Professor of Principles and Practice of Medicine in the Medical
Department of the Western Reserve University, Cleveland, Ohio.
[_Continued from page 103._]
But the contributions to medicine of all his predecessors dwarf into
insignificance when compared to those of Galen—who lived and wrote in
the middle of the second century—and whose writings were ultimate
authority, until they were attacked and publicly burned in the 16th
century by the arch-quack Paracelsus. Galen, although born in Pergamus,
in Mysia and living there, was called by the Emperors M. Aurelius, and
L. Verus to attend them in the northeastern frontier of Italy, and was
for a considerable period of time physician to the emperor, spending a
considerable portion of the last half of his life at Rome. He died in
Sicily in 201 aet 71 (?) There are ascribed to him 83 treatises on
medicine about which there is no question as to their genuineness, 19
that are questionable, 45 undoubtedly spurious, 19 fragments, 15
commentaries on Hippocrates’ works. Besides these, he wrote a great
number of works (not all on medicine) whose titles only are preserved,
so that altogether it is believed that the number of distinct treatises
cannot have been less than 500. These were, on (1) Anatomy and
Physiology, (2) Dietetics and Hygiene, (3) Pathology, (4) Semiology and
Diagnosis, (5) Materia Medica and Pharmacy, (6) Therapeutics including
Surgery, (7) Commentaries on Hippocrates, (8) Philosophical and
Miscellaneous. Most of these works are still extant in Greek (in which
they were originally written). They have been translated into many
modern languages. His works on anatomy and physiology are most valuable.
But it is not certain that he ever dissected human bodies. His knowledge
he derived from dissecting apes, bears, goats, etc., and his knowledge
of physiology from experiments on these animals. His pathology was
speculative.
In diagnosis and prognosis he laid great stress upon the pulse, on which
subject he may be considered as the first and greatest authority, for
subsequent writers adopted his system without alteration. He placed
great confidence in the doctrine of “critical days,” which he believed
to be influenced by the moon.
In materia medica he was not considered as good authority as
Dioscorides. He was prone to making prescriptions containing many
ingredients, some of which were entirely _inert_. He seems to have
placed more faith in amulets than in medicine, and is supposed to be the
author of the anodyne necklace, which was for a long time famous in
England. He was an allopathist in his notions, _i. e._, he believed that
disease is something contrary to nature, and is to be overcome by that
which is contrary to the disease itself. At the same time he taught that
nature is to be preserved by that which has relations to nature, in
accord. Hence his two indications, “Overcome Disease,” “Sustain Nature.”
Before this time, as already intimated, the medical profession was
divided into several sects, who were always disputing with one another.
After him, all these sects seem to have merged into his followers. The
subsequent Greek and Roman medical writers were compilers from his
writings, and being translated into Arabic, Galen’s works became
authority in the East as well as in Europe, and continued to be so for
fourteen hundred years. In 1559, Dr. Geynes was cited before the college
of physicians for impugning the infallibility of Galen. On his
acknowledgment of his error and humble recantation, signed with his own
hand, he was received into the college.
The great mass of Galen’s _works_, together with modern improvements and
researches, have now in great measure consigned them to neglect, but his
_fame_ can only perish with the science itself. As in the case of
Hippocrates, his immeasurable superiority over his contemporaries seems
to have acted as a check to all attempts at further improvement.
The first names of any renown that occur subsequent to Galen are those
of Oribasius, Alexander of Tralles, Ætius and Paulus Egineta, who
flourished between the fourth and seventh centuries. They were all
jealous Galenists, and those of their writings which are still extant
are, for the most part, compilations from the predecessors, especially
from their great master, Galen.
The writings of Paulus seem to be the last of any written in the Greek
language, which had been the language of medical science for more than a
thousand years. At about this time the Arabian school was beginning to
rise into notice. The earliest Arabian writers on medicine of whom we
have any notice or certain account, is Ahrum, who was contemporary with
Paulus. The most celebrated physicians of this school were Rhazes, (who
flourished in the ninth century, and was the first to describe
small-pox) and Avicenna who flourished early in the eleventh century,
and whose ‘Canon Medicina’ may be regarded as a cyclopaedia of all that
was known of medicine at that time (as well as collateral sciences).
This was a compilation from Greek writers, whose writings had been
translated into Arabic, (for Avicenna was not a Greek scholar himself).
Avenzoar, and Averrhoes flourished in the twelfth century. The last was
a celebrated philosopher as well as physician. The works of Hippocrates
and Galen, which, together with the works of Aristotle, Plato and
Euclid, were translated into Arabic in the ninth century, formed the
basis of their medical knowledge; but the Arabian physicians did good
service to medicine, introducing new articles from the East into
European materia medica, as for example, rhubarb, cassia, senna,
camphor, and in making known what may be termed the first elements of
pharmaceutical chemistry, such as a knowledge of distillation, and of
the means of obtaining various metallic oxides and salts.
Upon the decline of the Saracenic universities in Spain, which was about
the time of the death of Averrhoes, the only medical knowledge that
remained was to be found in Italy, where the School of Salerno acquired
considerable celebrity, which it maintained for some time, till it was
gradually eclipsed by the rising fame of other medical schools at
Bologna—where Mondino or Mundinus de Leozza publicly dissected two human
bodies in 1315.
Contemporary with Mondini, lived Gilbert, the first English writer on
medicine who acquired any repute; and the next century gave birth to
Linacre, who after studying at Oxford spent a considerable time at
Bologna, Florence, Rome, Venice and Padua, and subsequently became the
founder of the London College of Physicians. It was in this fifteenth
century that the sect of chemical physicians arose, who claimed that all
the phenomena of the living body could be explained by the same chemical
laws as those that rule inorganic matters. Although the illustrations
and proofs which they adduced were completely unsatisfactory, yet the
tendency at the present time is in the same direction, since chemistry
and physiology are better known.
This seems to be a period prolific of new diseases. In the thirteenth,
fourteenth and fifteenth centuries we hear most of leprosy, and of the
visitation of the plague in Europe. Whooping-cough and scurvy were never
described by any writer anterior to the fifteenth century. Syphilis was
first recognized in Italy in the fifteenth century, from which country
it spread rapidly over the whole of Europe.
In the sixteenth century the study of human anatomy may be said to have
been fairly established by the zeal and labors of Vesalius, and in this
and the succeeding centuries we meet with the names of many physicians
whose anatomical and physiological investigations tended either directly
or indirectly to advance the science of medicine. This was the epoch of
Eustachius, Fallopius, Asellius, Harvey, Rudbeck, Bartholini, Malpighi,
Glisson, Sylvius, Willis, Bellini, etc., names preserved in anatomy.
Chemistry was now being separated from alchemy, and advancing to a
science, and a combination formed between its principles and those of
physiology, which gave rise to a new sect of chemical physicians, quite
distinct from the sect represented two centuries before by Paracelsus.
The chemical school was succeeded by the mathematical school, of which
Borelli, Sauvages, Heill, Jurin, Mead and Freind were amongst the most
celebrated. While at the same time the old Galenists were fast
disappearing. To the rival sects of this period must be added the
Vitalists, which originated with Von Helmont, and with some
modifications was adopted by Stahl and Hoffman. The greatest physician
of the seventeenth century was, however, Sydenham, who, though inclining
to the chemical school, did not allow his speculative opinions regarding
the nature of disease to interfere with a careful consideration of the
indications for treatment, as derived from the symptoms, and from
experience.
Boerhaave, a Dutch physician and philosopher, occupied special
prominence in last part of the seventeenth and the early part of the
eighteenth centuries. He engaged in the practice of medicine at Leyden
in 1693, and became professor of theory and practice of medicine in the
university of that city in 1701. He was erudite, exact, simple and
eloquent, and hence as a lecturer very popular. He specially advocated
simplicity in practice of medicine. Professor of botany was added to his
duties in 1709. He wrote a treatise in 1703 (in Latin) advocating
mechanical and chemical hypotheses in medicine. In 1708 his institutes
of medicine extended his reputation; and in 1709 appeared his famous
‘Aphorisms’ on the diagnosis and cure of disease. In this was a well
defined classification of diseases, including their causes, nature and
treatment, which was adopted by his contemporaries. He was distinguished
as a botanist and chemist. He published a description of plants at
Leyden in 1710, and became professor of chemistry in 1718 in addition to
his other duties. He made chemistry popular by presenting it in a clear
and attractive style, in his lectures and in his ‘Elements of Chemistry’
(1724).
On account of his attack of gout he was constrained to give up the
teaching of botany and chemistry in 1727. He was elected a Fellow of the
Royal Society of London in 1730. His fame extended over the world. A
Chinese mandarin hearing of his fame addressed a letter to Boerhaave,
physician in Europe, which reached him in due time. His practice was
lucrative, and he spent money freely in the interest of science and
benevolence, yet such was his success that it is said that at his death
(in 1738) he left an estate of nearly a million dollars.
Cullen, who was born in 1710 and died in 1790, was undoubtedly the
greatest medical man of his age. It is especially interesting to read
the biographies of such men as Cullen and of Hunter his contemporary,
and of Jenner of the last half of the eighteenth century, and of John
Brown the quack—though much quoted.
The present century may be considered as the epoch of physiological
experiment and clinical observation. The efficient laborers of the last
eighty years in the field of medicine have been so numerous that it
would be impossible to notice at this time even those deemed most
celebrated, while it would be invidious to attempt such a selection.
In this time our materia medica has received a large number of most
important additions, amongst which may be noticed, morphia, quinia,
strychnia, iodine and the iodides, bromides, cyanohydric acid, cod-liver
oil, chloroform, chloral, nitrite, amyl and a long list of preparations
from the vegetable kingdom and from the hydrocarbon series.
The physical diagnosis of disease has been facilitated to an extent far
beyond what the most sanguine physician of the last century could have
deemed possible, by the discovery and practical application of the
stethoscope, the pleximeter, the speculum in various forms, the
ophthalmoscope, the laryngoscope and the thermometer; while chemistry
and the microscopy have been applied successfully to the investigation
of the various excretions, and especially of the urine, bile, and in the
study of digestion where the process could be observed in its various
stages in the person of Alexis St. Martin.
But the field for the medical historian broadens immensely and can best
be appreciated by study of a catalogue of medical books and periodicals
of the present century.