animal, vegetable and mineral kingdoms which act as stimulants,
sedatives, motor excitants, motor depressants, narcotics, hypnotics,
analgesics, anodynes, antispasmodics, mydriatics, myotics,
expectorants, tonics, dentifrices, sialogogues, antisialics,
refrigerants, emetics, antiemetics, carminatives, cathartics,
purgatives, astringents, cholagogues, anthelmintics, restoratives,
haematics, alteratives, antipyretics, antiphlogistics, antiperiodics,
diuretics, diluents, diaphoretics, sudorifics, anhydrotics,
emmenagogues, oxytocics, caustics, ecbolics, galactagogues, irritants,
escharotics, caustics, styptics, haemostatics, emollients, demulcents,
protectives, antizymotics, disinfectants, deodorants, parasiticides,
antidotes and antagonists."
Scarcely less interesting than the variety of remedies were their
methods of administration:
"Medicines are directed to be administered internally in the form of
decoctions, infusions, injections, pills, tablets, troches, capsules,
powders, potions and inhalations; and externally, as lotions,
ointments, plasters, etc. They are to be eaten, drunk, masticated or
swallowed, to be taken often once only--often for many days--and the
time {364} is occasionally designated--to be taken mornings, evenings
or at bedtime. Formulas to disguise bad tasting medicaments are also
given." We have no advantage over the early Egyptians even in elegant
prescribing.
With all this activity in Egypt, it is easy to understand that the
other great nations of antiquity also have important chapters in the
history of medicine. The earliest accounts would seem to indicate that
the Chaldeans, the Assyrians and the Babylonians all made significant
advances in medicine. It seems clear that a work on anatomy was
written in China about the year 2000 B.C. Some of the other Eastern
nations made great progress. The Hindoos in particular have in recent
years been shown to have accomplished very good work in medicine
itself. Charaka, a Hindu surgeon, who lived not later than 300 B.C.,
made some fine contributions to the medical literature in Hindostani.
There were hospitals in all these countries, and these provided
opportunities for the practice of surgery. Laparotomy was very
commonly done by Hindu surgeons, and one of the rules enjoined by
Hindu students was the constant habit of visiting the sick and seeing
them treated by experienced physicians. Clinical teaching is often
spoken of as a modern invention, but it is as old as hospital systems,
and they go back to the dawn of history.
It is among the Greeks, however, that the most {365} important
advances in medicine, so far as we are concerned, were made. This is,
however, not so much because of what they did as from the fact that
they were more given to writing, and then their writings have been
better preserved for us than those of other nations. The first great
physician among the Greeks was AEsculapius, of whom, however, we have
only traditions. He is fabled to have been the son of Apollo, the god
of music and the arts, and therefore to have been a near relative of
the Muses. The connection is rather interesting, because sometimes
people try to remove medicine from among the arts that minister to the
happiness of man, and place it among the sciences whose application is
for his profit. Medicine still remains an art, however. The temples of
AEsculapius were the first hospitals, though the priests were not the
only ones who practised medicine, for there were laymen who, after
having served for some time in the hospitals, wandered through the
country under the name of Asclepiads, treating people who were not
able to go to the hospitals or shrines. These evidently, then, were
the first medical schools in Greece as well as the first hospitals.
Six hundred years after AEsculapius came Hippocrates, of Cos, the
Father of Medicine. He undoubtedly had the advantage of many Egyptian
medical traditions and other Oriental medical sources, as well as the
observations made in the hospitals and shrines of AEsculapius. He
{366} wrote some great works in medicine that have never grown old,
Young men do not read them, old men who are over-persuaded of how much
progress is being made by their own generation in medicine neglect
them. The busy practitioner has no time for them. The great teachers
of medicine whom all the professors look up to and who think for us in
each generation turn fondly back to Hippocrates, and marvel at his
acumen of observation and his wonderful knowledge of men and disease.
Sydenham thought that no one had ever written like him, and in our
turn we honor Sydenham by calling him the English Hippocrates.
Boerhaave, Van Swieten, Liancisi, the great fathers of modern clinical
medicine, turned with as much reverence to Hippocrates as does Osler,
the Regius Professor of Medicine at Oxford, in our twentieth century.
Hippocrates wrote 2,500 years ago, but his writing is eternal in
interest and value.
The famous oath of Hippocrates, which used to be read to all the
graduates of medicine, well deserved that honor, for it represents the
highest expression of professional dignity and obligation. There is a
lofty sense of professional honor expressed in it that cannot be
excelled at any period in the world's history. Among other things that
Hippocrates required his adepts in medicine, his medical students when
they graduated into physicians, to swear to was the following: "I will
follow the system of regimen which {367} according to my ability and
judgment I consider for the benefit of my patients, and abstain from
whatever is deleterious and mischievous. I will give no deadly
medicine to man, woman, or child born or unborn. With purity and with
holiness I will pass my life and practise my art, Whatever in
connection with my professional practice, or not in connection with
it, I see or hear in the life of men which ought not to be spoken of
abroad, I shall not divulge, as reckoning that all such should be kept
secret. While I continue to keep this oath inviolate may it be granted
to me to enjoy life and the practice of my art respected by all men in
all times; but should I trespass and violate this oath may the reverse
be my lot."
It is sometimes thought that after the Roman medicine, which was an
imitation of the Greek (though Galen well deserves a place by himself,
and Galen is usually thought of as a Roman though he wrote in Greek
and had obtained his education at Pergamos in Asia Minor), there was
an interregnum in medicine until our own time. This is, however, quite
as much of an assumption as to suppose that the Egyptians had no
medicine--as we used to until we knew more about them--or that
old-time medicine is quite negligible because we were ignorant of its
value, The Middle Ages had much more of medicine than we are likely to
think, and just as soon as the great universities arose at the end of
the {368} twelfth and the beginning of the thirteenth centuries,
medicine gained a new impetus and flourished marvellously. These
university medical schools of the later Middle Ages are models in
their way, and put us to shame in many things. According to a law of
the Emperor Frederick II issued for the Two Sicilies in 1241,
[Footnote 23] three years of preliminary study were required at the
university before a student might take up the medical course, and then
he had to spend four years at medicine, and practise for a year under
the supervision of a physician of experience before he was allowed to
practise for himself. The story of the medicine of this time is all
the more wonderful because subsequent generations forgot about it
until recent years, and supposed that all of this period was shrouded
in darkness. It was probably one of the most brilliant periods in
medical history. Some of the men who worked and taught in medicine at
this time will never be forgotten.
[Footnote 23: For the complete text of this law, the first
regulating the practice of medicine in modern times, also the first
pure drug law, see Walsh's _The Popes and Science_, New York,
Fordham University Press, 1908.]
Probably the greatest of them was Guy de Chauliac, a Papal
chamberlain, whom succeeding generations have honored with the title
of Father of Surgery. His great text-book, the "Chirurgia Magna," was
in common use for several centuries after his death, and is full of
surgical teaching that we are prone to think much {369} more modern.
He trephined the skull, opened the thorax, operated within the
abdomen, declared that patients suffering from wounds of the
intestines would die unless these were sewed up, operated often for
hernia in an exaggerated Trendelenberg position, with the patient's
head down on a board, but said that many more patients were operated
upon for hernia "for the benefit of the surgeon's purse than for the
good of the patient." His directions for the treatment of fractures
and for taxis in hernia were followed for full four centuries after
his time. No wonder that Pagel, the great German historian, declared
that "Chauliac laid the foundation of that primacy in surgery which
the French maintained down to the nineteenth century." Portal, in his
"History of Surgery," declares that "Guy de Chauliac said nearly
everything which modern surgeons say, and his work is of infinite
price, but unfortunately too little read, too little pondered."
Malgaigne declared "the 'Chirurgia Magna' a masterpiece of learned and
luminous writing."
Chauliac's [Footnote 24] personal character, however, is even more
admirable than his surgical knowledge. He was at Avignon when the
black death occurred and carried away one-half the population. He was
one of the few physicians who had the {370} courage to stay. He tells
us very simply that he did stay not because he had no fear, for he was
dreadfully afraid, but he thought it his duty to stay. Toward the end
of the epidemic, he caught the fever but survived it and has written a
fine description of it. He was looked upon as the leader of surgery in
his time, and this is his advice as to what the surgeon should be as
given in the introductory chapter of his "Chirurgia Magna": "The
surgeon should be learned, skilled, ingenious and of good morals; be
bold in things that are sure, cautious in dangers; avoid evil cures
and practices; be gracious to the sick, obliging to his colleagues,
wise in his predictions; be chaste, sober, pitiful and merciful; not
covetous nor extortionate of money; but let the recompense be
moderate, according to the work, the means of the sick, the character
of the issue or event and its dignity." No wonder that Malgaigne says
of him: "Never since Hippocrates has medicine heard such language
filled with so much nobility and so full of matter in so few words."
[Footnote 24: For sketch of Chauliac see _Johns Hopkins Hospital
Bulletin_, 1909, or _Catholic Churchmen in Science_, second series.
Dolphin Press, Philadelphia, 1909.]
The old-time medical traditions of education which in the mediaeval
universities produced such men as William of Salicet and Lanfranc and
Mondeville and Guy de Chauliac, persisted during the next two
centuries in the southern countries of Europe, and then were
transferred to America through Spain. The first American medical
school was not, as has so often been said, at my own Alma Mater, the
University of {371} Pennsylvania, which had its first lectures in
1767, while the Physicians and Surgeons of New York did not come for
some ten years later and Harvard only in the following decade, but in
the medical school of the University of Mexico, where the first
lectures were held in 1578, and where a full medical school was
organized before the end of the sixteenth century. In this medical
school, which during the seventeenth century came to have several
hundred students, the university tradition of the olden time was well
preserved. Three years of preliminary study at the university were
required before a student could take up the course in medicine, and
four years of medical study were required before graduation. We have
some of the text-books, and know much about the curriculum of this old
medical school, and in every way it is worthy of the old university
traditions.
Unfortunately our universities in what is now the United States
developed very slowly. King's College (Columbia) did not become a
university in the sense of having law and medical schools as well as
an undergraduate department until the nineteenth century had almost
begun. Harvard did not have a law school affiliated with it until the
first quarter of the nineteenth century had almost run its course. The
affiliations between the medical schools and the universities in these
cases was only very slight, and the medical schools were entirely in
the hands of the {372} medical faculty, whose main purpose during a
great part of the nineteenth century was to make medical studies as
short as possible and as inexpensive as they could possibly be made
for the faculty, because that left so much more of the fees to be
absorbed by the historic septennate of professors who ruled and
managed the university. The consequence was that during most of the
nineteenth century two terms of four months each were all that was
required for the diploma in medicine in most American medical schools.
Three schools maintained a very high standard by requiring twenty
weeks in each of two calendar years. The medical school that was
considered one of the best in the country, and whose graduates
obtained the highest marks in the army and navy examinations, that of
the University of Virginia, required but two terms of four and
one-half months each which might be taken in the same calendar year,
and then gave the doctor's degree.
It may be as well to say that the doctor's degree or diploma was a
license to practise. There were no State regulations for the practice
of medicine, and no matter how obtained, a diploma allowed practise.
As some one has well said the diploma, then, was a license to
practise, not medicine, the Lord knows! but to practise on one's
patients until one had learned some medicine. It is out of this slough
of despond in medical education that we have climbed in the last
thirty-five years. We are getting back to the {373} old-time
university traditions. Let us hope that we shall not allow ourselves
to get away from them again. There are ups and downs in medical
practice and medical fashions and medical education, and all depends
on the men who compose the profession at any one time and not on any
mythical progress that holds them up and compels them to do better
than those who went before them. The highest compliment that can be
paid to American medicine and medical men is that, in spite of this
handicap of education they did not utterly degenerate, but, on the
contrary, somehow managed to maintain the dignity of the profession
and do much good work.
It is to you to-day, entering on this profession, that we look to do
your share in keeping up the dignity of the medical profession and in
maintaining standards in medical education. We have a glorious
tradition of 6,000 years behind us with the great men of the
profession worshipped as gods at the beginning, because men thought so
much of them, and remembered fondly as great masters when they came in
the after-time. From I-em-Hetep through AEsculapius and Hippocrates
and Galen and Guy de Chauliac and Sydenham and Boerhaave down to our
own time, the men whom we delight to honor are the ones who did not
work with an eye single to their own success, but who tried, above
all, to do things for humanity and for the profession to which they
belonged. The man who is successful as a {374} money-maker in his
profession is only doing half his duty. He must make medicine as well
as money, that is, he must by his observations help others to
recognize and treat disease better than they did before; he must labor
for the benefit of humanity, and, above all, he must see that there
are no decadence of professional spirit and no deterioration of
medical education as far as his influence can go. It is men of this
kind that we hope to send forth from Fordham, and you stand in the van
of them all, and I wish you God-speed.
{375}
UNIVERSITY MEDICAL SCHOOLS
{376}
"Knowledge comes but wisdom lingers."
--Tennyson, _Locksley Hall_.
"The foundation stones of the whole modern structure of human wisdom
have all been laid by the architects of yesterday. Thrice wise is he
who knows the quarries and builders of by-gone ages and is able to
differentiate the stones which have been rejected from those which
have been utilized."
--Anon.
"Ideo Medico id in primis curandum, ut ab aegro circumstantias omnes
accurate intelligat, intellectas consideret, ut inter curandum media
illa adhibeat, quae tollendo morbo apta sunt, ne ex medicina
nocumentum proveniat."
--Basil Valentine, _Triumphal Chariot of Antimony_.
[The physician must therefore especially take care that he
understand all the circumstances of his patient very clearly, and
after understanding them weigh them well, so that during his
treatment he may use those means which are especially suited to
control the disease, lest any harm should come from his medicine.]
{377}
UNIVERSITY MEDICAL SCHOOLS [Footnote 25]
[Footnote 25: Address to the graduates of St. Louis University
Medical and Dental Schools, May 31, 1910, at the Odeon, St. Louis.]
It affords me great pleasure to accept the invitation of your Faculty
to address the graduates of a university medical school here in the
Middle West. I wondered, of course, what I should talk to you about,
and have come to the conclusion that as an historian of medicine any
message I may have for you is likely to come from my own subject. It
so happens that we are just beginning to realize that the history of
medicine may have much greater significance for us than we have
usually been accustomed to think, and, above all, that it may mean
much in furnishing incentive for the maintaining and raising of
standards in medical education. In recent years there has come a very
decided improvement in medical education in the United States. It is
not hard to understand that the foreigner lifts his eyebrows in
surprise when he is told that most of our medical schools a generation
ago required but two terms of four months each, and that there was
then just beginning to be a demand for a little more complete course
and better facilities. There was a large number of medical schools,
turning out graduates every year with the degree {378} of doctor of
medicine, which was a license to practise in every state in the Union,
for there were no state or federal laws regulating the practice of
medicine. As for preliminary requirements the less said the better. If
a man could write his name and, indeed, he did not have to write it
very plainly, he found it easy to matriculate in a medical school and
to be graduated at the end of two scant terms of four months each. He
might come from the mines, or from the farm, or from before the mast,
or from the smithy, or the carpenter shop; he need know nothing of
chemistry, nor physics, nor of botany, nor of English and, above all,
of English grammar, and he was at once admitted to what was called a
professional school and graduated when he had served his time.
Practically no one was plucked. The desire of the faculty for numbers
of students forbade that in most cases. The two terms in medicine were
not even successive courses. The second-year student listened, as a
rule, to the same lectures that he might have heard the preceding
year.
We all know the reason now for this extremely low standard of medical
education. Proprietary medical schools made it their one business in
life to make just as much out of medical education as possible and the
historic septennate of professors, or sometimes the Dean, pocketed the
fees (I came near saying spoils) every year, and robbed medical
American education of {379} whatever possibilities it might have for
the real training of young men in the science and art and practice of
medicine. Perhaps the most interesting feature of this maintenance of
extremely low standards in medical education, however, is the fact
that in spite of it, men, or at least some of them, succeeded in
obtaining a good foundation in medicine and then by personal work
afterwards came to be excellent practitioners of medicine. Professor
Welch said not long since: "One can decry the system of those days,
the inadequate preliminary requirements, the short courses, the
dominance of the didactic lecture, the meagre appliances for
demonstrative and practical instruction, but the results were better
than the system. Our teachers were men of fine character devoted to
their duties; they inspired us with enthusiasm, interest in our
studies and hard work, and they imparted to us sound traditions of our
profession."
Nothing that I know is a better compliment to American enterprise and
power of overcoming the difficulties of the situation than the life
stories of some of the men who came from these completely inadequate
schools. If with the maimed training and incomplete education given a
generation ago American medicine not only succeeded in maintaining the
dignity of the profession to a noteworthy degree, but also developed
many men who made distinct contributions to world medicine, what will
we not do now that {380} our medical education is gradually being
lifted up out of the slough of despond in which it was and the
preliminary education for medical studies set at a standard where real
work of thoroughly scientific character can be looked for, from the
very beginning of the medical course?
Is it any wonder, then, that those of us who have the best interests
of American medicine at heart are watching with careful solicitude the
movement that is now reforming medical education in this country? The
one hope of medical education is, and always has been, organic
connection with a university. Real University Medical Schools, that is
medical schools as the genuine Post-Graduate Departments of
Universities with the fine training that they give, have opened our
eyes to what is needed in medical education in this country. Some of
the old-time medical schools here in the United States had been
connected by name with universities but this was more apparent than
real, and the medical faculty ruled absolutely in its own department
and throttled medical education and divided the income of the college
among themselves, devoting as little as possible to equipment, to
laboratories, to all that was needed for medical education.
Now has come the epoch of university medical schools in this country.
I came near saying America, but we must not forget that the
Spanish-American countries, having adopted their educational systems
from the mother Latin country, {381} have always maintained the
organic connection of the medical school with their universities, and
as a consequence a good preliminary education, the equivalent of three
years of college work with us, is required and has always been, and
then some four years in the medical school and, indeed, in most of the
countries five or six years and in one at least seven years of medical
study required. I have thought, however, that this story of medical
education in connection with universities and real university work
will be especially interesting to the graduates of this thorough
Western university, whose work in medicine is acknowledged as up to
some of the best standards of professional attainment and whose
organic connection with a great university assures not only the
continuance, but the future development of medical education here
along lines that shall place this among the serious progressive
medical schools of the world.