many absurdities held much important truth. SPRENGEL indicates LIBAVIUS
of Saxony as the person who first cultivated chemistry apart from
theosophy, and he names ANGELUS SALA as his successor. LEMERY, in the
middle of the seventeenth century, began to reform pharmaceutical
chemistry. After PARACELSUS chemistry became an indispensable study to
every physician. Our word _tartar_, the scale which forms on the teeth,
is of Paracelsian origin. He taught that the basis of all diseases was
a thickening of the juices and the formation of earthy matter, which
he called _Tartarus_, because it burns like the fire of hell. After
PARACELSUS we have VAN HELMONT, a true chemical discoverer who sought
in chemistry a theory of disease of which his doctrine of fermentation
in the body holds an important place. Next we have SYLVIUS, with his
doctrine of the opposition of acid and alkali. Digestion he considered
a process of fermentation or effervescence of the acid of the saliva
and pancreatic juice with the alkali of the gall. When either the acid
or the alkali predominated, disease was supposed to follow. The human
body was regarded as a laboratory, the stomach as a sort of test tube.
BOYLE made objections to the doctrines of this school, and HERMAN
CONRING taught that the proper place of chemistry was not in physiology
and pathology, but in pharmacy.
VIRIDET of Geneva endeavoured to prove that the fluids of the body are
either acid or alkaline by experiment. RAIMOND VIEUSSENS declared that
he had discovered an acid in the blood and a ferment in the stomach.
HECQUET opposed him, and said that digestion was not a process of
fermentation, but of trituration. PITCAIRN in England, BOHN and HOFFMAN
in Germany, and BOERHAAVE in Holland opposed the iatro-chemists, and
proved by observation that digestion is not fermentation, and that the
acid and alkali theories of disease supported by SYLVIUS were false.
By the influence and authority of these eminent physicians, the reign
of the chemical school of physiology was overturned. The great fault
of the iatro-chemists was their neglect of the effect of the solids of
the animal body; they assimilated the work of the physician, as Whewell
says, to that of the vintner or the brewer.
THE IATRO-MATHEMATICAL or MECHANICAL SCHOOL attacked, defeated, and
superseded the iatro-chemists. According to this sect, the human body
is a mere machine. Whewell explains that the Mechanical Physiologists
came into existence in consequence of the splendid results obtained
by the schools of Galileo and Newton. It was not so much the exposure
of the weaknesses of the chemical physiology as the effects produced
upon the world by the explanation of so many of the phenomena of the
external universe by the men who had revolutionized astronomy by
their discoveries; it was naturally hoped that that which served to
explain the great world of matter might also elucidate the little
world of man. Whewell divides the school into two parts—the Italian
and the Cartesio-Newtonian sect. The Italian calculated and analysed
the properties of the animal body which are undoubtedly purely
mechanical, the Cartesio-Newtonians went much further than this and
introduced many baseless hypotheses. The Italians occupied themselves
with such calculations as the force of muscles and the hydraulics of
the animal fluid. BORELLI was the first great investigator on these
lines; his work _De Motu Animalium_ (Rome, 1680), treats of the forces
and action of the bones and muscles. JOHN and DANIEL BERNOUELLI and
HENRY PEMBERTON pursued the same line of research. The principles
of hydrostatics were brought to bear on the questions of the blood
pressure and the breath. KEILL endeavoured to estimate the velocity
of the blood. The other school occupied itself with the corpuscular
hypothesis in physiology. The organs were considered as a species of
sieves. Both NEWTON and DESCARTES sought to explain physiology on a
theory of round particles passing through cylindrical tubes, pyramidal
ones through pores of a triangular shape, cubical through square
openings. The diameter and curves of the different vessels formed
subjects of calculations, and BELLINI, DONZELLINI, and GUGLIELMINI
in Italy, PERRAULT and DODART in France, COLE, KEILL, and JURIN in
England, devoted themselves to their study.[991]
The investigation of the size and shape of the particles of the
fluids, and the diameter and form of the invisible vessels, formed
a large part of the physiology of the beginning of the eighteenth
century. CHEYNE thought that fevers of the acute sort arise from
glandular obstruction; and MEAD, the royal physician and friend of
Newton, explained the action of poisons on mechanical principles. The
error of this school, as Whewell explains, lay in considering the
animal frame as a lifeless compound of canals, cords and levers; the
physicians, to its adherents, were merely hydraulic engineers. Some
iatro-mathematicians were, in fact, at the same time teachers both of
engineering and medicine.[992]
THE VITAL-FLUID SCHOOL. The mechanical explanation of the motions of
the animal body may satisfy some observers up to a certain point;
there, however, they must confess their theory fails them. How does
motion _originate_ in the living frame? FRIEDRICH HOFFMAN, of Halle
(b. 1660), assumed a principle, material, yet of a higher kind than
the adherents of the mechanical sect were inclined to recognise. This
principle is exceedingly subtle, and is endued with great energy. It
is the ether diffused through all nature, and which has its seat in
the brain of animals and acts upon the body through the nerves. This
vital fluid operates by laws which at one time were explained on the
principles of a higher mechanics, of which we know little, and at
another on metaphysical grounds, of which we know less. Naturally
the discoveries connected with electricity imported a new element
into these speculations. The vital principle was then held to be a
modification of the electric fluid. JOHN HUNTER discerned it in the
blood. CUVIER believed the vital fluid to be nervous. The objections to
the doctrine of a vital fluid “as one uniform material agent pervading
the organic frame,” are many. If the vital principle be the same in
every part of the body, how does it happen that the secretions are
all so different? How does the blood under the same influence furnish
all the different fluids produced by the glands? How is it the liver
secretes bile, the kidneys their peculiar fluid, the lachrymal gland
the tears? The hypothesis of a vital fluid really explains nothing.
THE PSYCHICAL SCHOOL held the doctrine of an immaterial vital
principle. This is at least as old as ARISTOTLE,[993] who attributes
the cause of motion to the soul. According to that philosopher the soul
has different parts: the _nutritive_ or _vegetative_, the _sensitive_,
and the _rational_. STAHL, the great discoverer in chemistry, opposed
the physiological theories of HOFFMAN, and declared that there is
something in living bodies which cannot be accounted for by mechanics
or chemistry. “All motion,” according to him, “is a spiritual act.”
Nutrition and secretion belong to the operations of the soul; but he
overlooked the fact that these are not peculiar to animals, but are
characteristics of vegetables, which have no soul. CHEYNE and MEAD,
PATERFIELD and WHYTT in England inclined to Stahl’s views. BOISSIER DE
SAUVAGES defended them in France. HOFFMAN and afterwards HALLER opposed
them, the latter inventing the theory of Irritability.
BOERHAAVE (1668-1738), professor of medicine at Leyden, was a man of
varied and profound erudition, conversant with the teaching of the
ancient philosophers and the Greek and Arabian physicians; he was in
addition fully conversant with all the discoveries connected with
the healing art down to his own time. Beyond this he was a natural
philosopher, chemist, botanist, and anatomist, and an indefatigable
experimentalist. In teaching medicine he simplified its study as much
as possible by rejecting the absurd and useless speculations which
encumbered it, and putting in their place the facts which he believed
his own experience and observation had enabled him to ascertain. He
published his system of medicine in two volumes, one entitled the
Instructions or Theory and the other the Aphorisms or Practice of
Medicine. “These short treatises,” says Dr. Thomson,[994] “which gave
to medicine a more systematic form than it had previously exhibited,
are remarkable for brevity, perspicuity, and elegance of style, for
great condensation of ideas, and for the number of important facts
which they contain relative to the healthy and diseased states of the
human economy.” The genius of Boerhaave raised the medical school
of Leyden to the highest distinction. Princes in all countries sent
him pupils; Peter the Great took lessons in medicine from him, and
so great was his reputation that when a Chinese mandarin directed a
letter to him, “To the illustrious Boerhaave, physician in Europe,”
it was duly delivered. He held the study of Mind to form an important
part of physiology. He taught that the change produced upon the
extremity of the sentient nerve must be transmitted by the nerve to
the brain before sensation can be produced. He considered the nerves
to be hollow undulatory canals. He also held that each of the senses
has its distinct seat in the common sensory or brain. His lectures
on the mental faculties are full of varied and curious information.
Considering the human body as a combination of various machines
arranged in one harmonious whole, he endeavoured to explain its
phenomena in health and disease on the principles of natural philosophy
and chemistry to the almost entire exclusion of vital forces, which,
however, he did not reject. He denied that all medical phenomena
are to be explained upon mechanical principles. He lamented that
“physiological subjects are usually handled either by mathematicians
unskilful in anatomy, or by anatomists who are not versed in
mathematics.” Yet his system of physiology embraced but a poor
conception of the mystery of life. He says, “Let anatomy faithfully
describe the parts and structure of the body; let the mechanician apply
his particular science to the solids; let hydrostatics explain the
laws of fluids in general, and hydraulics their actions, as they move
through given canals; and lastly, let the chemist add to all these
whatever his art, when fairly and carefully applied, has been able to
discover; and then, if I am not mistaken, we shall have a complete
account of medical physiology.”
It is to BOERHAAVE that we owe the peculiar chemical idea of affinity,
that mutual virtue by which one chemical substance loves, unites with,
and holds the other (_amat_, _unit_, _retinet_). He called it love.
“We are here to imagine, not mechanical action, not violent impulse,
not antipathy, but love, at least if love be the desire of uniting.”
It is to BOERHAAVE, therefore, we are indebted for a view of chemical
affinity which enables us to comprehend all chemical changes.[995]
The idea of affinity as marriage naturally leads to analysis as
divorce. Thus affinity, imperfectly understood before the time of
Boerhaave, made analysis possible. One of the first to express this
conviction was DR. MAYOW, who published his Medico-Physical Tracts
in 1674. He shows how an acid and an alkali lose their properties by
combination, a new substance being formed not at all resembling either
of the ingredients. He explains that, “although these salts thus mixed
appear to be destroyed, it is still possible for them to be separated
from each other, with their power still entire.”[996]
GEORGE ERNEST STAHL (1660-1734), chemist, was professor of medicine at
Halle (1694) and physician to the King of Prussia (1716). He opposed
materialism, and substituted “animism,” explaining the symptoms of
disease as efforts of the soul to get rid of morbid influences.
Stahl’s “anima” corresponds to Sydenham’s “nature” in a measure, and
has some relationship to the Archeus of Paracelsus and Van Helmont.
STAHL was the author of the “phlogiston” theory in chemistry, which
in its time has had important influence on medicine. Phlogiston was a
substance which he supposed to exist in all combustible matters, and
the escape of this principle from any compound was held to account for
the phenomenon of fire. According to STAHL, diseases arise from the
direct action of noxious powers upon the body; and from the reaction
of the system itself endeavouring to oppose and counteract the effects
of the noxious powers, and so preserve and repair itself.[997] He did
not consider diseases, therefore, pernicious in themselves, though he
admitted that they might become so from mistakes made by the soul in
the choice, or proportion of the motions excited to remove them, or
the time when these efforts are made. Death, according to this theory,
is due to the indolence of the soul, leading it to desist from its
vital motions, and refusing to continue longer the struggle against the
derangements of the body.[998] Here we have the “expectant treatment”
so much in vogue with many medical men. “Trusting to the constant
attention and wisdom of nature,” they administered inert medicines
as placebos, while they left to nature the cure of the disease. But
they neglected the use of invaluable remedies such as opium and
Peruvian bark, for which error it must be admitted they atoned by
discountenancing bleeding, vomiting, etc.[999] Stahl’s remedies were
chiefly of the class known as “Antiphlogistic,” or antefebrile.
DE SAUVAGES (1706-1767), the French physicist, was a disciple of Stahl,
and adopted his theory of soul as the cause of the mechanical action of
the body. He invented a system of classifying diseases under the title
of _Nosologia Methodica_, founded on the principles of natural history.
FRIEDRICH HOFFMAN (1660-1742) was a fellow-student with Stahl at Jena.
He was the author of a system of medicine in some respects original.
He distinguished in the human economy three principal agents: Nature,
or the Organic Body; the Sentient Soul; and the Rational Soul;
corresponding to the classification of the Scripture of body, soul,
and spirit—a classification which originated doubtless in Indian
philosophy. Hoffman did not admit with Stahl that the organic functions
of the human body depend on the agency of an intelligent soul or any
immaterial agent whatsoever, but are merely mechanical and chemical
properties of the elements which compose our bodies. The functions most
essential to life he considered to be the circulatory, secretory, and
excretory motions, and these seemed to him to depend upon the dilating
and contracting powers of the muscular fibres of the vascular system.
These powers then he held to be the cause of the organic functions
which depend on the animal spirits, an ethereal fluid contained in the
nerves and the blood.[1000]
Hoffman first made known the virtues of the Seidlitz waters; he also
invented a nostrum which was popular for a long time, and called
“Hoffman’s Anodyne Liquor.”
PHYSICIANS.
ARCHIBALD PITCAIRN, M.D. (1652-1713), was a famous physician of
Edinburgh. In 1692 he occupied a professor’s chair at Leyden with
great distinction. Among his pupils were MEAD and BOERHAAVE, who
both attributed much of their skill to his tuition. On his return to
Edinburgh he greatly interested himself in improving the teaching of
anatomy. He begged the Town Council to permit the dissection of the
bodies of paupers; and though the chief surgeons of the place did all
they could to oppose his efforts, they were successful, and Pitcairn
had the credit of laying the foundation of the great Edinburgh school
of medicine. He insisted on the strict adherence to Bacon’s method
of attending to facts of experience and observation. “Nothing,” he
said, “more hinders physic from being improved than the curiosity
of searching into the natural causes of the effects of medicines.
The business of men is to know the virtues of medicines; but to
inquire whence they have that power is a superfluous amusement, since
nature lies concealed. A physician ought therefore to apply himself
to discover by experience the effects of medicines and diseases,
and reduce his observations into maxims, and not needlessly fatigue
himself by inquiring into their causes, which are neither possible nor
necessary to be known. If all physicians would act thus, we should not
see physic divided into so many sects.” In his DISSERTATIONS (1701) he
discusses the application of geometry to physic, the circulation of the
blood, the cure of fevers by purgation, and the effects of acids and
alkalis in medicine. A learned and skilful physician, an accomplished
mathematician, and a thorough classical scholar, he was not discreet in
his political utterances. His library was purchased by Peter the Great
of Russia.
JOHN RADCLIFFE, M.D. (1650-1714), was famous for “his magnificent
regard for the advancement of learning and science.” The Radcliffe
infirmary and observatory at Oxford were built from funds bequeathed by
him.
SIR HANS SLOANE, M.D. (1660-1753), was a physician whose noble museum
and library were the foundation of the British Museum.
SIR RICHARD BLACKMORE, M.D. (1650-1729), wrote on inoculation for
small-pox, on consumption, gout, rheumatism, scrofula, diabetes,
jaundice, etc.
WALTER NEEDHAM, M.D. (died 1691), made important investigations in the
anatomy of the fœtus, and the changes of the pregnant uterus.
CLOPTON HAVERS, M.D. (died 1702), was the author of a standard work
on the bones, certain canals of which were called after him Haversian
canals.
JAMES DOUGLAS, M.D. (1675-1742), was an excellent anatomist, who was
one of the first to demonstrate from anatomy that the high operation
for stone might be safely performed. He was a skilful accoucheur, an
accomplished botanist, and a man of letters. Pope mentions him in the
_Dunciad_, and in a note describes him as a physician of great learning
and no less taste. He wrote several works, the most famous of which is
_Myographiæ Comparatæ Specimen; or a comparative description of all the
muscles in a man and in a quadruped; added is an account of the muscles
peculiar to a woman_. London, 1707.
WILLIAM CULLEN, M.D. (1710-1790), was the first professor in Great
Britain to deliver his lectures in the English language.[1001] He was
appointed lecturer on chemistry at Glasgow University in 1746, and
in 1751 was chosen regius professor of medicine. In 1756 he became
professor of chemistry in the University of Edinburgh; in 1760 he was
made lecturer on materia medica. Dr. Cullen earned great distinction
as a lecturer on medicine; he opposed the teaching of Boerhaave and
the principles of the humoral pathology, founding his own teaching on
that of Hoffman. His system was to a great extent based on the new
physiological doctrine of irritability as taught by Haller.
He attached great importance to nervous action in the induction of
disease, considering even gout as a neurosis.
His _First Lines of the Practice of Physic_ was long exceedingly
popular, but his fame as a medical writer rests on his _Nosology_, or
_Classification of Diseases_. In all his labours Dr. Cullen aimed at
the practical rather than the theoretical. “My business is not,” he
remarks,[1002] “so much to explain how this and that happens, as to
examine what is truly matter of fact.” “My anxiety is not so much to
find out how it happens as to find out _what_ happens.” Cullen invented
no ingenious hypothesis, rather he new-modelled the whole practice
of medicine; “he defined and arranged diseases with an unrivalled
accuracy, and reduced their treatment to a simplicity formerly
unknown.”[1003]
JAMES GREGORY, M.D. (1758-1822), exercised the greatest influence on
the progress of medicine in England. As the successor of Cullen, and as
the author of the famous _Conspectus Medicinæ Theoreticæ_, the name of
Gregory, borne by many ornaments of British science, became still more
distinguished.
SIR GILBERT BLANE, M.D. (born 1747), rendered important medical
services to the State by his researches on the diseases incident to
seamen. He banished scurvy from the fleet by his arrangements for
provisioning ships on foreign stations, particularly by making lemon
juice a regular ingredient of diet.
SIR WILLIAM WATSON, M.D. (1715-1787), was a devoted botanist and
student of electricity. His electrical researches raised him to a
position of European fame. He was the first in England who succeeded in
igniting spirit of wine by electricity; he was the first to note the
different colour of the spark, as drawn from different bodies; and his
researches in the power and accumulation of electricity, the nature of
its conductors, etc., qualified him to take part in the experiments
carried out in 1747 and 1748, by which the “electric current was
extended to four miles in order to prove the velocity of its
transmission.”[1004] The doctor’s house in Aldersgate Street was long
the resort of the most distinguished men of science in Europe. He was
not less the benign and generous friend to the poor and suffering, than
the ardent investigator of the secrets of Nature. His work _Experiments
and Observations on Electricity_ is quite a remarkable production
considering the age in which it was published (1768).
ROBERT WILLAN, M.D. (1757-1812), was the founder of the science of
skin diseases in England. His attention was directed in 1784 to the
elementary forms of eruption, and on this basis he erected his magnum
opus, _The Description and Treatment of Cutaneous Diseases_ (1798).
JOHN BROWN (1735-1788), was a systematizer of medicine, whose
popularity was even continental. He endeavoured to explain the
processes of life and disease and the principles of cure upon one
simple idea, the property of “excitability.” The “exciting powers” are
the external forces, and the functions of the body are stimulants, so
that “the whole phenomena of life, health as well as disease, consist
in stimulus and nothing else.” Diseases he divided as _sthenic_,
attended with preternatural excitement, and _asthenic_, characterized
by debility.
Ninety-seven per cent. of all diseases, he declared, require a
“stimulating treatment.” One good result of this theory was that it
introduced a milder treatment of disease than the bleeding and purging
doctors of his time advocated. The theory was called the Brunonian, and
received greater attention in Italy than in England.
JOHN MORGAN, M.D. (1736-1789), was born in Philadelphia. He wrote an
essay on his graduation at Edinburgh (1763), wherein “he maintained
that pus is a secretion from the vessels, and in this view anticipated
John Hunter.”[1005]
ROBERT JAMES, M.D. (1703-1776), was the inventor of the celebrated
fever-powder which bears his name.
FRANCIS DE VALINGEN, M.D. (1725-1805), was a Swiss who practised in
London. He was the first to suggest the employment of chloride of
arsenic in practice. His preparation was admitted into the London
Pharmacopœia.
ERASMUS DARWIN (1701-1802), a physician of Lichfield, was a true
poet of science. His fame rests on the _Botanic Garden_, in which he
describes the _Loves of the Plants_ according to the Linnæan system.
His most important scientific work is his _Zoonomia_, a pathological
work, and a treatise on generation, in which he anticipated the views
of Lamarck. He asks: “Would it be too bold to imagine that in the great
length of time since the earth began to exist, perhaps millions of ages
before the commencement of the history of mankind, would it be too bold
to imagine that all warm-blooded animals have arisen from one living
filament, which the Great First Cause endued with animality, with the
power of acquiring new parts, attended with new propensities, directed
by irritations, sensations, volitions, and associations, and thus
possessing the faculty of continuing to improve by its own inherent
activity, and of delivering down these improvements by generation to
its posterity, world without end!” He believed that plants possess
sensation and volition.
EDWARD SPRY, M.D. (lived in 1756). At the fire of Eddystone lighthouse
an old man was injured by the fall of a quantity of molten lead upon
him. Dying of his injuries in twelve days, he was examined by Dr.
Spry, who stated that he found in the stomach a lump of lead three and
three-quarter inches long by one and a half in breadth. As no surgeon
would believe this story, Dr. Spry performed a number of experiments
upon animals by pouring molten lead down their throats, with the result
that at the Royal Society, Dr. Huxham, in his letter to Sir William
Watson, “testified to his own belief in Mr. Spry’s veracity.”[1006]
JOHN COAKLEY LETTSOM, M.D. (1744-1815), was a learned and amiable
philanthropist, who published several important medical and scientific
works. His _Reflections on the Treatment and Cure of Fevers_ and
_The Natural History of the Tea Tree_ appeared in 1772. He wrote the
following lines:—
“When patients sick to me apply,
I physics, bleeds, and sweats ’em.
Sometimes they live, sometimes they die:
What’s that to me? I. Lettsom.”
He gave away immense sums in charity, he was not so unfeeling as his
verse would make him appear.
WILLIAM STARK (1742-1770) was the earliest writer who distinguished
between tuberculosis and scrofula.
JEAN ASTRUC (1684-1766), professor at Montpellier, the oldest of the
celebrated French obstetricians, was the author of a work on the
diseases of women from the pathological point of view.
JOHANN E. WICHMANN (1740-1802), a scientific physician of Hanover, in
1786 explained the cause of itch as due to the itch-mite passing from
one individual to another. He experimented upon himself. BONOMO had,
however, discovered the insect in the itch pustules in 1687.
Wichmann suggested the contagiousness of consumption, whooping cough,
diarrhœa, and several other complaints.
J. P. FRANK (1745-1821) was “the founder of medical police as a
distinct department of science.”[1007]
HOSPITALS.
The condition of the hospitals for the sick in the eighteenth century
was scandalous almost beyond belief. Thus, in the Hôtel Dieu of Paris,
the mortality at one time was 220 per 1,000; a state of affairs which,
however, we surpassed in the present century, when in the British
hospitals at Scutari the mortality reached between 400 and 500 per
1,000. In both cases this was due to overcrowding. At the Hôtel Dieu
two or three small-pox cases, or several surgical cases, or sometimes
even four lying-in women would be packed into one bed. A large
proportion of the beds were purposely made for four patients, and six
were frequently crowded in.
JOHN HOWARD (1726-1790), the philanthropist, by his splendid and
devoted labours in connection with the reform of prisons, hospitals,
and lazarettos, drew attention to the means of preventing the
communication of the plague and other infectious fevers. In the words
of Burke “his philanthropic spirit led him to dive into the depths
of dungeons; to plunge into the infection of hospitals; to survey
the mansions of sorrow and pain; to take the gauge and dimensions of
misery, depression, and contempt; to remember the forgotten; to attend
to the neglected; to visit the forsaken, and to compare and collate the
distresses of all men in all countries.” Not the least of his services
were those he rendered to the cause of sanitary science and public
health.
THÉOPHILE DE BORDEU (1722-1776) was a professor of anatomy and
midwifery at Montpellier. By his great work, _Recherches sur le Pouls_,
he so enraged his professional brethren (who, like the Jews, always
either maim or kill the prophets sent unto them), that he was attacked
in his personal character with disgraceful malignity for several years.
He rendered very great services to the progress of medical science. His
physiology was far in advance of his age, and many men have found in
his researches on the functions of the glands a mine of wealth for the
establishment of their own reputation.
M. F. X. DE BICHAT (1771-1802) was a celebrated French anatomist and
physiologist, whose great work, _Anatomie Générale_, was the foundation
of the reform of French medicine at the intellectual awakening after
the great revolution. Pathology, the science of disease, would have
been impossible without such researches as those of Bichat. He first
took a “commanding view,” not merely of the organs of the body, but of
the tissues of which they are built up. He resolved the complex into
its elements, and investigated the structure of each. He completed the
overthrow of the iatro-mathematical school, regarding the properties of
the _living_ tissues as _vital_ actions. He classified the functions
as _organic_ and _animal_, and greatly aided in systematising the
phenomena of life.
MESMERISM.
FREDERICK ANTON MESMER (1733-1815) studied medicine at Vienna. He
embraced astrology, and believed in the influence of the stars on
living beings. He came to think that cures might be effected by
stroking with magnets; afterwards he discarded the magnets, and
convinced himself that he could influence others by stroking them
with his hands alone. In 1778 Paris was greatly excited over the
miraculous cures of mesmerism. The medical faculty denounced him as a
charlatan, though a Government Commission in its report admitted many
of the facts, while tracing them to physiological causes. The Marquis
de Puysegur revolutionised the art of mesmerism by producing all the
phenomena without the mummeries and violent means resorted to by
Mesmer. Dr. John Elliotson in England in 1830 successfully practised
the art.
In 1845 BARON VON REICHENBACH declared he had discovered a new force
which he called _odyl_, and in 1850 his _Researches on Magnetism_ were
translated into English by Dr. Gregory, professor of chemistry in the
University of Edinburgh.
G. VAN SWIETEN (1700-1772) was a pupil of Boerhaave, and famous in
the history of medicine as the founder of the Old Vienna School. He
brought about the clinical teaching for which that school has since
been so famous. Following the instructions of Paracelsus, he introduced
into his practice the use of mercuric perchloride internally in the
treatment of syphilis. His commentaries on Boerhaave were considered to
be more valuable than the text itself.
DE HAEN (1704-1776), of the Hague, studied under Boerhaave, and having
been recommended by Van Swieten, was invited to Vienna as president
of the clinical school in the hospital of that city. Observation, and
the simplest treatment in disease, especially in fevers, made up the
chief part of his medical system. Purgatives and emetics and powerful
medicines he would use only on the most urgent necessity. Hygiene, both
for the patient and the state, he considered of the highest importance
in medical education. Clinical thermometry received great attention
from De Haen, who demonstrated that in what is considered by the
patient the cold stage of fevers there is really a notable increase in
the temperature.
JAMES YONGE (1646-1721), physician and F.R.S., wrote an important
treatise on the use of turpentine as a means of arresting hæmorrhage,
entitled _Currus Triumphalis de Terebintho_. He described the flap
operation in amputations, and was acquainted with the principle of the
tourniquet for the arrest of bleeding during operations.
JOHN ADDENBROOKE, M.D., died 1719, leaving by his will four thousand
pounds to found a hospital at Cambridge, which now bears his name.
JAMES DRAKE, M.D. (1667-1707), wrote a work, once deservedly popular,
entitled _Anthropologia Nova; or, a New System of Anatomy_.
JOHN ARBUTHNOT, M.D. (1658-1735), physician to Queen Anne, was a man of
extensive learning and of great scientific abilities, characterized by
Thackeray as “one of the wisest, wittiest, most accomplished, gentlest
of mankind.”
DANIEL TURNER, M.D. (1667-1741), achieved a certain fame as the
inventor of an excellent ointment, still known as “Turner’s Cerate,”
composed of oil, wax, and calamine.
RICHARD MEAD, M.D. (1673-1754), was the author of the _Mechanical
Account of Poisons_, a work which at once established his reputation.
He was elected a Fellow of the Royal Society in 1703. On the accession
of George II. he was appointed physician-in-ordinary to the King.
He was the friend of Radcliffe, and like him a generous promoter of
science and learning and of unbounded charity to those in misery. It
was Mead who persuaded Guy to bequeath his fortune to found the noble
hospital which bears his name. Mead was a political physician, and it
is said by Miss Strickland that his prompt boldness occasioned the
peaceable proclamation of George I. Mead’s work on the diseases of the
Bible, entitled _Medica Sacra_, is a curious and interesting treatise.
Excellent physician as he was, he recommended pepper and lichen as a
specific against the bite of a mad dog.
JOHN FREIND, M.D. (1675-1728), a learned and accomplished physician,
is famous as the author of an elaborate work, _The History of Physick
from the Time of Galen to the Beginning of the Sixteenth Century_. He
laid the plan of this important work whilst a prisoner in the Tower, to
which he was committed on suspicion of participation in the so-called
“Bishop’s plot.” He was liberated after about three months’ confinement
by the firmness of Dr. Mead, who refused to prescribe for Sir Robert
Walpole till he consented to admit him to bail.[1008] During his
imprisonment Freind wrote a Latin letter _On certain Kinds of Small
Pox_.
How near the physicians of Mead’s time came towards the discovery of
the germ theory of infectious disorders may be seen from his account
of the leprosy.[1009] In this treatise he says it has been found by
experiments that in the plague and other malignant eruptive fevers the
infection once received into articles of clothing remains in them for
a long time, and thence passes into human bodies, and “like seeds sown
produces the disease peculiar to them.” With reference to the retention
of the infection by dry walls, he says, “I thought it probable that
they may, by a kind of fermentation, produce these hollow, greenish, or
reddish strokes,” etc.
SURGEONS.
DOMINIQUE ANEL (1679-1730) was the famous French surgeon who invented
the operation for aneurism, which Hunter afterwards modified and called
by his own name.
He successfully treated lachrymal fistula, and invented several
surgical instruments which are named after him.
J. L. PETIT (1674-1750) in 1718 invented the screw tourniquet for
compressing bleeding arteries. He was one of the most famous surgeons
in the brightest period of the art in France, and was besides an
excellent ophthalmologist.
LE CAT (1700-1768) was the famous lithotomist, and opponent of the
doctrines of Haller.
LE DRAN (1685-1770) performed the first disarticulation of the thigh.
MORAND (1697-1773) performed disarticulation of the upper arm.
PIERRE JOSEPH DESAULT (1744-1795) was a great French anatomist and
surgeon, who instituted a clinical school of surgery at the Hôtel Dieu
in Paris. He frequently had an audience of six hundred.
He introduced many improvements in surgical practice and in the
construction of surgical instruments.
G. DE LA FAYE (d. 1781), a great surgeon and oculist, also
disarticulated the shoulder joint.
A. LOUIS (1723-1792) was a distinguished military surgeon.
R. B. SABATIER (1723-1811) was a distinguished surgeon, anatomist,
and ophthalmologist, and a man of great and all-round information on
medical subjects in general.
P. F. PERCY (1754-1825) was a military surgeon who introduced
cold-water dressings into French surgery.
ANTONIO SCARPA (1748-1832), the famous Italian anatomist, held the
chair of anatomy at Modena, was distinguished in every branch of
anatomical research, and investigated the minute anatomy of the nerves
and bones. He decided the long-debated question whether the heart is
supplied with nerves in the affirmative. He wrote on diseases of the
eye, on aneurism, and on hernia. He was an elegant scholar, “equally at
home in the criticism of the fine arts and in the details of scientific
agriculture.”
Amongst the principal Italian surgeons of the century were BERTRANDI
(1723-1797), TROJA (1747-1827), and PALLETTA (1747-1823).
Of the Germans the great names are, SCHMUCKER (1712-1786), RICHTER
(1742-1812), and SIEBOLD (1736-1807), who first taught surgery
clinically in Germany.
CALLISEN (1740-1824), the great Danish surgeon, and ANEL (1741-1801),
the founder of the Swedish School of Surgery, are two famous names
which must be remembered in the surgical history of the period.
WILLIAM CHESELDEN (1688-1752) was famous as a lithotomist and oculist.
His dexterity in the performance of lithotomy caused marvellous legends
to be told of him, it was even said that he had operated in fifty-four
seconds. He published his _Anatomy of the Human Body_ in 1713.
SAMUEL SHARP (1700-1778) excelled in nearly every branch of surgery,
and was a skilful operator, who by his efforts to stimulate English
surgeons to emulate the French did much to advance British surgery.
BENJAMIN GOOCH of Norwich, HEY of Leeds, and PARK of Liverpool, were
also famous in this period.
PERCIVAL POTT (1713-1788) was a surgeon to St. Bartholomew’s Hospital,
London, whose life formed a sort of epoch in the history of surgery in
England. Samuel Cooper says of him[1010] that he was in his time the
best practical surgeon, the best lecturer, the best writer on surgery,
the best operator of which the metropolis could boast.
JOHN HUNTER (1728-1793) was a physiologist and surgeon combined,
unrivalled in the annals of medicine. He raised surgery, which before
his time was little more than a mechanical art, to the rank of a
scientific profession. As a pathologist and comparative anatomist, he
rendered the greatest services to medicine and surgery. He dissected
500 different species of animals. One of the most brilliant surgical
discoveries of the century was Hunter’s operation for the cure of
popliteal aneurism, by tying the femoral artery above the tumour and
without interfering with it. He improved the treatment of rupture of
the tendo achillis, and invented a method of curing lachrymal fistula,
and of curing hydrocele radically by injection.
He was the first to describe phlebitis (inflammation of the veins), and
he made the discovery that the white blood corpuscles are antecedent
to the red. He investigated the subject of inflammation, the results
of which he published in his _Treatise on the Blood, Inflammation
and Gun-shot Wounds_. Other works of Hunter’s are his _Treatise on
the Natural History of the Human Teeth_, _A Treatise on the Venereal
Disease_, and _Observations on Certain Points of the Animal Economy_.
“His greatest monument is the splendid museum which he formed by his
sole efforts, which he made too when labouring under every disadvantage
of deficient education and limited means.” His brother-in-law, Sir
Everard Home, prepared the catalogue of the museum and then burned
Hunter’s manuscripts, probably that he might conceal the plagiarisms of
which he had been guilty in writing his book on Comparative Anatomy.
The Government purchased Hunter’s museum from his widow for £15,000,
upon condition that twenty-four lectures should be delivered every year
to members of the college, and that the museum should be open to the
public.
CHARLES WHITE, a Manchester surgeon (_circ._ 1768), was the first
to introduce what is known as conservative surgery. He first
resected[1011] the humerus, and taught the reduction of shoulder
dislocations with the heel in the arm-pit.
The German surgeons in the seventeenth century held simply the position
of barbers; they began life by cutting hair, shaving, cupping and
bleeding, and then rose to be dressers of wounds and ulcers, and to
treat fractures and dislocations.[1012] In 1713, Berlin acquired its
first anatomical theatre for the instruction of military doctors and
“medico-surgeons.” Dresden and Hanover began to improve the education
of clever barbers about the middle of the eighteenth century. The
Military Medical School of Vienna was opened in 1781. Barbers and
bathmen in the eighteenth century were trained into district medical
officers and surgeons by a course of instruction lasting from two
to three years. In Holland students were privileged to assist in
operations at the hospitals. The first surgical clinic in Germany was
established at Würzburg, in 1769. The Vienna surgical clinic arose in
1774. The greatest teacher of surgery in Germany, A. G. Richter, gave
clinical instruction at Göttingen, in 1781.[1013]
G. M. THILENIUS in 1784 performed the first division of the _tendo
achillis_ for the cure of club-foot.
JUSTUS ARNEMAN (1763-1807) was a surgical professor at Göttingen, who
wrote a system of surgery and advanced the study of diseases of the ear.
CAMPER (1722-1789), a Dutch surgeon of a mechanical turn of mind, made
improvements in trusses. LEGUIN, a Frenchman, was the first to employ
steel springs in trusses (1663). TIPHARIE in 1761 introduced the double
truss.[1014]
OBSTETRICIANS.
JOHANN PALFYN (1649-1730), a celebrated obstetric physician, in 1721
invented, or rather re-introduced, a species of forceps in difficult
labour.
HUGH CHAMBERLEN, M.D. (1664-1728), was the most famous man-midwife
of his day. His name is for ever associated with the invention of
the obstetric forceps—a noble instrument, which has saved more lives
than any mechanical invention ever associated with the healing art. A
monument was erected to his memory in Westminster Abbey, with a long
Latin epitaph by Bishop Atterbury.
WILLIAM SMELLIE (1680-1763), a distinguished English obstetric
physician, improved the midwifery forceps and suggested and performed
various operations in obstetric practice.
* * * * *
WILLIAM BROMFIELD (1712-1792) founded the Lock Hospital, London. He
invented a tenaculum (a fine sharp hook by which the mouths of bleeding
arteries are drawn out). He was a celebrated operator, and wrote a work
on surgery.
* * * * *
The Medical College of Philadelphia was the first institution
established in North America to give medical instruction. It was
organized in May, 1765, by Drs. Shippen and Morgan. The University
of Pennsylvania developed its medical department from this humble
beginning.
ANATOMISTS, PHYSIOLOGISTS, BOTANISTS, ETC.
ALEXANDER MONRO (1697-1767) was a very eminent surgeon and anatomist of
Edinburgh, whose Medical School owes more to him probably than to any
other individual. He wrote on the _Anatomy of the Bones_, and an _Essay
on Comparative Anatomy_.
FRANK NICHOLLS, M.D. (1699-1778), was a famous anatomist and
physiologist at Oxford. “He was the inventor of corroded anatomical
preparations, and one of the first to study and teach the minute
anatomy of tissues, in other words, general, as distinguished from
regional and descriptive anatomy.”[1015] He was one of the first to
describe correctly the mode of the production of aneurism, and he
distinctly recognised the existence and function of the vaso-motor
nerves.[1016]
BROWNE LANGRISH, M.D., was elected a Fellow of the Royal Society in
1734. He was the author of several medical treatises, one of which
was entitled _Physical Experiments upon Brutes to discover a Method
of dissolving Stone in the Bladder by Injections; to which is added a
course of Experiments with the Lauro-Cerasus; on Fumes of Sulphur_,
etc. 8vo. Lond., 1746. His researches on the action of cherry
laurel water are said to have suggested the use of prussic acid in
medicine.[1017]
JOHN FOTHERGILL, M.D. (1712-1780), was a distinguished botanist, who
collected a great number of rare plants from all parts of the world.
WILLIAM CRUIKSHANK (1745-1800) was an anatomist who discovered urea.
STEPHEN HALES (1677-1761), an experimental physiologist and
pathologist, produced dropsy by injecting water into the veins of
animals, and investigated by experiments on animals the relative
movements of the blood.
ANTONIO VALSALVA (1666-1723), a great Italian anatomist, held the
professor’s chair at Bologna and wrote a valuable treatise upon the ear
and its anatomy.
GIOVANNI SANTORINI (1681-1737) was a Venetian anatomist whose
investigations in the anatomy of the larynx, nose, face, etc., have
immortalised his name in connection with several structures of those
parts.
GIOVANNI B. MORGAGNI (1682-1772) was the great founder of pathological
anatomy. He was a pupil of Valsalva. His famous book on pathological
anatomy was not published until he was in his 79th year. He was the
author of the maxim that “observations should be weighed, not counted.”
The researches in morbid anatomy carried out by Morgagni formed an
epoch in the history of modern medicine, which may indeed be said to
rest on the two methods of Sydenham and Morgagni. The work of the
Italian anatomist was complementary to that of the English Hippocrates,
who neglected anatomy. Morgagni and the “Encyclopædic Haller,” whom we
are next to consider, were two of the brightest medical lights of the
century.
ALBERT VON HALLER (1708-1777), surnamed “the Great,” was a Swiss
physician of Berne, who was not only a distinguished scientist, but a
man of letters and a famous poet. He studied comparative anatomy at
Tübingen; in 1725 he removed to Leyden, which at that time was the
first medical school in Europe. He visited England in 1727, and made
the acquaintance of Sir Hans Sloane, Cheselden, Dr. James Douglas, and
other eminent persons. Leaving London, he went to Paris, but having
been detected by the police in dissecting in his lodgings, he had to
leave France, and he went to Basle to continue his investigations
in anatomy; there he studied mathematics under John Bernoulli, and,
having imbibed a taste for botany, studied the flora of Switzerland,
on which he afterwards published a work. In 1729 he returned to Berne
and lectured on anatomy; invited in 1726 to accept the professorship
of anatomy, surgery, and botany in the newly founded University of
Göttingen, he removed to that city, and by his influence a botanical
garden, an anatomical theatre, a school of surgery and midwifery were
established there. In 1747 he published his most valuable work, the
_Primæ Lineæ Physiologiæ_ which was used as a text-book in medical
schools.
VAN SWIETEN (1700-1772), the pupil of Boerhaave, established the first
clinical institution in Germany. He was with Sanchez the first to use
corrosive sublimate in medicine. To his exertions it was due that the
teaching of medicine was greatly improved in Austria.
J. F. MECKEL (1724-1774) was an anatomist whose researches on the
nerves, blood-vessels, glands, etc., have greatly contributed to our
knowledge of their physiological functions.
J. C. PEYER (1653-1712) and J. C. BRUNER (1653-1727) discovered the
glands in the intestines which are known to this day by their names.
A. PACCHIONI (1665-1726) described the glands we call in his honour
“Pacchionian.” W. COWPER (1666-1709) discovered those which bear his
name. M. NABOTH (1675-1721) described the structures we call ovula
Nabothi. H. MEIBOM (1638-1700) discovered the glands of the eyelids
named after him.
WALTER CHARLTON, M.D. (1619-1707), anatomist, a voluminous writer, was
to some extent a follower of Van Helmont.
THOMAS FULLER, M.D. (died 1734), published several pharmacopœias and an
account of eruptive fevers, with several other works.
NEHEMIAH GREW, M.D. (born about 1641), wrote _The Anatomy of Plants,
with an Idea of a Philosophical History of Plants_, which Sprengel
calls _opus absolutum et immortale_. Hallam says,[1018] “no man,
perhaps, who created a science has carried it further than Grew; few
discoveries of great importance have been made in the mere anatomy of
plants since his time.” His great discovery was the sexual system of
plants; “that the sexual system is universal in the vegetable kingdom,
and that the dust of the antheræ is endowed with an impregnating
power.”[1019]
He was the first to obtain sulphate of magnesia from the Epsom waters,
and to investigate its properties. His treatise on Epsom salts was
published in 1697.
WILLIAM BRIGGS, M.D. (died 1704), was famous for his “skill in
difficult cases of the eye.”
EDWARD TYSON, M.D. (died 1708), wrote on anatomy; he was the Carus of
Garth’s _Dispensary_, and the discoverer of “Tyson’s Glands.”
WILLIAM PITCAIRN, M.D. (1711-1791), was an accomplished botanist. He
lived in the Upper Street, Islington, where he had a botanical garden
five acres in extent, stocked with the scarcest and most valuable
plants. He introduced into St. Bartholomew’s Hospital a much freer use
of opium in the treatment of disease, and especially of fevers, than
had hitherto been customary, and that with the greatest benefit to the
patients.
PETER SHAW, M.D. (1694-1763), greatly facilitated the study of
chemistry in England by his translations of the chemical works of
Stahl and Boerhaave, as well as by his own works. He edited the works
of Bacon and Boyle, and published a number of books on medicine and
chemistry.
WILLIAM HUNTER, M.D. (1718-1783), was an earnest and devoted anatomist
and obstetrician. He was a pupil of Cullen, and was so successful a
practitioner that he expended £100,000 upon his house and anatomical
collection, etc. The Hunterian Museum of the University of Glasgow was
formed from this collection. The famous John Hunter was his younger
brother.
THOMAS DIMSDALE, M.D. (1711-1800), a celebrated promoter of inoculation
for small-pox, acquired a great reputation and immense wealth by the
process. Catherine II. of Russia paid him enormous sums for successful
inoculations, and gave him a barony.
WILLIAM HEBERDEN, M.D. (1710-1801), lectured on Materia Medica at
Cambridge. Dr. Munk[1020] gives an interesting extract from one of
Heberden’s lectures on Mithridatum and Theriaca, the famous classic
medicines; he proves that the only poisons known to the ancients were
hemlock, monk’s-hood, and those of venomous beasts, and that they had
no antidotes for these. He says that the first accounts of powerful
poisons concealed in seals or rings, poisonous vapours in gloves and
letters, etc., are idle inventions of ignorant and superstitious
persons.
BUFFON (1707-1788) was the celebrated French naturalist to whom “we owe
our first clear and practical connection of the distribution of animals
with the geography of the globe.”
GEORGE ARMSTRONG in 1769 opened the first children’s hospital in
Europe; he was the physician who first devoted special attention to the
diseases of children. Armstrong was a London man, and died 1781.
JOH. E. GREDRING (1718-1775) was a German physician who was the first
to investigate “the seat, cause, and diagnosis of insanity.”[1021]
JAMES CURRIE (1756-1805) advocated the cold-water treatment of typhus
fever patients, and thus introduced a method of treatment which
in one form or another is used at the present time for reducing
the temperature of the body in such cases. Currie determined the
temperature by the thermometer.
LADY WORTLEY MONTAGU (1690-1762) is famous in the annals of medicine
for her courageous adoption of the Turkish practice of inoculation
for small-pox in the case of her own son. By her zealous advocacy
she was instrumental in causing the practice to be introduced into
England in 1721. Dr. Keith having subjected his son to the operation,
experiments were conducted upon criminals by Maitland, and these
having been successful, the Prince of Wales and the royal princesses
were inoculated by Mead. On behalf of the Almighty, whose province was
supposed to be trespassed upon by these and similar proceedings, the
practice was violently opposed by the clergy and others.
EDWARD JENNER (1749-1823) introduced the practice of vaccination as a
preventive of small-pox. He commenced his investigations concerning
cow-pox about the year 1776. The practice of inoculation with the
virus of small-pox, which had been introduced into England through
the suggestion of Lady Wortley Montagu, indirectly led Jenner to his
grand discovery. His attention was excited by finding that certain
persons to whom he attempted to communicate small-pox by inoculation
were not susceptible to the disease; on pursuing his inquiries he found
that these persons had undergone cow-pox—a complaint common among the
dairy-servants and farmers in Gloucestershire, and that these people
were aware that cow-pox in some way was a preventive against the
small-pox. Local medical men had long been acquainted with this idea,
but had paid no attention to it, considering it merely a popular and
groundless belief. Jenner’s genius, however, led him to divine the
truth of the matter and turn it to practical advantage. The disease
which affects the udder of the cow was found to be inoculable in the
human subject, and could be propagated from one person to another,
rendering those who had passed through the complaint secure from an
attack of small-pox. Having confided the fact of this discovery to some
medical friends, it was taken up in 1796 by Mr. Clive, of St. Thomas’s
Hospital, who introduced vaccination into London. Vaccination was
adopted in the army and navy, and Jenner was honoured by professional
distinctions and a parliamentary grant of £20,000. He was made a Fellow
of the Royal Society, and his fame and the benefits of his discovery
were rapidly extended to continental nations.
BOOK VI.
_THE AGE OF SCIENCE._
CHAPTER I.
THE NINTEENTH CENTURY.—PHYSICAL SCIENCE ALLIED TO MEDICINE.
Exit the Disease-Demon.—Medical Systems again.—Homœopathy.—The
Natural Sciences.—Chemistry, Electricity, Physiology, Anatomy,
Medicine and Pathology.—Psychiatry.—Surgery.—Ophthalmology.
With the dawn of modern science was sounded the death-knell of the
disease-demon and its twin brother “Visitation.” When the French
Revolution, having at first intoxicated men, had had time to effect
its really beneficent aims, the age of modern science was fairly
inaugurated, and daily conferred some fresh blessing on the race.
The beginning of the nineteenth century saw the steam engine rapidly
approaching perfection. In 1801 took place the first experiment with
steam navigation on the Thames. In 1814 steam was first applied to
printing in the _Times_ office. In 1829 locomotive steam-carriages were
employed on railways at Liverpool. In the early years of the century
the electric telegraph was being developed. Machinery began to take
the place of hand labour in numberless branches of trade and industry.
Nobler than these material blessings, however, was the awakening of
the English people to a new and higher humanity. It seemed that as
Science began to shower her gifts on our nation, it yearned to become
the almoner of mankind, and in its turn to bless the world with the
precious gifts of freedom, education, improved sanitation, and the
means of developing the dormant higher powers of the species. The slave
trade of England was abolished by Parliament in 1807. In 1834 the
English government began to make annual grants in aid of education.
Sanitary commissions were appointed in 1838 and 1844, which were of
incalculable benefit, not only to our own national health, but in
suggesting to other countries the means of improving the health and
combating the ravages of preventable diseases. In the early years
of the century Dr. Birkbeck founded Mechanics’ Institutions, thus
commencing the era of enlightenment for the working classes, which
has resulted in raising the mental condition of our labouring and
lower middle classes to a higher level than that of any other nation
of the old world. Everywhere schools sprung up, books and newspapers
were multiplied, until everybody who could read had mental provender
provided at a merely nominal rate.
In relation to the history of medicine, the science of the century
has perhaps on the whole done greater service to the healing art
by that which it has taught doctors to leave undone than by what
it has taught them to do. It has arrested the murderous lancet of
the blood-letter; it has stayed the hand of the purger, who merely
bled in another manner; it has rescued the unhappy victims of mental
disorders from their dungeons, their beds of straw, and the cruel lash
of their keepers; it has liberated the invalid from the tyranny of the
medicine-monger; it is no longer possible to force down any patient’s
throat such a mass of filthy concoctions as the following items of
medicine enumerated in an apothecary’s bill for attending one Mr.
Dalby, of Ludgate Hill, which in five days amounted to £17 2_s._ 10_d._
The items for _one day_ (August 12) are:—
_s._ _d._
An emulsion 4 6
A mucilage 3 4
Jelly of hawthorn 4 0
Plaster to dress blister 1 0
A clyster 2 6
An ivory pipe 1 0
A cordial bolus 2 6
The same again 2 6
A cordial draught 2 4
The same again 2 4
Another bolus 2 6
Another draught 2 4
A glass of cordial spirits 3 6
Blister to the arm 5 0
The same to the wrists 5 0
Two boluses again 5 0
Two draughts again 4 8
Another emulsion 4 6
Another pearl julep 4 6
This is quoted in the _Historical Sketch of the Progress of Pharmacy
in Great Britain_,[1022] p. 17, not as an isolated case, but as an
illustration of the practice of apothecaries when attending patients of
the higher classes.
Homœopathy did much to remedy this state of affairs, and by deluding
people into believing that the billionth of a grain of a certain drug
skilfully manipulated was more effectual than the bolus and decoction
of the medicine-monger, tended gradually to destroy the popular faith
in the dosing system.
The student of medical history is often reminded forcibly of Tennyson’s
lines:—
“Our little systems have their day;
They have their day, and cease to be.”
As he reflects on the many schools, sects, and systems which have
dominated the practice of physic, he will often, as he passes them in
review one by one, ask mournfully with Hans Breitmann:—
“Vhere ish dot barty now?”
Where now is the Iatro-mathematical School, the party of the
Iatro-chemists, the Brunonian sect? One and all vanished into the
Ewigkeit!
To have maintained, in the zenith of their fame, that either of the
great medical schools could ever have so completely perished would
have been the rankest heresy; to believe now that the germ theory of
disease can ever be superseded is to be subjected to the charge, not of
medical heresy alone, but of the completest ignorance of science. Yet
there are some bold spirits who have dared even this. The history of
the past forbids the cautious historian of medicine to make too sure of
the permanence of any theory of disease or system of cure, but the germ
theory has claims to our acceptance which far outweigh those of any
other theories which we have reviewed. From the length of time it has
been under construction, from the marvellous care and minute caution
exercised by the profound scientists who have devoted their lives and
utmost energies to the innumerable experiments which their researches
have embraced, from the fact that not medical theorists merely, but
sober-minded scientists as well as practical surgeons and physicians,
have everywhere given their adherence to the germ theory of disease, we
have good reason to believe that it will hold its ground as a theory of
the cause—if not of much value as a system of cure—of a great number of
the most serious maladies which afflict the races of men and animals.
MEDICAL SYSTEMS.
GIOVANNI RASORI (1762-1837), of Milan, introduced a theory which was a
revival of Methodism combined with that of Brunonianism. The Methodists
held a status strictus and a status laxus, Brown a sthenic diathesis
and an asthenic diathesis.
Rasori taught a combination of these theories modified by his own. His
doctrines were accepted by a multitude of learned and eminent medical
men, yet his teaching was simply atrocious, and a study of it almost
makes one despair of any real advance for the healing art. His system
of therapeutics consisted in the endeavour to make a diagnosis of the
disease by watching the effects of the remedies which make it better or
worse! Bleeding was held to be the best diagnostic means: if it did the
patient good, the sthenic diathesis was assumed; if it made him worse,
the asthenic was demonstrated.
He administered enormous doses of powerful drugs, such as would be
considered nothing less than simply poisonous now. Baas says he gave 1
to 4 grammes of gamboge for diarrhœa, and 60 to 90 grammes of saltpetre
a day[1023]—doses which would be large for a horse.
The wonder is that anybody survived the treatment.
Homœopathy, faith-healing, peculiar-people treatment, anything,
however heterodox, is better than this licensed system of murder,
which actually received the adhesion of famous professors at Italian
universities, where the art of medicine was supposed to be taught sixty
years ago.
JOHANN A. ROESCHLAUB (1768-1835), a highly cultivated German physician,
was the founder of a medical system on the “Theory of Excitement.” Life
depends upon irritability which belongs to the natural disposition.
To be healthy, the body must be in a state of moderate irritation and
moderate excitability. Disease disturbs the happy medium upwards as
hypersthenia, or downwards as asthenia; in other words, by inducing too
much strength or actual debility.
JOHANN STIEGLITZ (1767-1840) was an eminent physician who opposed
the theory of excitement, saying, “There is no such thing as one
only saving system.” He was the founder of Etiological diagnosis (or
diagnosis dependent on a knowledge of the causes of disease).
C. W. VON HUFELAND (1762-1836), professor at Jena, and afterwards in
Berlin, opposed the theory of excitement. He used to say, “Successful
treatment requires only one-third science and two-thirds _savoir
faire_,” and, “To him who fails to make a religion of the healing art,
it is the most cheerless, wearisome, and thankless art upon earth;
indeed, in him it must become the greatest frivolity and a sin.”
F. J. W. BROUSSAIS (1772-1838), a physician of the vitalist school,
was a devoted follower of Bichat, who made it his chief aim to find an
anatomical basis for all diseases. He is particularly known for his
theory that all fevers arise from irritation or inflammation of the
intestinal canal. His long-exploded theory led to an enormous misuse
of bleeding. He christened his system “Physiological Medicine,” which
by directing attention to the morbid changes in the organs, led to the
rise of the pathological school of Corvisart, Laënnec, and Bayle. The
systems of Brown and Broussais must have destroyed, says Dr. De Noé
Walker, more human beings than the whole revolutionary wars from 1793
to 1815.
SAMUEL C. F. HAHNEMANN (1755-1843), the founder of Homœopathy, was
born at Meissen, near Dresden. He studied medicine at Leipsic, and
afterwards at Vienna, graduating at Erlangen in 1779. In his first
medical treatise he takes a despondent view of medical practice in
general, and of his own in particular, as he is candid enough to own
that most of his patients would have done better had they been let
alone.
In a letter to Hufeland upon the necessity of a regeneration in
medicine (1808), he declares that after eight years’ practice he had so
learned the delusive nature of the ordinary methods of treatment as to
be compelled to relinquish practice. He devoted much attention to the
science of chemistry.
Berzelius said of him, “That man would have been a great chemist had
he not been a great quack.” He translated Cullen’s _Materia Medica_ in
1790, and the necessary study of medicinal agents which this involved
set him thinking of a new theory of disease and cure which should
replace that which he had found so unsatisfactory; he came to the
conclusion, as the result of his researches, that “medicines must only
have the power of curing diseases similar to those which they produce
in the healthy body, and only manifest such morbid actions as they are
capable of curing in diseases.”[1024]
He thus proceeded to lay down the homœopathic law that the power of
medicines to alter the health must be _proved_ on the healthy body. He
endeavoured to discover a rule by which the effect of remedies might be
ascertained, and which should supersede the old method of working in
the dark.
Considering the endless powers which medicines possess, and feeling
sure that the Creator intended them to have some purpose, and that
to lighten the afflictions of the race, he felt that there must be
a better way of employing them than that which he considered had so
grievously failed in the past. He was therefore henceforth the enemy
of all empiricism. Antipathy, or the method by which contraries are
cured by contraries, so that the diseased part is acted upon by
something that opposes it, he considered a fatal error in medical
practice. Contrary medicine he held could at best be palliative and
temporary, not curative. He designated as Allopathy the method by which
it is attempted to remove natural disease from one part by exciting
artificial disease in another, or the principle of counter irritation.
The sciences of anatomy and physiology are quite superfluous to the
homœopathist; the remedies being merely addressed to symptoms, the
knowledge of their causes can have little or no concern to those who
follow Hahnemann’s doctrines. The application of a remedy for facial
neuralgia, as Dr. Mapother points out,[1025] has been applied over the
motor nerve of the face, the inventor being ignorant that it has no
connection with sensibility.
Hahnemann taught that all chronic maladies proceed from the itch.
Amongst other remedies for the itch, or psora, the swallowing of
lice or a decoction of them was seriously recommended, because these
parasites tickle the skin, and on the like-cures-like principle, would
be beneficial for itch![1026]
THE NATURAL SCIENCES.
The Natural Sciences in the closing years of the eighteenth century
began to render the most important services to the art of medicine, and
from that time onwards it has marked its progress step by step with the
advances of botany, chemistry, and physics. Linnæus invented a system
of the classification of plants which Adanson, Jussieu, De Candolle,
and others did much to improve; the anatomy and physiology, and even
the pathology of plants were closely studied, with results of the
greatest value to scientific medicine. Buffon excited the interest of
men of science by his declaration that there is no essential difference
between animals and plants, and that all organic life follows the
same plan. He explained the geographical distribution of the animal
kingdom. Hunter, Blumenbach, St. Hilaire, Cuvier, and others advanced
the sciences of comparative anatomy and physiology, and Lamarck divided
bony animals into _vertebrata_ and _invertebrata_. Cuvier, by founding
the doctrine of types, explained the general plan on which animals are
modelled. Pander and Baer rendered the greatest services to the study
of development—the former by his researches on the development of the
chick, the latter by his observations on the cleavage in the ovum. To
Hunter, Kielmeyer, and Owen in a later period we owe the most important
discovery—that the higher animals, even man himself, in the embryo pass
through the stages of development of the lower animals.
CHEMISTS.
JOSEPH PRIESTLY discovered oxygen in 1772, and thus introduced a new
chemical era. LAVOISIER, however, was the first to observe the vast
importance of the discovery, and CAVENDISH established his theories
by his researches on the composition of the air, water, and acids. It
is to Lavoisier’s discoveries in relation to oxygen that physiology
is indebted for the knowledge of the influence of that element on
respiration and the blood. Doctors looked upon it as the “air of life,”
and in its excess or deficiency saw the causes of certain diseases.
FOURCROY applied himself to the study of medical chemistry.
BERTHOLLET discovered the composition of ammonia, and the bleaching
properties of chlorine. He discovered chlorate of potash, and founded
the doctrine of chemical affinity.
DALTON (1776-1844) by his atomic theory and his discovery of the law
of multiple proportions still further advanced the science; in 1794 he
first described colour-blindness.
BERZELIUS (1779-1848) developed the atomic theory and improved our
knowledge of animal chemistry.
GAY-LUSSAC in 1805, with ALEXANDER VON HUMBOLDT, discovered that water
is composed of one volume of oxygen and two volumes of hydrogen.
SIR HUMPHRY DAVY (1788-1829) discovered the anæsthetic effect of
nitrous oxide gas, invented the safety-lamp for miners, and greatly
advanced the study of agricultural chemistry.
DUMAS (1800-1884) investigated the alkaloids.
PELLETIER in 1820 discovered quinine.
ORFILA (1787-1853), one of the most eminent men of the French school of
medicine, founded modern toxicology, the science of poisons. His fame
chiefly rests on his _Treatise of General Toxicology_ (1814), which is
a vast mine of experimental research on the symptoms of every kind of
poisoning.
SIR WILLIAM HYDE WOOLASTON, M.D. (1766-1828), was a distinguished
philosopher and chemist. One of his great discoveries was the
malleability of platinum, which is said to have produced him no less
than thirty thousand pounds. He was even more famous as a student of
ophthalmology than as a chemist.
MICHAEL FARADAY (1791-1867) was the great chemist, whose glory in
chemical science was overshadowed by his electrical discoveries.
JUSTUS VON LIEBIG (1803-1873) influenced the history of chemistry
by his successful efforts to spread the knowledge of the science
by improving the methods of investigation, and above all by the
application of chemistry to physiology, agriculture, and the arts.
ELECTRICIANS.
The history of electricity has an important bearing on that of
medicine. It will be necessary at least to indicate the chief points in
its progress. GILBERT published a treatise on the magnet in 1600. He
speaks of magnetic phenomena, and the extravagant stories circulated
about the attraction of magnets and amber by persons who gave no reason
from experiment. He distinguished magnetic from electric forces,[1027]
and it is to him that we owe the term “electric” itself.[1028]
Boyle repeated the experiments of GILBERT, but seems to have made no
discoveries. OTTO GUERICKE, of Magdeburg, next discovered that there
is electric force of repulsion as well as of attraction. HAWKSBEE, in
his _Physico-Mechanical Experiments_, 1709, observed the effects of
attraction and repulsion on threads hanging loosely. DUFAY, in 1733,
1734, and 1737, observed that electric bodies attract all those that
are not so, and repel them as soon as they are become electric by the
vicinity or contact of the electric body. In 1729, GREY discovered the
properties of _conductors_.
FRANKLIN distinguished between positive and negative electricity in
1747, and demonstrated the identity of the electric spark and lightning
in 1752. GALVANI in 1791 laid the foundation of the Galvanic Battery.
VOLTA discovered the “Voltaic pile” in 1800. Henceforward year by year
the science progressed by leaps and bounds. The use of the magnet in
medicine was known to Aetius, who lived A.D. 500. He says: “We are
assured that those who are troubled with the gout in their hands or
their feet, or with convulsions, find relief when they hold a magnet
in their hand.” Beckmann says[1029] this is the oldest account of
this virtue of the magnet. The more ancient writers refer only to its
internal uses. Lessing ascribes the external use of the magnet as a
cure for toothache and other disorders to Paracelsus. Marcellus in the
fifteenth century assures us that the magnet cures toothache, as also
does Leonard Camillus in the sixteenth century. Wecker about the same
period says it cures headache. Porta (1591) confirms this, and Kircher
(1643) states that it was worn about the neck to prevent convulsions
and nervous disorders. Magnetic toothpicks and ear-pickers were
extolled as cures for disorders of the teeth, ears, and eyes about the
end of the seventeenth century.[1030]
ANTHROPOLOGY.
JOH. F. BLUMENBACH (1752-1840), professor in Göttingen, was the founder
of Anthropology. He collected a great museum of skulls, and was famous
as a comparative anatomist. He wrote on physiology, anatomy, and
natural history.
PHILOSOPHERS.
VON SCHELLING (1775-1854) taught that “God is the indifference of the
ideal and real, soul and body, and the identity of subjectivity and
objectivity. In a word, the All.” He held that health is the harmony of
reproduction, irritability, and sensibility; disease, the alteration
of dimensions of the organism, by which it ceases to be a pure,
untroubled reflex of the All.
G. W. F. HEGEL (1770-1831) was the philosopher whose supreme principle
was absolute reason, and to whom in a great measure is due what is
known as Modern Materialism. He was opposed by R. H. LOTZE (1817-1884),
a medical philosopher of Göttingen, the author of the _Mikrokosmos_
and works on pathology, physiology, and psychology. He laid it down
that the significance of the phenomena of life and mind would only
unfold itself when by an exhausted survey of the entire life of man,
individually, socially, and historically, we gain the necessary data
for explaining the microcosm by the macrocosm of the universe. The
world of facts and the laws of nature are only to be understood by the
idea of a personal deity.
* * * * *
CHARLES DARWIN (1809-1882), grandson of Erasmus Darwin, startled and
shocked the whole Christian world by his theory that man has possibly
descended at a highly remote period from “a group of marine animals
resembling the larvæ of existing Ascidians.” He traced our ancestry
through the fish, amphibian, marsupial, and ape species; a theory
which, despite the original opposition it excited, is now generally
accepted. He is best known in connection with medical science by his
famous work, _On the Origin of Species by means of Natural Selection_,
1859, his _Descent of Man and Selection in Relation to Sex_, 1871, and
_The Expression of the Emotions in Man and Animals_, 1872. At first his
theory of the Descent of Man was held to teach that
“A very tall pig with a very long nose
Puts forth a proboscis quite down to his toes,
And then by the name of an elephant goes.”
Darwin recognised not merely a God but a Creator.
ANATOMISTS AND BIOLOGISTS.
SIR RICHARD OWEN, M.D., F.R.S., etc. (1804-1892), the celebrated
comparative anatomist and palæontologist, made it possible for us to
see what the extinct monsters were when he enabled us to construct
scientifically the models of the megatherium, plesiosaurus, and other
animals of remote ages. It has been well said of him that “the most
characteristic of his faculties was a powerful scientific imagination.
Fragments of bone which might be meaningless to less alert observers
enabled him to divine the structure and to present the images of whole
groups of extinct animal forms.”
At the suggestion of Dr. Abernethy (whose pupil he had been) he was
invited in 1828 to prepare the catalogue of the Hunterian collection in
the museum of the Royal College of Surgeons, of which Mr. Clift (whom
he eventually succeeded and whose daughter he married) was conservator.
This great work largely occupied some of the best years of Owen’s life,
the three quarto volumes on the Fossil Vertebrates and Cephalopods of
the collection not appearing till 1855. Meanwhile he had given to the
world his _Odontography_, his _Lectures on Comparative Anatomy and
Physiology_ (which won a continental reputation), and his famous work
on the _Archetype and Homologies of the Vertebrate Skeleton_. In 1849
he issued an important memoir _On Parthenogenesis_.
In 1856 Owen was appointed Superintendent of the Department of Natural
History in the British Museum, which, through his untiring exertions,
was at last to be suitably housed at South Kensington. In 1861 he
published his manual of _Paleontology_; from 1865 to 1877 a succession
of works on British Fossil Reptiles and the Fossil Reptiles of South
Africa.
F. G. HENLE (1809-1885) so early as 1840 advocated the germ theory of
disease. It was first suggested, however, by Latour’s discovery of the
yeast plant in 1836.
ST. GEORGE MIVART, M.D., F.R.S. (born 1827), the distinguished
anatomist and zoologist, is to a certain extent the opponent of Darwin,
as he denies that the doctrine of Evolution is applicable to the human
intellect. He is the author of many works on anatomy, biology, and
zoology.
THOMAS HUXLEY, F.R.S., M.D. (born 1825), the famous physiologist and
comparative anatomist and biologist, is a well-known writer on natural
science, and the most prominent of the scientific opponents of revealed
religion.
DR. ALFRED RUSSEL WALLACE (born 1822), the eminent naturalist,
published his _Contributions to the Theory of Natural Selection_ in
1870, and in 1878, in his volume _Tropical Nature_, still further
contributes to our knowledge of sexual selection, etc.
ERNST HAECKEL (born 1834), a celebrated German naturalist and writer on
science, is the chief supporter in Germany of Darwin’s theories. It may
be remembered in this connection that these were anticipated to some
extent by Lamarck (1744-1829) and Goethe (1749-1832).
HERBERT SPENCER (born 1820) has devoted his life mainly to the working
out of his “System of Synthetic Philosophy,” which proposed “to carry
out in its application to all orders of phenomena the general law of
evolution.”
GEORGE J. ROMANES, F.R.S. (born 1848), an ardent member of the
Darwinian school, is a distinguished physiologist and biologist.
PHYSICIANS AND PATHOLOGISTS.
LEOPOLD AUENBRUGGER (1722-1809), a physician of Vienna, was the
inventor of the method of detecting diseases of the chest by
percussion. By striking the chest _directly_ with the tips of the
fingers (not as we do now by interposing a finger of our left hand
while we percuss the chest mediately with the fingers of the other
hand) he diagnosed by the sound evoked the condition of the organs of
the thorax. His system was at first received with contempt and ridicule
by his profession; but in 1808, Corvisart translated Auenbrugger’s
great work, the _Inventum Novum_, into French, and the method quickly
achieved an European reputation.
RENÉ T. H. LAËNNEC (1781-1826), the celebrated French pathologist,
was the inventor of the stethoscope. His great discovery was purely
accidental—a fact which he declares in his famous work.
“In 1816 I was consulted by a young woman labouring under general
symptoms of diseased heart, and in whose case percussion and the
application of the hand were of little avail on account of the great
degree of fatness. I happened to recollect a simple and well-known fact
in acoustics, and fancied it might be turned to some use on the present
occasion. The fact I allude to is the great distinctness with which we
hear the scratch of a pin at one end of a piece of wood, on applying
our ear to the other. Immediately, on this suggestion, I rolled a
quire of paper into a kind of cylinder, and applied one end of it to
the region of the heart and the other to my ear, and was not a little
surprised and pleased to find that I could thereby perceive the action
of the heart in a manner much more clear and distinct than I had ever
been able to do by the immediate application of the ear.”[1031]
JEAN N. CORVISART (1755-1821) introduced into France Auenbrugger’s
method of percussion, one of the most important aids to _physical
diagnosis_.
GASPARD L. BAYLE (1774-1816) made those important researches on
tubercle and the changes in the lungs and other organs in consumption
which form the basis of our present knowledge of the subject. From
this time French physicians introduced great precision in their study
of symptoms, so as to invest them with a really scientific character.
Combined with the perfected methods of anatomical observation, a new
era in clinical medicine dates from this period.
LOUIS (1787-1872) made important researches on pulmonary consumption
and typhoid fever, and introduced the numerical or statistical method
in medical science, which was an important step towards making it an
exact science.
SIR ROBERT CHRISTISON (1797-1882) discovered the effects and properties
of Calabar bean, and was the most famous of all English investigators
of poisons and poisoning.
JOHN CHEYNE (1777-1836), in conjunction with WILLIAM STOKES
(1804-1878), a great clinical teacher and author of works on diseases
of the chest and heart, discovered the form of breathing in certain
disordered conditions which is called “Cheyne-Stokes’ respiration.”
ROBERT J. GRAVES (1797-1853), a great observer and clinical teacher,
gave his name to a disease.
SIR WILLIAM JENNER, M.D. (born 1815), was the first to establish beyond
dispute the difference between typhus and typhoid fevers.
JOHN HUGHES BENNETT, M.D. (1812-1875), was the first to introduce the
use of cod-liver oil in consumption into English practice (1841). He
claimed also to have discovered leucocythemia before Virchow.
ALFRED SWAYNE TAYLOR, M.D. (1806-1880), was the founder of forensic
medicine in England, and his great work on Medical Jurisprudence
(published 1836) has long been the standard authority in medico-legal
cases.
THOMAS HODGKIN (1797-1866) discovered the disease which goes by his
name.
CHARLES MURCHISON, M.D. (1830-1879), is celebrated for his researches
in epidemic diseases.
SIR THOMAS WATSON (1792-1882) was the author of the ever-popular
lectures, _The Practice of Physic_, a work whose graces of style and
elegance of phraseology entitle it to be considered a medical classic.
MATTHEW BAILLIE (1761-1823) was a famous pathologist. He devoted
special attention to the pathology of the brain, heart, lungs, stomach,
and intestines. It was he who first described the grey miliary tubercle
of consumption. In all his profound researches he never failed to
remember their practical end in the cure of disease.
JOHN ABERCROMBIE (1780-1844) is celebrated for his researches on
diseases of the brain and spinal cord.
RICHARD BRIGHT (1789-1858), the reformer of renal pathology, was the
discoverer of the disease which bears his name.
THOMAS ADDISON (1793-1860) discovered the disease of the suprarenal
bodies which is called after him.
KARL V. ROKITANSKY (1804-1878), one of the most famous of the founders
of the New Vienna School, was so indefatigable a pathologist that he is
said to have celebrated his thirty-thousandth post-mortem in 1866. His
great work, _The Handbook of Pathological Anatomy_, was published in
1841.
JOSEPH SKODA (1805-1881), a physician of the New Vienna School,
improved physical diagnosis by his application of the laws of sound. He
rendered percussion more perfect by correctly explaining the import of
the various sounds heard on striking the chest. He threw great light
upon our knowledge of the phenomena of heart diseases.
HEBRA (1816-1880) created a revolution in the science of skin diseases
by basing it upon pathological anatomy.
WUNDERLICH (1815-1877) introduced the use of the clinical thermometer
as an important aid to diagnosis, and claimed that “pathology is the
physiology of sick men.”
RUDOLPH VIRCHOW (born 1821), the constructor of the cellular pathology,
is a celebrated German pathologist and anthropologist. On the basis
of the cellular theory, which teaches that the cells live their own
independent life, have their own active properties, proliferations
and degenerations, Virchow built up his cellular pathology into a
comprehensive system, attaching greater importance to the cell changes
than to an altered condition of the circulation or quality of the
blood, as was previously held to account for pathological changes.
The theory explains many facts which were previously obscure, but is
not wholly satisfactory. Virchow’s system led to the foundation of
pathological histology.
SIR ANDREW CLARK, M.D., F.R.S., President of the College of Physicians,
London (born 1826), is a physician distinguished alike for his profound
scientific knowledge and his admirable skill in its application to
the relief and cure of disease. As a physiologist, anatomist, and
pathologist, especially in connection with the organs of respiration,
the kidneys, and digestive functions, Sir Andrew Clark occupies the
foremost place in English medical practice of the time. He has written
extensively on diseases of the chest, is one of the most brilliant
clinical lecturers of the day, and for many years has been a chief
attraction in the teaching power of the London Hospital.
SIR EDWARD H. SIEVEKING, M.D., etc. (born 1816), was with Dr. H. Jones
joint-author of the well-known _Manual of Pathological Anatomy_ (1854).
SAMUEL WILKS, M.D., F.R.S., etc. (born 1824), is an eminent pathologist
and neurologist. He published his excellent _Lectures on Pathological
Anatomy_ in 1859.[1032]
BRAIN AND NERVE SPECIALISTS.
PHILIPPE PINEL (1745-1826), a French physician, published a translation
of Cullen’s _Nosology_ (1785) in the language of his country. His claim
to our gratitude rests on the fact that he was among the first to
introduce the humane treatment of the insane. With his own hands he,
when physician to the Bicêtre and Salpêtrière, removed the bonds of
insane patients who had been chained to the wall for years.
SIR CHARLES BELL (1774-1842) made the greatest discoveries in
physiology since those of Harvey. We owe to him the knowledge that in
the nervous trunks are special sensory filaments whose office is to
convey impressions from the periphery to the sensorium, and special
motor filaments which convey motor impressions from the brain or other
nerve centre to the muscles. This great discovery of the functions of
the nerves, concerning which there previously existed much confusion
amongst physiologists, was published in 1807, and entitles England to
claim that in Bell and Harvey she has given to science the two most
distinguished physiologists of the world.
FRANZ J. GALL (1757-1828) was a skilful Viennese anatomist, who, by his
researches upon the anatomy of the brain, came to the conclusion that
the talents and dispositions of men may be inferred with exactitude
from the external appearance of the skull, and thus founded phrenology.
CASPAR SPURZHEIM (1776-1832), an anatomist, was a pupil of Gall, and
assisted in the development of phrenology.
JEAN M. CHARCOT (born 1825) is a Paris physician greatly distinguished
by his important investigations in diseases of the nervous system, upon
which he has written many works.
PIERRE FLOURENS (1794-1867), a distinguished French physiologist,
sought to assign their special functions to the brain, corpora
quadrigemina, and lesser brain by experiments. In 1847 he directed
the attention of the Academy of Sciences to the anæsthetic effect of
chloroform upon animals. Chloric ether in the same year was used at St.
Bartholomew’s Hospital as an anæsthetic in operations by Dr. Furnell.
ARMAND TROUSSEAU (1801-1866) was an eloquent and popular clinical
lecturer on medicine. He introduced tracheotomy in croup, and largely
contributed to our knowledge of laryngeal phthisis, etc.
CLAUDE BERNARD (1813-1878), the celebrated experimental physiologist
and pathologist, made numerous researches on the digestion of fat by
the pancreatic juice, the formation of sugar in the liver, and the
artificial production of diabetes by puncturing the fourth ventricle
of the brain, etc. He wrote _Physiologie et Pathologie du Systeme
nerveux_, 1858.
BROWN-SEQUARD (born 1817), the experimental physiologist, discovered
the vaso-motor nerves. He has investigated the functions of the spinal
cord, its normal and pathological states, the brain and sympathetic
nerves and ganglions, the inhibitory and other nerves.
PAUL BERT (1833-1886) was a physiologist and neuro-pathologist.
G. B. DUCHENNE (1806-1875) introduced electro-therapeutics by means of
the induced current in diseases of the nervous system.
ROBERT REMAK (1815-1865) still further pursued the treatment of nervous
diseases by means of the constant current. He investigated the subject
of the parasitic origin of certain diseases of the skin, and produced
favus experimentally.
ELIE VON CYON (born 1843) continued the investigation of
electro-therapeutics.
MARSHALL HALL (1790-1857) discovered reflex action, which fact he
communicated to the Royal Society in 1833.
JAMES BRAID, a Manchester surgeon, in 1841 investigated mesmerism,
and discovered what is now called hypnotism. He found that he could
artificially produce “a peculiar condition of the nervous system,
induced by a fixed and abstracted attention of the mental and visual
eye on one object, not of an exciting nature.” Thus Braid was the first
to investigate the subject scientifically, and to trace the phenomena
of mesmerism to their true physiological cause. Dr. Rudolf Heidenhain,
of Breslau, has recently traced these phenomena to inhibitory nervous
action.[1033]
HENRY MAUDSLEY, M.D. (born 1835), is the author of several important
works on mental diseases: _The Physiology of Mind_, _The Pathology of
Mind_, _Body and Mind_, and _Responsibility in Mental Disease_.
JOHN CONOLLY (1796-1866) was physician to Hanwell Asylum. To him is
due the honour of having first in England pressed upon the notice of
his profession the advantages of the “No Restraint” system in mental
diseases.
DR. FORBES WINSLOW was a popular and humane “mad doctor.”
JOHN C. BUCKNILL, M.D., F.R.S., etc. (born 1817), is a distinguished
student of mental diseases, and the author of several treatises on
Unsoundness of Mind in relation to Crime and Drunkenness. He is one of
the original editors of _Brain_, and for nine years he has edited the
_Journal of Mental Science_.
DAVID FERRIER, M.D., F.R.S., etc. (born 1843), a specialist in brain
surgery, is well known for his researches in cerebral physiology
and pathology, and has acquired great celebrity throughout the
English-speaking world for his investigations connected with the
localisation of the functions of the brain.
PAUL BROCA (1824-1880), the surgeon and anatomist, discovered that the
faculty of speech lies in the third left frontal convolution of the
brain, which in his honour is called Broca’s convolution.
JULES BECLARD (1818-1887) was a distinguished French physiologist.
HENRY C. BASTIAN, M.D., F.R.S. (b. 1837), is a pathological anatomist
and cerebral physiologist. His _Brain as an Organ of Mind_, 1880, is
one of his best known works, and his articles in Quain’s _Dictionary of
Medicine_, on Diseases of the Spinal Cord and Nervous System generally,
are equally valuable contributions to this department of medical
science.
JOHN HUGHLINGS JACKSON, M.D., F.R.S., although distinguished as an
ophthalmologist, is more famous for his researches and discoveries in
connection with the nervous system and the localisation of cerebral
functions.
DR. JULIUS ALTHAUS has made many valuable contributions to our
knowledge of the nervous system.
VICTOR A. H. HORSLEY, F.R.S., etc., pathologist and brain surgeon, is
the author of many papers on the functions of the brain and spinal
cord, and has made important contributions to our knowledge of the
functions of the thyroid gland, hitherto little understood, by which
the treatment of myxœdema will, it is hoped, be greatly improved.
SURGEONS.
The founding of museums of anatomy and surgical pathology by the
HUNTERS, DUPUYTREN, CLOQUET, BLUMENBACH, BARCLAY, and a great
number of other anatomists and surgeons, has greatly assisted to
advance the practical surgery of this century. Some of the more
important improvements in the art as practised at the present time
are the following, which are given in the article on Surgery in the
_Encyclopædia Britannica_:—The thin thread ligature for arteries,
introduced by JONES, of Jersey (1805); the revival of the twisting
of arteries to arrest bleeding by AMUSSAT (1829); the practice of
drainage in large wounds and after operations by CHASSAIGNAC (1859);
aspiration or the application of the principle of the air-pump for
removing pus and fluid from tumours, etc., by PELLETAN and others; the
plaster-of-Paris bandage and other similar immovable applications for
fractures, etc. (an old Eastern practice recommended in Europe about
1814 by the English consul at Bassorah); the re-breaking of badly set
fractures; galvanocaustics and écraseurs; the general introduction
of resection of joints (FERGUSSON, SYME, and others); tenotomy by
DELPECH and STROMEYER (1831); operation for squint by DIEFFENBACH
(1842); successful ligature of great arteries by ABERNETHY and ASTLEY
COOPER (1806); crushing of stone in the bladder by GRUITHUISEN of
Munich (1819), and CIVIALE of Paris (1826); cure of ovarian dropsy by
the removal of the cyst, discovery of the ophthalmoscope, and great
improvements in ophthalmic surgery by VON GRÄFE and others; application
of the laryngoscope in operations on the larynx by CZERMAK (1860) and
others, together with additions to the resources of aural surgery and
dentistry.
In the treatment of fractures English surgery was inferior to that
of continental practice, especially French, in the early part of the
present century. M. ROUX in 1814 pointed out our shortcomings in
this respect, contrasting English with French methods much to our
disadvantage.[1034]
SIR WM. BLIZZARD (1743-1835) was the first surgeon who tied the
superior thyroid artery for goitre. He founded in conjunction with
Maclaurin the medical school of the London Hospital.
BENJAMIN BELL (1763-1820), of Edinburgh, was the elder brother of Sir
Charles Bell. He was professor of anatomy, surgery, and obstetrics, a
man of letters and a famous operator. He published a _System of the
Anatomy of the Human Body_ and _The Principles of Surgery_.
JOHN ABERNETHY (1764-1831), the celebrated surgeon and lecturer on
anatomy, became the founder of the distinguished school of surgery and
anatomy at St. Bartholomew’s Hospital, London.
SIR ASTLEY COOPER (1768-1841) was the first surgeon to tie the
abdominal aorta.
SIR BENJAMIN BRODIE (1783-1862) was an anatomist and physiologist, as
well as a distinguished surgeon.
ABRAHAM COLLES, M.D. (1773-1843), was an eminent Dublin surgeon, the
author of a work on _Surgical Anatomy_, who has given his name to the
fracture of the radius at the wrist.
JOHN BURNS, M.D. (1775-1850), was a teacher of surgery and midwifery
at Glasgow. His world-wide reputation was gained for him by his
_Principles of Midwifery_.
JAMES WARDROP (1782-1869) was the author of a well-known treatise on
the pathology of the human eye.
BENJAMIN TRAVERS (1783-1858) was celebrated for his theory of
“Constitutional Irritation.”
LISTON (1794-1847) was famous for his resections of the elbow and other
joints.
SIR WM. LAURENCE (1783-1867) was one of the greatest clinical teachers
the British school of surgery has produced.
GEORGE GUTHRIE (1785-1856) accompanied Wellington in his campaigns, and
was in his time the great English authority on military surgery.
JAMES SYME (1799-1870) was a distinguished teacher of clinical surgery.
He improved the operation of exarticulation at the knee-joint, and
recommended the operation for amputating at the ankle which goes by his
name.
SIR JAMES PAGET, F.R.S. (born 1814), the distinguished surgeon, is the
author of the _Pathological Catalogue of the Museum of the College of
Surgeons_, _Lectures on Surgical Pathology_, etc.
JOHN ERIC ERICHSEN, F.R.S. (born 1818), is the author of _The Science
and Art of Surgery_, which has not only gone through nine large
editions in this country, but has passed through many editions in
America, and has been translated into German, Spanish, Italian, and
Chinese (partly). Probably no treatise on English surgery has exercised
so much influence on the progress of this branch of the healing art as
Mr. Erichsen’s noble work.
JONATHAN HUTCHINSON, F.R.S. (born 1828), one of the most distinguished
surgeons of the Victorian age, is famous throughout the empire as a
clinical teacher, especially in connection with specific and skin
diseases.
SIR HENRY THOMPSON (born 1820), the distinguished surgeon and
pathologist, is famous for his researches in the pathology of the
urethra and prostate gland, and for his clinical teaching in lithotomy
and lithotrity. He has taken an active part in the cremation propaganda.
SIR W. J. ERASMUS WILSON (1809-1884) was the famous specialist in
skin diseases, whose munificent benefactions to the Royal College of
Surgeons have enormously extended the resources of its museum and
library.
GYNÆCOLOGISTS.
SIR T. SPENCER WELLS, M.D. (born 1818), the celebrated ovariotomist,
and MR. LAWSON TAIT, well described by Dr. Baas as “the magical
operator and despiser of antiseptics,” in abdominal diseases,
especially those of women, are without rivals in the world as
benefactors to humanity by their life-saving discoveries.
ANATOMY IN ENGLAND.
Until 1832 the bodies of executed murderers were ordered for
dissection, by 32 Hen. VIII. c. 42, 1540. Surgeons were granted four
bodies of executed malefactors for “_anathomyes_” which privilege was
extended in the following reigns; but in consequence of the crimes
committed by “resurrection men” in order to supply the medical schools,
a new statute was passed in 1832, which prohibited the dissection of
murderers, and provided for the necessities of the dissecting room by
permitting, under certain regulations, the dissection of the bodies of
unclaimed persons dying in workhouses, etc.
Inspectors of anatomy were appointed, and various regulations were
made for the decent and reverent disposal of the remains. The Anatomy
Act was passed in consequence of the scandals connected with the
great Anatomy School at Edinburgh, at which Dr. Knox was a celebrated
teacher. It was discovered that a murderer named Burke provided bodies
for surgeons by killing his victims by suffocation, leaving no marks of
violence. The crime was known as Burking, and to remove the temptation
to such scandals as the robbery of graveyards, and the murder of
persons for the sake of the prices paid for their bodies, the wants of
the surgeons were provided for in a legal manner.
FRENCH SURGEONS.
ALEXIS BOYER (1757-1833), one of the most eminent French teachers of
surgery, wrote a great work on surgical diseases and operations, in
eleven volumes.
JEAN D. LARRY (1766-1842) was a famous military surgeon under Napoleon.
His opportunities for studying his profession must have been unique, as
he participated in sixty great battles and four hundred engagements.
He wrote several treatises on military medicine and invented field
ambulances.
PHILIBERT J. ROUX (1780-1854), surgeon to the Hôtel Dieu at Paris,
practised resections of joints, by which the articular diseased
extremity of the bone is removed and a false joint formed.
JACQUES LISFRANC (1790-1847) was a famous amputator, whose operation
for the partial removal of the foot is known by his name.
ARMAND VELPEAU (1795-1867) was a celebrated teacher of clinical surgery.
JOSEPH MALGAIGNE (1806-1865) was a very distinguished writer on
surgical anatomy and operative surgery.
AUGUSTE NELATON (1807-1874) was called “the Napoleon of Surgery.” He
invented the probe by which he detected the bullet in the wound of
Garibaldi.
GERMAN SURGEONS.
Plastic operations were revived by C. F. VON GRAEFE, of Warsaw
(1787-1840), DELPECH, DIEFFENBACH, B. LANGENBECK, and others. After
severe burns there is frequently great loss of skin; it was found
that this could be repaired by the transplantation of very minute
portions of skin from healthy surfaces; periosteum and bones were also
successfully transplanted.
VON KERN (1769-1829), the great Viennese surgeon, emphatically insisted
that surgery could not be divorced from medicine. He adopted the very
opposite treatment of wounds to that followed now by Lister; instead of
excluding the air for fear of the germs contained in it, he insisted
that operative wounds should be freely exposed to the atmosphere. He
applied the simplest dressings of wet lint.
F. SCHUH (1804-1865) greatly advanced scientific surgery by advocating
the use of the microscope in pathological anatomy.
VON WALTHER (1782-1849) was a great and scrupulously careful surgical
operator, who, like Kern, declared that surgery and medicine are
indivisible.
VON CHELIUS (1794-1876), a famous teacher of clinical surgery at
Heidelberg, was a well-known writer on surgery.
CONRAD J. M. LANGENBECK (1776-1851) and BERNHARD LANGENBECK (1810-1887)
greatly contributed to found military surgery in Germany.
G. F. L. STROMEYER (1804-1876), a famous military surgeon of Germany,
obtained great success in that department of operative surgery known as
subcutaneous division of tendons for the relief and cure of deformities
such as club foot.
FRIEDRICH ESMARCH (born 1823) is famous for his invention of the
method of bloodless amputations of limbs by the use of the bandage of
india-rubber which goes by his name.
AMERICAN SURGEONS.
VALENTINE MOTT (1785-1865), the celebrated New York surgeon, is said
to have tied more arteries for the relief or cure of surgical diseases
than any other surgeon.
SAMUEL GROSS (1805-1884), a great American teacher of surgery, was the
author of the well-known _System of Surgery_.
OPHTHALMIC SURGEONS.
J. A. H. REIMARUS (1729-1814), of Hamburg, first employed belladonna in
ophthalmic surgery.
JOSEPH BARTH (1745-1818), of Malta, founded an ophthalmic hospital, and
first lectured on eye diseases and their treatment.
JUNG-STILLING (1740-1817) was a celebrated coucher of cataracts.
DR. THOMAS YOUNG (1773-1829) rendered great services to optical
science, and was the first to describe astigmatism, or the want of
symmetry in the anterior refracting surfaces of the eyeball—a disorder
of vision which has considerable influence in causing headache.
J. A. SCHMIDT (1759-1809) first described syphilitic iritis; he called
eye disease with great justice “the elegant diminishing mirror of
diseases of the body.”
C. HIMLY (1772-1837) used mydriatics (dilators of the pupil, such
as hyoscyamus and belladonna) in operations on the eye. Atropine
afterwards superseded these.
G. J. BEER (1763-1821), a professor of Vienna, founded the famous
teaching of the Vienna school of ophthalmology, and greatly improved
the practice of the art and the instruments employed in it.
H. L. HELMHOLTZ (born 1821) invented that powerful aid to the
ophthalmic surgeon—the ophthalmoscope—in 1851. It is said that the
observation of the reddening of the pupil in a drowning cat first
suggested the invention to Méry in 1704. Helmholtz’s invention made
scientific ophthalmology possible. This branch of surgery may be said
to date from this great discovery.
HERMANN SNELLEN (born 1834), an oculist of Utrecht, introduced test
types for ascertaining the distinctness of vision.
R. BRUDENELL CARTER, the eminent ophthalmologist, is a well-known and
graceful writer on medical and scientific subjects.
CHAPTER II.
MEDICAL REFORMS.
Discovery of Anæsthetics.—Medical Literature.—Nursing Reform.—History
of the Treatment of the Insane.
CONSERVATIVE SURGERY.
What is known as “conservative surgery” is the distinguishing feature
of the art as practised at the present day. Whatever Lord Tennyson
may have had in his mind in his lines on the children’s hospital, the
highest surgical practice now is to save diseased and injured parts as
much as possible, instead of removing them. Antiseptic surgery and the
discovery of anæsthetics have alone made this possible.
DISCOVERY OF ANÆSTHETICS.
The Chinese have a drug named Mago, by which they have been able, so
they maintain, to destroy pain for thousands of years past. The vapour
of hemp seed and the drug mandragora have for ages been employed for
anæsthetic purposes previous to surgical operations. In Homer’s time
the properties of opium were well understood, and other narcotic drugs
were used for the same purpose. Patients were also sometimes stupefied
by strong drink, and among some savage tribes banana wine was copiously
administered so as to intoxicate the patient. It was not, however,
until the discovery of the true anæsthesia produced by sulphuric ether
and chloroform that grave surgical operations could be performed
without causing pain to the patient. Nitrous oxide gas, discovered by
Priestley in 1776, was recommended as an anæsthetic by Davy in 1800,
and its use was begun in America by Wells, the dentist, in 1844. The
discovery that by inhaling ether the patient is rendered unconscious
of pain is due to Dr. C. T. Jackson, of Boston, U.S. Mr. T. Morton,
of the same city, first introduced it into surgical practice in 1846.
Chloroform was discovered by Souberain in 1831, and independently by
Liebig in 1832. Dumas determined its composition in 1834. JACOB BELL
in London, and Dr. SIMPSON in Edinburgh, first applied chloroform
experimentally. The late Professor James Miller thus describes the
discovery of the anæsthetic effects of chloroform:[1035] “The trial
proceeded, and the safety as well as suitableness of anæsthesia, by
ether, became more and more established. But a new phase was at hand.
My friend, Dr. Simpson, had long felt convinced that some anæsthetic
agent existed superior to ether, and, in the end of October, 1847,
being then engaged in writing a paper on ‘Etherization in Surgery,’
he began to make experiments on himself and friends in regard to the
effects of other respirable matters—other ethers, essential oils, and
various gases; chloride of hydrocarbon, acetone, nitrate of oxide of
ethyl, benzine, the vapour of iodoform, etc. The ordinary method of
experimenting was as follows: Each ‘operator’ having been provided
with a tumbler, finger glass, saucer, or some such vessel, about a
teaspoonful of the respirable substance was put in the bottom of it,
and this again was placed in hot water, if the substance happened to
be not very volatile. Holding the mouth and nostrils over the vessel’s
orifice, inhalation was proceeded with, slowly and deliberately,
all inhaling at the same time, and each noting the effects as they
advanced. Late one evening—it was the 4th November, 1847—Dr. Simpson,
with his two friends and assistants, Drs. Keith and Matthews Duncan,
sat down to their somewhat hazardous work in Dr. Simpson’s dining-room.
Having inhaled several substances, but without much effect, it occurred
to Dr. Simpson to try a ponderous material, which he had formerly
set aside on a lumber-table, and which, on account of its great
weight, he had hitherto regarded as of no likelihood whatever. That
happened to be a small bottle of chloroform. It was searched for, and
recovered from beneath a heap of waste paper. And, with each tumbler
newly charged, the inhalers resumed their vocation. Immediately an
unwonted hilarity seized the party; they became bright-eyed, very
happy, and very loquacious—expatiating on the delicious aroma of the
new fluid. The conversation was of unusual intelligence, and quite
charmed the listeners—some ladies of the family, and a naval officer,
brother-in-law of Dr. Simpson. But suddenly there was a talk of
sounds being heard like those of a cotton-mill, louder and louder; a
moment more, then all was quiet, and then a crash. On awaking, Dr.
Simpson’s first perception was mental. ‘This is far stronger and better
than ether,’ said he to himself. His second was to note that he was
prostrate on the floor, and that among the friends about him there
was both confusion and alarm.” Each of the investigators related his
experience of the new drug, and the experiments were repeated, always,
however, on this first occasion, stopping short of unconsciousness.
They were all convinced that the new agent had full anæsthetic power
when pushed. Thus was it satisfactorily proved that chloroform was
something much better than ether. Dr. Simpson continued to pursue his
experiments upon himself until he had perfected the method he had so
happily discovered.
A curious incident connected with anæsthesia is mentioned by Dr. Paris
in his well-known work _Pharmacologia_.[1036] He relates an anecdote
which he heard from the poet Coleridge, which illustrates the curative
influence of the imagination.
“As soon as the powers of nitrous oxide were discovered, Dr. Beddoes at
once concluded that it must necessarily be a specific for paralysis;
a patient was selected for the trial, and the management of it was
intrusted to Sir Humphry Davy. Previous to the administration of the
gas, he inserted a small pocket thermometer under the tongue of the
patient, as he was accustomed to do upon such occasions, to ascertain
the degree of animal temperature, with a view to future comparison.
The paralytic man, wholly ignorant of the nature of the process to
which he was to submit, but deeply impressed, from the representation
of Dr. Beddoes, with the certainty of its success, no sooner felt
the thermometer under his tongue than he concluded the _talisman_
was in full operation, and in a burst of enthusiasm declared that he
already experienced the effect of its benign influence throughout his
whole body. The opportunity was too tempting to be lost; Davy cast an
intelligent glance at Coleridge, and desired his patient to renew his
visit on the following day, when the same ceremony was performed, and
repeated every succeeding day for a fortnight, the patient gradually
improving during that period, when he was dismissed as cured, no other
application having been used.”
MEDICAL LITERATURE.
The greatest historians of medicine are the Germans. Especially
valuable are the works of—
KURT P. J. SPRENGEL (1766-1833), of Pomerania, professor of medicine at
Halle. He was a great botanist, but his immortal work on the History of
Medicine eclipsed all his other labours for medical science.
HEINRICH HAESER (1811-1885), the author of the learned _Lehrbuch der
Geschichte der Medicin und der Epidemischen Krankheiten_, which is one
of the most popular works of this class.
DR. JOH. HERMANN BAAS, who is the author of the valuable and
encyclopædic _Grundriss der Geschichte der Medicin_, excellently
translated into English by Dr. H. E. Handerson, of Cleveland, Ohio
(1889).
DR. THEO. PUSCHMANN’S _History of Medical Education_ has recently been
translated into English by Mr. E. H. Hare (1891).
Amongst those of our own countrymen who have rendered great services to
medical literature are—
SIR CHARLES HASTINGS (1794-1866), the founder of the British Medical
Association.
SIR CHARLES SCUDAMORE (1779-1849), one of the greatest authorities on
gout, who popularised Hydro-therapeutics by his writings.
SIR JOHN FORBES (1787-1861), founder of the Sydenham Society.
SIR RICHARD QUAIN, M.D., editor of the Dictionary of Medicine which
bears his name.
MR. ERNEST HART (born 1836), editor (since 1866) of the _British
Medical Journal_, which, by his great literary ability and scientific
knowledge, has become the chief agent in the advancement of the
British Medical Association to its present proud position amongst the
scientific societies of the empire. Mr. Hart has rendered great public
services in improving the condition of the sick poor in workhouses,
and the creation of the metropolitan asylums. Mr. Hart’s labours in
connection with many questions of social and sanitary progress have
been pre-eminently crowned with success.
NURSING REFORM.
When the nineteenth century had run half its course, FLORENCE
NIGHTINGALE (born 1820) was providentially raised up to reform the
working of hospitals, schools, and reformatory institutions, after
the mismanagement of our military hospitals in the Crimea had led to
terrible suffering amongst our wounded soldiers. Her noble devotion
and self-sacrifice amongst the troops earned her the blessing of the
nation, and her name will for ever be gratefully remembered in all
questions connected with hospital reform and the improvement of nursing.
MRS. WARDROPER (died 1892), the exterminator of Mrs. Gamp and her
sisterhood, made her mark in the Crimean War, and put her finger on
some of the most flagrant abuses of the nursing system of the day. She
was the first superintendent of the Nightingale School of Nursing, and
the original trainer of technically educated nurses for hospitals and
infirmaries.
THE TREATMENT OF INSANITY.
It is customary to divide the treatment of the insane into three
periods—the barbaric, humane, and remedial. We must not, however,
suppose that in ancient times the treatment was everywhere barbaric,
and that only in recent times has it become humane and remedial;
nothing could be further from the truth. The treatment of persons
mentally afflicted in ancient Egypt and in Greece was not only humane,
but was probably remedial. In the temples of Saturn in Egypt, and in
the Asclepia of Greece, which were resorted to by lunatics, Dr. J. B.
Tuke thinks[1037] the treatment was identical in principle with that of
the present day. He praises the sound principles on which Hippocrates
and Galen treated insane patients, and there is no doubt that it was
directed towards a cure. With these exceptions little is known as to
the treatment of the insane before the advent of Christianity. The
earliest recorded case of the administration of medicine to an insane
patient is that in which Melampus was the physician, and the neglect
of the worship of Bacchus the cause of the malady. As Mr. Burdett well
remarks,[1038] nowadays the worship of Bacchus is responsible for
much of the insanity which exists. From several accounts in the Greek
poets we may assume that insanity prevailed in classic times in the
forms with which we are now familiar. Hippocrates adopted a peculiar
treatment in cases of suicidal mania. “Give the patient a draught made
from the root of mandrake, in a smaller dose than will induce mania.”
He remarks that although the general rule of treatment be “contraria
contrariis curantur,” the opposite rule also holds good in some cases,
namely, “similia similibus curantur.” It is evident therefore that in
some degree the Father of Medicine was in accord with Homœopathy.[1039]
Whatever may have been the practice of the ancients, it is certain that
in the Middle Ages the treatment of lunatics, up to the middle of the
last century, was simply disgraceful. Little or no effort was made to
cure or even to take proper care of the mentally afflicted. Some few
were lodged in monastic houses, many in the common jails. In 1537 a
house in Bishopsgate Street came into the possession of the Corporation
of London, and was used to confine fifty lunatics. This was the first
Bethlehem Hospital; it was removed in 1675 to Moorfields, and in 1814
the present hospital was built in St. George’s Fields. St. Luke’s was
instituted in 1751.[1040] Many lunatics were executed as criminals
or witches. It was not till the efforts of Pinel, Tuke, and Conolly
were directed to the proper care and treatment of the insane that the
barbarous period of European practice in regard to lunacy was happily
ended.
Mr. Bennett says:[1041] “The Germans seem to have excelled all other
nations in the ingenuity of the torture which they sought to inflict
upon their patients. Some of them advocated the use of machinery, by
which a patient, on first entering an asylum, was to be first drawn
with frightful clangour over a metal bridge across a moat, and then to
be suddenly raised to the top of a tower, and as suddenly lowered into
a dark and subterraneous cavern. These practitioners avowed, according
to Conolly, that if a patient could be lowered so as to alight among
snakes and serpents, it would be better still.” “One humane doctor
invented an excruciating form of torture in the shape of a pump, worked
by four men, which projected a stream of water with great force down
the spine of the patient, who was firmly fixed in a bath made for
this apparatus.” Patients were taken to a bath in the ordinary way
and allowed to bathe, but the bath had a bottom which gave way under
their weight and plunged them into “the bath of surprise” underneath.
Dr. Darwin is credited with having invented “the circulating swing”
for lunatics; it was worked by a windlass, and was capable of being
revolved a hundred times a minute. Esquirol approves this horrible
instrument of torture, and speaks of it as having passed from the arts
into medicine. Terror, cold water, shower baths, horrible noises,
smells, darkness, were employed by the faculty in the treatment of
insanity up to the beginning of the nineteenth century. The leaders of
the French Revolution added starvation to the treatment. In England,
in 1846, the diet in some of the licensed houses was starvation fare.
Cruelty was identical in form in all the countries of Europe. Esquirol,
in 1818, said the insane were either naked or in rags, no bedding was
allowed but a little straw, the stone cells were dark and damp, and
the wretched patients were chained in caves not good enough for wild
beasts. They wore iron collars and belts, and had no medical treatment
but baths of surprise and occasional floggings. Even up to 1850 this
state of things still existed in England.
In England, in 1820, one of the great sights of London was Bedlam. The
keepers were allowed to add to their income by exhibiting the patients
at one penny or twopence per head.
Doubtless the chief reason of the neglect and cruelty to which
lunatics were thus subjected in Christian Europe, so long fruitful
in all other works of mercy, was the theory of possession by an evil
spirit; conjurations and exorcisms were considered the only safe and
efficacious methods of expelling the demons. This grievous blunder is
one of many illustrations which might be given of the necessity of
making an accurate diagnosis before attempting to treat disease. Dr.
Baas says[1042] that lunatic asylums were established first at Feltre
in Italy. The next were those of Seville, established in 1409; Padua,
1410; Saragossa, 1425; Toledo, 1483; Fez, 1492.
Burton, in his _Anatomy of Melancholy_, thus describes Lycanthropy,
“which Avicenna calls _cucubuth_, others _lupinam insaniam_, or
wolf-madness, when men run howling about graves and fields in the
night, and will not be persuaded but that they are wolves or some
such beasts. _Ætius_ (lib. 6, cap. 11) and _Paulus_ (lib. 3, cap.
16) call it a kind of _melancholy_; but I should rather refer it to
_madness_, as most do. Some make a doubt of it, whether there be any
such disease. _Donat. ab Altomari_ (cap. 9, Art. Med.) saith, that he
saw two of them in his time. _Wierus_ (De Præstiv. Demonum, l. 3, cap.
21) tells a story of such a one at Padua, 1541, that would not believe
to the contrary but that he was a wolf. He hath another instance of a
Spaniard who thought himself a bear. _Forestus_ (Observat. lib. 10, de
Morbis Cerebri, c. 15) confirms as much by many examples; one among the
rest, of which he was an eye-witness, at Alcmaer, in Holland. A poor
husbandman that still hunted about graves, and kept in churchyards,
of a pale, black, ugly, and fearful look. Such belike, or little
better, were King Prœtus’ daughters (_Hippocrates_, lib. de insaniâ),
that thought themselves kine; and Nebuchadnezzar, in Daniel, as some
interpreters hold, was only troubled with this kind of madness. This
disease, perhaps, gave occasion to that bold assertion of Pliny (lib.
8, cap. 22, homines interdum lupos fieri; et contra), _some men were
turned into wolves in his time, and from wolves to men again_: and
to that fable of Pausanias, of a man that was ten years a wolf, and
afterwards turned to his former shape; to Ovid’s (Met. lib. 1) tale
of Lycaon, etc. He that is desirous to hear of this disease, or more
examples, let him read _Austin_ in his eighteenth book, _de Civitate
Dei_, cap. 5,” etc., etc.
CHAPTER III.
THE GERM THEORY OF DISEASE.
The Disease-Demon reappears as a Germ.—Phagocytes.—Ptomaines.—Lister’s
Antiseptic Surgery.—Sanitary Science or
Hygiene.—Bacteriologists.—Faith Cures.—Experimental Physiology and the
Latest System of Medicine.
Soon after the discovery of the microscope, men began to seek for
the causes of diseases in the infinitely little. ATHANASIUS KIRCHER
(1598-1680), a Jesuit priest of Fulda, seems to have been gifted
with the ability to foresee three of our greatest modern scientific
discoveries. He anticipated Darwin’s dictum that life is maintained
by struggle and counter-struggle. He described hypnotism in certain
animals, and detected, as he thought, micro-organisms with the
microscope, then in its infancy, in the blood and pus of patients
suffering with the plague and other infectious diseases, which
“worms,” as he termed the corpuscles, he considered to be the cause
of the disease. His instrument had enabled him to discover that all
decomposing substances swarmed with low forms of life. His theory,
however, gained little credence at the time.[1043] Next ANTONY VAN
LEEUWENHOEK, “the father of microscopy,” in 1675 published his
researches in a series of letters to the Royal Society, in which he
described minute organisms in waters, vegetable infusions, saliva, and
in scrapings from the teeth, and he was able to differentiate these
special forms of life. Some of his descriptions are so graphic that
microscopists can almost recognise these forms as bacteria with which
we are now familiar. Physicians still designating these as “worms”
began to attribute to their influence various diseases.
In 1701 NICHOLAS ANDRY wrote on this subject a treatise entitled _De
la Génération des Vers dans le Corps de l’Homme_. The germ theory of
putrefaction and fermentation originated with Andry; he maintained
that air, water, vinegar, fermenting wine, old beer, and sour milk
contained myriads of germs; he detected these in the blood and pustules
of small-pox, and believed that they could be found in other maladies.
His views met with general acceptance, and curiously enough it was
believed—and has since been verified by our own observation—that
mercurial preparations were fatal to such disease germs.[1044]
LANCISI in 1718 attributed the unhealthy effects of malarial air to
animalcules, and “inconceivable worms” met with as much ridicule in
Paris in 1726 as the “microbe” has been received with to-day. Linnæus
out of all this chaos thought order might possibly be evolved; he
believed that the actual contagion of certain eruptive diseases might
be discovered in these small living beings.
MARCUS ANTONIUS PLENCIZ in 1762 discussed the relation of animalcules
to putrefaction and disease in his works.[1045]
Notwithstanding all these clear indications, which, if followed up,
would have been fertile in result, the germ theory of disease fell
almost into oblivion. OTTO MÜLLER in 1786 began a more systematic study
of the life history of various micro-organisms, and thus advanced the
science of minute forms of life. The question arose, How do these forms
originate? Dr. Needham was the first to suggest the theory of their
spontaneous generation. Bonnet, of Geneva, disputed the results of Dr.
Needham’s experiments, and Spallanzani demonstrated by experiment the
correctness of Bonnet’s criticism.
FRANCIS SCHULZE in 1836, by a carefully devised experiment, struck
another blow at Needham’s theory of spontaneous generation. In 1837
SCHWANN convinced himself that the cause of decomposition must exist in
the air. SCHROEDER and VAN DUSCH in 1854 proved that filtration of the
air through cotton-wool was effectual in excluding germs. Then HOFFMAN
in 1860, and CHEVREUIL and PASTEUR working independently in 1861,
showed that a sterile solution could be kept sterile if the neck of
the vessel were bent in the form of an S, so that the micro-organisms
in the air entering the neck of the flask, would be deposited by
gravitation in the curve.
But the advocates of the theory of spontaneous generation were not yet
satisfied. They objected that by the boiling of the infusions, etc.,
under examination they lost the ability to become decomposed; but it
was shown that the admission of unfiltered air set up decomposition.
PASTEUR, BURDON SANDERSON, and LISTER next showed that blood, urine,
and milk would not decompose if proper precautions were taken to avoid
contamination. In 1872 CHARLTON BASTIAN endeavoured to rehabilitate the
spontaneous generation theory, but TYNDALL effectually disposed of his
contentions. It is settled that bacteria, or microbes, as these germs
are now called, when once destroyed by heat and by certain chemical
agents in any medium, cannot be resuscitated, and that Harvey’s axiom,
_omne vivum ex ovo_, applies to all forms of organisms. As DR. SIMS
WOODHEAD has said[1046] concerning the battle between the advocates and
opponents of the spontaneous generation theory:—
“The triumphs of surgery, of preventive inoculation of hygiene
in relation to specific infective diseases, of preservation of
food, have had their origin in the knowledge gained during the
battle which waged round the question of spontaneous generation or
_generatio æquivoca_; and to the disciples of that school every
acknowledgment must be made and due credit assigned for the attitude
of scepticism, and free, ingenious, and honest criticism which they
passed concerning half-formed and inadequately-supported theories and
imperfectly-conducted experiments, for to their efforts is certainly
due the fact that the experiments of their opponents became more and
more perfect, and if to-day we have perfect methods of sterilization
and of making pure cultivations, it is because nothing was taken for
granted, and because able men on both sides of the controversy were
ranged against one another to fight the matter to the death.”
Another question which had to be determined was whether these
organisms were of the animal or vegetable kingdom. EHRENBERG came to
the conclusion that in consequence of snake-like and rotary movements
of certain micro-organisms they were animals; and this opinion held
its ground till DAVAINE decided that bacteria must be considered as
belonging to the vegetable kingdom. Up to 1852 the animal theory was
unshaken; in 1854 COHN demonstrated the plant nature of bacteria.
In 1857 NAEGELI made a group of all the forms of lesser minute
organisms, and termed it Schizomycetes, or fission fungi. The
connection between micro-organisms and disease was the subject of
research also in another direction. The discovery by LATUM and SCHWANN
in 1837, that the yeast plant is a living organism, and the true cause
of fermentation, threw great light on the whole inquiry. Many observers
had long recognised the likeness of certain diseases to fermentation
processes, and it gradually became the opinion that such diseases were
similarly produced. In 1837 BASSI discovered that the silk-worm disease
was due to microscopic spores on the bodies of sick worms, and that
healthy worms became diseased when these spores were conveyed to them.
HENLE in 1840 declared that all contagious diseases must be caused by
the growth of something of a living nature, although he had searched
in vain for the living contagion of small-pox and scarlet fever.
When fungi were found to be the cause of favus, herpes tonsurans, and
pityriasis versicolor, the theory received a still greater impetus.
SWAINE, BRITTAN, and BUDD found micro-organisms in connection with
cholera. In 1857 PASTEUR demonstrated that lactic, acetic, and butyric
fermentations were produced by micro-organisms.[1047] In 1863 DAVAINE
came to the conclusion that the disease known as splenic fever is
caused by an organised being which kills the animal by multiplying
in its blood, and so changing its nature, after the manner of a
fermentation process. PASTEUR next took up the investigation of
silk-worm disease, and was ultimately able to confirm the opinion that
the disease was due to micro-organisms, and to devise a remedy for it.
ROBERT KOCH in 1877 described the life-history of the bacillus of
anthrax or splenic fever. PASTEUR also devoted much attention to the
same subject, and confirmed the observations of Koch. PAUL BERT,
on the other hand, argued that the bacilli were of no importance.
Ultimately he was convinced of his error by Pasteur; it was, however,
says PROFESSOR CRUIKSHANK,[1048] “principally the researches of Koch
which placed the doctrine of contagium vivum on a scientific basis.
Koch elevated the theory of contagium vivum to a demonstrated and
established fact.”
The whole matter is beset with fallacies. Because certain bacteria have
been discovered in the blood of animals suffering from a particular
disease, it must not be rashly concluded that these bacteria are
always its cause, they may be in some cases only its effects. At the
present time the nature of the contagion in many diseases, such as
hydrophobia, variola, vaccinia, scarlet fever, and measles, has not
been discovered. The comma-bacillus is associated with cholera in
some mysterious manner, yet experimenters have swallowed myriads of
comma-bacilli, and have remained never the worse. Although Pasteur’s
prophylactic treatment against hydrophobia is based upon the theory
that a micro-organism is the cause of the disease, Pasteur has never
yet discovered the bacterium of hydrophobia, yet there would seem to
be one. DR. SIMS WOODHEAD says:[1049] “It is a most remarkable fact
that although no micro-organisms can be found in the virus, filtration
through the Pasteur filter keeps back the effective part of the virus,
whilst heating to 100°C. destroys the activity of the virus.”
The disease-demon has now reappeared in the form of a germ.
THE PHAGOCYTE THEORY.
Some thirty-six diseases, many of which are amongst the most terrible
which afflict men and animals, are attributed by bacteriologists to
micro-organisms.[1050] It is sufficiently alarming to reflect that
enemies which can only be detected by a specialist armed with a
powerful microscope are everywhere around us, waiting to attack us in a
favourable spot, and slay us without hope of escape.
Yet the germ-theorists have not left us entirely without hope. One
of Pasteur’s most distinguished pupils, M. METSCHNIKOFF, offers us
salvation through faith in his phagocytes. The white blood corpuscles
are for ever on the watch for the incursions of disease germs.
These they instantly arrest and imprison by taking them into their
own substance, digesting and converting them to their own uses.
Whenever there is an extra demand for the services of these admirable
blood-police, a large number are attracted to the point where the
burglarious and murderous enemy has entrenched himself; and if the
system is in a position to maintain a sufficient force of these
guardians of health, the enemy is rapidly digested, and the effete
products are expelled by the regular physiological channels.
It has been found that men and animals may be insusceptible to an
infective disease by natural immunity. Not all persons subjected to
exposure to epidemic diseases contract them. Ordinary sheep readily
succumb to anthrax, but Algerian sheep resist any but large doses of
the virus.[1051] Acquired immunity is that by which one attack, say of
measles or of small-pox, protects against a second. Acclimatization
also affords immunity. Pasteur, in his researches on fowl cholera,
noticed that in non-fatal cases the disease did not recur. This set
him to work out a theory of attenuated inoculations which should
afford protection by giving the disease in a mild form in cultivations
of the micro-organism. Pasteur next endeavoured to protect animals
against anthrax by inoculating them with a mitigated virus. His
results were criticised and his researches opposed by Koch, who
came to the conclusion that the process did not admit of practical
application, chiefly because the immunity would only last a year, and
on account of the danger of disseminating a vaccine of the necessary
strength.[1052] The theory of protective inoculation in hydrophobia
has been much discussed. Pasteur’s explanation does not entirely
satisfy some experts. Dr. Sims Woodhead gives the following: “I am
inclined to think that the explanation advanced by Wood and myself,
that the treatment consists essentially in causing the tissues to
acquire a tolerance before the microbe has had time to develop, is
more in accordance with the facts. The tissue cells are acted upon by
increasingly active virus, each step of which acclimatizes the cells
for the next stronger virus, until at length, when the virus formed by
the micro-organisms introduced at the time of the bite comes to exert
its action, the tissues have been so far altered or acclimatized that
they can continue their work undisturbed in its presence; and treating
the micro-organisms themselves as foreign bodies, destroy them. When
the cells are _suddenly_ attacked by a _strong dose_ of the poison
of this virus, they are so paralysed that the micro-organisms can
continue to carry on their poison-manufacturing process without let or
hindrance; but when the cells are gradually, though rapidly, accustomed
to the presence of the poison by the exhibition of constantly
increasing doses, they can carry on their scavenging work even in its
presence, and the micro-organisms are destroyed, possibly even before
they can exert their full poison-manufacturing powers.”[1053]
PTOMAINES.
The germ theory has thrown great light upon the subject of certain
mysterious organic poisoning processes, which long puzzled analysts
and physicians. Diseased meat, fish, cheese, and other articles of
food frequently cause symptoms of poisoning in those who have partaken
of them. The analyst failed to detect the precise agent which caused
the mischief, and it was not till the bacteriologists investigated
the subject that it was satisfactorily explained. In 1814, BURROWS
described a poisonous substance in decaying fish. In 1820, KERNER
described a poisonous alkaloid which he discovered in sausages. In
1856, PANUM isolated a poison from some decomposing animal matter.
ZUELZA and SONNENSCHEIN from the same substance obtained a poison which
closely resembled atropine in its physiological action. SELMI between
1871 and 1880 described substances which he called cadaveric alkaloids
or ptomaines. Pasteur and others, working in the same direction, have
greatly advanced our knowledge of these deadly agents. Bacteria are now
known to have the power to build up deadly substances as they grow in
dead or living animal tissues, just as plants build up poisons in their
own tissues; these substances exert a deadly influence on the nerve
centres, and hence a cheese bacillus may be as dangerous to human life
as a dose of aconite.
LISTER’S ANTISEPTIC SURGERY.
What is commonly known as “Listerism” is a development of the germ
theory of disease, which has revolutionised the art of surgery by its
direct and indirect influence. Pus formation, the result of destructive
processes which prevent the healing of wounds, was discovered to be
due to the action of germs falling from the atmosphere on the injured
flesh. LISTER sought to destroy these germs by powerful disinfectants.
This was the first step in the antiseptic treatment. When carbolic-acid
lotions were applied for this purpose, LISTER discovered that the wound
healed rapidly. He believed that he had destroyed the micro-organisms
by the carbolic-acid lotions. But LISTER improved on this process, and
seeing how difficult it is to destroy the germs when they have once
entered the tissues, he invented a method whereby they were prevented
from gaining admission at all. He fought the micro-organisms in the
atmosphere of the operating room, in the dressings, instruments, and
hands of the operator, and thus gradually built up his system of
absolute surgical cleanliness called antiseptic surgery. Even those
surgeons who rejected his method in its entirety, and declined to adopt
his complicated system of dressings, devoted so much attention to the
minutest cleanliness, that they achieved results not less successful
than those of the inventor of the antiseptic system itself.
SANITARY SCIENCE.
Hygiene, the art of preserving health, has always been recognised
as a branch of medical science, not less important than that which
concerns itself with the cure of disease. MOSES (B.C. 1490) enjoined
the strictest cleanliness, and anticipated our modern sanitary laws.
HIPPOCRATES embodied in his works treatises on hygiene, which existed
in Greece probably long anterior to his time. The value of attention
to rules of diet and exercise was recognised by HERODICUS, one of
his preceptors, who introduced a system of medicinal gymnastics for
the improvement of the health and the cure of disease. Such rules
must to a greater or less extent have always been in force in any
well-constituted army. Gymnasts, athletes, and others must have been
fully aware of the necessity for attending to such rules. Hippocrates,
in his treatise _Airs, Waters, and Places_, has insisted on the duty
of the physician to study the effects of the seasons, the winds, the
position of cities, and the diseases which are endemic and epidemic
in them, the qualities of waters, and their effects on public health,
and so forth. Had men taken up the study of Hygiene where Hippocrates
left off, we should not have heard of the plagues, pestilences,
and epidemics which up to modern times periodically devastated the
civilized world.
HYGIENE.
Mr. PARKES, in the introduction to his _Manual of Practical Hygiene_,
defines hygiene in its largest sense to signify “rules for perfect
culture of mind and body.” The two are not to be dissociated. Every
mental and moral action influences the body; the physical conditions
equally re-act upon the mind. He admirably says: “For a perfect
system of hygiene we must combine the knowledge of the physician,
the schoolmaster, and the priest, and must train the body, the
intellect, and the moral soul in a perfect and balanced order. Then,
if our knowledge were exact, and our means of application adequate,
we should see the human being in his perfect beauty, as Providence,
perhaps, intended him to be; in the harmonious proportion and complete
balance of all parts in which he came out of his Maker’s hands, in
whose divine image, we are told, he was in the beginning made.” Mr.
Parkes asks if such a system is possible? He replies that we can even
now literally choose between health and disease. There are certain
hereditary conditions which we may not be able to avoid, and men may
hinder our acquisition of the boon; but as a race man holds his own
destiny in his hands, and can choose the good and reject the evil. Exit
the disease-demon! Fevers and other epidemic diseases are no longer
attributed to the anger of the Supreme Being; they may be prevented.
If we use the words scourge, plague, visitation, and the like, it
is merely because we recognise that Nature can take offence at our
violation of her laws, and visit us with the penalty.
One of the most important events of our time was the establishment of
the Registrar-General’s office in 1838. To DR. WILLIAM FARR we owe a
nation’s gratitude for the admirable manner in which he performed the
duties of his office. The Government Inquiry into the Health of Towns
and of the Country generally, undertaken by EDWIN CHADWICK, SOUTHWOOD
SMITH, NEIL ARNOTT, SUTHERLAND, GUY, TOYNBEE, and others, was of
immense importance to the national health. The medical officer to the
Privy Council, SIMON, carried on the work thus ably commenced with the
greatest vigour; and the consequence of the important departure was
that medical officers of health were appointed to the different towns
and parishes.
Various public health acts have followed from time to time, and it has
been found, in the words of Mr. Parkes, that “nothing is so costly in
all ways as disease, and that nothing is so remunerative as the outlay
which augments health, and in doing so, augments the amount and value
of the work done.”
It is a reproach frequently brought against medicine that it makes
little advance. Some have even said that in some respects we are no
better off than if we lived in the days of Hippocrates. However this
may be, we may be justly proud of the splendid work which hygienic
medicine has performed, and we have every reason to look hopefully
forward to the benefits this branch of medical science will confer upon
us in the near future. Hygiene is the outcome of physiology. Until we
knew the laws of life, it was impossible that hygiene should have a
scientific basis; and henceforth physiology and hygiene will go hand in
hand.[1054]
JOHN SIMON, C.B., F.R.S. (born 1816), the eminent physiologist,
pathologist, and surgeon, became the first appointed officer of health
to the City of London. He was for some time medical adviser to the
Privy Council. He rendered the greatest services to the health of the
nation by his reports and official papers on sanitary matters.
EDMUND A. PARKES (1819-1876) was the great sanitary reformer whose name
is gratefully enshrined in the “Parkes Museum of Hygiene,” instituted
in 1876, of University College, London.
LUDWIG J. P. SEMMELWEIS (1818-1865), “the Father of Antiseptic
Midwifery,” was professor in Pesth, and has earned the gratitude of
his profession and of the whole world by demonstrating that puerperal
fever was due to inoculation, that the poison which caused it was
introduced by organic matter below the nails and epidermis of the
students and doctors who had been engaged in anatomical or pathological
work and had not taken sufficient pains to disinfect and purify their
hands. He recommended careful washing with chlorine water before each
examination; the consequence of which was, that the mortality among
lying-in women fell in two months from twelve to three per cent. He
anticipated the methods of Lister, and died in a lunatic asylum, galled
by the attacks which his doctrines experienced.[1055] Sir Andrew
Clark said:[1056] “There are few such parallels in the history of
science, in regard to his tremendous moral heroism; in spite of every
conceivable difficulty, in positions of misrepresentation, in spite
of persecution, he continued his labours, until crowned with a full
clearing up of the difficulties. As to his martyrdom, there is not such
a history. The persecution to which he was exposed in the later years
of his stay in Vienna, his being hounded out of Vienna and settling in
Budapest, and his premature end in loss of reason, form indeed a sad
story, and one of the highest examples that can be presented.”
BACTERIOLOGISTS AND OTHER SCIENTISTS.
BENJAMIN W. RICHARDSON, M.D., F.R.S., etc. (born 1828). In 1865 he
made important researches on the nature of the poisons of contagious
diseases and discovered _septine_. In 1866 he discovered the use of
the ether spray for locally abolishing pain in surgical operations. He
introduced bichloride of methylene as an anæsthetic, and discovered the
influence of nitrite of amyl over tetanus, angina pectoris, etc. He
invented the _lethal chamber_ for killing animals without pain, and has
made many most important researches on the action of alcohol on man. In
1875 he gave a sketch of a “Model City of Health,” to be called Hygeia,
which awakened much interest and discussion.
JOHN BURDON SANDERSON, M.D. (born 1828), Professor of Physiology at
Oxford, made investigations respecting the cattle plague, 1865-66.
In 1883 he sat on the Royal Commission on Hospitals for infectious
diseases, and has made elaborate researches on animal and plant
electricity, and on the nature of contagion.
ROBERT KOCH (born 1843), the eminent bacteriologist, the discoverer of
the “comma” bacillus, and the tubercle bacillus, is Professor of the
Institute of Hygiene in Berlin.
JOHN TYNDALL, F.R.S. (born 1820), is one of the foremost of the
scientific explorers of the century. Besides his researches in relation
to magnetism, radiant heat, heat as a mode of motion, light, etc.,
Professor Tyndall has rendered very important services to medicine
by his studies on _The Floating Matter of the Air in Relation to
Putrification and Infection_, 1881.
LOUIS PASTEUR (born 1822), chemist, is celebrated for his researches
relative to the polarization of light, and for his investigations on
fermentation, the preservation of wines, and the propagation of zymotic
diseases in silkworms and domestic animals. Pasteur’s most important
work for medicine was the demonstration of the existence of the germs
which cause putrefaction.
The Minister of Public Instruction, addressing M. Pasteur on the
occasion of his seventieth birthday, summed up what is known as
Pasteurism in the following words: “Henceforward the formula is
definitive and complete. Your disciples give it in two words—ferments
and virus are living beings; vaccine is an attenuated virus, the basis
of medicine is the artificial attenuation of virus, and thus the
microbic treatment is founded.”
Pasteur’s later work has been chiefly in connection with the attempt to
discover a prophylactic for hydrophobia.
LIONEL S. BEALE, F.R.S. (born 1828), physiologist and pathological
anatomist, is a celebrated microscopist, author of _The Microscope in
its Application to Practical Medicine_; _Disease Germs, their Supposed
and Real Nature, and on the Treatment of Diseases caused by their
Presence_; and many other works of equal importance to medical science.
WILLIAM B. CARPENTER (1812-1885) was a celebrated physiologist, whose
great work has done more to popularise the study of physiology amongst
non-professional, as well as medical readers, than any other, except
that of Professor Huxley, which followed it.
Amongst other scientific workers of the century may be mentioned
PURKINJE, who rediscovered and described the bone corpuscles,
contributed greatly to the study of microscopical anatomy and
ophthalmology by his experiments with the ophthalmoscope.
R. WAGNER (1805-1864) in 1861 called an anthropological congress, which
was attended by several distinguished anatomists, and thus originated
the “Anthropological Congress.”
PANDER (1794-1865) and BAER (1792-1876) made important researches in
the history of development. To Baer is due the splendid discovery of
the mammalian ovum.
FRANÇOIS MAGENDIE (1782-1855) was the first to introduce the
experimental method into pathology and pharmacology. His investigations
in what are called pharmaco-dynamics, chiefly connected with the
alkaloids, introduced many of these powerful remedies into medical
practice. He admitted a vital principle in nervous activity, but for
the rest endeavoured to reduce medicine to mere physiological and
chemical laws.
MIRACLES OF HEALING, FAITH CURES, MIND CURES, CHRISTIAN SCIENCE
HEALING, ETC., ETC.
There are many things connected with the healing art on which the
public mind is better informed than the recognised authorities on
medicine. Mesmerism is now accepted by the faculty under the name
of hypnotism, and the miracles of healing wrought at the shrines of
saints, long the objects of scorn and contempt at the hands of the
medical profession, are now declared to be well within the domain
of scientific fact. The miracles of Lourdes, the faith cures at
Bethshan, and similar phenomena, having been subjected to the strictest
investigation by the most competent medical authorities, are proved to
be not impostures and delusions, but simple matters of fact. Science
having reluctantly accepted the faith-cure, now declares it to be “an
ideal method, since it often attains its end when all other means have
failed.”[1057]
Professor Charcot, while declaring that the faith-cure is entirely of a
scientific order, insists that its domain is limited; “to produce its
effects it must be applied to those cases which demand for their cure
no intervention beyond the power which the mind has over the body.”
That is to say, faith will cure paralysis and other disorders of motion
and sensation dependent on idea, but does not avail to restore a lost
organ or an amputated limb.
Professor Charcot believes also that the faith-cure may cause ulcers
and tumours to disappear, if such lesions be of the same nature as the
paralysis cured by the same means. In all this there is no miracle.
The diseases are all of hysterical origin, according to this eminent
authority, and being purely dynamic, and not organic, the mind has
power to influence and cure them. The mind of the invalid becomes
possessed of the overpowering idea that a cure is to be effected, and
it is so.
M. Littré has explained for us how this happens.[1058] The mind, which
is most eminently receptive of suggestion, will be the most likely to
be influential in curing the body in which it is enshrined, by the
powerful force of auto-suggestion.[1059]
In expressing this opinion, no question need arise of the efficacy
of prayer or of the intervention of the Divine power. The aim of the
physician is to understand the medical side of the subject, and science
is daily becoming more capable of offering an explanation of such
phenomena from a purely medical point of view. A curious instance of
faith-cure was recently given in a Catholic magazine.
The _Month_ for June, 1892, published an account, by the late Earl
of Denbigh, of a cure worked by a member of a family named Cancelli
on Lady Denbigh in 1850. She was suffering severely from rheumatism,
and the Pope (Pius IX.) mentioned to the Earl that near Foligno there
was a family of peasants who were credited with a miraculous power of
curing rheumatic disorders. Lord Denbigh succeeded in getting one of
the family, an old man, to come, and learned from him the legend of
the cure. The belief was that in the reign of Nero, the Apostles Peter
and Paul took refuge in the hut of an old couple named Cancelli, near
Foligno, and as a proof of gratitude, gave to the male descendants of
the family living near the spot the power of curing rheumatic disorders
to the end of time. Lord Denbigh described how the old man made a
solemn invocation, using the sign of the cross, and, in fact, Lady
Denbigh did recover at once. In a few days the pains returned, but she
made an act of resignation, and they then left her, and never returned
with any acuteness.
EXPERIMENTAL PHYSIOLOGY.
The question of vivisection, or experimental physiology, pathology,
and pharmacology, has become a burning one in England and America of
recent years. In a history of medicine so prominent a question cannot
be entirely ignored, although it would be out of place to discuss it
here at length. It has been claimed that almost all our real knowledge
of the healing art, and the most important steps of medical progress,
have been gained by experiments upon living animals. On the other hand,
it has been maintained by practical physicians and surgeons that the
method in question is not less misleading than cruel; that “the only
correct path is that of thoughtful experience.”[1060] On behalf of the
advocates of the experimental method, PROFESSOR MICHAEL FOSTER shall
state the case; that of the other side shall be given in the words of
SIR ANDREW CLARK, “the prince of physicians, and one of the noblest of
men,” under whom it was my happiness and privilege to study medicine in
the wards of the London Hospital.
PROFESSOR MICHAEL FOSTER says: “It would not be a hard task to give
chapter and verse for the assertion that the experimental method
has, especially in these later times, supplied the chief means of
progress in physiology; but it would be a long task, and we may content
ourselves with calling attention to what is in many respects a typical
case. We referred a short time back to the phenomena of ‘inhibition.’
It is not too much to say that the discovery of the inhibitory function
of certain nerves marks one of the most important steps in the progress
of physiology during the past half-century. The mere attainment of
the fact that the stimulation of a nerve might stop action instead
of inducing action constituted in itself almost a revolution; and
the value of that fact in helping us on the one hand to unravel the
tangled puzzles of physiological action and reaction, and on the other
hand to push our inquiries into the still more difficult problems of
molecular changes, has proved immense. One cannot at the present time
take up a physiological memoir covering any large extent of ground
without finding some use made of inhibitory processes for the purpose
of explaining physiological phenomena. Now, however skilfully we
may read older statements between the lines, no scientific—that is,
no exact—knowledge of inhibition was possessed by any physiologist,
until Weber, by a direct experiment on a living animal, discovered
the inhibitory influence of the pneumogastric nerve over the beating
of the heart. It was, of course, previously known that under certain
circumstances the beating of the heart might be stopped; but all ideas
as to how the stoppage was, or might be, brought about, were vague and
uncertain before Weber made his experiment. That experiment gave the
clue to an exact knowledge, and it is difficult, if not impossible, to
see how the clue could have been gained otherwise than by experiment;
other experiments have enabled us to follow up the clue, so that it
may with justice be said that all that part of the recent progress
of physiology which is due to the introduction of a knowledge of
inhibitory processes is the direct result of the experimental method.
But the story of our knowledge of inhibition is only one of the
innumerable instances of the value of this method. In almost every
department of physiology, an experiment, or a series of experiments,
has proved a turning-point at which vague, nebulous fancies were
exchanged for clear, decided knowledge, or a starting-point for the
introduction of wholly new and startling ideas.
“And we may venture to repeat, that not only must the experimental
method be continued, but the progress of physiology will chiefly depend
on the increased application of that method. The more involved and
abstruse the problems become, the more necessary does it also become
that the inquirer should be able to choose his own conditions for the
observations he desires to make. Happily, the experimental method
itself brings with it in the course of its own development the power
of removing the only valid objection to physiological experiments,
viz., that in certain cases they involve pain and suffering. For in
nearly all experiments pain and suffering are disturbing elements.
These disturbing elements the present imperfect methods are often
unable to overcome; but their removal will become a more and more
pressing necessity in the interests of the experiments themselves,
as the science becomes more exact and exacting, and will also become
a more and more easy task as the progress of the science makes the
investigator more and more master of the organism. In the physiology of
the future, pain and suffering will be admissible in an experiment only
when pain and suffering are themselves the object of inquiry. And such
an inquiry will of necessity take a subjective rather than an objective
form.”[1061]
Let the President of the Royal College of Physicians give his views
of the utility of vivisection from the point of view of a practical
physician:—
SIR ANDREW CLARK before the “Clinical Society of London” (_British
Medical Journal_, Feb. 3, 1883) said: “For whatever purpose they
may be employed; however carefully they may be designed and executed;
however successful may be the precautions taken to exclude error,
experiments have their subtle difficulties and dangers which are
perilous to truth, and cannot be wholly averted. By the prestige
of precision, which often undeservedly they profess, undue weight
is attached to their results; and by the assumption that in like
conditions the results would be the same in man as in the lower
animals, flagrant errors are committed, and currency is given to false
or inadequate generalisations. The experimenter interprets the results
of his experiments by the light of their structural results; he forgets
or he ignores the life-history of the processes by which they have
been evolved, and he takes no account of the fact, beyond controversy,
that different clinical states find occasionally the same structural
expression. In such circumstances doubt is inevitable, and it is only
to clinical medicine that any just appeal for its solution can be made.
To her, at last, all such experiments must be brought for trial; she
must be their examiner, critic, interpreter, user, and judge. And no
results of experiments can be made of any avail to medicine, or be used
with safety in her service, until they have been filtered through the
checks and counter-checks of clinical experience, and have responded
to the tests and counter-tests of clinical trial. Had these principles
exerted their just influence in the recent debates concerning questions
of this kind, we should not have had a seton in the neck of a man taken
as the parallel of a seton in the neck of a guinea-pig; we should
not have had the artificial tuberculosis of the rodent pronounced to
be identical with the natural tuberculosis of the child; we should
not have had grey tubercles and caseous pneumonias pronounced on the
grounds of mere likeness of structure to be of one and the same nature;
and we should have been spared the sight of science, drunken with
success and drivelling with prophecies, soliciting the public on the
common highway.”
APPENDIX.
_ON SOME OF THE MORE IMPORTANT MINERALS USED IN MEDICINE._
(Compiled chiefly from Royle’s _Materia Medica_.)
CARBONATE OF SODA is the _neter_ of the Hebrews. It was known to the
early Hindus, and is by them called _Sajji noon_ (_i.e._ Sajji or Soda
Salt); it is the Sagimen vitri of Geber. The Natron lakes of Egypt
were known to the ancients, and it was early employed in glass making,
etc. (Royle). On the shores of the Indian Ocean, the Red Sea, and the
Mediterranean, plants of the order _Chenopodeæ_ are burned to form the
ash called Barilla, and from this ash soda is obtained. Carbonate of
soda was also formerly prepared on the coasts of Scotland, Ireland,
Wales, and Normandy, by burning algæ or sea-weeds, and the ash so
obtained was called _kelp_. There is no doubt that the process is
extremely ancient, and the discovery of the properties of these ashes
accidental.
CHLORIDE OF SODIUM, or common salt, is so universally distributed that
it must have been known and used in food from the earliest ages.
BORAX is thought to have been the Chrysocolla of Pliny. It is the
_Sohaga_ of the Hindus (Sanscrit, _Tincana_), and is called _Booruk_ by
the Arabs. It is abundant on the shores of some of the lakes in Thibet,
and was brought into India across the Himalayas (Royle).
SULPHATE OF SODA, or Glauber’s Salt, is found on the soil in India and
other countries, and exists in the ashes of many plants, in mineral
springs, and in sea-water.
LIME was known to the Egyptians and Hindus.
MAGNESIA seems to have been known to the alchemists. Its name occurs
in Geber and other writers of the period. The CARBONATE OF MAGNESIA
was probably first used as a medicine by the Count de Palma at Rome.
Hoffmann introduced it into the list of Materia Medica.
EPSOM SALTS (SULPHATE OF MAGNESIA) was first discovered by Dr. Grew in
1675 in a spring at Epsom. It is found in many countries.
ALUM is mentioned in _Pliny_, xxxv. chap. 15, and probably is referred
to by _Dioscorides_ (v. chap. 122). _Shib_ was the generic term of alum
of various kinds in Arab writings. Egyptians and Hindus must have known
of its properties from the earliest ages of their civilization. It was
introduced into Europe from Syria by the Genoese.
_Green Vitriol_ or _Sulphate of Iron_ was known to the ancients. It is
mentioned, says Dr. Royle, in the _Amera Cosha_ of the Hindus (_Hind.
Med._, p. 44), and it is used by them as by the Romans in the time of
Pliny in making ink.
ZINC seems to have been first made known as a metal in Europe by
Paracelsus. The Hindus have imported it from China from remote times.
The Oxide of Zinc was anciently called tutty, probably from the Tamil
Tutanagum. In the East, says Royle, SULPHATE OF ZINC is called _suffed
tutia_, or white tutia, the Sulphates of Iron and Copper being called
_green_ and _blue tutia_ (_Hindu Med._, p. 100).
COPPER was one of the metals most anciently known. It was employed
in medicine by the Hindus and Arabs in the form of the Sulphate or
Blue-stone. VERDIGRIS, the DIACETATE OF COPPER, must have been known
wherever copper vessels were used. It was employed by the Greeks as a
medicine, by the Arabs, and probably also by the Egyptians.
LEAD was equally well known of old; the carbonate of the metal was one
of the most anciently known of the metallic salts. The Middle Ages
introduced the acetate of lead commonly known as SUGAR OF LEAD. EXTRACT
OF LEAD, or EXTRACT OF SATURN, or _Goulard’s Extract_, have been known
since the time of B. Valentine.
BISMUTH was first mentioned by Agricola in 1520.
SULPHUR was employed in medicine by the Greeks, Hindus, and Arabs.
Geber knew of its solubility in an alkaline solution, and Albertus
Magnus taught the method of procuring Sulphuret of Potassium by fusion.
PHOSPHORUS was discovered in 1669, when it was found in the Phosphate
of Soda and Ammonia of Urine by Brandt, an alchemist of Hamburgh.
Knuckel in Germany and Boyle in England had also the credit of
discovering it (Royle, _Mat. Med._).
NITRIC ACID was known to Geber, and probably also to the Hindus (Royle,
_Mat. Med._).
IODINE was obtained by M. Courtois in 1812 in the residual liquor of
the process for obtaining soda from sea-weed.
IODIDE OF POTASSIUM was first employed in medicine by Coindet.
BROMINE was discovered in 1826 by M. Balard, in _bittern_, the
uncrystallisable residue of sea-water. Bromide of Potassium was first
introduced into the London Pharmacopœia in 1836.
SAL AMMONIAC was known to Geber. Avicenna and Serapion mention it
by the name _Noshadur_. Persian writers give _Armeena_ as its Greek
synonym. The Sanskrit name is _Nuosadur_. In Egypt it is made from
camel’s dung. It must have been known to the Romans, as Pliny says that
one of the kinds of _Nitrum_ gives out a strong smell when mixed with
quicklime (Royle, _Mat. Med._).
CARBONATE OF POTASH is obtained by the burning of vegetables. It must
therefore have been known to primitive nations. “Dioscorides describes
it by the name τεφρα κληματινης, or _Cinis sarmentorum_, ashes of vine
twigs (‘cineris lixivium,’ _Pliny_, xxxviii. chap. 51). The Arabs are
usually supposed to have been the first to make known this alkali
(al-_kali_); but the Hindus, in works from which the Arabs copied, made
use of the ashes of plants” (Royle, _Mat. Med._).
TIN was the Bedel of Moses. It was used by the Egyptians, who probably
procured it from India. The Greeks and Romans obtained it from the
Phœnicians.
ANTIMONY was probably discovered by the Alchemists. The sulphuret of
the metal, however, is the στιμμι and stibium of the ancients. In Asia
it has been used from time immemorial for painting the eyebrows and
eyelids. Several of the Sulphurets of Antimony have long been used
in medicine. The Tartarate (TARTAR EMETIC) is supposed to have been
discovered by Mynsicht (Thesaurus, etc., Hamburgh, 1631).
MERCURY or QUICKSILVER was known to the ancients. It was probably
first prescribed internally by the Hindus. The Romans and Arabs used
it externally. Pliny says that mercury is poisonous, “unless, indeed,
it is to be administered in the form of an unction on the belly, when
it will stay bloody fluxes.” The Arabs appear to have re-introduced it
into the European practice (Royle). The red oxide was known to Geber.
CALOMEL is the subchloride of mercury. It occurs native in Carniola and
in Spain. The Hindus from very early times prepared it artificially and
prescribed it internally. It was introduced into European practice in
1608. BICHLORIDE OF MERCURY, or CORROSIVE SUBLIMATE, is the _ruskapoor_
of the Hindus, to whom, says Royle, it has long been known. It was
known also by the Chinese, and was prepared by Geber in the eighth
century. The, AMMONIO-CHLORIDE of mercury, or WHITE PRECIPITATE, was
discovered by Raymond Lully in the thirteenth century. CINNABAR or
VERMILION, the RED SULPHURET OF MERCURY, was known to the Greeks, and
was one of the pigments employed by the Egyptians. It has been used by
the Chinese and Hindus in medicine from very early times. The ointment
of mercury killed with oil or fat was used by the Saracens for killing
lice, just as it is used at the present time for the same purpose.
Preparations of ARSENIC have long been used in medicine. Dioscorides
applies the name Arsenikon (αρσενικον) to the yellow Sulphuret of
Arsenic.
The Arabs call it _zurneekh_, which is supposed by Sprengel to be
a corruption of Arsenikon. They were familiar with the white oxide
which they called _sum-al-far_, _mouse poison_ or _rat’s-bane_.
The Hindus are well acquainted with the form of arsenic known as
orpiment, which they call _hurtal_; realgar, which is their _mansil_;
and white arsenic, which they name _sanchya_. Royle thinks it was
first prescribed internally by the Hindus, who used it for leprosy
and intermittent fevers. It is a remedy of great value in many kinds
of skin diseases, and is of great use in agues and in all periodic
disorders, for which it is only inferior to quinine.
SILVER is supposed to have first been employed in medicine by the
Arabs. GOLD was employed by the Greeks and Arabs in medicine, but it is
not known which were the first to so use it. The Hindus used it long
before the alchemists investigated its properties.
INDEX.
A.
Abaris cured diseases by incantation, 203.
Abdominal surgery, 112, 197, 272, 296, 316, 361.
— surgery of Hindus, 113.
Abella (about 1059), 313.
Abercrombie, John (1780-1844), 454.
Abernethy, J. (1764-1831), 459.
Abipones, birth customs of, 52, 53.
Aborigines of Australia, their knowledge of medicine, 34.
— of South America, 35.
Abortion in Greece and Rome, 203.
Abracadabra, 263.
Abraxas, 263.
Abyssinians, the, 249.
Acacias, 35.
Accad, priests of, 27.
Accadian mythology, 15, 86.
Accadians, the, 86.
Achillini, A. (1463-1512), 337.
Aconite eaten by horses, 4.
Actual cautery, 183, 246.
Actuarius, John (c. 1283), 323.
Acupuncture invented by Chinese, 130.
Acute and chronic diseases first distinguished, 212.
Adamantius of Alexandria, 236.
Addenbrooke, J. (died 1719), 431.
Addison, T. (1793-1860), 454.
Ægidius Corbolensis, 314.
Ælfred, King, his services to medicine, 274, 275.
Æneas Sylvius, 336.
Æschryon (pharmacist), 209.
Æsculapius, 147, 148, 153.
Ætiology, 350.
Ætius (6th cent.), 237.
Affinity, doctrine of, 423, 449.
Afflacius, 311.
African disease theories, 22.
Agamede, a lady doctor, 155.
Agate, 257.
Agathinus of Sparta (1st cent. A.D.), 228.
Agni, 9.
Agricola, George (1494-1555), 351.
Agrippa, Cornelius (1486-1536), 337, 347.
Ague, 252.
Ahriman, 141, 142, 143.
Alaska, treatment of headache by natives of, 17.
Albertus Magnus (1193-1280), 321.
Albucasis (d. 1106), 243, 296.
Alchemy, 301, 350.
— of the Egyptians, 71.
Alcohol used everywhere, 46.
Alcuin, 300.
Aldabaran, 83.
Aldrovandi, 346.
Alexander of Tralles, 234.
Alexander Severus first established medical lectureships in Rome, 209.
Alexandria, her famous school, 194.
— Jews in, 83.
Alexandrian library, 287.
— philosophy, 83.
_Alexis_, diviners of North America, 26.
Algonquins, 32.
Ali Abbas, 296.
Aliptæ, 44, 171.
Alkinani, 289.
Alkins, Henry (born 1558), 363.
All, the, 450.
Allopathy, 447.
Almamon, 289.
Aloes, 275.
Alphanus Secundus (c. 1050), 310.
Althaus, J., 458.
Alum, 486.
Amaurosis, 211.
Amazon, aborigines of the, their medicine men, 26.
— — their intoxicating drink, 48.
_Ambre_ or _Embre_, an Egyptian medical book, 58.
America, discovery of, 345.
American medical education, 435, 436.
Ammon, 150.
Ammonia, 487.
Ammoniacum, 275.
Ammonius of Alexandria (B.C. 283-247), 198.
Amputations, 42, 70, 216.
— in Egyptian surgery, 70.
Amulets, 23, 31, 48, 129, 247-265, 327, 398, 404.
— of the Jews, 75.
Amussat, 458.
Anæsthesia, how anciently produced, 310.
Anæsthetics, 449, 464-466, 480.
Anathemata, 157.
Anatomy, 105, 175, 231, 326, 336, 364, 365, 381, 390, 391, 436.
— of ancient Egyptians, 64.
— at Alexandria, 195.
— in England, 461.
— at Oxford, 381.
— in Rome, 209, 215.
— at Salerno, 313.
— well understood by Hippocrates, 174.
— human, its revival in Europe, 325, 326, 351, 365.