THE EVOLUTION OF MODERN MEDICINE



A SERIES OF LECTURES DELIVERED AT YALE UNIVERSITY

ON THE SILLIMAN FOUNDATION

IN APRIL, 1913

by William Osler



THE SILLIMAN FOUNDATION

IN the year 1883 a legacy of eighty thousand dollars was left to the President and Fellows of Yale College in the city of New Haven, to be held in trust, as a gift from her children, in memory of their beloved and honored mother, Mrs. Hepsa Ely Silliman.

On this foundation Yale College was requested and directed to establish an annual course of lectures designed to illustrate the presence and providence, the wisdom and goodness of God, as manifested in the natural and moral world. These were to be designated as the Mrs. Hepsa Ely Silliman Memorial Lectures. It was the belief of the testator that any orderly presentation of the facts of nature or history contributed to the end of this foundation more effectively than any attempt to emphasize the elements of doctrine or of creed; and he therefore provided that lectures on dogmatic or polemical theology should be excluded from the scope of this foundation, and that the subjects should be selected rather from the domains of natural science and history, giving special prominence to astronomy, chemistry, geology and anatomy.

It was further directed that each annual course should be made the basis of a volume to form part of a series constituting a memorial to Mrs. Silliman. The memorial fund came into the possession of the Corporation of Yale University in the year 1901; and the present volume constitutes the tenth of the series of memorial lectures.

CONTENTS

Chapter I. Origin Of Medicine Chapter II. Greek Medicine Chapter III. Mediaeval Medicine Chapter IV. The Renaissance and the Rise of Anatomy and Physiology Chapter V. The Rise and Development of Modern Medicine Chapter VI. The Rise of Preventive Medicine



PREFACE

THE manuscript of Sir William Osler's lectures on the "Evolution of Modern Medicine," delivered at Yale University in April, 1913, on the Silliman Foundation, was immediately turned in to the Yale University Press for publication. Duly set in type, proofs in galley form had been submitted to him and despite countless interruptions he had already corrected and revised a number of the galleys when the great war came. But with the war on, he threw himself with energy and devotion into the military and public duties which devolved upon him and so never completed his proof-reading and intended alterations. The careful corrections which Sir William made in the earlier galleys show that the lectures were dictated, in the first instance, as loose memoranda for oral delivery rather than as finished compositions for the eye, while maintaining throughout the logical continuity and the engaging con moto which were so characteristic of his literary style. In revising the lectures for publication, therefore, the editors have merely endeavored to carry out, with care and befitting reverence, the indications supplied in the earlier galleys by Sir William himself. In supplying dates and references which were lacking, his preferences as to editions and readings have been borne in mind. The slight alterations made, the adaptation of the text to the eye, detract nothing from the original freshness of the work.

In a letter to one of the editors, Osler described these lectures as "an aeroplane flight over the progress of medicine through the ages." They are, in effect, a sweeping panoramic survey of the whole vast field, covering wide areas at a rapid pace, yet with an extraordinary variety of detail. The slow, painful character of the evolution of medicine from the fearsome, superstitious mental complex of primitive man, with his amulets, healing gods and disease demons, to the ideal of a clear-eyed rationalism is traced with faith and a serene sense of continuity. The author saw clearly and felt deeply that the men who have made an idea or discovery viable and valuable to humanity are the deserving men; he has made the great names shine out, without any depreciation of the important work of lesser men and without cluttering up his narrative with the tedious prehistory of great discoveries or with shrill claims to priority. Of his skill in differentiating the sundry "strains" of medicine, there is specific witness in each section. Osler's wide culture and control of the best available literature of his subject permitted him to range the ampler aether of Greek medicine or the earth-fettered schools of today with equal mastery; there is no quickset of pedantry between the author and the reader. The illustrations (which he had doubtless planned as fully for the last as for the earlier chapters) are as he left them; save that, lacking legends, these have been supplied and a few which could not be identified have with regret been omitted. The original galley proofs have been revised and corrected from different viewpoints by Fielding H. Garrison, Harvey Cushing, Edward C. Streeter and latterly by Leonard L. Mackall (Savannah, Ga.), whose zeal and persistence in the painstaking verification of citations and references cannot be too highly commended.

In the present revision, a number of important corrections, most of them based upon the original MS., have been made by Dr. W.W. Francis (Oxford), Dr. Charles Singer (London), Dr. E.C. Streeter, Mr. L.L. Mackall and others.

This work, composed originally for a lay audience and for popular consumption, will be to the aspiring medical student and the hardworking practitioner a lift into the blue, an inspiring vista or "Pisgah-sight" of the evolution of medicine, a realization of what devotion, perseverance, valor and ability on the part of physicians have contributed to this progress, and of the creditable part which our profession has played in the general development of science.

The editors have no hesitation in presenting these lectures to the profession and to the reading public as one of the most characteristic productions of the best-balanced, best-equipped, most sagacious and most lovable of all modern physicians.

F.H.G.

BUT on that account, I say, we ought not to reject the ancient Art, as if it were not, and had not been properly founded, because it did not attain accuracy in all things, but rather, since it is capable of reaching to the greatest exactitude by reasoning, to receive it and admire its discoveries, made from a state of great ignorance, and as having been well and properly made, and not from chance. (Hippocrates, On Ancient Medicine, Adams edition, Vol. 1, 1849, p. 168.)

THE true and lawful goal of the sciences is none other than this: that human life be endowed with new discoveries and powers. (Francis Bacon, Novum Organum, Aphorisms, LXXXI, Spedding's translation.)

A GOLDEN thread has run throughout the history of the world, consecutive and continuous, the work of the best men in successive ages. From point to point it still runs, and when near you feel it as the clear and bright and searchingly irresistible light which Truth throws forth when great minds conceive it. (Walter Moxon, Pilocereus Senilis and Other Papers, 1887, p. 4.)

FOR the mind depends so much on the temperament and disposition of the bodily organs that, if it is possible to find a means of rendering men wiser and cleverer than they have hitherto been, I believe that it is in medicine that it must be sought. It is true that the medicine which is now in vogue contains little of which the utility is remarkable; but, without having any intention of decrying it, I am sure that there is no one, even among those who make its study a profession, who does not confess that all that men know is almost nothing in comparison with what remains to be known; and that we could be free of an infinitude of maladies both of body and mind, and even also possibly of the infirmities of age, if we had sufficient knowledge of their causes, and of all the remedies with which nature has provided us. (Descartes: Discourse on the Method, Philosophical Works. Translated by E. S. Haldane and G. R. T. Ross. Vol. I, Cam. Univ. Press, 1911, p. 120.)



CHAPTER I — ORIGIN OF MEDICINE



INTRODUCTION

SAIL to the Pacific with some Ancient Mariner, and traverse day by day that silent sea until you reach a region never before furrowed by keel where a tiny island, a mere speck on the vast ocean, has just risen from the depths, a little coral reef capped with green, an atoll, a mimic earth, fringed with life, built up through countless ages by life on the remains of life that has passed away. And now, with wings of fancy, join Ianthe in the magic car of Shelley, pass the eternal gates of the flaming ramparts of the world and see his vision:

Below lay stretched the boundless Universe! There, far as the remotest line That limits swift imagination's flight, Unending orbs mingled in mazy motion, Immutably fulfilling Eternal Nature's law. Above, below, around, The circling systems formed A wilderness of harmony. (Daemon of the World, Pt. I.)

And somewhere, "as fast and far the chariot flew," amid the mighty globes would be seen a tiny speck, "earth's distant orb," one of "the smallest lights that twinkle in the heavens." Alighting, Ianthe would find something she had probably not seen elsewhere in her magic flight—life, everywhere encircling the sphere. And as the little coral reef out of a vast depth had been built up by generations of polyzoa, so she would see that on the earth, through illimitable ages, successive generations of animals and plants had left in stone their imperishable records: and at the top of the series she would meet the thinking, breathing creature known as man. Infinitely little as is the architect of the atoll in proportion to the earth on which it rests, the polyzoon, I doubt not, is much larger relatively than is man in proportion to the vast systems of the Universe, in which he represents an ultra-microscopic atom less ten thousand times than the tiniest of the "gay motes that people the sunbeams." Yet, with colossal audacity, this thinking atom regards himself as the anthropocentric pivot around which revolve the eternal purposes of the Universe. Knowing not whence he came, why he is here, or whither he is going, man feels himself of supreme importance, and certainly is of interest—to himself. Let us hope that he has indeed a potency and importance out of all proportion to his somatic insignificance. We know of toxins of such strength that an amount too infinitesimal to be gauged may kill; and we know that "the unit adopted in certain scientific work is the amount of emanation produced by one million-millionth of a grain of radium, a quantity which itself has a volume of less than a million-millionth of a cubic millimetre and weighs a million million times less than an exceptionally delicate chemical balance will turn to" (Soddy, 1912). May not man be the radium of the Universe? At any rate let us not worry about his size. For us he is a very potent creature, full of interest, whose mundane story we are only beginning to unravel.

Civilization is but a filmy fringe on the history of man. Go back as far as his records carry us and the story written on stone is of yesterday in comparison with the vast epochs of time which modern studies demand for his life on the earth. For two millions (some hold even three millions) of years man lived and moved and had his being in a world very different from that upon which we look out. There appear, indeed, to have been various types of man, some as different from us as we are from the anthropoid apes. What upstarts of yesterday are the Pharaohs in comparison with the men who survived the tragedy of the glacial period! The ancient history of man—only now beginning to be studied—dates from the Pliocene or Miocene period; the modern history, as we know it, embraces that brief space of time that has elapsed since the earliest Egyptian and Babylonian records were made. This has to be borne in mind in connection with the present mental status of man, particularly in his outlook upon nature. In his thoughts and in his attributes, mankind at large is controlled by inherited beliefs and impulses, which countless thousands of years have ingrained like instinct. Over vast regions of the earth today, magic, amulets, charms, incantations are the chief weapons of defense against a malignant nature; and in disease, the practice of Asa(*) is comparatively novel and unusual; in days of illness many millions more still seek their gods rather than the physicians. In an upward path man has had to work out for himself a relationship with his fellows and with nature. He sought in the supernatural an explanation of the pressing phenomena of life, peopling the world with spiritual beings, deifying objects of nature, and assigning to them benign or malign influences, which might be invoked or propitiated. Primitive priest, physician and philosopher were one, and struggled, on the one hand, for the recognition of certain practices forced on him by experience, and on the other, for the recognition of mystical agencies which control the dark, "uncharted region" about him—to use Prof. Gilbert Murray's phrase—and were responsible for everything he could not understand, and particularly for the mysteries of disease. Pliny remarks that physic "was early fathered upon the gods"; and to the ordinary non-medical mind, there is still something mysterious about sickness, something outside the ordinary standard.

(*) II Chronicles xvi, 12.

Modern anthropologists claim that both religion and medicine took origin in magic, "that spiritual protoplasm," as Miss Jane Harrison calls it. To primitive man, magic was the setting in motion of a spiritual power to help or to hurt the individual, and early forms may still be studied in the native races. This power, or "mana," as it is called, while possessed in a certain degree by all, may be increased by practice. Certain individuals come to possess it very strongly: among native Australians today it is still deliberately cultivated. Magic in healing seeks to control the demons, or forces; causing disease; and in a way it may be thus regarded as a "lineal ancestor of modern science" (Whetham), which, too, seeks to control certain forces, no longer, however, regarded as supernatural.

Primitive man recognized many of these superhuman agencies relating to disease, such as the spirits of the dead, either human or animal, independent disease demons, or individuals who might act by controlling the spirits or agencies of disease. We see this today among the negroes of the Southern States. A Hoodoo put upon a negro may, if he knows of it, work upon him so powerfully through the imagination that he becomes very ill indeed, and only through a more powerful magic exercised by someone else can the Hoodoo be taken off.

To primitive man life seemed "full of sacred presences" (Walter Pater) connected with objects in nature, or with incidents and epochs in life, which he began early to deify, so that, until a quite recent period, his story is largely associated with a pantheon of greater and lesser gods, which he has manufactured wholesale. Xenophanes was the earliest philosopher to recognize man's practice of making gods in his own image and endowing them with human faculties and attributes; the Thracians, he said, made their gods blue-eyed and red-haired, the Ethiopians, snub-nosed and black, while, if oxen and lions and horses had hands and could draw, they would represent their gods as oxen and lions and horses. In relation to nature and to disease, all through early history we find a pantheon full to repletion, bearing testimony no less to the fertility of man's imagination than to the hopes and fears which led him, in his exodus from barbarism, to regard his gods as "pillars of fire by night, and pillars of cloud by day."

Even so late a religion as that of Numa was full of little gods to be invoked on special occasions—Vatican, who causes the infant to utter his first cry, Fabulinus, who prompts his first word, Cuba, who keeps him quiet in his cot, Domiduca, who watches over one's safe home-coming (Walter Pater); and Numa believed that all diseases came from the gods and were to be averted by prayer and sacrifice. Besides the major gods, representatives of Apollo, AEsculapius and Minerva, there were scores of lesser ones who could be invoked for special diseases. It is said that the young Roman mother might appeal to no less than fourteen goddesses, from Juno Lucina to Prosa and Portvorta (Withington). Temples were erected to the Goddess of Fever, and she was much invoked. There is extant a touching tablet erected by a mourning mother and inscribed:

Febri divae, Febri Sancte, Febri magnae Camillo amato pro Filio meld effecto. Posuit.

It is marvellous what a long line of superhuman powers, major and minor, man has invoked against sickness. In Swinburne's words:

God by God flits past in thunder till his glories turn to shades, God by God bears wondering witness how his Gospel flames and fades; More was each of these, while yet they were, than man their servant seemed; Dead are all of these, and man survives who made them while he dreamed.

Most of them have been benign and helpful gods. Into the dark chapters relating to demonical possession and to witchcraft we cannot here enter. They make one cry out with Lucretius (Bk. V):

O genus infelix humanum, talia divis Cum tribuit facta atque iras adjunxit acerbas! Quantos tum gemitus ipsi sibi, quantaque nobis Vulnera, quas lacrimas peperere minoribu' nostris.

In every age, and in every religion there has been justification for his bitter words, "tantum religio potuit suadere malorum"—"Such wrongs Religion in her train doth bring"—yet, one outcome of "a belief in spiritual beings"—as Tylor defines religion—has been that man has built an altar of righteousness in his heart. The comparative method applied to the study of his religious growth has shown how man's thoughts have widened in the unceasing purpose which runs through his spiritual no less than his physical evolution. Out of the spiritual protoplasm of magic have evolved philosopher and physician, as well as priest. Magic and religion control the uncharted sphere—the supernatural, the superhuman: science seeks to know the world, and through knowing, to control it. Ray Lankester remarks that Man is Nature's rebel, and goes on to say: "The mental qualities which have developed in Man, though traceable in a vague and rudimentary condition in some of his animal associates, are of such an unprecedented power and so far dominate everything else in his activities as a living organism, that they have to a very large extent, if not entirely, cut him off from the general operation of that process of Natural Selection and survival of the fittest which up to their appearance had been the law of the living world. They justify the view that Man forms a new departure in the gradual unfolding of Nature's predestined scheme. Knowledge, reason, self-consciousness, will, are the attributes of Man."(1) It has been a slow and gradual growth, and not until within the past century has science organized knowledge—so searched out the secrets of Nature, as to control her powers, limit her scope and transform her energies. The victory is so recent that the mental attitude of the race is not yet adapted to the change. A large proportion of our fellow creatures still regard nature as a playground for demons and spirits to be exorcised or invoked.

(1) Sir E. Ray Lankester: Romanes Lecture, "Nature and Man," Oxford Univ. Press, 1905, p. 21.

Side by side, as substance and shadow—"in the dark backward and abysm of time," in the dawn of the great civilizations of Egypt and Babylon, in the bright morning of Greece, and in the full noontide of modern life, together have grown up these two diametrically opposite views of man's relation to nature, and more particularly of his personal relation to the agencies of disease.

The purpose of this course of lectures is to sketch the main features of the growth of these two dominant ideas, to show how they have influenced man at the different periods of his evolution, how the lamp of reason, so early lighted in his soul, burning now bright, now dim, has never, even in his darkest period, been wholly extinguished, but retrimmed and refurnished by his indomitable energies, now shines more and more towards the perfect day. It is a glorious chapter in history, in which those who have eyes to see may read the fulfilment of the promise of Eden, that one day man should not only possess the earth, but that he should have dominion over it! I propose to take an aeroplane flight through the centuries, touching only on the tall peaks from which may be had a panoramic view of the epochs through which we pass.



ORIGIN OF MEDICINE

MEDICINE arose out of the primal sympathy of man with man; out of the desire to help those in sorrow, need and sickness.

In the primal sympathy Which having been must ever be; In the soothing thoughts that spring Out of human suffering.

The instinct of self-preservation, the longing to relieve a loved one, and above all, the maternal passion—for such it is—gradually softened the hard race of man—tum genus humanum primum mollescere coepit. In his marvellous sketch of the evolution of man, nothing illustrates more forcibly the prescience of Lucretius than the picture of the growth of sympathy: "When with cries and gestures they taught with broken words that 'tis right for all men to have pity on the weak." I heard the well-known medical historian, the late Dr. Payne, remark that "the basis of medicine is sympathy and the desire to help others, and whatever is done with this end must be called medicine."

The first lessons came to primitive man by injuries, accidents, bites of beasts and serpents, perhaps for long ages not appreciated by his childlike mind, but, little by little, such experiences crystallized into useful knowledge. The experiments of nature made clear to him the relation of cause and effect, but it is not likely, as Pliny suggests, that he picked up his earliest knowledge from the observation of certain practices in animals, as the natural phlebotomy of the plethoric hippopotamus, or the use of emetics from the dog, or the use of enemata from the ibis. On the other hand, Celsus is probably right in his account of the origin of rational medicine. "Some of the sick on account of their eagerness took food on the first day, some on account of loathing abstained; and the disease in those who refrained was more relieved. Some ate during a fever, some a little before it, others after it had subsided, and those who had waited to the end did best. For the same reason some at the beginning of an illness used a full diet, others a spare, and the former were made worse. Occurring daily, such things impressed careful men, who noted what had best helped the sick, then began to prescribe them. In this way medicine had its rise from the experience of the recovery of some, of the death of others, distinguishing the hurtful from the salutary things" (Book I). The association of ideas was suggestive—the plant eyebright was used for centuries in diseases of the eye because a black speck in the flower suggested the pupil of the eye. The old herbals are full of similar illustrations upon which, indeed, the so-called doctrine of signatures depends. Observation came, and with it an ever widening experience. No society so primitive without some evidence of the existence of a healing art, which grew with its growth, and became part of the fabric of its organization.

With primitive medicine, as such, I cannot deal, but I must refer to the oldest existing evidence of a very extraordinary practice, that of trephining. Neolithic skulls with disks of bone removed have been found in nearly all parts of the world. Many careful studies have been made of this procedure, particularly by the great anatomist and surgeon, Paul Broca, and M. Lucas-Championniere has covered the subject in a monograph.(2) Broca suggests that the trephining was done by scratching or scraping, but, as Lucas-Championniere holds, it was also done by a series of perforations made in a circle with flint instruments, and a round piece of skull in this way removed; traces of these drill-holes have been found. The operation was done for epilepsy, infantile convulsions, headache, and various cerebral diseases believed to be caused by confined demons, to whom the hole gave a ready method of escape.

(2) Lucas-Championniere: Trepanation neolithique, Paris, 1912.

The practice is still extant. Lucas-Championniere saw a Kabyle thoubib who told him that it was quite common among his tribe; he was the son of a family of trephiners, and had undergone the operation four times, his father twelve times; he had three brothers also experts; he did not consider it a dangerous operation. He did it most frequently for pain in the head, and occasionally for fracture.

The operation was sometimes performed upon animals. Shepherds trephined sheep for the staggers. We may say that the modern decompression operation, so much in vogue, is the oldest known surgical procedure.



EGYPTIAN MEDICINE

OUT of the ocean of oblivion, man emerges in history in a highly civilized state on the banks of the Nile, some sixty centuries ago. After millenniums of a gradual upward progress, which can be traced in the records of the stone age, civilization springs forth Minerva-like, complete, and highly developed, in the Nile Valley. In this sheltered, fertile spot, neolithic man first raised himself above his kindred races of the Mediterranean basin, and it is suggested that by the accidental discovery of copper Egypt "forged the instruments that raised civilization out of the slough of the Stone Age" (Elliot Smith). Of special interest to us is the fact that one of the best-known names of this earliest period is that of a physician—guide, philosopher and friend of the king—a man in a position of wide trust and importance. On leaving Cairo, to go up the Nile, one sees on the right in the desert behind Memphis a terraced pyramid 190 feet in height, "the first large structure of stone known in history." It is the royal tomb of Zoser, the first of a long series with which the Egyptian monarchy sought "to adorn the coming bulk of death." The design of this is attributed to Imhotep, the first figure of a physician to stand out clearly from the mists of antiquity. "In priestly wisdom, in magic, in the formulation of wise proverbs, in medicine and architecture, this remarkable figure of Zoser's reign left so notable a reputation that his name was never forgotten, and 2500 years after his death he had become a God of Medicine, in whom the Greeks, who called him Imouthes, recognized their own AEsculapius."(3) He became a popular god, not only healing men when alive, but taking good care of them in the journeys after death. The facts about this medicinae primus inventor, as he has been called, may be gathered from Kurt Sethe's study.(4) He seems to have corresponded very much to the Greek Asklepios. As a god he is met with comparatively late, between 700 and 332 B.C. Numerous bronze figures of him remain. The oldest memorial mentioning him is a statue of one of his priests, Amasis (No. 14765 in the British Museum). Ptolemy V dedicated to him a temple on the island of Philae. His cult increased much in later days, and a special temple was dedicated to him near Memphis Sethe suggests that the cult of Imhotep gave the inspiration to the Hermetic literature. The association of Imhotep with the famous temple at Edfu is of special interest.

(3) Breasted: A History of the Ancient Egyptians, Scribner, New York, 1908, p. 104.

(4) K. Sethe: Imhotep, der Asklepios der Aegypter, Leipzig, 1909 (Untersuchungen, etc., ed. Sethe, Vol. II, No. 4).

Egypt became a centre from which civilization spread to the other peoples of the Mediterranean. For long centuries, to be learned in all the wisdom of the Egyptians meant the possession of all knowledge. We must come to the land of the Nile for the origin of many of man's most distinctive and highly cherished beliefs. Not only is there a magnificent material civilization, but in records so marvellously preserved in stone we may see, as in a glass, here clearly, there darkly, the picture of man's search after righteousness, the earliest impressions of his moral awakening, the beginnings of the strife in which he has always been engaged for social justice and for the recognition of the rights of the individual. But above all, earlier and more strongly than in any other people, was developed the faith that looked through death, to which, to this day, the noblest of their monuments bear an enduring testimony. With all this, it is not surprising to find a growth in the knowledge of practical medicine; but Egyptian civilization illustrates how crude and primitive may remain a knowledge of disease when conditioned by erroneous views of its nature. At first, the priest and physician were identified, and medicine never became fully dissociated from religion. Only in the later periods did a special group of physicians arise who were not members of priestly colleges.(6) Maspero states that the Egyptians believed that disease and death were not natural and inevitable, but caused by some malign influence which could use any agency, natural or invisible, and very often belonged to the invisible world. "Often, though, it belongs to the invisible world, and only reveals itself by the malignity of its attacks: it is a god, a spirit, the soul of a dead man, that has cunningly entered a living person, or that throws itself upon him with irresistible violence. Once in possession of the body, the evil influence breaks the bones, sucks out the marrow, drinks the blood, gnaws the intestines and the heart and devours the flesh. The invalid perishes according to the progress of this destructive work; and death speedily ensues, unless the evil genius can be driven out of it before it has committed irreparable damage. Whoever treats a sick person has therefore two equally important duties to perform. He must first discover the nature of the spirit in possession, and, if necessary, its name, and then attack it, drive it out, or even destroy it. He can only succeed by powerful magic, so he must be an expert in reciting incantations, and skilful in making amulets. He must then use medicine (drugs and diet) to contend with the disorders which the presence of the strange being has produced in the body."(6)

(5) Maspero: Life in Ancient Egypt and Assyria, London, 1891, p. 119.

(6) Maspero: Life in Ancient Egypt and Assyria, London, 1891, p. 118.

(7) W. Wreszinski: Die Medizin der alten Aegypter, Leipzig, J. C. Hinrichs, 1909-1912.

In this way it came about that diseases were believed to be due to hostile spirits, or caused by the anger of a god, so that medicines, no matter how powerful, could only be expected to assuage the pain; but magic alone, incantations, spells and prayers, could remove the disease. Experience brought much of the wisdom we call empirical, and the records, extending for thousands of years, show that the Egyptians employed emetics, purgatives, enemata, diuretics, diaphoretics and even bleeding. They had a rich pharmacopoeia derived from the animal, vegetable and mineral kingdoms. In the later periods, specialism reached a remarkable development, and Herodotus remarks that the country was full of physicians;—"One treats only the diseases of the eye, another those of the head, the teeth, the abdomen, or the internal organs."

Our knowledge of Egyptian medicine is derived largely from the remarkable papyri dealing specially with this subject. Of these, six or seven are of the first importance. The most famous is that discovered by Ebers, dating from about 1500 B.C. A superb document, one of the great treasures of the Leipzig Library, it is 20.23 metres long and 30 centimetres high and in a state of wonderful preservation. Others are the Kahun, Berlin, Hearst and British Museum papyri. All these have now been published—the last three quite recently, edited by Wreszinski.(7) I show here a reproduction from which an idea may be had of these remarkable documents. They are motley collections, filled with incantations, charms, magical formulae, symbols, prayers and prescriptions for all sorts of ailments. One is impressed by the richness of the pharmacopoeia, and the high development which the art of pharmacy must have attained. There were gargles, salves, snuffs, inhalations, suppositories, fumigations, enemata, poultices and plasters; and they knew the use of opium, hemlock, the copper salts, squills and castor oil. Surgery was not very highly developed, but the knife and actual cautery were freely used. Ophthalmic surgery was practiced by specialists, and there are many prescriptions in the papyri for ophthalmia.

One department of Egyptian medicine reached a high stage of development, vis., hygiene. Cleanliness of the dwellings, of the cities and of the person was regulated by law, and the priests set a splendid example in their frequent ablutions, shaving of the entire body, and the spotless cleanliness of their clothing. As Diodorus remarks, so evenly ordered was their whole manner of life that it was as if arranged by a learned physician rather than by a lawgiver.

Two world-wide modes of practice found their earliest illustration in ancient Egypt. Magic, the first of these, represented the attitude of primitive man to nature, and really was his religion. He had no idea of immutable laws, but regarded the world about him as changeable and fickle like himself, and "to make life go as he wished, he must be able to please and propitiate or to coerce these forces outside himself."(8)

(8) L. Thorndike: The Place of Magic in the Intellectual History of Europe, New York, 1905, p. 29.

The point of interest to us is that in the Pyramid Texts—"the oldest chapter in human thinking preserved to us, the remotest reach in the intellectual history of man which we are now able to discern"(9)—one of their six-fold contents relates to the practice of magic. A deep belief existed as to its efficacy, particularly in guiding the dead, who were said to be glorious by reason of mouths equipped with the charms, prayers and ritual of the Pyramid Texts, armed with which alone could the soul escape the innumerable dangers and ordeals of the passage through another world. Man has never lost his belief in the efficacy of magic, in the widest sense of the term. Only a very few of the most intellectual nations have escaped from its shackles. Nobody else has so clearly expressed the origins and relations of magic as Pliny in his "Natural History."(10) "Now, if a man consider the thing well, no marvaile it is that it hath continued thus in so great request and authoritie; for it is the onely Science which seemeth to comprise in itselfe three possessions besides, which have the command and rule of mans mind above any other whatsoever. For to begin withall, no man doubteth but that Magicke tooke root first, and proceeded from Physicke, under the presence of maintaining health, curing, and preventing diseases: things plausible to the world, crept and insinuated farther into the heart of man, with a deepe conceit of some high and divine matter therein more than ordinarie, and in comparison whereof, all other Physicke was but basely accounted. And having thus made way and entrance, the better to fortifie it selfe, and to give a goodly colour and lustre to those fair and flattering promises of things, which our nature is most given to hearken after, on goeth the habite also and cloake of religion: a point, I may tell you, that even in these daies holdeth captivate the spirit of man, and draweth away with it a greater part of the world, and nothing so much. But not content with this successe and good proceeding, to gather more strength and win a greater name, shee entermingled with medicinable receipts and religious ceremonies, the skill of Astrologie and arts Mathematicall; presuming upon this, That all men by nature are very curious and desirous to know their future fortunes, and what shall betide them hereafter, persuading themselves, that all such foreknowledge dependeth upon the course and influence of the starres, which give the truest and most certain light of things to come. Being thus wholly possessed of men, and having their senses and understanding by this meanes fast ynough bound with three sure chains, no marvell if this art grew in processe of time to such an head, that it was and is at this day reputed by most nations of the earth for the paragon and cheefe of all sciences: insomuch as the mightie kings and monarchs of the Levant are altogether ruled and governed thereby."

(9) Breasted: Development of Religion and Thought in Ancient Egypt, New York, 1912, p. 84.

(10) The Historie of the World, commonly called the Naturall Historie of C. Plinius Secundus, translated into English by Philemon Holland, Doctor in Physieke, London, 1601, Vol. II, p. 371, Bk. XXX, Chap. I, Sect. 1.

The second world-wide practice which finds its earliest record among the Egyptians is the use secretions and parts of the animal body as medicine. The practice was one of great antiquity with primitive man, but the papyri already mentioned contain the earliest known records. Saliva, urine, bile, faeces, various parts of the body, dried and powdered, worms, insects, snakes were important ingredients in the pharmacopoeia. The practice became very widespread throughout the ancient world. Its extent and importance may be best gathered from chapters VII and VIII in the 28th book of Pliny's "Natural History." Several remedies are mentioned as derived from man; others from the elephant, lion, camel, crocodile, and some seventy-nine are prepared from the hyaena. The practice was widely prevalent throughout the Middle Ages, and the pharmacopoeia of the seventeenth and even of the eighteenth century contains many extraordinary ingredients. "The Royal Pharmacopoeia" of Moses Charras (London ed., 1678), the most scientific work of the day, is full of organotherapy and directions for the preparation of medicines from the most loathsome excretions. A curious thing is that with the discoveries of the mummies a belief arose as to the great efficacy of powdered mummy in various maladies. As Sir Thomas Browne remarks in his "Urn Burial": "Mummy has become merchandize. Mizraim cures wounds, and Pharaoh is sold for balsams."

One formula in everyday use has come to us in a curious way from the Egyptians. In the Osiris myth, the youthful Horus loses an eye in his battle with Set. This eye, the symbol of sacrifice, became, next to the sacred beetle, the most common talisman of the country, and all museums are rich in models of the Horus eye in glass or stone.

"When alchemy or chemistry, which had its cradle in Egypt, and derived its name from Khami, an old title for this country, passed to the hands of the Greeks, and later of the Arabs, this sign passed with it. It was also adopted to some extent by the Gnostics of the early Christian church in Egypt. In a cursive form it is found in mediaeval translations of the works of Ptolemy the astrologer, as the sign of the planet Jupiter. As such it was placed upon horoscopes and upon formula containing drugs made for administration to the body, so that the harmful properties of these drugs might be removed under the influence of the lucky planet. At present, in a slightly modified form, it still figures at the top of prescriptions written daily in Great Britain (Rx)."(11)

(11) John D. Comrie: Medicine among the Assyrians and Egyptians in 1500 B.C., Edinburgh Medical Journal, 1909, n. s., II, 119.

For centuries Egyptian physicians had a great reputation, and in the Odyssey (Bk. IV), Polydamna, the wife of Thonis, gives medicinal plants to Helen in Egypt—"a country producing an infinite number of drugs . . . where each physician possesses knowledge above all other men." Jeremiah (xlvi, 11) refers to the virgin daughter of Egypt, who should in vain use many medicines. Herodotus tells that Darius had at his court certain Egyptians, whom he reckoned the best skilled physicians in all the world, and he makes the interesting statement that: "Medicine is practiced among them on a plan of separation; each physician treats a single disorder, and no more: thus the country swarms with medical practitioners, some under taking to cure diseases of the eye, others of the head, others again of the teeth, others of the intestines, and some those which are not local."(12)

(12) The History of Herodotus, Blakesley's ed., Bk. II, 84.

A remarkable statement is made by Pliny, in the discussion upon the use of radishes, which are said to cure a "Phthisicke," or ulcer of the lungs—"proofe whereof was found and seen in AEgypt by occasion that the KK. there, caused dead bodies to be cut up, and anatomies to be made, for to search out the maladies whereof men died."(13)

(13) Pliny, Holland's translation, Bk. XIX, Chap. V, Sect. 26.

The study of the anatomy of mummies has thrown a very interesting light upon the diseases of the ancient Egyptians, one of the most prevalent of which appears to have been osteo-arthritis. This has been studied by Elliot Smith, Wood Jones, Ruffer and Rietti. The majority of the lesions appear to have been the common osteo-arthritis, which involved not only the men, but many of the pet animals kept in the temples. In a much higher proportion apparently than in modern days, the spinal column was involved. It is interesting to note that the "determinative" of old age in hieroglyphic writing is the picture of a man afflicted with arthritis deformans. Evidences of tuberculosis, rickets and syphilis, according to these authors, have not been found.

A study of the internal organs has been made by Ruffer, who has shown that arterio-sclerosis with calcification was a common disease 8500 years ago; and he holds that it could not have been associated with hard work or alcohol, for the ancient Egyptians did not drink spirits, and they had practically the same hours of work as modern Egyptians, with every seventh day free.



ASSYRIAN AND BABYLONIAN MEDICINE

OF equally great importance in the evolution of medicine was the practically contemporary civilization in Mesopotamia. Science here reached a much higher stage then in the valley of the Nile. An elaborate scheme of the universe was devised, a system growing out of the Divine Will, and a recognition for the first time of a law guiding and controlling heaven and earth alike. Here, too, we find medicine ancillary to religion. Disease was due to evil spirits or demons. "These 'demons'—invisible to the naked eye were the precursors of the modern 'germs' and 'microbes,' while the incantations recited by the priests are the early equivalents of the physician's prescriptions. There were different incantations for different diseases; and they were as mysterious to the masses as are the mystic formulas of the modern physician to the bewildered, yet trusting, patient. Indeed, their mysterious character added to the power supposed to reside in the incantations for driving the demons away. Medicinal remedies accompanied the recital of the incantations, but despite the considerable progress made by such nations of hoary antiquity as the Egyptians and Babylonians in the diagnosis and treatment of common diseases, leading in time to the development of an extensive pharmacology, so long as the cure of disease rested with the priests, the recital of sacred formulas, together with rites that may be conveniently grouped under the head of sympathetic magic, was regarded as equally essential with the taking of the prescribed remedies."(14)

(14) Morris Jastrow: The Liver in Antiquity and the Beginnings of Anatomy. Transactions College of Physicians, Philadelphia, 1907, 3. s., XXIX, 117-138.

Three points of interest may be referred to in connection with Babylonian medicine. Our first recorded observations on anatomy are in connection with the art of divination—the study of the future by the interpretation of certain signs. The student recognized two divisions of divination—the involuntary, dealing with the interpretation of signs forced upon our attention, such as the phenomena of the heavens, dreams, etc., and voluntary divination, the seeking of signs, more particularly through the inspection of sacrificial animals. This method reached an extraordinary development among the Babylonians, and the cult spread to the Etruscans, Hebrews, and later to the Greeks and Romans.

Of all the organs inspected in a sacrificial animal the liver, from its size, position and richness in blood, impressed the early observers as the most important of the body. Probably on account of the richness in blood it came to be regarded as the seat of life—indeed, the seat of the soul. From this important position the liver was not dislodged for many centuries, and in the Galenic physiology it shared with the heart and the brain in the triple control of the natural, animal and vital spirits. Many expressions in literature indicate how persistent was this belief. Among the Babylonians, the word "liver" was used in hymns and other compositions precisely as we use the word "heart," and Jastrow gives a number of illustrations from Hebrew, Greek and Latin sources illustrating this usage.

The belief arose that through the inspection of this important organ in the sacrificial animal the course of future events could be predicted. "The life or soul, as the seat of life, in the sacrificial animal is, therefore, the divine element in the animal, and the god in accepting the animal, which is involved in the act of bringing it as an offering to a god, identifies himself with the animal—becomes, as it were, one with it. The life in the animal is a reflection of his own life, and since the fate of men rests with the gods, if one can succeed in entering into the mind of a god, and thus ascertain what he purposes to do, the key for the solution of the problem as to what the future has in store will have been found. The liver being the centre of vitality—the seat of the mind, therefore, as well as of the emotions—it becomes in the case of the sacrificial animal, either directly identical with the mind of the god who accepts the animal, or, at all events, a mirror in which the god's mind is reflected; or, to use another figure, a watch regulated to be in sympathetic and perfect accord with a second watch. If, therefore, one can read the liver of the sacrificial animal, one enters, as it were, into the workshop of the divine will."(15)

(15) Morris Jastrow: loc. cit., p. 122.

Hepatoscopy thus became, among the Babylonians, of extraordinary complexity, and the organ of the sheep was studied and figured as early as 3000 B.C. In the divination rites, the lobes, the gall-bladder, the appendages of the upper lobe and the markings were all inspected with unusual care. The earliest known anatomical model, which is here shown, is the clay model of a sheep's liver with the divination text dating from about 2000 B.C., from which Jastrow has worked out the modern anatomical equivalents of the Babylonian terms. To reach a decision on any point, the phenomena of the inspection of the liver were carefully recorded, and the interpretations rested on a more or less natural and original association of ideas. Thus, if the gall-bladder were swollen on the right side, it pointed to an increase in the strength of the King's army, and was favorable; if on the left side, it indicated rather success of the enemy, and was unfavorable. If the bile duct was long, it pointed to a long life. Gallstones are not infrequently mentioned in the divination texts and might be favorable, or unfavorable. Various interpretations were gathered by the scribes in the reference note-books which serve as guides for the interpretation of the omens and for text-books of instructions in the temple schools (Jastrow).

The art of divination spread widely among the neighboring nations. There are many references in the Bible to the practice. The elders of Moab and Midian came to Balaam "with the rewards of divination in their hand" (Numbers xxii, 7). Joseph's cup of divination was found in Benjamin's sack (Genesis xliv, 5, 12); and in Ezekiel (xxi, 21) the King of Babylon stood at the parting of the way and looked in the liver. Hepatoscopy was also practiced by the Etruscans, and from them it passed to the Greeks and the Romans, among whom it degenerated into a more or less meaningless form. But Jastrow states that in Babylonia and Assyria, where for several thousand years the liver was consistently employed as the sole organ of divination, there are no traces of the rite having fallen into decay, or having been abused by the priests.

In Roman times, Philostratus gives an account of the trial of Apollonius of Tyana,(16) accused of human hepatoscopy by sacrificing a boy in the practice of magic arts against the Emperor. "The liver, which the experts say is the very tripod of their art, does not consist of pure blood; for the heart retains all the uncontaminated blood, and irrigates the whole body with it by the conduits of the arteries; whereas the gall, which is situated next the liver, is stimulated by anger and depressed by fear into the hollows of the liver."

We have seen how early and how widespread was the belief in amulets and charms against the occult powers of darkness. One that has persisted with extraordinary tenacity is the belief in the Evil Eye the power of certain individuals to injure with a look. Of general belief in the older civilizations, and referred to in several places in the Bible, it passed to Greece and Rome, and today is still held fervently in many parts of Europe. The sign of "le corna,"—the first and fourth fingers extended, the others turned down and the thumb closed over them,—still used against the Evil Eye in Italy, was a mystic sign used by the Romans in the festival of Lemuralia. And we meet with the belief also in this country. A child with hemiplegia, at the Infirmary for Diseases of the Nervous System, Philadelphia, from the central part of Pennsylvania, was believed by its parents to have had the Evil Eye cast upon it.

The second contribution of Babylonia and Assyria to medicine—one that affected mankind profoundly—relates to the supposed influence of the heavenly bodies upon man's welfare. A belief that the stars in their courses fought for or against him arose early in their civilizations, and directly out of their studies on astrology and mathematics. The Macrocosm, the heavens that "declare the glory of God," reflect, as in a mirror, the Microcosm, the daily life of man on earth. The first step was the identification of the sun, moon and stars with the gods of the pantheon. Assyrian astronomical observations show an extraordinary development of practical knowledge. The movements of the sun and moon and of the planets were studied; the Assyrians knew the precession of the equinoxes and many of the fundamental laws of astronomy, and the modern nomenclature dates from their findings. In their days the signs of the zodiac corresponded practically with the twelve constellations whose names they still bear, each division being represented by the symbol of some god, as the Scorpion, the Ram, the Twins, etc. "Changes in the heavens . . . portended changes on earth. The Biblical expression 'hosts of heaven' for the starry universe admirably reflects the conception held by the Babylonian astrologers. Moon, planets and stars constituted an army in constant activity, executing military manoeuvres which were the result of deliberation and which had in view a fixed purpose. It was the function of the priest—the barqu, or 'inspector,' as the astrologer as well as the 'inspector' of the liver was called—to discover this purpose. In order to do so, a system of interpretation was evolved, less logical and less elaborate than the system of hepatoscopy, which was analyzed in the preceding chapter, but nevertheless meriting attention both as an example of the pathetic yearning of men to peer into the minds of the gods, and of the influence that Babylonian-Assyrian astrology exerted throughout the ancient world" (Jastrow).(17)

(16) Philostratus: Apollonius of Tyana, Bk. VIII, Chap. VII, Phillimore's transl., Oxford, 1912, II, 233. See, also, Justin: Apologies, edited by Louis Pautigny, Paris, 1904, p. 39.

(17) M. Jastrow: Aspects of Religious Belief and Practice in Babylonia and Assyria, New York, 1911, p. 210.

With the rationalizing influence of the Persians the hold of astrology weakened, and according to Jastrow it was this, in combination with Hebrew and Greek modes of thought, that led the priests in the three centuries following the Persian occupation, to exchange their profession of diviners for that of astronomers; and this, he says, marks the beginning of the conflict between religion and science. At first an expression of primitive "science," astrology became a superstition, from which the human mind has not yet escaped. In contrast to divination, astrology does not seem to have made much impression on the Hebrews and definite references in the Bible are scanty. From Babylonia it passed to Greece (without, however, exerting any particular influence upon Greek medicine). Our own language is rich in words of astral significance derived from the Greek, e.g., disaster.

The introduction of astrology into Europe has a passing interest. Apparently the Greeks had made important advances in astronomy before coming in contact with the Babylonians,—who, in all probability, received from the former a scientific conception of the universe. "In Babylonia and Assyria we have astrology first and astronomy afterwards, in Greece we have the sequence reversed—astronomy first and astrology afterwards" (Jastrow).(18)

(18) M. Jastrow: Aspects of Religious Belief and Practice in Babylonia and Assyria, New York, 1911, p. 256.

It is surprising to learn that, previous to their contact with the Greeks, astrology as relating to the individual—that is to say, the reading of the stars to determine the conditions under which the individual was born—had no place in the cult of the Babylonians and Assyrians. The individualistic spirit led the Greek to make his gods take note of every action in his life, and his preordained fate might be read in the stars.—"A connecting link between the individual and the movements in the heavens was found in an element which they shared in common. Both man and stars moved in obedience to forces from which there was no escape. An inexorable law controlling the planets corresponded to an equally inexorable fate ordained for every individual from his birth. Man was a part of nature and subject to its laws. The thought could therefore arise that, if the conditions in the heavens were studied under which a man was born, that man's future could be determined in accord with the beliefs associated with the position of the planets rising or visible at the time of birth or, according to other views, at the time of conception. These views take us back directly to the system of astrology developed by Babylonian baru priests. The basis on which the modified Greek system rests is likewise the same that we have observed in Babylonia—a correspondence between heaven and earth, but with this important difference, that instead of the caprice of the gods we have the unalterable fate controlling the entire universe—the movements of the heavens and the life of the individual alike" (Jastrow).(19)

(19) Ibid., pp. 257-258.

From this time on until the Renaissance, like a shadow, astrology follows astronomy. Regarded as two aspects of the same subject, the one, natural astrology, the equivalent of astronomy, was concerned with the study of the heavens, the other, judicial astrology, was concerned with the casting of horoscopes, and reading in the stars the fate of the individual.

As I mentioned, Greek science in its palmy days seems to have been very free from the bad features of astrology. Gilbert Murray remarks that "astrology fell upon the Hellenistic mind as a new disease falls upon some remote island people." But in the Greek conquest of the Roman mind, astrology took a prominent role. It came to Rome as part of the great Hellenizing movement, and the strength of its growth may be gauged from the edicts issued against astrologers as early as the middle of the second century B.C. In his introduction to his recent edition of Book II of the Astronomicon of Manilius, Garrod traces the growth of the cult, which under the Empire had an extraordinary vogue. "Though these (heavenly) signs be far removed from us, yet does he (the god) so make their influences felt, that they give to nations their life and their fate and to each man his own character."(20) Oracles were sought on all occasions, from the planting of a tree to the mating of a horse, and the doctrine of the stars influenced deeply all phases of popular thought and religion. The professional astrologers, as Pliny(21) says, were Chaldeans, Egyptians and Greeks. The Etruscans, too, the professional diviners of Rome, cultivated the science. Many of these "Isiaci conjectores" and "astrologi de circo" were worthless charlatans, but on the whole the science seems to have attracted the attention of thoughtful men of the period. Garrod quotes the following remarkable passage from Tacitus: "My judgment wavers," he says, "I dare not say whether it be fate and necessity immutable which governs the changing course of human affairs—or just chance. Among the wisest of the ancients, as well as among their apes, you will find a conflict of opinion. Many hold fixedly the idea that our beginning and our end—that man himself—is nothing to the Gods at all. The wicked are in prosperity and the good meet tribulation. Others believe that Fate and the facts of this world work together. But this connection they trace not to planetary influences but to a concatenation of natural causes. We choose our life that is free: but the choice once made, what awaits us is fixed and ordered. Good and evil are different from the vulgar opinion of them. Often those who seem to battle with adversity are to be accounted blessed; but the many, even in their prosperity, are miserable. It needs only to bear misfortune bravely, while the fool perishes in his wealth. Outside these rival schools stands the man in the street. No one will take from him his conviction that at our birth are fixed for us the things that shall be. If some things fall out differently from what was foretold, that is due to the deceit of men that speak what they know not: calling into contempt a science to which past and present alike bear a glorious testimony" (Ann. vi, 22).

(20) Manili Astronomicon Liber II, ed. H. W. Garrod, Oxford, 1911, p. lxix, and II, ll. 84-86.

(21) Pliny: Natural History, Bk. XVIII, Chap. XXV, Sect. 57.

Cato waged war on the Greek physicians and forbade "his uilicus all resort to haruspicem, augurem, hariolum Chaldaeum," but in vain; so widespread became the belief that the great philosopher, Panaetius (who died about 111 B.C.), and two of his friends alone among the stoics, rejected the claims of astrology as a science (Garrod). So closely related was the subject of mathematics that it, too, fell into disfavor, and in the Theodosian code sentence of death was passed upon mathematicians. Long into the Middle Ages, the same unholy alliance with astrology and divination caused mathematics to be regarded with suspicion, and even Abelard calls it a nefarious study.

The third important feature in Babylonian medicine is the evidence afforded by the famous Hammurabi Code (circa 2000 B.C.)—a body of laws, civil and religious, many of which relate to the medical profession. This extraordinary document is a black diorite block 8 feet high, once containing 21 columns on the obverse, 16 and 28 columns on the reverse, with 2540 lines of writing of which now 1114 remain, and surmounted by the figure of the king receiving the law from the Sun-god. Copies of this were set up in Babylon "that anyone oppressed or injured, who had a tale of woe to tell, might come and stand before his image, that of a king of righteousness, and there read the priceless orders of the King, and from the written monument solve his problem" (Jastrow). From the enactments of the code we gather that the medical profession must have been in a highly organized state, for not only was practice regulated in detail, but a scale of fees was laid down, and penalties exacted for malpraxis. Operations were performed, and the veterinary art was recognized. An interesting feature, from which it is lucky that we have in these days escaped, is the application of the "lex talionis"—an eye for an eye, bone for a bone, and tooth for a tooth, which is a striking feature of the code.

Some of the laws of the code may be quoted:

Paragraph 215. If a doctor has treated a gentleman for a severe wound with a bronze lances and has cured the man, or has opened an abscess of the eye for a gentleman with the bronze lances and has cured the eye of the gentleman, he shall take ten shekels of silver.

218. If the doctor has treated a gentleman for a severe wound with a lances of bronze and has caused the gentleman to die, or has opened an abscess of the eye for a gentleman and has caused the loss of the gentleman's eye, one shall cut off his hands.

219. If a doctor has treated the severe wound of a slave of a poor man with a bronze lances and has caused his death, he shall render slave for slave.

220. If he has opened his abscess with a bronze lances and has made him lose his eye, he shall pay money, half his price.

221. If a doctor has cured the shattered limb of a gentleman, or has cured the diseased bowel, the patient shall give five shekels of silver to the doctor.

224. If a cow doctor or a sheep doctor has treated a cow or a sheep for a severe wound and cured it, the owner of the cow or sheep shall give one-sixth of a shekel of silver to the doctor as his fee.(22)

(22) The Oldest Code of Laws in the World; translated by C. H. W. Johns, Edinburgh, 1903.



HEBREW MEDICINE

THE medicine of the Old Testament betrays both Egyptian and Babylonian influences; the social hygiene is a reflex of regulations the origin of which may be traced in the Pyramid Texts and in the papyri. The regulations in the Pentateuch codes revert in part to primitive times, in part represent advanced views of hygiene. There are doubts if the Pentateuch code really goes back to the days of Moses, but certainly someone "learned in the wisdom of the Egyptians" drew it up. As Neuburger briefly summarizes:

"The commands concern prophylaxis and suppression of epidemics, suppression of venereal disease and prostitution, care of the skin, baths, food, housing and clothing, regulation of labour, sexual life, discipline of the people, etc. Many of these commands, such as Sabbath rest, circumcision, laws concerning food (interdiction of blood and pork), measures concerning menstruating and lying-in women and those suffering from gonorrhoea, isolation of lepers, and hygiene of the camp, are, in view of the conditions of the climate, surprisingly rational."(23)

(23) Neuburger: History of Medicine, Oxford University Press, 1910, Vol. I, p. 38.

Divination, not very widely practiced, was borrowed, no doubt, from Babylonia. Joseph's cup was used for the purpose, and in Numbers, the elders of Balak went to Balaam with the rewards of divination in their hands. The belief in enchantments and witchcraft was universal, and the strong enactments against witches in the Old Testament made a belief in them almost imperative until more rational beliefs came into vogue in the eighteenth and nineteenth centuries.

Whatever view we may take of it, the medicine of the New Testament is full of interest. Divination is only referred to once in the Acts (xvi, 16), where a damsel is said to be possessed of a spirit of divination "which brought her masters much gain by soothsaying." There is only one mention of astrology (Acts vii, 43); there are no witches, neither are there charms or incantations. The diseases mentioned are numerous: demoniac possession, convulsions, paralysis, skin diseases,—as leprosy,—dropsy, haemorrhages, fever, fluxes, blindness and deafness. And the cure is simple usually a fiat of the Lord, rarely with a prayer, or with the use of means such as spittle. They are all miraculous, and the same power was granted to the apostles—"power against unclean spirits, to cast them out, to heal all manner of sickness and all manner of disease." And more than this, not only the blind received their sight, the lame walked, the lepers were cleansed, the deaf heard, but even the dead were raised up. No question of the mandate. He who went about doing good was a physician of the body as well as of the soul, and could the rich promises of the Gospel have been fulfilled, there would have been no need of a new dispensation of science. It may be because the children of this world have never been able to accept its hard sayings—the insistence upon poverty, upon humility, upon peace that Christianity has lost touch no less with the practice than with the principles of its Founder. Yet, all through the centuries, the Church has never wholly abandoned the claim to apostolic healing; nor is there any reason why she should. To the miraculous there should be no time limit—only conditions have changed and nowadays to have a mountain-moving faith is not easy. Still, the possession is cherished, and it adds enormously to the spice and variety of life to know that men of great intelligence, for example, my good friend, Dr. James J. Walsh of New York, believe in the miracles of Lourdes.(24) Only a few weeks ago, the Bishop of London followed with great success, it is said, the practice of St. James. It does not really concern us much—as Oriental views of disease and its cure have had very little influence on the evolution of scientific medicine—except in illustration of the persistence of an attitude towards disease always widely prevalent, and, indeed, increasing. Nor can we say that the medicine of our great colleague, St. Luke, the Beloved Physician, whose praise is in the Gospels, differs so fundamentally from that of the other writings of the New Testament that we can claim for it a scientific quality. The stories of the miracles have technical terms and are in a language adorned by medical phraseology, but the mental attitude towards disease is certainly not that of a follower of Hippocrates, nor even of a scientifically trained contemporary of Dioscorides.(25)

(24) Psychotherapy, New York, 1919, p. 79, "I am convinced that miracles happen there. There is more than natural power manifest."

(25) See Luke the Physician, by Harnack, English ed., 1907, and W. K. Hobart, The Medical Language of St. Luke, 1882.



CHINESE AND JAPANESE MEDICINE

CHINESE medicine illustrates the condition at which a highly intellectual people may arrive, among whom thought and speculation were restricted by religious prohibitions. Perhaps the chief interest in its study lies in the fact that we may see today the persistence of views about disease similar to those which prevailed in ancient Egypt and Babylonia. The Chinese believe in a universal animism, all parts being animated by gods and spectres, and devils swarm everywhere in numbers incalculable. The universe was spontaneously created by the operation of its Tao, "composed of two souls, the Yang and the Yin; the Yang represents light, warmth, production, and life, as also the celestial sphere from which all those blessings emanate; the Yin is darkness, cold, death, and the earth, which, unless animated by the Yang or heaven, is dark, cold, dead. The Yang and the Yin are divided into an infinite number of spirits respectively good and bad, called shen and kwei; every man and every living being contains a shen and a kwei, infused at birth, and departing at death, to return to the Yang and the Yin. Thus man with his dualistic soul is a microcosmos, born from the Macrocosmos spontaneously. Even every object is animated, as well as the Universe of which it is a part."(26)

(26) J. J. M. de Groot: Religious System of China, Vol. VI, Leyden, 1910, p. 929.

In the animistic religion of China, the Wu represented a group of persons of both sexes, who wielded, with respect to the world of spirits, capacities and powers not possessed by the rest of men. Many practitioners of Wu were physicians who, in addition to charms and enchantments, used death-banishing medicinal herbs. Of great antiquity, Wu-ism has changed in some ways its outward aspect, but has not altered its fundamental characters. The Wu, as exorcising physicians and practitioners of the medical art, may be traced in classical literature to the time of Confucius. In addition to charms and spells, there were certain famous poems which were repeated, one of which, by Han Yu, of the T'ang epoch, had an extraordinary vogue. De Groot says that the "Ling," or magical power of this poem must have been enormous, seeing that its author was a powerful mandarin, and also one of the loftiest intellects China has produced. This poetic febrifuge is translated in full by de Groot (VI, 1054-1055), and the demon of fever, potent chiefly in the autumn, is admonished to begone to the clear and limpid waters of the deep river.

In the High Medical College at Court, in the T'ang Dynasty, there were four classes of Masters, attached to its two High Medical Chiefs: Masters of Medicine, of Acupuncture, of Manipulation, and two Masters for Frustration by means of Spells.

Soothsaying and exorcism may be traced far back to the fifth and sixth centuries B.C.

In times of epidemic the specialists of Wu-ism, who act as seers, soothsayers and exorcists, engage in processions, stripped to the waist, dancing in a frantic, delirious state, covering themselves with blood by means of prick-balls, or with needles thrust through their tongues, or sitting or stretching themselves on nail points or rows of sword edges. In this way they frighten the spectres of disease. They are nearly all young, and are spoken of as "divining youths," and they use an exorcising magic based on the principle that legions of spectres prone to evil live in the machine of the world. (De Groot, VI, 983-985.)

The Chinese believe that it is the Tao, or "Order of the Universe," which affords immunity from evil, and according to whether or no the birth occurred in a beneficent year, dominated by four double cyclical characters, the horoscope is "heavy" or "light." Those with light horoscopes are specially prone to incurable complaints, but much harm can be averted if such an individual be surrounded with exorcising objects, if he be given proper amulets to wear and proper medicines to swallow, and by selecting for him auspicious days and hours.

Two or three special points may be referred to. The doctrine of the pulse reached such extraordinary development that the whole practice of the art centred round its different characters. There were scores of varieties, which in complication and detail put to confusion the complicated system of some of the old Graeco-Roman writers. The basic idea seems to have been that each part and organ had its own proper pulse, and just as in a stringed instrument each chord has its own tone, so in the human body, if the pulses were in harmony, it meant health; if there was discord, it meant disease. These Chinese views reached Europe in the seventeenth and eighteenth centuries, and there is a very elaborate description of them in Floyer's well-known book.(27) And the idea of harmony in the pulse is met with into the eighteenth century.

(27) Sir John Floyer: The Physician's Pulse Watch, etc., London, 1707.

Organotherapy was as extensively practiced in China as in Egypt. Parts of organs, various secretions and excretions are very commonly used. One useful method of practice reached a remarkable development, viz., the art of acupuncture—the thrusting of fine needles more or less deeply into the affected part. There are some 388 spots on the body in which acupuncture could be performed, and so well had long experience taught them as to the points of danger, that the course of the arteries may be traced by the tracts that are avoided. The Chinese practiced inoculation for smallpox as early as the eleventh century.

Even the briefest sketch of the condition of Chinese medicine leaves the impression of the appalling stagnation and sterility that may afflict a really intelligent people for thousands of years. It is doubtful if they are today in a very much more advanced condition than were the Egyptians at the time when the Ebers Papyrus was written. From one point of view it is an interesting experiment, as illustrating the state in which a people may remain who have no knowledge of anatomy, physiology or pathology.

Early Japanese medicine has not much to distinguish it from the Chinese. At first purely theurgic, the practice was later characterized by acupuncture and a refined study of the pulse. It has an extensive literature, largely based upon the Chinese, and extending as far back as the beginning of the Christian era. European medicine was introduced by the Portuguese and the Dutch, whose "factory" or "company" physicians were not without influence upon practice. An extraordinary stimulus was given to the belief in European medicine by a dissection made by Mayeno in 1771 demonstrating the position of the organs as shown in the European anatomical tables, and proving the Chinese figures to be incorrect. The next day a translation into Japanese of the anatomical work of Kulmus was begun, and from its appearance in 1773 may be dated the commencement of reforms in medicine. In 1793, the work of de Gorter on internal medicine was translated, and it is interesting to know that before the so-called "opening of Japan" many European works on medicine had been published. In 1857, a Dutch medical school was started in Yedo. Since the political upheaval in 1868, Japan has made rapid progress in scientific medicine, and its institutions and teachers are now among the best known in the world.(28)

(28) See Y. Fujikawa, Geschichte der Medizin in Japan, Tokyo, 1911.



CHAPTER II — GREEK MEDICINE

OGRAIAE gentis decus! let us sing with Lucretius, one of the great interpreters of Greek thought. How grand and how true is his paean!

Out of the night, out of the blinding night Thy beacon flashes;—hail, beloved light Of Greece and Grecian; hail, for in the mirk Thou cost reveal each valley and each height.

Thou art my leader, and the footprints shine, Wherein I plant my own....

* * * * *

The world was shine to read, and having read, Before thy children's eyes thou didst outspread The fruitful page of knowledge, all the wealth Of wisdom, all her plenty for their bread.

(Bk. III.—Translated by D. A. Slater.)

Let us come out of the murky night of the East, heavy with phantoms, into the bright daylight of the West, into the company of men whose thoughts made our thoughts, and whose ways made our ways—the men who first dared to look on nature with the clear eyes of the mind.

Browning's famous poem, "Childe Roland to the Dark Tower Came," is an allegory of the pilgrimage of man through the dark places of the earth, on a dismal path beset with demons, and strewn with the wreckage of generations of failures. In his ear tolled the knell of all the lost adventurers, his peers, all lost, lost within sight of the dark Tower itself—

The round squat turret, blind as the fool's heart, Built of brown stone, without a counterpart In the whole world.

lost in despair at an all-encircling mystery. Not so the Greek Childe Roland who set the slug-horn to his lips and blew a challenge. Neither Shakespeare nor Browning tells us what happened, and the old legend, Childe Roland, is the incarnation of the Greek spirit, the young, light-hearted master of the modern world, at whose trumpet blast the dark towers of ignorance, superstition and deceit have vanished into thin air, as the baseless fabric of a dream. Not that the jeering phantoms have flown! They still beset, in varied form, the path of each generation; but the Achaian Childe Roland gave to man self-confidence, and taught him the lesson that nature's mysteries, to be solved, must be challenged. On a portal of one of the temples of Isis in Egypt was carved: "I am whatever hath been, is, or ever will be, and my veil no man has yet lifted."

The veil of nature the Greek lifted and herein lies his value to us. What of this Genius? How did it arise among the peoples of the AEgean Sea? Those who wish to know the rock whence science was hewn may read the story told in vivid language by Professor Gomperz in his "Greek Thinkers," the fourth volume of which has recently been published (Murray, 1912; Scribner, 1912). In 1912, there was published a book by one of the younger Oxford teachers, "The Greek Genius and Its Meaning to Us,"(1) from which those who shrink from the serious study of Gomperz' four volumes may learn something of the spirit of Greece. Let me quote a few lines from his introduction:

(1) By R. W. Livingstone, Clarendon Press, Oxford, 1912 (2d ed., revised, 1915).

"Europe has nearly four million square miles; Lancashire has 1,700; Attica has 700. Yet this tiny country has given us an art which we, with it and all that the world has done since it for our models, have equalled perhaps, but not surpassed. It has given us the staple of our vocabulary in every domain of thought and knowledge. Politics, tyranny, democracy, anarchism, philosophy, physiology, geology, history—these are all Greek words. It has seized and up to the present day kept hold of our higher education. It has exercised an unfailing fascination, even on minds alien or hostile. Rome took her culture thence. Young Romans completed their education in the Greek schools.... And so it was with natures less akin to Greece than the Roman. St. Paul, a Hebrew of the Hebrews, who called the wisdom of the Greeks foolishness, was drawn to their Areopagus, and found himself accommodating his gospel to the style, and quoting verses from the poets of this alien race. After him, the Church, which was born to protest against Hellenism, translated its dogmas into the language of Greek thought and finally crystallized them in the philosophy of Aristotle."

Whether a plaything of the gods or a cog in the wheels of the universe this was the problem which life offered to the thinking Greek; and in undertaking its solution, he set in motion the forces that have made our modern civilization. That the problem remains unsolved is nothing in comparison with the supreme fact that in wrestling with it, and in studying the laws of the machine, man is learning to control the small section of it with which he is specially concerned. The veil of thaumaturgy which shrouded the Orient, while not removed, was rent in twain, and for the first time in history, man had a clear vision of the world about him—"had gazed on Nature's naked loveliness" ("Adonais") unabashed and unaffrighted by the supernatural powers about him. Not that the Greek got rid of his gods—far from it!—but he made them so like himself, and lived on terms of such familiarity with them that they inspired no terror.(2)

(2) "They made deities in their own image, in the likeness of an image of corruptible man. Sua cuique deu fit dira cupido. 'Each man's fearful passion becomes his god.' Yes, and not passions only, but every impulse, every aspiration, every humour, every virtue, every whim. In each of his activities the Greek found something wonderful, and called it God: the hearth at which he warmed himself and cooked his food, the street in which his house stood, the horse he rode, the cattle he pastured, the wife he married, the child that was born to him, the plague of which he died or from which he recovered, each suggested a deity, and he made one to preside over each. So too with qualities and powers more abstract." R.W. Livingstone: The Greek Genius and Its Meaning to Us, pp. 51-52.

Livingstone discusses the Greek Genius as displayed to us in certain "notes"—the Note of Beauty—the Desire for Freedom—the Note of Directness—the Note of Humanism—the Note of Sanity and of Many-sidedness. Upon some of these characteristics we shall have occasion to dwell in the brief sketch of the rise of scientific medicine among this wonderful people.

We have seen that the primitive man and in the great civilizations of Egypt and Babylonia, the physician evolved from the priest—in Greece he had a dual origin, philosophy and religion. Let us first trace the origins in the philosophers, particularly in the group known as the Ionian Physiologists, whether at home or as colonists in the south of Italy, in whose work the beginnings of scientific medicine may be found. Let me quote a statement from Gomperz:

"We can trace the springs of Greek success achieved and maintained by the great men of Hellas on the field of scientific inquiry to a remarkable conjunction of natural gifts and conditions. There was the teeming wealth of constructive imagination united with the sleepless critical spirit which shrank from no test of audacity; there was the most powerful impulse to generalization coupled with the sharpest faculty for descrying and distinguishing the finest shades of phenomenal peculiarity; there was the religion of Hellas, which afforded complete satisfaction to the requirements of sentiment, and yet left the intelligence free to perform its destructive work; there were the political conditions of a number of rival centres of intellect, of a friction of forces, excluding the possibility of stagnation, and, finally, of an order of state and society strict enough to curb the excesses of 'children crying for the moon,' and elastic enough not to hamper the soaring flight of superior minds.... We have already made acquaintance with two of the sources from which the spirit of criticism derived its nourishment—the metaphysical and dialectical discussions practiced by the Eleatic philosophers, and the semi-historical method which was applied to the myths by Hecataeus and Herodotus. A third source is to be traced to the schools of the physicians. These aimed at eliminating the arbitrary element from the view and knowledge of nature, the beginnings of which were bound up with it in a greater or less degree, though practically without exception and by the force of an inner necessity. A knowledge of medicine was destined to correct that defect, and we shall mark the growth of its most precious fruits in the increased power of observation and the counterpoise it offered to hasty generalizations, as well as in the confidence which learnt to reject untenable fictions, whether produced by luxuriant imagination or by a priori speculations, on the similar ground of self-reliant sense-perception."(3)

(3) Gomperz: Greek Thinkers, Vol. I, p. 276.

The nature philosophers of the Ionian days did not contribute much to medicine proper, but their spirit and their outlook upon nature influenced its students profoundly. Their bold generalizations on the nature of matter and of the elements are still the wonder of chemists. We may trace to one of them, Anaximenes, who regarded air as the primary principle, the doctrine of the "pneuma," or the breath of life—the psychic force which animates the body and leaves it at death—"Our soul being air, holds us together." Of another, the famous Heraclitus, possibly a physician, the existing fragments do not relate specially to medicine; but to the philosopher of fire may be traced the doctrine of heat and moisture, and their antitheses, which influenced practice for many centuries. There is evidence in the Hippocratic treatise peri sarkwn of an attempt to apply this doctrine to the human body. The famous expression, panta rhei,—"all things are flowing,"—expresses the incessant flux in which he believed and in which we know all matter exists. No one has said a ruder thing of the profession, for an extant fragment reads: ". . . physicians, who cut, burn, stab, and rack the sick, then complain that they do not get any adequate recompense for it."(4)

(4) J. Burnet: Early Greek Philosophy, 1892, p. 137, Bywater's no. LVIII.

The South Italian nature philosophers contributed much more to the science of medicine, and in certain of the colonial towns there were medical schools as early as the fifth century B.C. The most famous of these physician philosophers was Pythagoras, whose life and work had an extraordinary influence upon medicine, particularly in connection with his theory of numbers, and the importance of critical days. His discovery of the dependence of the pitch of sound on the length of the vibrating chord is one of the most fundamental in acoustics. Among the members of the school which he founded at Crotona were many physicians. who carried his views far and wide throughout Magna Graecia. Nothing in his teaching dominated medicine so much as the doctrine of numbers, the sacredness of which seems to have had an enduring fascination for the medical mind. Many of the common diseases, such as malaria, or typhus, terminating abruptly on special days, favored this belief. How dominant it became and how persistent you may judge from the literature upon critical days, which is rich to the middle of the eighteenth century.

One member of the Crotonian school, Alcmaeon, achieved great distinction in both anatomy and physiology. He first recognized the brain as the organ of the mind, and made careful dissections of the nerves, which he traced to the brain. He described the optic nerves and the Eustachian tubes, made correct observations upon vision, and refuted the common view that the sperma came from the spinal cord. He suggested the definition of health as the maintenance of equilibrium, or an "isonomy" in the material qualities of the body. Of all the South Italian physicians of this period, the personality of none stands out in stronger outlines than that of Empedocles of Agrigentum—physician, physiologist, religious teacher, politician and poet. A wonder-worker, also, and magician, he was acclaimed in the cities as an immortal god by countless thousands desiring oracles or begging the word of healing. That he was a keen student of nature is witnessed by many recorded observations in anatomy and physiology; he reasoned that sensations travel by definite paths to the brain. But our attention must be confined to his introduction of the theory of the four elements—fire, air, earth and water—of which, in varying quantities, all bodies were made up. Health depended upon the due equilibrium of these primitive substances; disease was their disturbance. Corresponding to those were the four essential qualities of heat and cold, moisture and dryness, and upon this four-fold division was engrafted by the later physicians the doctrine of the humors which, from the days of Hippocrates almost to our own, dominated medicine. All sorts of magical powers were attributed to Empedocles. The story of Pantheia whom he called back to life after a thirty days' trance has long clung in the imagination. You remember how Matthew Arnold describes him in the well-known poem, "Empedocles on Etna"—

But his power Swells with the swelling evil of this time, And holds men mute to see where it will rise. He could stay swift diseases in old days, Chain madmen by the music of his lyre, Cleanse to sweet airs the breath of poisonous streams, And in the mountain-chinks inter the winds. This he could do of old—(5)

a quotation which will give you an idea of some of the powers attributed to this wonder-working physician.

(5) Poetical Works of Matthew Arnold, Macmillan & Co., 1898, p. 440.

But of no one of the men of this remarkable circle have we such definite information as of the Crotonian physician Democedes, whose story is given at length by Herodotus; and his story has also the great importance of showing that, even at this early period, a well-devised scheme of public medical service existed in the Greek cities. It dates from the second half of the sixth century B.C.—fully two generations before Hippocrates. A Crotonian, Democedes by name, was found among the slaves of Oroetes. Of his fame as a physician someone had heard and he was called in to treat the dislocated ankle of King Darius. The wily Greek, longing for his home, feared that if he confessed to a knowledge of medicine there would be no chance of escape, but under threat of torture he undertook a treatment which proved successful. Then Herodotus tells his story—how, ill treated at home in Crotona, Democedes went to AEgina, where he set up as a physician and in the second year the State of AEgina hired his services at the price of a talent. In the third year, the Athenians engaged him at 100 minae; and in the fourth, Polycrates of Samos at two talents. Democedes shared the misfortunes of Polycrates and was taken prisoner by Oroetes. Then Herodotus tells how he cured Atossa, the daughter of Cyrus and wife of Darius, of a severe abscess of the breast, but on condition that she help him to escape, and she induced her husband to send an expedition of exploration to Greece under the guidance of Democedes, but with the instructions at all costs to bring back the much prized physician. From Tarentum, Democedes escaped to his native city, but the Persians followed him, and it was with the greatest difficulty that he escaped from their hands. Deprived of their guide, the Persians gave up the expedition and sailed for Asia. In palliation of his flight, Democedes sent a message to Darius that he was engaged to the daughter of Milo, the wrestler, who was in high repute with the King.(6)