A HISTORY OF MEDICINE.
BY JOHN BENNITT, M. D.,
Professor of Principles and Practice of Medicine in the Medical Department of the Western Reserve University, Cleveland, Ohio.
[Continued from page 103.]
But the contributions to medicine of all his predecessors dwarf into insignificance when compared to those of Galen—who lived and wrote in the middle of the second century—and whose writings were ultimate authority, until they were attacked and publicly burned in the 16th century by the arch-quack Paracelsus. Galen, although born in Pergamus, in Mysia and living there, was called by the Emperors M. Aurelius, and L. Verus to attend them in the northeastern frontier of Italy, and was for a considerable period of time physician to the emperor, spending a considerable portion of the last half of his life at Rome. He died in Sicily in 201 aet 71 (?) There are ascribed to him 83 treatises on medicine about which there is no question as to their genuineness, 19 that are questionable, 45 undoubtedly spurious, 19 fragments, 15 commentaries on Hippocrates’ works. Besides these, he wrote a great number of works (not all on medicine) whose titles only are preserved, so that altogether it is believed that the number of distinct treatises cannot have been less than 500. These were, on (1) Anatomy and Physiology, (2) Dietetics and Hygiene, (3) Pathology, (4) Semiology and Diagnosis, (5) Materia Medica and Pharmacy, (6) Therapeutics including Surgery, (7) Commentaries on Hippocrates, (8) Philosophical and Miscellaneous. Most of these works are still extant in Greek (in which they were originally written). They have been translated into many modern languages. His works on anatomy and physiology are most valuable. But it is not certain that he ever dissected human bodies. His knowledge he derived from dissecting apes, bears, goats, etc., and his knowledge of physiology from experiments on these animals. His pathology was speculative.
In diagnosis and prognosis he laid great stress upon the pulse, on which subject he may be considered as the first and greatest authority, for subsequent writers adopted his system without alteration. He placed great confidence in the doctrine of “critical days,” which he believed to be influenced by the moon.
In materia medica he was not considered as good authority as Dioscorides. He was prone to making prescriptions containing many ingredients, some of which were entirely inert. He seems to have placed more faith in amulets than in medicine, and is supposed to be the author of the anodyne necklace, which was for a long time famous in England. He was an allopathist in his notions, i. e., he believed that disease is something contrary to nature, and is to be overcome by that which is contrary to the disease itself. At the same time he taught that nature is to be preserved by that which has relations to nature, in accord. Hence his two indications, “Overcome Disease,” “Sustain Nature.”
Before this time, as already intimated, the medical profession was divided into several sects, who were always disputing with one another. After him, all these sects seem to have merged into his followers. The subsequent Greek and Roman medical writers were compilers from his writings, and being translated into Arabic, Galen’s works became authority in the East as well as in Europe, and continued to be so for fourteen hundred years. In 1559, Dr. Geynes was cited before the college of physicians for impugning the infallibility of Galen. On his acknowledgment of his error and humble recantation, signed with his own hand, he was received into the college.
The great mass of Galen’s works, together with modern improvements and researches, have now in great measure consigned them to neglect, but his fame can only perish with the science itself. As in the case of Hippocrates, his immeasurable superiority over his contemporaries seems to have acted as a check to all attempts at further improvement.
The first names of any renown that occur subsequent to Galen are those of Oribasius, Alexander of Tralles, Ætius and Paulus Egineta, who flourished between the fourth and seventh centuries. They were all jealous Galenists, and those of their writings which are still extant are, for the most part, compilations from the predecessors, especially from their great master, Galen.
The writings of Paulus seem to be the last of any written in the Greek language, which had been the language of medical science for more than a thousand years. At about this time the Arabian school was beginning to rise into notice. The earliest Arabian writers on medicine of whom we have any notice or certain account, is Ahrum, who was contemporary with Paulus. The most celebrated physicians of this school were Rhazes, (who flourished in the ninth century, and was the first to describe small-pox) and Avicenna who flourished early in the eleventh century, and whose ‘Canon Medicina’ may be regarded as a cyclopaedia of all that was known of medicine at that time (as well as collateral sciences). This was a compilation from Greek writers, whose writings had been translated into Arabic, (for Avicenna was not a Greek scholar himself). Avenzoar, and Averrhoes flourished in the twelfth century. The last was a celebrated philosopher as well as physician. The works of Hippocrates and Galen, which, together with the works of Aristotle, Plato and Euclid, were translated into Arabic in the ninth century, formed the basis of their medical knowledge; but the Arabian physicians did good service to medicine, introducing new articles from the East into European materia medica, as for example, rhubarb, cassia, senna, camphor, and in making known what may be termed the first elements of pharmaceutical chemistry, such as a knowledge of distillation, and of the means of obtaining various metallic oxides and salts.
Upon the decline of the Saracenic universities in Spain, which was about the time of the death of Averrhoes, the only medical knowledge that remained was to be found in Italy, where the School of Salerno acquired considerable celebrity, which it maintained for some time, till it was gradually eclipsed by the rising fame of other medical schools at Bologna—where Mondino or Mundinus de Leozza publicly dissected two human bodies in 1315.
Contemporary with Mondini, lived Gilbert, the first English writer on medicine who acquired any repute; and the next century gave birth to Linacre, who after studying at Oxford spent a considerable time at Bologna, Florence, Rome, Venice and Padua, and subsequently became the founder of the London College of Physicians. It was in this fifteenth century that the sect of chemical physicians arose, who claimed that all the phenomena of the living body could be explained by the same chemical laws as those that rule inorganic matters. Although the illustrations and proofs which they adduced were completely unsatisfactory, yet the tendency at the present time is in the same direction, since chemistry and physiology are better known.
This seems to be a period prolific of new diseases. In the thirteenth, fourteenth and fifteenth centuries we hear most of leprosy, and of the visitation of the plague in Europe. Whooping-cough and scurvy were never described by any writer anterior to the fifteenth century. Syphilis was first recognized in Italy in the fifteenth century, from which country it spread rapidly over the whole of Europe.
In the sixteenth century the study of human anatomy may be said to have been fairly established by the zeal and labors of Vesalius, and in this and the succeeding centuries we meet with the names of many physicians whose anatomical and physiological investigations tended either directly or indirectly to advance the science of medicine. This was the epoch of Eustachius, Fallopius, Asellius, Harvey, Rudbeck, Bartholini, Malpighi, Glisson, Sylvius, Willis, Bellini, etc., names preserved in anatomy.
Chemistry was now being separated from alchemy, and advancing to a science, and a combination formed between its principles and those of physiology, which gave rise to a new sect of chemical physicians, quite distinct from the sect represented two centuries before by Paracelsus. The chemical school was succeeded by the mathematical school, of which Borelli, Sauvages, Heill, Jurin, Mead and Freind were amongst the most celebrated. While at the same time the old Galenists were fast disappearing. To the rival sects of this period must be added the Vitalists, which originated with Von Helmont, and with some modifications was adopted by Stahl and Hoffman. The greatest physician of the seventeenth century was, however, Sydenham, who, though inclining to the chemical school, did not allow his speculative opinions regarding the nature of disease to interfere with a careful consideration of the indications for treatment, as derived from the symptoms, and from experience.
Boerhaave, a Dutch physician and philosopher, occupied special prominence in last part of the seventeenth and the early part of the eighteenth centuries. He engaged in the practice of medicine at Leyden in 1693, and became professor of theory and practice of medicine in the university of that city in 1701. He was erudite, exact, simple and eloquent, and hence as a lecturer very popular. He specially advocated simplicity in practice of medicine. Professor of botany was added to his duties in 1709. He wrote a treatise in 1703 (in Latin) advocating mechanical and chemical hypotheses in medicine. In 1708 his institutes of medicine extended his reputation; and in 1709 appeared his famous ‘Aphorisms’ on the diagnosis and cure of disease. In this was a well defined classification of diseases, including their causes, nature and treatment, which was adopted by his contemporaries. He was distinguished as a botanist and chemist. He published a description of plants at Leyden in 1710, and became professor of chemistry in 1718 in addition to his other duties. He made chemistry popular by presenting it in a clear and attractive style, in his lectures and in his ‘Elements of Chemistry’ (1724).
On account of his attack of gout he was constrained to give up the teaching of botany and chemistry in 1727. He was elected a Fellow of the Royal Society of London in 1730. His fame extended over the world. A Chinese mandarin hearing of his fame addressed a letter to Boerhaave, physician in Europe, which reached him in due time. His practice was lucrative, and he spent money freely in the interest of science and benevolence, yet such was his success that it is said that at his death (in 1738) he left an estate of nearly a million dollars.
Cullen, who was born in 1710 and died in 1790, was undoubtedly the greatest medical man of his age. It is especially interesting to read the biographies of such men as Cullen and of Hunter his contemporary, and of Jenner of the last half of the eighteenth century, and of John Brown the quack—though much quoted.
The present century may be considered as the epoch of physiological experiment and clinical observation. The efficient laborers of the last eighty years in the field of medicine have been so numerous that it would be impossible to notice at this time even those deemed most celebrated, while it would be invidious to attempt such a selection.
In this time our materia medica has received a large number of most important additions, amongst which may be noticed, morphia, quinia, strychnia, iodine and the iodides, bromides, cyanohydric acid, cod-liver oil, chloroform, chloral, nitrite, amyl and a long list of preparations from the vegetable kingdom and from the hydrocarbon series.
The physical diagnosis of disease has been facilitated to an extent far beyond what the most sanguine physician of the last century could have deemed possible, by the discovery and practical application of the stethoscope, the pleximeter, the speculum in various forms, the ophthalmoscope, the laryngoscope and the thermometer; while chemistry and the microscopy have been applied successfully to the investigation of the various excretions, and especially of the urine, bile, and in the study of digestion where the process could be observed in its various stages in the person of Alexis St. Martin.
But the field for the medical historian broadens immensely and can best be appreciated by study of a catalogue of medical books and periodicals of the present century.