granted by Henry VI, in 1446. In 1576 they were amalgamated with the
independent surgeons, and by Queen Elizabeth with the barber surgeons
and wig-makers. This confraternity was dissolved in 1784 and the
College of Surgeons founded immediately afterwards. In Edinburgh the
barbers and surgeons were united in 1505, to be separated at about the
same time as elsewhere in Great Britain.
During the eighteenth and nineteenth centuries on the continent
medicine and surgery were abruptly separated, and the latter was
almost entirely in the hands of the barbers. For hundreds of years
the dissection of corpses and the embalming of those who could afford
it, were in the hands of first the butchers and later of the barbers.
The greatest contempt was everywhere shown for one who attempted any
surgery. If for instance a nobleman while being bled by a barber
received the slightest harm the poor barber was heavily fined, while,
should the gentleman die, the culprit was given into the hands of the
dead man's relatives to be dealt with as they desired. Throughout the
monasteries and whenever the influence of the Church was felt it was
forbidden to the monks, who had the monopoly of knowledge, to perform
any surgical operation since the Church abhorred the shedding of
blood.[8]
[8] I leave it to defenders of the Faith to reconcile this abhorrence
with the persecutions of heretics and the tortures of the Inquisition
permitted by the same Church.
For hundreds of years the monks were not allowed to wear a beard;
this necessitated the employment of tonsors ("tonsorial-artists"
they call themselves to-day) to whom was left also the performance
of anything that partook of the nature of an operation, such as
bleeding, bandaging, etc. This calling, was however, recognized as a
most inferior one, and the barbers, like the bathkeeper, the shepherd
and the hangman, were not considered of good repute. Consequently,
such an one was not eligible for membership in any other guilds or
fraternities. In 1406 the Emperor Wenzel was rescued from prison, in
Prague, by the daughter of a bathkeeper; in gratitude he made her his
mistress, and declared both barbers and bathkeepers to be respectable;
but having lost his position his decree had no weight, and not until
1548, in Augsburg, were they really made eligible to the guilds. At
this time their most dignified labor was the sharpening of instruments.
In 1696 Leopold I. decreed their profession to be an art, and gave it a
position above that of the apothecary so that in their most dignified
occupation they were elevated to the making of ointments and plasters.
As surgery has for the profession of barber surgery to thank the
existence upon man of a beard, so the European continent may thank
the Crusaders of the eleventh century for having necessitated the
existence of the bathkeeper, because of the leprosy which they brought
home from the East. During the Crusades, as is well known, there were
founded numerous Orders having for their original purpose the care and
protection of pilgrims and injured soldiers. The three most celebrated
Orders were the Knights of St. John, the Knights Templar and the
Teutonic Order. Were this the place it would be most interesting to go
into a history of these religio-medico-military Orders, and show how
from most devout purposes and humble origin they grew into despotic
and tyrannical associations of great power, which it finally took all
the force of Church and State to suppress. As the then humble and
enthusiastic members of these Orders returned from the Holy Land they
established hospitals for the care of lepers, who became very numerous
in Europe. For instance it is stated that in France, in 1225, there
were two thousand hospitals for this purpose, while the King Louis the
Great founded, in 1260, a special hospital for those made blind by
Egyptian ophthalmia. It is well known also that during the middle ages
there was the greatest neglect of the ordinary canons of cleanliness
both among the upper and lower classes. The number of hospitals and
cloisters dedicated to the lepers being insufficient, bath houses were
built and bathkeepers were engaged in order, so far as possible,
to prevent the spread of leprosy. At this time the bathkeeper was
permitted to bathe and cup, later also to bleed, although the bleeding
was required to be done in the bathkeepers' own house, since he was
not usually permitted to enter a patient's house. As bathing became
less necessary for purposes already mentioned the bathkeeper took to
imitating the barber, though much later, and not until about 1750 in
some countries, were they permitted to do this publicly, and only after
having passed the examinations to which the barber was also subjected.
In Prussia they were only allowed to treat wounds and chronic diseases,
and so it came about that by the beginning of the eighteenth century a
really conscientious and efficient barber surgeon was supposed to have
served an apprenticeship in large hospitals, to have witnessed the work
of noted surgeons and to have served in the Army or Navy. He was also
supposed to be something of a linguist and to know a little botany;
particularly was he expected to be conversant with anatomy, although
there was a sad lack of cadavers--which was atoned for by the use of
carcasses of animals, for the main part swine.
Eckardt, writing at this time of the sixteen different virtues of a
barber, enumerated, first of all, fear of God; then that he should be
careful, prudent, temperate, and ready to use both hands with equal
dexterity; he claimed that "Arrogance seems most prevalent among
barbers, as a common saying would imply 'barbers are proud animals.'"
He expressed his surprise also at the envy and malice between
bathkeepers and barbers, and advised them both to consult physicians
and other masters.
The customs of the time must be blamed for this lamentable condition of
affairs. The boy who was destined to become a barber was apprenticed
at a time when he had scarcely learned to write. If he could write
legibly and read a little Latin no one dared refuse him. He learned
to shave and went from house to house for this purpose, spending the
little time remaining in sharpening knives, spreading plasters, picking
lint, taking care of children, doing all menial duties, and using the
same light as the housemaid because it would have been disrespectful
to his master's wife to use any other. After years of this work he
was gradually taken to visit patients and then was taught how to
bleed, cup, apply leeches, extract teeth and clysters. His master
knowing nothing of anatomy could give him no instruction, though by
the laws of apprenticeship he was bound to do so. Before concluding
this apprenticeship he was supposed to pass an examination, which his
master's laziness usually permitted him to escape. He then presented
the master with some silver instruments and was dismissed with an
injunction to be thankful that such a miserable specimen of God's
creatures had ever been taught to shave a beard or spread a plaster.
He now became a journeyman, still living at the house of his master,
and was not allowed to marry; after a while he received a paltry sum
as wages, got his dinners free and began to dabble on his own account.
Study was out of the question; these men could not understand what
little they did read and served the community mainly as bearers of
tales. After some years of activity as journeyman they could become
masters by applying to the authorities, presenting certificates, and
passing an examination before the physicians of the district.
Prussia was the first country to appreciate the necessity of regulating
medical practice, and the barbers and bathkeepers were placed under the
control of the Medical College founded, in 1685, by Prince Frederick
William. In 1724 this institution attained its greatest activity,
having a subordinate school in each province. In 1725 King Frederick
William issued a famous edict which did much to regulate medical
affairs throughout the kingdom, and directed among other things that
barbers and bathkeepers should "lead a religious, temperate, retired
and sober life, in order to be at their best whenever their services
were required." When their business was not sufficiently good they
assumed other cares, as, for instance, one man was surgeon, municipal
judge and post-master all at once. They were extremely envious of
each other and often dabbled in medicine without permission. It was
not until 1779 that the bathkeepers were permitted to rank in Prussia
with the barbers, and were allowed to use more than four basins, the
bathkeepers' guild being incorporated with that of the barber.
There being no temptation to enter these ranks it is not strange
that so late even as 1790 good surgeons were rare in Germany; not
one in fifty of the barbers really knowing the first principles of
the work they were supposed to perform. It came to such a pass that
surgeons were compelled to shave and perform other duties of the
hairdresser, for no surgeon, however skilled, was allowed to practice
as such, unless he was the proprietor of a head-shaving and bathing
establishment, with assistants and apprentices, and belonged to the
barbers' guild, or unless he was favored by Royal exemption. It was
the general lament in Germany, all through the 18th century, that
German surgeons were educated in barber shops. Even by the middle of
that century the practice of surgery was not considered an honorable
business, and those who practiced it were not permitted to carry a
sword, neither was a surgeon admitted into society nor tolerated among
physicians; moreover when unsuccessful he was bitterly and relentlessly
pursued. Under existing conditions the Reichstag either could or would
do nothing to alleviate the distressing condition. The physician
boasted of his education and treated the surgeon and his craft with
disdain, holding that surgery sustained the same relation to medicine
that geometry does to higher mathematics and physics. All this time,
however, while the physician contented himself with disdaining surgeons
he made no attempt to elevate the craft nor to himself study and adorn
it. Even by the beginning of the nineteenth century there were scarcely
any physicians in Europe who could diagnose a surgical case, while
dentistry they claimed called for no more skill than that sufficient
for tooth extraction. It was even claimed that so long as the people
generally were neglectful of their teeth the physician, or even the
surgeon, should be ashamed to concern himself with dentistry.
Von Siebold, in his day, deplored the position of the surgeon; his
large military experience had shown him the difficulties with which he
had to contend before he could enter society, while his ambitions and
high motives were scorned. Even the peasantry were bitterly opposed
to all operations. So intense were their feelings that he repeatedly
removed his patients to other towns before performing operations.
Nevertheless it was true that there were the best of reasons for lack
of confidence in any barber who dropped his razor for the purpose of
treating a fracture, a hernia or an obstetric case. The State required
a barber surgeon to call in a physician in all complicated surgical
cases. In such a case the physician demanded the control of the case
and reserved to himself the right to judge of what was required. He
would not even consider a surgeon who had obtained the doctorate as
his equal. Such consultations resulted in little but quarrels and
disagreeable scenes. If a village contained no physician the surgeon
treated also internal diseases, though he was not allowed to use strong
medicines. Every district had its special surgeon who, alone, had
charge of several villages where he had the right to keep journeymen
and apprentices and to do shaving and cupping. In the Prussian capital
city only twenty German and six French surgeons were allowed to
practice in 1725, besides the court and private surgeons.
Until 1808 every German surgeon carried on a medico-legal business
which was later separated from his surgery. In 1782 there were three
classes of surgeons; from the lower one might be promoted to a higher
after an examination. In Austria, in 1805, there were doctors of
surgery who were required to show a general knowledge of medicine and
who had the same rights as the physicians; there were also medical
surgeons who could practice under restrictions, and bathkeepers for
minor surgery. After the year 1773 barbers and bathkeepers were both
spoken of in Austria as surgeons; this was to break up the disputes
between them. According to an official feebill holding good in Prussia
in 1815, the highest fee that could be charged for an operation was for
lithotomy in adults, the maximum limit being about M. 140 ($35), while
the majority of operations ranged from M. 20 to M. 50 ($5.00 to $13.00
expressed in U. S. money). Of course this was at a time when the value
of money was much greater than now.
As already made plain, it was the Church which by its decrees brought
about the separation of surgery from medicine, a condition not existing
during the palmy days of Greece and Rome. Even the University of
Paris at one time refused to admit a student who had not foresworn the
study of surgery, while the denouncement of anatomy and surgery alike
was promulgated by both papal bulls and clerical decrees. While many
of the physicians considered surgery too burdensome a study, and many
others had a severe prejudice against it, the principal cause operating
to keep them apart was probably the fact that for surgeons there was
absolutely no social position. In 1774 Mederer was made Professor of
Surgery in Freiburg, in Breisgau; he delivered his opening address
on the wisdom and necessity of combining medicine and surgery. As a
result he was persecuted by the public, insulted by students, abused by
surgeons and constantly threatened with personal assault. He maintained
his position, however, and fought against the prejudice. Twenty-two
years later, when he left Freiburg, he referred in his last lecture to
his early experience. By this time public opinion had been so changed
that the students serenaded him and humbly apologized for what their
predecessors had done. Mederer could then see the success of his
efforts in that the constitution of France contained a clause combining
medicine and surgery, and the Royal Sanitary Commissioners of Vienna
had unanimously resolved in favor of such union.
The movement begun by Mederer was continued by men like Richter, Von
Siebold, Loder and others. In 1797, or over a hundred years ago, the
Electoral Academy of Erfurt offered a prize for the best essay on
the subject "Is it necessary and possible to combine medicine and
surgery theoretically as well as practically?" Fourteen papers were
submitted, of which twelve were in favor of union. Nevertheless the
Academy awarded the prize to the only writer who had opposed such
union. His reasons for such opposition were most puerile, as were all
the arguments subsequently advanced against it. Nevertheless a great
step was taken in advance, when the guilds and fraternities of barbers
and bathkeepers were abolished, in which good work Vienna, in 1783,
took the lead. It was then declared that shaving was the business of
the hair-dresser, and that barber surgeons must attend lectures in
surgery and anatomy. Bavaria followed in 1804, and four years later,
in Prussia, no one was permitted to practice surgery without having
studied medicine. The rules of 1786 regulating the respective positions
and duties between physicians and surgeons were annulled in 1808, and
by 1811 the barber license was no longer essential for the practice of
surgery, the privileges of the barber, as such, being abolished, while
for his trade only a common license was needed.
XII
THE STORY OF THE DISCOVERY OF THE CIRCULATION
A STUDY OF THE TIMES AND LABORS OF WILLIAM HARVEY[9]
[9] Address delivered at the Annual Commencement of the Medical
Department of the University of Chicago, (Rush Medical College), June
13, 1906.
History in general is but a record of the succession of great events
or epochs which have moulded the world's affairs. That which is of the
greatest import in the life of the individual may count for little in
the lives of his contemporaries, and yet it must be said that in the
events of to-day there has occurred a great epoch in the life of each
of you, presumably the most important as yet in your personal records.
This day is then in your personal histories one of the greatest
importance. It is desirable, therefore, that your lives be so moulded
and influenced by it that you may long hence look back to it and recall
its significance.
I do not know what advice I can give you which will be more fruitful
of results, than that among your studies you include that of the
lives of the great men who have moulded destiny and made the world's
history. Their lives were modified by little things, as have been and
will be yours, and yet out of small matters grew for them and for us
some of the most far reaching effects. Select the really great men of
whom you best happen to know and analyze their characters that you may
appreciate how they have become great; while if they have, as all great
men have, traits of smallness, study even wherein they are small, and
how such faults may be avoided.
History runs as does a fairly steady stream, save that every now and
then some event abruptly diverts its course or influences its current.
It has been so, for instance, with the history of medicine. For the
first sixteen hundred years of the Christian era men engaged in the
crude practices of our profession, utterly ignorant of the course of
the blood, as well as of its purposes. Then appeared upon the scene a
man who did his own thinking, who was willing to free himself from the
shackles of the past, to observe nature and to reason therefrom. In
this way came suddenly upon the world, as it were, an appreciation of
the Circulation of the Blood, than which perhaps no event in medical
history has been of greater importance or reflected more credit upon
its demonstrator.
It is my purpose, then, to-day to try to tell you, in a semipopular
way, how William Harvey came to make this great discovery, as well as
to give you some idea of the difficulties under which he worked, and of
the men and influences that surrounded him, believing that rather than
spend a half hour in humorous platitudes which may provoke a smile,
but which are quickly forgotten, it is much better to try to implant
something which may linger a while in your memories, and sufficiently
impress you with the value of observation and inductive reasoning,
since if you become thus fully impressed you will be spared in the
future many sad errors of speech and even of thought.
Before telling the story of Harvey's life and work let us study for a
few moments the general condition of affairs in Europe, in order that
we may better understand the men whose influence surrounded him, as
well as the spirit of the times and men's habits of thought.
Among the monarchs reigning in various parts of Europe during Harvey's
time there were, for instance, in that part of the Empire of the West
which was called Germany, Rudolph II, Matthias and Ferdinand. In
Sweden reigned King Sigismund, Charles IX, the great monarch Gustavus
Adolphus, and Queen Christine. In Prussia the throne had been occupied
by Joachim, George William and Frederick William, as electors, this
being before the days of the Prussian kings. In Russia the Czars Boris
Godunow, Michael Theodore and Alexis had occupied the throne.
France had but recently passed through the inhuman butchery of the
massacre of St. Bartholomew and its accompanying persecution of the
Huguenots, under Charles IX, who expressed the hope that not a single
Huguenot would be left alive to reproach him with the deed, but who
died himself soon after the massacre, which is said to have caused
him bitter remorse. Charles had been succeeded by his brother Henry
III, a weak, fickle and vicious monarch, whose weakness caused him
to be embroiled in civil strife, which was only concluded by his own
assassination at the hands of a Dominican friar. Then came Henry IV, he
of Navarre, afterwards surnamed The Great, who fought the famous battle
of Ivry in 1590, and who reigned for twenty-one years, the greatest
and most popular sovereign who ever occupied the throne of France.
Notwithstanding his noble qualities he did not succeed in preserving
his court from many of the contaminations of the age, and in his reign
it is said that no less than 4,000 French gentlemen were killed in
duels, chiefly arising out of quarrels about women. He was succeeded by
Louis XIII, who was still on the throne when Harvey died.
In Harvey's own country James I was occupying the throne when Harvey
appeared upon the scene. He was that royal pedant whom the Duke of
Sully pronounced "the wisest fool in Europe." After his death, and when
Charles I ascended the throne during his twenty-fifth year, in 1625,
Harvey was preparing to publish his great work. It was this Charles I
who retained as a favorite the worthless scoundrel Buckingham, whose
misconduct in Spain prevented the proposed marriage of the king with
the Spanish Infanta and brought about the Civil War. It was because
of the cost of this war, and of the king's disputes with Parliament
regarding the matter, that England was rent between the conflicts of
the Cavaliers and the Roundheads, two of the consequences of this
intestine strife being the execution of the Earl of Strafford and of
Archbishop Laud. The troubles thus engendered finally cost the life of
the king himself, who was beheaded in 1649. Harvey even lived to see
the first half of the short tenure of office of Cromwell as the Great
Protector, and was perhaps fortunate in dying before began the reign of
that odious profligate Charles II.
It is worth while to enquire for a moment what was doing on this side
of the ocean at this period which we have now under consideration. In
1607 Virginia was settled by the English, in 1614 New York, by the
Dutch, in 1620 Massachusetts and, three years later, New Hampshire,
by the English Puritans; in 1624 New Jersey, by the Dutch, in 1627
Delaware by Swedes and Finns, in 1630 Maine, by the English, in 1634
Maryland, by Irish Catholics, in 1635 Connecticut, by English Puritans.
Thus it will be seen that the active period of Harvey's life was
synchronous with the beginnings of our colonial activities. Very little
knowledge of what was going on in the then world of science was brought
to this country at this period of its existence, however, and it was
many years before in these colonies there were any exhibitions of
scientific interest save in extremely scattered and sporadic cases.
Among Harvey's literary associates were a number of celebrated English
poets, for example,--Marlowe (1593), Spenser (1598), Beaumont (1615),
Shakespeare (1615), Herbert (1635), Ben Jonson (1637), Massinger
(1639). Lord Bacon died a year or two after the appearance of Harvey's
book, while Baron Napier, the inventor of logarithms, had passed away.
His contemporaries in Italy, where he had studied, included Tasso
(1595) and Galileo (1645). Rubens had died in 1640, Michael Angelo in
1564 and Titian in 1576. In France, Calvin, the practical murderer of
Servetus, had passed away in 1564, Beza died in 1605, Descartes in
1650, Pascal in 1662 and Gassendi in 1655. Portugal had produced but
one great figure in the 16th century, namely Camoens, who died in 1579.
In Spain, Loyola, the ascetic and fanatic founder of the Jesuits, had
joined the great majority in 1556; but Cervantes did not die until
1616, Lope de Vega in 1635, Velasquez in 1660 and Calderon in 1667.