reading are to be found in the Scriptures. Here it is stated that
Joseph commanded his servants and physicians to embalm him (1700
B. C.). This shows that Egypt at that time possessed a set of men who
practiced the healing art, and that they embalmed the dead. This must
have required an idea of anatomy, which, needless to say, was crude
and unscientific, as dissection of the human body at that time was
prohibited, the penalty being death.
According to Pliny, the Egyptian kings encouraged post-mortems, for
the purpose of ascertaining the cause of diseases; and this method was
fostered by the Ptolemies, during whose reigns anatomy was raised to a
higher standard.
Through the writings of Moses in the sacred Scriptures, we learn that
the medicine of the Hebrews appertained mostly to public hygiene. Meat
of the hog and rabbit was forbidden, as being injurious in the Egyptian
and Indian climate. The relation of man and wife and the purification
of women were regulated. The measures suggested by Moses for the
prevention of the spread of leprosy have not yet been surpassed. Next
to Moses, Solomon acquired quite an efficient knowledge of compounding
remedies.
The Indian races were divided into castes, the priests alone enjoying
the privilege of practicing medicine. Their medical knowledge was
condensed in a book which they called _Vagadasastir_. They believed
the body gave rise, through seventeen thousand vessels, to ten species
of gas which conflicted and engendered disease. So far as we know,
they were the first to record a way of testing the specific gravity of
urine. Though accused of many absurdities, they claimed to cure the
bites of venomous snakes and compounded an ointment which eradicated
the cicatrices of smallpox,—a result which has not as yet been
attained in the present epoch. The Chinese attribute the invention of
medicine to Hoâm-ti, one of their emperors, who lived about 2687 B. C.;
but possessing no anatomical knowledge, their surgery, to say the
least, was barbarous. For over four thousand years the Chinese were not
allowed to communicate with foreigners, and naturally their progress
was at a standstill. They used cups, acupuncture, fomentations,
lotions, plasters, baths, etc. Their midwifery practice consisted
mainly of murderous principles, and it is only since the introduction
of missionaries that a reformation in the medical practice of the
Chinese empire has been accomplished.
The condition of medicine in Greece did not differ from that of the
“rude and uncivilized nations.” But later, Greek physicians are
credited with the most brilliant discoveries. The most distinguished
of Chiron’s pupils was Æsculapius, who occupies the most conspicuous
place in the history of medicine. Æsculapius is always painted with
a staff, because the sick have need of a support; and the serpent
entwined around it is the symbol of wisdom. The sons of Æsculapius
are considered the fathers of surgery, and, for their distinguished
valor at the siege of Troy, have been classed by Homer among the Greek
heroes.
The first operation of venesection, or blood-letting, formerly so
promiscuously done, with at times good, but oftener disastrous,
results, and now rarely resorted to, is attributed to Podalirius, of
recognized Grecian medical skill, the patient being a princess.
The early Greeks above all recognized the value of physical culture,
which to-day occupies a prominent place in our curriculum. Were the
children of to-day, like those of the ancient Greeks, compelled to
follow a routine of physical training, a rugged constitution would
replace many a “delicate” and “infirm” one, and the race propagated
would tend to develop a stronger character. Then the weak-minded,
now so conspicuously present, would be eradicated, and many diseased
conditions fostered by an “inanimate” race would disappear.
Hygeia, from whence comes Hygiene, or the art of preserving health, was
a pretended sister of Æsculapius. Anatomy could not flourish in Greece,
because a most exemplary punishment awaited any untoward conduct toward
the dead. Their peculiar religious beliefs regarding the rest of the
soul were responsible for this.
The knowledge of the functions of the body in health and disease was
appreciated by Pythagoras. Diogenes asserts that Alcmæon, one of
the Pythagoreans, wrote a work on the functions, which work would
consequently be the most ancient known treatise on physiology.
The age of Hippocrates (B. C. 460–370) was marked by a revolution in
medical science. “This central figure in the history of medicine”
was descendant of a family in which the practice of medicine
was hereditary. He was an extensive writer on such subjects as
epidemics, acute diseases, dislocations, fractures, etc. Owing to
the impossibility of establishing a physiology without an anatomical
basis, his references to these subjects are crude and incorrect.
To Hippocrates we owe the classification of endemic, sporadic, and
epidemic forms of disease, and their division into acute and chronic.
He wrote on diseases of women and epilepsy, and his therapeutics,
though crude, were a marked improvement on what had preceded. He wrote
fully on external diseases and surgical therapeutics. In obstetrics he
was a close observer and a thoughtful teacher. The brilliant theories
and practices so diligently observed and urged by this master were
thrown in the shadow by his thoughtless followers. The well-instructed
physician is not ignorant of the opinions of Hippocrates, for truly
the “divine old man” is the “Father of Physic.” He caused a revolution
in the practice of medicine, semeiology, pathology, and dietetics. He
taught physicians to observe attentively the progress of Nature, proved
the inutility of theories, and showed that observation is the basis of
medicine.
An important age, and one of marked progress in medicine, is from the
foundation of the Alexandrian Library (320 B. C.) up to the death of
Galen (A. D. 200). Under the Ptolemies dissection of human bodies was
allowed, and hence, as already stated, the science of medicine received
quite an impulse. Herophilus deserves first mention as a dissector. He
described the brain and its vessels, the eye, the intestinal canal, and
parts of the vascular system. The valves of the heart were more exactly
described by Erasistratus, who discovered the lymph vessels and pointed
out that the epiglottis prevents the entrance of food into the lungs.
Aretæus, more than any other up to his time, attempted to found
pathology upon a sound anatomic basis, an effort which shows the
scientific progress of his age.
Of all the physicians of antiquity, Galen was probably the most
brilliant genius. In the midst of disorder he led back to the safer
road of sound doctrine and accurate observation which distinguished
the Hippocratic school. He wrote extensively on anatomy, especially
regarding the muscles. He was the first vivisector, by exposing
the muscles of animals and demonstrating their functions, and his
classification according to their use is at present in vogue. Carefully
regulated vivisection has been, and always will be, of incalculable
benefit to the development of accurate medical knowledge, and an
indirect aid in the alleviation of human suffering. Galen divided the
body into cranial and thoracic cavities, and described the organs,
etc., contained therein. Anatomy and physiology, the fundamental bases
of medicine and surgery, made the most progress during the period just
reviewed, and next came the description of diseases, their medical and
surgical therapeutics.
After the sixth century medicine was exercised almost exclusively by
the monks of the West. They were unworthy the name of physicians, as
they resorted more to prayers, and were retarded by ignorance and
prejudice.
During the seventh and eighth centuries there were among the monks a
few traditionary remains of science, originating from the East. The
prelates, archdeacons, etc., though continuing the practice of the
healing art, were gradually discouraged by the church, but as late
as the middle of the fifteenth century the Bishop of Colchester was
chaplain and first physician to Henry VI. In 1452 physicians of the
University of Paris were not allowed to marry, the applicant, prior to
admission, taking the oath of celibacy.
During the twelfth century the school of Salernum, through the personal
interest manifested by Emperor Frederick II., acquired a degree of
reputation attained by few similar institutions in ancient times.
Schools in Paris and England were placed on an advanced standing,
the professors being salaried; and about this period the titles of
bachelor, licentiate, and master, were granted to the physicians.
During the thirteenth and fourteenth centuries medicine made remarkable
progress in France under St. Louis. During the reign of this prince the
teaching of medicine and surgery was divided into separate and distinct
classes. Medical institutions now became greatly encouraged, and in the
leading cities of Europe universities were erected under the auspices
of royalty.
Medical instruction experienced an important revolution in the European
countries during the fourteenth century. For the first time in Europe
anatomy was taught by dissection of the human body. Guy de Chauliac,
who lived at the end of this century, wrote a treatise on surgery which
served as the basis of European instruction until Ambroise Paré of
France published his celebrated work upon the same subject.
The fifteenth century was also one of improvement. The Arabs added
a few observations on pathology, especially of the eruptive fevers.
Some useful works on pharmacy and materia medica were published during
this epoch. During this era the operation was devised for replacing
the nose when removed by accident or disease, by using for the purpose
a piece of flesh taken from the arm, and applying it by a grafting
process. About the middle of this period the internal administration of
metallic drugs was introduced. Towards the latter end, the invention of
printing tended to assist the progress of medicine. Near the close of
this century scurvy was first noticed in Germany. During this period
more energy was devoted to postmortem demonstrations and the study of
symptoms of diseases.
To Benevieni we owe the commencement of the study of gross pathology
and pathological anatomy. Malgaigne remarks of him: “A eulogy which he
merits, and which he shared with no other person, and which has not
been accorded to him up to this time by the many historians of surgery,
who have superficially searched among these precious sources, is that
he was the first who had the habit, felt the need, and set the useful
example, which he transmitted to his successors, of searching in the
cadaver, according to the title of his book, for the concealed causes
of disease.” His observations on anatomical heart lesions, gall-stone,
and presence of parasites in the body, were original. John Fernel, who
has been surnamed “the modern Galen,” divided medicine into physiology,
pathology, and therapeutics. The fundamental maxim of therapeutics,
that every disease must be combated by contrary remedies, was early
laid down by him, and he claimed that anything that cured a disease
was contrary to it. Surgery was placed on a high scale during this
era, as thorough a course as the time afforded was given, and a rigid
examination held at its termination. Ambroise Paré contributed largely
toward making this a glorious century. He rose from the lowest walks
of life to the highest professional attainments and honors. He was the
first to control hemorrhage by tying the bleeding vessels, thus doing
away with the former crude and painful method of pouring on hot oil.
This procedure proved quite a boon to surgery; as an instance it may be
mentioned that prior to the introduction of this method in amputations
the bleeding was controlled by means of a hot iron, and this before the
days of anæsthesia.
Every age of ancient, mediæval, and modern medicine has had its
charlatans, and the more civilization progresses, the more popular
these quacks become with certain types of people, particularly those of
the middle and lower classes, although no class appears to be exempt.
Latent, unscrupulous, and unprincipled, they play upon the credulity of
the ignorant.
The central figure of the mediæval charlatans was Paracelsus, who was
given to drink and debauchery. He advertised extensively, similar
to the charlatans of to-day, and exerted an influence in his time.
“The school which he would have founded was nothing but a school of
ignorance, dissipation, and boasting—a school of medical dishonesty.”
During the sixteenth century the greatest discoveries took place
in anatomy, based upon dissections, the only rational method of
ascertaining anatomical knowledge. The lesser circulation of the blood,
or that through the lungs, was appreciated.
The officers of the universities were chosen by the students, who
assisted in laying out the curriculum. Compare this with the rigid
methods of medical instruction now in vogue. The practitioners were of
roving habits, which were evidently contracted during their student
days, as it was customary for them to go from one school to another,
the poor classes defraying expenses by begging and singing.
There was evident improvement in the social and mental status of
medical men upon the approach of the seventeenth century, and this
period is signalized by the discovery of the circulation of the blood,
one of the most important ever made in medicine. Chemistry now assumed
the dignified aspect of a science, which fact benefited the progress of
medicine.
It is difficult for us at the present time to understand why the
circulation of the blood was not discovered prior to this period, but
to the ancients it was incomprehensible. They believed the arteries
contained air, because after death they were found empty. William
Harvey, the discoverer of the circulation of the blood, did not publish
the results of his investigations until 1628, first submitting them to
fifteen years of proof. This naturally revolutionized physiology. The
capillary circulation, or that intermediate between the arteries and
veins, was described by Malpighi in 1628. Of course this was possible
only through the means of a microscope. No less remarkable was the
discovery of the lymphatic vessels. Peruvian bark (the alkaloid quinine
being more commonly employed) so universally employed as a specific for
malaria, was first used in the early part of this epoch.
During this period ophthalmology (which treats of the diseases of the
eye) was cultivated in France, cataract was first recognized, and
the diseases of the ear first systematically described. Altogether
the century showed marked progression, closing with the teachings of
Sydenham, “the English Hippocrates.”
The eighteenth century was one of continued progress. The eminent
observers devoted more time to microscopical work, studying the
minute structure of the tissues and cells. One of the most prominent
is Lieberkühn, who invented the solar microscope, with which he was
enabled to exhibit the circulation of the blood. The systematic
practice of the preventive inoculation against small-pox by vaccination
originated in this decade. The first inoculation with cow-pox was
in 1774. Edward Jenner, the English surgeon, was “the father of
vaccination,” which he first did in 1796. About 1800, Dr. Waterhouse,
then professor of medicine in Harvard College, performed the first
vaccination in America, the patients being his four children.
The treatment of the insane was changed from one of torture and
barbarous methods to a more scientific one, conducive to the comfort
and return to health of the patient.
This period marks the earliest example of medical teaching in this
country, consisting of the demonstrations of anatomy in Philadelphia by
Dr. Thomas Cadwalader, upon his return from Europe. This was previous
to 1750, about which time a body was dissected in New York. In 1754–56
Dr. William Hunter of Scotland delivered a series of lectures on
anatomy, accompanied by dissections, at Newport, R. I.
In 1762 Dr. Shippen laid the foundation of a medical school in
Philadelphia, which finally developed into the Medical Department of
the University of Pennsylvania. This was the first medical school
established in this country. In 1768 a school of medicine was organized
in New York, and the next in succession was the Medical Department of
Harvard College in 1782. The fourth was established at Hanover, 1797,
being connected with Dartmouth College. These were the only medical
colleges instituted prior to the present century. The first book on
American surgery was written in 1775 by Dr. John Jones, the title being
“Wounds and Fractures.”
“The tendency of the nineteenth century seems to be a continuation,
and, perhaps, in some respects an exaggeration of the condition that
obtained in France during the previous century; in other words, the
world has become practically an enormous school of pathological
anatomy and diagnosis—a school inaugurated by Bichat, as representing
so-called scientific or exact medicine.”
[Illustration: DR. OLIVER WENDELL HOLMES.]
Darwin has promulgated “the most influential philosophic doctrine
of this or any other century.” Our materia medica and the laws of
physics have been enriched by botanical discoveries, aiding greatly the
experimental researches of to-day. Helmholz has given us an instrument
called the ophthalmoscope, containing a series of numbered magnifying
lenses, with which the interior of the eye can be explored by looking
directly through the pupil of the eye, similar to looking through a
door into a room. Through his knowledge of physics, Seebach was able
to make fame through his discovery of thermal electricity. Daguerre,
who invented photography, must not be overlooked, as by means of this
process, many conditions are directly appreciated by the eye which
could not be told in words and still convey an idea of the tumor, etc.,
being described. It may not be amiss to mention here that the biograph
will in a few years prove an important factor in teaching the various
operations. One surgeon in France is now employing it. We must not
overlook Edison and his electrical achievements which directly and
indirectly affect medicine; nor Bell’s telephone, which is sometimes
used to locate a bullet. By placing the receiver to the ear and probing
for the bullet with electric conductors, the making and breaking of the
circuit upon contact with the missile is transmitted to the receiver
and distinctly heard. This procedure, however, has been discarded since
the introduction by Röntgen of the X-ray.
A very significant feature of the age has been the extraordinary
development of associations devoted to scientific discussions and
the publication of medical literature and journals. The formation of
medical societies, especially in the United States, has been quite
active. But few counties are without a medical organization, referred
to as “The ... County Medical Society.”
The American Medical Association was established by Dr. Nathan Smith
Davis in Philadelphia fifty-two years ago (1847). The first two years
no meetings were held, but since then regular annual meetings have been
in progress, the place of assembly being decided upon by a majority
vote of its members. It has met in the city of its birth five times,
the founder has been elected president twice, and is still (1900) in
active practice at the age of eighty-two. He has attended all its
meetings held in various cities from Boston to San Francisco.
The first medical journal in this country appeared in New York, 1797.
It was called “The New York Repository,” was published quarterly, and
managed to reach its twenty-third edition. Fifty years ago there were
about twenty journals published in the United States. At the end of the
century there are two hundred and thirty.
In 1810 there were six hundred and fifty students of medicine in
America, and one hundred graduates. At the present writing about twenty
thousand medical students are enrolled in our various colleges, and
during the spring of 1899 about three thousand five hundred received
the degree of M. D.
[Illustration: STARLING MEDICAL COLLEGE AND ST. FRANCIS HOSPITAL.]
The original branches, practice of medicine, surgery, obstetrics,
physiology, anatomy, therapeutics, and chemistry, have been subdivided
and specialized. Among the chief of these specialties are gynecology,
which treats of diseases of women; pediatrics, which treats of diseases
of children; dermatology, which treats of diseases of the skin;
ophthalmology, which treats of diseases of the eye; laryngology, which
treats of diseases of the throat and larynx; otology, which treats of
diseases of the ear; neurology, which treats of diseases of the nerves;
medical jurisprudence, which treats of the relation of medicine to law;
pathology, which treats of diseased tissues and organs; bacteriology,
which treats of the microbes; and physical diagnosis, which treats of
the art of discriminating disease by means of the eye, ear, and
touch. The nucleus of the teaching regarding the latter subject is due
to the efforts and observations of Corvisart, of France. He was the
first to ascertain the diseased areas of the lungs, by tapping on the
chest with the fingers, and listening to the pitch of the note thus
elicited. A low, dull note indicates that the lung is solid, as in
pneumonia; a flat note that fluid is present, and so on. By placing the
ear to the chest wall, sounds in health and disease are heard, which
vary in intensity, degree, etc. Laennec discovered by accident that
this method was greatly improved and the sounds more distinctly heard
if a cylindrical tube was interposed between the ear and the chest
wall. The outcome of this principle is the stethoscope.
[Illustration: DR. NATHAN SMITH DAVIS, OF CHICAGO.]
The name of Pravaz, the Lyons surgeon, has been perpetuated by the
hypodermic syringe which he devised. The employment of suitable drugs
in this instrument is the method par excellence for relieving pain.
With it drugs can be injected into unconscious patients. Suicides
who refuse to swallow emetics can have their stomachs emptied
most effectually of their contents by a hypodermatic injection of
apomorphine.
The thermometer used for taking the temperature of the human body is so
arranged that the mercury does not descend into the bulb until shaken
down, hence after taking the temperature it remains uninfluenced until
shaken down. Were an ordinary thermometer used, by the time it was
removed from the patient to the light the mercury would descend several
degrees.
Pasteur began the studies of fermentation in 1854. Through his
observations, aided by the microscope, the opinion was reached that
micro-organisms played an important role in the causation of disease.
Many of the laboratory investigators became imbued with the spirit,
and through their diligent observations the microbes causing many
diseases have been isolated. It remained for Koch to discover the
tubercle bacillus, or _Bacillus tuberculosis_, which is the cause of
consumption. The sputum of a patient, properly stained, and examined
under the microscope, will at once decide whether that individual has
consumption.
Having ascertained that bacteria were the cause of disease, sepsis
(blood poisoning), etc., it then remained to discover a method of
killing them, without any undue injury to the patient. Sir Joseph
Lister began experiments upon this hypothesis, and in 1867 was able to
publish favorable results. But lo! the world was slow to bend to a new
thought ably demonstrated, and for a score of years he was bitterly
opposed.