attention for a moment, is Morgagni, born in Italy in 1682, died in
1772. He was a pupil of Valsalva, whose assistant he became at the
age of nineteen. Brought up in this way, as it were in the domain of
anatomy, it is not strange that he devoted his attention throughout
his life especially to the anatomical products of disease. It matters
little to us now that he was wont to regard these products as the
causes of disease and thus neglected their remote causes. He it was
who taught us to apply to pathological anatomy the same scrupulous
attention to tissue alterations and changes which the ordinary
anatomist would note in dissecting a new animal form. He was scarcely
the founder of the science of pathological anatomy, for this credit
belongs to Benivieni, but he did very much to popularize the study and
to show its importance. More than this, he wrote a work which for his
day and generation was colossal. It bore the title "_De Sedibus et
Causis Morborum per Anatomen Indagatis._" It consisted of five books.
The first appeared in Venice in 1761. This proved a perfect mine of
information to which one may often turn even to-day, and read with
wonder the observations published one hundred and fifty years ago.
They stamp Morgagni as a great scientist as well as anatomist. His
industry will be indicated by the fact that even after he became blind
he did not cease to work.
Perhaps the most wonderful figure in the whole history of modern
medicine is that of Albrecht von Haller, of Berne, born 1708, died
1777, and often known as the Great. No more versatile genius than his
has ever adorned our profession. A most precocious child, he developed
remarkable abilities in the direction of poetry and music, as well as
medicine, and the only wonder is that he lived to such a ripe old age,
enjoying the fruits of his labors, having displayed throughout his
entire life an industry and productiveness which were most remarkable.
Before he reached the age of ten he had written a Chaldee grammar, a
Greek and Hebrew vocabulary, and a large collection of Latin verses and
biographies. During the next few years he translated many of the Latin
authors, and wrote an original epic poem of some four thousand verses
on the Swiss Confederacy. All of this work he had completed by the
age of twenty-one. It is not strange that among those who knew of his
precocity he was generally known and regarded as a "wonder child." It
will thus be seen, too, that medicine was but one of the many subjects
of his study. He studied a year in Tübingen, where the riotous living
of his fellow students repelled him; then he went to Leyden, falling
there under the influence of the illustrious Boerhaave. How much he
drew from this source no man may accurately say at present, but a
more brilliant example he certainly could not have had. He finished
his studies in Leyden before he was twenty and then traveled through
England and France, but was compelled to flee from Paris to escape
arrest for hiding cadavers in his room for purposes of dissection. This
will prove an evidence of taste for study if not of taste in other
directions.
Suddenly developing a passion for mathematics, he went to Basle and
worked so hard as to almost ruin his health. This necessitated a trip
to the mountains and here his interest in botany was aroused and
indirectly that in medicine continued. Soon after he returned to Berne
to take up the practice of medicine. Here he studied and worked so
hard as to arouse a suspicion of his sanity, but he kept up his health
by frequent trips to the Alps in search of flowers. His fondness for
botany and his taste for poetry seemed to grow with equal pace and he
seems to have been among the first of modern students to appreciate the
beauty and grandeur of Swiss mountain scenery. When he was twenty-five
years of age appeared the first edition of his poems, many editions
appearing later. Here in Berne also he published so many essays on
botany, anatomy and physiology that widespread attention was attracted
to his eminent learning, and he was called to fill the chair of
anatomy and botany in the new university of Göttingen, where he spent
seventeen years of extraordinary mental activity, publishing countless
papers and at the same time continuing his poetic and his nomadic
habits. He established in Göttingen a great botanic garden, founded
scientific societies, published five books on anatomy, all elaborately
illustrated, printed a series of commentaries on Boerhaave's lectures,
and is said to have contributed altogether thirteen thousand articles
relating to almost every branch of human knowledge. It is not strange
that the fame of the University of Göttingen depended largely upon
Haller's reputation.
But Haller developed a clear case of nostalgia, and after being fêted
by the nobility, honored by almost every monarch in Europe, and
receiving every honor that universities and philosophic societies
confer, he resigned from his chair in Göttingen and returned to Berne,
to his _fatherland_. Here, amid his old home surroundings, he worked
for twenty years more at the same tremendous rate, discharging diverse
duties of state and private citizenship, founding and promoting
industries and asylums, and serving constantly upon commissions of all
kinds. While thus engaged appeared that phenomenal work, his great
Treatise on Physiology, so full of original observations that it has
been stated that should discoveries which have been re-discovered
since Haller be collected they would fill several quarto volumes. The
physiological institute of Berne is to-day known as the _Hallerianum_,
as it should be, for it is distinctly the product of his genius.
He died at a ripe age, after having performed an incredible amount
of work, the greatest scholar of his own or perhaps of any century,
revered and honored, faithful to the last and exhibiting in his last
moments that "philosophic calmness of the cultivated intellect" of
which Cicero loved to write. It is related of him that on his deathbed
he kept his fingers on his own wrist, watching the ebbing away of
his own existence and waiting for the last pulsation from his radial
artery. Finally he exclaimed, "I no longer feel it," and then joined
the great majority.
Perhaps Haller's greatest contribution to physiological lore was his
doctrine of irritability of tissues. It took the place of much that had
caused previous discussion and is accepted to-day as explaining, as
nearly as we can explain, numerous phenomena.
In this same great wonder-century lived also John Hunter, the greatest
of England's medical students, the most famous surgeon of his day
and the most indefatigable collector in natural history and natural
science that ever lived. He was born in 1728 and died in 1783. He was
led to study medicine by the fame of his illustrious brother William,
and began his studies by acting as prosector for him. He soon became
a pupil of Cheselden, perhaps the most famous English surgeon of his
generation. Hunter developed very early those extraordinary powers of
observation and that originality in investigation which later made him
so famous. Early in his medical career he came for a time under the
influence of Percival Pott. This was at a time when surgery had emerged
from barbarism and when the French Academy of Surgery had erected it
into the dignity of a science. He entered St. George's Hospital in 1754
as a surgeon's pupil. Later he became a partner with his brother in the
latter's private school of anatomy, but John, being a poor lecturer,
was distinguished by his services in the dissecting-room rather than
in the amphitheater. The customs of his time and the jealousies of
the various medical factions then existing in London led to numerous
acrimonious disputes, in the literary part of which William Hunter,
who was much the more cultured student, took the lead, while John,
who lacked in scholastic ability and had much less education, was
relied on to supply the anatomical data. John was painfully aware of
his deficiencies in literary culture and is said once to have replied
to the disparaging remarks of an opponent: "He accuses me of not
understanding the dead languages, but I could tell him that on the dead
body which he never knew in any language living or dead."
It was in this way that he was led into unseemly encounters with the
Munros, of Edinburgh, and with his late teacher, Pott. The same sort
of dispute finally separated the two brothers, and they parted company
after a very unseemly exhibition of jealousy and fraternal discord.
After studying human anatomy for several years, John Hunter became
profoundly impressed with the need for much larger knowledge of
comparative anatomy, but about this time ill health compelled a
temporary change and so he went into the army as a staff surgeon.
This was at the time when Europe was engaged in the sanguinary Seven
Years' War, and so it happened that Hunter had ample opportunity for
studies and observations in military surgery--at the siege of Belleisle
and later in the war in the Peninsula. Here he made many of those
observations on gunshot wounds which he published at various periods
later and which helped to make him famous.
He resumed his work in London in 1763, and here again he had to
undergo a long trial of those qualities of passive fortitude and
active perseverance under difficulties which were his prominent
characteristics. His personal needs were small but his scientific
requirements were large, and to these latter he devoted every guinea
which he could earn in his small but slowly growing practice. His
own manners were so brusque, and he was so lacking in the refinement
of many of his colleagues and competitors, that it took rare mental
qualities to force him to the front, to which he nevertheless rapidly
advanced. Bacon has said, "He that is only real had need of exceeding
great parts of virtue, as the stone had need be rich that is set
without foil," and this was never more true than in John Hunter's case.
His leisure hours were never unemployed. He obtained the bodies of
all animals dying in the public collections in London and so began
to form that enormous collection which became known later as the
Hunterian Museum. As his means afforded it he built and added to his
accommodations and carried on those vast researches into animal anatomy
and physiology to which the balance of his life was devoted. Although
his practice gradually increased and he became in time the most famous
surgeon and consultant in London, he used, nevertheless, to spend three
or four hours every morning before breakfast in dissection of animals,
and as much of the rest of the day as he could spare. Pupils and
students who wished to consult him had to come early in the morning,
often as early as four o'clock, in order to find him disengaged. He
had that rare ability to do a maximum of work with a minimum of sleep
which has been so conspicuous in the case of Virchow. Before he died,
Hunter attained to a large competence, and his anatomical collection,
consisting of some ten thousand preparations, made largely with his
own hands, was purchased after his death by the Government, for
seventy-five thousand dollars, and presented to the College of Surgeons
where it forms the chief part of the so-called Hunterian Museum.
Hunter's principal claims to greatness obtain in this, that he not only
brought the light of physiology to bear upon the practice of our art,
but by his writings and teachings and especially by his example led men
to follow along the paths he cleared for them. It is no small claim
to glory to be known by such pupils as Hunter had. By these, by his
colossal industry in building up his museum, and by his writings, he
will ever be known as the most prominent figure in the medical history
of Great Britain.
The fifth man in this quintette of geniuses which I am presenting to
you to-day was Francis Xavier Bichat, who was born in France in 1771,
and died in 1802. Although he was thirty-one years old at his death,
his career was so phenomenal, almost meteoric, that it deserves to be
held up as showing what one can do in the early period of his life,
if he will but work. As one reads of his originality and talent one
is led almost insensibly to compare them with those of some of the
world's famous musicians who, also, have died in early manhood after
giving to the world their immortal works, e. g., Schubert, Mozart and
Mendelssohn. Bichat was the son of a physician and applied himself
early to medical studies in Nantes, Lyons, Montpellier and finally
in Paris, where he became the pupil and trusted friend of Desault,
then the greatest Parisian surgeon. When Desault died, in 1795,
this young man began lecturing for him, at the age of twenty-four.
He displayed a wonderful, almost feverish scientific activity, more
particularly in the direction of general and pathological anatomy. He
was the originator of the phrase which he made famous: "Take away some
fevers and nervous troubles, and all else belongs in the domain of
pathological anatomy." Coming upon the stage shortly after Morgagni
left it, he was able by his genius, his logical acumen and his graces
of speech and manner, to give an attractiveness and importance to this
subject which it had hitherto lacked.
It was his great service to more clearly differentiate closely
related diseased conditions and to insist upon a study of post-mortem
appearances in connection with previously observed clinical phenomena.
He also established the tendency of similar tissues to similar
anatomical lesions. In fact our view of what we call general tissue
systems we in reality owe to him, since without use of the microscope
he distinguished twenty-one kinds of tissue, which he studied under the
head of general anatomy, while he held that descriptive anatomy had to
do with their various combinations.
To Bichat was largely due the overthrow of purely speculative medicine
because he placed facts far in advance of theories and ideas. Books
he said are or should be merely "memoranda of facts." That he made
many such memoranda will appear from the fact that before his untimely
death he had published nine volumes of essays and treatises, nearly
all bearing on the general subject of anatomy, normal and morbid. He
also had not only his limitations but his faults. He strangely denied
the applicability of so-called physical laws to body processes, he
minimized the importance of therapeutics, and he sought to place the
vitalistic system upon a realistic basis. Nevertheless he set an
example not only for the young men of France, but of all times and
climes, which should be often held up before them.
And so I have thus placed before you five bright and shining
illustrations of what brains and application can accomplish, selected
from different lands in order to show that medicine has no country, and
from a previous century in order that you may the better realize how
meagre was their environment in those days as compared with that which
you enjoy. Perhaps you will say, "there were giants in those days."
True, but the race has not entirely died out. While Spencer and Virchow
live one may not call the race extinct, nor can the times which have
produced such men as Helmholtz, DuBois-Reymond, Darwin, Huxley, Leidy
or Marsh, fail to still produce an occasional worthy successor.
But it is time now to draw this rather rambling discourse to an end.
The effort has been partly to attract your attention to some of
the side lights by which the vista of your futures may be the more
pleasantly illumined, and partly, by placing before you brief accounts
of the careers of some of your illustrious predecessors, to show that
eminence in medical science inheres in no particular nationality nor
race, neither comes it of heredity nor by request. Like salvation it
is available to all who fulfill the prerequisites. It is a composite
product of application, direction, fervor in study, logical powers
of mind, honesty of purpose, capability of observation, alertness to
improve opportunities, all combined with that somewhat rare gift of
tact, which last constitutes the so-called personal equation by which
many humanitarian problems are solved. _Study nature for facts; study
lives of great men for inspiration how to use them._
"Were a star quenched on high
For ages would its light,
Still traveling downward from the sky,
Shine on our mortal sight.
So when a great man dies
For years beyond our ken,
The light he leaves behind him lies
Upon the paths of men."
If then you regulate your mental habits by such a code other habits
will of necessity fall into the proper line. The only other admonition
I would give you in parting is summed up in these beautiful lines of
our own Bryant:
"So live that when thy summons comes to join
The innumerable caravan which moves
To that mysterious realm where each shall take
His chamber in the silent halls of death,
Thou go not like the quarry slave at night,
Scourged to his dungeon, but sustained and soothed
By an unfaltering trust, approach thy grave
Like one who wraps the drapery of his couch
About him and lies down to pleasant dreams."
That the sentiment is not new, however, will appear in this other and
ancient version which Sir William Jones has thus rendered from the
Persian:
"On parent knees, a naked newborn child,
Weeping thou satst while all around thee smiled,
So live that, sinking to thy last long sleep,
Calm mayst thou smile while all around thee weep."
X
THE CAREER OF THE ARMY SURGEON[7]
[7] Commencement Address at the Army Medical School, Washington, D. C.,
May 29, 1909.--From "_The Military Surgeon_," July, 1909.
The experience of listening to a so-called Commencement Address under
these peculiar circumstances is doubtless as novel to you as is to
me its preparation. So different is this occasion from that usually
spoken of as Commencement Day, that it taxed my judgment as much as
it did my ability to--as it were--"meet the indication," and to try
to say the appropriate thing. It behooves me to remember that this
is in effect not an address to a class of students just entering a
learned profession, but an effort on the part of one on the borderland
of experiences gathered from a civil surgeon's work, yet enjoying a
quasi military title, with strong ties and leanings--to some extent
inherited--toward the course of the army surgeon and the fascinations
of the soldier's life. Self-evident it is that you need no admonition
which I could give, for the very fact of your presence here indicates
that your selection by your superior officers stamps their approval of
your ability as well as your character.
Time has wrought vast changes in the personnel of the army medical
corps, as in every other branch of the service. From the days of
Xenophon, with his selection of the best material afforded, to the
dark middle ages with practically no provision, then to the later
centuries with their menial barbers and barber surgeons, and then the
very gradually improved conditions which bettered the service, down
to the present time, when the best is none too good, there has been
that same evolution which has characterized all the rest of mankind's
surroundings and man's realization of his public and private duties.
From the days when the first duty of the so-called army surgeon was
to minister to his commanding general, and when the private soldier
received but the scantiest if any attention, we have arrived at that
time when the good health of the entire army is the aim and pride of
the medical corps, and when public opinion demands for every enlisted
man a degree of watchful care greater than many parents bestow upon
their own families. The line officer of to-day can no longer afford
to disregard the advice of his medical officers, and camp sanitation
is now of even greater importance than operative technique, because
preventable sickness and the incapacity caused by disease are
recognized as far more to be dreaded than the bullets of the enemy.
Public estimate of our duties to the sick and wounded has varied
largely during different epochs. Thus Homer makes Nestor say:
"A surgeon skilled our wounds to heal,
Is more than armies to the public weal."
Homer also lauded the services of the two sons of Aesculapius, whom he
deified as the grandest of heroes and the wisest of surgeons, and thus
wrote of them at the siege of Troy, twelve hundred years before the
birth of Christ:
"Of two great surgeons, Podalirius stands
This hour surrounded by the Trojan bands,
And great Machaon, wounded, in his tent
Now wants the succor which so oft he lent."
Again he thus describes an operation:
"Patroclus cut the forky steel away;
While in his hand a bitter root he pressed,
The wound he washed and styptic juice infused;
The closing flesh that instant ceased to glow,
The wound to torture, and the blood to flow."
Contrast the tender mercies thus described with an incident occurring
during one of the exciting experiences of Ambroise Paré, who one
day, during a battle, saw three desperately wounded soldiers placed
with their backs against a wall. An old campaigner inquired, "Can
those fellows get well?" "No," answered Ambroise. Thereupon the old
campaigner went up to them and cut all their throats, "sweetly and
without wrath." Note, if you will, the expression, "sweetly and without
wrath," since it implies a primitive form of humanity in providing
euthanasia for the hopelessly wounded.
While it has been from time immemorial the custom to attach surgeons
to various armies, some idea of prevailing notions of antiquity may be
gained from the statement that Xenophon had but eight field surgeons
with his 10,000 troops. In his army the sick and wounded were cared for
in adjoining villages, or, when on the march, were carried in the rear
of the troops, being cared for by women from "the baggage." Whether
these women were the "vivandieres" of those days I do not quite make
out, nevertheless they must have been much the same thing.
In the days of Rome's greatest glory each cohort of 420 men had four
surgeons, while each legion of ten cohorts had one legionary physician.
In the navy there was also one physician to each trireme; nevertheless
the wounded on land or sea received scant attention, although it
is interesting to read that each soldier carried with him the most
necessary bandages ready for use, an emergency packet supposed to be
quite modern.
A few hundred years later, in the Eastern Empire, the Emperor Maurice
ordered that throughout every division of from two hundred to four
hundred cavalry eight or ten of the strongest men be selected, in order
to bring to the rear those who were severely wounded, to supply them
with water, and to collect the weapons lying upon the field. These
mounted cavalrymen received a small reward for each person rescued.
Three hundred years later this arrangement was continued in operation
by Leo VI. Wherever it was possible the sick and wounded soldiers
were cared for by monks or by sisters, in the numerous hospices and
institutions which abounded throughout the East, and although the care
was often of the worst the efforts made were in the right direction.
Holy oil, laying on of hands, supplication, and the use of holy relics
constituted a large part of the treatment in vogue; nevertheless these
remedies were not quite so injurious as some of the other and more
disgusting ones whose use prevailed in those days.
Without doubt the two army surgeons who during the last 500 years
achieved more fame than any of their colleagues were Ambroise Paré,
and Baron Larrey. Such commanding figures were they, not only in their
professional work, but in the general influence which they wielded
alike upon sovereign and common soldier, that they will ever be
regarded as among the most memorable characters of common history. Paré
died in 1590, Larrey in 1842. Each was passed along from one ruler or
commander to his successor, and each was regarded as about the most
priceless legacy which could be thus transmitted.