the one that came into existence in connection with the University of
Alexandria. I have been at some pains, because it is so delightfully
amusing, to point out how closely the University of Alexandria
resembles our modern universities in most particulars. It was founded
by a great conqueror, who had gone forth to conquer the world, and
having attained almost universal dominion sighed for more worlds to
conquer. Then he set about the foundation of {382} a great city that
was to be the capital of his empire, and endowed a great institution
of learning in that capital that was to attract students from all over
the world. When he died prematurely the Ptolemys, who inherited the
African portion of his vast dominions, carried out his wishes. Money
was no object at Alexandria: they put up magnificent buildings,
founded a great library, bought a lot of first editions of books in
the shape of author's original manuscripts, stole the archives at
Athens, used Alexander's collection (made for Aristotle) as the
foundation of what we would call a museum, paid professors better
salaries than they received at that time anywhere else and housed them
in palaces. What a strangely familiar sound all this has! Then
Alexandria proceeded to do scientific work.
Euclid wrote his geometry, and, unchanged, it has come down to us and
we still use it as a text-book in our colleges. Archimedes, following
up Euclid's work, laid the foundation, of mechanics in his study of
the lever and the screw, and of hydrostatics and of optics in his
studies of specific gravity and burning mirrors and lenses. He made a
series of marvellous inventions showing that he was a practical as
well as a theoretic genius, who would be gladly welcomed, nay, eagerly
sought for, as a member of the faculty even of a university of the
highest rank or largest income in our modern times. Ptolemy elaborated
the system of astronomy that had been so ably {383} developed by
teachers at Alexandria before his time, and Heron invented his
engines, which we have had as toys in our laboratories for centuries.
We realized the true significance of one of them only when the turbine
engine was invented and we found that the principle of it was in the
toy engine of this old natural philosopher of Alexandria. They even
did their literature scientifically at the University of Alexandria.
We have no great original works from them in literature, but they
invented comparative literature; for this making the Septuagint
translation of the Holy Scriptures and doing the same for many other
religious documents of the surrounding nations for comparative study.
It is rather easy to understand, then, that a medical school arose in
connection with this scientific university, and that it did excellent
work. The collections of Aristotle contained many illustrations which
served as the basis for zoology, botany, comparative anatomy and
probably even comparative physiology. The Ptolemys were very liberal
and allowed dissection of the human body, so that human anatomy
developed from a definite scientific standpoint better then ever
before. The number of strangers in the town and the rather unhealthy
climate of Egypt left many unclaimed bodies. It has always been the
difficulty of obtaining bodies much more than prejudice against the
violation of the human body on any general principle, that has been
the reason {384} for the absence of human dissection in many periods
of the world's history. We object to having the bodies of friends cut
up, but we do not mind much if the bodies of those who are unknown to
us are treated in that way. So long as men did not travel much there
were few unclaimed bodies. With the advent of travel came abundant
material for dissection and the Ptolemys allowed the medical school to
use it.
Two great anatomists built up the structure of scientific human
anatomy on the rather good foundation that had been laid on animal
anatomy in the foretime. After all, the anatomy of the animal
resembles that of man so much that very precious knowledge had been
gained from zootomies in the previous ages. These two anatomists were
Erasistratos and Herophilos. Both of them studied the brain
especially, as might have been expected. For just as soon as the
opportunity for dissecting man was provided, this, his most complex
structure, attracted instant attention. Herophilos has named after him
the _torcular herophili_, and the name he gave the curious appearance
in the floor of the fourth ventricle--the _calamus scriptorius_--is
still retained. He describes the membranes of the brain, the various
sinuses, the choroid plexuses, the cerbral ventricles and traced the
origin of the nerves from the brain and the spinal cord, recognizing,
according to well-grounded tradition, the distinction between nerves
of sensation and motion. {385} He described the eye and especially the
vitreous body, the choroid and the retina. He did not neglect other
portions of anatomy, however, and his power of exact observation, as
well as his detailed study, may be judged from his remark that the
left spermatic vein in certain cases joins the renal.
Erasistratos, his colleague, was perhaps even a more successful
investigator than Herophilos. He represented the best tradition of
Greek medicine of the time. He had two distinguished teachers, one of
them Metrodoros, the son-in-law of Aristotle. It was probably through
this influence that Erasistratos received his invitation from the
first Ptolemy to come to Alexandria. The scientific work of Alexandria
was founded on Aristotle's collections, on his books, for his library
was brought to Alexandria as the foundation of the great University
Library, and then best of all on the direct tradition of his
scientific teaching through this pupil of his son-in-law.
Erasistratos' other great teacher was the well-known Chrysippos of
Cnidos. Cnidos was the great rival medical school to that of Cos.
Owing to the reputation of Hippocrates we know of Cos, but we must not
ignore Cnidos.
Erasistratos' discoveries were more in connection with the heart than
anything else. He came very near discovering the circulation. His
description of the valves and of their function is very clear. He
looked for large-sized {386} anastomoses between veins and arteries
and, of course, did not discover the minute capillaries which required
Malpighi's microscope to reveal them nearly 2,000 years after. Like
Herophilos, Erasistratos also studied the brain very faithfully.
One story that we have of Erasistratos deserves to be in the minds of
young graduates in medicine, because it illustrates the practical
character of the man and also how much more important at times it may
be in the practice of medicine to know men well rather than to know
medical science alone. Erasistratos was summoned on a consultation to
Antioch to see the son of King Seleucus. Seleucus was one of the four
of Alexander's generals who, like Ptolemy, had divided the world among
them after the young conqueror's death. His portion of the Eastern
world, with its capital at Antioch, was probably the richest region of
that time. There had been no happiness, however, in the royal
household for months because the scion of the Seleucidae, the heir to
the throne, was ill and no physician had been able to tell what was
the matter with him, and, above all, no one had been able to do
anything to awaken him from a lethargy that was stealing over him,
making him quite incapable of the ordinary occupations of men, or to
dispel an apathy which was causing him to lose all interest in affairs
around him. He was losing in weight, he looked miserable, he seemed
really to have been stricken by one of {387} the serious diseases as
yet undifferentiated at that time which were expressed by the word
phthisis, which referred to any wasting disease.
As a last hope then almost, Erasistratos was summoned from distant
Alexandria as a consultant in the case of young Seleucus. The
proceeding, after all, is very similar to what happens in our own
time. The head of an important department in medicine at a university
is asked to go a long distance to see the son of a reigning monarch,
or of a millionaire prince in industry, or perhaps a coal baron, or a
railroad king, and a special train is supplied for him and every
convenience consulted. A caravan was sent to bring Erasistratos over
the desert to Antioch. It is such consultations that count in a
physician's life. I hope sincerely that you shall have many of them
and that you shall conduct them as successfully as Erasistratos this
one.
The young prince's case proved as puzzling to Erasistratos for a time
as it had to so many other physicians before him. Like the experienced
practitioner he was, he did not make his diagnosis at once, however.
Will you remember that when you, too, have a puzzling case? It is when
we do not take time to make our diagnosis that it often proves
erroneous. Not ignorance, but failure to investigate properly, is
responsible for most of our errors. He asked to see the patient a
number of times, and saw him under varying conditions. Finally, one
day, while he was {388} examining the young man's pulse--and I may
tell you that Erasistratos made a special study of the pulse and knew
many things about it that it is unfortunate that the moderns
neglect--his patient's pulse gave a sudden leap and then continued to
go much faster than it had gone before. At the same time there came a
rising color to the young man's cheek. Erasistratos looked up to see
what was the cause of this striking change, and found that the young
wife of the King Seleucus, the prince's stepmother, had just come into
the room. Seleucus, as an old man, had married a very handsome young
woman, and it was evident that the young man's heart was touched in
her regard, and that here was the cause of the trouble. Erasistratos
did not proclaim his discovery at once. He did announce that now he
knew the cause of the trouble, that it was an affection of the heart
that would be cured by travel, and he proposed to take young Seleucus
back with him to Alexandria. In private, very probably, he told his
young patient that he had discovered his secret, and then persuaded
him that absence would be the thing for him. Very probably the young
man considered that cure was impossible, and with many misgivings he
consented to go to Alexandria, and as has happened many times before
and since, in spite of the patient's assurance to the contrary, the
travel cure proved effective even for the heart affection.
{389}
I hope sincerely that you shall have as much tact, as much knowledge
of men and women and as much success as this great teacher at the
first of our modern university medical schools, when the great
consultations do come your way, for it is easy to understand that when
the young man recovered under the kindly ministrations of Erasistratos
and the good effect of absence from the disturbing heart factor,
Erasistratos was loaded with the wealth of the East and acquired a
reputation that made him known throughout all the world of that time.
There is a curious commentary on this story that I think you should
also know. It is Galen who has preserved the incident for us. He does
so in the book on the pulse, mainly in order to show, as he thinks,
the fatuity of such observations. After giving the details he says,
"Of course, there is no special pulse of love." Poor Galen, how his
wits must have been wool-gathering, or how forgetful he must have been
of his own youth writing in the serenity of age, or how lacking in
ordinary human experience if that is his serious meaning. The older
man was by far the better observer, and I hope that you shall not
forget in the time to come that there are many things that affect men
and women besides bacteria and auto-intoxications of various kinds and
metabolic disturbances and nutritional changes. Erasistratos seems to
have known very well how much the mind, or as they called it in the
older terminology, and we {390} still cling to the phrase, the heart,
meant for many a phenomenon of existence supposed to be physically
pathologic and yet really only representing psychologic influences
apart from the physical side of the being. I may say to you that the
more you know about these old teachers of medicine the more you will
appreciate and value their largeness of view, their breadth of
knowledge of humanity and their practical ways.
It is no wonder that students from all over the world were attracted
to Alexandria for the next three centuries because of the
opportunities, for the study of medicine afforded them there. After
the first century of its existence not as much was accomplished as at
the beginning, because what always happens in the history of medicine
after a period of successful investigation, happened also there. Men
concluded that nearly everything that could be, had been discovered
and began to theorize. They were sure that their theories explained
things. Men have persisted in spinning theories in medicine. Theories
have almost never helped us and they always have wasted our time.
_Observation! Observation_ is the one thing that counts, Alexandria
continued to have her reputation, however, and in the first century of
the Christian era was the centre of medical interest. It was probably
here that St. Luke was educated, and as we know now from the careful
examination of the {391} Third Gospel and of the Acts, he knew his
Greek medical terms very well. Harnack has shown us recently once more
how thoroughly Luke converted the ordinary popular terms of the other
Evangelists into the Greek medical terms of his time. Luke must have
known medicine very well. His testimony to the miracles of Christ is
therefore all the more valuable, and so the Alexandrian medical school
has its special place in the order of Providence.
We are prone to think because of the curious way in which not only the
histories of medical education, but of all education, have been
written, that while there were some medical schools in the interval
from the days of Alexandria and Rome down to the modern time, these
were so hampered by unfortunate conditions that men practically did
nothing in education and, above all, scientific and medical education
until comparatively recent times. Nothing could well be more absurd
than such an opinion. The great universities founded during the
thirteenth and fourteenth centuries attracted more students to the
population of the countries of the time than go to our universities to
the number of our population in the present time. These universities
are the model of our universities of the present time and, indeed, the
history of many of the old European universities is continuous for
seven centuries. They had an undergraduate department in which
students were trained in grammar, rhetoric, logic, {392} arithmetic,
astronomy, music and gymnastics, and graduate departments of law,
theology and medicine. Professor Huxley, reviewing mediaeval
education, once said that the undergraduate education of the mediaeval
universities was better than our own. He doubted "that the curriculum
of any modern university shows so clear and generous a comprehension
of what is meant by culture as this old trivium and quadrivium did."
Their post-graduate work was just as fine as their undergraduate work.
They made the law of the world in the thirteenth century, and laid the
foundations on which the philosophy and theology of the after-time
have been built up. Strange as it may seem to many accustomed to give
credence to far different traditions, they did the same thing in
medicine. Take as a single example what they did for the regulation of
medical education and practice. A law of the Emperor Frederick II,
issued in 1241 for the Two Sicilies (Southern Italy and Sicily
proper), required three years of preliminary training in the ordinary
undergraduate course at the university before a man was allowed to
take up medicine, and four years at medicine before he got his degree.
But even this was not all; after graduation, a year of practice with a
physician was required before he was allowed to practise for himself.
If he were going to practise surgery an extra year of the study of
anatomy was required. But it may {393} be said by those who cannot
persuade themselves that the Middle Ages so far anticipated us: since
they knew almost nothing of medicine and surgery, what did they spend
their time at during these four years? The more we know about the
details of that early teaching, the more we respect them and the more
we admire the magnificent work of the old-time professors and their
schools.
Probably the most surprising feature of their teaching was surgery. We
are rather likely to think that the development of surgery was
reserved for our day. Nothing could be more untrue. The greatest
period in the history of surgery, with the possible exception of our
own time, is the century and a half from 1250 to 1400. What they
taught in surgery we know not from tradition, but from the text-books
of the great teachers which have been preserved for us, and which have
been recently republished. Three men stand out pre-eminent: William of
Salicet; Lanfranc, who taught at Paris, having been invited there from
Italy, where he had been a pupil of William of Salicet, and Guy de
Chauliac, to whom has been given by universal accord the title of
Father of Modern Surgery.
There is practically nothing in modern surgery that these men did not
touch in their text-books. Perhaps the most surprising thing is to
find that William of Salicet, in discussing his {394} cases, suggested
that sometimes he succeeded in obtaining union by first intention by
keeping his wounds clean. Alas for the surgery of succeeding
centuries, Guy de Chauliac, a greater mechanical genius than William,
insisted that union by first intention was an illusion and that it
could only come through pus formation. Laudable pus became the
shibboleth of surgery for centuries, imposed upon it by the genius of
a great man. Most men think that they think, they really follow
leaders, and so we followed blindly after Guy until Lister came and
showed us our mistake.
Guy was the professor of surgery down at Montpellier, and also the
physician to the Popes, who for the time were at Avignon. His
text-book of surgery is full of expressions that reveal the man and
the teacher. He said the surgeon who cuts the human body without a
knowledge of anatomy is like a blind carpenter carving wood. He
insisted that men should make observations for themselves and not
blindly follow others. He discussed operations on the head, the thorax
and the abdomen. He said that wounds of the intestines would surely be
fatal unless sewed up, and he described the technique of suture for
them. His specialty was operation for hernia. There are pictures still
extant of operations for hernia done about this time in an exaggerated
Trendelenberg position. The patient is fastened to a board by the
legs, head down, the board at an angle of {395} forty-five degrees
against the wall. The intestines dropped back from the site of
operation and allowed the surgeon to proceed without danger. Guy said
that more patients were operated on for the sake of the doctor's
pocket in hernia cases than for their own benefit. His instructions to
his students, his high standard of professional advice, all show us
one of the great physicians of all time and historians of medicine are
unanimous in their praise of him.
The next great development in medicine came at the time of the
Renaissance with the reorganization of the universities. In the
sixteenth century Italy particularly did magnificent work in the
universities, stimulated by close touch with old Greek medicine. At
Padua, at Bologna, above all, at Rome, the great foundations of the
modern medical sciences were laid. I need only mention the names of
Vesalius, Varolius, Eustachius, Fallopius, Columbus (who discovered
the circulation of the blood in the lungs), Caesalpinus, to whom and
rightly the Italians attribute the discovery of the systemic
circulation nearly half a century before Harvey. These men all of them
did fine work, everywhere in Italy. They were doing original
investigation of the greatest value. Whenever anybody anywhere in
Europe at this time wanted to do good work in science of any
kind,--astronomy, mathematics, physics and, above all, in any of the
medical sciences,--he went down to Italy; Italy was and continued for
five {396} centuries after the thirteenth to be what France was for a
scant half a century in the nineteenth, and Germany for a
corresponding period just before our own time. How curiously the
history of science and of medicine was written when it seems to
contradict this.
Above all, what ridiculous nonsense has been talked about Papal
opposition to science. The great universities of Italy in the
thirteenth and fourteenth centuries had charters from the Popes. They
were immediately under ecclesiastical influence, yet they did fine
work in anatomy and surgery. The Father of Modern Surgery was a Papal
physician. The Papal physicians for seven centuries have been the
greatest contributors to medicine. The Popes deliberately selected as
their physicians the greatest investigators of the time. Besides Guy
de Chauliac such men as Eustachius, Varolius, Columbus, Caesalpinus,
Lancisi, Malpighi were Papal physicians. We have even a more striking
testimony to the Papal patronage and encouragement of medicine and to
the Church's fostering care of medical education, here in America. The
first university medical school in America was not, as has so often
been said, the medical school of the University of Pennsylvania
founded in 1767, but the medical school of the University of Mexico,
where medical lectures were first delivered in 1578. Our medical
schools in this country have only become genuine university medical
schools in the sense {397} of being organic portions of the university
in the last twenty-five years. Before that their courses were brief
and unworthy and no preliminary education was required.
The universities of Spanish America from the very beginning required
three years of preliminary training in the university before medicine
could be taken up, and then four years of medical studies. These four
years became five and six years in certain countries, and at no time
during the nineteenth century did the medical education of Spanish
America sink to the low level unfortunately reached in the United
States. The lesson of it is clear. When medical education is seriously
undertaken as a university department, all is well. When it is not,
the results are disastrous.
In our day and country another great awakening of university life has
come and with it a drawing together in intimate union of universities
and their graduate departments. Above all, the medical schools have
profited by this closer connection with university work, and the
prospects for medical education in the United States and a new period
of wonderful progress in it are very bright. You have my hearty
congratulations, then, on your graduation from a great university
medical school here in the West, and I hope sincerely that you shall
prove worthy of Alma Mater. You have had the privileges of university
education and these involve duties. {398} This is ever true, though
unfortunately it is somewhat seldom realized. _Noblesse oblige_. We
hear much in these days of the stewardship of wealth, and do not let
us forget that there is a stewardship of talent and education. Much
more will be demanded of you because of your opportunities, and we
look for an accomplishment on your part far above the ordinary in
medical work and maintenance and uplift of professional dignity, that
shall mean much for your fellows.