Education: How Old The New

by James J. Walsh

Scarcely less interesting than the variety of remedies were their methods of administration:

"Medicines are directed to be administered internally in the form of decoctions, infusions, injections, pills, tablets, troches, capsules, powders, potions and inhalations; and externally, as lotions, ointments, plasters, etc. They are to be eaten, drunk, masticated or swallowed, to be taken often once only--often for many days--and the time [{364}] is occasionally designated--to be taken mornings, evenings or at bedtime. Formulas to disguise bad tasting medicaments are also given." We have no advantage over the early Egyptians even in elegant prescribing.

With all this activity in Egypt, it is easy to understand that the other great nations of antiquity also have important chapters in the history of medicine. The earliest accounts would seem to indicate that the Chaldeans, the Assyrians and the Babylonians all made significant advances in medicine. It seems clear that a work on anatomy was written in China about the year 2000 B.C. Some of the other Eastern nations made great progress. The Hindoos in particular have in recent years been shown to have accomplished very good work in medicine itself. Charaka, a Hindu surgeon, who lived not later than 300 B.C., made some fine contributions to the medical literature in Hindostani. There were hospitals in all these countries, and these provided opportunities for the practice of surgery. Laparotomy was very commonly done by Hindu surgeons, and one of the rules enjoined by Hindu students was the constant habit of visiting the sick and seeing them treated by experienced physicians. Clinical teaching is often spoken of as a modern invention, but it is as old as hospital systems, and they go back to the dawn of history.

It is among the Greeks, however, that the most [{365}] important advances in medicine, so far as we are concerned, were made. This is, however, not so much because of what they did as from the fact that they were more given to writing, and then their writings have been better preserved for us than those of other nations. The first great physician among the Greeks was AEsculapius, of whom, however, we have only traditions. He is fabled to have been the son of Apollo, the god of music and the arts, and therefore to have been a near relative of the Muses. The connection is rather interesting, because sometimes people try to remove medicine from among the arts that minister to the happiness of man, and place it among the sciences whose application is for his profit. Medicine still remains an art, however. The temples of AEsculapius were the first hospitals, though the priests were not the only ones who practised medicine, for there were laymen who, after having served for some time in the hospitals, wandered through the country under the name of Asclepiads, treating people who were not able to go to the hospitals or shrines. These evidently, then, were the first medical schools in Greece as well as the first hospitals.

Six hundred years after AEsculapius came Hippocrates, of Cos, the Father of Medicine. He undoubtedly had the advantage of many Egyptian medical traditions and other Oriental medical sources, as well as the observations made in the hospitals and shrines of AEsculapius. He [{366}] wrote some great works in medicine that have never grown old, Young men do not read them, old men who are over-persuaded of how much progress is being made by their own generation in medicine neglect them. The busy practitioner has no time for them. The great teachers of medicine whom all the professors look up to and who think for us in each generation turn fondly back to Hippocrates, and marvel at his acumen of observation and his wonderful knowledge of men and disease. Sydenham thought that no one had ever written like him, and in our turn we honor Sydenham by calling him the English Hippocrates. Boerhaave, Van Swieten, Liancisi, the great fathers of modern clinical medicine, turned with as much reverence to Hippocrates as does Osler, the Regius Professor of Medicine at Oxford, in our twentieth century. Hippocrates wrote 2,500 years ago, but his writing is eternal in interest and value.

The famous oath of Hippocrates, which used to be read to all the graduates of medicine, well deserved that honor, for it represents the highest expression of professional dignity and obligation. There is a lofty sense of professional honor expressed in it that cannot be excelled at any period in the world's history. Among other things that Hippocrates required his adepts in medicine, his medical students when they graduated into physicians, to swear to was the following: "I will follow the system of regimen which [{367}] according to my ability and judgment I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous. I will give no deadly medicine to man, woman, or child born or unborn. With purity and with holiness I will pass my life and practise my art, Whatever in connection with my professional practice, or not in connection with it, I see or hear in the life of men which ought not to be spoken of abroad, I shall not divulge, as reckoning that all such should be kept secret. While I continue to keep this oath inviolate may it be granted to me to enjoy life and the practice of my art respected by all men in all times; but should I trespass and violate this oath may the reverse be my lot."

It is sometimes thought that after the Roman medicine, which was an imitation of the Greek (though Galen well deserves a place by himself, and Galen is usually thought of as a Roman though he wrote in Greek and had obtained his education at Pergamos in Asia Minor), there was an interregnum in medicine until our own time. This is, however, quite as much of an assumption as to suppose that the Egyptians had no medicine--as we used to until we knew more about them--or that old-time medicine is quite negligible because we were ignorant of its value, The Middle Ages had much more of medicine than we are likely to think, and just as soon as the great universities arose at the end of the [{368}] twelfth and the beginning of the thirteenth centuries, medicine gained a new impetus and flourished marvellously. These university medical schools of the later Middle Ages are models in their way, and put us to shame in many things. According to a law of the Emperor Frederick II issued for the Two Sicilies in 1241, [Footnote 23] three years of preliminary study were required at the university before a student might take up the medical course, and then he had to spend four years at medicine, and practise for a year under the supervision of a physician of experience before he was allowed to practise for himself. The story of the medicine of this time is all the more wonderful because subsequent generations forgot about it until recent years, and supposed that all of this period was shrouded in darkness. It was probably one of the most brilliant periods in medical history. Some of the men who worked and taught in medicine at this time will never be forgotten.

[Footnote 23: For the complete text of this law, the first regulating the practice of medicine in modern times, also the first pure drug law, see Walsh's The Popes and Science, New York, Fordham University Press, 1908.]

Probably the greatest of them was Guy de Chauliac, a Papal chamberlain, whom succeeding generations have honored with the title of Father of Surgery. His great text-book, the "Chirurgia Magna," was in common use for several centuries after his death, and is full of surgical teaching that we are prone to think much [{369}] more modern. He trephined the skull, opened the thorax, operated within the abdomen, declared that patients suffering from wounds of the intestines would die unless these were sewed up, operated often for hernia in an exaggerated Trendelenberg position, with the patient's head down on a board, but said that many more patients were operated upon for hernia "for the benefit of the surgeon's purse than for the good of the patient." His directions for the treatment of fractures and for taxis in hernia were followed for full four centuries after his time. No wonder that Pagel, the great German historian, declared that "Chauliac laid the foundation of that primacy in surgery which the French maintained down to the nineteenth century." Portal, in his "History of Surgery," declares that "Guy de Chauliac said nearly everything which modern surgeons say, and his work is of infinite price, but unfortunately too little read, too little pondered." Malgaigne declared "the 'Chirurgia Magna' a masterpiece of learned and luminous writing."

Chauliac's [Footnote 24] personal character, however, is even more admirable than his surgical knowledge. He was at Avignon when the black death occurred and carried away one-half the population. He was one of the few physicians who had the [{370}] courage to stay. He tells us very simply that he did stay not because he had no fear, for he was dreadfully afraid, but he thought it his duty to stay. Toward the end of the epidemic, he caught the fever but survived it and has written a fine description of it. He was looked upon as the leader of surgery in his time, and this is his advice as to what the surgeon should be as given in the introductory chapter of his "Chirurgia Magna": "The surgeon should be learned, skilled, ingenious and of good morals; be bold in things that are sure, cautious in dangers; avoid evil cures and practices; be gracious to the sick, obliging to his colleagues, wise in his predictions; be chaste, sober, pitiful and merciful; not covetous nor extortionate of money; but let the recompense be moderate, according to the work, the means of the sick, the character of the issue or event and its dignity." No wonder that Malgaigne says of him: "Never since Hippocrates has medicine heard such language filled with so much nobility and so full of matter in so few words."