oral traditions, printed {343} books, maps and manuscripts
concerning America which circulated in Shakespeare's England. There
a predilection for romantic adventure is found to sway the Spaniards
in even greater degree than it swayed the Elizabethan. Religious
zeal is seen to inspirit the Spaniards more constantly and
conspicuously than it stimulated his English contemporary. The
motives of each nation are barely distinguishable one from another.
Neither deserves to be credited with any monopoly of virtue or vice.
Above all, the study of contemporary authorities brings into a
dazzling light which illumes every corner of the picture the
commanding facts of the Spaniard's priority as explorer, as
scientific navigator, as conqueror, as settler."
Here is magnificent praise from one who cannot be suspected of
national or creed affinities to bias his judgment. He has studied the
facts and not the prejudiced statements of his countrymen. The more
carefully the work of the Spaniards in America during the sixteenth
and seventeenth centuries is studied, the more praise is bestowed upon
them. The more a writer knows of actual conditions the more does he
feel poignantly the injustice that has been done by the Protestant
tradition which abused the good that was accomplished by the Catholic
Spanish and which neglected, distorted and calumniated his deeds and
motives. This bit of Protestant tradition is, after all, only
suffering the fate that every other {344} Protestant position has
undergone during the course of the development of scientific
historical criticism. Every step toward the newer, truer history has
added striking details to the picture of the beneficent influences of
the Church upon her people in every way. It has shown up pitilessly
the subterfuges, the misstatements and the positive ignorance which
have enabled Protestantism to maintain the opposite impression in
people's minds in order to show how impossible was agreement with the
Catholic Church, since it stood for backwardness and ignorance and
utter lack of sympathy with intellectual development. Now we find
everywhere that just the opposite was true. Whenever the Reformation
had the opportunity to exert itself to the full, education and culture
suffered. Erasmus said in his time, "Wherever Lutheranism reigns there
is an end of literature." Churches and cathedrals that used to be
marvellous expressions of the artistic and poetic feeling of the
people became the ugliest kind of mere meeting houses. Rev. Augustus
Jessop, himself an Anglican clergyman, tells how "art died out in
rural England" after the Reformation, which he calls The Great
Pillage, and "King Whitewash and Queen Ugliness ruled supreme for
centuries." The same thing happened in Germany, and education was
affected quite as much as art. German national development was
delayed, and she has come to take her place in world influence only in
the nineteenth {345} century, after most of the influence of the
religious revolt led by Luther in the sixteenth century has passed
away. These are but a few of the striking differences in recent
history that are so well typified by the contrast between what was
accomplished for art and culture and architecture and education by the
Catholic Spaniard and the English Protestant here in America during
the sixteenth, seventeenth and eighteenth centuries. Truth is coming
to her own at last, and it is in the history of education particularly
that advances are being made which change the whole aspect of the
significance of history during the past 350 years.
{346}
{347}
THE MEDICAL PROFESSION FOR SIX THOUSAND YEARS
{348}
"Tu recte vivis si curas esse quod audis;
Neve putes alium sapiente bonoque beatum."
--Horace, _Ep_., 1, 16.
[You are living right if you take care to be what people say you
are. Do not imagine that any one who is really happy is other than
wise and good.]
"Quod ipse sis, non quod habearis, interest."
--Publius Syrus.
[The question is what you are, not what you are thought to be.]
"May you so raise your character, that you may help to make the next
age a better thing, and leave posterity in your debt for the
advantage it shall receive by your example."
--Lord Halifax.
{349}
THE MEDICAL PROFESSION FOR SIX THOUSAND YEARS [Footnote 20]
[Footnote 20: This was the address to the graduates at the First
Commencement of the Fordham University School of Medicine, June 9,
1909.]
I have felt that the first graduation of the youngest of the medical
schools might very well be occupied with the consideration of the
place of the medical profession in history. We are rather apt in the
modern time to neglect the lessons of history and, above all, of the
history of science, first because it is not always easy to get
definite information with regard to it, and secondly and mainly
because we are likely to imagine that scientific and medical history
can mean very little for us. In America particularly we have neglected
the history of medicine and it has been one of the definite efforts at
Fordham University School of Medicine to renew interest in this
subject. It is entirely too important to be neglected and it has
valuable lessons for all generations, but especially for a generation
so occupied with itself, that it does not properly consider the claims
of the past to recognition for fine work accomplished, and for the
exhibition of some of the best qualities of the human intellect in the
pursuit of scientific and practical medical knowledge in previous
generations.
{350}
At the earliest dawn of history we find institutions called temples in
which men were being treated for their ailments. Those who treated
them we have been accustomed to speak of as priests. And such they
were, since their functions included the direction of religious
services. These religious services, however, were not the exercises of
religion as we know them now, but were special services meant to
propitiate certain gods who were supposed to rule over health and
disease. There were other kinds of temples besides these. We still
talk of temples of justice meaning our law courts, and our phrase
comes from an older time when people went to have their differences of
opinion adjudicated by men who conducted the services of praise and
prayer for particular deities who were supposed to mete out justice to
men, but the temple attendants were at the same time expert in
deciding causes, knowing right and wrong, wise in declaring how
justice should be done. These early temples, then, in which the ailing
were treated and over which experts in disease and its treatment
presided, were not temples in our modern sense, but were much like
hospitals as we know them now. They would remind us of the hospitals
conducted by religious orders, trained to care for the illnesses of
mankind and yet deeply interested in the worship of God.
Human institutions are never so different from one another, even in
spite of long distance of time {351} or place, as they are usually
presumed to be. Men and women have not changed in all the period of
human history that we know, and their modes and ways of life often
have a startling similarity if we but find the key for the
significance of customs that seem to be very different. These temples
of the gods of health and of disease, then, were places where patients
congregated and men studied diseases for generations, and passed on
their knowledge from one to another, and accumulated information, and
elaborated theories, and came to conclusions, often on insufficient
premises, and did many other things that we are doing at the present
time. The medical profession is directly descended from these
institutions. They are among the oldest that we know of in human
history. These special temples are only a little less ancient than
other forms of temples if, indeed, they were not the first to be
founded, for man's first most clamorous reason for appeal to the gods
has ever been himself and his own health.
With the reception of your diplomas this evening you now belong to
what is therefore probably the oldest profession in the world. In
welcoming you into it let me call your attention particularly to the
fact that the history of our profession can be traced back to the very
beginning of the course of time, for as long as we have any account of
men's actions in an organized social order.
{352}
We are very prone in the modern time to think that what we are doing
in each successive generation is of so much greater significance than
what was accomplished before our time that it is really scarcely worth
while to give much attention to the past. This self-sufficient
complacency with regard to the present would be quite unbearable only
that each successive generation in its turn has had the same tendency
and has expiated its fault by being thought little of by subsequent
generations. We shall have our turn with those we affect to despise.
It is supposed to be particularly true in every department of science
and, above all, in medicine that there is such a wide chasm between
what we are doing now and what was accomplished by our forebears, no
matter how intelligent they were in the long ago, that to occupy
ourselves seriously with the history of medicine may be a pleasant
occupation for an elderly physician who has nothing better to do, but
can mean very little for the young man entering upon practice or for
the physician busy with his patients. Medical history may be good
enough for some book-worm interested in dry-as-dust details for their
own sake and perhaps because he rejoices in the fact that other people
do not know them, but can have very little significance for the
up-to-date physician. This is an impression that is dying hard just
now, but it is dying. We are learning that there is very little that
we are {353} doing even now that has not been done before us and that,
above all, the great physicians, no matter how long ago they wrote,
always have precious lessons for us that we cannot afford to neglect,
even though they be 300 or 600 or 1,800 or even 2,500 years ago. At
all of these dates in the past there were physicians whose works will
never die.
In every department of human history the impression that we are the
only ones whose work is significant has been receiving a sad jolt in
recent years, and perhaps in no branch of science is this so true as
in medicine. We are coming to realize how much the physicians and
surgeons of long distant times accomplished, and, above all, we are
learning to appreciate that they approached problems in medicine at
many periods of medical history in the best scientific temper of the
modern time. Of course there were abuses, but, then, the Lord knows,
there are abuses now. Of course their therapeutics had many
absurdities in it, but, then, let us not forget that Professor Charles
Richet, the director of the department of physiology at the University
of Paris, declared not long ago in an article in the best known of
French magazines, the _Revue des Deux Mondes_, that the therapeutics
of any generation of the world's history always contained many
absurdities--for the second succeeding generation. The curious thing
about it is that some of these supposed absurdities afterward come
{354} back into vogue and prove to be precious germs of discovery, or
remedies of value that occasionally even develop into excellent
systems of treatment.
Of course there were superstitions in the old days, but, then, there
have been superstitions in medicine at all times. Any one who thinks
that we are without superstitions in medicine at the present time,
superstitions that are confidently accepted by many regular practising
physicians, must, indeed, be innocent. A superstition is in its
etymology a survival. It comes from the Latin _superstes_, a survivor.
It is the acceptance of some doctrine the reasons for which have
disappeared in the progress of knowledge or the development of
science, though the doctrine itself still maintains a hold on the
minds of man. Superstition has nothing necessarily to do with
religion, though it is with regard to religion that doctrines are
particularly apt to be accepted after the reasons for them have
disappeared. In medicine, however, superstitions are almost as common
as in religion. I shall never forget a discussion with two of the most
prominent physicians of this country on this subject.
One of them was our greatest pathologist, the other a great teacher of
clinical medicine, who came into medicine through chemistry and
therefore had a right to opinions with regard to the chemical side of
medicine. We had been discussing the question of how much serious
medical {355} education there was in the Middle Ages and how, in spite
of the magnificent work done, so many superstitions in medicine
continued to maintain themselves. I remarked that it seemed impossible
to teach truths to large bodies of men without having them accept
certain doctrines which they thought truths but which were only
theories and which they insisted on holding after the reasons for them
had passed away. I even ventured to say that I thought that there were
as many superstitions now, and such as there were, were of as great
significance as those that maintained themselves in the Middle Ages.
My chemical clinician brother on the right side said, "Let us not
forget in this regard the hold the uric acid diathesis has on the
English-speaking medical profession." And the brother pathologist on
the left side: "Well, and what shall we say of intestinal
auto-intoxication?"
Perhaps you will not realize all the force of these expressions at the
present time, but after you have been five years in the practice of
medicine and have been flooded by the literature of the advertising
manufacturing pharmacist and by the samples of the detail man and his
advice and suggestion of principles of practice, if you will listen to
them, perhaps you will appreciate how much such frank expressions mean
as portraying the medical superstitions of our time.
Surely we who have for years been much occupied with the superstition,
for such it now {356} turns out to be, of heredity in medicine, will
not be supercilious toward older generations and their superstitions.
Until a few years ago we were perfectly sure that a number of diseases
were inherited directly. Tuberculosis, rheumatism, gout, various
nutritional disturbances all were supposed to pass from father to son
and from mother to daughter, or sometimes to cross the sex line. For a
time cancer was deemed to be surely hereditary to some degree at
least. Now most of us know that probably no disease is directly
inherited, that acquired characters are almost surely not transmitted,
and that while defects may be the subject of heredity, disease never
is. Not only this, biological investigations have served to show that
what is the subject of inheritance is just the opposite,--resistance
to disease. A person whose father and mother had suffered from
tuberculosis used to think it almost inevitable that he too should
suffer from it. If they had died that he too would die. Our experts in
tuberculosis declare now, that if tuberculosis has existed in the
preceding generation there is a much better chance of the patient
recovering from it, or at least resisting it for a long time, than if
there had been no tuberculosis in the family. We had been harboring
the superstition of heredity, the surviver opinion from a preceding
generation, until we learned better by observation.
Let us turn from such discussion to the {357} beginnings of the story
of our medical profession as it has been revealed to us in recent
years.
The first picture that we have of a physician in history is, indeed,
one to make us proud of our profession. The first physician was
I-em-Hetep, whose name means "the bringer of peace." He had two other
titles according to tradition, one of which was "the master of
secrets," evidently in reference to the fact that more or less
necessarily many secrets must be entrusted to the physician, but also,
doubtless, in connection with the knowledge of the secrets of
therapeutics which he was supposed to possess. Another of his titles
was that of "the scribe of numbers," by which, perhaps, reference is
made to his prescriptions, which may have been lengthy, for there are
many "calendar" prescriptions in the early days, but may only refer to
the necessity of his knowing weights and measures and numbers very
exactly for professional purposes. I-em-Hetep lived in the reign of
King Tchser, a monarch of the third dynasty in Egypt, the date of
which is somewhat uncertain, but is about 4500 B.C. How distinguished
this first physician was in his time may be gathered from the fact
that the well-known step pyramid at Sakkara, the old cemetery near
Memphis, is attributed to him. So great was the honor paid to him
that, after his death he was worshipped as a god, and so we have
statues of him as a placid-looking man with a certain divine
expression, seated with a {358} scroll on his knees and an air of
benignant knowledge well suited to his profession.
I called attention in 1907 [Footnote 21] to the fact that the earliest
pictures of surgical operations extant had recently been uncovered in
the cemetery of Sakkara near Memphis in Egypt. These pictures show
that surgery was probably an organized branch of medicine thus early,
and the fact that they are found in a very important tomb shows how
prominent a place in the community the surgeon held at that time. The
oldest document after that which we have with regard to medicine is
the "Ebers Papyrus," the writing of which was done probably about 1600
B.C. This, however, is only a copy of an older manuscript or series of
manuscripts, and there seems to be no doubt that the text, which
contains idioms of a much older period, or, indeed, several periods,
probably represents accumulations of information made during 2,000 or
even 3,000 years before the date of our manuscript. Indeed, it is not
improbable that the oldest portions of the "Ebers Papyrus" owe their
origin to men of the first Egyptian dynasties, nearly 5,000 years B.C.
To be members of a profession that can thus trace its earliest written
documents to a time nearly some 7,000 years ago, is an honor that may
be readily appreciated and that may allow of some complacency.
[Footnote 21: _Journal of the American Medical Association_,
November 8, 1907.]
There is a well-grounded tradition which shows {359} us that an
Egyptian monarch with whose name even we are familiar, though we may
not be able to pronounce it very well--he was Athothis, the son of
Menes--wrote a work on anatomy. The exact date of this monarch's death
is sometimes said to be 4157 b.c. We have traces of hospitals in
existence at this time and something of the nature of a medical
school. Indeed, one may fairly infer that medical education, which had
been developing for some time, probably for some centuries, took a
definite form at this time in connection with the temples of Saturn.
Priests and physicians were the same, or at least physicians formed
one of the orders of the clergy and the teachers of medicine
particularly were clergymen. This tradition of close affiliation
between religion and medicine continued down to the fifteenth century.
How few of us there are who realize that until the fourteenth century
the professors of medicine at the great universities were not married
men, because members of the faculty, as is true at the present time of
many members of the faculty in the English universities, were not
allowed to marry. The old clerical tradition was still maintaining
itself even with regard to the medical teachers.
Perhaps the most interesting thing about this early history of
medicine in Egypt is that, with the very earliest dawn of medical
history, we have traces of highly developed specialism in medicine.
There were thirty-six departments of medicine, or {360} at least there
were thirty-six medical divinities who presided over the particular
parts of the human body. In the larger temples, at least, there was a
special corps of priest physicians for each one of these departments.
Herodotus, the Father of History, is particularly full in his details
of Egyptian history, and though he wrote about 400 B.C., nearly 2,300
years ago, his attention was attracted by this highly developed
specialism among the Egyptians. He tells us in quaint fashion,
"Physicke is so studied and practised with the Egyptians that every
disease hath his several physician, who striveth to excell in healing
that one disease and not to be expert in curing many. Whereof it
cometh that every corner of that country is full of physicians. Some
for the eyes, others for the head, many for the teeth, not a few for
the stomach and the inwards."
It is interesting to realize that the same state of affairs upon which
you young graduates will come now that you are going out to find an
opportunity to practise for yourselves at the end of the first decade
of the twentieth century, is not very different from that which the
great Father of History chronicles as the state of affairs among the
Egyptians between 600 and 1,000 before Christ,--let us say about 3,000
years ago. You, too, will find that every corner is full of
physicians, some for the eyes, others for the head, many for the
teeth, not a few for the stomach and everything else under the sun
quite as in {361} ancient Egypt. After a time you will probably find
that some little corner has been left for you, and you will work hard
enough to get into it first, and then to fill it afterward. The story
of how young physicians have got on in their first few years has
probably been interesting at all times in the world's history. I think
that I know about it at five different periods, and in every one of
these there seemed to be no possible room, and yet somehow room was
eventually found, though only after there had been a struggle, in the
midst of which a certain number of the young physicians found another
sphere of activity besides medicine.
Of course it is easy to think that these specialties did not amount to
much, but any such thought is the merest assumption. A single instance
will show you how completely at fault this assumption is. Dentistry is
presumed to be a very modern profession. As a matter of fact mummies
were found in the cemetery of Thebes whose bodies probably come from
before 3000 B.C., who have in their teeth the remains of gold fillings
that were well put in, and show good workmanship, nearly 5,000 years
ago. [Footnote 22] After dentistry, the specialty that we would be
sure could not have had any significant existence so long ago would be
that of ophthalmology. As a matter of fact, it is with regard to the
knowledge of eye diseases displayed by these early teachers of {362}
medicine that the "Ebers Papyrus" is most startling. It is especially
full in diagnosis and contained many valuable hints for treatment. As
for laryngology and rhinology, one of the earliest medical records
that we have, is the rewarding by one of the kings of Egypt of an
early dynasty (nearly 4000 B.C.), of a physician who had cured him of
a trouble of the nose of long standing, that seems to have interfered
with his breathing.
[Footnote 22: Burdett: "History of Hospitals."]
It is easy to think in spite of all this, that the Egyptians did not
know much medicine; but only one who knows nothing about it thinks so.
According to Dr. Carl von Klein, who discussed the "Medical Features
of the Ebers Papyrus" in the _Journal of the American Medical
Association_ about five years ago, over 700 different substances are
mentioned as of remedial value in this old-time medical work. There is
scarcely a disease of any important organ with which we are familiar
in the modern time that is not mentioned here. While the significance
of diseases of such organs as the spleen, the ductless glands, and the
appendix was, of course, missed, nearly every other pathological
condition was either expressly named or at least hinted at. The
papyrus insists very much on the value of history-taking in medicine,
and hints that the reason why physicians fail to cure is often because
they have not studied their cases sufficiently. While the treatment
was mainly symptomatic, it was not more so than is a great deal of
therapeutics {363} at the present time, even in the regular school of
medicine. The number and variety of their remedies and of their modes
of administering them is so marvellous, that I prefer to quote Dr. von
Klein's enumeration of them for you: