recent formation of ambulance corps and later of nursing bureaus,
within our own service, and the employment of trained nurses. This has
not been in all respects an easy matter to bring about, nevertheless it
has redounded to the credit and to the welfare of all concerned. Never
at any time were the sick and injured, either in private or in military
practice, so well cared for as now, and America should lead the world
to-day, as ever, in the adequacy of its provisions and the perfection
of its methods. In private this is notably the case in ordinary
hospital work, as seen by all travelers, upon the continent and in
Great Britain, who take pains to make comparisons with the way in
which things are done there and in our own country. Although Florence
Nightingale immortalized herself by showing what woman could do on
the battle field and in military camps, it has remained for Americans
to improve upon the lessons which she taught, while at the same time
revering her for her wonderful devotion to her self-imposed duty and
her enthusiasm. In its performance the lessons of the Crimean and the
Civil War, for instance, have left their impressions upon history in
such a way as may never be erased, and certainly no one was ever more
entitled to the designation of "angel of the sick room" than was Miss
Nightingale.
Wars of conquest bring about curious results and in unexpected ways.
While greed, lust and fanaticism have been the three great impelling
and underlying motives for most of the wars which man thrusts upon his
fellow-men, one far nobler motive has been the occasional and the only
just cause of strife, namely, the desire for liberty; still this is
always secondary and the product of some other man's or people's greed.
As only by the cataclysms of the natural world has it been prepared for
man's habitation, so by some wars have come benefits unforeseen, with
an amelioration of the condition of mankind in general, which could
not have been secured by any less drastic measures. It is, however, a
sad commentary on man's intelligence that most honor is paid to those
who have taken the most lives rather than to those who have saved
them. No school boy in the remotest districts but is brought up with
some trifling knowledge of the world's heroes, so-called, though they
were in reality the world's wholesale murderers. Yet you may find
many persons, credited with higher education, who are still densely
ignorant of the benefits conferred by those two greatest discoveries
in the world's history (both of Anglo-Saxon origin), _anaesthesia_ and
_antisepsis_, who will talk entertainingly and at length of Darius,
Caesar, Hannibal and the more modern military lights, yet who never
heard of Morton nor of Lister. Yet if to-day you inquire what is doing
in the various parliaments of the world you learn that the talk is
ever of more numerous and more powerful engines of destruction, and
that those in power have no time to devote to improvements in the army
or navy medical service, and that it is even now impossible to secure
anything like adequate attention to our needs in this direction.
Means of taking human life must be constantly at hand; means of saving
it are of small importance until the emergency has arisen; and then the
blame for inadequate provision of both means and men falls not where
it belongs, on the politicians who would not look ahead, but upon the
administration of the medical department, who work to the point of
desperation and despair in times of peace, who keep perpetual vigil,
with scant recognition of the sacredness of their purpose, and scant
aid in its accomplishment.
Are the lessons of the South African, the Spanish-American and the
Russo-Japanese wars to be forgotten almost before they have been
recited? Are we prepared to-day to give adequate care and attention
to our soldiers and sailors were war in sight? You well know that we
are not; every military or naval surgeon knows we are not; the medical
profession generally knows it; and our legislators have been told it
until we are tired of repeating it. Yet, what is the result? The same
indifference on their part, the same ignorance of what it all means;
and on the part of the public the same blindness and fatuous confidence
that "everything is all right."
For instance, if an adequate medical service is to be built up for war
there should be one officer to every 100 of enlisted men. Estimating
that an army of at least 400,000 men would be required were we engaged
with a first-class power--and what other would dare to engage with
us?--this means 4,000 army surgeons. Of these at least one-fourth
should be regular and experienced medical officers. In other words,
there should be for such an army at least 1,000 medical officers in
the regular service, and also at least 3,000 volunteer surgeons,
professionally and physically equipped for such work. Should anyone
object that this exceeds all the provisions of time past, the reply is
ready and all sufficient, namely, that in time past all such provisions
have been utterly inadequate; that the conditions of modern warfare
have undergone an entire change, that a sick, wounded or disabled man
is an encumbrance, and that it behooves us to prevent sickness, and to
cure the disabled man as quickly as possible. Furthermore, advances in
medicine and surgery have been so great that far more is now expected
of the medical corps than ever before, and it is a duty which we owe
to those who incur the dangers of fighting for us that we should care
for them. We are, therefore, under the very highest moral obligation
to give them our best, and enough of it. It must be a small inducement
that we offer to men to fight our battles if we permit them to feel
that they are not objects of our solicitude when sick or wounded.
There is another feature which we cannot disregard. So long as army
regulations require that a man educated in advanced science spend much
of his valuable time in acting as bookkeeper or clerk, there will
be less inducement to enter the service, and it will consequently
not attract men of highest proficiency. That which is required of
you is complicated and exacting. You must be good bookkeepers,
good sanitarians, and equally good surgeons, physicians and even
obstetricians. Above all, you are expected to be able to keep all the
men under your supervision ready for the "firing line" at a moment's
notice. You have received the highest compliment which the State can
pay when you have been adjudged versatile and competent enough to fill
all these rôles and do all these things.
Moreover, as you gain promotion other things will be expected of you,
even, I hope, the filling of the chairs in this modern Military Medical
School. It is in a way the West Point of the medical corps, and it
would seem as though there should not be the slightest difficulty in
replenishing vacancies in its faculty by detail from your ranks. The
collections and the literary labors of your corps constitute to-day
treasures exceeded in value by but few if any in this, the Nation's
Capital. The library, the museum and the archives of the medical
department have been models from which all the nations of the earth
have copied.
In this connection there occurs to me, by way of contrast, the story of
a French surgeon's experiences when he undertook to teach anatomy in a
conquered and reconstructed country.
After the French occupation of Egypt, Mehemet Ali took it into his head
to introduce European civilization into Africa, and imported all sorts
of artists, scientists and medical men, among them a practitioner of
Marseilles, a true Bohemian in the modern acceptance of the expression,
who presented himself in most seedy apparel, saying, "I am a doctor
of medicine, with plenty of courage, but no clothes; I want to try
my fortune." This man was Dr. Clot, who rapidly became a favorite
of the Viceroy. He soon learned Arabic so as to speak it fluently,
and in six months not only received an army commission, and became a
Bey, but took the chair of anatomy in the newly organized school of
medicine. Conditions were all against him. Mussulman fanaticism and
the prohibitions of the Koran opposed all anatomical pursuits, and so
soon as he proposed a dissection there was a general explosion. By
Mohammedan ceremonial one who even touches a dead body is thereby
rendered "unclean" for seven days. The Ulemas, the Muftis, and all of
the other fanatics, demanded of the Viceroy the closure of the school,
and declared dissection a sacrilegious profanation. Mehemet refused
this, and ordered Clot Bey to commence his demonstrations. Then one
day happened the following incident: The professor, scalpel in hand,
standing alongside the cadaver, began to open the thorax, when one
of the students, either from sheer fanaticism, or more bold than the
others, jumped upon him and stabbed him with a poignard. The blade
slid over the ribs, and Clot Bey, perceiving that he was not seriously
hurt, applied a piece of plaster to the wound, observing as he did
so, "We were speaking of the disposition of the sternum and the ribs,
and I now can illustrate to you why a blow directed from above has so
little chance of penetrating the cavity of the thorax." He continued
his lectures, and turned out some skilful practitioners. He became an
officer of almost every order in the world, and acquired more than
sixty decorations, although he never wore but one, the red rosette of
his own country. (_Med. Times and Gazette_, September 19, 1868.)
While just such an experience may never be duplicated again, the
Philippines, or some other country yet to fall under our rule, may
afford an opportunity for a similar display of _sang froid_.
While no one may see far into the future, the maxim, "In time of
peace prepare for war," is as true of the medical department as of
any. Were it a state secret no one would breathe it here, but it is
lamentably true and publicly known that even now we are not prepared
as we should be. The awful lessons of the Spanish War have been
forgotten. West Point officers have until comparatively recently
received no instruction in camp sanitation. Some of us worked hard a
while ago to have at least elementary instruction in it introduced
into their curriculum. As an illustration I believe that to-day they
are taught more about horse's feet and how to keep them in good
condition, than about those of their men. Line officers, especially
volunteer, have never been too ready to locate their camps where water
and drainage were the best, and the awful mortality of the Spanish War
was mainly due to preventable disease, while this was due to stupid
and inexcusable disregard, on the part of officers of the line (mainly
volunteer) of the advice of their medical officers.
But, after all, gentlemen, the discouragements you will meet with will
be far fewer than those with which your predecessors had to contend,
while the pleasant side of your lives will be far pleasanter than was
theirs. In fact, I think your lives have in many respects fallen in
pleasanter places than have ours. Discipline and order protect you to
a large extent from quackery and idiocy. The fads of the day disappear
before the appearance of the flag and the sound of the drum. So-called
Christian Science finds no place in your curriculum, and it will be
long, I trust, before the army chaplain tinctures the military hospital
with sectarian therapeutics or an Emanuel church cult. If by entering
the army one may escape disgusting influences of this character, then
it may become such a refuge that it shall thereby be made both inviting
and invincible.
It is pleasing to those of us who co-operated in the movement, to have
the assurances of the Surgeon General that the establishment of the
Medical Reserve Corps has been of actual benefit to the regular Army
Medical Department. While the military rank to which its members found
themselves suddenly elevated was not so lofty as to cause any attacks
of vertigo, none having been up to the present day reported, it at
least gives us satisfaction to realize that help may thus be afforded
from private life, and that a closer rapport has been effected.
And now it is well nigh as difficult a task to appropriately conclude
these remarks as to begin them. Men come and go; a few leave imprints
of their footsteps; the vast majority make no impression that lingers.
"Some when they die, die all; their mouldering clay
Is but an emblem of their memories;
The space quite closes up through which they passed."
Fain would I believe that many of you would make enduring records. Yet
each can do his best, and I doubt not each will do it. You have so
much to encourage you, so comparatively little to hamper or hold back.
Glorious is your work, glorious may be your fulfillment of it. We have
lived in a goodly time; you will enjoy one still more goodly. With
scientific progress, whose like the world has never known, and with an
altruism which makes the world constantly better, you will be able to
do things never done by your predecessors.
"'Tis coming up the steeps of time,
And this old world is growing brighter!
We may not see its dawn sublime,
Yet high hopes make the heart throb lighter!
Our dust may slumber underground
When it awakens the world in wonder;
But we have felt it gathering 'round!
We have heard its voice of distant thunder.
'Tis coming! Yes, 'tis coming!
"'Tis coming now, that glorious time
Foretold by seers and sung in story,
For which, when thinking was a crime,
Souls leaped to heaven from scaffolds gory!
They passed. But lo! the work they wrought!
Now the crowned hopes of centuries blossom,
The lightning of their living thought
Is flashing through us, brain and bosom;
'Tis coming! Yes, 'tis coming."
XI
THE EVOLUTION OF THE SURGEON FROM THE BARBER
If one attempt to scan the field of the history of medicine, to take
note of all the fallacies and superstitions which have befogged men's
minds, and brought about what _now_ seem to be the most absurd and
revolting views and practices of times gone by, and if one search
deliberately for that which is of curious nature, or calculated to
serve as a riddle difficult of solution, he will scarcely in the tomes
which he may consult find anything stranger than the close connection,
nay, even the identity maintained for centuries, between the trade of
the barber and the craft of the surgeon. Even after having studied
history and the various laws passed at different times, he will still
miss the predominant yet concealed reason for this state of affairs.
This will be found to be, in the words of Paget, the "maintenance of
vested rights as if they were better than the promotion of knowledge."
He will wonder also why women were licensed to practise surgery in the
fourteenth century and prevented in the nineteenth, or why specialties
were legally recognized in the sixteenth century only to lose their
dignity and identity a little later.
In thus attempting to consider the relations which have existed in
time past between barbers and surgeons I must ask you to remember
that there was a time when bleeding was deemed necessary for the cure
of almost all ailments, and that after the Church had condemned the
shedding of blood by any of her officials it was most natural to turn
for assistance to the barbers, who were supposed to be dexterous with
sharp instruments, with basins and with towels. Thus it happened that
when the barbers found themselves permitted to perform this sole act
they naturally ventured further and practised many parts of minor
surgery independently of the ecclesiastics.
Moreover there persist to-day in Europe many relics of the old customs,
and the barber surgeon is still a common figure in Germany, and
particularly in Russia, where the really educated surgeons are still
too few for a vast and widespread population. It must be remembered
also that the Church gradually imbued men's minds with a horror of a
dead body, and of the profanation which followed having anything to
do with it, and surrounded the study of anatomy with every possible
obstacle and obloquy; even to such an extent that to be known as having
dissected a human body was to be exposed to indignity, assault and even
death. It was, therefore only intense yearning for knowledge, on the
part of earnest men, which then permitted anatomical instruction to be
given or encouraged.
During the middle ages the greatest medical school in the world was
situated at Salernum (or Salerno), but a short distance from Naples.
This is not the place in which to discuss its history, although it
became famous above almost every other institution of learning of any
kind, and though, by one of the freaks of history, even the site of the
buildings is now lost and no one seems to know just where they stood.
In his time, namely, in 1240, the Emperor Frederick II was the great
patron of this college; his decrees concerning the regulation of the
study and practice of medicine deserve attention to-day. A part of one
of his enactments reads as follows: "Since it is possible for a man to
understand medical science only if he has previously learned something
of logic, we ordain that no one shall be permitted to study medicine
until he has given his attention to logic for three years. After these
three years he may if he wishes proceed to the study of medicine." And
again: "No surgeon shall be allowed to practise until he has submitted
certificates in writing, of the teachers of the faculty of medicine,
that he has spent at least one year in that part of medical science
which gives skill in the practice of surgery, that in the college he
has diligently and especially studied the anatomy of the human body,
and is also thoroughly experienced in the way in which operations are
successfully performed and healing afterwards brought about."
When first we hear of medical men in Great Britain they were commonly
spoken of as _leeches_, as among the Danes and Saxons; later the
clergy introduced books from Rome, and almost every Monastery had
some brother possessed of more or less knowledge of the medicine of
the day. The College of Salernum later gave great impetus to the study
of medicine, even before the days of William the Conqueror, which was
strengthened by the influence emanating from Naples, and particularly
from Montpellier. For centuries the Catholic clergy were almost the
only persons with sufficient education to study and practise physic;
which profession became in time so lucrative that many of the monks
abandoned their monasteries, neglecting their religious duties, and
applied themselves to the study of medicine. To such an extent was this
true that in 1163 the Council of Tours forbade monks staying out of the
monastery for more than two months at a time, or teaching or practising
physic. In taking this action the Council only repeated what had been
ordained by decree of Henry III in 1216, and by the second Council of
Lateran in 1139. No restraint was at first placed upon the secular
clergy, and many of the Bishops and other church dignitaries gained
both money and honor by acting as physicians to Kings and Princesses.
Next to the clergy the Jews possessed the largest share of learning.
Their nomadic life permitted an intercourse with the different nations
of the world, which was denied to most others, and there were many
who studied medicine and practised, not only among those of their
own race but amongst Moors and Christians alike. The priests became
extremely jealous of Jewish physicians and of lay surgeons, and
endeavored to secure through Rome a formal excommunication of all who
committed themselves to the care of a Jew, while by canon law no Jew
might give medicine to a Christian. But so celebrated were the Jewish
physicians, and so superior to everything else was men's desire for
life and strength, that even the power of Rome could not exclude them
from practice. Still less could the clergy restrain the lay surgeons
from the performance of their craft, and though it would appear that at
first, in England, the priests were not disposed to separate surgery
from medicine, the Pope became jealous of so much interruption to
the duties of the clergy and looked upon the manual part of surgery
as detracting from clerical dignity. Accordingly were made numerous
attempts to debar priests from the performance of surgical operations.
In 1215 the ecclesiastics were prohibited by Pope Innocent III from
undertaking any operation involving the shedding of blood, while by
Boniface VIII at the close of the thirteenth century, and Clement V,
about the beginning of the fourteenth century, surgery was formally
separated from physic and the priests positively forbidden to practice
it. It is to the Church then that we owe this absolute abandonment of
surgery to an illiterate and grasping laity. For some time, however,
the priests kept their hold upon surgery by instructing their servants,
the barbers, who were employed to shave their own priestly beards,
in the performance of minor operations. It was these men, who were
in some degree qualified by the instruction of the clergy, who first
assumed the title of barber surgeons, and who gradually formed a great
fraternity.
In France it was in the reign of Louis XIV that the hairdressers
were formally separated from the barber-surgeons, the latter being
incorporated as a distinct medical body. In London it was in 1375 that
the Company of Barbers were practically divided into two sections,
containing respectively those who practiced shaving, and those who
practiced surgery. In 1460 the surgeons were finally incorporated by
themselves as the Guild of Surgeons and took their place as one of the
liveried companies of the city of London. Similar separation occurred
in the original great Guild of Weavers, who divided into the Woollen
Drapers and Linen Armourers, the latter afterwards becoming the wealthy
and powerful Company of Merchant Tailors.
To trace the history of the London Company of Barbers a little more
fully, it was first formed in 1308 and incorporated in 1462 by a
charter. In one of the statutes of Henry VIII it was enacted that:
"No person using any shaving or barbery in London shall occult (i. e.
practise) any surgery, letting of blood or other matter except only
drawing of teeth." In 1540 Parliament passed an act allowing the United
Companies of Barbers and Surgeons each to have yearly the bodies of
four criminals for dissection. In 1518 the barbers and surgeons were
united in one company; the former being restricted from all operations
except tooth drawing, and the latter having to abandon shaving and hair
dressing.
It is interesting also to note that in Oxford, for instance, the
Barbers, Surgeons, Waferers and Makers of "Singing bread" were all of
the same fellowship, from 1348 to 1500; when, at last, the Cappers,
or knitters of caps, were united to them, in 1551, the barbers and
waferers abrogated their charter and took one in the name of the city,
until 1675, when they received a charter from the University.
The London Guild of Surgeons appears to have been first a mere
fraternity which had incorporated itself, and to have originated from
an association of the military barber surgeons who had been trained
in the hundred years war with France, 1337 to 1444. Its membership,
however, was select, and when the physicians declined an alliance
with it, it amalgamated with the barber companies in 1540. The United
Company of Barbers and Surgeons was peculiar in that strangers and
those who were not free men were admitted, while the journeymen of
the craft formed a subordinate body within the company. In 1745 the
surgeons separated from the barbers and formed a surgeon's company
which rapidly acquired influence. By a foolish blunder it forfeited
its charter in 1796 but was subsequently incorporated by George III,
in 1800, as the Royal College of Surgeons in London; a body which
has since maintained its identity, grown tremendously in wealth and
strength, and having become one of the licensing bodies of England,
has acquired the finest collection of books and specimens in the world
and has numbered the brightest intellects which the English surgical
profession has contained.