Produced by Charles Keller and David Widger
THE EVOLUTION OF MODERN MEDICINE
A SERIES OF LECTURES DELIVERED AT YALE UNIVERSITY
ON THE SILLIMAN FOUNDATION
IN APRIL, 1913
by William Osler
THE SILLIMAN FOUNDATION
IN the year 1883 a legacy of eighty thousand dollars was left to the
President and Fellows of Yale College in the city of New Haven, to be
held in trust, as a gift from her children, in memory of their beloved
and honored mother, Mrs. Hepsa Ely Silliman.
On this foundation Yale College was requested and directed to establish
an annual course of lectures designed to illustrate the presence and
providence, the wisdom and goodness of God, as manifested in the natural
and moral world. These were to be designated as the Mrs. Hepsa Ely
Silliman Memorial Lectures. It was the belief of the testator that any
orderly presentation of the facts of nature or history contributed
to the end of this foundation more effectively than any attempt to
emphasize the elements of doctrine or of creed; and he therefore
provided that lectures on dogmatic or polemical theology should be
excluded from the scope of this foundation, and that the subjects should
be selected rather from the domains of natural science and history,
giving special prominence to astronomy, chemistry, geology and anatomy.
It was further directed that each annual course should be made the basis
of a volume to form part of a series constituting a memorial to Mrs.
Silliman. The memorial fund came into the possession of the Corporation
of Yale University in the year 1901; and the present volume constitutes
the tenth of the series of memorial lectures.
CONTENTS
Chapter I. Origin Of Medicine
Chapter II. Greek Medicine
Chapter III. Mediaeval Medicine
Chapter IV. The Renaissance and the Rise of Anatomy and Physiology
Chapter V. The Rise and Development of Modern Medicine
Chapter VI. The Rise of Preventive Medicine
PREFACE
THE manuscript of Sir William Osler's lectures on the "Evolution of
Modern Medicine," delivered at Yale University in April, 1913, on the
Silliman Foundation, was immediately turned in to the Yale University
Press for publication. Duly set in type, proofs in galley form had been
submitted to him and despite countless interruptions he had already
corrected and revised a number of the galleys when the great war came.
But with the war on, he threw himself with energy and devotion into
the military and public duties which devolved upon him and so never
completed his proof-reading and intended alterations. The careful
corrections which Sir William made in the earlier galleys show that the
lectures were dictated, in the first instance, as loose memoranda for
oral delivery rather than as finished compositions for the eye, while
maintaining throughout the logical continuity and the engaging con moto
which were so characteristic of his literary style. In revising the
lectures for publication, therefore, the editors have merely endeavored
to carry out, with care and befitting reverence, the indications
supplied in the earlier galleys by Sir William himself. In supplying
dates and references which were lacking, his preferences as to editions
and readings have been borne in mind. The slight alterations made, the
adaptation of the text to the eye, detract nothing from the original
freshness of the work.
In a letter to one of the editors, Osler described these lectures as "an
aeroplane flight over the progress of medicine through the ages." They
are, in effect, a sweeping panoramic survey of the whole vast field,
covering wide areas at a rapid pace, yet with an extraordinary variety
of detail. The slow, painful character of the evolution of medicine from
the fearsome, superstitious mental complex of primitive man, with his
amulets, healing gods and disease demons, to the ideal of a clear-eyed
rationalism is traced with faith and a serene sense of continuity. The
author saw clearly and felt deeply that the men who have made an idea or
discovery viable and valuable to humanity are the deserving men; he
has made the great names shine out, without any depreciation of the
important work of lesser men and without cluttering up his narrative
with the tedious prehistory of great discoveries or with shrill claims
to priority. Of his skill in differentiating the sundry "strains"
of medicine, there is specific witness in each section. Osler's wide
culture and control of the best available literature of his subject
permitted him to range the ampler aether of Greek medicine or the
earth-fettered schools of today with equal mastery; there is no quickset
of pedantry between the author and the reader. The illustrations (which
he had doubtless planned as fully for the last as for the earlier
chapters) are as he left them; save that, lacking legends, these have
been supplied and a few which could not be identified have with regret
been omitted. The original galley proofs have been revised and corrected
from different viewpoints by Fielding H. Garrison, Harvey Cushing,
Edward C. Streeter and latterly by Leonard L. Mackall (Savannah, Ga.),
whose zeal and persistence in the painstaking verification of citations
and references cannot be too highly commended.
In the present revision, a number of important corrections, most of
them based upon the original MS., have been made by Dr. W.W. Francis
(Oxford), Dr. Charles Singer (London), Dr. E.C. Streeter, Mr. L.L.
Mackall and others.
This work, composed originally for a lay audience and for popular
consumption, will be to the aspiring medical student and the hardworking
practitioner a lift into the blue, an inspiring vista or "Pisgah-sight"
of the evolution of medicine, a realization of what devotion,
perseverance, valor and ability on the part of physicians have
contributed to this progress, and of the creditable part which our
profession has played in the general development of science.
The editors have no hesitation in presenting these lectures to the
profession and to the reading public as one of the most characteristic
productions of the best-balanced, best-equipped, most sagacious and most
lovable of all modern physicians.
F.H.G.
BUT on that account, I say, we ought not to reject the ancient Art, as
if it were not, and had not been properly founded, because it did
not attain accuracy in all things, but rather, since it is capable of
reaching to the greatest exactitude by reasoning, to receive it and
admire its discoveries, made from a state of great ignorance, and as
having been well and properly made, and not from chance. (Hippocrates,
On Ancient Medicine, Adams edition, Vol. 1, 1849, p. 168.)
THE true and lawful goal of the sciences is none other than this: that
human life be endowed with new discoveries and powers. (Francis Bacon,
Novum Organum, Aphorisms, LXXXI, Spedding's translation.)
A GOLDEN thread has run throughout the history of the world, consecutive
and continuous, the work of the best men in successive ages. From point
to point it still runs, and when near you feel it as the clear and
bright and searchingly irresistible light which Truth throws forth when
great minds conceive it. (Walter Moxon, Pilocereus Senilis and Other
Papers, 1887, p. 4.)
FOR the mind depends so much on the temperament and disposition of the
bodily organs that, if it is possible to find a means of rendering men
wiser and cleverer than they have hitherto been, I believe that it is in
medicine that it must be sought. It is true that the medicine which is
now in vogue contains little of which the utility is remarkable; but,
without having any intention of decrying it, I am sure that there is
no one, even among those who make its study a profession, who does not
confess that all that men know is almost nothing in comparison with
what remains to be known; and that we could be free of an infinitude
of maladies both of body and mind, and even also possibly of the
infirmities of age, if we had sufficient knowledge of their causes,
and of all the remedies with which nature has provided us. (Descartes:
Discourse on the Method, Philosophical Works. Translated by E. S.
Haldane and G. R. T. Ross. Vol. I, Cam. Univ. Press, 1911, p. 120.)
CHAPTER I -- ORIGIN OF MEDICINE
INTRODUCTION
SAIL to the Pacific with some Ancient Mariner, and traverse day by day
that silent sea until you reach a region never before furrowed by keel
where a tiny island, a mere speck on the vast ocean, has just risen from
the depths, a little coral reef capped with green, an atoll, a mimic
earth, fringed with life, built up through countless ages by life on the
remains of life that has passed away. And now, with wings of fancy,
join Ianthe in the magic car of Shelley, pass the eternal gates of the
flaming ramparts of the world and see his vision:
Below lay stretched the boundless Universe!
There, far as the remotest line
That limits swift imagination's flight,
Unending orbs mingled in mazy motion,
Immutably fulfilling
Eternal Nature's law.
Above, below, around,
The circling systems formed
A wilderness of harmony.
(Daemon of the World, Pt. I.)
And somewhere, "as fast and far the chariot flew," amid the mighty
globes would be seen a tiny speck, "earth's distant orb," one of "the
smallest lights that twinkle in the heavens." Alighting, Ianthe
would find something she had probably not seen elsewhere in her magic
flight--life, everywhere encircling the sphere. And as the little coral
reef out of a vast depth had been built up by generations of polyzoa,
so she would see that on the earth, through illimitable ages, successive
generations of animals and plants had left in stone their imperishable
records: and at the top of the series she would meet the thinking,
breathing creature known as man. Infinitely little as is the architect
of the atoll in proportion to the earth on which it rests, the polyzoon,
I doubt not, is much larger relatively than is man in proportion to
the vast systems of the Universe, in which he represents an
ultra-microscopic atom less ten thousand times than the tiniest of the
"gay motes that people the sunbeams." Yet, with colossal audacity, this
thinking atom regards himself as the anthropocentric pivot around which
revolve the eternal purposes of the Universe. Knowing not whence he
came, why he is here, or whither he is going, man feels himself of
supreme importance, and certainly is of interest--to himself. Let us
hope that he has indeed a potency and importance out of all proportion
to his somatic insignificance. We know of toxins of such strength that
an amount too infinitesimal to be gauged may kill; and we know that
"the unit adopted in certain scientific work is the amount of emanation
produced by one million-millionth of a grain of radium, a quantity
which itself has a volume of less than a million-millionth of a cubic
millimetre and weighs a million million times less than an exceptionally
delicate chemical balance will turn to" (Soddy, 1912). May not man be
the radium of the Universe? At any rate let us not worry about his size.
For us he is a very potent creature, full of interest, whose mundane
story we are only beginning to unravel.
Civilization is but a filmy fringe on the history of man. Go back as far
as his records carry us and the story written on stone is of yesterday
in comparison with the vast epochs of time which modern studies demand
for his life on the earth. For two millions (some hold even three
millions) of years man lived and moved and had his being in a world very
different from that upon which we look out. There appear, indeed, to
have been various types of man, some as different from us as we are
from the anthropoid apes. What upstarts of yesterday are the Pharaohs in
comparison with the men who survived the tragedy of the glacial period!
The ancient history of man--only now beginning to be studied--dates
from the Pliocene or Miocene period; the modern history, as we know it,
embraces that brief space of time that has elapsed since the earliest
Egyptian and Babylonian records were made. This has to be borne in mind
in connection with the present mental status of man, particularly in his
outlook upon nature. In his thoughts and in his attributes, mankind at
large is controlled by inherited beliefs and impulses, which countless
thousands of years have ingrained like instinct. Over vast regions of
the earth today, magic, amulets, charms, incantations are the chief
weapons of defense against a malignant nature; and in disease, the
practice of Asa(*) is comparatively novel and unusual; in days of
illness many millions more still seek their gods rather than the
physicians. In an upward path man has had to work out for himself
a relationship with his fellows and with nature. He sought in the
supernatural an explanation of the pressing phenomena of life, peopling
the world with spiritual beings, deifying objects of nature, and
assigning to them benign or malign influences, which might be invoked or
propitiated. Primitive priest, physician and philosopher were one, and
struggled, on the one hand, for the recognition of certain practices
forced on him by experience, and on the other, for the recognition
of mystical agencies which control the dark, "uncharted region" about
him--to use Prof. Gilbert Murray's phrase--and were responsible for
everything he could not understand, and particularly for the mysteries
of disease. Pliny remarks that physic "was early fathered upon the
gods"; and to the ordinary non-medical mind, there is still something
mysterious about sickness, something outside the ordinary standard.
(*) II Chronicles xvi, 12.
Modern anthropologists claim that both religion and medicine took origin
in magic, "that spiritual protoplasm," as Miss Jane Harrison calls it.
To primitive man, magic was the setting in motion of a spiritual power
to help or to hurt the individual, and early forms may still be studied
in the native races. This power, or "mana," as it is called, while
possessed in a certain degree by all, may be increased by practice.
Certain individuals come to possess it very strongly: among native
Australians today it is still deliberately cultivated. Magic in healing
seeks to control the demons, or forces; causing disease; and in a way it
may be thus regarded as a "lineal ancestor of modern science" (Whetham),
which, too, seeks to control certain forces, no longer, however,
regarded as supernatural.
Primitive man recognized many of these superhuman agencies relating
to disease, such as the spirits of the dead, either human or animal,
independent disease demons, or individuals who might act by controlling
the spirits or agencies of disease. We see this today among the negroes
of the Southern States. A Hoodoo put upon a negro may, if he knows of
it, work upon him so powerfully through the imagination that he becomes
very ill indeed, and only through a more powerful magic exercised by
someone else can the Hoodoo be taken off.
To primitive man life seemed "full of sacred presences" (Walter Pater)
connected with objects in nature, or with incidents and epochs in life,
which he began early to deify, so that, until a quite recent period, his
story is largely associated with a pantheon of greater and lesser
gods, which he has manufactured wholesale. Xenophanes was the earliest
philosopher to recognize man's practice of making gods in his own image
and endowing them with human faculties and attributes; the Thracians,
he said, made their gods blue-eyed and red-haired, the Ethiopians,
snub-nosed and black, while, if oxen and lions and horses had hands
and could draw, they would represent their gods as oxen and lions and
horses. In relation to nature and to disease, all through early history
we find a pantheon full to repletion, bearing testimony no less to the
fertility of man's imagination than to the hopes and fears which led
him, in his exodus from barbarism, to regard his gods as "pillars of
fire by night, and pillars of cloud by day."
Even so late a religion as that of Numa was full of little gods to be
invoked on special occasions--Vatican, who causes the infant to utter
his first cry, Fabulinus, who prompts his first word, Cuba, who keeps
him quiet in his cot, Domiduca, who watches over one's safe home-coming
(Walter Pater); and Numa believed that all diseases came from the gods
and were to be averted by prayer and sacrifice. Besides the major gods,
representatives of Apollo, AEsculapius and Minerva, there were scores of
lesser ones who could be invoked for special diseases. It is said that
the young Roman mother might appeal to no less than fourteen goddesses,
from Juno Lucina to Prosa and Portvorta (Withington). Temples were
erected to the Goddess of Fever, and she was much invoked. There is
extant a touching tablet erected by a mourning mother and inscribed:
Febri divae, Febri
Sancte, Febri magnae
Camillo amato pro
Filio meld effecto. Posuit.
It is marvellous what a long line of superhuman powers, major and minor,
man has invoked against sickness. In Swinburne's words:
God by God flits past in thunder till his glories turn to shades,
God by God bears wondering witness how his Gospel flames and
fades;
More was each of these, while yet they were, than man their
servant seemed;
Dead are all of these, and man survives who made them while he
dreamed.
Most of them have been benign and helpful gods. Into the dark
chapters relating to demonical possession and to witchcraft we
cannot here enter. They make one cry out with Lucretius (Bk. V):
O genus infelix humanum, talia divis
Cum tribuit facta atque iras adjunxit acerbas!
Quantos tum gemitus ipsi sibi, quantaque nobis
Vulnera, quas lacrimas peperere minoribu' nostris.
In every age, and in every religion there has been justification for
his bitter words, "tantum religio potuit suadere malorum"--"Such wrongs
Religion in her train doth bring"--yet, one outcome of "a belief in
spiritual beings"--as Tylor defines religion--has been that man has
built an altar of righteousness in his heart. The comparative method
applied to the study of his religious growth has shown how man's
thoughts have widened in the unceasing purpose which runs through his
spiritual no less than his physical evolution. Out of the spiritual
protoplasm of magic have evolved philosopher and physician, as well
as priest. Magic and religion control the uncharted sphere--the
supernatural, the superhuman: science seeks to know the world, and
through knowing, to control it. Ray Lankester remarks that Man is
Nature's rebel, and goes on to say: "The mental qualities which have
developed in Man, though traceable in a vague and rudimentary condition
in some of his animal associates, are of such an unprecedented power and
so far dominate everything else in his activities as a living organism,
that they have to a very large extent, if not entirely, cut him off from
the general operation of that process of Natural Selection and survival
of the fittest which up to their appearance had been the law of the
living world. They justify the view that Man forms a new departure in
the gradual unfolding of Nature's predestined scheme. Knowledge, reason,
self-consciousness, will, are the attributes of Man."(1) It has been
a slow and gradual growth, and not until within the past century has
science organized knowledge--so searched out the secrets of Nature, as
to control her powers, limit her scope and transform her energies. The
victory is so recent that the mental attitude of the race is not yet
adapted to the change. A large proportion of our fellow creatures still
regard nature as a playground for demons and spirits to be exorcised or
invoked.
(1) Sir E. Ray Lankester: Romanes Lecture, "Nature and Man,"
Oxford Univ. Press, 1905, p. 21.
Side by side, as substance and shadow--"in the dark backward and abysm
of time," in the dawn of the great civilizations of Egypt and Babylon,
in the bright morning of Greece, and in the full noontide of modern
life, together have grown up these two diametrically opposite views of
man's relation to nature, and more particularly of his personal relation
to the agencies of disease.
The purpose of this course of lectures is to sketch the main features of
the growth of these two dominant ideas, to show how they have influenced
man at the different periods of his evolution, how the lamp of reason,
so early lighted in his soul, burning now bright, now dim, has never,
even in his darkest period, been wholly extinguished, but retrimmed
and refurnished by his indomitable energies, now shines more and more
towards the perfect day. It is a glorious chapter in history, in which
those who have eyes to see may read the fulfilment of the promise of
Eden, that one day man should not only possess the earth, but that he
should have dominion over it! I propose to take an aeroplane flight
through the centuries, touching only on the tall peaks from which may be
had a panoramic view of the epochs through which we pass.
ORIGIN OF MEDICINE
MEDICINE arose out of the primal sympathy of man with man; out of the
desire to help those in sorrow, need and sickness.
In the primal sympathy
Which having been must ever be;
In the soothing thoughts that spring
Out of human suffering.
The instinct of self-preservation, the longing to relieve a loved one,
and above all, the maternal passion--for such it is--gradually softened
the hard race of man--tum genus humanum primum mollescere coepit. In
his marvellous sketch of the evolution of man, nothing illustrates more
forcibly the prescience of Lucretius than the picture of the growth of
sympathy: "When with cries and gestures they taught with broken words
that 'tis right for all men to have pity on the weak." I heard the
well-known medical historian, the late Dr. Payne, remark that "the basis
of medicine is sympathy and the desire to help others, and whatever is
done with this end must be called medicine."
The first lessons came to primitive man by injuries, accidents, bites
of beasts and serpents, perhaps for long ages not appreciated by his
childlike mind, but, little by little, such experiences crystallized
into useful knowledge. The experiments of nature made clear to him the
relation of cause and effect, but it is not likely, as Pliny suggests,
that he picked up his earliest knowledge from the observation of
certain practices in animals, as the natural phlebotomy of the plethoric
hippopotamus, or the use of emetics from the dog, or the use of enemata
from the ibis. On the other hand, Celsus is probably right in his
account of the origin of rational medicine. "Some of the sick on account
of their eagerness took food on the first day, some on account of
loathing abstained; and the disease in those who refrained was more
relieved. Some ate during a fever, some a little before it, others after
it had subsided, and those who had waited to the end did best. For the
same reason some at the beginning of an illness used a full diet, others
a spare, and the former were made worse. Occurring daily, such things
impressed careful men, who noted what had best helped the sick, then
began to prescribe them. In this way medicine had its rise from
the experience of the recovery of some, of the death of others,
distinguishing the hurtful from the salutary things" (Book I). The
association of ideas was suggestive--the plant eyebright was used for
centuries in diseases of the eye because a black speck in the flower
suggested the pupil of the eye. The old herbals are full of similar
illustrations upon which, indeed, the so-called doctrine of signatures
depends. Observation came, and with it an ever widening experience. No
society so primitive without some evidence of the existence of a healing
art, which grew with its growth, and became part of the fabric of its
organization.
With primitive medicine, as such, I cannot deal, but I must refer to
the oldest existing evidence of a very extraordinary practice, that of
trephining. Neolithic skulls with disks of bone removed have been found
in nearly all parts of the world. Many careful studies have been made
of this procedure, particularly by the great anatomist and surgeon,
Paul Broca, and M. Lucas-Championniere has covered the subject in a
monograph.(2) Broca suggests that the trephining was done by scratching
or scraping, but, as Lucas-Championniere holds, it was also done by a
series of perforations made in a circle with flint instruments, and a
round piece of skull in this way removed; traces of these drill-holes
have been found. The operation was done for epilepsy, infantile
convulsions, headache, and various cerebral diseases believed to be
caused by confined demons, to whom the hole gave a ready method of
escape.
(2) Lucas-Championniere: Trepanation neolithique, Paris,
1912.
The practice is still extant. Lucas-Championniere saw a Kabyle thoubib
who told him that it was quite common among his tribe; he was the son of
a family of trephiners, and had undergone the operation four times,
his father twelve times; he had three brothers also experts; he did not
consider it a dangerous operation. He did it most frequently for pain in
the head, and occasionally for fracture.
The operation was sometimes performed upon animals. Shepherds trephined
sheep for the staggers. We may say that the modern decompression
operation, so much in vogue, is the oldest known surgical procedure.
EGYPTIAN MEDICINE
OUT of the ocean of oblivion, man emerges in history in a highly
civilized state on the banks of the Nile, some sixty centuries ago.
After millenniums of a gradual upward progress, which can be traced in
the records of the stone age, civilization springs forth Minerva-like,
complete, and highly developed, in the Nile Valley. In this sheltered,
fertile spot, neolithic man first raised himself above his kindred races
of the Mediterranean basin, and it is suggested that by the accidental
discovery of copper Egypt "forged the instruments that raised
civilization out of the slough of the Stone Age" (Elliot Smith). Of
special interest to us is the fact that one of the best-known names
of this earliest period is that of a physician--guide, philosopher and
friend of the king--a man in a position of wide trust and importance.
On leaving Cairo, to go up the Nile, one sees on the right in the desert
behind Memphis a terraced pyramid 190 feet in height, "the first large
structure of stone known in history." It is the royal tomb of Zoser, the
first of a long series with which the Egyptian monarchy sought "to adorn
the coming bulk of death." The design of this is attributed to Imhotep,
the first figure of a physician to stand out clearly from the mists of
antiquity. "In priestly wisdom, in magic, in the formulation of wise
proverbs, in medicine and architecture, this remarkable figure of
Zoser's reign left so notable a reputation that his name was never
forgotten, and 2500 years after his death he had become a God of
Medicine, in whom the Greeks, who called him Imouthes, recognized their
own AEsculapius."(3) He became a popular god, not only healing men when
alive, but taking good care of them in the journeys after death. The
facts about this medicinae primus inventor, as he has been called, may
be gathered from Kurt Sethe's study.(4) He seems to have corresponded
very much to the Greek Asklepios. As a god he is met with comparatively
late, between 700 and 332 B.C. Numerous bronze figures of him remain.
The oldest memorial mentioning him is a statue of one of his priests,
Amasis (No. 14765 in the British Museum). Ptolemy V dedicated to him a
temple on the island of Philae. His cult increased much in later days,
and a special temple was dedicated to him near Memphis Sethe suggests
that the cult of Imhotep gave the inspiration to the Hermetic
literature. The association of Imhotep with the famous temple at Edfu is
of special interest.
(3) Breasted: A History of the Ancient Egyptians, Scribner,
New York, 1908, p. 104.
(4) K. Sethe: Imhotep, der Asklepios der Aegypter, Leipzig,
1909 (Untersuchungen, etc., ed. Sethe, Vol. II, No. 4).
Egypt became a centre from which civilization spread to the other
peoples of the Mediterranean. For long centuries, to be learned in all
the wisdom of the Egyptians meant the possession of all knowledge. We
must come to the land of the Nile for the origin of many of man's
most distinctive and highly cherished beliefs. Not only is there a
magnificent material civilization, but in records so marvellously
preserved in stone we may see, as in a glass, here clearly, there
darkly, the picture of man's search after righteousness, the earliest
impressions of his moral awakening, the beginnings of the strife
in which he has always been engaged for social justice and for the
recognition of the rights of the individual. But above all, earlier and
more strongly than in any other people, was developed the faith that
looked through death, to which, to this day, the noblest of their
monuments bear an enduring testimony. With all this, it is not
surprising to find a growth in the knowledge of practical medicine; but
Egyptian civilization illustrates how crude and primitive may remain a
knowledge of disease when conditioned by erroneous views of its nature.
At first, the priest and physician were identified, and medicine never
became fully dissociated from religion. Only in the later periods did
a special group of physicians arise who were not members of priestly
colleges.(6) Maspero states that the Egyptians believed that disease
and death were not natural and inevitable, but caused by some malign
influence which could use any agency, natural or invisible, and very
often belonged to the invisible world. "Often, though, it belongs to
the invisible world, and only reveals itself by the malignity of
its attacks: it is a god, a spirit, the soul of a dead man, that has
cunningly entered a living person, or that throws itself upon him
with irresistible violence. Once in possession of the body, the evil
influence breaks the bones, sucks out the marrow, drinks the blood,
gnaws the intestines and the heart and devours the flesh. The invalid
perishes according to the progress of this destructive work; and death
speedily ensues, unless the evil genius can be driven out of it before
it has committed irreparable damage. Whoever treats a sick person
has therefore two equally important duties to perform. He must first
discover the nature of the spirit in possession, and, if necessary, its
name, and then attack it, drive it out, or even destroy it. He can
only succeed by powerful magic, so he must be an expert in reciting
incantations, and skilful in making amulets. He must then use medicine
(drugs and diet) to contend with the disorders which the presence of the
strange being has produced in the body."(6)
(5) Maspero: Life in Ancient Egypt and Assyria, London,
1891, p. 119.
(6) Maspero: Life in Ancient Egypt and Assyria, London,
1891, p. 118.
(7) W. Wreszinski: Die Medizin der alten Aegypter, Leipzig,
J. C. Hinrichs, 1909-1912.
In this way it came about that diseases were believed to be due to
hostile spirits, or caused by the anger of a god, so that medicines,
no matter how powerful, could only be expected to assuage the pain; but
magic alone, incantations, spells and prayers, could remove the disease.
Experience brought much of the wisdom we call empirical, and the
records, extending for thousands of years, show that the Egyptians
employed emetics, purgatives, enemata, diuretics, diaphoretics and
even bleeding. They had a rich pharmacopoeia derived from the animal,
vegetable and mineral kingdoms. In the later periods, specialism reached
a remarkable development, and Herodotus remarks that the country was
full of physicians;--"One treats only the diseases of the eye, another
those of the head, the teeth, the abdomen, or the internal organs."
Our knowledge of Egyptian medicine is derived largely from the
remarkable papyri dealing specially with this subject. Of these, six or
seven are of the first importance. The most famous is that discovered by
Ebers, dating from about 1500 B.C. A superb document, one of the
great treasures of the Leipzig Library, it is 20.23 metres long and 30
centimetres high and in a state of wonderful preservation. Others are
the Kahun, Berlin, Hearst and British Museum papyri. All these have now
been published--the last three quite recently, edited by Wreszinski.(7)
I show here a reproduction from which an idea may be had of these
remarkable documents. They are motley collections, filled with
incantations, charms, magical formulae, symbols, prayers and
prescriptions for all sorts of ailments. One is impressed by the
richness of the pharmacopoeia, and the high development which the art
of pharmacy must have attained. There were gargles, salves, snuffs,
inhalations, suppositories, fumigations, enemata, poultices and
plasters; and they knew the use of opium, hemlock, the copper salts,
squills and castor oil. Surgery was not very highly developed, but
the knife and actual cautery were freely used. Ophthalmic surgery was
practiced by specialists, and there are many prescriptions in the papyri
for ophthalmia.
One department of Egyptian medicine reached a high stage of development,
vis., hygiene. Cleanliness of the dwellings, of the cities and of the
person was regulated by law, and the priests set a splendid example in
their frequent ablutions, shaving of the entire body, and the spotless
cleanliness of their clothing. As Diodorus remarks, so evenly ordered
was their whole manner of life that it was as if arranged by a learned
physician rather than by a lawgiver.
Two world-wide modes of practice found their earliest illustration in
ancient Egypt. Magic, the first of these, represented the attitude of
primitive man to nature, and really was his religion. He had no idea
of immutable laws, but regarded the world about him as changeable and
fickle like himself, and "to make life go as he wished, he must be able
to please and propitiate or to coerce these forces outside himself."(8)
(8) L. Thorndike: The Place of Magic in the Intellectual
History of Europe, New York, 1905, p. 29.
The point of interest to us is that in the Pyramid Texts--"the oldest
chapter in human thinking preserved to us, the remotest reach in the
intellectual history of man which we are now able to discern"(9)--one of
their six-fold contents relates to the practice of magic. A deep belief
existed as to its efficacy, particularly in guiding the dead, who
were said to be glorious by reason of mouths equipped with the charms,
prayers and ritual of the Pyramid Texts, armed with which alone could
the soul escape the innumerable dangers and ordeals of the passage
through another world. Man has never lost his belief in the efficacy
of magic, in the widest sense of the term. Only a very few of the most
intellectual nations have escaped from its shackles. Nobody else has
so clearly expressed the origins and relations of magic as Pliny in
his "Natural History."(10) "Now, if a man consider the thing well,
no marvaile it is that it hath continued thus in so great request and
authoritie; for it is the onely Science which seemeth to comprise in
itselfe three possessions besides, which have the command and rule
of mans mind above any other whatsoever. For to begin withall, no man
doubteth but that Magicke tooke root first, and proceeded from Physicke,
under the presence of maintaining health, curing, and preventing
diseases: things plausible to the world, crept and insinuated farther
into the heart of man, with a deepe conceit of some high and divine
matter therein more than ordinarie, and in comparison whereof, all
other Physicke was but basely accounted. And having thus made way and
entrance, the better to fortifie it selfe, and to give a goodly colour
and lustre to those fair and flattering promises of things, which our
nature is most given to hearken after, on goeth the habite also and
cloake of religion: a point, I may tell you, that even in these daies
holdeth captivate the spirit of man, and draweth away with it a greater
part of the world, and nothing so much. But not content with this
successe and good proceeding, to gather more strength and win a
greater name, shee entermingled with medicinable receipts and religious
ceremonies, the skill of Astrologie and arts Mathematicall; presuming
upon this, That all men by nature are very curious and desirous to know
their future fortunes, and what shall betide them hereafter, persuading
themselves, that all such foreknowledge dependeth upon the course and
influence of the starres, which give the truest and most certain light
of things to come. Being thus wholly possessed of men, and having their
senses and understanding by this meanes fast ynough bound with three
sure chains, no marvell if this art grew in processe of time to such
an head, that it was and is at this day reputed by most nations of
the earth for the paragon and cheefe of all sciences: insomuch as
the mightie kings and monarchs of the Levant are altogether ruled and
governed thereby."
(9) Breasted: Development of Religion and Thought in
Ancient Egypt, New York, 1912, p. 84.
(10) The Historie of the World, commonly called the Naturall
Historie of C. Plinius Secundus, translated into English by
Philemon Holland, Doctor in Physieke, London, 1601, Vol. II,
p. 371, Bk. XXX, Chap. I, Sect. 1.
The second world-wide practice which finds its earliest record among
the Egyptians is the use secretions and parts of the animal body as
medicine. The practice was one of great antiquity with primitive man,
but the papyri already mentioned contain the earliest known records.
Saliva, urine, bile, faeces, various parts of the body, dried and
powdered, worms, insects, snakes were important ingredients in the
pharmacopoeia. The practice became very widespread throughout the
ancient world. Its extent and importance may be best gathered from
chapters VII and VIII in the 28th book of Pliny's "Natural History."
Several remedies are mentioned as derived from man; others from the
elephant, lion, camel, crocodile, and some seventy-nine are prepared
from the hyaena. The practice was widely prevalent throughout the
Middle Ages, and the pharmacopoeia of the seventeenth and even of the
eighteenth century contains many extraordinary ingredients. "The Royal
Pharmacopoeia" of Moses Charras (London ed., 1678), the most scientific
work of the day, is full of organotherapy and directions for the
preparation of medicines from the most loathsome excretions. A curious
thing is that with the discoveries of the mummies a belief arose as to
the great efficacy of powdered mummy in various maladies. As Sir Thomas
Browne remarks in his "Urn Burial": "Mummy has become merchandize.
Mizraim cures wounds, and Pharaoh is sold for balsams."
One formula in everyday use has come to us in a curious way from the
Egyptians. In the Osiris myth, the youthful Horus loses an eye in his
battle with Set. This eye, the symbol of sacrifice, became, next to the
sacred beetle, the most common talisman of the country, and all museums
are rich in models of the Horus eye in glass or stone.
"When alchemy or chemistry, which had its cradle in Egypt, and derived
its name from Khami, an old title for this country, passed to the hands
of the Greeks, and later of the Arabs, this sign passed with it. It
was also adopted to some extent by the Gnostics of the early Christian
church in Egypt. In a cursive form it is found in mediaeval translations
of the works of Ptolemy the astrologer, as the sign of the planet
Jupiter. As such it was placed upon horoscopes and upon formula
containing drugs made for administration to the body, so that the
harmful properties of these drugs might be removed under the influence
of the lucky planet. At present, in a slightly modified form, it still
figures at the top of prescriptions written daily in Great Britain
(Rx)."(11)
(11) John D. Comrie: Medicine among the Assyrians and
Egyptians in 1500 B.C., Edinburgh Medical Journal, 1909, n.
s., II, 119.
For centuries Egyptian physicians had a great reputation, and in the
Odyssey (Bk. IV), Polydamna, the wife of Thonis, gives medicinal plants
to Helen in Egypt--"a country producing an infinite number of drugs
. . . where each physician possesses knowledge above all other men."
Jeremiah (xlvi, 11) refers to the virgin daughter of Egypt, who should
in vain use many medicines. Herodotus tells that Darius had at his court
certain Egyptians, whom he reckoned the best skilled physicians in all
the world, and he makes the interesting statement that: "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 under taking 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."(12)
(12) The History of Herodotus, Blakesley's ed., Bk. II, 84.
A remarkable statement is made by Pliny, in the discussion upon the
use of radishes, which are said to cure a "Phthisicke," or ulcer of the
lungs--"proofe whereof was found and seen in AEgypt by occasion that the
KK. there, caused dead bodies to be cut up, and anatomies to be made,
for to search out the maladies whereof men died."(13)
(13) Pliny, Holland's translation, Bk. XIX, Chap. V, Sect.
26.
The study of the anatomy of mummies has thrown a very interesting light
upon the diseases of the ancient Egyptians, one of the most prevalent
of which appears to have been osteo-arthritis. This has been studied by
Elliot Smith, Wood Jones, Ruffer and Rietti. The majority of the lesions
appear to have been the common osteo-arthritis, which involved not only
the men, but many of the pet animals kept in the temples. In a much
higher proportion apparently than in modern days, the spinal column was
involved. It is interesting to note that the "determinative" of old age
in hieroglyphic writing is the picture of a man afflicted with arthritis
deformans. Evidences of tuberculosis, rickets and syphilis, according to
these authors, have not been found.
A study of the internal organs has been made by Ruffer, who has shown
that arterio-sclerosis with calcification was a common disease 8500
years ago; and he holds that it could not have been associated with hard
work or alcohol, for the ancient Egyptians did not drink spirits, and
they had practically the same hours of work as modern Egyptians, with
every seventh day free.
ASSYRIAN AND BABYLONIAN MEDICINE
OF equally great importance in the evolution of medicine was the
practically contemporary civilization in Mesopotamia. Science here
reached a much higher stage then in the valley of the Nile. An elaborate
scheme of the universe was devised, a system growing out of the
Divine Will, and a recognition for the first time of a law guiding
and controlling heaven and earth alike. Here, too, we find medicine
ancillary to religion. Disease was due to evil spirits or demons. "These
'demons'--invisible to the naked eye were the precursors of the modern
'germs' and 'microbes,' while the incantations recited by the priests
are the early equivalents of the physician's prescriptions. There
were different incantations for different diseases; and they were
as mysterious to the masses as are the mystic formulas of the modern
physician to the bewildered, yet trusting, patient. Indeed, their
mysterious character added to the power supposed to reside in the
incantations for driving the demons away. Medicinal remedies accompanied
the recital of the incantations, but despite the considerable progress
made by such nations of hoary antiquity as the Egyptians and Babylonians
in the diagnosis and treatment of common diseases, leading in time to
the development of an extensive pharmacology, so long as the cure
of disease rested with the priests, the recital of sacred formulas,
together with rites that may be conveniently grouped under the head of
sympathetic magic, was regarded as equally essential with the taking of
the prescribed remedies."(14)
(14) Morris Jastrow: The Liver in Antiquity and the
Beginnings of Anatomy. Transactions College of Physicians,
Philadelphia, 1907, 3. s., XXIX, 117-138.
Three points of interest may be referred to in connection with
Babylonian medicine. Our first recorded observations on anatomy are in
connection with the art of divination--the study of the future by the
interpretation of certain signs. The student recognized two divisions
of divination--the involuntary, dealing with the interpretation of signs
forced upon our attention, such as the phenomena of the heavens, dreams,
etc., and voluntary divination, the seeking of signs, more particularly
through the inspection of sacrificial animals. This method reached an
extraordinary development among the Babylonians, and the cult spread to
the Etruscans, Hebrews, and later to the Greeks and Romans.
Of all the organs inspected in a sacrificial animal the liver, from its
size, position and richness in blood, impressed the early observers as
the most important of the body. Probably on account of the richness in
blood it came to be regarded as the seat of life--indeed, the seat of
the soul. From this important position the liver was not dislodged for
many centuries, and in the Galenic physiology it shared with the heart
and the brain in the triple control of the natural, animal and vital
spirits. Many expressions in literature indicate how persistent was this
belief. Among the Babylonians, the word "liver" was used in hymns and
other compositions precisely as we use the word "heart," and Jastrow
gives a number of illustrations from Hebrew, Greek and Latin sources
illustrating this usage.
The belief arose that through the inspection of this important organ in
the sacrificial animal the course of future events could be predicted.
"The life or soul, as the seat of life, in the sacrificial animal is,
therefore, the divine element in the animal, and the god in accepting
the animal, which is involved in the act of bringing it as an offering
to a god, identifies himself with the animal--becomes, as it were, one
with it. The life in the animal is a reflection of his own life,
and since the fate of men rests with the gods, if one can succeed in
entering into the mind of a god, and thus ascertain what he purposes to
do, the key for the solution of the problem as to what the future has in
store will have been found. The liver being the centre of vitality--the
seat of the mind, therefore, as well as of the emotions--it becomes in
the case of the sacrificial animal, either directly identical with the
mind of the god who accepts the animal, or, at all events, a mirror in
which the god's mind is reflected; or, to use another figure, a watch
regulated to be in sympathetic and perfect accord with a second watch.
If, therefore, one can read the liver of the sacrificial animal, one
enters, as it were, into the workshop of the divine will."(15)
(15) Morris Jastrow: loc. cit., p. 122.
Hepatoscopy thus became, among the Babylonians, of extraordinary
complexity, and the organ of the sheep was studied and figured as early
as 3000 B.C. In the divination rites, the lobes, the gall-bladder, the
appendages of the upper lobe and the markings were all inspected with
unusual care. The earliest known anatomical model, which is here shown,
is the clay model of a sheep's liver with the divination text dating
from about 2000 B.C., from which Jastrow has worked out the modern
anatomical equivalents of the Babylonian terms. To reach a decision on
any point, the phenomena of the inspection of the liver were carefully
recorded, and the interpretations rested on a more or less natural and
original association of ideas. Thus, if the gall-bladder were swollen on
the right side, it pointed to an increase in the strength of the King's
army, and was favorable; if on the left side, it indicated rather
success of the enemy, and was unfavorable. If the bile duct was long, it
pointed to a long life. Gallstones are not infrequently mentioned in
the divination texts and might be favorable, or unfavorable. Various
interpretations were gathered by the scribes in the reference note-books
which serve as guides for the interpretation of the omens and for
text-books of instructions in the temple schools (Jastrow).
The art of divination spread widely among the neighboring nations. There
are many references in the Bible to the practice. The elders of Moab
and Midian came to Balaam "with the rewards of divination in their hand"
(Numbers xxii, 7). Joseph's cup of divination was found in Benjamin's
sack (Genesis xliv, 5, 12); and in Ezekiel (xxi, 21) the King of Babylon
stood at the parting of the way and looked in the liver. Hepatoscopy was
also practiced by the Etruscans, and from them it passed to the
Greeks and the Romans, among whom it degenerated into a more or less
meaningless form. But Jastrow states that in Babylonia and Assyria,
where for several thousand years the liver was consistently employed
as the sole organ of divination, there are no traces of the rite having
fallen into decay, or having been abused by the priests.
In Roman times, Philostratus gives an account of the trial of Apollonius
of Tyana,(16) accused of human hepatoscopy by sacrificing a boy in
the practice of magic arts against the Emperor. "The liver, which the
experts say is the very tripod of their art, does not consist of pure
blood; for the heart retains all the uncontaminated blood, and irrigates
the whole body with it by the conduits of the arteries; whereas the
gall, which is situated next the liver, is stimulated by anger and
depressed by fear into the hollows of the liver."
We have seen how early and how widespread was the belief in amulets and
charms against the occult powers of darkness. One that has persisted
with extraordinary tenacity is the belief in the Evil Eye the power
of certain individuals to injure with a look. Of general belief in the
older civilizations, and referred to in several places in the Bible,
it passed to Greece and Rome, and today is still held fervently in many
parts of Europe. The sign of "le corna,"--the first and fourth fingers
extended, the others turned down and the thumb closed over them,--still
used against the Evil Eye in Italy, was a mystic sign used by the Romans
in the festival of Lemuralia. And we meet with the belief also in this
country. A child with hemiplegia, at the Infirmary for Diseases of the
Nervous System, Philadelphia, from the central part of Pennsylvania, was
believed by its parents to have had the Evil Eye cast upon it.
The second contribution of Babylonia and Assyria to medicine--one that
affected mankind profoundly--relates to the supposed influence of the
heavenly bodies upon man's welfare. A belief that the stars in their
courses fought for or against him arose early in their civilizations,
and directly out of their studies on astrology and mathematics. The
Macrocosm, the heavens that "declare the glory of God," reflect, as in
a mirror, the Microcosm, the daily life of man on earth. The first step
was the identification of the sun, moon and stars with the gods of
the pantheon. Assyrian astronomical observations show an extraordinary
development of practical knowledge. The movements of the sun and moon
and of the planets were studied; the Assyrians knew the precession of
the equinoxes and many of the fundamental laws of astronomy, and the
modern nomenclature dates from their findings. In their days the signs
of the zodiac corresponded practically with the twelve constellations
whose names they still bear, each division being represented by the
symbol of some god, as the Scorpion, the Ram, the Twins, etc. "Changes
in the heavens . . . portended changes on earth. The Biblical expression
'hosts of heaven' for the starry universe admirably reflects the
conception held by the Babylonian astrologers. Moon, planets and stars
constituted an army in constant activity, executing military manoeuvres
which were the result of deliberation and which had in view a fixed
purpose. It was the function of the priest--the barqu, or 'inspector,'
as the astrologer as well as the 'inspector' of the liver was called--to
discover this purpose. In order to do so, a system of interpretation was
evolved, less logical and less elaborate than the system of hepatoscopy,
which was analyzed in the preceding chapter, but nevertheless meriting
attention both as an example of the pathetic yearning of men to
peer into the minds of the gods, and of the influence that
Babylonian-Assyrian astrology exerted throughout the ancient world"
(Jastrow).(17)
(16) Philostratus: Apollonius of Tyana, Bk. VIII, Chap.
VII, Phillimore's transl., Oxford, 1912, II, 233. See,
also, Justin: Apologies, edited by Louis Pautigny, Paris,
1904, p. 39.
(17) M. Jastrow: Aspects of Religious Belief and Practice
in Babylonia and Assyria, New York, 1911, p. 210.
With the rationalizing influence of the Persians the hold of astrology
weakened, and according to Jastrow it was this, in combination with
Hebrew and Greek modes of thought, that led the priests in the three
centuries following the Persian occupation, to exchange their profession
of diviners for that of astronomers; and this, he says, marks the
beginning of the conflict between religion and science. At first an
expression of primitive "science," astrology became a superstition, from
which the human mind has not yet escaped. In contrast to divination,
astrology does not seem to have made much impression on the Hebrews and
definite references in the Bible are scanty. From Babylonia it passed to
Greece (without, however, exerting any particular influence upon Greek
medicine). Our own language is rich in words of astral significance
derived from the Greek, e.g., disaster.
The introduction of astrology into Europe has a passing interest.
Apparently the Greeks had made important advances in astronomy before
coming in contact with the Babylonians,--who, in all probability,
received from the former a scientific conception of the universe. "In
Babylonia and Assyria we have astrology first and astronomy afterwards,
in Greece we have the sequence reversed--astronomy first and astrology
afterwards" (Jastrow).(18)
(18) M. Jastrow: Aspects of Religious Belief and Practice
in Babylonia and Assyria, New York, 1911, p. 256.
It is surprising to learn that, previous to their contact with the
Greeks, astrology as relating to the individual--that is to say,
the reading of the stars to determine the conditions under which the
individual was born--had no place in the cult of the Babylonians and
Assyrians. The individualistic spirit led the Greek to make his gods
take note of every action in his life, and his preordained fate might
be read in the stars.--"A connecting link between the individual and the
movements in the heavens was found in an element which they shared in
common. Both man and stars moved in obedience to forces from which there
was no escape. An inexorable law controlling the planets corresponded to
an equally inexorable fate ordained for every individual from his birth.
Man was a part of nature and subject to its laws. The thought could
therefore arise that, if the conditions in the heavens were studied
under which a man was born, that man's future could be determined in
accord with the beliefs associated with the position of the planets
rising or visible at the time of birth or, according to other views, at
the time of conception. These views take us back directly to the system
of astrology developed by Babylonian baru priests. The basis on which
the modified Greek system rests is likewise the same that we have
observed in Babylonia--a correspondence between heaven and earth, but
with this important difference, that instead of the caprice of the
gods we have the unalterable fate controlling the entire universe--the
movements of the heavens and the life of the individual alike"
(Jastrow).(19)
(19) Ibid., pp. 257-258.
From this time on until the Renaissance, like a shadow, astrology
follows astronomy. Regarded as two aspects of the same subject, the one,
natural astrology, the equivalent of astronomy, was concerned with the
study of the heavens, the other, judicial astrology, was concerned with
the casting of horoscopes, and reading in the stars the fate of the
individual.
As I mentioned, Greek science in its palmy days seems to have been very
free from the bad features of astrology. Gilbert Murray remarks that
"astrology fell upon the Hellenistic mind as a new disease falls upon
some remote island people." But in the Greek conquest of the Roman mind,
astrology took a prominent role. It came to Rome as part of the great
Hellenizing movement, and the strength of its growth may be gauged from
the edicts issued against astrologers as early as the middle of the
second century B.C. In his introduction to his recent edition of Book II
of the Astronomicon of Manilius, Garrod traces the growth of the
cult, which under the Empire had an extraordinary vogue. "Though these
(heavenly) signs be far removed from us, yet does he (the god) so make
their influences felt, that they give to nations their life and their
fate and to each man his own character."(20) Oracles were sought on all
occasions, from the planting of a tree to the mating of a horse, and the
doctrine of the stars influenced deeply all phases of popular thought
and religion. The professional astrologers, as Pliny(21) says, were
Chaldeans, Egyptians and Greeks. The Etruscans, too, the professional
diviners of Rome, cultivated the science. Many of these "Isiaci
conjectores" and "astrologi de circo" were worthless charlatans, but
on the whole the science seems to have attracted the attention of
thoughtful men of the period. Garrod quotes the following remarkable
passage from Tacitus: "My judgment wavers," he says, "I dare not say
whether it be fate and necessity immutable which governs the changing
course of human affairs--or just chance. Among the wisest of the
ancients, as well as among their apes, you will find a conflict of
opinion. Many hold fixedly the idea that our beginning and our end--that
man himself--is nothing to the Gods at all. The wicked are in prosperity
and the good meet tribulation. Others believe that Fate and the facts
of this world work together. But this connection they trace not to
planetary influences but to a concatenation of natural causes. We choose
our life that is free: but the choice once made, what awaits us is fixed
and ordered. Good and evil are different from the vulgar opinion of
them. Often those who seem to battle with adversity are to be accounted
blessed; but the many, even in their prosperity, are miserable. It needs
only to bear misfortune bravely, while the fool perishes in his wealth.
Outside these rival schools stands the man in the street. No one will
take from him his conviction that at our birth are fixed for us the
things that shall be. If some things fall out differently from what was
foretold, that is due to the deceit of men that speak what they know
not: calling into contempt a science to which past and present alike
bear a glorious testimony" (Ann. vi, 22).
(20) Manili Astronomicon Liber II, ed. H. W. Garrod, Oxford,
1911, p. lxix, and II, ll. 84-86.
(21) Pliny: Natural History, Bk. XVIII, Chap. XXV, Sect.
57.
Cato waged war on the Greek physicians and forbade "his uilicus all
resort to haruspicem, augurem, hariolum Chaldaeum," but in vain; so
widespread became the belief that the great philosopher, Panaetius (who
died about 111 B.C.), and two of his friends alone among the stoics,
rejected the claims of astrology as a science (Garrod). So closely
related was the subject of mathematics that it, too, fell into
disfavor, and in the Theodosian code sentence of death was passed upon
mathematicians. Long into the Middle Ages, the same unholy alliance
with astrology and divination caused mathematics to be regarded with
suspicion, and even Abelard calls it a nefarious study.
The third important feature in Babylonian medicine is the evidence
afforded by the famous Hammurabi Code (circa 2000 B.C.)--a body of laws,
civil and religious, many of which relate to the medical profession.
This extraordinary document is a black diorite block 8 feet high, once
containing 21 columns on the obverse, 16 and 28 columns on the reverse,
with 2540 lines of writing of which now 1114 remain, and surmounted by
the figure of the king receiving the law from the Sun-god. Copies of
this were set up in Babylon "that anyone oppressed or injured, who had
a tale of woe to tell, might come and stand before his image, that of a
king of righteousness, and there read the priceless orders of the King,
and from the written monument solve his problem" (Jastrow). From the
enactments of the code we gather that the medical profession must have
been in a highly organized state, for not only was practice regulated
in detail, but a scale of fees was laid down, and penalties exacted
for malpraxis. Operations were performed, and the veterinary art was
recognized. An interesting feature, from which it is lucky that we have
in these days escaped, is the application of the "lex talionis"--an eye
for an eye, bone for a bone, and tooth for a tooth, which is a striking
feature of the code.
Some of the laws of the code may be quoted:
Paragraph 215. If a doctor has treated a gentleman for a severe wound
with a bronze lances and has cured the man, or has opened an abscess of
the eye for a gentleman with the bronze lances and has cured the eye of
the gentleman, he shall take ten shekels of silver.
218. If the doctor has treated a gentleman for a severe wound with a
lances of bronze and has caused the gentleman to die, or has opened
an abscess of the eye for a gentleman and has caused the loss of the
gentleman's eye, one shall cut off his hands.
219. If a doctor has treated the severe wound of a slave of a poor man
with a bronze lances and has caused his death, he shall render slave for
slave.
220. If he has opened his abscess with a bronze lances and has made him
lose his eye, he shall pay money, half his price.
221. If a doctor has cured the shattered limb of a gentleman, or has
cured the diseased bowel, the patient shall give five shekels of silver
to the doctor.
224. If a cow doctor or a sheep doctor has treated a cow or a sheep for
a severe wound and cured it, the owner of the cow or sheep shall give
one-sixth of a shekel of silver to the doctor as his fee.(22)
(22) The Oldest Code of Laws in the World; translated by C.
H. W. Johns, Edinburgh, 1903.
HEBREW MEDICINE
THE medicine of the Old Testament betrays both Egyptian and Babylonian
influences; the social hygiene is a reflex of regulations the origin
of which may be traced in the Pyramid Texts and in the papyri. The
regulations in the Pentateuch codes revert in part to primitive times,
in part represent advanced views of hygiene. There are doubts if the
Pentateuch code really goes back to the days of Moses, but certainly
someone "learned in the wisdom of the Egyptians" drew it up. As
Neuburger briefly summarizes:
"The commands concern prophylaxis and suppression of epidemics,
suppression of venereal disease and prostitution, care of the skin,
baths, food, housing and clothing, regulation of labour, sexual life,
discipline of the people, etc. Many of these commands, such as Sabbath
rest, circumcision, laws concerning food (interdiction of blood and
pork), measures concerning menstruating and lying-in women and those
suffering from gonorrhoea, isolation of lepers, and hygiene of the
camp, are, in view of the conditions of the climate, surprisingly
rational."(23)
(23) Neuburger: History of Medicine, Oxford University
Press, 1910, Vol. I, p. 38.
Divination, not very widely practiced, was borrowed, no doubt, from
Babylonia. Joseph's cup was used for the purpose, and in Numbers, the
elders of Balak went to Balaam with the rewards of divination in their
hands. The belief in enchantments and witchcraft was universal, and the
strong enactments against witches in the Old Testament made a belief in
them almost imperative until more rational beliefs came into vogue in
the eighteenth and nineteenth centuries.
Whatever view we may take of it, the medicine of the New Testament is
full of interest. Divination is only referred to once in the Acts (xvi,
16), where a damsel is said to be possessed of a spirit of divination
"which brought her masters much gain by soothsaying." There is only one
mention of astrology (Acts vii, 43); there are no witches, neither
are there charms or incantations. The diseases mentioned are numerous:
demoniac possession, convulsions, paralysis, skin diseases,--as
leprosy,--dropsy, haemorrhages, fever, fluxes, blindness and deafness.
And the cure is simple usually a fiat of the Lord, rarely with a prayer,
or with the use of means such as spittle. They are all miraculous,
and the same power was granted to the apostles--"power against unclean
spirits, to cast them out, to heal all manner of sickness and all manner
of disease." And more than this, not only the blind received their
sight, the lame walked, the lepers were cleansed, the deaf heard, but
even the dead were raised up. No question of the mandate. He who went
about doing good was a physician of the body as well as of the soul, and
could the rich promises of the Gospel have been fulfilled, there would
have been no need of a new dispensation of science. It may be because
the children of this world have never been able to accept its hard
sayings--the insistence upon poverty, upon humility, upon peace that
Christianity has lost touch no less with the practice than with the
principles of its Founder. Yet, all through the centuries, the Church
has never wholly abandoned the claim to apostolic healing; nor is there
any reason why she should. To the miraculous there should be no
time limit--only conditions have changed and nowadays to have a
mountain-moving faith is not easy. Still, the possession is cherished,
and it adds enormously to the spice and variety of life to know that men
of great intelligence, for example, my good friend, Dr. James J. Walsh
of New York, believe in the miracles of Lourdes.(24) Only a few weeks
ago, the Bishop of London followed with great success, it is said, the
practice of St. James. It does not really concern us much--as Oriental
views of disease and its cure have had very little influence on
the evolution of scientific medicine--except in illustration of the
persistence of an attitude towards disease always widely prevalent,
and, indeed, increasing. Nor can we say that the medicine of our great
colleague, St. Luke, the Beloved Physician, whose praise is in the
Gospels, differs so fundamentally from that of the other writings of the
New Testament that we can claim for it a scientific quality. The stories
of the miracles have technical terms and are in a language adorned
by medical phraseology, but the mental attitude towards disease
is certainly not that of a follower of Hippocrates, nor even of a
scientifically trained contemporary of Dioscorides.(25)
(24) Psychotherapy, New York, 1919, p. 79, "I am convinced
that miracles happen there. There is more than natural power
manifest."
(25) See Luke the Physician, by Harnack, English ed., 1907,
and W. K. Hobart, The Medical Language of St. Luke, 1882.
CHINESE AND JAPANESE MEDICINE
CHINESE medicine illustrates the condition at which a highly
intellectual people may arrive, among whom thought and speculation were
restricted by religious prohibitions. Perhaps the chief interest in its
study lies in the fact that we may see today the persistence of views
about disease similar to those which prevailed in ancient Egypt and
Babylonia. The Chinese believe in a universal animism, all parts being
animated by gods and spectres, and devils swarm everywhere in numbers
incalculable. The universe was spontaneously created by the operation
of its Tao, "composed of two souls, the Yang and the Yin; the Yang
represents light, warmth, production, and life, as also the celestial
sphere from which all those blessings emanate; the Yin is darkness,
cold, death, and the earth, which, unless animated by the Yang or
heaven, is dark, cold, dead. The Yang and the Yin are divided into an
infinite number of spirits respectively good and bad, called shen and
kwei; every man and every living being contains a shen and a kwei,
infused at birth, and departing at death, to return to the Yang and the
Yin. Thus man with his dualistic soul is a microcosmos, born from the
Macrocosmos spontaneously. Even every object is animated, as well as the
Universe of which it is a part."(26)
(26) J. J. M. de Groot: Religious System of China, Vol. VI,
Leyden, 1910, p. 929.
In the animistic religion of China, the Wu represented a group of
persons of both sexes, who wielded, with respect to the world of
spirits, capacities and powers not possessed by the rest of men. Many
practitioners of Wu were physicians who, in addition to charms and
enchantments, used death-banishing medicinal herbs. Of great antiquity,
Wu-ism has changed in some ways its outward aspect, but has not altered
its fundamental characters. The Wu, as exorcising physicians and
practitioners of the medical art, may be traced in classical literature
to the time of Confucius. In addition to charms and spells, there were
certain famous poems which were repeated, one of which, by Han Yu, of
the T'ang epoch, had an extraordinary vogue. De Groot says that the
"Ling," or magical power of this poem must have been enormous, seeing
that its author was a powerful mandarin, and also one of the loftiest
intellects China has produced. This poetic febrifuge is translated in
full by de Groot (VI, 1054-1055), and the demon of fever, potent chiefly
in the autumn, is admonished to begone to the clear and limpid waters of
the deep river.
In the High Medical College at Court, in the T'ang Dynasty, there
were four classes of Masters, attached to its two High Medical Chiefs:
Masters of Medicine, of Acupuncture, of Manipulation, and two Masters
for Frustration by means of Spells.
Soothsaying and exorcism may be traced far back to the fifth and sixth
centuries B.C.
In times of epidemic the specialists of Wu-ism, who act as seers,
soothsayers and exorcists, engage in processions, stripped to the waist,
dancing in a frantic, delirious state, covering themselves with blood by
means of prick-balls, or with needles thrust through their tongues, or
sitting or stretching themselves on nail points or rows of sword edges.
In this way they frighten the spectres of disease. They are nearly
all young, and are spoken of as "divining youths," and they use an
exorcising magic based on the principle that legions of spectres prone
to evil live in the machine of the world. (De Groot, VI, 983-985.)
The Chinese believe that it is the Tao, or "Order of the Universe,"
which affords immunity from evil, and according to whether or no the
birth occurred in a beneficent year, dominated by four double cyclical
characters, the horoscope is "heavy" or "light." Those with light
horoscopes are specially prone to incurable complaints, but much harm
can be averted if such an individual be surrounded with exorcising
objects, if he be given proper amulets to wear and proper medicines to
swallow, and by selecting for him auspicious days and hours.
Two or three special points may be referred to. The doctrine of the
pulse reached such extraordinary development that the whole practice
of the art centred round its different characters. There were scores
of varieties, which in complication and detail put to confusion the
complicated system of some of the old Graeco-Roman writers. The basic
idea seems to have been that each part and organ had its own proper
pulse, and just as in a stringed instrument each chord has its own tone,
so in the human body, if the pulses were in harmony, it meant health; if
there was discord, it meant disease. These Chinese views reached
Europe in the seventeenth and eighteenth centuries, and there is a very
elaborate description of them in Floyer's well-known book.(27) And the
idea of harmony in the pulse is met with into the eighteenth century.
(27) Sir John Floyer: The Physician's Pulse Watch, etc.,
London, 1707.
Organotherapy was as extensively practiced in China as in Egypt. Parts
of organs, various secretions and excretions are very commonly used. One
useful method of practice reached a remarkable development, viz., the
art of acupuncture--the thrusting of fine needles more or less deeply
into the affected part. There are some 388 spots on the body in which
acupuncture could be performed, and so well had long experience taught
them as to the points of danger, that the course of the arteries may be
traced by the tracts that are avoided. The Chinese practiced inoculation
for smallpox as early as the eleventh century.
Even the briefest sketch of the condition of Chinese medicine leaves the
impression of the appalling stagnation and sterility that may afflict a
really intelligent people for thousands of years. It is doubtful if they
are today in a very much more advanced condition than were the Egyptians
at the time when the Ebers Papyrus was written. From one point of view
it is an interesting experiment, as illustrating the state in which
a people may remain who have no knowledge of anatomy, physiology or
pathology.
Early Japanese medicine has not much to distinguish it from the Chinese.
At first purely theurgic, the practice was later characterized by
acupuncture and a refined study of the pulse. It has an extensive
literature, largely based upon the Chinese, and extending as far back as
the beginning of the Christian era. European medicine was introduced by
the Portuguese and the Dutch, whose "factory" or "company" physicians
were not without influence upon practice. An extraordinary stimulus was
given to the belief in European medicine by a dissection made by
Mayeno in 1771 demonstrating the position of the organs as shown in
the European anatomical tables, and proving the Chinese figures to be
incorrect. The next day a translation into Japanese of the anatomical
work of Kulmus was begun, and from its appearance in 1773 may be dated
the commencement of reforms in medicine. In 1793, the work of de Gorter
on internal medicine was translated, and it is interesting to know that
before the so-called "opening of Japan" many European works on medicine
had been published. In 1857, a Dutch medical school was started in Yedo.
Since the political upheaval in 1868, Japan has made rapid progress in
scientific medicine, and its institutions and teachers are now among the
best known in the world.(28)
(28) See Y. Fujikawa, Geschichte der Medizin in Japan,
Tokyo, 1911.