An Epitome of the History of Medicine

by Roswell Park

The first clinical institution in Austria was organized in Vienna, in 1754, by Van Swieten, though there was an "ambulatory clinic" (out-patient department) in Prague nine years before. During the century, however, hospitals were everywhere in bad condition. In the Hôtel-Dieu, at Paris, several patients—even as many as six—were sometimes put in the same bed; the convalescent and the dying found themselves thus associated; in Vienna the Allgemeines Krankenhaus was composed of seventeen hospitals that subsequently were amalgamated into one. In London numerous hospitals were founded, and as the medical staff of each became eminent they attracted numerous pupils; but later it became necessary to relieve the hospital wards, and private institutions for instruction were established by popular teachers, the most celebrated being the "Windmill Street School of Anatomy," founded by William Hunter about 1770, and the private school of Sir William Blizzard, which, established in 1780, developed, five years later, into the London Hospital Medical School.

While few, if any, of the lectures were compulsory, particularly in the natural sciences, even more attention than now was bestowed upon the accessory branches; botany, chemistry, and natural history were the recreation of many students and physicians. Pupils enjoyed the privilege of studying what they pleased—as they do practically to-day in the Portuguese University of Coimbra,—and professors exercised to the utmost their individuality in teaching. In Spain natural sciences found no admission, and even so late as 1770 no instruction in these branches was given, as they were regarded as dangerous to the purity of the faith; mineralogy for mining purposes was an exception, for even the most faithful Catholic needs money.

At the universities medical students were not permitted to go out without their scholastic cloaks,—a regulation that still obtains in Spain. That the number of students has enormously multiplied may be seen from the fact that the little University of Giessen, with scarcely any medical school at all, has always more students than had Halle in the days of the famous Hoffmann. In the middle of the last century Würzburg had at one time but three medical students, while to-day it has in the neighborhood of five hundred. Even then it was complained that, on account of the number of students, there was an educated proletariat arising, and in 1791 it was proposed, in Austria, that the rush for study should be repressed.

Among the Continental students the revels and bad behavior of past centuries were not to any great extent corrected; fights and debauchery were very common, and all sorts of orgies and bacchanals prevailed. The professors were, in large measure, independent of the State, and a single individual often represented a number of branches now taught by special chairs. When indisposed to lecture, they simply posted upon the blackboard: "Hodie non legitur," and this was the end of the matter. In 1777 Vienna had one hundred and forty-seven medical teachers, and in Germany there were two to every thirty-nine students. That in the last century one man often accomplished more than a great number of average teachers do to-day is amply demonstrated by the lives of Boerhaave, Haller, and others. Then, too, the Latin tongue was generally employed for purposes of instruction, though surgeons, for the most part, lectured in the vernacular; Cullen, in 1770, was the first in Great Britain to deliver purely medical lectures in English; and as the clergy gradually retired from the ranks of the profession, Latin more and more fell into disuse. Strange to say, as the clerical influence waned, the Jews began to enter medicine, the movement beginning about 1791, in France, under the promulgation of "civil equality" ideas; previously the Hebrews had been an almost universally suppressed people, and in Berlin were permitted to enter and leave the city by only one gate, and were forbidden to learn or write pure German, in consequence whereof their dialect was an Hebraic-Teutonic jargon, that even to-day prevails in some portions of western Europe. Educated Jews were few in number, since attendance upon universities was ordinarily denied them, although long before they had been admitted at Salamanca, Toledo, Salernum, and Montpellier. In Austria the prohibition was not removed until 1789, and even then, so bitter was the prejudice against the Semitic race, the clergy vigorously protested. It was the same clerical body that, in 1667, protested with the greatest vehemence against allowing Hebrew physicians to pass through the gates of Wurtemburg without paying toll, declaring that it was "better to die with Christ than be cured by Jews, who were aided by the devil."

Professors were often attached to the courts of their various sovereigns, and at one time the French court possessed a faculty of forty-eight physicians, surgeons, and apothecaries, the first two physicians being required to attend every morning when the king arose; hence originated the titles, still known in Germany, of "Hofrath" and "Geheimrath."

Medical fees, as a rule, were very small, though there were exceptional instances in which enormous sums were bestowed: Joseph II, of Austria, gave Guerin, who was summoned from Paris in consultation, an honorarium of 171,000 marks and made him a baronet. Taking all things into consideration, the income of the average practitioner in the eighteenth century would be in the neighborhood of $1000, which, however, was equivalent to three times that amount to-day. Fothergill, whose highest income in a single year was $25,000, bequeathed to the poor of London $1,000,000; Sir Astley Cooper had a yearly income of from $75,000 to $100,000, but it may be remembered that his practice during the first year netted him just $26, and that it was four years later before his income reached the sum of $500.

The physician of the last century was, at least, on occasions of moment, very different from other men, and to be recognized by his dress. A cap was placed upon his head when he graduated, in recognition of the fact that physicians at an earlier period belonged to the learned or clerical profession; and in later life he wore a purplish or scarlet cloak (to distinguish him from lawyers, whose professional color was yellow, and from theologians, who then, as now, sported the sombre black). The regulation full-dress costume of the English physician of the last century demanded a well-powdered wig, silk coat, knee breeches with stockings, buckled shoes, lace ruffles, cap, and goldheaded cane, to which, in cold weather, was added a muff—to preserve his delicacy of touch.

Surgeons were still strictly separated from physicians, even in education; nor were they esteemed as equal in rank, until the French Revolution brought about the doctrine of civil equality; perhaps this is one reason why this branch of the medical art made less conspicuous progress until recent times. The change was brought about, in France, by the abolition of eighteen universities and fifteen colleges of medicine, the Royal Society of Medicine (founded in 1776), and the Academy of Surgery (founded in 1731); but by this abolition charlatanism acquired such speedy control that the arrangement was soon abandoned. Thus it came about that surgical instruction was given in special institutions or in the universities, and the conditions of instruction finally improved. When the College of St. Come was abolished in 1753 the Société de Chirurgie, founded in 1731, became the Académie de Chirurgie; and, when the French Academy was formed in 1795, the Académie was merged into its medical department. The École Pratique, where Desault and Chopart taught, was established in 1750 for the practical education of surgeons. In England the Royal College of Surgeons was not incorporated until 1800. In Austria, in 1785, the Josephinum was opened by Joseph II, who also erected permanent military hospitals in Prague, Brünn, Milan, Mantua, Pesth, Olmütz, etc.; he also created the "Joseph's Akademie" in order to educate military surgeons and thus overcome the defects of army surgery; the Josephinum unquestionably exerted great influence in elevating the social and military position of army surgeons and attained historical importance after Brambilla compelled the recognition of surgeons as social equals of other members of the medical profession. As the result of these improvements, the various armies of Europe were soon furnished with better medical officers. Prior to this, too, the field hospitals had been as badly mismanaged as their civil prototypes, and the substitution, in 1793, of movable hospitals, as suggested at the close of the sixteenth century by Henry IV, of France, was scarcely an improvement. The whole system suffered from perpetuation of the dual and distinct functions of the physician and the surgeon, to destroy which was a part of the design of the Josephinum. How unpleasant was the position of the army surgeon up to this date may be inferred from the fact that in 1758 one was subjected to corporeal punishment at the command of his colonel, and that a general upon his death-bed could leave orders that fifty blows be given each of his medical staff in case the post-mortem disproved the diagnosis.

In Austria, at the beginning of the Seven Years' War, all military surgeons of the Protestant faith were compelled to become Catholics or leave the service. The condition of the wounded soldiers was as deplorable as can well be imagined; but upon this subject I cannot dwell.

The tendency of the nineteenth century seems to be a continuation, and, perhaps, in some respects, an exaggeration, of the condition obtaining in France during the previous century; in other words, the world has become practically an enormous school of pathological anatomy and diagnosis,—a school inaugurated by Bichat, as representing so-called scientific or exact medicine. Philosophically this has been a century of reaction against the idealism of the preceding age; it places the individual, rather than the idea, in the foregound. The mutual influence of medicine, philosophy, and the natural sciences is less conspicuous now than formerly. Recent philosophers who have exercised the greatest influence are: Schelling, who held to the equality of the real and the ideal; Hegel, whose supreme principle was absolute reason, of which religion was regarded as a representation; Hartmann, whose philosophy of the "unconscious" depends largely upon the results of natural sciences, embraces Darwinism, and is, in many respects, an extension and completion of Schopenhauer's pessimism and doctrine of the soul. But one who has exercised still more influence upon our profession is Comte, whose positivism contrasted strongly with the idealism and atheism of Schelling, and who required only this of philosophy,—namely, that it should work out the general ideas and results of other sciences; his most important follower was Claude Bernard, and upon these two the whole exact school of France is based. But the most influential philosophic doctrines of this or any other century have been those emanating from Charles Darwin, Herbert Spencer, Ernst Haeckel, Alfred Wallace, and their contemporaries and followers. Darwin (1809-1882) was the grandson of Erasmus Darwin, already mentioned, and his Variation of Animals and Plants Under Domes-tication, Origin of Species, and Descent of Man have found a place in all modern languages. The system known by his name is the pure science of nature, is founded upon scientific investigation, and by its merits alone has found almost universal acceptance; it has been added to and further elucidated by the efforts of Haeckel and Spencer.