped catheter. He em- 
ployed a hook-shaped knife to extract the dead 
foetus, and is said to have opened the abdomen in 
order to apply medicaments directly to ^the liver 
and spleen. 



54 THE HISTORY OF MEDICINE 

According to the Latin writer, Aulus Cornelius 
Celsus, Herophilus and Erasistratus "procured 
criminals out of prison, by royal permission, and, 
dissecting them alive, contemplated, while they 
were still breathing, the parts which nature had 
before concealed, considering their position, color, 
figure, size, order, hardness, softness, smoothness, 
and asperity." This hideous practice, already 
alluded to, found advocates and apologists among 
the Greeks, some holding "it is by no means cruel, 
as most people represent it, by the tortures of a few 
guilty, to search after remedies for the whole inno- 
cent race of mankind in all ages." Celsus, however, 
considered this sort of vivisection both cruel and 
superfluous, though dissection is necessary for in- 
struction. We learn from him that Ammonius, the 
Alexandrian lithotomist, was accustomed to split in 
pieces, by means of an instrument, calculi too large 
to be removed from the bladder whole. Celsus also 
makes mention of Heradides of Tarentum (230 
BX.), to whom it first occurred to adapt to the re- 
duction of dislocations the mechanical inventions 
of Archimedes. Heradides was the greatest of the 
Empirics, a medical sect who thought that success 
in practice did not depend upon a knowledge of 
philosophy or sdence, and that it is more important 
to heal disease than to know its cause. According to 
them, physidans, as was obviously the case with 



ROMAN ANATOMY AND SURGERY 55 

farmers and sailors, were in no need of theoretic in- 
struction. To Heraclides, the best product of this 
narrow school of medical thought, we are indebted 
for the investigation of the effects of numerous 
drugs, including opium. 

Celsus, who flourished in the early part of the first 
century A.D., was a Roman patrician and author, 
who must be considered an enlightened amateur 
and not a professional physician. Of his encyclo- 
paedic writings dealing with the so-called Arts — 
agriculture, medicine, war, rhetoric, philosophy, 
and jurisprudence — only one complete work sur- 
vives, namely, "De medicina, libri octo." It is 
based on the writings of the Hippocratic and Alex- 
andrian epochs and on the Greek medical works of 
his contemporaries. It displays a good knowledge 
of osteology, particularly of the skull with its su- 
tures, foramina, maxillary bones, etc* It shows 
that its author held a correct view of the part 
played by cartilage in the articulations, and of the 
diff^'ence in form between the male and female 
pelvis. Among various other matters Celsus speaks 
of the carotid arteries, and the cervical glands. In 
the neck there begin two passages. Of these alterum 
asperam arteriam naminant^ alterum stomachum. 
Arteria exterior ad pulmonem, stomachus interior ad 
ventriculum fertur: ilia spiritum^ hie cibum recipit. 
The oesophagus (stomachus) was known to lead to 



56 THE HISTORY OF MEDICINE 

the stomach (ventriculus) ; while the trachea (or- 
teria) carries air or spirit to the lungs. 

The anatomy found in the "De medidna" is 
largely incidental, but surgery is the exclusive topic 
of two of the eight parts into which the work is 
divided. Very little is known of the practice of 
surgery at Rome before the time of Celsus, but he 
makes mention of Asclepiades (about lOO B.c.)f 
who by his tact and urbanity succeeded in gaining 
for Greek medicine a foothold in the Roman metro- 
polis. Asclepiades advised tracheotomy in certain 
cases, employed venesection with discretion, and 
noted two instances of spontaneous dislocation of 
the femur. However, the distinction between 
surgeons and physicians was definitely made among 
the Romans, and Asclepiades was known as a 
physician rather than as a surgeon. He taught that 
the body consists of an infinite number of atoms, 
which surround countless minute tubular spaces or 
pores, a doctrine that became the fundamental 
principle of the Methodic school of medical thought. 

The pages of Celsus enable us to see the progress 
made in surgery between the fifth century B.C. and 
the first century A.D. For example, ligature was 
unknown in the Hippocratic era, but Celsus, after 
discussing various methods of arresting haemorrhage 
— the application of dry lint, cold, compression, 
vinegar, corrosives, and caustics — writes: ** Finally» 



ROMAN ANATOMY AND SURGERY 57 

if the bleeding continuesi the vessels which dis- 
charge the blood are to be taken hold of and tied 
on both sides of the wounded part, and cut through 
in order that they may retract/* In case that such 
procedure is impracticable, the red-hot cautery is to 
be applied to the bleeding vessel. Sometimes the 
application of a cupping instrument near the point 
of hemorrhage may prove eflfective. 

Contrary to the supposition of one of our writers 
of general history the removal of limbs by amputa- 
tion was practiced by surgeons before Harvey 
demonstrated the circulation of the blood. In fact, 
the Father of Medicine, in cases of gangrene, where 
loss of limb became inevitable, ventured to assist 
nature by amputating at the line of demarcation. 
It is to Celsus, however, that we are indebted for the 
first detailed description of amputation. Speaking 
of him a great modem surgeon. Lord Lister, who 
will be the subject of a subsequent chapter, writes: 
" He directed that the soft parts should be divided 
with a knife down to the bone, and then dissected 
up from it for some distance, so as to allow the saw 
to be applied at a higher level. The rough surface of 
the sawn bone was then to be smoothed off, and the 
soft parts, which, as he tells us, will be lax if this 
plan be pursued, were to be brought down so as to 
cover the end of the bone as far as possible. This 
method seems calculated to afford good results; 



58 THE HISTORY OF MEDICINE 

particularly as it appears prot)able from his writings 
that Celsus employed the ligature for arresting 
haemorrhage after amputation, and dressed the 
stump in a manner favorable to the occurrence of 
primary union," 

From the lucid pen of Celsus we have also de- 
scriptions of plastic surgery, of Uthotomy, the 
couching of cataract, venesection, trephining, relief 
of phimosis, urethrotomy, resection, the surgical 
treatment of hernia, cancer of the lip, vomica of the 
liver, and many other operative procedures. He 
mentions suture of the abdominal wall (including 
the peritoneum) and of the intestines, recognizes 
the advantage to the surgeon of ambidexterity, and 
gives the four classical symptoms of inflammation 
{Noke vera inflammationes sunt guatuor^ rubor et 
tumor f cum colore^ et dolore). There have been dis- 
covered in the ruins of Pompeii surgical instruments 
that throw further light on the practice of the first 
century of the Christian era. These include iron 
bistouries, bronze forceps and cupping instruments, 
a lancet with silver blade and bronze handle, probes, 
a double anal speculum, a three-bladed uterine, and 
an S-shaped catheter. Pliny, who was a victim of 
the same eruption of Vesuvius (79 a.d.) as destroyed 
the city of Pompeii, mentions an artificial iron hand, 
which was the product, however, of a much earlier 
period than his own. 



ROMAN ANATOMY AND SURGERY 59 

■ 

The age following that of Celsus was one of the 
most brilliant in the history of anatomy and surg- 
ery, though only a small fraction of the medical 
literature of the time is now in existence. Marinus» 
who lived in the time of Nero (54-68 A.D.)> was the 
author of numerous books on anatomy. He is 
known for his careful study of the muscles, glands, 
and nerves. He described seven pairs cl cranial 
nerves, including the auditory, facial, and hypo- 
glossal. His knowledge was gained by dissection, 
as well as by animal vivisection and experimenta- 
tion. About the time that the warlike Trajan, with 
the most highly organized armies the Roman 
Empire had seen, was extending his dominions to 
their utmost limits and celebrating his triumphs by 
the exhibition of ten thousand gladiators, there 
lived among his subjects Leonides, Rufus, Archi- 
genes, Aretseus, Heliodorus, and Soranus of Ephesus. 
The last-named was the greatest gynecologist and 
obstetrician of antiquity. He made use of the 
obstetric chair, practiced version in order to induce 
head presentation, and he discarded the old rough 
methods of treating pregnant women (jolting on 
ladders, etc.) which had been handed down by the 
Asclepiads of Cnidus. Soranus had, before going to 
Rome at the end of the first century B.C., been 
trained in anatomy at Alexandria. He contributed 
to the development of general surgery, especially 



6o THE HISTORY OF MEDICINE 

the treatment of fractures, and of injuries of tlie 
head, as well as to various other departments of the 
healing art. Unlike his great contemporaries, who 
were adherents of the Pneumatic or Ex:lectic schools 
of medical thought, Soranus was a Methodist, 
following Asdepiades in medical doctrine and Epi- 
curus, the disciple of Democritus, in philosophy. 
He was naturally opposed to all forms of supersti- 
tion, and tried to persuade the midwives to abjure 
their reliance on dreams and the practice of mystic 
rites and antiquated customs. The influence of 
Soranus was greatly extended through the transla* 
tion and interpretation of Caelius Aurelianus (fifth 
century a.d), the only distinguished writer on medi- 
cine, except Celsus, to employ the Latin language 
during the period of the Roman Empire. 

Rufus of Ephesus was educated at Alexandria, 
dissected monkeys and other animals, and experi- 
mented on live specimens. He knew that all bodily 
function is under the control of the nervous system. 
He was acquainted with the recurrent larjmgeal 
nerve, and produced loss of voice and of sensibility 
by compressing the pneumogastric in the region 
of the carotid arteries. He discovered the optic 
chiasma, described the capsule of the lens, and the 
tortuous course of the uterine artery. As a surgeon 
Rufus employed torsion of arteries and digital com- 
pression, as well as other means, for the arrest of 



ROMAN ANATOMY AND SURGERY 6i 



haemorrhage. He associated Filaria 
with impure drinking-water, and described leprosy, 
which at about this time was carried to the West by 
the returning Roman legions, as well as bubonic 
plague, traumatic erysipelas, and other diseases. 

Flap amputations were performed by Leonides 
of Alexandria, and by the two greatest surgeons of 
the time of Trajan — Archigenes and Heliodorus, 
who, like Ruf us, both employed torsion of vessels to 
arrest hsemorrhage. '^ Amputation above the elbow 
or knee," writes Heliodorus, ''is very dangerous 
owing to the size of the vessels divided. Some 
operators in their foolish haste cut through all the 
soft parts at one stroke, but it seems to me better 
to first divide the flesh on the side away from the 
vessels, and then to saw the bone, so as to be ready 
at once to check the bleeding when the large vessels 
are cut. And before operating I am wont to tie a 
ligature above the point of amputation." Speaking 
of operating for hernia he writes, ''We ligature the 
larger vessels, but as for the smaller ones we catch 
them with hooks, and twist them many times, thus 
closing their mouths." Even more relevant is his 
description of a minor amputation. "A circular 
incision," he writes, "is made round the digit near 
its base. From this two vertical incisions are made 
opposite one another and the flaps so formed dis- 
sected up. The base being thus laid bare, the digit is 



fo THE HISTORY OP MEDICINE 

to ht ranovtBd bjr c iittia^ fbraeps^ aod tke flaps are 
UMi wm^iK finpeiiiti aDd witureiL 
ttiidertix4c reaecticMM^ and the reoKnral of 
and treatad stricture. b)r internal 
Ardugenes perforned anqntatians not only for gan- 
girene and revere nijiinu» bntt in care of nafignant 
tonor or great delbniity« oanstricting the Knb 
above the point of anpQtatioOy cutting dovn opon 
tlie diief arteries and ligaturing tlienu He removed 
mammary and uterine canoen^ e mp lo y ed tke vag- 
inal ipeculunit treated injuries of the head, etc 
Heliodofus is known only as a sufgeon« but Arcfai- 
genes firrrilfd in many departments of w^^tnyf^ , 
Aretanis was pfobaUy indebted to Ardiigenes for 
Us knowledge of the vascular system^ of the struc- 
ture of the kidney and other ofgans, as well as for 
mudi of his dinical wisdom. In the pages of Aretaeus 
are found ctassical descriptions of phthisb, tetanus, 
diphtheria, epilepsy with its aura, satyriasis, diar 
betes, and elephantiasis. There are written in the 
Hippocratic spirit. They are not care histories, 
however, but generalized pictures that enable the 
clinician to know each q^edes of diseare in its ante- 
cedents, development, and probable outcome in in- 
dividual cases. Aretaeus introduced the term ''syn* 
cope^' into pathology, and established the distinc- 
tion between paralysis of cerebral origin, involving 
decussating fibers, and paralysis of spinal origin. 



ROMAN ANATOMY AND SURGERY 63 

Galen (130-201 AJ>.) was the greatest anatomist 
of antiquity, and, after Hippocrates, the greatest 
physician. His voluminous writings reflect the 
spirit of the highly organized Empire of the An- 
tonines, just as the Hippocratic writings reflect the 
freer spirit of the Periclean age. Galen, bom at 
Pergamus, directed in his early education by a wise 
and cultured father, was early initiated in the 
philosophy, medicine, and general learning of his 
time. By nature and training an Eclectic, he chose 
what seemed to him best in the teachings of all the 
schools of philosophy and all the medical sects, and 
ultimately harmonized all these in a system of his 
own. He was a professed disciple of Hippocrates, a 
votary of the Asclepieion of Pergamus, a follower of 
Aristotle, a student of the works of Plato, and was 
indebted for parts of his medical doctrine to the 
dogmatic, empiric, pneumatic, and the methodic 
schools of medical thought. 

Galen received his training in anatomy at Alex- 
andria and other places, and his works on that part 
of medical science show that he had diligently 
studied the writings of the great Alexandrian 
anatomists, of Rufus of Ephesus, and, above all, of 
Marinus, the expert dissector. Galen himself ex- 
amined with great care the human skeleton, the 
muscles of the Barbary ape, the brain of the ox, the 
nervous system and the viscera of the pig, the 



64 THE HISTORY OF MEDICINE 

blood-vessels of the embryo, and dissected and 
vivisected many animals — goat, fish, snake, etc. 
He was particularly intent on the function of each 
part of the body, and, seeking to demonstrate 
design in nature and purpose in each structure, he 
closely correlated anatomy and physiology. As a 
youth of twenty, he had written three books on the 
moveinent of the lungs, as well as a treatise for mid- 
wives on the anatomy of the uterus; at the age 
of twenty-eight, as physician to the gladiators of 
Pergamus, he showed special skill in the treatment 
of open wounds and of injuries to tendons; and, 
leaving his native city for the world's metropolis, he 
at the age of thirty-two demonstrated before the 
61ite of Roman society by experiments on living 
animals the mechanism of the nerves and muscles. 
Galen's contributions, however, to the knowledge 
of structure are found in almost every department 
of the study of anatomy. His descriptions of bones 
and ligaments approach the standard of the present 
day. He classified the vertebrae as cervical, dorsal, 
and lumbar, and employed the terms ** apophysis," 
** epiphysis," "symphysb." He knew in animal 
dissection the seven muscles of the eye, named the 
platysma, first described the popliteus and the 
interossei muscles, and explained the nature of the 
muscles involved in mastication, respiration, loco- 
motion, etc. He described the branches of the 



ROMAN ANATOMY AND SURGERY 65 

aorta, the ductus arteriosus, the three coats of the 
arteries, was aware of the anastomoses of the 
minute veins and arteries, proved, by ligaturing the 
femoral artery in two places and making an incision 
between the two ligatures, that the arteries contain 
blood. He gave directions for the dissection of the 
brain, recognized the pituitary body and the in- 
fundibulum; by dividing the hemisphere exposed 
the corpus callosum and the fornix; by making 
sections he studied the ventricles, the corpora 
quadrigemina, and other parts of the cerebrum; he 
mentioned the vermiform process of the cerebellum. 
He carefully traced the course of the trigeminal, 
auditory, facial, glossopharjmgeal, and other cranial, 
as also the course of the spinal nerves, and the 
connections of the vagus and sympathetic. Galen 
described the pleura and the pericardium, lungs, 
heart, and, very carefully, the abdominal organs, 
following Herophilus in the description of the geni- 
tals. More impressive than even his knowledge of 
neurology or osteology b the method, sjrstematic 
and comprehensive, displayed by Galen in his 
treatises on anatomy. 

As already implied, much of his knowledge of 
anatomy is bound up with physiological discussions. 
He was able to observe the motion of the exposed 
heart in two patients, and noted that the heart con- 
tinued to beat in vivisected animals after the large 



68 THE HISTORY OF MEDICINE 

plastic operations and of tracheotomy, is now re- 
garded as a predecessor of Galen. Oribasius (325- 
403) was the author of an encyclopaedia of medicine, 
which extended the influence of Galen and pre- 
served the memory of Archigenes, Heliodorus, and 
Antyllus. To Aetius of Constantinople (sixth cen- 
tury A.D.) we are likewise indebted for information 
concerning the surgery of Rufus, of Leonides (re- 
moval of glandular tumors from the neck, etc.)i and, 
particularly, of Archigenes. His voluminous work 
gives a definite account of the surgical treatment of 
aneurism. Alexander of Tralles was the author of a 
"Practica." With these Byzantine compilers is 
usually mentioned Paul of iEgina (625-690), who 
wrote an ''Epitome" of medicine in seven books. 
Paul, however, was an expert surgeon and described 
a great variety of operations. His treatment of 
cataract by depression, his failure to perform 
thoracentesis for empyema, an operation which had 
been known in Hippocratic times, his neglect of the 
methods of version followed by Soranus, and his 
practice of removing the testicles in case of scrotal 
hernia, indicate that surgery in his time had begun 
to relapse from a classical to a medieval standard. 
The pages of the ''Epitome" afford some insight 
into the practice of military surgery in the armies of 
the Roman Empire. 
At the time of Trajan there had been twenty 



ROMAN ANATOMY AND SURGERY 69 

cohorts of garrison troops of one thousand to 
fifteen hundred men each, with four surgeons to the 
cohort. Nine cohorts of Pretorian guards were in 
addition provided with physicians. In the rest of 
the Empire there were thirty legions of ten cohorts 
and about sixty*five hundred men each. These 
troops were attended by surgeons of the legion 
{medici legUmis)^ probably six or more to the legion. 
They wore the uniform of the legionaries, but were 
counted as of superior rank. In the fixed camps 
there were special medical officers. About the same 
time mention is made of military hospitals, also 
provided with regular superintendents. In the 
Roman armies of the sixth century every troop of 
two hundred to four hundred men was accompanied 
by eight or ten men on horseback to pick up the 
wounded. These first-aid men carried each a water 
flask, and received a gold piece for every man they 
rescued. In the military hospitals were male 
nurses. For each vessel in the navy, surgeons were 
also provided. 



REFERENCES 

Adams, Francis: [The ExtatU Works of Aretaus (translation). 

London, The Sydenham Societ>% 1846. 510 pp.; The Seven 

Books of Pauius MgMata (translation in three volumes), vol. 

n, pp. 247-511. London, The Sydenham Society, 1846. 
Allbutt, Sir Clifford T.: Greek Medicine in Rome. London, 192 1. 
Aristotte: Htstoria Ammalium (English translation by D'Airy 

Wentworth Thompson). Oxford, Clarendon Phas, 1910. 



70 THE HISTORY OF MEDICINE 

Vol. IV of the Works of Aristotle, edited by J. A. Smith and 

W. D. Ross. 
Finlayson, James: "Celsus," Glasgow Medical Journal, vol 

xxxvn, 1892, pp. 321-48; "Erasistratus," ibid., vol. xxxix, 

pp. 340-52: "Galen," British Medical Journal, 1892, vol. i, 

PP* 573f 730, 771; "Herophilus," Glasgow Medical Journal, 

1893, vol. XXXIX, pp. 321-40. 
Meunier, L£on: HisUnre de la MSdecine. Paris, iQix. 642 pp. 
Marx, K. F. H. : Herapkilus, ein Beitrag tur Geschichte dor Medisin. 

Carlsruhe and Baden, 1838. 103 pp. 
Ttmer, Sir William: "Anatomy," Encyclopadia BritatmicOt 

ninth edition. 



CHAPTER IV 

THE TRANSMISSION OF MEDICAL SCIENCE 

BY THE ARABS 

Before the death of Paul of JEpnsi the translatioii 
of Greek and Syriac medical works into the language 
ci the Mohammedan oonquerora of Asia Minor had 
b^;un, and even before the end of the fifth century 
the medical science of Constantinople had been 
carried as far east as the Persian province of Khora- 
san by the Nestorian heretics. The school and 
hospital at Gondisapor» controlled for the subse- 
quent centuries by this Christian sect, became the 
focus from which Greek, Syrian, Persian, and In- 
dian medical teachings were spread among the 
followers of the Prophet* Here was educated the 
Arab physician Harets ben Kaladah, who, though 
a Christian, became the adviser of Mohanuned in 
those hygienic and medical matters which Islam, 
like Judaism, made a part of religion. When the 
Arab conquerors overran Mesopotamia and Persia, 
they left undisturbed their fellow monotheists, the 
Nestorian physicians of Gondisapor. Among these 
about the middle of the eighth century certain 
Syrian families, the Bachtishuas, Messuas, and 
Serapions, were especially prominent as translators. 



72 THE HISTORY OF MEDICINE 

In 765 George Bachtishua, whose influence had for 
a time been supreme in the school and hospital of 
Gondisapor, was called to the recently founded city 
of Bagdad by the Abbaside Caliph al Mansur, who 
induced him to undertake the translation of a 
number of medical works into Arabic He returned 
to Khorasan before his death in 771 » but his son was 
later summoned to the court of Harun al Rashid, 
and the gnmdson Gabriel and the great-grandson 
were famous in the times of that Caliph and his 
successors. 

The Arabian Nights throws a curious light on the 
medical knowledge and general culture of the East- 
em Caliphate at the beginning of the ninth century. 
Readers of the story of Abu al Husn and his Slave- 
Girl will recall how the hero ''ate and drank, and 
made merry and took his pleasure, and gave gifts 
of gear and coin and was profuse with gold, and 
addressed himself to eating fowls and breaking the 
seal of wine-flasks and harkening to the giggle of 
the daughter of the vine as she guf^led from the 
flagon, and enjoying the jingle of the singing girls; 
nor did he give over this way of life till his wealth 
was wasted and the case worsened and all his goods 
went from him, and he bit his hands in bitter 
penitence." Then the slave-girl, the last of Abu 
al Husn's possessions, said: "O my lord, carry me 
to Harun al Rashid» fifth of the Abbasides, and 



MEDICAL SCIENCE OF THE ARABS 73 

seek of him to my price ten thousand dinars/* 
When she is brought before the Caliph, her accom- 
plishments and acquisitions are submitted to rigid 
inquisition. Among the various branches of learning 
open to students of the time she had not neglected 
medicine. She proves to be versed in the four ele- 
ments, the igm humor s, the thr ee kinds of spirits, 
the five seng gt^ Jhe^ three ventricles of the tetin . 
The number of veins is unknown, though some have 
thought to fix it at three hundred and sixty. There 
are two hundred and forty bones, and, contrary to 
the teaching of Galen, the mandible, the sternum, 
and the sacrum — intermediate between the verte* 
brae and the coccyx — consist of one bone each. 
The cause of all sickness is repletion and indigestion. 
Scurvy may result from eating salt food fasting. 
The endive is the most excellent of vegetables. 
Fermented liquor banisheth care and gladdeneth 
the heart of man, yet its sinfulness is greater than 
its use. One should not bathe on a full stomach. 
Yellowness of the whites of the eyes is indicative of 
jaundice. Medicine is taken to greatest advantage 
when Jupiter and Venus are in the ascendant. 
Cupping, like venesection, should be practiced in 
moderation, and it should be performed in the wane 
of the moon, and if it fall on a Tuesday and in the 
spring of the year, it will be the more efficacious, etc. 
From these fragments it is evident that the Slave- 



74 THE HISTORY OF MEDICINE 

Girl's medical lore is borrowed from Greek, Hebrew, 
Babylonian, and other sources. It is probable that 
the corrections of Galen's osteology, a knowledge of 
which is attributed in this fourteenth-century tale 
to the time of Harun al Rashid, are to be credited 
to Abdollatif (1162-1231), who, invited to visit 
Egypt in the reign of Saladin, enjoyed greater op- 
portunities of studying the human skeleton than 
usually came to Mohanunedan phjrsidans. 

The first of the Messuas to rise to distincti<M 
spent the early part of his life as an apothecary at 
Gondisapor, went to Bagdad as a physician, and, 
gaining the favor of Harun al Rashid by successful 
treatment and prognosis, entered into rivalry with 
Gabriel Bachtishua. Messua's son, usually called 
Messua the Elder, became the director of a college 
of translators at the request of the enlightened 
Caliph al Mamun (813-833), who wished to see 
translated into the Arabic language the sciences of 
all the lands under his sway. Messua the Elder and 
Serapion the Elder dispute the honor of having 
written the so-called Aphorisms of Damascenus. 
Greater, however, as a translator than the Bach- 
tishuas, Messuas, or Serapions was Honain ben 
Isaac (809-^73), a Christian Arab who put into hb 
native tongue the works of Hippocrates, Galen, 
Oribasius, and Paul of iEgina, and who wrote a 
treatise on ophthalmology and a commentary on 



MEDICAL SCIENCE OF THE ARABS 75 

Galen (Isagoge). During the ninth century the writ- 
ings of Archigenes, Dioscorides, Ruf us, Aristotle and 
other Greeks were likewise made accessible to read- 
ers of Arabic. At the same time the Arabs revised 
Syriac translations from the Greek, which had been 
made by Sergius in the sixth century, and translated 
a Syriac work C'Practica**) written by Serapion. 

The greatest of all the physicians to write in Ara* 
bic was the Persian Rhazes (860-^32), who studied 
at Bagdad and was the author of a comprehensive 
work on medicine, the ^* Continens,*' a briefer work, 
the '' Almansor,'* and a treatise on the smallpox and 
measles. He taught that inquietude, anxiety, and 
nausea are more frequent in the measles than in the 
smallpox; while, on the other hand, pain in the back 
is more peculiar to the smallpox than to the measles. 
He considered these diseases (the task of clearly 
differentiating which was ultimately accomplished 
by an English clinician) as an inevitable accompani- 
ment of a natural change in the condition of the 
blood. "Now the smallpox arises,*' he says, "wheQ 
the blood putrefies and ferments, so that the super- 
fluous vapors are thrown out of it, and it is changed 
from the blood of infants, which is like must, into 
the blood of young men, which is like wine perfectly 
ripened: and the smallpox itself may be compared 
to the fermentation and effervescence which takes 
place in must." And this is the reason why children. 



76 THE HISTORY OF MEDICINE 

especially males, rarely escape being seized with 
this disease, because it is impossible to prevent 
must — the nature of which is to effervesce and 
ferment — from changing into the state that super- 
venes. In young men, the maturation of the blood 
having been established, the disease seldom occurs, 
except in those cases in which a mild form, which 
has not brought to perfection the transition of the 
blood from the first state to the second, has been 
suffered in childhood. Old men are not susceptible 
except in pestilential, putrid, and malignant consti- 
tutions of the air, in which this disease is chiefly 
prevalent. Rhazes sought by treatment to bring it 
about that the unavoidable change in the blood 
*' should not be effected all at once and in a short 
time, with ebullition and fermentation, which are 
accompanied by frightful and dangerous accidents, 
but little by little, and in a long time, and gradually, 
by way of ripening, not putrefaction, and without 
fevers." He even sought to anticipate the occur- 
rence of the disease. 

There is no doubt that Rhazes was markedly 
original as compared with other writers in Arabic 
on medicine. He was called the "Experimenter/' 
"I do not suppose," he says, "that any great harm 
would happen to a man who should drink metallic 
mercury except severe pains in the stomach and 
intestines. I gave some to an ape which I had, nor 



MEDICAL SCIENCE OF THE ARABS 77 

did I see any evil befall him beyond that above 
mentioned, which I conclude from the fact that he 
twisted about, and kept biting at his stomach, and 
pawing it with his hands/' He made use of mer- 
curial ointments, and gave the first clear description 
of spina ventosa. Asked to choose a site for a 
hospital in Bagdad, Rhazes hung pieces of meat in 
different parts of the city in order to ascertain the 
place least favorable to putrefaction. Nevertheless, 
in spite of the evident independence of his spirit, he 
insbted on the value to the physician of supple- 
menting personal experience by a knowledge of the 
history of the medical profession. And when we 
turn to his larger wcH-ks, which also treat of smallpox 
and measles, we find to what an extent he relied on 
his Greek and Arabic predecessors. In the "Con* 
tinens*' (the ninth book of which was in the six*- 
teenth century translated into Latin by Vesalius) 
he refers to a dozen writers who had turned their 
attention to the study of smallpox before his time. 
These include Aaron, a Christian priest and physi- 
cian, who had flourished at Alexandria in the first 
half of the seventh century; Isaac, son of Honain, 
more distinguished as a physician, no less expert as 
a translator, than his father ; and Messua the Elder, 
who had anticipated what seemed most original in 
Rhazes, the view that smallpox is caused by an 
innate contagion, or ferment, in the blood. 



78 THE HISTORY OF MEDICINE 

Two other Persian physicians^ Haly Abbas and 
Avicennai preserved in encyclopaedic works written 
in Arabic the medical science of the ancients. The 
''liber Regis" of the former is largely based on 
Galen, and epitomizes the knowledge of the Arabs 
of the tenth century. It contains a good account of 
the symptoms and treatment of diabetes, a disease 
that had been described by Aretaeus and by one of 
the great physicians of India; it refers to anthrax, 
which was probably known to Rhazes as well as to 
Hippocrates, whom Haly Abbas regarded as the 
prince of the medical art* The book also gives 
directions for the treatment of melancholy and other 
forms of mental disorder. Haly Abbas advocated 
the search for new drugs, the virtues of which should 
be tested on animals. He held that the student of 
medicine should not neglect the opportunities 
offered for observation in hospital and private 
practice. Avicenna (980-1036) in his ''Canon'' 
gave systematic and logical expression to Arabic 
medical science. He based his doctrines on those of 
Aristotle and Galen, and he is particularly compar- 
able with the latter as a medical philosopher, whose 
writings mark the culmination of a long period of 
development. His book supplanted the "Conti- 
nens" and the "Liber Regis,'' and for centuries 
continued to be the authoritative textbook of medi- 
cine in the Western world, as well as in the Eastern, 



MEDICAL SCIENCE OF THE ARABS 79 

wheret indeed, its influence is still dominant. 
Avicenna described leprosy, already known to 
Aretaeus; treated spinal deformities, as had Hippoc- 
rates, by forcible reduction; observed filaria medi- 
nensb, as had Leonides of Alexandria, not to men- 
tion Agatharcides of Cnidus (second century B.c.)f 
Soranus of Ephesus, and others. Avicenna empha- 
sized the importance of diet and regimen, and paid 
particular attention to sldn diseases and nervous 
affections. Among other directions for determining 
the value of drugs, he mentions experiment on 
human beings. He was bolder than Paul of iEgina 
in operating for empyema, advocated the use of 
forceps in obstetrics, and, though addicted to the 
cautery rather than the knife, employed the ligature 
as one of the means of checking haemorrhage. 

Isaac Judaeus (850-950) was a contemporary of 
Rhazes rather than of Avicenna, but his mention 
here will serve to mark the westward migration of 
Arabian culture. He practiced in Egypt, and later 
settled in Kairwan (Tunis), the sacred city of 
Northern Africa. He was known for his treatment 
of eye troubles, and left treatises on diet, urine, 
fevers, etc. Besides these writings in Arabic, he is 
also credited with producing in Hebrew ^'The 
Physician's Guide,'' which reflects the wisdom of 
an experienced practitioner, as the following quota- 
tions bear witness. ** He whose business it is to bore 



8o THE HISTORY OF MEDICINE 

pearls must do his work carefully in order not to 
mar its beauty by haste. Even so he who under- 
takes the cure of human bodies, the noblest crea- 
tions on earth, should take thought upon the 
diseases with which he comes in contact and give 
his directions after careful reflection, so that he fall 
into no irremediable error. • . • The chief task of the 
physician b to prevent disease. • . . The majority 
of diseases are cured by nature. The more you 
demand for your treatment and the more highly 
you esteem your cure, so much the higher will you 
stand in the eyes of the people. Your art will be 
held of no account only by those whom you treat 
gratuitously. . • • Visit not the patient too often, 
nor remain too long with him, unless the treatment 
demand it, for it is only the fresh encounter that 
gives pleasure.'* 

Albucasis (912-1013), Avenzoar ( -1162), 
Averroes (ii 26^-98), and Moses Maimonides (1135- 
1204) belong to the Western Caliphate. Avenzoar 
was born in the neighborhood of Seville, Albucasis 
near Cordova; while the other two were bom in that 
capital, which as early as the tenth century boasted 
one million inhabitants, hundreds of mosques, nu- 
merous and splendid public libraries, and flourish* 
ing institutions of higher learning which became the 
models of the later European universities. Albucasis 
was the greatest of the Arab surgeons, and fully 



MEDICAL SCIENCE OF THE ARABS 8i 

■ 

recognized the value to the surgeon of a knowledge 
of anatomy. The last part of the "Tasrif," or col- 
lected works, is devoted to surgery, and, published 
separately and illustrated, is the earliest distinct 
work on that subject. It is based on the sixth book 
of Paul of iGgina* Albucasis, as was usual with the 
Arab physicians, emphasized the importance of the 
cautery, although the use of the ligature was also 
known to him. He gave directions for the surgical 
treatment ol defective, loose, and irr^:ular teeth. 
He described a case of extra-uterine pregnancy, 
anticipated the Walcher position in obstetric cases 
with presentation of knees and hands, and his 
illustrations picture forceps with crossed handles. 
Albucasis employed a more developed form of 
syringe than the bladder fitted with a reed used in 
antiquity, and was aware of the occurrence of 
haemophilia, and of salivation following the external 
use of mercury. ''Avoid perilous practices," he 
writes, ''as I have already warned you, so shall you 
have the more praise and profit, if God will.'' 

Avenzoar was the greatest of the Arab physicians 
after the time of Rhazes, and like him tempered his 
reverence of the past with a self-respecting reliance 
on his own clinical observations. The pages of his 
chief work "al-Teisir" (Assistance) report a number 
of interesting cases — an abscess of the pericardium 
which, while Avenzoar was still a student, caused 



82 THE HISTORY OF MEDICINE 

the death of his father, an abscess of the mediasti* 
num from which he himself recovered after cough- 
ing up sanious matter, an inflammation of the 
middle ear, cancer of the stomach, a hernia cured 
by rest. In the case of a patient suffering from a 
paralysis of the gullet he poured milk into the 
stomach by means of a tube passed into the oesopha- 
gus and made use of nutrient enemata. He per* 
formed tracheotomy experimentally on a goat and 
reconmiended resort to that operation in cases of 
threatened suffocation. He recognized tuberculosis 
of the intestines, and, like many physicians of 
antiquity, prescribed milk for phthisis. '^ Some- 
times there arise on the body,** he says, ^' under the 
external skin, little swellings which are commonly 
called Mtch,' and if the skin be removed there issues 
from various parts a very small beast, so small that 
he is hardly visible." Avenzoar was a surgeon as 
well as a physician, and justly appreciated the 
knowledge of osteology and of anatomy in general. 
He dedicated his great medical work to his friend 
and disciple Averroes, who was more eminent as a 
philosopher and as the commentator of Aristotle 
than as a physician, though he wrote a work — the 
^'CoUiget" — on the general principles of medicine. 
His enthusiasm for the teachings of Aristotle 
tended to weaken the authority of Galen, who for 
centuries had been regarded as almost infallible in 



MEDICAL SCIENCE OF THE ARABS 83 

spite of the independence of Avenzoar and other 
Arab physicians. As a philosopher Averroes did not 
believe in personal immortality, and, consequently, 
he was regarded as a heretic both by the Christians 
and by the Mohammedans. Toward the end of the 
twelfth century Arabic culture in Spain was checked 
by a recrudescence of orthodoxy, and after the 
death of Averroes the medical science of the Arabs 
suffered a rapid decline. 

The great Jewish Rabbi Moees Maimonides, 
driven from his native country by the persecution 
of fanatics, eventually found protection and patron- 
age at Cairo from the hands of the tolerant and 
enlightened Sultan Saladin. It was in response to 
Saladin's request for advice on matters of health 
that Msumonides prepared his most interesting 
medical treatise, the ''Book of Counsel'' C'Trac- 
tatus de Regimine Sanitatis"). In the preface, 
addressed to Saladin, the author describes the four 
parts comprised in the treatise: ''The first is a brief 
explanation of the general rules of health ; the second 
is for those sick persons who cannot find a physi- 
cian, or, at least, not one whom they can trust; the 
third contains the regimen proper for my lord's case, 
as it has been described to me; the fourth treats of 
matters useful to sick and well in all times and 
places." Maimonides wrote also a commentary on 
the "Aphorisms" of Hippocrates, summarized the 



84 THE HISTORY OF MEDICINE 

writings of Galen, prepared a book of ^'Aphorisms'* 
with quotations from Galen (whose errors and in- 
consistencies, however, he does not hesitate to ex- 
pose), as well as treatises on asthma, on poisons, on 
dietetics, and a translation of a book of Avicenna. 
Like that Persian physician Maimonides .was a 
disciple of Aristotle and of Galen. 

The chief wcMrk of Haly Abbas, a book of Galen's, 
the '^Aphorisms" of Hippocrates with the conmients 
of Galen, the treatises on fevers and on urine of 
Isaac Judaeus were translated from Arabic to Latin 
by Constantine the African in the eleventh century. 
In the twelfth century Gerard of Cremona did a like 
service for the '^ Aphorisms" of Damascenus, the 
"Practica" of Serapion the Elder, the "Canon" of 
Avicenna, a part of the writings of Rhazes, Albu- 
casis, and other Arab physicians; while the greater 
part of Galen and the ''Introduction" ("Isagoge") 
of Honain were likewise translated. The'Xolliget" 
of Averroes and the "Book of Counsel" of Mai« 
monides were made accessible to Christian nations 
about the middle of the thirteenth century. That 
very much of the medical science of the Arabs was 
available in western Europe at the beginning of the 
fourteenth century is manifest in the pages of the 
" Rosa Medicinae" of John of Gaddesden, who drew 
his materials from translations of Greek, Arabian, 
and Jewish physicians and from the works of Gil- 



MEDICAL SCIENCE OF THE ARABS 85 

bert the EngHshman^ who died in 1250, and the 
French physician Bernard de Gordon, who taught 
at Montpellier from 1285 till 1307. John of Gaddes- 
den does not refer to the writings of Avenzoar» 
which were later translated into Latin and printed 
in Venice (1490). The English physician, however, 
knows of Avenzoar, and maintains on his authority 
that the brilliant smaragdus found in the head of 
the green toad, if triturated with water or wine and 
given in a nine-grain dose, is an effective emetic in 
cases of poisoning. 

The belief in astiology, which had early prevailed 
in the Orient, spread throughout the civilized world, 
and was cultivated at Alexandria and Rome long 
before the time of the Arab conquests. Galen shared 
the superstitious views of his contemporaries as 
regards the influence of the heavenly bodies on 
one's health and fate, and, though his disciple 
Avicenna wrote a treatise on the uselessness of 
astrology, this pseudo-science continued to form a 
part of medical teaching for centuries. Purging and 
blood-letting were regulated in accordance with the 
positions of the planets and the signs of the zodiac. 
Medicinal plants were gathered under the appro- 
priate planetary influence. The moon was supposed 
to rule the brain, Mars the bile, Saturn the spleen, 
etc. Moreover, since among the Babylonians from 
the very remotest times the sun, moon, and the five 



88 THE HISTORY OF MEDICINE 

that the metals are condensed vapors, in the ax- 
teenth-century doctrine that three invisible sub- 
stances, sulphur, mercury, and salt, by their 
coagulation form physical bodies. Even at the 
present time some trace of the two pseudo-sdences, 
alchemy and astrology, remains in our use of the 
terms spirits of wine, spirits of nitre, tincture, 
martian preparations, saturnine compounds, lunar 
caustic, jovial disposition, etc* 

The pharmacy of the Arabs, interrelated with 
their chemistry and botany, in the early centuries 
of Mohammedan civilization had already made a 
considerable advance. It is at this period that we 
first hear of trade in drugs, developed from trade in 
spices, as a distinct vocation. The father of Honain, 
as well as the founder of the fortunes of the Messua 
family, was an apothecary. As early as the eighth 
century public pharmacies were established at 
Gondisapor and at Bagdad. The Arabs derived a 
knowledge of drugs from the Egyptians, the Hindus, 
and even more remote peoples with whom they 
came into commercial relations. They trandated 
Dioscorides and knew of the Greek in addition to 
the Indian means of producing anaesthesia. Before 
the end of the ninth century the first pharmaco- 
poeia had issued from the hospital at Gondisapor. 
We have already noted an inclination among the 
great Persian physicians to experiment on the 



MEDICAL SCIENCE OF THE ARABS 89 

effects of drugs. Isaac Judaeus advocated care and 
restraint in the use of remedies. Moses Maimonides, 
as already implied, showed the interest of his time 
in the study of toxicology. Avenzoar excelled in a 
knowledge of drugs, and was opposed to the use of 
purgatives, but showed himself rather credulous in 
reference to the virtues of the smaragdus, bezoars. 
theriacsi and mithridates. Very important in the 
history of materia medica are the Latin writings of 
the tenth or eleventh century attributed to Messua 
the Younger, which went through numerous edi* 
tions and formed the basis of the European pharma- 
copoeias. The work issued somewhat later under the 
name of Serapion the Younger was also a very in« 
fluential book of doubtful authenticity. The most 
extensive work in Arabic on materia medica was 
that written by Ibn Baitar in the thirteenth cen- 
tury, who describes some four thousand drugs and 
draws his material from Dioscorides, Galen, and 
earlier Arab writers and supplements it with his 
own observations. Senna, and other mild aperients, 
orange, lemon, tragacanth, and other adjuvants, 
syrups, juleps, robs, and other methods of admin- 
btration, alcohol, and other products of distillation, 
were known throughout Europe from the Arab 
treatises on pharmacy. Besides the drugs already 
mentioned, the following became widely used owing 
to the influence of the Arabs: aconite, aloes, amber- 



90 THE HISTORY OF MEDICINE 

gris, camphor, cannabis indica, doves, cubebs, gold, 
manna, mercury, musk, nutmeg, prunes, tamarind, 
violet-root, rose-water, sandalwood, etc. 

Arab institutions for the care of the sick were 
modeled after the infirmaries and hospitals of other 
nations. Besides the temples of health the Greeks 
had had public iatreia, difficult to distinguish from 
hospitals. Infirmaries for the indigait had existed 
in India and Ceylon for centuries before the be- 
ginning of the Christian era. The Romans provided 
valetudinaria for slaves and for soldiers* At Edessa 
in 372 a hospital of three hundred beds was estab- 
lished under Christian auspices, and to this were 
added in the following century a hospital for women 
and a school of medicine. The Nestorians, who for 
a time controlled these institutions, were compelled 
in 489 to take refuge in Persia. Shortly after their 
arrival in Persia the Nestorians, as we have already 
seen, were engaged in the teaching of medicine in 
the school and hospital at Gondisapor. The latter 
became the model of institutions founded by the 
Arabs in more than twenty of their cities. The first 
of these was established at Damascus in 707. Spe- 
cial provision was there made for the care of lepers 
and the blind. Before the middle of th^ ninth cen- 
tury, Bagdad had a hospital of which Messua the 
Elder became director, and numerous other hospi- 
tals arose in that city in the subsequent centuries, 



MEDICAL SCIENCE OF THE ARABS 91 

and with <me of these the great Rhazes was asso* 
ciated, as we have seen. The most famous of the 
Arab hospitals were the hospital founded at Damas- 
cus about 1 160 by Nureddin, as a thank-ofiFering for 
the deliverance of Islam from the menace of the 
Second Crusade, and the Mansur Hospital of Cairo, 
erected (1284) for rulers and subjects, freemen and 
slaves, rich and poor, men and women. At Damas- 
cus, Bagdad, and Cairo, provision was made for 
medical education, libraries were established, and 
courses of public lectures were given. The knoiN^- 
edge of ophthalmology was particularly advanced, 
and the insane were treated with much more con- 
sideration by the Arabs than by the Christians of 
the same period. In the Western Caliphate there 
were numerous hospitals in Cordova and other 
cities. In the twelfth century Avenzoar was superin- 
tendent of a hospital at Seville. 

It is true that the Arabs contributed little to the 
advance of anatomy, for their beliefs made dis- 
section a forbidden practice. They believed that in 
the world to come the body must be subjected to the 
examination of two angels, and that the absence of 
any part might endanger the eternal happiness of 
the person. Moreover, they held that death was a 
gradual process only complete with putrefaction, 
and that contact with a dead body was a contami- 
nation. Nevertheless, though it was left for the age 



92 THE HISTORY OF MEDICINE 

following that of the dommance of the Arabs to 
build upon the foundationa laid by the ancients in 
the department of anatomy, in this field also there 
is evidence of the transmission of medical science 
through the channel of Arabic literature. When we 
use the terms ligamentum nuchae, sagittal suture, 
dura mater, pia mater, infundibulum, or speak of 
the cochlea of the ear, or the auricles of the heart, 
we adopt a nomenclature^ suggested by the writings 
of Arab physicians, just as when we use the terms 
Adam's apple, and cauda equina, we follow the 
figurative mode of expression of the Jewish physt- 
dans, associated at times, as we have seen, with the 
Arabs. 

REFERENCES 

Arabian NiglUs, translated by Sir R. F. Burton In twelve volumea. 
London, i8(H. Vol. iv, pp. 171-80. 

Berthebt, M.: Introduction d Vkude de la ckimie des and^s H du 
moym dge. Paris, 1899. 330 pp.; Les arigines de Vakkimie. 
Paris, 1885, 446 PP- 

Browne^ E. G.: Arabian Medicine. Cambridge> 1921. 139 pp. 

Cholmeley, H. P.: John of Gaddesden and the JRosq Medicina. 
Oxford, Clarendon Press, 1912. 184 pp. 

Greenhill, W. A.: A Treatise an the Smallpox and Measles. By 
Abu Beer Mohammed ibn Zacariya Ar-razi (commonly 
called Rhazes). Translated from the Original Arabia Lon- 
don, The Sydenham Sodety, 1848. 3ia pp. 

Hopkins, A. J.: "Eadiest Alchemy," The Scientific Monthly, June, 

19181 pp. 530-37. 
Hyrtl, Joseph: Das Arabische und HArOische in der Anatomie. 

Vienna, 1879. 311 pp. 

Levy, Reuben: ''The 'Tractatus de Causts et Indiciis Morborum,' 

Attributed to Maimonides," ix 225 in Studies in the History 



MEDICAL SCIENCE OF THE ARABS 93 



and Method ef Sciene^f edited by Charles Sii^;er. Oxford^ 

Qarendon PresB, 1917. 
Spencer, Dr. Herbert: "Mercurio'sor Waldier's Positioii," Lancet, 

1913, vol. I, pp. 1568-69. 
Jewish Encyclopedia: "Moses ben Maimon,*' "Medidne," eta 



CHAPTER V 

THE REVIVAL OF ANATOMY AND SURGERY 
IN THE SIXTEENTH CENTURY 

Thb rise of modem anatomy and surgery is closely 
associated with the development of the Italian and 
French universities. Southern Italy was the natural 
meeting-place of the influences that contributed to 
the growth of medical science in the eleventh^ 
twelfth, and thirteenth centuries, and the tradition 
that the University of Salerno owed its origin to the 
combined efforts of an Arab, a Jew, a Greek, and a 
Roman, may be accepted as indicating the sources 
from which the Salemitan teachers of medicine de- 
rived their doctrines. Much of the teaching in the 
''civitas Hippocratica," as Salerno was called, re- 
lated to diet and other matters of hygiene, but 
anatomy and surgery were by no means overlooked. 
One of the earlier teachers at Salerno, Copho the 
Younger, a Jew, was the author of "De Anatome 
Porci,*' the first modem work on anatomy (about 
iioo). Toward the dose of the twelfth century, 
another of the Salemitan doctors, Roger of Palermo, ] 
wrote a treatise on surgery, " Practica," which was 
revised by his pupil Roland of Parma in the thir- 
teenth century. In the section dealing with wounds 



THE SIXTEENTH CENTURY 95 

of the intestines, the surgeon is directed to insert in 
the intestinal canal a small tubular piece of elder 
and then to stitch the raw edges of the bowel to- 
gether over it. In the school of Salerno women were 
admitted both as students and teachers, and one 
of them, Mercuriada, wrote a treatise on surgery. 
Nicholas of Salerno, in his '' Antidotarium," speaks 
oi a soporific sponge, prepared by saturating a 
natural sponge with a solution of mandragora, 
opium, hyoscyamus, lettuce, camphor, and nenu- 
phar. This anodyne was dried, kept till needed, and 
then moistened with hot water or steam, and held 
to the patient's nostrils till sleep was induced. 

Bologna, the second of the European universities, 
contributed to the advance of surgery and anatomy 
through the work of Hugh of Lucca, his son Theo- 
doric, Bishop of Cervia, William of Saliceto, Mon- 
dino, and his pupil Bertuccio. Hugh of Lucca, who 
is known to us through the writings of Theodoric, 
was appointed city surgeon of Bologna in 12 14, a 
few years later had experience of military surgery 
with the Crusaders in Egypt and Syria, and died at 
an advanced age about the middle of the thirteenth 
century. He observed strict cleanliness in the treat- 
ment of wounds, avoided the use of the probe, and 
employed compresses soaked in wine. Theodoric is 
quite definite concerning the advance made at 
Bologna in surgery, "For," he states, "it is not 



96 THE HISTORY OF MEDICINE 

necessary, as Roger and Roland have written, as 
many of their disciples teach, and as all modem 
surgeons profess, that pus should be generated in 
wounds. No error can be greater than this. Such a 
practice is indeed to hinder nature, to prolong the 
disease, and to prevent the conglutinaticm and 
consolidation of the wound." Both Hugh and 
Theodoric made use of anaesthetic sponges similar 
to those described by Nicholas of Salerno. William 
oi Salicejto (i 201-1977) was, however, the greatest 
surgeon of the thirteenth century, and the author of 
a systematic work on surgery C'Cyrurgia"). Like 
Hugh of Lucca he had had experience on the field of 
battle. He described wounds of various kinds, the 
suturing of intestines and nerves, the treatment of 
fractures and dislocations. His influence tended to 
restore the use of the knife in surgery, though he 
devoted considerable space to the discussion of 
different methods of cauterization. Saliceto dis* 
tinguished between haemorrhage from arteries and 
veins, but his knowledge of anatomy was, like that 
of all his contemporaries, very limited. 

The practice of human dissection, which had been 
held in abeyance by the force of traditional senti* 
ment and religious prejudice from the third century 
B.C. was indeed resumed to a certain extent in the 
thirteenth century, but it was not till 13 16 that a 
treatise on anatomy written by one who had dis« 



THE SIXTEENTH CENTURY 97 

fleeted the human cadaver made its appearance. 
This was the work of Mondino (^'De cxnnibus 
humani corporis interioribus membris Anathomia '')» 
who had made numerous dissections, two of which 
Qanuary and March, 13 15) are particularly men- 
ticmed. In the work of dissection, Mondino was 
aided by an able prosector, Otto Agenius Lustro- 
lanus, and a devoted girl disciple, Alexandra Galiani. 
It is further evidence of the enthusiasm for dissec- 
tion in the University of Bologna at the beginning 
of the fourteenth century that three years after the 
appearance of the *' Anathomia'' four students were 
brought to trial for having carried off by night the 
body of a criminal, which they and others of their 
kind were intent upon dissecting. 

Peter of Abano, a friend of Mondino's and also a 
dissector, but much better known as an exponent of 
the philosophy of AverroSs than as an anatomist, 
taught at the University of Padua; while Arnold of 
Villanova, who wrote on surgery as well as on 
alchemy and general medicine and, like Peter of 
Abano, was accused of heresy, stood associated with 
the famous school of Montpellier. More important 
than either of these from our present point of view 
was Lanfranchi, a third contemporary of Mondino's 
and a pupil of Saliceto's, who, about the close of the 
thirteenth century, carried to Lyons and to the Col- 
lege of Saint Cdme at Paris the teaching and prac- 



98 THE HISTORY OF MEDICINE 

tice of Bolognese surgery. He was the author of two 
works on surgery ("Chirurgia Parva" and "Chi- 
rurgia Magna"), and, like his master, protested 
against the tendency to fix a line between the func- 
tion of the surgeon and the function of the physi- 
cian, and between practice and theory. Lanfranchi 
gave a good account of the symptoms of fracture of 
the skull, and was the first to describe concussion 
of the brain. He recommended ligature among 
the means of arresting haemorrhage, held that ex- 
posure to the air favors the formation of pus in 
wounds, and advised neurotomy in cases of trau- 
matic tetanus. Henri de Mondeville, the pupil of 
Lanfranchi and Theodoric, who studied at Mont- 
pellier as well as at Paris and Bologna, aided in the 
introduction of Italian methods of surgery into the 
French schools. He was the physician of Philip the 
Fair and frequently attended that monarch and the 
Count of Valois during their military campaigns. 
Mondeville lectured on anatomy at the University 
of Montpellier in 1304, and set forth views of the 
structure and function of the body strongly remi- 
niscent of the teachings of Galen and the nomen- 
clature of the Arabs. His surgery, however, showed 
the influence of his Italian masters and contem- 
poraries. "Many more surgeons," he remarks with 
characteristic incisiveness, "know how to cause 
suppuration than to heal a wound." 



THE SIXTEENTH CENTURY 99 

Guy de Chauliac (1300-70) was the greatest 
surgeon of the fourteenth century. The son of 
humble country people of the French province of 
Auveiigne, he studied at Toulouse, Montpellier, 
Paris, and Bologna. He learned anatomy from 
Bertruccio, who taught dissection in four sessions 
devoted to the abdomen, thorax, head, and extremi- 
ties, and made use of dried specimens and bones 
prepared by boiling. De Chauliac was also in- 
debted to certain anatomical illustrations (eighteen) 
of Mondeville's. The 'Xhirurgia Magna" (1363), 
one of the greatest contributions to the development 
of surgery, shows that Guy de Chauliac was ac- 
quainted with medical history from the time of 
Hippocrates, and was under special obligation to 
Galen, Avicenna, Albucasis, and other Arabic writ- 
ers, as well as to his immediate predecessors in the 
French and Italian universities. At the same time 
his extensive knowledge of the practice and theory 
of others did not deprive him of independence 
and self-confidence. "For," he said, ''we are like 
children astride the neck of a giant, who see all the 
giant sees and something besides." In cases of 
fracture of the femur, in addition to splints reaching 
to the foot he employed a box or trusses of straw to 
support the limb and attached to the foot a lead 
weight by means of a cord passing over a little 
pulley. He followed Theodoric and others in using 



100 THE HISTORY OF MEDICINE 

narcotic inhalations to produce insensibility to pain, 
but adopted the theory of coction of irritant humors 
and laudable pus in the treatment of wounds. Like 
Saliceto he believed in restricting the use of the 
actual cautery, and advocated a close alliance be- 
tween surgery and medicine. He taught that cancer 
should be treated at an early stage and preferably 
with the knife; he gave directions for complete 
ablation of the gland in case of adenitis, and for 
suturing the intestines; he made use of the speculum 
in certain obstetrical operations; he gave an account 
of the Csesarean operation following the death of the 
mother. True to his own principles he did not con- 
fine his attention to surgery, but gained acquaint- 
ance with all the medical science of his time. He 
introduced the use of sugar in medicinal prepara- 
tions, and gave a careful description of the sjrmp- 
toms of leprosy to prevent the isolation of patients 
unjustly suspected of being lepers and to protect 
the general public against contagion. Much of Guy 
de Chauliac^s life was passed at Avignon where he 
was the physician of Pope Clement VI and his 
successors. In the Black Death epidemics of 1348 * 
and 1360 he took part in combating the pestilence, 
of the different forms of which he has left descrip- ^ 
tions. Some of the manuscripts of the ''Chirurgia 
Magna" contain illustrations of the opening of 
inguinal and axillary abscesses, of venesection, of 



THE SIXTEENTH CENTURY loi 

the application of the (Gooch) splint, of instru- 
ments for trepanning (borers, elevators, rugines, 
etc.)» for fistula operation, and for cauterization 
(olivary, dactiliary, punctuale, etc.)* 

In spite of the foundations laid in anatomy by 
Mondino and in surgery by Guy de Chauliac and 
by the other anatomists and surgeons trained at the 
French and Italian universities, the general Euro- 
pean practitioner of the fourteenth century no 
doubt deserved the satire leveled at him by the 
English poet Chaucer a few years after the death of 
Guy de Chauliac. Lines 5-8 in the following quota- 
tion are rather obscure, but refer to the attempts of 
the medical astrologers to bring magic influence to 
bear by means of diagrams of constellations made at 
the proper astrological moment. Such diagrams or 
images were frequently engraved on gems and were 
supposed to accumulate influence. 

With us ther was a Doctour of Phisyk, 

In al this world ne was tber noon him lyk 

To speke of phisik and of surgerye; 

For he was grounded in astronomye. 

He kepte his padent a ful greet del 

In houres by his magik naturel. 

Wei coude he fortunen the ascendent 

Of his images for his pacient. 

He knew the cause of everich maladye, 

Were it of hoot or cold, or moiste, or drye, 

And where engendred, and of what humour; 



102 THE HISTORY OF MEDICINE 

He was a verrey parfit practiaour. 

The cause y-knowe, and of his hann the rote, 

Anon he yaf the seke man his bote [remedy]. 

Ful redy hadde he his apothecaries, 

To send him drogges and his letuaries, 

For ech of hem made other for to winne, 

Hir frendschipe nas not newe to beginne. 

Wei knew he the olde Esculapius, 

And Deiscorides, and eek Rufus, 

Old Ypocras, Haly, and Galien, 

Serapion, Razis, and Avicen, 

Averrois, Damasden, and Constantyn, 

Bernard, and Gatesden, and Gilbertyn# 

Of his diete mesurable was he, 

For it was of no superfluitee. 

But of great norissing and digestible. 

His studie was but litel on the Bible. 

In sangwin and in pers he dad was al, 

Lyned with taffata and with sendal; 

And yet he was but esy of dispenoe; 

He kepte that he won in pestilence. 

For gold in phisik is a cordial, 

Ther fore he lovede gold in special. 

In Germany the universities were particularly 
late in providing instruction in medicine, and the 
first celebrated German surgeons acquired their 
skill on the field of battle. Pfolspeundt, a Bavarian 
army surgeon of the fifteenth century, mentions 
inddentally the treatment of gunshot wounds 
(1460). Speaking of the more familiar arrow wounds, 
he says, in the spirit of Chaucer's Doctour, that 



THE SIXTEENTH CENTURY 103 

recovery depends on the favorable conjunction of 
the planet that is in the ascendant. His knowledge 
of rhinoplasty and his use of a narcotic inhalation 
show that he was somewhat influenced by Italian 
surgeons. Hieronymus Brunschwig, an Alsatian 
army surgeon, bom at Strassburg in the early part 
of the fifteenth century, wrote as an old man "Das 
Buch der Wund-Artzney " (1497). He held that 
gunshot wounds are poisoned and that suppuration 
should be induced as a means of purification. He 
was acquainted with the work of the leading French 
and Italian surgeons. Hans von Gersdorff, also a 
native of Strassburg, gained experience of military 
surgery in the campaigns of Charles the Bold and 
was present at the battles of Granson (1476) and 
Nancy (1477). He wrote a *' Feldtbuch der Wundt- 
artzney " (151 7) illustrated, like Brunschwig's work, 
with excellent woodcuts. He performed about two 
hundred amputations, and developed a method of 
his own. He did not believe that gunshot wounds 
are necessarily poisoned, but in certain cases fol- 
lowed the practice of pouring hot oil into the 
^wounds. Giovanni da Vigo, in the " Practica Cop- 
iosa" (1514), had taught, according to Par6, "that 
wounds made by firearms partake of venenosity, 
by reason of the powder ; and for their cure he bids 
you cauterize them with oil of elder-flowers scalding 
hot| mixed with a little treacle.'* 



104 THE HISTORY OF MEDICINE 

In the meantime anatomy had made a great ad- 
vance in Italy under the influence of the Renais- 
sance spirit. The practice of dissection, which had 
gained a definite place in medical education through 
the efforts of Mondino, was continued at Bologna, 
Padua, and other Italian universities by 2^rbi, 
Achillini, and Marc Antonio delta Torre in the 
brilliant period of scientific and artistic activity at 
the dose of the fifteenth and the beginning of the 
sixteenth century. The greatest contribution, how- 
ever, to the advancement of the study of anatomy 
was made by the supreme genius of the time, 
Leonardo da Vinci, 1452-15 19, who has been de- 
scribed as a painter, sculptor, architect, engineer, 
musician, poet, philosopher, chemist, botanist, and 
geologist, and, in addition was referred to by 
William Hunter as the very best anatomist and 
physiologist of his time. We learn from an Italian 
painter and writer of the sixteenth century (Vasari) 
that Leonardo ''filled a book with drawings in red 
crayon outlined with a pen, all the copies made 
with the utmost care [from bodies] dissected by his 
own hand. In this book he set forth the entire 
structure, arrangement and disposition of the 
bones, to which he afterwards added all the liga- 
ments, in their due order, and next supplied the 
muscles. Of each separate part he wrote an explana- 
tion in rude characters written backwards and with 




DISSECTION SHOWING THE FEMALE VISCERA IN SITU 
Drawn by Leonardo da Vinci, circa 1510 



THE SIXTEENTH CENTURY 105 

the left hand, so that whoever is not practiced in 
writing, cannot understand them, since they are 
only to be read with a mirror/' These invaluable 
anatomical drawings are still preserved, and within 
the last twenty-five years have been made accessible 
in a series of splendid reproductions. 

Leonardo thus affords us one of the finest ex* 
amples of the mutual influence of art and medical 
science. The Greek sculptors, taught by the ob- 
servation of naked youth in the palaestra and 
gymnasium, had depicted the human form with 
remarkable fidelity, even exhibiting in their statues 
the contours of the pectineus muscle as developed 
by gymnastic exercises. For the intuitions of Greek 
artistic genius Leonardo did not disdain to sub- 
stitute scientific observation based on the dissection 
of more than thirty bodies of men and women. He 
studied human development and deterioration, 
measured the proportions of the skeleton, and com- 
pared with the human foot the foot of the bear, the 
ape, and the bird. He analyzed the play of the 
muscles, the expression of the emotions, and move- 
ment in general. He not only pictured the muscles 
as they appear to the eye of the artist, but repre- 
sented them schematically by straight lines and 
explained their action as a system of levers. Ex- 
plaining the mechanism of respiration, Leonardo 
states: ''All these muscles serve to elevate the ribs. 



io6 THE HISTORY OF MEDICINE 

and the elevation of the ribs pnxluoes a dilation of 
the chest, and the dilation of the chest involves an 
expansion of the lungs and, consequently, an at- 
traction of the air which through the mouth enters 
the lungs now increased in capacity/' He did not 
confine his attention to the bones, ligaments, and 
muscles, but depicted in his seven hundred and 
fifty or more sketches, the brain, nerves, blood- 
vessels, lungs, gravid uterus, heart, stomach, etc. 
It was Leonardo, who, with an artist's confidence 
in his own powers of observation, struck from the 
study of anatomy the fetters fastened upon it for 
centuries by the authority of Galen. His influence, 
however, was limited by his failure to bring to com* 
pletion the projected work on anatomy for which he 
had made such magnificent preparations. The 
works of Berengario da Carpi (1470-1530), who 
wrote extensive commentaries on Mondino, prove 
that their author, though a dissector and touched 
by the independent spirit of the Renaissance, did 
not stand altogether free from the prepossessions of 
traditional anatomy. It was reserved for the great 
Vesalius in his systematic and well-illustrated work* 
"De Humani Corporis Fabrica," to bring that 
anatomy to the test of observation. 

Andreas Vesalius, bom at Brussels December 31, 
1 514, attended the University of Louvain, and in 
1533 studied anatomy at Paris under the Galenist 



THE SIXTEENTH CENTURY 107 

Jacques Dubois (Jaoobus Sylvius). Interrupted in 
his studies by the wars between Francis I and the 
Emperor Charles V, Vesalius returned to Louvain 
in 1536. In the following year he went to Venice, 
and before the completion of his twenty-third year 
received his doctor's degree at Padua, a city at that 
time controlled by the enlightened government of 
the Venetian Republic. In spite of his youth he was 
inunediately appointed professor of surgery. As- 
suming the responsibility of imparting a knowledge 
of anatomy to the students of Padua, Vesalius al- 
most at once departed from the established practice 
of reading Galen in the lecture room, aiid directed 
attention to what he afterwards referred to as '' that 
true Bible, as we count it, of the human body and 
of the nature of man.'' The lecturer became a 
demonstrator, appealing from the authority of 
Galen to the evidence of the senses. The chief 
results of his observations as a dissector are em- 
bodied in the ^'Fabrica," which, completed and 
dedicated to the. Emperor in 1542, was printed in 
1543, in which year also appeared the revolutionary 
work of Copernicus. Discouraged by the opposition 
offered to his expositions of the truth, Vesalius re- 
linquished his professorship in the following year, 
and accepted appointment as physician to Charles 
V. On the abdication of that monarch, in 1556, 
Vesalius became physician at the court of the son, 



io8 THE HISTORY OF MEDICINE 

Philip II, residing in Spain from 1559 till 1563. 
From Spain he went as a pilgrim to Jerusalem, 
probably cherishing the hope of eventually resum- 
ing his activities as an anatomist at Padua. Broken 
in health, however, before he had started on his 
pilgrimage, further reduced by the privations of a 
rough and protracted voyage as he was returning 
from the East, Vesalius landed on the desolate 
shore of the island of Zante, and there died in 1564. 
Vesalius considered Galen as easily first among 
the students and teachers of dissection and as the 
greatest physician after Hippocrates. He followed 
up Galen's physiological experiments on living 
animals, and even accepted — provisionally at 
least — the Galenic theories of the circulation and 
other bodily functions. He did not fail, however, to 
point out Galen's shortcomings, to many of which 
he, as a dissector of lower animals, held the clue, 
and he was particularly severe with those disciples 
of Galen who contended that the Galenic anatomy 
described man rather than the ape. He showed that 
Galen in his description of the suture of the frontal 
bone, of the division of the inferior maxilla, in his 
account of the sacrum and coccyx, of the lumbar 
and abdominal muscles, of the muscles of the leg, 
foot, and hand, as well as in his account of the 
vascular system, had been too much influenced by 
observations made in dissecting apes. He showed 



THE SIXTEENTH CENTURY 109 

that the Galenic description of the occipital bone, 
of the intestines in general, of the caecum (the ap- 
pendix of which he knew to be particularly small in 
man), was borrowed from the anatomy of the dog; 
while the structure of both apes and dogs had vi- 
tiated the traditional descriptions of the lumbar 
vertebrae, the lungs, etc. Deluded by the dissection 
of oxen, the great anatomist of antiquity had falsely 
attributed to man a complex intracranial plexus of 
blood-vessels {reU tmrabile) ; while his knowledge of 
the uterus and of the form of the liver had also been 
obtained by the dissection of brute animab. 

Vesalius, moreover, corrected Galen's account of 
the foramina of the skull, of the processes of the 
cervical vertebrae, of the tubercles of the humerus, 
of the shafts of humerus and femur, of the form and 
consbtency of the sphenoid, of the internal struc- 
ture of the phalanges. The Galenic account of the 
muscles and movements was subjected to criticism 
— the dorsal as well as the abdominal muscles, the 
movements of the head, spine, and upper extremity, 
Vesalius discovered the semilunar cartilages of the 
knee-joint, and corrected Galen's mistakes in refer- 
ence to the cartilage of the patella, the articulations 
of the ribs, and the ligaments of the arm. Vesalius 
gave a better description of the brain than had 
been given before his time, discovered the inferior 
longitudinal sinus, described the septum lucidum, 



no THE HISTORY OF MEDICINE 

pointed out Galen's inconsistencies in reference to 
the ventricles, called in question his account of the 
meninges, and of the structure and functions of the 
nerves. He showed the defects in Galen's descrip- 
tion of the veins of the upper arm and axilla, 
mesentery and intestines, and claimed that Galen 
had been unduly influenced by Aristotle in reference 
to the vena cava, and the structure of the heart. 
The attempt of Vesalius to accommodate his state- 
ments to Galen's physiological doctrines did not 
blind him to the fact that the interventricular 
septum shows no visible perforations. He writes: 
*'The septum of the ventrides, composed as I have 
said of the thickest substance of the heart, abounds 
on both sides with little pits impressed in it. Of 
these pits, none, so far at least as can be perceived 
by the senses, penetrate through from the right to 
the left ventricle, so that we. are driven to wonder 
at the handiwork of the Almighty, by means of 
which the blood sweats from the right to the left 
ventricle through passages which escape human 
vision." In somewhat like spirit he treated the 
questions of the presence in man of an indestructible 
resurrection-bone, the absence of a creation-rib, and 
the position of heart and umbilicus. 

Among his many other contributions to the de- 
velopment of anatomy, Vesalius is to be credited 
with the discovery of the ductus venosus, the de- 



THE SIXTEENTH CENTURY in 

scription of the vena azygos, the aeminiferous ducts, 
the internal pterygoid and lingual muscles, the 
mediastinum and the pleura, an account of the 
structure of the pylons, liver, kidney, and spleen. 
He made post-mortem examinations, was a success- 
ful surgeon, and resisted the tendency to divorce 
the study of one branch of medical science from an- 
other. His great service was to make anatomy a pro- 
gressive study through his comprehensive volume, 
which recorded his own observations and contained 
illustrations, probably reproduced from his own 
drawings, and marked by a sense of truth and 
beauty not unlike that of Leonardo. 

" Mere knowledge without experience,'' said Am- 
broise Par6 (1517-^)1 "does not give the surgeon 
much self-confidence." The rapidly growing knowl- 
edge of anatomy and experience in the wars of 
Francis I and his successors combined in bringing 
to perfection the powers of that most illustrious of 
army surgeons. Bom near Laval in Maine, France, 
Par6 received early training as a barber surgeon, 
and even in his maturity he was treated super- 
ciliously, if not by the surgeons of Saint Cdme, at 
least by the doctors of the Facult6. Coming to 
Paris as a youth, he continued his apprenticeship 
and served three years as a dresser at the Hdtel 
Dieu. He had his first experience of military 
surgery in the Italian campaign of 1536, and soon 



iia THE HISTORY OF MEDICINE 

discarded Vigo's boiling-oil treatment, and further 
distinguished himself by an exarticulation of the 
elbow-joint, the first operation of the kind on 
record. He returned to Paris in 1539, but his ser- 
vices as an army surgeon were soon again in requisi- 
tion. His pages tell of the successful treatment of 
wounds inflicted by lance, sword, halberd, stone, 
arquebus, pistol, culverin, and other firearms. His 
treatise, ''La m^thode de traiter les plaies,*' ap- 
peared in 1545. He studied, as opportunity offered, 
the works of the great surgeons, pursued anatomy 
under Sylvius, prepared an epitome of the ''Fa* 
brica," and in 1549 produced an antomical treatise. 
In 1552 Par6 amputated without cauterization the 
leg of a gentleman hit by a cannon-ball. " I dressed 
him, God healed him Qe le pansay, Dieu le guarist). 
I sent him home merry with a wooden leg." His 
example fully revived the use of the ligature, and 
placed further restrictions on the use of the actual 
cautery. At the close of the same year he smuggled 
into the city of Metz, besieged by the Emperor, 
medical supplies from Henry II, and was welcomed 
by the nobles of the garrison, who said that since 
he had arrived they would no longer feel in danger 
of dying in case they should chance to be wounded. 
Five years later, after the battle of Saint Quentin, 
he was busy at La Fdre-en-Tardenois, and found the 
wounded particularly difficult to cure. The earth 



THE SIXTEENTH CENTURY 1 13 

for more than half a league around him was all 
oovered with the dead, and so many green and blue 
flies arose from them as to hide the sun. ''It was 
wonderful/' he continues, ''to hear them buzzing; 
and where they settled, there they infected the air, 
and brought pestilence with them/' In 1559 Pari 
was consulted, along with Vesalius, in the case of 
Henry II, accidentally wounded while tilting. The 
patient in this case succumbed to concussion of the 
brain. In 1564 Par6 courageously fought at Paris 
an epidemic of the plague, and published an ex- 
tensive work on surgery copiously illustrated. In 
1569 we find him successfully treating a nobleman 
near Mons, who had been suffering for months from 
a gunshot wound with fracture of the femur. In 
addition to local treatment, Par6, as usual, had 
regard to the general condition of the injured man, 
and advised the use of a forehead-doth of oil of 
roses and water-lilies and poppies and a little opium 
and rose-vinegar. At the same time the patient 
must be allowed to smell flowers of henbane and 
other narcotics. 

Par6 described various forms of fracture, including 
fracture of the neck of the femur, and fracture of 
the parietal bone with extrusion of brain substance ; 
he invented arterial forceps, many other kinds of 
surgical instruments, as well as artificial limbs, 
artificial eyes, and feeding-bottles; he encouraged 



114 THE HISTORY OF MEDICINE 

the use of the truss, insbted that regular surgeons 
should not abstain from the treatment of hernia, 
cataract, and stone, and followed the practice of the 
old French lithotomists in employing a grooved 
director; he suggested syphilis as a cause of aneur- 
ism and hypertrophy of the prostate as a cause of 
strangury; he revived version by the feet, advocated 
prompt evacuation of the uterus in case of haemor- 
rhage during labor, and knew of the possibility of 
the Caesarean operation during the life of the mother ; 
he performed bronchotomy, neurotomy, staphylo- 
plasty, and made use of the figure 8 suture in cases 
of hare-lip; he removed articular concretions, re- 
frained from the too frequent dressing of ulcers, 
improved the method of trepanning, and made 
advances in eye surgery. Like Guy de Chauliac, 
Par6 did not confine his attention to surgery, but 
wrote on various branches of medical science and 
insisted on isolation of those suffering from leprosy. 
The work of the father of modem surgery was 
supplemented by his favorite disciple Guillemeau, 
by Rousset, by Pierre Franco, by Laurent Colot, 
by the Italian Tagliacozzi, and by the naval and 
military surgeon William Clowes (i 540-1 604). With 
the father of modem anatomy must likewise be 
mentioned his contemporaries Vidius, Charles 
Etienne, the great Eustachius (1524-74), his pupils * 
Fallopius and Columbus, his fellow-student Serve- 



THE SIXTEENTH CENTURY 115 

tuSy as well as Ingrassias, Aranzi, the brilliant 
Varolius, Andrea Cesalpino, and Fabridus (iS37"" 
1619), the teacher of Harvey. 

REFERENCES 

' Ball, James Moores: Andreas Vesalius. St. Louis, 1910. 149 pp. 
Hdzmann, Charles L.: "Military Sanitation in the Sixteenth, 

Seventeenth, and Eighteenth Centuries," Annab cf Medical 

Hishryf pp. 281-300. m • 
Hopstock, H.: "Leonardo as Anatomist,'' Shtdies m Ike History 

and Method of Science, pp. 151-91, Clarendon Press, 1921. 
Leonardo da Vind: / ManoscriUi, edited by Sabacnikoff and 

Piuroati, with French transladon, and an introduction by 

Professor Duval. 2 vols. Paris, Turin, 1898, 1901. 
Quademi ffAnatomiOj edited by Vangensten, Hopstock, 

and Fonahn, with English and German translations. 

Christiania. 6 vols. 191 1-16. 
Locy, W. A.: "Anatomical Illustration before Vesalius," Journal 

of Morphology, Chicago, 191 1, pp. 945-87. 
McMurrich, J. P.: "Leonardo da Vind and Vesalius," Medical 

Library and Historical Journal, 1906, pp. 338-50. 
Plaget, Stephen: Ambroise Pari and his Times. London, 1897. 

304 PP- 
Pilcher, L. S.: "The Mondino Myth," Medical Library and 

Historical Journal, 1906, pp. 311-31. 
Roth, M.: Andreas BruxMensis (in German). Berlin, 1892. 

500 pp. 
Singer, Charles: ''The Figures of the Bristol Guy de Chauliac 

MS" {circa 1430), Proc. Roy. Soc. Med., 1917, vol. x 

(Section, History of Medicine), pp. 71-90. 
"Thirteenth Century Miniatures illustrating Medieval 

Practice," Proc^ Roy. Soc Med., 1915, vol. ix (S. H. M.), 

pp. 29-42. 
Welch, W. H.: The Times of Vesalius, Contributions cf Vesalius 

Other than Anatomical. Johns Hopkins Hospital Bulletin, 

I9i5t PP- 118-20. 
Vesalius: De Humani Corporis Fabrica Libri Septem, cum indice, 

etc. Venetiis, 1568. 510 pp. 



CHAPTER VI 

WILLIAM HARVEY AND THE REVIVAL OF 

PHYSIOLCXIY 

We have seen in an earlier chapter the views of 
Erasistratus and Galen concerning the structure 
and function of the heart, the arteries, and the veins. 
The advance in anatomy led by Vesalius prepared 
the way for a further advance in physiology. His 
careful study of the structure of the minute ramifica- 
tions of the veins and arteries must have brought 
him to the very threshold of the discovery of the 
circulation of the blood, and the second edition of 
the "De Fabrica" (1555) shows that he became 
very skeptical concerning the passage of blood from 
the right to the left ventricle through the septum of 
the heart. His incredulity on this score may have 
been strengthened by the " Restitutio Christianismi " 
of his fellow student Michael Servetus, published 
in 1553. In this book Servetus taught that the blood 
— or, at least, some of it — passes from the right 
ventricle to the left, not through the cardiac septum, 
but "is moved in a long passage through the lungs; 
by them it is prepared ; it is made bright; it is trans- 
fused from the arterious vein to the venous artery" ; 
in fact, that what we call arterial blood is "a mix- 



HARVEY AND PHYSIOLOGY 117 

ture made in the lungs of the inhaled air with the 
blood which the right ventricle communicates to 
the left." 

Before the death of Vesalius, Eustachius de- 
scribed a large vessel extending downward from the 
left subclavian vein, provided at its orifice with a 
semicircular valve, and containing a scanty, watery, 
fluid. The valves of the veins were known to 
Charles Etienne, another contemporary of Vesalius, 
to their master. Jacobus Sylvius, to Cannanus (in 
1546), and other anatomists. Fabricius, the pupil of 
Fallopius and the master of William Harvey, ob- 
served the valves of the veins independently in 
1574, and published an illustrated treatise on the 
subject ("De Venarum Ostiolis'O the year after 
Harvey's graduation at Padua. Two other pre- 
decessors of Harvey took an honorable part in the 
discovery of the circulation of the blood. Matheus 
Realdus Columbus, who had been the assistant and 
successor of Vesalius at Padua, became in 1545 the 
first professor of anatomy at the University of Pisa, 
and in 1548 was called to Rome. In the ^'De Re 
Anatomica," which was published after his death in 
1559, Columbus states that ''the blood is carried by 
the artery-like vein to the lung and being there 
made thin is brought back thence together with air 
by the vein-like artery to the left ventricle of the 
heart.'* Harvey indeed acknowledged his indebted- 



ii8 THE HISTORY OF MEDICINE 

ness to Columbus, *' that skilful and learned anato- 
mist/' as well as to Galen, for guidance in reference to 
the pulmonary circulation. Andreas Csesalpinus, 
1519-1603, approached even more neariy the mod- 
em explanation of the circulation of the blood. In 
his "Quaestiones Peripateticae " (1571) he wrote as 
follows: "Of the vessels ending in the heart, some 
send into it the material which they carry, for in- 
stance the vena cava into the right ventricle, and 
the vein-like artery into the left; some on the other 
hand carry material away from the heart, as for 
instance the aorta from the left ventricle and the 
artery-like vein, nourishing the lung, from the right. 
To each orifice are attached little membranes the 
function of which is to secure that the orifices lead- 
ing in do not let out and that those leading out do 
not let in.'' Caesalpinus also knew that the arteries 
dilate as the heart contracts. Moreover, in his 
"Quaestiones Medicse" (1593) he explains why, in 
case of ligature for venesection, the veins swell on 
the side of the ligature away froni the heart, and, in 
general, that "there is a sort of perpetual movement 
from the vena cava through the heart and lungs into 
the aorta." 

A year before the appearance of the "Medical 
Questions," Caesalpinus left Pisa, where he had been 
professor of medicine since 1567, for Rome. At the 
same time Galileo, the father of dynamics, went 



HARVEY AND PHYSIOLOGY 119 

from Pisa, his native dty, to accept appointment in 
the University of Padua. Though known mainly as 
a physicist, Galileo exerted a very great influence 
on the development of medical science. Bom in 
1564, he had entered the University of Pisa as a 
student of medicine in 158 1, and almost immediately 
discovered that the time occupied by the oscillation 
of a pendulum is constant as measured by the pulse. 
This discovery soon led to the invention of a simple 
instrument to determine the rate of the pulse 
(pulsilogium). In 1589 Galileo was appointed pro- 
fessor of mathematics at the University of Pisa, and 
in the following year his treatise on dynamics, " De 
Motu Gravium," was circulated as a manuscript. 
Shortly after his removal to Padua Galileo invented 
the thermoscope, the forerunner of the clinical 
thermometer, and devised a small but powerful 
machine for raising water. His lectures attracted to 
Padua students from all parts of Europe, among 
them the Archduke Ferdinand (afterwards Em- 
peror Ferdinand II) and Cosimo de' Medici (after- 
wards Cosimo II, Grand Duke of Tuscany). Before 
the close of the century Galileo had under his roof 
twenty resident pupils, including a number of 
Englishmen. At the same time he was on familiar 
term with Fabricius, the teacher and friend of 
Harvey, and there is every reason to believe that 
the immortal discoverer of the circulation of the 



I20 THE HISTORY OF MEDICINE 

blood in 1 598-1 602 came in contact with the il- 
lustrious pupil of Andreas Caesalpinus. 

William Harvey was bom at Folkestone, on the 
south coast of England, in 1578. From his sixteenth 
till his twentieth year he was in attendance at 
Gonville and Caius College, Cambridge, which had 
been refounded by John Kees (Caius), a former 
pupil and colleague of Vesalius (153^43) at Padua. 
During Harvey's undergraduate days Caius College 
afforded instruction in Latin, Greek, logic, mathe- 
matics, and anatomy, and there is evidence in his 
mature preference for the works of Cicero, Aristotle, 
and Avicenna, in his interest as an old man in the 
"Clavis Mathematical of William Oughtred, and 
in his lifelong devotion to dissection, that all of 
these early studies took root in his docile and sus- 
ceptible mind. He took his degree in Arts in 1597, 
and a year later went to Padua to study under 
Fabricius of Aquapendente, who seems to have 
treated him with marked cordiality. Harvey took a 
prominent part in the student organizations which 
governed the University of Padua, gained the 
friendship of several of Galileo's disciples (Wil- 
loughby, Fludd, and others), and graduated with 
distinction as Doctor of Medicine a few weeks after 
the completion of his twenty-fourth year. 

After his return to England, Harvey took up 
residence in London, and was admitted to the 



HARVEY AND PHYSIOLOGY 121 

College of Physicians, founded by Thomas Linacre 
— also a Doctor of Padua — in 1518. It was in a 
lecture at this institution that Harvey gave the first 
exposition (1616) that has come down to us of his 
views concerning the movement of the heart and the 
blood. In this lecture he expressed himself to the 
following effect: 

'4t is plain from the structure of the heart that 
the blood is passed continuously through the lungs 
to the aorta as by the two clacks of a water bellows 
to raise water. 

'^It is shown by the application of a ligature that 
the passage of the blood is from the arteries into the 
veins. 

''Whence it follows that the movement of the 
blood is constantly in a circle, and is brought about 
by the beat of the heart/' 

Further light is thrown on the genesis of Harvey's 
views by the following passage from the works of 
the distinguished chemist Robert Boyle: 

''And I remember, that when I asked our famous 
Harvey^ in the only discourse I had with him (which 
was but a while before he died), what were the 
things that induced him to think of a circulation of 
the blood? He answered me, that when he took 
notice, that the valves in the veins of so many parts 
of the body were so placed, that they gave free 
passage to the blood towards the heart, but op« 



122 THE HISTORY OF MEDICINE 

posed the passage of the venal blood the contrary 
way; he was invited to imagine, that so provident a 
cause as nature had not so placed so many valves 
without design; and no design seemed more prob- 
able, than that since the blood could not well, be- 
cause of the interposing valves, be sent by the veins 
to the limbs, it should be sent through the arteries, 
and return through the veins, whose valves did not 
oppose its course that way/' 

It was not till 1628 that Harvey puUished his 
** De Motu Cordis et Sanguinis in Animalibus,'' after 
confirming his views of the motion and function of 
the heart by the study of the structure of the 
auricles, ventricles, cardiac valves, the larger and 
smaller arteries and veins, by experiments in ligatur- 
ing, by numerous vivisections, by draining off the 
blood through a single small vessel, by calculating 
the quantity of blood passing through the left 
ventricle in the course of half an hour, by the ob- 
servation of pathological conditions, by the exami- 
nation of the vascular system in human embryos as 
compared with that of fishes, toads, frogs, serpents, 
and lizards. As a true Aristotelian Harvey held that 
it was as vain to seek to base the science of anatomy 
on an examination of the human body alone as to 
attempt to establish political science on the study 
of a single commonwealth. 

As the title of Harvey's disquisition indicates, it 



HARVEY AND PHYSIOLOGV 123 

is on the motion of the heart that he laid the chief 
emphasis. In the introductory letter to King 
Charles, he speaks of the heart of animals as the 
foundation of their life, and refers to what he has 
written of the motions of the heart. Similarly, in 
the dedication to the president and others of the 
Royal College of Phjrsidans, he makes mention 
of his new views of the motion and function of the 
heart, and in the introduction proper Harvey 
criticizes earlier doctrines as a preliminary to dis- 
cussing the motion, action, and use of the heart and 
arteries. These earlier doctrines appear untenable 
after we have closely studied the structure and 
mechanism of the heart. The opinion that blood 
oozes from the right to the left ventricle through 
pores in the septum is, according to Harvey, not to 
be tolerated. "For," he proceeds, "the septum of 
the heart is of a denser and more compact structure 
than any portion of the body, except the bones and 
sinews. But even supposing there were foramina or 
pores in this situation, how could one of the ventri- 
cles extract anything from the other — the left, e.g., 
obtain blood from the right — when we see that 
both ventricles contract and dilate simultaneously? 
Wherefore should we not rather believe that the 
right took spirits from the left, than that the left 
obtained blood from the right ventricle, through 
these foramina?" Incidentally, if the septum were 



124 THE HISTORY OF MEDICINE 

permeable, what need would there be of the oxt)- 
nary vessels? The opinion that the diastole of the 
arteries is simultaneous with that of the heart is also 
untenable; for how can two mutually connected 
bodies, simultaneously distended, draw anything 
from one another? Again, in the opening chapter of 
the ^'De Motu Cordis et Sanguinb/' Harvey states 
that he had discovered the motions and uses of the 
heart after numerous vivisections, and had been led 
to publish an exposition of his views. This he under- 
took the more willingly seeing that Fabricius had 
not written concerning the structure and functions 
of the heart. In his second chapter, which deals 
with the motion of the heart as seen in the dissection 
of living animals, Harvey notes that the heart in its 
systole — that is, in its essential motion — becomes 
hard, diminished in size, of a paler color, and so 
made apt to project or expel its charge of blood. 
He was later able to supplement this knowledge of 
the motion of the heart gained through vivisection 
by direct observation of the human heart in a case 
of extensive injury of the chest wall. He then 
demonstrated to King Charles, who was interested 
in his physiological and embryological investiga- 
tions, that the heart in diastole is retracted and 
withdrawn and in systole emerges and is protruded, 
and also that the diastole of the arteries is simul- 
taneous with the systole of the heart. 



HARVEY AND PHYSIOLOGY 125 

Proceeding to a closer scrutiny of the mechanism 
of the heart, Harvey finds that the heart's motion 
begins with the auricles and extends to the 'ventri- 
cles, as in a piece of machinery one wheel gives 
motion to another, yet all the wheels seem to move 
simultaneously. The blood is thrown into the ven- 
tricles by the action of the auricles. The motions 
of the heart constitute a kind of deglutition, a trans- 
fusion of the blood from the veins to the arteries. 
The valves of the heart have the purpose of pre- 
venting regurgitation. Blood continually flows into 
the right ventricle and is continually passed out of 
the left, and therefore moves from the vena cava to 
the aorta. Proceeding on the other hand from the 
right ventricle into the lungs by the pulmonary 
artery, and incessantly drawn from the lungs into 
the left ventricle, it cannot do otherwise than pass 
continuously by the obscure porosities of the lungs 
and the minute inosculations of vessels. What is 
the quantity and source of the blood that reaches 
the heart by way of the vena cava? 

Influenced by the knowledge derived from vivi- 
section, the structure of the ventricles and their 
valves, the relative size of the conduits leading to 
and from the heart, the quantity of the blood trans- 
mitted, Harvey "began to think whether there 
might not be a motion^ as it were^ in a circle. Now 
this I afterwards found to be true ; and I finally saw 



126 THE HISTORY OF MEDICINE 

that the blood, forced by the action of the left 
ventricle into the arteries, was distributed to the 
body at large, and its several parts, in the same 
manner as it is sent through the lungs, impelled by 
the right ventricle into the pulmonary artery, and 
that it then passed through the veins and along the 
vena cava, and so around to the left ventricle in the 
manner already indicated.*' That there is a circula- 
tion of the blood is confirmed, according to Harvey, 
by the fact that so large a quantity is transmitted 
by the action of the heart. If only one eighth of an 
ounce of blood were expelled from the left ventricle 
of the human heart at each contraction, and if there 
were two thousand or even one thousand pulsations 
every hour, a larger quantity would seem to be 
forced into the aorta in half an hour than is con- 
tained in the whole body. " In the same way, in the 
sheep or dog, say that but a single scruple of blood 
passes with each stroke of the heart, in one half 
hour we should have one thousand scruples, or about 
three pounds and a half of blood injected into the 
aorta; but the body of neither animal contains 
above four pounds of blood, a fact which I have 
myself ascertained in the case of the sheep.'* 

Harvey recognized, as had Caesalpinus, that the 
swelling of a limb ligatured as for venesection on 
the side of the ligature away from the heart proves 
that the veins carry the blood from the extremities 



HARVEY AND PHYSIOLOGY 127 

toward the heart. The valves which are found in 
the cavities of the veins themselves make plain the 
course of the circulation. Their function is simi- 
lar to that of the valves of the aorta and the pul- 
monary artery, namely, to prevent the reflux of the 
blood. Moreover, the effect of such a ligature as is 
used to bind a limb for amputation shows that the 
blood is carried to the extremities by the arteries. 
The arteries are conduits leading from the heart, 
while the veins are conduits leading to the heart. 
The blood passes from the arteries to the veins 
either immediately by anastomoses, or mediately 
by the pores of the flesh, or in both ways. It is 
forced from the capillary veins into the smaller 
branches, and from these into the larger trunks. 
It is necessary to conclude, says Harvey, ''that 
the blood in the animal body is impelled in a cir- 
cle, and is in a state of ceaseless motion; that 
this is the act or function which the heart performs 
by means of its pulse; and that it is the sole and 
only end of the motion and contraction of the 
heart." 

It has frequently been assumed that Harvey 
failed to demonstrate the passage of the blood from 
the arterioles to the venuoles, and that the circula- 
tion of the blood was fully established only when 
Malpighi gave ocular demonstration of the capillary 
circulation. Of course it must be admitted by all 



128 THE HISTORY OF MEDICINE 

that Harvey, in proving that the blood is carried 
from the heart to the extremities by the arteries and 
is returned from the extremities to the heart by the 
veins, gave logical proof of a connection between 
the minute arteries and the minute veins. But the 
fact that Harvey in 165 1 demonstrated by means of 
experiment that all of the blood from the right 
ventricle passes through the pulmonary artery to 
the pulmonary vein has been disregarded by many. 
In the presence of a number of his colleagues he in- 
jected about a pound of hot water into the right 
ventricle (of the heart of a man who had been 
hanged) after having tied the pulmonary artery. 
Not a drop of water or of blood made its way into 
the left ventricle. Then, the ligature having been 
undone, water was injected into the pulmonary 
artery, upon which a torrent of the fluid, mixed with 
a quantity of blood, immediately gushed forth from 
a perforation which had previously been made in 
the left ventricle. Before making this experiment 
Harvey had reached the conclusion that spirit and 
innate heat are to be thought of only as properties of 
the blood. ''There is, in fact," he says, "no occa- 
sion for searching after spirits foreign to or distinct 
from the blood ; to evoke heat from another source ; 
to bring gods upon the scene, and to encumber 
philosophy with any fanciful conceits. What we are 
wont to derive from the stars is in truth produced 



HARVEY AND PHYSIOLOGY 129 

at home. The blood is the only calidum innatum or 
first engendered animal heat." 

Almost immediately after the publication of the 
"De Motu Cordis/' Harvey was drawn into the 
royal service. In 1629 he was commanded by King 
Charles to attend James Stuart, Duke of Lennox, 
who was about to undertake an extensive tour of 
the Continent. In the following year he received 
appointment as Physician in Ordinary for His 
Majesty's Household, and became the personal 
friend and companion of Charles I. He accom- 
panied the monarch on that journey to Scotland in 
1633, which led to the ultimate breach between the 
King and his Scottish subjects. Two years later, at 
the command of Charles, Harvey examined the 
body of Thomas Parr, who had died at the reputed 
age of one hundred and fifty-two years and nine 
months. Harvey came to the conclusion that Pan- 
might have lived longer had he not, after being 
brought to London by the Earl of Arundel, indulged 
in rather rich fare, ''his ordinary diet consisting of 
subrancid cheese, and milk in every form, coarse and 
hard bread, and small drink, generally sour whey." 
In 1636 Harvey accompanied the Earl's embassy to 
Ferdinand II on behalf of Charles's sister Eliza- 
beth of the Palatinate, mother of Prince Rupert; 
and before the close of that year was sent to Italy 
by the Earl about some pictures for His Majesty. 



I30 THE HISTORY OF MEDICINE 

Arundel was famous as an art collector, and inter- 
ested in medical science, and, we may add, had been 
seeking to secure a ''booke drawne by Leonardo da 
Vinci." On his way to Venice Harvey was halted at 
Treviso "to do his guarantina^^^ on account of the 
pk^^ue (August 13), and displayed as much testiness 
as did the choleric Vesalius when held up by ex- 
tortionate customs officials at the Spanish frontier 
in 1564. From Venice Harvey passed to Florence 
(before September 17), where he was entertained by 
the Grand Duke of Tuscany, Ferdinand II, patron 
of the sciences and son of Galileo's pupil, Cosimo de' 
Medici. By December he had returned to his prac- 
tice in London. 

During the struggle between Charles I and his 
rebellious subjects Harvey was closely associated 
with the Royalist cause. When in 1639 the King 
joined the army under the Earl of Arundel in an 
expedition against the Scottish forces, Harvey ac- 
companied him. He was likewise present when, 
three years later, Charles raised his standard at 
Nottingham. It was probably about this time that 
his lodgings at Whitehall were pillaged, and his 
papers and specimens scattered or destroyed. At 
the battle of Edgehill, Harvey had charge of the two 
young princes and later aided in caring for the 
wounded. Harvey was in attendance on the King 
at Oxford, which the Royalist forces entered in 



HARVEY AND PHYSIOLOGY 131 

triumph October 29, 1642. About a year later he 
treated successfully Prince Maurice, brother of 
Rupert, suffering from a slow fever (typhus), 
*'the raging disease of the army." In 1645 Harvey 
was nominated by the King Warden of Merton 
College. It was in the Warden's House at Merton 
that Henrietta Maria, daughter of Maria de' 
Medici, had her lodging during that stormy time. 
On June 24, 1646, Oxford surrendered to the 
Parliamentary forces; whereupon Harvey seems to 
have retired to private life. 

In whatever circumstances he might be placed, 
his zeal for the advance of medical science was 
always unabated. Traveling with the Duke of 
Lennox through regions desolated by war, famine, 
and plague, he complained of the absence of any- 
thing to anatomize. Drawn to Scotland in 1633 in 
the retinue of King Charles, he studied the flights of 
gannets on the Bass Rock. While accompanying 
Arundel in Germany he demonstrated the drcula* 
tion of the blood at Nuremberg, and, in spite of the 
unsettled state of the country, "would still be mak- 
ing observations of strange trees and plants, earths, 
etc., and sometimes like to be lost." The slaughter 
of does in the royal hunt furnished material for his 
studies in embryology, and shortly after arriving at 
Oxford he used to visit George Bathurst of Trinity 
G>llege, ''who had a hen to hatch eggs in his cham- 



132 THE HISTORY OF MEDICINE 

ber, which they opened dafly to see the progress and 
way of generation." His example had a great in- 
fluence on Highmore, on Scarborough, his favorite 
pupil, who ** introduced geometrical and mechanical 
speculations into anatomy," on Wharton, on Willis, 
and other young men at Oxford interested in scien* 
tific investigation, as well as on Glisson, on Ent, and 
other original fellows of the Royal Society, organized 
after the Restoration for the promotion of physico- 
mathematical experimental learning. 

In his treatise, "On Animal Generation,*' follow- 
ing up the studies of Aristotle and Fabricius in no 
subservient s^rit, Harvey declared that the genera- 
tion of the chick is the result of epigenesis, and that 
all its parts are not fashioned simultaneously, but 
emerge in their due succession and order. Like his 
two great masters he also wrote a treatise on loco- 
motion ; he was a worthy successor of Aristotle in the 
field of comparative anatomy, and had a clearer 
knowledge than Fabricius of the physiology of 
respiration. He made use of his discovery of the 
circulation in surgery, and was not unacquainted 
with the practice of obstetrics. In 1649 he spoke of 
publishing a treatise on pathological anatomy based 
on his numerous post-mortems, and four years later, 
feeling still vigorous in mind in spite of his bodily 
afflictions and advanced years, exchanged letters 
with the Florentine Nardi concerning the problem 



HARVEY AND PHYSIOLOGY 133 

of contagion. About this time there was completed 
at Harvey's expense a building for the G)llege of 
Physicians^ to which honorable body he also pre- 
sented his patrimonial estate in 1656. Toward the 
close of his life attacks oi the gout, from which 
disease he had long suffered* became more frequent. 
He was stricken with cerebral haemorrhage June 3, 
1657, and died the same day. 

The scientists of Harvey's own time were pre- 
pared to accept the mechanical theory of bodily 
functions. As early as 1604, Kepler had explained 
the phenomena of vision involved in the refraction 
of light by the lens; in 1614 Sanctorius had recorded 
his experiments to determine by weight the insensi- 
ble perspiration of the human body, and in 1625 had 
described a pulsilogium and a clinical thermoscope 
of his own invention; and in 1622 Aselli had ob- 
served the lacteals and had recognized the function 
of the valves discovered in them. After the publica- 
tion of Harvey's "De Motu Cordis et Sanguinis" 
the French philosopher Descartes, accepting in the 
main the doctrine of the circulation of the blood, 
proceeded to sketch his views of the human ma- 
chine (1634), man the automaton, which were later 
developed in his treatise "De Homine." Jan de 
Wale confirmed (1640), by making incisions in 
ligatured vessels, Harvey's teaching concerning the 
direction of the flow of the blood in veins and ar- 



134 THE HISTORY OF MEDICINE 

teiies; Georg Wirsung discovered (1642) the pan- 
creatic duct; Pecquet made known (1651) his dis- 
covery that the lacteals pour their contents into the 
receptaculum chyli, and that the thoracic duct 
(previously observed by Eustachius) leads thence 
to the left subclavian vein; the l3ntnphatic vessels 
were noted by the Cambridge student George Joy- 
liffe in 1652, and, about the same time, Rudbeck 
traced the connection of the l3ntnphatics of the liver 
and intestines with the receptaculum chyli and 
thoracic duct. Before the death of Harvey, Whar- 
ton discovered the duct that bears his name, and 
Glisson gave an accurate description of the capsule 
of the liver. 

Willis was aided in the preparation of his '' Cerebri 
Anatome" (1664) by Sir Christopher Wren and by 
Richard Lower, who in his "Tractatus De Corde'* 
furthered the work of Harvey by definitely applying 
the new science of physics to explain the mechanism 
of the heart. Robert Hooke (the first microscopist 
to observe the cellular structure of plants) by ex- 
periments in artificial respiration (1667) proved that 
life may be maintained without muscular movement 
so long as the lungs are supplied with fresh air; and 
John Mayow in the following year demonstrated 
that in respiration only part of the air is taken up 
by the lungs, and that the gas which supports life is 
identical with that which supports combustion. 



HARVEY AND PHYSIOLOGY 135 

In the meantime the influence of Galileo and 
Harvey had advanced the cause of physiological 
research in Italy. Much of the progress centers 
about the name of Ferdinand II of Tuscany, whose 
brother Leopold de* Medici improved the thermo- 
scope of Galileo and was the first president of the 
Accademia del Cimento, founded at Florence in 
1657. To the University of Pisa, Ferdinand called 
Borelli, Malpighi, Bellini, and Stensen. For Borelli, 
the disciple of Galileo, physiology was a part of 
physics. He recognized that the action of a muscle 
is a mere contraction of its length, due to the fibers, 
or muscle substance proper, and not to the tendon. 
He estimated in pounds the force of the muscles 
of the jaw and heart. The motion of the heart 
differs from that of the arm or leg in being non- 
volitional ; it may be automatic, or caused by some 
organic necessity. The heart is like a wine-press, 
and, by propelling the blood into the arteries, 
causes them to distend. The arteries, then con- 
tracting, force the blood into their ramifications. 
By means of the microscope Malpighi, distinguished 
in embryology, pathology, and histology, observed 
(1661) the capillaries in the lung, mesentery, etc., 
of the frog, as well as in the lung of the tortoise. 
He thus found tJiat the blood is always contained 
in vessels, and does not escape from the arterioles 
to be taken up by the venuoles. These observations 



136 THE HISTORY OF MEDICINE 

were confirmed by Leeuwenhoek (1668), by the 
Irish scientist William Molyneux (1683), and others. 
In 1665 Malpighi observed the red blood corpuscles, 
but in this discovery he had been anticipated by 
Swammerdam. Bellini's study of the minute struc- 
ture of the kidneys and Malpighi's histological 
examination of the spleen, liver, brain cortex, lungs, 
tongue, skin, etc., as well as of the kidneys, became 
the basis of a more definite knowledge of the 
physiological action of these parts. The correlation 
of structure and function was the dominant idea of 
these investigators. Stenson, the discoverer of the 
duct of the parotid gland, furthered the investiga- 
tions of Borelli in reference to the mechanism of the 
muscles. 

It seems almost like a travesty of the mechanical 
theory of physiological action that in a later genera- 
tion it was taught, not only that the heart and 
vessels resemble waterworks and that the chest is 
like bellows, but that the glands may be compared 
to sieves, the teeth to scissors, and the stomach to a 
iSask. 

REFERENCES 

Brooks, W. K.: William Harvey as an Entbryologisif Johns 
Hopkins Hospital Bulletin, 1897, vm, pp. 167-74. 

Curtis, John G.: Harvey's Views on the Use and CirailaHon of 
the Blood. Columbia University Press, 191 5. 194 pp. 

Foster, Sir Michael: Lectures on the History of Physiology, 
Cambridge University Press, 1901. 310 pp. 



HARVEY AND PHYSIOLOGY 137 

Haldane, Elizabeth S.: Descartes, his lAfe and Times. London, 

1905. 398 pp. 
Mitchell, Weir S.: The Early History of Instrumental Precision 

in Medicine, 2d Congress of Am. Physicians and Surgeons, 

X891, pp. 159-81. 

Some Recently Discovered Letters of William Harvey. Phila- 
delphia, 1913. 59 pp. 
Tiemey, M. A.: The History and AnHquUies of the Castle and 

Toum of Arundd. London^ 1834, 2 vols. 772 pp. (pagina* 

tion continuous). 
Moore, Norman: "WiHiam Harvey," 7%e Dictionary of National 

Biography. 
Power, D'Arcy: William Harvey. London, 1897. 383 pp. 

(Bibliographical appendix.) 
Vi^lis, Robert: The Works of William Harvey. Translated from 

the Latin with a Life of the Author. London, The Sydeo* 

ham Sodety» 1847. 624 pp. 



CHAPTER VII 

SCIENCE AND PRACTICE; SYDENHAM. 

BOERHAAVE 

Is it possible to be a great physician without an in- 
timate knowledge of up-to-date science? Should the 
focus of a doctor's attention be something else than 
anatomy, histology, physiology, embryology, bac- 
teriology, chemistry, etc.? The lives of Thomas 
Sydenham and Hermann Boerhaave give us occa- 
sion to consider these questions. 

Sydenham's early life served to develop his prac- 
tical, rather than his theoretical, tendencies. Bom 
of a family of Puritan gentry at Wynford Eagle, 
Dorsetshire, September, 1624, he went in 1642 to 
Oxford, where his eldest brother William — soon to 
gain distinction as one of Cromwell's officers and 
councillors — was already in residence. Thomas 
was enrolled in May at Magdalen Hall, the recog- 
nized center of Oxford Puritanism, but he was com- 
pelled within a few months, or weeks, to quit the 
University on account of the impending struggle 
between the King and the Parliament. He returned 
to his home in Dorset, where the Sydenham family 
became, in the bitter local warfare that followed, 
the leaders of the Parliamentary forces. The father 



SCIENCE AND PRACTICE I39 

fought with the rank of Captain ; William Sydenham 
became Colonel and Governor of Weymouth; the 
mother, daughter of Sir John Jeffrey, was killed by a 
Royalist officer in 1644, and was avenged by one of 
the elder sons; Francis, a gallant young Major, fell 
a few months later in the defense of Weymouth; 
and Thomas, shortly after, was wounded in a 
cavalry skirmish. 

The fortunes of war which caused the departure 
of Sydenham from Oxford also brought about, as 
we have seen in the last chapter, the arrival of the 
Royalist Harvey; and, when peace was restored in 
1646 and the University passed to the control of the 
Parliamentarians, Harvey retired from his post at 
Merton and the Puritan soldier retiuned to his 
studies. Influenced by the advice of William's 
physician, Thomas Coxe, a Doctor of Padua, and 
later a Fellow of the Royal Society, Thomas Syden- 
ham now devoted himself to the profession of medi- 
cine. No doubt he availed himself of the opportuni- 
ties afforded at Oxford for the study of anatomy 
and botany and the reading of Hippocrates and 
other medical classics, but, though he left Magdalen 
Hall for Wadham College, soon to become, under 
the Wardenship of John Wilkins, the center of 
scientific research and the cradle of the Royal 
Society, there is no evidence that he was at all at- 
tracted to the pursuit of truth merely for the truth's 



I40 THE HISTORY OF MEDICINE 

sake. This is all the more striking in view of the line 
of brilliant devotees of medical science who were at 
Oxford during the years of Sydenham's prolonged 
residence — Willis, Wharton, Highmore, Petty, 
Goddard, Lower, Wren, Locke, Boyle, and others. 
He was created Bachelor of Medicine in 1648, and 
probably received also the degree of Master of Arts, 
some allowance being made, no doubt, for the fact 
that his studies had been interrupted by four years 
of civil war. 

In October, 1648, Sydenham was made a Fellow 
of All Souls' College, an appointment he continued 
to hold for about seven years. In the spring of 
1651, however, he was commissioned Captain of 
cavalry, and during the subsequent months he 
served in the second Civil War, in which one of his 
younger brothers, Major John Sydenham, was 
killed in Scotland, and in which Thomas himself had 
many stirring adventures, and seems on one occa- 
sion to have been left on the field among the dead. 
In September of the same year, all serious fighting 
having ended with Cromwell's victory over Charles 
II at Worcester, Sydenham was free to return to his 
studies. Before the close of 1653 Christopher Wren 
was appointed a Fellow of All Souls', but none of 
the associations of college life could convince the 
'' trooper turned physician" that the discovery of 
some minute part in the human body, or the search 



SCIENCE AND PRACTICE 141 

for final causes and the essential nature of disease, 
was the only way in which a doctor might promote 
the glory of God and the welfare of the human race. 
It was thus that he thought of his vocation. In 
1655 he relinquished his fellowship, married, and 
established himself in practice in London. 

Although Sydenham was not ambitious of the 
name of philosopher, and, as a follower of Francis 
Bacon, sought to avoid premature hypotheses and 
mere speculation, yet scattered through his writings 
are passages which outline a sort of philosophy not 
unknown in the American schools of to-day. In the 
case of Sydenham it was the outcome of his strongly 
marked individuality, his concentration of purpose, 
his Puritan training, his career as a soldier and 
successful practitioner. In his view practice is the 
touchstone of theory; the proof of the pudding is in 
the eating. He thought so little of opinions of any 
sort that he distrusted his own when they came in 
conflict with any one else's. And he would distrust 
them even as regards his best established methods 
of treatment, were it not that the phenomena of 
practice support the judgment of reason. We are 
forced to recognize the limitations of the human 
mind. There may be beings in those brighter orbs, 
which are scattered over the infinite expanse of the 
universe, whose intelligences far exceed those of 
finite man. ''Man, indeed/' he proceeds, ''may so 



142 THE HISTORY OF MEDICINE 

have his intellectual faculties shaped by Nature 
[that is, the whole complication of natural causes] 
as to be enabled to perceive not what is absolute 
truth, but only that which is necessary for him to 
know, and fitted to his nature. This applies to those 
whose medicine consists in vain speculations rather 
than in that solid experience which rests upon the 
basis of the senses/' 

Through his interest in religion, Sydenham was 
even drawn into the field of metaphysics, as is to be 
seen in the splendid fragment on "Rational The- 
ology.*' In this, with the aim of encouraging right 
conduct, the author develops arguments in favor of 
the existence of God, the supremacy of the inmia* 
terial over the material, and the immortality of the 
soul, but breaks off when it dawns on his candid 
mind that a belief in everlasting rapture and tor- 
ment is not essential to the practice of virtue. 

Sydenham's predominant interest in the imme- 
diately practical inclined him to turn from problems 
in medical science for which he saw no prospect of 
an early solution. "Etiology," he writes, "is a 
difficult, and, perhaps, an inexplicable affair; and 
I choose to keep my hands clear of it." The in- 
trinsic or essential nature of the plague and of 
venereal disease is unknown; and as "to what may 
be the essence of smallpox, I am, for my own part, 
free to confess that I am wholly ignorant; this in- 



SCIENCE AND PRACTICE 143 

tellectual deficiency being the misfortune of human 
nature, and common to myself and the world at 
large/' It is in Sydenham's opinion impossible for 
the physician to discover the ultimate causes of the 
majority of diseases, which are inscrutable, and it b 
quite sufficient to know whence the mischief imme- 
diately arises. In fact, the "whole philosophy of 
medicine consists in working out the histories of 
diseases, and applying the remedies which may dis- 
pel them; and Experience is the sole guide/' 

During the first few years of his practice in Lon- 
don, Sydenham had been fully occupied observing 
the general S3ntnptoms of fever. At that time inter- 
mittent fever and influenza were epidemic in Eng- 
land. Not far from Sydenham's residence in King 
Street, Whitehall, there lay a stretch of low and 
swampy land, and it is interesting to note that 
he early mentioned that abundant swarms of in- 
sects in summer are the precursors of autumnal 
diseases, and that before the end of his career he 
believed that a causal relationship existed between 
a marshy atmosphere and quartan ague. In Sep- 
tember, 1658, Oliver Cromwell died at Whitehall of 
an obscure fever, which his physicians called 
"bastard tertian." In the following year it is prob- 
able that Sydenham visited Montpellier, and his 
absence from London at the critical period following 
the Protector's death may have been suggested by 



144 THE HISTORY OF MEDICINE 

the dangers to which his political leanings exposed 
him; for at the beginning of 1659 he had sought 
election to Parliament as representative for Wey- 
mouthy and having failed in his candidaturei re- 
ceived a government appointment. We do not hear 
of him again in London till the sunmier of 1660, 
after the Restoration. Then he was suffering from 
an attack of gout, to which disease, like Harvey, he 
was a martyr. 

After the summer of 1661 Sydenham was able to 
pay attention to the more general aspects of the 
diseases he met in his practice. To be appreciated 
his writings should be studied in connection with 
the mortality statistics of London, then a dty of 
about 400,000 inhabitants, and the history of 
epidemics. His first treatise, ''Thomas Sydenham's 
Method of Treating Fevers, based on his own Ob- 
servation" (1666), deals with the epidemics of 
1661-1664. It was dedicated to Robert Boyle, who 
in 1660 had published the results of his experiments 
on air, who was interested in the effects of Peruvian 
bark and the discovery of other specifics, who had 
occasionally accompanied Sydenham in visiting the 
sick, and who had suggested the composition of the 
''Methodus Curandi Febres." Of the 16,665 deaths 
occurring in London in the year 1661 the mortality 
statistics assign fevers as the cause of 3490. Under 
this class of disease were included, besides inter- 



SCIENCE AND PRACTICE 145 

mtttents, "spotted fever*' (typhus), and, probably, 
infantile remittent fever and other ailments marked 
by high temperatures. After some abatement of 
fevers in 1662-64, there was an increase to 5257 
deaths in 1665, but the prevailing epidemic of that 
year was oi course the plague, which claimed no 
fewer than 68,596 victims. This Great Plague of 
London was associated by the Puritans with the 
evils of monarchy. In the first year of the reign of 
James I an epidemic of plague had caused 33,000 
deaths in London, and in the first 3^ear of the reign 
of Charles 1, 41,000. Sydenham speaks of it as ''the 
scourge for the enormity of our sins," and considers 
it as not amenable to ordinary treatment. He with* 
drew from the city when the epidemic was approach- 
ing its culmination, but returned later, and recorded 
his observations in the second edition of the ** Meth- 
odus.'* The appearance of this second book was the 
occasion of a letter to Boyle, the father of modem 
chemistry, 1668 (erroneously ascribed by the "En- 
cyclopaedia Britannica," Latham, Payne, and other 
biographers of Sydenham, to the year 1688), which 
shows his pride in his practice, and contains a little 
playful irony regarding his knowledge of science. 
"I have the happiness of curing my patients," he 
writes; "at least of having it said of me, that few 
miscarry under me; but cannot brag of my corre- 
epondency with some other of the faculty, who, not- 



146 THE HISTORY OF MEDICINE 

withstanding my profoundness in palmistry and 
chemistry, impeach me with great insufficiency, as I 
diall likewise do my taylor, when he makes my 
doublet like a hopsack, and not before, let him ad- 
here to what hypothesis he will/' 

From this letter we learn also that the physician 
and philosopher, John Locke, had been attending 
with Sydenham very many of his variolous patients. 
In the year 1666 the total number of deaths in Lon- 
don had fallen to 12,738. These included 1998 
deaths from plague, and only 741 from fevers, 38 
from smallpox, and 3 from measles. In 1667 the 
mortality from plague had dropped to 35, from 
fevers had risen to 916, and from smallpox and 
measles respectively to 11 96 and 82. In 1668 there 
were 14 deaths from plague, 1247 from fevers, 1987 
from smallpox, and 200 from measles. In 1669 
dysentery and other intestinal diseases, which had 
been on the increase since 1666, caused 4,385 deaths, 
plague 3, fevers 1499, smallpox 951, and measles 15. 
The dysenteric constitution, which Sydenham com- 
pares with the epidemics of North Africa (Morocco), 
was maintained during the next three or four years. 
Before 1673 smallpox was again on the increase; it 
continued to gain, and in 1674 became the predomi- 
nant epidemic. Out of 17,244 deaths in London in 
the year 1674 there were 2507 from smallpox, 795 
from measles, 3 from plague, 2,164 from fevers, and 



SCIENCE AND PRACTICE 147 

1777 from dysentery and other intestinal ailments. 
In 1675, as we learn from Sydenham, there pre- 
vailed in London epidemic coughs with pleurisy and 
pneumonia. ''Sometimes/' he states, ''there super- 
vene upon the cough the following symptoms: a 
succession of chills and flushes; pains in head, back, 
and limbs; an occasional tendency to sweats (espe- 
cially night sweats) ; sometimes the addition of pain 
in the side; sometimes a constriction and tightness 
at the chest; and, as the result of this last, difiiculty 
of breathing, tightness in the cough, and violent 
fever/' In a work with the significant title " Medical 
Observations Concerning the History and Cure of 
Acute Diseases" (1676), which may be considered a 
third, much enlarged, edition of the "Methodus," 
Sydenham placed before the learned world an ac- 
count of the history and treatment of the epidemics 
of fifteen years. 

The " Observationes Medicae'' is much more than 
a contribution to epidemiology. It aims to give 
graphic and natural descriptions of disease based on 
well-considered clinical data, and to establish a 
definite therapeutic procedure. He proposes as a 
follower of Bacon to advance from the observation 
of individual cases, and to reduce all diseases to 
clearly defined ** species, and that, with the same 
care which we see exhibited by botanists [like his 
contemporaries Grew and Ray] in their phytolo- 



148 THE HISTORY OF MEDICINE 

gies/' To write the natural history of a disease the 
physician should hold in abeyance every philo- 
sophical hypothesis and prepossession, and imitate 
" the exquisite industry of those painters who repre- 
sent in their portraits the smallest moles and the 
faintest spots/' At the same time it is necessary to 
portray in the clinical picture what is typical and 
characteristic of the species rather than the ad- 
ventitious or merely individual phenomena. ''No 
botanist/' says Sydenham, "takes the bites of a 
caterpillar as a characteristic of a leaf of sage/' 
Moreover, diseases must be studied in relation to 
the time of year in which they occur, for though 
many are good throughout the twelvemonth, others 
follow the seasons as truly as plants and birds of 
passage. 

The main part of medicine is the discovery of the 
indications of the various species of disease. These 
indications or symptoms furnish a clue to the right 
treatment, for disease is nothing but Nature's effort 
to restore the health of the patient by the elimina- 
tion of the morbific matter or to effect a renovation 
of the blood. For example, gout seeks to purify the 
blood of old men, plague to expel those infectious 
particles which we have taken in along with the air 
we breathe, just as an abscess may help to remove a 
thorn. Our natures are the physicians of our dis- 
eases, as indeed Hippocrates, that divine old man, 



SCIENCE AND PRACTICE 149 

taught. In the case of some diseases the practitioner 
should maintain the expectant attitude, or remain 
merely passive. He should, however, not hesitate to 
reSnforce the efforts of Nature when she is enfeebled 
and to coerce her when outrageous, always duly at- 
tending to her method and time of working a cure. 
To develop a system of natural therapeutics, a fixed 
and consummate method of treating disease, veri- 
fied by a sufficient number of experiments, must be 
the result of codperation. "If, in each age of the 
world," writes Sydenham, "a single person only had 
properly treated upon one single disease, the pro- 
vince of the physician, or the art of healing, would 
long ago have reached its height ; and would have 
been as complete and perfect as the lot of humanity 
admits." Sydenham recognized that medicine was 
to be advanced not merely by the preparation of 
accurate descriptions of diseases and the establish- 
ment of a definite method of treating them, but also 
by the discovery of specific remedies, an interest in 
which he shared with Robert Boyle. 

In describing the symptoms of the fevers of 1661- 
64, Sydenham states that all sgixes begin with shiv- 
erings and rigors, succeeded by heat, and termi- 
nated by sweats. In the hot and cold paroxysms the 
patient has a strong desire to vomit. One may speak 
of the stage of exhorrescence, the stage of ebullitiont 
and the stage of despumation. The commotion of 



ISO THE HISTORY OF MEDICINE 

the blood is Nature's means of bringing about a 
purification or renovation. For illustration it may 
be compared with ebullition or fermentation. Vernal 
intermittents are analogous to the workings of full 
beer barrels, when, having lain long in cool cellars, 
they are set near a fire. Depuration occurs by flow- 
ers or by dregs. The physician should be guided by 
Nature in the exhibition of emetics, diaphoretics, or 
purgatives. Evacuation by means of clysters may 
act as an oversized vent for beer whilst it is ferment- 
ing. If the patient was advanced in years or had 
been pulled down by evacuations, Sydenham pre-' 
scribed cordials. " But," he writes, " if the fermenta- 
tion be neither too active nor too languid, I leave it 
to itself, and use no remedies." Sydenham, the Eng- 
lish Hippocrates, had faith in the vis medicalrix 
naturm^ and resembled the Father of Medicine in his 
doctrine of atmospheric constitutions, in his avoid- 
ance of extremes, in his distrust of speculation and 
in the inclination to ground philosophy on observa- 
tion and practice, in his lofty professional ideals, 
respect for patients, and universal charity, in his 
humoral physiology, in his diagnosis and prognosis, 
in the use of cooling drinks, in his resort to hygienic 
measures (diet, riding and carriage exercise) and in 
his employment of simple remedies. At the same 
time Sydenham's name is associated with advances 
in the use of drugs, with the popularization of Peru- 



SCIENCE AND PRACTICE 151 

vian bark in the treatment of intermittent fever, with 
its recognition as a tonic, with the introduction of 
liquid laudanum and other preparations of opium, 
and with the exhibition of steel and mercury. He 
found antimonial emetics are not fit for children 
under fourteen years of age. ''I wish, with all my 
heart/' he writes, ''that instead of them something 
more safe, and equally efficacious, could be dis- 
covered." For kidney troubles he recommended the 
waters of different mineral springs, among them the 
waters of the suburb of London now known by his 
name. 

Among his contemporaries Sydenham was partic- 
ularly noted for his so-called cooling method of 
treating smallpox. He certainly held that the danger 
from cold in this disease b far less than that from a 
too heating regimen. He burlesqued the treatment 
then in vogue, and asked whether the subject's life 
might not be in danger if the stoutest porter in the 
best of health were, for the sake of experiment, put 
to bed with the curtains drawn and a large fire in the 
room to keep him in a sweat for some weeks, there 
being in attendance a nurse or two, who, if he should 
shift his position or put a finger out of bed, should 
correct his error by heaping on more clothes, and 
who, during all this time, should deny him small 
beer or other refreshing drinks and continue to ply 
him with posset and cordials, /'From an overhot 



152 THE HISTORY OF MEDICINE 

regimen/' he writes, "never good came, any more 
than from overhasty fruit any profit." The separa- 
tion of the peccant matter from the humors must be 
effected before it is eliminated by the sldn. We must, 
however, "not be so intent upon ensuring 2^;ainst 
an overheated state of the blood, as to expose our 
patient to any injury from cold, and by so doing 
arrest the eruption of the pustules/' Sydenham, 
though he clearly distinguished the two diseases, 
treated measles in much the same way as smallpox, 
and taught that the former is a disease superinduced 
upon the blood during an attempt at a new stasis, 
and that one attack assures as a rule against 
another. There is much, in fact, in Sydenham's 
views of smallpox and measles that is reminiscent 
of Rhazes, as there is also in his view that disease 
may be explained as a fermentation of the humors. 
It is probable, however, that the latter conception 
at least was suggested to Sydenham by the writ- 
ings of Willis or of some other physician of his own 
time. 

Indeed, although Sydenham focused his attention 
on the symptoms and treatment, there is sufficient 
evidence that he did not avoid adopting hypotheses 
regarding the nature and causation of disease. In 
harmony with Locke and Boyle he believed that 
the human frame is adapted to impressions from 
without, and that maladies are owing in part to 



SCIENCE AND PRACTICE 153 

mineral effluvia or other occult atmospheric influ- 
ences — to particles of the atmosphere — and in 
part to the different fermentations and putrefactions 
of the humors. He even compares diseases with the 
mosses, fungi, and mistletoe that grow on trees, the 
nutritive juice of which may have suffered perver- 
sion or depravation. At the same time he was aware 
that not merely the delicate are subject to infection. 
A man might be as strong as a wrestler, but if he 
went to certain parts of the country where fever 
was raging, he would sicken within a day or two. 
When in cases of intermittent fever the despuma- 
ticm has been incomplete, the fit may return when 
the patient seems out of danger; the latent matter 
presents itself anew, like ''broods of bees that 
grow gradually at stated times." The conditions 
that produce plague were for Sydenham a special 
object of curiosity, and the study of them brought 
him near to a juster view than Boyle's theories 
afforded of the part played by the atmosphere in 
the dissemination of disease. He had grave suspi- 
cions that the mere atmospheric constituti<xi was 
insufficient to originate plague. The disease must 
be perpetuated in sporadic cases in the intervals be- 
tween epidemics, or must continue to survive in 
some fames f or arise from some infected person from 
a pestilential locality. Otherwise Sydenham could 
not account for the fact that through the sanitary 



154 THE HISTORY OF MEDICINE 

measures of the Grand Duke Ferdinand II there 
had been stopped in 1650 at the borders of Tuscany 
a plague that had devastated nearly all the rest 
of Italy. When an epidemic rages, the exhalations 
from the sick and from the corpses of the victims 
of the disease spread the contagicm through the 
whole atmosphere of the affected area, so that the 
air, in itself and of itself, is sufficient to destroy 
those whose humors are adapted to the receipt of 
the influence. As regards the treatment of the 
plague, Sydenham remarks that Nature's method 
of eliminating the morbific matter by means of ab- 
scesses cannot be furthered by means of diaphoresis, 
and that it is here unsafe for the physician to at- 
tempt to follow the path of Nature. 

In 1680 appeared Sydenham's fourth book, 
^'Epistolse responsoriae duae," addressed to two phy- 
sicians connected with the University of Cambridge, 
from which institution he had received the degree 
of M.D. in 1676. The first of these letters deals with 
the epidemics of 1676, of 1678, and the succeeding 
years (intermittents again prevailing after 1678, and 
influenza after 1679), with the administration of 
Peruvian bark, and the treatment of rheumatism by 
lenitives and by simple, cool, nutritious diet, such as 
whey. The second letter deals with venereal disease. 
Sydenham noted that venereal lues had declined in 
strength since, in I493» it had first struck root in 



SCIENCE AND PRACTICE 155 

Europe, it being in his opinion characteristic of spe- 
cies of disease that they are modified in the course 
of time, that they become extinct and give rise to 
new species. He recognized the primary lesion — 
'^shanker''; called buboes the first stage of true 
lues; and spoke of the disease as extending to differ- 
ent parts of the body, attacking the bones, produc- 
ing phagedaenic ulcers, etc The taint of either 
parent may be transmitted to the offspring. A child 
may communicate it to the nurse, or an infected 
nurse may give it to a healthy child. Sydenham 
knew that syphilis, which he differentiated to some 
extent from gonorrhoea, had reached Europe after 
the discovery of America, but he held that its origi- 
nal home was not the West Indies, but the coast of 
Guinea or some portion of the negro country there- 
about. In fact, he thought it identical with the Afri- 
can disease called the "yaws.'' Some argue, says 
Sydenham, "that the cure of the venereal disease 
should not be taught. With such I disagree. If we 
reject all cases of affliction which the improvidence 
of human beings has brought upon themselves, there 
will be little room left for the exercise of mutual love 
and charity. God alone punishes. We, as we best 
can, must relieve. Neither must we be too curious 
in respect to causes and motives, nor too vexatious 
in oiu" censorship." According to his experience 
there was no true instance of this disease having 



156 THE HISTORY OF MEDICINE 

been extirpated except by means of salivation ex* 
cited by mercury. 

Further daims on our admiration of the clinical 
acumen and skill of the English Hippocrates are 
made by his recognition oi the protean character of 
hysteria and the relation of hysteria and hypochon- 
driasis, by his account of scarlatina, by hb differen- 
tiation of chorea from dancing mania, by his riding 
treatment for phthisis, by his classical description 
of gout and other chronic diseases. He described a 
species of insanity following prolonged malaria. 
Nor should we be misled by exaggerated statements 
of his indifference to the science of his time ; for he 
refers repeatedly to the circulation of the blood, 
mentions the lacteals^ speaks appreciatively of his 
English contemporaries who "have done good work 
in each kind of science that advances medicine,'' and 
held it essential for the physician, as for the surgeon, 
to know thoroughly the structure of the human 
body. He was not ignorant of contemporary studies 
of the anatomy of the kidneys, and he was aware of 
the encystment of renal calculi. He said that coma 
arises from an obstruction in the cortex of the brain, 
and that apoplexy may be caused by an extravasa- 
tion of blood from the capillaries of the cerebral 
arteries, and in his treatise on dropsy he made men- 
tion of the results of post-mortem examination of 
the abdomen. The special province of the physician. 



SCIENCE AND PRACTICE 157 

however, is not, in the judgment of Sydenhanii 
scientific research. It is rather comparable with 
that of a pilot whose only business it is to see that 
the ship be not sunk, not to speculate on the ebb 
and flow of the tide. The great English physician's 
consecration to the welfare of his patients, as well 
as to the Commonwealth, was a great factor in the 
establishment of hb fame both in Britain and on the 
Continent of Europe. Boerhaave is said never to 
have referred to Sydenham without removing his 
cap in salutation to " Angliae lumen, artis Phoebum, 
veram Hippocratid viri speciem.'* 

Hermann Boerhaave himself, bom near Leyden, 
Holland, in 1668, is sometimes called the Batavian 
Hippocrates. Like his Greek and English models he 
was discriminating in the use of drugs and made 
much of hygiene. He was a profound scholar, and 
served for years as professor and rector in the Uni- 
versity of Leyden. His numerous pupils, among 
whom were Pringle, Haller, Camper, van Swieten, 
and de HaSn, greatly extended the range of his in- 
fluence. He is especially deserving of remembrance 
as a clinical instructor. At his demonstrations he 
concentrated attention on a few patients, made use 
of a Fahrenheit thermometer, and he also sought to 
verify his diagnoses by post-mortems, explaining 
the pathological as a deviation from the physiologi- 
cal. Like Sydenham he condemned philosophers 



158 THE HISTORY OF MEDICINE 

who seek to invent rather than to discover, but he 
was in closer touch with the science of his own time 
than the English physician had been with that of 
the previous epoch. He taught botany and devel- 
oped the botanical garden at Leyden. He was the 
author of a work on chemistry (" ElementajChemiae/' 
1732), in which he taught that unlike combines 
with unlike, not like with like. He studied Boyle, 
Malpighi, Leeuwenhoek, and edited under the title 
''Biblia Naturae'' the writings of Swammerdam, 
who had described red-blood corpuscles and had 
opposed the ancient doctrine of spontaneous genera- 
tion. Boerhaave maintained that epidemics of small- 
pox are owing solely to contagion, and he showed a 
greater faith than Sydenham in the power of the 
human mind to arrive at the ultimate causes of 
disease. "He who," writes Boerhaave, "with the 
greatest possible exactness, weighs every particular 
thing which shall happen or has happened to his 
patient, and which may be learned from the obser- 
vations of himself or of others, and who then com- 
pares all these with one another, and places them in 
opposition to such things as occur in a state of health, 
and finally, from all this, with the nicest and strict- 
est control of his speculative powers, rises to the 
knowledge of the first cause of the disease, and of 
the remedies fit to remove it, he, and only he, de- 
serves the name of a true physidan/V 



SCIENCE AND PRACTICE 159 

One of his critics regrets that Boerhaave, pos- 
sessed of remarkable powers of observation, should 
at times have tied himself to groundless hypotheses, 
in opposition to the very principles which he advo- 
cated so strongly. His works are now little read, but 
his pupils and the record of his enormous private 
practice bear witness to his qualities as teacher and 
physician. A monument raised in his honor by the 
city of Leyden is inscribed : ** Sacred to the Genius of 
the Health-giving Boerhaave (Salutifero Boerhaavii 
Genio Sacrum)." 

REFERENCES 

Boyle, Robert: Works (edited by Thomas Birch). London, 

1772. Vol. V, pp. 38 and 74-126. 
Brown, J.: Spare Hours (Hora Subsedoai), third aeries, 1882, 

pp. 39-110, and pp. 221-33. 
Lusk, W. T.: ^The Illustrious Boerhaave,'* Popular Science 

Monthly, vol. 47 (1895), pp. 110-20. 
Osier, Sir William, and McCrae, Thomas: The Principles and 

Practice of Medicine. Ninth edition, 1920, pp. 320-30. 
Payne, J. F.: Thomas Sydenham, New York, 1900. 
Picard, Fr£dMc: Sydenham, sa Vie, ses (Euores. Paris, 1889. 
Sydenham, Thomas: Works (translated, with a life of the author 

by R. G. Latham). 2 vols., 1848 and 1850. Published by The 

Sydenham Society. 
Creighton, Charles: A History of Epidemics in Britain. 2 vols. 

Cambridge, 1891 and 1894. 
Prinzing, Friedridi: Epidemics ResuUi»g from Wars. Oxford 

(Clarendon Ptress), 1916. 



.CHAPTER VIII 

COMPARATIVE ANATOMY: JOHN HUNTER 

John Hunter, born near Glasgow in 1728, was, like 
Darwin, an indefatigable collector of natural history 
specimen^. As a boy, instead of going to schoc4, he 
wandered about the country, observing the ants, 
the bees, the tadpoles, and the larvae of caddis-flies, 
studying the habits of the birds, and making collec- 
tions of birds' eggs, which he compared in size, color, 
markings, and in the number characteristic of each 
species. In his twenty-first year he began at London 
those studies in anatomy and surgery which formed 
the basis of his subsequent activities. After eleven 
or twelve years of almost unremitting work in the 
dissecting-room and the hospital, he went, as sur- 
geon, with the military expedition to Belle-Ile, 
where he collected specimens which formed the 
nucleus of what is now known as the Hunterian Mu- 
seum. Service in Portugal gave him the opportunity 
of extending his observations. In 1764 he estab- 
lished at Earl's Court, at that time well to the west 
of the city of London, a country-seat stocked with 
ducks, geese, pigeons, fish, frogs, eels, river-mussels, 
sheep from Turkey, a shawl-goat from the East 
Indies, buffaloes, leopards, a beautiful little bull 



COMPARATIVE ANATOMY i6i 

presented by the Queen, and specimens of various 
other species, plant as well as animal. His town 
house became crammed with natural history speci- 
mens, so that, soon after his marriage in 1771, his 
bride, the accomplished Anne Home, found herself 
living either in a menagerie in the country or in a 
museum in the city. In 1783 he set up his famous 
establishment in Leicester Square. He held that 
Francis Bacon had been the chief cause of the ad- 
vance of science since the sixteenth century, and he 
determined to base his own generalizations on com- 
prehensive and careful observation of natural phe- 
nomena. Animals dying at the Tower of London 
and the city menageries were obtained by Hunter 
for dissection, and no animal was brought to Eng- 
land during the latter part of his career without his 
having an opportunity to examine it. 

Hunter lacked Darwin's opportunity of extended 
travel, but the material brought to his door offered 
an equivalent in some respects, and he lived in an 
age when men's imaginations were kindled by voy- 
ages of discovery as they had been in the Eliza- 
bethan. In 1 77 1 Edward Jenner, Hunter's pupil 
and familiar friend, was chosen at his suggestion to 
examine and classify the collections brought to Eng- 
land by Captain Cook from Australia, New Zealand, 
and other islands of the South Pacific. 

This incident serves to indicate the kind of influ- 



162 THE HISTORY OF MEDICINE 

ence exerted on Jenner by his master. It is indeed 
true that Hunter was interested in the problem of 
immunity and in the rivalry of diseases. He knew 
that people constantly exposed to the cause of cer- 
tain diseases become less affected, or less liable to be 
affected. He recorded the case of two children, in 
which smallpox, following inoculation, was held in 
abeyance for a time by an attack of measles. He 
said that cowpox and smallpox, if inserted at the 
same time in different parts of the same person, pro- 
duce each the same effect as if only one of them had 
been inserted. Nevertheless, Jenner's indebtedness 
to Hunter has sometimes been put in a false light, 
and Hunter's famous exhortation to his pupil to rely 
on experiment rather than on speculation or au- 
thority referred to a problem in natural history and 
not to vaccination. "I thank you," wrote Hunter, 
''for your experiment on the hedgehog; but why do 
you ask me a question by the way of solving it? I 
think your solution is just; but why think — why 
not try the experiment?" About three years later, 
that is, in 1778, Hunter turns suddenly from a dis- 
cussion of Jenner's disappointment in love to stimu- 
late him to undertake fresh experiments on hiber- 
nating animals. "I own," he writes, "I was glad 
when I heard you was married to a woman of for- 
tune; but 'let her go, never mind her.' I shall em- 
ploy you with hedgehogs."^ Again he writes: "I 



COMPARATIVE ANATOMY 163 

have but one order to send you, which is, send every- 
thing you can get, whether animal, vegetable, or 
mineral, and the compound of the two; namely, 
either animal or vegetable mineralized/* 

His cupidity for Nature was never satiated. At 
considerable expense he sent a surgeon to Greenland 
to examine the anatomical structure of large marine 
animals and to preserve the more interesting parts. 
In 1793, the year of his death, his zeal in the study 
of Nature was still undiminished. Writing to a 
gentleman in Africa he asked for specimens of the 
different species of swallows, in order that he might 
obtain a clue to their migrations, everything re- 
specting the bee tribe, such as wasps with their 
nests, also hornets with theirs, cuckoos, ostrich- 
eggs, and chameleons. "If a Foal camell was put 
into a tub of spirits and sent, I should be glad. Is it 
possible to get a young tame lion, or indeed any 
other beast or Bird," 

Hunter's writings along with the specimens pre- 
served in his museum show that he had dissected 
twenty-one species of quadrumana (apes, monkeys, 
lemurs), ten species of marsupials, fifty-one species 
of camivora, twenty species of rodents, five species 
of edentata, fifteen species of ruminants, ten species 
of pachyderms, six species of cetacea, and twenty- 
three other species of mammals scattered through 
the sub-classes. As regards human anatomy Hunter 



164 THE HISTORY OF MEDICINE 

dissected thousands of cadavers. There is like evi- 
dence that he dissected one hundred species of birds, 
fifty-nine species of fish, thirty-nine species of 
reptiles, forty-two species of molluscs, over ninety 
species of '^ articulate" and "radiate'' animals, and, 
in addition, twenty miscellaneous species of inverte- 
brates. His museum contained 13,682 specimens, 
including^ 2773 fossils. 

Sir Richard Owen, the leading authority on com- 
parative anatomy in the period following the death 
of Cuvier, credits Hunter with the first great at- 
tempt to arrange in concatenated system the di- 
versified facts of that branch of science. The idea of 
a graded series is a constant feature of Hunter's 
studies of the various anatomical structures, as well 
as of his attempts to lay the foundations of a phylo- 
genetic classification of animals. He considered, for 
example, whatever is uncommon in the organ of 
hearing in fishes as only a link in the chain of varie- 
ties displayed in the organ of like function in diflfer- 
ent animals, descending from the most perfect to the 
most imperfect, in a regular progression. Guided by 
the same principle he traced the development of the 
nervous system from the simple filaments of some 
of the lower organisms to the highly organized 
masses found in the monkey and in man, the most 
complex of the animals. In like manner he followed 
the development of the canine teeth, which he was 



COMPARATIVE ANATOMY 165 

the first to call cuspids, from the lion to man, noting 
the similarity in shape, situation, and function. 
Palmer, who edited Hunter's works in 1837, took 
him to task for teaching that man was originally 
constructed for the pursuit and capture of living 
prey. Though the criticism may have been well 
founded, it should be recognized that Hunter dis- 
tinctly taught that man, a more perfect or compli- 
cated animal than any other, is not made to come 
at his food by his teeth, but by his hands, directed 
by his superior ingenuity; also, that man is able to 
live in a much greater variety of circumstances than 
any other animal, has more opportunities of exer- 
cising the faculties of his mind, and is possessed of 
that high d^jee of sociability which implies superior 
educability. 

In tracing the affinities of the different species of 
animals Hunter supplemented his special studies of 
anatomical structure — for example, of the whale 
as a modified land animal, of the relationship of 
birds and batrachians, of the weak wings and highly 
developed legs of the ostrich — by common-sense 
observation as well as by experiment. He did not 
overlook the obvious resemblance of the horse, the 
ass, and the zebra, nor that of the wolf, dog, jackal, 
and dingo. Does not the natural gradation of ani- 
mals from one to the other, he asks, lead to the 
original species? The wolf has a closer resemblance 



i66 THE HISTORY OF MEDICINE 

to the fox than has either the dog or the jackal. The 
shephaxl's dog, all over the world» as well as the 
Esquimaux dog and the dingo, resembles the wolf 
in shape and disposition. Hunter owned one of a 
litter of puppies, the offspring of a wolf and a bitch. 
He described it as easily startled and particularly 
apprehensive of danger. It had the shape of the 
wolf refined, and a long coat almost as fine as that of 
the black fox. The mother was of the Pomeranian 
breed. A bitch of this same litter had in all thirty- 
five puppies, some of which were wild and so unruly 
that they could not be controlled by the most skill- 
ful dog-trainers. Hunter records another case of 
four puppies, the offspring of a she-wolf and a grey- 
hound. Two Were like the dog in color — large 
black spots on white ground; one was black; the 
fourth was dun, and would probably have been like 
the mother. Hunter owned a puppy of a second 
litter of this she-wolf. He also secured a female 
puppy of a she-jackal and a spaniel. It was of a 
wild disposition. When mature it gave birth to five 
puppies. One of these was given to Jenner, who 
subsequently reported that it was shy and appre* 
hensive, and remarkably fleet. 

Hunter's posthumous essays show with what care 
he compared the anatomical structure of apes, 
monkeys, and lemurs with that of man. In a species 
of gibbon he observed the absence of the tail, the 



COMPARATIVE ANATOMY 167 

l^igth of the appendix, as well as the similarity of 
the liver and other abdominal viscera to those of a 
human being. The uterus in form and position is 
like that of a child. In one species of Macacus he 
found that the muscles of the eye are as in man, and 
that the brain b very like the human. In another 
species of monkey he noted that the prostate gland 
is similar to the human prostate gland. ''The 
monkey/' says Hunter, "in generstl may be said to 
be half beast and half man; it may be said to be the 
middle stage." Again he described the mongoose as 
an exact degree from the monkey to the brute in its 
external form. 

Hunter supposed that the erect posture in man 
rendered him more liable to rupture, and contrib- 
uted to the descent of the testes. When the testes 
remain in the abdomen in man, as they do normally 
in the hedgehog and some other species of animab» 
we have an example of what Hunter was the first to 
call "arrested development.'' The erect posture 
accounted likewise in his judgment for the disposi- 
tion of the pelvic viscera in man, and affected the 
curves of the spine and the form of the foot, as well 
as the structure of the knee-joint. He noted the 
difiPerentiation of the hand from the foot in man and 
monkey. He believed that the thumb of the monkey 
is not so strong as that of man, "and has not that 
opposing motion." The walk of the monkey is very 



i68 THE HISTORY OF MEDICINE 

similar to that of a child who has hardly the power 
of supporting the center of gravity, he says. 

Hunter had observed at Belie-Ile that frogs live 
upon wormsi beetles, grasshoppers, caterpillars, and 
butterflies. Later he attained to the generalization 
that the large animals are made as a rule to live 
upon the less, and he anticipated the doctrines of 
Malthus so far as to teach that it is necessary ** that 
many animals should be made to prey upon others; 
else we should be overstocked with the smaller." 
He also held that modifications that occur in animal 
structure tend to progression rather than to retro- 
gression. Deviation from the original structure is 
not necessarily deterioration. It appears, he remarks, 
just the contrary; therefore we may suppose that 
nature is improving its works, or, at least, has estab- 
lished the principle of improvement in the body as 
well as in the mind. Variation furnishes the mate- 
rials of advance. In the individuals of each species, 
writes Hunter, varieties are every day produced in 
color, shape, size, and disposition. Some of these 
changes are permanent with respect to the propaga- 
tion of the animal, becoming so far a part of its 
nature as to be continued in the offspring. In the 
case of acquired properties, according to Hunter, it 
is only the susceptibility to certain influences that is 
inherited. Diseases like gout and scrofula are not 
really hereditary. 



COMPARATIVE ANATOMY 169 

He remariced, in his comparative study of the 
gizzard and stomach, the difficulty generally en- 
countered by the anatomist of distinguishing the 
proximate steps in the slow and imperceptible grada- 
tions of nature. His recognition of the gradual 
deviation from type as the rule did not blind him, 
however, to the possibility of exceptions. ''How 
far,'' he says, ''varieties in animals are gradual, or 
in what degree they, at once, produce a very dis- 
tinct variety, is perhaps not to be ascertained." He 
mentions the case of a white negress who had three 
children by a white man. One of the children was 
black, while the two others were tawny. Hunter 
was interested of course in atavism, and in the varia- 
tions that occur in domesticated animals. He speaks 
of latent hereditary dispositions, which pass over 
one or two generations, and start up again in the 
second or third. Again, animals living in a free and 
natural state are subject to fewer deviations from 
their specific characters than are animals influenced 
by culture. " From the variations produced by cul- 
ture, it would appear, that the animal is so suscepti- 
ble of impression, as to vary nature's actions and 
this is even carried into propagation." 

In 1766, the year preceding that in which Hunter 
became a fellow of the Royal Society, he wrote a 
description of the anatomy of an Amphibious Bipes, 
a species of Siren, which had defied the dassificatory 



170 THE HISTORY OF MEDICINE 

skill of linnseus. It was animals like this and the 
Southern Chimera, which did not seem to fit into 
the pigeon-holes of the System of Nature, that par- 
ticularly fascinated Hunter. He was deeply inter- 
ested not only in exceptional species of all sorts, but 
in giants, dwarfs, henm^rodites, and other mon- 
strosities. According to Owen he anticipated the 
principles set forth by Isidore Geoffroy Saint- 
Hilaire in his "Trait6 de T6ratologie '' (1832). 
Hunter observed that the natural hermaphrodite 
belongs to the inferior and more simple genera of 
animals, of which there is a much greater number 
than of the more perfect; and as animals become 
more complicated, have more parts, and each part is 
more confined to its particular use [by a physiologi- 
cal division of labor], a separation of the two neces- 
sary powers for generation seems also to take place. 
He raised the question whether there ever occurs in 
the genera of animals that are natural hermaphro- 
dites, a separation of the two parts forming distinct 
sexes, and he conjectured that the occurrence of 
such a variation might account for the distinction 
of sexes ever having happened. 

Darwin begins Part II of "The Descent of Man*' 
with the following statement: "With animals which 
have their sexes separated, the males necessarily 
differ from the females in their organs of reproduc- 
tion; and these are the primary sexual characters. 



COMPARATIVE ANATOMY 171 

But the sexes often differ in what Hunter has called 
secondary sexual characters, which are not directly 
connected with the act of reproduction/' A glance 
at the table of contents of this work of Darwin's will 
convince the reader that Hunter's conception is the 
dominant idea of the last two thirds of it. An in- 
trcxluctory chapter on the principles of sexual selec- 
tion is followed by chapters on secondary sexual 
characters in the lower classes of the animal king- 
dom — in insects, in lepidoptera, in fishes, amphib- 
ians, reptiles, in birds, and in mammals. The third 
and last part of ''The Descent of Man" consists of 
two chapters on the secondary sexual characters of 
man and a general summary and conclusion. "In 
all animals we are acquainted with," writes Hunter, 
"we see distinguishing marks between the male 
and female, exclusive of the parts peculiar to each." 
Hunter divides sexual characters into principal 
and secondary, and among the secondary properties 
which characterize the male and the female he 
mentions the beard, mane, spurs, horns, voice, etc. 
He carefully records cases in which the female 
pheasant had assumed the plumage of the male. He 
also refers to an interesting case in which the mam- 
mary glands were fully functional in a man. 

Owen says that Hunter was the first to enunciate 
the principle of the resemblance of the phases of 
embryonic life to the series of inferior forms of ani- 



172 THE HISTORY OF MEDICINE 

mal species. ** If,** wrote Hunter, ''we were capable 
of following the progress of increase of the number 
of the parts of the most perfect animal, as they first 
formed in succession, from the very first to its state 
of full perfection, we should probably be able to 
compare it with some one of the incomplete animals 
themselves, of every order of animals in the creation, 
being at no stage different from some of the inferior 
orders. Or, in other words, if we were to take a 
series of animals, from the more imperfect to the 
perfect, we should probably find an inferior animal, 
corresponding with some sts^e of the most perfect.** 
This idea, with which Hunter was struggling, has 
been neatly expressed in our times by saying that 
the human embryo in each of its stages of develop- 
ment resembles the mature form of some species 
lower than itself. Of course this generalization of 
Himter*d rested on numerous observations. He re- 
marked, as we have seen, that in the hedgehog the 
testes continue throughout life to be lodged in the 
abdomen, in the same position as in the human 
foetus. The appendix of a species of lemur is like 
that structure in the human fcetus, which, in turn. 
Hunter compared with the foetal appendix of the 
monkey. The resemblance of the disposition of the 
abdominal viscera in the lower manunals in general 
with that in the human foetus is another case in 
point. G>ngenital hernia and certain other ab- 



COMPARATIVE ANATOMY 173 

normalities were explained by Hunter as pernsting 
embryonic conditions. 

Geology afforded him another due to the affini- 
ties of the various species and genera of animals, as 
well as to the interdependence of natural and phyd- 
cal phenomena. He agreed with Hutton that geology 
has nothing to do with the original formation of the 
earth itself, but is concerned only with the changes 
of the earth's crust. Hutton, as Lyell remarks, pos- 
sessed little information regarding organic remains. 
Hunter, on the other hand, before the appearance of 
Hutton's ''Theory of the Earth,'" was attempting 
to match up fossil animals with those living species 
with which he was so eminently conversant. He 
distinctly taught that we should be unable to con- 
sider the operations affecting the surface of the 
earth if we had not the preserved parts of animals 
to guide us. They enable us to trace the history of 
the earth's crust just as we should trace the political 
events in any country by die monuments left. We 
must judge of the past by the present, supposing 
from the state of the earth as it now is what must 
have taken place formerly. 

Hunter further agreed with the uniformitarians 
in believing in the antiquity of the earth. Speaking 
of one collection of fossil bones he says that there 
was probably a succession of them for a vast series 
of yearsi many thousand years. In what was sup- 



174 THE HISTORY OF MEDICINE 

poeedly the last essay he wrote he used the exptes^ 
sion ** many thousand centuries/' This was criticized 
and a representative of the Royal Society suggested 
that he substitute ''years'' for ''centuries," but he 
withdrew the paper rather than make the change. 

Few fossils, says Hunter, correspond with recent 
specimens. They may not be of different spedes, 
but varieties of the same species. If they are really 
diflFerent spedes, then we must suppose the old are 
lost and that, therefore, a new creation nmst have 
taken place. That many are actually lost seemed 
plainly shown by the remains of land animals that 
are not now known. How they became extinct is not 
easily accounted for. His unexcelled kno^edge of 
dentition enabled him to identify a fossil white bear 
twice as large as the present white bear, and gave 
him assurance that the fossil teeth found at Salt 
Lick, near the Ohio, about 1767, bdonged to an ani* 
mal larger than the elephant. 

The teeth of the kangaroo are so singular that it 
is impossible from them to say what tribe it is of. At 
the same time Hunter was not unaware of the mar« 
supial character of the Australian fossil mammalia. 
Darwin, in that part of the "Origin of Spedes" that 
treats of geological succession, pays tribute to the 
work of Hunter by referring to his faithful followers 
Clif t and Owen. " Mr. Clift," writes Daiwin, " many 
years ago showed that the fossil mammab from the 



COMPARATIVE ANATOMY 175 

I 

caves were closdy allied to the living 
marsupials of that continent. In South America, a 
similar relationship is manifest, even to an unedu- 
cated eye, in the gigantic pieces of armor like those 
of the armadillo, found in several parts of La Plata; 
and Professor Owen has shown in the most striking 
manner that most of the fossil mammals, buried 
there in such numbers, are related to South Ameri- 
can types/' Hunter had dissected of course arma- 
dillos, sloths, and ant-eaters, and other specimens 
of South American species that proved of interest 
to Owen and Darwin. 

William Clift, the last and most devoted of 
Hunter's pupils, was received as an apprentice and 
amanuensis on his seventeenth birthday, February 
14, 1792. After Himter's death, in the autumn of 
the following year, Clift was placed in charge of the 
establishment in Leicester Square. Almost the sole 
occupant of the large building diuing the subse- 
quent six years, he spent his time studying the speci- 
mens in the museum and making extensive excerpts 
from his master's volumes of unpublished manu* 
scripts. When, in 1800, the museum was taken over 
by the G>llege of Suigeons and the collections were 
removed to new quarters, Clift was continued in 
charge with the title of Conservator. The greater 
part of Hunter's manuscripts were destroyed by his 
brother-in-law, Sir Everard Home, in 1823. In 1830 



176 THE HISTORY OF MEDICINE 

Richard Owen, who had studied under Hunter's 
pupil Abemethy, was appointed Gift's assistant. 
"From Clift/' says the "Dictionary of National 
Biography," "Owen imbibed an enthusiastic rever- 
ence for his great master, John Hunter, which was 
continually augmented by closer study of his 
works/' Owen married Clift's daughter in 1835, and 
helped Palmer edit Hunter's works. The paper, al- 
ready referred to as probably Hunter's last essay, 
"On Extraneous Fossils and their Relations," was 
not published till 1859, ^ ^^^ months after the ap- 
pearance of the "Origin of Species." In 1861 Owen 
published from Clif t's notes two volumes under the 
title " Essays and Observations in Natural History, 
Anatomy, Physiology, Psychology, and Geology, by 
John Hunter, being his Posthumous Papers on these 
Subjects." It was largely through Clift and Owen, 
and visitors to the Hunterian Museum, such as the 
younger Meckel (Johann Friedrich, 1 781-1833) and 
Cuvier, that the influence of John Hunter in com- 
parative anatomy and natural history was per* 
petuated. 

Hunter's attitude toward his profession was some- 
what different from Sydenham's. He regarded 
science as the essential basis of practice, and hoped 
by his investigations to establish new methods of 
treatment, or, as he said, to make discoveries in the 
art itself* He is now recognized as the founder of 



COMPARATIVE ANATOMY 177 

scientific surgery. Many of the reforms he effected 
in his profession were the direct result of his com- 
prehensive study of natural phenomena. " It is con- 
trary to the rules of surgery as founded on our 
knowledge of the animal economy/' he writes, ''to 
enlarge wounds simply as wounds/' which had been 
the general practice before the time of Hunter. Hb 
observation of tetanus in a deer as the result of a 
compound fracture stimulated his interest in the 
conditions of inflammation. He removed one ovary 
from a young sow, found that it subsequently had 
numerous offspring, and stated his conviction that 
there was no reason why the female of the human 
species should not bear spaying. His seemingly 
whimsical experiments in the transplantation of 
tissues have anticipated some of the most striking 
achievements of modem surgery. In his experi- 
ments on the temperature of animals he made use of 
a thermometer of his own invention very similar to 
the clinical thermometer of the present day. His 
studies in comparative odontology enabled him to 
observe the cause of the retardation and the difii- 
culty in cutting of the wisdom teeth in man, which 
arise, he says, from the want of room in the jaws for 
these late teeth. In fact. Hunter's scientific study of 
the teeth rescued dentistry from a state of crude 
empiricism and placed it, as surgery in general, 
on firm foundations. One of the most fruitful of his 



178 THE HISTORY OF MEDICINE 

investigations was his study of the circulation in the 
antlers of the deer. He ligated the artery supplying 
the circulation in the antlers of a buck in Richmond 
Park. The antlers, which were in the velvet, de* 
prived of their blood*8upprfy, grew cold. In two or 
three days, however, Hunter observed that the 
temperature had become normal again, and this he 
attributed to the establi^ment of a compensatory 
collateral circulaticm. Later investigation proved 
that the ligated artery had become obliterated. 

Soon after this experiment he applied his discov- 
ery in the hospital in the treatment of a case of 
popliteal aneurism, tying the femoral artery in the 
upper part of the thigh. His example opened the 
way to the triumphs of British and American vascu- 
lar surgery. One must mention in this conneotion 
Hunter's pupil Astley Cooper (the master of John 
Collins Warren, who played so large a part in the 
introduction of ether anaesthesia and in the founding 
of the Massachusetts General Hospital, and of 
Valentine Mott, who ultimately had one hundred 
and thirty-eight ligations for aneurism to his credit), 
Hunter's pupils Abemethy, Wright Post, and Phy- 
sick, the Father of American Surgery, as well as 
Physick's nephew, John S3mg Dorsey. 

It is not altogether irrelevant to mention Hunter's 
study of gunshot wounds, which gives him a place 
among the founders of modem military surgery, his 



COMPARATIVE ANATOMY 179 

study of the repair of tendons and his relation to 
subcutaneous and orthopeedic surgery, his influence 
on the treatment of hernia, his observations on the 
inflammation of veins, the clotting of blood, and the 
communicalnlity of puerperal fever* Hunter dis« 
covered the distribution of the olfactory nerves, ex- 
plained the placental circulation, traced the course 
of the tubuli uriniferi, advanced our knowledge of 
the lymphatic system, distinguished Hunterian 
chancre from chancroid ulcer, invented double bel* 
lows for the resuscitation of the apparently drowned 
and advocated the use of oxygen in the treatment of 
such cases. He experimented in artificial feeding, 
made a special study of intussusception, threw light 
on the nature of alcoholic fermentation, recorded a 
case of post-mortem digestion of the tissues of the 
stomach, observed hydatids in the liver of the mon- 
goose, and investigated the motion and the tempera- 
ture of plants. 

Hunter was interested in the mental processes 
and their development as a part of an interrelated 
system of natural phenomena. He studied color- 
blindness ten years before John Dalton, was inter- 
ested in the accommodation of the eyes, discovered 
what was later called the specific energy of the 
nerves, traced the growth of the perception of space, 
noted the abundance of human instincts, antici- 
pated modem psychology in reference to types of 



i8o THE HISTORY OF MEDICINE 

memory and imagination and the physiological 
phases of the emotions, studied the expression of the 
emotions in the lower animals, recognized the sur- 
vival value of anger and fear, and wrote in an en- 
lightened way concerning what is now called the 
sublimation of the emotions. 

REFERENCES 

Baron, J.: lAfe of Jenner. 2 vols., London, 1827^38. 

Groes, Samuel David: John Hunier and kis Pupils. Philadelphia, 

1881. 
Hunter, John: (i) Essays and Observations on NaHtral History, 

Anatomy, Physiology, Psychology, and Geology, being his 

Posthumous Papers, etc. Edited by Richard Owen. 2 vols., 

London, 1861. 

(2) Observations on Certain Parts cf the Animal (Economy. 
London, 1793. 

(3) Worhs. Edited by J. F. Palmer. London, 1837. 
Ottley, Drewry: The Life of John Hwtter. Philadelphia, 1839. 
P^t, Stephen: John Hunter, Man of Science and Surgeon, 

London, 1897. 
Stirling, William: Some Apostles of Physiology. 1902. 
Keith, Sir Arthur: Menders of the Maimed. 
Guerini, Vincenzo: A History of Dentistry. Philadelphia and 

New York, 1909, pp. 316, 318, 324. 



CHAPTER IX 

MORBID ANATOMY, ^ND HISTOLOGY: 
MORGAGNI, BICHAT 

WixraNGTON in his "Medical History" says that 
local pathology, the study of the tissues, and local 
diagnosis form the three legs of the tripod upon 
which the genius of modem medicine took her seat. 
The early history of these three — morbid anatomy, 
histology (urro9, tissue), and one aspect of local 
diagnosis — will occupy our attention in this and in 
the following chapter. 

Giovanni Battista Morgagni (1682-1771) has 
been called the Father of Pathology. Hb book 
"Concerning the Seats and Causes of Diseases in- 
vestigated by Anatomy*' ("De sedibus et causis 
morborum per anatomen indagatis," 1761) gave the 
results of postmortems known to himself, to his 
master Valsalva, and to others among their pre- 
decessors, such as Bonetus. Morgagni's study of the 
abnormal was based on a sound knowledge of the 
normal. He considered the commonest diseases the 
worthiest objects of investigation, and he was care- 
ful to establish the relations between the records of 
his autopsies and the symptoms of the precedent 
diseases. His aim was to explain disease by refer* 



1 84 THE HISTORY OF MEDICINE 

nected is'syphilis. Of the various manifestations of 
this disease a great many were known to him that 
were unknown to Hunter and other younger con- 
temporaries of the Italian pathologist. After telling 
of a rather hurried autopsy in which he had found 
aneurism of the aorta and a morbid condition of the 
lungs Morgagni surmises that a further examina- 
tion might have revealed a diseased state of the 
kidneys. "For these four parts — the lungs, the 
aorta, and the kidneys, with their appendages — we 
have found to be injured in those who have labored 
considerably, and for a long time, under this lues." 
He observed, in other cases of venereal disease, 
caries of the cranium, diseased epiglottis, as well as 
condylomata and gummata. Morgagni had not 
himself seen the liver affected, though very learned 
men reported that this organ was particularly liable 
to venereal infection. He believed indeed that the 
lues venerea might vitiate any viscus whatever. 

As early as 1743 Morgs^^ni observed the ossifica- 
tion of the coronary arteries. "As I examined," he 
writes, "the external surface of the heart, the left 
coronary artery appeared to have been changed into 
a bony canal, from its very origin to the extent of 
many fingers' breadth, where it embraces the greater 
part of the base. And part of that very long branch, 
also, which it sends down upon the anterior surface 
of the heart, was already become bony to so great a 



PATHOLOGY AND HISTOLOGY 185 

space as oould be covered by three fingers placed 
transversely." The subject in this case — an old 
man — had been carried into the hospital suffering 
from strangulated hernia. Inflammation of the 
bowels developed soon after his admission, and the 
patient succumbed almost immediately. Moi^gni 
was able to learn very little about his previous con- 
dition. The pulse was reported to have been weak 
and small, but not intermitting. Speaking of 
another case recorded by others before 1761, he 
wished we could know ^'what disorders, and what 
kind of death, had preceded in the man, in whom the 
coronary veins of the heart were found to be bony." 
He wished we could know, likewise, what particular 
disturbances had been felt by those in whom the 
corresponding arteries were bony. One writer had 
supposed that this condition might be extremely 
fatal, but that it was so he had been unable defi- 
nitely to affirm. After the death of Morgagni, Ed- 
ward Jenner conjectured that the heart disease from 
which John Hunter suffered for twenty years was 
caused by the ossification of the coronary vessels. 
In reference to his master's ailment he consulted 
Heberden, who had been the first, in 1768, to use the 
expression angina pectoris. Jenner's conjecture in 
reference to the condition of the coronary vessels in 
the case of Hunter was verified by the postmortem 
made by Everard Home. 



186 THE HI^ORY OF MEDICINE 

Morgagni has been credited with the first descri{>- 
tion of heart-block (later studied by Adams, 18271 
and Stokes, 1836), and with the first recorded case 
of disease of the mitral valve. He referred cyanosis 
in congenital heart disease to the general congestion 
of the venous system due to obstruction. He described 
lobar pneumonia with hepatization. He treated very 
fully biliary, renal, and cystic calculi and recorded 
cases of yellow atrophy of the liver, infantile jaun- 
dice, from which all of his fifteen children suffered, 
and tuberculosis of the liver and kidneys. 

According to Morg£^;ni, ^'In a woman who had 
not experienced more than dullness of hearing, Val- 
salva found the membrana tympani on both sides 
either totally or nearly destroyed by ulceration. 
On one side all the ossicles were thrown off, except 
the base of the stapes; and on the opposite side the 
incus was disjoined from the stapes.'' Morgagni 
adds that he liad never heard of any one who pre- 
served his hearing long after the stapes had been 
removed. He differed from his predecessors in 
reference to the causal relationship between intra- 
cranial suppuration and discharge from the ear, and 
supported his view by citing a case of abscess of the 
brain which was the ''consequence of the suppres- 
sion of ichor flowing out of the ear." No symptoms 
of brain abscess had been observed before the occur- 
rence of a diseased condition of the ear. 



PATHOLOGY AND HISTOLOGY 187 

Hydrophobia, in Morgagni*s opinion, is caused 
by a virus insinuated into the body. "Whoever, 
therefore, professes to have found out the nature of 
this disorder, must demonstrate the nature of this 
poison. But I do not even see that the seat of this 
disorder is confirmed/' He mentions, however, one 
case of hydrophobia in which the vessels in the 
meninges were extremely dbtended with blood. 
Tetanus was observed by Morgagni to result from 
apparently trivial injuries, such as the bite of a tame 
sparrow, or splinters driven into the hand. In one 
of the cases of tetanus he records, "A cart-wheel 
passed over the lower part of the left heel of a youth 
seventeen years of age; but no other injury was 
apparent except laceration of the common integu- 
ments.'* The first seat of a virulent gonorrhcea, he 
asserts, b in the larger canaliculi of the urethra. 
The term "Morgagni's fossa" (fossa navicularis 
urethrae) and many similar terms preserve his 
memory as a careful anatomist. "Morgagnian 
cataract" is a phase of hypermature cataract ob- 
served by him. In reference to traumatic cataract 
Morgagni, with his characteristic care in giving 
credit to those who have furthered the growth of 
medical science, quotes Hippocrates as saying that 
the sight is injured by wounds that are inflicted on 
the eye-brow or a little above it. 

Morgagni was in his eightieth year when he com- 



188 THE HISTORY OF MEDICINE 

pleted the ** De Sedibus/' the greatest landmark in 
the history of pathology. His birthplace was Forli, 
Romagna. At the age of sixteen he had begun his 
studies at the University of Bologna, where he im- 
bibed the view, once voiced by Malpighi, that sys- 
tems are ideal and mutable, observation and ex- 
perience solid and unchangeable. Before he was 
twenty he had graduated as doctor of medicine and 
doctor of philosophy. He succeeded his master Wai'' 
Baiv3,33 demonstrator anatomicus. He became known 
as a writer as early as 1706. Six years later he went 
to Padua, where he was appointed professor of 
anatomy in 171 5. He retained till the time of his 

death the chair which had been occupied by Vesalius 

• 

and many other distinguished anatomists. He wrote 
voluminously on a wide range of subjects, and was 
celebrated for general erudition and the elegance of 
his Latin. He had certain foibles, the parsimony 
that might be expected of a father of three sons and 
twelve daughters and the vanity that sometimes 
marks the character of great scholars and writers. 
The five books of the ''De Sedibus" contain the 
record of over six hundred dissections made by the 
author himself and the critical account of a great 
number of autopsies with which his extended read- 
ing had made him acquainted. In the words of 
Virchow, these books contain all that was known up 
to that time concerning changes produced by dis- 



PATHOLOGY AND HISTOLOGY 189 

ease in the structure of the human body. This 
greatest pathologist of the nineteenth century 
acknowledged the fundamental character of Mor- 
gagni's contributions. They furnished a starting 
point for the progress of modem medicine. '^The 
search for the sedes morhi has advanced from the 
organs to the tissues, and from the tissues to the 
cells/' 

It was Marie Frangois Xavier Bichat who made 
pathology dependent on a study of the tissues. He 
was bom in the village of Thoirette, France, Novem- 
ber 1I9 1771, and died at Paris July 22, 1802. His 
father was a doctor of medicine who had received 
his professional training at Montpellier. The son, 
Xavier Bichat, after a very thorough general educa- 
tion at Nantua and Lyons, began the systematic 
study of medicine in the latter dty in 1791. The 
political conditions of the time stimulated among 
the doctors a special interest in surgery, and Bichat 
came under the influence of Antoine Petit, the chief 
surgeon of the Hdtel Dieu of Lyons. The Bichats 
were not Revolutionists, and, after the siege of 
Lyons in 1793, Xavier left that city. Before the end 
of the year he took refuge in Paris, and entered as a 
student the school of the famous Desault, hoping 
later to become an army-surgeon. He mingled 
quietly with the other students of medicine at the 
Hdtel Dieu of Paris. The fall of Robespierre in 



190 THE HISTORY OF MEDICINE 

July, 1794, brought to the young man a greater 
sense of security and a fortunate incident gained for 
him the friendship and consideration of his master 
Desault. It was customary in the school for the 
students to take turns in preparing r6sum6s of the 
great surgeon's lectures. One day Desault spoke at 
length on fractures of the clavide, giving a demon* 
stration of the use of hb bandage. When the time 
came for the r6sum6» the student who was to have 
given it was not present and Bichat offered to take 
his place. E>esault'8 assistant, in whose presence the 
report was made, was deeply impressed by Bichat's 
clearness of thought and of expressbn. He told 
Desault of the incident, and the master, conscious 
of Bichat's extraordinary endowments, took the 
young man into hb home and treated him as a 
familiar friend and disciple. 

Henceforth Bichat seemed indefatigable. His only 
relaxation was change of work. He assisted Desault 
at the hospital, in hb operations, in his private 
practice, his professional correspondence, hb re- 
searches in surgery. When, toward the close of his 
life, Desault gave an extended course of lectures on 
the diseases of the bones, his tireless assistant pre- 
pared a careful statement of the teachings of the 
various authors from the time of Hippocrates con- 
cerning each question taken under consideration. 
At the same time Bichat continued to dissect. He 



PATHOLOGY AND HISTOLOGY 191 

along with Corvisart and others founded the Soci6t6 
m^icale d'6muIation, before which he read a num- 
ber of papers, including one on the synovial mem- 
brane and another dealing with the tissues in a more 
general way. After the sudden death of Desault, in 
1795, Bichat edited the fourth volume of his master's 
"Journal de Chirurgie/' compiled two volumes of 
extracts from the "Journal," and brought out the 
last volume of Desault's works. 

In 1797 Bichat undertook to lecture on anatomy, 
emphasizing the mutual relation of structure and 
function, and verifying his views by the experi- 
mental study of animals. He followed the course on 
anatomy with one on surgery, but was forced to 
desist for a time by a severe attack of haemoptysis. 
On his recovery he gave a more extended course on 
anatomy, establishing a dissecting room and direct- 
ing the work of about eighty students. In 1800 ap- 
peared two works setting forth Bichat's character- 
istic views concerning structure and function — 
"Traits des membranes," and "Recherches physi- 
ologiques sur la vie et la mort." The former became 
the basis of Bichat's "Anatomie g6n6rale" (1801), 
which established his claim as the founder of his- 
tology; the latter distinguished between the vie 
animale and the vie organique. These correspond to 
the functions which have to do with the external 
adjustments of the organism on the one hand and to 



192 THE HISTORY OF MEDICINE 

the functions which preserve the automatic activi- 
ties of the individual on the other hand* According 
to Bichat the cerebro-spinal nervous system and the 
ganglionic nervous system are the structures on 
which the animal functions and the organic func- 
tions respectively depend. At the same time he dis- 
tinguished the muscles of the animal life from the 
muscles of the organic life* 

Before the appearance of Bichat's ''Anatomie 
g£n6rale** the study of anatomy had been largely a 
study of the organs. These, according to Bichat» 
admit of histological analysis, disentanglement of 
their component parts. The organs, as he says, are 
made up of tissues which are of very different kinds 
and which really constitute its elements. Chemistry, 
he proceeds, has its simple bodies, which by various 
combinations, of which they are capable, form com- 
pound bodies; likewise anatomy has its simple tis- 
sues, which, by their fourfold or sixfold combina- 
tion, form the organs. Again, he compares the study 
of general anatomy to that to which an architect 
applies himself who, before constructing a house, 
tries to learn in detail the nature of the various 
materials he has to employ. The study of the gen- 
eral anatomist, as already implied, is analogous to 
that of the chemist who, before knowing the com- 
pound bodies, examines in isolation the elements 
which compose them, who before investigating, for 



PATHOLOGY AND HISTOLOGY ;i93 

example, the properties of the neutral salts, wishes 
to know their radicals. The study of general anat- 
omy, or histology, is in a sense, like chemistry, an 
abstract study: for no tissue exists in isolation; all 
tissues are combined in a more or less considerable 
number. 

What are the oi^ganic elements, which Bichat, in 
his search for a morphological unit comparable with 
the oxygen, nitrogen, carbon, and hydrogen known 
to the chemists of his time, discovered to be the 
components of the oi^gans of the body? He mentions 
twenty-one : cellular, nervous of animal life, nervous 
of organic life, arterial, venous, tissue of exhalants, 
that of absorbents and their glands, osseous tissue, 
medullary, cartilaginous, fibrous, fibro-cartilagi- 
nous, muscular of animal life, muscular of organic 
life, mucous, serous, synovial, glandular, dermal, 
epidermal, and pilous. It is of interest to find that 
the father of modem histology in the task of differ- 
entiating tissue from tissue considered the micro- 
scope of his time a hindrance rather than a help. 
He chose, instead, to submit them to the action of 
heat, air, water, the adds, the alkalies, and salts. 
He observed them under putrefaction and various 
other conditions, drying, boiling, and macerating 
them. "The relation," says Bichat, "of properties 
as causes with phenomena as effects is an axiom in 
physics, chemistry, and astronomy, almost too 



194 THE HISTORY OF MEDICINE 

hackneyed to repeat to-day. If my work establishes 
an analogous axiom in physiological science, it will 
have fulfilled its aim." According to him one must 
first discover the minute anatomy of the tissues, and 
the vital fimctions of the physiological elements. 
Pathological phenomena involve an alteration of 
these elements; therapeutics is concerned with 
restoration of the normal functions of the elements. 
At the same time Bichat regarded general anat- 
omy, or the study of the tissues, as an essential in-> 
troduction to descriptive anatomy as well as to 
pathology and therapeutics. The twenty-one tissues 
were- the subject of his "Anatomic g6n6rale"; their 
various combinations were the subject of his "Anat- 
omic descriptive." According to Bichat, descriptive 
anatomy examines the organs just as nature pre- 
sents them to us. It investigates first their external 
form, position, size, direction, etc. Then, pene- 
trating more deeply into their structure, it examines 
the number of systems — nervous, muscular, serous, 
mucous, etc. — which contribute to the formation of 
each, and the particular modifications they may 
undergo in each case; moreover, it must not be in- 
different to the relations of the structure to the func- 
tions. The stomach, for example, must be studied 
as an assemblage of tissues — mucous inside, serous 
outside, organic muscular in the middle. He who 
attempts to study the organs by means of the scalpel 



PATHOLOGY AND HISTOLOGY 195 

is like the architect who examines each room of a 
building, or like the chemist who investigates the 
reactions of the compounds without regard to the 
elements of which each is made up. Bichat pub- 
lished two volumes of the " Anatomie descriptive" ; 
at the time of his death he had almost completed a 
third volume and had prepared material for a fourth. 
Two of his friends brought the work to a conclusion 
in a fifth volume. Bichat and those with whom he 
was associated carried into the field of science the 
ardor and enthusiasm of the Napoleonic age. 

He pursued the study of morbid anatomy, espe- 
cially after his appointment as physician at the 
Hdtel Dieu in 1800, with an almost incredible vigor 
and heroism. At the same time he had the oppor- 
tunity of seeing all the remarkable cases of illness in 
that metropolitan hospital, where his amiable and 
magnanimous disposition almost disarmed envy it- 
self. He was natural and spontaneous without being 
inconsiderate. He was prepossessing, frank and 
candid, incapable of anger or impatience, quick to 
welcome the views or recognize the merit of others, 
generous and tolerant, approachable even when 
absorbed in work. He held, as we have seen, that 
disease involves an alteration of the tissues of which 
the organism is composed. '' Let us take for example 
the lungs," he is reported to have said in his last 
course of lectures. ''These organs are composed of 



196 THE HISTORY OF MEDICINE 

the pleura, of the parenchjrmatous structure of the 
lungs, and of the internal membrane. In pleurisy, 
the pleura only is inflamed, the pulmonary tissue 
and the mucous membrane remain untouched. In 
pneumonia, it is, on the contrary, the parenchjrmat- 
ous structure of the lungs that is affected, while its 
two membranes remain healthy. In the same man- 
ner catarrhal cough is exclusively confined to the 
mucous membrane, while the pulmonary tissue and 
the serous membrane are sound and healthy. We 
may reason in the same manner in relation to all the 
other organs.*' Thus Bichat, consciously building 
on the work of Motigagni, whom he considered the 
founder of pathological science, sought to advance 
from a pathology of the organs to a pathology of the 
tissues composing the organs. "It is to him," says 
Buisson, "that we are indebted for definite ideas 
concerning diseases of the peritoneum, diseases 
which had been usually confused with those of the 
organs covered by that membrane. He proved that 
each tissue has a special sort of malady, as well as a 
special character of vitality, and that even in the 
intestines, the morbid state of one tissue may be as- 
sociated with the healthy state of the neighboring 
tissues. Some authors had apprehended this truth ; 
Walter had indeed indicated exactly the nature of 
peritonitis; but, while all had observed particular 
facts, none had attached these ideas to a particular 
point of view." 



PATHOLOGY AND HISTOLOGY 197 

Bichat's study of therapeutics was, like his study 
of pathology and descriptive anatomy, based on his 
early study of the structure and functions of the 
tissues. In the presence and with the coSperation of 
more than forty students he examined the action of 
drugs on the various systems into which he had 
analyzed the organism. He was still engaged in this 
investigation when death overtook him. He had 
worn himself out with almost superhuman exertions. 
Within a few months he had opened more than six 
hundred bodies at the Hdtel Dieu and elsewhere. 
The fatigue resulting from his ceaseless activities 
had weakened his resistance to the inroads of dis- 
ease. On July 8, 1802, he examined some macerated 
tissues which were in such an advanced state of 
putrefaction that the students were driven out of 
the laboratory by the odor. When Bichat finally 
withdrew from his task he fell on the staircase in the 
hospital, and, hitting his head, was rendered for a 
time unconscious. On the following day he tried to 
resume his professional activities, but was seized 
by a violent headache. He succumbed to typhoid 
fever July 22. 

Corvisart, Napoleon's favorite physician, wrote 
to the First Consul: ''Bichat has just died on a 
battle-field which has claimed more than one victim ; 
no person, in so short a time, has done so much and 
so well." Napoleon shortly after gave directions 



198 THE HISTORY OF MEDICINE 

that a tablet be placed in the Hdtel Dieu commemo- 
rating the friendship and labors of Desault and 
Bichat. "Bichat," wrote Bonaparte, "would have 
greatly extended the domain of this science, so im- 
portant and so dear to humanity, if pitiless death 
had not struck him down at thirty years/' 

Buckle says that, " If we compare the shortness of 
his life with the reach and depth of his views," he 
"must be pronounced the most profound thinker 
and consununate observer by whom the animal 
frame has yet been studied." He adds: "We may 
except Aristotle, but between Aristotle and Bichat I 
find no middle man." We shall be safer, however, in 
accepting the soberer judgment of the physiologist 
Carpenter, who says: "Altogether Bichat left an 
impress on the science of life, the depth of which can 
scarcely be overrated ; and this not so much by the 
facts which he collected and generalized, as by the 
method of inquiry which he developed, and by the 
systematic form which he gave to the study of gen- 
eral anatomy in relation both to physiology and 
pathology," 

REFERENCES 

Bichat, M. F. X.: (i) TraiU des Membranes. 1800. 

(2) Eecherches pkysiologiques sur la vie ei la mart. i8oo. 

(3) AfuUomie ghirale, 2 vols. 1801. 

(4) Anatomie descriptive. 5 vols. 

Eydeshymer, A. C: "Xavier Bichat," InterstaU Med. Journal, 
St. Louis, 1908, vd. XV. 



PATHOLCXIY AND HISTOLOGY 199 

Morgagnif G. B.: (i) The Seals and Causes of Diseases (abridged 

by William Cooke). Boston, 1824. 
(2) The Seats and Causes of Diseases (translated by 

Benjamin Alexander). 3 vols., London, 1769. 
Virchow, Rudolf: "Morgagni and 'Anatomical Thought,'" 

BriHsh Medical Journal, April 7, 1894. Eleventh Intern. 

Med. Congress, Rome. 
Walsh, J. J.: Makers of Modem Medicine. New York, 1907* 

PP- 29-51. 



CHAPTER X 

LOCAL DIAGNOSIS: AUENBRUGGER. LAENNEC 

In the same year as Morgagni's ''De Sedibus et 
Causis Morborum/' appeared the ''New Invention 
for Discovering Obscure Thoracic Diseases by Per- 
cussion of the Chest." This "Inventum Novum" 
was the work of Leopold Auenbrugger (i 722-1 809), 
the son of an innkeeper of Graz, Austria. He was 
educated at the University of Viennat and in 175 1 
received an appointment in the Spanish Military 
Hospital of the Austrian capital. It was the age of 
Maria Theresa. In spite of the struggles of the Em- 
pire with Frederick the Great of Prussia and other 
enemies, Vienna continued to be one of the chief 
centers of European culture. At the time of the ap- 
pearance of the "Inventum Novum," the child 
prodigy Mozart was about to make his d£but at the 
Austrian court, Gluck was the Kapellmeister of the 
Empress, while Haydn held a similar position under 
the princely patronage of the Hungarian house of 
Eszterhazy. Into the culture life of Vienna at this 
time Auenbrugger was fitted by his talents and 
temi^erament to enter. He was popular at the im- 
perial court; extremely fond of music, he composed 
the libretto of an opera, **The Chimney Sweep" 



LOCAL DIAGNOSIS 201 

("Der Rauchfangkehrer'Of to please the Empress; 
and later received from her son, Emperor Joseph 11, 
the title Edler von Auenbrug on account of his 
geniality and other fine social qualitiest and not on 
account of his contribution to the advance of medi- 
cal science. 

In fact, the '' Inventum Novum" brought only an 
inadequate response from Auenbrugger's contempo* 
raries of the Old Vienna School. His teacher, the 
autocratic Gerard van Swieten, ignored it, as did 
also Anton de HaBn. These two leaders and volu- 
minous writers had studied at Leyden under their 
fellow countryman Boerhaave, whose influence they 
perpetuated. Maximilian Stoll (1742-86), however, 
who succeeded de HaSn as clinical teacher at 
Vienna, recognized the value of Auenbrugger'a 
method both in the diagnosis and treatment of 
pleurisy and empyema. And of course long after the 
prophet's death he foimd honor in his own country; 
for in 1839 Skoda, the leading clinician of the New 
Vienna School, wrote a treatise on percussion and 
auscultation, and '' diagnosis confirmed by post- 
mortem'' became the watchword in the medical 
circles of the Austrian capital. 

In the preface to the " Inventum Novum" Auen- 
brugger says: " I here present the reader with a new 
sign which I have discovered for detecting diseases 
of the chest. This consists in the percussion of the 



202 THE HISTORY OF MEDICINE 

human thorax, whereby, according to the character 
of the particular sounds thence elicited, an opinion 
is formed of the internal state of that cavity/' The 
brief treatise was the outcome of seven years' ob- 
servation, experiment, and reflection. ''What I have 
written I have proved again and again, by the testi- 
mony of my own senses, and amid laborious and 
tedious exertions/' But in spite of his confidence in 
the results he had achieved, he was far from believ- 
ing that he had exhausted the possibilities of his 
method, and he hoped that further observation and 
experience would lead to the discovery of other 
truths, in these or other diseases, of like value in the 
diagnosis, prognosis, and cure of thoracic affections. 
The sound obtained on the percussion of certain 
parts of the healthy chest resembles the stifled sound 
of a drum covered with a thick woollen cloth or 
other envelope. The most sonorous region is from 
the clavicle to the fourth rib anteriorly. ''The 
thorax ought to be struck, slowly and gently, with 
the points of the fingers, brought close together and 
at the same time extended/' The patient is told at 
first to breathe naturally; later he is directed to hold 
his breath after a full inspiration. During the exami- 
nation the patient must assume such an attitude as 
will render tense that part of the chest wall which 
at the moment is being subjected to percussion ; for 
thus a clearer sound is obtained. 



LOCAL DIAGNOSIS 203 

Auenbrugger believed that thoracic diseases of 
the worst description might exist without any symp- 
toms save those revealed by his method of percus- 
sion. If a naturally sonorous part of the chest is, on 
percussion, devoid of the usual resonance — yielding 
only the sound of a fleshy limb when struck — or if it 
gives out a sound duller than usual, disease exists in 
that part. He considered that the deviations from 
the natural sound are owing to the diminution of the 
amount of air normally contained in the lungs, a 
diminution which might arise from the occurrence of 
solids or liquids. An analogous sound may be ob- 
tained by striking a cask partly filled with water. 
The preternatural sound always accompanies a 
copious effusion of fluid in the thoracic cavity. 
Moreover, the '' effect of effused liquids in producing 
the morbid sound is at once proved by the injection 
of water into the thorax of a dead body; in which 
case it will be found that the sound elicited by per- 
cussion will be obscure over the portion of the cavity 
occupied by the injected liquid." In addition to the 
methods of investigation of which Auenbrugger 
gives here an indication, there is abundant evidence 
that he made it a practice, where it was feasible, to 
confirm his di^^^nosis by post-mortem examination. 

The appearances on dissection in cases where per- 
cussion had revealed an abnormal condition fall into 
two classes — those that involve primarily the 



204 THE HISTORY OF MEDICINE 

respiratory functions, and those found in the heart 
and pericardium. Under the first class Auenbrug^er 
noted the degeneration of the lung substance, the 
post-mortem organ being so engorged with blood a3 
to resemble liver in every respect, both as to color 
and consistency. Among the symptoms exhibited 
by patients suffering from such a d^eneration of 
the lung substance he mentions the diminution or 
entire absence of the natural sound over the affected 
part, and the relative immobility, during inspiration, 
of the chest on the affected side. Auenbrugger de- 
scribed vomicae resulting from the degeneration of 
the lung substance. They are encysted or contained 
in a sort of capsule; some of them are purulent, 
some are not; some are closed, others communicate 
with the bronchi. If, in the case of a patient suffer- 
ing from a purulent vomica which is discharging into 
the trachea, while the patient is coughing and spitn 
ting the physician places his hand over the site of 
the vomica, the noise of fluid within the chest will be 
distinctly manifest. When a vomica discharges its 
contents into the cavity of the pleura and upon the 
diaphragm, empyema is produced. ''If percussion 
is now applied, it will be found that the natural 
sound, which had been nearly lost on the site of the 
vomica, has in some degree been restored in that 
place; while it is more or less destroyed — according 
to the quantity of pus effused — over the posterior, 



LOCAL DIAGNOSIS 205 

and inferior parts of the chest." By dissection Auen- 
brugger also verified hisi diagnosis of unilateral and 
bilateral hydrothorax. Among the symptoms re- 
vealed by percussion he mentions a murmuring 
sound about the hypochondriac region. Moreover, 
in unilateral hydrothoraxt "the affected side, if com- 
pletely filled with water, is enfeebled and appears 
less movable during inspiration. In this case, also, 
the affected side yields nowhere the natural sound 
on percussion. If the chest is only half filled, a 
louder sound will be obtained over the parts to which 
the fluid does not extend, and the resonance will be 
found to vary according to the position of the pa- 
tient and the consequent level to which the liquid 
attains.'' Auenbrugger mentions hemothorax with 
and without an accompanying lesion of the lungs. 
He had never seen chylothorax, though he believed 
the disease existed in spite of the fact that the 
thoracic duct runs outside the pleura. 

As regards diseases of the heart and pericardium 
Auenbrugger's researches contributed to our knowl- 
edge of the symptoms and the morbid anatomy. In 
health the whole sternum yields on percussion as 
distinct a sound as the sides of the chest, except in 
the cardiac region, where it is somewhat duller; 
similarly on the left side of the chest, over the space 
occupied by the heart the sound loses part of its 
usual clearness. In hydropericardium the sound is 



206 THE HISTORY OF MEDICINE 

completely deadened as if the percussion were ap- 
plied to a healthy limb. Post-mortem discloses — in 
cases of dropsy of the pericardium — either a serous 
effusion or a purulent effusion, which commonly re- 
sembles turbid whey. The same signs are furnished 
by percussion in either case. "In the first variety 
the heart is rough, and, as it were, shaggy, with a 
coating of the purulent matter/' In the case of 
copious extravasation of blood into the pericardium 
percussion elicits none of the natural sounds over the 
space occupied by the extravasated blood. Similar 
results are yielded by percussion in cases of dilata- 
tion of the heart. 

In spite of such recognition as the "Inventum 
Novum'' early gained in Vienna and other centers 
of German medicine and its translation into French 
within a decade of its appearance, it remained for the 
great French clinician Corvisart (i 755-1 821) and 
his pupils to make Auenbrugger's influence at all 
general. Corvisart was an enthusiastic admirer of 
the teachings of the Vienna School, and was particu- 
larly familiar with the works of StoU. In 1808, a 
year before the death of Auenbrugger, he translated 
the "Inventum Novum" into French and wrote 
commentaries upon it. In 1806, under the direct 
encouragement of the Emperor Napoleon, he had 
published his own masterpiece, "Elssai sur les mala- 
dies et les 16sions du coeur et des gros vaisseaux.'* 



LOCAL DIAGNOSIS 207 

In this work Corvisart directs attention in the first 
place to diseases of the pericardium, notes the com- 
parative dullness of the sound resulting from per- 
cussion of the cardiac region in hydropericardium. 
and, later, studies the symptoms of dilatation, as 
well as of aneurism of the thoracic aorta. His diag- 
noses seemed to his pupils at times the result of 
intuition, but he was indeed a keen observer with a 
delicate sense of touch, and an acute sense of hearing 
that led him to anticipate the discovery of ausculta- 
tion. He also urged physicians not to neglect post- 
mortem examination, an injunction carefully heeded 
by his pupils Bayle and LaSnnec. 

"Our real knowledge," writes Osier of tuberculo- 
sis, " is a nineteenth century contribution, beginning 
with the work of Bayle on the structure of the tuber- 
cle and on its identity in the widely distributed 
lesions." In his early work, " Phthisie pulmonaire," 
Bayle spoke, like his predecessors, of types of 
phthisis other than the tuberculous, but in his later 
work, " Remarques sur les tubercles," he recognized 
the specific character of the disease. He defined 
tubercles as little cysts containing organized solid 
matter, capable of softening and breaking down. 
He had found them post-mortem in the lungs, 
mesentery, liver, kidnejrs, prostate, and other or- 
gans, but he had not observed them in the brain. 
The fact that they might occur so widely distributed 



208 THE HISTORY OF MEDICINE 

in the one subject seemed to indicate that all tu- 
bercles are identical in nature. He even used the 
expression "tuberculous diathesis" to designate a 
constitutional tendency to tuberculosis. In the 
diagnosis of diseases of the chest Bayle resorted to 
immediate auscultation. The employment of this 
method by Bayle led to its adoption by his fellow 
student LaSnnec and thus to the discovery of a 
much better method. 

Ren6 Thtephile Hyadnthe LaSnnec was bom at 
Quimper, Finist^ (the French Land's End), Feb- 
ruary 17, 1781. One of his relatives, under whose 
direction he began his professional education, had 
been a pupil of Jc^n Hunter's. Ren6 LaSnnec studied 
medicine as early as 1795 at the Hdtel Dieu at 
Nantes, accompanied a military expedition against 
an insurrection in the west of France in 1800, had a 
little experience in military hospitals, and before 
the end of 1800 went to Paris for further training in 
medicine. There he attended the popular clinics of 
Corvisart at the Unit6 (Charit6), met Bayle, and 
heard Bichat's last course. His medical education 
was very thorough. During three years as student 
at La Charit6 he wrote up four hundred cases that 
came under his observation. He discovered the del- 
toid bursa and the fibrous capsule of the liver; and 
he became a recognized authority in morbid anatomy. 
His culture was not confined to narrow professional 



LOCAL DIAGNOSIS 209 

lines; he was a linguist and something of a poet; he 
was versed in the writings of Hippocrates and the 
other great phjrsicians of the past, and he held that 
discoveries in medical science are made only by those 
who know its history. 

Among the many influences that led to LaSnnec's 
great invention was the work of Chladni in acoustics 
which had been stimulated in the first place by an 
intense interest in music. Chladni had given an ac- 
count of his researches in the presence of some of the 
leading scientists of Paris; and in 1809 had pub- 
lished a French edition of his work under the title 
"Trait6 d'acoustique." The Emperor had drawn 
general attention to the subject by the terse remark: 
''Chladni makes tones visible." One day about the 
middle of October, 1816, LaSnnec saw some boys at 
play in a court of the Louvre, who by listening at 
the end of a beam were able to hear the sound of the 
scratching of a pin transmitted from the other end. 
On the following day there occurred an experience 
which we shall relate in LaSnnec's own words. 

"I was consulted in 1816/' he writes, "in the case 
of a young person who showed symptoms of heart 
disease and in whom palpation and percussion gave 
poor results on account of her embonpoint. The age 
and sex of the patient forbidding the sort of exami- 
nation of which I have just spoken, immediate 
auscultation, I happened to recall a familiar fact in 



210 THE HISTORY OF MEDICINE 

acoustics, namely, that if one places his ear at one 
end of a piece of timber he can hear very distinctly 
the scratch of a pin at the other end. It occurred to 
me that I might take advantage, in the case with 
which I had to deal, of this physical property. I 
took a paper notebook, rolled it up tightly, applied 
one end to the precardiac region and listened at the 
other. I was as greatly surprised as I was pleased to 
hear the. heart-beats much more dearly and dis- 
tinctly than I had ever been able to hear them 
through the immediate application of the ear. From 
that time I took it for granted that this means might 
become a method useful and applicable not only in 
the study of heart-beats, but in the study of all 
movements which may produce a sound in the 
thorax, and, consequently, in the examination of the 
respiration, of the voice, of the r^e, and perhaps 
even of an effusicm in the pleura or pericardium.*' 
Under this conviction LaSnnec began at once a 
aeries of observations at the Necker Hospital (to 
which he had just been appointed vbiting physician) 
from which he was able to deduce a set of new signs 
of diseases of the chest, which he considered certain, 
simple, striking, and calculated, perhaps, to render 
the diagnosis of diseases of the lungs, pleura, and 
heart as definite as the indications furnished to the 
surgeon in the case of a stone in the bladder or of a 
fractured limb. The first instrument of which he 



LOCAL DIAGNOSIS 211 

made use was a cylinder of paper, tightly rolled, and 
kept in shape by means of paste. Later he tried 
various other materials. Following a series of ex- 
periments, he employed in his examinations of the 
chest sounds "a cylinder of wood, an inch and a 
half in diameter, and a foot long, perforated longi- 
tudinally by a bore three lines wide, and hollowed 
out into a funnel-shape, to the depth of an inch and 
a half, at one of the extremities/' To this instrument 
he gave the name ''stethoscope'' (crr^tfos, chesty 
and (TKoircti^, explore). 

La£nnec reported some of his results to the Acad6- 
mie des Science in 1818, and in 1819 published the 
first edition of his work " De 1' Auscultation Mediate." 
In 1820 he retired to Kerlouamec, where he spent 
two years resting and recuperating. In 1822 he re- 
turned to Paris, and received appointment as pro- 
fessor of medicine at the Coll^ de France. In the 
following year he was given the chair of clinical 
medicine at La Charit6. In 1826 appeared the sec- 
ond edition of his great work. 

Like Auenbrugger, of whose method of percussion 
he had made considerable use, LaSnnec sought first 
of all to establish the sounds heard on the examina- 
tion of a normal subject. "On applying the cylin- 
der," he writes, "... to the breast of a healthy 
person, we hear, during inspiration and expiration, 
a slight but extremely distinct murmur, answering 



212 THE HISTORY OF MEDICINE 

to the entrance of air into, and its expulsion from, 
the air cells of the lungs." 

Shortly after beginning his observations by means 
of the newly discovered method, LaSnnec, in the 
case of a woman suffering with a slight bilious fever 
and a recent cough, applied the cylinder below the 
middle of the right clavicle while she was speaking. 
Her voice seemed to come directly from the chest, 
and to reach the ear through the central canal of the 
instrument. This peculiar phenomenon was con- 
fined, he proceeds, to a space about an inch square. 
Ignorant of the cause of this singularity, he exam- 
ined the greater number of the patients in the hos- 
pital, and found the same phenomenon in about 
twenty of them. He began to suspect that it might 
be caused by tuberculous cavities in the lungs. The 
subsequent death of the majority of the patients 
who had exhibited this peculiarity gave him the op- 
portunity to verify his conjecture. In all cases post- 
mortem examination revealed lat^r or smaller cav- 
ities, which communicated with the bronchial tubes 
and which were the result of the breaking down of tu- 
bercles. "I found the peculiar phenomenon (which 
I have termed Pectoriloquy) to be perceptible accord- 
ing to the density of the walls of the cavity and its 
proximity to the surface of the lungs.'' 

LaSnnec, though inclined to admit, like Auen- 
brugger, the possibility of a phthisis nervosa, taught 



LOCAL DIAGNOSIS 213 

that pulmonary consumption is caused by the de- 
velopment in the lungs of tubercles which may ap- 
pear as isolated bodies or as a tuberculous infiltra- 
tion. Under the former come miliary tubercles, 
crude tubercles, encysted tubercles, and tuberculous 
granules. Under tuberculous infiltration he recog- 
nized the gray and the yellow. LaSnnec observed 
tubercles in the peritoneum, testicles, uterus, cervi- 
cal and mesenteric glands, heart, spleen, brain, 
bones of skull, ribs, vertebrae and their ligaments. 
For him scrofula was tuberculosis of the glands; he 
insisted on the frequency of tuberculous pleurisy ; in 
fact, he supported the doctrine of Bayle in reference 
to the specific character of tuberculosis. In pulmon- 
ary tuberculosis tubercles should be especially sus- 
pected at the apex of the lungs, and under the clavi- 
cle. The cure of phthisis is possible, since autopsies 
show us how nature has worked a transformation in 
the so-called ulcers of the lungs, that is, tuberculous 
cavities. Lafinnec had little faith in the therapeutic 
value of medicines, etc., in cases of phthisb. He ad- 
vocated, rather, hygienic treatment — nourishing 
food, travel, and fresh air, particularly sea air. 

In the judgment of LaSnnec segophony (a!^, 
atyo^, wild goat^ ^mnj^ sound) was indicative of 
pleurisy attended by a moderate effusion in the 
pleura, or of hydrothorax or other extravasation in 
the chest cavity. Simple aegophony is described by 



214 THE HISTORY OF MEDICINE 

him as a peculiar sound of the voice accompanying 
or following the articulation of words. He speaks 
of it as a kind of silvery voice, of a sharper and 
shriller tone than that of the patient. It seems to 
vibrate on the surface of the lungs, more like the 
echo of the voice than the voice itself. ** It has, more- 
over, another character, so constant as to lead me to 
derive from it the appellation of the phenomenon — 
I mean a trembling or bleating sound like the voice 
of a goat, a character which is the more striking be- 
cause the key or tone of it approaches that of this 
animal's voice." In another passage Laennec says 
that aegophony is characterized by the harsh, trem- 
ulous, silvery tones of the voice, which is commonly 
shriller than the natural voice of the patient, and 
seems to be quite superficial, and to float, as it were, 
on the surface of the lungs, instead of coming from 
the interior, like pectoriloquy or bronchophony. 
LaSnnec sought to produce experimentally the 
tremulous echo of a voice that seemed to him to 
occur in pleurisy with effusion, and other forms of 
thoracic disease. Accordingly, before applying the 
stethoscope he placed a bladder half filled with 
water between the scapulae of a young man with a 
well-marked natural bronchophony at this point. 
The stethoscopic sound seemed sharper and also 
slightly tremulous. A like experiment tried over the 
larynx seemed to give the like result* 



LOCAL DIAGNOSIS 215 

We owe, of course, to the investigations of LaSn- 
nee our knowledge of the various i41es and their 
diagnostic significance. In his classic description of 
lobar pneumonia we find the stages revealed by 
post-mortem examination coupled with the physical 
signs — the early crepitant rftle, and the mucous 
i^le that accompanies resolution. He held that a 
metallic tinkle could be heard in hydro-pneumo- 
thorax or pyo-pneumothorax. Surpassing the work 
of Bichat he gave a masterly description of bron- 
chitis with its sonorous and sibilant r&les. He de- 
scribed also the rdle humide and the souffle. We are 
indebted to LaSnnec for descriptions of bronchiec- 
tasis, oedema of the lungs, pulmonary "apoplexy,'.' 
haemorrhagic pleurisy, gangrene of the lungs and 
emphysema. It seemed to him that vesicular emphy- 
sema is, next to hypertrophy, the simplest of all the 
organic lesions of the lungs, since it consists merely 
in the dilatation of the air cells. On this account it 
remained long unknown, and had, he thought, not 
been correctly described by any author before his 
time. "I," he continues, "for a long time thougl^t 
it very uncommon, because I had observed only a 
few cases of it; but since I have made use of the 
stethoscope, I have verified its existence as well on 
the living as the dead subject, and am led to con- 
sider it by no means infrequent." In some cases the 
lung takes on a striking resemblance to the vesicular 
lungs of Reptilia. 



216 THE HISTORY OF MEDICINE 

It did not occur to LaSnnec to make use of the 
stethoscope in the diagnosis of pregnancy. This idea 
came first to his friend Dr. Kergaradec while verify- 
ing the facts contained in the first edition of " Medi- 
ate Auscultation." Dr. Kergaradec's conclusions 
are stated in the appendix of the second edition of 
that work. In putting his idea to the test he ob- 
served the foetal heart-beat, as well as the placental 
bruit, in a woman very near her confinement. The 
latter he described as an arterial pulsation accom- 
panied by a bellows sound. The foetal pulse» which 
is distinctly audible in the sixth month and some- 
times a little earlier, is usually twice as rapid as that 
of the mother. The placental sound, which is usually 
perceptible about the fourth month, is, on the other 
hand, isochronous with the pulse of the mother. 

"LaSnnec," saj^ Osier, "laid the foundations not 
only of our modem knowledge of tuberculosis, but 
of modem clinical medicine." By the invention of 
the stethoscope he brought into play one of the 
higher senses and armed the profession with the 
means of a more adequate diagnosis. He did not 
underrate his own achievement, holding, as he did, 
to the Hippocratic conviction that theory must rest 
on observation, and adopting as the motto of his 
work: An important part of the art is in my judg- 
ment to be able to explore (fteya 8c /leXos rfytvfuaC 
rrj^ rexyv^ cli/atro BvpacrOai cricoif eiv). Very much of 



LOCAL DIAGNOSIS 217 

LaSnnec's work was so well done that it needs tOKlay 
little change in the way either of correction or addi- 
tion. In the diagnosis of diseases of the heart his 
endeavors were soon supplemented by the investi- 
gations of his disciples of the Dublin School and 
other great leaders in clinical medicine. 

After completing the second edition, which was 
almost a new work, of the *' Mediate Auscultation/* 
LaSnnec once more retired to Finist&re in the hope 
of again reestablishing his health. The sea breezes 
and outdoor life failed, however, to revive his pow- 
ers, exhausted by years of constant activity, and 
August 13, 1836, he succumbed to one of those dis- 
eases from which his genius has rescued so many 
victims. 

REFERENCES 

Caxnac, C. N. B.: Epoch-making ContrHnUians to Medicine and 

Surgery. 1909. 
Meunier, L.: Histoire de la MSdecine, 191 1. 
Thayer, W. S.: "LaCnnec — One Hundred Years After," 

Canadian Medical Association Journal^ vol. ix, no. 9, 

Sept, 1919. 
Walsh, J. J.: Makers of Modem Medicine. Third edition, xgi5« 



CHAPTER XI 

ADVANCES IN PHYSIOLOGY 

Among the many advances in physiology in the 
nineteenth century must be mentioned above all the 
progress made in the study of the functions of the 
nervous system through the investigations of the 
experimental physiologists, Charles Bell, Ms^ndie, 
Marshall Hall, Johannes Mttller, and Claude Ber- 
nard. For this progress the way had been prepared 
by Albrecht von Haller. Bom at Berne, Switzerland, 
October i6, 1708, Haller was favored by striking 
natural endowments, as well as by almost unlimited 
opportunities for education. The accounts of his 
linguistic, literary, and scientific attainments while 
he was still little more than a child are not far from 
incredible. His more advanced education began at 
Tubingen, where he studied anatomy and, under the 
direction of Camerarius, botany. From Tttbingen he 
was drawn to Leyden by the reputation of Boer- 
haave. After graduating at the age of nineteen, he 
visited England, where he came in contact with some 
of the leading British scientists. At Paris he came 
under the influence of the anatomist Winslow, and, 
at Basel, before returning to his native city, he 
studied mathematics under Jean Bemouilli. In 



ADVANCES IN PHYSIOLOGY 219 

1736 Haller, after years of private practice, of a 
limited sort, and much study, was induced by 
George II of England to accept a professorship of 
medicine, anatomy, botany, and surgery in the 
newly established university of Gfittingen. Here as 
elsewhere he was indefatigable. After seventeen 
years' activity at this Hanoverian seat of learning 
he returned to his native Berne, where he spent the 
remaining twenty-four years of his life. 

Of Haller's many claims to distinction his work as 
a physiologist is the most convincing, though his 
knowledge of human and animal structure, on which 
his knowledge of physiological function was based, 
was very thorough. Haller's influence increased the 
range of experiments on living animals. He de- 
clared that, in spite of its apparent cruelty, vivisec- 
tion is of more value in the study of physiology than 
all other methods and that a single experiment of 
this kind has often cleared up misconceptions solu- 
ble by no other means of investigation. The func- 
tion and structure of mammals, birds, fishes, and 
still lower forms of life, helped him to explain the 
anatomy and physiology of man. 

Haller laid the progress of phjrsiology under par^ 
ticular obligation by his experiments on muscles and 
nerves and by the doctrine he based on these experi- 
ments. In 1752 they were reported to the RoyaF 
Society of Gfittingen, of which he was the founder 



220 THE HISTORY OF MEDICINE 

and president. He taught that irritability b the in* 
herent property of musde, while sensibility is the 
characteristic property of nerves. He used the term 
"irritability" in the sense of "contractility"; that 
is, in a much more restricted sense than Glisson, who 
in 1677 had spoken of the irritability of all animal 
tissues. Haller admitted that the usual stimulation 
which brings about the contraction of a muscle is 
conveyed by means of the nerves. Yet for this 
means of stimulation there might be substituted 
other forms which prove effective even when the 
connection between the nerve and the musde is 
severed. It is the function of the nerves, on the 
other hand, to transmit to the consciousness the 
changes called forth by peripheral stimuli; or, in 
other words, the nerves are exclusively the organs 
of sensibility. For example, the retina is a network 
oi nerve fibers which serve to transmit sensations of 
light. The rays of light coming from the object be* 
fore us produce an impression on the retina which 
constitutes a stimulus of the optic nerve. What we 
feel isinot the object itself, but the impression which 
the object makes on the particular nerve in question. 
It would seem to follow from this that the nerve of 
each sense has its own special mode of responding to 
stimulation, and that sensations are subjective in 
character, though they afford grounds for arriving 
at a judgment in reference to the nature of the outer 



ADVANCES IN PHYSIOLOGY 221 

world. Irritability may be found in detached parts 
of the body quite withdrawn from the empire of the 
soul. It is therefore absurd to seek to identify the 
soul with mere irritability. The nerves, the true 
organs of sensibility, contain, Haller was inclined to 
believe, a subtle, automatic fluid, being influenced 
no doubt in this belief by the contemporary dis- 
coveries in electricity. He also taught that memory 
is developed through the persistence of impressions 
on the brain substance. 

In 181 1 Sir Charies Bell (1774-1842) circulated a 
privately printed pamphlet, ^'An Idea of a New 
Anatomy of the Brain.'* In this occurred this pas* 
sage: "On laying bare the roots of the spinal nerves 
I found that I could cut across the posterior f asdcu* 
lus of nerves which took its origin from the posterior 
portion of the spinal marrow without convulsing the 
muscles of the back, but that on touching the an- 
terior fasciculus with the point of the knife the 
muscles of the back were immediately convulsed.'' 
In his work "The Anatomy of the Human Body" 
(7th edition) he admitted that sensibility is indeed 
seated in the nerves, but that is only one of their 
functions. There are nerves which possess no sensi- 
bility at all. He was led to surmise this difference of 
function by observing beforehand differences of 
structure, being early struck by the perfect regular- 
ity of the spinal nerves as contrasted with the very 



222 THE HISTORY OF MEDICINE 

great irregularity of the cranial nerves. He argued 
that if the endowment of a nerve depend on the rela- 
tion of its roots to the columns of the spinal marrow 
and the base of the brain, then the observation of 
their roots must indicate to us their true distinction 
and their different uses. It was necessary to know 
in the first place whether the phenomena exhibited 
on injuring the separate roots of the spinal nerves 
correspond with what was suggested by their anat- 
omy. He hesitated to put the question to the test of 
experiment because of the cruelty that seemed 
necessarily involved. It finally occurred to him, 
however, that it was best to experiment on an ani- 
mal in a state of insensibility, as otherwise it might 
be difficult to distinguish between the expression of 
pain and the effect produced through the motor 
nerves. 

^'I therefore,'* he continues, *' struck a rabbit 
behind the ear, so as to deprive it of sensibility by 
the concussion, and then exposed the spinal marrow. 
On irritating the posterior roots of the nerve, I 
could perceive no motion consequent, on any part 
of the muscular frame; but on irritating the anterior 
roots of the nerve, at each touch of the forceps there 
was a corresponding motion of the muscles to which 
the nerve was distributed. These experiments satis- 
fied me that the different roots and the different 
colunms from whence these roots arose, were devoted 




SIR CHARLES BELL 



ADVANCES IN PHYSIOLOGY ^23 

to distinct officest and that the notions drawn from 
the anatomy were correct/* In a paper communi- 
cated to the Royal Society of London in 1821, we 
find Sir Charles Bell pursuing a similar line of argu- 
ment and reporting a similar method of investiga- 
tion in ref er«ice to the function of one of the cranial 
nerves. He drew attention to the complicated nerve 
supply of the face, inexplicable on the assumption 
that the nerves are confined to a single function. 
He maintained that an oi^^an that has only one func- 
tion has only one nerve, and assumed that the pres- 
ence of a number of nerves supplying the same part 
of the body gave ground for surmising a variety of 
function. He submitted to special examination the 
facial nerve (partio dura)^ the branches of which are 
so largely concerned in the expression of the emo- 
tions, and the paralysis of which gives rise to what 
is now known as Bell's palsy. He produced artificial 
paralysis in experimental animals by dividing the 
nerve after its emergence from the stylo-mastoid 
foramen. The cutting of the nerve called forth no 
sign of pain. The muscles of the side of the face on 
which the nerve was cut no longer acted in harmony 
with the other muscles involved in the act of respira- 
tion, and in the expression of emotion so closely as- 
sociated with respiratory movements. If the facial 
nerve of one side of the face is cut and that of the 
other left intact and the animal is bled to deaths the 



224 THE HISTORY OF MEDICINE 

contrast in expression between the two sides of the 
face of the dying animal is most striking. 

The different functions of the nerves afford a clue 
to the functions of the brain and spinal cord. Some 
of the nerve trunks are made up of filaments that 
merely convey sensations; while other nerve trunks 
are made up of filaments that merely convey motor 
impressions to the muscles: a third class of nerve 
trunks are made up of the two kinds of filaments, 
as we have seen in the case of the spinal nerves. 
The brain and cord in turn are divided into parts 
concerned respectively with sensations and bodily 
movements. By many authorities in physiology 
Bell's contribution to neurology has been compared 
in value with Harvey's discovery of the circulation 
of the blood. As early as November 26, 1807, Bell 
had written to his brother: "I have done a more 
interesting nova anatomia cerebri humani than it is 
possible to conceive. I lectured it yesterday. I 
prosecuted it last night till one o'clock; and I am 
sure it will be well received." 

Francois Magendie, who founded the ''Journal de 
physiologie exp6rimentale" in 1821, confirmed in 
the following year, by experiments on a litter of 
eight puppies six weeks old, the results obtained by 
Sir Charles Bell in reference to the functions of the 
roots of the spinal nerves. At that time Magendie 
had not heard of Bell's experiments to determine 



ADVANCES IN PHYSK)LOGY 225 

these functions. First he cut, In one of the litter of 
pups, the posterior roots of the lumbar and sacral 
nerves of one side, leaving the posterior roots on the 
other side uncut in order that he might have a basis 
of comparison* The parts of the body to which the 
cut nerves were distributed were still capable of 
movement, though their sensibility was wholly ex- 
tinct. A second experiment of the same description, 
and a third, showed like results. Magendie then 
succeeded in another pup in cutting the anterior 
roots of the lumbar and sacral nerves of one side. 
The results here also were not hard to interpret, the 
part of the body concerned becoming completely 
motionless and lax, while retaining its sensibility. 
"Finally," writes Magendie, "to neglect nothing, I 
cut the anterior and the posterior roots at the same 
time; there was then an absolute loss of sensibility 
and movement.'* He concluded from this investiga- 
tion that the anterior and posterior roots have di£Fer- 
ent functions, in fact, "that the posterior appear 
more particularly destined for sensibility, while the 
anterior seem more especially connected with move* 
ment." 

Just three months later Magendie published an 
account of further experiments bearing on the func- 
tions of the roots of the spinal nerves. Interested in 
the action of drugs — morphine, strychnine, eme- 
tine, veratrine, brucine, piperine, bromine, iodine, 



226 THE HISTORY OF MEDICINE 

and prussic add — as well as in the functions of the 
nerves, he gave nux vomica to experimental animals 
and noted the modification of the action of the poison 
produced by cutting one or the other set of roots of 
certain spinal nerves. If the posterior roots alone 
were cut, tetanus was complete. When the anterior 
roots of the nerves supplying the hind leg were cut, 
this member remained supple and motionless, while 
under the influence of the poison all the rest of the 
body was thrown into convulsions. 

In 1833 Marshall Hall read before the Royal So- 
ciety a paper On the Reflex Function of the Medulla 
Oblongata and Medulla Spinalis. Consciously bas- 
ing his investigation on the work with decerebrated 
animals of certain French physiologists, Hall was 
particularly interested in phenomena brought about 
by eccentric, or peripheral, stimulation. He wished 
to distinguish these phenomena from sensation and 
volition, the characteristic functions of the cere- 
brum. Among these phenomena he mentions wink- 
ing, sneezing, coughing, swallowing, vomiting, tenes- 
mus and the maintenance of equilibrium. In the 
reflex function the muscles are excited by a stimulus 
acting along nerves proceeding to the medulla and 
muscular nerves proceeding from the medulla. The 
reflex function keeps the glottis open, through the 
superior laryngeal nerve connected with the cord, 
and keeps the sphincters closed. Infants bom with- 



ADVANCES IN PHYSIOLOGY 227 

out cerebrum or cerebellum are capable of sucking, 
grasping, and crying. Strangury may be caused re* 
flexly by the irritation of the rectum. Reflex action 
tis increased by strychnine and opium, decreased by 
ihydrocyanic add. 

In reaching his illuminating conclusions Marshall 
-Hall had experimented with snakes, turtles, frogs, 
toads, newts, and guinea-pigs. He tells particularly 
of dividing the spinal marrow of a very lively snake 
(coluber natrix), between the second and third 
vertebrae. ^'From the moment of the division of 
the spinal marrow, it lay perfectly tranquil and 
motionless, with the exception of occasional gasping 
and slight movements of the head.'' Upon stimula* 
tion, however, the body began to move with great 
activity. When carefully protected "from all ex- 
ternal impressions, it moved no more, but died with 
the precise position and form which it had last as- 
sumed." Hall argued that sensation can act, in in- 
ducing muscular motion, only through the medium 
of volition; that, in the experiments which were per- 
formed by him, volition, that is, the will, and not 
the power, to move, was annihilated; that in such 
cases — volition being destroyed and the agency of 
sensation excluded — the influence of external im- 
pressions, which might be supposed to induce pain, 
must have been exerted upon some property of the 
nervous system different from sensibility. In fine. 



228 THE HISTORY OF MEDICINE 

in Hall's judgment the cerebrum is the source of 
voluntary emotions, the medulla oblongata the 
source of respiratory motions, the medulla spinalis 
the middle arc of the reflex function, the sympathetic 
nervous system the source of nutrition, secretion, 
etc. 

About ten years after Magendie had given clear 
experimental proof of the difference in function of 
the anterior and posterior roots of the spinal nerves, 
a further confirmation of BelFs view was a£Forded by 
the great German scientist Johannes Mailer (1801- 
58), who has been called the founder of scientific 
medicine in Germany. ''The happy thought at 
length occurred to me," he writes, "of performing 
the experiment on frogs. The result was most satis- 
factory. The experiments are so easily performed, so 
certain and conclusive, that every one can now read- 
ily convince himself of one of the most important 
truths of physiology. ... It is quite impossible to 
excite muscular contractions in frogs by irritating 
mechanically the posterior roots of the spinal 
nerves; while, on the other hand, the slightest irrita- 
tion of the anterior roots immediately gives rise to 
strong action of the muscles. • . • The application of 
galvanism to the anterior roots of the spinal nerves, 
after their connection with the cord is divided, ex-' 
cites violent muscular twitchings; the same stimu- 
lus applied to the posterior roots is attended by no 



ADVANCES IN PHYSIOLOGY 229 

such effects. ... If in the same frog the three poste- 
rior roots of the nerves going to the hinder extremi- 
ties be divided on the left side, and the three an- 
terior roots on the right side, the left extremity will 
be deprived of sensation, the right of motion,*' 

MttUer must also be held responsible for formu- 
lating the so-called law of the specific eneiigy of the 
nerves. We find it as an implicit assumption in the 
works of Haller and other physiologists. John 
Hunter had stated that the only kind of sensations 
obtained by stimulating the optic nerve are sensa- 
tions of light, irrespective of the nature of the 
stimulus. According to Mailer the nature of the 
sensation depends not on outside objects but on the 
native substance of the sensory nerve involved in 
the sensation. For example, the optic nerve cannot 
be stimulated without giving rise, in accordance 
with its inherent energy, to sensations of light and 
color. Light and color do not exist as something 
fixed and objective which, affecting the sense of 
sight, calls forth a corresponding sensation ; but the 
mechanism of sight produces always sensations of 
the same mode whatever may be the nature of the 
stimulus. Similarly, the auditory nerve cannot be 
stimulated without giving rise to auditory sensa- 
tions; the gustatory nerve causes only sensations of 
taste. The character of the stimulus may be mani- 
fold, as we all know in the sense of sight: pressure. 



230 THE HISTORY OF MEDICINE 

percussion, friction, heat, cold, electricity, chemical 
reagents, the throbbing of an artery, an inflamma- 
tion of the retina. Whatever stimulates the optic 
nerve serves to dispel the sensation of darkness and 
to substitute sensations of light and color, just as by 
a stimulation of the motor nerves no effect may fol- 
low except the contraction of the muscles to which 
the nerves in question are distributed. It follows, 
of course, from this doctrine of the specific energy 
of the sensory nerves that our sensations do not re- 
veal the essential qualities of the objective world. 
Our knowledge of outside things is limited by our 
knowledge of the sensations aroused in us by stimuli. 
At the present time physiologists and psychologists 
believe as a rule that the nerve fibers are mere con- 
ductors, and that the specific differences of sensa- 
tions depend on the nature of the receptors, the in- 
born organization of the cortical areas to which the 
afiferent impulses are conducted, or on both of these. 
Johannes MflUer stands out as one of the greatest 
leaders in the progress of physiology. The compre- 
hensiveness of his interests as reflected in his two 
volumes, "Handbuch der Physiologic des Men- 
schen" (1833-40), the comparative character of his 
physiology, his recognition of the dependence of 
psych6logy on physiology (in which he followed the 
lead of Cabanis, the real founder of physiological 
psychology), and his striking personality, contrib- 



ADVANCES IN PHYSIOLOGY 231 

uted to make him a wonderfully inspiring influence. 
Following the example of VirchoWi many speakers 
and writers have said that there was something 
superhuman about Johannes MQllen Adopting this 
point of view, one should hasten to add that his was 
a sort of inunanent divinity that wrought its most 
notable achievements by purely human instru- 
mentality. While no single first-class contribution 
to physiology stands to his credit, the labors of his 
pupils bear witness to the commanding character of 
his genius. Let it suffice here to mention Helmholtz, 
the inventor of the ophthalmoscope and the ophthal- 
mometer, who measured the velocity of the nervous 
impulse, and was no less distinguished in acoustics 
than in optics; Du Bois-Reymond, who brought the 
apparatus of the physicist to bear on the study of 
the nerves and muscles; and Brttcke, who carried 
MUller's influence to Vienna. 

Claude Bernard (1813-77). advanced the study of 
the functions of the nerves (to which Bell, Magendie, 
Hall, and MUller so notably contributed) and 
furthered remarkably the solution of problems in 
other departments of physiology. He was bom near 
Lyons, studied medicine at Paris, and, after taking his 
degree, became an interne at the Hdtel Dieu under 
the superintendence of Magendie, and in 1841 was 
appointed assistant {prSparateur) in Magendie's 
laboratory at the College de France. In 1839 



232 THE HISTORY OF MEDICINE 

Magendie, on the basis of experiments on the roots 
of the spinal nerves, claimed that the anterior roots, 
though motor, were not wholly devoid of sensibility. 
This claim that there existed in the anterior txx>ts a 
sensibUitS en retour^ or, as it was afterwards called, 
sensibilitS rScurrente, was vigorously disputed, and 
it was only after a long series of experiments on dogs 
conducted by Magendie and Bernard that the claim 
was upheld. According to Bernard by means of the 
sensory fibers from the posterior txx>t which find 
their way into the anterior root a functional har- 
mony is established in the sensory-motor mechan- 
ism. For him the reflex movements, studied as he 
notes by Hall and Johannes Mailer, are the simplest 
of all. "The excitation carried by the sensory nerve 
arrives at the cord, it is propagated through the cord 
to the anterior root, and through the latter to the 
muscles.'* 

By a series of experiments begun in 1852 he de- 
cided the old question of the independent irritability 
of muscular tissue. He was well aware that the 
problem of the relation between nervous excitability 
and muscular contractility had been under discus- 
sion since the time of Haller. Curare, however, was 
in Bernard's hands the means of reaching a clear 
decision, for it kills completely the motor nervous 
system without diminishing the range of contraction 
of muscles. Bernard injected curare under the skin 



ADVANCES IN PHYSIOLOGY 233 

of a frog. He decapitated a second frog, laying bare 
the lumbar nerves. When the first frog was dead, 
he stimulated the hind legs of both by means of an 
electric current applied to the nerves. The muscles 
of the frog poisoned by curare did not contract 
under these conditions. When, however, the cur- 
rent was applied, not to the nerve, but directly to the 
muscles, the contractions were as marked in the one 
case as in the other. 

In 1851 Bernard began to investigate the function 
of the sympathetic nervous system, starting from 
the hypothesis that the sympathetic nerves were 
the producers of heat. On this assumption he cut 
the cervical sympathetic of a rabbit. Contrary to 
his expectation there was a decided rise instead of a 
fall in temperature, and the increased temperature 
was accompanied by a swelling of the arteries in the 
external ear. Brown-S^uard, at that time in Amer- 
ica, showed that the stimulation of the divided 
cervical sympathetic had the effect of decreasing 
the blood supply and the temperature in the ear of 
the rabbit. Claude Bernard repeated this experi- 
ment and verified the results obtained by Brown- 
S6quard. In 1858 Bernard announced the discovery 
that the submaxillary gland secretes under the 
double influence of the chorda tympani and branches 
of the cervical sympathetic. Both of these nerves 
are vaso-motor, producing their effects through the 



234 THE HISTORY OF MEDICINE 

unstriated muscles; for example, the unstriated 
muscular coat of the arteries discovered by Henle 
in 1840. The function of the cervical sympathetic 
is as a rule to cause a narrowing or constriction of 
the vessels, while the function of the chorda tym- 
pani is to cause a widening or dilation of the vessels. 
Thus Claude Bernard completed his discovery of 
the vaso*motor nerves, that is, the vaso-dilator and 
the vaso-constrieton He also opened up the ques* 
tion of the inhibitory functions of nerves by prov- 
ing (1846) that the stimulation of the vagus arrests 
the action of the heart, and that respiratory move- 
ments are checked by stimulating the superior 
laryngeal. 

Claude Bernard's doctor's thesis (1843) had been 
on the gastric juice in digestion. He found that cane 
sugar injected into the veins of a dog is excreted in 
the urine. If, however, it is first treated with gastric 
juice, it does not so appear. Seeking, later, to find 
out at what part of the body the sugar so treated 
lost its identity, he came upon an unexpected result, 
namely that sugar occurs in the hepatic vein in 
greater quantity than in the portal vein. Moreover, 
if the experimental animal be fed neither sugar nor 
starch, the sugar in the blood nevertheless persists. 
He obtained sugar from the liver itself, and, later 
still, isolated glycogen. It appeared then that the 
liver has two functions, and that one of its secre- 



ADVANCES IN PHYSIOLOGY 235 

tions is an ''internal secretion/* On the false as^ 
sumption that the vagus nerve might influence the 
hepatic secretion, he punctured the floor of the 
fourth ventricle, and produced what he called arti- 
ficial diabetes (experimental glycosuria), in 1849. 
He is considered, in consequence of this, the founder 
of experimental medicine. 

About 1848 he found one day on his laboratory 
table some rabbits, which had been brought in from 
the market. He noted that their urine was clear and 
acid, like that of camivora. He then fed them herbs, 
and, as he had anticipated, their urine became tur- 
bid and alkaline. After they had gone without food 
for a considerable time, he fed them cold boiled beef, 
which, faute de tnieux^ they ate readily enough. 
Again their urine became clear and acid. He con- 
cluded that all animals fasting are in a sense car- 
nivorous, since they are nourished on their own 
tissues. In a later experiment the rabbits were 
killed after a full meal. He found that the lacteals 
were white in the lower part of the duodenum about 
30 centimeters below the pyloris. This struck his 
attention, as with dc^ in similar circumstances he 
had noted the whiteness of the lacteals at the upper 
part of the duodenum. He noted that this difference 
coincided with the fact that in the dog the entrance 
of the pancreatic duct is quite near the pyloris, 
while in the rabbit its entrance b very low. The 



236 THE HISTORY OF MEDICINE 

idea then occurred to him that the pancreatic juice 
might be the cause of the emulsion of the fatty 
matter of the food, and thus facilitate its absorption 
by the lacteals. 

Like his master Magendie, Claude Bernard was 
interested in the action of poisons (for example, 
curare and carbon monoxide) and had constant re* 
(Course to vivisection* Nevertheless, their methods 
of investigation were in at least one respect con- 
trasted. Magendie called himself a ckiffannier, 
thus comparing himself, working haphazard in the 
field of knowledge, with those who go about the 
town picking up rs^, etc. Bernard, on the other 
hand, always had a definite aim in view, holding an 
hypothesb essential to successful research, though 
too agile mentally to neglect the clues that chance 
threw in his way, and too astute to be blinded by 
prepossessions. " Put off your imagination,** he said, 
"as you take off your overcoat, when you enter the 
laboratory ; but put it on again, as you do your over- 
coat, when you leave the laboratory.** He thought 
that one had little chance of finding anything unless 
he knew what he was looking for, yet in his own 
investigations he was again and again rewarded by 
the discovery of the unexpected. 

REFERENCES 

Bell, Sir Charles: "On the Nerves," Pkilosoffkical Transactians^ 
1821, pp. 397-424. 



ADVANCES IN PHYSIOLOGY 237 

The Anatomy qf Ae Humam Body. 3 vds., seventh 

edition, 1824* 
Bernard, Claude: Introduction d la Midecine ExpMmenUjie. 

1865. 
Lemons sur la Physiohgieei la Pathologie du SysAme 

l^erveux. 1858. 
FkMirena, M. J. P.: Memoir of Magendie (translation). Annwd 

Xoporif Smithsonian Institution, 1866, pp. 91-125. 
Foster, Sir Michael: Claude Bernard. (Masters of Medicine.) 
Hadley, P. B.: "Johannes MaUer/' Popular Science Monthly, 

vol. 72 (1908), pp. 513-33. 
Hall, Marshall: "On the Reflex Function of the Medulla Ob- 
longata and Medulla Spinalis," PkUosofkical Transactions^ 

1833. pp. 635-65. 
Stirlingi Sir William: Some Aposfks oj Physiology. 1902. 



^ «- 



CHAPTER XII 

EMBRYOLOGY AND KARL ERNST VON BAER 

The eighteenth oentuty fell heir to two opposed 
theories concerning the development of the embryo 
— epigenesis, and preformation or predelineation. 
They were supported by the authority of the two 
greatest embryologists of the preceding century, 
Harvey and Malpighi. Harvey had taught that the 
organism is built up gradually by the addition of 
part to part. Malpighi, on the other hand, had held 
that the chick existed preformed before the begin- 
ning of incubation. In the latter view two other 
early microscopists had concurred, namely, Swam- 
merdam and Leeuwenhoek. The first of these, 
whose works did not become generally known till 
1737, had studied the early stages of the develop- 
ment of the frog, and, interested in the meta- 
morphosis of the caterpillar, had observed the parts 
of the butterfly in the chrysalis. Leeuwenhoek 
( 1 632-1 723) was the first to describe the sperma- 
tozoa. It would seem that the wonders revealed to 
these early students of microscopy led them to be- 
lieve that further revelations of minute structures 
and minute organisms only awaited the develop- 
ment of better instruments and finer technique. 



EMBRYOLOGY AND VON BAER 239 

Moreover 9 as Professor W. M. Wheeler in his ad- 
mirable lecture on Wolff has indicated, there is a 
class of mind predisposed to emphasize the static 
rather than the dynamic, to view phenomena as 
being rather than becoming, as stable rather than 
transitional, and to fasten attention on the fixity of 
forms and species rather than on their transforma- 
tions. 

The investigations of Charles Bonnet (1720-93), 
and the authority of Haller, also favored, in the 
eighteenth century, the inclination to believe in the 
doctrine of preformation. While still a youth, Bon- 
net reported his observations concerning partheno- 
genesis in plant-lice, or Aphides. He had seen a 
single virgin aphis give birth to ninety-four daugh- 
ters, which without fertilization continued to pro- 
duce after their kind. Haller declared that no part 
of the animal frame was made after the other; that 
all were made together; and that there was no such 
thing as epigenesis. It follows logically from the 
doctrine of preformation that the ovum contains a 
complete animal that awaits the process of unfolding 
or evolution, and that the mother of the race bore 
within her all her posterity, preformed creatures 
impacted in preformed creatures like a series of 
boxes enclosed in boxes. This theory of emb(4te- 
ment^ was, indeed, definitely taught by Bonnet, 
Leibnitz and others* 



240 THE HISTORY OF MEDICINE 

Kaspar Friediich Wolff (1733-94) exposed the 
preformation idea in his Theory of Generation, 
which appeared first as a doctor's thesis in 1 759. It 
maintained that development consists in a series of 
new formations, and undertook to trace the stages 
by which the organs are gradually formed. Accord- 
ing to Wolff the theory of predelineation merely 
affirms the fact of generation without offering an 
explanation of the process. He dealt first with the 
structure and development of plants in order to dis* 
cover a clue to the more difficult problems presented 
by animals. In all plants little globules are to be ob- 
served before the appearance of fibers and vessels. 
The nutrient sap at first follows the path of least 
resistance; the vessels are formed by virtue of the 
hardening of the liquid nutriment. This principle of 
coagulation along with the vis essentialis corporis, 
the force through which the liquids in the organism 
are distributed and eliminated, is the cause of the 
process of development in all organic beings, both 
plant and animal. The primordial kidneys (now 
frequently called Wolffian bodies in honor of theii 
discoverer) are formed by the urine propelled by the 
essential force of the body. The globular particles 
which constitute all animal organs in their incep- 
tion — heart, blood-vessels, limbs, alimentary canal, 
kidneys, etc. — may always be distinguished under a 
microscope of moderate magnification. How, then, 



EMBRYOLOGY AND VON BAER 241 

can the predelineationists claim that a body is in- 
visible because it is so small, when the parts of which 
it is composed are easily distinguishable? Wol£F*8 
drawings illustrating the development of the chick 
are, on the whole, inferior to those made by Mai- 
pighi in 1672 and sent to the Royal Society of 
London. 

Wolff's opposition to the doctrine of preforma- 
tion, in which he had no doubt been schooled by hb 
Leibnitzian professor of philosophy Christian Wol£F, 
created a very unfavorable impression. His Theory 
of Generation implied that the act of creation was 
an incomplete process, and he became the object of 
the same sort of criticism as Darwin incurred just 
one hundred years later. He was warned by Haller 
of the danger of running counter to the teaching of 
religion. He was helpless in face of the disapproba- 
tion he encountered. During the Seven Years' War 
he served in the military hospitab in Schleswig and 
lectured on anatomy in a field hospital in Breslau. 
But the support that this patriotic service gained 
for him was not sufficient to overcome the hostility 
his heresy had aroused. He was refused a profes- 
sorship, and even forbidden to lecture on physiol- 
ogy in Berlin. In 1766 he accepted an invitation 
to the Academy of Sciences in St. Petersburg, and 
he spent the remainder of his life in the Russia of 
Catherine H. 



242 THE HISTORY OF MEDICINE 

Wolff's second great contribution to the advance 
of embryology, "De Formatione Intestinorum/' 
was published at St. Petersburg in 1 768 and 1769. 
Here, speaking of the development of the anterior 
body wall of the chick, he says: "This is one of the 
most important proofs of epigenesis. We may con- 
clude from it that the organs of the body have not 
always existed, but have been formed successively; 
no matter how this formation has been brought 
about. I do not say it has been brought about by a 
combination of particles, by a kind of fermentation, 
through mechanical causes, through the activity of 
the soul, but only that it has been brought about/' 
As implied in a correspondence with Haller, Wolff 
was not interested in proving that anything is true 
that is not true, and he accepted it as axiomatic that 
other investigators shared his simple devotion to the 
truth. This study of the development of the intes- 
tines was years after its production referred to by 
von Baer as "die grdsste Meisterarbeit, die wir aus 
dem Felde der beobachtenden Naturwissenschaf ten 
kennen"; that is, the most masterful performance 
known to us in the field of the observational sciences. 
In this work Wolff anticipated the embryologists of 
the nineteenth century by teaching that leaf-like 
embryonic layers give rise to the intestinal canal, 
the nervous system, the vascular system, etc. He 
furthered the study of embryology by applying the 



EMBRYOLOGY AND VON BAER 243 

method of strict observation in this difficult field, 
and by establishing a definite antithesis between the 
doctrine of epigenesis and the theory of predelinea- 
tion so tenaciously held by his contemporaries. 

In 18 1 2 the "De Formatione Intestinorum'* was 
translated into German, under the title "Ueber die 
Bildung des Darmkanals im bebrflteten HUhnchen," 
by Johann Friedrich Meckel, sometimes called the 
younger to distinguish him from his grandfather, 
J. F« Meckel, whose name is associated with the 
sphenopalatine ganglion. The younger Meckel is 
famous as the discoverer of Meckel's diverticulum 
of the intestines, which represents the remains of the 
vitelline duct, and as the author of an extensive 
work on comparative anatomy. He has already 
been mentioned in these pages as having some ac- 
quaintance with the work of Hunter. He is credited 
with an early statement of the recapitulation theory, 
namely, that the development of each higher animal 
is ''an epitome of the ancestral stages which pre- 
ceded it'* (Garrison). This theory, foreshadowed, 
as we have seen, in the writings of Hunter, was not 
accepted by von Baer without limitation, he, in- 
deed going so far as to say that the embryos of 
higher forms never resembled the adult stages of the 
lower forms but merely the embryos of such forms 
(Balfour). This theory, severely criticized by the 
embryologists of to-day and all but annihilated, has 



244 THE HISTORY OF MEDICINE 

served to stimulate countless investigators, espe« 
cially since Darwin's ''Origin of Species'' seemed to 
lend it a new significance. 

Karl Ernst von Baer was bom at the family 
estate of Priep in the Russian province of Esthonia* 
February 28, 1792. He passed a free and happy 
childhood in the country. At the age of eight he had 
not learned the alphabet, but this fact did not 
hamper his later progress. He attended school at 
Revalt and spent four years at the University of 
Dorpat, where he received his degree as doctor of 
medicine in 1814. Following his graduation he went 
to ^^enna to complete his professional studies, but 
his inclination for more general biological research 
was stimulated by a chance meeting with the botan* 
ist Martins in the spring of 1815. He decided to put 
himself under the instruction of Professor Ignaz 
DSllinger of WOrzburg, who in the previous year 
had published works on the value and significance 
of comparative anatomy and on the development 
of the brain (" BeitrSge zur Entwickelung3geschichte 
des Gehims"). DdUinger was a disciple of the 
philosopher Schelling. At the same time he was a 
keen observer, known to have improved the micro- 
scope, and a skillful teacher. Under his direction 
von Baer pursued the study of comparative anat- 
omy for two years. Before the expiration of that 
time, Ddllinger having expressed the wish to have 



EMBRYOLOGY AND VON BAER 24S 

somebody undertake a detailed study of the devel- 
opment of the chick, Christian Heinrich Pander, a 
friend of von Baer*s, was induced to come to Wflrz- 
burg and devote himself to the investigation. 

In 1817 Pander set forth the results of his research 
in a Latin thesis, which before the end of the year 
speared in a German translation, ''BeitrSge zur 
Entwickelungogeschichte des Hflhnchens im Ei." 
It was illustrated by sixteen excellent copperplate 
engravings, the work of the anatomist and archaeolo- 
gist E. J. D'Alton. Pander describes the formation, 
within the first twenty-four hours of incubation, of 
the three layers of what he was the first to name the 
" blastoderm/' All subsequent development is noth- 
ing else than ''a metamorphosis of this membrane, 
endowed with an inexhaustible supply of creative 
force, and of the three layers that compose it.'* The 
outer layer he called the ''serous," the middle layer 
he called the ''vascular," and the inner, the "mu- 
cous." The metamorphosis by which these three 
layers are transformed into the various organs and 
systems of the body is more precisely described by 
Pander, then a young man of twenty-four, than it 
had been by Wolff, whose theory and observations 
he in the main confirmed. In fact, it was not till the 
appearance of Pander's dissertation that students of 
embryonic development found the clue to the de- 
scriptions and the generalizations of hb eighteenth 
century predecessor. 



246 THE HISTORY OF MEDICINE 

Von Baer, in the meantime, after spending a few 
months in Berlin, had gone to KSnigsberg as pro- 
sector to Professor K. F. Burdach, under whom he 
had studied at Dorpat. He was appointed professor 
of zoStomy in 1819. In the same year, stimulated 
by the results of Pander's investigation, he began 
his special studies in embryology, which he pursued 
with intense energy for the subsequent seven 3^ears. 
In 1827 he began to publish statements of the re- 
sults of his researches. He had discovered as present 
in all vertebrate animals the notochord, the key, as 
Sedgwick has called it, to the whole of vertebrate 
morphology. He sprang into special prominence by 
the announcement of the discovery of the mam- 
malian ovum — '^Epistola de ovi mammalium et 
hominis genesi.'* He had verified the conjecture of 
Pr6vo8t and Dumas by finding the human ovum in 
a Graafian follicle. This capital discovery gave a 
new meaning to Harvey's dictum, omne vivum ex 
cvOf confirmed man's place in relation to the lower 
animals, and established human embryology as a 
branch of general biology. Some of von Baer's more 
general results appeared, also in 1827, in Burdach's 
" Physiologie," which contained, in addition, con- 
tributions on the development of invertebrates by 
Professor Rathke, and on the Entozoa in particular 
by the youthful K. T. E. von Siebold, 

In 1828 appeared the first volume of the work 



EMBRYOLOGY AND VON BAER 247 

which established the fame of Karl Ernst von Baer 
as the greatest embryologist of the nineteenth cen- 
tury — "Ueber die Entwickelungsgeschichte der 
Thiere — Beobachtung und Reflexion," The title is 
doubly significant, in the first place as indicating 
the beginning of comparative embryology, in the 
second place as indicating von Baer's unique com- 
bination of accurate observation and unerring pow- 
ers of generalization. Following up the results of his 
friend Pander, to whom the book was dedicated, 
von Baer traced carefully the development of the 
chick day by day, and at the same time took ac- 
count of other embryos. He recognized two chief 
layers in the blastoderm, the animal and the vege- 
tative, Pander's vascular layer consisting, in von 
Baer's judgment, of derivatives from the so-called 
serous and mucous layers. These layers were in no 
sense ordinary tissues, but true germinal layers, the 
source of all the systems and organs of the body. 
From the animal layer come the external skin, the 
sense organs, and the nervous system in general; 
from its derivative the muscular and osseous sys- 
tems. From the vegetative layer come the internal 
lining of the alimentary canal and all its dependen- 
cies — salivary glands, lungs, liver, etc. ; while from 
its derivative come the heart, blood-vessels, kid- 
neys, spleen, sexual glands, etc. The germ-layers, 
observed in the embryos of all species of animab 



248 THE HISTORY OF MEDICINE 

except the very lowest, produce the fundamental 
systems by f ormmg tubular cavities, from which the 
special parts and organs are in turn evolved. The 
formation of the central nervous system by the fold- 
ing of the outer germ-layer is an example familiar 
to alL As far as the development of the alimentary 
canal is concerned Wolff had anticipated the ob- 
servations of von Baer. In a similar way the walls 
ct the body and the bony skeleton arise from mus- 
cular and osseous tubes. 

By 1834 "^i^ B^^^ I^ added through continued 
research to his data concerning the development of 
animals. His publisher pressed him to complete the 
material for a second volume, and finally, having 
waited in vain, proceeded to publication in 1837 
without receiving the consent of the author. Von 
Baer in 1835 contributed a paper on the embryology 
oi fishes — '' Untersuchungen fiber die Entwicke- 
lungsgeschichte der Fische'' — and put on record 
the observation of the segmentation of the yolk in 
the ovum of the fish. The remainder of his long life 
was, however, given up to other scientific interests. 
As early as 1827 he had been invited to the Academy 
of Sciences at St. Petersburg; he had gone to the 
Russian capital to live in 1829, only to return to 
KOnigsberg the following year. But in 1834 ^^ took 
up permanent residence in his native country as 
zoological member of the St. Fetersbuiig Academy. 



EMBRYOLOGY AND VON BAER 249 

Von Baer traveled extensively^ sometimes at the 
instance of the Russian government, sometimes at 
the dictate of his scientific curiosity. He visited 
North Cape» Nova Zembla» the Volga^ the Caspian 
Sea» the Sea of Azov. He was interested in the 
phjrsical features of the country, in its resources, 
especially in its fisheries, and in the distribution of 
plants and animals. He had early written on the 
subject of fossils. In 1845 he published a paper on 
teratology. In i85ft-6i he visited the museums of 
London and other European cities. He made a 
spedal study of anthropology, particularly crani* 
ology, and in 1861, in conjunction with another 
embryologist, Rudolf Wagner, called together the 
first Congress of Anthropologists. One is impelled 
to ask whether after 1834 von Baer felt that fur* 
ther progress in embryology must depend on a fun- 
damental reconstruction of biological conceptions. 
In 1S62 he resigned his position as an active mem- 
ber of the Russian imperial Academy. A few years 
later he wrote his Autobiography at the suggestion 
of his admirers among the Baltic nobility, and on 
November 28, 1876, he died at Dorpat in his eighty- 
fifth year. 

Von Baer's special training and his opportunities 
for comprehensive observation would seem an al- 
most ideal preparation for the appreciation, if not 
indeed the discovery, of the doctrine of organic 



250 THE HISTORY OF MEDICINE 

evolution. On the basis oi his embryological studies 
he sought to classify animals under certain types, 
between which he recognized a distant kinship. In 
fact, according to von Baer» for one brief moment in 
the course of embryonic development there is a 
degree oi conformity between vertebrate and in- 
vertebrate animals. The further we go back in de- 
velopment, he says, the more we find agreement in 
animals of very different sorts. We are thus led to 
ask, he continues, whether in the beginning of de- 
velopment all animals are not essentially alike, and 
whether there is not for all a common or^;inal form. 
It need not, however, greatly surprise us to find 
that von Baer raised his voice in opposition to the 
teachings of Charles Darwin (''Reden und kleine 
Aufsfttze,'" 1864-77). In this respect he may be 
compared with Sir Richard Owen, from whom Dar- 
win and his friends hoped to gain support for their 
doctrines. The severest critics of a new theory are 
not unlikely to be men who have long cherished 
views only slightly dissimilar to those they feel 
called upon to discuss, and who thus bring to the 
discussion a special knowledge of the data and a 
keen sense of the danger of the generalizations in- 
volved. 

Professor Locy, referring to the period in the 
history of embryology between the work of von 
Baer and that of Francis Balfour states that there 



EMBRYOLOGY AND VON BAER 251 

were great general advances in the knowledge of 
organic structure that brought the whole process of 
development into a new light. ''Among the most 
important advancest" he continues^ ''are to be 
enumerated the announcement of the cell-theory, 
the discovery of protoplasm, the beginning of the 
recognition of germinal continuity, and the estab- 
lishment of the doctrine of organic evolution.*' In 
a passage dealing with the last item in this enumera- 
tion the same author says: "The general acceptance 
of the doctrine, which followed after fierce opposi- 
tion, had, of course, a profound influence on embry- 
ology. The latter science is so intimately concerned 
with the genealogy of animab and plants, that the 
newly accepted doctrine, as affording an explana- 
tion of this genealogy, was the thing most needed/' 
These great advances in the knowledge of organic 
structure were all made before the death <^ von 
Baer. At the same time there was a marked im- 
provement of the technique of investigation, and, of 
course, a steady accumulation of results. The princi- 
ples set forth by J. J. Lister in a paper read before 
the Royal Society in the beginning of 1830 led to a 
much-needed improvement of the microscope both 
in England and on the continent of Europe. About 
1855 von Gerlach made use of carmine as a nuclear 
stain, and before 1876 Golgi had introduced the use 
of silver nitrate in the study of the nervous system. 



252 THE HISTORY OF MEDICINE 

A further improvement in technique came through 
the introduction of the microtome in the prepara- 
tion of histological sections by Purkinje, by Lister, 
and by Wilhelm His, famous for his study of the 
devdopment of nervous tissue. 

Among the contributions to embryology before 
the discovery <^ the cell-theory mention should be 
made of the work of von Baer's colleague at KSnigs- 
berg, Martin Heinrich Rathke, who observed the 
branchial clefts and the visceral arches in the em- 
bryos of abranchiate animals, and by the applica- 
tion of the germ-layer doctrine in the investigation 
of lower species established his daim to be called the 
founder of invertebrate embryology. Von Siebold 
has already been associated with him. Herold's 
eariy study of the embryonic development of spiders 
should not be overlooked in this oxmection. Von 
Baer's discovery of the mammalian ovum, as his 
confirmaticm of the germ-layer doctrine, stimulated 
' a series of special studies. As eariy as 1825 Puridnje 
had described the germinal vesicle in the ovum of 
the tnrd. In 1833 Coste reported the discovery of 
the germinal vesicle in the mammalian ovum, and a 
year or two later Wagner discovered the germinal 
spot. Bischoff , early interested in human embryd- 
ogy, ultimately traced the development of the ovum 
in four species of mammals, namely, the rabbit, dog, 
guinea-pig, and deer. 



EMBRYOLOGY AND VON BAER 253 

Johannes MfiUer contributed to the progress of 
embryology personally and through the work of his 
pupils. In 1829-30 he investigated the development 
of the genito-urinary organs, and the name Mtil- 
lerian duct is still applied to the duct of the pro- 
nephros, which in the adult becomes converted into 
the genital passages. Mailer's ''Handbook of 
Physiology** by its statement of the results of in-^ 
vestigations in embryology helped (along with the 
books of Wagner and Valentin) to make the teach* 
ings of that branch of biological science widely 
known. We must defer, till the next chapter the con- 
sideration <^ the work of two of M(lller*s most dis- 
tinguished pupils, Schwann and Virchow. A third 
pupil, Reichert, by hb volume ''Histology and 
Embryology,*' brought to bear on the study of em- 
bryonic development the method and point of view 
suggested by the formulation in the preceding year 
(1839) of the cell-theory. In 1837 he had made a 
special study of the transformation of the visceral 
arches. The work of Reichert was followed by that^^ 
of a fcMorth pupil of- MiUWs, ;yon KOlUkevj who in 
1841 explained the cellular origin of the sperma- 
tozoa, their nature and function. In 1843 he pub- , 
lished a paper on the development of invertebrates, 
and in 1861 he wrote the first book on comparative 
embryology. Robert Remak, also a pupil of Jo- 
hannes Mailer's, in a study of the chick and frog, 



r 



254 THE HISTORY OF MEDICINE 

1851-55, reviewed and clarified the origin of the 
germ-layers from the blastoderm, and indicated to 
some extent their relation to the formation of the 
body cavities. A few years before (1849), Huxley 
had put forward the view that the ectoderm and the 
endoderm of the Ccdenterata are analogous to the 
serous and mucous germ-layers observed by Pander 
in the development of the chick. 

A few examples must suffice to show the nature of 
some of the advances made in embryology between 
the appearance of Darwin's/' Origin of Species*' and 
the death of von Baer. In 1861 Gegenbaur showed 
that the vertebrate ovum consists of a single cell, 
i and in 1865 he turned his attention with like results 
to the examination of the spermatozoon. That the 
embryo is formed from these unicellular elements 
and that development takes place through cell- 
division became the natural presuppositions of sub- 
sequent theories of heredity. The study of Amphi- 
oxus by Kowalevsky in 1866 tended to break down 
the sharp distinction that had been made between 
the vertebrates and the invertebrateSi and his doc- 
trine that all animals pass through a gastrula stage 
— a doctrine elaborated by Haeckel — went further 
toward establishing the unity of the development 
of all organisms. At about the same time, Fritz 
Mailer, one of the earliest German converts to the 
teachings of Darwin, gave a new formulation to the 



EMBRYOLOGY AND VON BAER 255 

theory of recapitulation , to which reference has al- 
ready been made, and which assumes that all animals 
of complex structure are the descendants of simpler 
forms. In 1874 another disciple of Darwin's, Francis 
Maitland Balfour, who had pursued some of his in- 
quiries at the newly established Zoological Station 
at Ns^les, made report before the British Asso- 
ciation at Belfast of some of those investigations 
which culminated in his volumes on Comparative 
Embryology (1879-81). And in 1875 Oscar Hertwig, 
known to the twentieth century as the author of a I 
monumental work on vertebrate .embryology (1901, 
et seq.), published his discoveries concerning the pro- 
cess of fertilization. 

In his lecture on ''Embryology and Medical 
Progress" Charles Sedgwick Minot says: "Embry- 
ology supplies facts which are directly valuable to 
the practitioner. It supplies explanations and in- 
terpretations of many anatomical structures and 
relations which would otherwise remain incompre- 
hensible. It supplies the dues to many common and 
rare anomalies, and it supplies to pathology a series 
of fundamental conceptions, without which our 
actual present pathological knowledge could not 
have been upbuilt. These claims of embryology to 
recognition are very great, but nevertheless they do 
not include her greatest claim to a preeminent place 
among the medical sdenoes. That greatest claim is 



256 THE HISTORY OF MEDICINE 

established in my opimon by the oontributioa of 
embryology to the solution of the problem of or- 
ganic structure." 

REFERENCES 

Haeckel, Ernst: EpoluHon of Man. 

Locy, W. A.: ^'Malpig^ in Embryology/' Popular Science 

Monthly^ 1905, v6i. 67, pp. 97-126. 
Minot, C S.: "Elmbryology and Medical ProgreB a ," Popular 

Science Monthly, 1906, vol. 69, pp. 5-30. 
Wheder,W. M.: Caspar Friedrick Wolff and tkeTkeoHa Genera^ 

tionist Woods HoU Biological Lec^ires, 1898, pp. 265:-^ 
Whitman, C. O.: Bonnets Theory of EoohOion, and EeoUOien 

and Epigenesis, Woods HoU Biological Lectures, 1894, pp. 

225-40, pp. 205^24. 



CHAPTER XIII 

THE CELI^THEORY AND CELLULAR 

PATHOLOGY 

Thb oell-theory npsulted from the investigations of 
the botanist Schleiden and the anatomist and 
physiologist Schwann. It teaches that the tissues of 
developing plants and animab are composed of cells, 
and it may be compared with earlier attempts to 
discover a morphological unit in the organism, such 
as Haller*s theory of fibers, Milne Edward's theory 
of globules, or Bichat's doctrine of elementary tis- 
sues. Cells had been observed by microscopists as 
early as the seventeenth century, notably by Robert 
Hooke (1665), who examined sections of cork under 
his compound microscope, and found them made up 
of little boxes or cells. He described the sections as 
''all cellular or porous in the manner of a honey- 
comb, but not so regular.'' His drawings of these 
cork cells were reproduced in his book ''Micro- 
graphia," one of the very early publications of the 
Royal Society. The observations made at this time 
by means of the microscope seemed to confirm 
speculations concerning atoms and pores which had 
persisted among medical philosophers from the time 
of Democritus. In the eighteenth century Wolff, as 



258 THE HISTORY OF MEDICINE 

already implied, recognized common elements in the 
minute structure of developing plants and animals. 
Huxley gives the following statement of Wolff's 
views: "Every organ, he says, is composed at first 
of a little mass of clear, viscous, nutritive fluid, 
which possesses no organization of any kind, but is 
at most composed of globules. In this semifluid 
mass cavities (Blftschen, Zellen) are now developed ; 
these, if they remain round or polygonal, become 
the subsequent cells; if they elongate, the vessels; 
and the process is identically the same, whether it is 
examined in the vegetating point of a plant, or in 
the young budding organs of an animal." 

Mathias Jakob Schleiden (1804-81) was inter- 
ested in the development of plants, their anatomy 
and physiology, rather than in their classification 
under barbarous Latin names. He studied the rela- 
tion of the cell-nucleus, which had been discovered 
by Robert Brown in 1831, to the development of the 
cell. Moreover, he attained to the view that the cell 
is the elementary organ of the plant. The develops 
ment of plant tissues depends on the nucleated cell. 
For Schleiden the development of the cells of plants 
was a matter of supreme interest. His treatment of 
this question appeared under the title " Ueber Phyto- 
genesis" in Mtiller's " Archiv" (1838). 

Theodor Schwann (1810-82) was a pupil of 
Johannes MUller at Bonn, and later (1834-38) at 



THE CELL-THEORY 259 

Berlin. Besides the formulation of the cell-theory a 
long list of triumphs stands to his credit, including 
the discovery of the sheath of the axis-cylinder of 
nerves, and the recognition of the organic nature of 
yeast and its r61e in fermentation. In 1837 Schleiden 
told Schwann of his observations of the nuclei of 
plant cells. Schwann had himself noted (under 
Mailer's direction) the nucleated cells of the noto- 
chord. The two friends compared the results of 
their investigations, and Schleiden recognized in 
Schwann's sections of the notochord nucleated cells 
similar to those he had himself observed in plants. 
Subsequently Schwann included in his investiga- 
tion the cellular origin and development of various 
tissues, and arrived at the generalization that 
"There is one universal principle of development 
for the elementary parts of organisms, however 
different, and that principle is the formation of 
cells." In 1839 appeared his "Microscopical Re- 
searches concerning the Harmony in Structure and 
Growth of Animals and Plants." In this work he 
says: "The development of the proposition that 
there exists one general principle for the formation 
of all organic productions, and that this principle is 
the formation of cells, as well as the conclusions 
which may be drawn from this proposition, may be 
comprised under the term cell-theory.'* 
The views of biologists concerning the nature and 



26o THE HISTORY OF MEDICINE 

origin of cells were soon modified by further dis- 
coveries. In 1835 Dujardin had observed a semi- 
fluid, jelly-like substance in protozoa, endowed with 
all the qualities of life. The term "protoplasm'* was 
first used by Purkinje in 1839, to designate the 
germinal ground-substance of the embryo. In 1846 
von Mohl observed a jelly-like substance in plants 
to which he applied the name ''protoplasma." A 
few years later Cohn noted the similarity, if not 
identity, of animal and plant protoplasm. In 1852 
Remak established the fact that it is by cell-divi- 
sion that the tissues develop from the three embry- 
onic layers. Two years later Virchow was making 
the cell-theory the basis of his system of pathology. 
Rudolf Virchow (i 821-1902) was bom in Pome- 
rania, began the study of medicine at Berlin in the 
year in which Schwann's Microscopical Researches 
appeared, and received his degree during the dean- 
ship of Johannes Mtiller, who was his model and 
ideal. In the following year he was demonstrator of 
anatomy at the Charit6 Hospital (Berlin). Here he 
had special chai^ of chemical and histological inves- 
tigations, and his work in microscopic pathological 
anatomy suggested to his mind the need of studying 
the relationship between pathology and physiology. 
In 1847 he established the "Archiv" (fOr pathol- 
ogische Anatomie und Physiologic und ftir klinische 
Medizin") since known by his name. About the 



THE CELL-THEORY 261 

same time he was appointed by the Prussian govern- 
ment to investigate an epidemic of typhus fever 
in Upper Silesia. His report not only recommended 
certain hygienic measures but took the government 
to task for the deplorable social conditions in that 
province, and advocated complete and unlimited 
democracy, and *' education, with her two daughters, 
freedom and prosperity/' He was already showing 
the personal spirit and political tendencies that 
later made him the vigorous opponent of Bismarck. 
Some years later he wrote : " I uphold my own rights, 
and therefore I also recognize the rights of others. 
This is the principle I act upon in life, in politics and 
in science. We owe it to ourselves to defend our 
rights, for it is the only guarantee for our individual 
develc^ment, and for our influence upon the com- 
munity at large/' From the summer of 1848, the 
year of the attempted revolution in Prussia, till the 
summer of the year following he published a weekly 
on Medical Reform, which ultimately had a great 
effect on the sanitation of Berlin. But the govern- 
ment could not tolerate his activity as an agitator. 
Hb pay was suspended for a time in the spring of 
1849, and Virchow took advantage of a call to Wurz- 
burg to withdraw from Prussian territory. At the 
University of Wtirzburg he was closely associated 
with von K5lliker, who had treated the segmenta- 
tion of the egg, and, as we have seen, other phases 
of embryonic development. 



262 THE HISTORY OF MEDICINE 

In 1854 Virchow began to edit a six-volume 
''Handbuch der spedellen Pathologic und Thera- 
pie/' In the first volume he states that there is no 
essential difference between physiological and path- 
ological laws. The human body, like all organisms, 
is composed of minute elements, each of which can 
be ultimately traced to a single cell and its sphere of 
influence. These organic cellular elements and ele- 
mentary precincts are anatomically recognizable. 
They are at the same time morphological and vital 
units, differing from inorganic matter both in their 
composition and in their power to reproduce them- 
selves. It would be a mistake, however, to regard 
the body as a mere aggregation of these vital units. 
They are parts of a higher unity. Some would de- 
scribe this higher unity as a vital principle or con- 
structive vital spirit, which in consistency they are 
bound to postulate in plants as well as in animals. 
According to Virchow the expression '* constructive 
vital spirit'' is purely figurative, like the expression 
"Landesvater" as applied to a monarch. The unity 
of the living body consists only in the interdepend- 
ence of its living elements. The harmonious inter- 
action of these elements, all derived or^^ally from 
one simple element, is the condition of life. ''Life 
does not proceed discontinuously, or by fits and 
starts, but in the regular, legitimate succession of 
generations.'' Pathological derangement must, to 



THE CELL-THEORY 263 

begin with, involve definite elements. Every dis- 
ease has therefore a local, anatomical starting point 
or seat. 

In 1856 Virchow was recalled to Berlin as pro- 
fessor of pathology and director of a new Pathologi- 
cal Institute. In 1858 he gave a series of twenty 
lectures to members of the medical profession. 
These were published under the title "Cellular 
Pathology as Based upon Physiological and Patho- 
logical Histology." After pointing to the advances 
in medicine which in the past had followed the work 
of the Alexandrian anatomists, of Vesalius, and of 
Bichat, who developed the principles of general 
anatomy, Virchow says: "What Schwann, however, 
has done for histology, has as yet been but in a very 
slight degree built up and developed for pathology, 
and it may be said that nothing has penetrated less 
deeply into the minds of all than the cell-theory in 
its intimate connection with pathology." In a rela- 
tively short time Bichat came to exercise an extraor- 
dinary influence on the state of medical opinion. The 
hesitancy to build upon the discoveries of Schwann 
was owing, according to Virchow, to the continued 
incompleteness of knowledge in the medical pro- 
fession of the intimate structiue of the tissues. 
Particular difficulty had been found in deciding 
which parts of the body are the source of action — 
what parts are active, what passive. "The chief 



264 THE HISTORY OF MEDICINE 

point in this application of histology to pathology is 
to obtain a recognition of the fact that the cell is the 
ultimate morphological element in which there is 
any manifestation of life, and that we must not 
transfer the seat of real action to any point beyond 
the cell/* 

At the sautne time the idea of the cell was in need of 
restatement* Hooke and other early observers were 
inclined to magnify the importance of the cell-wall 
and to minify the importance of the cell-contents. 
Indeed, the very name ''cell" tended to fix upon the 
enclosing membrane as the characteristic feature. 
Virchow held that Schwann in his observations had 
been unduly influenced by the botanist Schleiden. 
Schleiden was particularly prone to exaggerate the 
importance of the cell-wall because he thought that 
the nucleus never lay free in the interior of the cell 
but was always enclosed in the cell-wall. The typical 
plant cell was thought to consist of an extraneous 
membrane of cellulose, generally found to be desti* 
tute of nitrogen, and nitrogenized contents di£Fering 
from it. To this type of plant cell the cartilage cell 
with its capsule seemed to be comparable, but the 
capsule is not an essential part of the cartilage cell; 
it is really the result of excretion, and in the young 
cell may be observed to be very thin, Virchow came 
to the general conclusion that when we separate 
from the cell all that has been added to it by an 



THE CELL-THEORY 265 

after-development, ''we obtain a simple, homo- 
geneous, extremely monotonous structure, recurring 
with extraordinary constancy in living organisms. 
But just this very constancy forms the best cri- 
terion of our having before us in this structure one 
of those really elementary bodies, to be built up of 
which is eminently characteristic of every living 
thing — without the pre-existence of which no liv- 
ing forms arise, and to which the continuance and 
maintenance of life is intimately attached." 

In this opening lecture of the series Virchow also 
restated his view of 1854 in reference to the relation 
of cell to cell within the organism, making more ex- 
plicit the analogy between the cells in the body and 
the citizens in the State. The highly developed 
organism, whether plant or animal, must be re- 
garded as made up of a larger or smaller number of 
similar or dissimilar cells. Every animal is a sum of 
vital elements, each of which manifests all the char- 
acteristics of life. Life cannot be especially attrib- 
uted to one particular seat or organ, such as the 
brain of man, but it must be recognized in each in- 
dividual cell, the constantly recurring structure, or 
morphological and vital unit. ''Hence it follows 
that the structural composition of a body of con- 
siderable size, a so-called individual, always repre- 
sents a kind of social arrangement of parts, an ar- 
rangement of a social kind, in which a number of 



266 THE HISTORY OF MEDICINE 

individual ezbtences are mutally dependent, but in 
such a way, that every element has its own special 
action, and, even though it derive its stimulus to 
activity from other parts, yet alone efifects the 
actual performance of its duties." 

In his second lecture on "Cellular Pathology'' 
Virchow enunciated what Lord Lister has described 
as the true and fertile doctrine that every morbid 
structure consists of cells which have been derived 
from pre-existing cells as a progeny. His earlier 
study of parasitic organisms had not converted him 
to a belief in spontaneous generation. In the first 
volume of the " Handbook of Special Pathology and 
Therapeutics," already referred to, he had written a 
section on plant and animal parasites. We are in- 
debted to him for the first good descriptions of some 
of the nonbacterial fungus infections (mycoses) ; and 
this volume of 1854 gives a list of thirty metazoan 
parasites, classified as trematodes, cestodes, nema- 
todes, etc. In this list are found the Tcenia solium^ 
Trichina spiralis (to which Virchow at a later date 
directed his attention to the great benefit of the 
public health), Ancylostoma duaderuUe, FHaria medp- 
nensiSf as well as the parasitic causes of hepatic 
distomiasis, and of bilharziasis. In 1858 he was pre- 
pared to maintain that even in pathology no devel- 
opment of any kind begins de novo, and that the 
theory of spontaneous generation is to be rejected 



THE CELL-THEORY 567 

just as decisively in the history of individual parts 
as in that of entire organisms. A taenia solium does 
not owe its origin to the intestinal mucus nor a 
fungus take its life from decomposing animal or 
vegetable matter; ''equally little are we disposed 
to concede either in physiological or pathological 
histology, that a cell can build itself up out of non- 
cellular substance. Where a cell arises, there a cell 
must have previously existed {omnis ceUtda e ceU- 
fda)t just as an animal can spring only from an 
animal, a plant only from a plant. In this manner, 
although there are still a few spots in the body where 
absolute demonstration has not yet been afforded, 
the principle is nevertheless established, that in the 
whole series of living things, whether they be entire 
plant or animal organisms, or essential constituents 
of the same, an eternal law of continuous develops 
ment prevails. There is no discontinuity of develop- 
ment of such a kind that a new generation can of 
itself give rise to a new series of developmental 
forms. No developed tissues can be traced back 
either to any large or small simple element, unless 
it be to a cell." This clear statement of the law of 
the genetic continuity of cells was based of course in 
part on the studies of von K5llikeri Remak, and 
other embryologists. 

Karl Blind is the authority for an anecdote in- 
tended to throw light on Virchow's view of his own 



268 THE HISTORY OF MEDICINE 

contribution to the development of the ceU-theory. 
At a party given in honor of >^rchow on the eve of 
his departure for Cambridge, where he was to give 
an address at a Harvey celebration, Blind broached 
the question of Harvey's claim to be the first dis- 
coverer of the circulation of the blood. Professor 
Hecker of Berlin had given proofs of the worthless- 
ness of Harvey's claims in the early part of the nine- 
teenth century, and Blind himself had found addi- 
tional evidence in the writings of Leonardo da Vinci. 
\^chow in a conversation lasting nearly half an 
hour made eager attempts to convince Blind of his 
mistake, and finally observed (according to Blind) : 
'*It might as well be contended, and it has even 
been contended, that the cellular theory was not my 
own." This remark seemed, to the narrator of the 
story, directed against those who had pointed out 
the claims of Schleiden and Schwann. Blind's own 
judgment was that Virchow had worked out a 
cellular theory of his own, correcting the mistakes of 
his predecessors, and giving a demonstration of his 
aphorism, Omnis cdltda e cellula. 

The pathology of Morgagni was a pathology of 
the organs; that of Bichat a pathology of the tissues 
composing the organs; cellular pathology in turn 
fixed attention on the elements that go to the forma* 
tion of the tissues. Naturally the cell-theory en- 
abled Virchow to review the work of Bichat, and to 



THE CELL-THEORY 969 

make a more thorough analysis of the components 
of the various organs and systems. As constituting 
one class of normal tissues he recognized those com- 
posed exclusively of cells. Of this class the epithelial 
formations are typical — the epidermis, the rete 
Malpighi, the nails, the crystalline lens, the mucous 
and serous membranes, and the active elements of 
the glands, which, Remak showed, owe their origin 
to the proliferation of epithelial structures. A sec- 
ond class of normal tissues includes those in which 
the cellular elements are separated by a certain 
amount of intercellular matter. To this class belong 
those to which Johannes MttUer gave the name 
"connective tissues.'' (In the earlier medical litera- 
ture they had been called "cellular," that is, 
"areolar"; which indicates very definitely how 
the term "cell" had shifted its meaning.) To 
Virchow's third class belong the highly specialized 
tissues, under which class come the nervous and 
muscular systems, the vessels and the blood. In 
oonstdering the physiology and pathology of the 
brain, we must take into account not only its 
nervous tissue, but its membranes, vessels, and in- 
terstitial substance. (We owe to Virchow the term 
neuroglia," as well as "mycosis," "embolism," 
arthritis deformans," "heterotopia," etc.). Simi- 
larly a long bone is to be r^arded as an organ con- 
sisting of at least three tissues besides the osseous. 



41 
$€ 



270 THE HISTORY OF MEDICINE 

Do the general types established for the phy^o- 
logical tissues hold good for the pathological? Yes, 
every pathological structure has its physiological 
prototype. At times the new formation (neoplasm) 
corresponds to the type of tissue in which it occurs 
as a pathological phenomenon, as when a fatty 
tumor develops in adipose tissue. The neoplasm is 
then said to be homologous. In contrast with 
homology heterology is the occurrence of a new 
formation in a type of tissue from which it differs, 
as, for example, in fatty defeneration of muscular 
tissue, or amyloid degeneration of the kidneys. 
Pathological conditions may arise not only from the 
misplacing of tissues (heterotopia) but also from 
their retarded or premature development (hetero- 
chronia), as, for example, when bone is invaded by 
a cartilaginous tumor, and, lastly, from the mere 
variation of their quantity (heterometria). Under 
heterometria is included hyperplasia, involving an 
increase in the number of the cells. Hypertrophy 
may result merely from the enlargement of the in- 
dividual cells, as, for example, in the enlargement of 
the hepatic cells in hypertrophy of the liver. Patho- 
logical states may be caused also by intracellular 
changes. 

Virchow included in his "Cellular Pathology" 
the consideration of the diseases of the blood and the 
blood-vesseb. He describes the minute crystals of 



THE CELL-THEORY 271 

haematoidin, discovered by him, and mentions their 
occurrence in the cicatrix following cerebral haemor- 
rhage. Leukaemia, first observed and named in 
1845, b here spoken of as **a permanent, progressive 
leucocytosis.'* Virchow dbtinguishes it from pyae- 
mia, notes the haemorrhagic tendency associated 
with it, and connects it causally with the lymphatic 
glands and the spleen. Chlorosis, which usually in- 
volves imperfect development of the acxta, and 
frequently of the heart and sexual organs, b not to 
be confused with leukaemia. Perhaps, however, 
Virchow^s greatest individual triumph in pathology 
was hb doctrine of embolism, and the consequent 
clearing-up of the nature of thrombosb and phlebi- 
tb. Setting aside the speculations of the French 
pathologbt Cruveilhier (1791-1873), with whom the 
idea of phlebitis had become almost an obsession, 
Virchow inquires in reference to the facts concerning 
the composition and the origin of the thrombus. 
Microscopic examination reveals that the coagu- 
lated mass consbts of broken-down cells, of dis- 
integrated fibrin, and of white and red blood- 
corpusdes undergoing disorganization, and, in the 
case of the last-named, in process of discoloration. 
Though it may look like pus, it should never be 
regarded as pus. The pathological condition begins 
with the copulation, the formation of the thrombus 
in the blood. Virchow readily admits that at times 



272 THE HISTORY OF MEDICINE 

phlebitis, as well as arteritis and endocarditis, may 
give rise to thrombosis; but real phlebitfe is an in- 
flammation of the walls, and not of the contents of 
the vein* Moreover, he finds that not infrequently 
the small branches of the peripheral veins become 
quite filled with masses of coagulunx The greater 
number of these thrombi become prolonged beyond 
the mouths of the iM-anches, and greatly enlarged. 
From these prolonged thrombi partides (emboli) 
are carried along by the blood stream. Minute 
fragments may hence be wedged tightly into the 
nearest system of arteries or capillaries. *'Thus we 
see that as a rule all the thrombi of the periphery of 
the body produce secondary obstructions and meta- 
static deposits in the lungs/' It is also noted that 
embolism in certain cases occasions sudden occlu- 
sions <^ the vessels of the eye or brain. 

To Johannes Miiller, who had laid down the law 
of the oorrespcxidence between embryonic and 
pathological development, Virchow owed no doubt 
S(mie of his interest in the pathology of the foetus, 
in what he called "agenesia"* (aplasia cerebri), as 
well as in allied subjects, such as the structure of the 
umbilical cord, and tubal pregnancy. MQller's his- 
tological study of tumors exerted a no less decisive 
influence 6n Virchow's uncompleted work of three 
volumes, "Die Krankhaften Geschwfllste" (1863- 
67), one of his greatest contributions to pathology. 



I 



THE CELI^THEQRY 273 

In this work is maintained the point of view of the 
Cellular Pathology. It must be ever realized, said 
Virchowy that tunx>rs, whether they are parasitic in 
origin or not, are always portions of the body, and 
do not develop from some morbid humor of the 
organism, ncH* independently through some special 
force of their own substance. He hdd that tumors 
owe their origin as a rule to the less highly special- 
ized tissues, to the connective tissue, and, more 
particularly, the epithelial. At one time he was 
inclined to trace the derivation of cancers to the 
mesoblast, but, probably influenced by investi- 
gators who thought these growths were also c^ 
epithelial origin, he left this part of his w(M*k unfin- 
ished. He gave the first description of hematoma 
of the dura mater, and of glioma. 

Virchow was also the first to describe leontiasis 
ossea; he discovered the lymphatic sheaths of the 
cerebral arteries; in his doctor's thesis he treated the 
topic of the inflammation of the cornea (keratitis), 
and noted that wounds of the cornea repair without 
the presence of plastic exudations; he maintained 
that Peyer's patches are only lymphatic glands, and 
that in disease they play a part comparable with 
that of axillary and inguinal glands; he set forth in 
detail the pathology of syphilis; he investigated 
tuberculosis, and established the relation to it of 
lupus; and he explained the forms of parenchymat- 



274 THE HISTORY OF MEDICINE 

ous inflammation. Virchow was not disdainful of 
therapeutics, and his attitude in this regard may 
have influenced his student Hoppe-Seyler, and 
others closely associated with him. He is also men- 
tioned in connection with the investigation of septi- 
caemia, leprosy, cholera, smallpox, diphtheria, pella- 
gra, the pearly disease of cattle, Addison's disease, 
exophthalmic goitre, and cretinism. He was inter- 
ested in the composition of adipodre. He was active 
in municipal, as well as national politics, and in- 
stituted in Berlin a system of sews^ disposal and 
other sanitary reforms. In what was named, by 
him, the ''Kulturkampf," he considered himself the 
champion of liberal culture against the forces of 
obscurantism. On the eve of the Franco-Prussian 
War he stood as the advocate of European disarma- 
ment, but during the conflict he took a very promi- 
nent part in the organization of the ambulance and 
hospital service. He also contributed to the im- 
provement of civil hospitals and of nursing. Along 
with his varied pursuits he made extensive collec- 
tions, labeling over twenty-three thousand speci- 
mens, which he presented to the Pathological Mu- 
seum. 

In the judgment of Virchow medicine as an ap- 
plied science must rest on the firm basis of the 
natural sciences. At the same time he looked upon 
the classical literatures as the source of European 



THE CELL-THEORY 275 

culture. He encouraged the archaeological researches 
of Schliemann, and in 1879 was with him in the 
Troas» and, nine years later, in Egypt, Nubia, and 
the Peloponnesus. Like von Baer he devoted a 
great deal of energy to the study of anthropology, 
particularly craniology. He followed the genetic 
method of seeking the eq>lanation of things in their 
origins. He applied that method to the study of 
medicine. ''For me,'' he said, ''medicine does not 
begin to-day, and I hold it impossible to be com- 
pletely at home in it, if one does not interpret it 
genetically/' He was the first to write on the rela- 
tion of medicine to the fine arts. Perhaps it was his 
sense of historical perspective that made him con- 
temptuous of the trace of humoral pathology that 
survived in the teachings of the great Viennese 
pathologist Rokitansky, and made him at the same 
time distrustful of the doctrines of Darwin, of Koch 
and von Behring. 

REFERENCES 

Blind, Karl: "Personal Recollections of Virdiow/' North Ameri- 
can ReneWf 1920, vol. 175, pp. 613-34. 

Geddes, Patrick: "Protoplasm," EMcydopcedia Britannica. 

Israel, Oscar: Rudolf Virchow, Annual Report, Smithsonian 
Institution, 1901-02, pt. i, vol. 57, pp. 641-59. 

Tyson, James. The CeU-Doctrine. 1878. 

Virchow, Rudolf: Cellular Pathology as Based upon Physiological 
and Pathological Histology (translated by Frank Chance). 

Wilson, E. B.: The Cell in Deoehptnent and Inheritance. 1896. 



CHAPTER XIV 
THE nmODUCnON OFAK^SIHEnCS 



The tide <d Friodeir's vorfc. -EMpahmemtM and 
Obatufstioiit on DilJpiwit fGocb €t Air"* (i774* ^ 
90f[*)p gives flomc iiMJifiwioii <m iHiw flnie was umnu 

^ T^P ^Pffff ffp y the CuClDIBtXV OK CSBCS flB uK BEtteT DttTC 

<tf dbe righttTuUi uoiLBiy. Xhe <MMmmiitJUtt <tf tlie 

fSH^ csfbofi dioKide, as well as oxygaif mtrageo, and 
hydrogen^ wen kinds of air. The namrs by wUcli 
wt know tfaem had Id wait upoo theo* dtffeicntia- 
tacMit opoo their analysis, or upoo the analysis of the 
oompotuids of which they formed parts, such as 
water, nitric add and other adds. A great step for* 
ward was made when, on August I, 1774, Priestley 
in an apparatus from whidi air was exduded ignited 
lithaiye by means of a buming-glasB. He tested die 
facUiious air thus obtained by {rfadng in it a piece 
of lighted dxarooal. In the belief that die supporter 
of combustion is also the supporter of life he put two 
mice into the neidy isolated gas. He then inhaled 
some of the gas, and observed an exhilarating effect. 
^'Who can tdl," he writes, "but in time this pure 
air may became a fashionaMe artide in luxury? 



ANiESTHETICS 277 

Hitherto only two mice and myself have had the 
privilege of breathing it/* 

Before the end of the century the investigations 
of Priestley, Scheele, and others inspired Dr. 
Thomas Beddoes to found in one of the suburbs of 
Bristol the Pneumatic Institution to carry on ex- 
periments, and to treat patients by means of the 
newly discovered factitious airs. This enterprise 
has been described as a scientific aberration, but 
Beddoes was fortunate in choosing as an assistant 
to superintend the experiments Humphry Davy, 
then (1798) nineteen years old. Davy experimented 
for months with nitrous oxide, which had been dis- 
covered some time previously and which in 1793 
was produced by heating ammonium nitrate; that 
is, the process still in use to-day. The fact that it 
supports combustion like pure oxjrgen may have 
directed special attention to it, but it had been 
declared poisonous, and had even been described 
as the "principle of contagion.'' Davy, however, 
finally ventured on the crucial experiment of in- 
haling large quantities of the gas. After being sub- 
jected to nitrous oxide in an air-tight chamber for an 
hour and a quarter he inhaled twenty quarts of the 
pure gas. 

"A thrilling," he says, in describing the experi- 
ence, "extending from the chest to the extremities, 
was almost immediately produced. I felt a sense (tf 



278 THE HISTORY OF MEDICINE 

tangible extension highly pleasurable in every limb; 
my visible impressions were dazzling, and appar- 
ently magnified; I heard every sound in the room, 
and was perfectly aware of my situation. By de- 
grees, as the pleasurable sensations increased, I lost 
all connection with external things; trains of vivid 
visible images rapidly passed through my mind, and 
were connected with words in such a manner, as to 
produce perceptions perfectly novel. I existed in a 
world of newly connected and newly modified ideas: 
I theorized, I imagined that I made discoveries. 
When I was awakened from this semi-delirious 
trance by Dr. Kinglake, who took the bag from my 
mouth, indignation and pride were the first feelings 
(xxxiuced by the sight of the persons about me. My 
emotions were enthusiastic and sublime, and for a 
minute I walked round the room perfectly regard- 
less of what was said to me. As I recovered my 
former state of mind, I felt an inclination to com- 
municate the discoveries I had made during the ex- 
periment. I endeavored to recall the ideas: they 
were feeble and indistinct; one collection of terms, 
however, presented itself; and with the most in- 
tense belief and prophetic manner, I exclaimed to 
Dr. Kinglake, ' Nothing exists but thoughts! The uni- 
verse is composed of impressions ^ ideas ^ pleasures and 
painsr'* 
The discovery of the properties of ''laughing gas'' 



ANAESTHETICS 279 

appealed to the popular imaginatioa, and inhaling 
nitrous oxide became a regular form of entertain- 
ment. Davy, made famous by this and other bril- 
liant discoveries, was appointed assistant lecturer 
in chemistry at the Royal Institution, London, 
where his youth, scientific acumen, and wonderful 
powers of expression soon drew upon him the atten- 
tion of the fashionable world. In 1800, the year 
preceding his appointment at London, there ap- 
peared his '^Researches, Chemical and Philosophi- 
cal, chiefly concerning Nitrous Oxide,** which sets 
forth the following conclusion: ''As nitrous oxide in 
its extensive operation appears capable of destroy- 
ing physical pain, it may probably be used with 
advantage during surgical operations in which no 
great effusion of blood takes place.*' Davy's sugges- 
tion led to no immediate effects in the practice of 
surgery. Between the years 1820 and 1828 Hick- 
man, a young surgeon of Shropshire, England, ex- 
cruciated by the sufferings of those upon whom he 
was called to operate, carried on a series of experi- 
ments on animals in order to discover a method of 
inducing insensibility to pain by means dt inhala- 
tions. His early experiments were concerned with 
the study of asphyxiation, animals being rendered 
unconscious by enclosing them in glass and pre- 
venting the access of air or by exposing them to 
carbon dioxide prepared from calcium carbonate 



28o THE HISTORY OF MEDICINE 

and sulphuric add. Rebuffed by the profession In 
his own country, he succeeded in 1828 in having his 
methods of producing anaesthesia investigated by 
the Academy of Medicine in Paris. He failed to 
gain the approbation of that body, though there is 
evidence that by that time he was u^ng nitrous 
oxide and that his claims were supported to some 
extent by the distinguished army-suiigeon Baron 
Larrey. Ethyl ether was destined to be employed 
before nitrous oxide in surgical operations. 

Ethyl ether had been described as a preparation 
before the middle of the sixteenth century. As an 
inhalation it was used in Birmingham, England, as 
early as 1785, in the treatment of asthma and other 
respiratory affections. Dr. John Collins Warren, of 
Boston, Massachusetts, employed it in 1805 in the 
treatment of the advanced stages of phthisis. In 
18 1 8 there appeared a brief article in the ''Journal 
of Science and the Arts," London, containing the 
following statement: "When the vapour of ether 
mixed with common air is inhaled, it produces effects 
very similar to those occasioned by nitrous oxide." 
It had already evidently been considered a source 
of fun, for the writer, after describing the method 
of inhalation and the effects, gives expression to a 
warning, one gentleman after inhaling a large quan- 
tity having been thrown into a ''lethargic state, 
which continued with occasional periods of inter- 



ANiESTHETICS a8i 

mission for more than thirty hours/* This brief 
article, or note, was pfx>bably written by the cele* 
brated chemist Michael Faraday, then a young man 
of twenty-seven acting as Davy's assistant at the 
Royal Institution. 

* In spite of the warning concerning its imprudent 
use, ethyl ether, like nitrous oxide, continued to 
furnish entertainment both in England and in the 
United States (where the anaesthetic effects of ether 
inhalation were soon recognized by Godman (1822) 
and other physicians). In 1839 at an ''ether frolic" 
at Anderson, South Carolina, a colored boy, who 
had been forced to inhale a considerable amount of 
ether, after remaining unconscious for an hour, 
showed no subsequent ill effects. This may have 
encouraged the others. At all events, one of the 
j^ung men present on that occasion became in 1842 
a pupil of Dr. C. W. Long, of Jefferson, Georgia, 
and here the sport of inhaling ether was maintained* 
Dr. Long observed that he and the others did not 
experience pain from any blows and bruises they 
received while under the influence of the intoxicant. 
This led him to think it might be of value in surgery, 
and on March 30, 1842, he administered ether to 
James Venable and removed a small tumor from the 
patient's neck. Venable, the first person to undergo 
an operation under etherization, was somewhat 
addicted to inhalation as a pastime, and his bill 



282 THE HISTORY OF MEDICINE 

from Long, whidi is still preserved^ shcyws that ether 
with operation cost two dollars and ether without 
operation twenty-five cents. Dn Long continued to 
use the anaesthetic in his limited country practice; 
but he did not publish an account of his experiences 
with it, and there is no evidence that he exerted any 
influence in bringing about the general use of ether 
in Slurry. 

Two or three years after this occurrence, an itiner- 
ant lecturer, G. Q. Colton, entertained an audience 
at New Haven, G)nnecticut, by a lecture on 
'' Laughing Gas,*' demonstrating on a few of his 
hearers the effects of inhaling nitrous oxide. A 
j^ung dentist, Dr. Horace Wdls, who was among 
those present, made an observation — similar to 
Long's in the case of ethyl ether — that those ex- 
hilarated by the inhalation of laughing gas seem to 
experience no pain from even rather severe injuries. 
Impressed by this fact, and hoping to turn it to ac« 
count in his practice, he determined to submit him- 
self to a decisive test. Accordingly, on the day 
following the lecture. Wells had one of his own teeth 
extracted while under the influence of the anaesthetic 
administered by Colton. He felt no pain. Hence- 
forth Wells made oxistant use of nitrous oxide in his 
practice as a dentist. He foresaw not only the part 
anaesthesia was to play in dentistry, but also its 
value to surgery in general. In the autunm of 1845 



ANiESTHETICS 283 

he visited Boston in order to direct the attention of 
the medical profession to the virtues of nitrous 
oxide. He seized an opportunity to give a demon- 
stration before the Harvard Medical Coll^;e; but 
on this public occasion he failed. At this time he 
was thrown in contact with Dr. Charles T, Jackson 
and with William T. G. Morton (1819-1868). Wells 
and Morton had been partners for a short time in 
Boston in 1843. They were both interested in a new 
method of making false teeth, and, therefore, had a 
special motive for discovering a means of painless 
extraction. 

In 1844 Morton, without relinquishing his very 
lucrative practice as a dentist in Boston, had entered 
the office of Dr. Jackson as a student of medicine, 
and had matriculated at the Harvard Medical Col- 
lege. In that same year he had begun to experiment 
with ether as an anaesthetic. He continued his ex- 
periments, both on animals and human beings, in 
the summer of 1846. From Jackson he learned the 
different kinds and preparations of ether, the effects 
of the inhalations (as observed by his preceptor in 
the case of college students), and the necessity of 
making use of ether free from impurities. Finally 
Morton had the courage to try the effects of ethyl 
ether inhalation on himself, in September, 1846. 
He relates his experience in the following words: 
** I shut myself up in my room; seated myself in the 



a84 THE HISTORY OF MEDICINE 

operating chair and commenced inhaling. • • • It 
partially suffocated me but produced no decided 
effect. I then saturated my handkerchief and in- 
haled it from that. I looked at my watch and soon 
lost consciousness. As I recovered I felt a numbness 
in my limbs with a sensation like a nightmare and 
would have given the world for some one to come 
and arouse me. I thought for a moment I should 
die. ... At length I felt a slight tingling of the 
blood in the end of my third finger, and made 
an effort to touch it with my thumb, but without 
success. ... I pinched my thigh, but . . . sensation 
was imperfect. ... I immediately looked at my 
watch. ... I had been insensible between seven and 
eight minutes.'' 

Before the end of the month, Morton, with char-- 
acteristic boldness, made successful use of ether in 
extracting a tooth. The patient was given a hand- 
kerchief saturated with the anaesthetic, and was 
directed to inhale. He lapsed into unconsciousness 
almost immediately. A firmly rooted bicuspid was 
removed, and in about a minute the patient re- 
covered consciousness. This was on September 
30th. Within less than a week the enterprising^ 
Morton, then a young man of twenty-seven, called 
on Dr. Warren, senior surgeon of the Massachu- 
setts General Hospital, told of his success, and 
asked for an opportunity to give a public demon- 



ANiESTHETICS 285 

stration of his method of rendering insensible to pain 
patients about to undergo surgical operations. He 
did not have to wait long for an invitation to be 
present at an operation, and to put his method to 
the test. 

At the appointed time, ten o'clock on the morning 
of October 16, 1846, Morton was not present. This 
increased the skepticism of those assembled to wit- 
ness the test, and raised a doubt in the minds of 
some concerning the good faith of the young dentist. 
Dr. Warren, the operating suiigeon, seemed to share 
to some extent the general feeling of incredulity. 
Indeed, after waiting for a time, he was about to 
begin the operation without Morton's assistance 
when the latter appeared on the scene. He had been 
delayed in securing some apparatus he thought de- 
sirable in administering the ether, namely, an in- 
haler provided with a stop-cock and fitted into a 
glass vessel containing the ether. He now adjusted 
the apparatus, and in about three minutes the pa- 
tient sank into a state of insensibility. The operator 
made an incision about three inches long in the neck, 
and proceeded to extirpate a tumor just below the 
jaw on the left side. The patient, when he recovered 
from the effects of the ether, said that he had suf- 
fered no pain during the operation, though he had 
had the feeling that a blunt instrument was passing 
roughly across his neck. Warren, as well as the 



286 THE HISTORY OF MEDICINE 

others present, was convinced that Morton had 
made good his claim, though the patient soon after 
the first incision had begun to speak incoherently, 
and had appeared to give indications of suffering, 
his agitation continuing till the operation was over. 
On the following day Dr. Hayward removed a 
tumor from the arm oi a woman while she was under 
the influence of the inhalation. In this case the 
anaesthetic was adminfetered throughout the opera- 
tion, and the patient remained unconscious except 
for a disagreeable dream toward the dose. Morton's 
triumph was complete. 

The use of ethyl ether as an anaesthetic soon 
gained the recognition it deserved. Every success- 
ful operation under etherizaticm increased the con- 
fidence of the profession and strengthened the public 
faith in Morton's innovation. Three weeks after his 
first success with the anaesthetic. Dr. Hayward am- 
putated a lower extremity above the knee, the pa- 
tient remaining unconscious throughout the opera- 
tion. The prestige of the Massachusetts General 
Hospital, and the support q( such leaders in the 
medical world as Wanen, Hayward, and Bigelow, 
account for the rapid headway of surgical anaesthesia 
throughout all civilized countries. Henry J. Bige- 
low, considered at that time one of the best surgeons 
in America, who had been appointed to the staff of 
the Massachusetts General Hospital and professor 



ANiESTHETICS 287 

of surgery In the Harvard Medical CcXleg^ in the 
year of the great discovery, did his utmost to en- 
courage Morton. As early as November 3d he read 
a paper dealing with the new anaesthetic before the 
Academy of Arts and Sciences. He published this 
paper in the " Boston Medical and Surreal Journal " 
November i8th. Three days later Dr. Oliver Wen- 
dell Holmes suggested the terms "anaesthesia" and 
"anaesthetic'' in the sense in which they are still 
employed. 

In the following weeks Bigelow carried a sample 
of ether to London, arriving in that metropolis 
December 17th. Two days later it was there used 
by a dentist in extracting a tooth, and on December 
2ist Robert Liston, the famous surgeon, employed 
it in an amputation of the thigh. Syme, his cousin 
and sometime partner, used it in his Edinburgh 
practice the following year. On January 19, 1847, 
Simpson, who had discussed with Liston in the pre- 
ceding Christmas holidays the use of ethyl ether, led 
a notable advance by introducing the anesthetic 
into the practice of midwifery. After several 
months, referring to his experience with ether, he 
wrote: "I have employed it with few and rare ex- 
ceptions, in every case of labor that I have attended ; 
and with the most delightful results. • . • I have 
never had the {Measure of watching over a series of 
better or more rapid recoveries; nor once witnessed 



a88 THE HISTORY OF MEDICINE 

any disagreeable result follow to either mother or 
child ; whilst I have now seen an immense amount of 
maternal pain and agony saved by its employment.'' 
Among the European apostles of surgical ansesthesia 
must also be mentioned Pirogoff, the illustrious 
Russian^military surgeon. It seems almost incredi- 
ble that in the year following the use of ethjd ether 
for the first. time Jn an American hospital he could 
have written his ''Practical and Physiological Re- 
8earche^tx>nceming Etherization." Two years later 
appeared a medical report of his expaiences in the 
Caucasus containing interesting statistics of the 
results of amputating under the new conditions. 

On November 4, 1847, Professor (later, Sir) 
James Young Simpson of Edinburgh ^ discovered 
the anaesthetic effects of chloroform on human 
beings. This compound had been discovered almost 
simultaneously, in 1 831, by Guthrie in America, 
Liebig in Germany, and Soubeiran in France. In 
1834 ^^ great French chemist J. B. Dumas cor- 
rectly described its composition and gave it the 
designation ''chloroform." In the March preceding 
Simpson's discovery, its anaesthetic effects <mi lower 
animals had been recorded by the noted French 



* "Chloric ether" — that it, an alcoholic solutkm of chloroform — 
had been tried by Morton before his succeae with ethyl ether. Warren 
had used "chloric ether" by preference after October 16, 1846. It 
had also been employed at St. Bartholomew's Hospital, London, in 
the summer of 1S47. 



ANiESTHETICS 289 

physiologist Flourens. In his search for an anaesthe* 
tic inhalation less irritant than ethyl ether, Simpson 
had been advised to try chloroform ('' perchloride 
of formyle'') by Waldie, described as a chemist of 
Liverpool, but bom, like Simpson himself, in the 
county of Linlithgow, Simpson, after examining 
with the assistance of his colleagues, Keith and Dun- 
can, a great variety of chemicals in the hope of find- 
ing a substitute for ethyl ether, decided to put 
cUoroform to the test. The three friends inhaled it 
one evening from tumblers in the dining-room of 
Simpson's home in Edinburgh. They became exhila- 
rated, and the members of the household enjoyed 
the liveliness of the ensuing conversation. Then the 
three became suddenly insensible. Nothing daunted , 
however, by this first experience, they inhaled the 
chloroform repeatedly that same evening. Simp- 
son's niece was inclined to try it also. Folding her 
arms across her breast and inhaling the chloroform, 
she fell asleep crying, 'Tm an angell Oh, I'm an 
angel!" 

Within the following week Simpson tried the new 
anaesthetic on upwards of thirty people, using it in 
extracting teeth, opening abscesses, to annul the 
pain of dysmenorrhoea, neuralgia, etc. Moreover, 
he employed it with conspicuous success in obstetric 
practice. The lady to whom it was first adminis- 
tered in child-birth had previously been delivered 



290 THE HISTORY OF MEDICINE 

in the country, after prolonged labor, only by sacri- 
ficing the life of the child. In this, her second con- 
finement, she was worn by anxiety and sleepless- 
ness, and pains supervened a fortnight before full 
time. Three hours and a half after the occurrence 
of the first pains, at the beginning of the first stage 
of parturition, she inhaled from a handkerchief on 
which a teaspoonful of chloroform had been poured. 
Ten or twelve minutes later a like amount was ad- 
ministered, and the child was bom twenty-five min- 
utes after the beginning of the first inhalations. 
The patient was not aroused by the aying of the 
child nor at the coming away of the placenta. When 
she did regain consciousness she remarked to Simp- 
son that she had had a very comfortable sleep, that 
she had needed it having been so tired, but that she 
would now be able for the work before her. Simpson 
made no haste to set her right, and when the nurse 
came back into the room with the child, the mother 
could hardly believe it was her own living baby, as 
she said. 

Before ithe middle of November chlorofcMin was 
used as an anaesthetic in three operations at the 
Royal Infirmary of Edinburgh in the presence ol 
Dumas, who chanced to be visiting Scotland at the 
time. The notes of the operating surgeon. Professor 
Miller, supply the following account of the first case, 
'^ A boy, four or five years old, with necrosis of one 



ANAESTHETICS 291 

of the bones of the forearm. Could speak nothing 
but Gaelic. No means, consequently, of explaining 
to him what he was required to do. On holding a 
handkerchief, on which some chloroform had been 
sprinkled, to his face, he became frightened and 
wrestled to be away. He was held gently, however, 
by Dr. Simpson, and obliged to inhale. After a few 
inspirations he ceased to cry or move, and fell into a 
sound, snoring sleep. A deep incision was now made 
down to the diseased bone; and, by the use of the 
forceps, nearly the whole of the radius, in the state 
of sequestrum, was extracted. During this opera- 
tion, and the subsequent examination of the wound 
by the finger, not the slightest evidence of the suffer- 
ing of pain was given. He still slept on soundly, and 
was carried back to his ward in that state. Half an 
hour afterwards he was found in bed, like a child 
newly awakened from a refreshing sleep, with a 
dear, merry eye and placid expression of counte- 
nance. ... On being questioned by a Gaelic inter- 
preter who was found among the students, he stated 
that he had never felt any pain, and that he felt 
none now. On being shown his wounded arm, he 
looked much siurprised, but neither cried nor other- 
wise expressed the slightest alarm.'' 

In the other operations performed at the Royal 
Infirmary at this time Simpson made use of a hollow 
sponge in administering the ansesthetic. In one of 



292 THE HISTORY OF MEDICINE 

these cases — a soldier who*had an opening In the 
cheek, the result of exfoliation of the jaw — Miller 
recognized that it would have been impossible to 
employ any complicated inhaling apparatus applied 
to the mouth of the patient. In the other case Dr. 
Duncan operated on a young man suffering from 
necrosis of the first phalanx of the great toe and 
ulceration of the integuments. On November 15th 
Miller removed from a private patient an encysted 
tumor beneath the angle of the jaw. At that date 
Simpson had administered chloroform to fifty per- 
sons. 

As the acknowledged champion of surgical anaes- 
thesia he was very successful in meeting the aigu- 
ments and beating down the prejudices of his oppo- 
nents. Many of his contemporaries in Scotland and 
elsewhere considered pain as a punishment that 
should be received in a spirit of meekness, and the 
resort to anaesthetics seemed to them an impious 
attempt to thwart the divine will. Simpson was 
attacked from the pulpit and passages from the 
Bible were quoted to prove the wickedness of his 
undertakings. But he met arguments of this sort by 
appealing to the same authority. ''My exponents 
forget/' he said, ''the twenty-first verse of the 
second chapter of Genesis; it is the record of the first 
surgical operation ever performed, and that text 
proves that the Maker of the universe, before he 



ANiESTHETICS 293 

took the rib from Adam's side for the creation of 
Eve, caused a deep sleep to fall upon Adam/* En- 
lightened clergymen gave him of course their sup- 
port, and the opposition to the use of anaesthetics in 
midwifery, which had been particularly bitter — 
pointing to the wickedness of trying to remove a 
part of the primal curse on woman — broke down 
when Queen Victoria gave her countenance to the 
use of chloroform on the occasion of the birth of 
Prince Leopold in 1853. 

Anaesthesia was not only, as it has been called, the 
death of pain; it did away to a considerable extent 
with shock, and, by obviating the necessity of great 
speed in the performance of operations, made the 
introduction of antiseptic methods possible. Before 
ethyl ether and chloroform came into use haste was 
one of the recognized criteria of good surgery. One 
reads of Cheselden performing a lithotomy in less 
than a minute; of Langenbeck, surgeon general of 
the Hanoverian army in the Napoleonic era, ampu- 
tating a shbulder while one might take a pinch of 
snuff; of Sir William Fergusson, the founder of con- 
servative surgery, who was at times so speedy that 
the onlookers had to keep on the alert for fear of 
missing the whole operation through one moment's 
inattention; of Pirogoff, who was so rapid and dex- 
terous in the use of the knife as to challenge com- 
parison with a sleight-of-hand artist. When, on 



294 THE HISTORY OF. MEDICINE 

December 21, 1846, an anaesthetic was first used in 
England in a major operationi the surgeon, Robert 
Liston, proceeded as expeditiously as usual, remov- 
ing the limb of the patient at the thigh in twenty- 
five 'seconds, according to the statement of the 
dresser. Among the onlookers on this occasion at 
the University College Hospital, London, was a 
young student of nineteen still working for his de- 
gree in arts, Joseph Lister, whose contributions to 
surgery about twenty years later were no less the 
consequence of the introduction of anaesthesia than 
of the development of bacteriology. 

Within those twenty years the study of anaes- 
thetics continued to advance. Ethyl chloride, the 
anaesthetic effects of which on animals had been re- 
ported by Flourens in 1847, was tried in surgery in 
1848. Improved methods of administration arose 
from the work of John Snow who invented an in- 
haler in 1847 and published the results of his vari- 
ous experiments in 1858. His successor, J. T. Clover, 
invented his chloroform inhaler in 1862. This was 
followed by the Junker inhaler in 1867. Nunneley 
investigated in 1849, and the years following, the 
anesthetic properties of carbon dioxide, ethyl bro- 
mide, and other compounds. In 1853 Alexander 
Wood invented the hypodermic syringe and thus 
prepared the way for the triumphs of local anaes- 
thesia; while in 1866 Sir Benjamin Richardson 



ANAESTHETICS 295 

added to his numerous oontributions^to anaesthesia 
the use of the ether spray. In 1864 a committee of 
the Royal Medical and Chirui^cal Society recom- 
mended the mixture of alcohol, chloroform, and 
ether first used by Harley. In the years following 
1863 the use of nitrous oxide, which had been al- 
lowed to lapse after the death of Horace Wells in 
1848, was greatly stimulated through the advocacy 
of Colton both in America and Europe; and in 
1868 Edmund Andrews proved that the anaesthetic 
effects of nitrous oxide do not depend on partial 
asphyxiation. He thus cleared up a misconception 
of long standing. His mixture of oxygen and 
nitrous oxide gave very satisfactory results. 

REFERENCES 

Bigelow, Henry J.: Surgical Anasthesia. Addresses and Other 
Papers. 1900. 

Gofdon, Laing: Sir James Simpson (Masters of Medidne). 
1898. 233 pp. 

Gwathmey, J. T. (b collaboratioa with CSiarks Baskerville): 
Anesthesia. 1914. 943 pp. 

Kelly, H. A.: ''Hypnotism/' Maryland Medical Journal, vol. 
Lm, 1910, pp. 81-97. 

Paget, Sir James: "Escape from Fda; the History oC a Dis- 
covery," The Nineteenth Century, vol. 6, 1879, pp. 11 19-32. 

Rice, Nathan P.: Trials of a Public Benefactor. 1859. 460 pp. 

Young, Hugh H.: Long, the Discoverer of Anesthesia, Johns 
Hopkins Hospital Bulletin, vol. vxn, 1897, pp. i74-^« 



CHAPTER XV 

THE THEORY OF ORGANIC EVOLUTION 

When Charles Darwin, in October, 1836, returned 
to England from his voyage round the world, which 
had occupied nearly five years, he had arrived at no 
theory concerning the origin of species. In 1837, 
however, he made the following note: "In July 
opened first note-book on Transmutation of Species. 
Had been greatly struck from about the month of 
previous March on character of South American 
fossils, and species on Galapagos Archipelago. 
These facts (especially latter) origin of all my 
views/' In the months intervening between Octo- 
ber, 1836, and July, 1837, he had been thrown into 
dose contact with the great geologist Sir Charles 
Lyell, the champion of the uniformitarian doctrine. 
This doctrine, that the changes that have taken 
place in the earth's crust in the past were owing to 
agencies still in operation, had been splendidly 
stated by the Scotch geologist James Hutton in 
1785. Hutton's views, howev^, had been ignored 
by some scientists, and decried by others because of 
their alleged anti-religious tendency. The hostility 
to Hutton's teaching in 1822 was thus expressed by 
one of the leading English geologists, who was will- 



THEORY OF ORGANIC EVOLUTION ^^ 

ing to concede some recognition to the facts gath- 
ered by the Scotch geologist in reference to granite 
and other rocks: ''The wildness of his theoretical 
views, however, went far to counterbalance the util- 
ity of the additional facts which he collected from 
observation. He who could perceive in geology noth- 
ing but the ordinary operation of actual causes, car- 
ried on in the same manner through infinite ages, 
without the trace of a beginning or the prospect of 
an end, must have surveyed them through the me- 
dium of a preconceived hypothesis alone." Professor 
Sedgwick, under whom Darwin had studied geology 
at Cambridge, in a similar vein eloquentiy de- 
nounced the unscriptural tenets of Hutton and 
Hutton's disciples. Both Sedgwick and Henslow, 
the botanist, Darwin's chief masters at Cambridge, 
were dei^men, and Darwin, till the time of his 
appointment as naturalist to the Beagle expedition, 
planned to take orders ultimately in the Established 
Church of England. 

Sir Charles Lyell (i 797-1 875) had been an early 
convert to the uniformitarian view, but fully con- 
scious of the strength of the opposition, and natur- 
ally kindly and sympathetic as regards the opinions 
of his intellectual inferiors, his public utterances 
were of the most tactful sort. A careful study of 
Gibbon had convinced him that the frontal attack 
is not the most effective method of combating re- 



298 THE HISTORY OF MEDICINE 

* 

ligious prejudice, and had helped him to develop 
further a pleasing style of composition, which an 
early acquaintance with the classics and the con- 
stant example of a father oi scholarly tastes had 
already made second nature. At the age of twenty 
he observed on the coast of East Anglia the action 
of the sea in the f ornaation of new land as well as in 
the wearing down of the cliffs; and in the following 
years he found abundant evidence in his native 
Forfarshire, in the action of rain and rivers and the 
formaticHi of limestone, that all observable changes 
in the earth's crust were not owing to the Noachian 
deluge. 

By 1825 Lydl was a convinced uniformitarian, 
and was considering how he could express his con- 
victions without rousing unnecessary opposition 
and without giving offence to his older contempo- 
raries. In 1827 he had completed the first sketch of 
his Principles of Geology, and two years later, in 
preparing the book for the press, he made a pre- 
liminary statement, in a letter to a friend, of his 
doctrine ''that no causes whatever have from the 
earliest time to which we can look back to the pres- 
ent, ever acted, but those that are now acting, and 
that they never acted with different degrees of 
energy from that which they now exert" The first 
volume appeared in 1830 with the subtitle ''An 
Attempt to Explain the Former Changes of the 



r - 



THEORY OF ORGANIC EVOLUTION ±99 

Earth's Surface by Reference to Causes now in 
Operation/* Lyell was not oblivious to the logical 
outcome of applying the uniformitarian doctrine to 
the study of the organic world, and when Sedgwick 
and others charged him with holding that the crea- 
tion of new species is going on at the present day he 
readily admitted it. He thought it impossible that 
any one should read his work without perceiving 
that the notion of uniformity in the existing causes 
of change implies that ^'they must for ever prcxluce 
an endless variety of effects, both in the animate and 
inanimate world.*' 

When Darwin was leaving England in 1831 the 
extremely orthodox Henslow advised him to take 
Lyell's first volume with him, but to pay no atten- 
tion to it, except in regard to facts, for it was alto- 
gether wild as far as theory goes. Needless to say it 
made a very deep impression on the mind of the 
young naturalist. Lyell's second volume appeared 
in 1832, and a copy of it was sent to Darwin at 
Montevideo. This second volume was full of facts 
concerning variations, hybridism, and the struggle 
for existence; and it no doubt had a great effect on 
Darwin's subsequent observations and on his 
maturer generalizations. In fact, in dedicating the 
second edition of ''A Naturalist's Voyage" to Lyell 
the author with characteristic generosity writes: 
''This edition is dedicated with grateful pleasure as 



300 THE HISTORY OF MEDICINE 

an acknowledgment that the chief part of what- 
ever scientific merit this journal and the other works 
of the author may possess, has been derived from 
studying the well-known and admirable ' Principles 
of Geology.* " 

Darwin was very slow and systematic in arriving 
at hb generalizations. Soon after he b^gan to col- 
lect data relating to the transmutation of species, 
he turned particular attention to the different spe- 
cies and varieties of plants and animals under do- 
mestication, and to the success of the horticulturist 
and the breeder attained by a careful selection of 
certain strains for purposes of propagation. Ad- 
mitting that species might arise in nature by the 
perpetuation of chance variations he was at a loss 
to discover any causative influence corresponding 
to what he saw at work in the improvement of 
domestic plants and animals. In the autumn of 
1838 he read Malthus's ''Essay on Population/' 
which developed the teaching that it is a constant 
tendency among all living things to increase more 
rapidly than the means of subsistence; the resultant 
disproportion between the two rates of increase was 
the occasion of wars, vice, and misery. The idea 
flashed into Darwin's mind of a natural selection^ 
comparable in its effects to the artificial selection he 
had noted in his study of the improvement of culti- 
vated plants and domesticated animab. Natural 



THEORY OF ORGANIC EVOLUTION 301 

selection might occur in such hard conditions as 
would cause organisms to compete with one another 
for their very existence. It occurred to Darwin that 
under these circumstances '^favorable variations 
would tend to be preserved, and unfavorable ones 
to be destroyed. The result of this would be the 
formation of new species. Here, then, I had a theory 
by which to work." 

He deliberately refrained from making a written 
statement of his own views till 1842, when he wrote 
out a sketch, which he expanded two years later to 
a manuscript of 231 folio pages. He explained his 
theory in a letter to the American botanist Asa 
Gray in 1857. He stated that his belief that spe- 
cies have really changed depended "on general facts 
in the affinities, embryology, rudimentary organs, 
geological history, and geographical distribution of 
organic beings." He maintained that if such a 
selective agency as has developed our breeds of 
domestic animals, had, during the long ages revealed 
by the study of geology, exerted an influence on the 
organic world in general, it would have produced 
the miracles of design and adjustment in plants and 
animals that had hitherto baffled his powers of ex- 
planation. Such an agency he now finds in natural 
selection. He mentions also the slowness of the 
changes in species, the struggle for life, and the 
spontaneous occurrence of favorable variations. 



302 THE HISTORY OF MEDICINE 

Darwin had begun, in this year, at the urgent re- 
quest of Lyell, who feared the new theory might be 
forestalled by some other naturalist, the composition 
of a treatise. When he had written about a half of 
it, he received a manuscript from Alfred Russet 
Wallace setting forth a theory almost identical with 
his own. 

Wallace's experience had corresponded in differ- 
ent respects with Darwin's. He had spent many 
years in scientific exploration in South America and 
in the Malay Archipelago; he had come under the 
influence of Lyell ; he had long considered the prob- 
lem of the origin of species; and he had finally been 
led to a solution by Malthus's ''E^ssay on Popula- 
tion." He had learned from the "Principles of 
Geology" that the inorganic world was and always 
had been in a continual state of slow modification. 
Consequently forms of life must have become modi- 
fied and constantly adjusted to the new conditions in 
order to survive. The slowness of the changes re- 
vealed by the examination of fossils was such as to 
afford opportunity for the continuous automatic 
adjustment of organic beings to the inorganic en- 
vironment. In 1855 he arrived at the conclusion 
that each species has come into existence in the same 
environment as a closely allied species and in suc- 
cession to it. This indicated the fact of evolution, 
but failed to explain the process, "In February^ 



THEORY OF ORGANIC EVOLUTION 303 

1858,'* he writes, "I was suffering with a rather 
severe attack of intermittent fever at Temate, in 
the Moluccas; and one day, while lying on my bed 
during the cold fit, wrapped in blankets, though the 
thermometer was at 88 Fahr., the problem again 
presented itself to me, and led me to think of the 
' positive checks' described by Malthus in his ' Essay 
on Population,* a work I had read several years 
before, and which had made a deep and permanent 
impression on my mind. These checks — war, dis- 
ease, famine, and the like — must, it occurred to 
me, act on animals as well as man. Then I thought 
of the enormously rapid multiplication of animals, 
causing these checks to be much more effective in 
them than in the case of man ; and while pondering 
vaguely on this fact, there suddenly flashed upon 
me the idea of the survival of the fittest — that the 
individuals removed by these checks must be on the 
whole inferior to those that survived. In the two 
hours that elapsed before my ague fit was over, I 
had thought out almost the whole of the theory; 
and the same evening I sketched the draught of my 
paper, and in the two succeeding evenings wrote it 
out in full, and sent it by the next post to Mn 
Darwin/' . 
^ In the "Origin of Species" (1859), which the 
majority of scientists regard as exerting a greater 
influence on the development of ideas than any 



304 THE HISTORY OF MEDICINE 

other book produced in the nineteenth century, 
Darwin turns his attention first to the occurrence of 
variation under domestication. He is not, as has 
been supposed by some of his critics, unaware of the 
occasional occurrence of sudden deviations from the 
parental tjrpe, such as in the well-known case of 
ancon sheep, to which he makes reference. He also 
speaks of sporting plants, and recognizes that a 
seedling may exhibit remarkable deviation from 
type. But his main concern here is with those slight 
variations of which the horticulturist takes ad* 
vantage in the improvement of cultivated plants, 
and whidi afford the material that enables the 
breeder of horses, or cattle, or dogs to produce such 
distinct types of domestic animals. He was re- 
luctantly inclined to believe that all the different 
breeds of horses were derived from one wild stock. 
Domestic dogs on the other hand he thought had 
probably descended from several wild species, 
though one could not think that a parent type at all 
resembling the Italian greyhound, the Blenheim 
spaniel, the bull-dog, the bloodhound, etc., had 
ever existed freely in a state of nature. Many of the 
remarkable breeds and varieties are of course under- 
going constant modification through a purposeful 
process of artificial selection. 

Darwin made a particularly dose study of the 
breeds and sub-breeds of pigeons, keeping every 



THEORY OF ORGANIC EVOLUTION 305 

breed he could purchase or otherwise obtain, secur- 
ing specimens of skins from India and Persia, con- 
sulting eminent pigeon-fanders, and noting the 
references to domestic pigeons in the ancient litera- 
tures. He was convinced that the English carrier, 
the tumbler, the runt, the barb, the pouter, the 
turbit, the Jacobin, the trumpeter, the laugher, the 
fantail, etc., all draw their descent from the rock- 
pigeon (Columba livia). When two birds belonging 
to two distinct domestic breeds are crossed the 
mongrel offspring are liable to show the character- 
istic color and markings of the ancestral rock-pigeon. 
"I crossed," writes Darwin, "some uniformly white 
fantails with some uniformly black barbs, and they 
produced mottled brown and black birds; these I 
again crossed together, and one grandchild of the 
pure white fantail and pure black barb was of as 
beautiful a blue colour, with the white rump, double 
black wing-bar, and barred and white-edged tail- 
feathers, as any wild rock-pigeon 1 " In spite of their 
common ancestry the breeds are so different among 
themselves that an ornithologist seeing them for the 
first time would describe them as belonging to 
well-defined species, the differentiation depending 
not only on their general appearance, but on the 
character of their voice and disposition, on the 
shape and size of their eggs^ and on their anatomical 
structure, for example, the shape of the skull, the 



306 THE HISTORY OF MEDICINE 

number of the ribe, and the number of the caudal 
and sacral vertebrae. How have these differences 
been established? By accumulative artificial selec- 
tion, the pigeon-fander retaining for breeding pur- 
poses the birds that showed certain desirable char- 
acteristics. ''Some variations useful to him have 
probably arisen suddenly, or by one step/' But in 
general the variations put at the disposal of man's 
choice have been limited in range, and the develop- 
ment of new breeds has, consequently, been a slow 
process. Of this fundamental part of his theory, so 
directly an outcome of the personal observations of 
an Englishman oi Darwin's class and associations, 
he gave a fuller treatment in a later work — "The 
Variation of Animals and Plants under Domestica- 
tion" (1868). 

''Why if man can by patience select variations 
most useful to himself, should nature fail in selecting 
variations useful, under changing conditions of life, 
to her living products?" Even in the same species 
no two individuals are cast in precisely the same 
mould. This holds true of plants and animals in a 
state of nature as in those under domestication. 
Owing to the struggle for life, the fierceness of which 
had in Darwin's judgment not been fully appre- 
ciated by Lyell and others who had treated of it, any 
variation, however slight, in any degree profitable 
to the individual, "will tend to the preservation of 



THEORY OF ORGANIC EVOLUTION 307 

that individual, and will generally be inherited by 
his offspring. The offspring, also, will thus have a 
better chance of surviving, for, of the many indi- 
viduals of any species which are periodically bom, 
but a small number can survive. I have called this 
principle, by which each slight variation, if useful, 
is preserved, by the term of Natural Selection, in 
order to mark its relation to man's power of selec- 
tion." This process of natural selection Darwin 
considered the main but not the exclusive means of 
modification. 

What are the proofs that the one million and more 
living species now found on the earth owe their 
origin to development from other species, that is, to 
Evolution, rather than to acts of Special Creation? 
Darwin helps us to answer this question by indi- 
cating that in spite of the incompleteness of the 
geological record it is evident that all extinct or- 
ganic beings fall into the same system with living 
beings, and that a continuity may be observed to 
exist between classes of extinct and classes of living 
plants and animals, as, for example, between the 
fossil and the recent marsupials of Australia, and 
between the fossil and the recent edentata of Amer- 
ica. The facts of geographical distribution prove 
that, besides this succession or continuity in time, 
there is between like groups of living beings a degree 
of contiguity in space. Just so far as they are not 



308 THE HISTORY OF MEDICINE 

liable to the invasion of plants and animals conti- 
nents have their own characteristic faunas and 
floras. The species of oceanic islands are related to 
the species of that mainland from which they are 
most accessible to the inmiigration of plants and 
animals. In addition to the lines of proof suggested 
by the facts of geological succession and geographical 
distribution Darwin points out the interrelationship 
of all organic beings. This is the argument from 
classification. 

On this subject he writes as follows: ''It is a truly 
wonderful fact — the wonder of which we are apt 
to overlook from familiarity — that all animals and 
all plants throughout all time and space should be 
related to each other in group subordinate to group, 
in the manner which we everywhere behold — 
namely, varieties of the same species most doaely 
related together, species of the same genus less 
closely and unequally related together, forming 
sections and sub-genera, species of distinct genera 
much less closely related, and genera related in dif- 
ferent degrees, forming sub-families, families, or- 
ders, sub-classes, and classes. . • . On the view that 
each species has been independently created, I can 
see no explanation of this great fact; but, to the best 
of my judgment, it is explained through inheritance 
and the complex action of natural selection, entail- 
ing extinction and divergence of character." More- 



THEORY OF ORGANIC EVOLUTION 309 

over, the doctrine of common inheritance enables 
us to explain the likenesses among organisms re- 
vealed by the study of rudimentary organs, embry- 
ology, and morphology in general. 

It is with the consideration of these likenesses 
that Darwin begins his volume on ''The Descent of 
Man" (1871), which undertakes to make good the 
prediction contained in the ''Origin oi Species" that 
through the principles laid down in that work light 
would be thrown on the origin of man and his his- 
tory. The general anatomical structure of man is 
analogous to that of other mammals. The human 
skeleton may be compared bone for bone with the 
skeleton of the monkey, bat, or seal. The "Origin 
of Species" had mentioned the structural resem- 
blance o( the hand o( man, the wing of the bat, the 
fin of the porpoise, and the leg ot the horse, as well 
as the likeness in the number of cervical vertebrae of 
creatures so different as the elephant and the giraffe. 
A similar correspondence is found in the muscles, 
blood-vessels, viscera, and nerves of man and the 
lower mammalia. The diief fissures and convolu- 
tions of the human brain are comparable to those in 
the brain of the orang-outang. Moreover, the fact 
that man is liable to certain communicable and in- 
communicable diseases that affect the lower animals 
seemed to Darwin to indicate a dose similarity of 
tissues and blood. 



310 THE HISTORY OF MEDICINE 

Embryonic development begins in man as in the 
lower animals with the ovum. In the human em- 
bryo the arteries run in arch-like branches as in 
animals with functioning gills; the heart exists as a 
simple pulsating vessel; the os coccyx projects like a 
true tail. " In the embryos of all air-breathing verte- 
brates» certain glands, called the corpora Wolffiana, 
correspond with and act like the kidneys of mature 
fishes/' The convolutions in the brain of the human 
foetus at the end of the seventh month correspond 
in their development to those of the adult baboon. 
In the embryo the great toe is shorter than the other 
toes, and projects at an angle from the side of the 
foot, as in the adult simian. In 1859 Darwin had 
explained the similarity of the embryonic forms of 
mammals, birds, and reptiles on the principle oi 
common ancestry. 

The study of rudimentary organs, vestigial struc- 
tures, arrested developments, and reversions, fur- 
nished Darwin with further evidence of man's hum- 
ble origin. In this connection he mentions the vermi- 
form appendix, the os coccyx and filum terminale^ 
traces of a supra-condyloid and an inter-oxidyloid 
foramen, the mammse of males (sometimes fully 
developed and functioning), supernumerary mam- 
mae, the nictitating membrane, cleft-palate, and the 
imperfectly developed wisdom-teeth. As regards 
the canine teeth he cites HaeckeFs observation that 



THEORY OF ORGANIC EVOLUTION 311 

in every large collection of human skulls some may 
be found with the canine teeth projecting consider- 
ably beyond the others as in the anthropomorphous 
apes» but in a less degree. ''He," writes Darwin, 
"who rejects with scorn the belief that the shape of 
his own canines, and their occasional great develop- 
ment in other men, are due to our early forefathers 
having been provided with these formidable weap- 
ons, will probably reveal by sneering, the line of his 
descent. For though he no longer intends, nor has 
the power, to use these teeth as weapons, he will 
unconsciously retract his 'snarling muscles' (thus 
named by Sir C. Bell), so as to expose them ready 
for action, like a dog prepared to fight.'' (At the 
time Darwin wrote this passage — rather excep- 
tional in its tone — he was planning to publish his 
work "The Expression of the Emotions in Man and 
Animals," a subject sugs;ested to him by Bell's 
work "Anatomy of Expression/') 

The panniadus camosust and the structures as- 
sociated in the same system with it, especially the 
f unctionless muscles of the ear, are not overlooked 
by Darwin. The frequency of deviations from the 
so-called "normal" musculature is a commonplace 
observation in every dissecting room. One anatomist 
has recorded two hundred and ninety-five muscular 
variations in thirty-six subjects. Many muscles 
found occasionally in the human subject correspond 



312 THE HISTORY OF MEDICINE 

to musdes usually found in monke3rs and other 
mammals. Darwin's tubercle, malformations of the 
external ear, the arrested brain-development of 
idiots, the persistence and distribution of hair, sup- 
port the evidence afiForded by the muscles, teeth, etc. 
Moreover, monstrosities are " so similar in man and 
the lower animals, that the same classification and 
the same terms can be used for both, as has been 
shown by Isidore Geoffroy St. Hilaire." 

A great deal of space in "The Descent of Man'' is 
given to the development of the intellectual and 
moral processes in man and the lower animals, and, 
as we have seen in a previous chapter, to a consider- 
ation of secondary sexual characters. Darwin thus 
affords a biological basis for the psychology of the 
cognitions, volitions, and emotions. Into the choice 
of a mate, influenced by voice, brilliant plumage, 
and other secondary sexual characters, a conscious 
— aesthetic — element enters. Since sexual selec- 
tion involves consciousness, it may be viewed in re- 
lation to artificial selection; in fact, sexual selection 
as between man and woman is a matter of artificial 
selection. Therefore it is not surprising that Darwin 
should reach the following conclusion: "Man scans 
with scrupulous care the character and pedigree of 
his horses, cattle, and dogs before he matches them; 
but when he comes to his own marriage he rarely or 
never takes any such care. He is impelled by nearly 



THEORY OF ORGANIC EVOLUTION 313 

the same motives as the lower animals, when they 
are left to their own free choice, though he is in so 
far superior to them that he highly values mental 
charms and virtues. On the other hand he is strongly 
attracted by mere wealth or rank. Yet he might by 
selection do something not only for the bodily con- 
stitution and frame of his offspring, but for their 
intellectual and moral qualities. Both sexes ought 
to refrain from marriage if they are in any marked 
degree inferior in body or mind; but such hopes are 
Utopian and will never be even partially realized 
until the laws of inheritance are thoroughly known.'* 
Darwin's doctrine of pang^iesis (1868), which he 
put forward as a tentative hypothesis which could 
be given up as soon as any better might be found, 
has been described by Weismann (1834-1914), the 
spokesman of the Neo-Darwinians, as the first 
theory of heredity worthy of the name. Weis- 
mann's own theory of the continuity of the germ- 
plasm (1885) was anticipated to some extent by 
Francis Galton in the year following the appearance 
of "The Descent of Man." Haeckel, another early 
German disciple of Darwin, speaks of the English 
naturalist's influence in every branch of biology, 
especially in comparative anatomy and ontogeny, 
and in zoSlogical and botanical classification. It 
was indeed revolutionary. "Darwin's extraordi- 
nary marshalling of facts," says GarrisoUi, "in evi- 



314 THE HISTORY OF MEDICINE 

dence of the survival of the fittest by natural selec- 
tion in the struggle for existence^ had the same far- 
reaching influence upon biological speculation that 
the discoveries of Copernicus had upon astronomy. 
• . • It created the sciences of comparative physiol- 
ogy and pathology, by pointing to the dose struc- 
tural and functional relaticmship between human 
tissues and those of animals and {Jants.*' 

It is important that the student oi medidne 
should recognize that many problems concerning 
the relation of inheritance to pathology still await 
solution. How shall we explain the facts of heredi- 
tary immunity, such as Darwin noted in negroes as 
regards malaria and yellow fever, or such as have 
been observed in individuals in epidemics of cholera 
and other deadly diseases? How shall we account 
for the transmission of familial diseases like Fried- 
reich's ataxia, or of such hereditary defects as hae- 
mophilia, color-blindness, deaf-mutism, and poly- 
dactylism? Has pathology solved the problems of 
hereditary predispositions and diatheses? What 
vestigial structures are pathogenic? What diseases 
or malformations have resulted from the assump- 
tion of the erect posture? 

REFERENCES 

Bland-Sutton, Sir John: EvoluHon and Disease, 1890. 
Darwin, Charles: (i) The Origin of Species. 1859. 

(2) The Descent of Man, 1871. 
Osbom, H. P.: From the Greeks to Darwin. 1894. 



THEORY OF ORGANIC EVOLUTION 315 

Poulton, E. B.: Charles Ikumn, and the JTieary iif Natmal Sel^ 

tian. 1896. 
Soott, W. B.: The neary €ff EpokUum. 1919. 
Wdamann, August: The EnointHon Theory (tmnslated {rocn the 

second German edition, 1904, by J. A. and Margaret R. 

Thomson). 2 vob. 1904. 
See also leferenoes on page aia of the author's IfUrodnutitM to 
Ae History oi Scieme. 



CHAPTER XVI 

THE FOUNDERS OF BACTERIOLOGY 

In 1820 Ozanam, a French historian of epidemic and 
infectious diseases, wrote that many writers had 
dealt with the animal nature of infectious materials. 
Several had maintained not only that these develop 
from animal substance but that they are themselves 
organic and living beings. Varro, Columella, Lucre- 
tius, Father Kircher, Landsi, Vall'sneri, Reaumur, 
Christ, Long, Plendz, Menuret, Rasori, and others 
had supported this view. Fremont had maintained 
that infectious materials arise and develop in the 
body through fermentation. ''I will not waste 
time/' adds Ozanamt ''in refuting these absurd 
hypotheses.'' 

Leeuwenhoek, by means of an excellent lens, 
ground and mounted by himself, had observed 
bacteria as early as 1683. In 1701 Nicolas Andry 
expressed the conviction that air, water, vinegar, 
fermenting wine, beer, cider, and sour milk are full 
of germs; that germs exist also in blood, urine, and 
the pustules of smallpox patients; and that mercury 
cures venereal disease because it kills the invisible 
pathogenic organisms. By the year 1726 the doc* 
trine of the causal relationship between micro* 



FOUNDERS OF BACTERIOLOGY 317 

organisms and disease was so notorious as to be 
made the subject of a French satire (''Sjrst&me d*un 
m£dedn anglais sur la cause de toutes les esp^s de 
maladies 'Of in which the fainter* the belly-nipper, 
etc, were playfully described. 

More serious attempts at classification appeared 
before the dose of the eighteenth century. Linnaeus, 
in the last edition of his ''Systema Naturae'' (1768), 
classed bacteria along with other microscopic forms 
in the cat^;ory " chaos/' In spite of his distrust oi 
the observaticHis of the microscopbts, however, he 
recognized that organic beings might be the cause 
ci fevers, venereal lues, and exanthemata. In fact, 
in an earlier work he had expressed the belief that 
parasites cause measles, dysentery, plague, small- 
pox, etc In 1786 was published the '^Animalcula 
infusoria fluviatilia et marina" of Otto Friedrich 
M jiller, of Copenhagen, who under the general name 
of "infusoria" sought to classify, according to form, 
movement, and habitat, the microscopic beings so 
inadequately treated by Linnaeus. MuUer made 
use of the terms "monas," "bacillus," "vibrio" 
"spirillum"; though he laid the chief emphasis on 
differences of form, he noted the serpentine and 
other movements characteristic of some kinds, and 
the inclination of others to form filaments, pellicles, 
and clusters, and, above all, he furnished well-exe- 
cuted illustrations of the organisms he had observed^ 



330 THE HISTORY OF MEDICINE 

ments — that an insufficient quantity of air had 
been allowed for the support of life in the infusoria, 
and that the conditions of the experiments had 
robbed the air of its life*8upporting quality. In 1836 
Franz Schulze tried to meet these criticisms by 
filtering the air in a flask (containing an infusion) 
through concentrated sulphuric add. He renewed 
the air in this way for over two months. The in- 
fusion remained free from, micro-organisms. When 
at the end of that time, however, unfiltered air was 
admitted to the infusion, various living forms de- 
vebped. In 1837 Schwann used molten metal or a 
spirit flame for the same purpose as the concen- 
trated sulphuric add served in Schulze's experi- 
ment. Both Schulze and Schwann were open to the 
criticism of having subjected the air to vitiating 
influences. In 1854, however, Schroder and von 
Dusch showed that a thick layer of cotton wadding 
sufficed to exdude all germs, while permitting free 
access of air. In 186 1 Pasteur found an even simpler 
means of exduding germs while freely admitting 
air. The infusion was placed in a flask the neck of 
which terminated in a long stem, curved down and 
then up somewhat like the letter ''S." This stem 
was left open, and the outside air allowed to enter. 
After the infusion in the flask had been boiled, the 
germs from the outside air would at first be killed 
by the steam, while, later, as the apparatus cooled, 



FOUNDERS OF BACTERIOLOGY 321 

such germs as found their way into the end of the 
open stem would be arrested in its curves* 

It was urged by Pasteur's opponents that if altera- 
tions occurring in infusions, after they had been 
duly boiled, were brought about solely through the 
agency of germs in the air, then these germs must 
everywhere be present in great abundance and 
variety. Pasteur replied that they were much more 
abundant in some localities than in others, and he 
proceeded to secure experimental proof of his con- 
tention. He filled a large number of flasks with in- 
fusion, heated them to the boiling point, and then 
hermetically sealed them. He opened twenty of 
these flasks, sealing them again immediately, at the 
foot of the Jural Alps; twenty others at an altitude 
of eight hundred and fifty meters above sea-level; 
and an additional twenty at an altitude of two 
thousand meters. On examining the contents of 
these sixty flasks after some days, it was found that 
eight out of the first twenty, five out of the second 
twenty, and only one out of the third twenty showed 
the presence of microscopic beings. Other objections 
to his doctrine of biogenesis he proved to be based 
on careless experimentation. "No,'\he said at the 
end of his communication to the Acad6mie des 
Sciences in 1864, "there is no circumstance known 
to-day that permits us to assert that microscopic 
beings have come into the world without germs, 
without parents similar to themselves/' 



322 THE HISTORY OF MEDICINE 

Several years before the final overthrow of the 
theory of spontaneous generation, Pasteur had 
demonstrated the part played by germs in various 
kinds of fermentation. We have seen in previous 
chapters that an analogy had been traced by the 
predecessors of Rhazes between fermentation and 
at least one form of disease, and that a like compari- 
son was familiar in the time of Sydenham. Robert 
Boyle had declared that ** He that thoroughly under- 
stands the nature of ferments and fermentations 
shall probably be much better able than he that 
ignores them to give a fair account of divers phe- 
nomena of certain diseases (as well fevers as others) 
which will perhaps be never properly understood 
without an insight into the doctrine of fermenta- 
tions." In 1836 Cagniard de la Tour, the French 
physicist, observed that yeast plays a part in al- 
coholic fermentation, that it seems to be a living 
plant, and that its growth keeps pace with the pro- 
cess of fermentation. About the same time Schwann 
arrived independently at like conclusions. 

Pasteur was interested in 1856 in fermentation in 
connection with the manufactiu^ of beetroot alco- 
hol, and examined the globules of the ferment by 
means of the microscope. In the years following he 
succeeded in showing that lactic (1857), tartaric 
(1858), butyric (1861), and acetic (1862) fermenta- 
tions depend likewise on the presence of definite 



FOUNDERS OF BACTERIOLOGY 323 

living organisms. For example, if PeniciUium glau- 
cum grows in a racemate solution, the solution 
gradually becomes laevo-tartaric. (Pasteur's mas- 
terly analysis of racemic acid into dextro-tartaric 
and laevo-tartaric laid the foundation-stone of 
stereo-chemistry in 1848.) In his study of the differ- 
ent kinds of fermentation Pasteur first determined 
in which constituent of the fermentable substance 
the characteristic change occurred. In the second 
place he studied under the microscope such organ- 
isms as invariably accompanied the fermentation in 
question. He then made a solution of the ferment- 
able constituent, added such ingredients as he con- 
ceived necessary for the growth of the organism, 
boiled the solution so as to render it free of germs, 
and placed in the solution thus prepared a trace of 
the essential ferment. In this way he put to the test 
his hypotheses concerning the organic causes of 
fermentation. The cause of butyric fermentation 
he found to be a micro-organism that could live only 
in the absence of oxygen, in fact, an anaSrobic vi- 
brio. Pasteur followed up these studies of fermenta- 
tion by investigating the ammoniacal decomposi- 
tion of urine and the part played in so-called putre- 
faction by micro-organisms. 

He now turned his attention to the diseases of 
wine. He soon found that wine becomes sour 
through the activity of Mycoderma acetic the pres- 



324 THE HISTORY OF MEDICINE 

ence of which is betrayed by the appearance of a 
pellicle on the surface of the liquor, that the bitter- 
ness of wine is owing to an organism that shows 
under the microscope branching and twisted fila- 
ments, while the turning and ropiness of wine result 
from the development of other micro-organisms. 
At the time of these investigations Pasteur had 
become fully conscious of his purpose to arrive, as he 
expressed it to the Emperor in 1863, at the knowl- 
edge of the causes of putrid and contagious diseases. 
After treating what he called the spontaneous alter- 
ations or diseases of wines, he undertook, at the 
urgent request of Dumas (now a Senator and par- 
ticularly influential in the Ministry of Agriculture), 
to investigate the diseases of silkworms. In 1836 
Bassi had made the remarkable discovery that one 
communicable disease of silkworms, muscardine, is 
caused by a fungus, the minute spores of which are 
transferred from the diseased to the healthy worms 
through the atmosphere or by actual contact. In 
1857 Naegeli had described the micro-organism of 
the disease, pibrine^ that Pasteur was now especially 
called upon to investigate. After five years of ardu- 
ous labor Pasteur succeeded in tracing out the his- 
tory of this infection, devised means of eradicating 
it, and discovered the cause of a second disease of silk- 
worms, flacherie^ which he ascribed to an oi^anism 
that developed in the intestinal canal of the wwm. 



FOUNDERS OF BACTERIOLOGY 3^5 

In 1871 he resumed his study of alcoholic bever- 
ages, and undertook to discover the causes of the 
diseases c^ beer. Why does it become thick, sour, 
slimy, or putrid? He came to the conclusion that 
every *^ marked alteration in the quality of beer coin- 
cides with the development of miax>-oi:f;anisms 
foreign to the nature of true beer yeast/' Beer is 
unalterable so long as it contains no living germs; 
disease ferments will not develop in bottled beer 
after being heated to a temperature of from 50^ to 
55* C. When, says Pasteur, we see beer and wine 
undergo marked alterations because they harbor 
micro-organisms, which gain an entrance unnoticed 
and then increase enormously in numbers, we must 
be convinced that similar experiences must befall 
in the case of the lower animals and of man. 

A number of important advances in bacteriology 
prepared the way for Pasteur's study of anthrax in 
1877. The BaciUtis anthracis was observed as a 
little rod-like structure in the blood of animals that 
had died of anthrax, or splenic fever, by Delafond 
in 1838. In 1850 a like observation was made by 
Davaine (as well as by Rayer), who came to recog- 
nize the importance of the discovery only after read- 
ing Pasteur's paper on butyric fermentation. In 
1863 he inoculated some rabbits with the blood of a 
sheep that had died of anthrax, and upon the death 
of the inoculated animab concluded that they also 



326 . THE HISTORY OF MEDICINE 

had succumbed to . anthrax. In that same year 
Delafond studied the organisms under a watch 
glass, saw the little rods grow into filaments, and 
attempted to discover ''the mechanism of fructifi- 
cation/' Even before the observations of Davaine 
and Rayer, Pollender had observed the bacillus in 
the blood o( cows that had died of anthrax (1849). 
Important as are these observations of this patho- 
genic micro-organism, the cause of widespread in- 
fection, they are less deserving of emphasis in the 
history of bacteriology than the achievements of 
Ferdinand Cohn (1828-^8) and of Robert Koch. 

Cohn's discovery, in 1857, of the sporulation of 
microscopic organisms led to the clearing up of a 
number of difficulties, such as the persistence of 
living forms in infusions of hay, milk, and cheese, 
which had baffled experimenters from the time of 
Spallanzani. G>hn's researches concerning bacteria 
furnished a system of classification, which, retaining 
what was of value in earlier systems — such as the 
Hallier's concept of the micrococcus and Ehren- 
bei^g's concept of the spirillum and the spirochaeta 
— still dominates to-day the grouping and the no- 
menclature of schizomycetes. G>hn recognized that 
all bacteria are plants. He classified the micrococci 
as chromogenic, zymogenic, and pathogenic. Among 
the bacilli he mentioned of course the bacillus 
anthrads. He showed, moreover, by striking calcu- 



FOUNDERS OF BACTERIOLOGY 327 

lations the marvelously rapid increase of bacteria 
under conditions favorable to their development, 
and thus drew attention to the part they play in the 
struggle for existence. In 1876 he observed the 
germination of the spores of certain bacteria. In 
April the same year Koch announced to Cohn the 
results of his study of the anthrax bacillus. To this 
brilliant investigation and to Koch's other achieve- 
ments we shall return presently. 

At the beginning of 1877 the French physiologist 
Paul Bert maintained that by the use of compressed 
oxygen he could destroy the bacillus anthracis in 
the blood of animals that had died of anthrax, and, 
then, by inoculating the blood so treated, cause 
death in the inoculated animals without the appear- 
ance of fresh bacilli. Therefore, he argued, the 
bacillus anthracis is neither the cause nor the neces- 
sary effect of anthrax. Pasteur, assisted by Joubert, 
tackled the subject. He found it possible to obtain 
a pure culture of the organism in urine rendered 
neutral or slightly alkaline. The inoculation of a 
trace of this culture produced a typical case of 
anthrax. How then account for the results of Bert's 
experimentation? In the first place Pasteur stated 
that the spores of bacillus anthracis could resist for 
three weeks the action of pure oxygen under a pres- 
sure of ten atmospheres. In the' second place the 
death of animals, following the inoculation of the 



328 THE HISTORY OF MEDICINE 

blood of anthrax victims^ without the appearance of 
bacilli was really owing to septicaemia, which in 
turn owed its development to pathogenic micro- 
organisms. He was able to point out in the Uood of 
animals that had died of anthrax, in addition to 
bacillus anthrads, the vibrion septigue (bacillus of 
malignant oedema), which he had himself discovered. 
Nevertheless, he did not believe that septicaemia is 
a specific infection, and he later discovered Staphy- 
lococcus pyogenes and Streptococcus pyogenes. 
Pasteur also discovered the pneumococcus. 

Until Pasteur^s study of chicken cholera in 1880, 
Edward Jenner's great success in the production of 
artificial immunity remained an isolated phenome- 
non. Some years before this the micro-organism of 
chicken ch(^era had been described. Toussaint es- 
tablished the causal relationship between the or- 
ganism and llie disease. Pasteur found that the best 
culture medium was a broth of chicken gristle 
neutralized with potash, and that the smallest dxx>p 
of a recent culture would kill a chicken. When, how- 
ever, hens were given an old culture, which had been 
put away and forgotten for a few weeks, though 
they were affected by the disease they did not suc- 
cumb to it. If these hens were then exposed to the 
unattenuated virus, they were either unaffected, or 
they experienced the disease in a mild form. "Was 
not this fact," writes Vallery-Radot, "worthy of 



FOUNDERS OF BACTERIOLOGY 329 

being placed by the side of the great fact of vaccina- 
tion, over which Pasteur had so long thought and 
pondered?" Was it possible to develop an animal's 
resistance to other infectious diseases? By the be- 
ginning of 1 88 1 Pasteur was able to announce the 
essentials of his preventive treatment for anthrax. 
He had found that bacillus anthracis could be culti- 
vated in neutralized chicken broth at 42** to 43® C. 
without developing spores, and that by being kept 
for ten or twelve days the culture became so at- 
tenuated as to give rise merely to a benignant form 
of the disease. Moreover, the weakened culture can 
be cultivated at 30** to 35° C. and yet yield spores 
of the same degree of virulence as the bacilli that 
formed them. The bacilli may recover their original 
virulence by being passed through a series of guinea- 
pigs, the second being inoculated with the blood 
of the first, and so forth. (Similarly, the micro- 
organism of chicken cholera, after it has become 
weakened through contact with oxygen, may be 
strengthened by being passed through a series of 
sparrows or canaries.) 

It was the methods and principles established by 
these studies that led to Pasteur's successful treat- 
ment of hydxx>phobia in 1885, and to the subsequent 
founding of the Pasteur Institute. "Here," says 
Garrison, "Pasteur labored almost to the end of his 
life, with such brilliant pupils as Metchnikoff , Roux, 
Yersin, Calmette, Chamberland, and Pottevin." 



330 THE HISTORY OF MEDICINE 

Robert Koch (1843-1910) bom in the Kingdom 
of Hanover, was a pupil at Gottingen of the dis- 
tinguished histologist Henle, who in 1840 Iiad re- 
vived the doctrine of a cotUagiunt anitnatum. Koch 
took his degree in 1866, the year in which Hanover 
was conquered and annexed by Prussia. In the 
Franco-Prussian War he served as a volunteer army 
surgeon. After the war was over, he was appointed 
district physician of a small place (WoUstein) in 
Posen. There he devoted himself to the study of 
infectious diseases. 

In 1876 Koch began to publish the results of his 
investigations concerning the etiology of anthrax 
("Die Aetiologie der Milzbrand-Krankheit, be- 
grOndet auf die Entwickelungsgeschichte des Bacil- 
lus anthracis"). He showed in the first place that 
mice develop anthrax when inoculated with blood 
containing the bacilli; that by successive inocula- 
tions the disease may be passed from one to another 
of a long series of mice. At the same time he noted 
the rapid growth of the organisms in the blood, 
lymph, etc., and the presence of countless numbers 
of them in the spleens, of the inoculated animals. 
He then proved that in a suitable culture medium, 
such as fresh ox blood serum or the aqueous humor 
of an ox's eye, at a temperature of from 18° to 40® C. 
and with free access of air the anthrax bacilli grow 
to great length and develop numerous spores. He 



FOUNDERS OF BACTERIOLOGY 331 

had been able to observe this process, by means of 
the microscope, in a drop of aqueous humor to which 
a small portion of fresh spleen containing bacilli was 
added. In a fresh drop of aqueous humor he also 
saw these spores develop into typical anthrax 
bacilli. This beautiful piece of work, which of itself 
entitles Robert Koch to a place beside Pasteur as 
one of the great founders of bacteriology, placed in 
his hands an absolutely pure culture of a patho- 
genic micro-oi'ganism, and gave him the means of 
proving that the bacillus anthrads is the sole cause 
of splenic fever. The spores on account of their 
resistance to the action of prolonged moisture or 
dryness play of course an important part in the dis- 
semination of the disease. 

In 1878 Koch published his investigations con- 
cerning the etiology of wound infections. He be- 
lieved that the "parasitic" nature of these diseases 
is probable, "but that an adequate proof therefor 
had not been given and that such proof would not 
be forthcoming till we succeed in discovering the 
parasitic micro-organisms in all cases of the disease 
under investigation, till we succeed in showing them, 
moreover, in such numbers and distribution as to 
explain all the morbid phenomena, and, finally till 
we succeed in establishing for every kind of wound 
infection a definite, morphologically distinct, micro- 
organism as the parasite/' He sought to discover 



332 THE HISTORY OF MEDICINE 

the characteristic organisms in septicaemia, pysenua^ 
erysipelas, etc., by experiments on animals, inject- 
ing into mice and rabbits such substances as putres- 
cent meat infusion or blood. He was able to study 
the effects of injecting, into mice, blood impreg- 
nated with chain-forming micrococci, and to pro- 
duce in rabbits a disease markedly resembling ery- 
sipelas in man. The main result of this investigation 
seems to have been to strengthen Koch's conviction 
of the indubitable differences of pathogenic micro- 
organisms and of their inalterable constancy of 
behavior. 

Koch always laid great stress on the value for the 
progress of medicine of improved technique and new 
methods of investigation. In 1877 he had advo- 
cated the use of photography as practiced by him- 
self in the identification of microscopic organisms. 
He adopted Weigert's method of staining with ani- 
line dyes, especially methyl violet and fuchsin, and 
he sought means to overcome the constant move- 
ment of the micro-organisms recognized by him as 
one of the chief obstacles of the investigator. In 
1881, a year after he was called to the Imperial 
Health Bureau in Berlin, he devised his method of 
obtaining pure cultures with fixed, coagulable, 
culture media. After he had developed his method, 
discoveries fell into the lap of the investigator like 
ripe fruit, as Koch himself said. 



FOUNDERS OF BACTERIOLOGY 333 

In 1882 he announced the discovery (^ the JSociZ^Kf 
tuberculosis^ thus confirming the views of others in 
relation to the specific and communicable character 
of tuberculosis. In the course of his experiments 
carried on in the hope of discovering a cure for 
tuberculosis Koch found that tuberculous guinea- 
pigs differ from healthy guinea-pigs in their manner 
of reacting to inoculations of tubercle bacilli, alive 
or dead. From this fact he inferred that there was 
in the bacilli a soluble substance which would prove 
a means of diagnosis and of control. His tuberculin 
— a glycerine extract of pure culture of bacilli — 
was announced at the International Medical Con- 
gress held at Berlin in 1890. Later he produced a 
new tuberculin, which has become recognized as of 
great value in diagnosis. He held that the bacilli of 
bovine tuberculosis do not cause tuberculosis in man. 

In 1883 Koch went to Egypt and India as leader 
of the German Cholera Commission: recognized in 
amoebae the cause of tropical dysentery; discovered 
in the comma bacillus the cause of Asiatic cholera; 
and in another bacillus the cause of infectious con- 
junctivitis. In 1885 he received appointment at the 
University of Berlin as professor in the faculty of 
medicine and director of the newly established 
Hygienic Institute. In 1891 his great powers as an 
organizer were called into play in connection with 
the new Institute for Infectious Diseases. In the 



334 THE HISTORY OF MEDICINE 

following year cholera broke out in the dty of Ham- 
burg, but the menace to the fatherland was averted 
by the medical science of Koch, always alive to the 
dangers of water-borne infections. He further served 
Germany by fighting t)T>hus in the southwestern 
part of the country, as well as by suggesting sani- 
tary legislation, and organizing conferences. In 

1896 at the request of the British govemmtat he 
investigated Rinderpest in South Africa, and de- 
veloped a method of preventive inoculation. In 

1897 he studied bubonic plague at Bombay. He had 

• 

recognized in 1883 that blood-suddng insects are 
transmitters of disease, and a considerable part of 
the last fifteen years of his life was spent in the study 
of tropical medicine. In 1906 he was again in Africa 
as head of the Sleeping Sickness Conunission. 

REFERENCES 

Dudaux, Exnile: Histoire d^un Esprit, 1896. 395 pp. 

Knopf, S. A.: Robert Kock, Johns Hopldos Hospital Bulletin, 

191 1, vol. xxn, pp. 425-28. 
Kodi, Robert: (i) Bacteriologkal Dtagnosis cf Cholera (tran^- 

tion by G. Duncan). 1894. 150 pp. 
(2) InoestigoHans into the Etiology of Traumatic Infective 

Diseases (translation by W. Watson Qieyne). 1880. 74 pp. 
Roger, Henri: "Les Sciences MMicales," in the first volume of 

La Science Fran^aise, 1915. 
LOfHer, Friedrich: Vorlesungen uber die geschichtliche Banir 

vickdung der Lehre von den Bacterien, 1887. 252 pp. 
Tyndall, John: "Spontaneous Generation," Popular Science 

Monthly, vd. 12, 1877, pp. 476-88 and 591-604. 
See also references on page 230 of the author's Introduction to 
the History of Science. 



CHAPTER XVir 

ANTISEPTIC SURGERY: LORD LISTER 

Joseph Lister, the story of whose achievements in 
surgery is so closely associated with that of the de* 
velopment of bacteriology^ was bom in the London 
district (Upton) April 5, 1827. He received his 
early schooling at two Quaker institutions (his 
family belonging to the Society of Friends), took his 
bachelor's degree at University Coll^;e, London, 
proceeded at the age of twenty-one to his profes- 
sional education at the University College Hospital 
and Medical School, and at the age of twenty-five 
received the M.B. and F.R.C.S. He had already 
come in contact with several men whose names are 
known in the history of science: Joseph Jackson 
Lister, his father, already referred to as contributing 
to the production of the achromatic lens; Thomas 
Graham, who formulated the law of the diffusicm of 
gases; W. B. Carpenter, whose wc^k on ''Mental 
Physiology*' has had a great effect on the progress 
of psychology; William Jenner, who during Lister's 
early years as a student of medicine was working 
out the distinction between typhus fever and ty- 
phoid; William Sharpey, the distinguished teacher 
of physiology; and Wharton Jones, noted as an 



336 THE HISTORY OF MEDICINE 

ophthalmic surgeon and as one of the pkmeersy in 
England, in the study of embryology. BefOTe tak- 
ing his degrees in medicine lister had served six 
months as house physician and nine months as 
house surgeon (to Erichaen) at the University Col- 
lege Hospital. 

Among the results of his extended education were 
a considerable command oi ancient and modem 
languages, skill as a draughtsman and microsoopist, 
love of scientific truth and a taste for researdi. In 
i853t the year following his graduation in medicine, 
he published two papers in the ''Quarterly Journal 
of Microscopical Science." The first of these re- 
corded the discovery oi the sphincter and the dilator 
of the iris as distinct muscles, and confirmed the 
views of K6lliker as regards the ncmstriated and the 
cellular structure of the tissue in question. The 
second paper, illustrated like the first by delicate 
drawings, dealt with the arrectares ptii^ especially 
those of the scalp. He prepared his sections by tying 
the tissue to be examined between two thin slips of 
pine and allowing it to dry for twenty-four houiB, 
by which time the piece of scalp having adhered to 
one of the slips could be cut, by means of a sharp 
razor, in very fine shavings along with the wood in 
any plane desired. This was an original form of 
microtome. 

In the autumn of 1853 Lister went to Edinburgh, 



ANTISEPTIC SURGERY 337 

on the advice of Shatpey^ in order to attend the 
surgicai dinics of Syme, an excellent teacher and 
the foremost sui^geon at that time in Great Britain. 
The youi^ man was very cordially received. Hebe- 
came a frequent visitor in Syme*8 home* where he 
met a large number of agreeable and cultured people, 
among them Dr. John Brown, the author of "Rab 
and his Friends/' In the congenial society of Edin- 
burgh, a city more beautiful then even than now, 
Lister threw off much of his natural shyness and 
restraint, though, in spite of the favor his accom- 
plishments and admirable dispositicm gained for 
him, he never lost his native modesty. He socm be- 
came Syme's house surgeon at the Royal Infirmary, 
where in this period following the introduction of 
the use of anaesthetics, he had abundant oppor- 
tunities to develop skill as an operator. About this 
time he wrote home: *'If the love oi surgery is a 
proof of a person's being adapted for it, then cer- 
tainly I am fitted to be a surgeon; for thou canst 
hardly conceive what a hig^ d^;ree of enjoyment I 
am from day to day experiencing in this bloody and 
butcherly department of the healing art." The 
young house surgeon had twelve dressers, who 
called him "The Chief," a title he retained for life 
among his many loyal disciples. In the autumn of 
1855 he gave an extra-mural course of lectures on 
surgery. In the following spring he married Syme's 



340 THE HISTORY OF MEDICINE 

as if it had been drawn fresh from die veins of die 
animal. Moreover, by ligating die vessek in die 
amputated leg of a sheep or a cat he oould keep 
blood uncoagulated for several days. After other 
papers dealing with the cos^^ulation of the Uood 
Lister delivered the Croonian lecture on that sub- 
ject before the Royal Society of London in 1863. 
Though he had been considerably influenced by the 
work ol Hunter^ he refused to commit himself to the 
vitalisdc hypothesis as regards coagulation, nor, as 
he said, ''to any particular theory of the nature of 
life, or even to the belief that the actions of living 
bodies are not all conducted in obedience to physical 
and chemical laws/' He was more and ukm^ inclined 
to emphasize the influence on coaguladon of foreign 
solids, and of diseased tissues which acted like 
foreign solids. 

At the beginning of i860 Lister had been ap- 
pointed professor of surgery at the University of 
Glasgow. At that institution he was the colleague 
of Allen Thomson, the anatomist and embryologist, 
to whom he was largely indebted for his appoint- 
ment, of Sir William Thomscm (afterwards Lord 
Kelvin), professor of physics, and of other men dis- 
tinguished in letters and science. He sent his father 
an interesting account of his induction as a member 
of the Faculty. The ancient rite demanded that the 
new professor should give a dissertation in Latin; 



ANTISEPTIC SURGERY 341 

but Lister was summoned to the oeremoay on very 
short notice, did not set pen to paper till the morn- 
ing of the day on which he was to appear before his 
colleagues, and wrote the last third of his disquisi- 
tion while on the train from Edinburgh to Glasgow. 
He acquitted himself creditably, and was sochi busy 
with his large classes and considerate private prac- 
tice. He faced additional responsibilities when in 
the following year he received appointment as 
surgeon in the Glasgow Royal Infirmary. 

In order to appreciate the benefits Lister con- 
ferred upon surgery one must know something of 
the condition of the hospitals before the introduction 
of the antiseptic system. After the use of ether and 
chloroform had become general, operations gradu- 
ally increased both in number and range. Although 
deaths from shock grew less frequent, the pres- 
ence of septicaemia, pyaemia, erysipelas, and hospi- 
tal gangrene, etc, caused an alarming mortality. 
Worst of all, writes Sir Rickman Godlee, Lister's 
nephew and biographer, ''was the appearance of the 
moist grey slough surrounded by an angry blush, 
which heralded the onset of hospital gangrene. The 
limits of the original wound were then lost sight of. 
What might be the shape or size or even the posi- 
tion of the scar in the event of the patient's recovery 
became a matter of the greatest uncertainty, be- 
cause it was impossible to foresee the amount oi 



34^ THE HISTORY OF MEDICINE 

tissue which would perish from the destructive 
effects of the disease and the heroic measures taken 
to combat it." These diseases were particularly rife 
in the large hospitals. Sir James Simpson led the at- 
tack on "Hospitalism" (1869). A statistical inquiry 
conducted by him showed that out of 2098 amputa- 
tions in country practice 226 had proved fatal, and 
that out of 2089 amputations in hospital practice 
855 had proved fatal; and that the larger the hospi- 
tal the greater the mortality. ''Most hospital sur- 
geons/* he said» "ever remain content with losing 
one-third to one hall of all their amputation cases, 
and nine tenths of some." Institutions which had 
been developed through centuries of philanthropic 
endeavor were proving a curse, unable to meet the 
needs of the cities ever increasing in size as a result 
oi the industrial revolution. 

Lister in his new appointment had to face the 
practical problems of controlling these diseases, the 
only solution of which had seemed to many able 
surgeons the demolition of the hospitals. Glasgow, 
with a population of 390,000, was then, as now, one 
of the industrial centers of Great Britain, and in 
1861 the Glasgow Royal Infirmary was no better 
than other city hospitals. Sir Hector Cameron, at 
one time Lister's house surgeon and assistant, says 
that every wound discharged pus freely, and putre- 
factive changes occurred in the discharges of all. 



ANTISEPTIC SURGERY 343 

''Secondary hsemorrlu^/tetanus, erysipelas, septi- 
caemia, pyaemia, and hospital gangrene," he pro- 
ceeds, "were never all absent from the hospital 
wards, and at times pyaemia and hospital gangrene 
became alarmingly epidemic." Lister, though he 
had for some time past taught that suppuration is a 
form of putrefaction, was still without the clue to a 
real explanation of putrefactive changes. Even after 
his successes had begun, a terrible state of affairs 
was discovered at the Royal Infirmary. "A few 
inches below the surface of the ground," he writes, 
'' on a level with the floors of the two main accident 
wards, with only the basement area, a few feet wide, 
intervening, was found the uppermost tier of a 
multitude of coffins, which had been placed there 
at the time of the cholera epidemic of 1849, the 
corpses having undergone so little change in the 
interval that the clothes they had on at the time of 
their hurried burial were plainly distinguishable." 
He was horrified also by the custom of the "pit 
burial " of paupers still practiced in the old cathedral 
churchyard adjoining the Infirmary, more particu- 
larly as he associated infectious disease with a con- 
taminated state of the atmosphere. Such were the 
circumstances in which Lister developed his method 
of antiseptic surgery. 

In 1864 he was especially interested in the study 
of suppuration (in relation to decomposition), a 



344 THE HISTORY OF MEDICINE 

subject to which he had given considerable atten- 
tion since his student days. He was therefore very 
deeply interested in the fact that carbolic acid had 
proved effective at Carlisle not only in deodorizing 
the sewage, but even in destroying the entozoa that 
had infested the cattle in the fields fertilized by the 
sewage. It occurred to him that carbolic add might 
prevent suppuration in cases of compound fracture. 
He had long felt that to make an open wound behave 
like a closed one would be a notable advance in 
scientific surgery. The first attempt to use carbolic 
acid in the treatment of compound fracture was not 
successful. This was in the spring of 1865, the year 
in which Lister's attention was first directed to 
Pasteur's studies of fermentation and putrefaction. 
In August of the same year, however, the new 
method was employed with complete success in a 
case of compound fracture of the tibia. The patient 
was a boy of eleven, who had been run over by a 
wagon. Lister felt that recovery was as rapid and 
satisfactory as if the fracture had been merely a 
simple one. 

In announcing this and other successes Lister said : 
** In the course of an extended investigation into 
the nature of inflammation, and the healthy and 
morbid conditions of the blood in relation to it, I 
arrived, several years ago, at the conclusion that the 
essential cause of suppuration in wounds is decom- 



ANTISEPTIC SURGERY 345 

portion, brought about by the influence of the atmo* 
sphere upon blood or serum retained within them, 
and, in the case of contused wounds, upon portions 
of tissue destroyed by the violence of the injury. 

"To prevent the occurrence of suppuration, with 
all its attendant risks, was an object manifestly 
desirable; but till lately apparently unattainable, 
since it seemed hopeless to attempt to exclude the 
oxygen, which was universally regarded as the ag^nt 
by which putrefaction was effected. But when it had 
been shown by the researches of Pasteur that the 
septic property of the atmosphere depended, not 
on the oxygen or any gaseous constituent, but on 
minute organisms suspended in it, which owed their 
energy to their vitality, it occurred to me that de- 
composition in the injured part might be avoided 
without excluding the air, by applying as a dressing 
some material capable of destroying the life of the 
floating particles/' 

At the time of this statement — March, 1867 — 
the list of successful cases of compound fractures, 
abscesses, contused and lacerated wounds, amputa- 
tions, strangulated inguinal hernias, etc., had grown 
so great that Lister felt impelled to impart the 
knowledge of his procedure to the profession. His 
wards in the Glasgow Royal Infirmary had become 
the healthiest in the world. 

In 1869 Lister was called to Edinburgh as pro- 



346 THE HISTORY OF MEDICINE 

f essor of clinical surgery on the retirement of Syme, 
and at first found himself in a very critical atmos- 
phere. He gave in his first lecture a history of the 
germ theory, referring to the work of Schwann, 
Pasteur, and others. He had repeated Pasteur's 
experiment in which putresdble fluids remained 
pure in the presence of atmospheric air, and he 
showed to his audience flasks in which the contents, 
kept free from dust, were still sweet and clear after a 
space of two years. As Lister said in later life, from 
the beginning of his campaign in favor of the anti- 
septic method he had the youth on his side. He was 
idolized by the Edinburgh students, and his classes 
were very large. The poet Henley, who was one of 
Lister's patients at the Royal Infirmary, has ex- 
pressed in a sonnet his sense of the surgeon's influ- 
ence and personality. 

THE CHIEF 

Hit brow b large and pladd, and his eye 

Is deep and bright with steady looks that stilL 

Soft lines of tranquil thought his face fulfill — 

His face at once benign ^nd proud and shy. 

If envy scout, if ignorance deny 

His faultless patience, his unyielding will, 

Beautiful gentleness and splendid skill, 

Innumerable gratitudes reply. 

His wise, rare smile is sweet with certainties, 

And seenu in all his patients to compel 

Such love and faith as failures cannot quell. 

We hold him for another Heracles, 

Battling with custom, prejudice, disease, 

As once the son of Zeus with Death and Hell. 




LORD LISTER 



ANTISEPTIC SURGERY 347 

At Edinburgh, where Lister spent eight years in 
teaching, practicing, demonstrating and developing 
his method and technique (as previously at Glas* 
gow, and later at London), surgeons from the conti- 
nent appeared, eager to sit at the feet of the master 
of modem scientific surgery, Dn Saxtorph, profes- 
sor of surgery in the University of Copenhagen, 
visited Edinburgh in the summer of 1869. In the 
following year he wrote to Lister: '* Formerly there 
used to be every year several cases of death caused 
by hospital diseases, especially by pyaemia, some- 
times arising from the most trivial injuries. Now, I 
have had the satisfaction that not a single case of 
pyaemia has occurred since I came home last year, 
which result is certainly owing to the introduction 
of your antiseptic treatment.'' 

In the same month in which these words of com- 
mendation were written, the Franco-Prussian War 
began. The Prussians felt convinced that the sani- 
tary organization of their armies could compete with 
the best in the world. A large medical division was 
provided, which on occasion could be broken up into 
smaller units. There were twelve light hospitals for 
every thirty thousand combatants. Each soldier 
carried a tin of dressings. One soldier in eight had 
been especially trained for emergency duties. In- 
structions had been given concerning the safety of 
the open air and the dangers of infection in crowded 



348 THE HISTORY OF MEDICINE 

rooms. Many df the surgeons were aware of the 
antiseptic value of carbolic add. Lister's treatment 
was, however, not in use; though he published at 
the beginning of September, 1870, a brief statement 
of "A method of antiseptic treatment applicable to 
wounded soldiers in the present war/' Stromeyer, 
who has been called the father of modem military 
surgery in Germany, in one series of thirty-six am- 
putations through the knee-joint recorded one hun- 
dred per cent failures; von Nussbaum amputated 
in thirty-four successive cases without a single suc- 
cess. In the lower limb scarcely an amputation re- 
covered, death resulting from exhaustion, sloughing 
of the flaps, and frequently from pysemia. Hospitals 
became hotbeds of pyaemia in spite of what had 
seemed perfect arrangements. Among the French 
forces conditions were much worse. Their hospitab 
surpassed in horror the records of the Crimean War. 
Out of I3ii73 amputations of all kinds, including 
those of fingers and toes, 10,006 proved fatal. 

Before the end of the war, von Nussbaum was a 
convert to the Lister method. In the years following 
he was at the head of the Allgemeines Krankenhaus 
in Munich. It was overcrowded, partly on account 
of the industrial growth of the city, and a severe 
epidemic of hospital gangrene occurred. In 1872, 
1873, and 1874 the percentage of wounded or oper- 
ated that were attacked by that disease — to-day 



ANTISEPTIC SURGERY 349 

almost unknown — mounted to twenty-six, to fifty, 
to eighty. Von Nussbaum was in despair. He ap- 
pealed to Lister for help, and dispatched one oi his 
assistants to Edinburgh to learn the antiseptic 
method. It was soon put into effect at Munich. 
Henceforth hospital gangrene was banished from 
the Allgemeines Krankenhaus. Von Nussbaum's 
book, with an account of the antiseptic treatment 
went through four German editions in six years, and 
was translated into French, Italian, and Greek. 
Thiersdi oi Erlangen (later oi Leipzig) was, how- 
ever. Lister's first disciple among the surgeons of 
Germany, and Richard von Volkmann his most re- 
doubtable champion. Von Mikulicz-Radecki, who 
was Billroth*s assistant at Vienna, was sent by his 
master to visit Lister at London in 1879. Lucas- 
Championni^re, the French pioneer of the antiseptic 
method, had visited Glasgow as early as 1868; and 
he published his "Chirurgie antiseptique " in 1876. 
In the previous year Lister in response to urgent 
invitations had visited a number of German uni- 
versity centers — Munich, Leipzig, Berlin, Halle, 
and Bonn. According to the "Lancet," his progress 
through Germany took on the character of a 
triumphal march. 

While the antiseptic treatment was making rapid 
headway throughout Europe, Lister felt that he still 
had before him the task of converting his native 



350 THE HISTORY OF MEDICINE 

place to the truth of the new doctrine. The oppor- 
tunity came in 1877 when he was invited to accept 
the post of professor oi dinical surgery in King's 
College, London. He reluctantly consented to do so. 
He was received with a considerable show oi skepti- 
cism. He and those who had accompanied him from 
Edinburgh felt helpless for a time in facing a con- 
servatism and inertia that seemed hostile to every 
innovation. In about a month, however, a patient 
appeared who had broken his knee-cap. Lister cut 
down, and united the two pieces of the fractured 
patella by means of a silver wire. He operated suc- 
cessfully in cases refused by the leading London sur- 
geons. Some who had been set up as his rivals and 
competitors became his pupik and followers. It was 
soon realized that through the introduction of the 
antiseptic method the scope of surgery was greatly 
extended. Both in London and elsewhere operaticHis 
on the brain, as well as on the thoracic and abdomi- 
nal viscera, were undertaken with ever-increasing 
freedom. Orthopaedic sux^gery extended its range. 
Albrecht von Graefe, the most famous of eye sur- 
geons, recognized the added power that came from 
the antiseptic method. Moreover, surgeons now 
took courage to interfere in the early stages of an 
affection, an advantage particularly notable in the 
treatment of cancer. 
One of Lister's old students at London writes 



ANTISEPTIC SURGERY 351 

(1918), in answer to a recent critic: **Fn>m the day 
of Lister's entry we never saw the temperature rise 
after an operation in any of his patients, and never 
saw a blush on a wound. To us who had been 
taught that inflammation was necessary for heal- 
ing ... it was a miracle, the more so that Lbter 
immediately did operations that hitherto we had 
learned must always prove fatal/* It is true that 
a formidable list of achievements, some preceding 
the development of the antiseptic method, may be 
placed to Lister's credit. For example, in 1861 he 
described an original amputation in the neighbor- 
hood of the knee. In 1862 he recorded the successful 
use of a tourniquet of his own invention to control 
the abdominal aorta. In 1864 Syme told with pride 
that Professor Lister of Gla^;ow had succeeded in 
the excision of the wrist for caries. In 1868 he tested 
the value of catgut ligatures by tying the carotid 
artery oi a young calf, and found a month later 
Qanuary, 1869) that the ligatures had been replaced 
by living tissue. He devoted much time to the study 
of ferments, such as the lactic ferment, and the rela- 
tion of micro-organisms to the blood; and came to 
the conclusion about 1881 that the spray of car- 
bolic acid solution, which he had long used in his 
operating-room to destroy the pathogenic organ- 
isms in the air, was not essential to the antiseptic 
method. He also experimented with the double cya- 



352 THE HISTORY OF MEDICINE 

nide of mercury and zinc and other antiseptic pre- 
parations. Nevertheless, it was not to these particu- 
lar achievements, not to any of his later operations, 
such as the excision of the knee-joint, that Lister 
owed his fame, but to the steadfast vigilance with 
which he applied a great principle. 

Lister received a baronetcy in 1883. In the same 
year he visited Austria and Hungary, but did not 
hear for some time later of the work of Senmielweiss, 
frequently regarded as his forerunner. In 1892 he 
attended the Pasteur jubilee at Paris and with his 
usual magnanimity ascribed all his own triumphs in 
surgery to the work of the founder of bacteriology. 
In 1895 he became President of the Royal Society. 
In 1896 he was chosen President of the British As- 
sociation for the Advancement of Science, and in the 
following year he was raised to the peerage. In 1902 
was celebrated the fiftieth anniversary of his en- 
trance into the medical profession. At a banquet 
given in honor of Lord Lister by the Royal Society, 
Mr. Thomas Bayard, the American Ambassador, 
addressing the great surgeon, said : ** My Lord, it is 
not a profession, it is not a nation, it is humanity 
itself which with uncovered head salutes you.'' 
Lord Lister died in 1912. A public funeral service 
was held in Westminster Abbey, where a marble 
medallion now commemorates him. But, in accord- 
ance with special instructions he had given, he was 



ANTISEPTIC SURGERY 353 

buried beside his wife in a simple tomb in the West 
Hampstead Cemetery. 

REFERENCES 

Allbutt, % Clifford T.: ''Lord Lister," Encyclopedia Britannica. 

Bloch, Oscar: "Antiseptic Treatment oC Wounds," BrUish Medi- 
cal Journal, 1902, pp. 1825-28. 

Cameron,^ Hector: "The Evolutbn of Modem Surgery," 
British Medical Journal, 1902, pp. 1844-48. 

fkxllee, Sir Rickman: Lard Listor, 1917. 676 pp. 

Lister, Baron Joseph: CoUected Papers. 2 vols. - 

Lucas-Championni^ Just: ''An Essay on Scientific Surgeryt" 
BriHsh Medical Journal, 1902, pp. 1819-21. 

Von Mikulicz-Radedd, Johann: "Treatment of Fractured Patel- 
la," British Medical Journal^ 1902, pp. 1828-31. 



CHAPTER XVIII 

THE HISTORY OF SYPHILIS 

T&B term '^syphilis" was first used, so far as we 
know, by the distinguished Italian physician Fracas- 
toro, who in 1530 wrote a poem "Ssrphilis sive 
Morbus Gallicus/' But the synonymous expression 
and its many equivalents — "French pox/* "Gal- 
lische Krankheit/* '^mal francese/* etc. — were 
extensively used before the dose oi the fifteenth 
century, and were soon translated into some of the 
languages of Africa and Asia. In France syphilis had 
a great many names, but only one of these had any 
geographical reference, namely, "mal de Naples,'' 
a term that found echoes in three or four other lan- 
guages. In England the disease was called, among 
other things, "Spanish pox''; and similar expres- 
sions were used in Scotland, Holland, Germany, 
and in the western part of North Africa. The Rus- 
sians called it at times the "Polish disease"; and 
the Persians knew it as the "Turkish disease." The 
Portuguese, turning their eyes to the east rather 
than to the west, spoke of the "Castilian disease." 
The Spaniards, however, used occasionally the term 
"Indian measles," and, also, "disease of the island 
of Hispaniola" (that is, Santo Domingo). 



i 



THE HISTORY OF SYPHfLIS 355 

There was a fierce epidemic of syphilis in Europe 
near the end of the fifteenth century. Its diffusion is 
associated with the military expedition in Italy, 
under the leadership of Charles VIII of France, in 
1494 and 1495. The army of the French kii^, made 
up of adventurers from various countries, and ac- 
companied by a dissolute train oi camp-followers, 
met with little opposition. There was a slight en- 
gagement with a force of Spaniards and Neapolitans 
at Rapallo (near Genoa) in September, 1494. 
Charles halted for a short time in FlcH^nce on his 
triumphal progress south; lingered four weeks in 
Rome, then governed by Alexander Borgia; and 
entered Naples February 22, 1495. Here he stayed 
for about three months. Some historians attribute 
the epidemic to Spanish mercenaries in the army of 
Charles; others put it down to the Spaniards in 
Naples, which had for some time been a possession 
of the House of Aragon, and particularly to the gar- 
rison of a fcMtress in the harbor, who held out for 
three weeks after the French troops had entered the 
dty, and who then for the most part went over to 
the service of Charles. Professor Robinson men- 
tions as one of the momentous results of this cam- 
paign that the intellectual leadership of Europe 
passed from Italy to England, France, and Ger- 
many. However that may be, the venereal plague 
ran within a few months through the Italian cities. 



356 THE HISTORY OF MEDICINE 

and reached the borders of France, Switzerland, and 
Germany. 

There is evidence to show that syphilis had ap- 
peared along the line of march in 1494, that is, before 
Charles had reached Naples, namely, in the camp at 
Rapallo, in the neighboring city of Genoa, and in 
Rome. It developed into a virulent epidemic at 
Naples before May, 1495, and, it seems reasonable 
to suppose, hastened the retirement of the French 
northwards. We hear of its breaking out in 1495 at 
Florence, at Bologna (at which center of learning, as 
elsewhere, it was regarded as a new and unheard-of 
disease), at Cremona, Verona, and Novara, where a 
part of the retreating army was besieged for several 
months. The epidemic seems not to have reached 
Modena, Ferrara, and Venice till the following year. 
Syphilis at the time of this European epidemic was 
extremely malignant, a fact explained by Bloch, who 
maintains that this was the first appearance of die 
disease in the Old World, on the ground that it here 
found virgin soil, as he expresses it. The secondary 
symptoms appeared very early — often in a few 
days; the patients had high fever; they suffered 
intense pains (especially in the joints) and severe 
skin affections; they fell into general decline, and 
very frequently died. 

Charles reached Lyons in November, 1495, but 
the greater part of his forces, after leaving Italy, 



THE HISTORY OF SYPHILIS 357 

had scattered in all directions. The disease was soon 
prevalent in the south of France, and by the be- 
ginning of 1497 had become so general that the 
Parliament of Paris issued regulations in the hope of 
controlling ''la grosse v^role," which for two years 
had afflicted the kingdom, as well Paris as other 
places. The Emperor Maximilian I, in an edict 
dated August 7, 1495, recognized the danger for his 
dominions of the new and unheard-of scourge. Some 
of his troops had taken part with the enemies of 
France at the protracted si^:e of Novara, where the 
epidemic had prevailed; and German, Hungarian, 
and Slav mercenaries had formed part of the army of 
Charles. The fact that six thousand Swiss mercen- 
aries also accompanied the French accounts for the 
early appearance of syphilis in Switzerland. The 
disease reached Great Britain in 1497 from French 
and, probably, Spanish ports. It was carried to the 
Netherlands in 1496 by the retainers of a Spanish 
princess. It appeared in Russia in 1499 coming by 
way of Poland. The latter country is said to have 
got the infection from an individual woman, who 
had made her way from Rome to Cracow as early 
as 1495. 

When we turn to Spain, we find new light is 
thrown on the history of the syphilis epidemic by 
the evidence of reliable witnesses. The most impor- 
tant of these is the physician Ruy Diaz de Isla, who 



358 THE HISTORY OF MEDICINE 

at the age of thirty-one was practicing at Barcelona 
at the time of the return of Columbus from the West 
indies in 1493. Before 1521 this physician wrote a 
book dedicated to the King of Portugal — "Against 
the Reptilian Disease, Commonly Called in Spain 
the Buboes/' The first chapter deals with the birth 
and origin of the disease on the island of Hispaniola. 
He states that it made its appearance in Spain in the 
city of Barcelona in the year 1493. The city became 
infected, and from it all Europe and all the known 
and accessible parts of the earth. It had its birth 
and origin in the island of Hispaniola. When the 
island had been discovered by the Spaniards, they 
had had intercourse with the natives, and the disease 
being readily contagious it presently appeared on 
the ships. At the time Columbus returned to Spain, 
Ferdinand and Isabella were in the dty of Barce- 
lona, and while they were receiving accounts of the 
voyage and the discoveries the disease began to 
infect the people and to spread through the city. 
According to de Isla a great many Spaniards in- 
fected with the disease joined the army of Charles in 
the following year and thus infected the main body 
of the French army. The Indians of Hispaniola 
called the disease "Guajmaras,'' and applied other 
names to it. As for the physician's own name for 
it, he consider^ it appropriate; because a reptile 
is a hideous, fearful, and dreadful animal, and the 



THE HISTORY OF SYPHILIS 359 

disease is likewise hideous^ fearful, and dreadful. 
It is a severe disease, forming abscesses and cor- 
rupting the flesh, breaking and rotting the bones, 
and shortening and drawing up the sinews. And, 
since de Isla knew that the disease from remote 
times had existed in Hispaniola, whence it had 
spread throughout the world, he called it the rep- 
tilian disease of the island of Hispaniola. He also 
insisted that the disease had never been seen and 
never known before the voyage of Columbus, and 
that nothing like it could be found described in 
medical works. 

De Isla's conviction that the reptilian disease had 
existed from time immemorial on the island of His- 
paniola rested on the fact that the natives had 
developed a complete system of therapy in its treat- 
ment — the use of guaiac, balata, and other vege- 
table remedies, the regulation of diet, care regarding 
water and air, and abstention for a certain time from 
sexual intercourse. With an eye on the difhculties 
experienced in his own time by civilized peoples in 
dealing with an unknown disease, de Isla argued 
that the very stupid natives of Hispaniola must 
have known guaynaras for very many generations 
before arriving at their clever and orderly treatment 
of it. The Spanish physician maintained that mer- 
cury was the only reliable remedy for the reptilian 
disease as it existed in Europe ; he employed it as an 



36o THE HISTORY OF MEDICINE 

inunction. He advocated a well considered plan for 
the state control of syphilis* Besides his experience 
in treating at Barcelona some of the crew accom- 
pan3dng Columbus (among them the pilot Vicente 
Pinzon), as well as other people in the city infected 
with the disease, de Isia saw practice at Seville 
(where Columbus had passed four weeks or more 
before reaching Barcelona), and, subsequently, had 
served many years in All Saints' Hospital at Lisbon, 
where he had abundant opportunities of studying 
83^hilis. 

The American origin of syphilis is likewise upheld 
by Oviedo, the author of the "General and Natural 
History of the Indies,'' who crossed the Atlantic 
many times, spent over forty years in America, and 
was particularly well acquainted with the island of 
Hispaniola. As a boy of fifteen he had been present 
at the landing of Columbus at Barcelona, where he 
made friends with the sons of the discoverer and 
with Vicente Pinzon. In 1501 Oviedo spent six 
months in Sicily with Gonsalvo de Cordova, who in 
1495 had been sent from Spain with an army to 
oppose Charles VIII, and whose secretary Oviedo 
became in 15 12. On a visit to Italy the young man 
was much amused to hear that the Italians called 
syphilis "mal francese" and that the French called 
it "mal napolitain," for he was well aware it should 
be called "mal de las Indias." According to him 



THE HISTORY OF SYPHILIS 361 

some of 4he companions of Columbus had become 
infected at the time of the first voyage to America, 
and> after their return to Spain, the infection passed 
to Italy and other countries. It had not been known 
in Spain until the return of Columbus in 1493. 
Immediately it had spread among the lower classes^ 
and later had found its way among the gentry and 
nobility. Oviedo knew that some of the soldiers 
under the command of Gonsalvo de Cordova in 
1495 were infected before quitting Spain. 

Oviedo believed that syphilis was found not only 
in Hispaniola, but throughout the West Indies and 
on the American mainland. It was less dangerous, 
he said I in those regions than in Spain and the other 
countries of the Old World. The Indians knew how 
to cure it by the use of guaiac (which was fresher and 
consequently more efficacious in the Indies than in 
Europe), and other vegetable remedies. Of the 
Christians who had intercourse with the native 
women few escaped with impunity. 

The statements of Oviedo in reference to the 
comparative mildness of the disease among the 
American natives and the marked susceptibility of 
Europeans to the infection are fully corroborated 
by Las Casas, known as "the Apostle of the Indies/* 
who also refers, like Oviedo and de Isla, to the suc- 
cess of the native therapy. Moreover, he is able 
to support by the testimony of the aborigines the 



362 THE HISTORY OF MEDICINE 

theory of de Isla regarding the antiquity of the 
disease in the island of Hispaniola. He took great 
pains, he says, to question the Indians as to whether 
the disease had long existed on the bland. They 
answered in the affirmative; it had been present so 
long among them before the coming of the Chris* 
tians that there was no memory of its beginning. 
Of the truth of this, Las Casas felt there €X>uld be no 
doubt« Indeed, we know from other sources that the 
presence of guajmaras in Hispaniola was implied in 
the earliest traditions of the natives. 

Las Casas was bom in Seville in 1474* His father 
accompanied Columbus in 1492, and the young man 
was present when the discoverers in 1493 brought 
ten Indians from Hispaniola to Seville, where they 
remained for about a month before proceeding to 
Barcelona. He went to the West Indies in 1498, and 
was ordained as a priest in 1510 on the island of 
Hispaniola, where he passed altogether twenty years 
of his life. He was appointed Bishop of Chiapa, 
Mexico, in 1543. He lived to the age of ninety-two, 
and left a manuscript "History of the Indies." In 
the judgment of this well-informed witness the 
disease known to the Italians as "mal francese" 
was carried to Europe by the Indians Columbus 
took to Spain in 1493 or by the Spaniards who had 
been infected in Hispaniola at the time of its dis- 
covery. 



THE HISTORY OF SYPHILIS 363 

Ab regards the epidemic in Barcelona, following 
the return of Columbus from his first voyage to the 
West Indies, we have valuable corroborative evi- 
dence in a letter written in June, 1495 (printed in 
the following March), by the Sicilian phj^ician 
Nicol6 Scillacdo. The letter is addressed to his 
former teacher at Pavia, Ambrogio Rosato, physi- 
cian to Ludovico Sforza (who a few months later 
overcame the French resistance at Novara). Scil- 
lacdo had left Italy for Spain in February, unaware 
of the imminent epidemic. It is with some gusto he 
announces to his master the advent of a new disease. 
Among the symptoms he had observed in those 
infected in Barcelona were purulent pustules, in- 
tense fever, arthritis with severe pains, dermal 
crusts, and swellings colored at first blue and later 
blackish. The disease begins most frequently in the 
genitals, but spreads to the whole body. According 
to the statement of Scillacdo this new spedes of 
malady had but recently invaded Spain. The 
disease does not run longer than a year in an indi- 
vidual case (annum morbus nan excedit). This state- 
ment gives us reason to affirm that it had been 
under observation in Barcelona for a year or two. 

According to Osier, ''writers who contend for the 
antiquity of the disease in Asia and Europe rely on 
certain old Chinese records, on references in the 
Bible and in old medical writers to diseases resem- 



i 



364 THE HISTORY OF MEDICINE 

bling syphilis and on suggestive bone lesions in very 
old skeletons. The balance of evidence, according 
to the best syphilographers, is in favor of the Amer- 
ican origin/' No European bones belonging to a 
date earlier than 1493 show satisfactory indications 
of the disease; though skeletons belonging to a later 
period have been found with the characteristic signs 
wherever the infection has been carried — even in 
regions so remote from Europe as the Philippines, 
New Caledonia, and Australia. In America, on the 
other hand, this sort of negative evidence is not so 
decisive. For example, two skulls have been found 
in Tennessee, one of which shows signs of syphilitic 
caries, the other the thickening of the nasal bones 
indicative of syphilb. Their discoverer thought 
them probably the most ancient syphilitic bones in 
the world. It is not positively known, however, 
that they belong to the pre-Columbian period. 

The outbreak of syphilis in Europe at the end of 
the fifteenth century was a challenge to the medical 
science of the time. The problems it raised could 
not be answered by consulting the volumes of Galen 
and his commentators. Its extreme virulence seems 
to have prevented its early observers from confusing 
it with gonorrhoea. Berengario da Carpi treated it 
with inunctions of mercury as early as 1500, and, 
therefore, disputes with Diaz de Isla, the honor of 
introducing this form of treatment. Before the 



THE HISTORY^OF SYPHILIS 365 

middle of the sixteenth century Mattioli employed 
metxniry internally. Mercmial plasters came into 
use» as well as fumigations, sulphur baths, and 
guaiacum. Sarsaparilla, which had been used in 
America in the treatment of syphilis, was used by 
the Portuguese even on the coast of India as early 
^ 1535* In addition to the symptoms already re- 
ferred to, the phj^icians of the sixteenth century 
took note of the primary lesion, the falling out of the 
hair, affections of the internal organs, and disorders 
of the nervous system. Paracelsus recorded the 
observation of congenital syphilis. The venereal 
nature of the disease and its special mode of trans- 
mission were soon generally recognized, and in 1557 
Femel stated definitely that the disease always gave 
rise to a little sore and pustule at the point of the 
primary inoculation. Par6 noted, as we have seen, 
the connection between aneurism and syphilis, and 
wrote in detail concerning hereditary syphilis. 

After the beginning of the seventeenth century 
there was a clearer recognition of the minor causes of 
infection — the communication of the disease to 
physicians and midwives by l)dng-in women, infec- 
tion from drinking-vessels, inoculation by kissing, 
and the transmission of the disease through the 
operation of cupping, the infection of the child by 
the nurse and of the nurse by the child. The list of 
syphilitic affections was gradually increased — 



366 THE HISTORY OF MEDICINE 

chancre of the tonsil, nasal syphilis, lesions of larynx, 
windpipe, and lungs, gummata of the brain, syphili- 
tic neuralgias, and diseases of the spinal cord. As 
we have seen in the seventh chapter, Sydenham 
noted the lessened virulence of the disease in the 
seventeenth century as gauged by the records of 
the end of the fifteenth century, held that this 
species of disease is not immutable, attempted to 
trace the stages passed through in individual cases, 
and considered syphilis identical with yaws. 

In the eighteenth century Landsi described car- 
diac syphilis, and supported the observations of 
Par6 by giving syphilis as one of the causes of aneu- 
rism. We have seen in the ninth chapter that Mor- 
gagni held syphilis to be not only one of the causes 
but the preponderating cause of aneurism, that he 
had observed syphilitic lesions in nearly all of the 
thoracic and abdominal viscera and believed that 
venereal disease might vitiate any viscus whatever. 
''At last, John Hunter came and laid the true foun- 
dations of the science of venereal affections'* 
(Ricord). It is true that Hunter, in spite of his 
numerous post-mortems, failed to observe sjrphilis 
of the viscera, and that he confused syphilis and 
gonorrhoea; but he based his generalizations in this 
field, as elsewhere, on observation and experimenta- 
tion, and had the courage to inoculate himself with 
venereal virus and to study the results over a long 



THE HISTORY OF SYPHILIS 367 

period before knocking the disease down with nier« 
cury, as he expressed it. It is not improbable tliat 
this was the cause of the angina pectoris from which 
he suffered for many years and which resulted in his 
death. As mentioned in the eighth chapter he suc- 
ceeded in differentiating Hunterian chancre from 
ch^mcroid ulcer. Before the end of the eighteenth 
century Benjamin Bell taught that there is a differ- 
ence between the virus of gonorrhoea and that oi 
syphilis. 

At the beginning of the nineteenth century Her- 
nandez confirmed the views of Bell by inoculating 
with the poison of gonorrhoea seventeen convicts at 
Toulon. Hunter and Hernandez in their resort to 
experiment in investigating venereal disease may be 
regarded as forerunners of Philippe Ricord (1800- 
89) who in the years 1831 to 1837 niade at Paris 
twenty-five hundred inoculations, and proved that 
gonorrhoeal secretion never produces chancre nor 
constitutional syphilis. He established the three 
stages of syphilis, held that the induration of the 
chancre is subsequent to the passage of the poison 
into the general system, and that in its third stage 
the disease is non-communicable. Virchow, as 
already stated in the thirteenth chapter, set forth 
in detail the pathology of syphilis. In considering 
the various phases of the subject he of course did not 
overlook the histological. He noted, for example, 



368 THE HISTORY OF MEDICINE 

the resemblance of the indurated chancre to all 
gummatous formations. He observed that a syphil- 
itic cicatrice in the bones of the cranium gives eAd- 
dence of a diminished growth in the center and an 
increased growth in the periphery. This and other 
indications of syphilis he maintained are not to be 
found in skeletons of a date earlier than the closing 
years of the fifteenth century. Further advances in 
the knowledge of venereal disease followed the 
development of the science of bacteriology. Neis- 
ser's discovery of the micro-organism of gonorrhcea 
in 1879, Ducrey's isolation of the bacillus of vene- 
real ulcer in 1889, and the success of Metchnikoff 
and Roux in inoculating monkeys with syphilis in 
1903, cleared the way for the discovery by Fritz 
Schaudinn in 1905 of the piotozoon Treponema palU- 
dum as the cause of syphilis. 

Schaudinn (1871-1906), bom at a small place in 
East Prussia^ received his training as a zodlogist at 
Berliui attaining the doctorate at the age of twenty- 
three. Four years later he was an instructor in his 
specialty, and in 1904 he was engaged at the Im- 
perial Health Bureau as an expert in protozodlogy. 
Under the auspices of this institution he pursued 
investigations at Rovigno on the Istrian coast. In 
the year of his death he accepted an appointment 
in the Institut ftir Schiffs- und Tropen-hygiene at 
Hambui^. He studied the hookworm recognized as 



THE HISTORY OF SYPHILIS 369 

the cause of anaemia among the miners of West- 
phalia, and confirmed the discovery of Looss in refer- 
ence to the life-history of that parasite. Schaudinn 
made important contributions to the classification 
of protozoa (such as Spirochata and Trypanosoma) 
as well as their mode of reproduction, including the 
mechanism of cell-division. Although he had not 
studied medicine, the control of disease soon became 
one of the main purposes of his work in science. He 
insisted on the necessity of knowing the complete 
history of microscopic parasites, and traced satis- 
factorily the life cycles of a number of pathogenic 
protozoa that infest man and the lower animals, 
such as Plasmodium vivax (the relation of which to 
the human blood-vessels he established) and 7>y- 
panosoma nocHuB. He distinguished Entom^a his- 
toliHca from Entomcsba coU. Moreover, he estab- 
lished a method of studying protozoan infections 
which helped to guide the investigations of odiers. 
Five years after Schaudinn had determined the 
causative i^nt of syphilis, Ehrlich announced the 
discovery of a specific. 

Paul Ehrlich (i 854-1 91 5) was bom at Strehlen, 
Silesia; received his early education in his native 
place and in the neighboring city of Breslau; after 
spending a semester at the University of Breslau, 
proceeded to Strassburg, where he began the study 
of medicine; and later visited as a student at two 



370 THE HISTORY OF MEDICINE 

Other German universities. He took advantage of 
the freedom of German university life and pursued 
intensively those studies that laid daim on his 
interest. Although at Strassburg he had the privi- 
lege of the instruction of Julius Cohnheim, Ehriich 
was more influenoed by Carl Weigert, his cousin, 
with whom he was closely associated. He was soon 
distinguished for his contributions to haematology, 
based on improved methods of staining. In 1882 
he employed f uchsin red in staining tuberde bacilli. 
His investigations were early guided by the hy- 
pothesis that the molecules of living tissue combine 
with foods, poisons, dyes, and other chemicals by 
virtue of selective affinities. In 1885 he reached the 
conclusion that cell protoplasm takes up oxygen as 
benzene takes up bromine. That is, the elements of 
the protoplasm that enter into combination with the 
extraneous molecules are analogous to the side-chain 
of the benzene ring. In 1886 he injected methylene 
blue in the blood of a rabbit and discovered that the 
nervous tissue has a special affinity for that particu- 
lar dye. In 1891 the phenomena of immunity of 
mice to gradually increased quantities of vegetable 
poison gave Ehriich ground for the extension of his 
principles. By the exercise of what he called his 
''chemical im^nation*' he pictured a poisonous 
substance as made up of two kinds of parts, the 
actual carriers of the poison, <x* toxophores, and the 



THE HISTORY OF SYPHILIS 371 

effecters of the connection with the protoplasm, or 
haptophores. When the poison is administered in 
small quantities, the side-chain elements — chemo- 
receptors — of the protoplasm break away from the 
ring and render the toxin harmless by combining 
with the haptophore. At the same time the proto- 
plasm is stimulated to produce a very great number 
of chemo-receptors, which neutralize the poison 
when adminbtered in larger quantities. Ehrlich on 
the basis of further experiments eventually estab- 
lished an international standard for the administra- 
tion of diphtheria antitoxin. 

The fact that pathogenic micro-organbms share 
with the living tissues of the human body the prop- 
erty of combining with certain chemical substances, 
as their specific affinity for certain aniline dyes 
bears witness, suggested means for their destriKrtion. 
The pathogenic protozoa revealed by the micro- 
biological studies of Schaudinn and others olff ered a 
special field tor a therapy based on micro-chemistry. 
Ehrlich had something of Sydenham's faith regard- 
ing the discovery of specifics. Quinine is a specific 
for a disease caused by a protosoOn. We must learn 
to destroy all pathogenic protozoa without injuring 
the tissues of the patient. The ideal was a tkerapia 
steriUsans^ one injection of which would destroy all 
the microbes, which, otherwise, might become im- 
mime to the poisonous influence of the injected 



Z72 THE HISTORY OF MEDICINE 

chemical substance. In trypan red Ehrlich discov- 
ered such a specific for sleeping sickness in mice. 
This is, of course, a trypanosome disease. In 1894 
Thomas and Breinl, of the Liverpod Sdxxd of Trop- 
ical Medicine, had discovered that injections of 
atoxyl destroy the parasite in human beii^ suffer- 
ing from sleeping sickness. It was found, however, 
that there are grave objections to its administration. 
Atoxyl was found to be para-amino-phenylarsenic 
add, and Ehrlich discovered (as he thought) in one 
of its derivatives — arsenophenylglydn — a remedy 
for all tr)rpanosomia9es. Would one of these com- 
I^ex arsenic compounds prove effective against 7>e- 
panema pallidum, the protozoSn of syphilis? After 
a long series of experiments carried out by Ehrlich 
and his Japanese asastant Hata a q^edfic was 
found in "606" — Salvarsan, or dioxydiamido ar- 
senobenzol. The discovery was announced in the 
early part of 1911. It is interesting to note, in con- 
nection with the conjecture of Sydenham regarding 
the identity of syphilis and yaws, that "606'' acts 
as an ideal remedy in the latter disease, which b 
caused by a parasite — Treponema pertenue — 
hardly distinguishable from Treponema pallidum. 

The veteran Sir Jonathan Hutchinson (1828- 
19 1 3), who had seen over a million cases of syphilis, 
wrote shortly before his death: "For the student of 
pharmacology syphilis has many important lessons. 



THE HISTORY OF SYPHILIS 373 

The marvel which we witness in the certain and 
speedy disappearance under the influence of mer- 
cury of a large sclerosis as hard as cartilage, is more 
than equalled by the melting away of a big tumour- 
gumma under that of iodide of potassium/' The 
record of Hutchinson and others may serve to 
remind us that the successful treatment of syphilis 
had its beginnings before the advent of recent 
chemotherapy. 

REFERENCES 

Blocfa, Iwan: Per Ursprung der SyfkiUs. 2 vob., iQOt. 

Alao a brief history of syphilis in Power and Murphy's 

System of Syphilis, vol. i, 1914, pp. 3-39. 
Brown, H. M.: Must the History of Syphilis be Rewrittenf Bull. 

Soc Med. Hist., Chicago, 1917, n, pp. 1-14. 
Calkins, Gary N.: "Fritz Schaudinn," Science^ N.S., vol. xxiv 

(1906), pp. 154-55- 
Montgomery, T. H., Jr.: 'Tritz Sdiaudinn^'* Popular Science 

Monthly, vol. 70 (1906), pp. 274-78. 
SudhofT, Karl: The Origin of Syphilis, and The End rf the Fable 

cf the Great Syphilis Epidemic in Europe foUcwing the Dis^ 

cavery of the AnHlles (tianslattons by A. Allemann), BulL 

Soc. Med. Hbt., 1917, u, pp. 15-26. 
See also obituary notice of Paul Ehrlich in the Proceedings of 
the Rpyal Sodety, series B, vol. 92 (1921), pp. i-viL 



CHAPTER XIX 

PREVENTIVE MEDICINE IN THE TROPICS 

More than a century before the appearance of 
syphilis in Europe the eastern hemisphere was rav- 
aged by another disease which had its origin in the 
tropics. The Black Death, or Plague, which even 
since the beginning of the twentieth century has 
carried off millions of the inhabitants of India, in 
the fourteenth swept to the northwest and claimed 
about sixty million victims. This was not its first 
nor its last visitation of Europe. We have already 
seen its disastrous effects in London and elsewhere 
in the time of Sydenham ; and within the last twenty- 
five years this dreaded disease has threatened the 
ports of Italy, France, Germany, and Great Britain, 
as well as those of America both on the Atlantic and 
the Pacific. The virulent outbreak at Hong-Kong in 
1894 led to the study of the pestilence in the light 
of modem bacteriology and parasitology. Within a 
few months Kitasato and Yersin had discovered the 
BadUiis pestis. Of the two forms of the disease — 
the pneumonic and the bubonic — the former may 
be conveyed from one person to another by means of 
bacilli borne by the air. Bubonic plague is trans- 
mitted to man from the rat by fleas. The chief 



PREVENTIVE MEDICINE 375 

preventive measure is the extermination of diseased 
rats. Haffkine's prophylactic vaccine has a marked 
effect both in decreasing the chances of infection and 
in increasing the chances of recovery in cases in 
which infection takes place. 

It was Dr. (afterwards Sir Patrick) Manson who 
prepared the way for the greatest triumphs of pre- 
ventive medicine in the tropics by demonstrating 
thoroughly, in 1879, that the mosquito is the inter- 
mediate host of FUaria sanguinis hominis, the para- 
site in certain particularly hideous forms of filariasis. 
Manson traced the life-cycle of the nematode in the 
mosquito and in the definitive host, man. He ob- 
served the filarise in the stomach of the mosquito 
after it had sucked the blood of a patient suffering 
from filariasis, found that within a few hours they 
broke down the blood corpuscles in the abdomen 
of the insect, the escape of the haemoglobin bringing 
about a thickening of the plasma. The viscosity of 
the plasma seemed to stimulate the filariae to wriggle 
out of their sheaths. Once rid of these they moved 
about freely and found their way into the thoracic 
muscles of the mosquito, where they underwent 
metamorphosis, the young parasites showing a 
remarkable increase in size. The mosquito, about a 
week after sucking the blood of the filariasis patient, 
lays her eggs on the surface of stagnant water, and 
then dies. The filariae find their way into the water 



376 THE HISTORY OF MEDICINE 

from the dead body of the intermediate host, and 
thence into the stomach of the definitive host, and 
from the stomach reach the lymphatic tnmks. 
There they attain sexual maturity, and give birth 
to a new generation of filariae, which eventually pass 
by way of the lymphatic vessels into the blood 
stream. 

In the year following Manson's discovery of the 
life-history of FUaria sanguinis hominiSf Alphonse 
Laveran, a French army surgeon on service in 
Algeria, observed in the blood of patients suffering 
from malaria parasites which he considered the 
cause of the disease, a judgment that was soon con- 
firmed by Dr. Richard and others. These protozoa 
were accurately described by Marchiafava and Celli 
in 1885. There are three varieties of this group 
of hsemocytozoa, Pldsmodium vivaXf Plasmodium 
maiaruB, and Plasmodium falciparum^ the parasites 
respectively of tertian, quartan, and aestivo-autum- 
nal fevers. Golgi, the histologist, who as early as 
1885 had shown that the paroxysms of malarial 
patients occur at the same time as the sporulation 
of the parasites, took the first step (1889) toward 
establishing the relationship between the varieties 
of the parasite and the various forms of malarial 
fever. Golgi 's discovery of the coincidence between 
the malarial paroxysms of the patient and the sporu- 
lation of Plasmodia was confirmed by Dr. (after- 



PREVENTIVE MEDICINE 377 

wards Sir William) Osier, while the task of determin- 
ing the exact casual relationship between pemicious, 
tertian, and quartan fever on the one hand, and P. 
falciparum^ P. vivax^ and P. malaruB on the other 
hand, was inmiediately completed by Marchiafava 
and Celli* 

In 1886 Dr. G. M. Sternberg directed the atten- 
tion of the medical profession in the United States 
to the views of Laveran concerning the etiology of 
malaria, and these soon gained support from the 
investigations of Councilman, Abbott, Thayer, and 
others, including Osier. As early as 1883 Dr. A. F. 
A. King had put forward as worthy of observation 
and experiment the supposition that mosquitoes 
(rather than marsh vapor) are the source of malarial 
infection. In 1889 Theobald Smith demonstrated 
that Texas fever is caused in cattle by a haematozoan 
parasite, later (1893) shown to be carried by an 
insect. It remained for Manson to formulate a 
definite verifiable hypothesis concerning the relation 
of the mosquito to the malaria parasite. With his 
studies of filaria in mind he proceeded on the sup- 
position that the protozoa, after undergoing sexual 
reproduction, complete their life-cycle in the body 
of an insect host. Laveran had observed in the blood 
of malarial patients withdrawn from the circulation 
that some of the gametocytes put forth motile fila- 
ments. These processes, mistaken by Manson for 



378 . THE HISTORY OF MEDICINE 

spores (and later shown to be of the nature of 
spermatozoa), he correctly supposed to play an 
essential part m maintaining the life of the protozoa 
in the body of some suctorial insect* In 1894 Man- 
son communicated his hypothesis to Major (now 
Sir) Ronald Ross, who undertook its verification in 
the malarial districts of India, where he was on 
service. 

This was a very difficult task; for the spedes of 
mosquito that might prove the intermediate host of 
the protozo6n and the form the latter might bear in 
the body of the insect were alike unknown at that 
time. Ross, in the course of an investigation extend- 
ing about two and a half years, fed hundreds of mos- 
quitoes of different species on persons suffering with 
malarial fever, and then examined the tissues of 
each insect in the hope of discovering the parasite. 
As he stated in 1900, '' nothing but the most con- 
vincing theory, such as Manson's theory was, 
would have supported or justified so difficult an 
enterprise/' Finally eight mosquitoes of a species 
with spotted wings were fed on a malarial patient. 
On dissecting the seventh of these specimens the 
investigator achieved his first success. 

''The tissues of the stomach (which was now 
empty owing to the meal of malarial blood taken by 
the insect four days previously being digested) were 
reserved to the last. On tumuig to this organ I was 



PREVENTIVE MEDICINE 379 

struck by observing, scattered on its outer surface, 
certain oval or round cells of about two or three 
times the diameter of a red blood corpuscle — cells 
which I had never seen in the hundreds of mosqui- 
toes eicamined by me. My surprise was complete 
when I next detected within each of these cells a few 
granules of the characteristic coal4>lacb melanin of 
malarial feoer — a substance quite unlike anything 
usually found in mosquitoes. Next day the last of 
the remaining spotted-winged insects was dissected. 
It contained precisely similar cells, each of which 
possessed the same melanin; only the cells in the 
second mosquito were somewhat larger than those in 
the first. • • • 

** These fortunate observations solved the nudarial 
problem. As a matter of fact the cells were the 
zygotes of the parasite of remittent fever growing in the 
tissues of the gnat; and the gnat with spotted wings 
and^boat-shaped eggs in which I found them be- 
longed (as I subsequently ascertained) to the genus 
Anopheles. Of course it was impossible absolutely 
to prove at the time, on the strength of these two 
observations alone, that the cells found by me in 
the gnats were indeed derived from the hcBmanuB" 
hid(B sucked up by the insects in the blood of the 
patients on whom they had fed ; — this proof was 
obtained by subsequent investigations of mine; 
but . • . the clue was obtained : it was necessary only 
to follow it up — an easy matter." 



380 THE HISTORY OF MEDICINE 

The zygote^ which is the ovum of the female game- 
tocjrte fecundated by the motile filament of the male 
gametocyte, gives rise to spores or blasts^ which are 
found distributed in various parts of the insect. 
** Beyond this it was difficult to go, but at last, after 
examining the head and thorax of one insect, I 
found a large gland consisting of a central duct sur- 
rounded by large grape-like cells. My astonishment 
was great when I found that many of these cells 
were closely packed with the blastSf which are not 
in the least like any normal structure found in the 
mosquito. Now I did not, at this time, know what 
this gland is. It was speedily found, however, to be a 
large racemose gland consisting of six lobes, three 
lying on each side of the insect's neck. The ducts of 
the lobes finally unite in the common channel which 
runs along the under surface of the head and enters 
the middle stylet^ or lancet^ of the insect's proboscis. 
It was impossible to avoid the obvious conclusion. 
Observation after observation showed that the 
blasts collect within the cells of this gland. It is the 
salivary or poison gland of the insect, similar to the 
salivary gland found in many insects, the function of 
which in the gnat had already been discovered — 
although I was not aware of the fact. That function 
is to secrete the fluid which is injected by the insect when 
it punctures the skin^ fluid which causes the well* 
known irritation of the puncture, and which is 



PREVENTIVE MEDICINE 381 

probably meant either to prevent the contraction of 
the torn capillaries or the coagulation of the ingested 
blood. . • • The blasts must evidently pass down the 
ducts of the salivary gland into the wound made by 
the proboscis of the insect, and thus cause infection 
in a fresh vertebrate host.*^ 

Ross's investigations were carried on from 1895 to 
1899. In 1897 Dr. W. G. MacCallum discovered the 
function of the motile filaments already referred to, 
and in 1898-99 Bignami and others demonstrated 
that all mosquitoes acting as hosts of malarial para- 
sites belong to the genus Anopheles. In 1900 Dr. 
Sambon, accompanied by friends and servants, suc- 
ceeded in living in a malarial district near Rome 
(Ostia) without contracting fever — and that from 
the beginning of July till October 19th — exercis- 
ing the sole precaution of remaining within a well- 
screened hut from sunset to sunrise. It was also 
shown that mosquitoes that had bitten malarial 
patients in Italy could, when carried to England, 
transmit the infection to people who had never been 
in a so-called malarial district. Mr. Manson, the 
son of Dr. Manson, submitted to the experiment 
necessary to establish this fact. 

Methods of sanitation, developed largely by Ross, 
were soon extensively employed in the control of 
malaria. These included the use of nets and wire 
screens, the protection of tanks and other water 



383 THE HISTORY OF MEDICINE 

receptacles, the clearing away from the neighbor- 



hood of human habitations of empty tins, broken 
bottles, gourds, buckets, and bits of pottery in which 
mosquitoes might lay their eggs, the drainage of 
swamps, the filling-in of poob and puddles, the 
extirpation of undergrowth, the oiling of stagnant 
waters, the killing of mosquitoes by fumigations, 
and the destruction of the larvae by means of fish 
and other natural enemies. At the same time the 
systematic use of quinine as a preventive was 
greatly extended in the tropics through the influence 
of Koch. Ross visited the west coast of Africa in 
1899, and before the dose of 1901 encouraging re- 
sults of sanitary measures suggested by the discov- 
ery of the part played by Anopheles in malarial 
infection were reported from Sierra Leone, Lagos, 
Hong-Kong, certain points in the Malay Peninsula, 
as well as from Italy, India, North Africa, and the 
American Tropics. In 1902 Ross received the Nobel 
Prize for his efforts to control malaria, the scourge of 
the tropics, and of all diseases whatsoever probably 
the most detrimental to the health and efficiency of 
man. At Ismailia, on the Suez Canal, where Ross 
was in charge of sanitation, the number of cases of 
malaria was reduced from 1551 in 1902 to 37 (all 
cases of relapse) in 1905. 

It was by the ingenuity and resolution of Major 
Walter Reed, an American army surgeon, that an- 



PREVENTIVE MEDICINE 383 

other great triumph over tropical disease was made 
possible. Bom in Virginia in 185 1, he succeeded by 
severe application to study in securing the doctor's 
degree at the University of Virginia before he had 
completed his nineteenth year. He continued his 
medical studies in the Bellevue Hospital Medical 
College, New York, had considerable hospital ex- 
perience in that city and in Brooklyn, became dis- 
trict physician in one of the poorest parts of the 
metropolis, and was appointed one of five inspectors 
on the Brooklyn Board of Health. He soon gave up 
the idea of general practice, and, having passed the 
examination of the Medical Corps of the United 
States Army, he married, and at the age of twenty- 
four entered upon his garrison duties in the West. 
He had an extended experience of frontier life — 
Arizona, 1876-80, Nebraska, 1882-87, and Dakota, 
1891-93. For a short time in 1881 he was stationed 
at Fort McHenry, Baltimore, and was able to pursue 
at the Johns Hopkins University the study of phys- 
iology, but a greater opportunity, which he seized 
with avidity, came in 1890-^1, when he served as 
examiner of recruits at Baltimore. He now devoted 
himself to pathology and bacteriology, and was in 
dose relation with Welch, Councilman, Abbott, 
Thayer, Nuttall, and other leaders in medical sci- 
ence, at the Johns Hopkins Hospital. He undertook 
an investigation into the so-called lymph nodules of 



384 THE HISTORY OF MEDICINE 

the liver in typhoid fever, and gave further evi- 
dence of an aptitude for research. 

After his two years of service in Dakota, Reed 
was appointed curator of the Army Medical Mu- 
seum at Washington and professor of bacteriology 
in the Army Medical School. He was deeply inter- 
ested in the discovery of the Klebs-L5ffler badllus, 
and was the champion of the antitoxin treatment 
of diphtheria. He made numerous contributions to 
professional periodicals, and prepared reports on 
malarial fevers at Washington Barracks and Fort 
Myer, and on serum diagnosis in typhoid fever. In 
1897 Reed and Dr. James Carroll were appointed by 
Surgeon-General Sternberg to investigate the claim 
of Professor Sanarelli of Bologna that BaciUus ictef'- 
oideSf found by the Italian scientist in the blood of 
yellow-fever patients in Brazil, was the cause of 
yellow fever. It was especially desirable that the 
organism observed by Sanarelli should be compared 
with Bacillus X, which had been observed ten years 
previously, by Sternberg himself, in yellow-fever 
patients. In a preliminary report in 1899 Carroll 
and Reed stated that Bacillus icteroides (ultimately 
shown to be identical with Bacillus X) is really a 
variety of the hog-cholera bacillus, with which Reed 
had become familiar while working with Welch and 
Clement at the Johns Hopkins Hospital. After the 
beginning of the Spanish- American War of 1898, 



PREVENTIVE MEDICINE 385 

Reed was made chairman of a committee to inves- 
tigate the origin and spread of typhoid fever in the 
United States military camps, but his great opening 
came, when, in 1900, yellow fever having broken out 
among the American troops in Cuba, he was made 
chairman of an Army Board, composed of Carroll, 
Lazear, Agramonte, and himself, appointed to inves- 
tigate the cause of the disease. 

How little was known, at the time of the Spanish- 
American War, concerning the cause of yellow fever 
and its mode of transmission is shown by a report of 
the officers of the United States Marine Hospital 
Service, which declared that it was spread by the 
infection of places and articles of bedding, clothing, 
and furniture. "More recently,*' this report of 
1898 continues, ''the idea has been advanced that 
probably the germ of yellow fever enters the general 
circulation through the respiratory organs in some 
obscure manner, and incubating in the blood di- 
rectly poisons this life-giving stream. However this 
may be, the present opinion is that one has not to 
contend with an organism or germ which may be 
taken into the body with food or drink, but with an 
almost inexplicable poison so insidious in its ap- 
proach and entrance that no trace is left behind/' 
The American army in Cuba almost succumbed to 
its unseen enemies. After two months' campaigning 
it "was utterly used up and of no value whatever as 



386 THE HISTORY OF MEDICINE 

a fighting machine/* at least four fifths of the troops 
being incapacitated by tropical diseases and ty- 
phoid. When Gorgas took control of the sanitation 
of Havana he was influenced by the rather vague 
assumption that yellow fever was a filth disease. 
Though he was thrown into daily contact with Dr. 
Carlos Finlay, Gorgas took very lightly the mos- 
quito hypothesis which the Havana doctor had been 
maintaining stoutly since 1881. By the middle of 
1900 Gorgas had made Havana, in his judgment, 
the cleanest city in the world, but there were more 
cases of yellow fever than for several years previ- 
ously, and the inhabitants twitted him with the 
fact that the disease was particularly prevalent in 
the cleanest sections of the Cuban capital. 

Reed, who arrived at this juncture — June, 1900 
— soon found his way, with the able support of Car- 
roll, Lazear, and Agramonte, through the welter of 
misconceptions concerning the etiology and trans- 
mission of yellow fever. Some time was spent by 
the Board in giving the coup de grdce to Sanarelli's 
hypothesis. Agramonte had previously — at San- 
tiago — found Bacillus icteroides in thirty-three 
per cent of the yellow-fever patients examined by 
him. Now, however, eighteen cultures from as many 
yellow-fever patients failed to show the presence of 
the hog-cholera bacillus. At the end of July Reed 
went to the Pinar del Rio Barracks, where a number 



PREVENTIVE MEDICINE 387 

of cases of yellow fever had occurredi and there he 
made two very important observations* He noted 
in the first place that several non-immunes had 
come into intimate contact with clothing and bed- 
ding contaminated by . yellow-fever patients with- 
out any apparent deleterious effects. He noted in 
the second place that a prisoner confined with eight 
others in a cell of the guardhouse had contracted the 
disease, while his companions had escaped infection, 
and that it had been surmised at the time that the 
victim had been bitten by an insect, perhaps by a 
mosquito. Very soon after his arrival in Cuba Reed 
had taken account of Finlay's hypothesis, as well as 
of the attempts to put it to experimental proof, and 
had obtained from Finlay eggs of the Stegomyia, the 
supposed carrier of the pathogenic organism. More- 
over, Reed had been impressed by the work of Ross, 
Bignami, and others concerning the dissemination 
of malaria. He declared it to be ''of the highest 
importance that the agency of an intermediate host, 
such as the mosquito, should either be proven or 
disproven." 

Ross's belief in an intermediate host had been 
influenced by the report of Dr. H. R. Carter's ob- 
servations in Mississippi (1898) concerning the time 
that elapsed between the arrival of cases of yellow 
fever in isolated farmhouses and the occurrence of 
secondary infections. Finlay's attempts to produce 



388 THE HISTORY OF MEDICINE 

yellow fever by the Wte of Stegomyia had failed 
because he did not know that the insect does not 
become infectious till about twelve days or more 
after feeding on a yellow-fever patient, and that 
the blood of the patient does not infect the insect 
except in the first three days of sickness. The first 
experiments of Lazear with supposedly infected 
mosquitoes failed for similar reasons, but on August 
27th| Dr. Carroll allowed himself to be bitten by 
mosquitoes that had fed on yellow-fever patients, 
and one of the insects was able to produce the 
desired result. After some slight premonitory symp- 
toms he developed a severe case of yellow fever 
August 3ist. On September 13th Lazear, while 
working among yellow-fever patients at Las Animas 
Hospital, Havana, observed a mosquito biting his 
hand. He allowed it to take its fill. He was attacked 
by yellow fever September i8th, and died of the 
disease a week later. On the basis of these and other 
cases Reed stated in the following month — ''The 
Etiology of Yellow Fever: A Preliminary Note*' — 
that the mosquito acts as the intermediate host for 
the parasite of yellow fever. The task remained by 
a series of well-controlled experiments to support 
this statement and to test the claims of other pos- 
sible means of infection besides the bite of the mos- 
quito. Accordingly a quarantined camp, named in 
honor of Dr. Lazear, was established about a mile 
from Quemados, Cuba. 



PREVENTIVE MEDICINE 389 

" It was now proposed," writes Reed, "to attempt 
the infection of non-immune individuals in three 
different ways, namely, first, by the bites of mos- 
quitoes which had previously bitten cases of yellow 
fever; second, by the injection of blood taken during 
the early stages from the general circulation of 
those suffering from the disease; and, third, by 
exposure to the most intimate contact with fomites. 
For this purpose, in addition to the seven tents pro- 
vided for the quartering of the detachment, two 
frame buildings each 14 x 20 feet in size were con- 
structed. These buildings, having a capacity of 
2800 feet, were exactly similar, except that one of 
them, known as the 'Infected Mosquito Buidling,' 
was divided near the middle by a permanent wire 
screen partition and had good ventilation ; while the 
other, designated as the 'Infected Clothing Build- 
ing,' was purposely so constructed as to exclude 
anything like efficient ventilation. These houses 
were placed on the opposite sides of a small valley, 
about eighty yards apart, and each seventy-five 
yards distant from the camp proper. Both houses 
were provided with wire screen windows and double 
wire screen doors, so that mosquitoes could be kept 
within or without the buildings as the experiment- 
ers might desire." 

On December 5th Private Kissinger, who (with 
Moran) had volunteered without pecuniary reward, 



390 THE HISTORY OF MEDICINE 

''solely in the interest of humanity and the cause of 
science/' to submit to the experiment, was bitten by 
infected mosquitoes, and in about tliree and a half 
days suffered an unmistakable attack of yellow fever. 
During the week following the onset of his illness 
four other cases of the disease were produced by the 
same means in the Infected Mosquito Building. 
On December 21st and 22d Moran was bitten, and 
on Christmas morning he had a sharp attack of the 
fever; but two other volunteers, who slept for fifteen 
nights on the other side of the wire screen partition, 
by which the building was divided, remained in good 
health because they were protected from the mos- 
quitoes. A building is infected only in as much as it 
harbors infected mosquitoes. In the Infected Cloth- 
ing Building Dr. Cooke and Privates Folk and 
Jemigan slept every night from November 30th till 
December 19th in close contact with blankets, 
sheets, pillow-slips and pyjamas polluted beyond 
description by yellow-fever patients in Las Animas 
Hospital and other institutions. The three remained 
in perfect health in spite of passing twenty nights 
in hot, ill-ventilated, and noisome quarters. In a 
later experiment — January 4, 1901 — Jemigan was ' 
inoculated with blood drawn from a yellow-fever 
patient in the early stage of the disease. He de- 
veloped yellow fever in about four days. Blood 
taken from him within the first three days of his 



PREVENTIVE MEDICINE 391 

31nes8 and injected into a non-immune proved cap- 
able of transmitting the disease, a fact which was 
taken to indicate that the casual agent is a living 
organism and not merely a chemical toxin. It was 
further proved by e3q)eriment that the blood of a 
yellow-fever patient remains infectious after passing 
through a fine filter, but that it loses its virulence 
after being heated to 55^ C. 

The general conclusions announced by the Army 
Board were: That yellow fever is conveyed from the 
sick to the well solely by the bite of the female 
Stegamyia mosquito; that the insect can become in- 
fected only after sucking the blood of a patient 
within the first three days of the sickness ; that the 
period of extrinsic incubfttion is from twelve to 
twenty dajrs ; that the period of intrinsic incubation 
is from three to six days; that yellow fever may be 
produced artificially by injecting a non-immune 
with the blood of a patient in the early sti^ of the 
disease; and that the causal aig^t of yellow fever 
is a sub-microscopic parasite. "These discoveries/* 
writes Gorgas, "have been of enormous benefit to 
mankind, and upon them has been based the sani- 
tary work against yellow fever which has been so 
successful." 

To the splendid efforts of Major (later Surgeon- 
General) Gorgas, who at the time of the Army 
Board's report — February, 1901 — was chief sanir 



392 THE HISTORY OF MEDICINE 

tary officer of Havana, the practical success of con- 
trolling yellow fever was due. All cases of the disease 
occurring in the city were required to be reported 
immediately to the Health Department. The pa- 
tients were carefully screened from mosquitoes in 
order that they might not become the source of 
further infection. A war was carried on against the 
insects by the use of fumigations of sulphur and of 
pyrethrum powder, by the destruction of larvae, 
and by the protection of barrelSi cisterns, etc., and 
by the removal of tin cans and other breeding-places. 
Any ship with yellow fever on board was fumigated 
in order to kill infected mosquitoes, and the non- 
immune passengers or members of the crew were 
detained at a quarantine station for a period of six 
days. There had been three hundred and ten deaths 
from yellow fever in Havana in 1900; there were 
only eighteen in 1901. Of these eighteen cases, 
seven occurred in the month of January, five in 
February, one in March, one in July, two*in August, 
and two in September, For the first time since the 
capture of Havana by the British during the Seven 
Years' War, the city became free from yellow fever. 
"For two hundred years before this time [1762],'* 
writes Gorgas, "Havana had been subject to epi- 
demics of yellow fever, but from 1762 up to the 
year 1901, there was probably not a single day when 
Havana did not have a case of this disease within its 



PREVENTIVE MEDICINE 393 

bounds/* Gorgas attacked the Anopheles mosquito, 
as well as the Stegomyia^ and the number of deaths 
from malaria in Havana was reduced from three 
hundred and twenty-five in 1900, to one hundred 
and fifty<Kine in 1901, to seventy-seven in 1902, and 
to four in 1912, 

Eariy in 1902 Gorgas called the attention of 
Surgeon-General Sternberg to the value of appljdng 
the principles established by the Reed Board to the 
sanitation of the Isthmus of Panama in case the 
United States should take over the construction of 
the Canal. He was soon relieved of duty at Havana, 
and ordered to the United States in order that he 
might be in touch with preparations for work on 
the Isthmus. In the spring of 1904 he, as sanitary 
adviser accompanied the Commission (Isthmian 
Canal) on a visit of inspection to Panama* His 
oiganization b^an in June. Finding "that the 
Fruich had lost yearly by death from yellow fever 
about one third of their white force,'' he made an 
onslaught on the mosquitoes, principally by the use 
of fumigations in the city of Panama. Success was 
not immediate. There was a great deal of yellow 
fever within the ensuing twelve months, but in the 
autumn of 1905 the number of cases rapidly de- 
clined. After November the disease ceased to exist 
in the dty of Panama. One case occurred at Colon 
in the spring of 1906, but since then not one case of 
yellow fever has originated on the Isthmus. 



394 THE HISTORY OF MEDICINE 

''Of the six important tropical diseases/' says 
Osier, "plague, which reached the Isthmus one 
year, was quickly held in check. Yellow fever, the 
most dreaded of them all, never recurred. Beri-beri, 
which in 1906 caused sixty«eight deaths, has gradu- 
ally disappeared. The hookworm disease, ankylo- 
stomiasis, has steadily decreased. From the very 
outset, malaria has been taken as the measure of 
sanitary efficiency. Throughout the French occa^ 
pation it was the chief enemy to be considered, not 
only because of its fatality, but on account of the 
prolonged incapacity following infection. In 1906, 
out of every 1000 employees there were admitted to 
the hospital from malaria 821 ; in 1907, 424; in 1908, 
282; in 1912, no; in 1915, 51; in 1917, 14. The 
mortality from the disease has fallen from 233 in 
1906 to 154 in 1907, to 73 in 1908 and to 7 in 1914. 
The death rate for malarial fever per 1000 popula- 
tion sank from 8.49 in 1906 to o.ii in 1918. Dysen- 
tery, next to malaria the most serious of the tropical 
diseases in the Zone, caused 69 deaths in 1906; 48 in 
1907 ; in 1908, with nearly 44,000 only 16 deaths, and 
in 1914, 4." 

REFERENCES 

Gorgas, W. C: SanilaUan in Panama. 1915, 998 pp. 
Kelly, H. A.: Walter Reed and Yellow Fever. 1906. 293 pp. 
Lankester, E. Ray: The Kingdom of Man (chapter m, "Sleeping 
SickneflB"). ^907. 191 pp. 



PREVENTIVE MEDICINE 395 

Mastersi Walter E.: EsseiUiak (tf Trapkal MedMne. 1920. 

703 pp. 
Oder, Sir WiUiam: The EnMum rf Modem Medicine. 1921. 

243 PP- 
Rosenau, Milton J.: PreDenike Medicine and Hygiene. 1914. 

1074 pp. 

R068, Sir Ronald: Mosqmto Bri§ades and Hew lo Organm Them* 

1901. 98 pp. 



CHAPTER XX 

MEDICAL SCIENCE AND MODERN WARFARE 

The achievements of medical science in the emer- 
gency created by the outbreak of war in 1914 were 
owing in no inconsiderable degree to officers imbued 
with the spirit of research and with the enterprise 
that had checked the ravages of yellow fever and 
malaria, discovered the cause and the mode of 
transmission of Malta fever and trypanosomiasis, 
developed a treatment for amoebic dysentery, 
adopted measures for the cure of beri-beri, and 
dealt successfully with hundreds of thousands of 
cases of hookworm disease. 

Preventive measures against typhoid, the appli- 
cation of which to millions of men was one of the 
important successes of the World War, were made 
possible by the work of Sir Almroth Wright and 
others. The Bacillus typhosus had been discovered 
by Eberth in 1880. In 1896 PfeiflFer and KoUe suc- 
ceeded in inoculating two volunteers with the 
disease. In this same year Wright devised his pre- 
ventive inoculation — an emulsion of dead typhoid 
bacteria. With this he inoculated British troops in 
India to about the number of four thousand in 1898- 
1900. During the Boer War Wright, in co5peration 



MEDICAL SCIENCE AND WARFARE 397 
with Sir William Leiafaman, extended the prophylac- 



tic treatmait to 100,000 troops in South Africa. 
It was adopted by the medical officers of the Frendi 
and German colonial troops. The prevention of 
typhoid among the Japanese sddiers was one of the 
outstanding features of the Rus8o-J^>anese War of 
1904. Of 12,801 men of the United States army, 
who during the Mexican border troubles of 1912 had 
received preventive treatment under the direction 
c^ Major Russell, only two devdoped typhoid. This 
result is all the more striking when we recall that 
at the time of the Spanish- American War there had 
been among 107,973 men in the United States 
encampments 20,738 cases of typhoid fever and 
1580 deaths. During the World War preventive 
measures, including the chlorination of waters and 
the control of carriers, were made more and more 
effective. The technique of prophylactic inocula- 
tion was developed among the British by officers 
working under the direction of Leishman. From the 
beginning of 1916 the triple vaccine, for the pre- 
vention of the paratyphoids — the bacteriology of 
which had been set forth by Buxton in 1902 — as 
well as of typhoid proper, came into use, and was 
followed by other polyvaccines. Among the mil- 
lions of United States troops, in the two years sub- 
sequent to the declaration of war in April, I9I7> 
there were only 227 deaths from typhoid fever. 



39« THE HISTORY OF MEDICINE 

The labors, toward the dooe of the nineteenth cen* 
tury, of the Prussian army surgeon Emii von Behring 
and others had prepared the way for the successful 
emplojrment of serums in the World War. The Bacil- 
lus tetani had been discovered by Nioolaier in 1884. 
Five years later Kitasato had succeeded in growing 
the organism in pure culture. In 1890 von Behring 
in collaboration with Kitasato published an article 
concerning the production of diphtheria immunity 
and tetanus inununity in animals. His serum ther* 
apy (as explained in Die Blutserumlherapie, 189a) 
is founded on the principle that the serum of animals 
rendered immune to a disease acts, if introduced 
into a living organism, as an antidote to the virus 
of the bacteria concerned. In the first part of the 
World War there were a great many losses through 
tetanus — so many, in fact, among the allied 
troops in the weeks following the first battle of the 
Mame as to give rise to the most serious apprehen- 
sions. In the month of October, 1914, the ratio of 
cases among the wounded was 32: 1000. This was 
quickly reduced to 2 : 1000 by the use of anti-tetanus 
serum. During the war the serum treatment was 
used also to control cerebrospinal meningitis. The 
pathogenic organism had been isolated by Weichsel- 
baum in 1887. Dr. Simon Flexner had undertaken 
the investigation of the disease in 1905 and after a 
series of experiments bad produced a prophylactic 



MEDICAL SCIENCE AND WARFARE 399 

serum. In 1914-15 a severe epidemic broke out 
among the Canadian troops and (according to 
Osier) the infection was carried by them to England. 
It was particularly rife in the camp on Salisbury 
Plain. In 1915 it was discovered that a better serum 
could be prepared by injecting into animals dif- 
ferent strains of the menigoooocus, the differentia- 
tion of which is still under investigation. It was 
also found desirable to isolate soldiens suspected of 
being carriers^ as the infection is readily conveyed 
from person to person by coughing and sneezing. 

Influenza, another disease disseminated through 
discharges from the mouth and nose, baffled the 
resources of medical sdaice, and became very 
deadly in the armies, as well as in the civil pop- 
ulations throughout the world. For example, it 
b^an to attract special attention among the British 
troops on the northern part of the western front 
about April, 1918, that is, a few weeks after the 
beginning of the final campaign. It was soon, known 
to be pandemic and extremely infectious. The 
earlier cases were quite mild, but the disease became, 
as it spread, more and more virulent. June 23d a 
committee which had been appointed to study 
influenza reported to the Director General of the 
Medical Services that the contagion of this disease 
appears to be air-borne. "The main principle to be 
followed, therefore, is to spread troops as widely 



400 ^ THE HISTORY OF MEDICINE 

as possible, avoiding the crowding of men in tents, 
billets, messrooms, etc/* Whenever the military situ- 
ation permitted, the troops were to sleep in the open 
air in individual blanket-shelters. Influenza patients 
were to be kept separate from other patients. Of 
course it was frequently impossible to live up to 
the sanitary suggestions contained in this British 
report. This was notably the case in the traiisporta- 
tion of troops. In September the American trans- 
port Nestor left the United States for England with 
2807 soldiers on board. Two or three days later she 
was forced to land 660 patients and contacts at 
Sydney, Cape Breton. But, in spite of this precau- 
tion, 1000 more men were taken ill before the ship 
reached Liverpool. The military camps in the 
United States were severely smitten, and the deaths 
from influenza and its complications outnumbered 
the country's total losses in battle. 

The stimulating influence of war on research in 
the various sciences is obvious to every student of 
history. The effect of the World War on the prog- 
ress of medical science was early recognized and is 
becoming every day more manifest. At the begin- 
ning of 1917 Sir F. W. Andrewes expressed the 
opinion ''that in pathology, no less than in the other 
sciences, advances have been made, under the 
stress of national necessity, during the two years 
and a half of war which could hardly have been 



MEDICAL SCIENCE AND WARFARE 401 

expected in twenty years of ordinary woric; and 
although it has been 'war work/ it represents a 
solid contribution to science which will be valid for 
the years of peace to come." The occurrence of 
dysentery among the troops in Gallipoli, Egypt, 
Mesopotamia* and other regions led to a renewed 
investigation of the causative agents of both the 
badllary and amoebic forms of the disease, and to a 
modification of the use of emetine and emetine 
bismuth iodide in the treatment of amoebic dys- 
entery. Ailments like trench foot, trench nephritis, 
and trench fever, incident to life at the front under 
new and peculiar conditions, were a challenge to the 
medical science of the twentieth century as syphilis 
had been to the less highly developed medical science 
of the sixteenth century. Trench fever, named toward 
the end of 19 15, was proved by investigations to be 
transmitted by the louse, and this discovery sug- 
gested as a means of control such a crusade i^ainst 
the insect carriers as had proved effective in combat- 
ing tyjAus in Serbia and elsewhere. Trench fever 
is probably not only a newly recognized disease but 
an absolutely new disease, caused by a micro- 
organism which has now for the first time invaded 
the tissues of man. Trench nephritis, on the other 
hand, had been described during the American 
Civil War. Soldier's heart, closely studied by J. M. 
Da Costa among the Federal troops, had been 



402 THE HISTORY OF MEDICINE 

observed in the Crimean War. After the outbreak 
of the World War disordered action of the heart 
(investigated by AUbutt and others) as well as 
pyrexias of uncertain origin, became familiar to 
every medical officer. Infective jaundice, which 
was no doubt rife among the American soldiers in 
1861-65, and is now known to be caused by a para« 
site {Spirodiata icterofuBmorrhagia)^ was epidemic 
at times during the recent war ; while toxic jaundice 
was of frequent occurrence in munition factories. 

Observations made during the World War give 
considerable promise of advance in our knowledge 
of psychiatry. Some of the methods of testing the 
mental fitness of the men and of rating the officers 
were rather crude and illogical, and the statistical 
methods applied to the data led at times to results 
which the scientific mind will receive with caution. 
Nevertheless, great enterprise was shown — notably 
in America — in the task of taking stock of the 
mental equipment of millions of young men. It has 
been claimed as the result of extensive investigation 
that a very large percentage of twelve*yearK>ld 
minds is found among American men of military 
age. The records of the discharge of soldiers from 
the British armies as permanently unfit on account 
of nervous or mental diseases have, similarly, been 
regarded as indicating that a considerable propor- 
tk>n ol the male population of a highly civilized 



MEDICAL SCIENCE AND WARFARE 403 

country possesses a neurotic or neuropathic predis* 
position. 

The British War Office recognized three forms of 
war neurosis — shell shock, hysteria, and neuras- 
thenia. Needless to say, the symptoms described 
under each of these cat^ories show that the classifi- 
cation was not wholly satisfactory. Some cases 
included under shell shock were definitely known to 
be the result of the percussion of explosives, to the 
direct effect of which organic changes, like the rup- 
ture of the tympanic membrane and the alteration 
of the spinal fluid, bore witness. Other cases of shell 
shock seemed more purely psychic in their mani- 
festations. Both types contributed to corroborate 
the teachings of Darwin and James concerning the 
intimate relations between the emotions — fear, for 
eacample — and the physiological concomitants of 
the emotions. Does the shattering effect, on the 
body, of air-vibrations constitute the agitation we 
call fear, or does ^he recognition of danger provoke 
the physiological symptoms? The well-attested fact 
that a cold wind playing upon a sleeper may give 
rise to a dream of fear seems to support the view 
that it is the bodily state that gives substance and 
character to the emotion. 

Colonel Mott holds that in any case there is a 
vicious circle, the perceptual feeling of fear stimulat- 
ing the physiological »vmptoms and these in turn 



404 THE HISTORY OF MEDICINE 

giving reinforcement to the psychic condition. In 
his patients he found evidence of a persistence of the 
bodily changes characteristic of a state of fear. 
About ten per cent of the cases of severe neuras- 
thenia showed some of the symptoms of Graves's 
disease, among the exciting causes of which fright, 
worry, and mental shock have long been recogniased. 
Other cases gave evidence of an unusual amount of 
adrenin in the blood, an increase of which secretion 
occurs as a result of fright, as has been shown ex- 
perimentally by Cannon. The view here taken con- 
cerning the importance for the emotional life of the 
internal secretions — of the thyroid as well as the 
adrenals — might be supported by referring to 
Addison's disease, in which the atrophy of the 
adrenals may give rise to languor, anaemia, and 
cardio-vascular asthenia. Fear, including the in- 
creased heart rate, is a preparation for fight or 
flight; but, as Mott remarks, in trench warfare, 
which is particulaiiy prolific of war neuroses, the 
emotions are deprived of their natural functions. 
The soldier can neither fight nor take refuge in 
flight; he can only adopt the crouching attitude of 
immobility. The result may be a deep-seated 
emotional derangement. 

''In the dreams of soldiers, ideas of past war 
experiences are revived with great vividness in the 
great majority of cases, even in those who are unable 



MEDICAL SCIENCE AND WARFARE 405 

to recollect their dreams. For besides thoee patients 
who wake up in a fright and cold sweat, there have 
been numerous instances of soldiers who have 
walked in their sleep, and many others have talked, 
shouted out orders, and cried out in alarm as if 
again engs^^ed in battle (not a few of these have been 
mutes). But the strangest phenomena of foi^otten 
dreams of soldiers suffering from shock are observed 
in those who in their sleep act as though they were 
engaged in battle, and go through the pantomime of 
fighting with bombs, with bayonet, with machine 
gun and with rifle, and yet remember none of these 
things when they wake. Evidently during their 
sleep vivid ims^inings of their previous experiences 
are arousing defensive and offensive reactions in 
face of the imaginary enemy." Neuropathic patients 
who show symptoms, in the early morning, of 
nervous exhaustion and irritability are not infre- 
quently the victims of dreams of a highly emotional 
sort which may be beyond the power of recall of the 
waking consciousness. 

In the treatment of war hysteria persuasion, sug- 
gestion and psychoanalysis proved effective. It 
was found advisable to explain the symptoms and 
the natiue of the neurosis to a few of the more intel- 
ligent patients and to employ their powers of per- 
suasion to induce a new mental attitude in the 
others. Grateful patients already on the highroad 



406 THE HISTORY OF MEDICINE 

to recovery thus became very helpful in bringing 
about cures* Any form of treatment that in^ired 
in the patient the confidence that something eflFee- 
tive was being done in his bdialf had a therapeutic 
value. Even where no bodily derangement was 
Mspected a thorough physical examination was 
necessary in Cfrder to establish the physician in the 
confidence of the patient. The physician's p^^onal- 
ity and the surroundings generally had a powerful 
influence on the suggestible minds of the patients. 
In addition to its suggestive value electricity enabled 
the physician to prove to patients suflFering from 
hysterical paralysis that their muscles had not tost 
the power of contraction. It also restored sensibility 
in cases of hysterical anaesthesia, and thus renewed 
the patients' consciousness of the affected parts. 
Passive movements of an apparently paralyzed 
Kmb might afford the kinaesthetic cue for active, 
voluntary movements. The metiiod of psychoanaly* 
sis — t»eaking down dissociations and inducing an 
integration of consciousness by the revival of re- 
pressed emotional ^cperiences — found many cham* 
pions among those who succeeded in the treatment 
of war hysteria. The revival of the repressed e^q^^- 
ence — such as remorse in connection with the 
death of a comrade — must be emotional in diar- 
acter in order to bring about a satisfactory catharsis ; 
and the revived experience should be recalled ^ain 



MEDICAL SCIENCE AND WARFARE 40^ 

and again till the memoty loses its dramatic vivid- 
ness. The fact that an anxiety neurosis may super- 
vene on the removal of the hysterical symptoms 
should warn us that dissociation is after all a means 
of defense against unbearable mental strain. ''My 
dearest wish," wrote a young correspondent towards 
the dose of the war, "is to forget the whole grew- 
some business.*' What Culpin calls "the ever* 
growing sense of horror" led at times to prolonged 
amnesias, the treatment of which by the method of 
psychoanalysis had to be undertaken with the ut^ 
most caution. 

In reporting on the surgical developments of the 
World War Dr. W. S. Bainbridge writes: "In the 
many hospitals and casualty clearing stations 
vi^ted, the method of treating war wounds varied 
greatly. There were those who believed in the use 
of the strongest antiseptics, as at the Grand Palais, 
where phenolization was employed, while others 
favored incising freely with drainage and practically 
no antiseptics. More and more the two extremes are 
being emphasized; on the one hand, the Carrel 
treatment with its scientific laboratory control and 
systematic use of strong antiseptic solutions, and on 
the other, d&ridemefU and immediate closure/* The 
faihire of the ordinary antiseptic methods to meet 
the conditions of warfare on the western front, where 
the heavily manured soil was charged with or« 



408 .THE HISTORY OF MEDICINE 

ganbms, soon led to modificatioiis, such as the vse 
of drainage with antiseptics, and the use of hypo- 
chlorites. The Carrel method, which attracted gen- 
eral attention in 1916, soon found rivals in other es- 
sentially antiseptic methods. In 191 7-1 8 the method 
of primary wound suture, immediate or delayed, 
came into special prominence. ''Under favorable 
conditions," continues Bainbridge, "primary union 
by immediate or delayed suture of war wounds 
which have been operated on and properly purified, 
is now the last word in this branch of sui^gery. Ex- 
perience in the Worid War has taught entirely new 
lessons to the surgeons who found themsdves con- 
fronted with unprecedented conditions both in 
regard to the masses and classes of war wounds 
they were expected to handle. Perhaps the most 
important lesson of all, with the closest bearii^ on 
wound treatment in general, consists in the recogni- 
tion of the fact that antiseptics are inefficient with- 
out the most careful and thorough mechanical 
purification of the wound, including the complete 
removal of all dead or nonviable tissue/' 

Sir Henry Gray eicpresses a similar conclusion. 
''Much discussion," he writes, "took place during 
the early periods of the war as to the best form of 
dressing and the most effective lotions to be em- 
ployed in the treatment of wounds. It was hoped 
that by the early use of suitable disinfectants much 



MEDICAL SCIENCE AND WARFARE 409 

would be done to combat the d&set of sepds. It has 
been found that antiseptics per se have but little 
influence in this direction, and that the best hope of 
averting the danger of severe sepsis lies in early and 
efficient operation. The use of ordinary disinfectants 
and impregnated dressings is of little or no value in 
most cases until such operation has been carried 
out/' He adds that eusol and similar solutions are 
too evanescent in antiseptic action when in contact 
with the tissues to make their use worth while, and 
Carrel's method is out of the question in the eariy 
treatment of war wounds. The experience of the 
twentieth century has confirmed the judgment of 
the sixteenth that all gunshot wounds are necessarily 
infected, and for Gray sepsis, shock and haemorrhage 
are interdependent phenomena. The wounded must 
be carefully guarded against all emotional and sen« 
sory stimuli liable to provoke shock, and the loss of 
every additional ounce of blood is of the utmost 
importance. "Nothing," as Gray says, "has been 
more striking than the rapid spread of the use of 
blood transfusion as a therapeutic measure for the 
combating of shock-haemorrhage. During the first 
two years of the war transfusion was performed only 
by a few specially experienced surgeons, and was 
regarded more as an interesting curiosity than as a 
practical measure in the treatment of shock. It is 
only during the last two years that its scope has 



410 THE HISTORY OF MEDICINE 

been realised, aod that it has beeo adopted as a 
recognized part of the treatment of the severely 
wounded man." 

War sui^ery was greatly facilitated by improved 
methods of anaesthesia, as wet! as by radiography 
and other means of determining before operation 
the nature of the injury and the exact location of 
bullets, shrapnel, or other foreign bodies. Local or 
regional anaesthesia was frequently employed even 
in major operations. Nitrous oxide and oxygen came 
into very general use. Sometimes these inhalations 
were onnbined with small quantities of ether, or 
administered after preliminary injections, nerve 
blocking, etc. There occurred a revaluation of the 
various anaesthetics and combinations of anaesthet- 
ics, and an increased discrimination in their use. 
Moreover, professional opinion was rendered so 
unsettled in reference to the worth of the various 
methods of inducing surgical anaesthesia that the 
search for new drugs and anaesthetic preparations 
has been greatly stimulated. 

In the localization of foreign bodies, as well as of 
fractures and other injuries, radiography was indis- 
pensable. Unless the cases suffering from bullet or 
shrapnel wounds were screened, it was as a rule 
impossible to conjecture the location of a projectile. 
A bullet entering the back above the scapula might 
lodge in the anterior wall of the abdomen without 



MEDICAL SCIENCE AND WARFARE 411 

its passage through the lungs being revealed by any 
remarkable symptoms. Small fluorescent screens 
that could be closely applied to the skin of the 
patients were used by some radiographers. Frac- 
tures and other injuries that could not be detected 
on the screen were often revealed by an examination 
of the plates. In many cases stereoscopic radio- 
graphs proved invaluable to the operator. Besides 
radiography, other ingenious devices were used in 
the localization of bullets and other projectiles. 

The exigencies of the World War entailed a very 
gre^t extension of orthopsedic surgery. Through the 
activity of Sir Robert Jones — exponent of the 
practice and principles of Hugh Owen Thomas and 
John Hunter — the British Orthopaedic Centers 
with only two hundred and fifty beds at the start 
developed into the Special Military Surgical Hospi- 
tals with thirty thousand beds. In these institutions 
the general sui^eon, the orthopaedic surgeon, the 
neurologist, as well as the experts in hydrotherapy, 
massage, gymnastics, vocational training, etc., 
cooperated in the repair of injuries and the restora- 
tion of the functions of nerves and muscles. To 
obtain the best results it was essential to secure con- 
tinuity of treatment. The importance of the work 
of the advanced units in the prevention of deformi- 
ties was very clearly recognized. At the earliest 
possible moment after the occurrence of a fracture 



412 THE HISTORY OF MEDICINE 

It became the practice to adjust a suitable qiliiit. 



such as a Thomas 1% sfrfint or a swiveled Thomas 
arm splint. Fractures of the femur at the begimiing 
of the war frequently resulted in serious deformities; 
later* Jones was aUe to report a series of five hun* 
dred cases of compound fracture of the femur with 
an average shortening of less than half an inch. 
Remarkable successes were gained by the patient 
treatment of comminuted septic fractures. In the 
judgment of Sir Robert Jones ''the weight oi the 
body should not be allowed on the unsupported 
femur for at least six months after the recumbent 
treatment of the fracture.** A badly sprained ankle, 
however, should make a complete recovery in four- 
teen days: whereas immobilization for weeks in 
plaster would indefinitely perpetuate weakness and 
disability. The theory of the Belgian surgeon Wil- 
lems that joint lesions should be treated on the 
principle of immediate active mobilization led of 
course to a procedure far more drastic than any 
employed in the British Special Military Sui^cal 
Hospitals, where an opposed principle in the main 
prevailed. 

One of the outstanding successes in restorative 
work was the plastic surgery at Queen's Hospital, 
Sidcup, at Val-de«Grftce (Paris), at Boulogne, at Le 
Mans, and at the American Ambulance at Neuilly, 
The general sui^geons and the dentists here entered 




PLASTIC SURGERY OF THE FACE 



414 THE HISTORY OF MEDICINE 

eariy stages of the war* Moreoveri Tuffier ibund 
that a considerable number of those whose limbs 
had been amputated in 1914-15 had to undeiigo a 
further operation before they could take advantage 
of prosthetic devices of recent invention. However, 
the severity of our criticism of the medical and the 
surgital treatment of the soldiers in the opening 
years of the World War may be considered in some 
sense a measure of the progress that has been made 
in the medical sciences in general, not only in the 
special fields here emphasized but in the develop* 
ment of the treatment of venereal disease, in brain 
and heart surgery, and in various other depart* 
roents of the healing art, 

REFERENCES 

Allbutt, Sir Clifford T.: "The Investigation of the Significance 
of Disoidera and Diseases of the Heart in SoldierB," pp. 
90-92, British Medicine in the War (collected from BriUsh 
Medical Journal), 1917. 

Bainbridge, W. S.: ''Report on Medical and Surgidd Devdop- 
ments of the War.'* U. S. Namd Medical BuUeiin, 1919. 

Culpin, Millais: Psychaneuroses of War and Peace. Cambridge. 
1920. 

Da Costa, J. M.: ''On Irritable Heart" American Journal cj 
Medical Sciences, 1871, pp. 17-52. 

Gillies, H. D.: Plastic Surgery of the Face. Oxford, 1920. 

Gray, Sir H. M. W.: The Early Treatment of War Wounds. Lon- 
don, 1919. 

Jones, Sir Robert (editor and contributor): Orthopcedic Surgery 
of Injuries, 2 vols. Oxford, 1921. 

Lelean, Percy: Sanitation in War. Philadelphia, 1917. 

Mott, F. W.: "War Neuroses," Handbook, Clinical and Sd- 
entific Meeting. British Medical Assodationt 1919. 



INDEX 



INDEX 




ec of Tnlla, M. 
^JlbnU.SIr T. c'u. 69. 3S3.4T4- 




AmbideiUrity. s*- 

la ^BblIlM>c• M Nanllr. 41 



Anatomy, It, lO. iT,i>,40MMq., ei.Oi. 

•eq., lei at Kq., tot, 143 M Rq., ate. 

Ancoo •beep. 3<u. 

Andrem*. St F. W„ 400. 

Andiy, Nicolu. SiC 

Anniiiim.eT.dil, 114, 17), t(J,lS4, MT. 

161,366. 
AiMtlna pcctocli, 1B4, 1)1, 367. 



». r*. W, 1*9 at M* 



A^nriBU. d WppoaMM, sa. M. b. 
^luta orebfl, >Ti. 
Ap(X)livria,6f 
ApopleiT, lot, its. 



Appendb, vcfmUatm, io>. rtr, 

AnUaoiM, »> All 4t, TI. 
Antm*, St, 6a. T4. 
Ari^Mtk. 47. 69. n. it, 14, I 
Anny Bouil, 3>i ct ma, 



afif" 



AkIu*. 6. 

A»;l«[daibl (ANltlllldKl. a. JI, 4 



Ai-ijdvilulion. J J 



I. 73.'«i% 



Athlcclo. 13, 19, 31, 4ti, 
Alomi. ae, SOl 

Atropfa'r of tbe Urs, iSO. 
Auenbruoter, aoo et mn. 
' folMU, I7. 



D, iRi, ii4> m. «(& 



So. >i, Bj. 

Bo, >a, B3, S4, 91. 
7>. 79. ■?■ 99. [ao> 



4i8 



INDEX 



Babykmb, x ec leq. 

BaciBus otUhracis, 317, 397. 

BaciUus icUroides, 384, 396* 

BaciUMS, Krtk9-LAiUr, 384. 

Ba e i ttiu pestit, 374< 

BaciUus Utawi, 398. 

Bacilhu tmbtrauosis, 333. 

BaciUus typhosus, 396. 

BaciUus X, 384. 

Bacon, Fniiids, i6t. 

Bttcteriolofy, 3x6 et '«q., 335. 3S*. IM, 

383. 384. 4X<> 
Bachtishwa, 73 et tea. 
Bmt. Karl Braat v., tSi. t4t. 
Bagdad, 7a, 88, 90* 
Bainbridfe, W. S., 407. 4x4. 
Balfour, P. M., aso, ass* 
Ban, Jaawi lloorM, X15. 
Bandacins, 36, 46, 67. x9Qb 
Baroekma, 358. 
Bark, Peniviaa, X44, 154* 
Bann, J^ x8o. 
Baakenrllie, dMrtetk sff. 
Baad, 3a4. 
Batte. X3, 31, 73* 

Bayard, Tbomas, 35'* 
Bayle, aoT, ao8. 

Beddoet, Thomaa, a7T> 

Belli Bic Bbdi ▼•, sTSt ^OS* 

Bell, Bauamin. 367. 

Bell. Sir Charlea, ai8, aai. 136, 3x1. 

Bellevue Hospital Medfcal Cofl^, 3>3* 

Bellini, 135. 136. 

Betensario da Carpif >06k 

Beri-beri, 394, 396. 

Bernard, Claade, a 18, 131, 137, 

Bernard of Gordon, 8s. 

Bert. Paul, 3a7* 

Berthelot, M., pa. 

Bertucdo, 95. 99. 

Bkfaat. t8x. 189. aoB, txs. tS7» ittS* 

Bifldow, Henry J., a86, 095^ 

Bignami, 381, 387. 

BUharxiaala, 7. a6dw 

BUroth, 349. 

Biotamia, 3ax. 

Biology, 3x3. 
BladiOR, 2$a. 
Black Death, xoo, 374- 
Bland-Sutton, air foim, 3i^ 
Blaitodenn, 145. 
BlasU, 38a 
Blind, Kail, 367, 21$, 
Block, I wan, 373^ 
Block, Oacar, 353* 
Blocking, nerve, 4x0. 
Boerkaave, 138, 157. x8a, aoi, att. 
; Bologna. 95, 99, x88, 356, 384. 
Bone grafta. 4x3. 
Booetut, z8x. 
Bonnet. Ckarlea, I39» 3x8. 
Boielli, X35. X36. 
Borgia, Alexander, 355. 
Boulogne. 4xa. 

Boyle, Robert. 140, X44> X59. 3M, 
Brain, a8, i09i ^ mugfry, 4x4. 



Biandikd cfcft i, gS3^ 

Brelnl, 37a. 

Bredau, 369^ 

Britidi Aandatkm for the A d t aimm et 

of Sdenoe. 35a. 
Braockiectada, ais, 
BronckltJa. ax5. 
Bronckopbony, SX4. 
Bronckotomy, 1x4. 
Brooks, W. K., X3tfi. 
Brown, H. M.. 373- 
B rown , J.^XS9. 337- 
Brown, Robert, a58* 
Browne, & G., 9*. 
BrUcke, a3X. 
Bmit. flacert al, ax6fc 
Bronscuwig, Hieroayimii, Xttl> 
Buboes, 353. 
Buckle, 198. 
Buisson, X96w 
Buidack, K. F., 146k 
Boms, treatment of with 

4x3. 
Burton, Sir R. P., fik 

Cabanls,S3A. 
CkUus Aureliafflis, 60. 
Cvsalplnus, xxs. 1x8. xa6i. 
Cesarean operation. ioo» X14. 
CMamus scHptoHus^ 50w 
Calculi, XX, X56, x86. 
Calkins. Gary W., 373. 
Calmette. 339. 
Oamac. C. N. B., ai7« 
Camkfidge, 154. 
Quneniius, ai8. 
Cameron, Sir Hector, 34a, 353* 
Camp Laaear, 388. 
Camper, X57. 

Cancer, 58, 6a, 67, 8a, xoo, 35<^ 
Canine teetk. 3xa 
Cmmtdbis indica, 90. 
Cannanng, xx7. 
** Canon, 78. 
Cannon, W. B., 404. 
CarboUc add. 344* 343^ 



Caries, asx. 

Carmine. asi» 

Carpenter, W. B., 198, 335. 

Otftdyeaitmeat, 407 et aeq. 

Carrieiv, 397. 

Carroll. James, 384 et mn* 

Carter, H. R., 387. 

Case kistories, 40. 

Casualty clearing stations, 407 cf ae 

Cataract. 51, 58. 67, 68, X14, x87. 

Catgut ligatures, 35X. 

Catkerine II, a4X. 

Caton, Richard, 44. 

Cautery, 3, 57, 79, 8x, 96, tx«i 

Cell nudeus, 358. 

Cell-itheory, tsi, V3, 857 et se<u 

CdU, 376, 377. 

Cdsus. 54. 

Cerebrospinal menkulCia, 398, 399. 



INDEX 



419 



Cervical f « t ebm, 6» 
Chamberland. 329, 
Chancre, HmterlaA, 36?. 
Cliarlea VIII, 355- 
ChauUac, Guy de, 99. 
Chemlatnr, 87, 15S, I9li 
ChgiDo-reccpCoca, 37 !• 
CheMlden, a93« 
Chiclcea dnlcm, 3it* 
Chladnl, 309. 

Chlorinatkm of water, 397. 
Chloroform, a88 et acq. 
Chloroeia, 7. 

^oleraja74.334,a48. 

Qioliiieley, H. P., 93. 

Chorea, xs6i 

Chronic dueaae, 41. 

Chylotborax, 305. 

Circulatkm, 5ti 108, It6 et tea., 136, 

173. it3* 339> 
Cfaxnimcision, 3, 4. 
Ctvitaa Hippooaticn, 94. 
Classification. 35S, 308, 3I3« dl7» 3a6w 
Clcttieiit, 384- 
gift, i74f 175, 176. 
Clifton, Francis. 44. 
Clover, J. T., 394. 
Clowes, William, XI4. 
Cnidus, 34, 37. 3t. 40, Sif 99» 
Coagulation, 339 et seq. 
Coction. 43. 53f 67, 100. 
CaUnUraUt, 3S4. 
Cohn, Ferdinand, 360, 33A. 
Cohnheim, Julius. 370. 
College de France, 331. 
CoUdge de Saint Cdme, til. 
••Colliget," 83, 84. 
Colon, 393* 

Color-blindneai, X79> 314. 
Colot, Laurent, 1x4. 
Colton, G. Q., 383, 395* 
Columbus, M. IL, 1x4, xif. 
Columella, 316. 
Coma, 39i 156. 
Comma baciUus, 333. 
Condylomata, 184. 
Congress of Anthropolofllflta, t49k 
Conjunctivitis, 333< 
Constantine the African, 84. 
Constitutions, 34i 76, 146, 190, 
ConimgimH ^nimatmm, 330. 
"Continens," 7S. 

Continuity of the fermphMA, Zt^ 
Contractility, 330, 333. 
Contraction, 133. 
Cooke. 390. 
Cooper. Astley, 178. 
Copho the Younger, 94* 
Cordova, 80. 
Corviaart, 197. 306, ao8, 
Cos. 34, 37, 3X. 51. 
Coste, 353. 

Councilman, 376, 383* 
Craniology, 349, 379. 
Crasis, 43. 
Creightoo, Charles, iS9> 



Crethiim, 974* 

Crisis. 43. 

Critical <li9«> 98, 4t. 

Crotona, 34, 37* 38, 39, 30ii 

Crudity, 43. 

Cuba, 3Ss et seq. 

Culpin, M., 407, 414- 

CHHure, puis, 33X et Mi|b 

Cupping, 3. 57. 74. 364. 

Curare. 333. 

Curtis, J. G., Z3A. 

Cuvier, 176. 

Csranosis, 186. 

Cycles, life, 369. 377- 

Da Coft». J. M., 401, 414^ 

D'Alton, 345. 

Damascenus. 74, >4> 

Damascus, 90. 

Dancing numin, 156. 

Darius, 30. 

Darwin. Charles. 160, 170, X74i S4i* 330^ 

354/ 375. 396 et seq., 313, 314. 403- 
Davaine, 335. 336. 
Deal-mutism, 3x4. 
Deafness, 39i x83> 
DtMdememt, 407. 
Delafond, 335. 390^ 
Delagtei^, 4x3. 
Ddinum. 30. 
Democedes, 39^ 
Democritus, 37, 39, 60. 357> 
Dentistry, xx, X3. x8, 8x, 165, X77, xSo, 

383 et seq., 4x3. 
Desault. X89 et seq. 
Descartes. X33i X37« 
Development, arrested, 167, 3x0. 
Diabetes, 63, 78; artificial, 335. 
Diagnosis, 39« xoo, x8x, 300 et seq., 333* 
Diaphoretics, 30. 
Diathesis, 308. 

Diet, 13, 30, 39, 3X, 37, 43, 79, 94. ISO. 
Dietetics, 8^ 
Digestion, 53> 334- 
Dilatatioa. 13, 306, 3071 
Diodes, 40. 
Dloscorides, 75* M. 
Diphtheria, 63, 374. 37X. 384. 398. 
Diseases, of beer, 33S; of wine, 334. 
Dislocations, 30, 36, 54. 
Disordered action of the henit. 409. 
DissecUon, 49, 54, A». 60, 9l> 90, 104, to8L 

I30, x6o et seq., 190^ 
Distomiasis, 366. 
Dogmatists, 47, 63- 
D6Uinger. 344* 
Dorpat, 344. 
Dorsal vertebne, 64. 
Doraey, X78. 
Dreams, 404-405. 
Dropsy, 156. 306. 
Drugs, 5. 6, 7, 33. 79, 87, 88, 89, 90. XS7. 

197, 335. 
Dublin School. 3x7. 
Du Bois-Resrmond, 331. 
Dudauz, Emile, 334. 



i2o 



INDEX 




>M 



^ E,, S46t sif» ipOi lfl4> 

I. jot 

IHpKllf ▼•, 390t 



Dyaotcty, 6, 14^ 147.333. JM»JP(i4U- 
Pipviw* set 



BdodsB. JS4. 
Kdcan* 90. 

Bdinbaiih, 336 ct feq. 
Edu ct io H , aw i dlc al , 7 V »♦ •> "^ 'ITt 
_ 158, joi, 9iS, aai, jIs. im- 
ta^* I ct aeo., 
nrenbof, 390b 
nvlkh, 369 et ««. 
I. IQ3- 
^37.43* 

Bliadr.86. 
Bllett, G. G., 4^ 
yjnbatnitoi, 9, 3. 

BmboUam, 969, 37>< 373* 
Bnbryolofy, 4S. 131, i7t ct ceq., t33 

et MQ., ass. 301, ao9» 310, 336. 34OW 
Bmeaii. 29, 
Emetics, isx* 
Bmetlne, 401.' 
Bmotion*. 180, 403 et m^t 
Bmpedoclet, 37. 33. 
Emphywaic, ais* 
Empirics. S4> 63. 
Empyema, 79, aoi, J04. 
Epoemic aiseMes» 4Z« 
Endocarditis, »7». 
Eadodenn, aS4- 
Bneoetat so. 

Efliloaoa. 344- 
Bpldaunis, 94, as. 

Epidemic, 41. 144. I47, IS3, 134 138. 
Epjsenesis, 13a, 14S. 933. 
Bpilepssr, 4* iS, 3S» 49, te. 
Epiphysis, 64. 
Enslstimtos, 49. 
Eridisen, 336. 

Bnrslpelas, 36, 61, 339, 341* 
Ether, aSo, 410 et «q. 
Ether frolic. a8x. 
Ether spray, a9S. 

Ethyl chloride; ethyl bromide, 994. 
Btienne. Charles, Z14, 1x7. 
Etiology, 4, zi. x6. 18, 39, 149, IS9, 153, 
156. 158, 330. 331, 377, 386, 388, 396. 
Eugenics, 3za, 3X3* 
Eusol, 409. 

Eustachius, 1x4, 1x7, 134- 
Exantheraata. 3x7* 
Sxdaioo. 3SX, 3$a. 
Exercise, 99. Stt Athletics and Gym- 



eftke 
69, 

r,47.4PiSS.6«.«4Ci 
7^ Tt. 79, 89. 88, ict, Z93, 198, 13s, 
134, 149, iSi. ite, 191. i97» sea, 9X1. 

9X4, 9X9, 999« 993. 997, 998, 

977, 979, 98s. 3x8. 3l9w 338. 3SI. 





9S. 

Fandajr, a8x. 

Fear. 39. x8o. 

Peedag. attlftdal. 89, X7». . 

FefdfaHad II, Giaad D^kt of 

130. I3S. IS8. 
Feisason, A. R., mu 
FctgMSon, 393. 

Fer ment a tfa o, 7S. 77. ISC» 939i 399. 344* 
Fte t m e ats , 3aa et esq. 

Ferad, 36s- 
FcrdUsatioB, s^ 
Fibers, theory of, 9S7« 
Ftfsrte, 6x. 79. 966^ 373* 
Pfterlasis. 37S. 
Flnlay, 386 et esq. 
Ftejayson, James. 9X, 44, 98^ 
Flezner, SbnoB, 398* 
FlouRoa, 337. 989. 994* 
FhiORScent so^enSb 4ii« 
Foments tfama, a9w 
Fomes, XS3. 389. 



FossHs. X73. X74. 309, 307- 

Foster. Sir if ickad. X38, 937* 

Fracaatortos, 354. 

Fkactnics, xa. x6, 99, 38. 60, 98. 99. 113. 

x8a, 190, 344. 34S. 3S0, 411 ct seq. 
Franco, Piene, 1x4. 
Fremont, 3x0. 
Friedrdcfa^i ataiin, 314. 
Pttchsla. 370b 
Fwmlgstinns, $, to, a8iS» 389. 309 Ct ceq. 

Gnddeaden, John of , 84, 90. 

Galapagna Axchlpelaao, 996b 

Galen, 63. 74. 7S. 84. 99. xo6. 107» 108. 

Galileo, xt8, X3S* 

Gall-stones, xx. 

GouMtocyter. 377. 380. 

Gangrene, 36, 57. 9XS. 330^ 

Garrison, 3x3. 

Gas gangrene, 4x3. 

Gaslndat 254, 

Geber, 86. 

Geddes. Patrick, 973. 

Gegenbaur, 354. 

Genoa, 356. 

Geographical dlstilbation, 949. 30X, 307. 

308. 
Geological sorrecslon, 308. 
Geology, 173. 



INDEX 



421 



Geoi«i II. fig^ 
Ccmnlof 

I. ▼., 951. 



OermiiMil mnrinuJty, tsi. at6,SSi* 
Germinal liQFcn, 245 ct mq., sS4> 
Gcmlottl •pot. asa. 
GcrmiBal vesicle. 3Ss> 
Gcndorif, Ham ▼.. 109. 
Gfflbert the RmHrfiman, $4, 
GOliei. H. Di,4X^ 
GitotiMi, 243. 

dobuiee, tlwoty 01, 999* 
dycosen, S34- 



«4X»3«» 



Goddaid, I40w 

Onflf^^ Sir Kiel 

^^**^— **. ati. 

Goitre. fipiirlMlwIt, S94» 404. 

Golil. asi. 376. 

GoDdlMpor. 71. S8. 

GoBOVTlioea. Z55» ia7»J^3M«t 

GofdoD. Laiag, 395. 

GorvM, W. C. 388 et •§«. 

Gfittinfea, 919. 

Gout. 6, IS, 148. 156. tM. 

Gnele. Albrecht ▼.. 338, 350^ 

Gnham, Thomas, 335* 

Giaad Pahria. 409. 

Gtapliiacui, 41* 

Gnnrea's diseaee, 274, 404. 

Gfay, Asa. 301. 

Gny. Sir H. M. W.. 408 etna* 

Greenliill, W. A.. 93. 

Grom, & D.. 180. 

Goerini, Vuioeiiao. i8a 
GnUlemeaii, 114. 
Gummata, 184. 366b 
CiMshot wim i a J a , ia3» 
Gtttlirie, a88. 
Girathmey, J. T.. agf. 
Gymnaatom, as. ap^ 3ii 
Gsrmaaatica, 4xx* 



Hadley. P. B.. 337. 

Hadoei. as6. 310. 31J. 

H tt mBm rnbid m, 379* 

Hcmatoidia. 371* 

Hematology, 3701 

Hematuria, 5. 7* 

Higmocyknoat 376w 

Hgrnophilia, 81, 314- 

HaBmorrhase. 19. 56, 60. 96, 183, 371, 

409. 
Hannothonuc, 305. 
Hate, Aatoa de, iS7. aoi. 
Haldaae, BUaabcth &, 137. 
HaU. Marahall, 318, 336, 337. 
Haller, 157. ax8, 339, 341. 3S7« 
Hauler, 336. 
Haly Abhaa. 78. 
Hammniabi. Code of. 14. 
Haptophorea, 37 x* 
Harrta ben Kaladah. 71- 



Iiariey.a9S. 

Harper. IL F., 81. 

Harua al Raahld, 71. 

Hanraid Medical Cottage, 183. i9% 

Harvey, iij, xi«, 188, a4»» 86IL 

Hata, 37a. 

Havana. 386 et Mq. 

Hayward, a86. 

HeaUnf by flrat hifriUloa, jd^ 

Hearat papyma, 8. 

Heartji)^, i86( h. mnm. dM. 

Hcberden, 185. 

Hdamaan, iif. 

HeUodoma, 59* 6i, dtb 

Hehnholts. 331, 

Hematoma, 373* 

Heale, 334t 330. 

H ealey, 346> 

Henalow, 379, 3991 

Hepatoaoopy, 18. 

HeffacUdea. 84. 

Heredity, 313. 

Herma«*»Dditea, 198^ 

Hernaades, 367. 

Hemfa^ 58,68, 80,. U4, 17a. z8gi 

Herodlcua, 39. 

Heiodotoa, X3. 

Herald. 353. 

HcropliUiia, 40. 6$. 

Hertwig, Oacar, 355. 

Heterochronla. 370. 

Heterology, 370^ 

Heterometria, 37a 

Heterotopia, 369, 370, 

Higlimofe, 233, X40. 

Hindua. 88. 

Hippocxatea. x, 33^45. 46, 74* X3P. M^t 

187 309w 

Hto, WObelm, 3S3. 

Hiapaniola, 354 at aeq. 

Hiatology, 48, x8x et aeq. 

Holmea, B. T., ax. 

Holmea, OUver Wanddl, a88w 

Home. Sir Bvetard. 175, 185. 

Homology, 370, 309. 

Hoaala, 74« 84. 

Hong-Koog, 374, 383. 

Hoolce, Robert, 34* ^57. a64. 

Hookworm diaeaae, 7. 394. 30*. 

Hopldna, A. J., 93. 

Hoppe-Seyler, 374. 

Hopatock, H.. xx5. 

Hospital gangrene, 341. 

Hospitalism, 343. 

Hospitals, 7x. 78, 90, 374* 986, 34^ 

H6tel Dieu. 3o8, 331. 

Humors, 42. 150. 373, 375. 

Hunter. John, xoo et aeq., X85, 339, 343$ 

340.366.367,411. 
Hunterian Muaeum, x6o, 176. 
Hutchinaon, Sir Jonathan, 37a. 



Hutton. Jamaa, 396^ 
Huxley, T. H., 358. 
Hydatids^ X79. 

Hydropericardium. 305. 307. 
Hydrophobia, X87. 389. 



423 



INDEX 



Hydro-pneiUBotlioraXc 9tS» 
Hydrotbonuc, 205* ii3. 
Hyveia, 24, 33. 
HygleiM. 13. 04. 'SO, I57. 
Hygienic IiifUtut«, 333* 
Hyotcyamiu, 95* 
Hyperplaala, a70> 
Hypertrophy, no. 
Hyitochlorltet. 408. 
HypochondriMit, 156. 
Hypodermic flyriiiae, jg4. 
Hyrtl, 93. 

Hyttoia, x8, 156, 403 et nq. 
Hyiterlcal ■ngellieala, 406. 
Hyiterlcal panlyiig, a$, 406^ 

Utielft. 90. 
ba Baiur, 801 
mhotep, 3> 

iBiiieauite cI o hub of woundit 407* 
aununity, 162, 3x4, 328, 370 «t Mq., 

396. . 

mperlal Health BofCiii, 339f 3^ 
mpotenoe, 3^ t 
Bcubatioa, 34; fitrhnir, 30i; latitadc, 

39X. 

adia, 90> 

nflamaiatioii, 58, 338. 
ailueaia, 147. 309-4oa 
nftuoria, 3x7. 
ngraMiat. lis* 

nhalatioai, 6, lOo, X03f 276 et «q. 
nheritaaoe, 3X3f 314. 
nttitttte for Iitfectioos Dlwawe. 333- 
BStruBieBta, 4. xs. 36, 46. $3. 58. 69, 8x, 

xox, XX3, X34* X37. 338. 344, 355. 357. 
Bteraal ■ecretioas, 335. 404. 
ateraatiooal Medical Coagreii, 333. 
ateroMd muaclet, 64. 
Btrlasic hicubatioB, 39X. 
auactiona, 6. 39f 360, 364. 39 x. 
aveatam Novum of AueabruoBr, aoa 
odide of potaadum, 373. 
nltabllky, 330, 333. 
.saaoHBa 84* 

jia, Ruy Dias de, 357 et nq. 
samiUa, 38 a. 
•nel, OKar, 375* 
Itaac ben Honain, 77* 
saac JadKUif 79> 
tch, 83. 

^ ackna, Charles, T., 383* 
^ ames, William, 403. 

astrow, Morrii, jr., sx. 
^ auadloe, x8, 73. x86, 403. 

eaaer, Edward, X85, 328. 

eaner, William, 335. 

emina, 390. 

oachim, H.. 3X. 

ohas Hopkini UnlTenity, sSjt 



1 

\ ooea. Sir Robert, 4x1 et «q. 
^ oaee, Whartoa, 335* 
oaes, W. H. S., 44. 



Junker Inlitler, 194. 

Kahun papyrus, 8. 

Keee, John, 130. 

Keith, Sir Arthur, 180. 

Keith, Dr.. 389. 

KeUy. H. A., 395. 394* 

Kepler, X33. 

Keratitia. 373> 

Kerpuadec aid 

King's CoOese, Loodoa, aSOt» 

Kircher. 3x6. 

Kissincer. 389U 

Kitasato, 374. 396. 

Kittcrman, P. G^ 3X. 

KUh^-LBMm lacflbM, 3S4* 

Knopf, a A., 334. 

Koch, 7. 375> 330 ct MQ., 38a. 

KoUe, 396. 

KOlllker, ▼., 353« i6x, 867* 33& 

Kowalearsky, 354* 



LadnneCf aoo at 

Lancet, 349. ^ 
Landsi. 3x6. 366. 
Lanfianchl, 97, 98. 
Langenbecic, 393. 
', & R., 



oubert, ^37* 
byliffe. 



134- 



.394. 

Laparotomy, 47. 

Las Animas Hospital, 388, 3901, 

Las Casas, 36X. 

Laughing gas, 383. 

Laversn, Alphonse, 376. 

Law, The, 33. 

Lasear. 385 et seq. 

Leeuwcnhodx, X36, 338, 3x6. 

Leibnitz, 239. 

Leishnwn, 397* 

Lelean, Percy, 4x4. 

Le Mans, 4x3. 

Leonardo da Vfaid, 104, iis» 130, a68i. 

Leonidcs, 59. 6x, 79* 

Ltomtiasii o«MS, 373. 

L«prasy, 6x, 79> 90, XOO, It4« 874* 

Leucocytosis, 371* 

jL^ucorrhuea, 6b 

LeukKmia, 37 x. 

Levy, Reuben, gtt 

Liber regis, 78. 

Liebig, 387. 

Ligature, 56, 6x, 67, 79» 8lf 9S, lit. 

Linacre, xsx. 

Liniments, sa 

Linnaeus. 3x7. 

Lister. Lord, 57. 153, 394. 335 et seq. 

Lister, Joseph Jackson, asx, 335* 

Liston. Robert, 287. 294. 

Uverpool^i£o<^o/l^p!caPlledi^ 

372. 
Locke, X40. 

Locy, W. A.. XX5, 250, 257. 
LOffler, Friedrich, 334. 384. 
Long, C. W., 38x, a95t 3x6, 
Lourdes, 24. 
Louvaia, xo6w 



INDEX 



4»3 



Lowo', Rldiard. iMi 14a. 
I iiirM Chi in ptaanfem, Mp, stti 
Lucca, Hugh ot, 95. 
Lucmlui, jiO. 



ij^'wJh.. ISO. 

Lnll. sir Oaifaa, jgfi et 
Lyoiu, it^ 



UcMniHch, J. P., iis. 
Mumdlc. tiS. »4. 
lUmonlda, Mom, So, Ij. 
Uilaiti, II, il, 41. 141. 149> IS4. art 
tt «., 3U « ieq.. 3*6. 



St'Sf-K 



Mutcn. W. B., M5. 
Mano<dltl>, II. 
Mutioll, 36;. 
MudmUiu I, Bmpcr 
Mayov. John, iJ4. 



Medicine, experimental. IJS- 




;:«.. 



UdU, T., «6o. 

Udliraaix. WIDkM, 13d, 

MoadevQle, Head ik, lA 

Uoadlno, 9J, DT, 106. 

Uonunmen. T. M., 373. 

MontpeUla, Ij. 97. {«, DO. IM- 

Moodie, R. L.. 11. 

Moon, Normaa, I3T. 

Moran. 3*5- 

M^.K^tni. Oi, T8i, i»T, m,it*.i6i. 



»«,>53.>to.lT*> 




Neuron. 49. 
NenrMomy. 9S. 114. 
Nli:t»lu of Salenia. 9S. 
Nlcolaler, 39S. 
Nltroui odde. itt. et leq., 
Notocbord, lib, 15(1. 
Novaia. ajfl, 3J?, 363. 
Number Ion. >7 et mi. 
Nunneley, 194. 
Nuraddln. 01. 
Nuidni, 174. 
Nua^Mun, 1., 34*. 34>- 



Oath, Tbe, 33. 

Obatetiica, ji, gt, n, li, 1 

OdontoCofy, m. 
(Xdema, II J. 



u ctUata ■ «U«1«, 367, J«I. 



4*4 



INDEX 



Qph flwl Molotyt T4« ••• 

OpnthalmonwCcr, aai. 

OphtbalmanoiK, ajs. 

Opium, 46. S5. 

Orpwk: eirohitkMi. 9$x« ag6 ct 

OrpuM. mdi inM i t a r y, joi, 3O0> 

CMbMius. 68. 74. 

Ortbopaedlc Centen, 4x1 et leq. 

OrthofMBdic •ursery, 4x1 et nq* 

Onboni, H. P., 3x4. 

Oder. Sir WlUJaa* XS0» J07f ax6i a63. 

_377, J04. JM. 

OKeolocy. 55. 65. 74- 

OMeopoiotteal gnra* 41J. 

Ottia, 3S1. 

Oitiey, Oiewiy, i9m, 

Oviedo, 360. 

Ovum. 346, 35a, 354- 

Owca. Riclwrd, 174. I7S. If6. ito, Sflw 

Oxford. X30. 

Oxyiea. 376 et leq., 995. 34St 4iOw 

Oiamm, 316. 

pMlna, X07f 18S* 
PiBSei. Sir Jmincs. 99S. 
PHwet. Stephen. 115. iMi 
Pfeleontolo^. X73. I74« 
PiiJner. J. P., ilo. 
PalpsuJoo. 4a 
Flaliy, Bett't. aas. 

FuiaceA, 34. 33. 
Plunma, 393 et leq. 
Pauioeatic juioe, 33Ai 
Piuder, C. H., 345. 

PUgeiMile, 313* 
Ponniculmt camosut, jll. 
Panuxlnu. 365. 
IHuBffiiwcgiii treatment, 413. 
Plualyris. 3*. 63; artificial. 3331 hyater- 

IcM. 35. 406; infantile, la. 
Farultet. 366b 
^raaitology, 374. 
Pantypbold. 307. 
Par6, Ambrolae, ixi et acq. 
Parthenogeneaii, 339. 
PaMeur, 320 et aeq.. 344. 34S» 34*. 3Sa. 
I^Meur Inatitute, 339^ 
Pathology. tSi et aeq., 357 et aeq^. 314. 

333. 
Paul of iWaa> 6S, 74. 79. Sx. 
Payne. J. P.. X59. 
Pieariy diaeaae of cattla, a?^ 



P^brine. 324. 
Pecquet. X34* 
Pectoriloquy, aia, ax4. 
PeUagia. 374. 
Pemphigua, 6w 
PtnidUium fllanoMi, saj. 
Pepila,43. 
Percuaakm, aoi. 
Pergamua. 34. 63. 
Peritonitia, 196. 
Petit. Antolne, 189. 
Petty. X40. 
Peyer'e patcbei. 373. 
Pfelffer, 396. 



^4.«.if.Wtt,aii 

. 5. 6. 7. 23, fpw •7. ••, 80, 9OW 

157. 197. 335. 

Phfloiiopher'a etoae. 86. 

PhUoaopheta, 37.38. 

PhikMophy. 33. 28, 29, A 14It iSOi 

Pbimoaw. 58. 
Phlebitis, 371. a7a. 



Phthiaie, 43. 6a, 156, aia at aaq. 

Phyiidc. X78. 

Phyiiology. 38, 38. 43, 116 at aeq., iMk 

X9x,et eec^^xS et ae«^ ajo, 314. 
Pkard, PrtdMc, X59. 
Pilcher. L. a, 1x5. 
Pfnardel Rk> BamdeB, 386. 
Pfnsan.360. 
PifOffn. a88, 393. 
Plague, 6x. too. ix3, UOi, I4S. IS4. 334. 

374.394- 
Plasmodia, 3A9. 376 at aaq. 
Plaatcn, 6w 

Plaatk aufgefy, 67. 68, m, 4S3. 414* 
Platynna, 64. 
Plends, 316. 
Pletboia,SS- 
Pleufinr. xa, 46, 47, X96, 
Pleuritic filctlon. 40. 
Pneuma, 47, 5a. 60. laS. 
Pneumatic doctrine, 63. 
Pneunmtic Inatitutioa, a77« 
P ium mo c o e aUt 3a8. 
Pneumohydrothoffux. 401. 
Pneumonia, 46, x86» 196* axg- 
Podalirlua. 34. 
Pollender. 3a6. 
Polydactylian, 3] 
Popllteua muade. 

Poppy. 5- 

Poree, 56. 

F^Mt. Wright, 178. 

Poet-mortem, 5x. 5a, x8i et aeq., sot. 

Poiture. ereet, x67- 

Pottevin. 339. 

Pott's diaeaae. xo, 41* 

PoulUcea. ao. 

Poulton. B. B.. 315- 

Power. D'Arcy. X37* 

PraicBflotaa. 46. 

Predelioeation. 339- 

Preformation, 239. 

Pregnancy, 3x6; extn^nterina, 8x, a7g* 

Preventive Inoculations, 396. 

Preventive mrdiniw, 374 ci aeq. 

Prfivost, 346. 

Priestley. 376. 371- 

Priest-physidana. x at aaq. 

Primary anion, 58. 

Primary wound suture. 408. 

** Prinoplaa of Geology,*^ 398, 308. 

Pringle. 157. 

Prinsing. Priedrlch, X59. 

Prognosia, 41, X50, aoa. 

Propbyhuds, 397. 

PKoatate, si. 167, 



INDEX 



42s 




Protoplaaai, 251, jte. 
I^otoBoa, 369, 375- 
ProtojoOlogy, 366. 
FqrcUatryr 7«. 9i. 40a. 
Piychoanalyii*, 405 et aeq. 
Piycbology, 179. xto. S30. aia. 40fl d 

Ptolemy Philaddpbiw, 40^ 
Ptolemy, Soter, 40^ 
Puerperal fever, 41, 179. 
Pulie. 7, 47, SI. 
PultUofhim, Ii9t 13). 
Purgation, 13, 29. 
Purgativct, ao. 
Purkinje, 35s. 
Putrefaction, 77. 343. S44* 
Pyemia, a?!, 33a. 34Z- 
Pyofenic infectknifl, zi. 
Pyo-pneumothorax, a 15. 
Pyrethrum powder. 35a. 
Pyrexia of uncertain origiii. 40tt 
Pytbagofaa, 37. 3S* 

Victoria, 393. 
'■ Hospital, Sidcop. 4*9, 
. 371. 3Sa. 

Radlographf, ttereotOQplc. 411. 

Radiogapky, 4i<^ii< 

RAlet, aio. ais. 

Ramandni, zSa, 183. 

Rapallo. 355. aj& 

Raaori. 316. 

Rathke. ad6, 35s* 

Rayer, 396. 3^7. 

Rteumur, 316. 

Recapltoiatioo tlMoiy, 343, 3SS. 

Redi. 318. 

Reduction, 3^ 

Reed. Walter, 38a et aeq. 

Reflexes, aa6 et leq. 

Reichert. as3. 

Remak. 3S3. ate. 367. 369. 

Resection, 58, 6a, 67. 4x3. 

Reapiration, 41. 105; artificial, i^ 

Resuscitation, I79w 

ReU mirabiU, 109. 

Rbaxes. 75. 87. 9X, 9S* 

Rheumatism, 18. 

Rhinoplasty, Z03, 4X3. 4M* 

Rice. Nathan P.. 395* 

Richard. J75. 

Richardson, Sir BaUnmin, 394^ 

RickeU, la 

Ricord, 367. 

Rinderpest. 334. 

Robespierre, X89. 

Robinson. J. H., 35S. 

koger. Henri, 334- 

Rofler of Palenno, 94* 

Rokitansky, 338. 

Roland of Parma, 94. 

Rome, 350. 3S6b 

Ro8ato,363. 



Rosemui* m* J** 39S* 

Ross. Sir Ronld. 44* 37S. 3T8 «t ieQ.» 

387. 395- 
Roth, M., IIS. 
Rousset» 1x4. 
Roux, 339. 36B. 
Rovigno, 368. 

Royal CoUeoe of Phyridans, 133. 
Royal Infirmarv, of Edinburgh, 390* 

337 et seq.; of Glasgow, 341 et seq. 
Royal Society of London, 3S^ 
Rudbeck. X34. 
Ruffer, Sir St. A., ti* 
Rufus, 59. 63, 7S. 
Rupture, 167. 
Russell, M»iot, 397* 

Sacred disease, 35. 

Sainte Anne de Beaupi4, 34. 

St. Hilaire. Isidore Geoffrey, 3x1. 

Sal Ammoniac, 30. 

Sa l e r no, 94. 

Saliceto, Winiam of, 95» 96, 97. lOO. 

Salivation, 8x, 136. 

Salvaraan, 379. 

Salves. 30. 

Sambon, 381. 

Saaarelli, 384 ct sag. 

Sanctorius, 133. 

Sanitation. 361 , 3T4* 334. 38i, 386 ct ae^ 

Santo Domingo, 354 ^ «^. 

SarHiparlUa. 36s. 

Satyriasis, 63. 

Saxtorph. 347. 

Scarborough, 133. 

ScartaiUna, 156. 

Schaudinn. 368, 369, 

Scbeele, 377> 

Schelliag. 344. 

SckiUosoma kamaiobimm, 7, 

SckitomyuUs, 336w 

Schleidcn, 358. 

Schroder, 3ao. 

Schulae, Frans, 330. 

Schwann, 353. 357 et 

Science and pnctioe, x 

ScOlacdo, 363. 

Sck^rosis. 373. 

Scott, W. B.. 315.^ 

Screens, fluoreaoent, 4'i* 

Scrofula, x68, 3x3. 

Scurvy, 6, 73. 

.Secondary sexual chanctera, 171, 3x3. 



., 3M, 393, 346w 
et 



Secretions, internal, 335. 
Sedgwick, 346. 397. 390. 
SegmenUtion of the yolk, 348. 
Selection, artificial, 300, 304: mtrnil. 

300 et seq. 
Semmelweiss, 3S9. 
Sensibility, 330, 333. 
SeiMiS, 409. 

Septkaemfai. 338, 333, 34X. 
Septum, interventricular, no, xx6, 133. 
Serapk>n the Elder. 74. 84. 
Serapion the Younger, 89. 
Setsiai. 73. 



426 



INDEX 



ServetiM, ki4« 1x6. 

Seville. 360. 36a. 

Slom. Ludovioo, 363. 

Sharpey. 335. 337* 

Shell tbock, 403 et wq. 

Shock, 34X* 

Sidcup, plutic sursuy at, 4xa. 

Siebold. v.. 346, asa. 

Silver nitiHte, asi. 

Simpton, Sir Junea Young, 987 et eeq., 

343. 
Shiser, Charles. 45. 93» xiS- 
Siuxia. aoi. 

Sleeping lirlruMi (trypenoeomiaali), 334- 
Smallpox, XX, 75* 146. iSi, X5a, i6a, 

374- 
Sniith, Theobald, 377* 
Snow, John, a94. 
Soldier^! heart, 401, 41^ 
Sonmua. S9. 79. 
Soubeiran, aSS. 
SouJU, a 15. 
SpaUanxani, 3x9, 336. 



Special creation. 307 

Special Military SuigiGal Hoepitalf. 4x1 

etteq. 
Speciea of diaeaae. 41, 6t. 147. 14^1 XS5. 

363.366. 
Spedfica, X44, 140, 369 et mq. 
Spencer, Dr. H., 93* 
SptrmaUmaa, a3S* a53i tS4. 
Spina PtntosAt 77. 
SpiriUum, 326. 
Spirita. S7. 
Spirockmla, 326, 369. 
Splenic fever, 335- 
Splintt, 3. xa, 99, xox, 4x9. 
Spontaneous generation, xsS, a66, 31S. 

333,334- 
Sporadic caaes, 153. 
Sporea, 334. 337, 330, 33i» SSO. 
SporuUtkm, 336, 376. 
Sprains, 39. 4X3. 
Staining. 333, 370. 
Stapkyhcouut pyonmu, 33S. 
Staphyloplaaty. XX4. 
Steam baths, ap. 
Steel, X51. 

SUtamyic, 387. 3S8, 39Ii 393* 
Stenaen, 135. 136. 
Stereo-chemistry, 333. 
Sternberg. G. M., 377. 3*4 et seq. 
Stethoscope, aii. 
SUrling. William. 180, a37. 
StolcoB. x86. 
StoU, 30X, ao6. 
Stiaasburg, 369, 370. 
SirtpkKocau pyoggnss, 338. 
Stromeyer, 348. 
Struggle for ttfe, 30X, 306, 3x4* 
Succuaaion, 40* 
Sudhoff, Kjurl, 373. 
Suggestion. 405 et seq. 
Sulphur baths. 365. 
Surgery, 3 et seq., 36. 46 et asq.. 70. io. 



8x, 8a, 94 at aeq., xte at aeq., a76 at 

seq.. 335 et seq., 407 et seq. 
Suture, of the intestines. 58, 95t 96, xoo{ 

of the nerves. 96, 4x3* 
Survival of the fittest, 30X, 3x4. 
Swammerdam, X36, X58, 338. 
Swieten, Van, 157. aox. 
Sydenham, X38-XS9. x83, 366, 373, 374- 
Sylvius, Jacobus, X07. xxa. 
Syme, 387. 337. 346, 351. 
Symphysis. 64. 
Syncope, 63. 
Syphilis, xo, xt4, xsSt lt4« aT3. 354 et 

seq. 
Sysima Nakirm, 3i7* 

Tmnia toUum, a66, 867* 

Tagliacoxai, XX4. 

"Tasrif."8x, 

Technique. 333. 

Tclesphorus, 34. 

Temperature, 39> 

Temi>le priesU. 31*''' 

Temples of health, 13. 34, 90. 

Tendon transplantation, 4x3- 

Tenesmus. 39. 

Teratology. X70, 349. 3Xt. 

Tetanus. 36. 63, 98. X87. 336, 343* 898* 

Thayer, W. a, 3x7. 377, 383. 

Theodoric, 95. 98, 99. 

Therapeutics. X94. X97. 374« 37t* 

Tkerapia jUriUsaus, 371. 

Thermometer. I57» X77* 

Thermosoope. xxp. I33. X3S« 

Theurgy. 36, 39. 

Thieisch. 349. 

Thomas. H. (X, 4x1; leg and arm splhitSa 

4x3. 
Thompson, D*A. Wcntvorth, 69. 
Thomson, Allen, 340. 
Thoracentesis, 61. 
Thoth, 37. 
Thrombosis. 371. 
Tiemey, M. A., X37* 
Tissues, transplantation of, X77« 
Torculair HerophiU. 49. 
Torre, M. A. deila, X04. 
Toulouse, 99. 

Tour, Cagniaid de k, 3St. 
Tourniquet. 351. 
Touasaint. 338. 
Toxophores. 37O). 
Trachea, 53. 
Tracheotomy, $6, 89. 
Trajan. 59. 

Transmission. 386. 396. 40X. 409. 
Transphmtation, 01 tendons, 413; at 

tissues, X77. 
Trench fever, 40X. 
Trench foot, 40X. 
Trench nephritis. 401. 
Trephining, 3, 36, 58, 4x3. 
Trtpontma poSUdum, 368; T. PtrUmtt, 

371. 
Trichina spiralis, 366. 

Tropical medidne, 334* 374 et aeq. 



INDEX 



427 



Trypao red, 37t. 

Try^nosoma noeitim, 369. 

TrypuuMomiMb, 373, 39^ 

Tuberclei, ao7, 9I3> 370> 

Tuberculin. 333> 

Tuberculods, 8a, 186, 973* 

Tablnsen, a 18. 

Tuffier, 414. 

Tumon. 6. 8. 6a, aja, a73* 

Turner, Sir wUlinm, 70> 

Tyndall, 334. 

Typhoid fever, 33S. 385. 386, 396 et leq. 

Tyi>hut fever, X3i» MS. 161, 334. 335> 

401. 
Tytctti, Jamet, 978< 

XJkxn, 5, 67. 114. 367. 
Unifonnitarina doctrine, 196. 
Univenltlet, early, 94. 
University College (London), 335* 
University of Glaiflow, 340. 
University of Pisa. 119, X3S* 
University of Virginia, 383> 
Uretluotomy, 58, 6a« 
Urine, 79. 84- 

Vacdnation, 169. 

Vaoclnes, 37S. 397- 

Val>de-grftoe, 4xa« 

Valentin, 353. 

Valetudlnaria, 90> 

Vallery-Radot, ReaS, 398. 

Vallisneri. 316. 

Valsalva, x8i, x8a, x88. 

Valves, sa» XX7» xax, 12s, laj, t33, 186. 

Variation. x68, 169, 300, 301, 304. 3o6. 

VaroUttS, 11 j. 

Varro, 3x6* 

Veins. 46. 

Venable. Jamca, 98t. 

Venexeal disease, 10, 1x4, 154. 155. 156, 

X79. X83. X84, X87. 973. 316, 354 ct aeq., 

414* 
Venesection, 3. 56. 58, 74* 100. 
Vermiform appadix, 109. 167* 17'. 3X0. 
Vermifttget, $. 
Vesalius. X06-XX5, a63« 
Vestigial structures, 310, 314* 
Veterinary surgeon, 16* 
Vibrio, 3x7. 
VIdius, XX4. 

Vienna Sclwol, Old, New, MX. 
VUlanova, Arnold, 97* 



Vbcbow, x88, X99» 83t. 953* tte, 9751 

267, 
Vis medieatrix fMMra, a%, 43. 80. xso. 
Vivisection, 47. 54. 59. 00, 64. xo8, 199, 

ax9, aaa, aa?. a3a, azt. 
Vocational training, 41 x. 
Volkmann, v., 349> 

Wagner, 953* 

Walcher posltloo, 81, gj. 

Waldie, 389. 

Wallace, Alfred Ruasd, 309. 

Walsh. J. J.. X99, 9x7. 

Warfare, modem, 396 et m/i^ 

Walter. 196. 

War neuroses, 403 et 

Warren J. C, X78, a8o, 9I 

Wdchselbaum, 398. 

Wdgert. 33a, 370. 

Weismann, 313, 3X5* 

Welch, W. H., XX5. 383. 384. 

Wells, HoTMe, a8a, a95* 

Wharton, X3a, X34t 140. 

Wheeler. W. M., 356. 

Whitman, C. C, as6b 

Wilson, B. B., 975* 

Winslow, ax8. 

Willems, 4xa. 

WiUis. X3a, X34. X37> X40, ZSB. 

WiUow. ao. 

Wirsung, Georg. Z34. 

Wisdom-teeth, 3x0* 

Withhucton. B. T., 45. z8l. 

WoUr. Christian, 94X. 

Wolff. K. F.. 940, 345, a48, 957* 

WolflSan bodies, 940, 3x0. 

Wood. Alexander. a94* 

World War, 396 et seq. 

Wounds, gunshot, X78. 

Wren, X34, X40. 

Wright, sir Akafoth, 396 «t 

Wdrsbozg, 944. a6z« 

Yaws, X55. 366, 37t. 
Yeast, 399, 395. 
YeUow fever, 384 ct sag. 

Yersln, 399.374. 
Young, H. H., 995* 

Zerbi, Z04» 

ZoSlogiairstadon at Napki, 955. 

ZytaU$t 379* 9l^ 



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