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A HISTORY .OF MEDICAL , EDUCATION<br />
•*
Ihr durchstudirt die gross' und kleine Welt,<br />
Urn es am Ende gehn zu lassen,<br />
Wie's Gott gefallt.<br />
Vergebens, dass ihr ringsum wissenschal'tlieh schweift,<br />
Ein Jeder lernt nur, was er lernen kann;<br />
GOETHE.<br />
Nature is made better by no mean,<br />
But nature makes that mean : so, o'er that art,<br />
Which you say adds to nature, is an art<br />
That nature makes. * * * *<br />
__ . , . This is an art<br />
Which does mend nature—change it rather : but<br />
The art itself is nature.<br />
SHAKESPEARE.<br />
Oui; cela etoit autrefois ainsi: mais nous avons change tout, wla ot «„„., (.«.„.„<br />
maintenant la medecine d'une methode toute nouvelle? g MOLIERB.<br />
'<br />
US faiSOnS<br />
°
A HISTORY<br />
* ••$•<br />
OF<br />
MEDICAL EDUCATION<br />
FROM<br />
THE MOST REMOTE TO THE MOST RECENT TIMES<br />
BY<br />
DR THEODOR PUSCHMANN<br />
PUBLIC PROFESSOR IN ORDINARY AT THE UNIVERSITY OF VIENNA<br />
TRANSLATED AND EDITED BY<br />
EVAN H. HARE<br />
M.A. (OXFORD), F.R.C.S. (ENGLAND), L S.A. (LONDON)<br />
UNIVERSIDADE DE SAO f AULO<br />
LONDON<br />
H. K. LEWIS, 136 GOWSR STREET<br />
MDCCCXCI
60UECAO JOHN LANE<br />
BIBUOTECA/FSft<strong>USP</strong><br />
an
TRANSLATOR'S PREFACE.<br />
VERY few words are required from me here; but to say<br />
nothing at all would savour of disrespect to the Author,<br />
whose work I have endeavoured to render more accessible<br />
to English readers, as well as to that very public, whose<br />
benevolent consideration for this English edition is now<br />
solicited.<br />
The truth is that I am very conscious of my responsi<br />
bilities to both.<br />
In the course of the translation, it became apparent that<br />
some slight addition was required in the chapter on England.<br />
With the Author's approval I have added a few<br />
pages, which contain matter limited almost exclusively to<br />
statements of facts concerning the existing arrangements<br />
at the universities and medical schools of the United<br />
Kingdom. I have much pleasure in acknowledging the<br />
debt I owe in connection with this to the " Guide to the<br />
Medical Profession," by C. B. KEETLEY, Esq.. F.R.C.S.,<br />
and to the "Students' Numbers" of the "Lancet" and<br />
" British Medical Journal." To these sources I beg to refer<br />
those in need of more detailed information.<br />
It now remains for me to express my most grateful<br />
thanks to those who have assisted me in various ways.<br />
While the responsibility for errors and shortcomings of all<br />
kinds must rest entirely upon myself, I have to thank those<br />
whose names I am about to mention, that such inaccuracies<br />
and deficiencies are not more numerous than is actually the<br />
case. From members of my own family I have received<br />
very great help. To my neighbour, H. A. B. COLE, Esq.,<br />
M.I.N.A., I am especially indebted for valuable assistance<br />
throughout the year and a half during which I have been<br />
engaged with the work. To A. W- CADMAN, Esq., I am
vi TRANSLATOR'S PREFACE.<br />
under a great obligation for revising a portion of my MS.<br />
Herr OTTO GERNER, of Ealing, has rendered me very<br />
considerable assistance in revising MS., for which I beg to<br />
thank him very much. I have much pleasure in acknowledging<br />
the courtesy and promptitude with which Professor<br />
PUSCHMANN has replied to the questions with which I have<br />
from time to time been obliged to trouble him.<br />
In spite, however, of the numerous lines of defence I<br />
have arranged to oppose the invasion of mistakes, I am<br />
well aware that some—perhaps many—have broken through<br />
and established themselves. I am not, however, about to<br />
point out the weak spots in my armour.<br />
Nor will I presume to utter a word of criticism upon<br />
Professor PuSCHMANN's work. For the task of the critic,<br />
whether of books or institutions, an independent standpoint<br />
is needful, and this, never attainable in ideal perfection, is<br />
by some unapproachable; and certainly a translator's<br />
views, in regard to a work he translates, must be peculiarly<br />
liable to distortion.<br />
My additions are indicated by square brackets in the<br />
text and by my initials in the notes.<br />
I have now said enough, but may be permitted to express<br />
the hope that some readers will be found to whom the<br />
chapters of the- learned Austrian professor will afford as<br />
much pleasure and instruction as they have to their English<br />
Editor.<br />
E. H. H.<br />
CROUCH END.<br />
October, 1891.
PREFACE.<br />
THE following work is the first attempt at a systematic<br />
exposition of the history of medical education. In<br />
literature, up to the present time, only fragmentary<br />
contributions have been made to this end, such as have<br />
to deal with the origin and development of individual<br />
medical schools and institutions, their scientific doctrines<br />
and methods of teaching, the persons engaged and their<br />
work. These sources of information had to be collected,<br />
examined and compared with one another before becoming<br />
of use for this book. For particular parts of the subject<br />
reliable and detailed information was at times found want<br />
ing; the documents required to throw light upon them<br />
being perhaps still locked up in archives and libraries. I<br />
must limit myself to affording information up to that point<br />
only where the fountains of knowledge become small or<br />
altogether dry, and I must leave it for later inquirers to dig<br />
up this ground and to collect material for the solution of<br />
questions to which no answer can now be given.<br />
The history of medical teaching is full of significance,<br />
not only in its relation to the history of medicine and<br />
of education, but also generally in relation to the history of<br />
civilization, of which it. may truly be said to constitute a<br />
necessary and an essential part. On this ground I have<br />
considered myself bound, as well as entitled, to carefully<br />
follow up and present the connection which my theme<br />
has with the general development of civilization. Many<br />
a fact which, viewed apart from general contemporary<br />
efforts, appears enigmatical and astounding, receives in<br />
this way a flood of light upon its meaning.
viii PREFACE.<br />
If I have made use of this opportunity to rectify numerous<br />
errors which have been incorporated in textbooks of the<br />
history of medicine and at the same time to bring some<br />
truths into prominence which have hitherto not attracted<br />
notice, the value of my book as a contribution to knowledge<br />
will certainly not be thereby injured.<br />
I fulfil an agreeable duty in giving utterance here to my<br />
most respectful thanks for kind assistance afforded me in<br />
my undertaking by the following gentlemen :—Ministerial-<br />
Rath Dr. B.von David, and Sektions-Rath Dr. von Kleemann<br />
of Vienna, Geh. Ober.-Med.-Rath Dr. Kersandt, and Geh.<br />
Ober.-Regierungs-Rath Dr. Althoff of Berlin, Medicinal-<br />
Rath Dr. Geissler of Dresden, Regierungs-Rath Dr. Bumm<br />
of Munich, Dr. von Riedel of Madrid, Physician to H.M.<br />
the Queen of Spain, Prof. Serra de Mirabeau of Lisbon,<br />
Prof. A. Corradi of Pavia, Prof. Albini of Naples, Prof.<br />
Anagnostakis of Athens, Prof. Felix of Bucharest, Prof.<br />
von Winiwarter of Liege, Dr. Daniels of Amsterdam, Prof.<br />
Petersen of Copenhagen, Prof. H. Heiberg of Christiania,<br />
Prof. Hedenius of Upsala, Prof. Rauber of Dorpat, Prof.<br />
Kollmann of Basel, Geh. Rath Prof. Hegar of Freiburg-im-<br />
Brisgau, Geh. Rath Prof. Schultze of Jena, Prof. Eckhard of<br />
Giessen, Prof. (Esterlen of Tubingen, Prof. W Krause of<br />
Gottingen, Prof. Uffelmann of Rostock, Prof. G. Ebers of<br />
Leipzig, Profs. Buhler and Heinzel of Vienna, and also the<br />
superintendents and officials of the libraries of Paris,<br />
London, Munich and Vienna.<br />
VIENNA.<br />
THE AUTHOR.
INTRODUCTION<br />
CONTENTS.<br />
I. MEDICAL TEACHING IN ANCIENT TIMES.<br />
India<br />
PAGE<br />
Egypt 18<br />
The Jews 26<br />
The Parsees 32<br />
The Greeks before Hippokrates 34<br />
The Time of Hippokrates 47<br />
In Alexandria 72<br />
Medicine in Rome 83<br />
Medical Teaching in Rome 96<br />
The Medical Profession in Rome 123<br />
II. MEDICAL TEACHING IN THE MIDDLE AGES.<br />
The Influence of Christianity 134<br />
Arabian Civilization 154<br />
Medical Science and Medical Teaching among the<br />
Arabs 162<br />
Medicine among the Germans and Teaching in the<br />
Monastic Schools 184<br />
The School of Salerno 197<br />
The Medical School of Montpellier 212<br />
The most ancient Academies of Italy 220<br />
The most ancient Academies of France . 227<br />
The other Universities of Europe existing in the<br />
Middle Ages 231<br />
The Training of Doctors in general 2<br />
7
X CONTENTS.<br />
PAGE<br />
24.2<br />
Teaching in Anatomy<br />
Teaching in Pharmacy and in Medical Practice 251<br />
Medical Examinations<br />
Surgery and Midwifery<br />
The Medical Profession and Medical Literature of<br />
this Period<br />
III. MEDICAL TEACHING IN RECENT TIMES.<br />
266<br />
2 7^<br />
The Character of the Sixteenth Century 285<br />
Emancipation from the belief in Authorities in the<br />
Sphere of Medicine and the progress of Science 294<br />
The Universities in the.Sixteenth Century ? 312<br />
Medical Teaching 3 2 ° v '<br />
The Medical Profession and its attitude towards the<br />
' •'•* 'I<br />
movements of the Sixteenth Century 335<br />
The experimental direction taken by the Natural<br />
Sciences, Physics and Chemistry during the<br />
Seventeenth Century 34 1 ^ /<br />
Microscopical investigation in Anatomy and experi<br />
ment in Physiology 353<br />
Progress in the other branches of Medical Science<br />
during the Seventeenth and Eighteenth Centuries 368<br />
The character of that period in regard to Art and<br />
Philosophy • 3 Sl<br />
The Learned Societies and Universities in the Seven<br />
teenth and Eighteenth Centuries 3 85^<br />
Medical Teaching in the theoretical departments and<br />
in Anatomy, Botany, Chemistry and Materia Medica 396 v/<br />
Clinical Teaching in the Seventeenth and Eighteenth<br />
Centuries 4io\/<br />
Teaching in Surgery, Ophthalmology and Obstetrics 418<br />
Medical Teaching at the close of the Eighteenth<br />
Century and position of the Medical Profession 433 \J<br />
IV. MEDICAL TEACHING IN MODERN. TIMES.<br />
The wide outlook of the Natural Sciences in the<br />
Nineteenth Century 440
CONTENTS. XI<br />
PAGE<br />
Physics and Chemistry in the last hundred years 452<br />
Medical Systems and the Progress in Anatomy and<br />
Physiology 461<br />
Diagnosis, Pathological Anatomy and Experimental<br />
Pathology, Nosology, and Materia Medica 472<br />
Surgery, Ophthalmology, Obstetricsand State-Medicine 483<br />
Medical Teaching at the present time 495 L-<br />
England 49 8<br />
North America 534<br />
France % 535 C<br />
Austria-Hungary 555<br />
The greater and lesser German States before the<br />
foundation of the German Empire 574<br />
Prussia and the present German Empire 584 L.<br />
Italy 59 8 "<br />
Spain and Portugal 601<br />
Holland and Belgium 603<br />
Switzerland 606<br />
Denmark. Norway. Sweden 608<br />
Russia 611<br />
Greece and the Christian lands of the Balkan<br />
Peninsula .. 612<br />
Final Considerations 613
HISTORY OF MEDICAL EDUCATION.<br />
INTRODUCTION.<br />
Quis nescit, primam esse historiae legem, ne quid falsi dicere audeat ? dein<br />
ne quid veri non audeat? ne qua suspicio. gratiae sit in scribendo ? ne qua<br />
simultatis ?<br />
CICERO, De oraloie ii, 15.<br />
THE historical development of medical, teaching exhibits<br />
a character similar to that of medical science in general.<br />
Necessity, the inventive Instructor of Mankind, furnished<br />
the occasion, as indeed HIPPOKRATES* says, for the<br />
first attempts at healing. The combative* habits of<br />
rude barbarians, whose favourite pursuits were hunting<br />
and war, entailed the infliction of wounds for which help<br />
was demanded. Sympathizing friends and fellow-soldiers<br />
tended the hurts, washing out the wounds and dressing<br />
them with cooling herbs. Soon there arose a select few,<br />
who investigating the healing properties of plants, turned<br />
their knowledge of this subject to account for the benefit<br />
of- their neighbours. If they were naturally endowed with<br />
the gifts required for observing Nature they no doubt<br />
soon made the attempt, as occasion offered, to study the<br />
fundamental character of the wounds which they undertook<br />
to treat. In this way gradually a kind of medical craft<br />
was formed, the members of which, by empirical methods,<br />
arrived at remarkable dexterity in healing external injuries.<br />
In the case of internal affections, particularly however in<br />
the case of epidemics, the causes of which are not so manifest<br />
as those of external injuries, recourse was had for counsel<br />
to those who, in that early period of civilization, passed<br />
* HIPPOKRATES. Ed. Littre. Paris 1839. ' • l ' P-- 574-<br />
B
INTRODUCTION.<br />
for the representatives of all knowledge*—the priests. To<br />
them, people looked the more readily for help, inasmuch as<br />
the origin of these diseases, being dark and mysterious,<br />
was ascribed to supernatural powers. The priests took<br />
care, by prayers and offerings to appease the anger of the<br />
gods and to enlist their sympathy. By these measures they<br />
instilled hope and confidence into the minds of the sick—in<br />
fact they subjected them to " expectant treatment." Here,<br />
however, it could not fail to be noticed, that results did<br />
not always tally with expectations; often indeed expected<br />
results entirely failed to occur at the very time when the<br />
public attention was directed to the matter, as in the case<br />
of widely devastating pestilences. Unless the priests were<br />
willing to lose their reputation, which was injuriously<br />
affected by these disappointments, it became necessary for<br />
them to aim at ensuring a greater influence upon the<br />
course of the prevailing diseases, by ordering diet and<br />
drugs. For this, they felt the want of medical knowledge,<br />
which they now sought to acquire by careful observation of<br />
the phenomena of diseases and by investigation of their<br />
causes and means of cure. In course of time they collected<br />
a quantity of information which, transmitted by word of<br />
mouth or by writing, became the property of later generations<br />
and by these was rendered more and more complete. The<br />
practice of the healing art was now exercised according to<br />
strict rules and the acquisition of the required knowledge<br />
was pursued systematically.<br />
Medicine was included among the subjects which were<br />
taught in the Temple-schools, and the priests took care<br />
that the medical knowledge acquired there should be<br />
bound up so closely with religious exercises, held in awe<br />
* " The Sanscrit vaidya from vid, to know, and the Latin medicus from medh,<br />
to be wise, point out that the Doctor has received his name from his insioht." CH.<br />
LASSEN : Indische Alterthumskunde, London u'nd Leipzig 1874, Bd. ii, S. ei7.<br />
Of. AD. PICTET : Etymologische Forschungen iiber die alteste Arzneikunst bei den<br />
Indogermanen in der Zeitschrift fur vergleichende Sprachforschung, Bd. v, S. 24<br />
et seq., Berlin 1856.
INTRODUCTION. 3<br />
by popular superstition, that the priests themselves<br />
should appear to be of essential importance in the treat<br />
ment of diseases. They however were compelled, in<br />
accordance with the advance of knowledge, to prove<br />
themselves capable men independently of such external<br />
assistance. And in this way the emancipation from<br />
religious influence and the formation of an independent<br />
medical class w r as brought about. The representatives of<br />
this class combined the knowledge received at the Temple-<br />
schools with the medical experience of the Empirics.<br />
They did not limit themselves, like the Priests, exclusively<br />
to the treatment of internal diseases but attached them<br />
selves also to surgery and obstetrics. This combination of<br />
internal with external Medicine, which was brought about<br />
by the followers of HIPPOKRATES and generally by the<br />
doctors of the Greek and Roman periods of civilization<br />
acted on both branches of the healing art as a stirring and<br />
stimulating force, and led to great results. The wonderful<br />
progress which the healing art, and especially surgery,<br />
made in Alexandria and Rome affords an intimation of the<br />
great advances probable in the immediate future had not<br />
political revolutions, attending the downfall of the Roman<br />
Empire, put a stop to the further development of Medicine<br />
as of other Sciences and Arts. Races in an early stage of<br />
civilization, as were those which then peopled the world,<br />
must assimilate to themselves the knowledge acquired in<br />
former days before presuming to think of increasing if by<br />
-discoveries or inventions of their own. During the next<br />
thousand years intellectual development proceeded in the<br />
•direction of breadth rather than of height, for while the<br />
sum of knowledge was not substantially increased it never<br />
theless diffused itself over a larger tract of the inhabited<br />
earth. Even in the Orient, where traditions of distinct<br />
periods of civilization are interwoven with the crowded<br />
actions and efforts of a people pressing with the enthu<br />
siasm of youth towards ends of the loftiest character—even<br />
there practically no important treasures in the domain of
INTRODUCTION.<br />
medicine have been bequeathed to us, none, at least,<br />
of any permanence or profoundly affecting its growth.<br />
Arabian medicine is but an episode—though a grand<br />
one—in the history of the Science^ In the West<br />
the priests took over again the office of teachers of<br />
medicine. The Roman and German peoples* were<br />
converted to the belief that the Christian Church<br />
possessed and preserved not only the truths of heavenly<br />
life but the knowledge of this world too. The Cleric<br />
united in himself, at that period, all learning; and the<br />
Cloister became the School of Man. The practice of the<br />
healing art had for priests, even then, many inconveniences<br />
in store ; respect for their Order forbade them toi&ndertake<br />
surgical operations, since through their mistakes death<br />
might ensue to their patients, and they abstained from the<br />
treatment of the diseases of women. It was thus -possible,<br />
that an independent class of practitioners should'maintain<br />
itself and grow alongside of, but unconnected -with, any<br />
priestly profession. Amongst these might be reckoned the<br />
numerous Jewish doctors who settled down in Christian<br />
lands and on account of their practical ability combined<br />
with extensive knowledge were highly esteemed : so, too,<br />
those people who in the south of Europe had become<br />
acquainted with Arabian medical science. These latter<br />
played a prominent part in the foundation of self-supporting<br />
medical schools at Salerno and MontpeVier'- while the<br />
Christian cleric, on his side, exercised a c^mtrolling influence<br />
upon the origin of the oldest Universities and their<br />
regulations. The Universities, which henceforth served as<br />
centres of learning and culture, reckoned also the training<br />
of doctors amongst their tasks, but they had regard only<br />
to the acquirement of theoretical knowledge and neglected<br />
practical aims. This deficiency in the training of practitioners<br />
had to be filled up by visits to hospjtals or by the<br />
personal teaching of experienced practical men, if the<br />
young doctors wished to enjoy the confidence of their<br />
patients. From this circumstance the priestly origin of<br />
1
t*7^*ifca> INTRODUCTION.<br />
Universities brought about the result that the medical<br />
teaching there imparted, by preference brought internal<br />
diseases into the sphere of consideration. Hence arose<br />
the necessity that along with skilled physicians should be<br />
found -a class of doctors devoting themselves to surgery<br />
and the treatment of external injuries. The formation of<br />
these wound-doctors was a matter connected with trade<br />
and ha
6 • * INTRODUCTION. •<br />
:,.'•» • ' •. ., ,;. .1<br />
• . - * - - • , • ' • ^ if. ' • . * ' • - * • '<br />
• „ . •* . '*'. •'<br />
wbich" represent the contests of .medical science, and while<br />
-^bearing" indisputable testiagnofty to. the state of medicine at<br />
different .periQdggiy-e.^direetion^form, and completeness to<br />
thejiistory of the science,, The form and method of medical<br />
, • £ea,ching were^eg_ial§ted.as imiach bythe general condition<br />
pf^ivihz.atibn at any given time as by the particular position<br />
of medical science. ,TKe age .of scholasticism demanded •<br />
•; that medical, theories brought forward in the lecture-rooms i<br />
.should be in accordance with the , dictates of the ruling."<br />
.authorit-ips;* so also the^following periods were satisfied<br />
with formal theses, historical and theoretical; and only in<br />
the seveeteentH century did,,the observation of Nature and'<br />
H-* independent investigation advance into 1 '- the foreground.<br />
v ;With-the _awakening of the Natural-Sciences, especially<br />
,-, Chemistry ,an^ Physics, with the foundation of schools of<br />
",t^natomy where students had the opportunity of dissectfcg<br />
:the;huma,n-fblody, with the introduction of clinical teaching<br />
••: in to','appropriate hospitals and the inducement of students<br />
tp undertake private independent work, a complete revolution*<br />
was "brought about iri medicab education. Practical<br />
u. demonstrations and experiments^ which had hitherto^bee?'<br />
.•' either altogether wanting, or n^4£e1i<br />
permitted, formed now an essential part^of medicaTtra^<br />
Xing, ' In this way it obtained that broad foundation**whicn<br />
. 'is so indispensable foe a harmonious structure in thtr^duW.<br />
. tibr^ of doctors *and by these means the lattef fee'ca^ne",<br />
. .fjtted both for the practice of their art and also for scientific/<br />
V investigation.
«•*-*.- '• •-<br />
»•*'•' HI * • •<<br />
•' '«• . i- -C .- ' 'S ' .-"W ' '•<br />
: • ^.-x^y-.t.<br />
• ,' • *?*•" ,1k. > • • *<br />
... 'Vife'v' •<br />
I. MEDICAL TEACHING IN ANCIENT TIMES.<br />
'* INDIA. '" •F..<br />
THE roots of our civilization lie in the East. On the •<br />
banks of the Ganges, on the plains of Egypt, and in seagirt<br />
Greece, thousands of years ago, Arts and Sciences,<br />
flourished and attained a remarkable development. The,.<br />
healing art there also celebrated its" earliest triumphs. itwas<br />
in India at first practised by the priests; who the're,,<br />
as elsewhere, passed as the.treasurers of all knowledge,<br />
ituman and divine. In the oldest writings of the Indians,<br />
the Vedas, which originated, six hundred years before^<br />
GhrisJ", diseases appear to'have been lookedj on as punjsh-<br />
,;meats-inflicted by angry deities or spirits, or Is the result,'•<br />
*o*f*t% art-magic of wicked men. To allay these visitations^<br />
prayers, offerings and-conjurations were employed. But<br />
jLl!rea"dV in; the Rig-Veda* we find certain dietetic and<br />
roekcinal remedies referred to. •The larger the siim pf<br />
medical knowledge and experience .grew, the .more did -<br />
men recognize the necessity of conferring, the privilege of<br />
.•the,practice^of medicine not 'exclusively on the priests but<br />
alsp^on the members of other castes," if by their knowledge<br />
#id*ability they showed themselves fitted for it. Thus 4<br />
^distinct medical,class-by degrees was developed, organizing<br />
fl-gelf"put of the three higher grades of society; onlylhe<br />
tiered Sudra, 'who, by their racial peculiarity, were<br />
distinguished from the Aryan ^immigrants, remained excluded.<br />
Later an,1 by ,tfre levelling ..influence of Buddhism,<br />
this limitation was in some degree removed. Detailed<br />
* ROTH in the Zeitephrift der -dfptschen morgenlandischen Gesellshaft, B^<br />
xxiv, S. 301 et seq., and Bd. xxv*;/&,~6jjr5.'et':seq.. * .{
8 ANCIENT TIMES.<br />
information concerning the training of doctors is found in<br />
the two commentaries on the Ayur-Veda composed by<br />
CHARAKA and SUSRUTA and constituting the oldest medical<br />
works in Sanscrit literature. CHARAKA* counsels youths,<br />
who are desirous of studying medicine, that they should<br />
seek a teacher "whose precepts are sound, and whose<br />
practical skill is generally approved, who is clever,<br />
dexterous, upright, and blameless; who knows also how<br />
to use his hands, has the requisite appliances and all his<br />
senses about him, is confident with simple cases and sure<br />
of his treatment in difficult ones; of genuine learning,<br />
unaffected, not morose or passionate, patient and kind to<br />
his pupils." Those pupils were pronounced to be.quite<br />
fitted for the study of medicine " who spring from a family<br />
of doctors or associate with doctors and who have lost<br />
none of their limbs and none of their senses." On<br />
admission, the teacher admonished his pupils "to be chaste<br />
and temperate, to speak the truth, to obey him in all*<br />
things and to wear a beard." As the three best means of<br />
acquiring medical knowledge, were mentioned : the study<br />
of medical writings, the personal teaching of the instructor,<br />
and association with other doctors. " When the doctor"'<br />
says CHARAKA « attended by a man known to the patient<br />
and having the right of entry into his house, advances into<br />
the dwelling of the sick man he should make his appearance<br />
in good clothes, with an inclination of the head he<br />
should be thoughtful but of firm bearing and observe all<br />
possible respect. So soon as he is within, word, thought<br />
and attention should be directed to nothing else but the<br />
examination of the patient and what appertains to his<br />
fL Z'l -t CVen thG WisCSt " Sa ? s he " ^come<br />
puffed up with his wisdom. Many recoil even from a man<br />
of skill if he loves to boast. And medicine is by no means<br />
easy to learn. Therefore let each one practise himseff Tt<br />
carefully and incessantly. Concerning the procedures and<br />
m^sr^.18;^;.^:i.-rt:t in the zeitschr - der
INDIA. 9<br />
accomplishments of the practitioner much may be learnt<br />
from others; for the whole world may be called a teacher<br />
of the man of understanding and to fools only is a foe.<br />
Considering this, even from the counsel of an adversary he<br />
may venture to expect prosperity, honour and livelihood,<br />
and to act in accordance with such counsel."<br />
He strongly recommends intercourse with other doctors.<br />
u For conversation with a colleague increases knowledge,<br />
confers pleasure, enlarges experience, imparts readiness of<br />
speech, and induces consideration. Whoever is uncertain<br />
about something learnt, will have his doubts removed by<br />
repeated instruction; whoever has no uncertainty or doubt,<br />
will be able thus to fortify his opinion. Thus often a man<br />
comes to hear what up to that time he never knew. Often<br />
a teacher can seize the opportunity of a conversation of this<br />
kind to fully and at once impart to his pupil some information<br />
partially or entirely withheld hitherto." In Susruta*<br />
(Chap. 2.) it is said that the doctor should choose as<br />
pupil the son of a Brahman, being Ksatrya or Vaisya (nobleman<br />
or freeman) and of good family: he should be sixteen<br />
years of age, should show a respectable behaviour, should<br />
possess a love of cleanliness, kindness and bodily strength,<br />
understanding, a good memory, and the desire to learn and<br />
to reach the ends he has in view. " He must have a clean<br />
tongue, small lips, regular teeth, a noble countenance, wellformed<br />
nose and eyes, a cheerful spirit and good bearing<br />
and be prepared to undergo weariness and pain. And<br />
whoever possesses the opposite characteristics should not<br />
be admitted to the doctor's calling."<br />
The admission of the scholar ensued on a propitious day<br />
and the festivities connected therewith were celebrated in<br />
the evening when the moon and stars were shining above.<br />
They thus began. The gods were propitiated by offerings<br />
of rice, flowers, and precious stones on an altar which consisted<br />
of a mound of earth measuring four ells on each<br />
* The Susruta Samita ed. by UDOY CHAND DUTT, Calcutta 1883.<br />
{Bibliotheca Indica, fasc. 490, 500.)<br />
i"' !
IO ANCIENT TIMES.<br />
side situated towards the north or east and which was<br />
covered with cowdung* and Kusa-Grass (Poa Cynosuroides),<br />
while the Brahmans and Doctors received presents. Then<br />
the Brahman conducting the ceremony drew a line upon<br />
the earth, sprinkled the place with water and allowed the<br />
novitiate of medicine to take a seat on his right side.<br />
Before him a fire was made in which, obediently to the<br />
directions of religion, wood of Khadira (Acacia catechu)<br />
Palasa (Butea frondosa) Devadaru (Cedrus deodara) and<br />
Vilva (iEgle marmelos), or of Vata (Ficus Bengalensis), Jaina<br />
dumbara (Ficus glomerata), Asvattha (Ficus religiosa) and<br />
Madhuka (Bassia latifolia), was burned after havingpreviously<br />
been dipped in curdled milk, honey and clarified butter.<br />
At the end of the ceremony the teacher conducted his<br />
pupil, three times round the fire and thus addressed him,<br />
at the same time calling the god of Fire to witness: '< Lay<br />
aside now all passionate desires, all anger, covetousness,<br />
foolery, conceit, pride, envy; all roughness, duplicity,<br />
deceit and indolence, and all blameworthy conduct. Thy<br />
hair and thy nails shalt thou from this time: forth keep<br />
short, a red cloak shalt thou wear and lead a pure life,<br />
all dissolute intercourse shalt thou avoid and shalt obey him<br />
who is set over thee. Thou must stay, go, lie down or<br />
sit down, eat and study as I direct and always be diligent<br />
to further my success. If thou dost neglect this, thou dost<br />
commit a sin and all knowledge is useless and unavailing<br />
to thee. If however I act badly towards thee, while thou<br />
fulfillest thy duty, I then commit a sin and my knowledge<br />
bears no fruit." Further, he admonished him that later on<br />
as a doctor he should treat without reward Brahmans.<br />
^, teachers, poor people, his friends and neighbours, religious<br />
people, orphans and foreigners and should give them<br />
remedies. So on the other hand he ought to refuse any<br />
medical advice to those who kill animals by hunting or<br />
'* T ^ blrdS ' aS Hkewi$e to ° utlaws and criminals.<br />
Whosoever thus practises makes himself known as a<br />
* The cow was considered sacred.
INDIA. II<br />
man of wisdom and acquires friends, renown, virtue, riches<br />
and other desirable things." On certain days the pupil<br />
should not study, for example on the 8th, 14th and 15th<br />
days of the new and full moon ; it was likewise forbidden<br />
him to study " in the morning or evening twilight, during-;<br />
thunder and lightning (when this happens at an unusual<br />
period of the year), when the king of the country is laid up<br />
on a bed of sickness ; after a visit to the scene of a con<br />
flagration, after attending a burial, during war, on any high<br />
festival, during any alarming manifestation of Nature such<br />
as an earthquake or meteoric shower, or on such a day as<br />
the Brahmans themselves might select on which to abstain<br />
from study, or which he might himself consider polluted for<br />
any reason."<br />
In these sometimes strange rules there lay obviously at<br />
bottom a reasonable notion, namely to secure to the<br />
students the relaxation and leisure necessary to their call<br />
ing, as well as to remind them that when their attention is<br />
given up to other things they understand in only a super<br />
ficial and incomplete way what they are taught. SuSRUTA<br />
further demands (Chap. 3) that the students of medicine<br />
should receive both theoretical and practical training : first<br />
they should read medical treatises and then learn the prac<br />
tice of the.art. "The man who has had nothing but a<br />
theoretical training" says he "and is unskilled in the<br />
details of treatment knows not what to do when he comes<br />
to a patient and behaves himself as pitiably as a coward on<br />
a battle-field. On the other hand a doctor who is only<br />
practical does not win the esteem of the best men." " Both<br />
these classes of incompletely prepared doctors are not<br />
fitted for practice, any more than a Brahman is to perform<br />
Church ceremonial properly if he has only read half the<br />
Vedas or than a bird is to soar in the air if it has only one<br />
wing. For, if medicines are administered by an unskilful<br />
doctor they may—although like nectar in flavour—work<br />
like poisons or other instruments of destruction."<br />
• Such people, as SuSRUTA remarks, only obtain permis-
12 ANCIENT TIMES.<br />
sion to practise when the Government is careless and lax.<br />
The instruction consisted in the teacher reading to the pupil<br />
extracts from the medical writings, and making him repeat<br />
them again, so often, that finally the student knew them by<br />
heart. The delivery should be " in a loud and clear voice<br />
and with distinct accentuation of the words which should<br />
not be slurred over or rendered indistinct by a nasal tone."<br />
The scholar must endeavour to lay hold of what is taught<br />
him not only by the ear but by the understanding: otherwise<br />
he " resembles an ass who bears a burden of sandalwood,<br />
knowing only the weight, not the worth of his load."<br />
(Chap. 4). The teacher is enjoined (Chap. 9) to instruct<br />
the pupil in the carrying out of surgical operations, in the<br />
application of ointments and generally in practical matters<br />
for "without practical training' and merely by hearing<br />
lectures and by the repetition of discourses, no one is fitly<br />
prepared for medical practice." Particular surgical operations<br />
were taught and practised.on fruits, for instance<br />
melons ; puncturing was practised on bladders or leather<br />
bottles filled with water, mud or clay; scarification, on<br />
pieces of leather stretched out and with the hair on ; bloodletting<br />
upon the vessels of dead animals or the stalk of a<br />
water-lily; explorations with the probe,' on worm-eaten<br />
wood, bamboo, reeds or dried gourds; extraction of teeth,<br />
•on dead animals; the opening of abscesses, on a lump of wax<br />
spread out on a piece of Salmali (wood of Bombax Malabaricum)<br />
; the sewing up of wounds on thick garments or<br />
the edges of two pieces of t'hin leather; the application of<br />
bandages, on models of the human body prepared from wood<br />
or clay; the application of caustics and cauteries on thin<br />
slices of meat; the drawing-off of urine from the bladder or<br />
the removal of matter from the pelvis by means of reeds<br />
and an earthen vessel provided with a spout and filled with<br />
water, or else a gourd. In India very high consideration was<br />
given to surgery. When DHANVANTARI (Chap; 1) asked<br />
his pupils which branch of the healing art he should ex<br />
pound to them, they answered : 'teach us everything but
.'K.<br />
INDIA.<br />
take surgery as the foundation of your discourse !' Indian<br />
medicine has in this sphere of work achieved remarkable<br />
results. The Indian doctors were familiar with amputation,<br />
tapping the abdomen, laparotomy, suturing the intestine;<br />
they removed stone from the bladder by operation, treated<br />
cataract by couching the lens, undertook plastic operations,<br />
practised turning and extraction in the case of abnormal<br />
presentations in childbed and undertook Caesarean section<br />
in the case of those who died before delivery.* The great<br />
number of different instrumentst shows how experienced<br />
they were in surgical technicalities : we find among them<br />
knives of various shapes, lancets, cupping-glasses, trocars,<br />
probes, reed-like catheters, scissors, bone-saws, polypus-<br />
forceps, specula and many more. The examination of the<br />
body of the patient was performed with great care.<br />
SUSRUTA (Chap. 10) admonished young doctors to bring<br />
all five senses to bear on this subject. " By the sense of<br />
hearing we can, for instance, determine whether the con<br />
tents of an abscess are frothy and gaseous, for the emptying<br />
of such is attended with noise; by the sense of feeling we<br />
may know whether the skin is hot or cold, rough or smooth,<br />
thick or thin; by the sense of sight we can determine<br />
corpulence or emaciation, vital power, energy, and change<br />
of colour; by the sense of taste we can assure ourselves<br />
concerning the state of the urine in diabetes and other<br />
diseases of the urinary tract; and by the sense of smell we<br />
can recognise the peculiar perspiration of manyy, diseases<br />
which has an important bearing on their identification."<br />
"At the same time the patient must be interrogated con/fi<br />
cerning the character of the quarter he lives in, considera<br />
tion must be taken of the time of year, the patient's position,<br />
his apprehension, the nature of his pain, his natural powers,<br />
his appetite and the duration of his illness : we then\<br />
should proceed to the examination of the urine, the gaseous!<br />
* VUI.LERS in the Janus, Bd. i, S. 242 el seq. Breslau, 1846.<br />
t Well collated in T. A. WISE'S Review of the History of Medicine among<br />
the Asiatics, London, 1867, Vol. i, p. 354 et stq.
14 ANCIENT TIMES.<br />
* .and solid excreta and the menstrual flow, and also make<br />
inquiries concerning the surroundings of the patient, in<br />
< reference to the nature of the disease."<br />
The Indian doctors were careful observers of Nature.<br />
They were aware of crepitation as throwing light on the<br />
•t diagnosis of a fractured bone, and of the sweet taste* of<br />
the urine in certain cases of sickness (diabetes mellitus)<br />
long before these facts were known in Europe.<br />
The high development of the healing art and especially<br />
of surgery in India, excites the more surprise from the fact<br />
that the study of anatomy and physiology was if not completely<br />
non-existent at least on quite a wrong track. The<br />
small anatomical knowledge of the Indian doctors was<br />
dependent on the fact that they certainly never undertook<br />
the dissection of the human body; indeed such investigations<br />
were forbidden, or at least made difficult by religious<br />
injunctions. Nevertheless they appreciated the importance<br />
of anatomy for practical medicine and declared that the<br />
doctor must acquire a competent knowledge of the human<br />
body before undertaking the treatment of its diseases.<br />
Magisterial authority was required for anyone beginning<br />
the practice of physic.<br />
By SUSRUTA (Chap. 10) it is said that the student of<br />
1 medicine at the termination of his studies must petition.<br />
the king to grant him authority to practise independently.<br />
In this connection SuSRUTA imparts to him certain<br />
maxims which throw remarkable light on the social<br />
position of Indian doctors. "Keep thy hair and nails<br />
short " he writes " keep thy body clean, wear white linen,<br />
put on shoes and carry a stick or umbrella in thy hand.<br />
Let thy bearing be humble and thy heart pure and free<br />
from guile. Show thyself courteous in speech and friendly<br />
to every human being and take 1 care that thy servant has a<br />
good character." He recommends him peculiar caution<br />
.when his patients " are learned Brahmans, princes, women<br />
•*!.' '' '<br />
,-.,* Perhaps the observation that ants sought out and enjoyed this urine<br />
led them to make this discovery. „
INDIA. 1 5<br />
children or old men, timorous people, servants of the king,<br />
crafty or feeble folk, calumniators of doctors, poor, miser.-<br />
able or irritable people, orphan children or persons who<br />
conceal their illnesses or are not supervised in their actions."<br />
He Very earnestly warns him however against " gossiping<br />
or jesting with women or taking any presents from them<br />
with the exception of some light refreshment." Further<br />
he gives the shrewd, if somewhat unkind, advice " only to<br />
treat such persons as have curable diseases but to avoid<br />
any cases of incurable disease and generally to give up<br />
every patient who is not cured at the end of a year's treat<br />
ment, for curable diseases commonly become incurable in<br />
a year."<br />
CHARAKA* shows still greater caution in recommending<br />
the doctor " not to order any remedies for persons disliked<br />
by the king or people or who are themselves hostile to<br />
the king or people ; and moreover, very deformed persons,<br />
or such as are corrupt, difficult, wild or intractable are not to<br />
receive advice or help, nor are the dying, or women either,<br />
except only in the presence of their lord or guardian."<br />
CHARAKAf fills his pupils with contempt for those people<br />
" who making a great display in the train of a learned<br />
doctor eagerly seek after opportunities for practice. No<br />
sooner have these people heard of a patient than they<br />
hurry off to him, fill his ears with their own medical<br />
ability and are unceasing in their enumeration of the<br />
failures of the attending doctor. They try to win over the<br />
friends of the patient by little attentions, flatteries, and<br />
innuendoes and they extol their own modesty. If they<br />
happen to have secured a case they deem it an occasion<br />
for making perpetual visits. In order to conceal their<br />
want of skill—being unable to cure the complaint 1 —they<br />
attribute their want of success'to the absence of the neces<br />
sary means and nursing, and to the patient's neglect of<br />
medical injunctions. If they notice that things are going<br />
badly with the patient they at once make off. • If they find<br />
* Op. cit., S. 448. f i, 29, in EpT;H op. cit., S. 452.
I 6 ANCIENT TIMES.<br />
themselves in mixed company they affect modesty and yet<br />
without appearing to do it, they magnify their own skill and,<br />
speaking as laymen, undervalue the knowledge of the truly<br />
accomplished. However, they avoid the company of the<br />
learned as travellers do the dangers of a close forest." A<br />
picture fresh as life, the realistic touches of which show much<br />
resemblance to some scenes of the present day! The<br />
doctors in India took an important position. Nowhere has<br />
the respected calling of the doctor been more beautifully<br />
or strikingly portrayed than in the Indian proverb : " To<br />
the sick man the doctor is a father: to the man in health, a<br />
friend: the sickness passed and health returned, a preserver."*<br />
The Indian doctors were, like other learned men,<br />
free from taxes and other charges and for the services<br />
they rendered patients were paid by presents. It seems _,<br />
that their claims in this respect were not small, judging from<br />
the information we have respecting the remarkable cures<br />
of the doctor GIVAKA KOMARABHAKKA who lived in the*<br />
time of BUDDHA.t He was the son of a courtesan and was<br />
brought up at the cost of a prince who adopted him; he was<br />
then trained by a Professor whose teaching he enjoyed for<br />
seven years, till at last he became a famous practitioner.<br />
Has this account an allegorical significance ? Is there a<br />
desire to show how the mean mercenary activity of the<br />
doctor maybe ennobled by the high ideal aims of his work ?<br />
In the schools of the Bikkhus, the Buddhist monks, which<br />
were formed after the model of the Brahman schools, the<br />
sciences were neglected and the formation of character<br />
through renunciation of the world and its delights was<br />
chiefly aimed at. The Bikkhus considered life worthless,<br />
so naturally cared nothing for remedies for the purpose of<br />
maintaining it. Their, rule only to eat what others had left K<br />
and to make usej of the urine of a cow as a remedy shows<br />
'X<br />
* BOHTLINGK: Indische Spriiche, Petersburg. 1870. *<br />
t The Sacred Books of the East translated by MAX MUUJKK, Oxford 1881,<br />
Vol. xiii, p. 191, xvii, p. 173 d seq., xx, p. 102 ft set).<br />
t KOPPEN Religion des Buddha, S. 338. l K -
INDIA. *7<br />
how little importance they attached tp the care and health<br />
of the body. And yet it was after all a Buddhist King,<br />
named ASOKA or PRYADARSIN who promoted the erection<br />
of hospitals not only for men but for beasts. In these estab<br />
lishments were held professional consultations, and medicine<br />
was dispensed just as in our clinical institutions.* To be<br />
sure it was not so much the love of knowledge, as philan<br />
thropic tendencies which inspired ASOKA here : neverthe<br />
less medical knowledge did in any case gain some advan<br />
tages therefrom.<br />
In Ceylon also there were infirmaries. King PANDUKAB-<br />
HAYO is said to have founded as early as the fifth century<br />
before Christ a hospital at his residence of Anaradhapura,<br />
and one of his successors, DUTTHAGAMINI who reigned in<br />
the second century before Christ could boast at his death<br />
that he had erected in eighteen places infirmaries provided<br />
with sufficient means, and carefully arranged so that sufferers<br />
should be treated with professional care, and be provided<br />
with medicines. Of King BuDHADASO living in the fourth<br />
century after Christ it is related that he practised the<br />
healing art himself and compiled a useful work on<br />
medicine. He arranged a sanitary organization embracing<br />
the whole country, appointed one medical officer for every<br />
ten villages and erected hospitals in many places, appro<br />
priating revenues from twenty villages for their support.<br />
Moreover, he founded institutions for the reception of<br />
cripples, deformed persons, and the destitute poor, and he<br />
took care that the Army should have doctors—not only the<br />
soldiers but The elephants and horses also.f Hospitals<br />
existed in Kashmir J as early as in the reign of King<br />
MEGHAVANAin the first century of our era.<br />
* G. BU'HLER : Contributions to the interpretation of the Asoka inscription in<br />
the Zeitschr. d. deutschen Morgenl. Ges. 1883, Bd. 37, S. 98 et seq. (2 Edikt.<br />
des Konigs Asoka der von 263-266 v. Chr. regierte).<br />
f The Mahawanso edit, by G. TURNOUR, Ceylon 1837, PP- 6 7> l 9 6 > 2 4.?»<br />
245-<br />
X HENSINGER in the Janus (ii, 393) has given some information on this<br />
subject frornthe " Annales de Caschmir " by KALHANA.<br />
1<br />
C
I 8 ANCIENT TIMES.<br />
The relations, which the inhabitants of India maintained<br />
with the Greeks from the time of the expedition of<br />
ALEXANDER OF MACEDON, their active intercourse-with<br />
the neighbouring Persians which later on extended itself<br />
over the domains of knowledge, and their subjection by<br />
the Arabs, exercised a great influence upon the development<br />
of Indian medicine, while in recent times European<br />
medicine, and particularly the professional theories and<br />
practice of the English have there become paramount.<br />
EGYPT.<br />
BY far more ancient than the medical records of the<br />
Indians are those which disclose to us the^ condition of<br />
medical science amongst the Egyptians of old. They<br />
arise out of that early period of civilization of which the<br />
Pyramids—those mighty witnesses of a legendary pastspeak<br />
to us; they stand forth in pictorial representation<br />
on the walls of temples and tombs, in implements—such<br />
as surgical instruments—which have been preserved by<br />
chance, and in papyrus-rolls of which the more important<br />
have only been discovered and deciphered during the last<br />
half-century. In Egypt, as in Babylon, the custom prevailed<br />
of laying the sick out before the houses in the<br />
streets and passages so that the passers-by might tender<br />
advice as to the treatment of their infirmities. Interest in<br />
medical subjects was taken by the whole people, and " in<br />
that land where the fruitful soil bore abundance of herbs<br />
potent for good or evil, nearly everyone was, so to speak, a<br />
doctor, a descendant of P^ON and learned among men."*<br />
But there were also persons who practised medicine professionally<br />
and to this end underwent systematic teaching.<br />
The Egyptian physicians, on account of the happy results<br />
obtained by their treatment earned great reputation and<br />
were even summoned to the courts of foreign princes.<br />
The Persian King CYRUS entrusted his sick mother to the<br />
* HOMER : Odyssey iv, 229-232.
EGYPT. 19<br />
care of an Egyptian oculist and DARIUS too had a bodyphysician<br />
who came from that country.*<br />
The position of the members of the medical profession<br />
in Egypt, like that of the representatives of other learned<br />
callings was on a level with the position of the priests ; and<br />
doctors were accorded corresponding privileges. In the<br />
schools associated with the temples not only priests but<br />
judges, doctors, astronomers, mathematicians and other<br />
learned persons were trained. These teaching-institutes<br />
combined, as our Universities do, all the higher training and<br />
subserved not education only but research. The most<br />
renowned of these schools were situated at Heliopolis,<br />
Memphis, Thebes, Sais, and Chennu. Here besides a<br />
corresponding general education the pupils acquired the<br />
requisite technical training for the particular pursuit of<br />
their lives. They lived in the houses attached to the<br />
school under the inspection and discipline of their teachers.<br />
"Let not idleness overtake thee" is the warning of the<br />
teacher in one of the passages translated by CHABAS " else<br />
shalt thou be severely chastised. Hang not thine affections<br />
upon pleasures and take care that the books fall not from<br />
thy hand. Exercise thyself in conversation and speak with<br />
thy superiors in learning. When thou shalt grow older<br />
thou wilt recognize how important this is: whoso is<br />
dextrous in his craft achieves power and fame." t The<br />
Egyptian student life appears in many respects to have<br />
been like that of to-day. Thus the teacher reproves the<br />
conduct of his light-hearted pupil EMENA in these words :<br />
'" It has been reported to me that thou neglectestthy studies<br />
and seekest only thy pleasure, wandering from tavern to<br />
tavern. But what profiteth the odour of beer? Avoid it;<br />
for it drives people away from thee, impoverishes thy wits,<br />
and likens thee to a broken oar upon the deck of a ship." %<br />
* HERODOTUS iii, i, 129.<br />
f CHABAS: Melanges egyptologiques, Paris 1862, p. 117.<br />
X LAUTH : Die alt-agyptische Hochschule zu Chennu ind. Sitzungsber. d. k.<br />
bayr. Akad. d. Wiss., Histor. Kl. 1872, S.67.
20<br />
ANCIENT TIMES.<br />
Studies were not limited to the sons of the favoured classes<br />
but were accessible to all. Industry and talent were held<br />
to be the only conditions imposed upon those who sought<br />
admission to a course of study. Instruction was founded<br />
upon "the sacred books" in which all the wisdom of the<br />
Egyptians was contained. THOTH,* the god of Wisdom,<br />
was looked upon as their author "who also conferred<br />
enlightenment upon doctors." The sacred or hermetic<br />
books formed a kind of encyclopedia and consisted of<br />
forty-two parts. They dealt with the mandates of religion,<br />
church ceremonies, the administration of justice, philosophy,<br />
the art of writing, geography, cosmogony, astronomy, the<br />
knowledge of weights and measures, medicine etc. With<br />
medicine the last six books were concerned, being called the<br />
" Ambres" and the first of these contained a description of<br />
the different parts of the body ; the second, instruction<br />
concerning diseases ; the third, discussions about surgical<br />
instruments and probably about operations also ; the fourth,<br />
instruction in materia medica; the fifth, a description of<br />
diseases of the eye, which, it is well known, are widely<br />
spread in Egypt, and the sixth, instruction on diseases of<br />
women.f The Author begins with anatomy as the groundwork<br />
of medicine, passes on to pathology and finally mentions<br />
the specialities which presuppose a knowledge of the<br />
other parts of medicine: he arranges his matter in such a<br />
way as to correspond closely with the rational system of our<br />
modern scientific method. Unfortunately the text-book of<br />
general medicine has been lost. Only some fragments are<br />
said to have been preserved which are probably to be found<br />
in the Book of the Dead, published by LEPSIUS, and in the<br />
EBERS papyrus. G. EBERS is of opinion that the papyrus<br />
named after him contains the fourth of the medical hermetic<br />
books—the treatise on materia medica.J Although<br />
* THOTH is the Hermes of the Greeks. Gi UGNI AUT ; de "Kp.uoO seu Mercurii<br />
mythologia, Paris 1835.<br />
t Cf. CLEMENS ALEXANURINUS : Stromata, lib. vi, cap. 4; Edit. Dindorf.<br />
% G. EBERS: Papyios Ebers, Leipzig 1875, T. i, S, 9.
EGYPT. 21<br />
this was written in the seventeenth century B.C. it most<br />
likely represents a later treatment of the original text.<br />
GALEN extracts many passages from it, although it is known<br />
that he had no high opinion of the scientific value of the<br />
work* It is not known whether the six medical books<br />
as well as the remaining thirty-six hermetic books were<br />
lectured upon to all students of the Egyptian temple<br />
schools alike, or only to those who had in view the practice<br />
of medicine. These latter had in any case to study and<br />
master the contents of the medical writings : moreover they<br />
were bound strictly to conform to the rules therein laid<br />
down when engaged later in the practice of their pro<br />
fession and they drew punishment upon themselves if they<br />
practised in any other way.f<br />
It is not probable that medical teaching confined itself to<br />
the medical works belonging to the hermetic writings or to<br />
the works illustrating these, in which the libraries connected<br />
with the temple schools were without doubt very rich. We<br />
must take it that the students' in addition to this received<br />
practical guidance in the examination and treatment of the<br />
sick. The rule existed in Egypt, that patients should be<br />
brought into the temple, to await help and the alleviation of<br />
their pains at the hands of the priests. The latter were also<br />
called to the dwellings of those sick people who were too<br />
ill to be brought into the temple. Is it not probable that I<br />
the teachers of Medical Science made use of these opportu<br />
nities to point out to the students the practical carrying out ^<br />
of the theories which they had taught them ? It is also very<br />
likely, that the students assisted, as pupils of the priests,<br />
in the treatment of the sick in the temples, since this may<br />
be looked on as a part of God's service and a religious act.<br />
Moreover, the condition of the healing art in Egypt gives<br />
support to the presumption that their theoretical learning<br />
was made easier to acquire by the help of practical teaching.<br />
From the pictorial representations which have been pre<br />
served upon the temple walls it is evident that they were<br />
* GALEN : Ed. Kiihn, T. xi, p. 798. t DIODOR. h cap. 82.
22 ANCIENT TIMES.<br />
acquainted with circumcision and castration. * In the<br />
EBERS papyrus the expression is used : " Restoration oi<br />
sight in the pupils at the back of the eyes," a passage which<br />
the editor has referred to the operation for cataract. The<br />
Cesarean section after the woman's death was perhaps<br />
first carried out in Egypt.f Can such things as these be<br />
learned from books ? The requisite skill for carrying out<br />
such operations can only be acquired by the man who frequently<br />
looks on at, and himself practises, the required<br />
manipulations. Again, bones reunited after fracture have<br />
been observed in mummies ; in their jaws artificial teeth<br />
have been discovered; and various surgical instruments<br />
have been found in tombs such as knives, scissors, lancets,<br />
forceps, probes, cupping apparatus of bullock's horn etc.<br />
* In ROSENBAUM'S edition of K. SPRENGEI.'S Gesch. d. Arzneikunde (Leipzig<br />
1846) Bd. i, S. 73 note; as in H. HAKSER'S Lehrbuch der Geschichte der<br />
Medicin (Jena 1875) Bd. i, S. 57, the remark is found that the Ancient<br />
Egyptians were acquainted with amputation. This statement depends upon<br />
LARREY who in his "Relation historique et chirurgicale de l'expe'dition de<br />
l'armee d'orient" .(Paris 1805), p. 45 note, writes: " Le genial Desaix<br />
poursuivit l'ennemi jusqu' au-dela. des cataractes et donna ainsi a. la commission<br />
des arts la facilit6 de visiter les monuments de la fameuse Thebes aux<br />
cents portes, les temples renommes de Tentyra, de Carnak et de Luxor, dont les<br />
restes attestent encore l'antique magnificence. C'est dans les plafonds et les<br />
parois deces temples, qu'on voit.des bas-reliefs representants des membres<br />
coupes avec des instruments trfcs-analogues a ceux dont la chiruroie s- sert<br />
aujourd' hui pour les amputations. On retrouve ces memes instruments dans<br />
lesh.eroglyphesetl'onreconnaitles traces d'autres operations chirurgicale. qui<br />
prouvent que la chirurgie dans ces temps recules marchait de front ave'c les<br />
autres arts, dont la perfection parait avoir
EGYPT. 23<br />
Anatomical teaching was not in any case associated with<br />
practical demonstrations on the human body. Since,<br />
according to the religious conceptions of the Egyptians the<br />
welfare of the soul depended upon the body being preserved<br />
with the greatest care, the dissection of the human subject<br />
was clearly not to be thought of.<br />
Even wounding the body was regarded with so much<br />
abhorrence that the operation which had to be performed<br />
upon the corpse before the embalming process brought<br />
hatred and contempt upon the operator who carried it out.<br />
This functionary had to take himself off and fly as soon as<br />
he had made the incision in the left side of the abdomen<br />
through which the intestines were removed, while at the<br />
same time he was pelted with stones by the relations and<br />
friends of the deceased ; a custom, which obviously must<br />
have been intended to typify the defence of the latter.<br />
The operators, on whom devolved these duties took a<br />
place in the social scale similar to that of our dissecting-<br />
room attendants. They possessed neither anatomical<br />
knowledge nor scientific interest of any kind, and were by<br />
the prevailing prejudice kept from making any investiga<br />
tions which their calling did not force upon them.<br />
The embalming of corpses exercised thus no beneficial<br />
influence upon the development of anatomical knowledge.<br />
This is apparent too in the strange, crude conceptions<br />
about the construction and composition of the human body<br />
which we find in the papyrus-rolls.*<br />
So the anatomical knowledge of the Egyptian doctors was<br />
certainly very small: they knew however that the heart<br />
is the seat of origin of the blood-vessels which are dis<br />
tributed from thence to all parts of the body : a fact which<br />
even a thousand years later was not generally understood<br />
and recognized. In the examination of the sick the<br />
Egyptian doctors were at pains " to investigate the beat of<br />
* See for example med. papyrus-roll, i, which has been described by CHABAS,<br />
Melanges Egypt, pp. 55-79, and by BRUGSCH : Recueil des monuments<br />
egyptiens, Leipzig 1863, Partieii, p. 101 et seq.
24<br />
ANCIENT TIMES.<br />
the heart "* and to test the nature of the urine. Thus they<br />
soon observed that the urine of the pregnant female is<br />
turbid and rich in precipitated matterf and they made use<br />
of this observation in the diagnosis of pregnancy. They<br />
attached great importance to dietetics and a reasonable<br />
regimen of life; they recommended cleanliness and temperance,<br />
baths, J- frictions and gymnastics for the preserving<br />
of health. The hygienic properties of sea-baths are said to<br />
have been known to them at an early period and used by<br />
them in the treatment of the poet EURIPIDES. § Frequent<br />
use was made of emetics, purgatives and clysters. In the<br />
medical papyrus-roll i". are found twenty-eight prescriptions<br />
for the preparation of clysters which were generally<br />
accepted by the ancients as an Egyptian discovery.||<br />
Prayers were combined with medical treatment in sickness,<br />
and were specially written for each case. In conformity<br />
with the priestly character of the doctors, they<br />
offered up these prayers themselves, and ascribed at least<br />
as much importance to them as they did to their medical<br />
directions. But seldom can there in those times have been<br />
such enlightened views as the Doctor NEBSECHT shows—in<br />
the novel "Uarda"by G. EBERS, that profound authority<br />
on life in ancient Egypt—where he delegates the singing<br />
of prayers to the old blind Pastophorus TETA.<br />
The Pastophori constituted a class of priests, vxho for the<br />
rest as G. EBERS has had the kindness to point out to me,<br />
neld by no means so low a rank as is attributed to them in<br />
historical works. The doctors were bound to maintain a<br />
spiritual character and allowed themselves therefore to<br />
rank with the Pastophori, although the higher priestly<br />
* Pap. EBERS, op. cit. i, p. 27) T. 45.<br />
t Med. papyr.-roll, i, in CHABAS, op. cit. p. 69.<br />
{ HEROD ii, 37, 38.<br />
a! 0 "<strong>T'</strong> LAERT> "!' 6 ; !t has been thou * ht that the *«* ES «f E<br />
(Iph. m Tau. v, „M) : 6dXaa
EGYPT. 25<br />
dignities probably remained open to them * On the other<br />
hand the Pastophori were by no means likewise doctors, as<br />
many think, but had as a body quite other functions as<br />
their name, indeed, indicates. The relation of the Pasto<br />
phori to the doctors was doubtless the same, as that of the<br />
scholar to the cleric in the Christian middle ages; all<br />
scholars did not belong to the Clergy but at the same<br />
time all clergymen might be considered scholars.<br />
Many doctors were members of the great priest-colleges<br />
and lived in the teaching-institutions belonging to the<br />
temples. They there taught medicine and carried on<br />
medical practice. It was to the interest of the priest-<br />
colleges that the ablest and most prominent representatives<br />
of the healing art should be selected for these positions,<br />
for their power was increased by the. number of the<br />
students and their renown by the successful cures effected<br />
in their temples.<br />
The doctors partook of the privileges and advantages<br />
which the priesthood in Egypt enjoyed. They were<br />
exempt from taxes and were maintained at the public<br />
cost. From the sick they received for their medical care<br />
no payment but presents : in any case they expected that<br />
at the completion of the cure offerings should be brought<br />
to the temple with which they were connected. Some<br />
times models of the parts of the frame which had been<br />
healed were hung up in the temple; the British Museum<br />
contains several of these. During war, or in the case of<br />
anyone falling ill upon a journey, the doctors were bound<br />
to render help gratis.f<br />
Whether there existed, in addition to the doctors par<br />
taking of the priestly character, other practitioners who<br />
learnt and practised their calling as Empirics is not certain<br />
but is. probable. The designation " Sunnu " (" one having<br />
knowledge ") was applied also to doctors. For the rest,<br />
the number of priest-doctors can hardly have been sufficient<br />
* The High priest of Sais bore the title " Chief of the Doctors."<br />
t DIODOR. i, 73, 82—HERODOT. ii, 37.
26 ANCIENT TIMES.<br />
for all requirements. When we are informed* that<br />
Egyptian doctors confined themselves to practice in<br />
particular departments of their profession and to the treatment<br />
of particular diseases, so that " one treated only<br />
affections of the eye, another those of the head or teeth or<br />
abdomen or internal organs," it is evident that only in<br />
populous districts can the existence of such specialities<br />
have been possible and the sick man have had it in his<br />
power to make a selection from a number of practitioners.<br />
In the great temples, the priest-colleges of which reckoned<br />
many doctors amongst their members, naturally enough one<br />
chose this, and another that, speciality : but in general such<br />
a sharp division of the healing art into departments was<br />
not carried out.<br />
Egyptian medicine exercised a great influence upon the<br />
medical science of Greece. The fame of it outlasted the<br />
political revolutions of later times and formed a historical<br />
background for those medical schools which raised Alexandria<br />
to a prominent place among the nurseries of scientific<br />
life in ancient times.<br />
THE JEWS.<br />
JEWISH civilization is^daughter of_that_of_Egypt, j Moses,<br />
the great lawgiver and teacher of the Jewish people was<br />
a pupil of the Egyptian priest-schools, and there studied<br />
medicine in addition to other arts and sciences, f On the<br />
Egyptian pattern he founded a priestly class among the<br />
Jews, which included the representatives of intelligence<br />
and learning. Its members were supported by the people<br />
and served them in turn as Priests, Teachers, Judges and<br />
Doctors. The Mosaic legislature regulated the lives of the<br />
people by precepts which were directed towards improving.<br />
their morals, their health, and their material welfare.. The<br />
prophylaxis of disease and a rational dietary were looked<br />
upon as the essential antecedent conditions. These ends<br />
* HERODOT. ii, 84.<br />
t CLEMENS ALEXANDRINUS : Stromat. Lib. i, cap. 153.
THE JEWS. 27<br />
were served by those laws which dealt with the care of the<br />
newly-born, the nourishing of the child, the regimen of<br />
the mother or nurse, the relation of the sexes (as for<br />
instance the laws touching on cohabitation w T ith menstrua<br />
ting women and the marriage between blood-relations) :<br />
by those relating to cleanliness, clothing, food, dwellings<br />
and places of burial: so too by the directions for recog<br />
nizing leprosy or certain sexual afflictions, and for prevent<br />
ing their extension.* 'People sought for the relief of sick<br />
ness by means of prayers and offerings, thus appealing to<br />
the theurgical character of Jewish medicine, according to<br />
which all affections were looked upon as scourges sent<br />
from God. In addition however dietetic and medical<br />
remedies were employed.f For skin-eruptions J the priest-<br />
doctors recommended above everything the separation of<br />
the sick from the healthy, most scrupulous cleanliness and<br />
frequent baths.<br />
They were acquainted also with the use of medicinal<br />
springs. And the favourable influence exercised by music<br />
in many cases of psychical disturbance was known.§ For<br />
fractures they applied bandages. || Castration was per<br />
formed in two ways either by crushing or excision of the<br />
testes. And their performance of the operation of cir<br />
cumcision shows that the Jewish priest-doctors possessed a<br />
certain dexterity in surgery.<br />
Mention was made of midwives while the Jews were still<br />
undergoing captivity in Egypt. Their practice is described<br />
* Exod. ii, 15. 26; xix, 6; xxii, 31. Lev. vii, 23; xi. xii. xiii. xiv. xv.<br />
xvi. xviii. xix. xx, 18. Num. xii, 15; xvi, 41. Deut. xiv, 21; xxviii, 27,<br />
58-61. Ezek. xvi, 4, etc.<br />
t Cf. TRUSEN : Darstellung der biblischen Krankheiten, Posen 1843, s. 1.<br />
J. B. FRIEDREICH : Zur Bibel, Niirnberg 1848, i, s. 41 et seq., 193 et seq. R. J.<br />
WUNDERBAR ; Biblisch-talmudische Medicin, Rigaund Leipzig 1850, H. 1, S. 8<br />
et seq., 73 et seq.<br />
% By this general expression the term Zaraat is more properly translated than<br />
by Leprosy as it usually is.<br />
§ 1 Sam. xvi, .23.<br />
|| Ezek. xxx, 21.
28 ANCIENT TIMES.<br />
in several passages with realistic completeness.* King<br />
Solomon manifested great interest in the natural sciences,<br />
especially in medical science, and is said himself to have<br />
been.the author of a book on the subject.t During his reign<br />
the influence of foreigners especially of the neighbouring<br />
Phoenicians made itself extensively felt. Still more did<br />
this become the case as the Israelitish people lost their<br />
national independence. Their political fortunes brought<br />
them into close relations with the Assyrians, Babylonians,<br />
Chaldees, and Persians and afforded their learned men<br />
opportunities of becoming acquainted with the acquisitions<br />
of. these peoples in the domain of culture and of making<br />
them their own. They thus gained a broad view of the<br />
spiritual development of man and became freed from those<br />
narrow-minded prejudices which were a result of their<br />
somewhat cramped political surroundings. From this,<br />
medical science drew the advantage that professional<br />
practice ceased to be a monopoly of the priests.J From<br />
this time forth besides them not only the Laity practised<br />
the healing art but doctors were applied to who did not<br />
even belong to the Jewish faith. In this respect people<br />
went so far at a later period as to permit even the rite<br />
of circumcision to be performed by a non-Jewish doctor<br />
when an Israelitish operator was not at hand.§ In<br />
the same way it was held obligatory on Jewish doctors to<br />
extend medical aid to persons of other faiths. They might<br />
claim payment for their services,|| and were esteemed and<br />
'lonoured by their fellow-citizens.f They were taken into ;<br />
council by the authorities on questions of sanitary adminis- 1<br />
tration and medical jurisprudence. Later on, each town<br />
was compelled to have a medical officer and sometimes 1<br />
* Gen. xxv, 24-26; xxxviii, 27-30. Exod. i, 15-21.<br />
t SUIOAS: Ezekias.<br />
t SVBRAND: Diss. hist. med. de necessitate quee fuit apud veteres inter religionem<br />
et medicinam, Amstel. 1841, p. 28 et seq.<br />
§ Talmud Tr. Menachoth, 42*.<br />
I Exod. xxi, 19,<br />
If JESUS SIRACH, xxxviii, 3.
THE JEWS. 29<br />
also a surgeon in addition. Besides other duties they<br />
were bound to carry out circumcision. Special doctors<br />
were appointed for the priests who in consequence of<br />
their ceremonies in the Temples involving cold baths,<br />
light clothing, walking with bare feet on the cold stones<br />
and fasts, were much predisposed to abdominal diseases*<br />
Although the medical profession was open—to-all, yet<br />
those connected with the priesthood seem especially to have<br />
devoted themselves to it, as appears from the information<br />
at our disposal. Medical science on account of its intimate<br />
relation with the religious and social legislation of the Jews<br />
was surely drawn into the domain of education in the Priestschools<br />
as in the Prophet-schools which were frequented<br />
by full-grown youths. Certain prophets, as for instance,<br />
ELISHA were famous for their successful cures. Who ever<br />
aspired to be considered a learned man was obliged to be<br />
possessed of some medical knowledge. This, indeed, was<br />
a part of general education and was sought after by those<br />
who desired to occupy a prominent position in public life.<br />
The technical training of doctors was effected through the<br />
personal instruction of pupils by a teacher who was practised<br />
and experienced in the healing art. As to the nature of<br />
this teaching and the appliances used in it, we unfortunately<br />
possess no information in regard to the earlier<br />
times but only in regard to the later—the Talmudic period.<br />
The Talmud, the origin of which dates from the first century<br />
after Christ, contains a number of expressions borrowed<br />
from the vocabulary of the Greek tongue, especially its<br />
medical terminology, and even directly refers to a connection<br />
with the medical science of the Greeks. Talmudic<br />
medicine lacks originality and is supported chiefly by the<br />
teaching of Greek doctors.? The anatomical knowledge<br />
of the Talmudists, of whom some distinguished themselves<br />
as doctors, does not rise above that which had been pro-<br />
* Talmud Tr. Schekalim v, 1,2.<br />
f J. BERGEL (Die Medicin der Talmudisten, Berlin u. Leipzig 1885) attacks<br />
this asserted connection but is able to adduce no facts in support of his views.
ANCIENT TIMES.<br />
pounded by GALEN. Their observations on the development<br />
of the foetus deserve notice, especially as to the formation<br />
of the bones. With this aim, they betook themselves to<br />
the dissection of the human body. Thus it is narrated in<br />
the Talmud that the pupils of Rabbi ISMAEL BEN ELISHA<br />
studied the individual bones on the corpse of an unfortunate<br />
woman, who had suffered the penalty of death, and<br />
that Rabbi ISMAEL examined the foetuses of certain pregnant<br />
female slaves, who, with this object in view, were put to<br />
death during their pregnancy* At the same time the<br />
Talmudic philosophers endeavoured by dissections of<br />
animals to enlarge and confirm their anatomical knowledge.<br />
They recognized the important bearing which<br />
observations and examinations made on animals have on<br />
medical knowledge and they drew definite conclusions<br />
from this method of research.<br />
In this way they found out that wounds of the kidneys<br />
are not always fatal and that the spleen can be removed<br />
and even the uterus cut out without the death of the animal<br />
resulting.t The doctors performed amputations and were<br />
acquainted with the use of artificial feet and legs,J were<br />
skilled" in the treatment of fractures and dislocations,<br />
healed umbilical rupture in the newborn by a compression<br />
bandage and in retention of the placenta removed it by<br />
art, operated on urinary fistula, made observations on<br />
hermaphroditism, referred to the fact that the descent of<br />
the testes is sometimes not completed, and published some<br />
valuable experiences upon injuries of the internal organs :§<br />
especially so in observing that injury to the spinal cord in<br />
animals is followed by paralysis of the hind-legs. They<br />
possessed a great number of surgical instruments and<br />
* J. M. RABBI.NOWICZ: La Me'decine du Thalmud, Paris 1880, p. 75.—RAB-<br />
BINOWICZ: Einleitung in die Gesetzgebung und Medicin des Talmuds, deutche<br />
Ubers. 1883, S. 250.—Talmud Tr. Bechoroth, 45*.<br />
t RABBI NO WICZ p. crt.-Talmud Tr. Sanhedrin 31, 33* u. 93", Bechoroth<br />
28 b .<br />
% WUNDEHBAR op. cit. iv, S. 66-68.<br />
§ RABBINOWICZ op. cit. S. 258 etseq.
THE JEW'S. 31<br />
appliances * and showed themselves dexterous and ex<br />
perienced in operative midwifery; they were acquainted<br />
with several causes of abortion, undertook embryotomyt<br />
and carried out the Caesarean section on the dead and on<br />
the living.:}; The Talmudic philosphers devoted an ardent<br />
study to the medical writings of the Greeks, and made<br />
their scientific acquisitions accessible to the doctors of the<br />
Jewish people. The medical science of Greece had already<br />
by that time become the common property of the whole<br />
civilized world. The Jews possessed at that epoch cele<br />
brated high-schools at Tiberias, Sura and Pumbeditha, in<br />
which, as before in the prophet-schools, medicine was<br />
probably taught at least in its general outlines. Teaching<br />
lasted only for part of the year: during the remainder the<br />
students went about their business in order to supply<br />
themselves with the necessary means to support life.§<br />
Among them were to be found, mechanics, merchant-folk,<br />
and perhaps doctors who were anxious to acquire from the<br />
teachers of the high schools scientific foundations for their<br />
observations. And conversely the teachers themselves,<br />
who were only at home in theoretical subjects, sought<br />
eagerly for information from experienced practitioners<br />
upon doubtful and difficult points of practice. || Many<br />
doctors seem to have undertaken the treatment of both<br />
internal and external affections, while in other instances<br />
they only devoted themselves to either the one or the other<br />
branch of medical science. Whosoever wished to practise<br />
as a doctor had to obtain the permission of the magistrates<br />
* WUNDERBAR (op. cil. i, S. 50-56) enumerates 56 distinct kinds, among<br />
them knives, scissors, probes, lancets, cupping instruments of horn, perforators,<br />
portable commodes, spoons, sieves, etc.<br />
f Talmud Tr. Bechoroth 46% Nidah 19.<br />
t On the meaning of Joxe dophan see also VIRCHOW'S Archiv Bd. 80, H. 3,<br />
S. 494. Bd. 84, H. 1, S. 164. Bd. 86, H. 2, S. 240. Bd. 89, H. 3, S. 377.<br />
Bd. 95, H. 3, S. 485.—A. H. ISRAELS in d. Ned. Tijdschr. v. GENEESK 1882,<br />
p. 121 et seq.<br />
§ P. BEER : Skizze einer Geschichte der Erziehung und des Unterrichts bei den<br />
Israeliten, Prag. 1832, S. 55.<br />
I Talmud Tr. Nidah 2i b .
32 ANCIENT TIMES.<br />
of the place in which he wished to settle. " No one may<br />
practise the healing art however fully qualified he may be<br />
without the permission of the Beth-Din (the couacil of the<br />
town) and whoso practises without such permission, even if<br />
fully qualified, is culpable."* Whether this permission<br />
was granted after examinations, and if so of what character<br />
these were, is unknown to me. In the following centuries<br />
Jewish medicine was merged completely into that of the<br />
other nations. Jewish doctors and philosophers exercised<br />
a beneficial influence upon the scientific development of<br />
medical science, especially in the middle ages, and have, at<br />
every period, maintained a prominent position in this<br />
domain of knowledge.<br />
THE PARSEES.<br />
ONLY very sparse accounts have been handed down to us<br />
concerning the medicine of the ancient Persians. With<br />
them, also, the healing art stood in intimate relation to<br />
culture, and the priests and Magi practised it. The general<br />
conception was that diseases, which were called into existence<br />
by evil spirits, could be dispersed by conjurations and<br />
prayers. With these many superstitious ceremonies were<br />
combined; here magic celebrated its marriage with medicine,<br />
t THRITA, a hero celebrated by tradition who later<br />
on was added to the celestial spirits, was considered the<br />
first doctor whose privilege it was to remove diseases and<br />
to subdue the demons who sent them. He was worshipped<br />
on this account as the patron and guardian of doctors and<br />
so to speak as the god of the art of healing. The<br />
religious law-books of the ancient Persians recommended<br />
purity of mind and body as the best medicine to ward off<br />
sickness. Sexual excesses were threatened with severe<br />
punishment. In the same way the induction of abortion<br />
was forbidden. As to the treatment of diseases we learn<br />
that in addition to prayers and medicines, of which they<br />
* WU " DI " BAR : * cit - ! > S ' 36- t PUNY : hist. nat. xxx, ,.
THE PARSEES. 33<br />
vere acquainted with a great number from the vegetable<br />
:ingdom, the knife too came into use. Those who cured<br />
liseases .by prayer alone were looked upon as the most<br />
sxcellent doctors ; they were, so to speak, " doctors of<br />
[2£tors/[ Then came those who ordered medicinal herbs<br />
md the lowest place was assigned to those who handled<br />
he knife.* Whoever wished to be a doctor was obliged to<br />
>ractise first of all among the lowest despised classes. So<br />
oon as he had accomplished three satisfactory cures upon<br />
nembers of these classes, he was at liberty to practise<br />
imong the higher grades of society. But if the three<br />
est-patients died he was never allowed to become a<br />
loctor. As in ancient Egypt so here too the doctors<br />
>ractised the veterinary art as well as their own. There<br />
vas a kind of medical-taxation regulated in accordance<br />
vith the position and wealth of the patients. From a priest<br />
he doctor might demand nothing further for his services<br />
han a benediction ; on the other hand from the chief of a<br />
>rovince he received four oxen, from his wife, a female<br />
:amel; from the chief of a town, a large draught-horse,<br />
rom his wife, a mare ; from the head of a village, a medium-<br />
iized draught-animal, from his wife, a cow ; from a house<br />
holder, a small draught-animal, from his wife, a she-ass. In<br />
ike manner it was ordained how much he should demand<br />
or the treatment of the various domestic animals.f<br />
This fragmentary information supplies us with no in-<br />
ormation regarding the medical knowledge or professional<br />
caching among the ancient Persians, and enables us to<br />
orm no settled opinion as to the state of medical science<br />
imongst them. In any case, their doctors were later on<br />
.urpassed in skill by their Egyptian and Greek colleagues,<br />
or the Persian kings caused doctors from these countries<br />
o repair to their courts.<br />
* Vendidad vii, 118-121. t Ibid, vii, 105, 117.
34<br />
ANCIENT TIMES.<br />
THE GREEKS BEFORE HIPPOKRATES.<br />
THE earliest information concerning the medical science of<br />
the Greeks is veiled in mythical surroundings. In these<br />
APOLLO appears as a god sending diseases and pestilences<br />
but also vouchsafing the remedies to cure them and control<br />
their power for evil. When, later on, the several characteristic<br />
powers and attributes of this god of Light,—who in<br />
the worship of a primitive people obvipusly represented the<br />
Sun were personified and obtained separate representatives,<br />
ASKLEPIOS assumed the character of the God of the<br />
healing art. Tradition spoke of him as the son of<br />
APOLLO, in order to give expression to the intimate<br />
relations of the two. Enlightened Greeks of a later age<br />
explained this in an allegorical manner when they said:<br />
" If ASKLEPIOS is the air,—indispensable to the health of<br />
man and beast, yet APOLLO is the sun and rightly is he<br />
called the father of ASKLEPIOS, for the sun by his yearly<br />
course makes the air wholesome."* HOMER and PlNDAR<br />
celebrate the cures of ASKLEPIOS ; but neither they nor<br />
HESIOD call him a god. How the fame of his cures, preserved<br />
by legend and enlarged by posterity gradually led<br />
to his apotheosis, unfortunately no information has been<br />
handed down to us. Later on, temples were erected to<br />
him, and by fervent worshippers powers ascribed to him<br />
similar to those of ZEUS the creator and preserver of all<br />
things. The poets, who, as HERODOTUSt says, found<br />
serviceable material in mythology, adorn the narratives of<br />
the birth and life of ASKLEPIOS with their rich fancy.<br />
PlNDAR states that he was instructed in medical science by<br />
the centaur CHEIRON : he was taken to CHEIRON " that he<br />
might teach him the ways of healing diseases which bring<br />
many woes on mankind. All who approached him suffering<br />
from ulcers arising from internal causes, those too whose<br />
members were injured by the sword or by the stone slung<br />
* PAUSANIAS vii, 23. t HERODOT. ii, 53.
THE GREEKS BEFORE HIPPOKRATES. 35<br />
from afar and those again whose bodies were enfeebled by<br />
excessive heat and cold; all these he delivered from their<br />
multifarious ills : on some using gentle incantations, giving<br />
others refreshing drink or applying soft healing salves to<br />
:heir wounds : some also he cured by operation."*<br />
By ASKLEPIOS stood his wife EPIONE the "Pain-Soother"<br />
ind his daughters HYGIEIA, JASO and PANAKEIA whose<br />
illegorical significance is seen in their names. These all<br />
issisted him. Doubtless, there is more historical truth<br />
:ontained in the statement that he had two sons, MACHAON'<br />
ind PODALIRIOS, to whom he transmitted his acquirements<br />
n the healing art. They were numbered among the suitors<br />
)f HELEN and proceeded to Troy with the Grecian armies<br />
is commanders of the Thessalian warriors from Trikka,<br />
thome, and Oichalia. They were considered as dexterous<br />
n the art of war as in that of medicine, and were on<br />
everal occasions called upon by their comrades in arms to<br />
dve professional counsel and help.f MACHAON made<br />
limself chiefly prominent as a surgeon, while PODALIRIOS<br />
listinguished himself in the treatment of internal diseases.<br />
^.s in the Iliad, so too in the vEthiopis of the poet<br />
^RKTINOS which was composed soon after the former poem<br />
>ut is now only extant as a fragment, allusion is made to<br />
his separation of the two chief branches of medical<br />
cience, in the words : " then ASKLEPIOS bestowed the<br />
ower of healing upon his two sons, nevertheless he<br />
:iade one of the two more celebrated than the<br />
ther : on one did he bestow the lighter hand, that he<br />
light draw missiles from the flesh and sew up and heal<br />
11 wounds ; but the other he endowed with great precision<br />
f mind so as to understand what cannot be seen, and to<br />
eal seemingly incurable diseases.":];<br />
It is noteworthy that here internal medicine was given<br />
le preference. This opinion remains to the present day,<br />
* PINDAR Pyth. Od. 3, 80-95.<br />
t Dionoit. iv, c. 7 1.<br />
1 F. G. WELCKKR : Kleine Schriften, Bonn 1850, Bd. iii, S. 47.
3 6<br />
ANCIENT TIMES.<br />
and must have originated in the fact that the recognition<br />
and cure of internal diseases appears more difficult and<br />
wonderful to the laity than the. treatment of external<br />
injuries, the cause and seat of which are, in most cases,<br />
apparent to everyone.<br />
The healing art of those early periods of Greek history<br />
was limited essentially to extracting arrows and lancepoints,<br />
arresting bleeding, alleviating pain, and applying<br />
bandages. In the Iliad a great number of wounds of<br />
various kinds are described, and the methods of treatment<br />
which were applied to them illustrated.* MACHAON and<br />
PODALIRIOS are not the only doctors mentioned in the<br />
heroic poems of HoMER.f ACHILLES, PATROKLOS, and<br />
other military commanders and warriors were renowned<br />
for their healing powers. Many of them owed their knowledge<br />
on the subject to CHEIRON,! " the Man of the<br />
Hand." They made use of these acquirements for the<br />
welfare and assistance of their men, just as other heroes<br />
gladdened their men's spirits by their power of song; but<br />
they did not use the healing art as a calling or for pay.<br />
The instruction in medical science took place under the<br />
personal supervision of a teacher who united in himself<br />
knowledge and experience. The father imparted<br />
his medical lore to his sons, and these in turn bequeathed<br />
their art to their progeny.§ This fact appears<br />
to lie at the root of those legends which suggest that<br />
medical acquirements were confined to the relations of<br />
CHEIRON and ASKLEPIOS, and were preserved by them as<br />
precious family legacies. As the professional fame of the<br />
descendants of ASKLEPIOS became more and more widely<br />
* Ilias iv, 190. v, 73-75, 112, 694. xi, 349-60, 397, 846. xiii. 438-45.<br />
xiv, 409-439. xv, 394. Cf. DAREMBERG: La Me'decine dans Homere, Paris<br />
1865. H. DUNBAR : The Medicine and Surgery of Homer, Brit. Med. Jour.<br />
Lond. 1880, 10 Jan.<br />
t Bias xiii, 213. xvi, 28..<br />
t Bias iv, 219. xi, 831. Panofka in den Sitzungsber. d. Akad. d. Wiss. zn<br />
Berlin, Philos-hist. Kl. 1843, s - 269 et seq.<br />
§ PI.ATO,: jderepubl. x,c. 3.
THE GREEKS BEFORE HIPPOKRATES.<br />
spread, and a thankful generation began to attribute the<br />
honour of godhead to their ancestor, it may easily have<br />
arisen that other practitioners took to giving themselves<br />
out as members of the family, and in possession of the<br />
family secrets. So gradually there became developed a<br />
professional class tracing its origin from ASKLEPIOS.<br />
The Asklepiadae, the putative descendants of this mythical<br />
ancestor of Greek doctors, united, later on, into societies<br />
which celebrated their mutual relations by offerings made<br />
in common and by religious festivals. An inscription<br />
found in the, ruins of the temple of ASKLEPIOS at Athens,<br />
and published by GlRARD,* and which KOHLER ascribes to<br />
the first half of the third century, establishes the fact that<br />
these w r ere ancient"customs. The Asklepiadae were moreover<br />
doctors bound together in a guild and by no means<br />
identical with the priests who were established at the<br />
temples of ASKLEPIOS as K. SPRENGEL and other medical<br />
historians have erroneously thought.<br />
The most ancient sanctuaries of ASKLEPIOS were situated<br />
at Trikka in Thessaly, at Titane, Tithorea, Epidauros, on<br />
the Island of Kos, at Megalopolis, in Knidos, Pergamus,<br />
Athens,t and other places. Here the god of the healing art<br />
was worshipped and approached by the sick who implored<br />
at his hands a deliverance from their maladies. In connection<br />
with the temples where the religious service was held ?<br />
were dwelling-places for the priests and. attendants of the<br />
temple, and large covered' and pillared halls which served<br />
as places of retreat for the pious pilgrims and the helpless<br />
sick.J<br />
The Asklepieia were generally distinguished for their<br />
healthy situation and cheerful surroundings. They were<br />
* P. GIRARD: " L'Ascle'pieion d'Athenes d'apres de re'centes de'couvertes " in<br />
the Bibliotheque des ecoles francaises d'Athenes et de Rome, T. 23, p. 85,<br />
Paris 1881.<br />
"t JOH. HEINR. SCHULTZE mentions in his Historia Medicinae (Lips. 1728),<br />
p. 118-125, a great number of Asklepieia and names the authors by whom they<br />
are mentioned.<br />
% PAUSANIAS ii, c. 11, 27 et seq. x, 32, and GIRARD op. cit. p. 5.
3 ANCIENT TIMES.<br />
lilt in a fertile region on mountains or hills in the<br />
cinity of forests and woods which protected them from<br />
jurious winds and evil epidemic influences and by the<br />
de of streams and springs yielding a fresh, sweet-tasting<br />
ater.* Some had salubrious thermal and mineral springs<br />
great celebrity for the cure of disorders. These<br />
mples of health were surrounded by pleasant well<br />
ired-for gardens, in which fresh water was continually<br />
wing, and contained in their interior statues, frescoes,<br />
id votive offerings of all sorts. By the side of statues of<br />
SKLEPIOS and other deities were memorial tablets keep-<br />
g alive the fame of celebrated doctors as favourites of the<br />
)ds.f<br />
Stringent rules provided that these sanctuaries should be<br />
ipt clean and free from anything which might endanger<br />
eir sanitary condition. On the gate of the temple at<br />
Didauros were inscribed these words : " Whoso desires to<br />
iter here, must possess a pure spirit."J There, as strictly<br />
in Delos, it was forbidden that a birth a burial or a<br />
emation should take place in the precincts of the temple.<br />
/en if a patient died there the sanctuary was held to be<br />
filed. The persons who sought relief were compelled to<br />
•serve scrupulous cleanliness, to bathe in the stream, in<br />
e sea, or at the fountain, and to fast and abstain from wine<br />
certain number of days before venturing to approach the<br />
mple or to make prayers or offerings to the deity.<br />
veet-smelling vapours which arose from the fumigations<br />
ed the air, and the song of priests extolling the might<br />
d power of the god of healing entranced the soul. Con-<br />
rsation with fellow-sufferers whom the patients met in<br />
2 halls of the temple, and the sight of the numerous<br />
tive tablets and inscriptions telling of happy restora-<br />
ns to health which had occurred in the place, imparted<br />
nfidence and hope. Willingly did they therefore submit<br />
* PAUSANIAS iii, 24. viii, 32. VITRUV. : dearchit. i, c. 2.<br />
+ ANAGNOSTAKIS in the Bull, de corn hellen: i, p. 212, pi. ix.<br />
J CLEMENS ALEXAND. : Stromat. v, c. i, 13.
THE GREEKS BEFORE HIPPOKRATES. 39<br />
to the injunctions of the priests and with painstaking care<br />
follow their orders.<br />
As in the famous Amphiaraion and in other ancient<br />
oracular places so too in the temples of ASKLEPIOS means<br />
of cure were suggested by dreams. The sufferers slept<br />
during the night in the hall of the temple and awaited the<br />
dreams in which the deity should reveal himself to them.<br />
When, in them, the treatment of their malady was not<br />
clearly and plainly pronounced, they told the substance<br />
of their dreams to the priests and their assistants, who<br />
expounded the same to them, naming the remedy they<br />
were to apply. If the patient on the first night had no<br />
dream at all, he passed another and if necessary a third<br />
night in the Asklepieion. If dreams refused to come to<br />
him altogether, he begged the priest or some other<br />
man of a pious disposition to sleep there for him and to<br />
dream. This method of consultation by deputy was<br />
already customary at oracles* and led, later on, to deceit;<br />
for cunning speculators, like many spiritualistic mediums<br />
of the present day, turned the intercourse with celestial<br />
beings into a profitable business.! The deceit was of<br />
a still grosser kind when the priests appeared at night<br />
in the mask of the god to the visitors at the temple in<br />
order to make them believe they had been dreaming.<br />
ARISTOPHANES has represented this in his comedy of Plutos<br />
in an exceedingly droll manner.J<br />
The remedies which were enjoined were—at least in the<br />
more ancient times—rather of a dietetic and psychical than<br />
of a strictly medical character. Many of the methods of<br />
cure recommended were thoroughly rational § and highly<br />
adapted to bring about a successful issue. W T hich may<br />
* HERODOT. viii, c. 134.<br />
t Cf. the biography of APOLLONIOS of Tyana by PHILOSTRATOS i, 89. iv, 1.<br />
% v, 620 et seq.<br />
§ Cf. VERCOUTRE: "La Medicine sacerdotale dans l'antiquite grecque " in<br />
the Re-vue Archeolog, Paris 1885. Ser. iii, T. 6, p. 285 etseq.-v. WILLAMO-<br />
WITZ-MOELLENDORFP: Die Kur des M. J. Apellas, in dessen PhiloK Untersuchungen,<br />
Berlin 1886, H. 9, S. 116 et seq.
4°<br />
ANCIENT TIMES.<br />
be explained in this way that the dream-pictures giving<br />
expression to the predominant, sometimes the single, subject<br />
of interest in the mind of the sleeper, drew forth from<br />
the depths of his soul some half or wholly forgotten<br />
reminiscences of happy cures effected.<br />
When the dreamers failed then the priests came to their<br />
aid. The latter having by tradition and personal experience<br />
acquired some medical knowledge of their own were able<br />
to help the sick with counsel and explanation. When<br />
they got either no result at all or an unfavourable one,<br />
they withdrew themselves by sophistical artifices from the<br />
painful position.*<br />
The priests of the temples of Asklepios were not<br />
doctors, as many assume. Certainly there were among<br />
them as among their assistants the Zakoroi, many who<br />
were skilled in medical science,t indeed they had probably<br />
learned the subject systematically. But between the<br />
healing art as practised in the Asklepian temples and<br />
that of the professional doctors the great distinction existed<br />
that in the former case it was held to be not a fruit of the<br />
human understanding, but a divine revelation. Medical<br />
interference must from this circumstance here have<br />
appeared at least superfluous. On this ground it is not<br />
probable that between the priests of Asklepios and the<br />
doctors there existed any competitive or unfriendly relations.!<br />
It is much more reasonable to take the contrary<br />
for granted, when one considers what humble reverence<br />
both doctors and Asklepiadae paid to the sanctuaries of<br />
Asklepios, and what submissive trust they reposed in his<br />
imagined utterances in doubtful cases of their practice.<br />
The Asklepiadae settled down by preference in the<br />
neighbourhood of the Temples dedicated to Asklepios and<br />
founded medical schools there. Among these, those which<br />
were situated at Rhodos, Kroton, Kyrene, Kos and Knidos<br />
* ARTEMIDOR: Oneirocrit. v, 94.<br />
t GIRARD op. cit. p. 34.<br />
| MALGAIGNB in the "Journal de Chirurgie," Paris 1846, iv, p. 340.—CH.<br />
DAREMBERG in the " Revue Archeol.,' Paris 1869, T. 19, p. 261 et seq.
THE GREEKS BEFORE HIPPOKRATES. 41<br />
•acquired the highest reputation. A noble spirit of emula<br />
tion was established among them which favoured the<br />
development of medical knowledge.* So too must the<br />
fact that the Asklepiadae were constant frequenters of the<br />
temples, where they saw maladies of all kinds, heard of<br />
successful cures and the means employed to effect them,<br />
and read the thanksgivings left on record by the cured,<br />
have operated powerfully upon them and increased their<br />
professional knowledge and experience.<br />
The schools of the Asklepiadae were societies of doctors<br />
who subscribed to the same theories and corresponded<br />
rather to our Academies than to the departments of Univer<br />
sities. The training of doctors was carried on by the same<br />
methods as in the most ancient times, the teacher impart<br />
ing to one pupil or more the knowledge and skill required<br />
for the practice of medicine. In the admission of students<br />
no limitation was miade, as in former times, to scions of<br />
families deriving their origin from Asklepios,t and if the<br />
Asklepiadae sought by keeping registers of their pedigrees<br />
to preserve this belief, they only wished in this way to<br />
assert that the healing art of their ancestor Asklepios was<br />
transmitted by them pure and unadulterated.J On a like<br />
ground they enjoined on their students strict secrecy con<br />
cerning the subjects taught them and forbade them to<br />
•impart their knowledge to others, not of the Asklepiadae -<br />
guild.§ Similar rules were made by other learned societies<br />
to prevent the profanation of their secrets especially where<br />
a religious bond held them together as, in this case, the<br />
common worship of Asklepios.<br />
Medical teaching began in early youth. If the father was<br />
a doctor he naturally was the first teacher of the son who<br />
devoted himself to medicine : he then both sought for and<br />
* GALEN : Ed. Kiihn, T. x, p. 5.<br />
t GALEN op. cit. T. ii, p. 281.<br />
X For the rest, the still existing fragments of the genealogical tablets of the<br />
Asklepiadae, are of a later period and consequently have no claim to authenticity.<br />
TZETZES (12th century post Christ.): Histor. var. chil. ed. Th. Kiessling. Lips.<br />
1826, p. 276, v. 944-989.<br />
§ HIPPOKRATES : Ed. Littre', T. iv, p. 642.
4 2 ANCIENT TIMES.<br />
found opportunities for further practical training amongst<br />
other skilful doctors. The teacher imparted to the pupils<br />
his opinions concerning the structure and functions of the<br />
body, explained to them the origin of sicknesses and brought<br />
them to the bedside and there pointed out to them the symptoms<br />
of the various maladies and their treatment. The<br />
pupils were obliged to pay* an honorarium for their instruction<br />
and to teach the sons of their teacher the healing art_<br />
without remuneration. When the training of the student<br />
was finished, he was received into the Society of the Asklepiadae<br />
on taking the following oath :f—" I swear by Apollo,<br />
the Healer, by Asklepios, by Hygieia and Panakeia and by<br />
the other gods and goddesses and call them to witness,<br />
that I will hold to this my oath with all my strength and<br />
capacity. I will revere him who has taught me the healing<br />
art as I do my parents, sharing my means of living with<br />
him and caring for his wants. His children shall be treated<br />
by me like my brothers and sisters; and his sons, should<br />
they wish to learn the healing art, will I teach without<br />
payment or indebtedness on their part. The professional<br />
rules and all that I have heard and learned of the healing<br />
art, will I impart to my own sons, to the sons of my<br />
teacher and to my pupils who, in accordance with the<br />
professional law, have been consigned and bound to me<br />
for that purpose; but beyond these, to none. The way of<br />
living of the sick, as far as I am able and know, will I<br />
regulate for their good and protect them from injurious<br />
and unwholesome influences. Never will I give a deadly<br />
drug, not even if I am asked for one, nor give any advice<br />
tending in this direction. Neither will I at any time give<br />
to a woman any drug or instrument for the purpose of<br />
causing abortion. Purely and holily will I spend my life<br />
and possess my art. Castration will I not carry out J even<br />
* PLATO: Menon c. 27. Protagoras c. 3.<br />
t HIPPOKRATES op. cit. T. iv, p. 628-632.<br />
t The words : obrefj.iuj Si ouSe /j.^v\i9tiAjvTaQ have at all times afforded great<br />
difficulty to commentators and translators. They mostly think that the person<br />
taking the oath binds himself not to perform lithotomy. By this explanation
THE GREEKS BEFORE HIPPOKRATES. 43<br />
on those who suffer from stone, but leave this to those<br />
people who make a business of it. When I enter a house<br />
it shall be for the purpose of healing the sick. I will do<br />
wrong to no one intentionally nor inflict any injury, and I<br />
wifl never incite to unchastity either women or men, bond<br />
or free. Whatever I, in my medical practice or out of it<br />
may hear or see in respect of the private life of men, if<br />
such ought not to be publicly known, thereon will I observe<br />
silence and secrecy. May it be my lot, observing and not<br />
breaking this oath, to make full use of my life and art and<br />
to earn an enduring reputation among men. If, however,<br />
I break my oath and am forsworn, may the opposite happen<br />
to me." From the tenor of this oath, which without doubt<br />
belongs to the Ante-Hippokratic period, it is clear that castration,<br />
which was undertaken in order to supply eunuchs, was<br />
left to those people who undertook the performance of<br />
however, the ovSs fif,v of the text is superfluous and disturbing to the sense since<br />
lithotomy could only have been undertaken in the case of those suffering from<br />
vesical calculus. LITTRE conjectured therefore that ufriovrag should be substituted<br />
for XiQtwvrac, so the translation should run : " I will not perform lithotomy even<br />
if the patients request me." But perhaps the passage does not refer exclusively<br />
to lithotomy: for the doctors of that period were not at all shy of undertaking<br />
other operations and busied themselves also with the investigation and treat<br />
ment of diseases of the bladder. (HIPPOKRATES op. cit. T. vi, p. 150.)—The<br />
view of R. MOREAU, CHARPIGNON and others has greater authority, that it is a<br />
question in this passage of the forbidding of castration ; for this appears in<br />
close connection with other disgraceful things, for instance the giving of poisons,<br />
procuring abortion, etc. Moreover the word TE/XVEIV occurs in this sense in<br />
Greek literature, though it is true the compounds kurk^vuv and airoriiiv^v<br />
were used with this meaning more frequently. The immediately following<br />
oide iirjv XiQiwvrac means then, that castration is not permitted even in those<br />
suffering from stone although the considerations against it must have been<br />
less in such cases, since lithotomy by the methods of operating then in use<br />
generally resulted in incapacity for sexual intercourse in consequence of the<br />
destruction of the seminal ducts. Moreover \tfi*v has also the meaning " to<br />
suffer from a swelling of stony hardness," and according to TH. GOMPERZ is<br />
used, in this sense, of indurations in the eyelids, joints, uterus, etc. Perhaps<br />
reference is here made to the testes and the passage in question must be trans<br />
lated: "I will not perform castration even in those who have indurated testes."<br />
— Cf. CHARPIGNON: fitude sur le serment d'Hippocrate, Orleans and Paris<br />
1881.-TH. PUSCHMANN in Bursian's Jahresber. f. Alterthumswissenschaft<br />
1884, iii, p. 55, and in the Jahresber. iiber. d. Fortscher. d. ges. Medicin,<br />
herausgeg. v. VIRCHOW U. HIRSCH. 1883, i, S. 326.
44 ANCIENT TIMES.<br />
this operation as a matter of business. Perhaps other<br />
branches of surgery, for instance cystotomy and the treatment<br />
of fractures and sprains, were practised by empirics<br />
who had acquired great skill and certainty therein.* At<br />
any rate we are permitted to assume that in addition to<br />
the Asklepiadae there were other doctors who did not<br />
belong to their association.f It was at a later period that<br />
all doctors were called " Asklepiadae."<br />
The Philosophers exerted great influence upon the development<br />
of medical science and especially upon the training<br />
of practitioners. The mode of Greek thought which sought<br />
to fathom the origin and essential characters of things<br />
brought into view before all else Man and Nature surrounding<br />
him. PYTHAGORAS who saw in number, in the relations<br />
of masses, and in law, the principles lying at the bottom of<br />
every existent thing, was himself a doctor and concerned<br />
himself with the 1 structure of the body and with the activity<br />
of thought and spirit no less than with the procreation and<br />
development of man. After a somewhat lengthy sojourn<br />
in foreign lands especially in Egypt where he must have %<br />
been initiated into the wisdom of the learned priests, he<br />
settled down in the Greek colonial town of Kroton in Lower<br />
Italy, where the famous Asklepian school was situated.<br />
There he founded a confederation which strove after<br />
objects of an ethical and political, rather than a philosophical,<br />
character. Its members were generally doctors<br />
and soon found here a centre for the scientific interests<br />
which* they had in common. They turned their attention<br />
chiefly to dietetics and sought by simple remedies, by<br />
fomentations, by frictions and ointments to bring about<br />
cures; surgery was neglected by them.§ Amongst the<br />
disciples of PYTHAGORAS are mentioned the doctors<br />
PHILOLAOS, ELOLATHES who considered health to be due<br />
* Cf. H. HAESER; Geschichte der Medicin, 3. Aufl., Jena 1875, h S. 88.<br />
f WELCKKR op. cit. S. 103 et seq.<br />
X DIODOR. i, 69, 98.<br />
§ JAMBLICH : de vita Pythag. c. 29, § 163 et seq.
THE GREEKS BEFORE HIPPOKRATES. 45<br />
to the harmonious correspondence of humours in the body,<br />
likening it to a condition of harmony in music,* EPI-<br />
MARCHOS, METRODOROS and others. Probably ALKM^EON<br />
and DEMOKEDES who had received their professional training<br />
in Kroton, belonged to his school. The last-mentioned<br />
by his successful cures spread the fame of the healing art<br />
of his native country in foreign lands and obtained a<br />
prominent position at the court of King DARlUSt whose<br />
sprained foot he was able completely to restore after the<br />
vain attempts of his Egyptian body-surgeons. ALKM/EON<br />
is said to have been the first to undertake anatomical<br />
dissections and by these means he discovered the origin of<br />
the optic nerves from the brainj. He taught that the<br />
human spirit is immortal and. like the stars is engaged in<br />
everlasting movement. He sought to explain the origin of<br />
the five senses and formulated the first theory of sleep.<br />
" When the blood," he said, " retires into the great blood<br />
vessels, sleep comes on ; when it again disperses into the<br />
smaller vessels awakening takes place."§ His views con-cerning<br />
the nourishing of the child in its mother's womb<br />
and concerning the causes which lie at the bottom of the<br />
infertility of hybrids are deserving of less attention. One<br />
of the most prominent natural philosophers of that time<br />
was EMPEDOKLES, who, musing on the eternity of the<br />
universe, attacked || the theory of the origin and extinction<br />
of matter, seeing in it himself nothing but change manifesting<br />
itself in association and division, and being evoketd<br />
by love and hate. He established, as ARISTOTLE tells us,^[<br />
that doctrine of the four elements which exerted the greatest<br />
influence upon the physiology and pathology of later times<br />
* KUHN : Opusc. Acad., Lips. 1827, i, p. 47-86.<br />
f HEROD, iii, c. 129-134.<br />
X CHAI.CIDIUS in Platon. Timaeum ed. Meursius, Lugd-Bat, 1617, p. 340.<br />
M. A. UNNA: De Alcmseone Crotoniata ejusque fragmentis quae supersunt in<br />
CH. PETERSEN : Philologisch-historische Studien, 1. H., Hamburg 1832, S. 41-87.<br />
§ PLUTARCH : de placit. phijos. v, c. 24.<br />
|| HIPPOKRATES op. cit. T.'vi, p. 474.<br />
^f ARISTOTEI.ES : Mataph. i, 3, 4.
46 ANCIENT TIMES.<br />
and he already foreshadowed that great theory of creation<br />
which asserts that the development of organisms proceeds<br />
from lower to higher forms, and that only the conformable<br />
survive. He was of opinion that not only men and<br />
brutes but plants also are endowed with souls; he busied<br />
himself with the subject of the senses and with the act of<br />
respiration which he sought to elucidate in a mechanical<br />
way; and he regarded the labyrinth of the ear as the seat of<br />
hearing. His contemporaries ANAXAGORAS of Klazomene,<br />
and DIOGENES of Apollonia directed their attention chiefly<br />
to anatomy. The former undertook the dissection of<br />
animals* and noticed the lateral ventricles of the brain :<br />
moreover he was the first to give utterance to the opinion—<br />
raised into a dogmaf by later doctors—that the bile is the<br />
cause of acute sickness. DlOGENES left behind him a<br />
description of the vascular system which it must be confessed<br />
contains numerous errors.^ HERAKLITOS saw in<br />
the constant changes of form, in the everlasting mutations<br />
of things, the individual nature of these. Like EMPEDOKLES<br />
he ascribed a weighty influence upon the activities of the<br />
organism to fire, the internal heat. His views hold a place<br />
in the collection of dogmas belonging to the Hippokratic<br />
school and for a' long time played an important part in<br />
physiology and pathology. In a higher degree was this<br />
the case with the theories of LEUKIPPOS and DEMOKRITOS.<br />
The materialism which dominated their doctrine of atoms,<br />
led to the investigation of nature,, as the only way which<br />
promised results. DEMOKRiTOS§ devoted himself with<br />
great zeal to anatomical investigations and appears to have<br />
been very skilful in them for he was able to compose a<br />
special treatise upon the structure of the chameleon.|| He<br />
* PLUTARCH : Perikles, c. 6.<br />
t Vide die Nach-Galen'sche Schrift liber die kritischen Tage in HIPPOKRATES<br />
op. cit. T. ix, p. 300 et srq.<br />
X ARISTOTELES: Hist. Animal, iii, 2.<br />
§ ARISTOTELES: de generat. i, 2.—CICERO: Tusc.qufest. v, 39.<br />
|| PLINIUS: Hist. Nat. xxviii, c. 29.
THE GREEKS BEFORE HIPPOKRATES. 47<br />
also appears to have written on various diseases ; on ca<br />
rabies, on the healing influence of music,* etc.<br />
A tradition, having origin in remote times,? tells that the<br />
people living in the vicinity of the great philosopher, considering<br />
him to be insane, summoned HIPPOKRATES to<br />
Abdera to investigate his case. But he, knowing the abundance<br />
of wisdom and intellect possessed by DEMOKRITOS<br />
may well have felt himself compelled to give utterance to<br />
the opinion that he was the wisest of all men. He owed to<br />
his intercourse with DEMOKRITOS many suggestions and<br />
doubtless much in formation. J The philosophers reckoned<br />
the study of man and of diseases as belonging to their<br />
weightiest problems.§ Many of their number belonged to<br />
the medical profession, and practised as doctors.<br />
This happy relation of mutual understanding between<br />
philosophy and medicine was maintained till a later period,<br />
and was attended with advantages to both departments of<br />
learning, drawing the former away from barren speculation<br />
and towards a secure foundation of facts, and offering the<br />
latter a deeper comprehension of things and a general<br />
scientific foundation for professional endeavours and aims.<br />
THE TIME OF HIPPOKRATES.<br />
THE medical school at Rhodes appears to have exi<br />
only a short time : for the later authors make no further<br />
mention of it.|| In the fifth century before Christ the<br />
medical school of Kroton was in the highest repute<br />
owing, no doubt, partly, to its connection with the<br />
Pythagoreans. The School of KyreneH commanded the<br />
second position, and there other branches of knowledge,<br />
* GELLIUS: Noct. Attic, iv, c. 13.<br />
t HIPPOKRATES op. cit.T. ix, p. 320-386.-SOBANCS: Leben des HIPPOKRATES<br />
in IDELER: Physici tt medici Graeci minores (Berlin 1841) T. i p 2-c?_<br />
JELIANUS: Var. hist, iv, c. 20. ' '<br />
t CELSUS: Praef.—SORANUSO/,. «7.p. 252.-3CETHIUS: de musica i, 1.<br />
§ ARISTOTELES: de respir. c. 8.—CELSUS : Preef.<br />
GALEN op. cit. T. x, p. 6.<br />
U HEKODOT. iii, c. 131.
48 ANCIENT TIMES.<br />
especially mathematics and philosophy, were ardently<br />
pursued* Not long after this the Asklepiadae-Schools of „<br />
Knidos and Kos flourished. Unfortunately the writingst<br />
of THEOPOMPOS, treating of these, have been lost: but we<br />
possess in the Hippokratic collection a source giving us<br />
valuable information concerning their performances and<br />
individual administration. According to it there existed<br />
between these two schools essential differences in respect<br />
of medical theories and methods of investigation and<br />
treatment. The doctors of Knidos were good observers<br />
and skilful surgeons, showed an interest in scientific questions<br />
and liked treatment to be as simple as possible. \ v<br />
Since, however the work in which their maxims, were<br />
collected, namely the Knidian Sentences, has not been<br />
handed down to us, if we wish to form a conception of<br />
their scientific significance we are obliged to refer to the<br />
few remarks made upon the subject by other writers of<br />
antiquity. They proceed for the most part from opponents of<br />
the Knidian-school and are consequently neither favourable<br />
nor just. The reproach is made against the latter that it was<br />
» contented with inquiring into the subjective complaints of<br />
the sick and in consequence neglected the accurate objective<br />
investigation of their bodies.^ The Knidian doctors<br />
were further blamed in that they divided diseases accord-.<br />
ing to the various parts and organs of the body, and distinguished<br />
between too many forms of disease. They laid<br />
it down as a law, for instance, that there were seven kinds<br />
of diseases of the bile, twelve of the bladder, four of the<br />
kidneys, as many kinds of strangury, three forms of<br />
i tetanus, four of jaundice, three of consumption and several<br />
forms of quinsey, assigning chiefly the exciting causes as<br />
The points of distinction between them.§ Their descrip-<br />
* Cf. HouDART : Histoire de la me'decine grecque depuis Esculape jusqu' a<br />
HIPPOCRATE, Paris 1856, p. 128 et seq. •-1 ;<br />
f Photii Bibl. p. i2o b ed. BEKKER.<br />
;<br />
X HIPPOCRATES op. cit. T. ii, p. 224.
THE TIME OF HIPPO*KRATES. 49<br />
•tion of the symptoms of disease was short and striking<br />
as may be seen by the fragment of RuFUS concerning<br />
nephritis* In chronic diseases they ordered chiefly milk,<br />
whey and purgatives, for consumption they recommended<br />
much exercise on foot. EURYPHON, one of the most noted<br />
doctors of this school who lived in the age of HIPPOKRATES<br />
and distinguished himself as a medical author,t advised<br />
consumptives to drink asses' milk or to take women's milk<br />
straight from the breast, + and as appears from a scene of<br />
the comic dramatist PLATON he also used moxae in this disease.§<br />
Another representative of this School, KTESIAS,<br />
lived for a long time as body-physician at the Persian<br />
Court and composed historical works on Persia and India<br />
and also some medical writings. || Of the remaining<br />
Knidian doctors of that period we know little more than<br />
the names.^f Information concerning the school of Knidos<br />
is more meagre almost than the remains left of its once<br />
flourishing civilization.<br />
More favoured by fate was the medical school of Kos.**<br />
Its merits in connection with medical science have been<br />
handed down to posterity by HIPPOKRATES—its most renowned<br />
representative. The doctors of Kos were indebted<br />
to him for their writings having by later generations been<br />
made the foundation of the structure of medical teaching<br />
and for their school being even at the present day named<br />
with admiration and reverence.<br />
" A ray of glory fell on her; its glow<br />
Did straightway immortality bestow."<br />
* GEuvres de Rufus d'Ephese, ed. par Daremberg et Ruelle, Paris 1879, P><br />
'59-<br />
f GALEN op. cit. T. vi, p. 473 ; xi, 795; xv, 136; xvii, A. 886; xix, 721.<br />
X GALEN op. tit. T. vii, 701.<br />
§ GALEN op. cit. T. xviii, A. 149.<br />
|| DIODOR, ii, c. 32.—CEuvres d'Oribase ed. p. BUSSEMAKER ET DAREMBERG<br />
Paris 1851-76, T. ii, p. 182.—GALEN op. cit. T. xxiii, A. 731.<br />
If HOUDART op. cit. p. 255 et seq.<br />
** M. DUBOIS (De Co insula, Paris 1884) tells us about the excavations<br />
carried on in the Island of Kos by order of the French Government.<br />
E
5° ANCIENT TIMES.<br />
HIPPOKRATES, whose life extended approximately over<br />
the period between 460-377 B.C. was a scion of an ancient<br />
family of the Asklepiadaa residing on the island Kos and<br />
tracing its descent from ASKLEPIOS and HERAKLES. His<br />
grandfather and father distinguished themselves by their<br />
medical skill. From the latter HIPPOKRATES received his<br />
first instruction in medical science. For his more extended<br />
medical training he betook himself to Athens where he<br />
received manifold suggestions and instruction. There, at<br />
that period, flowed in a mighty stream all that Greece<br />
possessed of the Great, the Beautiful, and the Noble. It<br />
was the age of PERIKLES—that period of outward splendour,<br />
of civic prosperity, and of artistic activity, when the spirit<br />
of Hellenism was celebrating its imperishable triumphs.<br />
By the side of the philosophers SOKRATES and PLATO were<br />
to be seen the great tragic poets EURIPIDES and SOPHOKLES,<br />
the historian THUKYDIDES, the sculptor PHEIDIAS and the<br />
Architect lNNESlKLES,'who were filling the world with their<br />
fame, while the comic dramatist ARISTOPHANES and the lyric<br />
poets ION of Chios and DiONYSiOS attuned men's minds to<br />
happiness and serenity. Athens was adorned with splendid<br />
buildings ; there arose the Propylasa, the Temple of Athene<br />
with its rich ornamentation of statues and sculpture, the<br />
imposing broad steps leading to the Akropolis, and the<br />
Odeion, while PHEIDEAS was creating the Olympian Zeus<br />
and the two statues of Pallas Athene. Impressions<br />
such as these must have exercised an influence upon<br />
the spiritual development of HIPPOKRATES; must have<br />
stimulated his ambition and fortified his energies. He<br />
sought the opportunity, in his intercourse with prominent<br />
doctors and philosophers, to perfect himself in his own<br />
province, and soon it was his lot to occupy a distinguished<br />
position in this sphere. His successful cures caused him<br />
to be much sought after as a doctor and his fame began to<br />
overstep the limits of his native land. He was summoned<br />
first to this and then to that town in order to give professional<br />
advice in difficult cases. His renown brought him a
THE TIME OF HIPPOKRATES.<br />
multitude of pupils who hoped under his guidance to train<br />
themselves into becoming skilful doctors* Among these<br />
were his sons THESSALOS and DRAKON and his son-in-law<br />
POLYBOS. THESSALOS, if his speech to the Athenianst<br />
contained in the pseudo-Hippokratic writings and dating<br />
from early times, is founded on fact, took part in his youth,<br />
as military surgeon, in the expedition of ALKIBIADES<br />
against Sicily: he lived later as body-physician at the<br />
court of King ARCHELAOS of Macedonia J and was<br />
esteemed as the author of numerous writings, of the<br />
Hippokratic collection.§ That certain portions of these<br />
proceed from POLYBOS is a fact historically authenticated :<br />
for ARISTOTLE cites a fragment upon the distribution of the<br />
blood vessels from a book of POLYBOS which is found word<br />
for word in the Hippokratic writing upon the nature of<br />
man. || POLYBOS practised in Kos and at a later period<br />
gave instruction in medicine in the place of his father-in-<br />
Jaw.^f Around the life of HIPPOKRATES a multitude of<br />
traditions and legends are crowded, only a few of which<br />
•can have truth in them. Thus the tale that he burned the<br />
library of Knidos ** or the Temple of ASKLEPIOS in his<br />
native town ft so that he might appear as the discoverer of<br />
medical learning contained in the inscriptions there and<br />
•which he appropriated to himself,—this tale which contradicts<br />
all that we know of the character of HIPPOKRATES<br />
is certainly false. Had he perpetrated an incendiary act of<br />
this kind, worthy of HEROSTRATOS, instead of the universal<br />
reverence which was paid to him in- ancient times, he would<br />
•only have met with scorn, however important a man he<br />
* HIPPOKRATES op. cit. T. ix, p. 420.—SORANUS op. cit. p. 254.<br />
f HIPPOKRATES op. cit. T. ix, 404.<br />
X GALEN op. cit. T. xv, p. 12.<br />
§ GALEN op. cit. T. vii, 855,89c. ix, 859. xvii, A. 796, 882.<br />
|| Cf. ARISTOTELES : Hist. Animal, iii, c. 3.—HIPPOKRATFS op. cit. T. vi,<br />
p. 58, and GALEN op. cit. T. iv, 653. xv, 108, 175. xyiii. A. 8.<br />
If GALEN op. cit.T. xv, n.<br />
** SORANUS op. cit. p. 253.<br />
ft PLINIUS: Hist. Nat. xxix, c. 1.<br />
51
2 ANCIENT TIMES.<br />
5<br />
might have been in his profession. The writings ascribed<br />
to him bespeak genuine philanthropy, sincere religious<br />
feeling, and glowing patriotism. From the prevailing petty<br />
agitations of political or social parties he held himself<br />
aloof and lived only for his science and his calling. The<br />
words which EURIPIDES addresses to the Natural Philo<br />
sopher may be applied to him :<br />
" Oh ! happy the man<br />
Who exploring the realms of knowledge has thoroughly surveyed them.<br />
Thought does not lead him towards strife pernicious to the citizens<br />
Or to a deed of wrong:<br />
He thoroughly investigates the never-aging Universe<br />
Of the Everlasting Mother—Nature ;-how it came into being:<br />
Never harbours in the heart of the upright man<br />
A thought of shameful actions."<br />
HIPPOKRATES passed the last years of his life in Thessaly :<br />
and there he is said to have died. Even up to the time of<br />
SORANUS* his tomb was pointed out in the district<br />
between Gyrton and Larissa: on it a swarm of bees had<br />
settled, and the honey thence derived was considered to<br />
have the power of healing sores in the mouths of children.<br />
The high importance of HIPPOKRATES was already recognized<br />
by his contemporaries. PLATO t compared him with<br />
POLYKLEITOS and PHEIDIAS, and ARISTOTLE X called him<br />
the 'Great' HIPPOKRATES. His writings were preserved<br />
by his successors with the works of the other members of<br />
his family and served them for medical teaching and for<br />
instruction when they had need of counsel in their professional<br />
practice. When the Ptolemies began to found a<br />
library and with this object caused the works of the most<br />
celebrated authors to be bought, transcripts of the Hippokratic<br />
collection reached Alexandria. Through the unprincipled<br />
acts of interested speculators, who turned the<br />
love for books manifested by Egyptian kings to their own<br />
account, the opportunity was seized upon for ascribing to<br />
renowned authors many works not belonging to them in<br />
* Op. cit. p. 254. t Protagoras c. 3. J Polit. vii, 4.
THE TIME OF HIPPOKRATES. 53<br />
order to increase their selling value * The librarians who<br />
were charged with the inspection and examination of the<br />
acquired books did not always possess the knowledge and<br />
means necessary to distinguish the true from the false or to<br />
make certain of the authenticity of documents. Thus it<br />
came about that certain works were declared to be by<br />
authors who really had had no hand in them. The Hippokratic<br />
writings among others met with this fate : even at<br />
that time people had been at work upon them with the<br />
result that essential differences had been introduced into<br />
the text.t Can we wonder then if to the collection which<br />
originally contained only the works of HIPPOKRATES and<br />
of his nearest relatives, other writings have been added<br />
which did not emanate from them at all.J The transcribers,<br />
who used the manuscripts at hand in the libraries to copy<br />
from, contributed to this, by giving confirmation and more<br />
general acceptance to certain writings as of real Hippokratic<br />
origin, and bold editors increased the error by<br />
arbitrary additions to, and enlargements and alterations<br />
of, the text.§ When GALEN wrote his commentary to the<br />
works of HIPPOKRATES he had before him a copy of the<br />
text with many different readings : he followed the plan, as<br />
he says himself, || of always considering the most ancient<br />
reading as the correct one. Under these circumstances it<br />
is conceivable that even in very ancient times differences<br />
of opinion prevailed as to which writings were really composed<br />
by HIPPOKRATES and which were not. This question<br />
has exercised the ingenuity of the learned and of critics up<br />
to the most recent times, and even in the last few years<br />
LlTTRE, ERMERINS, KUHLEWEIN and others have made<br />
attempts to bring it nearer solution. In its present form<br />
* GALEN op. cit. T. xvi, 5.<br />
f GALEN op. cit. T. xvii, A. 606.<br />
X Cf. the letter of ST. AUGUSTINE to FAUSTUS, the ManicfiEean, L. 7,3, 6 (T.<br />
vi, p. 493. Edit. FROBEN 1556).<br />
§ GALEN op. cit. T. xv, 21. xvii, A. 795.<br />
|| GALEN op. cit. xvii, A. 1005.
54 ANCIENT TIMES.<br />
the collection of medical writings known by the name<br />
of the Hippokratic collection contains, by the side of a<br />
great number of treatises which without any doubt were<br />
composed by him and his nearest relatives, a mass of<br />
writings not less in quantity which came from other<br />
authors. Almost all belonged to the age of HIPPOKRATES,<br />
only a few additions coming from an earlier or<br />
later period. They furnish a complete survey of the<br />
medical acquirements possessed by people in the age of<br />
HIPPOKRATES and give us important information regarding<br />
the regulation of medical teaching and the position of the<br />
medical profession which with the help of other notices of<br />
the subject in literature we will try to illustrate in an<br />
accurate way.<br />
It was generally recognized that the art of healing is<br />
not to be transferred from one person to another in any<br />
mysterious manner but has to be learned like any other<br />
art and that for this purpose recourse must be had to<br />
teachers who understand it, and are skilled in the<br />
practice of it.* The doctors' calling stood open to all.<br />
Medical studies began in early youth.f The teaching was<br />
probably organized in the same way as in the Platonic<br />
academies and other schools of philosophy; a teacher<br />
undertook the whole medical training of a student and<br />
made him acquainted with everything worth knowing in<br />
the various branches of medicine. He only was allow r ed to<br />
act as a teacher who was in actual practice, and who<br />
appeared to unite knowledge and experience in medicine.<br />
He demanded an honorarium from the students whose<br />
medical training he undertook, for the teaching<br />
given by him ; this was secured by an agreement and<br />
was sometimes pretty considerable. On the entry of a<br />
pupil on his course of study care was taken to see that he<br />
was in good health; for the doctor must appear healthy in<br />
which case the people think " that he is at liberty to look<br />
* PLATO : Ion. c. 8. Gorgias c. 14, on the civic qualification (beginning).<br />
f PLATO: Rep. L. iii, c. 16. HIPPOKRATES op. cit. T. iv. p. 638.
THE TIME OF HIPPOKRATES. 55<br />
after the health of others."* The author of the Hippo<br />
kratic writing "on the Physician" takes this opportunity<br />
of making the amusing remark that it is also advantageous<br />
for a doctor to be "fairly plump in body"; unfortunately<br />
he omits to inform us whether the confidence of the patients<br />
m this case depended upon their belief that fat men are<br />
kinder than thin, or whether their plumpness suggested a<br />
larger income and consequently a more extensive practice.<br />
Furthermore it was enjoined upon doctors " to keep them<br />
selves clean, to be respectably dressed, and to make use of<br />
sweet ointments spreading an agreeable, but not suspicious,<br />
aroma."t Many seem to have given too great weight to<br />
this piece of advice, so that there was opportunity given for<br />
making merry over practitioners "Adorned with curls on<br />
the forehead and oiled, and overburthened with rings."!<br />
"The doctor, like a prudent man, will be careful to ob<br />
serve silence on many matters and in intercourse with his<br />
patients to maintain a becoming demeanour. Good manners<br />
have a most favourable influence on public opinion."<br />
'•'When he acts inconsiderately or rashly, he will be<br />
blamed." " Let there be deep thought without ill-humour<br />
in his lineaments : he must not appear arrogant or misan<br />
thropic. Whoso bursts out laughing and is unrestrained<br />
in his behaviour will be considered—an uncultivated man.<br />
This must be avoided. It is highly important that the<br />
doctor should know how to conduct himself properly: for<br />
his relations to his patients then become very close. Not<br />
only these are committed to the hands of the doctor but in<br />
treating them he has also to do with their wives and<br />
daughters and property. It is worth a man's while to be<br />
master of himself."§ In another Hippokratic writing it is<br />
said that "the doctor should assume a certain courtliness<br />
of manner, for a rough disposition is displeasing to the<br />
* HIPPOKRATES op. tit. T. ix, 204.<br />
t HIPPOKRATES op. cit. T. ix, p. 266.<br />
X ARISTOPHANES: Clouds: v, 330.<br />
§ HIPPOKRATES op. tit. T. ix, 206.
56 ANCIENT TIMES.<br />
healthy and the sick alike." And again "he should not<br />
chatter too much with the people but only say what is<br />
necessary and what appertains to the treatment." Like a<br />
true philosopher he must strive " to be free from covetousness,<br />
to be reserved, modest, dignified, to form opinions and<br />
judgments for himself, to be of a peaceful disposition,<br />
sociable and of pure morals; he must speak intelligently,<br />
and should acquire prudent habits in life, must be on his<br />
guard against vice and superstition, and be distinguished<br />
for piety."* The author of the book " on the Sacred<br />
Disease " gives expression in one place to belief in the<br />
power and goodness of God; he is speaking of the idea<br />
that diseases are sent by God and he makes use of these<br />
beautiful words : " I cannot believe that there is any defilement<br />
of the body of man caused by God—injury to the<br />
lowest by an act of the Highest. Should a blemish be<br />
caused to it or a hurt inflicted upon it by anyone, the Deity<br />
is much more ready to cleanse and restore it than to cause<br />
it further abasement; for God it is who purifies us from the<br />
heaviest afflictions and takes away their stains."f<br />
Beside this ethical training of the doctor his scientific<br />
education was not neglected. This matter was entered on<br />
with the correct view that the normal relations of the body<br />
must be first studied, J since the knowledge of these forms<br />
the groundwork of all medical acquirements^ Anatomy<br />
was for the most part pursued upon the bodies of the lower<br />
animals. The dissection of the human body was made difficult<br />
by religious and social prejudices. Only in the case of<br />
enemies and traitors to the state or of heinous criminals<br />
was examination of the human body possible. Opportunities<br />
of this kind were certainly made use of by doctors<br />
seeking for information to confirm and augment their<br />
anatomical knowledge. The corpses of children left out<br />
* HIPPOKRATES op. cit. T. ix, 232-234.<br />
t HIPPOKRATES op. cit. T. vi, 362.<br />
+ Cf. PLATO: Laws, I., xii, c. 10.<br />
§ HIPPOKRATES op. cit. T. vi, 278.—ARISTOTLE : Eth. Nicom. i, 13.
THE TIME OF HIPPOKRATES.,<br />
to die must also have attracted their attention. So too<br />
may the glimpses into the structure of the body afforded by<br />
external wounds have been not without result. Various<br />
accounts point to the fact that there was no shrinking with<br />
horror from opening and examining the human body*<br />
Even if no scientific aims were pursued in these investigations,<br />
evidence is nevertheless afforded that anatomical investigations<br />
were possible. That these were actually undertaken<br />
is an assumption of great probability in consequence of<br />
certain remarks of ARISTOTLE and the Hippokratic writers<br />
and above all in view of the extent of the anatomical knowledge<br />
of that period. The author of the Hippokratic<br />
treatise "on the joints" says incidentally of dislocation of<br />
the spine that it is permitted in the dead, but not in the<br />
living, to open the body by incision in order to reduce the<br />
dislocation by the hand, and in the lecture " on the Heart "<br />
the statement is made that this organ is to be withdrawn<br />
from the body of a dead person for the purpose of examination<br />
in the manner customary for a long time previously.t<br />
A passage in the 5th book of the Epidemics speaks indeed<br />
of a dissection which was undertaken for the purpose of<br />
determining the origin and extent of a disease.^ Speaking<br />
generally they appear to have confined themselves to<br />
opening the thoracic and abdominal cavities; and the<br />
position and form of the contained organs are fairly<br />
correctly described. ARISTOTLE who on various occasions<br />
drew comparisons between the structure of the human body<br />
and that of the lower animals declared that the internal<br />
organs of man were as yet but little known.§ Certainly,<br />
the knowledge possessed by the doctors, of the Hippokratic<br />
period, of the brain, nerves, vessels and even muscles was<br />
scanty and deficient. On the other hand, the bones were<br />
* PLINIUS: Hist. Nat, xi, 70.—VALER. MAXIM, i, 8, 15.—PAUSANIAS iv, 9.<br />
—HEHODOT. ix, 83.<br />
f HIPPOKRATES op. tit. T. iv, 198. vi, 16. ix, 88.—GALEN ii, 280.<br />
X HIPPOKRATES op. cit. T. v, 224.—ARISTOTLE : de part, anim : iv, 2.<br />
§ ARISTOTLE: Hist. anim. i, 16.
58 ANCIENT TIMES.<br />
very exactly described and even minute particulars noticed<br />
about them which only strike one on very careful examination.<br />
That human bones served chiefly as objects for study<br />
appears certain from the descriptions. If the examination<br />
of the human body or of parts of the same was the privilege<br />
only of certain prominent investigators, nevertheless the<br />
dissection of animals, which, as ARISTOTLE more than once<br />
observes, formed the principal source of anatomical knowledge,<br />
was accessible to everyone. This no doubt formed<br />
an essential assistance in anatomical teaching. Perhaps<br />
artificial imitations of skeletons were used for this purpose<br />
like that one which was preserved as a votive offering at<br />
Delphi and originally, according to UPORT, came from<br />
HIPPOKRATES.* Broadly, anatomical teaching consisted<br />
in this, that the teacher imparted to his pupils what he<br />
himself knew or thought about the structure and composition<br />
of the human body. It was the same with instruction<br />
in physiology, which consisted of a loose fabric of unfounded<br />
hypotheses and unsupported speculations. Training in the<br />
examination and treatment of the sick promised much<br />
greater results. The doctors of ancient Greece were masters<br />
in the art of observing the symptoms of diseases and in<br />
controlling them in ways conformable to nature. To the<br />
complaints of the sick and even to their dreams they paid<br />
great attention; but they attached the greatest weight to a<br />
close examination of the ailing body. In performing this<br />
the colour and condition of the skin and mucous membrane<br />
were observed, as also the state of the abdomen and the<br />
form of the thorax ; the temperature was tested by application<br />
of the hand; and the excretions were subjected to a<br />
.careful examination. By the touch they were able to<br />
recognize the size of the liver and spleen: nay, even the<br />
change in form of the latter which occurs in certain diseases.f<br />
Succussion served them at the same time for diagnosis and<br />
for therapeusis as pus might thus be caused to break through<br />
* PAUSANIAS X, 2, 4.<br />
t HIPPOKRATES op. cit. T. vii, 244. —PLATO : Timaeos, c. 33.
THE TIME OF HIPPOKRATES. 59<br />
into the bronchial tubes. They were acquainted with the<br />
pleuritic friction-sound and with vesicular crepitation which<br />
were compared with the creaking of leather and the boiling<br />
of vinegar respectively.* In this connection it is expressly<br />
stated that the ear was placed for a considerable time<br />
against the chest-wall to enable the sounds to be heard<br />
(TTOWOV yjiovov wpotrk^wv TO oy? aKovaZprj 7rpo? ra irkevpd).<br />
The descriptions of individual diseases and of their course,<br />
as they mostly lend themselves to observation in private<br />
practice are admirable. Certain particular descriptions, as<br />
those of pneumonia, pleuritis, and phthisis, (which they<br />
considered contagious,) are so complete that even now<br />
little can be added to them. Among the causes of disease,<br />
in addition to the influence of heredity and defects of diet<br />
much also was ascribed to climate, nature of soil, the<br />
quality of the drinking-water, the time of year, the winds<br />
and the temperature. Prognosis stands on a high grade of<br />
development. In the Hippokratic writings a number of<br />
symptoms are mentioned which foretell a favourable or<br />
unfavourable termination to diseases. The doctors valued<br />
very highly the art of " predicting the future from the past<br />
and present." " Truly" writes the author of the<br />
Prognostics, " it is better to cure diseases than to foretell<br />
their course, but this is unfortunately not always possible."t<br />
In other passages the doctors are exhorted to observe<br />
caution in prognosis and are warned against asserting more<br />
than they can be answerable for.J The Hippokratic doctors<br />
have earned for themselves imperishable fame by their<br />
therapeutic principles which have endured from their time<br />
to ours. The high importance of dietetics was recognized<br />
by them in such a way as is seldom the case among their<br />
representatives of a later age. In a life spent in accord<br />
ance with natural laws, in the use of baths, in exercise of<br />
the body and in wholesome nourishment they saw the best<br />
* HIPPOKRATES op. cit. T. vi, 24. vii, 92, 94.<br />
f HIPPOKRATES op. cit. T. ii, no.<br />
X HIPPOKRATES op. tit. T. ix, 6 et seq.
60 ANCIENT TIMES.<br />
means of avoiding illness. The doctor was looked upon as<br />
the hodman of Nature, whose efforts to heal it was his duty<br />
to second and imitate. Above all things he had to<br />
endeavour to remove the causes of the complaint if possible,<br />
in his general treatment to have regard to the special circumstances<br />
of the case, and especially to keep his attention<br />
fixed rather upon the patient than the disease: he had to<br />
be careful always to render aid or at least never to do any<br />
harm.*<br />
The therapeutic agents used were chiefly of a dietetic<br />
nature: but mention is made of the more important<br />
drugs of the materia medica, which are still ordered at the<br />
present day. They were used as lotions, fomentations,<br />
injections, clysters or draughts. For blood-letting they<br />
employed venesection, scarification, and cupping. All these<br />
things were not only taught to the students in theoretical<br />
discourses but were also pointed out and explained at the<br />
bed-side. With this object they either accompanied the<br />
teacher in his professional visits f or received the necessary<br />
instruction in the Iatreion attached to his residence.:}:<br />
The latter was an institution like our private sanatorium, in<br />
which patients obtained medical advice, received medicines,<br />
were operated upon, and sometimes stayed and were taken<br />
•care of for a considerable time.§ They were, as is mentioned<br />
in the Hippokratic treatise " on the Doctor," so<br />
situated as to be sheltered from the wind and the dazzling<br />
sunshine for " if for the doctor engaged in his work the<br />
sunshine is not unpleasant, to the patient it is troublesome,<br />
and injurious to his eyes." "The chairs must, as far as<br />
possible, be all of a similar height. Only the instruments<br />
should be made of bronze : for it seems a superfluous luxury<br />
to have the utensils of this metal. The drinking-water<br />
supplied to the patients must be agreeable and pure."<br />
* HIPPOKRATES op. cit. T. i, 624. ii, 634. v, 314. vi, 92, 490.<br />
f PLATO : Gorgias, c. ii.<br />
X HIPPOKRATES op. cit. T. ix, 206 el seq.—^ESCHINES in Timarch. 124.<br />
§ PLATO: "Laws,'' i, 14. Repub. iii, 13, 14.—HIPPOKRATES op. cit.T. ii,<br />
•604. iii, 272 et seq. ix, 206 etseq.—ARISTOPHANES: Acharn, v, 1030.
THE TIME OF HIPPOKRATES. 6l<br />
' The napkins must be kept clean and be of soft texture as<br />
also the linen used for the eyes and the sponges for the<br />
wounds for these things are of great importance for the<br />
healing. The instruments must be adapted in size, hard<br />
ness, and delicacy to the purpose for which they are<br />
used." In the Iatreia besides surgical instruments there<br />
were always at hand sponges^ clean soft linen, slings,<br />
bandages, cupping glasses, porringers, enema syringes,<br />
basins, bathing-tubs, etc. The metal of which these objects<br />
were made, imparted to the whole a very bright aspect*<br />
The number of Iatreia possessed by a place depended<br />
upon its wants in this respect. " Where many diseases pre<br />
vail " writes PLATO f " there are also many Iatreia." The<br />
doctors prepared the medicines themselves, and bought the<br />
substances used for this purpose from simplers or else col<br />
lected them themselves. There were no apothecaries in<br />
our sense of the word: for the pharmacopolae not only<br />
traded in drugs and special preparations but also sold other<br />
things such as amulets, burning glasses and curiosities of<br />
all kinds. J His students and assistants stood by the doctor<br />
while compounding the drugs, performing operations, and<br />
generally during the treatment of the sick. The assistants<br />
were, as PLATO says, also called doctors. Students too<br />
were employed in this service, especially such as already<br />
possessed some knowledge of the healing art " so that they,<br />
upon occasion, could give directions and apply remedies<br />
without hesitation." The duty also devolved upon them of<br />
watching over the state of health of the patient during the<br />
absence of the doctor, their teacher, "so that nothing-<br />
which had occurred in the interval should remain unknown<br />
to him." The Hippokratic author gives strict warnings<br />
upon this point not " to entrust such duties to the<br />
inexperienced : for if a mistake is made the blame falls<br />
upon the doctor." The students were also instructed in the<br />
* ANTIPHANES in POLLUX : Onom.x, 46.<br />
t PLATO : Rep. iii, 13.<br />
X CJ. W. A. BECKER : Charikles iii. S. 52, Leipzig 1854. 2 Aufl.<br />
Jl
62 ANCIENT TIMES.<br />
H- •<br />
use of surgical instruments and apparatus* " In surgical<br />
operations the assistants," as is described in The Doctor's<br />
laboratory,' " in part hold forth that, part of the body on<br />
which the operation is performed and in part hold the rest<br />
of the body secure: and while thus employed must<br />
observe silence, only listening to what the master says."<br />
" The instruments must be so placed that they are not in<br />
the way but are ready to hand when required. If one<br />
of the students hands them to the operator he should lay<br />
them out in order for himself beforehand and be prepared<br />
to execute the orders of the operator." Complete directions<br />
were given to the operator concerning his clothing,<br />
his attitude, the manner in which he; should hold his arms<br />
and how he should place his feet during the operation.<br />
" The nails ought not to project beyond the finger tips and<br />
tftet not to be too short, since use is made of the tips of the<br />
fingers. A man should test this on himself by moving the<br />
fore-finger against the thumb, bending the hand so as to<br />
present a level surface with the finger tips, and then<br />
pressing one hand against the other. It is a very favourable<br />
circumstance for a doctor if the spaces between the<br />
fingers of his hand are large and if the thumb is in good<br />
opposition to the forefinger." " He must accustom himself<br />
to the use of both hands and be able to accomplish the<br />
same tasks with one hand as well, as nicely, with equal<br />
celerity and order, as with the other, without its being<br />
tedious or difficult for him."f The doctors of the Hippokratic<br />
period practised surgery as well as internal medicine.<br />
It appears that as yet there were no specialists]: though<br />
some doctors no doubt by ^preference gave special attention<br />
to particular departments of medical science, for<br />
instance the treatment of the eyes or teeth.§ Surgery<br />
was in a very imperfect state, which is explained by the<br />
neglect of anatomy.<br />
* HIPPOKRATES op. cit. T. ix, 216.<br />
t PLATO: Laws iv, 10.—HIPPOKRATES op. cit.m, 278 et seq., 288. ix, 242.<br />
X CICERO : ,de oratore iii, 333.<br />
§ Cf. BKCKER op cit. S. 59.
THE TIME OF HIPPOKRATES. 63<br />
The tying of vessels for the purpose of arresting the<br />
flow of blood was not yet known and therefore it was<br />
impossible to risk such operations as amputations and the<br />
removal of large tumours which entail a free loss of blood.<br />
On the other hand trepanning, the operation for empyema,<br />
paracentesis abdominis, and similar operations where the<br />
loss of blood is insignificant, were carried out.<br />
The descriptions and treatment of wounds and fistulse<br />
but especially that of dislocations and fractures deserve<br />
recognition. Here the experience gained in the gymnasia<br />
must have materially contributed to pave the way for a<br />
simple and natural method of cure. Fractures and dislocations,<br />
which occurred in the practice of gymnastics<br />
demanded prompt assistance and the teachers installed at<br />
the gymnasia must have acquired a certain amount of<br />
knowledge in these matters to enable them to make the<br />
necessary preparations for such accidents. If they were<br />
endowed with good powers of observation and practical<br />
dexterity they could not have failed to take notice of other<br />
ailments which came in their way. Through the study of<br />
medical treatises and intercourse with doctors they then<br />
sought to obtain enlightenment and confirmation on the<br />
subjects of their private experiences. Certain gymnasts,<br />
as IKKOS and HERODIKOS the latter of whom, as PLATO<br />
says, associated medicine with gymnastics, gained great<br />
reputation for themselves by their medical ability. They<br />
made use principally of dietetic means of cure, vapour<br />
baths, ointments, frictions and exercise of the body, as in<br />
long runs* At the same time we must not look upon the<br />
gymnasts as doctors. PHILOSTRATOS defines in his book<br />
" on Gymnastics" the position of gymnasts and their<br />
relations to the healing art, in a short and striking manner,<br />
when he says " that their appropriate work consists in such<br />
matters as these—dispersing collections of fluid, removing<br />
superfluous material, making hard places soft, making other<br />
* PLATO: Rep. iii, 14. Protagoras c 8. Phadros c. 1.—HIPPOKRATES op.<br />
cit. T. v, 302.—PLINIUS: His. Nat. xxix, 2.
64 ANCIENT TIMES.<br />
parts fat, modifying the shape or raising the temperature<br />
of parts," whereas in serious organic diseases, in wounds,<br />
and affections of the eyes and matters of that kind, applica<br />
tion was made to the doctor.*<br />
The Hippokratic doctors possessed fairly advanced knowledge<br />
in gynaecology. They were acquainted with various "<br />
alterations in the position of the uterus, with the prolapse of<br />
this organ, and with a great number of diseases of the female<br />
sexual organs. Midwifery was in the hands of midwives and<br />
only in difficult cases was the help of the doctor sought. They<br />
trusted to the workings of Nature and interfered only when<br />
danger menaced the life of mother or child. In abnormal<br />
presentations they employed turning; prolapsed extremities ;';<br />
were replaced or when this was impossible, separated from .<br />
the body.t SOKRATES the son of " the stout and dignified^<br />
midwife PH>ENARETE," as he calls himself with pride, has<br />
left us some information about the vocation of the midwife.<br />
Women who devoted themselves to the business must have<br />
borne children but must also have reached the age at which.<br />
they could no more become pregnant. They gave information<br />
whether of not the birth was near at hand, endeavoured .<br />
by medicines and psychical means to hasten it, tried to*,<br />
alleviate the pain, and divided the umbilical cord after the<br />
birth. When they considered it necessary they producedabortion.<br />
Along with this they carried on the no doubt very<br />
lucrative business of match-making attaching themselves to<br />
it of course on more grounds than one. J Many midwives,<br />
it appears, took pregnant women into their homes.§<br />
No information has unfortunately reached us con- •<br />
cerning the professional training of midwives. Probably<br />
they were instructed in their duties by an old colleague*<br />
who was already rich in experiences of this field of activity^ „<br />
Does not a tradition worked into poetry, that the practice A;<br />
* PHILOSTRATOS : to irepl yvfivaar^g, Jidit. Daremberg, Paris 1858.<br />
f HIPPOKRATES op. cit. T. viii, 146 et seq., 480, 512.<br />
+ PLATO Theaetetos, c. 6. > %<br />
§ ARISTOPHANES: Lysistratos v,
THE TIME OF HIPPOKRATES. 65<br />
of midwifery was at first confined to men and was given<br />
over to women only after they had received instruction<br />
from men, point to the fact that the midwives owed their<br />
medical knowledge to the doctors?*<br />
_ Medical practice was permitted to everyone who con<br />
sidered that he possessed the requisite knowledge. The<br />
doctors treated patients, as has been already said, either<br />
in the Iatreia or else visited them professionally in their<br />
own homes. In the Hippokratic writings and especially<br />
in the "Epidemics" a number of cases of illness are<br />
mentioned and in every instance the residences of the<br />
patients are given. In their visits the doctors took<br />
with them certain of their assistants and pupils and<br />
charged them with many of the functions appertaining<br />
to the treatment. Thus they had firmly fixed in their mind<br />
" the medicines and their properties and all that has been<br />
written upon the subject " as also the methods of treatment,<br />
before they trusted themselves with the sick. " On enter<br />
ing a sick room a man should sit down, show a modest<br />
dignified demeanour, should not speak too much or let<br />
himself become embarrassed. He then should approach the<br />
patient, pay attention to him, reply to his complaints,<br />
remove any hindrances to his repose, criticize any want of<br />
order,, and be prepared to render any service." These<br />
visits must be frequently repeated, in which way any<br />
mistakes can be corrected. The doctor must take care to<br />
see how the sleeping apartment of his patients is situated,<br />
and whether they are disturbed by noise or annoyed by<br />
strong smells and in such a case he must urge with tact but<br />
with firmness that such conditions be improved.f In<br />
serious cases of illness consultations between several<br />
doctors took place " for it is no subject for shame " as is<br />
stated in the Hippokratic treatises " if a doctor, who in a<br />
"given case of disease is in doubt and from want of ex<br />
perience does not see to the bottom of the circumstances<br />
•'•* HYGINUS: fabul. 274.—WELCKER op. cit. S. 195 et seq.<br />
r».v f HIPPOKRATES ofi. cit. T. ix, 238 et seq.
66 ANCIENT TIMES.<br />
attending it, calls in other doctors so that he may confer<br />
with them and place on a firmer basis the treatment for<br />
the relief of the patient."*<br />
Many doctors practised not only at their own place of<br />
residence but even undertook journeys for this purpose.<br />
On these occasions they took instruments with them which<br />
were of simple manufacture and easy to carry, t The<br />
doctors were entitled to demand a fee for services rendered<br />
to patients. J But the Hippokratic author exhorts them " to<br />
allow themselves to be influenced only by the motive of<br />
gaining in this way a greater opportunity for improving<br />
their knowledge. They were also to conduct themselves<br />
in this respect in not too sordid a spirit, but to consider the<br />
means and position of the patient, sometimes indeed to<br />
afford gratuitous aid and to consider that the recollection<br />
of a good deed is of more value than a temporary profit.<br />
The opportunity should not be neglected of helping a<br />
stranger or a poor man, for a love for humanity goes hand<br />
in hand with a love for knowledge." §<br />
Quite at an early period the practice of paying doctors<br />
out of public funds was instituted, the obligation being<br />
laid on them of treating patients without further charge.<br />
This regulation must have existed before CHARONDAS (7th<br />
century B.C.).|| In any case it was, an ancient institution,<br />
and DEMOKEDES who was mentioned in the preceding<br />
chapter affords a well-known instance of it from the sixth .<br />
century B.C. for he, before coming to Darius, had been district<br />
medical officer in ^Egina with the yearly pay of a talent, was<br />
then appointed to a similar post in Athens with a salary of<br />
one hundred minae, and was called thence to Samos by POLY-<br />
KRATES, who settled upon him the salary of two talents.^f<br />
* HIPPOKRATES op. cit. T. ix, 260, 262.<br />
t HIPPOKRATES op, cit. T. ix, 236.<br />
X PLATO : Politikos, c. 37.—ARISTOTLE : Rep. iii, 16.—XENOPHON : Memorabil.<br />
i, 2, 54.—PLINIUS: Hist. Nat. xxix, 2.<br />
§ HIPPOKRATES op. cit. T. ix, 258.<br />
|| Diodor. xii, 13.<br />
% Herodot. iii, 131.
THE TIME OF HIPPOKRATES. 67<br />
The BrjfwatevovTe,, the " people's doctors " were elected by<br />
the community. In Athens, the candidates desirous of<br />
idling such posts had to present themselves at a public<br />
meeting of the citizens, to give information concerning<br />
their education and to name the master from whom they<br />
had learned the healing art. In the election, which probably<br />
was conducted in the same way as those of other<br />
public officers, the most able candidate came off victorious.*<br />
Similar to that of Athens must have been the procedure<br />
for.the appointment of public medical officers in the other<br />
towns of Greece. Their salaries were levied upon the town<br />
and its environs, as were the sums required for providing<br />
music and other things for the public advantage. In an<br />
inscription discovered at Delphi which however dates from<br />
a somewhat later period (214-163 B.C.) it is mentioned that<br />
some had immunity from this tax.f Besides the State<br />
subsidy the amount of which depended upon the work<br />
the doctors had to do and the wealth of the town, the<br />
public medical officers probably had an Iatreion erected and<br />
maintained at the cost of the public.} There they received<br />
patients who sought professional assistance at their hands,<br />
and imparted medical teaching. The public medical officers<br />
were summoned in the case of epidemics to give directions<br />
calculated to remove the same, and attended the authorities<br />
as experts. Their particular duty, however, consisted in<br />
the treatment of sick people without charge. The public<br />
in establishing a doctor in this way wished especially to<br />
assure themselves that in case of necessity their citizens<br />
should at all times find medical aid at hand. Although<br />
from the information that has reached us it is not certain<br />
that free treatment was exclusively for the poor, it may be<br />
assumed that this was practically the case and people of<br />
* XENOPHON : Memorab. iv, 25.—PLATO: Gorgias, C. IC, 70.— Politikos, c.<br />
2 > 37-—Cf- also BOCKH: Staatshaushalt der Athener 1, c. 21.<br />
f C. WESCHER and P. FOUCART : Inscriptions k Delphes, Paris 1863, p. 20,<br />
No. 16.<br />
X Cf. VERCOUTRE : " La Medecine publique dans l'antiquite grecque" in the<br />
.Revue Archeologique, Paris 1880, Ser. ii, T. 39, p. 332.
68 ANCIENT TIMES.<br />
means showed their recognition of the doctor's services by<br />
presents. < ,<br />
Just as the Greeks originated the institution of public<br />
medical officers, so too did they take care that their troops<br />
were provided with doctors. LYKURGOS considered this<br />
an important matter and appointed medical officers to the<br />
Spartan army* Among the " ten thousand " commanded<br />
by XENOPHON there were eight military medical officers, f<br />
THESSALOS the elder son of HIPPOKRATES must have been<br />
practically a military medical officer for a certain time, and<br />
the author of the HIPPOKRATIC treatise " on the Doctor"<br />
writes "that the doctor gives himself the best training in<br />
surgery by entering on service with an army : " and he also<br />
takes occasion to remark that already a distinct literature<br />
of military medical science existed, in which the wounds<br />
met with in war were described.} The Army of ALEXANDER<br />
of Macedon was accompanied by PHILIPPOS of Akarnania,<br />
KALLISTHENES of Olynthia, GLAUKIAS and ALEXIPPOS—all<br />
celebrated doctors of that period.<br />
The medical profession enjoyed high consideration. The<br />
expression of HOMER§ "that a single doctor is as valuable<br />
as many other men put together" was held to be true at a<br />
later period also. Doctors who distinguished themselves by<br />
unselfish devotion and remarkable performances in their<br />
calling and deserved well of their country were rewarded<br />
with eulogies and honours. On the bronze tablet of Idalion<br />
which dates from the 5th century B.C. the services of the<br />
doctor ONASILOS are commemorated : he served in war with<br />
his pupils gratuitously and received in consequence a grant<br />
and exemption from taxes. || The Athenians are reported<br />
to have overwhelmed HIPPOKRATES with honours, initiated<br />
* XENOPHON : on the Government of Sparta, c. 13.<br />
f XENOPHON : Cyropasd. i, 6, 15.—Anabasis iii, 4, 30.<br />
X HIPPOKRATES op. cit, T. ix, 220.<br />
§ llias xi, 514.<br />
|| M. SCHMIDT: Der Inschrift von Idalion, Jena 1875, and Sammlung<br />
Kyprischer Inschriften, 1876, Taf. 1..
THE TIME OF HIPPOKRATES. 69<br />
him into the Eleusinian mysteries at the public expense,<br />
crowned him with a golden crown, and distinguished him<br />
in other ways.* The doctor EUENOR who, as is stated in<br />
an inscription of the year 388 B.C.,t " being entrusted by<br />
the people with the superintendence of the preparation of<br />
medicines for the public Iatreion, for this purpose has<br />
devoted a large sum out of his private means and has<br />
treated many sick people gratuitously," was publicly praised<br />
for this act and was honoured with a wreath and by having<br />
conferred on him rights of citizenship. In the inscription<br />
of Karpathos which WESCHERj ascribes to the end of the<br />
4th or beginning of the 3rd century B.C. it is stated " that<br />
in consideration that MENOKRITOS, the son of METRO-<br />
DOROS of Samos in his position of public medical officer<br />
has devoted himself for more than twenty years with zeal<br />
and devotion to the care of the sick and has comported<br />
himself with spotless integrity in his professional capacity<br />
and in his private life ; in consideration further that during<br />
a pestilence which broke out in the town and exposed to<br />
great danger both natives and strangers, by his self-sacrifice<br />
and frugality he contributed chiefly to restore health; in<br />
consideration finally that instead of demanding payment<br />
he willingly lived in indigence, saved many citizens in<br />
dangerous diseases without receiving any reward, as would<br />
have been only right and just, and that he never refused to<br />
visit sick people living in the environs of the town—the<br />
people of Brykontion have decided to honour him and to<br />
adorn him with a golden wreath and to cause this decree<br />
to be proclaimed publicly at the games of Asklepios and<br />
further to confer on him the privilege of participation in all<br />
festivals of the people of Brykontion and to erect to him a<br />
marble statue in the temple of Neptune on which this<br />
decree of the people extolling him, shall be inscribed."<br />
* HIPPOKRATES op. cit. T.ix, 402.<br />
t RHANGABE : Antiquites hellen. 1855, T. ii, No. 378.— E. CURTIUS in d.<br />
Gott. gelehrt. Anz. 1856, No. 196 et seq.<br />
| Revue Archeologique, Paris 1863, T. viii, p. 469.
ANCIENT TIMES.<br />
Certain authors,* relying upon the isolated judgments of<br />
doctrinaire philosophers, have considered that the medical<br />
profession since it was practised for money and was classed<br />
among the "handicrafts of citizens"—for so the word<br />
8r)/jLLovpyia may be translated —did not meet with its due<br />
share of respect among the Greeks. But PLATO says<br />
expressly that "the true doctor follows a nobler object<br />
than the making of money" and that the healing art<br />
even if it is practised for rewards yet is not mercenary.f<br />
Although he writes in the " Laws " that the health of the<br />
body does not belong to those goods which are of primary<br />
importance to the State, yet he declares it to be a duty<br />
of the State to take care that able doctors are trained<br />
up:j The amount of esteem given to the doctor<br />
depended, as it always has', upon the individuality of the<br />
doctor himself, his acquirements, his endowments in the<br />
qualities of intelligence and of sympathy, and upon the out<br />
ward conduct of his life. A slave, who as the assistant<br />
of a doctor, acquired an important amount of information<br />
and manifested great devotion and industry, remained<br />
however still in a subordinate dependent position. It<br />
seems moreover that the doctors derived from the slave<br />
class did not have such a technical education as other<br />
doctors but learned their art in a purely empirical manner.<br />
" If any one" says PLATO " should care to exchange some<br />
philosophic conversation with such a man upon the struc<br />
ture and functions of the body he would assuredly enjoy a<br />
hearty laugh and exclaim : ' Thou fool! thou art no doctor<br />
but the dry-nurse of thy patients.' " §<br />
In judging of a doctor his scientific education served very<br />
certainly as an important point for consideration. Ignorant<br />
and unskilful doctors were laughed at and mocked and given<br />
* Cf. K. F. HERMANN : Lehrbuch der griech. Privat-Alterthumer, Heidelberg<br />
1852, iii, S. 192.<br />
+ PLATO: Rep. i, c. 15, 18.<br />
X PLATO : Laws i, 6.—Rep. iii, 16.<br />
§ PLATO : Laws iv, 10. ix, 4.
THE TIME OF HIPPOKRATES. 71<br />
over to public scorn. In the Hippokratic " Law " they are<br />
likened to the supernumeraries in a theatre " who appear to<br />
be actors, are clothed and wear masks like them and yet<br />
are only so in name, not in reality." * In another place it<br />
is said that it is with unskilful doctors as with bad pilots.<br />
u If they alter the rudder and commit a mistake in a calm<br />
sea no one notices it; but if an adverse wind and violent<br />
storms arise and the ship is cast on shore every one is convinced<br />
that their ignorance and mistakes are to blame.<br />
Even so is it with bad doctors, who form a majority among<br />
their professional colleagues. When they are treating<br />
lighter cases of illness, in which the greatest mistakes<br />
may be committed, without serious results ensuing, their<br />
want of skill will not strike the laity ; when on the other<br />
hand they are called to a serious, violent, dangerous case<br />
it becomes clear to every one that they know nothing<br />
about it and give wrong directions." f " Ignorance is a<br />
bad possession, a poor ornament, a constant illusion, a<br />
picture of the fancy, affords no pleasure or happiness, and<br />
is the nurse of timidity and of rashness." J The Hippokratic<br />
doctors exhorted their pupils to diligence and<br />
assiduous study. "Art is long, life short" they told<br />
them,§ and " the healing art cannot be learned in a<br />
hurry." || They strongly recommended perusal of the<br />
medical treatises and with affecting piety recalled the<br />
honest, if not always successful attempts, which the doctors<br />
of an earlier period made to advance medical knowledge<br />
and to raise it to the rank of a science.1[<br />
The intimate relations between medicine and philosophy<br />
which existed before HIPPOKRATES were made still more<br />
binding by him and his school and endured to a later period.<br />
" Philosophy and medicine have mutual need of one another<br />
and each is illustrated by the other. The doctor, who is<br />
also a philosopher stands in the highest position " writes a<br />
* HIPPOKRATES op. cit. T. iv, 638. § HIPPOKRATES op. cit. T. iv, 458.<br />
+ HIPPOKRATES op. cit. T. i, 590. || HIPPOKRATES op. tit. T. vi, 330.<br />
X HIPPOKRATES op. cit. T. iv, 640. f HIPPOKRATES op. cit. T. i, 596.
ANCIENT TIMES.<br />
Hippokratic author.* SOKRATES and PLATO had amongst<br />
their pupils several doctors and students of medicine as<br />
may be gathered from the frequent use of similes drawn<br />
from medical science ; and ARISTOTLE the founder of comparative<br />
anatomy and the advanced explorer in all departments<br />
of the investigations of Nature wrote f "most<br />
naturalists seek in medicine the end and object of their<br />
studies and of the doctors those who practise their art in a<br />
scientific spirit begin the study of medicine by working at<br />
natural science."<br />
IN ALEXANDRIA.<br />
THE youthful ALEXANDER of Macedon had subdued in a<br />
rapid series of conquests a great part of Europe, Africa,<br />
and Asia. The Thracian and Illyrian races as far as the<br />
Danube, Greece, Phoenicia, Palestine, Egypt, Persia and<br />
the whole of Asia Minor were subject to the sway of<br />
his sceptre; even many Indian states recognized his<br />
sovereignty; and from Italy and the Celtic tribes came<br />
embassies to seek his protection and alliance. Already<br />
must his heart, swollen with ambition, have conceived the<br />
daring project of a world-monarchy embracing all the<br />
regions of the earth as far as they were then known. But<br />
his sudden death put an abrupt termination to all these<br />
hopes. He died at the age of thirty-three in the vigour* of<br />
youth and in possession of a power such as no mortal had<br />
exercised before him. The tragedy of his death is of even<br />
greater significance than his unexampled victories and<br />
successes. His empire fell to pieces as quickly as it had<br />
been built up. Aspiring generals shared in the heritage<br />
and made themselves masters of single provinces. But<br />
only his political creations were demolished. Whatever in<br />
the way of civilization and knowledge had been advanced<br />
by means of him or under his sway remained firm and<br />
bore rich fruit.<br />
* HIPPOKRATES op. cit. T. ix, 232. f ARISTOTLE: De Sensu, C. 1.
IN ALEXANDRIA. 73<br />
The contact of the spirit of Greece with the peoples of<br />
the Orient exercised an abiding influence upon both sides.<br />
The Orientals learned to understand Science and Art which<br />
with them were but little developed if at all, and obtained<br />
the opportunity of acquiring Grecian education and refine<br />
ment of manner; while the Greeks were freed from that<br />
narrow-mindedness which, evidently as a consequence of<br />
their small political commonwealth, had resulted in an over-<br />
estimation of themselves and a contempt for foreigners.<br />
Hellenism drew from this source that cosmopolitan colour<br />
ing which distinguished the efforts of the later Greeks.<br />
Art and Science derived from this acquaintance with<br />
foreigners many suggestions and improvements; espe<br />
cially so the natural sciences, —Zoology, Botany, Compara<br />
tive Anatomy, and Materia Medica. These received a rich<br />
influx of material from lands thrown open to discovery,<br />
which, arranged and sifted by able hands, facilitated and<br />
promoted the carrying on of systematic work in these<br />
branches of knowledge. ALEXANDER'S dreams of future<br />
political power were soon forgotten. Only the plan of<br />
making Egypt the central state, and Alexandria—named<br />
after him—the capital of the world-empire he strove to<br />
create, was carried out, though in a manner quite different<br />
from his intentions. Egypt was indeed not the political, but<br />
the intellectual, centre of nations and undertook the part of<br />
dispenser of civilization, being especially called to this, as<br />
much by its situation as by its possessing a history of<br />
thousands of years. The princely family of the PTOLEMIES,<br />
on whom after ALEXANDER'S death the dominion of the<br />
Nile valley devolved, were of Greek descent and remained<br />
true to their Greek character in their new home.<br />
While the trade and industry of Egypt flourished and<br />
her ships sailed as far as Madeira westwards, and east<br />
wards to India and Persia, Arts and Sciences were<br />
nurtured at home and Greek culture was diffused. The<br />
PTOLEMIES brought artists and learned men from Greece<br />
to their court; caused magnificent buildings to be
74<br />
ANCIENT TIMES.<br />
erected, adorned their residences with the choicest objects<br />
the world could produce, and supported the sciences with<br />
royal liberality. They laid out botanical and zoological<br />
gardens, founded libraries, and created the Museum and the<br />
Serapeum,* two institutions in which learned men received<br />
accommodation and maintenance so that they might devote<br />
themselves to scientific studies without having to give<br />
their attention to providing the daily necessaries of life.<br />
These edifices contained, besides day and night apartments,<br />
great halls for meals and covered colonnades adorned with<br />
pictures, opening on to spacious courts and shady pleasure<br />
grounds.t The great libraries, in founding and extending<br />
which no expense was spared, stood adjoining, and no<br />
doubt in organic connection with them. Ecclesiastics of<br />
high rank exercised supreme control over these institutions<br />
and in conjunction with the heads of the several departments'—into<br />
which the whole was divided according to the<br />
sciences pursued—exercised administrative power.<br />
The Museum lay in immediate vicinity to the royal palace<br />
and was even treated as a part of it. The Serapeum was<br />
situated in a more remote part of the town and ranked after<br />
the Museum in importance. The library of the Serapeum<br />
was not sO rich as that of the Museum. The lofty welllighted<br />
halls of the libraries, in which the statues of<br />
celebrated men of learning were erected, contained many<br />
thousand papyrus-rolls of the most important works,<br />
especially of Greek literature. As to their number,<br />
accounts differ: while AMMIANUS and GELLIUS, for<br />
instance, estimated the whole of the papyrus-rolls of the<br />
Museum-library at 700,000, EPIPHANIUS reports that the<br />
number only reached 54,8004 The learned men who lived<br />
in the Museum and Serapeum formed societies like our<br />
* G. PARTHEY: Das Alexandrinische Museum, Berlin 1838.—Fr. RITSCHLL<br />
Die Alexandrinischen Bibliotheken, Breslau 1838.<br />
t STRABO xvii, 1.<br />
X AMMIAN. xxii, 16.—A. GELLIUS: Noct. Attic, vi, 17.—Cf. also PARTHEV<br />
op. cit. S. 77.
IN ALEXANDRIA. 75<br />
Academies. In friendly intercourse and in free conversation<br />
they discussed the scientific questions which had been<br />
suggested to them by reading or observation. Their princely<br />
patrons took a stirring interest in their investigations and<br />
encouraged them by large stipends and rich presents. They<br />
busied themselves with grammar, with criticizing the texts<br />
of the manuscripts contained in the libraries, with the art<br />
of poetry, with music, history, philosophy, mathematics,<br />
mechanics, astronomy, geography, the natural sciences, and<br />
medicine. But these " priests of the Muses," as THEOKRITOS<br />
calls them,* did not live only for research : they devoted their<br />
time also to teaching. Students from all countries inhabited<br />
by Greeks came to Alexandria in order to obtain there the<br />
best instruction for their future professions. The Museum<br />
and Serapeum were thus not only academies but also high<br />
schools. Information is unfortunately wanting concerning<br />
the relation of these to the institutions which served the<br />
purpose of teaching medicine.<br />
Two medical schools arose in Alexandria founded by<br />
different persons but alike, or nearly so, in the scientific<br />
principles guiding them. Both took their stand on the<br />
doctrines of the schools of Kos and Knidos and made the<br />
scientific acquisitions of these the foundations for their own<br />
investigations. At the head of one was HEROPHiLOSf and<br />
of the other ERASISTRATOS.<br />
The former was born about the year 300 B.C. at Chalcedon.<br />
His teachers were CHRYSIPPOS of Knidos who made himself<br />
remarkable for rejecting the too frequent employment of<br />
blood-letting and drastic medicines, who tried to set limbs by<br />
bandaging and who recommended -J vapour baths in dropsy,<br />
and PRAXAGOROS of Kos one of the most copious medical<br />
writers of that period.§ HEROPHILOS attained to such<br />
importance that no less than four doctors of ancient times<br />
* Idyll, xvii, v. 112.<br />
t K. T. H. MARX: Herophilus, Karlsruhe und Baden 1838.<br />
X GALEN op. cit. T. iv., 495. xi, 148, 230, 252.<br />
§ C. G. KUHN : De Praxagora Coo. progr., Lips. 1823.
]6 ANCIENT TIMES.<br />
undertook the task of writing his life. His most eminent<br />
services lay in the sphere of anatomy. He was at pains<br />
to fill up an essential gap in the Hippokratic teaching by<br />
submitting the nervous system to a careful examination,<br />
and he succeeded in throwing some light upon this<br />
hitherto but little investigated department of Anatomy.<br />
He described the membranes of the brain, the choroid<br />
plexuses, the venous sinuses, the torcular Herophili<br />
(named after him), the cerebral ventricles and the calamus<br />
scriptorius which was so called by him; he traced the<br />
origin of the nerves to the brain and spinal cord and recognized<br />
that the nerves transmit sensation and motion.* He<br />
also gave attention to the structure of the eye, described<br />
the vitreous body, the choroid, and the retina, drew attention<br />
to the singular form of the duodenum and noticed that<br />
the coats of the arteries are thicker than those of the<br />
veins.f How exact he was in his anatomical investigations<br />
is shown by his observation that the left spermatic vein in<br />
certain cases joins the renal vein.J He recognized various<br />
forms of the pulse according to its volume, strength,<br />
frequency, and regularity and laid the foundation for a<br />
scientific treatment of the indications afforded by it.§<br />
HEROPHILOS had also remarkable experience as a surgeon,<br />
as is seen by his remark that dislocations of the femur<br />
relapse after reduction on account of the destruction of the<br />
ligamentum teres at the time of injury.|| He recognized<br />
the cessation of menstruation when pregnancy exists and<br />
composed a text-book of midwifery, in which subject<br />
he is said to have imparted instruction.^ Throughout, he<br />
held himself bound to the principle that in practical<br />
medicine a man should not be contented with theoretical ,<br />
* GALEN op. cit. T. ii, 712, 731. iii, 708. xix, 330.—RUFUS op. cit. p. 153.<br />
PLUTARCH : de placit. philos. iv, 22.<br />
t RUFUS op. cit. p. 154, 171. —GALEN op. cit. T. ii, 572, 780. iii, 445.<br />
\ GALEN 0^5. cit. ii, 895.<br />
§ GALEN op. cit. T. viii, 592, 956, 959.—PLINIUS: Hist. Nat.xi,88. xxix, 5. J<br />
|| ORIBASIUS op. cit. iv, 233.<br />
% GALEN op. cit. T. ii, 150.
IN ALEXANDRIA. 77<br />
information, but should look upon experience alone as really<br />
important* STOB^US relates that HEROPHILOS answered<br />
the question, who is the best doctor, thus : " He wdio knows<br />
how to distinguish the possible from the impossible."f<br />
His contemporary ERASISTRATOS who participated with<br />
him in the fame won by the school of Alexandria<br />
derived his origin from Iulis in the island of Keos.<br />
He too had been taught by CHRYSIPPOS of Knidos:<br />
in addition to him METRODOROS, the son-in-law of<br />
ARISTOTLE, is mentioned among his teachers. ERASIS<br />
TRATOS lived for a long time at the court of the King<br />
SELEUKOS NlKATOR where he achieved distinction by a<br />
remarkable diagnosis. ANTIOCHOS, the son of the King,<br />
was ill and ERASISTRATOS recognized by the agitation<br />
which he manifested at the sight of his stepmother that his<br />
disease had been occasioned by the hopeless love he bore<br />
her.J GALEN makes the humorous remark, touching this<br />
story, that he is unable to understand the foundation for<br />
this diagnosis, for " there is no such thing as a lover's<br />
pulse."§ Like HEROPHILOS, ERASISTRATOS was very<br />
diligent in anatomical investigations. He described the<br />
convolutions of the brain and considered the greater<br />
intricacy of these in man as compared with brutes to be<br />
the cause of the intellectual preponderance of the former<br />
over the latter. [| He distinguished the motor from the<br />
sensory nerves, but thought that the former arose from, the<br />
membranes, and the latter from the substance, of the brain.!<br />
He recognized the bronchial arteries, assumed an anatomical<br />
connection by anastomosis between the arteries and the<br />
veins and described the valves of the heart so accurately<br />
that GALEN was unable to add anything to his description.**<br />
* PLINIUS: Hist. Nat. xxvi, 6.<br />
t STABJEUS : Elorileg: Ed. A. Meinecke iv, 2.<br />
t PLUTARCH : Vita Demetrii, c. 38. —PLINIUS : Hist. Nat. xxix, 3.<br />
§ GALEN op. cit. T. xiv, 631.<br />
|| GALEN op. cit. T. iii, 673.<br />
^f RUFUS op. cit. p. 185.<br />
** GALEN op. cit. iii, 465, 492. v, 166.
78 ANCIENT TIMES.<br />
Most remarkable of all is his recognition of the lacteal<br />
vessels,* the functions of which he evidently could not<br />
know or at most could only surmise: science had to wait<br />
for this for nearly two thousand years. His attempts to<br />
explain digestion and other physiological processes in a<br />
mechanical way deserve also due recognition : and those<br />
too made for the purpose of discovering the origin of<br />
diseases by pathological dissections.t<br />
HEROPHILOS and ERASISTRATOS were undoubtedly<br />
assisted in their anatomical investigations by much impor-<br />
' tant work previously done, as by that of DlOKLES of<br />
Karystus whom GALEN mentions with praise:J but above<br />
all they owe their extraordinary results to the circumstance<br />
that the Egyptian Kings placed at their disposal, in any '<br />
quantity they wished,'human subjects for dissection. They<br />
even had the opportunity of opening living men ! Criminals ' j<br />
from the prisons were handed over to them for this purpose<br />
" so that they could study the particular organs during life<br />
in regard to position, colour, form, size, disposition, hard<br />
ness, softness, smoothness and superficial extent, their pro<br />
jections and their curvatures." They justified these vivi<br />
sections in this way, saying " it must be permitted to<br />
sacrifice the lives of a few criminals if by doing so a per<br />
manent advantage accrues to the lives and health of many<br />
worthy men." Their opponents replied to this " that it is<br />
not only a cruel practice and degrades the healing art, which<br />
should serve as a blessing to mankind, not as a torture, but<br />
is also superfluous, since the people whose abdomens have<br />
been ripped up, diaphragms cut away, and thoracic cavities<br />
opened, die before it is possible to make scientific experi- 1<br />
ments on them."§ The pupils and followers of these two<br />
* GALEN op. cit. T. ii, 649. iv, 718.<br />
f GALEN op. cit. T. xix, 373.—CELSUS: Proem, and. iii, 21.—DIOSKORIDES,<br />
Ed. C Sprengel, Lips. 1830, T. ii, p. 72. C/ELIUS AURELIANUS • de chron. iii, 1<br />
8. v; 10.<br />
X GALEN op. cit. T. ii, 282, 716.<br />
§ CELSUS: Proem.—TURTULLIAN : de anima, C. 10.
IN ALEXANDRIA. 79<br />
leaders of the Alexandrian school neglected, unfortunately,<br />
the exact methods of inquiry which HEROPHILOS had carried<br />
to remarkable results, and trod the convenient, easy paths of<br />
speculation. Only a few like the anatomist EuDEMOS, the<br />
doctors BACCHIOS of Tanagra and MANTIAS who did good<br />
service in materia medica, the obstetricians DEMETRIOS of<br />
Apamea and ANDREAS of Karystus, who gave a comprehensive<br />
and fairly complete exposition of the various causes<br />
of difficult labour, the surgeon PHILOXENOS and others were<br />
notable exceptions. Certain of them transported their<br />
classes to other localities and founded and fostered medical<br />
schools like ZEUXIS at Laodicea and HlKESlOS at Smyrna.<br />
The slight differences between the followers of HERO-<br />
PHILOS and ERASISTRATOS respectively became gradually<br />
less and less : the former distinguishing themselves from the<br />
latter chiefly in being more conservative and in ascribing a<br />
greater authority to the writings of the Hippokratic authors<br />
which they furnished with commentaries. But both schools<br />
were doomed to destruction inasmuch as they ceased to<br />
strive, by independent investigations, after an increase of<br />
knowledge and confined themselves' to holding fast to<br />
theories which had been handed down to them and which<br />
gradually congealed into dead formulas. "Truly it were<br />
easier" writes PLINY "to sit and listen quietly in the<br />
schools, than to be up and wandering over deserts and to<br />
seek out new plants every day." *<br />
Under such circumstances it was not surprising, that<br />
thinking doctors forsook these dogmatists and swore<br />
allegiance to an empiricism which, though certainly<br />
not promising a solution of physiological and pathological<br />
problems, satisfied the requirements of medical<br />
practice. Under the influence of the scepticism which,<br />
started by PYRRHON and extended by KARNEADES the<br />
founder of the so-called third Platonic Academy, had<br />
reached a commanding position in the world, they arrived<br />
at the opinion that on this earth there is no certainty, no<br />
* PLINIUS: Hist. nat. xxvi, 6.
80 ANCIENT TIMES..<br />
.—. *<br />
real knowledge concerning phenomena and that probability<br />
is the highest limit that.,human understanding can reach.<br />
They thus resigned themost beautiful hopes which have<br />
animated scientific effort, and pronounced such effort to be<br />
without prospect. The Empirics neglected anatomy and<br />
physiology, declaring the study of them to be superfluous<br />
and unfruitful; they did not concern themselves at all<br />
about the essential nature of diseases but were satisfied<br />
with observing their symptoms, discovering their immediate<br />
causes, seeking remedies and trying which appeared<br />
adapted to effect a cure. In this they allowed themselves to<br />
be guided chiefly by experience and moreover did not confine<br />
themselves to consulting their own previous observations<br />
but also had, regard to those which had been made by others<br />
and which in course of time had become historical. When...'<br />
they met with previously unknown symptoms a course of<br />
treatment was adopted which had been found to be useful *<br />
in cases of a somewhat similar character. In thus adding<br />
the decision per analogiam to that by experience and that*<br />
by history they completed the so-called empiric tripod.<br />
The Empirics gave their attention chiefly to practical<br />
medical science. Materia medica, midwifery and surgery.;<br />
were by them essentially improved. The method of performing<br />
lithotomy, as described by CELSUS, we owe to them.,<br />
Even the first attempts at lithotrity, which were undertaken 1 1<br />
by AMMONlOS, date from this period.* Materia medica was<br />
enriched by the works of NlKANDER and of KRATEVAS<br />
who dedicated his book upon the medicinal properties of<br />
drugs, which was furnished with coloured drawings, to<br />
King MITHRIDATES of Pontos. Besides these, PHILINOS<br />
a pupil of HEROPHILOS, SERAPION, GLAUKIAS and. HERAr<br />
KLIDES of Tarantum were among the well-known representatives<br />
of the Empiric sect.f While the sciences in-<br />
* CELSUS vii, 26.<br />
f CH. DAREMBERG (Histoire des sciences medicales, Paris 1870, T. i, p. 159)<br />
has arranged in chronological order, beside one another, the adherents of this*<br />
and of the two dogmatic schools in Alexandria.
IN ALEXANDRIA. gl<br />
Alexandria flourished and prospered, protection was<br />
make the 1° ? ^ " "^ ^ Were SOOn *><br />
make themselves homeg ^<br />
withT°p m SyHa and ° f thG ATTALI » P -gamos v ed<br />
rls<br />
P LEM A IES in their guardianship of Intellectual<br />
treasures. The ATTALI founded both elementary schools*<br />
a'nd T EK ^ '" '^ lGarned Hke th0Se in Alexandria<br />
and their library was, after that of the Museum and that of<br />
the Serapeum, the most celebrated of ancient times The<br />
opposition which they offered to the PTOLEMIES 'in the<br />
purchase of manuscripts, led to an order forbidding the<br />
exportation of papyrus leaves from Egypt which was the<br />
indirect cause of the discovery of a durable material for<br />
writing upon, namely parchment, the name of which comes<br />
from Pergamos. The schools, thus founded, attained a high<br />
, position and attracted men of learning who distinguished<br />
themselves in textual criticism, mathematics, and especially<br />
in medicine.. Pergamos for a long time enjoyed a prominent<br />
position as a centre of medical training; and<br />
, GALEN one of the greatest doctors and investigators of any<br />
period, received his first medical instruction there.<br />
The last King of Pergamos, the weak-minded ATTALUS III<br />
has acquired a bad reputation in the history of medical<br />
science. In continual fear of being poisoned by his<br />
enemies, he desired that effectual antidotes against poisons<br />
should be discovered and caused for this purpose experiments<br />
to be made upon criminals and other persons of<br />
whom he wished to be quit. "With his own hand he<br />
•cultivated poisonous plants, henbane, hellebore, hemlock,<br />
aconite and doryknion in the royal gardens and collected<br />
their juices and fruits in order to study their properties " f<br />
The murderous MITHRIDATES of Pontos, another of these<br />
royal poison-mixers devoted himself to a similar pastimehe<br />
daily took some poison in order to accustom himself<br />
gradually to the use of the same. These experiments<br />
* TH. MOMMSEN : Rom. Geschichte, Bd. v, S. 334.<br />
t PLUTARCH : Vita Demetrii, C. 20.<br />
G
82<br />
ANCIENT TIMES.<br />
although undertaken at the instance of madness and cruelty,<br />
had this advantage for medical science, that they led to a careful<br />
examination of the properties and powers of many substances<br />
; and the statements of medical authors of a later<br />
period testify that they were not unproductive of results.<br />
The benevolent protection which was extended to they;<br />
sciences by the first PTOLEMIES was changed later intoj^<br />
indifference and mistrust, and gave place at last to a;<br />
feeling of hatred and contempt. The seventh PTOLEMY^<br />
drove men of learning from Alexandria and shut up their<br />
institutions. When these were reopened at a later<br />
period, they bore the signs of decay on their face. The<br />
appointments for learned men at the museum were now ,<br />
held at the caprice of the Prince and served as rewards<br />
for flattery and base services. The biting words of TlMON<br />
of Phlius might have been said of this period, " that the -<br />
museum is a great food-trough in which scribblers fatten c<br />
and quarrel about things they do not understand."* Under ]<br />
the Roman dominion it came to such a pass that athletes '<br />
were nominated as members of the museum. The cetebrated<br />
libraries were partly destroyed by fire, partly pluh-,,<br />
dered by the foreign conquerors who came to Egypt. Some<br />
of their literary treasures reached Italy and Constantinople,<br />
and served to found or enlarge the libraries formed there.<br />
What remained must, at the capture of Alexandria, have<br />
suffered mutilation at the hands of the Arabs or have been<br />
destroyed by the Christians.<br />
In the year 389 the temple of SERAPIS was changed into<br />
a Christian Church, and in the Serapeum " monks, so-called,<br />
took up their abode ; who" as EUNAPIOS writes " in their<br />
figures resembled men but in their manner of livingswine."<br />
t He must surely have had in his mind unclean .<br />
Oriental monks and not highly cultivated people like the |<br />
Benedictines of our day. The medical schools in Alexandria ,|<br />
maintained their prominent position under the Roman ;<br />
* ATIIENJEOS: Deipnosophistse, i, p. 11, Basil. 1535, Ed. Bedrotus.<br />
t EUNAPIOS in aedes i, p. 43, in Parthey op. cit. S. 102.
MEDICINE IN ROME.<br />
dominion and even improved it, probably contributing<br />
materially to that remarkable expansion which the art of<br />
sealing experienced under the Arabs.<br />
MEDICINE IN ROME.<br />
THE Italian peninsula formed for centuries the scene of<br />
embittered quarrels and feuds, the final result of which was<br />
the subjection of isolated communities to the Roman<br />
dominion. The small rural states, which by degrees were<br />
swallowed up in the general Roman commonwealth, had<br />
devoted but little attention to the arts and sciences, and the<br />
Etruscans only could show any pretence to acquisitions of<br />
civilization containing germs rich in promise of future<br />
development. The science of medicine exhibited a<br />
character partly theurgical, partly empirical. Prayers<br />
offerings, mystical and magical sentences, and invocations<br />
of deities, along with certain potent simples, the action of<br />
which chance had taught and experience confirmed, formed<br />
the principal materia medica of which the people availed<br />
themselves in sickness. Some knowledge of the treatment<br />
of wounds they also possessed, as well as of such subjects<br />
as the arrest of bleeding and the cure of fractures and<br />
dislocations. SENECA * characterizes the position of the<br />
healing art of that period appropriately in the words :<br />
medicina quondam paucarum fuit scientia herbarum<br />
quibus sisteretur fluens sanguis, vulnera coirent.<br />
A real medical profession did not exist, and good friends,<br />
charitable women, and true devoted servants afforded, as in<br />
Homer's time, in case of necessity the required help. The<br />
Romans considered that the foundation and extension of<br />
their political power were the only employments which<br />
claimed the enlistment of the energies of the nation.<br />
Having concern with things of inferior importance such as<br />
the healing art appeared to them opposed to such aims.<br />
The sum of medical knowledge was from this circumstance<br />
* Epist. 95.<br />
83
84<br />
ANCIENT TIMES.<br />
not added to by them and the practice of the art remained<br />
in the same hands as before. To be sure the inspection of<br />
entrails, which the Haruspices undertook might have been<br />
able to'serve for imparting information of an anatomical<br />
nature, but these priests lacked the necessary training and<br />
in their investigations they kept in view not scientific aims<br />
but mystical religious exercises which predisposed them to<br />
find peculiarities even where none existed. Notwithstanding<br />
this, the numerous expressions in anatomical<br />
terminology* which are borrowed from the Latin tongue<br />
point to the fact that the Romans knew and were able to<br />
distinguish from one another the most important organs of<br />
the body. But only very loose relations existed between<br />
anatomy and the practice of the healing art.<br />
The Roman father of a family as he appears before us in M. |<br />
PORCIUS CATO, had his book of recipes which he consulted |<br />
in cases of sickness affecting his family, slaves, or domestic<br />
animals.f In ' this, besides many superstitious magical j<br />
formula, all manner of expedients were detailed for use<br />
against internal affections and the treatment was sketched<br />
which was to be employed in injuries, fractures, dislocations,<br />
wounds, abscesses, fistulae, nasal polypi and many<br />
other complaints. Great importance was ascribed to<br />
dietetics, and certain domestic remedies, such as colewort,<br />
stood in high esteem.% Even wine was frequently used<br />
for these purposes and CATO "whose virtue" as HORACE<br />
writes "often grew warmer under the influence of good'<br />
wine,"§ recommended it as an addition to various remedies^<br />
The patriarchal custom of the father of the family being<br />
also the family doctor, naturally disappeared with the<br />
development of the healing art and formed certainly an<br />
exception even in CATO'S time.<br />
* RENE BRIAU : "Introduction de la medecine dans leLatium et a Rome" in<br />
the RfSvue archSol., Paris, 1885, Ser. iii, T. 6, p. 197.—Jos. HYRTL: Onomato-<br />
logia anatomica, Wien 1880.<br />
t 1'LINIUS: Hist. nat. xxix, c. 8.—PLUTARCH : Cato major, c. 23.<br />
X PLINIUS: Hist. nat. xx, C. 33.<br />
§ Od. iii, 21, Ad amphoram. ^m
MEDICINE IN ROME. 85<br />
The increased demands which were made upon the<br />
knowledge and skill of those who professed the art of heal<br />
ing and the great advances made in political and social con<br />
ditions justified the education of a distinct medical class.<br />
Unfortunately historical information fails us as to how<br />
this process was brought about. May we not suppose that<br />
the want of assured medical assistance which was ex<br />
perienced in the frequent military expeditions of the<br />
Romans, exerted an influence in this direction ? In the<br />
most ancient times the soldiers used to dress each other's<br />
wounds and carried with them bandages for this purpose.<br />
Each took his share in caring for the wounded * but the<br />
medical help which they received appears to have been<br />
inadequate, so much so that after the battle of Sutrium<br />
(309 B.C.) more warriors were lost by dying subsequently<br />
of wounds than were killed in action by the enemy.f<br />
Yet it is certain that at that time the healing art was prac<br />
tised as a profession in Rome. This is demonstrated not<br />
only by the testimony of the authors of antiquity,^ who on<br />
various occasions make mention of doctors, but also in a<br />
convincing manner by numerous other facts. The Lex<br />
Aquilia made the doctor who had neglected a slave after<br />
an operation responsible if he met his death in conse<br />
quence^ PLUTARCH || relates, that among the persons<br />
attached to the Embassy which the Romans sent to<br />
Bithynia there was a man on whom the operation of tre<br />
phining had been successfully performed, and even in the<br />
twelve law-tables of Numa mention is made of teeth<br />
artificially bound together with gold thread.^! On the other<br />
hand PLINY** plainly affirms that Rome for many centuries<br />
did without doctors though not without medicine (sine<br />
* TACITUS: Annal. iv, 63.<br />
f LIVIUS viii, 36. ix, 32. x, 35. xxx, 34.<br />
J DION. HALICARN. i, 79. x, 53.— LIVIUSXXV, 26.<br />
§ Institut. iv, tit. 3. § 6 and 7.<br />
|| Cato major, c. 9.<br />
% CICERO: de leg. ii, 24.<br />
** PLINIUS: Hist. nat. xxix, 5.
86<br />
ANCIENT TIMES.<br />
medicis, nee tamen sine medicina). But he meant by this<br />
only to say that in Rome until the immigration of Greek<br />
doctors of whom he soon afterwards speaks there were<br />
really no persons who deserved the name of doctors and he<br />
remarks that Greek medicine was expected with joyful<br />
eagerness but that when a man came to make its acquaintance,<br />
he was undeceived about it (Medicine vero etiam<br />
avidus, donee expertam damnavit) ; he corrects himself in<br />
a later passage by saying that the calling itself was not<br />
alluded to so much as the particular kind of practice then<br />
carried on*<br />
The Greek influence had made itself felt in Rome long<br />
before Romans were acquainted with the scientific acquirements<br />
of Greek doctors ; and it is indicative of the mode<br />
of thought of that period that this influence showed itself<br />
first in the sphere of religious mysticism. Already, at' 1<br />
an earlier period, the Romans, during severe epidemics,.\<br />
had had recourse to the oracles, and to the healthdeities<br />
of the Greeks, who were propitiated in conjunction<br />
with their native Gods. A temple was dedicated<br />
to APOLLO as Healer during a pestilence which raged ,<br />
in Rome in the fifth century B.C.f In the year 291<br />
B.C. the service of ASKLEPIOS was transplanted from<br />
Epidauros to Rome ; a proceeding which has been enlarged<br />
upon by various authors with poetic ornamentation and<br />
even glorified by the painter's art.I In the year 154 B.C.<br />
a Collegium Aisculapii et Hygeise was erected in Rome,<br />
the document of foundation of which has been preserved<br />
in an inscription found in the Garden of the Palestrine<br />
Palace.§ As Rome after the Punic wars grew up to that<br />
* PLINIUS op. cit. xxix, 8.<br />
f Livius iv, 25, 29. vii, 20. xl, 51.<br />
X VAI.ER. MAXIM, i, 6; 8, Livius x, 47. xxix, 22.—OVID : Metam. xv, v.<br />
626-744.—PANOFKA; Asklepios und die Asklepiaden, Berlin" 1840, S. 52 u.<br />
Tafel ii, 3.—BOTTIGER in K. SPRENGEL'S Beitragcn 2. Gesch. d. Med., Hal'le<br />
1795, i, 2, S. 163 et seq.<br />
§ SPON : Recherches curieuses d'antiquite', Lyon 1683, p. 326.343 and reprinted<br />
by J. ROSENBAUM : K. Sprengel's Versuch einer Geschichte d. Arznei-
MEDICINE IN ROME. 87<br />
world wide power which was able to contest successfully<br />
the supremacy over the Mediterranean and the lands on<br />
its shores, the immigration from abroad increased to a<br />
remarkable extent. Whoever by birth, ability, talent, or<br />
knowledge overtopped his fellows, betook himself to the<br />
City on the Tiber, since there he might hope soonest to<br />
bring his superiority to a profitable recognition. Thither<br />
flocked a herd of adventurers seeking their fortunes, and<br />
leaving no stone unturned to accomplish their object, as<br />
well as that vast multitude of slaves who were drawn by<br />
rich Romans from abroad in order to minister to their<br />
increased luxury. The inordinate enjoyment of sensual<br />
pleasures resulted in new vices and new diseases against<br />
which help was sought at the hands of foreign doctors.<br />
The Greeks, as heretofore, formed the largest contingent<br />
of the foreign immigration : their tongue and culture were<br />
widely diffused in Rome. Nothing illustrates the import<br />
ance possessed by Hellenism at that period more, than<br />
that CATO himself, that despiser of all appertaining to<br />
Greece, felt himself impelled to study its language and<br />
literature, and that the same General Lucius ^EMILIUS<br />
PAULUS, who conquered the Greeks on the field of battle<br />
caused his children to be educated by Greek teachers.<br />
Only on the arena of politics and in war did the Greeks<br />
yield to the Romans : in a competition of intellects the<br />
Greeks were victors.<br />
Graecia capta ferum victorem cepit et artes<br />
Intulit agresti Latio.*<br />
Education and medical science experienced in Rome the<br />
most important modifications from this cause. The won<br />
derful advancement which medical science owed to the<br />
Greeks make it intelligible that every effort was made to<br />
profit by their knowledge and skill in this sphere. The Greek<br />
kunde, Leipzig 1846, S. 208 Anm., and G. PINTO: Storia della Medicina<br />
Roma, Roma 1879, p. 191.<br />
* HORATIUS: Epist, i. 1, v. 156.
88 ANCIENT TIMES.<br />
doctors were sought out in Rome and their Roman colleagues<br />
were compelled to pick up special information in<br />
Greek medical literature if, in the struggle for existence,<br />
they did not wish to be worsted. The medical art of the<br />
Romans, so far as it took its rise on a national foundation,<br />
yielded before the influx of Grecian science and, like all<br />
civilization of a lower character when absorbed by that of<br />
a higher, left its traces behind only in popular tradition.<br />
Professional medicine in Rome was henceforward<br />
Greek. Its practice was founded on Greek writings and ,<br />
its prominent representatives belonged to the Greek nation.<br />
This preponderance was maintained even until the later<br />
periods of antiquity. The Romans have never acquired<br />
for themselves an independent position in this sphere of<br />
intellectual activity and their best medical works possess<br />
the value merely of collated treatises for which the creations<br />
of Greek genius served as a copy.<br />
The Greek doctors who were the first to migrate to Rome<br />
were not, it appears, the most respectable members of their<br />
profession. Offensive in consequence of their foreign<br />
manners and of their bias towards quackery, which however<br />
natural in their oriental home was opposed to the severe<br />
customs of the Romans, they soon made themselves despised<br />
and hated for their covetousness and boastfulness. Certainly<br />
but few of them were inspired by enthusiasm for their art or<br />
by love of their fellow-creatures : pursuit of riches and pleasure<br />
attracted the majority of them from their home to foreign<br />
lands. The grave accusations which CATO made against<br />
them, even if exaggerated, were not wholly undeserved*<br />
The doctor ARCHAGATHOS (a good beginning!) who<br />
came from the Peloponnesus to Rome about 219 B.C. at once<br />
attracted public attention. His surgical operations excited<br />
such a sensation that the Senate conferred Roman citizenship<br />
upon him and at the public cost bought a consulting<br />
room for him in a populous quarter of the city. But his<br />
love "of cutting and burning" and perhaps some unsuc-<br />
* PI.INIUS op. cit. xxix, 5, 7, 8.
MEDICINE IN ROME. 89<br />
•cessful results of operative treatment, soon deprived him of<br />
the confidence of the people who now called him not a<br />
surgeon but an executioner (Carnifex).*<br />
The Bithynian doctor AS.KLEPIADES later on attained a<br />
prominent position, having settled in Rome in the time of<br />
POMPEY. Possessed of a thorough general education, endowed<br />
with unusual intellectual gifts, an acute, penetrating<br />
understanding, and rich experience of life, he soon raised<br />
himself above the crowd of ordinary doctors. His polished<br />
manners in society, his trustworthy courteous aspect in conjunction<br />
with his gifts of speech, which enabled him to give<br />
appropriate expression to his unbounded self-confidence,<br />
provided him with an introduction to the highest circles of<br />
Rome and procured him the distinguished friendship of such<br />
men as CiCERO, L. CRASSUS, MARCUS ANTONIUS and others.<br />
King MiTHRiDATES sought by promises to attract him to<br />
his Court, but, as ASKLEPIADES declined his invitations,<br />
-had to be satisfied with the transmission of his writings.<br />
ASKLEPIADES preferred to remain in Rome where he<br />
-acquired great riches and was honoured " as one sent<br />
from Heaven." He knew well how to maintain, and<br />
if possible, to enhance, the high opinion entertained<br />
of him by the people and disdained no means to this<br />
•end. Thus he ' restored a man to life ' whose obsequies<br />
were actually about to be carried out. With quackish<br />
boastfulness he declared, that people might cease to consider<br />
him a doctor if he were ever taken ill himself;<br />
•and Death was so good as not to give him the lie, for he<br />
died from the fall of a ladder.f Like other people of<br />
his disposition ASKLEPIADES disclaimed any authority and<br />
believed only in himself. He rejected the dogmatic<br />
teaching of his predecessors and contrived a medical system<br />
•of his own founded upon the atomic doctrine of the<br />
* PLINIUS op. cit. xxix, 6.<br />
t PLINIUS op. tit. vii, 37. xxvi, 7, 8, 9. CICERO: de oratore. i, 14.—<br />
APULEIUS : florid., c. 19.—SEXT. Empir. ad logic, dogm. i, c. 91, ad. mathem.<br />
Iv, c. 113 etc.
9°<br />
ANCIENT TIMES.<br />
Epicureans as the latter had received it from DEMOKRITOS<br />
and in a somewhat modified form from HERAKLIDES of<br />
Pontus. He taught that the human body is compounded<br />
of atoms having no constant shape and subjected to<br />
continual motion and change, and of spaces lying between<br />
them which allow the movements of the juices and also<br />
transmit sensation. He attributed health and sickness to<br />
the activity and disposition of the atoms and their relation<br />
to the spaces between them* The human soul appeared<br />
to him as the result of the activity of thought. He said<br />
that it is, as it were, a breath which penetrates every part<br />
of the body, and, in no manner, has its seat in any particular<br />
organ ; an assertion which has given an opportunity to the<br />
ecclesiastical author TERTULLIAN of indulging in some<br />
insipid witticisms.t The materialistic ideas, which at the<br />
same time found an eloquent advocate in the poet<br />
LUCRETIUS, had many friends and adherents among men of<br />
intellectual advancement. ASKLEPIADES sought to combine<br />
them with the moral philosophy of the Stoa in order that<br />
they might give no offence to natures spiritually endowed.<br />
In this way he insured for his teaching the applause and<br />
admiration of the educated laity while the doctors were won<br />
over by the preference he showed for the humoral pathology.<br />
The defective views of physiology and pathology afforded<br />
by the theory of juices of the Hippokratic writers could not<br />
satisfy thinking doctors. When ASKLEPIADES suggested<br />
the part played by the solid structures of the body, the<br />
matter appeared obvious to them. In this, as also in<br />
introducing materialism into medicine he rendered great<br />
services to the development of that science. His<br />
therapeutic principles culminated in the doctrine that the<br />
doctor must so act as to make his patient well quickly,<br />
. safely, and in an agreeable manner. He was opposed to the<br />
misuse made by the doctors of his time, of drastic purga-<br />
* CAEL. AURELIANUS : de acut. i, 14, 15.<br />
f TERTULLIAN: de anima, c. 15.
MEDICINE IN ROME. 9 r<br />
tives, emetics, and sudorifics and recommended in their<br />
stead chiefly active and passive exercise of the body,,<br />
frictions, baths, the drinking of cold water, clysters and<br />
other similar remedies combined with a strict regulation of<br />
the diet. To induce sleep he caused his patients to lie in<br />
hammocks which were put into gentle swinging motion. In<br />
croup he recommended the performance of tracheotomy,*<br />
as others before him had done.<br />
The teachings of ASKLEPIADES were more extensively<br />
elaborated by his pupils and adherents and formed the funda<br />
mental tenets of the medical sect called the Methodists.<br />
The actual founder of this, THEMISON of Laodicea a pupil<br />
of ASKLEPIADES, undertook the task of adapting the<br />
philosophical system of his master to the comprehension<br />
and requirements of practical doctors. He said that<br />
diseases indicate either a state of increased or diminished<br />
tension, or else a state involving a mixture of these two<br />
conditions, manifested by the organs, at various times, in<br />
the way of exalted, impaired, or otherwise modified<br />
secreting activity.f The characters common to all diseases<br />
were called "Communities" and to attack them by<br />
remedies which possessed an opposite action was decided<br />
to be the proper aim of medical treatment. The Methodists<br />
confined themselves to treating the general symptoms of<br />
diseases : to investigate their seat and origin they con<br />
sidered superfluous and almost hopeless. They busied them<br />
selves chiefly with Semeiology and Therapeutics and<br />
directed their attention by preference to questions con<br />
nected with practice. Their doctrines were so simple and<br />
easy to learn and so conveniently carried out that they<br />
found a ready acceptance with the majority of doctors.<br />
But such as cherished the interests of science could not<br />
fail to observe their deficiencies. The Community-doctrine<br />
which sought to explain everything according to a pattern<br />
* CELSUS ii, 14. iii, 4. iv, 19. —CAEL. AUREL. : de acut. i, 15. iii, 4, 8.—<br />
PLINIUS: Hist. Nat. xxvi, 7, 8, 9.<br />
f CELSUS : Praef.
92<br />
ANCIENT TIMES.<br />
model, and which not only left unanswered questions of<br />
scientific theory but seemed unprofitable in practice, was<br />
bound to prove itself as superficial and untenable in<br />
time as was the immature materialism which pretended to<br />
have found a solution of the problem of organic life in a<br />
fortuitous concourse of atoms.<br />
For this reason intelligent men embraced an eclecticism<br />
which sought to combine the Greek philosophy of nature with<br />
the humoral theories of the Hippokratic writers and the tissue<br />
pathology of the Methodist school, and, by the adoption of<br />
the Pneuma—a spiritual element pervading the body and<br />
denominating it,—to fill up a broad gap in the various medical<br />
systems. The doctrine of the Pneuma was by no means new:<br />
it was already pointed at in the Hippokratic writings, discussed<br />
at length by the Peripatetics, applied by ERASIS<br />
TRATOS to explain many processes in the human organism<br />
and at a later period dragged again to the front at the Stoa.<br />
Certain doctors, as for instance ATHEN/EUS of Attalia,ascribed<br />
such a prominent part to the Pneuma, that they<br />
have been characterized as " Pneumatists." In medical<br />
practice the Eclectics took their stand upon a foundation of v<br />
facts and saw in experience the only true and certain guide<br />
for conduct in their craft. Yet they did not assume an<br />
indifferent or hostile attitude towards scientific investigation<br />
but favoured the same, and made progress themselves<br />
in paths, such as those of anatomy and physiology, the use<br />
of which in practice was not immediately apparent.<br />
Eclecticism was prepared for and led up to in an efficient<br />
manner by the writings of the Encyclopaedists which set<br />
forth in a connected form all that had been achieved in the<br />
preceding periods of civilization in the different paths of<br />
intellectual effort. Besides philosophy, history, politics,<br />
military science, geography, the natural sciences, agricul- ;<br />
ture, painting and sculpture, etc. they introduced medicine<br />
also into the field of observation. Their writings on<br />
this subject bring into review all the medical knowledge of<br />
that period and are so much the more valuable in that they
MEDICINE IN ROME. 93<br />
contain a multitude of extracts from medical works which<br />
have been lost. The best known Encyclopaedists were<br />
M. TERENTIUS VARRO, A. CORNELIUS CELSUS and the<br />
elder PLINY. The last mentioned in writing his natural<br />
history made use of not less than 2,000 books as he<br />
himself relates* and CELSUS in his work on Medicine<br />
which by its elegant expositions and classic language<br />
ranks with the best examples of Roman literature, gives<br />
us some, if insufficient, recompense for the great number<br />
of medical works of the Alexandrian period of which an<br />
envious fate has robbed us. Eclecticism developed into an<br />
organic whole, instinct with life, uniting the advantages of<br />
the other medical systems in itself without their deficiencies<br />
and faults. Holding fast to the traditions of past ages but<br />
free from that pedantry of the schoolmaster which regards<br />
every departure from the beaten track as wanton risk, it<br />
was admirably adapted to encourage activity in research<br />
among individuals and to render possible the advance of<br />
science. Eclecticism was a want,—a necessity,—for medical<br />
science if it was not to be reduced to the dead level of rude<br />
empiricism or one-sided methodism. It is thus easily comprehensible<br />
that it obtained dominion in medicine. The<br />
doctors attached themselves to it with enthusiasm and<br />
medical literature received an eclectic colouring. Even<br />
the teaching of GALEN which during fifteen centuries of<br />
the history of the world passed in medical matters as the<br />
highest and as an almost infallible authority was in its<br />
origin nothing but a purified eclecticism. It certainly soon<br />
obtained the power of standing alone and erected itself into<br />
a compact system through the creative power of its founder,<br />
who disclosed a crowd of facts to medical science and<br />
opened for it new paths.<br />
GALEN was born in the year 131 of our era at Pergamos the<br />
future seat of government of the Attali. His father the architect<br />
NlKON was an able and educated man who possessed<br />
sound acquirements in mathematics, physics, and the natural<br />
* PLINIUS op. cit. i, praef.
94<br />
ANCIENT TIMES.<br />
sciences. With loving care he superintended the education<br />
•of his son and paid particular attention that he should be<br />
instructed by distinguished teachers. Furnished with an \<br />
-admirable preliminary training, GALEN began in his 17th<br />
year his medical studies. He first of all attended the medical<br />
school of his native town at which the anatomist SATYRUS,<br />
a pupil of QuiNTUS, STRATONICUS the Hippokratic, the<br />
Empiric ,/EsCHRlON and others were working. On. the<br />
death of his father which occurred four years later he left<br />
Pergamos and betook himself to Smyrna in order to continue<br />
his studies there under the guidance of PELOPS a<br />
famous anatomist and of ALBINUS the Platonist; he then<br />
went to Corinth where he received instruction from another<br />
distinguished anatomist, NuMESlANUS* He now travelled<br />
through Asia Minor and Egypt mainly with the object of<br />
increasing and confirming his acquirements in the natural<br />
sciences. In Alexandria where the medical schools and<br />
•other institutions of a similar kind were of the first order, \<br />
he remained until his 28th year. He devoted himself with /<br />
great zeal to anatomy, greater opportunity being afforded<br />
him for this study there than anywhere else.f At the same<br />
time he endeavoured to enlarge and refine his knowledge<br />
in the other branches of medical science. Alexandria was<br />
filled to overflowing^ with medical practitioners and there<br />
was probably no medical system, no method ol treatment<br />
which had not its adherents and advocates amongst the<br />
doctors residing there. Nowhere could the student of<br />
medicine see and learn so much as in Alexandria. On this<br />
-account the young doctors came there when they wished to<br />
perfect themselves in their specialities. Even in later ']<br />
times the best recommendation a doctor could have was to<br />
have studied in Alexandria.§ Rich in intellectual acquire-<br />
* J. Cu. ACKEUMANN : Vita Galeni in Galeni opera. Ed. Kuhn, T. 1 (Intro- *"<br />
•duction) gives the references for this. p<br />
t GALEN ii, 220.<br />
X FUI.GENTIUS : M)thol. i, p. 16.<br />
4 AMMIAN. Marcell. xxii, 16.
MEDICINE IN ROME. 9$<br />
ments, GALEN turned his steps back to his home and undertook<br />
the, professional treatment of gladiators and prizefighters.<br />
But the mean and petty circumstances of his<br />
native town, and an insurrection which broke out there,<br />
induced him after some years to settle in Rome. In order<br />
to become known there he gave public lectures on the<br />
structure and functions of the human body. The interest<br />
of the subject and the practical knowledge of the lecturer<br />
soon attracted a numerous audience composed of representatives<br />
of the most distinguished circles of the capital.<br />
Amongst his hearers were men in influential positions<br />
such as the philosophers EUDEMUS and ALEXANDER of<br />
Damascus, the prefect SERGIUS, the consuls BOETHUS<br />
and SEVERUS, who afterwards mounted the throne, and<br />
BARBARUS the uncle of the Emperor Lucius. In this way<br />
GALEN succeeded, within a short time, in obtaining a<br />
profitable medical practice. But the envy and jealousy of<br />
his colleagues and other adverse circumstances disgusted<br />
him with residence in Rome. He on that account took to<br />
travelling and visited various parts of Italy and Greece, the<br />
island of Cyprus, Palestine, and Pergamos, his home. A<br />
year later he was called by the Emperors Lucius VERUS<br />
and A. MARCUS AURELIUS to Aquileia to accompany them<br />
in their campaign against the Germans. The death of the<br />
former changed his destination : he remained in Rome and<br />
was appointed body-physician to the young heir to the<br />
throne, COMMODUS* How long he held this office,<br />
whether he returned to his home and if he did at what<br />
period, is unknown. As little do we know when and where<br />
he died. As SuiDAS points out he must have reached his<br />
70th year, for his death did not take place before 201 A.D.<br />
If the life of GALEN has been fully described here, the<br />
justification lies not only in the extraordinary importance<br />
which he acquired in reference to the healing art but that<br />
at the same time a prominent example is given of the<br />
method employed in the training of able doctors at that<br />
* GALEN xiv, 648 et seq.
g6 ANCIENT TIMES.<br />
period. GALEN was an experienced and skilful doctor, a<br />
learned investigator, a teacher of medicine much in request^<br />
and an uncommonly industrious author. His literary<br />
activity is evident from the number of his writings which<br />
in KUHN'S edition fill 21 volumes each containing about. I<br />
1,000 pages. It is certain that among these are many ji<br />
works which have been falsely ascribed to him: but on the<br />
other hand a multitude of works really written by him are<br />
absent from the edition—works which partly have been<br />
lost,f partly only existed as translations and, have never<br />
been printed. GALEN'S works treat of philosophy,,<br />
anatomy, physiology, materia medica, practical medicine,<br />
surgery, gynaecology, the history of medicine, etc. They<br />
place before the reader all that had been attained in this<br />
sphere of work and, like the Hippokratic collection, exhibit |<br />
a picture of the condition of contemporary medical science;<br />
while particular parts throw much light upon the professional<br />
acquirements of the doctors as well as upon their':!<br />
social condition.<br />
Medical teaching also is mentioned in them in numerous<br />
passages. The development of this was strictly dependent<br />
upon the destinies of medical science in general. The subject<br />
matter and aims of teaching were regulated by the •<br />
progress of science and by the system prevailing at the time,<br />
while the manner of imparting instruction was defined by<br />
the relations of the medical profession to spciety at large.<br />
i i<br />
i, MEDICAL TEACHING IN ROME.<br />
1<br />
• ' • i<br />
IN 'the most ancient periods of Roman history medical<br />
knowledge was transmitted from the father to the son or to<br />
a relative and friend. The personal superintendence of the<br />
pupil by the medical practitioner remained also at a later<br />
period the commonest, if not the only, form of medical<br />
teaching. When the medical art of the Greeks was transplanted<br />
to Rome, medical teaching became possessed of<br />
material borrowed from the rich medical literature of the
MEDICAL TEACHING IN ROME.<br />
Greeks and also assumed the external form which it had in<br />
Greece. The Greek doctors who had migrated to Rome<br />
there acted as teachers of their art and introduced the<br />
regulations of their home. As in Greece so also in Rome<br />
the practice of medicine was a Jree-profeaaion which every<br />
one who thought he possessed the necessary ability was at<br />
iberty to carry on. There were no legal ordinances regulating<br />
the character of the training of doctors. They obtained<br />
their special knowledge how and where they liked.<br />
Their education was consequently not at all uniform. ''The<br />
medical profession contained in itself individual members<br />
differing widely in respect of their knowledge. Alongside<br />
of men who at that period were an honour to their calling<br />
there were persons who had no knowledge of medical, or of<br />
any other, science. PLINY* was right in complaining<br />
" that people believed in anyone who gave himself out for a<br />
doctor even if the falsehood directly entailed the greatest<br />
danger." "Unfortunately there is no law" he writes<br />
further on "which punishes doctors for ignorance and no<br />
one takes revenge on a doctor, if, through his fault, someone<br />
dies. It is permitted him by our danger to learn for<br />
the future, at our death to make experiments, and without<br />
having to fear punishment to set at nought the life of a<br />
human being."<br />
The junior members of the profession, who wished to<br />
do honour to their calling were naturally anxious to acquire<br />
some fundamental knowledge of their subject. They<br />
addressed themselves to this by a preliminary course, of<br />
philosophical study which at the same time completed<br />
their general education. GALENf wrote a treatise upon'the<br />
necessity that a doctor should possess training both in mind<br />
and morals—in a word should be a philosopher. In CATO'S<br />
time general education embraced, besides a knowledge of<br />
law, military science, and agriculture, an acquaintance with<br />
medicine as well; it consisted in fact of an encyclopaedic<br />
* PLINIUS: Hist. Nat. xxix, 8.<br />
f GALEN op. cit. i, 53-63.<br />
H<br />
97
98 ANCIENT TIMES-.<br />
review of all things of most importance and use in practical<br />
life.<br />
When, with the transplantation of Greek civilization<br />
to Roman soil the sphere of these sciences was so much<br />
enlarged that the knowledge of them had to be reserved for<br />
specialists, the conception of a " general education " became<br />
of a less extensive kind. The necessities of the particular<br />
case and custom regulated the subjects of instruction<br />
taught in the schools. Reading, writing, and reckoning<br />
constituted the elementary stage. To these, after the<br />
Punic wars, was added, for advanced pupils who desired a<br />
higher training, the study of the Greek language and literature<br />
along with the perusal of Latin works, with which was<br />
associated instruction in history, geography, astronomy,<br />
the natural sciences, philosophy, music, and other branches<br />
of knowledge. The schools of rhetoric had an academic<br />
character and in them industrious youths learned dialectics Jf<br />
and the art of speaking in public*<br />
Ancient times knew nothing of medical schools in our<br />
sense of the word. Medical teaching was everywhere |<br />
imparted by a single teacher in all its branches. Even<br />
when numerous teachers of medical science were working 1<br />
at one place there was not, as it appears, any organic connection<br />
uniting them for a division of labour. Students<br />
eager for knowledge were not satisfied with listening to one<br />
teacher but sought out other doctors in order to become<br />
acquainted with their opinions and experiences.<br />
At first, medical teaching was entirely a private con- '.';<br />
cern. ALEXANDER SEVERUS (225-235 A.D.) was the first<br />
to grant stipends to teachers of medicine and to assign \<br />
them public lecture-rooms, for which concession indeed they<br />
were compelled to bind themselves to teach poor students<br />
who were supported by the state, without remuneration.t<br />
CONSTANTINE called upon the doctors to initiate a large<br />
* J. MARSUARDT: Das Privatleben der Romer im Handbuch der romischen |<br />
Alterthumer, Leipzig 1879, Bd. vii, S. 90 et seq. I<br />
f LAMPRIDIUS: Alexander Severus, c. 44.
MEDICAL TEACHING IN ROME.<br />
granted th "^ • '"** *"" SC ~ « » -turn<br />
th ArcMatri "^ Tr" 6 ** But at a '*« P»od<br />
of Archte"'a° r SUCH d0Ct ° rS ES had fil,ed ">e office<br />
theldve [I ^h PPe , ar '. m0re t tha " ° therS * t0 h -e devoted<br />
^s mnarted ' ^ i " ° f ^ ^ Medi «' 'aching<br />
" ^parted e.ther for an honorarium or without re<br />
muneration.t The duration „j ,i • , w "- nout rewas<br />
different inTcs!<br />
pe "° d of stu
IOO ANCIENT TIMES.<br />
superfluous, for they were only concerned to acquire that<br />
mechanical routine in the treatment of diseases which appeared<br />
to them necessary to their calling.<br />
Anatomy had attained a high grade of development<br />
through the efforts of the Alexandrians and of RUEUS<br />
of Ephesus, MARINUS, QUINTUS, and their pupils LYKUS,<br />
SATYRUS, Ir-ELOPS and yEsCHRlON who were GALEN'S<br />
teachers. The position and form of the various bones<br />
was known, as too their respective connections, the<br />
sutures, the periosteum, the medullary membrane, the<br />
articular cartilages, various joints with the ligaments and<br />
tendons associated with them and the most important<br />
groups of muscles, while a fairly accurate conception<br />
was made of the form and position of the organs in<br />
the thoracic and abdominal cavities. GALEN* already referred<br />
to the analogous formation of the sexual organs in<br />
the two sexes and declared that they chiefly differed from<br />
one another in this, namely, that in the female the parts<br />
were disposed with a direction inwards, in the male with a<br />
direction outwards. The vascular system was as yet but<br />
little investigated : but a distinction was recognized between<br />
arteries and veins and the different kind of blood in these<br />
two kinds of vessels was noticed.f The knowledge of the<br />
nervous system possessed by the doctors of this period excites<br />
our astonishment. GALEN gave an accurate description<br />
of the brain and spinal cord,* and represented the course<br />
of many nerves. Thus he alludes to the optic nerve, the<br />
third cranial nerve or oculomotor, the fourth or trochlear,,<br />
the different branches of the fifth or trigeminus, the.<br />
auditory and facial, the vagus and glossopharyngeal, the<br />
nerves of the larynx and pharynx, the sympathetic, and<br />
even points out the ganglia upon the last; so too he<br />
refers to the radial, ulnar, median, crural and sciatic<br />
* GALEN iv, 635.<br />
t GALEN iii, 491.<br />
X CH. DAREMBERG: Exposition des connaissances de GALIEN sur ranatomie|<br />
et la physiologie du systeme nerveux, Paris 1841.—F. FALK : GALEN'S Lehre<br />
vdm gesunden und kranken Nervensystem, Leipzig 1871.
MEDICAL TEACHING IN ROME. IOI<br />
by RUEUS th VI " a ^<br />
aIready been mentioned<br />
liL.T ',<br />
E P hesian > who was also the first to bring to<br />
light the distinction of nerves into motor and sensory*<br />
/he results obtained in anatomical investigation were<br />
chiefly supported by dissection of the lower animals.<br />
Only exceptionally, opportunities presented themselves<br />
for studying human anatomy; and even in Alexandria,<br />
where since the Ptolemies, freer views prevailed on this<br />
subject, such opportunities in GALEN'S time occurred but<br />
seldom^ Only the corpses of hostile soldiers, fallen on the<br />
battle-field, of criminals who had been executed or were<br />
found unburied, of stillborn children or children exposed<br />
to die, were employed for this purpose.f Again, injuries<br />
which were associated with laying bare of the soft parts<br />
occasionally gave some information about the position of<br />
organs. There was naturally no thought to be entertained<br />
of vivisection in Rome, and CELSUS expressed accurately<br />
the common sentiment when he wrote :—" The opening<br />
of the living body I consider horrible and superfluous, that<br />
of corpses on the contrary I hold to be necessary for<br />
learnefs : for they must know the position and arrange<br />
ment of the different parts of the body. For the purpose<br />
of learning these things corpses are more suitable than<br />
living and wounded men."J GALEN narrates, that the<br />
doctors who marched with the Roman army in the war<br />
with Germany, received permission to dissect the corpses<br />
of their fallen foes. Unfortunately, he adds, they were<br />
unable to derive thence any addition to their knowledge<br />
as they lacked the requisite preliminary acquaintance with<br />
anatomy.§ On another occasion he informs us how by<br />
chance he became possessed of two skeletons of which<br />
one was obtained from a corpse which had been floated<br />
out of its grave by a flooded stream, and the other was from<br />
the body of a robber who had been slain in the moun-<br />
* CEuvres de RUFUS, publie'es par CH. DAREMBERG et CH. EM. RUELLE,<br />
Paris 1879, p. 153, 170.<br />
f GALEN ii, 385. J CELSUS : Prsefat. § GALEN xiii, 604.
102 ANCIENT TIMES.<br />
tains* GALEN'S anatomical statements rest chiefly on<br />
dissections of the bodies of the lower animals. He says<br />
so himself; it is also evident from his descriptions of<br />
particular organs. He represents for instance the hand<br />
and foot not of a man but of a monkey. For his anatomical<br />
studies he made use chiefly of the kinds of<br />
monkeys which resemble man.t He thought that their<br />
bodies were structurally identical with those of men and<br />
thus allowed himself to be led into some mistakes the<br />
correction of which was made only at a much later age.<br />
In addition, he dissected bears, pigs, horses and donkeys,<br />
ruminants, once even an elephant, also various smaller<br />
four-footed beasts, besides birds, fishes and snakes, all with<br />
the view of enlarging his anatomical knowledge.<br />
Anatomical teaching began by the several, parts being<br />
pointed out and explained to the students on the naked<br />
body of a living man, and the organs lying under the skin,<br />
named. To this were added, later, dissections of animals<br />
having forms approaching the human. In this way the<br />
several bones and groups of muscles and the inner parts<br />
of the body were noted and the position and arrangement<br />
of the organs in the body-cavity, studied. " If they do not<br />
resemble the corresponding structures of the human body<br />
in every particular point," writes RUFUS, who employed<br />
this method of teaching, " yet this is the case for the most<br />
part: but no doubt people got a more correct picture in<br />
former times, when they were allowed to make use of<br />
human bodies for such investigations."J GALEN speaks in<br />
a similar way of anatomical teaching. " A man cannot<br />
learn anatomy from books alone," he says, " neither can<br />
he from a superficial observation of the parts of the body."§<br />
He recommends, therefore, an assiduous, searching study<br />
of it, beginning with the bones, and passing on to the<br />
muscles, arteries, veins, nerves, and internal organs.<br />
Not only did dissections of animals subserve the purpose.<br />
* GALEN, ii, 221. f GALEN ii, 223.<br />
X RUFUS d'Ephese op. cit. p. 134. § GALEN ii, 220.
MEDICAL TEACHING IN ROME. 103<br />
of teaching, but human skeletons or prepared bones were<br />
used also. May we not assume that in many cases models<br />
formed of marble were employed for this purpose ? The<br />
Vatican museums possess three of such carvings. Two of<br />
these represent the bony thorax: one appears as whenopened,<br />
and affords a view of the heart, the lungs, and the<br />
diaphragm, with indications of the liver and intestines.<br />
The third copy also exhibits the heart and both lungs."*<br />
WELCKER doubts whether these were applied to medical<br />
teaching and thinks merely that "the rare spectacle of a<br />
chest laid open, of a thorax stripped of all flesh, which the<br />
butcheries of the gladiators and the execution of criminals<br />
gave the doctors, at times, opportunities of witnessing;<br />
coupled with the peculiar tendency of many Roman<br />
sculptors to copy realistically anything they met with,<br />
often without any artistic feeling or taste, were the<br />
associated conditions which led to the preparation of these<br />
carvings."f The imitations of mummified human bodies,<br />
brought forward at feasts for the purpose of inciting! the<br />
guests to enjoy life can be as little noticed here as can the<br />
numerous representations of the inhabitants of the kingdom<br />
of Death which have been handed down to us on tombs,<br />
on gems, and in bronze: for they stood in no kind of<br />
relation to anatomical teaching.§ So too the figure used<br />
by BLUMENBACH as the title-page vignette of his<br />
"Geschichte und Beschreibung der Knochen (Gottingen<br />
1786) " , which was taken from an ancient cornelian and<br />
represents a bearded elderly man, grasping with his left<br />
haild a human skeleton erect before him, points rather<br />
* EM. BRAUM in the Bullet, dell'instituto archeol., Roma 1844, p. 16, 19.—<br />
J. M. CHARCOT and A. DECHAMBRE: De quelques marbres antiques concern.<br />
des e'tudes anatomiques in the Gaz. hebd. de me'd. et de chir., Paris 1857, T.<br />
iv. No. 23, 27, 30 (where too the so-called ^Esop of the Villa Albani in Rome is<br />
mentioned).<br />
t F. G. WELCKER : Kleine Schriften, Bd. iii, S. 223.<br />
X PETRONIUS: Satyr., c. 34.<br />
§ G. E. LESSING: Wie die Alten den Tod abgebildet haben.— J. M. F. v.<br />
OLFERS : Uber ein Grab bei Kumse in den Abhandlungen der Akad. d.<br />
Wiss., Berlin 1830.
104 ANCIENT TIMES.<br />
to the creation of man by PROMETHEUS, than to anatomical<br />
teaching.<br />
It is uncertain whether drawings were made use of<br />
in the teaching of anatomy, but it is not at all improbable,<br />
since use was made of this method of conveying<br />
information in teaching other things* Whether the ]<br />
representations of the uterus and ovaries contained in<br />
certain manuscripts of MUSCIO have their origin in ancient<br />
times naturally cannot be determined. The same is the<br />
case with the anatomical drawings in the " Introductio j<br />
Anatomica Anonymi" said to have been taken from a<br />
Leyden manuscript, which were published by J. ST.<br />
BERNARD (Leyden, 1744).<br />
The description of the functions of the human body j<br />
and of its different parts was associated with anatomical<br />
teaching. Men proceeded in this matter from the a priori<br />
assumption of a systematic teleological formation of the<br />
organs, and supposed that the latter were only created<br />
in order that the functions demanded by Nature should<br />
be carried out. The opinion advanced by EPICURUS<br />
and later by ASKLEPIADES and contrary to the above<br />
mentioned view, namely that Nature makes many un^<br />
successful attempts before she attains a permanent<br />
result, and that the use of organs, that is to say, their<br />
functions are first acquired after, and in consequence of,<br />
their construction thus arrived at,t found in GALEN a<br />
bitter opponent. With all the intellectual acuteness, and<br />
with all the learning at his command, he made the attempt ]<br />
to verify a teleological view, which he considered to be the<br />
best means of reconciling the realism of ARISTOTLE with 1<br />
the idealism of PLATO. Yet the foreboding seems from<br />
time to time to have arisen in his mind that speculation j<br />
alone could give no satisfactory answer. Hence he was<br />
led to the path of observation and experiment,—the only |<br />
path leading to results in this matter. In this way he<br />
* MARQUARDT op. cit., Bd. vii, S. 107, 802.<br />
f GALEN iii, 74, 364.
MEDICAL TEACHING IN ROME. 105<br />
endeavoured to investigate the act of breathing and<br />
the action of the heart. In animals he divided the spinal<br />
cord, the intercostal muscles or their nerves, and removed<br />
certain ribs* in order to see what changes were caused<br />
by this proceeding, in the respiration. In this way he found<br />
that in quiet breathing the diaphragm plays the principal<br />
part and that the intercostal muscles only take part in<br />
forcible respiration.f He observed the movements of the<br />
heart in animals after the thoracic cavity had been opened ;<br />
he also once had the same opportunity in the case of a boy<br />
whose heart had been laid bare by a penetrating wound of<br />
the thorax. J By means of numerous total or partial<br />
divisions of the spinal cord and of different nerves and<br />
by slicing the brain in layers, which operations he carried<br />
out on pigs, he hoped to discover the physiological<br />
significance of these organs.§ The results which he<br />
obtained and which he minutely describes may not have<br />
answered his expectations, but these attempts deserve full<br />
recognition, for they were the first of the kind and pointed<br />
out the right method by which these problems are to be<br />
solved.<br />
GALEN was supported in his researches by an ex<br />
tremely happy imaginative faculty which put the proper<br />
word in his mouth even in cases where he could not<br />
possibly arrive at a full understanding of the matter—<br />
where he could only conjecture the truth. When for<br />
instance he declares that sound is carried "like a wave "||<br />
or expresses the conjecture that that constituent of the<br />
atmosphere which is important for breathing also acts by<br />
burning,!" he expresses thoughts which startle us, for it was<br />
* GALEN ii, 475, 681, 696. iv, 685. v, 289.—ORIBASIUS op. cit. iii, 236.<br />
+ GALEN iv, 465 et seq.<br />
X GALEN ii, 631.<br />
§ GALEN ii, 677, 682,692, 697. v, 645.—CH. DAREMBERG: Histoire des<br />
sciences me'dicales, T. i, p. 224.<br />
|| GALEN iii, 644.<br />
If GALEN iv, 487.-^6?/. also HJESER : Geschichte der Medicin, Bd. i, S. 360,<br />
3 Aufl.
106 ANCIENT TIMES.<br />
only possible nearly two thousand years later to understand<br />
their full significance.<br />
In the time of GALEN the doctors felt but small<br />
interest in the problems of physiology. Practical medicine<br />
claimed their chief attention. The art of healing<br />
was thought more highly of by them than the science<br />
of man—and was also more profitable. Their aims in<br />
this direction led to a diligent study of materia medica..<br />
Numerous collections of recipes in verse and prose, and<br />
lists of drugs give expression to these efforts in .their '<br />
literature. The pharmacological writings of PHILO of<br />
Tarsus, of SCRIBONIUS LARGUS, of SEXTIUS NIGER, of<br />
MENEKRATES, of ANDROMACHUS, of DAMOKRATES, are<br />
among the most prominent examples, but above all is the<br />
work of PEDANIUS DiOSKORiDES of Anazarba in Cicilia<br />
who had become acquainted with a great part of the Roman ,|<br />
Empire as a military doctor and from youth had looked<br />
•J\upon the study of therapeutic agents as his life's work*<br />
h -/ He subjected to a systematic review, distinguished by its<br />
yl completeness, all the medicinal agents known at that time<br />
in the three kingdoms of Nature. In his work the various 1<br />
"'" names are given by which they were known in different<br />
' countries, their native countries mentioned, the way to find<br />
>;,(them or to prepare them artificially described, and their<br />
• therapeutic action explained. This book is therefore a<br />
very important one not only for medical science but also<br />
for comparative philology and especially for botany.<br />
DiOSKORiDES has described therein about 500 plants and<br />
so accurately as to render the determination of the majority<br />
of them possible. E. MEYER has characterized his services<br />
in this department by the words: " What THEOPHRASTUS<br />
is to us in the general botany of the ancients, that is<br />
DiOSKORiDES to us in their special botany—the fountainhead,<br />
worth more alone than all the rest put together."!<br />
* PEDANII DIOSCOIUDIS materia medica, ed. CURT. SPRENGEL, Lips. 1829,<br />
T. i, p. 4.<br />
t E. MEYER : Geschichte der Botanik, Konigsberg 1885, Bd. ii, S. 117.<br />
i
MEDICAL TEACHING IN ROME. 107<br />
The Work of DiOSKORiDES was highly valued by GALEN,<br />
who appeals to it on various occasions, and formed throughout<br />
the middle ages even to late times the most valuable<br />
handbook of materia medica. It certainly served in no<br />
small degree to arouse and maintain consideration for<br />
botanical and pharmacological studies. "The doctor<br />
should be acquainted with all plants or at least with the<br />
majority and those most used" writes GALEN. "The<br />
species, or if it is preferred the different sorts are:<br />
trees, bushes, herbs, thorns and shrubs. Whoever is able<br />
to distinguish them from their very young state until their<br />
full growth will find them in many parts of the world.<br />
Thus I myself have found plants in various districts of<br />
Italy which those who had only seen them in the dry state<br />
were unable to recognize either during their growth or<br />
afterwards. Every vendor of salves knows the plants and<br />
fruits Avhich are brought here from Crete; but not one<br />
knows that many of them grow in the neighbourhood of<br />
Rome. Therefore no one thinks of looking for them when<br />
the time of their ripening has arrived."* He declares<br />
thereupon that he is informed upon this point and does hot ,<br />
neglect to gather the plants at the right time before they<br />
have been dried up by the heat of the sun and the fruit is<br />
over-ripe. In another place he remarks f that it is impossible<br />
to learn botany from books—of which many were<br />
provided with drawings J—but only by hunting for and<br />
observing the plants under the direction of a teacher.<br />
" This method of teaching" he adds "applies not only to<br />
the case of plants but to all specimens of materia medica in<br />
general."<br />
The doctors were compelled to pay great attention<br />
to this subject, as they were obliged to prepare the<br />
medicines themselves. To be sure, some preferred for<br />
convenience to buy not the raw material but the medicines<br />
already made up at the druggists who kept at their stores<br />
* GALEN xiv, 30.—MEYER op. cit. S. \qv. f GALEN xi, 797.<br />
X PLINIUS: Hist. nat. xxv, 8.<br />
t- -c-Z, \<br />
r' •'<br />
*,'*!.<br />
V. •
108 ANCIENT TIMES.<br />
in addition to these things dyes for the hair, applications<br />
to improve the complexion and other articles for the<br />
toilet* But in general the doctors only cared to buy the<br />
simple drugs required for making up their prescriptions.<br />
The fear of being cheated by having damaged or adul- ,<br />
terated goods sold them induced many to acquire drugs at<br />
first hand or themselves to collect and prepare them. GALEN<br />
undertook even long journeys for this purpose: he also<br />
caused drugs to be sent to him from the countries which<br />
produced them, through the hands of trustworthy friends<br />
so as to be sure that they were genuine.f This care was<br />
necessary, for the adulteration of drugs was systematically<br />
carried out, and it was not even possible to get pure in<br />
Rome the balsam-juice produced in the royal domain of<br />
Engaddi in Palestine and which was a state monopoly.<br />
The drugs for the Court were on this account collected<br />
under the supervision of officials, packed in paper, furnished<br />
with a label giving the name of the plant and sometimes<br />
the place where it was found : they were then sent<br />
to Rome and kept there in special storehouses. J These<br />
contained such a stock of drugs that after satisfying the<br />
needs of the Court, some could be sold thence to private.<br />
persons. This however was by no means sufficient to<br />
materially injure the trade in adulterated articles. The<br />
adulterations, for the rest, were not effected so much by<br />
the druggists as by the purveyors and simplers who<br />
brought the plants from the mountains to the city.§ The<br />
adulterations were effected so skilfully that the most<br />
experienced connoisseurs, as GALEN says,|| were deceived<br />
and considered the goods pure. He himself in his youth,<br />
as he narrates,^ had received instruction from a man who<br />
occupied himself with rectifying such adulterations, and<br />
paid him a large fee for being initiated into these secrets.<br />
Being well acquainted himself with the whole matter he<br />
* PLINIUS op. cit."xxx\v, 25. t GALEN xii, 216. xiv, 7 et seq.<br />
X GALEN xiv, 9, 25, 79. § GALEN xiii, 571. || GALEN xiv, 7.<br />
*ft GALEN xii, 216.
MEDICAL TEACHING IN ROME. IO9<br />
gave students the valuable advice to devote great attention<br />
to the study of the materia medica: "Young students<br />
must see the specimens not once or twice but often. For<br />
it is only by applying oneself with intelligence to these<br />
things" he writes* "and by examining them frequently<br />
that one gets a thorough knowledge of them."<br />
Each drug was provided with a ticket on which its name<br />
and that of its discoverer, the disease it was prescribed for,<br />
the method of using it, and often the name of the patient<br />
were inscribed. Ointments for the eyes which formed<br />
saleable articles of trade, were packed in vessels on<br />
which the seal of the doctor who had prepared<br />
them was impressed. Seals of this kind have been<br />
found in France, England, Germany, and Transylvania,<br />
especially in places where Roman legions had been<br />
encamped. More than 160 different stamps of ophthalmic<br />
surgeons have been described.t The prescriptions were<br />
long and complicated: theriaca for instance consisted of<br />
more than 70 different vegetable and animal products.J<br />
Many of them were disgusting and nauseous, and<br />
GALEN was surprised at the prescriptions of the doctor<br />
XENOKRATES who had even recommended human flesh<br />
" for, of course, it is forbidden in the Roman empire to<br />
devour men."§ On another occasion where mention is<br />
made of a doctor who ordered the country-folk goats-dung,<br />
GALEN made the witty remark that a thing of this kind is<br />
not suitable for refined townsmen ; dung being only useful<br />
to farmers.|| The unthinking public cherished the mistaken'opinion<br />
that the most expensive remedies were also<br />
the most potent for goodl and a rich purse-proud man was<br />
* GALEN xiii, 570.<br />
f C. L. GROTEFEND: Die Stempel der romischen Augenarzte, Hannover<br />
18b'j.—J. KLEIN: Stempel romischer Augenarzte, Bonn 1874 (Nachtrag zu<br />
Grotefend's Buch).—MARSJUARDT op. cit. S. 758.— HERON JDE VILLEFOSSE et<br />
H. THEDENAT : Cachets d'oculistes romains, Tours et Paris, 1882.<br />
X GALEN xiv, 83 et seq.<br />
§ GALEN xii, 248.<br />
|| GALEN xii, 299.<br />
^f PLINIUS: Hist. Nat. xxix, 8.<br />
iuteti*— \
I 10 ANCIENT TIMES.<br />
highly indignant when GALEN recommended him. the same<br />
kind of medicine which he had used with good effect upon<br />
his slave. When he heard that it was made of nothino- but<br />
cheap ingredients he called o
MEDICAL TEACHING IN ROME. I II<br />
stone,—to which GALEN assigned an origin similar to that<br />
ot gouty tophi,—* and consumption! were more closely investigated.<br />
For the last mentioned disease among other<br />
things sea voyages were recommended and residence in<br />
sanatoria of suitable climate especially in Egypt The<br />
pathology of the nervous system was pursued also with<br />
zeal and success. GALEN states that he was able to trace<br />
m one case paralysis of the fingers to an injury of the<br />
spinal cordj and ARET^US was aware that the nerve fibres<br />
cross soon after their origin and thence explains the fact<br />
that after wounds of one hemisphere of the brain the<br />
opposite side of the body is paralyzed.§<br />
Instruction in practical medicine was given partly during<br />
the private practice of the teacher who took students with<br />
him to his patients, partly in Iatreia. The latter were<br />
arranged after the Greek pattern and were called Tabernae<br />
medic* or Tabernse medicinae.\\ They were the shops or<br />
public places of business of the doctors who received and<br />
treated patients at them, performed surgical operations, prepared<br />
and sold medicines, and dwelt with their assistants<br />
and pupils. Into some of these institutions patients—for<br />
instance people of unsound mind—were admitted.^ Many<br />
towns erected Iatreia at their own cost and gave them<br />
over to doctors to induce them to take up their permanent<br />
abode there.** As GALEN,tt who has left complete information<br />
on this point, says, they were for the most part<br />
situated in large buildings with high doors letting in plenty<br />
of light and air and were furnished with surgical instruments<br />
and medical appliances.<br />
* GALEN xiii, 993. xvii A, 835.<br />
f CELSUS iii, 22.—ARET/EUS : de chron. i, 8.—C/EL. AUREL.: de chron<br />
», 14.<br />
+ GALEN viii, 213.<br />
§ ARET,£US: de chron. i, 7.<br />
I PLAUTUS : Amphytryo iv, 4. Epidic. ii, 1.<br />
If PLAUTUS: Menachmi v, 947-956".—SPARTIANUS : Vita Hadriani, c. 12.<br />
** GALEN.xviii B, 678.<br />
tt GALEN xviii 6,629-925.
112<br />
0<br />
ANCIENT TIMES.<br />
The convalescent homes* and sick rooms which the<br />
great landlords caused to be built for their family -<br />
domestics and numerous slaves, may also have afforded,^\<br />
opportunity for practical teaching in the examination<br />
and treatment of the sick. In any case it was here that|tj<br />
the slaves, who were trained for doctors at the wish of<br />
their lords, were instructed in the healing art. The military \<br />
hospitals, with stalls for sick horses, which were established<br />
wherever masses of troops were collected, must have some- '\<br />
times subserved a similar purpose.t ,<br />
The buildings, which ANTONINUS PlUS caused to be ',<br />
erected in the vicinity of the temples of ASKLEPIOS at<br />
Epidauros and on the island in the Tiber cannot be looked<br />
upon as institutions for the sick. They were to give<br />
admission to dying persons and pregnant women over- |<br />
taken by the pains of labour, so that the sanctuaries should 'I<br />
be kept pure and undefiled.J<br />
Care and treatment of patients in Iatreia and other<br />
institutions of that kind was comparatively rare in ancient<br />
times. Patients were for the most part visited in their.*<br />
dwellings by the doctors. For this reason instruction .,<br />
in the practice of medicine was more common there |<br />
than in Iatreia and hospitals. The doctors used to".^<br />
be accompanied by. the students of medicine while ,<br />
visiting the sick and in a suitable case explained<br />
to them the symptoms and treatment of the disease.<br />
By this the pupils were guided in forming their own j<br />
judgment of pathological changes by observation and*"|<br />
manipulation of the ailing body. When the sick rnanf<br />
PHILISKUS was treated by the doctors SELEUCUS and<br />
STRATOKLES they brought with them, as PHILOSTRATUS§<br />
narrates, more than 30 pupils. The witty epigram off<br />
* COLUMELLA: de re rusticaxi, 1. xii, 3.—SENECA: de iia i, 16. nat. qusesMI<br />
i, pisef.—TACITUS : de orat. dial., c. 21.<br />
f HYGINUS : de munit. castrorum, c. 34.<br />
X PAUSANIAS ii, 27.<br />
§ PHILOSTRATUS : Vita Apollonii Tyan. viii, 7. ,
MEDICAL TEACHING IN ROME. .113<br />
MARTIAL on his doctor SYMMACHUS is well known : " I was<br />
U1-- Ihou earnest forthwith to me—accompanied by 100<br />
pupils: 100 ice-cold hands were laid on my body. Till<br />
then I had no fever: now I have."*<br />
GALEN exhorts his pupils to. take care that on entering<br />
a sick room they do not wake their patient or arouse his<br />
anger by making a noise with their feet or by speaking<br />
loudly. He then gives them kindly-meant advice in regard<br />
to their clothing, their behaviour, and the language they<br />
should use with patients: he recommends them cleanliness<br />
and a proper attention to their hair and forbids them to<br />
eat onions or garlic before visiting a patient, or to drink too<br />
much wine, lest they annoy the sufferer by the offensive<br />
odour from their mouths and "stink like goats."t The<br />
high significance and importance of training in practical<br />
medicine was acknowledged on all sides. GALEN ridiculed<br />
the' learned theorists and sophists who " from their high<br />
chairs shower down upon their pupils detailed explanations<br />
but if called to a patient have no idea of the complaint he<br />
is suffering from.''J<br />
The public naturally betook themselves rather to doctors<br />
who possessed some practical training than to those who<br />
were only able to make fine speeches about the healing art.§<br />
Surgery had, as CELSUS|| remarks, soon after the time<br />
of HIPPOKRATES separated itself from the rest of medicine.<br />
From this time forth, it formed a separate and independent<br />
subject of knowledge and education. In Rome it<br />
•i was not usual for the doctors who treated internal diseases<br />
to practise surgery as well: for this reason GALEN<br />
abstained from practising the latter when he settled down<br />
there.5 CELSUS mentions the surgeons PHILOXENUS<br />
GORGIAS, SOSTRATUS, HERON, the two APOLLONII, and<br />
the lithotomist AMMONIUS of Alexandria, and again the<br />
elder TRYPHON. EUELPISTUS and MEGES of Rome, who<br />
* MARTIALIS: Epigram, v, 9.<br />
f GALEN xviii B, 144-152.—CELSUS iii, .6.' + GALEN xviii B, 258.<br />
§ LUCIAN: Hippias, c. 1. || CELSUS vii, Praefat. fl GALEN x, 455.<br />
I
HA T^' 'ANCIENT TIMES.<br />
distinguished themselves both as teachers and writers in<br />
the field of surgery. Unfortunately their works have been<br />
lost and we have to consult references to them in later<br />
authors if we wish to form, an opinion as to what they<br />
accomplished. CELSUS writes " that these men have made<br />
many improvements and discoveries in surgery."<br />
If we compare the position of this branch of the healing<br />
art under the Roman Emperors with that of Hippokratic<br />
surgery we are surprised by the wonderful progress made.<br />
The Roman surgeons not only possessed correct information<br />
about the nature and treatment of many diseases and<br />
wounds which demand surgical interference, but they<br />
ventured upon the performance of major operations where<br />
sound knowledge of anatomy and of the use of surgical<br />
instruments was required.<br />
Their supply of instruments was fairly large. The<br />
excavations at Herculaneum and Pompeii, during the<br />
carrying out of which a great number of such implements<br />
were discovered, have afforded valuable information<br />
upon this point. We learn thus that the following<br />
were in use — straight and curved needles, probes<br />
of various kinds, hollow sounds, curved and toothed<br />
forceps, catheters with a gentle S-shaped curve, several<br />
forms of clips, among them some with clasps and slides,<br />
conical and spheroidal cupping instruments, sharp and blunt<br />
hooks, pronged and disk-shaped cauteries, knives, spatulae,<br />
lint, lancets, bistouries, rectal and vaginal specula etc.*<br />
Of the specula some were in one piece, some in two or<br />
three. In the year 1882 one of four parts was found: it<br />
was composed of two straight and two S-shaped branches.t<br />
They were acquainted with various kinds of bandages and<br />
with apparatus for extension and for securing immobility<br />
* B. VUI.PES: lllustrazione di tutti gli strumenti chirurgici scavati in<br />
Ercolano e Pompei, Napoli 1847.—QUAHANTA and VULPES in the Museo<br />
Borbonico, Vol. xiv, 36. xv, 23.<br />
f A. JACOBELLI -. Speculi chirurgici scavati dalle rovine delle cittk dissepolte<br />
Pompei ed Ercolano in the Morgagni, Napoli 1883, T. xxv, p. 185 et seq.
•:'.i:<br />
MEDICAL TEACHING IN ROME, 115<br />
which came into use in the treatment of fractures and<br />
luxations.<br />
The performance of surgical operations was rendered<br />
easier by the fact that better methods of arresting haemor<br />
rhage had been learnt: they were no longer limited to<br />
application of cold, compression, styptics and cautery, but<br />
the vessels were subjected to ligature * and torsion f if the<br />
other methods failed to effect the purpose. For this reason<br />
vascular new growths could be removed and amputations<br />
and resections undertaken. ANTYLLUS went so far as to<br />
operate for aneurism.J In amputation the circular method<br />
and the flap method were both employed.§<br />
The skill of the Roman surgeons achieved its greatest<br />
_ triumphs in resection. ANTYLLUS and HELIODORUS ||<br />
removed diseased portions of a bone while carefully pre<br />
serving its continuity : they took away the humerus in its<br />
.entirety, a part of the acromion-process, so also parts of the<br />
femur, tibia, radius, and ulna, even the inferior maxilla,<br />
while sparing the joints, and parts of the superior maxilla.'<br />
Plastic surgery also was not unknown to them. By<br />
traction of the neighbouring parts of the skin and the sub<br />
jacent connective tissue they sought to restore lost tissue<br />
on the ears, the cheeks, the nose and the lips.f<br />
The question has been discussed by many learned men<br />
whether among the ancients artificial appliances were used<br />
to supply the place of lost limbs. On a vase belonging to the<br />
Durand Collection in the Louvre the figure of a man is<br />
represented with what appears to be at first sight, a wooden<br />
leg.** But on a closer inspection one sees that the leg is<br />
* CELSUS V, 26.—GALEN x, 314.<br />
f ORIBASIUS iv, 485.—RUFUS in Aetius xiv, c. 51.<br />
X ORIBASIUS iv, 52. Cf. ED. ALBERT in the Wiener Med. Blattern 1882, No<br />
; 3, 4, 5-<br />
§ CELSUS vii, 33.—ARCHIGENES and HELIODORUS in QRIBASIUS iv, 244, 247.<br />
I ORIBASIUS iii, 582. 615 e^eg.<br />
f CELSUS vii, 9.—ANTYLLUS in ORIBASIUS iv, 56 et seq.<br />
** E. RIVIERE: Prothese chirurgicale chez les anciens in the Gazette des<br />
Hop., Paris 1883, No. 132, 136.
Il6 ANCIENT TIMES.<br />
not absent but is bent round a long staff. On the other hand<br />
it is certain from a remark of LUCIAN * that artificial feet<br />
were prepared from fig-tree wood and that those who had<br />
undergone amputation made use of them.<br />
Tracheotomy was certainly performed but did not<br />
yield good results, it appears, and consequently was<br />
distrusted.f<br />
CELSUS J has thoroughly described the operation for stone „<br />
in the bladder. He mentions at the same time that the*'<br />
surgeon AMMONIUS made the attempt to crush in the<br />
bladder the larger "stones which were difficult to remove.<br />
Unfortunately the description of the procedure is not<br />
sufficiently clear to enable one to point to it as equivalent<br />
to lithotrity. But a passage in the biography of the<br />
saintly THEOPHANES composed by an anonymous author,<br />
affords conclusive proof that lithotrity was known and<br />
practised in ancient times: for it is stated therein that.<br />
THEOPHANES suffered from stone in the bladder which,<br />
by instruments which had been introduced, was crushed<br />
to pieces and then passed externally.§ OLYMPIOS believes,<br />
that instruments resembling forceps and having small,<br />
sharp, tooth-like points on them, like those found at<br />
Miletus, were used for this purpose.||<br />
A lengthening and laceration of the abdominal wall was<br />
looked upon as the primary cause of hernia ; but GALEN<br />
brought into view in addition to this the part played by the<br />
muscles.l For the relief of hernia trusses or the radical<br />
operation were recommended.** Of the latter HELIODORUS<br />
has left a description which by its minuteness and clearness<br />
* LUCIAN : Ad. indoct. c. 6.<br />
+ ARETSUS; de acut. i, 7.—CELIUS AURELIAN : de acut. iii, 4—GALEN<br />
xiv, 734.<br />
X CELSUS vii, 26.<br />
§ Corp. script, hist. Byzant., Bonn 1839, Vol. xxvi, Th. i, p. xxxiv.—<br />
Patrolog. ed. Migne. Ser. grsec, T. 108, p. 37, Paris 1863.<br />
|| R. BRIAU in the Gaz. hebd. de med et de chir., Paris 1858, No. 9.<br />
If GALEN vii, 730.<br />
** CELSUS vii, 20.
MEDICAL TEACHING IN ROME. 117<br />
arouses just admiration* Even the symptoms of incarcerated<br />
hernia were described by some observers.f<br />
HELIODORUS divided strictures of the urethra with a<br />
cutting instrument and then placed bougies made of dried<br />
paper, and metal sounds in the urethral It was also<br />
known how to operate in a skilful way in cases of phimosis<br />
^ and paraphimosis, condylomata and haemorrhoids. §<br />
Ophthalmology was also able to show remarkable results.<br />
.Not only trichiasis, hypopyon, leucoma, lachrymal fistula<br />
and other affections of the external parts of the eye were<br />
subjected to operative treatment, but even cataract itself.<br />
To be sure surgeons were ignorant of the essential nature<br />
of this disease, but they cured it. Here, as so often in<br />
medicine, Art preceded Science. Operation in cataract<br />
was effected by couching the diseased lens. If the lens<br />
rose up again or showed a soft consistence they then in<br />
addition proceeded to subject it to discission.|| Perhaps<br />
extraction was also known. Certainly the remark of<br />
PLINY that the doctors from greediness preferred pushing<br />
away, to extracting, the scale in the eye, is too deficient<br />
in clearness, for us to refer it to that operation. The<br />
statement of GALEN that some surgeons instead of displacing<br />
the lens have made the attempt to clear it away<br />
externally,! rather justifies the assumption that the extraction<br />
operation was practised.** A description of it is no<br />
* ORIBASIUS iv, 484.-ED. ALBERT: Die Herniologie der Alten, Wien 1878<br />
S. 144.<br />
t CELSUS vii, 18, 2O.-ARET.EUS : de acut. ii, 6—PAULUS #0IN. iii, 4,_<br />
AETIUS. xiv, 24.<br />
X ORIBASIUS iv, 472.<br />
§ ORIBASIUS iv, 466, 470.—PAULUS MG. vi, 79.<br />
|| CELSUS vii, 7._GALEN x, IO^.-VEGETIUS RENATUS: Mulomediciua ii,<br />
i7;-PAULus^GiN:vi,2..-A. ANAGNOSTAKIS: Contributions a l'histoirede la<br />
chirurgie oculaire chez les anciens, Athenes 1872.<br />
f PLINIUS: Hist. Nat. xxix, 8.-GALEN X, 987—Cf. hereon v. HASNER :<br />
Phakolog. Studien, Prague 1868.<br />
** H. MAGNUS (Geschichte des grauen Staares, Leipzig 1877, S. 226 et seq)<br />
defends, on grounds not to be gainsaid, the view that it is here not a question<br />
of cataract extraction but of puncture for hypopyon. In any case as ALFR V
Il8 ANCIENT TIMES.<br />
where to be found. The Arabian author RHAZES ascribes<br />
>a- knowledge of it to ANTYLLUS and states at the same time<br />
that the latter was acquainted with the method of removal<br />
of cataract by suction* It is much to be deplored that the<br />
ophthalmological literature of ancient times has for the<br />
most part been lost.<br />
.F The work of the celebrated ophthalmic surgeon DEM0S-<br />
.'THENES which at the end of the thirteenth century was<br />
; made use of by SlMON of Genoa and a copy of which<br />
perhaps lies hidden in some library at the present day<br />
would throw light upon many things about which now<br />
only conjectures are possible. * ,<br />
The course of surgical teaching embraced accordinglo<br />
CELSUSt first of all the general principles of the art of<br />
operating and then the treatment of wounds and abscesses,<br />
and all diseases of the bones. He required of the<br />
surgeon treating wounds "that he should be of such<br />
an age as to enjoy the use of all his faculties, should<br />
possess a steady and firm hand which never shakes,<br />
and should be able to use the left as dexterously as the<br />
right hand : his eyesight should be quick and clear, his i<br />
spirit fearless and not so prone to sympathy as to allow!<br />
himself, by the cries of the patient, whose treatment he has<br />
undertaken, to operate more quickly than the case requires<br />
or to remove less than is necessary. He should not allow<br />
himself to be influenced in any way in his work by the<br />
noise made by the patient." The surgeons were assisted<br />
in the operations by their assistants and pupils. The<br />
services which these had to render are fully discussed in<br />
many of the passages specified above.<br />
GRAEFE (Klin. Monatsbl. f. Augenheilkunde 1868 Januar) says '* The infancy<br />
of extraction is one of the most difficult chapters in investigating the history<br />
of medicine " and a positive answer to the question whether the ancients were<br />
acquainted with it, is not possible.<br />
* RHAZES: Continens ii, c. 3, Abs. 7-ed. Venet. 1506, fol. 41.—SicHELin<br />
the Archiv. f. Ophthalm. 1868, xiv, 3, S. 1.<br />
f CELSUS vii, Praef.
-*<br />
MEDICAL TEACHING-IN ROME. I 19<br />
Midwifery was practised by midwives : only in difficult<br />
cases did these call in the help of doctors and surgeons*<br />
Women desirous of being trained for midwives should, as<br />
SORANUS says in his work on gynaecology " know how to<br />
read, possess understanding and a good memory, be active<br />
and respectable, quick witted, healthy and strong, and<br />
should have long thin fingers and short nails." It was not<br />
demanded of them, as it was in Greece, that they should<br />
have already themselves given birth. But SORANUS considers<br />
it right that they should not be too young. He further<br />
recommends midwives to be habitually temperate, quiet<br />
and trustworthy, not greedy of money, or superstitious, not<br />
to be induced for the sake of gain to give medicines to<br />
procure abortion or to allow themselves to be hindered in<br />
the fulfilment of their duties by dreams, forebodings,<br />
mysteries or religious rites. He also advises them to pay<br />
especial attention to the care of their hands, to rub them<br />
frequently with fine ointment, and to avoid working with<br />
wool, which makes the skin hard and dry.f In the training<br />
of the midwives, regard was had both to theory and<br />
practice, but care was especially taken that they should be<br />
instructed in dietetics, materia medica, and the necessary<br />
surgical manipulations. Their acquaintance with the structure<br />
of the female genital organs was very meagre:<br />
SORANUS was of the opinion that there was no need for<br />
them to know much about the subject. They had fairly<br />
correct information about the. course of a normal birth, and<br />
about the help which should be rendered at that time; they<br />
supported the perineum of the mother with a napkin, tied<br />
the umbilical cord after the birth, were careful as to the<br />
delivery of the placenta, etc. They were also made<br />
acquainted with the various presentations of the fcetus and<br />
received fitting directions about the choice of a wet nurse,<br />
* SORANUS EPHES.US, Ed..Dietz, p. loj.-Cf. J. PINOFF in the Janus i, S.<br />
7°5-75 2 - »> 16-52, 217-245, 730-744.<br />
f SORANUS p. 3-5.
120 ANCIENT TIMES.<br />
and about the care of the newly born child* They even<br />
undertook important operations such as turning by the<br />
head or feet in faulty presentations.! Embryotomy was<br />
only performed when all attempts to deliver a living child<br />
were fruitless.J<br />
A law said to have been made by NuMA POMPILIUS,<br />
ordained that the Cesarean section should be performed<br />
on women dying in labour, in order if possible to save the<br />
life of the child.§ PLINY || narrates that it was also carried<br />
out on living parturient women, and SCIPIO AFRICANUS<br />
owed his life to this operation.<br />
Many midwives did not confine their sphere of action<br />
to midwifery and the treatment of women's diseases, but<br />
advanced into the domain of general medical science, and<br />
consequently were really female doctors.^<br />
Midwives enjoyed great respect. By the Courts they were<br />
considered** to be experts and later on possessed the right<br />
of bringing an action in support of claims for services<br />
rendered.ft Numerous inscriptions give expression to the<br />
honours paid to them. On a tombstone, as described by<br />
MOMMSEN, there is found a laudatory epitaph to " the incomparable<br />
spouse—noblest woman and accomplished midwife."<br />
One of the most celebrated of medical authors and<br />
doctors, THEODORUS PRISCIANUS, even dedicated a book<br />
to a midwife " the charming helper of his art" as he calls<br />
her.H<br />
* SORANUS p. 79 et seq.<br />
't SORANUS p. noetseq.<br />
X SORANUS p. 113 el seq.—TERTULLIAN : de anima, c. 25.<br />
§ Pandect, lib. x., tit. 8, de mortuo inferendo.<br />
|| PLINIUS: hist. nat. vii, 7.<br />
If MARTIAL: Epigr. xi, 71.— APULEIUS: Metamorph. v, 24.—PLINIUS: hist.<br />
nat. xxviii, 7, 18, 23, 80—JUVENAL, ii, 141.<br />
** SENECA : Epist. 66.<br />
ft Pandect, lib. 50, tit. 13.<br />
XX TH. PRISCIAN. lib. iii, Prsef.
-nf^j/uuiytfuAu-n J.V. ,..i... ftm<br />
*<br />
MEDICAL TEACHING IN ROME. 121<br />
THE MEDICAL PROFESSION IN ROME.<br />
The practice of the medical profession was, as has<br />
already been said, free to anyone without his being<br />
obliged to show by any examination his fitness for the<br />
same; but as. early as 88 B.C., the Lex Cornelia made<br />
him liable to arrest if death was brought about by his<br />
fault. Moreover the candidature for employment in the<br />
public sanitary service, and for reception among the number<br />
of doctors favoured by definite privileges, so too the con<br />
ditions of suing for medical fees, and especially the<br />
•extraordinaria cognitio, must have afforded occasion for a<br />
distinction being made in practical life if not in law,<br />
between the scientifically trained doctors and the dabblers'<br />
in medicine.*<br />
Since many doctors had received a training that was<br />
incomplete and limited to certain departments, not<br />
having been taught in all branches of medical science,<br />
they, under these circumstances, attached themselves to<br />
certain parts of it. They could in a shorter time acquire<br />
thein- knowledge necessary for practice in a narrowly circum-<br />
,s\g scribed department of the healing art. Specialities,<br />
.isai the beginnings of which reach back to an earlier period'<br />
ibri gradually acquired a bad reputation, becoming not so<br />
;ca| much the indication of extraordinary efforts in a special<br />
sphere as of half-educated charlatanry. The representa<br />
tives of this class exposed their weakness in an awkward<br />
manner in their intercourse with educated doctors, and<br />
served for favourite objects of scorn to the comic<br />
dramatists.<br />
The sub-division of medical work was exaggerated<br />
;bisi. in a senseless manner. There were not only surgeons,<br />
accoucheurs, gynaecologists, ophthalmic surgeons, dentists,'<br />
and aurists, but also specialists for nearly every<br />
part of the body. Some confined themselves to the<br />
* TH. LOWENFELD : Inaestimabilitat und Honorirung der artes liberates nach<br />
Tomischem Recht, Miinchen 1887, S. 428.<br />
jimi "' iiiiir<br />
't.
122 ANCIENT TIMES.<br />
treatment of fistulae and ruptures, or of definite parts<br />
of the body, for instance the buttocks, others had to<br />
do exclusively with lithotomy, operations for hernia<br />
or for cataract* In an epigram of MARTIAL t it is said:<br />
" CASCELLIUS draws teeth out or restores them, HYGINUS<br />
burns away eyelashes growing against the eye, FANNIUS<br />
cures a swollen uvula without cutting it, EROS removes<br />
marks burnt into the skin of slaves, and HERMES is the best<br />
doctor for hernia." There were special doctors for diseases<br />
of children and also for those of old age.<br />
Many specialists made use of particular methods of cure<br />
and employed particular agents such as water, wine, milk,<br />
certain medicines and plants, as for instance hellebore.t<br />
Able doctors, like GALEN, despised these proceedings and<br />
devoted their attention to all branches of medical science<br />
although they might in practice prefer this or that branch<br />
of it. " I believe " writes CELSUS§ " that it is quite possible<br />
to master all the departments of the healing art. If they<br />
are sub-divided, however, I prefer the doctor who is skilled<br />
in the greatest number of them."<br />
Friendly relations existed between physicians and<br />
surgeons. "They support and recommend one another<br />
reciprocally," || says PLUTARCH. It does not appear that<br />
the surgeons occupied a lower social position than the<br />
doctors for internal diseases as was the case in later times:<br />
and nothing leads us to conclude that the former possessed<br />
a poorer general education than the latter.<br />
In many cases several doctors were brought into consultation<br />
by the patients or their friends : they then settled<br />
in a general interchange of opinion the diagnosis and<br />
treatment. These consultations may easily have ledf not<br />
infrequently to stormy differences of opinion in which the<br />
* Pseudo-GALEN : de part, artis medic. Ed. CIIARTIER ii, 282.—GALEN<br />
V, 846.<br />
t MARTIAL : Epigr. x, 56.<br />
X PLINIUS: Hist. nat. xxix, 5.<br />
§ CELSUS vii, Prsef.<br />
|| PLUTARCH: de fraterno amore, c. 15.—GALEN xviii A, 346.<br />
% PLINIUS op. cit. xxix, 5.
THE MEDICAL PROFESSION IN ROME. I 23<br />
limits of good behaviour were passed. The dissimilar<br />
scientific, training is illustrated by the fact that educated<br />
and experienced doctors like GALEN, in disgust at the<br />
ignorance and want of ability of their colleagues, passed<br />
a sharp judgment upon their views and medical directions*<br />
TiiEODORUS PRISCIANUS has left us a realistic<br />
description of such consultations.f " While the patient "<br />
he writes " racked by his pains, tosses himself to and<br />
fro on his bed, doctors in crowds rush in, each one of<br />
whom is only concerned to fix the attention of the rest<br />
upon himself, and cares but little for the condition of the<br />
patient. In a spirit of emulation like that displayed in a<br />
circus or at a pugilistic contest, one endeavours to gain<br />
extraordinary fame by his oratory or his dialectics, another<br />
by the artistic building up of theses—a structure which his<br />
adversary soon levels with the ground." The popular<br />
humour made merry over these things and invented the<br />
anecdote mentioned by PLINY that in an epitaph it was set<br />
forth how the deceased expired in the midst of the doctors<br />
who were treating him.<br />
The medical profession did not at first enjoy that respect<br />
which the strenuous, self-sacrificing activity of its members<br />
deserved. Romans of rank had even at the best only a<br />
patronizing regard for medicine and looked upon the<br />
practice of it as a business which was fitted for persons<br />
of low birth, for servants or slaves.J When at a later<br />
period the immigration of foreign doctors came about<br />
and practitioners of medicine from Greece, Egypt, Asia<br />
Minor and Palestine settled in Rome, the narrow-minded<br />
bias and civic prejudice with which all foreigners were<br />
regarded were obstacles in the way of any improvement<br />
in the social position of doctors.<br />
It is true that the doctors themselves were largely responsible<br />
for this. The boastfulness, covetousness and vice by<br />
which some among them made themselves scorned, afforded<br />
* GALEN viii, 357. x, 910. xiv, 623 et seq.<br />
f THEOD. PRESCIANUS i, Prsef.<br />
X PLINIUS op. cit. xxix, 8.
124 ANCIENT TIMES.<br />
to their enemies effective weapons to turn against the<br />
whole profession. PLINY states that doctors so far misused<br />
their position of trust as to practise legacy-hunting<br />
and adultery and to compass the death of a human being by<br />
the administration of poison*<br />
GALEN goes so far as to compare the doctors in Rome to<br />
robbers and says that between them there exists but one<br />
point of difference, namely that the latter carry on their<br />
infamous practices in the hills and the former in the town.f<br />
To this were added the obtrusive and braggart manners of<br />
many foreign practitioners, displeasing to the dignified<br />
seriousness of the Romans. THESSALUS, who called himself<br />
the " Conqueror of Doctors " made his way along the<br />
streets with such a crowd of attendants " as was scarcely<br />
possessed by a street performer or a celebrated circusrider."<br />
% Some doctors carried on the hunt for patients<br />
quite openly and did not blush to ask the passers-by to enter<br />
their dispensaries which in this case not unfrequently<br />
degenerated into places of resort for idlers and swindlers.<br />
The desire to become known and to get practice induced<br />
many " to recommend themselves to the favour of powerful<br />
and influential persons, to strut along the streets with them,<br />
to give banquets and to make buffoons of themselves, while<br />
others by the splendour of their dress, by costly rings and<br />
other ornaments sought to dazzle the unreasoning multitude."<br />
§ As in all times, so then also, ignoramuses and<br />
quacks loved to conceal by the splendour of external<br />
semblance the essential hollowness within.||<br />
Doctors who possessed more knowledge and intelligence<br />
resorted to frequent appearance in public in order to make<br />
themselves known. They held popular lectures, arranged<br />
discussions with their colleagues which led to embittered<br />
* PLINIUS op. cit. xxix, 8.—MARTIAI.IS : Epigr. vi, 31.—TACITUS: Annal.<br />
iv, 3. xii, 67.<br />
t GALEN xiv, 622.<br />
X PLINIUS: Hist. Nat. xxix, 5.<br />
§ GALEN iv, 600.<br />
|| LUCIAN : Ad indoctum, c 29.
THE MEDICAL PROFESSION IN ROME. 125<br />
wars of words and as a general rule contributed more to the<br />
amusement than to the instruction of the public, and they<br />
performed surgical operations before the eyes of the people<br />
in the theatre, the circus, or other public places* This<br />
custom, which is still kept up in Italy by itinerant practitioners<br />
and especially by dentists, seems to be of Grecooriental<br />
origin and to have first reached Rome at the time<br />
of the immigration thither of foreign doctors.<br />
The fees received by doctors for their services were<br />
naturally of various amounts and depended upon the means<br />
of the patients and the position and ability of the doctors.<br />
GALEN received from the Consul BOETHUS whose wife he<br />
had treated for a long period 400 gold pieces.t MANLIUS<br />
CORNUTUS, formerly Praetor and Legate to the Aquitani<br />
paid the doctor who cured him of a skin disease 200,000<br />
sestertii.J CHARMIS who distinguished himself by his coldwater<br />
treatment received a similar sum for a cure which he<br />
effected abroad.§ When L. STERTINIUS was offered the<br />
post of body-physician to the Emperor CLAUDIUS he declared<br />
that the pay of 250,000 sestertii was too low, since,<br />
as he showed by enumerating the families where he was<br />
medical attendant, his practice secured to him the annual<br />
income of 600,000 sestertii. || The doctor KRINAS, who<br />
made astrology the foundation of his prescriptions, left behind<br />
him as PLINY tells us a fortune of ten million sestertii<br />
although he had expended large sums upon public buildings.<br />
It is told of the surgeon ALCON % that, after he had been<br />
condemned to a fine of ten million sestertii and to banishment,<br />
within a few years of his return he again amassed a<br />
similar fortune. But such splendid receipts were certainly<br />
* PLUTARCH : de adulatore et amico, c. 32.<br />
f GALEN xiv, 647. This sum has according to MARQUARDT (op. tit. Bd. v.<br />
S. 70) a value cf about 8,000 marks.<br />
X PLINIUS : Hist. Nat. xxvi, 3. Over 40,000 marks. MARQUARDT op. cit.<br />
S. 72.<br />
§ PLINIUS op. cit. xxix, 5, 8.<br />
|| PLINIUS op. cit. xxix, 5.<br />
If PLINIUS op. cit. xxix, 8.
]26 ANCIENT TIMES.<br />
.only the lot of a few fortunate ones. The great majority of<br />
doctors earned hardly as much as the maintenance ot lite<br />
required The * unequal distribution of wealth which<br />
was accumulated in the hands of certain families and<br />
gave the great masses of the people over to poverty,<br />
offered to but few doctors the opportunity of acquiring riches<br />
by the exercise of their art. The inconsiderate competition<br />
for which they themselves were responsible, contributed<br />
also to this state of affairs by reducing the rate of pay for<br />
their services to the smallest possible. Whoever has a<br />
poor practice remains necessarily himself a poor man.<br />
It came to such a pass that doctors gave up their calling<br />
if it did not support them and devoted themselves to the—<br />
as it appears-more profitable business of gladiator or<br />
undertaker. The spiteful epigram of MARTIAL refers to<br />
this • he says " DiAULUS was a doctor, is now an undertaker:<br />
he makes the best use in his power of his professional art."<br />
« For the rest, while he was still a doctor he was little more<br />
than an undertaker."t<br />
Only slowly and by degrees did the social positions ot<br />
doctors improve. They owed this partly to the successful<br />
efforts of those members of their profession who by the<br />
depth of their knowledge and the purity of their character<br />
won the respect and admiration of their fellow-citizens,<br />
partly to the continually increasing recognition of the<br />
necessity and importance of the medical art. Educated<br />
people began to feel a lively interest in anatomical and<br />
physiological investigations and in medical science generally.<br />
"I am of opinion" writes GELLIUS "that it is a disgrace<br />
not merely for a doctor, but for every independent man<br />
who has been well brought up, to be ignorant of those<br />
things which concern the human body and of the means<br />
for preserving health which Nature lays open before our<br />
eyes. I have on this account given all the time I could<br />
spare to the study of medical works, since it was in them<br />
> # GALEN xii, 916.<br />
> f MARTIALIS: Epigr. i, 30. 47. viii, 74.
iiMipHP(iJJ|il. ."T»""P<br />
&4. '<br />
THE MEDICAL PROFESSION IN ROME. I 27<br />
that I hoped to find the best instruction."* In the same<br />
way PLUTARCH thought that everyone should be able to<br />
feel his own pulse intelligently and to recognize what<br />
affected him beneficially or injuriously.t Moreover the<br />
ethical side of the medical calling was prominently<br />
brought into notice by some authors. " The doctor should<br />
not be constrained to visit the sick " writes LuciANj " he<br />
should not be intimidated or brought to them by force but<br />
should go freely and willingly." It is impossible to char<br />
acterize the high dignity, the ideal worth of the healing art<br />
better than in the words of SENECA : " People pay the<br />
doctor for his trouble ; for his kindness they still remain in<br />
his debt." " Thinkest thou " he says elsewhere " that thou<br />
owest the doctor and the teacher nothing more than his<br />
fee ? We think that great reverence and love are due to<br />
both. We have received from them priceless benefits<br />
from the doctor health and life, from the teacher the noble<br />
culture of the soul. Both are our friends and deserve our<br />
most sincere thanks not so much by their merchantable art<br />
as by their frank good-will."§<br />
Even at an earlier period the necessity of medical aid<br />
led to such appointments as family doctors, doctors for<br />
communities, the army,, and societies. Rich people who<br />
possessed large establishments and many slaves took care<br />
to have a doctor at command at any time in case of<br />
sickness. With this object they made a contract with a<br />
neighbouring doctor, which bound the latter for a yearly<br />
salary to afford any medical services required. || Still more<br />
convenient for them was it when there existed in their<br />
household a slave with medical knowledge whom they<br />
could trust with the care of the health of themselves and<br />
their relatives.^ Slaves of this kind were much in request<br />
* GELLIUS: Noct. Attic, xviii, 10.<br />
f PLUTARCH : de sanitate tuenda praec. c. 24-25.<br />
X LUCIAN : Abdicatus (The disowned son), c. 23.<br />
§ SENECA: de benefic. vi, 15, 16, 17.<br />
|| VARRO: de re rustica. i, 16.<br />
*TT SUETON : Nero, c. 2.—Calig. c. 8.—SENECA : de benef. iii, 24. \ \
128 ANCIENT TIMES.<br />
and commanded a higher price than most; they were<br />
even sold for larger sums than Eunuchs* It occurred ,<br />
sometimes too that young and gifted slaves were instructed<br />
in medicine and trained up to be doctors at the cost ot<br />
their masters. The dependent position of these doctors<br />
excused them somewhat if instead of confining the apphcation<br />
of their medical knowledge to dressing wounds and<br />
curing diseases, they sometimes abused it by perpetrating<br />
horrible deeds and serious crimes at the command of.<br />
their masters.t If the master was himself a doctor they<br />
served him in the capacity of assistant: if they treated<br />
patients independently they were obliged to hand over any<br />
fee received in this way to the master, forming for him by<br />
such means a highly lucrative source of income. Under<br />
these circumstances it is easily understood that he was very<br />
unwilling to confer freedom on a slave of-this kind; for by <<br />
doing so he not only diminished his income but raised up •<<br />
an opponent, doubly dangerous to him since he knew the<br />
master's patients. As little were the laymen inclined to<br />
deprive themselves of a slave possessed of medical knowledge<br />
since they thus lost a resident doctor always at hand<br />
and devoted to their service.! The law was compelled '<br />
therefore to reconcile the mutually opposed interests of<br />
masters and slaves, laying down on the one hand the<br />
conditions under which the slaves were entitled to demand'<br />
freedom and the scale by which the loss of income might:.<br />
be calculated, and on the other hand imposing obligations<br />
'upon the freed men in respect of their former masters, which<br />
protected the latter from inordinate losses.§ The slaves<br />
educated in medicine, belonging to the State, who probably<br />
had the care of the ailing servi public/, appear to have been<br />
generally under more favourable conditions and in a better<br />
position than their colleagues who were the property of<br />
private people.<br />
* Cod. Just, vi, tit. 43, £ vii, tit. 7, i, 5.<br />
f CICERO: ad Pison., c. 34.—Pro Cluentio, c. 14 e* seq.—Tacitus Annal.xv, 63.<br />
X Digest, xl, tit. 5,0. 41, 6.<br />
§ Digest, xxxviii, tit. 1, c. 25-27.
THE MEDICAL PROFESSION IN ROME. 129<br />
Certain material advantages and privileges were granted<br />
to the free doctors as it was recognized how useful and<br />
important the healing art is to the general good. When<br />
C-ESAR, during a famine which fell upon Rome in the year<br />
46 B.C., ordered the expulsion of foreigners he expressly<br />
excepted the doctors and teachers from this general rule<br />
"so that they should be all the more willing to dwell in the<br />
city and even should induce others to come and live there."*<br />
The Emperor AUGUSTUS granted to the doctors in 10.A.D.<br />
immunity from taxes and other burdens, professedly in<br />
recognition of the successful treatment of an obstinate<br />
rheumatic complaint carried out on him by his bodyphysician<br />
MuSA, an enthusiastic advocate of hydrotherapeutics.f<br />
VESPASIAN renewed or confirmed this privilege<br />
and HADRIAN published rules defining the immunities<br />
bestowed on doctors.J<br />
From this ordinance which was renewed under<br />
ANTONINUS PIUS, we learn that they were exempt from<br />
bearing various offices entailing expenditure of time and<br />
money, as that of overseer of the public games, the aedileship,<br />
and the priestly function : they were also free from<br />
having soldiers quartered on them and from military service<br />
: moreover they were not compelled to contribute to<br />
the purchase of grain and oil, when this was done by the<br />
State, to execute the functions of judge or legate or to<br />
perform any military or other public service.§ ANTONINUS<br />
PIUS ordained however at the same time that these extensive<br />
privileges should not be granted to all doctors without<br />
distinction but only to a certain definite number of them.<br />
It was decreed that in smaller towns only five, in middlesized<br />
towns seven, and in larger ones ten doctors should<br />
enjoy this immunity and that at any time on their being<br />
* SUETON : J. Caesar, c. 42.<br />
t DION CASSILS liii, 3O.~SUETON: Augustus, c. 59.—HORAT : Epist. i, 15.<br />
X Digest. 1, tit. 4. de muner. et honor, lex 18, 30.<br />
§ Digest, xxvii. tit. 1. de excusat., c. 6, 8.—E. KUHN : Die stadtische und<br />
burgerl. Verfassung des rom. Reiches, Leipzig 1864, i, S. 69 et seq.<br />
K
13°<br />
ANCIENT TIMES.<br />
found guilty of culpable negligence the magistracy might<br />
deprive them of such immunity.<br />
Moreover in granting these privileges p r e ^ <br />
shown in favour of doctors who practised m their native<br />
owns as against those who had emigrated from others.<br />
These immigrants were only respected when they had n<br />
some way prominently distinguished themselves. And in<br />
cases of exceptional merit the prescribed n u *<br />
receiving immunity might be exceeded. ALEXANDER<br />
SEVERUS made a decree that in the provinces the imtunity<br />
should no longer be granted by the State magis- |<br />
tracy but by the burghers and landowners who were the<br />
besMudges'of the character and ability of the doctors t<br />
whom they trusted themselves in sickness* At a later<br />
period there was granted to the doctors the extraordinary<br />
cognitio or the right to bring their actions for fees in arrear<br />
directly before the highest court in the province.f It<br />
would appear that at first all that was sought was to retain<br />
able and educated doctors, by such privileges, in a particular<br />
spot, as the example of ARCHAGATHOS teaches us<br />
Soon however they may have had certain definite duties :<br />
laid upon them in the interest of the public When the<br />
institution of public medical officers as it existed in Greece<br />
was introduced into the Roman Empire, the rights bound<br />
up with the duties of public service were reserved for<br />
them And the above mentioned privileges were at a later,<br />
period bestowed chiefly if not exclusively upon the public<br />
medical officers. The number of the latter was dependent<br />
upon the size of the town and was, as it appears, settled in<br />
accordance with the law for the granting of immunities.<br />
In Gaul there were public medical officers % before the^<br />
time of STRABO, in Asia Minor perhaps even earlier, § and|<br />
in Latium at any rate under TRAJAN, as we learn from an<br />
* Digest. 1, tit. 9. de decretisab ord. fac, c. 1.<br />
t Digest, i, tit. 13,0. 1.<br />
t STRABO iv, 1. .<br />
§ VERCOUTRE op. cit. p. 351.-ORELL1: Inscnpt. lat, No. 3507.
THE MEDICAL PROFESSION IN ROME. 131<br />
epitaph which is devoted to the salaried doctor of the town<br />
of Ferentinum.*<br />
In Rome a doctor was appointed for every district of the<br />
city. The public medical officers were especially bound to<br />
attend the poor without being paid by them; but they were<br />
by no means debarred from private practice. Moreover<br />
they were called into consultation in epidemics and other<br />
occurrences which entailed an increase of sickness and<br />
mortality: in addition, the duty of medical teaching was<br />
included in the list of their obligations. From the community<br />
they received a salary which consisted chiefly of<br />
articles of natural produce. In large cities like Rome they<br />
formed colleges which when a place fell vacant completed<br />
the establishment by election. But their choice was subject<br />
to imperial ratification. The office seems often to<br />
have passed from father to son.f Under the rule of the<br />
Emperors VALENTINIAN I. and VALENS (368 A.D.) the<br />
qualifications for, and conditions of, holding office as<br />
public medical officer were settled in detail. J<br />
Since this period they bore the official title of Archiatri<br />
populares the origin of which dates from a still earlier<br />
time. The word Archiater is found in ARET^US§ and is<br />
obviously, by the analogy of other expressions, formed<br />
upon the root ap% indicating dignity and high position.||<br />
At the earliest period it appears to have been used to<br />
designate the doctors of the imperial Court. STERTINIUS<br />
XENOPHON, on whose history an interesting light has been<br />
thrown by the discovery, a short time ago, of his gravestone<br />
covered with inscriptions,^ bore the title of Archiater<br />
* MARQUARDT op. cit. vii, 755.<br />
t VERCOUTRE op, cit. p. 321.<br />
X Cod. Theodos. xiii, T. 3. de med. et profess., c. 8-10—Cod. Justin, x,<br />
T. 52, c. 10.<br />
§ ARETJEUS : de acut. cur. ii, 5.<br />
|| G. CURTIUS: Grundzuge der griechischen Etymologie, Leipzig 1879,8.<br />
189.<br />
1 M. DUBOIS : Un medecin de l'empereur Claude. Bull. d. corresp. helle'n.<br />
J88I, NO. 7, 8.
132 ANCIENT TIMES.<br />
and even before him probably M. Livius EuTYCHUS. In<br />
a similar way, NERO'S private medical attendant, ANDRO-'<br />
MACHUS was denominated Archiater, the Emperor wishing<br />
by this to point out, as GALEN says,t that he surpassed<br />
other doctors in experience and knowledge. In another<br />
passage GALEN makes mention of the doctors MAGNUS /><br />
and DEMETRIUS who at that time enjoyed the dignity of<br />
Archiater.J At a later period the Court doctors bore the •<br />
title Archiatri palatini in contradistinction to the Archie J<br />
atnpopulares—the public medical officers. At the Court.;;<br />
of the Emperor ALEXANDER SEVERUS were seven doctors<br />
of whom however the first, the private body-physician, alone |<br />
received a salary in money, the rest only receiving their<br />
board. Moreover they participated in the privileges and<br />
favours which were extended to Archiatri and to doctors in<br />
general.§ Like the Courts and Communities, so too<br />
Societies had their private doctors. Doctors were also<br />
appointed for certain classes of officials, for the personnel<br />
of the theatre, for the Circus and the Gladiators.||<br />
The various troops had their doctors who accompanied<br />
them into the field and treated the sick and woundedH<br />
soldiers either in their tents or in the military hospitals. 1<br />
They bore arms like other soldiers^ and enjoyed the<br />
immunities granted to other doctors. But little information -,<br />
exists as to the relative rank of military medical officers or \<br />
their relations to those set over them.** At the head of<br />
the whole military medical establishment there was probably<br />
a general medical officer on the staff.tt In the 1<br />
same way the navy was provided with doctors: and|<br />
* R. BRIAU : Archiatrie romaine. Paris 1877, c. 2.<br />
f GALEN xiv, 211.<br />
X GALEN xiv, 261.<br />
§ LAMPRIDIUS : Alexander Severus, c. 42.<br />
H R. BRIAU : L'assistance me'dicale chez les Romains, Paris 1869.<br />
% On TRAJAN'S column at Rome two military doctors are represented binding<br />
up wounds and drawing out arrows: they are armed.<br />
** R. BRIAU : Du service de sante militaire chez les Romains, Paris 1866. |<br />
-j-f ACHILLES TATIUS: de Clitop. et Leucipp. amor, iv, 10.
THE MEDICAL PROFESSION IN ROME. 133<br />
amongst them were specialists, as a remark of GALEN<br />
informs us.*<br />
Doctors who rendered important services by their ability<br />
were distinguished by titles and dignities, by promotion<br />
and other honours. In Rome, as elsewhere, it was chiefly<br />
the Court doctors on whom these marks of favour were<br />
bestowed.f MUSA was raised to equestrian rank by the<br />
Emperor AUGUSTUS, and his statue was placed in the<br />
temple of ASKLEPIOS. STERTINIUS XENOPHON received for<br />
his exertions as military doctor the corona aurea and the<br />
hast a pura at the hands of CLAUDIUS. AS imperial bodyphysician<br />
he obtained such influence that he was nominated<br />
to the Secretaryship of State for Greek affairs. Thanks<br />
chiefly to him, his home, the island of Kos, was relieved<br />
from taxation.| In later times it not unfrequently happened<br />
that doctors accepted high positions at Court or in the<br />
government of the State and in that case they probably<br />
renounced the practice of their profession.<br />
The decline of the Roman Empire smothered scientific<br />
effort, and annihilated many excellent arrangements which<br />
had been made in the spheres of teaching and of medical<br />
science; but the essential principles of organization were<br />
maintained, even if by ignorance and unfavourable circumstances<br />
they were misused or even entirely perverted. The<br />
rich medical literature which was saved, handed over to<br />
later times the acquisitions of a former age and pointed<br />
out to medical investigation the path it must follow in order<br />
to achieve success.<br />
END OF PART I.<br />
* GALEN xii, 786. t Cod. Just, xii, tit. 13.<br />
X TACITUS: Annal. xii, 61.
II. MEDICAL TEACHING IN THE MIDDLE AGES.<br />
THE INFLUENCE OF CHRISTIANITY.<br />
THE organization of the Roman State became subject t<br />
insidious diseases which, attacking the vital parts, led to a<br />
long period of infirmity brought finally to an inglorious<br />
conclusion by the victorious assaults of external foes<br />
Incapacity and profligacy upon the Throne, the division of<br />
the government among numerous rulers mutually, envious<br />
and hostile, the corruption of officials and the venality^ a<br />
haughty and overbearing soldiery, undermined the political<br />
basis of the State, while social life in Rome was poisoned<br />
by the loosening of family ties, love of pleasure, pride, the<br />
reckless squandering of riches by the wealthy contrasted<br />
with the misery of the great masses of the people, and<br />
finally the audacious effrontery with which vice manifested<br />
itself on all sides. The people of the North, those healthy<br />
children of Nature, coming to Rome first as mercenary<br />
soldiers, then as regularly engaged defenders, and finally -;<br />
as governing lords, accelerated this process of decay and<br />
gave, out of compassion, the death-blow to the Roman<br />
Empire worn to pieces as it was by internal troubles and<br />
bleeding and maimed by innumerable wounds. The courage<br />
and heroism, which had covered the name of the Romans<br />
with glory and had made their state powerful, were extinct J<br />
or if an isolated courageous act occasionally recalled past |<br />
times it served only to illuminate with a momentary lightening-flash<br />
the dark night of the present. The struggles of<br />
the ambitious towards ideal perfection found outlets rather<br />
in the domain of theology and of self-sacrificing piety.<br />
This mode of thought, led up to by the severe simplicity of<br />
manners of the disciples of the Stoa, but which was first!<br />
extended into more general acceptance by Christianity,
A<br />
I<br />
THE INFLUENCE OF CHRISTIANITY 135<br />
found in the patient bearing of suffering and in abstention<br />
from the pleasures of life the greatest and highest virtue<br />
it was possible for man to strive after. The Christian<br />
doctrine of Faith gave an effective spur to such ideas in<br />
offering to people an expectation of a life after death in<br />
which all injustice is reconciled, virtue receiving its reward<br />
and vice its punishment. The poor and miserable of this<br />
world were afforded the hope of a better and brighter<br />
future in store for them which might console them for the<br />
wretchedness of the present; pity was instilled into the<br />
hearts of the rich, and sinners were filled with fear and<br />
horror and by these means were urged to better things.<br />
This solution of social questions corresponded to the wants<br />
and conditions of civilization of that period and on that<br />
account was bound to obtain for itself general recognition.<br />
The first adherents of Christianity belonged to the circles<br />
of the oppressed and the poor : at a later period it found<br />
believers also amongst those blessed with worldly posses<br />
sions, the so-called higher classes of society, members of<br />
which, disgusted by the moral depravity of the time, sought<br />
for comfort and edification in the doctrines of the new<br />
Gospel.<br />
So long as the Christian Church consisted of elements<br />
such as these, its purity endured, and the religion of peace<br />
and love remained as conceived of in the mind of its revered<br />
Founder. But when, with its extension and increase, power<br />
and riches were added to it, and from this cause a number<br />
of ambitious and unprincipled adventurers were attracted,<br />
it became the battle-field of human passions and gave rise<br />
frequently to more evil than good.<br />
Christianity concerned itself only with the moral culture<br />
of mankind : to the training of the intellect it remained<br />
indifferent, sometimes even openly hostile. This was<br />
only natural : for in a theory of life which like that held<br />
by the Christian Church saw its goal in the perfect ideal of<br />
a world invisible, and declared the moral improvement of<br />
man to be its principal or only task, no great importance
136 THE MIDDLE AGES.<br />
could be ascribed to scientific investigation. But science<br />
stood in direct opposition to Christian dogma when it made<br />
the manifestations of Nature, as for example the human<br />
body—which the Christian faith held as impure and worth<br />
less, if not despicable—the subject-matter of its study. The<br />
natural sciences and theoretical medicine consequently made<br />
no essential progress under the authority of the Christian<br />
Church. .V<br />
On the other hand the science of medicine has to thankA<br />
the initiative of the Church for the foundation of numerous<br />
hospitals and other benevolent institutions which satisfied the<br />
promptings of humanity and the requirements of the healing<br />
art in an equal degree. The development of the sciences<br />
was at this time also impeded by other conditions and cir<br />
cumstances. The constant wars and predatory expeditions<br />
of hostile races, the religious persecutions and controversies<br />
on points of dogma, the social changes called forth by the<br />
insecurity of property and life, the grievous pestilences<br />
which depopulated whole countries and turned them into<br />
wildernesses ;—all these things diverted attention from<br />
scientific pursuits and deprived people who were inclined<br />
to such, of the repose required for successfully engaging in<br />
them. But the chief cause of the arrest of scientific pro<br />
gress was the fact that the peoples who had divided the<br />
Roman Empire among themselves were far inferior to the<br />
Romans in education and consequently had first of all<br />
the task imposed upon them of assimilating to themselves<br />
the culture of their predecessors. This process endured<br />
for centuries and was completely effected only at the end<br />
of the Middle Ages.<br />
The division of the Roman Monarchy into an Eastern and<br />
Western half gave once more clear political expression to<br />
the old opposition between the Orient and the Occident<br />
which had never entirely disappeared. But a natural result<br />
was the disintegration of that great state organization of<br />
which one limb was thus separated from the other. The<br />
loose connections of the provinces with the central power at
THE INFLUENCE OF CHRISTIANITY 137<br />
Rome or Constantinople facilitated their acquisition of<br />
freedom. The German races, borne on by the tide of<br />
peoples setting from the North and East towards the South<br />
and West, soon made themselves at home in their new<br />
abodes and founded new States. At the close of the fifth<br />
century the Ostrogoths, followed later by the Lombards,<br />
ruled in Italy, the Visigoths in Spain and South West<br />
France, the Burgundians and Franks in the East and North<br />
•of this district, while the Anglo-Saxon races crossed over<br />
into Britain, and the Roman province of Africa was the<br />
prey of the Vandals. Tribes of Saxons, Bavarians,<br />
Alemanni and Franks remained in Germany and the sway<br />
•of the Byzantians was pressed upon in Asia by the Persians,<br />
and in Europe by the Goths, Huns, and Slavs in an ever<br />
increasing degree.<br />
The conquerors preserved many of the political and<br />
social regulations which they found existing in the countries<br />
subdued by them. This was a triumph which those who<br />
had been defeated in a contest of physical strength, were,<br />
in consequence of their higher culture, able to celebrate<br />
•over their less educated conquerors. The latter were able<br />
to recognize the great advantages which would accrue to<br />
them from an increase of knowledge and on this account<br />
took care that the Schools and Teaching-institutions should<br />
be as far as possible preserved. The civilizing influence of<br />
the Romans had been felt in all parts of the Empire, but<br />
especially in the western half. Numerous places of<br />
education in Gaul, Spain, Britain and North Africa bore<br />
witness to this. The literary efforts of the Roman authors<br />
who drew their origin from these lands show how success<br />
ful in their work were these institutions.*<br />
After the pattern of the establishments for advanced<br />
teaching in Athens, Alexandria, and Rome there arose also<br />
high schools both in the East and in the various larger<br />
* MOMMSEN op. cit. Bd. v, S. 69 et seq., 100 et seq., 176 et seq., 643, 655<br />
•et seq. — GIBBON : Decline and Fall of the Roman Empire. Vol. i, p. 49-50,<br />
Lond. 1828.
T38 THE MIDDLE AGES.<br />
towns of Italy, Gaul and Spain* in which, along with<br />
Greek and Roman literature, were also taught grammar,<br />
history, philosophy, rhetoric, jurisprudence, mathematics,<br />
physics and astronomy, and sometimes also medicine. The<br />
organization of these places resembled in many respects<br />
that of the English Universities. They had in view not so<br />
much preparation for any particular calling as the object of<br />
giving a general education embracing all subjects of knowledge<br />
then in the possession of mankind. The professors<br />
of 'these high schools were paid at the public cost and<br />
enjoyed immunities, freedom from taxation, and other<br />
privileges. Their number was limited and was regulated— ; !<br />
as was that of the Archiatri—in accordance with the size<br />
of the town. Thirty-one professors were appointed to the •<br />
high school at Constantinople which was founded in the<br />
fifth century A.D.f Besides the professors nominated by<br />
the authorities of the town or the Government there appear<br />
to have been other teachers who, like private tutors of<br />
the present day, made a profession of teaching without<br />
receiving any regular salary.<br />
The sons of wealthy parents were generally accompanied<br />
to the high schools by attendants who, partaking of the<br />
characters both of governors and servants, in most cases<br />
belonged to the class of slaves either actual or recently<br />
emancipated. The teachers received from their pupils a<br />
fee settled by agreement. For such fees to produce a<br />
satisfactory income it was a matter of great importance 1<br />
to the teachers that they should have numerous pupils.<br />
The student life, as it was developed in Rome and.!<br />
Athens, resembled in many respects the Continental student :i<br />
life of the present day. The students joined in societies-1<br />
according to the country of their birth, sought to attract<br />
and enrol new comers, " freshmen," by all means of per-<br />
* F. CRAMER : Geschichte der Erziehung und des Unterrichts im Alterthumjl<br />
Elberfeld 1832, Bd. i, S. 477 et seq.<br />
' f J. C F. BAHR : De literarum universitate Constantinopoli, Heidelberg-<br />
1835.—SAVIONY: Geschichte des romischen Rechts, Bd. i, S. 396.
THE INFLUENCE OF CHRISTIANITY. 139/<br />
suasion, artifice and often even force, held drinking bouts<br />
and feasts and, on occasion, gave vent to the furious<br />
passions of youth. There was, indeed,- no lack of out<br />
rageous and insolent conduct and deplorable excesses. In<br />
Antioch it happened once that the students wrapped in a<br />
rug a pedagogue who had incurred their dislike, and tossed<br />
him in the air and caught him again such a number of times<br />
that he finally fainted away. The philosopher LlBANlus,<br />
who occupied a professorial chair at the same time and<br />
place, admonished his pupils who had probably participated<br />
in this rough sport in the following terms: " Bad enough<br />
were it for students to lay hands on ordinary citizens, to<br />
insult a goldsmith, to provoke a shoemaker, to beat a<br />
carpenter, to kick a weaver, to maul a shopkeeper, or to<br />
threaten an oil merchant: but to ill-use a pedagogue is an<br />
injury to one occupying a most respectable and useful<br />
position and deserves chastisement with the rod and the<br />
whip."*<br />
For the rest, the students were subject to strict laws.<br />
According to an ordinance of VALENTINIAN (370 A.D.) they<br />
were obliged on entering upon their studies to produce<br />
testimonials from the magistrates of their native towns, and<br />
their names, addresses and the position of their parents<br />
were entered on a public register. They were forbidden to<br />
waste their time in pleasure-seeking. If they transgressed<br />
these injunctions they rendered themselves liable to<br />
corporal punishment and could be expelled from the<br />
school. The prefect of the town made a yearly report<br />
upon the ability and behaviour of the students to the<br />
superior imperial authority, f<br />
With the twentieth year of age the studies had to come<br />
to an end. It thus appears that they began pretty early.<br />
In the Isagoge in artem medicam% falsely ascribed to<br />
* LIBANIUS : Orat. et declamat. Ed. J. J. REISKE, Altenburg 1795, T. iii,<br />
p. 254, 259 (crept TOV rawifroq).<br />
t Cod. Theodos. L. xiv, T. 1, 1.<br />
X VAL. ROSE: Anecdota graeca et graecolatina, Berlin 1864, ii, p. 169, 244<br />
et seq.
140 THE MIDDLE AGES.<br />
SORANUS but certainly of ancient origin the proper time for<br />
the commencement of medical studies is declared to be the,<br />
fifteenth year. The author takes the opportunity of remarking<br />
" that the student must be industrious, intelligent and<br />
of ready apprehension, in order to understand and learri<br />
quickly; that he needs also a strong body that he may<br />
bear the exertion to which he will be subjected." It was.<br />
moreover required of him that he should possess a scientific<br />
preliminary training and that he should have been taught<br />
grammar, the history of literature, rhetoric, mathematics<br />
and astronomy. " The doctor," he adds, " must combine<br />
gentleness and modesty with becoming dignity, must<br />
possess an irreproachable character, must not act with<br />
haughtiness but must treat the poor and the rich, slaves<br />
and free all alike." The medical lectures which were<br />
delivered in the high schools by learned theorists, the.<br />
Iatrosophists as they were called, consisted of philosophic<br />
examination and profound discussion of various questions<br />
of physiology and pathology : but they did not suffice to<br />
prepare those who attended them for the actual practice of<br />
medicine. This part of medical training was effected in a<br />
more satisfactory and practical way by the Archiatri and<br />
by practising doctors generally, who imparted instruction<br />
in the healing art.<br />
The schools of the Sophists and the higher teaching institutions<br />
demanded no definite confession of .faith from |<br />
their teachers or pupils. Heathens and Christians taught<br />
at them, and in their lecture rooms the adherents of various > j<br />
churches and sects mixed freely. Only during the short<br />
reign of JULIAN were the Christians excluded from the I<br />
position of teachers in the heathen schools. Already at<br />
that time weak attempts were made to free Christians from<br />
a heathen education but only one hundred years later did<br />
success crown the efforts of SALVIANUS, of PRUDENT1US,<br />
OROS1US and others to produce a literature containing I<br />
Christian subject-matter and founded on the writings of the ;<br />
Old and New Testaments. The indifference and contempt j
THE INFLUENCE OF CHRISTIANITY. 141<br />
which the lights of the Christian Church manifested in<br />
regard to the intellectual creations of the Greeks and<br />
Romans* the one-sidedness which moved them to confine<br />
their choice of material to what had been transmitted<br />
through Jewish and Christian channels, and the tendency to<br />
disparage the civilization acquired in ancient times, gave to<br />
these literary productions a very prejudiced character and<br />
make it clear to us why enlightened contemporaries, not<br />
affected by religious bias, were able to discern in them<br />
no sign of progress in the intellectual development of<br />
man.<br />
If the struggle between the Christian training and that of<br />
the Ancients had been decided with the weapons of the<br />
intellect the. superiority of the latter must have been<br />
proved: but it was soon transferred to the fields of political<br />
power where the victory falls to the strongest. When the<br />
Christians, after having for centuries been persecuted by<br />
the heathen, at length obtained dominion in the state, they<br />
on their side began to oppress their former oppressors.<br />
Eagerly labouring to dig up the roots which attached man<br />
kind to the heathen past, they attacked the system of<br />
teaching resting upon the study of the ancients, and endea<br />
voured so to modify it in accordance with their way of<br />
thinking that it should assume a form compatible with<br />
Christian dogma. Failing in this they employed force<br />
and abolished the teaching-institutions. By an edict of<br />
JUSTINIAN' of the year 529 the schools of philosophy at<br />
Athens and Alexandria were closed. The last of the Greek<br />
philosophers abandoned their homes and sought protection<br />
and freedom for thought in foreign lands. In Constantinople<br />
and other places, especially in the countries of the west,<br />
the temples of the Muses were transformed into Christian<br />
schools in which the study of religion was the predominant<br />
feature. The priests took over the direction of education<br />
and became the representatives of knowledge. To them<br />
* Archiv. f. Geschichte u. Literatur; herausg. v. F. C. SCHLOSSER U. BERCHT<br />
i, S. 253 et seq.
142 THE MIDDLE AGES.<br />
religious faith was the highest law, and limits were imposed<br />
on investigation which no one dared to transgress.<br />
In the schools which arose at the residences of the<br />
bishops and adjoining the cloisters, not only theology and<br />
Church history were taught but also all subjects belonging<br />
to general education or of importance and use in daily life.<br />
Medical science was frequently included in the list of subjects.:<br />
and was.especially cultivated in the schools of the<br />
East. ST. BENEDICT introduced this system into the lands<br />
of the West and aroused the members of the order which<br />
he founded to the study of medicine. CASSIODORUS also'<br />
recommended the pursuit of medical knowledge to the<br />
monks into whose cloisters he had retired after-having<br />
played an important part in political life for many years as<br />
Minister to THEODORIC, King of the Ostrogoths: he gave<br />
them detailed advice as to which medical authors of<br />
antiquity they should make the- groundwork of their<br />
studies.*<br />
Medicine was very zealously pursued, it appears, in the<br />
schools of the Nestorians. Prominent members of the<br />
priesthood in this sect were famed for their medical<br />
abilities and were taken into council by the princes.f The<br />
teaching establishments of the Nestorians were arranged<br />
like the schools of ST. ORIGEN at Alexandria.^ Adherents<br />
of other Faiths and even heathen were employed as<br />
teachers at them but naturally only in profane sciences.<br />
The students had to pay a fee for being taught, sometimes<br />
a not inconsiderable one. The Church paid the fees for<br />
poor scholars and afforded them support besides. The best<br />
known educational establishments were at Edessa, Nisibis,<br />
Seleucia and Dorkena: at a later date schools of the same<br />
,kindnwere founded in Baghdad, Messene, Hirta, Matotha,<br />
Jemama and other towns in Syria.§ Many were much<br />
* CASSIODOR : Institut. divin. lect. i, c. 31.<br />
t ASSEMANI: Bibliotheca orientalis, Rome 1728, iii, pars 1, p. 166.<br />
X ASSEMANI op. cit. iii, pars 2, p. 919 et seq.<br />
§ ASSEMANI op. cit. iii, pars 2, p. 924.
THE INFLUENCE OF CHRISTIANITY.<br />
143<br />
frequented ; Nisibis at one time numbered 800 students, of<br />
whom some came even from Italy and Africa.<br />
When the Nestorian men of learning were driven out of<br />
Edessa by the religious fanaticism of the Byzantine Emperors,<br />
they fled to Persia where they contributed<br />
essentially to the rapid progress which the sciences, and<br />
especially the science of medicine, made at the school of<br />
Gondisapur. While its origin dated probably three centuries<br />
earlier* the period of its prime was under KESRA<br />
NUSCHIRVAN in the sixth century. This monarch was<br />
thoroughly acquainted with Greek literature and was the<br />
benevolent protector of all scientific effort. At his hands<br />
the exiled Nestorians found the same hearty reception as<br />
the philosophers of Athens ; in the same way he supported<br />
and helped the Jewish and Syrian men of learning who<br />
were the means of transmitting to the Persians the culture<br />
of the Greeks. He sent his physician-in-ordinary,<br />
BURZWEIH, to India, in order that he might make himself<br />
acquainted with the medical practice of that country and<br />
bring back drugs and medical writings : and he imposed as<br />
a condition when concluding peace with the Emperor of -<br />
Byzantium that the doctor TRIBUNUS of Palestine, one of<br />
the most celebrated practitioners of his time, should be "<br />
given over to him for a year. In Gondisapur the knowledge<br />
of the West and the wisdom of the East came into contact.<br />
Greek medicine here walked hand in hand with that of the<br />
Persians and Indians, and this alliance concealed the germs<br />
of the rapid growth which the science experienced under<br />
the Arabs. Medical teaching at the School of Gondisapur<br />
was chiefly, if not exclusively, carried on by the learned<br />
Nestorians. It was not merely theoretical but more indeed<br />
of a practical nature and took place in the Hospital.f This<br />
hospital was maintained during the Arab rule and was<br />
mentioned even at the end of the tenth century.<br />
* J. H. SCHULZE: De Gondisapora Persarum quondam Academia Medica in<br />
Comment. Acad. Petropolit. 1751, xiii, p. 437 et seq.<br />
t ASSEMANI op. cit. iii, pars 2, p. 940 et seq.
144 T H E MIDDLE AGES.<br />
Medical science made no remarkable progress during<br />
the time of the decline of the Roman Empire and the |<br />
period following thereupon. The training of doctors was,"
¥•<br />
THE INFLUENCE OF CHRISTIANITY. 145<br />
cumstance that his works were not destroyed by the theosophists<br />
of the Christian and Islamite eras, filled with<br />
rage and brutal fanaticism as they were against the<br />
literary memorials of antiquity; but that they were on the<br />
contrary carefully preserved and zealously studied and even<br />
given wider extension.<br />
While the theoretical departments of the study of medicine<br />
were doomed to inaction, a prospect of successful<br />
scientific effort disclosed itself to practical medical science<br />
through the foundation of hospitals. The charitable institutions<br />
which Christian philanthropy called into existence<br />
afforded opportunities for the observation of diseases<br />
and injuries of all kinds and offered facilities to doctors for<br />
acquiring education in their art and for amassing experience.<br />
To assert that the foundation of public hospitals is<br />
exclusively a product of jChristianity is certainly inaccurate.<br />
Even the Buddhists, as we have seen, were acquainted with<br />
such institutions, and the Iatreia of the Greek physicians<br />
and especially those maintained at the public cost, were<br />
essentially nothing but public hospitals. The convalescent<br />
institutions of the Romans which were fitted up for slaves<br />
and soldiers differed from them only in the fact that they<br />
were intended for particular classes of the community.<br />
The Spaniards on reaching Mexico after the discovery of<br />
America, found hospitals there too and even praised them*<br />
highly. VlRCHOW is right when he says that " every<br />
civilization which humanizes the manners and customs<br />
of people up to a certain degree and giyes a more finished<br />
form to society, ends by being moved to the foundation of<br />
hospitals." t<br />
Christianity however deserves the incontestable merit' of<br />
having kindled into a clear flame of enthusiasm the sparks<br />
of true philanthropy which she found glowing in obscurity.<br />
No other religion, no political or social power<br />
* PRESCOTT : The conquest of Mexico, London 1863, 2nd Ed., i, p. 26, 169.<br />
t" VIRCHOW : Tiber Hospitaler und Lazarethe in seinen gesammelten A.bhand-<br />
lungen, Berlin 1879, "> S. 8-<br />
L
146 THE MIDDLE AGES.<br />
has essayed or has effected so much for the human race<br />
as Christianity, Where it spread and found adherents,<br />
there works of mercy were practised and temples were<br />
erected to objects of charity. The extraordinary results<br />
which the Christian religion succeeded in effecting in the<br />
first centuries after its origin depended certainly in great<br />
measure on the humanitarian ideas which it proclaimed.<br />
To be sure, acts of philanthropy were conspicuous even<br />
in ancient times, acts which claim our admiration; but<br />
they were at best isolated and produced no enduring effect.<br />
Christianity united the humanitarian efforts of individuals<br />
and gave a collective character to charity. Ancient times<br />
saw in the slave, a beast endowed with human speech, a<br />
possession intended for profitable use; Christianity while<br />
unable, it is true, to do away with slavery had regard also to |<br />
the dignity of man existing even in slaves. CATO advised<br />
cultivators of the soil to sell their old and sick slaves like<br />
cattle no longer able to work and old iron.* Many masters<br />
drove their slaves out of their houses when through sickness<br />
and old age they had become unprofitable ; indeed,<br />
the Emperor CLAUDIUS in order to put a stop to this<br />
abuse caused the slaves, in this case, to be proclaimed i<br />
freemen.f Christianity preached compassion for the<br />
oppressed, support for the poor and helpless, and care for<br />
the sick. Many adherents to this faith gave their possessions<br />
to the poor, or to the Church in order that she might<br />
give alms therewith. The Church in Rome in the third<br />
century provided 1,500 poor with daily sustenance J and the<br />
Church at Antioch maintained over 3,000 at the time of<br />
St. Chrysostom.§ The erection of homes for the poor and<br />
sick, and of other charitable institutions appears to have<br />
begun in the East.<br />
The slaves were treated better and with greater humanity<br />
in Greece than in any other country of the ancient world : ||<br />
* CATO: de re rustica, c. 2. J EUSEBIUS : Hist, eccles, vi, 43.<br />
t SUETON: Claudius, c. 25. § CHRYSOST. : hom. 66 in Matth.<br />
|| MOMMSEN op. cit. v. 250.<br />
i
THE INFLUENCE OF CHRISTIANITY. 147<br />
there, even in the times of heathendom poor people and<br />
strangers found a friendly welcome and medical care in the<br />
Aenodochia, in the event of sickness.<br />
Christianity, in fine, organized the administration of<br />
charity and called institutions into existence which in size<br />
and prevalence surpassed previous experience. The<br />
institution at Caesarea founded by ST. BASIL resembled<br />
a town; it contained numerous dwellings for the poor<br />
and sick, was excellently administered, and had special<br />
doctors and attendants for the sick in its service*<br />
GREGORY of Nazianzus calls this institution "the treasury<br />
of piety, where disease becomes a school of wisdom,<br />
where misery is changed into happiness."t EDESSA<br />
possessed in 375 A.D. a hospital which was provided with<br />
.300 beds.J Similar institutions arose in other places of<br />
Asia Minor, as also in Alexandria and Constantinople, for<br />
the relief of the suffering and infirm.<br />
The first Christian infirmary was, as ST. JEROME narrates,<br />
founded in Rome by the widow FABIOLA who belonged to<br />
the ancient family of the Fabii, at the end of the fourth<br />
century.§ Other rich private persons followed her pious<br />
example and the erection of charitable institutions became<br />
the fashion with distinguished Roman ladies. In any case,<br />
if PAULA built a hospital she conferred a greater blessing<br />
on humanity by so doing than by condemning her daughter<br />
to .perpetual virginity, although she was for this act<br />
honoured by ST. JEROME with the title of the mother-inlaw<br />
of God, as GIBBON says.|| Elsewhere in Italy, as also<br />
in Gaul and Spain, asylums for the sick and poor were<br />
erected. The Bishop MASONA of Merida (573-606), a<br />
* GREGORY of Nazianzus: Orat. funebr. in Basil. & Orat. de pauperum<br />
•cura.—BASILIUS: Epist. 94.<br />
f C.SCHMIDT: Die biirgerliche Gesellshaft in der altromischen Welt und ihre<br />
Umgestaltung durch das Christenthum, Leipzig 1857, S. 246.<br />
X E. CHASTEL : Die Christliche Barmherzigkeit in den ersten Jahrhunderten<br />
der Kirche, fibers v. Wichern, Hamburg 1854, S. 13-.<br />
§ HIERONYMUS: Ep. 77, Ed. Vallarsi.<br />
|| GIBBON op. cit. c. 37. p. 398.
J4.8 THE MIDDLE AGES.<br />
Goth, founded a hospital to which Christians and Jews,<br />
slaves and freemen found admittance, and he ordered<br />
that half of the gifts received by the Church" should be<br />
given to this institution. He ordered the doctors who<br />
were appointed to it, to go round about the town and<br />
invite the sick to let themselves be taken to this establishment.<br />
The Hotel-Djeu at Lyons was founded in 542 A.D.<br />
by CHILDEBERT I. and was under the supervision of<br />
laymen.*<br />
The Church pronounced the care of the sick to be a<br />
work pleasing to God. The faithful strove earnestly with<br />
one another in this matter how best to help the afflicted<br />
and did not shrink from performing the meanest and most<br />
disagreeable tasks. FABIOLA carried the sick to their<br />
beds in her arms and washed out wounds which others<br />
scarcely dared to look upon.t The Empress PLACILLA<br />
AUGUSTA undertook the duties of a maid-servant in the<br />
hospitals.!" The Christians displayed a self-sacrificing<br />
activity in great epidemics such as at that period afflicted<br />
the human race. When in the third and fourth centuries<br />
contagious pestilences raged in Alexandria and Carthage<br />
the Christians took charge of the sick without distinction<br />
of creed, nursed them, and buried the dead.§ Many were<br />
consequently attacked by the disease and succumbed to it.<br />
The heroic spirit of love shown by the Christians on such<br />
occasions, filled with astonishment and wonder people of<br />
other faiths. Even JULIAN, the most zealous antagonist of<br />
Christianity recognized thus their charitable work, he wrote:<br />
" We see what it is that makes the enemies of the gods<br />
powerful; it is their kindness to strangers and the poor,<br />
their care for the dead, and their holiness of life—even if<br />
assumed.'"'|| He felt himself induced to copy the example<br />
* C. F. HENsiNGERin the Janus i, S. 772 et seq.<br />
t HIERONYMUS: Ep. 84.<br />
X THEODORET : Hist. Eccles. v, 19.<br />
§ EUSEBIUS: Hist. Eccles. vii, 22. ix, 8.—SOZOMENOS: Hist. Eccles. v, 16.<br />
|| JULIAN : Epist. 49.
THE INFLUENCE OF CHRISTIANITY 149,<br />
'of the Christians, and decided to erect hospitals in all<br />
important towns.<br />
Among diseases leprosy (under this name a number of<br />
different kinds of skin disease being included) engaged<br />
particularly the attention of the public. The lepers were<br />
shunned by the people on account of their horrible appearance,<br />
even indeed by their own relations and friends ; they<br />
were also dreaded on account of the danger of infection to<br />
which others were exposed in their presence. The Christians<br />
felt pity for these unfortunate people also, and gave<br />
them protection and care in their hospitals. ST. BASIL<br />
" embraced them as brothers, not for the purpose of making<br />
a parade of his courage but to give an example to those<br />
whom he entrusted with the care of them."* He assigned<br />
to them a special department in his institution at Caesarea.<br />
In Constantinople a hospital was devoted to lepersf and in<br />
Italy leper-houses arose in many places at an earlier<br />
period than institutions for other sick people.J In France<br />
there were leper-houses as early as the time of ST.<br />
GREGORY of Tours (560) and in a testamentary document<br />
of the year 636, institutions of this kind are mentioned at<br />
Verdun, Metz and Mastricht.§ One hundred years later<br />
ST. OTHMAR collected the lepers from the districts near<br />
St. Gall and erected a hospital for them. Christian philanthropy<br />
provided, besides asylums for the poor and sick,<br />
institutions in which the aged infirm, cripples, blind people,<br />
women lying in, orphans, and deserted and foundling<br />
children were received and taken care of.<br />
The abandonment of newly-born babes was forbidden as<br />
early as the time of VALENTINIAN : but this criminal practice<br />
was supported by the public immorality.|| In the fifth<br />
* GREGORY of Nazianzus. op. cit. Orat. viii.<br />
t DUCANGE: Constantinop. christ., Paris 1680, iv, 165.<br />
X MURATORI : Antiq. ital. med. sevi, T. i, Dissert. 16.<br />
§ R. VIRCHOW : Zur Geschichte des Aussatzes in VIRCHOW'S Archiv, Bd. 20,<br />
Berlin 1861, S. 169.<br />
|| LECKY : Sittengeschichte Europas von Augustus bis zu Karl dem Grossen,<br />
Leipzig 1870, ii, 20 etseq. (' History of European Morals').
150 THE MIDDLE AGES.<br />
century the custom arose in certain towns of Gaul e.g. in<br />
Aries, Treves, Macon and Rouen of laying children, of<br />
whom it was wished to be rid, before the Church doors.<br />
The priests took care of these poor abandoned infants<br />
and caused them to be reared. The first foundling<br />
hospitals appear to have arisen at Treves, Angers and<br />
Milan*<br />
Unfortunately the care which the Christians devoted,<br />
to the sick and helpless did not always manifest itself'<br />
in this noble and reasonable manner. The words of ST.I<br />
JAMES:f "Is any sick among you? let him call for the<br />
elders of the Church and let them pray over him anointing<br />
him with oil in the name of the Lord. And the prayer of<br />
faith shall save the sick, and the Lord shall raise him up "<br />
display ignorance and superstition in so far as they pronounce<br />
the help of the doctor to be superfluous, and the<br />
power of prayer to be sufficient to heal the sick. It was a<br />
return to that theurgical point of view from which diseases<br />
were looked upon as punishments inflicted by God and only<br />
to be removed by penance and prayers. The sufferers came<br />
now to the Christian Church as they formerly did to the<br />
temple of ASKLEPIOS to request advice and aid from the<br />
priests. Happy recoveries, the cause of which was ascribed,<br />
to the intercession of a saint, resulted in an increased throng<br />
of sick people. And thus, especially in Churches where the<br />
bones of saints reposed, there became developed a kind of,<br />
worship, hardly distinguishable from that offered at the<br />
temples of ASKLEPIOS.J The sick spent nights there in<br />
fasting and prayer, hoping that the saint would appear to<br />
them in a dream or a vision and would indicate the remedy<br />
suited to effect their recovery, and the priests interpreted<br />
the hallucinations and dreams of the patients, wrote down<br />
the histories of the successful cases which occurred, and<br />
took care that by means of pictorial representations of<br />
* CHASTEL op. cit. S. 53, 138.<br />
t Gen. Ep. St. James, c. 5, v. 14, 15.<br />
X ALB. MARIGNAN : La me'decine dans l'eglise au sixieme siecle, Paris 1887
THE INFLUENCE OF CHRISTIANITY.<br />
the parts of the body which had been successfully treated<br />
the recollection of such cures should be kept fresh and<br />
enduring in the minds of the faithful. The reverence<br />
which was paid to the martyrs who had suffered death for<br />
their faith very easily led to great healing powers beingascribed<br />
to their remains. The sick hoped to obtain relief<br />
from their sufferings if they were allowed to see or to touch<br />
the saint's body or articles belonging to him, to visit his<br />
grave or to taste of the dust, covering it. Amulets and<br />
miracles played a prominent part henceforth in the medicine<br />
of the Christians. The mystical enthusiasm of the<br />
Neoplatonists and the Neopythagoreans, which had .just<br />
been employed as a weapon in the contest against the<br />
Christian Church, now found acceptance with the latter:<br />
and under ecclesiastical protection, fraud and superstition<br />
made their power felt in a sphere where not merely the<br />
progress of science but the health—even the life of men<br />
frequently depends upon the truth.<br />
The medical literature of that period bore the character<br />
of dependence. Poor in original ideas, incapable in original<br />
research, writers were satisfied in collating what had been<br />
effected in bygone times and working it up into concise<br />
epitomes. The practising doctors demanded books of<br />
receipts answering to their daily requirements. Of this<br />
nature were the writings of QuiNTUS SERENUS SAMONICUS,<br />
SEXTUS PLACITUS PAPYRENSIS, VINDICIANUS, MARCELLUS<br />
EMPIRICUS, LUCIUS APULEIUS, CASSIUS FELIX, THEODORUS<br />
PRISCIANUS and others, the Latin translations of certain<br />
works of the Hippocratic writers, of DiOSKORiDES, GALEN<br />
and SORANUS, and compilations from PLINY, CAELIUS,<br />
AuRELlANUS and others. In their language as in their<br />
subject matter they indicate the rapid decline of intellectual<br />
aspiration after science which characterizes this period.<br />
More valuable and richer in matter were the literary<br />
performances of the Greeks in this domain : yet it might<br />
here too be detected that the creative power of ancient<br />
times was gone. The judgment passed by the philosopher
152 THE MIDDLE AGES.<br />
LONGINUS upon his contemporaries in the third century<br />
was equally applicable to the Greeks. " In the same<br />
manner as some children always remain pygmies, whose<br />
infant limbs have been too closely confined; thus our<br />
tender minds fettered by the prejudices and habits of a<br />
just servitude, are unable to expand themselves or to attain<br />
that well proportioned greatness which we admire in the<br />
ancients."*<br />
In the fourth century, ORIBASIUS by the wish and command<br />
of the Emperor JULIAN whose body-physician and<br />
friend he was, made a collection of extracts from the most<br />
important writings of the most famous medical authors of<br />
ancient times,t enriching the same with many interesting<br />
additions of his own. After the same plan AETIUS in the<br />
sixth century collected a number of treatises upon the particular<br />
departments of medicine. Since many of these<br />
proceeded from doctors, whose works have been lost, and<br />
many things are alluded to therein which are not to be<br />
found elsewhere, this collection forms a priceless source of<br />
information not merely for the history of medicine but also<br />
for that of philosophy and other branches of knowledge.<br />
Unfortunately the use of it is made difficult if not impracticable<br />
by the fact that the Greek text of the work has not<br />
as yet been printed in its entirety.<br />
ALEXANDER of Tralles, who lived about the same<br />
period as AETIUS, is placed by FREIND by the side of<br />
HIPPOKRATES and ARET/EUS. Being the first doctor who<br />
for a long time had shown any originality in thought or<br />
practice he recalled to remembrance once more the mighty<br />
past of Greek medical science. His text-book of special<br />
pathology and therapeutics of internal diseases which has<br />
been edited by me,J contains a multitude of medical obser-<br />
* LONGINUS: De sublim., as quoted by GIBBON, op. cit. Vol. i c. ii, p. 76.<br />
f This was edited by CH. DAREMBERG with the support of the French<br />
Government (Paris 1851-76).<br />
X TH. PUSCHMANN : Alexander von Tralles, Originaltext und Ubersetzung,<br />
Wien 1878-79, 2 Bde. On pp. 108-286 of the Introduction is a description of<br />
the scientific performances and services of A. of T.
THE INFLUENCE OF CHRISTIANITY. 153<br />
vations and experiences, made by him in his practice of many<br />
years' duration and shows us in the author a man combining<br />
a correct judgment with extensive knowledge. The<br />
compendium of general medical science composed with<br />
great originality and independence by PAULUS vEGINETA<br />
belongs to the seventh century and, particularly in its<br />
surgical sections, is of great value, since the operative<br />
attainments of the surgeons of that period are fully<br />
described therein.*<br />
The medical writings of the Byzantines bore almost<br />
without exception the stamp of superficiality and consisted,<br />
like the works of MELETIUS, THEOPHANES NONNUS, SIMON<br />
SETH, NIKETAS, DEMETRIUS PEPAGOMENUS, NICOLAUS<br />
MYREPSUS and others, to a large extent of compilations<br />
made without judgment, and collections of receipts. A<br />
tendency to encyclopaedic literature developed itself<br />
about the same time, finding representatives in PHOTIUS,<br />
MICHAEL PSELLUS and others: the same inclination<br />
was shown also in the Origines of ISIDORE of Seville and<br />
the Elementa Philosophise of the monk BEDA. The<br />
Encyclopaedists skimmed over all sciences, discoursed of<br />
God and the world, of heaven and earth : they began with<br />
theology and ended with the art of cooking. They drew<br />
even medicine into the field of their observation ; but they<br />
seldom did more than furnish a catalogue of names for<br />
things with which they were really but slightly acquainted.<br />
The medicine of the Byzantines came to a worthy conclusion<br />
in the person of JOHANNES ACTUARIUS whose<br />
writings on the urine and on the physiology and pathology<br />
of the mind are allied both in substance and form to the<br />
best literary performances of the Greeks.t He appeared<br />
as HAESER says "like the last flickerings of a dying flame "<br />
shortly before the Turks erased for centuries the glorious<br />
name of the Greeks from the history of nations.<br />
* F. ADAMS: The seven books of PAULUS ,/EGINETA, London 1844-47.<br />
t J. L. IDELER : Physici et medici Graeci minores, Berlin 1841-42, i, pp. 312-<br />
386. ii, 1-193, 353-463.
154 THE MIDDLE AGES.<br />
If we survey the character of the intellectual activity of<br />
this period we cannot wonder at the dearth of production in<br />
original matter. On the contrary We feel a legitimate surprise<br />
that notwithstanding the heavy oppression, which weighed<br />
on the spirits of mankind, and despite the terrible confusion,<br />
of all social conditions, energy and power were yet forth^ ,<br />
coming, and equal to the accomplishment of independent<br />
intellectual tasks. Like desert-plants which are hardy<br />
enough to dare the arid conditions of life to which they are<br />
exposed, so the intellectual performances of that time were<br />
compelled, with painful endurance, to maintain the struggle<br />
for existence. We should not expect them to transform<br />
the bare wilderness into a place of luxuriant fertility, but<br />
must be thankful if they rejoice the eye of the weary '<br />
wanderer with the green leaf of hope.<br />
* * .,<br />
ARABIAN CIVILIZATION. / ,« *<br />
W H E N the Semitic hordes of the Arabian peninsula, accuse<br />
tomed as they were to a life of restless wandering and to<br />
unceasing campaigns and forays, set forth for the purpose<br />
of subduing the world, the attractions of art and science"<br />
were far from their thoughts. Of these things they knew<br />
only as much as transient relations with the neighbouring<br />
peoples had taught them. Arabian literature consisted<br />
of little more than certain heroic poems in which as<br />
GOETHE says* "the love of home; the greed of fame,<br />
courage, and an unappeasable thirst for revenge " were the<br />
subjects of song "tempered by the woes of love, by charity<br />
and sacrifice." The Koran " chapters of which lying<br />
scattered about, scrawled on palm-leaves, pieces of leather,<br />
flat bones and other coarse material or even entirely<br />
entrusted to the memory of the faithful. ABU BEKR was<br />
the first to collect and OTHMAN to arrange in the existing.<br />
order,"t laid the foundation of a literary Arabic language.<br />
* GOETHE : Noten und Abhandlungen zum west-ostlichen Divan.<br />
t E. MEYER op. cit. iii, S. 90.
ARABIAN CIVILIZATION.<br />
For the Koran, inasmuch as it was the religious and civic<br />
law book of the adherents of Islam, was read and spread<br />
wherever the doctrines of MUHAMMED found believers, and<br />
with it the Arabic language extended from country to<br />
country. It is owing to this fact that Arabic became the<br />
speech used in the religious worship of Islam and thus<br />
formed the link uniting the different peoples who professed<br />
the same faith. This circumstance as well as the care and<br />
perfecting which it consequently underwent, explain the<br />
fact that it became the language of the educated and<br />
learned. It gained the same importance in the Muham-<br />
medan world as the Latin tongue did in the Christian<br />
middle ages.<br />
Gradually, a rich literature and a flourishing civilization<br />
sprang from it, embracing in its domain nearly one half of<br />
the earth as known at that time. The Indians in the East,<br />
the Goths in Spain, the Armenians and Tartars on the<br />
Caspian, and the Ethiopians at the outlet of the Red Sea<br />
adopted with their religion the language of the Arabs.<br />
To be sure, these various nations retained each its own<br />
language for national intercourse and exceptionally such<br />
language furnished a literary production, which while differ<br />
ing from Arabic literature in the form of the characters<br />
used, breathed in its contents the same spirit and the same<br />
mode of thought.<br />
The Arabian people probably contributed but little to<br />
what we are-in the habit of calling Arabian culture. The<br />
roots of this must be sought among the Persians, the<br />
Greeks of Asia Minor and of Alexandria, and in India:<br />
nearly all the peoples subdued by the Arabs took part in its<br />
development from the Pillars of HERCULES in the West'to<br />
the Sea of Darkness, as the Arabs called the Indian Ocean,<br />
in the far East. During the first decades of their appear<br />
ance as prominent actors in the world's history, they were so<br />
much occupied with quarrels among their rulers and wars<br />
of conquest that they had but little leisure for the arts of<br />
peace. It was "the day of ignorance." The anecdote<br />
•**
156 THE MIDDLE AGES.<br />
reported by ABULFARAG* is well known, how that OMAR,<br />
being asked after the .conquest of Alexandria what should<br />
be done with the numerous books which were stored therej :|<br />
answered : " Either these writings contain what is given<br />
in the Koran, and in this case they are superfluous :<br />
or they contain other things and are consequently hurtful<br />
: in either case they must be destroyed." Perhaps<br />
there is no foundation for this tale, perhaps the farfamed<br />
libraries of the Ptolemies may for the greater |<br />
part, as history tells, have fallen a prey at an earlier |<br />
period to fire or to the mania for destruction of a Chris- J<br />
tian mob; be this as it may, the story indicates the<br />
characteristic spirit which animated the first Arab con<br />
querors.<br />
As soon as the political dominion of the Arabs was secured,<br />
under the dynasty of the house of OMMIYAH higher intel-;;<br />
lectual aspirations manifested themselves. The Caliph<br />
MOAWIYAH, who took up his residence at Damascus, •-.<br />
founded schools, libraries, and observatories there. He<br />
invited the learned of foreign lands, especially Greeks, to<br />
come to his Court and gave them important works to<br />
•carry out; even the mosques were built under the direction<br />
•of Greek architects and artificers. \<br />
Greek culture reached the Arabs partly from Alexandria,<br />
partly was transmitted through Syria and Persia. Medicine<br />
chose the same routes. In the seventh century numerous<br />
medical schools existed in Alexandria in which instruction *<br />
was imparted according to the doctrines of GALEN-t.<br />
Among the teachers of medical science there was<br />
ALKINANI, a Christian doctor of Arabian origin, who at j<br />
a later period was converted to Islam. He seems to have '<br />
been the chief agent in bringing it about that medical |<br />
studies and teaching were transferred from Alexandria to ;<br />
* ABULFARAGIUS : Hist, dynast, ed. Pococke, >Oxon. 1672, p. 114.—V,<br />
HAMMER-PURGSTALL: Literaturgeschichte der Araber, Wien 1850, Bd. i, Einl<br />
S. xxxviii.<br />
t L. LECLERC: Histoire de la Medecine Arabe, Paris 1876, i, p. 38 et seq.
ARABIAN CIVILIZATION. 157<br />
Antioch and Harran.* About the same period lived the<br />
Greek THEODOCUS who took up an influential position as<br />
body-physician of HEDSCHADSCH, the sanguinary governor<br />
of Irak: as author he won approval for his excellent dietaries<br />
and as teacher of medicine he trained numerous pupils—<br />
among them FQRAT BEN SCHANNATHA, a Jew—who became<br />
celebrated doctors.f The prince CHALID BEN JAZID, who had<br />
been taught in medicine by MARIANUS, a Christian Monk,<br />
probably once a teacher in the medical school of Alexandria,<br />
caused works on medicine, alchemy and astronomy<br />
to be translated from Greek into Arabic by the elder<br />
STEPHANUS, a Greek of Alexandria. These were the first<br />
translations from a foreign tongue, which were made under<br />
the rule of Islam, as is stated by the author of the Fihrist.J<br />
Greek literature had found many friends and admirers in<br />
Asia Minor where Hellenism had ever since the time of<br />
ALEXANDER THE GREAT of Macedon possessed an important<br />
influence which it was able to maintain under the<br />
political changes of the Roman period.<br />
Learned Nestorians, who carried on teaching as a profession<br />
in the School at Edessa, translated the writings! of<br />
ARISTOTLE from Greek into Syriac.§ Even at an earlier<br />
date Syriac translations of the New Testament and other **<br />
theological works had been prepared. The Nestorians<br />
continued this meritorious work when they founded educational<br />
establishments in Persia, and displayed an aptitude.<br />
for it, meeting with much success at the school of Gondisapur.<br />
They were however by no means the only people<br />
engaged in such work. Members of other religious societies<br />
* v. HAMMER-PURGSTALL op. cit. Bd. ii, S. 194.—FREINO . Hist. MedicinEe,<br />
Venet. 1735, p. 89.<br />
f LECLERC op. cit. i, p. 82.<br />
X Fihrist means " the Index.'' It is an Arabic bibliographical work on the<br />
scientific treatises translated into Arabic from Greek, Ancient Persian and<br />
Sanscrit. Its author—MUHAMMED IBN ISHAK who died year 380 of the Flight.<br />
E. H. H.<br />
§ J. G. WENRICH: De Auctorum Graecorum versionibus et commentariis<br />
Syriacis, Arabicis, Armeniacis, Persicisque commentatio, Lips. 1842, p. 8.
158 THE MIDDLE AGES.<br />
and sects distinguished themselves in a similar way.<br />
Numerous Jacobites made themselves known likewise as<br />
translators,* among them notably SERGIUS who lived at<br />
the court of KESRA NUSCHIRWANS. He was a friend of<br />
the Greek historian AGATHIAS, and as familiar with Greek<br />
as with Syriac ; he was distinguished for his learning, and<br />
the best translator of his time.f By him numerous medical<br />
works—and to such, being a doctor, he devoted especial<br />
attention—were rendered into Syriac from the Greek,<br />
among them certain writings of HIPPOKRATES. Moreover<br />
he wrote explanatory notes to ARISTOTLE and completed the *<br />
medical compendium of the Alexandrian doctor AHRON.J<br />
The numerous Jewish men of learning who had settled<br />
in Syria and Persia, were the means of bringing about an<br />
acquaintance with Hebrew culture and, in addition, must<br />
have contributed to an increased extension of Greek<br />
literature, especially in the domain of medicine. The<br />
system of teaching among the Jews was admirably organized<br />
and their high schools at Tiberias in Palestine, at<br />
Sepphoris and Tvfisibis in Syria, and at Sura and Pumbeditha<br />
in Persia acquired great fame.§<br />
By the rendering of Greek works into the SyriacA<br />
Hebrew, and Persian languages, the study of these was put<br />
within easier reach of the Arabs. The mutual relations of<br />
kinship among these tongues facilitated the translation of<br />
the compositions from them into Arabic. This pursuit 1<br />
was systematically exercised and conducted under the<br />
Abbassides. AL MANSUR, the second Caliph of this line<br />
of rulers, the founder of the new capital of Baghdad,<br />
charged his body-physician GEORG BACHTISCHUA with the<br />
translation of medical works from Greek into Arabic, as is<br />
stated by IBN ABU OSEIBIA.[| According to the statement<br />
* WENRICH op. cit. p. 11.<br />
t AGATHIAS: Histor. iv, c. 30.—ASSEMANI op. cit. T. ii, p. ,,- ,2, _<br />
-ABULFARAG op. cit. p. 94, 172. ' ' '' %,.y<br />
X WENRICH op. cit. Index xxxv.-<br />
§ CRAMER op. cit.i, S. 109 et seq.<br />
I WENRICH op. cit. p. 13.—LECLEHC op. cit. i, p. i24 et s,q.
ARABIAN CIVILIZATION.<br />
of HADJI KHALFA he is said to have sent envoys to<br />
Constantinople, in order to fetch from thence the writings<br />
of EUCLID and works on natural science. One of his<br />
successors HAROUN AL RASCHID, celebrated in story, the<br />
contemporary of the Frankish Emperor CHARLEMAGNE<br />
with whom he had communications, imposed as the<br />
condition of peace after the defeat of the Byzantine<br />
Emperor NlCEPHORUS that manuscripts of Greek literary<br />
masterpieces should be delivered up to him. The treasures<br />
of this kind, also, which fell into his hands at Ancyra and<br />
other Greek towns as well as on the island of Cyprus were<br />
to him welcome prizes of war. He commanded that they<br />
should be translated into the Arabic language. In this<br />
work one of his doctors, JOHANNES MESUE (MASEWEIH) a<br />
Syrian Christian, who attained a prominent position<br />
under AL MAMUN, assisted him with advice and personal<br />
effort.<br />
This prince erected an establishment for translating<br />
where works were rendered into Arabic from foreign<br />
tongues. "To this end he brought together" as LEO<br />
AFRICANUS writes* "a great number of learned men<br />
acquainted with various languages, and made inquiries<br />
about the authors and writings in the Greek, Persian,<br />
Chaldaean, and Egyptian languages, many of which were<br />
known to himself. Thereupon he sent many of his<br />
servants to Syria, Armenia, and Egypt to buy the books<br />
indicated, and they brought together immense loads of<br />
them. And now AL MAMUN caused the useful books—such<br />
as dealt with medicine, physics, astronomy, music, cosmography<br />
and chronology to be selected, and appointed as<br />
•superintendent of the translators from the Greek, JOHANNES,<br />
son of MESUE, for at that time Greek studies flourished<br />
among the Christians; many others being placed under his<br />
direction. For Persian literature he appointed MAHAN<br />
and the above-mentioned MESUE. These and many other<br />
* LEO AFRICANUS in Fabricius Bibl. Graeca, Hamburg 1726, xiii, p. 261.—<br />
MEYER op. cit. iii, 115.
Ifjo THE MIDDLE AGES.<br />
learned men translated the Medicine of GALEN and after- '<br />
wards all the works of ARISTOTLE."<br />
From the Byzantine emperors AL MAMUN obtained a#<br />
number of Greek manuscripts, the learned PHOTIUS who (<br />
lived for a long time at the court of Baghdad transmitting<br />
them to him. Moreover Indian works—such as the*'<br />
treatise on poisons by CHANAK and the Ayur-Veda ofVj<br />
SUSRUTA and CHARAKA—were translated and, as it appears,<br />
first into Persian and then into Arabic. The Indian doctor's<br />
who, like MANKAH, SALEH BEN" BALEH and others, had<br />
settled in Baghdad, rendered in this way important services,.*<br />
Thus too certain literary productions of 4 the Chaldees found;<br />
their way to the Arabs.<br />
This establishment for translating continued to'exist !<br />
under the successors of AL MAMUN ; among the men, of<br />
learning who were* appointed to it", HONEIN (JOHANNITIUS) j<br />
who translated the most important Greek authors, made •.,<br />
himself especially remarkable.<br />
On these foundations an independent medical .literature '<br />
gradually developed. The commencement of it reaches '<br />
back into the ninth "century; but only in the eleventh* did it<br />
attain its prime. The progress of Arabian culture: was<br />
favourably influenced in an extraordinary degree by the<br />
disintegration of the empire,into numerous independent,<br />
states. The princely residences of the Samanides. at<br />
Bokhara, of the Ghasnawides at Ghasna, of the Buides'in<br />
Persia, of the Hamadanites in Mesopotamia and Syria, of**<br />
the Edrisites in Magreb, of. the Aglabites in Kairwan and t<br />
of the Fathimites in Egypt forined so many centres for,<br />
artistic and scientific efforts, like points of crystallization in*<br />
a saturated liquid. They found the most effectiveprotec-;<br />
tion however among the Ommiades. in Spain, who obtained<br />
dominion there after being driven from their home about<br />
the middle of the eighth century. ABDERRAHMAN, the<br />
* At the time of MUHAMMED there existed at Senaa in Southern Arabia a<br />
famous medical school, the Principal of -which, HARIT BEN KALDAH, had<br />
acquired his knowledge in India as LASSEN (Indische Alterlh. ii, 519) narrates^
ARABIAN CIVILIZATION. l6l<br />
first prince of this house, enlarged his seat at Cordova<br />
and adorned it with buildings the remains of which even<br />
now excite wonder. He planted there the first palm—an<br />
incident which he has celebrated in an elegy which gives<br />
touching . expression to the longing he felt for distant<br />
•Baghdad.*<br />
The brilliant period of the Arabian dominion in Spain<br />
began with ABDERRAHMAN III. He caused great buildings<br />
to.be erected, aqueducts and streets to be made, and<br />
induced men of learning from the East to come to Spain.<br />
Learned men stood in high respect at his Court, and held<br />
conferences, being separated into departments according<br />
to their respective sciences. His successor HAKIM II.<br />
devoted still greater attention to scientific effort. He was<br />
himself a man of learning and took a personal part in<br />
discussing the burning questions of the day. Above all, he<br />
bought up scarce books which he studied thoroughly and<br />
added notes to them. His library is said to have contained<br />
600,000 volumes and the catalogue alone to have filled 44<br />
volumes-. He founded in Cordova a sort of Academy, the<br />
members of which were entrusted with special researches<br />
on the history of the country, the history of literature and<br />
the natural sciences.t<br />
If the sciences flourished under circumstances such<br />
as these, it was due certainly in a great measure to the<br />
sympathetic assistance which was extended to them by<br />
the reigning sovereigns;' but, the memories of Roman<br />
culture still cherished in Spain, the care taken by the<br />
Visigothic conquerors for what remained of it, the settle-<br />
v ment iii the Country of industribus and enterprising Jews<br />
who built schools and spread education on all sides, and<br />
finally the happy coalescence of the Semitic character<br />
with Roman and Germanic elements, all exercised, with<br />
out doubt, a noteworthy influence in the same direction.<br />
% ,-. * •<br />
* v. HAMMER-PURGST ALL op. tit. iii, 31.—MEYER op. cit. iii, 126.,<br />
4 Cf. R. DOZY : Geschichte der Mauren in Spanien, deutche Ubers., Leipzig<br />
1874, ii, S. 68 et\siq. ';.,<br />
M
162 THE MIDDLE AGES.<br />
And thus it came about, that at a time when the rest<br />
of Europe was sunk in ignorance, superstition, and<br />
barbarism, on the Spanish peninsula an intellectual life<br />
was unfolding itself, rich and fruitful in every path of<br />
mental activity. In the twelfth century Spain possessed 70<br />
public libraries and 17 teaching institutions of a higher<br />
class. Cordova produced 150 authors, Almeria 52, Murcia<br />
61, Malaga 53* The performances of the Arabs in mathematicsf<br />
and physics,J especially in mechanics and optics,<br />
and again in chemistry,§ astronomy|| and geography!<br />
are well known. They were the first to introduce<br />
measurement and experiment into the investigation of<br />
Nature. The excellent work of ALHAZEN on refraction<br />
prepared the way for a rational comprehension of the<br />
physiology of vision, and GEBER was the founder of<br />
scientific chemistry.**<br />
MEDICAL SCIENCE AND MEDICAL TEACHING<br />
AMONG THE ARABS.<br />
ATTENTION and care were even in the earliest periods of<br />
Islam devoted to medicine, as ABULFARAG observes.ft And<br />
yet the Arabs made but little progress in this domain and no<br />
discoveries of primary importance. This is owing to the<br />
absence, in their nation, of an independent development<br />
of medical or indeed of any other science. Hence sprang<br />
also that unlimited belief in authority which both deterred<br />
them from testing the accuracy of scientific results<br />
* MICH. CASIRI : Bibl. Arab. Hisp. Escur., Madrid 1760, T. ii, p. 71.<br />
f M. CANTOR: Geschichte der Mathematik, Leipzig 1880, i, S. 593 et seq.<br />
X J. C. POGGENDORFF: Geschichte der Physik, Leipzig 1879, S. 56 et seq. -<br />
§ H. KOPP: Geschichte der Chemie, Braunschweig 1843, i, S. 51 et seq.<br />
|| W. WHKWELL: History of the Inductive Sciences. New Edition. London<br />
1847. Vo1 - *< P- 2 3*> et 5f -7-<br />
% O. PESCHEL: Geschichte der Erdkunde, Miinchen 1877. S. \04 et. seq.<br />
** H. KOPP: Beitrage zur Geschichte der Chemie, Braunschweig, 1875, iii, S.<br />
13 et seq,<br />
tt ABULFARAG op. cit. p. 160.—Cf. A. SPRENGER: De origin, med. arab.,<br />
Leyden 1840, p. 6.
MEDICAL SCIENCE AMONG THE ARABS.<br />
as received by them, and also took away from them all<br />
courage for independent investigation. And then came<br />
social and religious prejudices, which nipped in the bud<br />
every attempt which was made in this direction.<br />
Anatomy and physiology remained, therefore, essentially<br />
at the standpoint they had reached under GALEN. The<br />
dissection of human subjects being forbidden by the<br />
religious creed of the Muhammedans, clearly any increase<br />
in anatomical knowledge was not to be thought of. Incidental<br />
observations, as those made by ABDEL-LETIF on the<br />
occasion of an epidemic in Egypt, in which by the examination<br />
of the skulls of the dead he succeeded in correcting*<br />
numerous osteological mistakes of GALEN, formed an exception<br />
to the rule. Generally speaking, anatomical<br />
literature was limited to abstracts and short compendiums<br />
founded upon the works of GALEN. In the same way his<br />
physiological theories were slavishly followed. Even the<br />
promising results, which physics and chemistry arrived at<br />
in the way of experiment, produced scarcely any reform in<br />
this matter. Students were not in the position to make<br />
them thoroughly profitable for the study of human physiology<br />
and failed to apply these methods of inquiry to that<br />
science.<br />
The Arabs manifested greater independence in practical<br />
medicine. Their numerous writings upon this subject are<br />
certainly also dependent upon the works of the ancients<br />
and consist for the most part of extracts, commentaries and<br />
translations of the same ; but here and there we do find an<br />
independent observation, a personal experience, which<br />
selves to show that the author was master of the subject<br />
and was in a position to advance the knowledge of it. The<br />
scientific work accomplished by such men as RHAZES, ALI<br />
ABBAS, ABULKASEM, AVICENNA, AVENZOAR, AVERROES,<br />
MAIMONIDES, IBN EL-BEITHAR, OSEIBIA and othersf holds<br />
an honourable position in the history of medicine, and<br />
* ABDOLLATIPHII Hist. JEgypt. ed. WHITE, Oxon. i8co, p. 277.<br />
t WUSTENFELD: Gesch. der Arab. Arzte u. Naturforscher, Gottingen 1840.
164 THE MIDDLE AGES.<br />
deserves recognition all the more, inasmuch as the authors<br />
lived at a time, when the development of medicine was<br />
nowhere making any progress.<br />
The Arabian doctors gave great attention to the examination<br />
of the body of the patient. They noted all the<br />
symptoms of disease, but attached most importance to the<br />
character of the pulse and the peculiarities of the urine.<br />
They attained to a remarkable ability in prognosis. They J<br />
paid' a fitting attention* to dietetics and enlarged the<br />
pharmacopoeia by the addition of numerous remedies. They<br />
were zealously anxious to discover the causes of disease<br />
and obtained some success in this quest. AVENZOAR drew<br />
attention to the Sarcoptes hominis, pointing out its relation<br />
to scabies.t ABULKASEM left behind him an excellent<br />
description of the Dracunculus medinensis and the conditions<br />
of disease arising therefrom.J Special pathologyhas<br />
to thank the Arabian doctors for many contributions:<br />
they gave valuable information as to the causes and<br />
character of certain diseases, for example, the malignant ;<br />
epidemics, small-pox, measles and other. exanthemata,^<br />
F consumption, || face-ache^ etc. On the other hand, operative<br />
surgery certainly lost ground among the Arabs. The<br />
neglect of anatomy and the dislike peculiar to Orientals<br />
of any interference with the human body which is attended .<br />
with bleeding were to blame for this. Caustics and cauteries<br />
took the place of the knife. Where surgeons incised<br />
before, they now were satisfied with cauterizing and<br />
burning. Even ABULKASEM deplored the decline of<br />
* Cf. EL-ANTERI'S admirable verses in v. HAMMER-PURGSTALL op. cit. Bd.<br />
vii, S. 499.<br />
t RASPAIL: " Memoire sur l'histoire naturelle de 1 insecte de la gale in the<br />
Bull. gen. de therap., Paris 1834, T. vii, p. 169.—F. HEBRA (Acute Exantheme<br />
u. HaUtkrankheiten'in VIUCHOW'S Handbuch, Bd. iii, S. 413, Erlangen i860)<br />
did not "believe that AVENZOAR was acquainted with the Sarcoptes.<br />
X ABULKASEM; Chirurgie ii, 93, Edit. LECLERC, Paris i86i,p. 230.<br />
§ RHAZES: De variolis et morbillis, Edit. CHANNING, London 1766.<br />
|| WALDENBUHG: Die Tuberkulose, Berlin 1869, S. 25.<br />
•f AVICENNA: Canon iii, fen. 1, tract. 1, c. 12.
MEDICAL SCIENCE AMONG THE ARABS. 165<br />
surgery. "The operative Art" he writes "has disappeared<br />
from among us almost without leaving any trace<br />
behind. Only in the writings of the ancients do we find<br />
some references to it but these, by bad translations, by errors<br />
and alterations, have become nearly unintelligible and use<br />
less."* On this occasion he mentions numerous occurrences<br />
of practice which throw a strong light upon the ignorance<br />
of his surgical colleagues. Cauteries were the most fre<br />
quently used and most important instruments for the treat<br />
ment of wounds. The hot iron was recommendedf for<br />
the arrest of bleeding, besides compression, the application<br />
of cold, and the ligature; it was employed in a multitude of<br />
affections—for instance in palsies,J wounds and fistulae,§<br />
gangrene, || cancer and other new growths,! in psoriasis,**<br />
for the opening of hepatic abscess,ft in carious inflamma<br />
tion of the hip joint, in the vertebral disease of children, J;];<br />
and many more. The use of heated instruments in surgery<br />
was brought to a high stage of development by the Arabian<br />
doctors. A large number of the 151 surgical instruments,<br />
representations of which are added to the manuscripts of<br />
ABULKASEM, were used in this way. In contradistinction<br />
to the use of cauteries, the art of operative surgery receded<br />
into the back ground and was unable to maintain that stage<br />
of perfection which it had reached under the surgeons of<br />
the Roman Empire. Amputation was ventured upon only in<br />
the case of the forearm or leg or at most only just<br />
above, at the elbow or knee joint: never in the upper<br />
arm or thigh.§§ The skin was fixed by bandages above<br />
and below the place where it was purposed to make<br />
the incision and before the beginning of the operation<br />
was drawn up with the object of securing as large a flap as<br />
possible to cover the bone. The bleeding accompanying<br />
* ABULKASEM : Introd. op. cit. p. 1. fl id. op. cit. i, 50, 53, p. 53, 54.<br />
t Mem op. cit. i, 56 p. 56. ** id. op. tit. i, 47, p. 50.<br />
X Id. op. tit. i, 6, 9, p. 17, 19. ff id. 0p. cit. i, 28, p. 33.<br />
§ Id. op. cit. i, 17, 19, 36, p. 25, 27, 38. X% J't- p. tit. i, 43, p. '46.<br />
I Id. op. cit. i, 52, p. 54. §§ id. 0p. dt. ii, 89, p. 219.
166 THE MIDDLE AGES.<br />
the amputation ABULKASEM arrested by styptics and<br />
cauteries ; in describing the operation he says not a single<br />
word about tying the vessels. In another passage he<br />
narrates that he made a resection of part of the bone in a<br />
case of necrosis of the tibia*<br />
Tracheotomy was no longer practised in his time. He<br />
only knew it from the descriptions of the ancients, but<br />
considered it indicated in cases in which the danger of<br />
suffocation was imminent by reason of new growths.t<br />
AVENZOAR performed the operation on a goat, as he<br />
informs us, with the object of observing the result.J<br />
Lithotomy was described by ABULKASEM who in the same<br />
place alludes to lithotrity.^ MOSES MAIMONIDES improved<br />
the method of circumcision, which custom was in use among<br />
the Arabs, and introduced several precautionary measures<br />
to be observed in this operation. || In the treatment of<br />
fractures and dislocations which ABULKASEM considered in<br />
his third book, the approved principles of the doctors of<br />
antiquity were pursued.! It only deserves mention that<br />
AviCENNA recommended the reduction of the dislocated<br />
humerus by direct pressure, i.e. direct reposition.**<br />
Cataract was removed by depression of the lens into the<br />
vitreous.tf Extraction was considered, if not impossible, at<br />
least very dangerous.H ABULKASEM alludes, as RHAZES<br />
did before him, to the curing of cataract by suction and<br />
remarks that this procedure was practised in Persia.§§ So<br />
* Id. op. cit. ii, 88, p. 216.<br />
f Id. op. cit. ii, 43, p. 120.<br />
X AVENZOAR -. Altheisir., Lib. i, Tr. x, c. 14, Venet. 1542.<br />
§ ABULKASEM ii, 60 op. cit. p. 151 et seq.<br />
|| J. B. FRIEDREICH : Zur Bibel, Niirnberg 1848, ii, S. 46 et seq.—H. PLOSS:<br />
Geschichtliches und Ethnologisches iiber Knabenbeschneidung im Deutschen<br />
Arch. f. Gesch. d. Med. Leipzig 1885, viii, S. 324 et seq.<br />
^f ABULKASEM iii, op. cit. p. 270-342.<br />
** AVICENNA : Canon iv, fen. 5, tract. 1, c. 11, 14.<br />
tt ABULKASEM ii, 23 op. cit. p. 92 et seq.<br />
XX AVENZOAR: Altheisir., Lib. i, tract. 8, c. 19.—AVICENNA op. cit. iii, 3,<br />
tract. 4, c. 20.<br />
§§ ABULKASEM ii, 23 op. cit. p. 93.
MEDICAL SCIENCE AMONG THE ARABS. 167<br />
too the ophthalmic surgeon ISA BEN ALI makes mention of<br />
this method of operating; a manuscript of his work gives<br />
on the margin an illustration of the hollow needle used for<br />
this purpose.* CANAMUSALl who frequently performed<br />
this operation, made a preliminary incision in the cornea so<br />
that the hollow needle could be more easily introduced.t<br />
Midwifery was the business of midwives, who rendered<br />
the required help in normal confinements and even<br />
undertook obstetric operations. The strict seclusion of<br />
women agreed to by the custom of society prevented<br />
doctors occupying themselves with practice of this kind.<br />
They had only occasional opportunities J in this respect;<br />
in their writings they concerned themselves chiefly with<br />
advising the midwives what remedies to employ for the<br />
relief of women seeking their aid and with giving them<br />
counsel in the performance of certain operations.§ Among<br />
the instruments specified by ABULKASEM as being used in<br />
the extraction of the dead foetus, we find a dilator, bearing<br />
some resemblance to midwifery forceps ;|| but it is clear, as<br />
MULDER has remarked, that it was never used for the<br />
extraction of a living child.% Another illustration shows<br />
the form of the cephalotribe used for a similar purpose.**<br />
One pleasing symptom is the active interest, which the<br />
Arabian doctors took in the history of their science. The<br />
works of IBN DSCHOLDSCHOL and of IBN ABU OSEIBIAff<br />
form a priceless source of information, though unfor<br />
tunately one but little used, for the study of the history of<br />
medicine, as indeed also for that of the history of civiliza<br />
tion in general. The taste for history which was instilled<br />
* SICHEL in the Archiv. f. Ophthalmol. 1868, Bd. xiv, 3, p. 9.<br />
t LECLERC op. cit. i, p. 535.<br />
X C. J. v. SIEBOLD : Geschichte der Geburtshilfe, Berlin 1839, i, S. 272, note.<br />
§ SIEBOLD op cit. i, S. 298 el seq.<br />
|| ABULKASEM ii, 76, 77, op. tit. p. 180 et seq. and Appendix Fig. 103.<br />
% J. MULDER : Geschichte der Zangen u. Hebel in der Geburtshilfe, Leipzig<br />
1798, S. 9.—SIEBOLD op. cit. i, S. 295, Note 1.<br />
** ABULKASEM op. cit. Fig. 106.<br />
tf WUSTENFELD op. cit. S. 132 et seq.—LECLERC op. cit. ii, 187 et seq.
l68 THE MIDDLE AGES.<br />
^~ —k' • **' "<br />
into the Arabs in their education, induced them to adorn<br />
their writings with a multitude of quotations through which<br />
many important matters have been saved from oblivion.<br />
What surprising disclosures on the civilization, and particularly<br />
on the medicine, of antiquity may we expect, as soon<br />
as the literary treasures of the Muhammedan seats of<br />
learning in the East and in North Africa, such as Kairwan,<br />
are thrown open to science !<br />
Even in the earliest ages of Islam elementary schools<br />
were universally erected near the mosques, in which<br />
children learned to read the Koran. To this was added<br />
later on the reading of other compositions, besides<br />
grammar and instruction in writing. Attendance at school<br />
began in the sixth year of age.* Religion formed the<br />
basis of the higher teaching as well as of the more<br />
elementary. The higher teaching institutions, too, were at<br />
first in connection with the mosques. In the niches and<br />
cosridors of these or in adjacent halls, the learned gathered<br />
a circle of inquiring students around them and held discourses<br />
upon theological, philological, philosophical, legal<br />
and medical questions. During the first centuries any one<br />
might act as a teacher without being obliged to show his<br />
qualifications; from the teachers of theology and law only<br />
was it demanded that they should give account of their own<br />
education by a teacher of publicly recognized ability in the<br />
branch of knowledge they professed. Many teachers<br />
carried on some other calling as well: they worked as<br />
readers and preachers in the mosques, as officials, judges,<br />
secretaries, overseers at the markets, and even as tradesmen<br />
and mechanics.t The teachers of medical science were no<br />
doubt in most cases skilled as practical doctors. The<br />
lectures being gratis, it was natural that teachers not<br />
possessed of private means should be careful to get their<br />
* D. HANEBERG: Uber das Schul-und Lehrwesen der Muhamedaner im<br />
Mittelalter. Munchen 1850, S. 4 et seq.<br />
t F. WUSTENFELD : Die Academien der Araber und ihre Lehrer, Gottingen<br />
1837, S. 6.
MEDICAL SCIENCE AMONG THE ARABS. 169<br />
' ~ ' **r j-c —<br />
'•f"'<br />
living by other pursuits. Many supplied the students with<br />
board and lodging, in order to earn, by the presents and<br />
money they received from them, something towards defray<br />
ing their expenses. Sometimes they selected a son-in-law<br />
from among them.* The lectures were delivered either<br />
with or without the use of a copy or notes. SAMACH-<br />
SCHARI made the witty remark: " The reputation of the<br />
learned man lies in his lecture-book like that of the<br />
merchant in his money-box." The words of the teacher<br />
were copied down by the students, and the latter<br />
even subjected themselves to reproof if they neglected<br />
this. The teacher ascertained for himself by questions<br />
whether the students had understood the substance of his<br />
discourse. Discussions often ensued, in which it occasionally<br />
happened that an able scholar, finding himself by chance<br />
among the listeners, achieved a victory over the teacher<br />
himself.f Entrance to the lectures was free to all, without<br />
distinction of nationality. In the lecture halls were to be<br />
seen youths, hardly outgrown their boyhood, beside middle-<br />
aged and even white-bearded old men. Many came from<br />
far off in order to learn the opinions of a noted teacher.<br />
Since Arabic was used in teaching in all countries subject<br />
to Islam, it was easy for the learned of the several nations<br />
to make themselves understood by one another,—to increase<br />
their own knowledge or to communicate it to others. The<br />
love of travel manifested by the Arabs, aroused by religious<br />
pilgrimages, was thus promoted among the men of learning<br />
and students. In their wanderings from one high school to<br />
another they effected an exchange of intellectual acquisitions<br />
and contributed in this way to produce an equal develop<br />
ment of culture in all countries subject to the Arab sway.<br />
The students often had drawn out for them by the teachers<br />
testimonials of attendance at their lectures and the permis<br />
sion was accorded them in writing to spread abroad by<br />
tongue or by pen the knowledge they had acquired. Some<br />
* HANEBERG op. cit. S. 31. t HANEBERG op. cit. S. 12.
170 THE MIDDLE AGES.<br />
teachers were in this respect very ready to come forward. j<br />
Of one of these it is said in a somewhat exaggerated strain<br />
that " he covered the earth with certificates of attendance<br />
and licenses to teach."*<br />
Many schools and mosques possessed large libraries.<br />
QUATREMERE has described 40 and v. HAMMER-PuRGSTALL<br />
made important additions to this number.t The love of<br />
possessing books was moreover widely spread among<br />
private people. The doctor ALGIZAR (IBN DSCHEZZAR)<br />
left behind him when he died in the year 1009 at Kirwan a<br />
library which weighed 25 hundredweight. J<br />
In the 1 rth-century the Madaris began to arise: these<br />
may be compared either to European Academies, according<br />
to WUSTENFELD or to Gymnasia as MEYER suggests. They<br />
most of all resembled English Colleges. They were, in fact |<br />
boarding establishments devoted to the higher teaching, in<br />
which teachers and pupils lived together. Some possessed J<br />
imposing buildings ; all were provided with libraries. The.<br />
most celebrated Madaris were at Baghdad, Basra, Bokhara,<br />
Nisabur, Damascus, Samarcand and Cairo ;§ Spain at the<br />
most flourishing period possessed 17 of such institutions.<br />
WUSTENFELD has described 37 of these places and has<br />
given detailed information about the conditions of life<br />
amongst the teachers engaged at them and their literary j<br />
works. If we peruse the copious list of their writings we<br />
find that they deal chiefly with theology, law, philosophy,<br />
and philology; only a few treat of mathematics, chemistry,<br />
the natural sciences, and other subjects, but not one with<br />
medicine. It appears therefore that these institutions<br />
served chiefly for education in the humanities, theology, and<br />
* HANEBERG op. cit. S. 22.<br />
f QUATREMERE : " Sur le gout des livres chez les Orientaux "' in the Journal-<br />
Asiat. Ser. iii, t. iv, p. 35, Paris 1838, and Ser. iv, t. xi, p. 187 et seq Paris 1848.<br />
-LECLERC op. cit. i, 583 et seq.—A. v. KREMER : Culturgeschichte des Orients- |<br />
unter den Khalifen, Wien 1877, ii, S. 434.<br />
X LECLERC op. cit. i, 584.<br />
§ WUSTENFELD op. cit. S. 6.
MEDICAL SCIENCE AMONG THE ARABS. I 7 I<br />
law, while other establishments were provided for instruction<br />
in the natural sciences and in the science of medicine.<br />
The Society of the "Brethren of Purity" which arose in<br />
the 10th century at Basra did not reckon teaching among<br />
its peculiar tasks. It certainly endeavoured to extend<br />
education by the publication of treatises in theology, philosophy,<br />
mathematics and the natural sciences; but the goal<br />
it had in view was the alliance of reason and faith and the<br />
establishment or purification of faith through knowledge.<br />
F DlETERlCl has illustrated their efforts and their performances<br />
in a series of valuable writings.<br />
The " House of Wisdom " founded by the Caliph HAKIM<br />
BllMRlLLAH in the year 1105 at Cairo exhibited in many<br />
respects the character of a University. There medicine<br />
was taught in conjunction with other sciences, and amongst<br />
the well paid teachers who were appointed to the institution<br />
were not only theologians, grammarians, philosophers, and<br />
lawyers but also mathematicians, astronomers, and doctors.<br />
Moreover, it was permitted to non-Muhammedans, for<br />
instance, Jews and Christians to attend the lectures which<br />
were given there and to make use of the library belonging<br />
to the institution which filled 18 rooms.*<br />
The study of medicine was conducted in various ways.<br />
Whoever wished to devote himself to the medical calling,<br />
could acquire the special knowledge by placing himself<br />
under the personal guidance of a senior doctor of experience,<br />
or else in the medical teaching establishments, or finally in<br />
the medical schools connected with many hospitals. Many<br />
may have combined all three methods in order to get a<br />
thorough education in the healing art. The medical lectures<br />
which were held in the higher teaching institutions attached<br />
to the Mosques and in similar establishments, for instance<br />
in the " House of Wisdom " dealt, in all probability, chiefly<br />
with theoretical subjects and made the students acquainted<br />
with literature, whereas practical medical knowledge was<br />
acquired principally in the hospitals. According to<br />
v. HAMMER-PURGSTALL op. cit. Bd. i, Einleit, S. lxiv.
iy2 THE MIDDLE AGES.<br />
MACRIZI* there were, even in the pre-Islamite time,<br />
hospitals in Egypt, provided with doctors and drugs.<br />
Amongst the Muhammedans the mosques and" the buildings<br />
belonging to them frequently served as shelters for poor<br />
strangers and as hospitals for the sick. Under the rule of<br />
Islam the first hospital for the sick was erected in the year<br />
707 by the Caliph EL WELID BEN ABD-EL-MALIK who took<br />
care that travellers without means if they fell ill should<br />
receive medical assistance. " He appointed doctors to the<br />
\ hospitals and defrayed their expenses : he commanded<br />
"-* that lepers should be shut up so that they should not go<br />
%' into the streets, and provided for their wants and also for<br />
those of blind people."<br />
- • . ' At a later period hospitals and infirmaries were erected<br />
in all.the larger towns, owing their foundation to pious<br />
legacies. The majority of them served also for medical<br />
teaching. The arrangements existing in the medical school<br />
at Gondisapur and in the medical teaching establishments<br />
connected with the hospitals of the Nestorians were taken<br />
for a pattern. The hospital doctors worked here as teachers<br />
of medicine, and gave their pupils instruction in the various<br />
branches of medical science. The information which has<br />
reached us concerning the hospitals of the Arabs gives us<br />
some insight into their condition and circumstances. The<br />
hospital at Gondisapur, which for many generations was under<br />
the direction of members of the BACHTISCHUA (BOCHTJESU)<br />
family, maintained its good reputation under the Arab<br />
dominion. It was connected with a well-managed dispen-<br />
•, s'ary over which the elder MESUE, the founder of another<br />
famous medical family, presided for more than 40 years. In<br />
the year 869 SABUR BEN SAHL, who rendered great services<br />
to materia medica, was the director of this establishment. It<br />
probably continued to exist down to a later period, passing,<br />
however, into the shade as the splendid, endowed hospitals<br />
* MACBIZI'S Description of hospitals in Cairo according to WUSTENFELD'S,<br />
translation in the Janus, Breslau 1846, i, S. 28 et seq.
MEDICAL SCIENCE AMONG THE ARABS. I 73<br />
of the Arabs in Baghdad and other places came into<br />
prominence.<br />
In Baghdad as early as the gth century there existed a<br />
hospital and medical school.* The Vizier An BEN<br />
ISSA in the year 914 founded a second. He learned<br />
to recognize the want of doctors and of medicines<br />
during an epidemic which prevailed among the<br />
troops and throughout the country, and decided to do<br />
something to improve this state of affairs. He commanded<br />
that the sick should be visited daily by the doctors, and<br />
should have medicine and food given them, and he caused!\a<br />
new hospital to be opened. When he was told that .•<<br />
certain villages, chiefly inhabited by Jews, were entirely *?{•<br />
without medical assistance, he replied that the unbelievers<br />
also must be cared for. At the instancet of SlNAN BEN-<br />
TSABET BEN CORRA yet other hospitals were erected in<br />
Baghdad. The rich bequests of SEDJAH, the mother of<br />
the Caliph MOTTAWAKL, which were intended for charitable<br />
purposes, afforded the means for this. The largest and most<br />
famous of these hospitals was established in the year 977<br />
by ADHAD ED DAULA, an Emir of the Buides dynasty, or<br />
perhaps having fallen into decline (being of earlier origin)<br />
was by him restored and its usefulness extended.J According<br />
to the statement of IBN ABU OSEIBIA, RHAZES is sai4<br />
to have assisted in its original foundation, inasmuch as he<br />
selected a situation for it suitable in hygienic respects.$<br />
To this hospital 24 doctors were appointed, who ranked.<br />
according to their ability. There were specialists among<br />
them, some devoting themselves only to the treatment of<br />
fevers, others to the healing of wounds, to the reduction<br />
of dislocations, or to diseases of the eyes. The sick were**•/?.<br />
separated into different sections, according to the nature of<br />
their ailments. Noteworthy observations made by the<br />
•f - .*•<br />
* M. STEINSCHNEIDER in VIRCHOW'S Archiv, Bd. 52, S. 372.<br />
t From his biography in LECLERC, op. cit. i, 365, 559 et seq.<br />
_ X v. HAMMER-PURGSTALL, op. cit. iv., 358.—WUSTENFELD : Gesch. d. Arab.<br />
Arzte, S. 42, Anm.—LECLERC, op. cit. i., 561.
174 T H E MIDDLE AGES.<br />
doctors in particular cases of disease were written down<br />
and preserved. A high official—a kadi—carried on the<br />
administration of the hospital; under him was a treasurer.<br />
IBN EL MARISTANIA, who worked as doctor forsome time ^<br />
at this institution, composed a history of it, which has unfortunately<br />
been lost. This hospital existed certainly up<br />
to the 13th century, perhaps to a still later time.<br />
There were hospitals also at Merv, at Ray, the birthplace<br />
of RHAZES, at Ispahan, Schiraz, Jerusalem, Antioch,<br />
Mecca, and Medina. In Damascus there were several;<br />
the largest, it is supposed, owed its origin to NUREDDIN.<br />
It served also as an institution for medical teaching. In<br />
the carpeted courtyard medical lectures were given after.<br />
the visits to the sick ; they often lasted for many hours.<br />
A medical library in this institution supplied the literary<br />
requirements of the teachers and the taught. The number<br />
of students was very large. In the list of teachers are .<br />
names among the most famous in Arabian medical science.*<br />
The sick were separated. according to their ailments: for<br />
instance there was a special department for those suffering<br />
from diseases of the eyes.f Such admirable care was<br />
taken of the sick that many, as ABD EL LETIF states,:].<br />
feigned sickness so as to be allowed to remain in the<br />
institution; for there they were regaled "with tender<br />
chicken, pastry, sherbet, and fruits of all kinds." In<br />
Damascus there existed also other medical schools: some-*<br />
times the same professor taught at two such establishments.'<br />
The medical schools of Damascus-held the first rank in the<br />
13th century among their sister institutions, and surpassed<br />
in fame even those of Baghdad and Cairo.<br />
MACRIZI has left complete information concerning the<br />
hospitals of Egypt and their organization. He states that<br />
the first hospital was established by IBN TULUN about the<br />
v<br />
* If this hospital was first established by NUREDDIN, who died in 1173, some<br />
of the facts mentioned here probably refer to other hospitals of Baghdad.<br />
f LECLERC, op cit. i., 565 et seq.—ABULFARAG op. cit. p. 343.<br />
X ABD-ALLATIF: Relation del'Egypte, ed.'SILV. DE SACY, Paris 1810, p. 441.
MEDICAL SCIENCE AMONG THE ARABS. I 75<br />
year 875, and was provided with abundant means for its<br />
maintenance. " He made it a rule of the hospital that<br />
neither soldier nor slave should be received in it; he<br />
erected also two baths, one for men and the other<br />
for women, and bequeathed both of them to the hospital<br />
and other institutions. He commanded further, that when<br />
a patient was brought there, his clothes and money should<br />
be taken from him and given into the charge of the hospital<br />
steward, then that other clothes should be put on him, that<br />
he should be put to bed, have some food given him, and<br />
that he should have medicine, diet, and professional attendance<br />
until he recovered ; then after receiving a chicken and<br />
a cake to eat, he should be discharged, taking with him his<br />
money and clothes."* In the hospital there was a department<br />
for people of unsound mind. This institution does<br />
not seem to have existed for long; in MACRIZI'S time it<br />
w r as almost completely forgotten.<br />
He then mentions KAFUR'S hospital, which was erected<br />
in the town of Misr, in the year 957, and the one which<br />
was named after the street El Magafir and apparently only<br />
existed for a short time. A hospital existed in Fostath as<br />
early as the 10th century; another, to which for a short<br />
time IBN ABU OSEIBIA gave his medical services, owed its<br />
origin to NASR SALADIN.<br />
The most remarkable of all these foundations was the<br />
.'•- great Mansurian hospital at Cairo. The Sultan, EL<br />
MANSUR GlLAVUN constructed this at great expense<br />
by altering a noble castle which had up to that time<br />
served as the residence of a princess. The foundation<br />
walls, the stones and marble columns of that part of the<br />
castle which was pulled dowii, were used in building the<br />
hospital. All artificers of Misr and Cairo were compelled<br />
to work at it and were not allowed during the time it was<br />
being built to undertake other work. The Sultan rode<br />
daily to the site, inspected the workmen, even assisted<br />
* MACRIZI in WUSTENFELD'S translation, op. cit. S. 30.
176 THE MIDDLE AGES.<br />
with his own hands and compelled the passers-by to drag<br />
stones or to perform other services. He met, also, with A<br />
remarkable good fortune in the work: in excavating the<br />
ground a workman discovered a box filled with gold and ",ij<br />
precious stones the value of which was sufficient to cover<br />
the whole cost of building. Four large wards enclosed the<br />
court, in each of which was a fountain, fed by a reservoir<br />
situated in the middle of the court. At the completion of J<br />
the building the Sultan said : " I have founded this place' 1<br />
for those of my own station and for those of lower rank.<br />
I have intended it as an establishment for kings and for<br />
./servants, for soldiers and emirs, for the great and the little,<br />
i for freemen and for slaves, for men and for women." He '\<br />
provided medicines, doctors, and everything else that anyone<br />
could require in any sickness whatsoever. The Sultan<br />
appointed male and female ward attendants for the service<br />
of the patients and furnished them with wages. He had<br />
beds constructed for the sick and provided them with every |<br />
kind of covering which was required in different kinds of i<br />
sickness. Each class of patients had a separate room.<br />
He designed the four wards of the hospital for those suffer- |<br />
ing from fevers or similar diseases, he appointed one court I<br />
for those suffering from diseases of the eyes, one for those J<br />
with wounds, one for those afflicted with diarrhoea, and one<br />
for women. A room for convalescents he divided into two<br />
compartments, one for men and the other for women.<br />
Water was laid on in all these places. A special room was<br />
appointed for cooking food and preparing drugs and syrups, J<br />
another for mixing confections, balsams, and ointments for |<br />
the eyes, and the like. The provisions were preserved in<br />
distinct places; the syrups and drugs in a room by themselves.<br />
The principal doctor had a room for himself where 1<br />
he could give lectures. The number of patients was not ;|<br />
limited, but every one in distress and poverty who came<br />
there found acceptance; nor was any limit fixed to the j<br />
time a patient might be kept there, and anything required!<br />
by those who lay sick at their own homes was sent to them
MEDICAL SCIENCE AMONG THE ARABS. I 77<br />
from the establishment.* This hospital, in course of<br />
time, underwent many improvements and enlargements.<br />
A large pavilion was erected in the garden,<br />
where the patients could take walking exercise in the<br />
shade. A cistern lying, at the door of the hospital,<br />
out of which animals were wont to drink, was removed,<br />
" since the people were injuriously affected by<br />
the offensive smell of the filth," and a water-conduit was<br />
laid down. The founder of the institution bequeathed it<br />
so much landed property that the yearly revenue belonging<br />
to it amounted nearly to one million dirhem. Two officials<br />
were commissioned to collect the money pouring in from<br />
the landed possessions of the institution : others had control<br />
over the expenses and superintendence over the buildings'<br />
and the kitchen. According to LECLERC,f at first only<br />
patients of unsound mind were admitted into this hospital<br />
and not till a later period sufferers from other ailments.<br />
They were well cared for there and enjoyed a comfortable<br />
existence. If they suffered from sleeplessness the time was<br />
passed with music, tale-telling, and other diversions. On<br />
leaving the institution each convalescent received five gold<br />
pieces so that he was not compelled to engage immediately<br />
in heavy work. Connected with the hospital was a mosque<br />
in which the Koran was constantly read and expounded.<br />
Moreover there was a library to which six eunuchs were<br />
appointed as servants, an orphan-asylum, with a school in<br />
connection, and an institution for the higher teaching.<br />
There could have been no charitable foundation at that<br />
time existing in the world able to vie in magnificence,<br />
grandeur, and extent with this structure.<br />
MACRIZI goes on to describe the Muajjid Hospital at<br />
Cairo which was opened about the year 1420, but only<br />
served for a short time as an institution for the sick.<br />
There were hospitals also in Fez, as we are told by LEO<br />
AFRICANUS : some had special departments for the insane.<br />
* MACRIZI in WUSTENFELD, op. cit., S. 34.<br />
f LECLERC op. tit. i, 570.<br />
N
178<br />
THE MIDDLE AGES.<br />
Spain is said to have been rich in hospitals ; but the infor<br />
mation concerning them is very meagre. There was a<br />
hospital in the 12th century at Algesiras and according to<br />
a report bearing the stamp of oriental exaggeration, Cor<br />
dova is said to have possessed as many as 50 of these<br />
institutions.<br />
The loving care which the Muhammedans took of the<br />
mentally afflicted, had its foundation in religion. They<br />
saw frequently in the hallucinations and disordered speech<br />
of these patients manifestations of a supernatural world,<br />
and paid a fitting respect to the recipients of such favours.<br />
The Christians embraced a similar opinion; only they dis<br />
cerned in these things the punishments of God and the<br />
workings of the Devil and of evil spirits. The insane<br />
found therefore in the countries subject to Islam friendly<br />
words and careful attention in the hospitals; whereas by<br />
the Christians they were treated as criminals, were cast<br />
into prison and beaten, or were exterminated with fire and<br />
sword as wizards and witches* In Baghdad and Cairo<br />
institutions for the insane existed long before it was thought<br />
of erecting them in the lands of Christendom, and the first<br />
in these lands arose in Spain, the intellectual development,f<br />
of which country was greatly influenced by Arabian civili<br />
zation. The balance inclines decidedly in favour of the<br />
Muhammedans, as regards the humane treatment of the »<br />
insane; Christianity here exhibits an ugly blemish, for which<br />
the religious zeal of its adherents must bear the blame.<br />
The Arabs had separate departments in their hospitals'<br />
for the various kinds of diseases afflicting mankind; there<br />
were even separate institutions for certain diseases, for<br />
instance those of the eyes. The students who visited these<br />
hospitals were, under the guidance of experienced doctors,<br />
initiated into the art of recognizing and treating diseases.<br />
They assisted at the performance of surgical operations<br />
and were frequently able to acquire a practical acquaint-<br />
* LECKY op. cit. ii, 68 et seq. DESMAISONS : Des Asiles d'alien6s en Espagne,<br />
Paris 1859.
MEDICAL SCIENCE AMONG THE ARABS. I 79<br />
ance with midwifery, as ALI BEN ABBAS advised them to<br />
do. In the apothecaries' shops they had the opportunity<br />
of becoming acquainted with the preparation of medicines.<br />
The Arabs introduced apothecaries' shops; it<br />
seems that they were made acquainted with them through<br />
the Nestorians.* The Arab apothecaries dealt not only<br />
in drugs (notably sandalwood, on which account they<br />
were also named Szandalani), perfumery, cosmetic, and<br />
other applications, but also were occupied in compounding<br />
drugs into medicines: and they introduced dispensaries.<br />
They deserve commendation for their systematic use of<br />
distillation and for the discovery of certain remedies.<br />
Their chemical and botanical studies were very useful to<br />
them in their work. Botany formed, as HADJI KHALFA<br />
says,f a science ancillary to medicine. Many doctors<br />
were zealous botanists; it is narrated of RACHID EDDIN<br />
IBN ASZURI that he was attended on his botanical excursions<br />
by a painter, who made pictures of the plants in<br />
their various stages of development.^ MUHAMMED BEN<br />
ALI BEN FARAK, the body-physician of the prince of<br />
Cadiz, is said even to have laid out a botanical garden.§<br />
The Arabian doctors strove not only to acquire a thorough<br />
knowledge of medicine and natural science, but showed a<br />
keen interest in the teachings of the philosophers, and were<br />
at the head of all liberal intellectual efforts.<br />
The names of AVICENNA, of AVERROES, and of MOSES<br />
JVIAIMONIDES are almost more conspicuous in the history<br />
of philosophy than in that of medicine. The groundwork<br />
of their philosophical ideas was formed by the system of<br />
ARISTOTLE, which they carried to a further development in<br />
various directions. While AVICENNA was led by this path<br />
to a teleological Theism which recommended him to the<br />
* K. SPRENGEL: Geschichte der Botanik. Leipzig 1817, i, S. 205.<br />
f HADJI KHALFA: Lexicon bibliographicum et encyclopa:dicum ed. G.<br />
FLUGEL, London 1845, T - iv, p. 114. /<br />
X HADJI KHALFA : op. cit. T. i, p. 227, No. 36I.-LECLE.
T8O THE MIDDLE AGES.<br />
Christian schools of the Middle Ages, AvERROES attained<br />
to a pantheistic naturalism, which, on account of its rationalistic<br />
character, was not only condemned by the Christian<br />
Churches but also raised him up many adversaries among<br />
his own countrymen and co-religionists. When AVERROES<br />
declared that religion existed only for the benefit of the<br />
weaker intellect, that man could by his reason alone and<br />
without any revelation arrive at a knowledge of the essence<br />
of things ; when in the place of a creation brought about,<br />
by the^almighty will of the Godhead, he set up Nature,<br />
which, by a kind of Aristotelian ivrekfyeui, he conceived<br />
to have been promoted from potentiality to actuality; when<br />
finally he preached the permanency of the world' and of<br />
matter, the mingling of God with Nature, and the consubstantiality<br />
of reason—in all this he shook the foundations<br />
of a monotheistic system of religion and was bound to<br />
expect bitter opposition from its'adherents*<br />
His pupil and disciple the Jewish doctor MOSES MAIMO-<br />
NIDES experienced this too when he made the attempt to<br />
reconcile the precepts of the Talmud with the demands of<br />
reason. He opened broader paths of intellectual activity<br />
for the Jews. As MUNK says: "From SPINOZA down<br />
to MENDELSSOHN, the Jews have produced no advanced<br />
thinker who has not received the first sanction for his<br />
philosophy in MAIMONIDES."<br />
A relio-ious toleration towards people of other faiths<br />
prevailed in the countries under Islam during the first<br />
centuries of its existence, such as was not found anywhere<br />
at that period among the Christians. The high teaching<br />
institutions and medical schools numbered among their<br />
teachers and students many Jews, Christians and followers<br />
of other religions. Not only Muhammedan, but Christian<br />
and Jewish doctors also were appointed to their hospitals,<br />
and patients who did not hold the prevailing belief found<br />
at them nevertheless welcome admittance and- kind<br />
attention. Even the prophet MUHAMMED himself had re-<br />
* E. RENAN : AVerroes et l'Averroisme, Paris i860.
MEDICAL SCIENCE AMONG THE ARABS. l8l<br />
commended an unbeliever to his adherents as a doctor.*<br />
Jews and Christians and especially Nestorians played<br />
an important part as body-physicians at the Courts of<br />
the Caliphs and Muhammedan princes; they were even<br />
advanced to influential positions in the sanitary service.<br />
Medical practice was at first free to all; it gradually, however,<br />
became customary that the doctors should obtain certificates<br />
from the teachers who had instructed them in the<br />
healing art, since they thus instilled greater confidence into<br />
the mind of the public.f A professional blunder which<br />
resulted in the death of a patient was the occasion, in the<br />
year 931, of calling upon all the doctors of Baghdad and<br />
the neighbourhood to submit themselves to examination ;<br />
this examination was waived only in the case of the Court<br />
doctors and of practitioners whose ability was generally<br />
recognized. All other practitioners, reaching 860 in number,<br />
had to prove their fitness for the medical calling by an<br />
examination, held by the body-physician of the Caliph, SlNAN<br />
BEN TSABET BEN CORRA.J MEYER§ thinks that this was<br />
a temporary police regulation directed against charlatanism,<br />
since no successor to this examiner is mentioned; but<br />
similar arrangements existed in Baghdad in the 12th century<br />
and in Cordova even at an earlier period. || To me it appears<br />
therefore that we cannot doubt that the beginnings of<br />
the system of medical examinations are to be sought for<br />
among the Arabs.<br />
It was a frequent occurrence amongst the Arabs, as<br />
amongst other Orientals, for the son to choose the profession<br />
of his father. Certain families, as the Bachtischua,<br />
whose pedigree has been arranged by MEYER,! the Corra,**<br />
* v. HAMMER-PURGSTALL op. tit. ii, S. 192.—ABULFARAG op. cit. p. 99.<br />
t LECLERC op. cit. i, 574.<br />
X CASIRI op. cit. T. i, p. 438/— LECLERC op. cit. i, 576.<br />
§ MEYER op. tit. iii, 122.<br />
|| LECLERC op. cit. i, 577.<br />
1f MEYER op. ait. iii, 109.<br />
** WUSTENFELD: Gesch. d. Arab. Arzte, S. 34 et seq.
l82 THE MIDDLE AGES.<br />
the Honein, and the Zohr* families, to the last of which<br />
AVENZOAR belonged, furnished doctors through many<br />
generations, among them some very celebrated. This was<br />
the case too in other departments of learning, as the<br />
example of the Sobki family adduced by WOSTENFELD,t<br />
proves. Many doctors confined their practice to a special . •<br />
department of medicine as for example ophthalmology.<br />
Even at an earlier period the regulation was made of nominating<br />
Proto-mediciJ who, unless this was merely a title, no<br />
doubt exercised supervision over the other doctors. Probably<br />
this office was always joined with that of bodyphysician.<br />
Are we at liberty to assume that it was connected<br />
with the introduction of medical examinations? -<br />
IBN BEITHAR, the author of the best Arabian work on<br />
materia medica, who was body-physician at the Egyptian<br />
Court was nominated the chief of all doctors and herba- |<br />
lists (apothecaries ?) of that country.<br />
The doctors enjoyed a superior position in social life:<br />
many acquired great influence as the friends and advisers<br />
of rulers. The physicians in ordinary at the Court of the<br />
Caliphs received higher pay and richer presents than the i<br />
other learned men and officials§ and were loaded with<br />
honours and distinctions. Not a few attained the dignity<br />
of Vizier which was equivalent to the rank, if not always of<br />
minister, in any case of privy counsellor or aulic coun<br />
sellor. ||<br />
On the other hand there seems to have been by no<br />
means an absence of those members of the medical profession<br />
who decoy the public by the unclean means of<br />
charlatanism. RHAZES felt himself induced in consequence<br />
to compose a treatise " upon those conditions and circumstances<br />
of the medical art which turn the hearts of the<br />
* Id. op. cit. S. 88 et seq.<br />
f Id.: Akademien der Araber, S. 119.<br />
X LECLERC op. cit. i, 576.<br />
§ v. HAMMER-PURGSTALL op cit. Bd. i, Einleit., p. 1.<br />
|| LECLERC op. cit. i, 578.
MEDICAL SCIENCE AMONG THE ARABS. 183<br />
majority away from the most respectable doctors and<br />
induce them to resort to the lowest class of practitioners."*<br />
The Arabian doctors gave full attention to the<br />
theoretical problems of their calling; but they entertained a<br />
temperate and modest conception of life and took things as<br />
they are, not as they ought to be. In the " Doctor's guide,"<br />
the author of which is said to have been the Jew ISAAC<br />
ISRAELI, rules of life are laid down for them which bear<br />
testimony to this. There it is said : " The most important<br />
problem for the doctor is, how to avert illness." "The<br />
majority of diseases are cured by the help of Nature<br />
without the aid of the doctor." " If you can cure the<br />
patient by dietetic means, forbear to order drugs." " Never<br />
rely upon magic means in the treatment of a patient, since<br />
they mostly rest on folly and superstition." " Hold forth<br />
the prospect of recovery to patients, even when you are<br />
not assured of it yourself; so shall you at least second the<br />
efforts of Nature to cure them." " If a doctor has come<br />
from afar, and speaks a foreign language, then the multitude<br />
think him a clever man, come to him in crowds, and seek<br />
his advice." " Never speak unfavourably of other doctors ;<br />
for everyone has his successful and his unsuccessful<br />
times. Let your deeds speak your praises, not your<br />
tongue." "Visit your patient when he is at his worst. At<br />
that time come to an understanding with him about your<br />
fee: for if the patient is well he takes no thought of the<br />
matter." " Make your fee as high as possible, for what is<br />
done gratis is considered of little value." " Bestow the<br />
greatest attention upon the cure of princes and rich people ;<br />
for after their recovery they will be munificent to you, will<br />
always value and love you, whereas common people when<br />
they are cured hate you if they think of the fee."t Might<br />
we not readily believe that this book was written yesterday?<br />
* M. STEINSCHNEIDER in VIRCHOW'S Archiv, Bd. 36, S. 574 et seq.<br />
t SOAVE in the Giorn. Veneto di scienze mediche i86r, ser. ii, T. 18, p. 393<br />
et seq.—D. KAUFMANN in the Magazin f. d. "Wissensch. d. Judenthums, Berlin<br />
1884, S. 97 et seq.
184 THE MIDDLE AGES.<br />
Arabian culture fell from its high elevation almost as<br />
rapidly as it had climbed to it. The celebrated schools of<br />
the Nestorians were declining even in the 9th century*<br />
The higher teaching institutions of the Arabs lasted till the<br />
14th century and then disappeared more or less rapidly,<br />
and with them disappeared that scientific life which had<br />
borne such rich fruit for the human race. The religious<br />
wars which, in the East under the name of Crusades, were<br />
carried on by adventurers eager for booty, and in the West<br />
led Christian princes to the conquest of Spain and of the<br />
Italian islands in the Mediterranean, evokedt the religious<br />
fanaticism of the Muhammedans and paralyzed their intellectual<br />
efforts. The Mongolian and Turkoman tribes which<br />
in the 13th century burst in with fire and sword upon the<br />
Aryo-Semitic world crushed to fragments the ancient<br />
homes of civilization in Asia and turned flourishing towns<br />
into desolate wastes. The East never recovered from this<br />
blow and Turkish dominion became the symbol and sign<br />
of intellectual death. But in the Christian lands of the<br />
West the seeds of Arabian culture germinated into that<br />
vigorous growth of intellectual effort which showed its first<br />
high development in the Schools of Salerno and Montpellier.<br />
MEDICINE AMONG THE GERMANS<br />
AND TEACHING IN THE MONASTIC SCHOOLS.<br />
THE German tribes, which attained to power, after the socalled<br />
migration of the nations, in the western half of the<br />
Roman Empire had in the fifth century, already for some<br />
time past raised themselves above that low grade of civilization<br />
on which they stood when TACITUS wrote his<br />
description of them.J They had entered into relations<br />
with the Romans both in war and peace and had learnt to<br />
recognize their superiority in science and art. As soldiers<br />
* ASSEMANI op. cit. iii, pars ii, p. 940.<br />
•f v. KREMER: Ibn Chaldun und Seine Culturgeschichte, Wien 1879, S. 39.<br />
X TACITUS : Germania, c. 5, 19 et seq.—GIBBON op. cit. c. 9.—Rev. scient.,<br />
Paris, Oct., 1873.
MEDICINE AMONG THE GERMANS. 185<br />
in the Roman Army, as joyfully welcomed allies, or as<br />
hostages, they had the opportunity of enjoying the advantages<br />
of Roman civilization and of acquiring knowledge<br />
which they transmitted to their countrymen who remained<br />
at home. The germs of a noble civilization in the German<br />
race, which excited the astonishment and praise of TACITUS,<br />
were brought to greater perfection and to further development<br />
by the higher education.<br />
When the tribes of the Goths and other German peoples<br />
were driven from their homes by hordes of Huns pressing<br />
in upon them from the East, and when, thirsting for<br />
action and longing for riches and power, they began their<br />
world-famed wanderings, they possessed already a literary<br />
language, an orderly system of government, an assured<br />
administration of justice, and manifold acquirements in<br />
the various spheres of intellectual life. In medicine they<br />
held the view that diseases are produced by supernatural<br />
powers, which should be propitiated by prayers and magic ;<br />
but they did not neglect the use of healing herbs and other<br />
means, the favourable action of which experience had taught.<br />
It was especially incumbent upon the women, who played a<br />
very prominent part in the life of the Germans, to bind up<br />
wounds and to nurse the sick.* Only by degrees and<br />
chiefly under the influence of Roman civilization a special<br />
medical profession became developed among this people.<br />
The Greek and Roman doctors, who in the capacity of<br />
military surgeons came among them or, like ORIBASIUS and<br />
ANTHIMUS, stayed in their country in exile or as envoys,<br />
must have contributed to this in no small degree.<br />
GuiZOT t remarks that it is difficult to picture the intellectual<br />
condition of the Germans before the migration of<br />
the nations, and we may add that in regard to their medical<br />
acquirements this is especially the case. It is clear from<br />
comparative philology however that they had special<br />
* TACITUS op. cit. c. 7, 8, 18.<br />
t GUIZOT : Cours d'histoire moderne. Histoire de la civilization en France,<br />
Bruxelles 1829, i, p. 204.
186 THE MIDDLE AGES.<br />
designations for particular diseases * and we are permitted<br />
to draw many inferences from the analogy of the development<br />
of civilization among other peoples and especially by<br />
looking to the contemporary condition of the Germans of<br />
the North. There too, wise women practised the healing<br />
art, and people went so far as to worship a goddess of<br />
medicine, ElR by name.f BRUNHILDA, "the doctoress,"<br />
and the " Norns," % understood the art of delivering<br />
women. When SiGRDRlFA (BRUNHILDA) tells SiGURDR<br />
that he must know runes of a certain kind for the child to<br />
be delivered from the mother and when it is said of JARLS-<br />
SOHN KONR that he knew the runes and gave assistance to<br />
women in childbed, reference is obviously made to mystical :J<br />
formulas to which immense importance was attached in<br />
connection with the act of giving birth to a child. Even<br />
the hero G6NGUHROLF gave aid in child-birth by a laying *<br />
on of hands. Princes and heroes—indeed even ODIN<br />
himself, " the doctor"—were esteemed as especially<br />
experienced in medicine; § this indicates perhaps that it<br />
was practised chiefly by men of position who were the<br />
heads of large households, just as was the case in CATO'S •{<br />
time at Rome.<br />
Among the named diseases, we find derangement of the<br />
mind, impotence, but most frequently chronic suppuration of<br />
the leg which frequently ended fatally. These people were*<br />
well acquainted with the treatment of wounds. Even amputation<br />
was performed and the loss of the leg was made good<br />
by an artificial limb of wood. Wooden legs were, as it<br />
appears, not uncommon. Mention is also made of gastroraphy.<br />
This information has its source however from the<br />
period of the voyages of the Vikings, when already com-<br />
* AD. PICTET: Die alten Krankheits-Namen bei den Indogermanen in der<br />
Zeitschr. f. vergl. sprachforschung, Bd. v, S. 321 et seq.<br />
f K. WEINHOLD: Altnordisches Leben, Berlin 1856, S. 385 et seq.<br />
X The three Fates in Northern Mythology.<br />
§ Sigurdhar-koida i, 17. Fafnismal 12. Sigrdrifumal 9. Rigsmal 40.<br />
Fornalda sogur iii, 276. Saxo Gramm. i, 1,25,33, 128. Prof. R. HEINZEL.<br />
of Vienna had the kindness to call my attention to these passages.
MEDICINE AMONG THE GERMANS.<br />
munication existed between the North Germans and the<br />
more highly developed civilization of other peoples.<br />
SNORRI STURLUSON and HRAFN SWEINBOIRNSSON obtained<br />
great reputation by their successful cures. The<br />
latter is even said to have performed lithotomy with<br />
success* The mystical VlTOLF passed as the patron of<br />
the surgeons of the North.f INGIGERD, daughter of the<br />
Russian King INGVAR, founded a small hospital and consigned<br />
the nursing of the patients to gentle-handed<br />
women.J<br />
In the ioth century there were already in Norway a<br />
number of doctors, who practised their art as a profession.<br />
Even at that early period people had private medical<br />
attendants who were highly paid.§ There existed also<br />
even then a medical tax. The amount of the medical<br />
honorarium depended upon the gravity of the suffering<br />
which was relieved.<br />
In the Sudermanian law-book which, although first published<br />
in 1327, rests upon the authority of ancient enactments<br />
it was ordained that he only should be recognized as<br />
a doctor who had cured an incised wound, a fractured bone,<br />
an internal injury, a mutilation or a deep stab. Midwifery<br />
was naturally delegated to women. Mention is already<br />
made however of Caesarean section. It would not be right<br />
to apply to the Germans of the first centuries, as many<br />
medical historians do, the accounts here given, some of<br />
which clearly bear the stamp of later periods of civilization.<br />
They, at the most, authorize us to make certain<br />
presumptions as to the state of medical science among<br />
them.<br />
The knowledge and customs brought by the Goths,<br />
* Sagenbibliothek des skandinav. Alterthums, herausg. von P. E. MULLER,<br />
iibers. von K. LACHMANN, Berlin 1816, S. 176.—L. FAYE : Rafn Sweinbjornsens<br />
liv og verksomhed, Kristiania 1878.<br />
+ GRIMM: Mytholog. 994, 1101.<br />
+ WEINHOLD op. cit. S. 390.<br />
§ Vapnfirdlinga saga, c. 13, 29.
l88 THE MIDDLE AGES. ..v., ,-<br />
Lombards, Franks, Burgundians, and other German races,<br />
from their homes into the countries subdued by them soo$<br />
became mingled with all which had been bequeathed tQ<br />
these countries by former periods of civilizatiq|. The<br />
readiness with which the conquerors took to the higher<br />
education of the conquered shows that they were sufficiently I<br />
prepared and ripe to receive the same. Their medical<br />
science grew up into that system of medicine, which the<br />
Greeks and Romans had established. * Only among the<br />
people were certain traces preserved of the therapeutic |<br />
lore of the Celtic, Basque, Gaelic, Gothic, and Anglo- |<br />
Saxon races.<br />
In the laws of the Visigoths, which, partly committed ;<br />
to writing in the fifth century, contained without doubt<br />
much matter of Roman origin, it was laid down* how<br />
much the doctor should demand for different cases e.g. J<br />
the operation for cataract. Before undertaking such a<br />
case, he made an agreement with the patient or his %<br />
relatives, in which the professional fee was fixed ;^but he<br />
could only claim it if the treatment proved successful' 1<br />
In the other case he had to answer for an unfortunate<br />
issue. If the death of a slave resulted from his,treatment<br />
he was obliged to replace the loss; if it was a<br />
question of injury inflicted on the health or life of a free- J<br />
born citizen, he was condemned to a corresponding fine or<br />
given over for punishment to the relatives of the injured<br />
or dead. It is indicative of the social position of the<br />
doctor that he might see and examine females of the<br />
position of freewomen only in the presence of their<br />
relatives, for fear he should misuse such occasions by :•<br />
improper behaviour.<br />
The Visigothic law contains also rules concerning moral J<br />
responsibility, as to the punishment for crimes against the<br />
person e.g., wounding and mutilation, about cases of procuring<br />
abortion, and in regard to sexual transgressions^<br />
* Leg. Wisigoth, lib. xi, tit. i, de medicis et segrotis.—F. DAHN : Westgothische<br />
Studien, Wurzburg 1874, S. 3, 61, 145, 220, 222, 230 etc.
MEDICINE AMONG THE GERMANS. 189<br />
Of especiaf interest is the rule contained therein, that the<br />
doctor w 7 as entitled to demand a fee of 12 solidi for the<br />
instruction in medicine which he gave his pupil; it is clear<br />
from this that doctors were educated in their art under the<br />
personal supervision of a master, just as was the case in<br />
ancient times.<br />
The law books of the Alemanni, the Salii, Ripuarii, Bur-<br />
gundians, Bajoari, Frisians, Saxons, and Lombards contained<br />
also regulations as to punishments for wounds inflicted upon,<br />
and other offences committed against, the person.*<br />
The training of doctors was consonant to the method of<br />
teaching a trade. The tyro in medicine resigned himself to<br />
a respectable doctor, who furnished him with medical infor<br />
mation. Many doctors sought to complete their knowledge<br />
in the large towns of the Byzantine empire and Italy.<br />
Many Greeks, Romans, and Jews were to be found among<br />
them, and were especially in request at the courts of<br />
princes.<br />
ThetGreek doctor, PETRUSt was physician in ordinary to<br />
the Visigothic King, THEODORIC II. MARILEIF of Poictiers<br />
filled this post at the court of the Merovingians, having<br />
raised himself to this position from the lowest social cir<br />
cumstances, and REOVAL, who had acquired his medical<br />
training in Constantinople, enjoyed the same honour.J<br />
The latter performed an operation for removal of the testes<br />
with success.<br />
The work of a physician in ordinary at the Ffankish<br />
Court was certainly very profitable, as the riches acquired<br />
by MARILEIF testify, but it was also attended with many<br />
dangers. When AUSTRIGILDIS the wife of King GuNTRAM<br />
was carried off by a pestilence which raged in the year 580,<br />
she expressed a wish before her death that after that event<br />
her two doctors, NlCOLAUS and DONATUS, should be<br />
executed as a punishment for riot having saved her ; and<br />
* Corpus juris German, antiq. ed., F. WALTER, Berbl. 1824, T. i.<br />
t FREDEGAR : Chron., C. 27, O. ABEL'S translation.<br />
X GREGORY of Tours v, 14. vii, 25. x, 15.
190 THE MIDDLE AGES.<br />
the pious GUNTRAM considered himself bound to give<br />
effect to the last wishes of his spouse.*<br />
CHARLEMAGNE is said to have consulted Arabian physicians,<br />
as is stated by BUL^US and FRElND:f but these<br />
assertions, although not sounding improbable considering<br />
the respect which Arabian medicine enjoyed at that<br />
time, are, nevertheless, not authenticated by reference to<br />
the sources from which they are derived. It is certain<br />
that one of his private physicians bore the German name<br />
of WINTARUS.J In the life of Louis THE Pious it is<br />
narrated, that the wife of CHARLES, HlLDEGARD by name,<br />
bore him two sons, of whom one died as soon as he was<br />
born, and the other, namely LOUIS, was taken from his<br />
mother's womb and reared by artificial nourishment^ It is<br />
uncertain whether allusion is here made to Caesarean section<br />
or to a labour completed by manual aid. CHARLEMAGNE<br />
had at any rate a mean opinion of medicine, || which<br />
is probably explained by the neglected condition of<br />
the medical science of his time. It was therefore intelligible,<br />
that he should be moved to raise up this science<br />
from its debased condition, and to spread the knowledge<br />
of it more widely. On this ground, at the capitulation of<br />
Diedenhofen (Thionville) in 806 he issued an order that boys<br />
should be instructed in the healing art.^f MEYER** thinks<br />
that they had only to receive an introduction to the art of<br />
nursing the sick, since one " does not let children study<br />
medicine."<br />
But the study of this science was in ancient times begun<br />
quite in early youth. And in the schools of this period<br />
* Idem v, 35.<br />
t FREIND: Hist, med., p. 148.<br />
X IMGIL'S Leben des Abtcs Sturm von Tulda, C. 25, ed. MIGNE, T. 105, p.<br />
443-<br />
§ J. L. W. SCHMIDT, im Progr. des hess. Gymnas. zu Giessen, 1872, S. 5.<br />
|| EINHARD: Vita Caroli Magni, C. 22, ed. PERTZ, Hannov. 1863.<br />
IT PERTZ: Mon. Germ, iii, p. 131, De medicinali arte ut infantes hanc<br />
discere mittantur.<br />
** MEYER op. cit. iii, 413.
MEDICINE AMONG THE GERMANS. 191<br />
boys of 14 or 15 years of age were to be found.* For the<br />
rest, this teaching may have almost entirely been limited<br />
to the reading of the medical writings of antiquity, and to<br />
explaining the meaning of these, as was also the case in<br />
many monastic schools. Later on, the students learnt how<br />
to recognize the medicinal plants, opportunities being<br />
afforded for this in the imperial gardens, t They seem to<br />
have drawn into the domain of teaching even the practice<br />
of medicine itself. The w*ords in ALCUIN'S poem on<br />
CHARLEMAGNE^: can hardly be understood otherwise than<br />
to imply that in the neighbourhood of the court there was<br />
a hospital in which doctors performed different functions.<br />
"One let the patients' blood, another mixed herbs in a<br />
pot, that one cooked some pap, while this one prepared a<br />
drink."<br />
Probably the infirmaries attached to many monasteries<br />
served as examples for such arrangements. The monks<br />
took a keen interest in the care of the sick. " Learn to<br />
know the properties of plants and the art of mixing<br />
remedies," said CASSIODORUS to them§ "but place all your<br />
hope on the Lord who preserves life eternally. If the<br />
language of the Greeks is not unknown to you, you have<br />
the book of herbs of DiOSKORiDES, who has described<br />
and pictured forth the plants of the field with surprising<br />
accuracy. Afterwards, read HIPPOKRATES and GALEN in<br />
the Latin translation, that is to say, the Therapeutics of<br />
the latter which he has addressed to the philosopher<br />
* J. CH. F. BAEHR : De literarum studiis a Carolo Magno revocatis ac schola<br />
Palatina instaurata, Heidelberg 1856, S. 26, Anm. 33.<br />
t Capit. de villis. Cf. MEYER op. tit. iii, S. 397 et seq.<br />
X Alcuinii carmina, ed. E. DUMMLER in Mon. Germ. Poet, lat., T. i, p. 245,<br />
No. xxvi, v. 12-16.<br />
Accurrunt medici mox Hippocratica secta ;<br />
Hie venas fundit herbas, hie miscet in olla,<br />
Ille coquit pultes, alter sed pocula praefert;<br />
Et tamen, 0 medici, cunctis impedite gratis<br />
Ut manibus vestris adsit benedictio Christi.<br />
If in the first line we read tecta for secta, the allusion to a hospital is still plainer<br />
§ CASSIODORUS: Inst, divin. lect. i, C. 31.
192 THE MIDDLE AGES.<br />
GLAUCON, and the work of an anonymous writer, which,<br />
as the examination of it shows, is compiled from various<br />
authors. Furthermore study the medicine of AURELIUS<br />
C/ELIUS, the book of HIPPOKRATES upon herbs and methods '.<br />
of cure, and various other writings on the healing art, J<br />
Y which I have installed in my library and have bequeathed j<br />
to you." Certain members of the Benedictine order came<br />
into profitable notoriety as doctors, like the Abbot BER-<br />
THARIUS at Monte-Casino in the 9th century* Perhaps<br />
even at an earlier period pious pilgrims and patients were<br />
admitted and cared for at that place ; ST. BENEDICT the J<br />
founder of the order having observed this custom in the East<br />
and having accordingly imposed it as a duty on his followers. J<br />
But the more certain information on this point namely that<br />
institutions of this kind existed in Monte-Casino, dates<br />
from the nth and 12th centuries and not before.f<br />
The custom of bringing helpless sufferers into the "<br />
Churches and Monasteries,.for the priests to sprinkle them<br />
with holy water and to offer up prayers for their recovery<br />
found universal acceptance in the first centuries of the<br />
Middle Ages. From this the rule gradually came into I<br />
existence of erecting institutions there in which the infirm .%<br />
and ailing found shelter. The priests and monks who<br />
superintended these, in addition to psychical means of cure,<br />
employed also healing herbs and other remedies the<br />
favourable action of which they had learnt to recognize J<br />
from medical literature or from private experience. In this<br />
way medical knowledge came to form an essential part of<br />
the education of the priest, of which he felt the need in<br />
the practice of his profession.<br />
The schools of the Middle Ages, regarding as they did<br />
the training of the cleric as their most important task, j<br />
endeavoured to satisfy this want when they accepted 1<br />
*" '"1<br />
* DE RENZI : Storia docum. della scuola - medica di Salerno, 2 Ed., Napoli 1<br />
1857, p. 64 et seq.<br />
t TOSTI : Storia della badia di Monte Casino, Napoli 1842, i, 229, 341 et seq.<br />
ii, p. 193, 209, 289.—Reg. S. Bened. 36 in MURATORI script, rer. Ital.
MEDICINE AMONG THE GERMANS.<br />
medical science as a part of their curriculum as far as it<br />
could be taught in a purely theoretical manner. This was<br />
the case in many monastic schools notably those of Gaul<br />
for instance at Rheims, Chartres, Fleury, Dijon, Bee in<br />
Normandy, and St. Denis.* Moreover, the stores of medical<br />
manuscripts possessed by many of these monasteries,! and<br />
the literary activity of the monks, all point to the fact that<br />
medicine was assiduously practised and studied at the<br />
places and by the persons in question. When the students,<br />
by teaching and by the reading of medical treatises had<br />
acquired some general knowledge of the healing art, they<br />
may perhaps also have received some practical training in<br />
the same, while seeking and collecting medicinal plants<br />
under the supervision of their teacher, or compounding<br />
medicines and giving their services during the treatment of<br />
the patients. It is very likely that these relations assumed<br />
some such form as the author of the Journal^ of Walafridus<br />
Strabo describes with fruitful imagination, and knowledge<br />
which must be recognized as valuable.<br />
Many teachers of medicine obtained great renown. Thus<br />
RICHER relates that in the year 991 he travelled to Chartres<br />
to hear HERIBRAND'S exposition of the Aphorisms of<br />
HIPPOKRATES. HERIBRAND gave him instruction also in<br />
the semeiology of diseases and taught him in what subjects<br />
HIPPOKRATES, GALEN, and SORANUS are agreed. He possessed<br />
considerable knowledge of materia medica, botany,<br />
and surgery as RICHER declares with high commendation.§<br />
From the school of Chartres many celebrated doctors<br />
issued, among them JOHANN, the private physician of<br />
* J. B. L. CHOMEL: Essai historique sur la me'decine en France, Paris 1762.<br />
f The library at Tegernsee contained, for example, in 1500, 281 medical<br />
treatises, as we are told by LAMMERT (Volksmedicin u. medecin. Aberglaube in<br />
Bayern, Wiirzburg 1868, S. 4). •><br />
X This was published (1856-57) in the yearly report of the training institu<br />
tion of the Benedictine Monastery at Maria-Einsiedeln. It is however an<br />
imaginative work of P. MARTIN MARTY and by no means true, as some<br />
authors have strangely thought.<br />
§ PERTZ : Monum. Germ., T. v. ^Script, iii), p. 643.<br />
O
194 THE MIDDLE AGES.<br />
HENRY I. of France.. GERBERT D'AURILLAC,—when Pope<br />
known as SYLVESTER II.—worked at the Episcopal School<br />
of Rheims for some time as teacher of medicine.<br />
At the Court of CHARLEMAGNE besides the Palace<br />
"School in which the children of the Emperor and of certain<br />
distinguished dignitaries were taught, there was a kind of<br />
Academy numbering among its members the chief men of<br />
learning of the time. In this capacity they bore special<br />
names; ALCUIN was called FLACCUS, CHARLES himself<br />
was KING DAVID. They devoted themselves to theology,<br />
philosophy, arithmetic, geometry, astronomy, Latin, Greek,<br />
history, geography, and poetry.* This Academy appears<br />
however to have existed only for a short time, whilst the<br />
Court-school was still flourishing in the middle of the 9th<br />
century. In the year 789 the Synod of Aix decided that<br />
at the monastery and cathedral of that town there should<br />
be formed a school in which boys might be able to learn|he<br />
Psalms, writing, singing, the reckoning of ecclesiastical<br />
festivals, and Latin grammar.t The pattern for this institution<br />
was the school at Tours, where ALCUIN lived from 796<br />
as Abbot of St. Martin's Monastery. There were celebrated<br />
schools of this kind at Fulda, Hersfeld, Corvey, Reichenau,<br />
St. Gallen, Mainz, Worms, Speyer, Koln, Miinster, Bremen,<br />
Hildesheim, Magdeburg, Paderborn, Halberstadt, at<br />
Salzburg, Freising, Passau, Tegernsee, Benedictbeuern,<br />
Regensburg, at Milan, Parma and other places in Italy, as<br />
also in many monasteries of France, in England, as at<br />
Canterbury, and in Ireland.<br />
The curriculum of the Roman schools formed the foundation<br />
of the teaching in these institutions. Instruction was'<br />
given in orderly succession and included in one department<br />
the three elocutionary subjects of grammar, rhetoric,<br />
and dialectics, and in the other arithmetic, geometry,<br />
* W. F. C. SCIIMEIDLER: Die Hofschule und die Hof-Akademie Karls des<br />
Gfossen, Breslau 1872.<br />
t F. A. SPECHT : Geschichte des Unterrichtswesens in Deutschland von den<br />
.altesten Zeiten bis zur Mitte des 13 Jahrhunderts, Stuttgart 1885, S. 21.
MEDICINE AMONG THE GERMANS. 195<br />
astronomy, and music. These were called the Trivium and<br />
the Quadrivium. The conceptions formed of these subjects<br />
of education did not however by any means correspond<br />
with those of to-day; thus, in rhetoric, for example, not<br />
only the elementary principles of oratory were taught, but<br />
the Latin official style was practised, for the priests of that<br />
time drew up documents and attended to the affairs of<br />
government offices. The study of jurisprudence and of<br />
the laws was frequently added to this. By geometry was<br />
understood chiefly geography and physical geography, a<br />
knowledge of which HRABANUS MAURUS considered<br />
especially useful for doctors, since they might thus be able<br />
to learn the special climatic conditions of different localities<br />
and the position of particular places, and to make use of<br />
such knowledge in giving directions to their patients*<br />
Instruction in the natural sciences was combined with<br />
these subjects, the most important of the matters<br />
known at that time in the three natural kingdoms, in<br />
anthropology, and in meteorology, being taught. Later<br />
on, schools were founded wherever there was a parish.<br />
The instruction was limited to elementary subjects. When<br />
towns began to come into a flourishing state, at the end of<br />
the 12th century, town-schools arose, aiming at the same<br />
objects in education as the monastic and religious schools<br />
and even surpassing them in performance.<br />
Such was the preliminary training, which the educated<br />
doctors of that time possessed, especially when they<br />
belonged to the priestly order. That alongside of these<br />
there were many practitioners who were devoid of such<br />
admits of no doubt. The great majority of empirics had<br />
no knowledge of medical literature and learned medicine<br />
as a handicraft. Scientific work in medicine was in an<br />
extremely low state. The treasures of knowledge,<br />
inherited from ancient times were not increased, nay,<br />
were not even preserved intact. No experimental investi-<br />
* SPECHT op. cit. S. 145.—ST. FELLNER: Compendium der Naturwissenschaften<br />
an der Schule zu Fulda im 10 Jahrhundert, Berlin 1879, s - 28.
196<br />
THE MIDDLE AGES.<br />
gation, hardly any observations of nature can be credited<br />
to this period.<br />
The literature of medicine and the natural sciences consisted<br />
chiefly of extracts from and commentaries on more<br />
ancient works. Independent ideas and experiences hardly<br />
ever found a place therein. To this category the following<br />
compositions belong: the book of recipes of the Milanese<br />
Archbishop BENEDICTUS CRISPUS, the encyclopaedic work<br />
of HRABANUS MAURUS, Archbishop of Mainz and primus<br />
preceptor Germanic which K. SCHMID translates as "the<br />
first schoolman of Germany," the description of plants by<br />
WALAFRIDUS STRABO, Abbot of Reichenau, the medical .,<br />
writino-s of the Abbot BERTHARIUS, the book on the healing<br />
virtues of plants by the enigmatical MACER FLORIDUS, the<br />
Lapidarius of Bishop MARBOD of Rennes, the Bestaanus of f<br />
the Englishman PHILLIP DE THAUN, the Natural Philosophy<br />
of his fellow-countryman ALEXANDER NECKAM, the Physica<br />
of ST. HlLDEGARD, Abbess of the monastery on the ,\<br />
Rupertsberg near Bingen —" a treatise on materia medica<br />
unmistakably founded on popular traditions" as MEYER* ,<br />
appropriately designates this work—and the far-famed 4<br />
Physiologus.<br />
The intellectual life of Christian Europe at that time<br />
resembled a landscape which fatigues by its uniform flatness<br />
and desolate sterility, while only at rare intervals<br />
there breaks upon the traveller's view a bit of scenery able<br />
to engage his eye. Then in the south of our portion of the'<br />
globe arose pictures, entrancing men with their gorgeous j<br />
colouring, giving courage new life, and filling all hearts with<br />
hope. The bright constellation of Arabian culture shed its<br />
light over these lands and sent some rays to the other parts<br />
of the Christian West—rays which served to foster intel- ;<br />
lectual development and at the same time to illuminate the<br />
path of its advance.<br />
> * MEYER op. cit. iii, 518.
THE SCHOOL OF SALERNO. 197<br />
THE SCHOOL OF SALERNO.<br />
AT Salerno, in Lower Italy, where the influence of the<br />
Arabs first made itself felt, in consequence of the neigh<br />
bourhood of Sicily which had for long been subject to their<br />
rule,* there arose a medical school which as early as the<br />
10th century enjoyed> a widely spread reputation. The<br />
origin of it is unknown although already much has been<br />
written on the subject.<br />
If we disregard the barren speculations which some<br />
authors have given utterance to on the subject, the following<br />
opinions come to the front.<br />
Some think that it existed as early as the 7th century<br />
and was associated with traditions of the Greek predomi-<br />
* *•<br />
nance which both in language and customs was maintained<br />
in that locality for a longer period than in other parts of<br />
Italy ;f others, as K. SPRENGEL, PUCCINOTTI J and for<br />
some time also S. DE RENZI, derive its origin from the<br />
Benedictines who had founded monasteries in Monte-<br />
Casino, in La Cava and Salerno; while HALLER and others<br />
ascribe its foundation to the Arabs. MEYER § proposed<br />
the hypothesis that in Salerno at first there existed a Guild<br />
or Corporation of Doctors who carried on their teaching<br />
secretly until it was made public by CONSTANTINUS AFRI-<br />
CANUS, and that in this way the foundation was laid for the<br />
development of a medical teaching institution in our sense<br />
of the word.<br />
Convincing evidence in support of these views has not<br />
been adduced by anyone.<br />
The historical facts connected with medicine in Salerno<br />
reach back to the middle of the 9th century; in documents<br />
of the years 848 and 855 JOSEPH and JOSHUA are named<br />
* Cf. A. F. v. SCHACK : Poesie und Kunst der Araber in Spanien und Sizilien,<br />
Berlin 1865, ii, 1-252.<br />
t G.. MOROSI : Studii sui dialetti greci della terra d'Otranto, Napoli 1870.<br />
X Storia della medicina, Livorno 1855, ii, p. 247 el "seq.<br />
§ Op. tit. iii, 451.
198 THE MIDDLE AGES.<br />
as doctors practising there* There in the year 900 lived<br />
RAGENIFRID, a Lombard as his name indicates ; who was<br />
private physician to the Prince WAIMAR of. Salerno ; and<br />
half a century later the doctor PETRUS who stood in high<br />
favour with Prince GlSULF and was raised to the bishopric<br />
of Salerno. In this period we meet with many doctors<br />
belonging to the priestly order, but alongside of these,<br />
Jewish doctors practised the healing art in Salerno, as is<br />
authenticated by historical testimony.!<br />
The doctors of Salerno had such a reputation in the 10th<br />
century that they were brought to foreign Courts to be<br />
made body-physicians to the rulers. One of these played<br />
a remarkable part at the court of LOUIS THE SIMPLE of<br />
France. He was doctor to the wife of this monarch when<br />
a scientific quarrel arose between him and his colleague<br />
DEROLDUS who-was serving as medical attendant to the<br />
king and was afterwards Bishop of Amiens : this dispute<br />
resulted, as RICHER narrates,! in a mutual attempt to<br />
poison one another out of envy. Patients of the higher<br />
class already at that time repaired to Salerno in order to<br />
obtain the advice of doctors residing there. For this purpose<br />
the Bishop ADALBERON went thither in the year 984<br />
from Verdun, but found no cure for his sufferings.§ Again,<br />
the Abbot DESIDERIUS, who afterwards ascended the papal<br />
throne under the name of VICTOR III., hoped to regain at<br />
this place his health shattered by night watches and fasts.||<br />
The Duke GuiSCARD sent his son BOHEMUND there, that<br />
his wound received in war might be healed; for a similar<br />
reason WILLIAM THE CONQUEROR who became King of<br />
England passed some time in Salerno.<br />
* S. DE RENZI : Storia docum. della scuola med. di Salerno, Napoli 1857,<br />
p. 157 et seq.<br />
f S. DE RENZI : Collectio Salernitana iii, 325, Napoli 1852.<br />
X RICHER : Hist., lib. ii, c. 59 in PERTZ : Monum. German., T. v (script. Hi),<br />
p. 600.<br />
§ Gest. episcop. Virdun. in PERTZ : Mon. Germ., T. vi (script, iv), p. 47 &<br />
Hu&o FLAV. Chron., lib. i in PERTZ: Mon. Germ., T. x (script, viii), p. 367.<br />
|| DE RENZI: Storia doc. della scuola, p. 150.
THE SCHOOL OF SALERNO. 199<br />
The fame of its doctors increased more and more, and<br />
patients came from distant countries to be treated by them.<br />
The lyric poet HARTMANN VON DER AUE laid the scene of<br />
his famous poem " Der arme Heinrich " here but made his<br />
knight recover from his leprosy not through the skill of the<br />
doctors but by a miracle.<br />
Even as early as the nth century no certain information<br />
existed about the age and origin of the school of Salerno.<br />
ALPHANUS, well known both as poet and physician who<br />
afterwards was raised to the bishopric of Salerno, states that<br />
medicine flourished there even before GuAlMARUS II., that<br />
is in the 9th century.* The Norman historian ORDERICUS<br />
VlTALlS who lived about the year 1140 narrates that when<br />
the famous RODOLFUS known as MALA CORONA came to<br />
Salerno, even for a long time previously important medical<br />
schools had existed there, f On yet another occasion this<br />
author bears witness to the long existing reputation of the<br />
place. In the ancient Chronicle of Salerno, made use of<br />
by ANT. MAZZA and rediscovered by S. DE RENZI.J it is<br />
stated, that the medical school there was founded by four<br />
doctors, namely, the Jewish Rabbi ELINUS, the Greek<br />
PONTUS, the Saracen ADALA, and a native of Salerno, who<br />
lectured each in his native language. Amongst the first<br />
teachers are mentioned GuGLlELMUS DE BONONIA, MiCHAEL<br />
SCOTTUS, GUGLIELMUS DE RAVEGNA, ENRICUS DE PADUA,<br />
TETULUS GRiECUS, SALOMONUS EBR^US, and ABDANA<br />
SARACENUS.<br />
It is clear that these reports should not be regarded as<br />
historical facts; but some grains of truth probably lie<br />
hidden in them. There was a desire to point out that<br />
persons belonging to different nations—Jews, Arabians,<br />
* DE RENZI : Collect. Salern. i, p. 95, note.<br />
t Ord. Vit. Hist, eccles. iii in Hist. Normann. scriptor. ed. DUCHESNE, Paris,<br />
1619, p. 477 " ubi maxima medicorum scholce ab untiquo tempore habentur."<br />
X MAZZA: Urbis Salern. hist, et antiq., Nap. 1681, printed in GRSV'IOS<br />
et PURMANN: Thesaur. antiq. et hist. Italia., Lugd. Bat. 1723, t. ix, pars 4.<br />
DE RENZI : Storia docum., p. xxvi et seq. & Collect. Salern. i, p, 106 et seq.
200 THE MIDDLE AGES.<br />
Greeks, and Latins contributed to the foundation of the<br />
school of Salerno, that the instruction there was at first<br />
given in different languages and that the medical doctrines<br />
of the Salernians were developed out of the scientific<br />
knowledge acquired by the Greeks and Romans, the<br />
Hebrews and the Arabs. Some of the names quoted are<br />
marred by incorrect calligraphy; it is easy to understand .,<br />
that ELINUS arose from ELIAS, and PONTUS must be<br />
improved into GARIO-PONTUS and ADALA into ABDALLAH.<br />
It is clear then from these considerations that we do not<br />
know, when and how the School of Salerno arose. The<br />
beginnings of it were either so unpretentious that they<br />
were unnoticed, or they reach so far back into antiquity f<br />
as to be beyond the historian's grasp. The political<br />
fortunes of this town, constantly changing as they were,<br />
and bringing its inhabitants into touch with the-Romans,<br />
the Greeks, the Lombards, the Arabs, and the Normans,<br />
were bound to leave deep traces in the development of<br />
their civilization and to exert a powerful influence on all<br />
1 departments of intellectual life.<br />
The custom usual in ancient times, of men of learning<br />
privately taking in pupils and instructing them in the<br />
sciences, obtained also in Italy in the middle ages* If the<br />
doctors followed this example there can never have been<br />
any dearth of students to live with them in Salerno, the<br />
mild climate and the noble situation of which, on the shores<br />
of a bay not far from shady woods and healing mineral •<br />
springs, attracted patients from far and wide.<br />
It is not known when the doctors who learned the \<br />
healing art in Salerno joined together into a common<br />
activity and gave themselves an organization. At first, •<br />
as it appears, any doctor might act as a teacher of<br />
medicine without distinction of nationality or religious<br />
* W. GIESEBRECHT: De litterarum studiis apud Italos primis medii aevi '<br />
sseculis, Berol. 1845, p. 15.—S. DE RENZI (Storia docum., p. 161) cites a great ,<br />
' number of doctors who were practising in Italy during the time of the<br />
Lombards ; one of these was designated as Magister Scolce.
THE SCHOOL OF SALERNO. 201<br />
faith. At a later period many priests were found amongst<br />
the teachers of medicine there, of whom some attained<br />
to high dignity in the Church. But these never gained<br />
the exclusive right to teach as was the case in most<br />
of the other high schools of the middle ages. The institution<br />
throughout maintained that lay character which it had<br />
had from the beginning.<br />
In Salerno, women were admitted to the profession of<br />
teaching and some of them became prominent also as<br />
medical authors. Among the female doctors the best known<br />
was TROTULA the authoress of a frequently quoted work<br />
on the diseases of women and the treatment of them before<br />
during and after labours. In her writings she discusses all<br />
branches of pathology even the diseases of the male sexual<br />
organs—a truly painful subject for female sensibility. Her<br />
colleague ABELLA wrote de natura seminis humani.<br />
COSTANZA CALENDA the daughter of the Prior (Principal)<br />
of the medical school, distinguished alike for her beauty<br />
and her talents, and MERCURIADE and REBECCA GUARNA<br />
belong to a later period.<br />
In the early times of the School of Salerno the.teachers<br />
were probably dependent for their pay upon the fees which<br />
students gave them for instruction. Afterwards they received<br />
regular stipends, differing in amount and in some<br />
cases producing a yearly income of 12 ounces of gold ; in<br />
course of time the stipends were naturally increased.<br />
Teachers enjoyed freedom from taxes also and sometimes<br />
the usufruct of houses and ground property as well.*<br />
Many teachers were engaged in giving medical instruction<br />
at the same time, as is evident from the list of them given<br />
by S. DE RENZI.t To their lectures representatives of all<br />
nations had access; neither sex nor religion raised any<br />
impediment. Jewish students were very numerously<br />
* DE RENZI : Collect. Salern. i, 366 et seq.—Storia docum. op. cit. Appendix<br />
Docum. No. 296 et seq.<br />
t DE RENZI : Collect. Salernit. 1,517. iii, 326 el seq. It contains 340 names<br />
in a period of about 1000 years.
202 THE MIDDLE AGES.<br />
represented in the i ith century, as MAZZA informs us.<br />
When on the other hand the Jewish traveller. BENJAMIN<br />
VON TUDELA narrates that on visiting Salerno in 1160 he<br />
met not one single doctor among the numerous members of<br />
his faith living there, his assertion .contradicts all other<br />
reports, in which we either find it expressly s,tated that<br />
certain Salernian doctors did belong to the religion of<br />
MOSES, or else we are at liberty to assume this fact from<br />
the names.*<br />
Students came to Salerno from far and wide, even from<br />
Germany and France, to devote themselves to medicine. A<br />
student from Koln who had attended medical lectures in<br />
Salerno in the 12th century, but, owing to illness was<br />
obliged to return home, gives vent in a poem to complaints<br />
about the treacherous people of Salerno who were hateful to<br />
him.| Another student, ^EGIDIUS (GILLES) VON CORBEIL,<br />
who afterwards lived in Paris as canon and private<br />
physician to PHILIPPE AUGUSTE, King of France, proclaimed<br />
there with tongue and pen the fame of the<br />
medical school of Salerno.<br />
Of the kind of teaching in the several subjects the<br />
following is known : Anatomy was taught on the pig.<br />
In the Demonstratio Anatomica, proceeding from an<br />
anonymous author and which obviously formed a collegelecture,<br />
rules are given how to proceed. According to this<br />
the animal was killed by severing the vessels of the neck,<br />
then was hung up by the hind legs and after the blood had<br />
escaped the carcass was made use of for teaching. This,<br />
as it appears, was limited to opening the great cavities of<br />
the body and demonstrating the organs lying therein.<br />
Some remarks were added on the form and the. presumed<br />
* Cf. M. STEINSCHNEIDER in VIRCHOW'S Archiv, Bd. 38 (1867), S. 74 et seq.<br />
f Laudibus eternum nullus negat esse Salemum ;<br />
I Hue pro morbis lotus circiimftuit orbis.<br />
Nee debet sperni, fateor, doctrina Salerni<br />
Quamvis exosa mihi sit ge7is ilia dolosa.<br />
JAC. GRIMM: Gedichte des Mittelalters in Kleine Schriften, Berlin 1866,<br />
S. 64.
THE SCHOOL OF SALERNO. 203<br />
function of such organs in man ; reliance being placed<br />
upon the writings of GALEN, RUFUS, and THEOPHILUS<br />
PROTOSPATHARIUS, although the scientific elevation of<br />
these men was beyond the lecturer's reach. So too<br />
COPHO'S Anatomy of the Pig consists essentially only, of<br />
an enumeration of the most important parts of the body.<br />
And yet we find therein certain indications of more<br />
searching inquiry and some observations in pathological<br />
anatomy. Thus it is said, for instance, that it is possible to<br />
inflate the lungs by introducing a pipe into the trachea*<br />
Again, mention is made of effusions into the pericardium<br />
and pleura.<br />
More attention was devoted to practical medicine. As<br />
early as the year 820 a public hospital was founded in<br />
Salerno by the high priest ADELMUS, which was brought<br />
into connection with the Benedictine monastery. At a<br />
later period several other infirmaries and charitable institu<br />
tions arose, which were endowed with valuable property<br />
and conducted by members of charitable orders.f It is<br />
uncertain whether clinical instruction was imparted at<br />
these places or not.<br />
ARCHIMATTH^US gives in a treatise J complete advice<br />
as to how a doctor should comport himself on visiting a<br />
patient. He should place himself under the protection of<br />
God, he says, and implore the assistance of the angel who<br />
guided TOBIAS. On the way to see the sick person he<br />
should question the messenger who has summoned him<br />
upon the circumstances and the conditions of the illness of<br />
the patient; then if not able to make any positive diagnosis<br />
after examining the pulse and the urine, he will at least<br />
excite the patient's astonishment by his accurate knowledge<br />
of the symptoms of the disease and thus win his confidence.<br />
The author also considers it a matter of great importance<br />
* DE RENZI : Collect. Salern. ii, 389.<br />
t DE RENZI : Storia docum. della scuola med. di Salerno, p. 563, Doc. 329.<br />
X Anomymi Salernitani de adventu medici ad segrotum ed. A. G. E. Tn.<br />
HENSCHEL, Vratist 1850.—DE RENZI : Collect. Salernit. ii, 74-81, v, 333-349.
204 THE MIDDLE AGES.<br />
that the patient should confess to the priest before the<br />
doctor comes to him ; for " if mention is afterwards made<br />
of this matter the patient believes that there is no hope for<br />
him." " When the doctor enters the dwelling of his patient<br />
he should appear neither haughty nor covetous, but must'<br />
greet him with a modest demeanour, and then seat himself<br />
near the sick man, accept the drink which is offered him<br />
and praise in a few words the beauty of the neighbourhood,<br />
the situation of the house, and the generosity of the family,<br />
if it should seem to him suitable so to do." Hereupon<br />
the way of examining the pulse and the urine is described.<br />
"When the doctor quits the patient, he should promise<br />
him that he will get quite well again, but should inform his<br />
friends that he is very ill; in this way if a cure is effected j<br />
the fame of the doctor will be so much the greater, but if<br />
the patient dies people will say that the doctor had fore<br />
seen the fatal event."<br />
The author then discusses the treatment of the patient<br />
and especially his diet, the employment of baths and bleeding<br />
and explains how the doctor should act if he is asked :<br />
to dinner by the patient " as is usual," and when he demands >]<br />
the fee for the services rendered.<br />
This treatise is a strange mixture of valuable medical<br />
experience, deep piety, and sly calculation. It is, as is<br />
clear from the way in which it is written, obviously<br />
intended for beginners in the healing art and throws a<br />
remarkable light on the social position of the medical<br />
practitioner of that period.<br />
The medical principles of the Salernian school rested ,<br />
upon the theories of ancient times. The doctrine of juices<br />
of the Hippokratic writers, the "Communities" of the<br />
Methodists, and GALEN'S teaching formed their foundation;<br />
while the progress made in materia medica, for which<br />
thanks are due to the Arabs, maintained its place. The<br />
descriptions of diseases are true to nature and are illustrated<br />
by many original observations. The accounts given<br />
of intermittent fever, of disturbance of the mental faculties,-i<br />
"
THE SCHOOL OF SALERNO. 205<br />
of pneumonia, phthisis, psoriasis, lupus (malum mortuum)<br />
ulcers on the sexual organs (among which it is easy to<br />
recognize the chancre) especially deserve mention.<br />
The Salernian doctors were well acquainted with the evil<br />
significance of many symptoms in regard to prognosis;<br />
thus they declared that where diarrhoea supervened in<br />
phthisical cases the patients soon died. In treatment they<br />
laid great value upon a reasonably regulated manner of<br />
living and a suitable diet. If, for example, a commencing<br />
pulmonary phthisis was suspected, they ordered good and<br />
strengthening nourishment for the patient. People subject<br />
to pneumonia were directed to live in an atmosphere of<br />
even temperature; in winter, for example, in a heated<br />
room.*<br />
For cooling the air of the sick room AFFLACIUS recom<br />
mended that an arrangement should be made so that drops<br />
of water should continually fall to the ground and there<br />
evaporate.f Iron was ordered for enlargement of the<br />
spleen.<br />
Surgery had a position inferior to that occupied by it in<br />
the time of the Greeks and Romans. This was due partly<br />
to the neglect of anatomy, partly to the fact that surgery<br />
was practised less by educated doctors than by empirics,<br />
especially since many members of the medical profession<br />
belonged to the priesthood.<br />
In earlier times surgical knowledge was chiefly confined<br />
to the treatment of wounds, the cure of fractured bones,<br />
and the reduction of dislocations.<br />
It was not till the end of the 12th century that a doctor<br />
undertook to represent in writing the principles of surgery<br />
as they had been preserved by tradition. This work, the<br />
author of which was RUGGIERO, but which is generally<br />
named after ROLANDO, a later editor, shows that the<br />
surgeons of the Salernian school sought for instruction not<br />
* DE RENZI : Collect. Salern ii, 215 et seq.<br />
f DE RENZI : Collect. Salernit. ii, 741 (fiat etiam urtificialiter pluvialis aqua<br />
circa cegrum).
206 THE MIDDLE AGES.<br />
so much in the writings of the ancients as in their own<br />
experience. They were in this way saved indeed from<br />
that uncritical acceptance of the observations of strangers<br />
which is a frequent feature of Arabian literature, but at the<br />
same time they were deprived to a certain degree of those<br />
important suggestions and corrections which a knowledge<br />
of history affords in the study of any branch of knowledge.<br />
It is certainly noteworthy that among the means recommended<br />
for the arrest of haemorrhage, in addition to styptics<br />
mention is made of suturing and applying ligatures* The<br />
internal use of sea-sponge was recommended for the<br />
removal of bronchocele or the operation of excision was<br />
performed with the use of hair-ligatures; to avoid relapses, ,<br />
the whole capsule was extirpated. Massage of the bron- .<br />
chocele was also employed.f<br />
Among other operations are mentioned trephining, the<br />
removal of nasal polypi, resection of the inferior maxilla,J<br />
the operation for hernia, which was performed according to<br />
the directions of PAULUS JEGINETA, and lithotomy according |<br />
to the precepts of CELSUS. The operation for cataract was<br />
performed by puncture of the sclerotic. Allusion is also<br />
made to ulcerative loss of substance in the palate and on<br />
the penis which refers to cancer and syphilis, and<br />
malignant tumours of the rectum and uterus are mentioned.<br />
The decline of operative surgery and the frequent""<br />
employment of the cautery demonstrate the influence of<br />
Arabian medicine.<br />
It fared even worse with midwifery than with surgery «<br />
although this branch was practised by scientifically trained<br />
women. TROTULA alludes to turning in but one single<br />
* Chirurg. ROGERI in DE RENZI : Collect. Salern. ii, 436.<br />
T A. WOLFLER : Die chirurg. Behandlung des Kropfes, Berlin 1887, S. 10 et<br />
seq.<br />
X DE RENZI : Collect. Salernit. ii, 445, 513, 628, 650 (lib. ii, of the Commen-'<br />
taries of the four Masters). The mysterious four Masters remind one of the<br />
four Doctors of Law at Bologna, of whom SAVIGNY speaks' (Geschichte des<br />
romischen Rechts, Bd. iv, S. 68).
THE SCHOOL OF SALERNO. 207<br />
passage of her book* In a general way, midwifery consisted<br />
chiefly in the employment of internal remedies and<br />
psychical aids.<br />
The School of Salerno was the first to establish a fixed<br />
and exclusive organization by the introduction of examinations<br />
in obedience to the order of the civic authorities.<br />
King ROGER (RUGGIERO) as early as the year 1140<br />
promulgated the law: "Whoever from this time forth<br />
desires to practise medicine must present himself before<br />
our officials and judges, and be subject to their decision.<br />
Anyone audacious enough to neglect this shall be punished<br />
by imprisonment and confiscation of goods. This decree<br />
has for its object the protection of the subjects of our<br />
kingdom from the dangers arising from the ignorance of<br />
practitioners."f<br />
The Emperor FREDERICK II., of the Hohenstaufen<br />
family, confirmed this law and in the year 1240 gave to<br />
the medical school of Salerno complete rules in regard to<br />
the subjects studied there. He says in his orders : " Since<br />
it is possible for a man to understand medical science, only<br />
if he has previously learnt something of logic, we ordain<br />
that no one shall be permitted to study medicine, until<br />
he has given his attention to logic for three years. After<br />
these three years he may, if he wishes, proceed to the<br />
study of medicine. In this study he must spend five years<br />
during which period he must also acquire a knowledge of<br />
surgery, for this forms a part of medicine. After this, but<br />
not before, permission may be given him to practise,<br />
provided that he passes the examination prescribed by<br />
the authorities and at the same time produces a certificate<br />
showing that he has studied for the period required by the<br />
* DE RENZI : Collect. Salern. i, 149 et seq.—v. SIEBOLD op. cit. i, 317.<br />
t Quisquis admodo mederi voluerit, officialibus nostris et judicibus se presentet,<br />
eorum discutiendus judicio ; quod si sua temeritate presumpserit, carceri con-<br />
slrivgatur bonis suis omnibus publicutis. Hoc enim prospectum est, ne in regno<br />
nostro subjecti periclitenlur ex imperitia medicorum. Hist, diplom. Frid. II<br />
imperat. ed. HUILLARD-BREHOLLES, Paris 1854, T. iv, pars 1, p. 149, tit. 44.
208 THE MIDDLE AGES.<br />
law."* "The teachers must during this period of five years<br />
expound in their lectures the genuine writings of HIPPO<br />
KRATES and GALEN on the theory and practice of<br />
medicine." " But even when the prescribed five years<br />
of medical study are passed, the doctor should not forthwith<br />
practise on his own account but for a full year more<br />
he should habitually consult an older experienced practi<br />
tioner in the exercise of his profession."<br />
Concerning the motives which brought about the introduction<br />
of medical examinations it is said : " We further<br />
the cause of the individual, while caring for the public |<br />
good. Accordingly, in view of the grievous loss and '<br />
irremediable injury which may arise from the ignorance |<br />
of doctors, we decree that in future no one is to assume<br />
the title of doctor or to proceed to practise or to take<br />
medical charge, unless he has previously been found<br />
competent in the judgment of teachers at a public meeting 4<br />
in Salerno, has moreover by the testimony in writing of his !<br />
teachers and of our officials approved himself before us or<br />
our representatives in respect of his worthiness and<br />
scientific maturity, and in pursuance of this course has<br />
received the state-license to practise. Whoever transgresses<br />
this law and ventures to practise without a licence,<br />
is subject to punishment by confiscation, of property and i<br />
imprisonment for a year."f |<br />
In regard to the education of surgeons it was decreed, |<br />
"that no surgeon shall be allowed to practise, until he<br />
has submitted certificates in writing of the teachers of the<br />
Faculty of Medicine, that he has spent at least one year jj<br />
in the study of that part of medical, science which gives<br />
skill in the practise of surgery, that in the colleges he has j<br />
diligently and especially studied the anatomy of the human<br />
body, and is also thoroughly experienced in the way in ,<br />
which operations are successfully performed and healing is*<br />
brought about afterwards."! ,*<br />
* Hist, diplom. Frid. II. op. cit. p. 235, lib. 3, tit. 46.<br />
f op. cit. p. .50, tit. 45. t °P- cit - P- 2 36- 'I
THE SCHOOL OF SALERNO. 209<br />
If the doctor had passed the examinations and received<br />
the state-license to practise, a diploma was made out for<br />
him which ran thus: "Notum fadmits fidelitati vestrse,<br />
quod fide lis noster N.N. ad curiam nostram accedens,<br />
examinatus, inventus fidelis et de genere jidelium ortus et<br />
sujfficiens ad artem medicinae exercendam, extitit pe<br />
nostram curiam approbatus. Propter quod de ipsius<br />
prudentia et legalitate confisi, recepto ab eo in curia<br />
nostra fidelitatis sacramento et de arte ipsa fideliter<br />
exercenda juxta consuetudinem juramento, dedimus ei<br />
licentiam exercendi artem medicinse in partibus ipsis : u<br />
admodo artem ipsam ad honorem et fidelitatem nostram et<br />
salutem eorum qui indigent, fideliter ibi debeat exercere.<br />
Quocirca fidelitati vestrse praecipiendo mandamus,<br />
quatenus nullussit, qui praedictum N.N. fidelem nostrum<br />
super arte ipsa medicinae in terris ipsis, ut dictum est,<br />
exercenda impediat de cetero vel perturbet."*<br />
In the oath which the young doctor had to take on this<br />
occasion, he was bound "to give advice to the poor, gratis,<br />
and to inform the magistrates of apothecaries who made up<br />
medicines not corresponding to prescriptions." It was.<br />
moreover, laid down by law how much he might demand<br />
for a visit to a patient. According to this the' highest payment<br />
for a visit in the daytime within the town amounted<br />
.* to half a gold tarenus ;f if the visit was outside the district<br />
the fee was three or at most four tareni exclusive of<br />
travelling expenses.<br />
The doctor was forbidden to enter into partnership with<br />
apothecaries, or himself to keep an apothecary's shop.<br />
The apothecaries were directed to prepare the medicine<br />
according to the prescription of the doctors, and to<br />
furnish it at a regular price. Before they were permitted<br />
* to practise their business they had to bind themselves by<br />
oath to provide drugs according to prescribed form, and to<br />
* PETE^DE VINEIS: Epist, lib. vi, c. 24, Basil 1740.—Hist. dipl. Frid. II, op.<br />
cit. p. 150, Note 2.<br />
t A gold tarenus was a gold coin weighing 20 grains.<br />
P
2IO THE MIDDLE AGES.<br />
be guilty of no fraud in this matter. At the same time it<br />
was specified what advance of price they might allow themselves<br />
to make on medicines which perhaps had to be kept<br />
in stock for a long time before being used, and a prospect<br />
was given of a law being made regulating the number<br />
of apothecaries' shops in the various towns of the country*<br />
Moreover inspectors were nominated who had to. supervise<br />
the preparation of medicines, and to attest the satisfactory<br />
character of this by their certificates; in Salerno itself the<br />
teachers of medicine exercised supervision in this matter, t<br />
"At the same time we ordain," it is said in the same passage,<br />
«that no one shall give lectures on medicine and surgery<br />
elsewhere than in Salerno, or assume the title of teacher,<br />
unless he has been carefully examined in the presence of<br />
our officials and of the teachers of these arts." The punish- ,<br />
ment of death was imposed on the officials who violated<br />
their duties in giving effect to these laws.<br />
The rules of -the Emperor FREDERICK II. served as a<br />
pattern for succeeding arrangements in medical studies^<br />
They formed the first attempts at a state organization for<br />
the same. Unfortunately in the following centuries the<br />
influence of the secular power was in this as in other<br />
domains thrust into the background by the increasing<br />
authority of the clergy. This fact gave a distinct colouring<br />
to civilization, and governed the development of univer<br />
sities up to the most recent times.<br />
The medical school of Salerno flourished in the i ith and<br />
12th centuries. In this period it displayed an important<br />
literary activity to which witness is borne by the works<br />
of GARIOPONTUS, PETRONCELLUS, ALPHANUS, the two<br />
COPHOS the Platearii, of CONSTANTINUS AFRICANUS, who<br />
by his translations contributed greatly to make Salernian<br />
doctors acquainted with Arabian medicine; by the Dispensatory<br />
of BARTHOLOM^US, which soon after was translated<br />
into German,% the writings of AFFLACIUS, ARCHI-<br />
* Hist, diplom. Frid. II, op. cit. p. 236. t op. cit. p. 151, tit. 47.<br />
X Jos. HAUPT in den Sitzungsber. d. K. Akad. d. Wiss., Philos-histor. Kl.,<br />
Wien 1872, Bd. 71, S. 451 ft seq.
THE SCHOOL OF SALERNO. 211<br />
MATTHOUS, MUSANDINUS, and ^GIDIUS VON CORBEIL, the<br />
collection of recipes of NICOLAUS PROPOSITUS, the Uro-<br />
scopie of MAURUS, but above all the famous Rules of Health<br />
of the school of Salerno, which were translated into all<br />
languages, and lived through more than 200 editions.<br />
In the year 1252 King CONRAD decided to enjarge the<br />
school of Salerno into a university in which law and the<br />
artes might be fostered. But his plan came only partially<br />
into effect. King MANFRED in the year 1258 restored<br />
the university of Naples, which had shortly before been<br />
abolished, and in Salerno only the medical school remained.<br />
Certainly the science of law was taught there along with<br />
that of medicine, but no academical honours were granted<br />
in that branch of learning.*<br />
When medical schools arose in Naples and in other<br />
towns of Italy and France the number of students in<br />
Salerno diminished. It came to this, that the quality of<br />
the teaching given there was gradually surpassed in excel<br />
lence by that of the other schools, and the scientific activity<br />
of Salerno declined. ^EGIDIUS VON CORBEIL complained of<br />
this, saying that there beardless, immature youths received<br />
the honours of doctors and dared to act as teachers of<br />
medicine.<br />
" Far from the height of thy fame art thou sunk to the depths, O Salerno!<br />
Once adorned with such fame, thou art sunk to the very foundation,<br />
Dost thou suffer that now on the site of thy past noble structure<br />
Seedlings should sprout prematurely : of medicine sons, but unworthy ?<br />
Schoolmaster's cane so persuasive and training severe of an elder<br />
Better would suit their case than, young as they are, to be mounting<br />
Steps of professorial chairs in pompous prpcession."f<br />
In the 14th century PETRARCH said : " The story goes<br />
that medicine took its rise in Salerno, but all alike falls<br />
a prey to withering age." Subsequently the school of<br />
Salerno declined more and more, and all attempts to<br />
* J- A. DE N.GR.S in J. C. G. ACKEUMANN'S Regimen sanitatis Salerni,<br />
Stendal 1790, p. 83.<br />
t -ffioiD.us v. CORBEIL : de medicam. compos., v, 569 et seq., nach H.<br />
HAESER in Nord u. Slid 1877, *», 7, S. 145.
212<br />
THE MIDDLE AGES.<br />
instil new life into it by privileges and endowments were<br />
in vain. A decree of the French Government, which for<br />
some time guided the destinies of the country, on the 29th<br />
of November, 1811, put an end to the oldest medical<br />
school in Europe.<br />
THE MEDICAL SCHOOL OF MONTPELLIER.<br />
THE origin of the medical school of Montpellier is also<br />
veiled in the obscurity of tradition. It is unknown at what |<br />
period the doctors there began to instruct students in the<br />
science of medicine. Among the doctors who practised<br />
medicine in the 10th and nth centuries at Montpellier<br />
there were probably many Jews and Arabs ; the fact that a ^<br />
large proportion of the population of this town consisted ,:<br />
of members of these nations, and the vicinity of Spain, J<br />
where Jewish doctors existed in great numbers and in<br />
high respect under the dominion of the Arabs, justify this<br />
assumption.<br />
The Jews had a large. share in the triumphs which<br />
Arabian medicine celebrated in Spain. The names of<br />
MOSES MAIMONIDES, CHASDAI SCHAPROUT, JUDAH<br />
HALEVI, NACHMANIDES and others speak as to their<br />
work in the different paths of intellectual life. The<br />
Rabbis and learned men among the Jews interested them- •}<br />
selves in medicine, and the medical schools of the Jews at<br />
Toledo, Granada, and Cordova stood in high esteem'. The •<br />
Arabian princes of the Iberian peninsula as well as their<br />
Christian successors chose Jews, by preference, for their<br />
private doctors* But the Jewish doctors earned the<br />
greatest merit. in acting as mediators between ArabianJ<br />
medical science and Western Christendom. Partly by<br />
translations of Arabic works which they prepared, partly<br />
by word of mouth, they made the inhabitants of the adjoining<br />
Christian countries acquainted with the scientific<br />
acquisitions of that nearly related Semitic race.<br />
* J. M U N Z : Uber die jildischen Aizte im Mittelalter, Berlin 1877, S. 17<br />
tt seq.
THE MEDICAL SCHOOL OF MONTPELLIER. 21<br />
The Arab and Jewish schools of Spain preserved, for<br />
a long time even after the conquest of the country by the<br />
Christians, the reputation of learning. So late as in the<br />
nth and 12th centuries philosophers thirsting for knowledge<br />
made pilgrimages to Spain, especially to Toledo,<br />
there to be initiated into the wisdom of the Arabs. Such<br />
were GERBERT, known later as Pope SYLVESTER II., HER-<br />
MANNUS CONTRACTUS, DAVID MORLEY, PIETRO VON<br />
ABANO, ARNALD VON VILLANOVA and others.<br />
An important influence upon the origin and development<br />
of the school of Montpellier must, without doubt,<br />
be ascribed to these circumstances. There has even been<br />
an attempt to show that a Jewish doctor from Narbonne<br />
was the first to teach medicine there* When BENJAMIN<br />
of Tudela visited Montpellier in the year 1160 he found as<br />
he says many Jews amongst the inhabitants. But even<br />
then the reaction against the Jewish power was making<br />
itself felt. Count WILLIAM of Montpellier in 1121 made an<br />
order in his will that no Saracen or Jew should be admitted<br />
to the dignity of high bailiff (bailli), and in 1146 and<br />
1172 this interdiction was renewed in respect of the Jews,<br />
it probably appearing no longer necessary with regard to<br />
the Saracens. In any case the fact indicates that before<br />
that time the Arabs and Jews in Montpellier possessed<br />
rights like those of their Christian fellow citizens and<br />
ventured to lay claim to the most important posts.<br />
Up to the time of the conquest of Spain by the Christiansa<br />
spirit of toleration reigned there, furthering the best<br />
interests of humanity and of science : the foundation of<br />
the Montpellier medical school took place during this<br />
period, as history testifies. When Bishop ADALBERT of<br />
Mainz came thither in the year 1137 the school already<br />
existed and even already possessed buildings of its own as<br />
we learn from the words of Bishop ANSELM of Havelberg<br />
*' RAVEL in the Re'vue the'rapeut. du midi, Montpellier 1855.—CARMOLY :<br />
Histoire des mgdecins juifs, Bruxelles 1844, p. 77.—A. GERMAIN: Histoire de<br />
la commune de Montpellier, Montpellier 1851, T. i, p. Ixix.
214<br />
THE MIDDLE AGES.<br />
who lived at that time* Bishop ADALBERT obtained<br />
instruction, from the doctors who taught medicine in<br />
Montpellier, upon the causes of natural phenomena and<br />
of diseases, certainly " not with the object of making<br />
money from the knowledge of these matters but only in<br />
order to learn to understand the deeply hidden meaning of<br />
things " as his biographer adds.<br />
In a letter of ST. BERNARD written in 1153 it is<br />
narrated that the Archbishop of Lyons, being ill, repaired<br />
to Montpellier, to be under the treatment of the doctors<br />
there, and on this occasion not only spent what he had<br />
with him but ran into debt-t JEAN DE SALISBURY, who<br />
also belonged to that period, stated that those who wished<br />
to devote themselves to medicine acquired the knowledge<br />
necessary for this at Salerno or Montpellier. So too^<br />
yEGIDIUS VON CORBEIL and HARTMANN VON DER AUE<br />
have borne witness to. the ancient renown of the school of<br />
Montpellier. ;<br />
The Monk C^ESARIUS VON HEISTERBACH called Montpellier<br />
the " Fountain of Medical Wisdom " and remarked<br />
with regret that the doctors of that school would not believe<br />
in miracle-healing even speaking of it in an ironical way.<br />
In the year 1180 WILLIAM IV., Count of Montpellier<br />
promulgated a decree that anyone " whoever or of what,<br />
ever origin he might be, should have the right of giving<br />
medical instruction there without being called to account<br />
by anyone." J Although as a result of this the medical<br />
school arose into great prominence, still unlimited freedom<br />
* Anselmi episcopi Havelbergensis vita Adelberti Moguntini in Bibl. rer.<br />
german. ed PH. JAFFE, Berol. 1866, iii, 592.—A. DUBOUCHET: Un document<br />
curieux sur l'ecole de medecine de Montpellier in the Gazette hebd. des sciences<br />
m&l. de Montpellier, 10 Juli 1886.<br />
f Expendit et quod habebat et quod non habebat in BERNARD. Epist. 307,<br />
according to ASTRUC: Memoires pour servir k l'histoire de la faculte de<br />
me'deeinede Montpellier, Paris 1767, p. 7.<br />
X Mando, volo, laudo aique concedo in perpetiium, quod omues homines quicunque<br />
sint vet undecunque sint sine aliqua interpellations regant scolas de Jisica<br />
in Montepessulano. ASTRUC op. cit. p. 34.
THE MEDICAL SCHOOL OF MONTPELLIER. 215<br />
in teaching could not be supported, since by its means<br />
many undesirable persons were attracted. Teachers and<br />
students alike desired that to meet this difficulty certain<br />
rules should be laid down. It is indicative of the power<br />
which the clergy had in the meanwhile acquired that the<br />
papal legate was applied to, who in conjunction with the<br />
bishops of Maguelone and Avignon and others made the<br />
wished for regulations in the year 1220.<br />
Cardinal CONRAD, who laid the foundation for the larger<br />
development of the school of Montpellier, was a German,<br />
and descended from the Swabian family of the Counts of<br />
Urach. In the statutes devised by him he first of all<br />
referred to the fact that medical science had for a long<br />
time flourished and had acquired renown in Montpellier,<br />
and then he laid it down as a law that from that time forth<br />
no one should act as a teacher of this science who had<br />
not been examined in it and received the license at the<br />
hands of the Bishop of Maguelone with the assistance and<br />
by the interrogatories of his teachers; that no one should<br />
be regarded as a student who did not in his studies follow<br />
the direction of his teacher; that the Bishop of Maguelone<br />
in association with three respectable senior teachers should<br />
elect a Chancellor to preserve discipline and adjust<br />
differences between masters and students ; that the Bishop<br />
should support the Chancellor with his authority ; and that<br />
teachers and students should assist one another and take<br />
care that no harm, should come to the school* Many<br />
students, as we learn from section 14 of these statutes,f<br />
interrupted their studies in order to engage in practice,<br />
returning later to Montpellier to continue their studies.<br />
The students paid their teachers fees for the instruction<br />
they received. It is true no mention at all is made in the<br />
* ASTRUC op. cit. p. 37.<br />
t Quando scholaris redit a locis, in quibus practicaverit, libere sibi addicat,<br />
quemcunque voluent, magistrum, dum tamen priori sua magistro non teneatur<br />
ratiove salari vet allerius alicujus rei. ASTRUC op. cit. p. 39.—A. GERMAIN<br />
op. cit. T. iii, 424.<br />
.»
6 THE MIDDLE AGES.<br />
laws of CONRAD about excluding persons professing other<br />
than the Christian faith from the school; and yet such were<br />
doubtless to a certain extent repelled by the powerful<br />
influence which the bishop was allowed to possess there.<br />
Nevertheless there were still in the 13th and 14th centuries<br />
many Jewish students and doctors at this place, among<br />
them JACOB BEN MACHIR, better known under the name<br />
of PROFATIUS, who was probably even engaged as a<br />
teacher* In the year 1230 it was decided that no one<br />
should practise medicine until he had been examined and<br />
found competent by two masters in medical science,<br />
chosen as examiners by the bishop. The successful result<br />
of his examination was notified to him by a certificate<br />
bearing the signatures of the bishop and of the examiners.<br />
Whoever practised medicine without submitting to this<br />
examination was threatened with the punishment of excommunication.<br />
The surgeons however were not bound<br />
to submit themselves *to examination. The laws against<br />
quacks, it would seem, were not stringently observed ; yet "<br />
from time to time they must necessarily have been recalled<br />
to men's minds.<br />
The statutes and lists of lectures, which were issued in<br />
the year 1240, were framed upon the regulations of the<br />
Emperor FREDERICK II. published for Salerno.f The<br />
medical school was thus completely organized.<br />
Instruction was also given in law at Montpellier from<br />
' the end of the 13th century ; and in like manner there<br />
were as early as 1242 teachers of philosophy. Pope<br />
NICOLAS IV. in 1289 decided to erect there a Studium<br />
generate, i.e., a University. But he did not succeed in<br />
merging the medical school with the other faculties into<br />
one large establishment for teaching. It preserved its<br />
rights jealously and maintained its independence. And<br />
thus it came about that in Montpellier henceforth there<br />
* CARMOLY op. cit. S. qo. He mentions other Jewish teachers of medicine,!<br />
A «<br />
e.g., SAMUEL BEN TIBBON.<br />
•"- GEHMAIN op. cit. T. iii, p. 424.
THE MEDICAL SCHOOL OF MONTPELLIER. 21 7<br />
were, properly speaking, two distinct universities, one<br />
comprising the medical, the other the remaining faculties.<br />
Each formed a distinct institution, had its own Chancellor,<br />
and bore the name of a University. And each was entitled<br />
to such a name; for in the Middle Ages by the Studium<br />
generate was meant, not the union of all faculties in one<br />
place, but an institution for the higher teaching which was<br />
generally accessible, and gave certificates which were<br />
universally recognized* The expression Studium generale<br />
was in the 14th century replaced by that of University,<br />
with which was associated the idea of a corporation, of an<br />
organized society. And even at that time the terms<br />
" Gymnasium " and " Alma mater " were made use of to<br />
apply to the High Schools. While the bishop filled the<br />
dignity of Chancellor henceforth in the University at<br />
Montpellier, which represented the legal, philosophic and<br />
-theologic faculties, and which was first founded in 1421, the<br />
same office at the School of Medicine was conferred on one<br />
of its teachers. All attempts which were afterwards made<br />
to subject the medical school to clerical influence were<br />
fruitless. The medical faculty maintained its autonomy<br />
even under the centralizing power of the French kings, and<br />
Louis XIV. felt himself obliged to withdraw a decree<br />
ordering the union of the medical with the other faculties.f<br />
As the election of the chancellor by the bishop and three<br />
teachers appointed by him had many disadvantages<br />
attached to it, Pope CLEMENT V. in 1308 ordered that the<br />
candidate must secure from that time forth, in addition to<br />
the consent of the bishop, the votes of two-thirds of all the<br />
masters of the medical high school.<br />
It was at the same time laid down what books should<br />
* H. DENIFLE: Die Entstehung der Universitaten des Mittelalters bis 1400,<br />
Berlin 1885, S. 15 el seq.—Cf. on the other hand G. KAUFMANN : Geschichte der<br />
deutschen Universitaten, Stuttgart 1888, i, 98 et seq.<br />
t A. DUBOUCHET : Documents pour servir a l'histoire de l'universite de<br />
medecine de Montpellier in the Gaz. hebd. des sciences me'd. de Montpellier<br />
1887, No - 4-
2l8 THE MIDDLE AGES.<br />
form the foundation for teaching, and the order of study<br />
and examination in them was explained. Every student<br />
had to attend medical lectures for at least five years and to<br />
practise medicine for eight months or two summers* before<br />
being allowed to graduate. In 1350 it was laid down by<br />
law that no one should practise medicine before attaining<br />
the degree of Magister.f It is clear from the list sent to<br />
the Pope in 1362 that all students of medicine at Montpellier<br />
were graduates in artibus,% and consequently<br />
possessed a preliminary education in general knowledge.<br />
The statutes of this medical school for the year 1340 §<br />
afford us a glimpse into its condition. They deal with<br />
the high office of the Chancellor, who administered the<br />
government of the school; with the office of Dean,—<br />
which was conferred on him who had longest acted as<br />
teacher there, and was really an honorary post, the chief<br />
duty of its incumbent being to represent the Chancellor;—<br />
with the election of two Procurators from among the<br />
teachers, to superintend the management of the property ;<br />
and possessions of the university ; with the general<br />
meetings of teachers taking place twice every year, in<br />
which they took counsel together upon matters affecting --\<br />
the teaching and the finances of the school; and with the<br />
duties of teachers and students. The latter were obliged<br />
to present themselves directly after their arrival to- the<br />
Procurators who entered in a book their names and the date<br />
of the commencement and termination of their studies, '«<br />
receiving a fee for this which varied in amount according<br />
to whether it was question of a Student or of a Bachelor:<br />
* In locis famosis quinque annos, si in artibus magistri existantidonei,alioquiit<br />
per sex annos, pro quolibet anno octo d'untaxat mensibus computalis ejusdem facul- ,<br />
tatem oudiverint medicince, ac in similibus locis per octo menses aul per duas<br />
astates adminus ejusdem medicince praxim duxerint exercendam. ASTRUC op.cit.<br />
p. 46.<br />
f ASTRUC op. cit. p. 54.<br />
X DENIFLE op. cit. S. 355, note 562.<br />
§ A. DUBOUCHET op. cit. Gaz. hebd., No. 6 et seq.
THE MEDICAL SCHOOL OF MONTPELLIER. 219<br />
this corresponded to the fees for immatriculation and exmatriculation<br />
of our times.<br />
The students on their acceptance into the society of<br />
the high school promised to observe conscientiously its<br />
laws. They were bound during the first three years of their<br />
student-life to attend medical lectures, holidays excepted,<br />
for 24 full months. Hereupon followed an examination, in<br />
which each of the teachers set a question, and then the<br />
degree of Bachelor. In this capacity the student con<br />
tinued his studies for at least two years, but delivered<br />
at the same time lectures upon certain extracts from the<br />
medical writings of the ancients. The candidature for the<br />
degree of Master of Medical Science formed the conclusion<br />
of study.<br />
He who gave regular instruction at least for the whole<br />
winter through was looked upon as a teacher in ordinary.<br />
The teachers chose in their meetings the subjects they<br />
wished to discourse upon ; the elder had precedence of the<br />
younger in this matter. Moreover, scrupulous care was<br />
taken, that a subject, which ought to be thoroughly con<br />
sidered within the space of a year, should not be spread<br />
over several.<br />
At first every Master and, within certain limitations, even<br />
every Bachelor was authorized to teach, without however<br />
receiving any remuneration at all for such teaching. It was<br />
not till the year 1498 that four regular chairs of medicine<br />
were founded, the incumbents of which for a stipend of<br />
one hundred livres had to lecture the whole year through<br />
without further pay ! The appointment to these professor<br />
ships was in the hands of the Bishop after nomination by<br />
the other teachers of the medical school. The stipend of<br />
the Professors was raised under CHARLES IX. to 400 and<br />
under HENRY IV. to 600 livres. Besides this they were,<br />
like other members of the University, free from taxes and<br />
many other burdens.<br />
The medical school of Montpellier passed the period of<br />
its greatest lustre in the 13th and 14th centuries. From
220 THE MIDDLE AGES.<br />
far and wide at that period came the sick, as the Bishop of<br />
Hereford from England and King JOHN of Bohemia, to seek<br />
help from the doctors there who were especially valued for<br />
their practical skill.* But a competition dangerous to<br />
their interests gradually waxed greater, as the universities,<br />
founded at that time in Italy, France and Germany arrived<br />
at a state of maturity. « j<br />
THE MOST ANCIENT ACADEMIES OF ITALY.<br />
THE Emperor FREDERICK II. created the academy at<br />
Naples f in the year 1224, in which all the sciences were to .•:<br />
be taught, iji order that young men, thirsting for knowledge, f<br />
should not, be compelled " like beggars to seek intellectual<br />
fpod away from their own country." % At first, as it appears,<br />
all the faculties were represented here ; but as early as 1231<br />
the medical disappeaied, since, by an imperial decree,<br />
medicine from that time forth might be taught only in<br />
Salerno. In 1252 the other faculties were also transferredJf<br />
to Salerno and united with the medical school there into a<br />
university. f<br />
Still, the* high school at Naples was restored in 125&VJ<br />
Situated, as it was, in the chief town of the country, |<br />
more easily accessible from the north and east and j<br />
endowed with greater privileges and more money than its 4<br />
elder sister at Salerno this institution afterwards surpassed!<br />
the latter in the number of its students as well as by its<br />
importance and its achievements.<br />
The story of the birth of the high school of Bologna like<br />
that of the schools at Salerno and Montpellier is lost in the<br />
* ARNALD VON VILLANOVA: Breviar. iv, 10.—GUY VON CHAULIAC: Chir., '<br />
tr. vi, d. 2, c 2.<br />
f MUBATORI : Rer. It. script, viii, p. 496.<br />
X HUILLARD-BREHOLLES op. cit. T. ii, p. 450. Disponimus apud Napolim^<br />
doceri arles cujiiscunque professionis et vigere sludia, ut jejuni et famelici doctrinarum<br />
in ipso regno inveniant unde ipsorum aviditati satisfacial, neque compellantnr<br />
ad invest igandas scie/iti'is peregrinas nationes expetere nee in alienis regionibu<br />
mendicare. • ,
THE MOST ANCIENT ACADEMIES OF ITALY. 221<br />
earlier ages.* The Emperor FREDERICK I. promised his<br />
protection to the university there in 1158, and bestowed<br />
upon it independent jurisdiction, f It was at that time<br />
really nothing but a school of law ; but other sciences were<br />
taught there in the 12th century, and the doctors were<br />
probably already associated in a college. J<br />
In the 13th century the medical and philosophical faculty<br />
was organized, as "a University of Artists." The school<br />
of law in the meanwhile continued to* maintain preponderance<br />
over the other faculties by the number of its<br />
teachers and students.<br />
It was only after 1280 that the medical faculty, when<br />
THADD^US FLORENTINES was a teacher in it, became<br />
known and celebrated in wider circles. For the rest, the<br />
organization of the university at Bologna was centred not<br />
so much on its faculties as on the incorporation of it's<br />
students. These were at first divided into the Citramontani<br />
and the Ultramontani each division being composed<br />
of several " nations." These territorial societies of<br />
t students, the antitypes of which are found in the associations<br />
which existed in the high schools of antiquity, e.g.,<br />
at Athens, sprang from the necessity felt by the students of<br />
joining themselves together in a foreign land with the<br />
mutual ties of a common home : they were organized after<br />
the fashion of the Italian corporations.<br />
At the head of each of the two student-corporations was<br />
a Rector, who was originally not exactly the head of the<br />
university but only managed the affairs of the students who<br />
had chosen him as their representative. At first, this<br />
dignity was bestowed on professors as well as on students,<br />
but alter the middle of the 13th century only on the latter<br />
* F.- C. v. SAVIGNV: Geschichte des romischen Rechts im Mittelalter<br />
Heidelberg 1834, Bd. iii, S. 164 et seq.<br />
t Cod. Auth. Habita.—GIESEBRECHT in den Sitzungsber. d. K. b. Akad. d.<br />
Wiss., histor. Klasse 1879, Bd - ii, S. 285.<br />
% M. MEDICI : Compendio storico della scuola ariatomica di Bologna 18*;-,<br />
P- 3-
222 THE MIDDLE AGES.<br />
and in the statutes of the university of the 14th century<br />
this was even officially recognized.* After the 16th<br />
century there was only one Rector for the two .student-<br />
corporations.<br />
As the Italian towns possessing high schools competed<br />
with one another, by the bestowal of privileges and distinctions,<br />
in attracting foreign students, the latter gradually<br />
acquired a position of extraordinary power and the<br />
professors came to hold a place of relative dependence.<br />
In Bologna and Padua the students even had the rightf<br />
to elect the Professors. In Montpellier their representatives,<br />
the Procurators, were allowed to stop the pay of<br />
Professors if they did not lecture with sufficient assiduity.J v|<br />
The Rector, chosen from among the students, who at<br />
first had jurisdiction only over the corporation to which he<br />
belonged, exercised it later over the whole university, even<br />
over the Professors and their families. It is true that hehad<br />
at hand a member of the legal faculty as Chancellor,<br />
and a state of things must have been developed similar to<br />
that which for a while existed in the 16th and 17th<br />
centuries at the German universities when the Rectorship<br />
was conferred on students of distinguished families. The "<br />
Rectors had no influence over the systems of study and<br />
examination ; this was left entirely to the Professors. The /<br />
latter received fees from the students for the instruction<br />
which they gave ; from the beginning of the 13th century i :=<br />
the town also granted them a certain stipend.<br />
According to a report made in 1371 by the Cardinal- .)<br />
Legate ANGLICUS§ three Magistri were teaching at that<br />
time in Bologna the theory of medicine, three the practice<br />
* Ad recloralus igilur officium eligatur scolaris nostras universilalis, in the<br />
statutes of Bologna University. SAVIGNY op. cit. Bd. iii, S. 643.<br />
f C. MEINERS: Geschichte der Entstehung und Entwickelung der hohen •<br />
Schulen unseres Erdtheils, Gottingen 1802.—SAVIGNY op, cit. Bd. iii, S. 292<br />
et seq.<br />
X THOMAS U. FELIX PLATTER: Zwei Autobiographien her. v. Fechter, Basel ;<br />
1840, S. 155.<br />
§ DENIFLE op. cit. S. 208 et seq.
THE MOST ANCIENT ACADEMIES OF ITALY. 223<br />
of medicine, and one surgery. They were paid by the<br />
town ; there were also with these other teachers who drew<br />
no pay. In 1388, 68 Professors were employed there, 14<br />
teaching medicine, 27 civil law, 12 canon law, and 15 the<br />
arts, grammar, and the business of the notary; in 1451 the<br />
number of teachers reached even more than 170, and as a<br />
result there was a reduction in the number of professorial<br />
chairs * Among the Professors engaged, there in the<br />
middle ages we're Frenchmen, Germans, Spaniards,<br />
Englishmen, Portuguese, Poles, and Greeks,f and among<br />
the students, too, all European nations were represented.<br />
The Professors, on entering on their duties, had to bind<br />
themselves by oath not to teach their science anywhere but<br />
in Bologna, and to contribute to the success of the high<br />
school of that place with all their powers.J This did not,<br />
however, prevent both students and teachers withdrawing<br />
on various occasions in considerable numbers from Bologna<br />
and seeking another place for their studies. This happened<br />
as early as 1222, and furnished an opportunity for the<br />
foundation or extension of the high school at Padua, where<br />
perhaps, long before this, schools for certain sciences had<br />
already existed.<br />
The university of Padua was formed after the pattern of<br />
that of Bologna. There, too, the Rector was at the head<br />
of the student-associations, of which there were four, distinguished<br />
by their nationalities, namely, those of the<br />
Italians, the French, the Provencals and the Germans. §<br />
There, also, the Rector was chosen from among the<br />
students ; it was only demanded of him that he should<br />
possess an unimpeachable reputation, should be at least<br />
22 years of age, and should have lived for a year in<br />
Padua upon his private means. The university of Padua,<br />
* E. COPPI : Le universita italiene nel medio evo, Firenze 1880, S. 257.<br />
t MAZETTI : Repertorio di tutti i professor! dell' universita di Bolo?na<br />
Bologna 1847.<br />
+ E. COPPI op.-tit. S. 78, note.<br />
§ F. C COLLE : Storia dello studio di Padova, 1824.
224 THE MIDDLE AGES.<br />
like that of .Bologna, was frequented chiefly by jurists. In<br />
1268 there were in Padua three teachers of medicine and<br />
of the natural sciences. It was really not until the 15th.<br />
and 16th centuries that medical science attained to a<br />
flourishing condition in Padua and BolOgna.<br />
The academy of Vercelli, which existed in 1220, owed, \<br />
a sudden popularity to the fact that in consequence of. ,<br />
quarrels in the year 1228 a number of professors and „<br />
students of Padua left that town. The town council. J<br />
of Vercelli made an agreement* with them, and they were<br />
induced, by various advantages held out to them, to settle J<br />
down there. All branches of learning were represented ^<br />
at Vercelli; medicine had two professorial chairs. Yet ;j<br />
the academy existed not much longer than one century. , ,<br />
The university at Vicenza originated probably in a similar!<br />
manner, students and teachers coming thither j froml<br />
Bologna. It enjoyed a favourable reputation as a school<br />
of law in the beginning of the 13th century. In i26i.a<br />
teacher of medicine was appointed there for the first time,<br />
receiving a yearly stipend of 150 librae denariorOfn.. In<br />
Modena, where, as early as the 12th century, legal science<br />
was largely pursued, a teacher of medicine was appointed<br />
first in the 14th century. Reggio (Emilia) had a school<br />
of law, though one of no great importance, since 1188.<br />
The academy of Arezzo, in which medicine, among other<br />
subjects, was taught, existed as early as the 13th century,t<br />
but was formally declared a university only in I355> and<br />
decayed in the 16th century.<br />
Siena was known for its excellent school as early as<br />
1203. In 1241 medicine was taught there in addition to<br />
other sciences, and in 1247 there were already three teachers<br />
of this subject. When the appointing of foreign professors<br />
came to be discussed in the town council in 1285 an endeavour<br />
was made to secure RANUCCIUS, who had great<br />
experience in surgery ; moreover, a Magister ORLANDUS<br />
* COPPI op. cit. S. 109 et seq.—SAVIGNY op. cit. Bd. iii, S. 666 etseq.<br />
t SAVIGNY op. cit. Bd. iii, S. 312 el seq.
THE MOST ANCIENT ACADEMIES OF ITALY. 225<br />
taught medicine there* In 1321 the university of Siena<br />
was enlarged, receiving accessions from Bologna. DINO<br />
DI GARBO, who at that time represented medicine at Siena,<br />
drew a yearly stipend of 1,155 lire. At a later period the<br />
university decayed, and its decline was not materially<br />
retarded in consequence of its official recognition by the<br />
Emperor CHARLES IV- in 1357 as a studium generate. It<br />
was not till the end of the 15th century that it recovered<br />
itself.<br />
Piacenza possessed a school of law at the end of the<br />
12th century, which was raised into a university in 1248.<br />
The Magister HUGO, a clergyman, taught medicine there<br />
at that time. The academy obtained first under GALEZZA<br />
VlSCO'NTl a certain reputation ; in 1399 it possessed 71<br />
teachers, 22 of them being medical. It was abolished in<br />
V H03-<br />
At the seat of the papal Court there arose in 1244 an<br />
institution for teaching, endowed with the privileges of a<br />
university, in which theology, law, oriental tongues, and<br />
afterwards medicine were taught. Situated first at<br />
Avignon and then at Rome, it was united with the academy<br />
which had existed in the latter place since 1303. Here, in<br />
1514, 88 Professors were engaged in teaching, namely,<br />
4 teachers of theology, 11 of canonical, 20 of civil, law, 15<br />
of medicine, and 38 of philosophy, mathematics, rhetoric<br />
and German; on the other hand/the number of students<br />
was relatively small. Under Pope ALEXANDER VI. the<br />
building of the Sapienza was begun, the halls of which<br />
serve for the seat of the university of Rome at the present<br />
day.<br />
In Perugia a school of law existed in the 13th century;<br />
but other sciences also and especially medicine were<br />
taught there. In 1308 the Pope proclaimed the school a<br />
university. Here at first one but, after 1314, two teachers<br />
of medicine were appointed, only however for a period of<br />
three years. In the roll of 1339, alongside of four doctors<br />
* DENIFLE op. cit. i, S. 437.<br />
Q
2§j& THE MIDDLE AGES.<br />
of canonical and three of civil law, one of philosophy, and<br />
one of logic, appear also three of medicine, and against 119<br />
students of law we find 23 medical students; these however<br />
were exclusively from distant parts; the native students<br />
were not counted* The majority certainly were of<br />
Italian origin, many however came from Germany. It isnoteworthy<br />
that the teachers and students of law bore the<br />
title of Dominus, those of medicine and philosophy that of '.<br />
Magister. In 1342 the number of teachers was increased<br />
and in the statutes of 1366 we find a regulation that there J<br />
should be at least seven teachers of medicine. In 1431<br />
there were eight, of whom one had to teach osteology as a |<br />
speciality.<br />
Treviso had in the.13th century an institution for the higher J<br />
teaching which was transformed into a studium generate ,<br />
in 1314: this received the imperial favour in 1318. The<br />
town decided to found twelve scholarships, three of them 1<br />
being devoted to medicine. Only a short duration of life<br />
was' destined for this university ; as early as the beginning<br />
of the 15th century it had ceased to exist. j<br />
The academy at Pisa arose in 1343 out of a school of<br />
law. It had to contend with many adverse circumstances:'!<br />
thus, for instance, in 1359 all the professors were dis- ]<br />
charged, there being no money for their salaries. In i4 D 3)'|<br />
the university was broken up for a time and opened again 4<br />
only in 1473, under LORENZO DE MEDICI, who showed it<br />
great favour. From that time it made rapid advances and<br />
attained to a position of high importance at the end of the<br />
15th century. This was due in a large measure to the cir- j<br />
cumstance that the university of Florence which as early ;<br />
as the 14th century had renowned medical teachers on its j<br />
staff and possessed charters of foundation from the Pope .•<br />
and Emperor, was in 1473 removed to Pisa.<br />
The university of Pavia was also developed out of a<br />
school of law. It was raised into a studium generate ^1361 •<br />
by the Emperor CHARLES IV. Medical science was zealously<br />
* DENIFLE op. cit. i, S. 546.—COPPI op. cit. S. 127, note.
THE MOST ANCIENT ACADEMIES OF FRANCE. 227<br />
cultivated and promoted there.* Among the students were<br />
many Germans. In Ferrara there were in the 13th century<br />
celebrated schools for instruction in the liberal arts. They<br />
were united into a university in 1391 and care was taken,<br />
at the same time, that the sciences of law and medicine<br />
should be represented. In 1474, 51 professors were teach<br />
ing there, among them being several lecturers on medicine.<br />
Turin became* possessed of an academy in 1405, and<br />
Catania of one in 1445. In Parma also, in Cremona, Lucca,<br />
and other towns of Italy, instruction was given temporarily<br />
in certain sciences, for instance in law and medicine, without<br />
however the development in these places of regular universities<br />
endowed with legal privileges.<br />
THE MOST ANCIENT ACADEMIES OF FRANCE.<br />
IN France, at this period, a great number of academi<br />
arose.f At Orleans, Angers and Rheims there were, as<br />
early as the 13th century or even earlier, much-frequented<br />
schools of law which were afterwards proclaimed univer<br />
sities. The authorities were anxious to attract foreign<br />
students and on this ground bestowed on them many<br />
privileges. Thus the German students at Orleans were<br />
subject to special jurisdiction, had free entry to the theatre<br />
and were all treated as noblemen, without distinction of<br />
birth.J Instruction in medicine was given only excep<br />
tionally and at no time attained to any importance. For<br />
example, Angers in 1362 had among 44 teachers only one<br />
who lectured on. medicine. A similar state of affairs<br />
existed at Toulouse where in 1229 a studium generate was<br />
founded. Medicine was regarded with as little respect in<br />
the academies at Avignon, Cahors, Grenoble and Orange<br />
.. * ALF. CORRADI in the Memorie e documenti per la storia dell' university d<br />
Pavia, Pavia 1878, i, 99-145.<br />
t E. PASQUIER: Recherches de la France, Paris 1633, p. 888 et seq.<br />
X SAVIGNY op. cit. Bd. iii, S. 402 et seq.<br />
-
22g THE MIDDLE AGES.<br />
which were founded in the 14th century* Regarded<br />
singly, none of these academies had at any time many<br />
students. The witty remark was made about Orange, as<br />
we are told by Golnitz, that the whole university consisted<br />
of three persons, the Rector, the Secretary and the<br />
Beadle.t So too the academies at Perpignan, Aix, Dole,<br />
Caen, Poitiers, Valance, Lyons, Bordeaux, Bourges and<br />
Nantes which arose before or during the 16th century<br />
never attained to any greater importance.<br />
The political and social development of France was of<br />
such a nature as to cause the small provincial universities<br />
to give way on all sides to Paris which formed the centre of<br />
all intellectual life. This university arose from the union<br />
of the mutually independent schools for higher education in<br />
Paris in which, as early as the 12th century, law, medicine<br />
and several other sciences were taught. JOHN of Salisbury |<br />
has left us accurate information about the management of<br />
these schools, and the studies which were pursued at<br />
them.t It is not known how it came about that the<br />
teachers of these subjects entered into an alliance among<br />
themselves and formed an association. Probably it was<br />
in 1209, at the instance of Pope INNOCENT III., who<br />
ordered the masters in the various sciences to frame laws,;<br />
for their own use.§ In 1215 the Magistri of the four chief<br />
branches of learning represented corporations—faculties in<br />
our sense of the word—and had their own separate<br />
statutes. || It was not, however, until 1254 that they were<br />
united into a university. Besides being divided into faculties,<br />
another division into four "nations" existed at Pans j<br />
as early as the 13th century, an arrangement obviously]<br />
modelled upon that of the Italian universities. This<br />
appears to have exercised greater influence on academic<br />
* G. BAYLE: Les me'decins d'Avignon, Avignon 1882, p. 43 et seq.<br />
f A. GOLNITZ: Ulysses Belgico-Gallicus, Leyden 1631, p. 468.<br />
t JOHANNES SARESBERIENS.S: Metalog, lib. ii, c. 10, Ed. MIONB (Patrol.<br />
lat. Bd. 199, p. 867).<br />
§ A. F. THERY : Histoire de l'education en France, Paris 1858.<br />
|| BULHLUS: Historia universitatis Parisiensis, Paris• 1665-73, T. iii, p. 81.
THE MOST ANCIENT ACADEMIES OF FRANCE. 229<br />
administration than the division into faculties. The study<br />
of the artes liberates formed the preliminary step to the<br />
study of theology, law and medicine, the "philosophical<br />
faculty" forming, as it were, a foundation for the three<br />
others.<br />
By "medical faculty" was understood not only, as is<br />
now the case, the staff of teachers of the medical school,<br />
but the whole body of legally qualified doctors in Paris.<br />
Since originally every doctor who had passed the examination<br />
was at liberty to teach in the high school it was<br />
natural to identify the two classes, the more so that frequently<br />
the same persons played a leading part in both.<br />
But not every doctor was able or willing to act as teacher<br />
of his art. The medical corporation decided, therefore,<br />
to depute annually certain of its members to the duty<br />
of teaching. This, however, demanded knowledge and<br />
ability not possessed by everyone; it was, therefore, very<br />
natural that a class of doctors who made teaching their<br />
profession was gradually formed. These circumstances<br />
must be carefully considered if we wish rightly to understand<br />
the state of the university of Paris at this time and<br />
of the medical studies pursued there. They explain the<br />
independent position held by the medical faculty in regard<br />
to. the university, the influence exerted by the doctors who<br />
held themselves aloof from professorships upon medical<br />
teaching, and many other facts which, as they are transmitted<br />
by history, appear singular and enigmatical. In<br />
Paris, too, the Rector was originally the head of the associations<br />
of students—of the "nations." Since the<br />
members of these "nations," either as students or<br />
graduates, belonged to the philosophical faculty, or stood<br />
m relation to it, it ensued of its own accord that the Rector<br />
gradually came to have the management of this faculty.<br />
The faculty of the liberal arts, however, formed the,<br />
foundation of the whole university; thence came it that<br />
the Rector afterwards advanced to the head of this. As<br />
early as 1280 he was looked upon as head of the whole
23°<br />
THE MIDDLE AGES.<br />
university ; the theological faculty alone formed an exception<br />
; but in the middle of the 14th century this also came.<br />
under his authority.<br />
He alone could be elected to the office of Rector ,|<br />
who possessed an academical degree in the philosophical J<br />
faculty, in other words, a good general education. The<br />
usage gradually came into vogue of conferring this dignity<br />
upon a man in a prominent position of life, who sometimes<br />
if not always belonged to the teaching-staff. A similar<br />
arrangement prevailed afterwards at the academies at. :<br />
Vienna, Prague, and other places. A Dean of the medical |<br />
faculty is mentioned in the year 1267; this was PETRUS J<br />
LEMONENSIS* The Dean was elected by the medical g<br />
corporation, the President of which he was. He was not:<br />
allowed, at least in later times, to give lectures lest the. j<br />
administrative business which was entrusted to him should^<br />
cause him to neglect them. ']<br />
The teachers in the faculty of medicine were divided |<br />
into those whose duty it was to give lectures and demon- j<br />
strations—thereby satisfying a definite want in the plan ;|<br />
of studies—and into those who lectured of their own free |<br />
will. The former presided at discussions and on solemn |<br />
occasions, and were called Doctores, or Magistri actu-i<br />
regentes ; their position corresponded nearly to that of our<br />
professors in ordinary. The other members of the teaching<br />
staff, the Doctores non regentes, were not bound to employ<br />
themselves actively as teachers, and in consequence had |<br />
no participation in the various privileges and sources of<br />
income which the class just mentioned enjoyed. ^ The<br />
teachers of the university generally gave instruction at :<br />
their dwellings. The medical faculty had a building of \<br />
its own for the first time in 1505. Up to that time its meetings<br />
were held in the church of the Mathurins, or in the |<br />
cathedral of Notre Dame. We get information as to the|<br />
numerical relations of the several faculties from the fact-<br />
* BCCHEZ : Delafaculte de medecine de Paris in the Journal des progres des-*<br />
sciences et institutions me'dicales, Paris. 1822.
THE OTHER UNIVERSITIES OF EUROPE. 233<br />
that in the year 1348 there were in Paris 32 magistri of<br />
theology, 18 of canon law, 46 of .medicine, and 514 of artes<br />
liberates* The number of doctors belonging to the medical<br />
faculty of Paris, reached 29 in the year 1311, 31 in 1395,<br />
and 36 on an average from 1391 to 1431. When the<br />
English besieged Paris in 1442 there were only 10 or 12<br />
qualified doctors in the city; but around these a number<br />
of students were gathered who practised under their<br />
supervision. At a later period also the medical faculty<br />
did not .increase in the same proportions as the city<br />
of Paris; for in 1500 the former consisted of 72 doctors^<br />
in 1566 of 81, in 1626 of 85, in 1634 of 101, in 1675 of<br />
105, and in 1768 of 148.f With these there were in<br />
Paris a great number of practitioners who had the right,<br />
it is true, to practise, but had not obtained the title<br />
of doctor, and consequently could not be members of<br />
the medical faculty ; so, too, there were numbers of sur*<br />
geons who had passed examinations, and other medical<br />
men recognized by the law. The organization and arrangements<br />
of the university of Paris formed the pattern for<br />
the majority of the academies which were founded in the<br />
following centuries in Germany, England, and other<br />
countries.<br />
THE OTHER UNIVERSITIES OF EUROPE EXISTING<br />
IN THE MIDDLE AGES.<br />
THE most ancient universities of Spain arose probab<br />
the influence of Arab traditions. At Palencia, even in the<br />
time of the Goths, there were celebrated schools: in the<br />
beginning of the 13th century ALPHONSO VIII. erected a<br />
university there in which however there was no medical<br />
* DENIFLE op. cit. i, ,S. 123, from, whom I borrow these figures, considers<br />
all these magistri to be regentes; but this assumption is contradicted by all<br />
other circumstances.<br />
t A. SPRINGER: Paris im 13. Jahrhundert, Leipzig 1856.—J. C. SABATIER:<br />
Recherches historiques sur la faculte'de medecine de Paris, 1835. • r ,
THE MIDDLE AGES.<br />
faculty. But this educational establishment existed only<br />
for a short time. The university of Salamanca which was<br />
founded in 1243 by FERDINAND III. was developed, as it<br />
appears, out of a cathedral-school. There all branches<br />
were represented with the exception of theology which<br />
was not added until the 14th century. Two teachers, as<br />
was the case also in other academies of that period, gave<br />
instruction in medicine. Salamanca acquired a reputation<br />
which spread far beyond the boundaries of Spain and was<br />
declared by Pope MARTIN V to be one of the four chief<br />
academies of Christendom, the others being Bologna,<br />
Naples and Paris.*<br />
The other universities of the Iberian peninsula were of<br />
less importance. In Seville the study of the Oriental i<br />
tongues, especially of Arabic, was chiefly pursued; the<br />
academy there served for the training of missionaries and<br />
was first provided with the other faculties in the beginning<br />
of the 16th century. The university of Lisbon was founded<br />
in 1288 but was removed to Coimbra in 1308. This fate<br />
befel it several times for it came back to Lisbon in 1338,<br />
was transferred to Coimbra again in 1354, then to Lisbon<br />
once more in 1377, to return to Coimbra in 1537. It almost<br />
gives one the impression that the two towns had agreed<br />
between them that the seat of the university should change<br />
from one to the other about every 20 years. All branches<br />
of knowledge were taught there ; yet in 1400 there was only<br />
one professorial chair for medicine.<br />
In addition to those above mentioned Spain possessed<br />
universities in the following places: about the year 1260<br />
there was one in Valladolid, in 1300 one at Lerida, in 1254<br />
at Huesca, in 1411 at Valencia, in 1446 at" Gerona (?), in<br />
1450 at Barcelona, in 1474 at Saragossa, about 1480 at<br />
Siguenza, in 1482 at Avila, in 1483 at Palma, in 1499 at<br />
Alcala. The faculty of medicine was not represented at<br />
some of them. The Spanish universities appeared as much<br />
* V. DE LA FUENTE: Historia de las universidades en Espaiia, Madrid 1884-<br />
85, 2 Vols.
THE OTHER UNIVERSITIES OF EUROPE. 233<br />
by political events as by the geographical position of their<br />
country to be especially called to the great task of trans<br />
mitting the culture of the Arabs to Christian Europe; and<br />
they might well hope that as a result of the stimulating<br />
effect of the rich treasures of knowledge left them by their<br />
Semitic predecessors they would long sustain an important<br />
part amongst the establishments for advanced teaching.<br />
If, notwithstanding this, they produced no enduring in<br />
fluence on the development of the sciences and if, after a<br />
brief period of prosperity, which like a friendly gleam of<br />
light illuminates the history of the 16th century, they sank<br />
into a condition of intellectual torpidity which robbed them<br />
of the power of independent movement, the fault lies in that<br />
political and religious oppression which here reached an<br />
unexampled height. Even in the worst days of despotism<br />
and of superstition there was no lack of latent intellectual<br />
life ever ready to bloom afresh ; but the buds were crushed<br />
under foot and could only advance to maturity if removed<br />
from their native soil.<br />
The old English universities of Oxford and Cambridge<br />
were gradually developed out of the schools which existed<br />
in those places as early as the 12th century.* It is un<br />
certain when they assumed the academic character. In<br />
the first decades of the 13th century they appear already<br />
as organized corporations—in fact as universities. Medical<br />
science was certainly taught in these institutions along with<br />
other branches of knowledge, but only as part of a general<br />
philosophical education. For this purpose one teacher of<br />
the subject sufficed to point out to the students the most<br />
important facts in connection with it. The same conditions<br />
•obtained at the universities of St. Andrews founded in<br />
1411, Glasgow founded in 1450, and Aberdeen founded in<br />
1494.<br />
The first university on German soil was erected in the<br />
* H.C.MAXWELL LYTE : A History of the University of Oxford from the<br />
earliest times to 1530, London 1886.—JAMES BASS MULLINGER : The University<br />
of Cambridge, Cambridge 1873.
THE MIDDLE AGES.<br />
year 1348 at Prague, the residence of the Emperor CHARLES<br />
IV. An ardent friend and patron of all scientific and<br />
artistic effort, this prince was anxious to make the subjects<br />
of his empire and especially of his patrimonial possessions<br />
in Bohemia, acquainted with the advantages of Italian and<br />
French civilization. On this account, he created in his '<br />
capital a studium generate which was arranged after the<br />
pattern of the university of Paris. It comprehended four<br />
faculties in all, and fixed stipends were assigned to the<br />
professors. The students, as in Paris and Bologna, were<br />
divided into four nations namely Bohemian, Bavarian,<br />
Saxon, and Polish. At their head was the Rector,, who<br />
had to belong to the clergy, though not to any monastic<br />
order, i.e., he was obliged to have received one of the lower<br />
forms of consecration; also to be of at least 25 years of<br />
age, of legitimate birth and to have passed a blameless 1<br />
life.* Even students could be elected to this dignity. The<br />
supreme control of the university was conferred on the<br />
Archbishop of Prague—on a high prelate, as was usual in<br />
many academies at that period. The university of Prague<br />
rose quickly into prominence. BENESCH DE WAITMUEL<br />
an author of the 14th century said that " in no place in<br />
Germany did the sciences receive such careful cultivation as<br />
in Prague, students coming thither from England, France,,<br />
Lombardy, Hungary, Poland and the adjacent countries,<br />
among them. being the sons of nobles and princes, and<br />
high prelates from the different parts of the world."t<br />
Even if the reports of the number of students, which the<br />
academy mustered at that time are exaggerated,%—and in<br />
* W. TOMEK : Geschichte der Prager Universitat, Prag. 1849.<br />
t DENIFLE op. cit. i, S. 600.<br />
X According to these there are said to have been in Prague at that time<br />
30,000 students; similar reports exist in the cases of Bologna, Oxfor.d, and<br />
Louvain. Probably not only the students and scholars who were being prepared<br />
for university studies, were included, but also all who had studied there in<br />
former years as well as the officials and artificers. who had business relations<br />
with the academy. Cf. PAULSEN in SYREL'S histor. Zeitschr. 1881, Bd. 45, S.<br />
2 9< etseq. . ; rt
THE OTHER UNIVERSITIES OF EUROPE. 235<br />
any ease they are very uncertain,—still we are at liberty<br />
to assume that the number was not insignificant.<br />
In 1372 the faculty of law constituted itself a separate<br />
university and chose its own Rector; it consisted at that<br />
time of 37 members of the Bohemian, of 48 of the Bavarian,<br />
of 41 of the Polish, and of 29 of the Saxon nations.<br />
Medical study met by no means with its due recognition ;<br />
it was represented by one or at most two teachers.<br />
NlCOLAUS DE GEVICKA, BALTHASAR DE TUSCIA and<br />
WALTHER are mentioned as the first.<br />
The national and religious quarrels which afterwards<br />
broke out in Prague resulted in many foreign students<br />
quitting the university and in the neglect of study there.<br />
Thus its decline commenced, and in the sphere of medicine<br />
became somewhat marked as early as at the close of the<br />
15th century.<br />
The university of Vienna was founded in 1365, but really<br />
only in 1385 came into actual existence. It was organized<br />
in imitation of the university of Paris. Its members, like<br />
those of that university, divided themselves into four<br />
" nations " at the heads of which were Procurators, who<br />
elected the Rector. The Rector was the head of the<br />
whole university, representing it before the outside<br />
world and holding jurisdiction in it. The Provost of the<br />
Church of ST. STEPHEN filled the office of Chancellor.<br />
The general assembly of the doctors who had taken<br />
diplomas constituted the medical faculty; their principal,<br />
the Dean, was elected by them. All were entitled to teach ;,<br />
yet but few devoted themselves to teaching, indeed, seldom<br />
more than six or eight.* The Doctores regentes received<br />
regular stipends. The first teachers of medicine were<br />
JOHANN GALLICI of Breslau, HERMANN LURCZ of Niirn-<br />
berg, HERMANN VON TREYSA of Hessen, CONRAD VON<br />
SCHIVERSTADT and MARTIN VON WALLSEE.<br />
In the year 1364 King CASIMIR of Poland founded an<br />
* J. ASCHBACH : Geschichte der "Wiener Universitat, Wien 1865, i, S. 326.
236 THE MIDDLE AGES.<br />
academy in Cracow to which two professorial chairs of<br />
medicine were allotted. But these plans were not realized<br />
until 1400.<br />
A papal document of foundation was drawn out for<br />
Culm also in 1387, but the university appears never to have<br />
come into existence. The university of Heidelberg arose<br />
in 1386. It had at first only four professors for all the<br />
faculties. The first teacher of medicine was appointed in<br />
1390. He remained for long the only representative of this<br />
science.* At Koln on the Rhine an academy was founded<br />
in 1388, w T hich made a splendid start. It existed until 1798<br />
and was only abolished under the French rule at the same<br />
time as the universities of Treves and Mainz. The<br />
academy of Erfurt which as early as 1379 received the<br />
privileges of a studium generate and, in any case, existed<br />
as such from 1392 obtained a great reputation in the 15th<br />
century, especially for its attention to legal science. It<br />
existed till 1816. The two Hungarian academies of Fiinfkirchen<br />
and Ofen, which were founded in the 14th century,<br />
had but a short duration of life ; the latter was restored at<br />
the end of the 15th century. The university of Wurzburg<br />
only existed ten years after its foundation in 1403. Its<br />
history, which has an extraordinary importance in reference<br />
to medical science, really begins only in 1582 after it had<br />
been again opened at the conclusion of a long period of inactivity.<br />
In the 15th century the following universities also<br />
were founded at the dates given :f Leipzig (1409), Rostock<br />
{1419), Louvain (1426), Greifswald (1456), Freiburg-im-<br />
Brisgau (1457), Basel (1460), Treves and Ingolstadt (1472),.<br />
Tubingen and Mainz (1477), Upsala (1477) and Copenhagen<br />
(1479). Medical studies played a modest part at<br />
these academies. There were seldom more than one or.<br />
two teachers to instruct students in medical science and the<br />
number of the pupils was generally not much greater;<br />
* J. F. HAUTZ: Geschichte der Universitat Heidelberg, Mannheim 1862,<br />
2 vols.<br />
t Cf. PAULSEN in SYBEL'S histor. Zeitschr. 1881, Bd. 45, S. 266 el seq.
THE TRAINING OF DOCTORS IN GENERAL. 237<br />
THE TRAINING OF DOCTORS IN GENERAL.<br />
THE universities of the middle ages were institutions of a<br />
different kind to those of the present day. The conceptions<br />
which are associated with things change with the<br />
lapse of time just as the names do by which we designate<br />
them. The academies of that period, moreover, differed<br />
considerably among themselves according to the time and<br />
place of their origin. Those of Salerno and Montpellier<br />
appear to have been, as it were, technical schools of<br />
medicine, to which the other faculties were somewhat<br />
loosely linked. The academies at Bologna, Padua, and<br />
other places in Italy resembled wandering colonies of professors<br />
and students, who pitched upon a site wherever<br />
the best prospect of freedom and the greatest advantages<br />
were offered ; many associated themselves with one of the<br />
numerous schools of law existing in several towns from a<br />
remoter period. The university of Paris and the academies<br />
of England and Germany, which were modelled on it, give<br />
the impression of philosophical faculties which afforded<br />
medicine a place, along with other sciences, within the<br />
circle of the studies pursued within their walls ; at certain<br />
of these universities, such as Paris, Vienna, Prague, Basel<br />
and other places, medical teaching stood in close connection<br />
with the corporation of doctors, as was also originally the<br />
case in the oldest medical schools at Salerno and Montpellier.<br />
Just as artisans and artists in their guilds, so also<br />
the masters of medicine claimed the right of determining<br />
in their general meetings in what manner their art should<br />
be taught, and who possessed the requisite knowledge for<br />
independently practising it. So, too, in the other<br />
academies, the medical faculties had a somewhat different<br />
signification to that possessed by them to-day, for at that<br />
time they gave no complete technical education, but only<br />
the theoretical basis for this which depends upon literature;
238 THE MIDDLE AGES.-<br />
and.they left the students to acquire at a later period the<br />
requisite practical knowledge of the healing art under the<br />
guidance of a practising doctor, or in the hospitals. In ,;<br />
consequence of this, the centre of gravity of a doctor's ,<br />
training was shifted away from the faculty and at the<br />
-same time from the university, and this was especially the<br />
case in England, while in Germany from a frequent absence<br />
of the necessary institutions, and from scarcity and limitation<br />
of means, the practical training of doctors was in<br />
general neglected.<br />
The course of medical studies, as a rule, was tolerably<br />
similar in the different universities, both from custom<br />
and in deference to the requirements of the law. The<br />
possession- of a general preliminary training, including the<br />
subjects which were taught at the monastic and cathedral J<br />
schools, and also at the town schools, was presupposed. If<br />
these institutions for the higher teaching existed in towns<br />
in which universities were afterwards established, they<br />
Were incorporated with the latter, as in Paris, Prague, 'j<br />
Vienna, and other places. Thus it came about that many.<br />
students acquired at the university itself that preliminary I<br />
training necessary for their future technical studies, the ;<br />
philosophical faculties almost taking the place of our ,<br />
gymnasia. This arrangement obtained at the Austrian |<br />
academies in the form of the two yearly courses of<br />
philosophy, which had to be attended before the com*<br />
mencement of medical studies up till the year 1848, and in<br />
a modified form it exists at the present day in the univeivj<br />
sities of England. The Emperor FREDERICK II., we are<br />
told, issued an order that a general scientific educatiofi||<br />
should precede the commencement of medical studies, and<br />
that three years should be devoted to the same. Gradually<br />
it became usual that in most academies the students before |<br />
beginning medical study should graduate in artibus, or, at<br />
all events, should attend lectures in the philosophical<br />
faculty for a certain number of years. In Paris, after ail<br />
attendance of two years at such lectures they could obtain :
THE TRAINING OF DOCTORS IN GENERAL. 239<br />
t-he ; degree of bachelor, and after three and a half years the<br />
license and the degree«of master of philosophy.*<br />
: The period of studentship in the department of medicine<br />
lasted four or five years; but could be shortened by a half or<br />
a- whole year if the student possessed an academical degree<br />
in the faculty of philosophy. This time was divided into<br />
two portions, the first comprising the first two or three<br />
years and ending with the examination for the degree of<br />
bachelor, while the second, forming the two last years of<br />
studentship, was concluded with the acquisition of the<br />
license to practise.<br />
" : The medical teaching consisted chiefly of theoretical dis<br />
cpurses. The medical writings of the ancients and their<br />
Arabian and Italian commentators formed the foundation<br />
for these. The teacher added technical explanations and<br />
remarks on his own practice to the reading of these books.<br />
The various subjects were generally apportioned among<br />
the teachers so that each particular theme, as anatomy,<br />
fevers, blood-letting, dietetics, materia medica, special<br />
pathology, surgery, etc., was treated in an exhaustive way.<br />
The lecture rooms, as they appear in contemporary<br />
pictorial representations^ show us the teacher on a raised<br />
seat reading out of a bulky volume to his pupils, who are<br />
Seated on forms or stand near him, and are engaged in<br />
copying down his words.<br />
Concerning the subject-matter of medical lectures, a list<br />
of the studies of the medical faculty at Leipzig at the end of<br />
the 15th century gives us accurate information. It was<br />
there laid down as a rule that the first lecture in winter<br />
should begin at seven o'clock in the morning, in summer at<br />
six, and should deal with theoretical medicine. Three<br />
* L. HAHN : Das Unterrichtswesen in Frankreich, Breslau 1848.<br />
•f* Cod. Galeni Dresd., No. 92, fol. 20b, 30a, 39a, 296a. No. 93, fol. 587b,<br />
608b.—CH. MEAUX ST. MARC: L'ecole de Salerne, Paris 1880 (Vignette).—<br />
LACROIX: Science et lettres au moyen-age, Paris 1877.—L. GEIGER : Renaissance<br />
und Humanismus, Berlin 1882, S. 408 (after a ceiling-painting of<br />
LAURENTIUS DE VOLTOLINA).
240 THE MIDDLE AGES.<br />
years were spent upon this subject, and in such a way that" •<br />
for the first year's lectures the first Canon of Avicenna,<br />
with the explanations of JACOBUS FOROLIVIENSIS, served as<br />
a guide ; for the second year the ars parva of GALEN, with<br />
the commentary of TRUSIANUS; and for the third the)<br />
Aphorisms of HIPPOKRATES, with GALEN'S remarks, upon<br />
them. At one o'clock in the afternoon the lectures on\<br />
practical medicine took place: these also claimed a three<br />
years' course. The foundation for the.first year's lectures*<br />
on this subject was the 9th book of the Liber Medicinalisf<br />
ad Almansorem of RHAZES which contained pathology,<br />
,with the remarks of JOH. ARCULANUS ; for the. second year -j<br />
•the subject of fevers ; and for the third general therapeutics,<br />
after the Canon of Avicenna, with the explanations of 4<br />
DINO DE GARBO and others.<br />
Along with these regular lectures, delivered by appointed |<br />
professors, certain doctors belonging to the medical faculty<br />
dealt with particular subjects in special lectures; the J<br />
subjects being chosen by them as they liked, and being of<br />
such a nature as, for example, the Prognostics of HlPPO- 1<br />
KRATES.<br />
The course of study recommended to the students in<br />
1520 by MARTIN STAINPEIS, professor in the medical*|<br />
faculty at Vienna, was of the same kind.* In his book he*<br />
enumerates the medical writings which they should readyj<br />
and arranges them according to their contents in such away<br />
that they appear, if studied in orderly succession, |<br />
calculated to make students acquainted by degrees with<br />
the several parts of medical science. Mention is there j<br />
made of the most important medical authors of antiquity;<br />
and amongst the Arabs, with their expounders, and also&<br />
of the works of a number of Italian doctors which had at ,<br />
that time obtained a considerable notoriety. STAINPEIS<br />
discusses the use of this reading to the future doctor, M<br />
* MARTIN STAINPEIS: Liber de modo studeridi seu legendi in medicina,<br />
Vienn. 1520, f. vii et seq.—A. v. ROSAS: Geschichte der Wiener Hechschulgu.bes.<br />
der med. Facultat, Wien 1843, i, 149 et seq. ,.
THE TRAINING OF DOCTORS IN GENERAL. 241<br />
and gives the advice that numerous students should<br />
always study together,, in order that they may set<br />
one another right on things not clearly understood by<br />
any of their number. "Before going to sleep every<br />
student must, like an ox, chew the cud of what he has<br />
learnt during the day" (fol. xvii). In this way the first<br />
three years of medical studentship were passed. During the<br />
second half of this period, and consequently after obtaining<br />
the degree of Bachelor, the students of medicine occupied<br />
themselves with hearing lectures on special subjects, taking %<br />
part in discussions which occurred every week under the *%•<br />
superintendence of the professors, assisting at anatomical - ,<br />
dissections, visiting hospitals and learning the practical -;<br />
treatment of diseases.<br />
The discussions, which were usual even in the schools of<br />
the Iatrosophists of antiquity, and also were zealously<br />
carried on by the Arabs,- formed an essential part of<br />
medical teaching. They were in conformity with the<br />
entire method of education of the scholastic period, which<br />
aimed rather at dialectic versatility than at depth of knowledge,<br />
.more at dead scholarship than at that practical<br />
ability which life demands. Looking at their real effect,<br />
these discussions served as a useful completion of the<br />
theoretical lectures, for they gave the students an opportunity<br />
of showing whether they had, or to what extent they<br />
had, mastered the contents of the latter. They were also,<br />
as it were, examinations which the students subjected<br />
themselves to in the presence of their teachers and fellowstudents.<br />
The learners were thus made acquainted with<br />
deficiencies in their knowledge and the teachers with<br />
imperfections in their teaching. Unfortunately these discussions<br />
frequently degenerated into an empty display of<br />
words, which did not advance the matter, but only satisfied<br />
personal vanity. "The young people," said JOHN of<br />
Salisbury, " pride themselves on their knowledge of HIPPO<br />
KRATES and GALEN, make use of unfamiliar expressions<br />
and introduce, their aphorisms on every occasion." The<br />
R
242<br />
THE MIDDLE AGES.<br />
bachelors were also bound to teach the young students by<br />
translating and expounding extracts from the medical<br />
writings of the ancient authors, and by giving lectures<br />
on certain parts of medical science. Here, too, usage<br />
resulted in the formation of definite rules : thus it was<br />
established in Paris that there should be 50 lectures upon<br />
the Aphorisms of HIPPOKRATES, 30 upon the book de<br />
regimine, 38 on acute diseases, and 36 upon the Prognostics*<br />
There is no doubt that this method of teaching<br />
had many advantages for the students. The Jesuits, who<br />
introduced it afterwards into their schools, have to thank it<br />
in great measure for the successful results which they<br />
obtained.<br />
TEACHING IN ANATOMY.<br />
MEDICAL teaching in the universities bore thus essentially<br />
a theoretical character; only in certain subjects were<br />
attempts made to join with it practical demonstrations.<br />
k, For while anatomy was taught chiefly from books, it was<br />
•*• likewise illustrated by drawings and sketches, by the<br />
', examination of the living body, and by the dissection of<br />
"' dead animals and of the human subject. Unfortunately<br />
but few anatomical drawings of this period have been<br />
preserved. HENRI DE MONDEVILLE, who was first a professor<br />
in Montpellier, and afterwards physician in ordinary<br />
•'•» to PHILIP LE BEL of France (1285-1314) added thirteen'<br />
illustrations to his Anatomy, as GuiDO DE CAULIACO states.t ,<br />
The royal library at Berlin possesses the college note-bookj<br />
of a student, who in 1304 copied down the lectures delivered<br />
there; on the margin are rough pen and ink sketches,<br />
for which H. DE MONDEVILLE'S drawings served probably<br />
as a copy. A parchment manuscript of the beginning of<br />
the 15th cefntury which is preserved in the Royal Library g<br />
* SABATIER op. cit.<br />
t GUY VON CHAULIAC : Chirurgia, Tract. 1, doctr. 2, c. 1.
TEACHING IN ANATOMY. 243<br />
at Dresden* contains initials with drawings illustrating<br />
incidents in a doctor's life, and also several anatomical<br />
demonstrations. It appears evident from this that in<br />
teaching, naked persons were brought forward on whom<br />
the particular parts of the human body were pointed out<br />
and explained. Perhaps the internal organs were indicated<br />
by outlines upon the skin. The dissection of animals<br />
formed the aid to anatomical teaching in most general use<br />
In Salerno, pigs were used, by preference, for this purpose ;'<br />
in other academies this example was imitated. Again,'<br />
bears, monkeys, but especially dogs were made use of.f<br />
In the pecuniary accounts of the medical departments of<br />
this period the purchase of pigs and other animals for<br />
anatomical investigation sometimes played a not inconsiderable<br />
part. The dissection of the bodies of the lower<br />
animals continued to be usual, after that of the human subject<br />
had become an established thing, since an opportunity<br />
for the latter was but seldom afforded.<br />
Dissection of the human subject was in the first centuries<br />
of the middle ages opposed by religious and political<br />
ordinances and also by social prejudices. It seems, that<br />
the doctors of that time were not entirely without this<br />
most important medium of medical education; but the '<br />
anatomical knowledge of GALEN and his expounders<br />
satisfied them, and no desire for independent investigation<br />
was manifested by them. Doctors of intelligence certainly<br />
never failed to recognize the importance of anatomy to •'•<br />
medicine;{ but not before the 13th and 14th centuries'<br />
* Codex Galeni No. 92, 93, with the commenta.y of NICOL V. REGGIO NO<br />
92, fol. 19b, 26b, 34b, 50a, 59a, 83b, 93b, 96b, ,09a, ,Sla, 158a, ,64b, , V<br />
lK, 3 ° 4a 'r L ' CH ° ULANT: Geschichte und Bibliographic der anatomischen<br />
Abbildung, Leipzig 1852, S. 2.<br />
t MONDINO: de anatomia (matricis).-Mag. Richardus in HAESER op cit<br />
'' I :~H' ' Ver 2 an S enhdt u "d Gegenwart des Museums fur<br />
menschliche Anatomie an d. Wiener Universita:, Wien 1869, p : xii<br />
X Thus TADDEO ALDEROTTI (.223-1303), declared that'he could give no<br />
accurate information on the nature of pregnancy, since he had unfortunately<br />
never had an opportunity of dissecting a pregnant woman.-A. CORRADI •
244 THE MIDDLE AGES.<br />
were the obstacles removed which made its study difficult<br />
or impossible.<br />
The Emperor FREDERICK II. exhorted the students of<br />
Salerno to give their attention to anatomy, and ordered<br />
that no surgeon should be allowed to practise before he<br />
had given proofs that he had devoted himself to the study<br />
of anatomy for a whole year. On the suggestion of<br />
MARTIANUS, Protomedicus of Sicily, he issued an order<br />
in 1238 that every five years a corpse should be dissected<br />
in the presence of the physicians and surgeons*<br />
At Bologna dissections of the human subject were probably<br />
carried on as early as the 13th century. In 1302, by J<br />
command of the judge, even a medico-legal dissection was<br />
performed there, the suspicion having arisen that a man :<br />
had been poisoned; two physicians and three surgeons<br />
were appointed to make this examination. From the des-1<br />
cription of this event it is not to be inferred that it was the |<br />
first case of the kind but on the contrary that people<br />
already possessed some experience in such examinations<br />
and in the conclusions to be drawn from them.t For a<br />
similar reason GULIELMUS DE SALICETO is said to have |<br />
dissected the 'corpse of the nephew of the Marchese PAL- J<br />
LAVICINI.J The Franciscan monk SALIMBENI narrates that,<br />
during an epidemic which raged in Italy in 1286, a doctorf<br />
opened the corpses of many persons who had died from 1<br />
the disease in order to find out its cause. During the great<br />
plague of 1348 several doctors made this attempt ;§ unfor-|<br />
tunately the results obtained were not of much value.<br />
There was also no hesitation in preparing by boiling and J<br />
maceration the bodies of celebrated persons for transport,<br />
when they died far away from their homes. This was done j<br />
Dello studio et dell' insegnamento dell' anatomia in Italia nel medio evo in the<br />
Kendiconti del R. istit. Lombardo, Milano 1873, ser. ii, vol. vi, p. 634.<br />
* A. BURGGRAEVE: Pre'cis de l'histoire de l'anatomie, Ghent 1840, p. 47.<br />
•*- MEDICI op. cit. p. 5 et seq. 10.<br />
t PUCCINOTTI: Storia della medicina ii, pars ii, 357.<br />
§ A. CORRADI: Annali delle epidemie in Italia, Bologna pro a. 1286 and<br />
1348.
TEACHING IN ANATOMY<br />
245<br />
in the case of the bishops, princes and nobles who in 1167<br />
came with the army of FREDERICK BARBAROSSA to the neighbourhood<br />
of Rome and succumbed there to a pestilence *<br />
and in the case too of the Emperor himself when he was<br />
drowned near Jerusalem in the river Saleph.f The corpse<br />
of LOUIS IX. of France who died in 1270 near Tunisf was<br />
treated in the same way; as also were the bodies of PHILIP<br />
THE BOLD and his Consort.§ Pope BONIFACE VIII. forbade<br />
this practice in 1300 || and in so doing robbed anatomical<br />
inquiry, precisely when it was starting afresh, of an aid,<br />
the loss of which was sensibly felt. MONDINO wrote that<br />
certain bones can only be properly recognized, after they<br />
have been prepared by boiling but that he did not so prepare<br />
them himself as he was fearful of committing a sin.f<br />
His commentator BERENGER of Carpi, indeed, says of him<br />
that he did not always offer resistance to this sin and, in<br />
spite of it, sometimes boiled human bones.**<br />
MONDINO, who practised the profession of teaching in<br />
Bologna, performed a great number of dissections.tt He<br />
himself states, in speaking on a certain occasion of the<br />
comparative size of the uterus in the young female during<br />
menstruation and in pregnancy, that in 1315 he dissected<br />
two female subjects.JJ His prosector OTTO AGENIO of<br />
Lustrula and a young lady ALASSANDRA GILIANI of<br />
Persiceto are said to have assisted him in his work.§§<br />
* G. H. PERTZ: Monum. Welforum ant. in Script, rer. German., Hannov.<br />
1869, p. 41.<br />
t BENEDTCTUS PETROBURG : Gesta regni Henrici II. in Script, rer. Brit. med.<br />
a>vi, London 1867, T. 49, Vol. ii, p. 89.<br />
X CORRADI op. tit. anno 1270.<br />
§ MURATORI: Rer. script, it. viii, 861.<br />
|| Deer, de sepulturis.—jTirf. also CORRADI: Dello studio dell* anatomia op.<br />
cit. p. 865.<br />
*|[ MONDINO : De anatomia auris.<br />
** Comment. Bonon. 1521, f. 510.<br />
tf Maltoties, as GUY VON CHAULIAC writes in his Surgery (i, 1, 1).<br />
XX MONDINO : de anatom. matricis.<br />
§§ Although AL. MACCHIAVELLI (Effemeridi sacro-civili, Bologna 1736, p. 60<br />
et seq.) says of the latter that she knew how to clean the blood-vessels even to
246 THE MIDDLE AGES.<br />
Practical instruction on the dead body was concluded in<br />
four lessons, as is stated by GuiDO DE CAULIACO, who<br />
had attended those of BERTUCCIO, a pupil of MONDINO.<br />
In the first lecture the organs of nutrition that is to say<br />
those of the abdomen were described "since these fall<br />
into decomposition most rapidly," in the second the membra<br />
spiritualia namely the thoracic organs, in the third 7 the<br />
membra animata (the brain) and in the fourth the extremities*<br />
In order to see and to study the ligaments, the<br />
cartilages, the joints, the larger nerves, etc., the bodies<br />
were dried for a considerable time in the sun, buried in the<br />
ground to putrify or placed in running water, sometimes<br />
in boiling water. Many anatomists, like the Magister<br />
RiCARDUS, considered such treatment of the human body<br />
to be " horrible " and preferred therefore to teach anatomy<br />
on the bodies of the lower animals. Others were induced<br />
to adopt a similar course not so much by a religious dread<br />
as by the circumstance that opportunities for dissection of<br />
human bodies occurred but seldom.<br />
Many doctors provided themselves with bodies, when they<br />
could not get them in a legitimate way, by theft. Thus a<br />
trial took place at Bologna in 1319 in which a teacher of<br />
medicine at that place and four of his pupils were charged<br />
with having taken home with them out of the grave the<br />
corpse of a man who had been hanged, for the purpose of<br />
dissecting it.f Such cases may pretty often have happened<br />
at that time. People countenanced this procedure, and ;<br />
while unwilling to give them freely, allowed the corpses to •<br />
be taken. " The laws against the desecration of graves<br />
were silent" as CORRADlJ says "without being abolished: |<br />
their minutest branches without tearing them and that she then filled them ;<br />
with a coloured fluid which after coagulating allowed the form of the vessels to<br />
be plainly seen, this statement is not confirmed by any ancient writer. It is<br />
ceitainly improbable that the art of injection was already known at a time when i<br />
anatomy was but little advanced. Cf. M. MEDICI op. cit. p. 28 et seq.<br />
* GUY v. CHAULIAC: Chirurgia op. cit.<br />
f MEDICI op. cit. p. 36, 427 et seq.<br />
X CORRADI op. cit. p. 642.
••*'W" "*"'"'<br />
TEACHING IN ANATOMY. 1 '*<br />
and the authorities interfered only if decided violence had<br />
been used or a great scandal raised."<br />
Only quite gradually was legal permission granted for<br />
dissection of the human body. The Senate of Venice<br />
in 1368 issued an order that a dissection should be per<br />
formed once a year in order that physicians and surgeons<br />
might inform themselves upon the relative position of<br />
the different parts of the body* The university of<br />
Montpellier was granted the right in 1375 of dissectingt<br />
every year the body of a criminal on whom the death<br />
sentence had been carried out, and the university of Lerida<br />
was in 1391 granted the same privilege by King JOHN<br />
I.| He decreed that the town authorities should deliver<br />
over for this purpose the corpse of -a criminal who had<br />
been put to death by forcible submersion in water, in order<br />
that the body should be completely uninjured. FERDINAND<br />
THE CATHOLIC permitted the physicians and surgeons at<br />
Saragossa to open the bodies of persons who died in the<br />
hospital there if they considered it would serve any useful<br />
purpose,§ and the Pope confirmed this permission in the<br />
case of the doctors of the Monastery della Guadelupe in<br />
Estremadura.|| The medical faculty at Tubingen received<br />
permission from Pope SlXTUS IV. in 1482 to dissect the<br />
bodies of executed criminals.^] In the statutes of the<br />
university of Bologna of the year 1405 it was enjoined<br />
"that no doctor or student of medicine, or anyone else,<br />
shall appropriate a corpse without permission of the<br />
Rector." On a dissection being held under the guidance<br />
of a professor, a definite number of students were invited<br />
* CORRADI op. tit. p. 635.<br />
t ASTRUC op. cit. p. 32.<br />
X GERMAIN op. cit. iii, 134.—DENIFLEO^. cit. i, S. 507.<br />
§ A. H. MOREJON: Historia bibliografica de la medicina espagnola, Madrid<br />
1842, i, 252.<br />
|| MOREJON op. cit. ii, 25. Unfortunately he does not say when this<br />
occurred.<br />
1 L. F. FRORIEP: Die anatomischen Anstalten zu Tubingen, Weimar 1811,<br />
Beil. i, 14.
248 THE MIDDLE AGES.<br />
to be present at it; no more than 20 might attend at the<br />
dissection of a male subject; at that of a female—a rarer<br />
event_no more than 30; so that everyone might see distinctly.<br />
No student was allowed to attend these demonstrations<br />
until he had attended medical lectures for two<br />
years. The Rector had to take care that all medical<br />
students in turn should have the opportunity of seeing<br />
dissections, and that the members of all student-corporations<br />
should be equally respected in receiving invitations<br />
to be present at them.. On this ground a rule was made,,;<br />
that no student who had seen the dissection of a male: j<br />
body should be invited a second time in the same year to a<br />
similar demonstration. If such took place in the following J<br />
year of studentship he was generally not again invited to<br />
the dissection of a male but only of a female subject, so<br />
that under favourable circumstances he might during his<br />
studentship assist at the dissection of two male subjects<br />
and one female. The students who were present had to ,<br />
bear the expense of getting, removing, preparing and burying<br />
the corpse; this, however, was not allowed to exceed<br />
16 Bologna pounds for a male, and 20 for a female body.<br />
Of this sum the professor who performed the dissection<br />
received 100 solidi. The members of the Teachers' College<br />
relieved one another in this function; no teacher was at<br />
liberty to decline the demand of the students that he should<br />
undertake the dissection of a corpse.*<br />
In 1442 it was ordained by law that the authorities or<br />
magistrates of Bologna should deliver over to the university<br />
every year two corpses, one male and the other female,<br />
or when the latter could not be obtained both male, for<br />
anatomical dissection. It was not here prescribed that<br />
the bodies should be those of criminals who had been<br />
executed, but it was left to the judgment of the magistrates<br />
to procure them in whatever way it was possible (quo modo J<br />
cumque fieri poterit); only they were not allowed to make j<br />
* Statut. dell' univ. di Bologna v. 1405, Rubr. 96, in CORRADI : Dello studio<br />
dell' anat. in Italia op. cit. p. 638 etseq. 647.
TEACHING IN ANATOMY. 249<br />
such use of the bodies of persons whose homes had been in<br />
Bologna* The same conditions obtained in Padua,<br />
Ferrara, and Pisa.f In general, care was taken to devote<br />
to anatomical investigation the bodies of criminals on<br />
whom the punishment of death had been carried out. The<br />
populace, as in the ages of antiquity, regarded the mutilation<br />
and cutting to pieces of the dead body as a desecration,<br />
to which one was at liberty to expose only those<br />
persons who, by their execrable crimes, had drawn general<br />
contempt upon themselves. As the demands of science<br />
increased, this method of getting dead bodies did not<br />
suffice, and people were obliged to find out how to procure<br />
them in other ways. But even then the principle was<br />
adhered to of employing for this degrading purpose (as it<br />
was thought to be in the opinion of the publie) only the<br />
bodies of strangers, or, if of natives, then only those of<br />
lowly origin. If in Pisa the dead bodies of the burgesses<br />
of the town, and of the students and doctors, with the<br />
consent of their relatives, were used for this purpose it was<br />
an exception, and is probably explained by the democratic<br />
spirit which prevailed there at the time.J<br />
Practical teaching in anatomy was developed in the<br />
universities of other countries at a later period, and to a<br />
much smaller extent than in the academies of Italy. Not<br />
until the 15th century were such demonstrations commenced<br />
in Paris. In Prague, anatomical dissections took<br />
place from the year 1460, after the medical faculty there<br />
had, by a present, come into possession of a house of its<br />
own.§ In Vienna, Professor GALEAZZO DI S. SOFIA, who<br />
had been called thither from Padua, instituted in 1404 the<br />
first anatomical demonstration, a male subject being given<br />
up to him for this purpose. It took place in the town<br />
hospital, and lasted eight days. At the conclusion the<br />
* Statut. v. 1442, Rubr. 19, in CORRADI op. cit. p. 648.<br />
t CORRADI op. cit. p. 638.<br />
X FABRONI : Hist. Acad. Pisan., Pisa 1792, T. ii, 73.<br />
§ HYRTI. : Geschichte der Anatomic in Prag., 1841, S. 9.
250 THE MIDDLE AGES.<br />
professor collected money from the spectators, which was<br />
poured into the chest of the faculty* Twelve years<br />
passed before the next public anatomical dissection took<br />
place; it was repeated again in 1418. To this demonstration<br />
doctors and students of medicine, surgeons,<br />
apothecaries and other persons of learning or distinguished<br />
position were invited. In 1433 a special lecturer) on<br />
anatomy was appointed, Dr. JOH. AiGEL, of Niirnberg.<br />
The faculty was in 1440 disappointed in its expectation of .<br />
an anatomical dissection in a singular manner. The body<br />
of a criminal, who had been hanged, was for this purpose<br />
given over to it; but when they were about to begin dissecting,<br />
the man came to life again. As a result of this he<br />
was pardoned, and sent away in charge of the beadle of<br />
the university to Alt-Otting, his home, in Bavaria, where<br />
he afterwards on account of fresh crimes died on the<br />
gallows. In 1452 for the first time in Vienna a female j<br />
subject was dissected ; only physicians and surgeons were<br />
allowed to be present. In the 15th century an anatomical 4<br />
demonstration on a corpse took place about once in every<br />
eight years. The statutes of the medical faculty at<br />
Tubingen of the year 1497 decreed that every three or four<br />
years a human body should be publicly dissected; on these<br />
occasions a professor had to read the descriptive account '<br />
from MONDINO'S Anatomy to the spectators. A similar<br />
course was adopted in the other German academies.<br />
It is not astonishing that under these conditions the<br />
science of anatomy made at that period no visible progress, j<br />
MONDINO'S anatomical work, the first produced since ancient<br />
times the author of which had dissected human bodies,,<br />
showed, nevertheless, no advance upon the position taken<br />
by GALEN. Resting on a teleological foundation, it gives<br />
about 80 pages of rather bare description to the position of<br />
the different parts of the body, i.e., the organs of the three<br />
great cavities of the body and to their presumed uses ; of the<br />
muscles, those only of the abdominal parietes are thoroughly<br />
* HYRTL : Vergangenheit und Gegenwart op. cit. S. viii.
PHARMACY AND MEDICAL PRACTICE. 251<br />
described; numerous notes upon diseases and operations<br />
on particular parts of the body, which are scattered about<br />
among the descriptions, indicate the purpose the book<br />
was intended to serve. At the same time it gained<br />
an extraordinary reputation, and formed for more than<br />
three hundred years the favourite text-book of anatomy.<br />
Neither did anatomical knowledge receive any noteworthy<br />
advancement from GuiDO DE CAULIACO, MATTH^US DE<br />
GRADIBUS, PETRUS DE ARGELATA, and their successors.<br />
The rough woodcuts which the Leipzig professor MAGNUS<br />
HUNDT added* to his work on anatomy cast a lurid light<br />
on the condition of anatomy in the 15th century. The<br />
anatomical drawings in the work of JOHANNES DE KETHAM'<br />
occupy a higher position, proceeding as they do in part<br />
from the hands of skilful artists like B. MONTAGNA.<br />
TEACHING IN PHARMACY AND IN MEDICAL<br />
PRACTICE.<br />
OPPORTUNITY was afforded for the study of medicinal<br />
plants in the gardens adjoining many of the monasteries.<br />
Many doctors moreover laid out gardens of this kind, as<br />
MATTH^US SYLVATICUS at Salerno, and the Magister<br />
WALTER in Venice, to whom the Senate assignedf a site<br />
for the purpose. But the universities at this period did not<br />
yet possess this valuable aid to teaching, and the knowledge<br />
of medicinal plants was chiefly communicated by<br />
theoretical teaching and by books which were sometimes<br />
embellished with botanical drawings. The students learned<br />
how to recognize drugs and how to prepare remedies in<br />
the dispensaries, which arose in all the larger towns from<br />
the 13th century onwards. STAINPEIS recommended<br />
students and young practitioners frequently to visit dispensaries<br />
with this object. FELIX PLATTERJ narrates<br />
* CHOCLANT op. cit. S. 24. t MEYER op. tit. iv, 255.<br />
X PLATTER op. cit. S. 151.
252 THE MIDDLE AGES.<br />
" that in addition to continual studying and attending of<br />
lessons in Montpellier he made a frequent practice of<br />
observing the preparation of all kinds of medicines at the<br />
dispensary," and he collected many herbs which he "neatly "<br />
wrapped in paper.<br />
The apothecaries got the greater part of their drugs<br />
from abroad, and a stirring trade developed in these articles<br />
in the middle ages, travelling from the East through Italy*<br />
In addition to medicaments, the apothecaries' shops contained<br />
other articles for sale, as various spices and aromatics,<br />
wax candles, paper, sugar, and sweets; in many .<br />
places, especially in Germany, the apothecaries carried on<br />
at the same time the trade of ginger-bread bakers, and<br />
were bound to send every year in Lent as a present to the<br />
councillors all kinds of dainties.f A contract dating from<br />
1424, in which an apothecary undertook to supply the<br />
necessary medicaments for the ducal Court at Este, gives;J<br />
us information concerning the drugs which at that time<br />
were kept in store in the dispensaries and were chiefly<br />
used.J This information is supported and completed by<br />
certain statements made upon the contents of a dispensary<br />
at Kosel, in Silesia, in 1417,§ and upon the drugs and<br />
medicaments which the apothecaries in Frankfort-on-the-<br />
Main sold in 1450.|| Certain drawings in the already «<br />
mentioned Dresden Codex, and in various early editions of<br />
medical works, give a clear picture of the arrangements of<br />
the dispensaries of that period. \]<br />
A<br />
* W. HEYD : Geschichte des Levantehandels, Stuttgart 1879, ii, 550 et ssq.<br />
t A. PHILIPPE: Geschichte der Apotheker, iibers. v. H. LUDWIG, Jena 1859, ,j<br />
i, S. 87.<br />
X A. CORRADI : Su i documenti storici spett. alia medicina, chirurgia, farmaceutica,<br />
in Annal. univ. di med., Vol. 273, Milano 1885.<br />
§ HENSCHEL in the Janus, Breslau 1847, "1 I S 2 -<br />
|| J. C FLUCKIGER: Die Frankfurter Liste, Halle 1873.<br />
If Cod. Galeni No. 92, fol. 181b, 182a, 193a, 265a, 266a.—CHOULANT in<br />
NAUMANN'S Arch. f. d. zeichnenden Kiinste, Leipzig 1855, Bd. i, 2, S. 264.—<br />
H. PETERS : Mittelalterliche Apotheken im Anzeiger des germ. Nationalmuseums,<br />
Niirnberg 1885, Bd. i, H. 1-2.—A. ESSENWEIN in d. Beil. z. Anz. d,<br />
germ. Nat., Bd. i, No. 11-12.
PHARMACY AND MEDICAL PRACTICE. 253<br />
The apothecaries in Italy and France as early as the 13th<br />
century formed confederacies, which framed their own<br />
laws and kept a strict watch to see that their rights were<br />
not encroached upon* In Germany the first apothecaries'<br />
shops are said to have been erected at Wetzlar in 1233, at<br />
Schweidnitz in 1248, at Wiirzburg in 1276, at Augsburg in<br />
1285, at Esslingen in 1300, and'at Frankfort-on-the-Main<br />
in 1343. In the 15th century, not only every considerable<br />
town, but many also of the middle-sized and small ones,<br />
had apothecaries' shops, as, for example, Znaim, Pressburg,<br />
Krems, Budweis, Olmiitz, Briinn, and Kuttenberg.f The<br />
education of the apothecaries was that of men training for<br />
a handicraft.! The works of NiCOLAUS MYREPSOS<br />
NICOLAUS PROPOSITUS, CHRISTOPHOR DE HONESTIS,'<br />
SALADIN of Asculum, QUIRICUS DE AUGUSTIS, and others<br />
served chiefly as the text-books.<br />
Before permission to practise their business was granted<br />
to apothecaries they had to undergo an examination in<br />
which their masters and some doctors put the questions.<br />
Superintendence of the apothecaries' shops and visits of<br />
inspection were duties assigned to the doctors, and at a<br />
later period were especially performed by the townphysicians.<br />
Instruction of a practical nature in the treatment of the<br />
sick was also, like practical treaching in materia medica, a<br />
task which the universities did not impose upon themselves.<br />
But we must not from this at once draw the conclusion<br />
that the students of that time as a general rule<br />
received no clinical instruction. Celebrated historians<br />
have formed this erroneous opinion because in the accounts<br />
which deal with the more ancient history of the academies<br />
and medical faculties little or nothing is said on the subject.<br />
Practical instruction in the treatment of the sick was inde-<br />
* A. CORRADI : Gli antichi statuti degli speziali in Annali univ. di med.,<br />
Vol. 277, Milano 1886.<br />
t STAINPEIS op. cit. f, 29.<br />
X STAINPEIS op, cit. f. 29b.
254 THE MIDDLE AGES.<br />
pendent of the universities "because the latter were not in<br />
connection with hospitals. When the student of medicine<br />
had passed his bachelor's examination he endeavoured to» '.<br />
educate himself in medical practice under the guidance of<br />
the teacher whose theoretical lectures he had attended, or<br />
of some other experienced doctor. For this purpose he<br />
accompanied him when he visited his patients, and took<br />
pains to get an opportunity at the hospitals of seeing how<br />
people were relieved in their sufferings, and of learning the<br />
art of giving such relief. As soon as he had acquired some<br />
knowledge of this subject he was allowed to assist and represent<br />
his master, and might begin, under the supervision and ^<br />
•on the responsibility of the latter, himself to treat the patie$£s. ,<br />
This method of medical education, which resembles that of .<br />
to-day, was recommended in the arrangement of. medical.*<br />
studies made by the Emperor FREDERICK II.<br />
The young doctors at Salerno were placed, as has been<br />
said, at the conclusion of the period of studentship. as ; * prescribed<br />
by law, under the supervision of an older pi»<br />
titioner for another year, as a necessary preliminary tqp.thl<br />
independent exercise of their calling.<br />
In the manuscript of GALEN belonging to the' 15th<br />
-century, preserved at Dresden, which has already been<br />
mentioned several times, numerous initial miniatures are<br />
found which refer to clinical teaching. Thus No. 93 fol.<br />
461b shows a picture of a patient suffering from marasmus, J<br />
and lying in bed ; near him stands a doctor dictating a pre-,;|<br />
scription to his pupils; two nurses are also present. The |<br />
illustration on fol. 565b represents a doctor demonstrating ><br />
to his pupils two patients whose legs are covered with ^<br />
ulcers. Fol. 468b shows a surgical operation on the leffJ<br />
which the pupil is performing in presence of his teacher^<br />
500b, the opening of an abscess in the axilla. In Co^TQg.<br />
fol. 268b is seen a clinical visit to children, and on fol. i*58al<br />
and fol. 295b naked pregnant women are represented!* ,.<br />
* Cf. also Cod. Galeni No. 92, fol. 7b, 17b, 43a, 75b, 121a, 128a, 208a, 224a. 1<br />
No. 93, fol. 458a, 471b, 475b, 482b, 496a, 504a, 535b, 560b.
PHARMACY AND MEDICAL PRACTICE. 255<br />
In Montpellier, where a hospital existed as early as the<br />
year 1198, it was usual for the students of medicine, after<br />
obtaining the bachelor's degree, to practise medicine under<br />
the guidance of an experienced physician. ASTRUC* brings<br />
forward several instances in the biographies of the earlier<br />
teachers of medicine at the school of Montpellier, where this<br />
system was observed and by no means looks upon them: as<br />
exceptions but as the general rule. The medical faculty of<br />
Paris in 1449 required of the bachelors that they should<br />
diligently visit the hospitals or accompany a skilful practitioner<br />
in his visits to patients and refused to grant them<br />
the license when this rule was not observed.f<br />
In the oldest statutes of the medical faculty of Vienna<br />
dating from the 14th century the rule is laid down that<br />
bachelors of medicine must practise the healing art within<br />
the walls of Vienna only with the knowledge and under the<br />
guidance of their teacher or of some other doctor of the<br />
fatuity of Vienna.J STEINPEIS gave the students excellent<br />
t^ice as to how they should act on these occasions.§<br />
o>ve all things, he says, it is important to find out the<br />
cause,of the disease ; then the ailing part of the body may<br />
be carefully inspected and finally the rest of the body submitted<br />
to a careful examination.<br />
At the university of Ingolstadt the bachelors of medicine,<br />
according to the statutes of 1472, were obliged to take an<br />
oath before the Dean that within the city and for six miles<br />
round they would visit the sick and practise only if sent as<br />
* ASTRUC op. cit. p. 236 (apres son baccalaureat it alia en Provence pour y<br />
exercer la medecine, suivant Vusage de ce temps-la), p. 243 (apres quoi it alia<br />
passer le temps, qu'il eloit alors destine pour s'exercer a. la pratique apres le<br />
baccalauriat), etc.— Cf. PLATTER op. cit. S. 154.—In the statutes of 1240 is<br />
fjp^id : Item nullus magisler presenlet aliquem (for the License) nisi We<br />
itekarit in practica extra villam Montispessulani per dimidium annum (in<br />
G^R^'AIN op. cit. iii, 424).<br />
:. t HAZON: Eloge historique de la faculte' de medecine de Paris, 1770, p. 20<br />
(qu'ils suivissent les hopitaux ou la pratique de quelque maitre pendant le cours<br />
de la licence, faule de quoi its n'etoient point admis a ce degre).<br />
\ J. ZEISL: Chronol. dipl. universit. Vindob. Vienn. 1755, Statut. p. 80.<br />
§ STAINPEI-S op. tit. f. 102b et seq.
256 THE MIDDLE AGES.<br />
the representatives of their teacher or of some other doctor ><br />
of the faculty of that place* They thus performed nearly<br />
the same functions as practitioners of our day at the poli-<br />
clinical institutions of many academies.<br />
In the middle ages there was no lack of hospitals in which fi|<br />
bachelors of medicine could find opportunities for acquiring, ^J<br />
practical education in the healing art. The great number of v<br />
these institutions must excite in us the more astonishment'<br />
inasmuch as only a certain proportion of them is known to us*<br />
The information which has reached us concerning them is in-<br />
complete and defective. So much of it as refers to Germany,<br />
or as deals with leper-houses has been collected by VlR-<br />
CHOW.t Besides this, rich material lies scattered in archives<br />
and libraries: many sources of knowledge are probably as<br />
yet undiscovered. It would be a thankworthy task, to write<br />
a history of the foundation and development of hospitals in<br />
the middle ages, and would cast many a ray of light upon<br />
the history of medicine and the general history of civiliza<br />
tion. Christianity had called into existence a number*of<br />
charitable institutions, as I have explained on a previous<br />
page. Wherever its doctrines were made known and found<br />
adherents, houses for the poor and infirm of all kinds arose<br />
by the side of churches and monasteries. The Christian<br />
missionaries, who travelled from Italy and France to the<br />
countries of Northern and Eastern Europe were carriers of |<br />
civilization, preaching humanity and spreading knowledge*f|<br />
—at least in so far as it did not come into conflict with<br />
their own interests. Christian charity celebrated imperish<br />
able triumphs in founding numerous clerical and lay Orders<br />
the members of which made the care of the sick the task of<br />
their lives. An enthusiasm of philanthropy filled all hearts •<br />
in a way seen but once in the history of the world. High<br />
born princesses and poor peasants, knights and burghers vied 1<br />
* C. PRANTL : Geschichte der Ludwig Maximilians-Universitat zu Ingolj?||<br />
stadt, Landshut, Miinchen 1872, i, 50. ii, 43.<br />
f VIRCHOW'S Archiv.»Bd*i8, S, I38r(l62>, 273-329.—Bd. 19, S. 43-93,-Bd.<br />
20., S. 166-197, 459-51 2 ' ,'C s
PHARMACY AND MEDICAL PRACTICE. 257<br />
with one another in works of mercy. It is quite possible<br />
that many were induced to consecrate their lives to the<br />
service of mankind, not so much by ideal love as by hopes<br />
of reward in the world to come, and other less noble influences;<br />
but is this a reason why their good deeds should<br />
have conferred fewer blessings ? The longing and striving<br />
after ideals, which men, discontented with the present<br />
believed to be realized in the supersensuous world of the'<br />
future, had an ennobling effect upon character, tempered<br />
harshness of manner and threw a charm round many an<br />
undertaking which otherwise might have seemed foolish or<br />
despicable. This feature of romance was peculiarly impressed<br />
on the aspect of the Crusades, in which a wild<br />
craving for adventures and low covetousness were associated<br />
with piety and simple faith. Even if the particular<br />
object of these military expeditions was not, or only tem<br />
porarily, attained,—the object namely of emancipating from<br />
the Muhammedan dominion that land, once the cradle of<br />
Christianity,—yet many results advantageous to the development<br />
of civilization accrued therefrom; for by means of<br />
, these wars commercial relations were opened up between<br />
the Orient and the Occident, the intellectual horizon of<br />
Europe was enlarged, and the feeling of mutual dependence<br />
was awakened among the Christians in their intercourse<br />
with people professing another faith. This feeling manifested<br />
itself in the foundation of hospitals and of Orders and<br />
united people differing in creed in a common work for the<br />
welfare of the sick.<br />
The large hospital which the Knights of St. John possessed<br />
in the 12th century in Jerusalem was able to accommodate<br />
2,000 patients. It consisted of numerous buildings supported<br />
by 124 marble columns as we are informed by the Knight<br />
Sir JOHN MANDEVILLE. Five physicians and three surgeons,<br />
who were appointed to this hospital, took charge of<br />
the medical service* In 1236 the Order possessed 4,000<br />
lodges which were distributed over the different countries<br />
* F. v. RAUMER : .Geschichte der Hohenstaufen, Leipzig 1858, vi, 439.
258<br />
THE MIDDLE AGES.<br />
of Christendom; but only a century later Pope CLEMENT<br />
VI complained that the distinguished Knights of the Order<br />
took more pleasure in beautiful horses and dogs, in banquets,<br />
fine clothes, gold and silver vessels and valuables of all<br />
kinds, and generally in the accumulation of riches than in<br />
the care of the sick and the giving of alms*<br />
The German Order also, having erected a large number<br />
of hospitals, disregarded, after the 14th century, more and<br />
more the care of the sick and preferred gaining political<br />
power by conquests in war.<br />
The Order of the Lazarists, which arose in Palestine and<br />
undertook the task of attending to the wants of lepers,<br />
founded a multitude of leper-houses.t When leprosy, as<br />
the result of improvements in hygiene and a more correct,<br />
diagnosis of the various ailments which people had up to<br />
that time included under the name, gradually diminished<br />
and become wholly extinct in certain countries- as early as<br />
the 16th century, the Knights of St. Lazarus felt themselves<br />
excused from their duty of nursing the sick.<br />
The civil societies for the care of the sick attached themselves<br />
more loyally to this task, even if some of these too<br />
degenerated at a later period.<br />
The Order of the Holy Ghost was a creation of Pope<br />
INNOCENT III., who had formed it as an instrument for -fl<br />
enabling him to bestow upon sick-nursing an organization j<br />
embracing the whole of Christendom.% As VlRCHOW says, it ,<br />
must needs impress us favourably and may help, at the same |<br />
time, to reconcile us to " this strong man who humbled the |<br />
Emperor and deposed kings; the unappeasable persecutor ;<br />
of the Albigenses," to note that he " yet looked mercifully<br />
upon the poor and the sick, and sought out the helpless ,<br />
and miserable." § The Order of the Holy Ghost is first<br />
* J. TAAFFE: The history of the holy military sovereign order of St. JOHN<br />
of Jerusalem, London 1852, ad ann. 1343.<br />
•j- F. v. RAUMER op. cit. vi, 534.<br />
t HURTER: Geschichte des Pabstes InnocenzIII., Hamburg 1842.<br />
§ VIRCHOW : Gesammelte Abhandlungen, Berlin 1879, ii, S. 24.'
PHARMACY AND MEDICAL PRACTICE. 259<br />
mentioned in a document of the year 1198 ; already at that<br />
time lt possessed two hospitals in Rome, one in Montpellier<br />
and seven others elsewhere in France. In 1204 the<br />
Hospital of the Holy Spirit, built by INNOCENT III was<br />
consecrated at Rome; the site on which it was erected is<br />
said to have borne the old Saxon Hospice at so remote a<br />
time as the 6th century under Pope SYMMACHUS * The<br />
Order of the Holy Ghost displayed extraordinary activity<br />
Even soon after its origin it erected hospitals at various<br />
places, as, for example, at Zurich, Halberstadt, Vienna<br />
Spandau, Breslau, Riga, Liibeck, Bremen, and Hamburg<br />
or undertook the direction of those, which previously<br />
existed as at Memmingen, Freiburg-im-Brisgau, Mainz, and<br />
Ulm. VlRCHOW has collected information concerning 1,4<br />
.hospitals of this Order in Germany, which, with a few<br />
exceptions, were founded in the 13th and 14th centuries f<br />
There existed, besides, many other hospitals conducted by<br />
other societies for nursing the sick.<br />
The foundation of charitable institutions followed the<br />
path taken by advancing civilization in Europe Italy<br />
France, Southern and Western Germany took the lead and<br />
the Northern and Eastern countries of our continent<br />
followed them. In order to form an opinion on this movement<br />
and its results in particular cases, it is best to fix one's<br />
eyes on a limited district. Thtiringen, Saxony, Brandenburg<br />
Pomerania, and Silesia-those countries, in fact<br />
which at that time formed approximately the boundaries of<br />
civilization-were, as early as in the 13th century, richly<br />
provided with hospitals and leper-houses ;J even small<br />
places, the names of which are scarcely mentioned in<br />
history, possessed institutions of this kind. In Silesia we<br />
hnd them in the following towns at the dates given —<br />
Breslau (1214), Kloster-Trebnitz, Neisse (1226), Neumarkt<br />
* C L. MORICHINI: Degli istituti di carita, Roma 1870 p QO-rn.,<br />
vius: Geschichte der Stadt Rom im Mittela.ter, Stuttgart^ f 4 6 ^ " ° '<br />
f VIRCHOW op. cit. ii, 45 et seql<br />
4 ''<br />
X VIRCHOW'S Archiv, Bd. ,8, S. 150 H seq., 275 et seq., 3IO H seq, fc
260<br />
THE MIDDLE AGES.<br />
(1334), Bunzlau (1261), Brieg .(1273), Glatz (1275),<br />
Miinsterberg (1276), Liegnitz (ia8o), Sagan (1283) Steuum<br />
(I29o), Ratibor (1295), G, Glogau (1296), Gorhtz (1298 ,<br />
Sprottau and Schweidnitz (1299), Beuthen (1302), Oels<br />
(l P 3o7), Frankenstein (1319), Freistadt 1320) Lowenberg<br />
1322 Leubus (1330), Strehlen (1347), Goldberg (1348),<br />
etc Certainly the references made to these are incomplete •<br />
and unprecise, but they give us a picture of the abundant<br />
preparation which had been made for the care of the sick. *<br />
It may be fairly assumed that in countries the civilization<br />
of which was older and of more advanced development, and |<br />
the wealth of which was greater, the arrangements made<br />
were certainly not worse, but probably better. Frankfort- J<br />
on-the-Main possessed in the 13th century three or four<br />
hospitals* The Katharinen-Hospital at Regensburg, |<br />
erected for the sick and infirm, had 250 patients m the ,<br />
middle of the 13th .century. Such a number formed<br />
certainly an exception at that time, for most of the hospitals,<br />
were small, and could take in only a few persons The,<br />
directors of the Regensburg institution drew attention to<br />
the fact that it was over-crowded, and that as a result he<br />
air was polluted and diseases were communicated to the<br />
healthy The extent to which want of cleanliness and<br />
unsanitary conditions prevailed in the 15th century at<br />
certain hospitals is indicated by the severe remarks which<br />
THOMAS PLATTER made concerning his sojourn in the<br />
hospital at Breslau.t , . j<br />
As yet, unfortunately, but little investigation has beenf<br />
made to what extent and in what way the hospitals 0<br />
the middle ages approached the subject of teaching medical ,<br />
students and young doctors. The erection of institutions j<br />
for the sick in many places was effected before the settle- -,<br />
ment in such places of scientifically trained doctors. bicK .-<br />
nursing thus generally precedes medical treatment.<br />
* G L KRIEGK : Deutsches Burgerthum im Mittelalter, Frankfurt a M.<br />
J868, i, S. 76 et seq.-W. STRICKER : Geschichte der Heilkunde in Frankfurt,<br />
**•» a. M. 1847, S. 129. ,gj^<br />
•j- PLATTER op. cit. S. 22. * ;vy
MEDICAL EXAMINATIONS. 26l<br />
MEDICAL EXAMINATIONS.<br />
THE medical examinations, which students of medicine<br />
had to pass, before being permitted to practise, had their<br />
prototype in the arrangements made by the Emperor<br />
FREDERICK II. at Salerno. In course of time however the<br />
place of the single examination, occurring at the conclusion<br />
of the studies, was taken by examinations for the degree<br />
of Bachelor, for the license, and for the degree of Magister<br />
or of Doctor. These academical degrees were apparently<br />
first introduced at Bologna and Paris. In Salerno and<br />
Naples they were instituted by CHARLES of Anjou in 1278<br />
and 1280, as appears from the documents cited by S. DE<br />
RENZI* All candidates for the degree of bachelor of<br />
medicine, were obliged to have attended medical lectures<br />
for two or three years and then to give proofs in an oral<br />
examination held before members of the medical faculty<br />
That they had acquired a general theoretical knowledge<br />
of the several branches of medical science. By a<br />
solemn act, the ''determination," in which the candidate<br />
discussed a scientific question which had been propounded<br />
to him, he was transferred from the class of the scholars<br />
into that of the " baccalarii " as they were called in the<br />
corrupt Latin of the middle ages. The word is by some<br />
commentators, associated with baculum, a stick, which is<br />
said to have been handed to the bachelors presumably as a<br />
token of their new dignity, f It may with greater prob<br />
ability be derived from bacca lauri: it recalls the crowning of<br />
poets with the laurel-wreath, of which mention is made in the<br />
history of the middle ages. After an interval of two or<br />
three years, which the candidate made use of to acquire<br />
more extensive education in his department of learning and<br />
especially practical training, the examinations which pre<br />
ceded the conferring of the license followed the bachelor's<br />
* S. DE RENZI : Storia docum. della scuola med. di Salerno, Doc. No 28*7<br />
291. ' "<br />
t DE RENZI :%>ria docum. della scuola med. di Salerno, p. 556.
262 THE MIDDLE AGES.<br />
degree. Before granting this it was required that the<br />
bachelor besides having attended lectures should have<br />
taken part in discussions, and should have been catechized<br />
by the professors on more than one occasion, should have<br />
given lectures himself, have assisted at anatomical demonstrations<br />
and have thoroughly trained himself in the<br />
practical art of healing. The examinations were moreover<br />
held by the medical faculty and consisted of the exposition<br />
of one of the aphorisms of HIPPOKRATES, the description ,<br />
of certain diseases and the answering of questions connected<br />
with these subjects. If the result was favourable,J<br />
the candidate was presented by two members of the<br />
faculty to the Chancellor of the University, who conferred<br />
the license upon him in a solemn manner.<br />
,. As the dignity of Chancellor was always vested in a high<br />
ecclesiastic who looked upon himself as the representative<br />
Of the Pope, the highest patron of teaching, it resulted that.<br />
this act took place in the Church. It bore therefore some-,.<br />
what of a religious character, which excluded members of<br />
other faiths, as for example Jews, from obtaining the license:<br />
but even at a very early period a way out of this difficulty<br />
seems to have been found, the granting of the license in<br />
such cases being transferred to the faculty* _ The doctors,<br />
who had in the examinations shown their fitness for<br />
medical practice and had received permission to practise,<br />
were called Masters or Magistri.<br />
After the title of Doctor had become usual among the<br />
jurists at Bologna t and had found entrance into all schools<br />
of law, the medical faculties began also to make use<br />
of it. The word "Doctor" occurs even in the litera<br />
ture of antiquity J and there indicates a teacher ( fron ><br />
docere). In this sense the title of Doctor was given also|<br />
i<br />
* DE RENZI op. cit. p. 558, 572. ., *<br />
t SAVIGNY op. cit. i, 476.—GRUNER'S Almanach fur Arzte, Jena 1789, b. |<br />
• 250 et seq. jj<br />
X CICERO : de orat. i, 19.—SUETON.: Caesar c. 42.—Valer. Maxim, n, 3--P<br />
QUINTILIAN : Instit.orat. xi, 3, xii, 2.—ERSQH and GRU&ER: Encyklop. sect. I, ;<br />
i Th.2-s,S.23fetseq. "*•
MEDICAL EXAMINATIONS. 263<br />
by the medical faculty to those who were actively engaged<br />
as teachers of medical science. This was the case at most<br />
of the academies as early as the 13th century. And as<br />
the right to teach was possessed by every medical man who<br />
was legally qualified for the practice of his profession, so<br />
also was the title of Doctor gradually conferred upon all<br />
legally qualified practitioners. When people began to<br />
distinguish between the Doctores legentes et non legentes,<br />
—between those who made a practice of teaching and<br />
those who neglected to do so—the custom arose of calling<br />
the former Professors.<br />
This expression also draws its origin from ancient times;*<br />
it comes from profiten "to practise or teach publicly an art<br />
or science." At the German universities the title "Professor"<br />
came first into vogue in the 16th century and only<br />
those academical teachers were designated by it who were<br />
commissioned to hold lectures and for the instruction they<br />
imparted in this way drew a salary or remuneration. They<br />
were in fact members of the College of Teachers, called,<br />
at an earlier time, Doctores legentes.<br />
The change in the significance of titles and forms of<br />
politeness, which is effected in course of time, has its<br />
foundation for the most part in human vanity. At the<br />
present time it is the case with the title of Professor as it<br />
formerly was with that of Doctor; it is bestowed on<br />
members of the medical profession who hold themselves<br />
quite aloof from the function of teaching, whereas many<br />
academic teachers are already less inclined to bea.r the<br />
title of Professor than such titles as Geheimrath, Hofrath,<br />
or Regierungsrath.<br />
Anyone who possessed a qualification to practise<br />
medicine could obtain the dignity of Doctor of Medicine.<br />
No special examinations were necessary for this ; on the<br />
other hand it was demanded that the candidate should be<br />
* CELSUS: Prsef. and ii, 6.—SUETON : Rhetor. 5.—QUINTIUAN : Inst. orat.<br />
Prooem, and i, 9. xii, 11.—SAVIGNY op. cit. i, 396.—H. CONRING: Antiq.<br />
acad. i, 24. - , >
264 THE MIDDLE AGES.<br />
of honourable and legitimate descent, of irreproachable<br />
character and respectability, at least 26 years old, without<br />
bodily defect or deformity. In some universities the age<br />
was fixed at 28 years, and a concession in respect of<br />
age was only allowed if the candidate did not look too<br />
effeminate and young. Persons who were misshapen or<br />
repulsively ugly were not allowed to take this degree,<br />
and, truly, for a singular reason, namely lest pregnant<br />
women seeing them might bear children with marks to<br />
correspond.<br />
The act of promotion was associated with a public discussion<br />
and various ceremonies which were intended to<br />
typify the acceptance of-the candidate into the medical.<br />
corporation, and to bring plainly before his eyes the high'<br />
significance of his new dignity. The ceremony was performed<br />
with the co-operation of the whole faculty, and<br />
amid the ringing of bells. It began with a discourse by<br />
the candidate for the doctor's degree, the merits of which<br />
were reviewed in a speech by the professor, who conducted<br />
the proceedings. The candidate then took an oath that he<br />
would always fulfil his duties to the faculty and the<br />
medical profession generally; hereupon the so-called ?<br />
' doctor's hat' was placed upon his head, a ring put on his *<br />
finger as a token of the knightly rank, to which the dignity j<br />
of doctor was considered equivalent, a golden belt fastened |<br />
on him, and a book of HIPPOKRATES opened before him. He |<br />
was then invited to sit down by the side of the President, j<br />
who, embracing him, conferred a blessing upon him. The<br />
ceremony closed with the thanks of the new doctor, andfj<br />
was followed by a banquet in which all members of the ]<br />
faculty took part. The expenses of this, in addition to .<br />
the fees which were paid and the presents which were i<br />
given to various persons, made the promotion to the degree ,<br />
of doctor a rather costly affair. In Vienna the candidate!<br />
was under the obligation of presenting one doctor of<br />
the medical faculty with a complete attire ; 14 ells of good<br />
cloth had to be used for this. For the rest, he was by no j
MEDICAL EXAMINATIONS.<br />
means forbidden to gratify several of his colleagues in this<br />
way. Moreover, every doctor of the faculty received a<br />
cap and a pair of woven gloves, every licentiate and<br />
bachelor a pair of ordinary gloves "in choosing which,<br />
however, the reputation and honour of the faculty are to<br />
be respected." *<br />
Similar demands were made at other universities. The<br />
expenses caused by the promotion to the higher degree in<br />
Paris reached the largest amount. Poor candidates for the<br />
Doctorate, if distinguished for their learning, were<br />
exceptionally excused the high charges and at certain<br />
academies this practice was carried out regularly at stated<br />
intervals, t Many were repelled by the charges connected<br />
with promotion from taking it, and were content to practise<br />
medicine as licentiates. The latter enjoyed in respect of<br />
medical practice the same rights as the doctors. The only<br />
difference between them consisted in this, that the doctors<br />
were accredited members of the faculty in the enjoyment of<br />
full rights, consulted together upon the business matters con<br />
nected with it, determined its laws, and shared in certain<br />
privileges. It was a characteristic feature of the Studium<br />
generate that the degree of doctor was of recognized value<br />
'in all countries of Christendom. It is true, that even in<br />
earlier times some limitations were imposed on this<br />
privilege; they, however, restricted not so much the<br />
right of practising medicine as a calling, in any and<br />
every locality, as they did the claim of an alien doctor<br />
to be received as a member enjoying full rights in the<br />
medical faculty of a university not his own. The faculties<br />
saw in promotion an important source of income, which<br />
was encroached upon if doctors who had received the<br />
higher degree in a foreign academy were without any<br />
further ceremony regarded as members of their own.<br />
Thus the doctors of Bologna in 1298 refused to receive a<br />
colleague—the son of a citizen of that town—into their<br />
* ROSAS op. cit. i, S. 35.—HAUTZ op. tit. i, 160.<br />
t COPPI op. cit. p. 204.
266 THE MIDDLE AGES.<br />
own society, because he had taken the degree of Doctor of<br />
Medicine in Salerno and was not yet 30 years old. He<br />
answered with some self-importance that he made up for<br />
the scarcity of his years by the abundance of his know- - ?|<br />
ledge* Between Paris and Montpellier continual quarrels j<br />
of this kind prevailed and such also was the case with other<br />
high schools. An end was only put to this state of things<br />
when it was arranged that doctors seeking admission into a ;<br />
faculty other than the one at which they had taken their •<br />
academical degree, should pass certain examinations, which |<br />
were for the main part mere formalities, and pay the ;<br />
regulated fees. Thus the medical men entitled to practise,<br />
who had received their theoretical education at the |<br />
universities, were divided into doctors and licentiates and<br />
were distinguished from one another not by attainments,lj<br />
but only by title.<br />
SURGERY AND MIDWIFERY.<br />
I<br />
IN the practice of their profession doctors were divided into |<br />
two classes, viz., those who dealt chiefly with internal, and<br />
those who preferred to treat, external diseases. The separa|j<br />
tion of surgery from internal medicine existed, as has been J<br />
explained on an earlier page, even in ancient times. This<br />
separation may therefore have been maintained also during<br />
the first centuries of the middle ages, without at the same<br />
time any absolute divorce existing between the representatives<br />
of the two branches. Being each equal to the<br />
other in the knowledge and skill required for practising<br />
them, so certainly they may have enjoyed in social life:<br />
an equal degree of respect. In the curriculum of study<br />
arranged by the Emperor FREDERICK II., the interdependence<br />
of these two branches of the healing art was prominently<br />
set forth and the medical schools of Salerno and;<br />
Montpellier gave due attention to surgery in their scheme of<br />
teaching and educated both categories of doctors. People<br />
MEINERS : Geschichte der hohen Schulen, Bd.ii, S. 267.
SURGERY AND MIDWIFERY. 267<br />
distinguished medical men as medici physici and medici<br />
chirurgi and by this probably wished to indicate that both<br />
classes possessed an equivalent technical education. The<br />
title physici was also used in the place of medici. Unfortunately,<br />
at a later period, most universities, following the<br />
example of Paris, neglected teaching in practical medicine<br />
and especially in surgery. Since at the same time the<br />
practice of surgery was' forbidden to the doctors who<br />
belonged to the priestly calling, the need of a class of<br />
practitioners, especially devoting their attention to the treatment<br />
of wounds, became very manifest. To this was added<br />
the fact that the wars and standing feuds between small<br />
territorial lords, the Crusades, and especially the great<br />
pestilences which devastated countries in the middle ages,<br />
afforded the proof that the doctors at hand were neither<br />
in numbers nor knowledge equal to the requirements. These<br />
circumstances favoured the formation of a surgical profession,<br />
which really only in the 13th century assumed a<br />
decided shape.* It was composed of doctors and licentiates<br />
of medicine, who had strongly pronounced inclinations<br />
or gifts for surgery, of practitioners to whom the<br />
acquisition of an academical degree was denied on religious<br />
or social grounds and of a multitude of empirics who had<br />
acquired a remarkable dexterity in the treatment of surgical<br />
ailments. Concealed in its ranks were individuals of widelyvarying<br />
scientific attainments.<br />
The surgeons of Italy and France as a general rule stood<br />
on an equal footing with the physicians of their native<br />
countries, respectively. They attended for some time the<br />
lectures at the university f and acquired a general scientific<br />
and practical training, which answered the requirements of<br />
the time. Many had at the same time the right of treating<br />
internal diseases and distinguished themselves in this branch<br />
as much as in surgery. The names of HUGO and THEO-<br />
* A. CHIAPELLI : Studii sull' esercizio della medicina in Italia negli ultimi<br />
tre secoli del medio evo, Milano 1885, p. 5.<br />
f COPPI op. cit. p. 199.
,268 THE MIDDLE AGES.<br />
DORICO BORGOGNONI, BRUNUS LONGOBURGENSIS, GULIEL-<br />
MUS DE SALICETO, LANFRANCHI, HENRI DE MONDEVILLE, 1<br />
GUIDO DE CAULIACO, PETER of Argelata, MARCELLO j<br />
CUMANO, L. BERTAPAGLIA and others belong to the most ]<br />
distinguished which the surgical literature of that time or •<br />
the history of medicine in general can show.<br />
The surgeons of Paris as early as about the middle of ,<br />
the 13th century formed a society, organized after the<br />
pattern of the medical faculty. It was named St. C6me<br />
after ST. COSMAS who was chosen for its patron saint.|<br />
The members of this society held meetings regularly atwhich<br />
they discussed business connected with the pro- j<br />
fession and the teaching of it, and imparted to their pupils \<br />
instruction in their art. The teaching was apparently for"<br />
the most part of a practical nature, the pupils accompanying<br />
their instructors in their visits to the sick, and there^<br />
learning the technical details of surgery. LANFRANCHI,-j<br />
who taught at the college of St. Come, performed opera-.|<br />
tions in the presence of his pupils and received their.|<br />
assistance in them. The pupils also assisted in the public ,<br />
and gratuitous relief of the sick which the members of J<br />
the college presided over, and visited the hospitals where<br />
their teachers held appointments. Certain of the pupils<br />
probably executed there the duties now performed by our 1<br />
sick-attendants and male-nurses. Besides this, they werefj<br />
admitted to anatomical demonstrations, if an opportunity : j{<br />
for such occurred. The students had, at the conclusion of :<br />
their studies, to undergo an examination, and as early as the j<br />
year 1254 the surgeons requested that examiners should be |<br />
appointed for this purpose. k<br />
An edict of PHILIP LE BEL of the year 1311 ordained j<br />
that nobody should engage in the practice of surgery whb|<br />
was not considered competent by the masters, and had?<br />
received a license permitting him to practise from thej<br />
king's body-surgeon.* Afterwards the students of surgery<br />
were obliged to take the degree of Magister Artium atthe^<br />
* BUCHEZ: De la faculte de meM. de Paris, op. cit. 1822.
SURGERY AND MIDWIFERY. 269<br />
university, and to attend some lectures of the medical<br />
faculty.<br />
In the year 1416 the College de St. Come was incor<br />
porated as a separate faculty of the university of Paris. Its<br />
pupils thus obtained a scientific education which was in no<br />
way inferior to that of the physicians. In spite of this<br />
they were not regarded as equal to them in social position.<br />
This tendency to place the surgical profession in the<br />
background, which was first apparent in Paris, originated<br />
partly in the already-mentioned circumstance that the<br />
clergy—who laid claim at that time to the highest position<br />
in social life —kept themselves aloof from it, partly in the<br />
fact that many uneducated people of the lower class were<br />
associated with the surgeons, but above all was the result<br />
of petty jealousies and quarrels with the medical faculty,<br />
which asserted an unwarrantable claim to a superiority in<br />
scientific attainments. The struggle between the physicians<br />
and surgeons continued until the beginning of the 18th<br />
century, and was prosecuted with a bitterness which<br />
resulted in deplorable excesses on both sides. The medical<br />
faculty of Paris in the year 1350 made it obligatory on its<br />
members and students to abstain from the practice of surgery<br />
and expelled those who contravened this prohibition*<br />
Finding too little humility and subjection among the sur<br />
geons, the faculty in 1372 brought to effect their design of<br />
giving barbers the right not only of letting blood but also of<br />
practising all so-called minor surgery—of treating ulcers<br />
and wounds, so long as they were not dangerous to life.<br />
And, indeed, the want may have arisen of a class of<br />
assistants to stand at the service of the physicians of that<br />
time, for the purpose of performing those minor services of<br />
surgery in almost daily request; for the specialists for<br />
wounds who had technical training were few in number and<br />
consequently much occupied. By these arrangements the<br />
boundary between the surgeons and the barbers, at no time,<br />
probably, insurmountable, was still further broken down.<br />
* A. F. THERY : Histoire de l'education en France, Paris 1858.
270<br />
THE MIDDLE AGES.<br />
The medical faculty of Paris endeavoured to render it easier I<br />
for the latter to become trained surgeons by inaugurating I<br />
lectures for them in 1491, which were delivered in the<br />
French language, and dealt with the various parts of surgery |<br />
and the art of operating* In fact, out of the condition of *<br />
barbers there arose a great number of surgeons, some of «<br />
whom by the introduction of improvements have rendered<br />
imperishable services to the healing art.<br />
In the other countries of Christian Europe surgery was in<br />
a more debased condition than in Italy and France. If the ;<br />
' "i<br />
Netherlander, JEHAN YPERMAN, in the 13th, and the English- \<br />
man, JOHN ARDERN, in the 14th 'century, far excelled in<br />
knowledge their colleagues in their respective countries,<br />
they owed this entirely to the circumstance that they had ,'<br />
received their technical education in France. In Spain only<br />
do more favourable conditions appear to have prevailed '<br />
for some time. In Saragossa the doctors were examined<br />
in surgery, and received the title of Medico-Surgeons; an<br />
arrangement which was not abolished until 1585^<br />
What kind of practitioners practised surgery in Germany,<br />
certain facts which are reported as having occurred at the<br />
end of the 12th century sufficiently indicate. When the<br />
Margrave DEDO VON ROCHLITZ UND GROIX had to accompany<br />
the Emperor HENRY VI., in 1190, to Italy, he feared<br />
the hot climate and the fatigues of the journey on account<br />
of his corpulence ; he summoned a doctor who straightway!<br />
laid open his body in order to extract the fat. It is notsur-|<br />
prising that the Margrave sank under this singular operation.J ;<br />
In 1195 LEOPOLD V., Duke of Austria, broke his leg through<br />
a fall from his horse, and in such a way that the broken ends<br />
of the bone protruded through the skin. His doctors treated<br />
him with plasters and medicines until mortification set in.;<br />
They refused to submit the limb to amputation, although;'<br />
* HAZON : op. cit.<br />
t V. DE LA FUENTE: op. cit. ii., p. 479.<br />
X Chron. mont. seren, ed. ECKSTEIN in the Progr. d. latein. Hauptschule zu<br />
Halle, Halle 1844, p. 53.
SURGERY AND MIDWIFERY. 271<br />
the patient desired it. One of his servants at last performed<br />
the operation, but the result, as might have been expected,<br />
was- unfavourable. The duke died on the following day*<br />
Temerity and cowardice, the offspring of ignorance, were<br />
the peculiarities which distinguished the great majority of<br />
the German surgeons of that time. Even the Biindth-<br />
Erzney of the German knight, HEINRICH VON PFOLSPRUNDT,<br />
the most prominent surgeon produced by the Fatherland in<br />
the 15th century, cannot be compared with the surgical<br />
works of the Italians and French; for it was really nothing<br />
more than an introduction to bandaging and to the treatment<br />
of wounds and external injuries.<br />
In no country was surgery during the middle ages able<br />
to rise to the height it attained in ancient times. We certainly<br />
find in the writings of certain surgeons remarks<br />
which display a correct knowledge of the tasks of surgery,<br />
an excellent gift of observation and a rich experience, but<br />
the keynote of these works was that intellectual feebleness<br />
which characterized the whole age. T. BORGOGNONI<br />
recommended a treatment of as simple a "kind as possible<br />
and referred to healing per primam (by first intention).f<br />
Among the methods of arresting haemorrhage, ligature was<br />
mentioned by LANFRANCHI and others. LANFRANCHI<br />
endeavoured to advance the diagnosis of fractures of the<br />
skull and confined the operation of trephining to those<br />
cases in which the brain was implicated in consequence of<br />
depressed fragments. J GuiDO DE CAULIACO (Gui de Chauliac)<br />
wrote that the wounded man on holding a metal rod<br />
between his teeth and touching it feels a pain in the skull at<br />
the situation of the fracture. He also gave the precise indications<br />
for trephining and described the operation.§ He<br />
avoided amputation : if mortification invaded an extremity,<br />
* WILLIAM OF NEWBURGH: Hist. rer. Angl. lib. v., c. 8, in Rer. brit. med.<br />
aevi script., Vol. 82, Pt. 2, p. 432 et seq., London 1885.<br />
t Chirurg. ii, c. 27.<br />
X LANFRANCHI : Chir. parva, c. 7.<br />
§ G. DE CAULIAC: Ars chirurg. tr. iii, doctr. 2, cap. 1, Venet. 1546.
272 l ric ;c...,c,.. ...<br />
he Waited until aline of demarcation was formed at the next j<br />
'joint and the mortified part separated itself from the limb of'l<br />
its own accord* In the treatment of fracture of the thigh.1<br />
he employed long-continued extension of the limb which he<br />
sought to effect by means of a weight suspended to a cord<br />
which ran over rollers.t The bandages which were used to<br />
apply to broken extremities were smeared with white of,,<br />
egg which after coagulating gave fixation—of a kind—to',-1<br />
the limb.J The cesophagus-tube was known and was<br />
used for artificial feeding.§ Fistulae were enlarged by<br />
gentian root or converted by the knife into open wounds.||<br />
In the operation for rectal fistula JOHN ARDERN enjoyed a<br />
great reputation.^ Ruptures were treated by long-continued<br />
lying on the back or by trusses.** Herniology<br />
underwent essential improvement at the hands of GuiDO<br />
DE CAUL1ACO who distinguished the various forms of<br />
* hernia according V the outlet involved, and separated!<br />
varicocele, hydrocele and sarcocele from hernia of every,<br />
kind.tt Endeavours were made to effect the radical cure by<br />
cauterizing the outlets after the replacement of the pro.<br />
lapsed intestine. The removal of the testis which was<br />
resorted to in scrotal hernia was only undertaken by the,<br />
wandering empirics: .Even lithotomy, which was performed!<br />
after the method of CELSUS, lay in the hands of specialists j<br />
of this kind. In strictures of the urethra bougies of wax,<br />
tin or silver were employed. In diseases of the bladder^<br />
and in gonorrhoea JOHN ARDERN ordered injections^ Cer^l<br />
tain descriptions of ulcers and gangrenous destruction of|<br />
* Id. op. cit. tr. vi, d." I, c. 8. j<br />
+ Id. op. cit. tr. v, d. i, c. 7 (adpedem ligo pondus plumbo transeundo ckordam^<br />
super parvam polfgeam'; itaque tenebit tibiam in sua longitudine.)<br />
X Id. op. cit.tr. v, d. i, c. i.<br />
§ M. C. BROEKX : La Chirurgie de M. J. YPERMAN in the Annal. de 1 acad.<br />
d'arche'ol. de Belgique, Anvers 1863, p. 128-326.<br />
|| G. DF. CAULIAC op. cit. tract, iv, d. 1, c. 5.<br />
If A. GORE in the Dublin Journal of Medical Science, 1883, p. 269 et seq. ' |<br />
** BROEKX : YPERMAN op. cit., p. 178.<br />
tt G. DE CAULIAC op. cit. tr. vi, d. 2, c. 6, 7.—E. ALBERT : Die Herniologie'd.<br />
Alten, S. 161 et seq.
SURGERY AND MIDWIFERY. 273<br />
4 the sexual organs refer most probably to syphilis and<br />
-Venereal affections. The story that. YPERMAN healed<br />
numerous " leprous '.' persons with a mercurial ointment<br />
throws a strong light on the more ancient history of syphilis,<br />
as to ,which it was erroneously assumed for a long, time<br />
that it came into general prevalence only at the end of<br />
the 15th century* Indeed this remedy was then generally<br />
used for ulcers and skin diseases.t GuiDO DE CAULIACO<br />
advised that intractable ulcers should be treated by laying<br />
on them a plate of lead on which mercury had been rubbed.<br />
In carcinoma he recommended the actual cautery and<br />
sublimated arsenic!<br />
.Surgery gained an important advantage by the revival of<br />
plastic operations which, as has been stated previously, were<br />
known in ancient times. At Norcia and Preci in Calabria the<br />
members of several families gave constant attention to the<br />
1 " performance of particular surgical operations for instance<br />
herniotomy, lithotomy, the operations for cataract, etc.<br />
Here arose the -first knowledge of the rhinoplastic operation.<br />
The surgeon BRANCA, who practised at Catania in<br />
Sicily at the commencement of the 15th century, excited<br />
a legitimate astonishment by the art with which he<br />
.replaced lost noses and lips by adaptation of neighbouring<br />
parts of the skin of the face.§ His son ANTONIO, also,<br />
possessed considerable skill in the same art; but, afterwards,<br />
instead" of the skin of the face a suitable portion of<br />
the skin of the arm was used to replace the loss of sub-<br />
, Stance. This, procedure came by degrees to be known<br />
among surgeons and even reached Germany, as is clear<br />
t from PFOLSPRUND<strong>T'</strong>S book.<br />
Mention must not be omitted of the fact that already at<br />
* BROEKX: YPERMAN op. cit. p. 145.<br />
f Annals of Waverley in ALF. CORRADI: Nuovi documenti per la storia'<br />
delle malattie veneree in Ann. univ. di med. Milano 1884, vol. 269, p. 289.<br />
X G. DE CAULIAC. : op. cit. tr. iv, doctr. 2, c. 6.<br />
BARTH. FACIUS: Devirisillustr. Florent. 1745^.38.—E. ZEIS: Geschichte<br />
der plast.. Chirurgie, Leipzig 1863, S. 188 et seq.<br />
T
274<br />
THE MIDDLE AGES.<br />
this time anaesthetic inhalations were made use of in great j<br />
surgical operations. They are mentioned first in the Antidotarium<br />
of NlCOLAUS PROPOSITUS; for this purpose a<br />
new sponge was used, which having been saturated with<br />
solutions of narcotic substances, for instance, opium, hyoscyamus,<br />
etc., was dried in the sun and before use was placed<br />
in hot water; it was then held to the nose of the patient j<br />
when the rising vapours reduced him to a condition of<br />
stupefaction and unconsciousness of pain.*<br />
The-treatment of diseases of the eyes lay for the most<br />
part in the hands of empirics who attempted by ointments<br />
and medicaments to effect their cure. The best ophthalmic ^<br />
surgeons belonged, as A. BENEDETTI says, to the Eastjf<br />
from thence BENVENUTUS GRAPHEUS and others came to<br />
Europe and by their art achieved great success. The<br />
operation for cataract was carried out by depression of<br />
the affected lens as in ancient times : GUIDO DE CAULIACO<br />
says that, in order to prevent it rising again the lens should ;<br />
be held down during the recital of three paternosters or<br />
one miserere.%<br />
In the middle ages it fared even worse with midwifery<br />
than it did with ophthalmic practice. The doctors who<br />
belonged to the priesthood, did not venture to engage in it, j<br />
that they might be preserved from undue familiarity with ;<br />
women, and other practitioners did not concern themselves<br />
with it. Ignorance, idleness, and other causes prevented-\<br />
the doctors from practising midwifery. They were called<br />
to parturient women only when it was a question of removing<br />
a dead foetus from the uterus or of extracting a<br />
retained placenta. Medical interference was as a general<br />
rule limited to these two tasks, in this province. GuiDtij<br />
DE CAULIACO says in his work upon surgery that he is<br />
unwilling to dwell at length upon midwifery, seeing that as<br />
* G. DE CAULIAC.: Chirurg., tr. i, doct. i, c. 8.—A. CORRADI : Escursioni<br />
d'un medico nel Decamerone, inAtti dell'istituto Lombardo, 1878, p. 127 etseq.<br />
•(• A. HIRSCH : Geschichte der Augenheilkunde op. cit. S. 295.<br />
J G. DE CAULIAC op. cit. Ir. vi, doctr. 2, c. 2.
SURGERY AND MIDWIFERY. 275<br />
a rule it is practised by women. It is true that in the work<br />
on natural science by THOMAS CANTIMPRATENSIS and in<br />
the Breviarium attributed, perhaps incorrectly, to ARNALDUS<br />
DE VlLLANOVA, allusion is made to turning by the head<br />
and feet,* and GUY also speaks of the conversion of an<br />
abnormal presentation into a normal one ; but it is impossible<br />
to decide how far these remarks rest upon literary<br />
reminiscences or how far they are the result of private<br />
experience. If the mother died before delivery Cesarean<br />
.section was performed in order if possible to save the life<br />
of the child. In certain cases the operation was even performed<br />
during the mother's life. The bishop PAUL of<br />
Merida, celebrated for his medical skill, who lived as<br />
early as in the 6th century, removed a dead child by an<br />
incision in the abdomen in a case of extra-uterine fcetation.f<br />
In 1350 a pregnant woman of Medingen in Swabia was<br />
condemned to death for having, as was supposed, stolen<br />
three consecrated hosts to sell to the Jews ; Csesarean<br />
section was performed on her before she was burnt.J As<br />
a rule, midwives undertook the duties of midwifery and the<br />
manual interference required during the birth of a child.<br />
They probably learned their art as a handicraft. Their<br />
medical knowledge differed much in different countries. In<br />
Italy and France some among them elevated themselves<br />
into becoming female doctors, and extended their knowledge<br />
over the whole field of medical science ; in Germany<br />
they were seldom more than well-practised nurses, who<br />
had amassed some experience iri midwifery. At first it<br />
was not demanded of them that they should submit to<br />
examinations. Public opinion, in this case represented by<br />
the most respectable women of the place, pronounced<br />
judgment upon their ability. These also exercised a<br />
certain control over the midwives. Afterwards, the mid-<br />
* ARNALD DE VILLANOVA: Breviarium, lib. iii, c. 4.<br />
t C. F. HEUSINGER in the Janus i, 764 et seq.<br />
X G. LAMMERT : Volksmedicin u. medicin. Aberglaube in Bayern, "Wiirzburg<br />
1868, S. 12.
MEDICAL PROFESSION AND LITERATURE. 277<br />
that in the exercise of his calling he puts an end in a<br />
summary manner to all the afflictions a man has to bear,<br />
but as a matter of fact the hangman, performed medical<br />
services, in dressing the wounds inflicted by the rack,<br />
reducing the joints which had suffered dislocation, etc. In<br />
most countries, certainly, medical practice was only<br />
permitted in the case of those who had given proof of<br />
their ability by successfully passing examinations.<br />
Quackery was forbidden in Paris as early as in the year<br />
1220. Infringements of this law were severely dealt with as<br />
the reports of a trial, in the year 1311, which originated in<br />
circumstances of this nature, sufficiently indicate.* It was<br />
a matter of excommunication. In Vienna also, people of<br />
this kind were excluded from participation in the sacraments,<br />
f At the same there was no lack of charlatans of<br />
either sex. And, indeed, it occurred not unfrequently that<br />
empirics who had received no systematic medical education<br />
received testimonials and diplomas from high lords and<br />
magistrates, if they attained to success in practice, and a<br />
scarcity of doctors prevailed.<br />
A probable estimate may be formed of the value of<br />
medical fees if we take note of the payments sanctioned<br />
by law which were prevalent in certain localities. Thus in<br />
the 14th and 15th centuries at Venice, for each professional<br />
visit in ordinary cases of sickness 10 soldi were paid; in<br />
Milan the doctor might demand for every day of treatment<br />
12-20 soldi, for a night visit one ducat, and if called outr<br />
side the city, for each day 4-6 lire. J JOHN ARDERN<br />
demanded for the. operation for rectal fistula a fee of at<br />
least 100 gold sols. Rich and distinguished patients pre-?<br />
sented their doctors with large sums and estates, while the<br />
poor sought to pay their debt by a pair of fowls, eggs, or<br />
fruit. § The salaries which the physicians in ordinary and<br />
the medical officers of towns received, show, what a high<br />
value was placed upon medical services at that time. The<br />
* HAZON op. cit. X CHIAPELLI op. tit. p.- 29."'<br />
f ROSAS op. cit.i, 124 et seq. t § CHIAPELLI op. tit. p. 28.
278 THE MIDDLE AGES.<br />
dukes of Savoy, who, as is well known, cannot be classed<br />
amongst rich princes, gave their physicians in ordinary a<br />
yearly stipend of from 40 to 60 gulden; at the court of<br />
Naples they received, on the other hand, from 100 to 300<br />
ducats. In Prague the usufruct of several estates was<br />
assigned to the royal physicians in ordinary.<br />
The institution of the Archiatri populares, the paid<br />
medical officers of towns, was probably kept up in many<br />
towns of Italy without interruption from ancient times<br />
through the entire period of the middle ages. The Ostrogoths<br />
and Lombards received it from the Romans and most<br />
likely handed it on unchanged to their successors in the<br />
dominion of Italy. In Rome, as also in Denmark and<br />
Sweden, the name of archiater was used as a title for a high<br />
medical official even up to the most recent times.<br />
The duties of the town medical officers were these: to<br />
attend gratis the officials of the town and the poor of the<br />
town, to provide medical service for the town hospitals, to<br />
assist the magistrates as experts, and to accompany the<br />
citizens into the field in time of war; they also exercised<br />
control over the apothecaries' shops and licensed houses,<br />
and conducted the public sanitary service. At a later<br />
period in many places they also undertook the teaching of<br />
the lower class of attendants on the sick and examined<br />
them. In Venice there .were 12 physicians and 12<br />
surgeons appointed by the town; the former receiving<br />
from 15 to 100 ducats annual pay and the latter from 10 to<br />
130. Even smaller places devoted a regular sum to this<br />
purpose in their budget of expenditure. Treviso paid its<br />
three public medical officers 728 lire a year, Conegliano -J<br />
350 lire to physicians, 250 to surgeons, and Palermo granted<br />
to its two town doctors 50 ounces of gold a year.* In J<br />
Germany public medical officers were first appointed in the<br />
14th century. In an order of the Emperor SlGlSMUND,<br />
of the year 1426, it is said: "In every imperial town ;|<br />
there is to be a cnief-doctor; he is to be paid 100 gulden. \<br />
* CHIAPELLI op. cit. pp. 22, 31.
MEDICAL PROFESSION AND LITERATURE. 279<br />
A church must provide him with them. He is to physic<br />
when necessary each and everyone gratis and he must<br />
earn his pay by true and faithful service/'* Frankforton-the-Main<br />
had in 1348 a town doctor who received<br />
clothing and 30 curnocks of corn ;f there were afterwards<br />
three, their pay ranging between 10 and 100<br />
gulden. Doctors were also appointed for the troops, the<br />
hospitals, the monasteries, and particular prisons, and<br />
received regular pay.<br />
Doctors, especially medical officers of towns, enjoyed in<br />
many places freedom from taxation and other privileges.<br />
Some received, free of charge, the freedom of the city they<br />
had settled in. In social position they ranked with the<br />
nobility. The members of the medical profession belonged<br />
for the most part to the wealthy classes; among them we<br />
find names representative of the most distinguished families<br />
of Italy. On the other hand the surgeons, especially in<br />
Germany, as a rule had a tendency to issue from the poorer<br />
classes.<br />
Among doctors the Jews were very numerously represented.<br />
While, during the first centuries of the middle<br />
ages medical study languished in the Christian States<br />
of the West, it was the privilege of the Jews to derive<br />
instruction from their contact with Arabian civilization<br />
and from the investigation of learned Rabbis. It was<br />
not therefore surprising if they excelled their Christian<br />
colleagues in knowledge and skill. And thus it came<br />
about that especially in countries in which, as in Germany,<br />
medicine was very much neglected, the Jews were in<br />
the greatest request as doctors. Not only princes and<br />
ruling lords but even bishops and popes had Jewish physicians<br />
in ordinary; at most monasteries Jews were appointed<br />
as doctors, as ARNALDUS DE VlLLANOVA declares.^<br />
* MOEHSEN : Geschichte der Wissenschaften in Brandenburg, Berlin 1783, S.<br />
564.—P. FRANK : System der medicin. Polizei, Wien 1817, vi, 1, S. 174.<br />
t KRIEGK op. tit. S. 8.<br />
J.GUDEMANN : Geschichte des Enziehungswesens der Juden, Wien, i, S. 155.
280 THE MIDDLE; AGES.<br />
In Prague in the 12th century nearly all medical practicewas<br />
in the hands of Jewish doctors; and the same<br />
appears to have been the case at Avignon * In Frankforton-the-Main<br />
ADAM LONICERUS was the only Christiandoctor<br />
; all his colleagues at that place belonging to the<br />
faith of Israel.f This is partly explained by the fact that'<br />
most of the other learned careers were closed to the Jews.<br />
It is true, that at several Church Councils it was decreed<br />
that Christians should not seek advice from Jewish doctors ;<br />
the priests however did not regard themselves as included<br />
in this prohibition, which, for the rest, had but little effect,'if<br />
there was an absence or scarcity of doctors belonging to*<br />
the Christian faith at any particular place. When the waves<br />
of religious passion rose higher and the persecutions of the<br />
Jews began, the results became remarkable even in this<br />
walk of life. In the statutes of the medical faculty at<br />
Ingolstadt of the year 1472 the Christian doctors were forbidden<br />
to hold consultations with their Jewish colleagues^<br />
and in the regulations for midwives issued at Regensburg cj<br />
in 1451 it was set forth that" they might go to any woman<br />
in need of their assistance " except to a Jewess to-whom .<br />
they must not go." § ^<br />
The clergy were more and more deterred from medical* |<br />
practice both by the laws of the Church and by the increasing<br />
professional competition which confronted them'<br />
after the foundation of the universities. At the Councils<br />
of Rheims (1131), Montpellier (1162), Tours (1163), Paris<br />
(1212), at those of the Lateran (1139 and 1215) and also'by<br />
the decretals of the Popes ALEXANDER III. (1180) and<br />
HONORIUS III. (1219) medical practice and especially<br />
surgery were forbidden to priests. This prohibition was<br />
probably not obeyed, as it had so often to be repeated, or<br />
* J. v. HASNER in the Prager Vierteljahrsschrift 1866, Bd. 90.—G. BAYLE op.<br />
oit.\>. 68.<br />
f W, STRICKER: Geschichte der Heilkunde in Frankfurt-a-M., 1847, S. 68.',**,<br />
X PRANTL. op. cit. ii, 47.<br />
" §1 G. LAMMERT : Geschichte des biirgerlichen Lebens, Regensburg a880,. S. 2.89.<br />
: :
MEDICAL PROFESSION AND LITERATURE. 281<br />
in any case it was frequently eluded, stipends, dispensations<br />
* and many other arrangements offering even a direct<br />
invitation to ignore it. All the same, this much was accom<br />
plished, that priests at least held themselves aloof from per<br />
forming surgical operations and treating women..' On the<br />
other hand medical teaching was still at many academies<br />
left for some time in their hands. The reason being that<br />
sometimes benefices were associated with the position of<br />
teacher, and the tenure of these benefices presupposed the<br />
priestly character of, the incumbent. Thus for example H.<br />
LURCZ, professor of medicine at the University of'Vienna,<br />
was at the same time minister of Hohlfeld in Bavaria; he<br />
kept a substitute there and gave lectures himself in Vienna.t<br />
As a result of such conditions at many universities celibacy<br />
was demanded of the teachers of medicine. When in 1479<br />
the Elector PHILIP wished to install a layman as Professor<br />
of medical science in Heidelberg, the Academy protested<br />
because he was not a clergyman. This matter was only<br />
carried through after the Pope in 1482 had given per<br />
mission that laymen, even when married, might be created<br />
Professors of Medicine. J In Paris, where so much import<br />
ance was attached to celibacy that JEAN DE POIS was de<br />
prived of his license in 1395 because he had married, these<br />
rules were abolished in 1452 by Cardinal D'ESTOUTEVILLE.<br />
In many cases the matter was passed over in silence and the<br />
benefices given to candidates who could not satisfy all the<br />
provisions of the canonical law.§<br />
Clericalism made its predominating influence felt in<br />
every walk of public and private life. It triumphantly<br />
associated itself with all the intellectual efforts, which so<br />
numerously manifested themselves during the period of<br />
scholasticism. It dominated even the literature of natural<br />
* A. CORRADI in Rend. d. R. ist. Lomb. 1873, Ser. ii, v. vi, p. 863.<br />
f ASCHBACH op. cit. i, S. 410.<br />
X J. F. HAUTZ op. cit.<br />
§ PAULSEN in SYBEL'S histor. Zeitschr. Bd. 45, S. 310, 434.—HEFELE: Conciliengeschichte<br />
vii, 355. y-
282 THE MIDDLE AGES.<br />
science and of medicine. One purpose alone did this •<br />
literature serve—that namely of making science the foundation<br />
and support of theological dogma. The works on<br />
natural science of the 13th century bore an encyclopaedic<br />
character. The most prominent authors were ALBERTUS<br />
MAGNUS, Dominican monk and afterwards Bishop* of<br />
Regensburg, the Minorite BARTHOLOM^US ANGLICUS,<br />
the Frenchmen THOMAS. DE CANTIMPRE and VINCENT<br />
DE BEAUVAIS, the Italians BRUNETTO LATINI, the teacher<br />
of DANTE, and RiSTORiO D'AREZZO, and the German<br />
KUNRAT VON MEGENBERG. The Natural Philosophy composed<br />
by the monks of the Mainau Monastery belongs<br />
to this period. Medical literature in the strict sense was<br />
chiefly composed of writings explanatory of the works of<br />
the ancients and of the Arabian authors known by their<br />
Latin translations. Of this nature were the works of<br />
the following: TADDEO ALDEROTTI called FLORENTINUS,<br />
DINO and TOMMASO DI GARBO, BARTOLOMEO VARIGNANA,<br />
TORRIGIANO, GlACOMO DELLA TORRE, GIOVANNI and j<br />
MARSILIO DI S. SOFIA, GIACOMO DE DONDI, FRANCESCO<br />
DI PIEDIMONTE and JACQUES DESPARS of Tournay. Short<br />
extracts from the comprehensive therapeutic works of the<br />
Arabs arranged for the instruction of students and the use<br />
of doctors, and comparative tables, in a concise form, of the<br />
drugs in most frequent use, answered the requirements<br />
of the day. To this period belong the Clavis Sanationis<br />
of SiMON of Genoa, the medical Pandects of MATTH^US<br />
SYLVATICUS, the Aggregator Brixianus of GUGLIELMO<br />
CORVI, the Medical Compendiums of GlLBERTUS ANGLICUS<br />
and of the Scotchman GORDON and the writings of<br />
JOHANNES DE TORNAMIRA, of the Portuguese VALESCUS<br />
DE TARANTA, of NiCCOLO FALCUCCI, the Florentine, of<br />
MICHELE SAVONAROLA, ANTONIO GUARNERI and others.<br />
PETRUS DE ABANO, celebrated for his knowledge in natural<br />
science, took up a more independent position and in his<br />
Conciliator diferentiarum delivered a severe and, in some<br />
places, most destructive criticism upon the prevalent<br />
theories of medical science.
MEDICAL PROFESSION AND LITERATURE. 283<br />
About the same time the Englishman ROGER BACON and<br />
the Catalonian ARNALDUS DE ViLLANOVA asserted the<br />
claims of freedom in investigation and declared that the<br />
natural sciences and medicine had no assured foundation<br />
except in observation and experience. They opened thus<br />
a more independent and direct path for medical science,<br />
which became manifest in the writings of their disciples,<br />
especially at the schools of Montpellier and Prague and<br />
was shown in the numerous collections of clinical cases,<br />
which were composed in the 14th and 15th centuries.<br />
While holding fast to the prevailing doctrines they yet<br />
brought forward many a valuable observation of their own<br />
which served to enrich the science of medicine. Thus<br />
HUGO BENCIO described cases of periodical insanity, of<br />
spermatorrhoea, and of syphilis. MATTEO FERRARI DE<br />
GRADIBUS treated a student who suffered from writer's<br />
cramp, and observed paralysis of the facial nerve associated<br />
with distortion of the face, hallucinations of the sight and<br />
obstinate salivation. BAVARIUS reported upon a paralysis<br />
of the upper extremities combined with disturbance of<br />
speech and weakness of memory which was said to have<br />
followed a violent inflammation of the throat* HENRI DE<br />
MONDEVILLE and GuiDO DE CAULIACO saw cases of<br />
wounds of the brain with loss of its substance, without<br />
permanent disturbance of the intellectual faculties resulting.t<br />
Corresponding with the revival of an independent<br />
observation of clinical cases, there ensued a more<br />
energetic study of anatomy and more successful enterprise<br />
in surgery, as has been explained on a previous page.<br />
Other branches of medical science also underwent improvement.<br />
A remarkably rich balneological literature<br />
arose, which treated of most of the baths known at that<br />
time. Germany was dealt with among other countries.<br />
HANNS FOLZ, the barber and minstrel of Ntirnberg, in 1400<br />
* CH. DAREMBERG op.cit. i, p. 338 et'seq.<br />
f G. DE CAULIAC. op. cit. tract, iii, doctr. 1, c. 1.
THE MIDDLE AGES."<br />
composed a " little book of all the baths which are naturally<br />
hot." Many popular medical writings appeared at the<br />
same time, especially in Germany; such were the collections<br />
of recipes intended for household use or the; direct<br />
tions and rules for diet which were worked up after the<br />
pattern of the Regimen Salernitanum, as the Dispensatory<br />
of ORTOLF of Bavaria, the Garden of Health, which issued<br />
from Mainz, etc.<br />
The middle ages were, therefore, by no means' so destitute<br />
and devoid of intellectual equipment as they are represented<br />
to have been by many authors. A stirring life prevailed in<br />
all provinces of mental activity. If the results gained did<br />
not correspond to the pains and labour bestowed, the reason<br />
lay in the fact that the efforts to advance were made in a<br />
wrong direction or encountered obstacles they could not<br />
surmount. The yoke of scholasticism weighed heavily:<br />
upon science, and the authority of the Church pointed out<br />
to it goals which lay remote from its essential aims and<br />
which were not to be reached.<br />
END OF PART II.
III. MEDICAL TEACHING IN RECENT, TIMES.<br />
THE , CHARACTER OF THE SIXTEENTH<br />
J. . . CENTURY.<br />
IN proportion to the increase of knowledge and its<br />
.more extensive prevalence, the conviction gained ground<br />
that thought must be freed from the fetters which held it<br />
in check. What in the 13th century had been felt by only<br />
;a few select spirits and proclaimed by them with dauntless<br />
-.courage, at the end of the 15th century filled the hearts of<br />
•all- cultivated men. The impulse towards freedom and<br />
independence exerted an influence on all provinces of in<br />
tellectual life and formed the fundamental note which<br />
resounded in art as well as. in science, in religion no less<br />
than in politics.<br />
In the history of civilization movements of mighty import<br />
like those of the 16th century, do not arise suddenly but<br />
are the outcome of a long preceding activity. They exist<br />
long before they appear, they escape superficial observation<br />
and are recognizable only by the eye of knowledge. Like<br />
the seeds of plants which crowd the soil, they germinate in<br />
obscurity and shoot up only when their time has come.<br />
The origin of the efforts for reform of the 16th century<br />
dates far back in the middle ages. The history of this<br />
.struggle tells us of unsuccessful attempts, of fruitless toil,<br />
of hopes trampled underfoot, and of sacrifices sealed by<br />
blood. Even in the earlier centuries enthusiastic and<br />
devoted men fought for freedom of thought: but<br />
the combatants were isolated and were overpowered by<br />
their opponents. LUTHER and MELANCHTHON had their<br />
forerunners who suffered death for their convictions.
286 RECENT TIMES.<br />
The suppression of robber bands and attacks on the<br />
feudal system were prepared for and favoured by the<br />
development of an independent and well-to-do burgherclass.<br />
Art and science were recalled to the investigation<br />
of antiquity and the observation of Nature by the study of<br />
humane learning cultivated in Italy since the time, of<br />
PETRARCH. The artists freed themselves from the traditions<br />
of the middle ages and gave to the forms they<br />
portrayed a freer expression, which having been learnt in<br />
Nature's own school, was true and warmed men's hearts<br />
by sympathy.<br />
What the early times of the Renaissance did for art,<br />
was accomplished for science by the study of the original<br />
works of the Greeks and Romans and the commencement<br />
of an independent investigation of nature. In the schools<br />
of the middle ages the writings of the Roman classic<br />
authors had seldom been studied in the original texts; those<br />
of the Greek, never. The Latin which was spoken in<br />
teaching and in the daily intercourse between teachers and<br />
pupils was very different from the language of ClCERO or<br />
QuiNTiLlAN. The Greek language was nowhere brought<br />
into the domain of teaching and the knowledge of it was<br />
so rare that PETRARCH in 1360 was able to name scarcely<br />
ten men of learning in Italy who were acquainted with it.*<br />
In other countries there was at least no improvement upon<br />
this state of things. The literary works of antiquity were<br />
made accessible to the middle ages chiefly by Latin<br />
translations, commentaries, and abridgements which were<br />
generally prepared not from the originals but from renderings<br />
of these into Arabic. People attached little importance<br />
here to form and expression of speech; for these were not<br />
looked upon as means for education of the mind but were<br />
esteemed to be nothing but the worthless shell containing<br />
the rich treasure—the real object of pursuit. Even this<br />
however was not maintained pure and unadulterated ; for<br />
* G. VOIGHT : Die Wiederbelebung des classischen Alterthums, Berlin 1881,<br />
ii, 107.
THE SIXTEENTH -CENTURY. 287<br />
it underwent such alterations.*" as were in the age of<br />
scholasticism considered indispensable for preserving the<br />
sanction of the Church and the spiritual welfare of the<br />
-faithful. When people recognized that in this manner<br />
they did not attain to the full, unrestricted possession of<br />
the rich legacies of knowledge which ancient times had left<br />
behind them, they began once more to study the writings of<br />
antiquity in the form in which they were originally transmitted<br />
to posterity. The classical authors of ancient<br />
heathendom awoke to new life and in words of flame made<br />
known the greatness and the glory of the past. This<br />
occurred first in Italy where numerous remains of buildings,<br />
statues, and inscriptions reminded men of the civilization<br />
of the Romans. In that land a knowledge of true Latinity<br />
was again acquired, and from thence spread to other<br />
countries, in the 15th century.<br />
At the German academies professorial chairs for Latin<br />
eloquence and rhetoric were founded, the incumbents of<br />
which excited by their successful efforts in prose and verse<br />
the astonishment and envy of their contemporaries. At the<br />
same time the knowledge of the Greek language obtained a<br />
general prevalence in the circles of the learned. For this<br />
thanks are to a large extent due to the Greek refugees, who,<br />
after the conquest of their native country by the Turks,<br />
came to Italy and founded there a new home. CHRYSO-<br />
LARAS, GEORGIOS of Trebezond, THEODOROS GAZA, BES-<br />
SARION, CONSTANTINE LASKARIS, and others brought many<br />
valuable Greek manuscripts with them, and collected round<br />
them a circle of select pupils. At the courts of the<br />
Medici, those princes of Italy so pre-eminently susceptible<br />
to the attractions of art and science, a worship of Hellenism<br />
became developed which gathered around it the most prominent<br />
men of the state. Learned societies which were<br />
called Platonic Academies* made the cultivation of Greek<br />
literature the task of their lives. The bright forms of<br />
P. VILLARI : Nicolo Macchiavelli und seine Zeit, Deutsche Ubers.,<br />
Rudolstadt 1882, i, 147 et seq.
288 ... ..RECENT TIMES.;<br />
Greek life caused magical pictures to pass .before their<br />
minds' eyes of the serene felicity, of' man, and drew them<br />
away from the contemplation of the m ournfuL seriousness, of,<br />
Christian, renunciation which hated and condemned plea^<br />
sure. They elevated themselves to the ideals of. freedom '<br />
and of ancient heroic greatness, even if in regarding the<br />
wretched political circumstances of the. present they wepe,.<br />
pressed again to the earth. Thei writings, of. the wise ^<br />
men of. antiquity afforded them. abundant inspiration and j<br />
instruction ; .it was in these they discovered the foundation^. +<br />
of philosophy, law, mathematics, astronomy, geography,<br />
and physics, of the natural sciences and of medicine. , With<br />
the restoration of Greek and Roman literature there wa||<br />
disclosed a world of ideas and of endeavours which seem^cr<br />
fitted to step into the place of the now defunct forms of Jfe<br />
of the middle ages. The spirit of the age strugglingHo- 1<br />
wards a.modern development of civilization thought to §j|d #<br />
in it a serviceable wreapon for the great struggle with the<br />
Church and with scholasticism,—and was not deceived. #<br />
Certainly, humane learning was limited to a small circle; '<br />
but this circle comprised the intellectual elite of the nations.^<br />
The ideas of humane learning soon seized upon the minds.<br />
,of men with such force that no one could escape from them, *,<br />
not even those, who like the representatives of the Church .<br />
and of ecclesiasticism, must have discerned in them their *<br />
natural enemies. They found a friendly reception even at<br />
the Papal Court. NICHOLAS V- was their well-wishing<br />
friend and patron,, though probably more from personal<br />
vanity than from inward conviction. PlUS II., before*<br />
ascending;the Throne, and while still bearing the name of *<br />
../ENEAS SYLVIUS, had worked zealously in favour of their<br />
extension in Germany, and remained at all times their true<br />
disciple and their advocate both with tongue and pen. To<br />
be sure, their influence was manifested less in religion than a<br />
it was in art and in science. The Humanists, as a rule,<br />
avoided direct assaults upon the dogmas of the, Churchy<br />
And there was no fear that the jovial and sometimes even<br />
*.*
THE SIXTEENTH CENTURY.<br />
289<br />
rather frivolous gods of Greece would supplant the object<br />
of Christian worship as had perhaps been the wish of many<br />
representatives of humane learning, like PETER LUDER,<br />
BUSCHIUS, or ULRICH VON HUTTEN. The influence exerted<br />
by humane letters upon the Christian religion consisted<br />
chiefly in the fact that they provoked a comparison with<br />
the supernatural and ethical conceptions of antiquity, and<br />
thus rendered possible a more unbiassed judgment of the<br />
Christian doctrines.<br />
Art owed to antiquity a rich inspiration. The strictly<br />
limited circle of ideas belonging to the Jewish-Christian<br />
legend, which up to this time had almost exclusively formed<br />
material for artists, and which, by its continual repetition,<br />
gradually became monotonous, now received a welcome<br />
enrichment in the mythology of the Greeks and in the heroic<br />
history of Rome. The treatment of form now showed an<br />
unconstrained and bold character contrasting agreeably<br />
with the stiffness and clumsiness of the earlier periods. The<br />
figures—even those borrowed from the transcendental worlds<br />
of religious mysticism—now appeared in nearer sympathy<br />
with the feelings of mankind. Reflecting glory from ideal<br />
conceptions of the good, the beautiful, and the true, they no<br />
longer appeared to the eye as powers darkly threatening<br />
290<br />
RECENT TIMES.<br />
influence on other countries, especially upon Germany and<br />
the Netherlands as the names of ALBRECHT DURER, HANS<br />
HOLBEIN and LUCAS CRANACH testify. At Niirnberg the<br />
arts of the wood carver and the goldsmith reached high<br />
perfection. The free towns of Germany produced a race<br />
of citizens manifesting taste and intelligence in art and<br />
combining a more cheerful enjoyment of life with moral<br />
seriousness. Among them artistic and scientific efforts<br />
' found zealous disciples and representatives. In the field of<br />
science humane learning was cultivated chiefly by the<br />
learned societies which arose on all sides after the pattern<br />
of the so-called Platonic Academies. The Rhenish Society<br />
was the best known of them, among its members being<br />
such men as the learned Abbot TRITHEMIUS and WiLLiBALD<br />
PIRKHEIMER the patrician of Niirnberg, besides RUDOLF<br />
AGRICOLA, the poet CONRAD CELTES, JOH. REUCHLIN,<br />
ERASMUS of Rotterdam and others.<br />
The first result of the growing interest taken in Greek<br />
and Roman Literature was, that the manuscripts which had<br />
been handed down from former times were compared, and<br />
a text was furnished resting upon considerations of grammar^<br />
and of sense, which seems to have answered all requirements.<br />
This formed the commencement of the scientific<br />
treatment of philology which exerted such a very far-*<br />
reaching influence upon the development of the culture of<br />
the following periods. Philology played the part of the<br />
magician who set free the Dormant Beauty of science,<br />
locked in a sleep of a thousand years, and afterwards<br />
remained to her a fatherly protector watching her first<br />
steps with anxipus care. The sciences, and by no means<br />
least of all the natural sciences, have to thank philology<br />
that they hit upon the right method of investigation : for<br />
they learnt from it painful accuracy in sifting scientific<br />
material and severe criticism of results won.<br />
Td medicine also in its new form philology afforded<br />
essential service. -Editions of most of the medical authors<br />
of antiquity were prepared.. The doctors who devoted
THE SIXTEENTH CENTURY. 2£1<br />
themselves to this branch of literary activity, prepared<br />
themselves for it by a sound philological training; not a<br />
few of them were teachers of the ancient languages before<br />
they attached themselves to medicine. The knowledge of<br />
Greek passed in those days as a necessary piece of<br />
intellectual equipment for anyone laying claim to be called<br />
an educated doctor; just as to-day such an one is expected<br />
to understand the use of the microscope.<br />
If the literary activity of the doctors, kindled by the<br />
study of humane letters, developed in an unexpected manner<br />
and contributed to the extension of medical knowledge,<br />
thanks are in a large measure due to the art of printing<br />
books which was invented in the 15th century. This art<br />
came suddenly into existence, but not without a history of<br />
derivation from antecedent sources : for it was prepared for<br />
by the arts of wood-carving and copper-engraving and by<br />
the somewhat imperfect method of impression from fixed<br />
types perhaps introduced into Europe from China, and by<br />
other things. Nevertheless it was an extraordinary advance,<br />
when moveable type was first brought into use about the<br />
year 1440. By this the impression of extensive works<br />
and trade on a large scale were first rendered possible.<br />
To be sure printing had at first to contend with many<br />
drawbacks. It was a very tedious process and, consequently<br />
very costly. Thus for example the impression of<br />
the Bible—the first great work which proceeded from the<br />
Mainz press founded by GUTTENBERG and afterwards<br />
belonging to FUST-SCHOFFER—took n years and cost<br />
4,000 gulden before the 12th sheet was completed.<br />
Printing gradually attained to a wider prevalence in proportion<br />
to the improvements introduced into the art.<br />
DAREMBERG estimates the number of medical writings<br />
printed up to the year 1500 as about 800.*<br />
The new discovery exerted a mighty influence upon the<br />
intellectual movements of the 16th century. The pulpit,<br />
which up to this time had been the only place from which<br />
* CH. DAREMBERG: Histoire des sciences me'dicales, T. i, 313.
292<br />
RECENT TIMES.<br />
the people were addressed, now found a rival, ready to<br />
become, on occasion, an adversary. Liberal ideas here<br />
found an ally, and the struggle against the hitherto dominant<br />
authorities was carried on with serviceable weapons.<br />
But. the fullest significance of printing was in aiding the<br />
development of science ; for the acquisitions of the intellect<br />
could now be made easily accessible and become the common<br />
property of all. The study of the treasures of knowledge<br />
handed down from ancient times incited to a critical<br />
examination of their real foundation, and the special )<br />
investigation required led to the correction of old errors<br />
and the discovery of new facts.<br />
The reformation of science thus effected forms, with the<br />
corresponding change in religious and political life, the<br />
most remarkable phenomenon of an age characterized by<br />
the emancipation of individual opinion. These aims<br />
received unexpected furtherance by the discovery of<br />
America which at the end of the 15th century excited the<br />
wonder and astonishment of mankind. A population was<br />
there discovered like the inhabitants of Europe in bodily<br />
form and in spiritual nature, together with a civilization<br />
which bore many points of resemblance to the manners<br />
and customs of the old world. Neither the Church nor<br />
Antiquity had possessed any knowledge of these things,J<br />
any more than of the fauna and flora of the new continent.<br />
Disappointed in the two highest authorities known at that<br />
time, thinkers and philosophers became suddenly independent<br />
and compelled to trust to their own observations.<br />
Some decades after the discovery of America the first circumnavigation<br />
of the earth was made and with it incontestable<br />
proof was furnished that the earth was round. The<br />
Greek philosophers had already conjectured that its shape<br />
was spherical and ARISTOTLE considered it as certain; but<br />
LACTANTIUS and other Fathers of the Church * had contested<br />
this view and declared it absurd. Their authority<br />
sustained with this a serious defeat. The prestige of the<br />
* O. PESCHEL op. cit. S*. 96 et seq.—W. WHEWELL op. cit. i, 226 et seq.
THE SIXTEENTH CENTURY. 293<br />
Church was still more shaken when the heliocentric theory<br />
—said already to have been put forward by PYTHAGORAS—<br />
was established by COPERNICUS and KEPLER* The<br />
theologians combated this theory, knowing right well that<br />
with its acceptance, the earth would appear as nothing<br />
more than one of the countless luminaries which crowd the<br />
.firmament and that man—its inhabitant—would lose the<br />
dominant position claimed for him under the mode of<br />
regarding the universe professed by the Christians. The<br />
rivalry between the heliocentric and geocentric doctrines<br />
was also decided against the Church. It can be easily<br />
understood how by these events the belief in the inadequacy<br />
of the human understanding—a doctrine preached by<br />
scholasticism and supported by the authority of the<br />
Church—was undermined. Protestantism went farthest,<br />
by extending the right of man to form an opinion even in<br />
matters of theological dogma. On no department of<br />
intellectual work did the independence of mind thus<br />
acquired cause a deeper or more lasting impression than<br />
on the natural sciences and medicine.<br />
Mineralogy received scientific consideration for the first<br />
time. The doctor GEORGIUS AGRICOLA made an attempt<br />
to classify minerals into different groups on the basis of<br />
their external characteristics. Botany began to rise out of<br />
the dependent relations in which it stood with regard to<br />
materia medica and dietetics, and to assume the form of a<br />
science worthy of cultivation for its own sake. It was<br />
enriched by a multitude of descriptions of plants, and the<br />
flora of Europe, as well as that of the newly-discovered<br />
trans-oceanic countries, underwent close examination. Certain<br />
botanists undertook to separate plants into different<br />
departments according to definite points of resemblance,<br />
in order to facilitate the study of them. CONRAD<br />
GESSNER and A. CESALP1NI made use of the flowers and<br />
* WHEWELL op. cit. i, 381 et seq.—J. W. DRAPER : Geschichte der geistigen<br />
Entwickelung Europas, Leipzig 1871, S. 521 et seq. (' History of the intellectual<br />
development of Europe.')
294<br />
RECENT TIMES.<br />
fruit foi? this purpose, and were in consequence the precursors<br />
of LINNJ^-US. A new period also began in the<br />
history of zoology, inaugurated by the great work of the ;<<br />
. learned GESSNER. This not only contained all the facts<br />
which had been ascertained in this department of science<br />
during the preceding periods, but also a number of fresh<br />
observations. Other investigators chose certain classes of<br />
the animal kingdom as the objects of their study, as, for<br />
example, B. BELON in the case of birds, and RONDELET in<br />
that of fishes, and some again occupied themselves with<br />
the fauna of foreign countries. So, too, in physics and<br />
chemistry energetic activity prevailed. NICOLAS CuSANUS,<br />
the free-thinking Bishop of Brixen, and the great artist<br />
LEONARDO DA VINCI had already worked at physics with<br />
success* While mathematical science under HlERONY-<br />
MUS CARDANUS, TARTAGLIA—who discovered how to solve<br />
cubic equations—and others was improved, optics had made<br />
also material progress, for which thanks are due chiefly to<br />
GiAMBATTlSTA PORTA, the discoverer of the camera obscura,<br />
and to JOHANN KEPLER. Physics and chemistry, however,<br />
first achieved really important successes in the 17th<br />
century ; then first did they become invested with great<br />
significance in relation to medicine.<br />
EMANCIPATION FROM THE BELIEF IN. f<br />
AUTHORITIES IN THE SPHERE OF MEDICINE,<br />
AND THE PROGRESS OF SCIENCE. ^<br />
MEDICAL science underwent the same process of development<br />
as the other arts and sciences, as civilization advanced..<br />
It shook off the yoke of authority which rested only on<br />
tradition, and became independent. This fact appears<br />
natural and conceivable only in connection with the efforts.!<br />
which were then crowding the history of the time; apart<br />
from these it may, indeed, be impressed on the memory,<br />
but not on the understanding. The movements in the<br />
* POGGENDORF, op. cit. S. 113 et seq.<br />
H
THE PROGRESS OF SCIENCE. " 295<br />
direction of freedom were manifest ip all branches of<br />
medicine, and in some subjects, especially in anatomy,<br />
materia medica, surgery, and midwifery, obtained even in<br />
the 16th century remarkable results.<br />
In anatomy, men ceased to rely upon the infallibility of<br />
GALEN, and began to make independent investigations on<br />
,the dead body. GABRIELE ZERBI, in his anatomical<br />
description of the human body, already treated separately of<br />
bones, muscles, and vessels. He made mention of the oblique<br />
and circular muscular fibres of the stomach, and alluded to<br />
the puncta lachrymalia, the ligamenta uteri, etc.* AL.<br />
ACHILLINI noticed the ductus choledochus opening into the<br />
duodenum, and also the ileocaecal valves.t BERENGAR, of<br />
Carpi, corrected several mistakes of MONDINO, and is<br />
looked upon as the discoverer of the foramina of the<br />
sphenoid bone, and of the vermiform appendix ; moreover<br />
he referred to the fact that the thorax in men and the<br />
pelvis in women are in each case proportionately wider<br />
than in the other sex.J CANANI furnished an excellent<br />
description of the muscles, and was the first "to observe the<br />
valves of veins in the vena azygos.\<br />
All these investigators were surpassed in richness of discovery<br />
by ANDREAS VESALIUS, who may be called the reformer<br />
,of anatomy. He was descended from a German family which<br />
originally bore the name of WlTlNG, and transferred its home<br />
f from Wesel to Brussels. The investigations of VESALIUS<br />
^ embraced all parts of anatomy, and formed the basis for a new<br />
^system of anatomical teaching. || He explained the nutrition<br />
of the bones by means of the vessels of the periosteum and<br />
the vasa nutrientia, and was the first to point out that<br />
nerves penetrate muscles. In the vascular coats he distinguished<br />
two layers, of which the inner one was of firmer<br />
* MEDICI, op. cit. p. 43.<br />
+ BURGGRJEVE op. cit. p. 55.—MEDICI op. cit. p. 51.<br />
X CARPI : Commentaria cum ampl. addition, super Anat. Mundini, Bonon.<br />
IS 21 -<br />
§ AMATUS LUSITANUS: Curat, med. cent., Basil 1556, p. 84.<br />
|| BURGGRJ-EVE op. cit. p. 72 et seq.
296 RECENT TIMES.<br />
consistence than the outer, and composed of muscular fasciculi.<br />
He described the heart fairly accurately, its position,, j<br />
movements, and changes of form, and also the apparatus of<br />
the valves ; yet he was never able completely to get rid of<br />
the old mistake that the blood passes through the septum<br />
of the heart. But whereas in the first issue of his chief<br />
anatomical work in 1543 he expressed as yet ho doubt 1<br />
whatever on the subject, in the second edition of 1555 he,<br />
declared, being perhaps influenced by SERVET, that he<br />
could not understand how it was possible for the blood, even<br />
in very small quantity, to transude from the right to the<br />
left side of the heart through the thick, firm substance of the<br />
septum.* Important progress is shown in his description<br />
of the abdominal walls and of the stomach, the liver, and<br />
the male and female sexual organs. He was acquainted'.<br />
with the corpora cavernosa and the seminal ducts, refers<br />
to the vesiculae seminales, and discussed the changes which.<br />
the uterus undergoes in pregnancy. He devoted great care<br />
to the examination of the brain, drew attention to the<br />
distinction between the gray and white substance, and ,:<br />
noticed the corpus callosum, the septum lucidum, the A<br />
pineal gland, and the corpora quadrigemina.<br />
The discoveries of VESALIUS aroused an unprecedented<br />
amount of attention. Not only in medical circles was<br />
astonishment felt at the boldness with which he pointed out<br />
the erroneousness of what people had hitherto considered to *<br />
be true. Those who revered the ancients, and pinned their<br />
faith upon received authority, persecuted him in the most %;<br />
violent manner, headed by his former teacher SYLVIUS,<br />
who, making a poor enough joke upon his name, called 4<br />
him VESANUS,—a madman, who was contaminating Europe<br />
wdth his poisonous blasts.f The discoveries of VESALIUS , *<br />
were improved upon and extended in many directions by<br />
his contemporaries EUSTACH1US and FALOPPIUS. The<br />
* H. TOLI.IN in the Biolog. Centralblatt 1885, Bd. 5, S. 474 et seq.<br />
t JACOB. SYLVIUS: Vesani cujusdam calumniarum in Hipp, et Galen j<br />
depalsio, Paris 1551.
A<br />
i<br />
THE PROGRESS OF SCIENCE.<br />
former occupied himself with the structure of the kidneys,<br />
and made mention of the excretory tubes (ducts of<br />
BELLINI).* On the other hand, the discovery of the valve<br />
named after him at the opening of the vena cava inferior<br />
into the auricle is wrongly ascribed to him, for it was<br />
known at an earlier period. But he improved the knowledge<br />
of the organ of hearing, observed the tympanic<br />
muscles, the spiral form of the cochlea, and the trumpetshaped<br />
tube which bears his name to the present day; he<br />
also left an excellent description of the base of the brain.<br />
FALOPPIUS, the gifted pupil of VESALIUS checked with<br />
scrupulous care the discoveries of his teacher, correcting<br />
and 'completing them by a multitude of new facts.<br />
With VESALIUS he was the greatest contributor to the<br />
reformation of anatomy. He furnished valuable information<br />
upon the development of the bones and teeth, described<br />
the petrous bone more accurately, enriched myology by<br />
admirable descriptions of the muscles of the external ear, of<br />
the face, of the palate, and of the tongue, made explicit<br />
statements upon the anastomotic connections of certain<br />
blood-vessels, for instance of the carotid and vertebral<br />
arteries, and discovered the nervus trochlearis. We owe<br />
to him some advance in the anatomy of the organs of sense.<br />
He instituted accurate investigations upon particular parts<br />
of the organ of hearing and of the eye, by which he was able<br />
to give fuller information upon the ligamentum ciliare, the<br />
tunica hyaloidea, the lens, and other anatomical points. So<br />
too in the case of the female sexual organs ; the oviduct<br />
(known in anthropotomy as the Fallopian tube) has immortalized<br />
his name in anatomical terminology.<br />
Of the remaining anatomists of this period the following<br />
rendered services to the development of their science:<br />
INGRASSIAS, by his labours in osteology especially by his<br />
discovery of the stapes and of the inferior turbinated bone,<br />
ARANZIO, who made researches into the anatomy of the<br />
foetus, VAROLIO, of whom the pons reminds us, by his<br />
* BURGGR^VE op. cit. p. 2Qi et seq.
298 RECENT TIMES.<br />
examinations of the brain and nervous system, VOLCHER<br />
KOYTER by his contributions to the history of development<br />
and to pathological anatomy, FABRIZIO AB AQUAPENDENTE<br />
by the first complete description of the valves of the veins,<br />
CASSERIO by his labours upon the organs of voice and of<br />
hearing, ADRIAN VAN DEN SPIGEL who gave his attention<br />
chiefly to the liver, a lobulus of which still bears his name,<br />
SALOMON ALBERTI by his description of the lachrymal<br />
apparatus, and PETER PAAW who was the first to draw<br />
attention to the racial varieties of the skull.*<br />
The progress made by physiology at this period was not<br />
so great: which was but natural; for the existing facts of<br />
anatomy had to be firmly grasped before men could venture<br />
to ask the meaning of them. But at least, the fruitlessness<br />
of mere speculation was recognized and recourse was again<br />
had to the method of inductive investigation, already<br />
pointed out by ARISTOTLE. Thus EUSTACHIUS injected ;<br />
water into the renal arteries, with the object of studying<br />
the formation of urine.t<br />
Highly indicative of the complete change effected in the<br />
way of thinking among medical investigators are the words<br />
of REALDO COLOMBO, that a man learns more in one day by<br />
the dissection of a dog than by continually feeling the pulse<br />
and studying GALEN'S writings for many months together.J<br />
MICHAEL SERVET and REALDO COLOMBO, the prosector<br />
and of VESALIUS his successor in the professorship of Padua,<br />
were the first to correct the old mistake that the blood<br />
passes through the septum of the heart from the right side<br />
to the left, and hinted at the passage through the lungs.<br />
To which of the two the priority of this discovery belongs<br />
cannot be decided with certainty, although innumerable ;<br />
probabilities point to SERVET. § For the rest, neither the<br />
* K. SPRENGEL: Versuch einer pragmat. Geschichte der Arzneikunde,.<br />
Halle 1827, iii, 64 etseq.<br />
t BARTH. EUSTACHIUS: De renum structura, Vend. 1564, c. 37, 46.<br />
+ REALDO COLOMBO : De re anatomica, Venet. 1559, lib. xiv, p. 258.<br />
§ H. TOLLIN in the Deutschen Archiv f. Gesch. d. Med., Bd. vii, i88^,S.<br />
171 et seq., and in VIRCHOW'S Archiv, Bd. 91, S. 39 et seq.
THE PROGRESS OF SCIENCE. 299,<br />
one nor the other stated clearly and unequivocally how the<br />
passage of the blood is effected from the • pulmonary artery<br />
to the pulmonary veins. The triumphs of physiology did<br />
not begin until the 17th century, when experimental investigation<br />
was crowned with success by the discovery of the<br />
circulation of the blood.<br />
The progress made in anatomy was bound to exert a<br />
stimulating and helpful influence upon surgery, as being the<br />
branch of medicine chiefly concerned with the structure of<br />
the human body. The methods of operating employed by the<br />
surgeons of antiquity were partly forgotten, or only practised<br />
by a few who preserved the knowledge of them as a secret which<br />
they transmitted to the narrowestcircle of theirfriends. Itwas<br />
thus necessary that they should be discovered afresh, which<br />
task was accomplished by certain gifted practitioners who<br />
were led to this work by the need of improvement in the<br />
methods hitherto used. The revival of the study of ancient<br />
writings had but a limited effect in this direction, for the<br />
unlearned wound-doctors were, as a general rule, not at all<br />
in touch with literature, and the educated doctors frequently<br />
lacked the practical knowledge necessary to form an opinion<br />
upon the experiences bequeathed by the ancients.<br />
The introduction of fire-arms into warfare was of extraordinary<br />
importance in its effect on the development of<br />
surgery. While up to this time the wounds to be treated<br />
were chiefly cuts or stabs, now gunshot wounds stepped<br />
into the foreground. Symptoms hitherto entirely unknown<br />
resulted from wounds produced in this way.<br />
The writings of the ancients naturally gave no information<br />
upon these matters. Surgeons were, therefore,<br />
obliged to make observations for themselves, and to<br />
accumulate experience; to form opinions of the nature<br />
of gunshot wounds and of the way to treat them. This<br />
had a most powerful influence in promoting their emancipation<br />
from traditional authority and their intellectual<br />
independence. The excessive amount of * disturbance<br />
induced by gunshot wounds and many complications and
3°°<br />
RECENT TIMES.<br />
sequelae which were observed to attend them, aroused the.<br />
suspicion that other circumstances, besides the mechanical.<br />
wound, were operative in these cases. So the surgeons<br />
came to form the conjecture that the serious results of gunshot<br />
wounds were produced by burning and poisoning, and<br />
they explained this by the nature of the materials, namely \<br />
powder and lead, which were the immediate agents in<br />
causing the wounds. In order to render the supposed '-\<br />
influence innocuous they treated gunshot wounds with<br />
stimulating and caustic applications. This method of cure<br />
obtained general acceptance until a lucky accident smoothed<br />
the way for more correct knowledge. After a battle there<br />
happened to be a scarcity of hot oil for cauterizing the<br />
wounded. The famous French surgeon AMBROISE PARE<br />
who has described the fact in a very clear manner,* used<br />
instead of it merely a dressing of simple soothing oint-- J<br />
ment and awaited with anxiety the result which should '<br />
follow this procedure. Who can describe his astonishment<br />
when on the next morning he found the wounds he had<br />
treated in this way present a good appearance, being<br />
neither painful nor inflamed nor swollen, whereas other •<br />
wounds, which had been cauterized in the old way, had<br />
become so? Repeated trials confirmed this experience<br />
and the successes which were obtained by this simple ;<br />
method of treatment led to cauterization—inconvenient J<br />
alike to the patient and the doctor—being gradually laid<br />
aside. PARE and MAGGI also made the statement that gunshot<br />
wounds are not attended with burning since musket<br />
balls can be fired on to sacks filled with gunpowder with- ;<br />
out causing its ignition.f<br />
In any case, however, the kind of wounds caused by the<br />
new method of carrying on war was essentially changed.<br />
The missiles produced great destruction of the bones which<br />
* CEuvres D'AMBROISE PARE ed. par J. F. MALOAIGNE, Paris 184*0, T. ii, p.<br />
127 el seq.— LE PAULMIER: Ambroise Pare' d'apres de nouveaux documents,<br />
Paris 1885.<br />
f CEuvres D'AMBR. PARS op. cit. T. ii, 134.
THE PROGRESS OF SCIENCE. 301<br />
were seldom if ever implicated in wounds caused by. the<br />
weapons in use at an earlier period. Amputation, but<br />
seldom practised before, was now frequently required.<br />
With increased experience the surgeons acquired great<br />
certainty in performing these operations and began to<br />
improve upon the methods till then in use. The chief<br />
mistakes made were that surgeons had a tendency to postpone<br />
them too long, to perform them when the soft parts<br />
were unhealthy or gangrenous and to cauterize the stump<br />
with the hot iron or with hot oil in order to arrest the<br />
bleeding, and to remove the necrotic tissue. Important steps<br />
in advance were therefore made, when BOTALLO demanded<br />
the prompt performance of amputation, as soon as signs of<br />
threatening gangrene presented themselves, and again when<br />
surgeons once more began to make the separation in the<br />
healthy parts, and finally when HANS VON GERSDORF, who<br />
was able to boast that he had performed about 200 amputations,<br />
covered the stump with moistened bladders and<br />
applied cooling dressings, in this way securing for the<br />
stump a sufficient covering of skin and soft parts which by<br />
the employment of the hot iron used to be too extensively<br />
destroyed. To prevent the danger of profuse haemorrhage<br />
during the operation, the limb was constricted with bandages<br />
above the line of incision. By the pressure on the<br />
blood-vessels and nerves caused by the bandages, it was<br />
hoped, as A. PARE states,* not only to prevent haemorrhage,<br />
but also to diminish the pain and to bring about a local<br />
anaesthesia. Ligature of the arteries which was again<br />
recommended by A. PARI2 t afforded the greatest security<br />
against the threatening haemorrhage.<br />
This method, as has been said, was already known to the<br />
surgeons of ancient times; in the middle ages also it was<br />
occasionally employed by certain distinguished operators.<br />
* CEuvres D'AMBR. PARE op. cit. T. ii, p. 222.<br />
t CEuvres D'AMBR. PARE op. cit. T. ii, 226 et seq.- ADAMKIEWICZ : Die<br />
mechanischen Blutstillungsmittel bei verletzten Arterien von Pare bis auf die<br />
neueste Zeit, Wurzburg. 1872.
302 RECENT TIMES.<br />
PARE states that he was led to the attempt to ligature<br />
vessels by the study of GALEN : he reintroduced this procedure<br />
for the first time in an amputation in the lower part<br />
of the thigh, in the year 1552. He afterwards adopted<br />
ligature en masse in place of that of isolated arteries, tying<br />
the nerves along with the vessels. The belief was that in<br />
this way the discharge of the " nervous spirit" was pre- .<br />
vented. For secondary haemorrhage the arterial trunks<br />
were compressed by the external application of the fingers;<br />
mention is also made of a method which, in the somewhat<br />
Obscure description of it by A. PARE, appears to answer to<br />
ligature in continuity.<br />
Among the diseases liable to occur as the result of<br />
wounds erysipelas, hospital gangrene, diphtheria, pyaemia,<br />
trismus, and tetanus were noticed*<br />
The technical procedure in lithotomy underwent a marked<br />
improvement in the 16th century. The method in use up to<br />
that time, described by CELSUS and simplified by PAULUS<br />
AEGINETA, was amended by passing into the urethra, before<br />
the operation, a curved hollow sound shaped like a catheter, ,..:<br />
the convexity of which abutted on the perineum. As the<br />
incision in the pars membranacea was made on the groove<br />
of this sound, the hand of the operator took a more certain<br />
direction—a matter of great importance for the result.<br />
This procedure was called the operation with the large<br />
instrument, and BERNARDO DI RAPALLO was looked upon<br />
as its discoverer. It became more generally known through.<br />
MARIANO SANTO. The disadvantages which sometimes<br />
accompanied perineal lithotomy, namely, suppuration of<br />
the prostate and of the ejaculatory ducts with the<br />
impotence arising therefrom, but above all things the<br />
impossibility of removing by the perineal wound either<br />
very large or encysted stones, suggested the idea of<br />
*<br />
* F. WURTZ : Practica der Wundartzney, Basel 1642, S. 271, 538, 645 et seq;.<br />
—TH. BILLROTH: Historische Studien iiber die Beurtheilung und Behandlung<br />
der Schusswunden, Berlin 1859, s - "5 et seo -—WOLZENDOKFF im Deutschea<br />
Archiv f. Gesch. d. Medicin, Bd. ii, S. 23 et seq.; Leipzig 1879.
THE PROGRESS OF SCIENCE. 303<br />
going in search of the stone from above by an incision<br />
over the pubic symphysis* PIERRE FRANCO performed<br />
high lithotomy for the first time in 1560 with success<br />
on a child aged two years after having made a vain<br />
attempt to remove the stone, which was the size of a<br />
hen's egg, by the old method. He felt himself especially<br />
induced to operate in this way as the bladder protruded<br />
forwards with some firmness. ROUSSET gave afterwards<br />
the very reasonable advice, that the bladder should be filled<br />
with water before proceeding to the operation. The high<br />
operation had also many dangers attached to it, which<br />
rendered its success questionable. PlERRE FRANCO<br />
recognized this fact and in consequence practised perineal<br />
lithotomy again, introducing a new method. In this the<br />
incision upon the curved staff introduced into the bladder<br />
was carried sideways from the raphe and prolonged through<br />
the prostate. Lateral lithotomy, as this procedure was<br />
called, had at least the advantage that by it stones of considerable<br />
size could be removed. P. FRANCO made the<br />
remark, that calculi in the female sex are frequently<br />
removed by simple dilatation of the urethra. Lithotrity<br />
had nearly fallen into oblivion. A. BENEDETTI stated that<br />
some surgeons crushed the calculus with iron instruments<br />
without making any incision, but he did not treat of this<br />
procedure at any length, t PROSPER ALPINI J described<br />
a particular method which he had learnt in Egypt. It consisted<br />
of squeezing the stone by pressure from outside into<br />
the urethra, which had been dilated.<br />
Surgeons sought to effect the cure of hernia by long<br />
continued lying on the back or by trusses: and not unfrequently<br />
the operation for radical cure was decided upon.<br />
For this, in inguinal hernia the sides of the opening were,<br />
* C. B. GDNTHER: Der hohe Steinschnitt seit seinem Ursprunge, Leipzig<br />
1851.<br />
t AL. BENEDICTUS : Omnium h vertice ad calcem morborum signa, causae<br />
etc., Basil. 1508, lib. xxii, C. 48:<br />
X De medicina-iEgyptorum iii, C. 14.
304 RECENT TIMES. ,<br />
after returning the prolapsed bowel, sewn together with<br />
gold or lead wire or thread. Great credit is due to J<br />
AMBROISE PARE in that he limited as, far as possible %<br />
operative interference to- cases of strangulated hernia.<br />
Only in such cases did he perform regular herniotomy,<br />
It is true that other surgeons, as P FRANCO and RoussEf,<br />
did the same operation before him ; but the procedure *<br />
was laid upon a scientific foundation first by A. PAR:E »;<br />
and a prospect was, in consequence, held out * to<br />
patients with this affection of being cured, whereas at an<br />
earlier time they were generally left to their fate * The H<br />
operative relief of urethral stricture by forcible division<br />
with a knife, known at an earlier period to surgeons of the *«<br />
time of the Roman Empire, was rescued from oblivion by /*<br />
A. PARE. Bougies, also, were made use of in these affections,<br />
and were smeared with appropriate medicaments;^<br />
these were especially recommended by LAGUNA.<br />
The knowledge of plastic operations had in the 16th *<br />
century long ceased to be a secret of the empirics of<br />
Norcia and Preci. Several able surgeons devoted them-; >|<br />
selves to them, and acquired great skill in performing them.<br />
GASPARE TAGLIACOZZI, Professor at Bologna, obtained the<br />
greatest success in this branch of surgery and has left a<br />
thorough description of the procedure.f To replace the<br />
loss of substance he employed the skin of the upper part •'!<br />
of the arm, like A. BRANCA before him. From all parts of<br />
Europe patients came to him to be operated on. The i<br />
story that he had at one time in his hospital 12 German<br />
Counts, ig French Marquises, 100 Spanish Grandees and*<br />
one English Esquire, who had all lost their noses through<br />
dissolute living and desired fresh ones from him,J if only a<br />
witty anecdote yet shows how widely spread his fame as an<br />
operator was. TAGLIACOZZI earned but small thanks fo|<br />
* E.ALBERT: Die'Herniologie der Alten, S. 180 et seq.—A. GYERGYAI in<br />
the Deutschen Arch. f. Gesch. d. Medicin, Leipzig 1880, Bd. iii, S. 326 et seq.<br />
t De chirurgia curtoium per insitionem, Ed. TROSCHEL, Berol. 1831. ,|<br />
X J. BICKERSTAFF: The Tattler, Lcndon 1723, iv, No. 260.
THE PROGRESS OF SCIENCE.<br />
305<br />
his philanthropic actions. A narrow fanaticism saw in his<br />
attempts to restore the loss of nose or lips a presumptuous<br />
interference with the rights of the Creator. After his<br />
death, the pious sisters of the monastery, in which his<br />
earthly remains had been laid, heard during several weeks<br />
a voice crying " TAGLIACOZZI is damned ! " At the instance<br />
of the clergy of Bologna his corpse was taken from the<br />
grave and reinterred in unconsecrated ground.* Silliness in<br />
matters of faith such as that manifested in the 16th century<br />
finds an excuse in the low state of civilization of the period.<br />
We of the 19th century however are not at liberty to treat<br />
such displays with laughter and contempt; for when, about<br />
40 years ago, the employment of ether was suggested in<br />
difficult labours to produce anaesthesia the English zealots<br />
rose angrily to oppose it, appealing to the words of the<br />
Bible in reference to woman, "In sorrow shalt thou bring<br />
forth children ! "<br />
Besides TAGLIACOZZI, other surgeons like GRIFFON of<br />
Lausanne and CORTESI of Bologna made themselves known<br />
by their successful rhinoplastic operations. The loss of<br />
the nose was not only the result of disease, generally<br />
syphilis, but sometimes was consequent upon an order of the<br />
magistrates. This punishment was by an edict of the<br />
Eniperor FREDERICK III. imposed upon adulteresses and<br />
mothers who prostituted their daughters. The Municipal<br />
law of Augsburg of the year 1276 decreed that " vagrant<br />
girls or ' Hiibschlerinnen,' " as they were called, should<br />
have their noses cut off if they roamed about the streets<br />
during Lent or on Saturday night, except when distinguished<br />
foreigners were present in the town.f<br />
Ophthalmic surgery did not take any remarkable share<br />
in the progress made by other branches of surgery at this<br />
period. It lay almost entirely in the hands of itinerant<br />
* A. CORRADI : Dell' anticaautoplasticaitaliana, Sep.-Abdr. 1874.<br />
t HUILLARD-BREHOLLES : Hist. dipl. Fried. II, op. cit. iv, p. 168, 170, lib.<br />
iii, tit. 74, 80.—LAMMERT : Zur Geschichte des biirgerlichen Lebens op. cit.<br />
S. 76.<br />
X
306<br />
RECENT TIMES'.<br />
quacks who often undertook with audacious boldness the<br />
most serious operations without possessing any knowledge<br />
of the structure of the eye or of the nature of the diseases<br />
they were treating. When one of these gentry, who<br />
shortly before had been a serving man, was asked how he<br />
could be so confident as to operate on cataract, he replied<br />
that the patient had nothing to lose for if the operation<br />
miscarried he only remained blind as he was before.<br />
Midwifery also was during the first half of the 16th<br />
century completely neglected. How small the knowledge^!<br />
of doctors on this subject was at that time is shown by the "<br />
text-book for midwives published by EuCHARiUS R6SLIN in<br />
1512 under the title " The Pregnant Woman's Rosegarden,"<br />
This contains incredible mistakes and representations of<br />
various positions of the foetus in utero which can only have<br />
been fabricated by a fertile fancy, and never actually<br />
observed. His imitators, WALTHER REIFF and JACOB<br />
RUEFF, citizens and engravers of Zurich, known too as<br />
authors of religious dramas, were in much the same<br />
position. Even more insignificant was the. work of L<br />
BONACCIUOLI, professor at Ferrara, which was dedicated to<br />
LuCREZiA BORGIA and in which among other things it is<br />
stated that sometimes 70 or more foetuses escape at the same<br />
time from pregnant women; the author appears to have<br />
confounded them with intestinal worms* With the im<br />
provement of anatomy and surgery a prospect was opened<br />
up-of midwifery also being for the first time placed on a<br />
scientific foundation. Here again it was AMBROISE PARE<br />
who initiated more correct views and better methods oi<br />
treatment. He settled what should be considered indications<br />
for turning—a procedure known in ancient times though<br />
hitherto but little used—and gave directions for its per-<br />
formance.f It was owing to him that from henceforth it<br />
secured for itself a permanent position in operative mid<br />
wifery. His doctrines received a wider development and<br />
* E. C. J. v. SIE.BO.LD op. cit. ii, 17.<br />
+ CEuvres D'AMBROISE PARE, ed. MALGAIGNE, T. ii, 628 et seq.
THE PROGRESS OF SCIENCE.<br />
307<br />
a firmer foundation at the hands of PIERRE FRANCO and<br />
JAQUES GUILLEMEAU. The former recommended for<br />
extracting the child, that a speculum having three branches<br />
should be introduced into the vagina : into this he endeavoured<br />
to guide the head or the feet of the child. He<br />
thus came near to the discovery of the midwifery forceps *<br />
GUILLEMEAU was acquainted with placenta previa without<br />
however understanding how it arose and he performed an<br />
accouchement force on the daughter of A. PARE. Caesarean<br />
section was undertaken on the living; but it appears in<br />
several cases, of which mention is made, to have been a<br />
question merely of abdominal section in extra-uterine<br />
fcetation. Thus BAUHIN relates that JACOB NUFER, a<br />
Swiss gelder, in the year 1500 opened the abdomen of his<br />
wife who was pregnant " in the manner in which he was<br />
accustomed to do it in the case of swine "—and this after<br />
13 midwives and numerous surgeons had attempted in vain<br />
to deliver her in the natural way.f In this case he is said<br />
to have given exit to a living child after the first incision.<br />
But on the other hand some cases must be referred to<br />
.Caesarean section proper.^ Recourse seems to have been<br />
had to this operation even more frequently than was<br />
necessary; A. PARE cautioned surgeons against this and<br />
referred to the dangers of the operation. But people were<br />
not sufficiently advanced in knowledge to be able to define<br />
the conditions under which it is proper to undertake<br />
Caesarean section although the works of ARANZIO on contraction<br />
of the pelvis perhaps afforded to doctors some<br />
suggestions upon the subject.<br />
The spirit of criticism was aroused also in other departments<br />
of medicine and shook men's faith in doctrines and<br />
processes which relied for their support upon prevailing<br />
authorities. PIERRE BRISSOT pronounced it to be wrong, in<br />
* SIEBOLD op. cit. ii, 83.<br />
f SIEBOLD op. cit. ii, 94 et seq.<br />
X SIEBOLD op. cit. ii, 106 et seq.—O. WACHS : DerWittenberger Kaiserschnitt<br />
von 1610, Leipzig 1868.
3o8<br />
RECENT TIMES.<br />
inflammatory diseases, to bleed at a point remote from the<br />
affected part, as was customary at that time, and on the<br />
contrary performed the operation in its vicinity. His<br />
opponents, holding fast to the old opinions, attacked him<br />
vehemently on this account and affirmed that his innovation<br />
was as dangerous for the body as the religious belief of<br />
LUTHER was for the soul.* More important than all these<br />
disputes about the method of bleeding was the fact that in<br />
consequence of them doubts arose whether bleeding itself<br />
was always requisite in particular cases. About the same<br />
time MICHAEL SERVET combated the erroneous doctrines<br />
concerning the concoction of the juices. Moreover the<br />
exaggerated importance which men attached to the pulse<br />
;*'and to the character of the urine, experienced a reasonable<br />
•'•* and necessary limitation. Unprincipled adventurers and<br />
/ignorant empirics made such things the means of intoler-<br />
: able abuses. The urine-glass formed, as it were,the token<br />
of the doctor as may be seen in the pictures of the Dutch<br />
".school and was said to give information upon the most<br />
secret and wonderful things. It was only likely that<br />
honourable doctors and men of intelligence not in the<br />
profession, like the Bishop DUDITH of Horekowicz, should<br />
turn from these practices and strive to obtain a scientific<br />
treatment of the subject of the urine. But in truth any<br />
such treatment could only be undertaken with success<br />
when chemistry had attained to a higher development.<br />
No one effected more in this direction during the 16th<br />
r century, than THEOPHRASTUS BOMBASTUS PARACELSUS,*<br />
-.. of Hohenheim. This man, who forms one of the most<br />
V> remarkable figures in the history of civilization, by some<br />
unduly honoured and by others overwhelmed with scorn<br />
and hatred, has but seldom been judged correctly and<br />
without prejudice. He was of a nature like FAUS<strong>T'</strong>S:<br />
While fastening his eyes on the highest and noblest objects,<br />
he suffered shipwreck in consequence of his bold, ambitious<br />
* K. SyRENGEi.: Geschichte der Arzneikunde iii, 176 after MOREAU : De<br />
miss, sanguis, in jpleurit., Paris 1630, p. 102.
THE PROGRESS OF SCIENCE.<br />
3°9<br />
plans and, in the strife with the conditions which surrounded<br />
him, lost all; lost even himself. But these sad facts<br />
cannot rob him of the credit of having rendered a great<br />
service to medicine in combating the theory of juices<br />
as held by the ancients, and in being the first to give ex<br />
pression to the thought that the processes of life are of a<br />
chemical nature, and that chemical changes form the con<br />
ditions of health and disease. He recognized the falsity of<br />
the doctrine derived from ancient times that the heart is the<br />
source of heat, and said that every part of the body con<br />
tains its own source of heat.* He referred to the analogy<br />
between gout and calculous diseases, saying that both are<br />
characterised by the deposit of solid material, and he<br />
recommended the use of alkaline waters in these cases.<br />
The internal employment of various chemical, and especially<br />
mineral, substances was first attempted by him. To this<br />
category belong mercury in different forms, several combi<br />
nations of lead, antimonial medicines, precipitated sulphur,<br />
sulphate of copper, ferric oxide, and other preparations of<br />
iron. PARACELSUS declared that the task of chemistry 1<br />
was not the fabrication of gold, but the production, of<br />
medicines. He devoted diligent study to that science,t<br />
and was the first to avail himself of tincture of galls for<br />
determining the presence of iron in mineral waters.<br />
The evil results entailed by the too long continued use<br />
of certain minerals—as, for instance, mercury—did not<br />
escape his notice. He had learnt to recognize them among<br />
the workmen in the mines of Idria. In the same way he .,,<br />
described the effects of arsenic, and the diseases to which<br />
miners are exposed in smelting many metals. In taking ,;,'<br />
chemistry out of the hands of the alchemists, and in making<br />
it useful to medical science, he gave an incentive to the<br />
treatment of it in a scientific manner, and to the foundation<br />
of a medical chemistry.<br />
The effects of these circumstances were seen in pharma-<br />
* PARACELSUS : Paramirum, Lib. i.<br />
t KOPP : Gesch. der Chemie op. cit. i., 96.
310 RECENT TIMES.<br />
cology. Numerous remedies which had been almost or<br />
completely forgotten were once more called to mind, and<br />
new ones were discovered. At the same time the pharmacopoeia<br />
was much enriched by.the addition of drugs introduced<br />
from America. The Emperor CHARLES V., by the<br />
advice of VESALIUS, made use of a decoction of china<br />
root (smilax china) when he lay ill with the gout. Guaiacum<br />
enjoyed a great reputation as a specific remedy for<br />
syphilis. ULRICH VON HuTTEN, who himself suffered for<br />
many years from this disease, has given a complete description<br />
of the effects of guaiacum*<br />
In the domain of internal medicine, the spirit of independence<br />
awakened by the struggle against the faith in<br />
authority brought forward a number of observations which<br />
contributed largely to the knowledge of diseases. Syphilis,<br />
which at this period was of unwonted virulence, and spread<br />
like an epidemic—on this account being considered a new<br />
"disease which had reached Europe from the newly discovered<br />
countries across the ocean —had a startling light<br />
thrown upon its real nature by the establishment of genetic.;<br />
relations between the primary local affection on the one •<br />
hand, and the ensuing secondary and tertiary symptoms on<br />
the other. Numerous treatises dealt with the course,<br />
symptoms, and treatment of this affection, and took into<br />
consideration every aspect presented by the disease.<br />
The first contributions upon scurvy date from the same<br />
period. VASCO DE GAM A in his expedition of 1498 lost no<br />
less than 55 of his ship's company, who succumbed to this<br />
disease.f The appearance of it was also observed in the<br />
maritime countries bordering on the North Sea and Baltic<br />
and in certain other districts.<br />
So too, at the end of the 16th century the earliest<br />
* U. v. HUTTEN : De Guajaci medicina, Mogunt. 1519.—F. F. A. POTTON :<br />
Livre du chevalier allemand Ulrich de Hutten sur la maladie francaise,<br />
Lyon, 1865.<br />
f A. H'RSCH: Handbuch derhistorisch-geographischen Pathologie, Stuttgart<br />
1883, ii, 358 et seq.
THE PROGRESS OF SCIENCE. 311<br />
accounts are given of spasmodic ergotism—Ergotismus<br />
convulsivus—which was distinguished both by its symptoms<br />
and by its geographical distribution from the gangrenous<br />
form of the same toxic affection and which in earlier times<br />
was commonly designated Ignis sacer.<br />
In consequence of the careful study of the symptoms of<br />
disease and the progress of medical science it gradually<br />
became possible to separate the multifarious nosological<br />
conceptions commonly formed of leprosy and plague and<br />
to apportion them to the various diseases from which they<br />
had been taken. As a result of this, along with various<br />
affections characterized by eruptions on the skin, the typhus<br />
and typhoid fevers gained an independent place in scientific<br />
pathology. FRESCATORIUS, the most distinguished epidemiologist<br />
of the 16th century, published the first description<br />
of exanthematic typhus. BAILLOU left the first unmistakable<br />
account of whooping-cough and croup. Besides these<br />
works of fundamental importance, the literature dealing<br />
with individual cases deserves to be mentioned, being of<br />
great significance in the development of medical science.<br />
Particular observations are even now full of interest, such<br />
as those upon gallstones by A. BENEDETTI; the description,<br />
illustrated by a drawing, of the renal calculi of the<br />
DUKE ALBERT V. of Bavaria to which popular superstition<br />
assigned the form of Jesuits' heads ;* the case narrated by<br />
F. VALLERIOLA, in which a pistol-ball, which had penetrated<br />
the abdomen, was after a certain period passed per anum<br />
without producing any further complications ;f the report<br />
of a case by DODON^EUS, who at the post-mortem examination<br />
of a French prince, for long a sufferer from urethral<br />
discharge and pain in the region of the kidneys, found<br />
suppuration of the ureters and induration of the kidneys ; %<br />
the experiences of FELIX PLATTER in the treatment of<br />
mental diseases and his outspoken expressions against<br />
* CREDE and DISTEL in VIRCHOW'S Archiv, Bd. 96, S. 501 et seq.<br />
t Observat. medicin. lib., iv, c. 9. Lugd. 1605.<br />
X Medic, observat. exempla rara, Harderwyk 1521, p. 72, c. 41.
3I2<br />
RECENT TIMES.<br />
coercive measures and the confinement of the insane in<br />
prisons ; and many others.<br />
It has been possible here only to glance at the rich ,<br />
acquisitions made by medical science in the 16th century:<br />
for a complete description of particular lines of progress<br />
would carry us too far and is not the task of the writer, of<br />
this work. The examples adduced are sufficient to indicate<br />
how the spirit of the age was reflected in the development<br />
of medicine.<br />
THE UNIVERSITIES IN THE SIXTEENTH<br />
CENTURY.<br />
THE intellectual life, thus developing itself with unexp<br />
energy, resulted in the foundation of numerous universities. |<br />
In Spain and Portugal, which countries in consequence of<br />
the discoveries across the ocean were .pressed into the fore- f<br />
ground among places of public interest, academies were<br />
founded at Toledo (1520), Baeza (1533), Compostella (1534),<br />
Granada (1540), Ossuna and Gandia (1549), Almagro (1552),<br />
Orchuela (1555), Tarragona (1572), and Oviedo (1580);<br />
universities arose even in the new world, at Lima (1551)<br />
and Mexico (1553). But in the evolution of science the J<br />
importance of these was but small. They quickly sank :<br />
into oblivion when Spain, destined by fate to play the part J<br />
of the leading maritime power, had, through the short- ;<br />
sighted ecclesiastical policy of her rulers and the narrow- .<br />
minded priest-ridden character of her people, fallen precipitately<br />
from the political height which she had attained. I<br />
England and the Netherlands, stepping into the place of<br />
Spain, soon came to rule the trade and intercourse with<br />
the countries across the ocean, and knew better how to<br />
make use of the advantages of their position. Their prosperity<br />
grew apace, and they became the wealthiest countries |<br />
of the world. They united in their possession the riches of<br />
America and the treasures of Asia; for even the Oriental<br />
trade, which had hitherto found its way across Italy, now
THE UNIVERSITIES IN THE l6TH CENTURY. 313<br />
adopted another route and reached the coasts of Great<br />
Britain, Holland, and North Germany by sea. These facts<br />
afford the explanation of the remarkable phenomenon that<br />
the last mentioned countries from this time forth played an<br />
important part also in the scenes of intellectual life, in art<br />
and science, while, on the other hand, they throw light upon<br />
the decline of Italy, which began at this period, and became<br />
clearly evident at the conclusion of the 17th century. Italy<br />
contained in the 16th century only two academies, those of<br />
Macerata (1540) and Messina (1548).<br />
In France universities were founded at Rheims (1558);<br />
Douai (1561), Besancon- (1564), and Pont-a-Mousson<br />
(1572).* To these, the universities of Lausanne (1536)<br />
and Geneva (1569), situated in French Switzerland, were<br />
added. Moreover, King FRANCIS I. founded the College<br />
de France, where lectures were delivered gratis, which<br />
everyone was free to attend. Among the twelve richlyendowed<br />
professorships one was devoted to medicine.<br />
In the British islands Edinburgh (1583) and Dublin (1591)<br />
possessed each a university. Similar institutions arose in<br />
the Netherlands at Leyden (1575) and Franecker (1585).<br />
On the eastern boundaries of civilization Wilna (1597) was<br />
made the seat of an academy. The number of German<br />
universities was also considerably increased. As early as<br />
at the Diet of Worms in 1495 tne Emperor MAXIMILIAN I.<br />
issued an order to the Electors that each should found an<br />
academy in his own country. What the Electors effected, that<br />
also the other territorial lords desired to achieve if it was in<br />
any way possible. And in this manner a number of universities<br />
were created, many of which were scarcely in possession<br />
of the barest necessaries for their existence. In<br />
1502 the Elector FREDERICK THE WlSE of Saxony<br />
founded, with the Emperor's permission, the academy<br />
at Wittenberg, which in the following decades formed<br />
* TOURDES: Origine de l'enseignement me'd. au Lorraine. La faculte de<br />
me'd. de Pont-a-Mousson, Paris, 1876.—LEGRAND : L'universite de Douai,<br />
Douai 1888.
314 RECENT TIMES.<br />
the centre of the movements connected with religious<br />
reform. The foundation of the university at Frankforton-the-Oder<br />
for the Margraviate of Brandenburg followed<br />
in 1506. The first academy which came into<br />
existence after the Reformation, and bore a decidedly<br />
Protestant character, was that of Marburg, in Hessen,<br />
which was founded in 1527, but which only in 1541<br />
received the sanction of the Emperor. And like the<br />
Marburg university there arose that of Konigsberg, in<br />
Prussia (1544), under the influence of MELANCHTHON,<br />
whose son-in-law, SABINUS, was its first Rector* In 1549,<br />
O. VON TRUCHSESS, Bishop of Augsburg, founded at<br />
Dillingen an educational establishment for the clergy,<br />
which in 1554 was invested by the Pope with the rights of<br />
a university. Afterwards it was conducted by the Jesuits,<br />
and was abolished in i8o4.f The university of Jena.<br />
(1558) arose from the circumstance that the Elector JOHN<br />
FREDERICK of Saxony desired to have a university in the<br />
neighbourhood of his residence, when, after the unfortunate<br />
battle of Mvihlberg he was compelled to exchange his.<br />
country for that of his cousin MORITZ. His example was<br />
followed by the Duke JULIUS of Brunswick, who in 1576.<br />
created the university of Helmstadt, which existed up tothe<br />
year 1809. The medical faculty of this university bore<br />
on its coat of arms a crowned ox under a star.J<br />
Academies in the dominions of the Hapsburg dynasty<br />
were founded at Olmiitz (1573) and Graz (1585), and bore<br />
the stamp of Catholicism; they were, however, not provided<br />
with all the faculties. The university of Wiirzburg,<br />
reopened in 1582 by the Prince Bishop JULIUS<br />
ECHTER, alone possessed a richer equipment for the<br />
advancement of medical studies. For the rest, the other<br />
newly-arisen universities had seldom more than one<br />
medical professor. Theology always as yet occupied the<br />
* M. TOPPEN : Die Griindung der Universitat zu Konigsberg, 1844.<br />
t PAULSEN : Geschichte des gelehrten Unterrichts op. cit. S. 268.<br />
X Geschichte der ehemaligen Hochschule zu Helmstadt, Helmstadt 1876.
THE UNIVERSITIES IN THE l6TH CENTURY. 315<br />
foreground. The Protestant academies fought no less<br />
zealously for the new faith than did the Catholic universities,<br />
under the guidance of Jesuits, defend the authority<br />
of the Pope. No one who did not adhere to the Lutheran<br />
belief was tolerated at the academy of Helmstadt. The<br />
Duke of Brunswick, in 1584, declared to the General<br />
Consistory that it was better that such people should " go<br />
straightway to the devil than that they should sully and<br />
contaminate his churches and schools."* However, it was<br />
already a great advance in the direction of tolerance that<br />
he only wished those of another faith, in the world to come,<br />
and did not use force to help them on the road thither.<br />
Unfortunately this occurred only too often even under the<br />
rule of Protestantism, as, not to mention the cruel and<br />
bloody persecutions of which England and the countries<br />
subject to her were the scene, the example of the unfortunate<br />
MICHAEL SERVET testifies, who, on the prosecution<br />
of CALVIN, came to the stake at Geneva owing to his failure<br />
to comprehend the doctrine of the Trinity in Unity of the<br />
Godhead.t<br />
The effect of the split in the Church upon the universities,<br />
which attached themselves to the movements of<br />
religious reform, manifested itself first by the act of shaking<br />
off the yoke of Rome and by a removal of direct papal<br />
interference. But ecclesiastical influence was not thus<br />
abolished ; Protestant theologians merely stepped into the<br />
place of their Catholic predecessors, making their rule<br />
oppressively felt in many countries—for example, in<br />
England—and extending their control in an unjustifiable<br />
manner over all possible paths of intellectual life. A freer<br />
spirit animated the Protestant academies of Germany.<br />
The priesthood of the new Church here won less power<br />
and developed gradually into an organ of the State Govern-<br />
* PAULSEN op. cit. S. 178 following E. L. T. HENKE: Georg Calixtus<br />
und seine Zeit, Halle 1853.<br />
t W. E. H. LECKY: History of the Rise and Influence of the Spirit of<br />
Rationalism in Europe.
316 RECENT TIMES.<br />
ment, which, on grounds of political expediency, was<br />
obliged to avoid brutal outbreaks of religious intolerance.<br />
In France the control of the universities and generally of<br />
the whole system of education by the State was gradually<br />
introduced by the energy of the governments, just as in<br />
the Protestant countries of Germany it came about under<br />
the influence of the Reformation.<br />
In the Catholic countries of Germany this process<br />
was only accomplished in the 18th century, and in<br />
other States, as in Italy, only in the 19th. It resulted,;<br />
in the introduction of many changes in the organization<br />
of the universities. The dignity of Chancellor, if<br />
not entirely abolished, was conferred upon high officials<br />
or trusted friends of the Government, and the charter was<br />
no longer conferred by the Church but by the State. The<br />
cosmopolitan character of the universities ceased to exist<br />
at the same time; henceforth they were no more than the<br />
highest educational establishments of the State, and their<br />
academical degrees were no longer, as formerly, of value in<br />
all countries of Christendom, but only in a narrowly-defined<br />
political district. The unlimited freedom which the learned<br />
professions enjoyed in the middle ages was done away<br />
with, and a system of tests gradually became developed<br />
which recognized knowledge only when it had been acquired<br />
in particular training grounds. The financial condition of<br />
the universities of Germany and of several other countries<br />
which attached themselves to Protestantism sustained as a<br />
general rule a great revolution. The Professors lost the<br />
prospect of an increase of their incomes by the acquisition<br />
of fat benefices. The slight rise in their stipends which<br />
resulted from the secularization of the Church property<br />
afforded but a poor compensation. Everywhere it was<br />
felt that the secure support afforded heretofore by the rich<br />
pecuniary possessions of the Church now no longer existed.<br />
How insignificant was the amount demanded at that time<br />
for the support of a university is shown by the annual<br />
budget of the academy of Tubingen for 1541-42. The
THE UNIVERSITIES IN THE 16TH CENTURY. 317<br />
income reached 5,176 florins, the expenditure 4,853 florins ;<br />
in the latter were included the stipends of three professors<br />
of theology, six of law, two of medicine, and ten of the<br />
liberal arts, the amounts varying from 4ofl. to 20ofl., in all<br />
2,394ft*<br />
The requirements of a small university of that period<br />
were not great, as is seen by the example of Greifswald<br />
where the whole extent of the university was included in a<br />
single house. It consisted of three lecture-rooms, the<br />
senate-chamber, a stall for the trade in academical books,<br />
the library, the chamber for the records, dwelling rooms for<br />
two professors, several apartments where students lived,<br />
and the prison in the basement.f The Catholic academies<br />
were in a more favourable position in this respect. Pope<br />
JULIUS III., in the year 1553 promulgated a bull by which<br />
it was made legal to grant spiritual benefices to secular<br />
professors,—a practice, indeed, which had long been sanctioned<br />
by usage and passed over in silence. The celibacy<br />
of university teachers became, in consequence of this,<br />
objectless, and gradually ceased to be observed even in<br />
Catholic countries. In Protestant academies it was naturally<br />
done away with; yet custom had such a powerful effect<br />
that in Tubingen, for example, the usage was still adhered<br />
to, and celibacy was demanded even of the professor of<br />
medicine, long after the university had become Protestant.<br />
The salaries of the professors differed in different<br />
countries and in the various faculties ; those of the professors<br />
of medicine, as a rule, were on a lower scale than<br />
in the case of the theologians and jurists. In Paris each<br />
professor of medicine received in 1505 twelve livres a<br />
year.| In Konigsberg, in the year 1544, salaries of 200 and<br />
of 150 florins were given to the two teachers of medicine.§<br />
* F. PAULSEN in SYBEL'S histor. Zeitschr. 1881, Bd. 45, S. 278 et seq.<br />
t F. PAULSEN op. cit. S. 304, 407.<br />
X HAZON op. cit.<br />
§ D. H. ARNOLDT: Historie der Konigsbergischen Universitat, Konigsberg<br />
1746.
318 RECENT TIMES.<br />
k_, r<br />
, . - -<br />
In Heidelberg before the Reformation the three professors!<br />
of medicine drew the yearly stipends of 180, 160 and 140<br />
florins. In 1588 these were raised to 270, 180 and 170 fL,<br />
and in addition, each professor received free lodging, a<br />
tun of wine and twelve measures of corn a year* The<br />
Duke WILLIAM of Bavaria in 1537 established in Ingolstadt<br />
a teacher of law with the stipend of 300 fl. This<br />
was the highest salary paid at that time at a German<br />
university.t<br />
The students, as a body, were in like manner powerfully<br />
influenced by the great events of the time. The struggle<br />
against authority opened up along all lines of attack, the<br />
study of humane learning seeing its ideals in the unconstrained<br />
life of the ancient world, but above all the division<br />
in the Church, engendered a spirit of freedom and liberty<br />
which sometimes rose in revolt against every interference<br />
with complete independence. The records of the Senate<br />
of the university of Tubingen contain remarkable notes for<br />
the history of manners among the students of the 16th<br />
century. Thus in a letter of the year 1564 addressed to<br />
the Senate the nuns of Silchen complained that they were<br />
molested by the frerquent and importunate visits of the<br />
students. Many students in Tubingen were married and<br />
fathers of families. In 1575 the young students were forbidden<br />
to marry without the consent of their parents. Ir<br />
1589 the Senate was informed that a widow misconductec<br />
herself with the students ; as a punishment for this she wa:<br />
11 chained up in a little room."J Similar excesses occurrec<br />
at Wittenburg.§ Among the students also of Catholii<br />
universities, as we learn from information to hand concern<br />
* HAUTZ op cit.<br />
t MEINERS : Geschichte der Entstehung der hohen Schulen, Gottingen 1801<br />
X R. v. MOHL: Nachweisungen iiber die Sitten und das Betragen der Tubii<br />
ger Studierenden wahrend des 16 Jahrhunderts, Tubingen 1871.—JOH. HUBEI<br />
Deutches Studentenleben in Kleine Schriften, Leipzig 1871, S. 364 et seq.--<br />
GEBHARDT in the Zeitschr f. allgem. Gesch. edited by ZWIEDINECK-SODB:<br />
HORST, Bd. iv, 1887, S, 962.<br />
§ j. F. A. GILLET: Crato von Crafftheim, Frankfurt-a-M. i860, i, 101.
THE UNIVERSITIES IN, THE 16TH CENTURY 319<br />
ing that of Ingolstadt, a rough, violent tone prevailed.* The<br />
students lived partly in " Bursen " or boarding-houses, as they<br />
existed in the middle ages, partly at the houses of private<br />
people or professors. The latter found a sometimes highly<br />
desirable source of income in housing and attending to<br />
students. The son of MARTIN LUTHER kept a boarding-<br />
house for students in Wittenberg which was much fre-<br />
quented.t In Heidelberg it not unfrequently occurred that<br />
the professors caused the wine which formed a portion of<br />
their pay, to be publicly retailed : they might safely calcu<br />
late upon their pupils devoting themselves to it with at<br />
least as much assiduity as to their lectures. Poor students<br />
were exposed to the bitterest want. THOMAS PLATTER<br />
, has given a touching picture of their miserable existence in<br />
his autobiography. Cold and hungry, clothed in rags and<br />
begging for alms, he, with his companions, traversed Swit<br />
zerland and Germany. The travelling students formed a<br />
vagabond class which put credulity and ignorance under<br />
contribution and in many places became a serious annoy<br />
ance to the country. A deep social gap divided these<br />
beggar-students from the rich and distinguished young<br />
men to whom, at most universities where they studied, a<br />
privileged position was assigned. These frequently sought<br />
to cut a figure by costly feasts and banquets, by an appear<br />
ance of prodigality and by excessive luxury in dress. The<br />
pantaloons, "for example, of some students used to cost<br />
above 100 fl.: a sum, the value of which we begin to grasp<br />
when we consider that the midday meal of the Tubingen<br />
students of that period, consisting of three courses and<br />
a quart of wine, was paid for at the rate of 38 florins a<br />
year. Laws, sermons and books inveighed against the<br />
prodigality of the students but, as it seems, without result.<br />
Professor Museums, of Frankfort-on-the-Oder, criticized<br />
severely the fashion of pantaloons in a tractate hearing the<br />
< title: " An Exhortation and Admonition against the decoy-<br />
* B. GEBHARDT op. cit. S. 957.<br />
t PAULSEN ; Gesch. d. gel. Unterrichts S. 16.1.
o2Q<br />
RECENT TIMES.<br />
ing, manners- and honour-compromising, pantalooning<br />
Trousers-devil" (Frankfort-on-the-Oder, 1556). A resolution<br />
of the Senate of the Tubingen Academy of the year<br />
1554 cautioned "the noblemen, so lately arrived here, in<br />
respect of their unrefined and indelicate trousers" and.<br />
called upon them "to lay aside such an objectionable and<br />
soldiering garment."<br />
MEDICAL TEACHING.<br />
THE changes, brought about in medical science, exercise<br />
an influence upon medical teaching inasmuch as the<br />
quantity of subject matter as well as the number of .pro-?<br />
fessorships and the means of instruction were augmented:!<br />
the method, also, of medical education, in response to the |<br />
importance acquired by anatomy and surgery, took by j<br />
degrees a somewhat more practical direction. Events! 3<br />
which had occurred in the history of civilization, discoveries<br />
and inventions of many kinds, likewise exercised ;j<br />
a powerful influence upon the system of education.<br />
Before the discovery of the art of printing, libraries were j<br />
the rarest and costliest things. The medical faculty of fe<br />
Paris possessed in 1395 no more than nine works, among _<br />
which the Continens of RHAZES was the most highlyf<br />
prized. When King LOUIS XI. in 1471 wished to borrow<br />
this work, in order to have it copied, long consultations<br />
were held by the faculty upon the subject and they only<br />
granted permission after the King had deposited as caution-<br />
money 12 marks in silver and had granted a loan of 100 '<br />
thalers in gold* Private persons could make collections<br />
of books only by the expenditure of large sums of money.<br />
Even so prominent and wealthy a doctor as TADDE0 .<br />
ALDEROTTI, left at his death only four books; in thej<br />
property bequeathed by the doctor FREIDANK we find no<br />
* J. C. SABATIER op. cit— KOSEGARTEN (Geschichte derUniversitat Greifswald,<br />
Greifswald 1857, ii, 232) g^s a catalogue of the books which in 1482 were<br />
in the possession of the medical faculty of Griefswald.
MEDICAL TEACHING. 32 1<br />
more than three* The preparation of a copy of a work<br />
claimed years of strenuous application and demanded<br />
attainments at that time by no means common. With the<br />
discovery of printing a revolution was effected in this<br />
t respect, similar to that which in the most recent times has<br />
been brought about by the substitution of machine- for<br />
hand-work in the preparation of goods. The foundation<br />
and improvement of academical libraries were by this<br />
facilitated or, properly speaking, for the first time made<br />
possible. The universities in this way gained an aid to<br />
teaching which promoted the development, at once, of the<br />
intellect and of the character. They recognized its importance<br />
thoroughly, and took pains to procure the money<br />
necessary for the acquisition of books and to regulate the<br />
use of these collections by judicious arrangements and<br />
instructions.t The rules of the medical faculty of Montpellier<br />
in 1534 provided, that the library should be opened<br />
-at 6 a.m. in summer and at 8 a.m. in winter, and should<br />
be closed at 4 p.m. The students were held responsible<br />
for any injury occurring either by loss or disfigurement<br />
of the books, t<br />
ft 1 "*"<br />
In the 16th century the practice was also commenced of<br />
providing the universities with botanical gardens. The<br />
republic of Venice set a good example, in this respect, to<br />
all other states by causing a botanical garden to be laid<br />
out at Padua in 1545.§ Then arose those at Pisa (1547)<br />
and Bologna (1568) where afterwards A. CESALPINI "the<br />
greatest botanist of his century " taught and worked. In<br />
1577 LEYDEN acquired a botanical garden ; Montpellier in<br />
1593. In the German academies the earliest were founded<br />
at Leipzig (1580), Breslau (1587), Basel (1588) and Heidel-<br />
* KRIEGK op. cit. i, 17.<br />
t PRANTL op. cit. i, 215.<br />
J DUBOUCHET in the Gaz. hebd. des scienc. me'd. de Montpellier 1887, Noil,<br />
p. 124. Compare also the very detailed Rules for the Library of the ficole<br />
de Medecine of Paris for the year 1395 in SABATIER op. cit.<br />
§ MEYER op. cit. iv, 256 et seq.<br />
Y
322<br />
RECENT TIMES.<br />
bere (1593)* At first the y ° nly * SerVed t0 P r0m0te<br />
the study of medicinal plants. The teaching of botany<br />
was combined with demonstrations on the plants a<br />
procedure which facilitated the comprehension of the jj<br />
lectures in an extraordinary degree. Moreover, herbaria •*<br />
or collections of dried plants, probably introduced since the i<br />
middle of the 16th century,t were applied to the same purpose,<br />
as also were drawings of plants. Even in ancient<br />
times care was taken to embellish botanical works with<br />
drawings Those of the manuscripts of DiOSKORiDES,<br />
which are now possessed by the Imperial Court Library at<br />
Vienna, date from the 5th century. From later times, also,<br />
especially from the 15th century, numerous drawings of<br />
plants have been preserved.* By the invention of woodand<br />
copper-engraving it became possible to multiply he<br />
drawings at pleasure. Distinguished artists, nay, even the , J<br />
master-hand of a GuiDO RENI, made drawings for the engraver.<br />
Botanical literature was in the 15th and 16th<br />
centuries enriched with a great number of illustrated works<br />
of this kind. . .<br />
Anatomy owed still more to the art of painting, lne<br />
most celebrated painters of this period devoted diligent<br />
study to the anatomy of the human body. LEONARDO DA<br />
VINCI received instruction from his friend, the anatomist<br />
MARC ANTONIO DELLA TORRE, upon the course and form |<br />
of the muscles and upon the position of particular parts of !<br />
the human body. He supplied the latter with drawings for 1<br />
an anatomical work, which he desired to publish, but which {<br />
never appeared. These came afterwards for the most part<br />
into the possession of the Biblioteca Ambrosiana at Milan .<br />
and then reached Paris; certain of them became the property |<br />
of the English Royal Family and were published by means of ^<br />
engraving in the case of some of the drawings, in the easel<br />
of others by photography.§ MICHELANGELO, too, occupied |<br />
* HAUTZ op. cit. :„<br />
t MEYER op. cit. iv, 266 et seq. X MEYER op. cit. iv, 273 «* se f '<br />
VASARI : Leben der ausgezeichneten Maler, Bildhauer und Baumeister.<br />
Deutsche Ubersetzung, Stuttgart, 1843, Bd. iii, S. 26.-R. KNOX : Great ArustsJ
•<br />
MEDICAL TEACHING. 323<br />
himself for many years with anatomical studies, and during<br />
his sojourn in Rome was assisted in these by the anatomist<br />
REALDO COLOMBO who provided him with the body of a<br />
wonderfully handsome young negro to study.* He made<br />
observations upon the structure of man in the vaults of S.<br />
Spirito at Florence, and followed with great attention the<br />
dissections at which he had the opportunity of assisting.<br />
The report even went abroad that he made use of a<br />
living man as model when he had to represent the<br />
Saviour upon the Cross exactly as in ancient times<br />
a similar tale, as is well known, was told of PARRHASIOS<br />
when he painted PROMETHEUS torn by the vulture.f<br />
Among the anatomical drawings of MICHELANGELO<br />
mention may be made of the sketch of a dissection, and of<br />
the picture of a human body the muscles of which are<br />
shown after removal of the skin : the latter is characterized<br />
by close accuracy in its proportions. The skeleton studies<br />
•of RAFAEL also are drawn strictly after nature; they<br />
produce a powerful effect by their essential truth and by<br />
their fidelity of expression. Rosso DE Rossi, a pupil of<br />
ANDREA DEL SARTO, produced some excellent representations<br />
of the muscles and of the human skeleton, which<br />
were multiplied by means of copper-engravings.^<br />
Sculpture was influenced also by studies in this direction<br />
as is clear from the statue of ST. BARTHOLOMEW preserved<br />
in Milan Cathedral in which the muscles are shown laid<br />
bare: this was the work of MARCO AGRATE. The<br />
anatomical plates of VESALIUS and the drawings accompanying<br />
his two larger works came from the school oi<br />
TITIAN and were probably chiefly the work of JAN VAN<br />
and Great Anatomists, London 1852.—CHOULANT op. tit. p. 6 et seq.—K. F.<br />
H. MARX: Uber Marc Antonio della Torre und Lionardo da Vinci in Abhdlgn.<br />
der Gottinger Soc. d. Wissensch., Bd. iv, 177 et seq.-C. LANOEB in the Situngsber'.<br />
d. k. k. Akad. d. Wiss. Math.-Naturwiss. Kl., Wien 1867, Bd. 55, i, 637.<br />
* A. CORRADI inRendic. del R. 1st. Lomb. di sc. e.lett., Vol. vi, ser. ii, p. 643.<br />
t HAESER op. tit. ii, 27.—CHOULANT op. til. p. 10 et seq.—Ann. SENECA":<br />
Controvers., lib. x, c. 5 (No. '34).<br />
X CHOULANT op. cit. S. 16 et seq.
3 2 4<br />
RECENT TIMES.<br />
CALCKER, certain sheets and certain improvements in other<br />
sheets being perhaps by TITIAN himself. It is quite'<br />
possible that, in addition to the two well-known figures *<br />
of a man and woman, he had a hand also in the title<br />
page where VESALIUS appears performing the dissection J<br />
of a corpse in the anatomical theatre in the presence<br />
of a large concourse of spectators. The anatomical ',|<br />
plates of the pre-Vesalian period have a lower value, s<br />
as, for example that of B. PASSAROTTI—a representation<br />
of' blood-letting—which, it would appear, served for the .<br />
instruction of surgeons and barbers* ALBRECHT DURER |<br />
and LEONARDO DA VINCI published works on the pro-1<br />
portions of the human body f which were translated into<br />
foreign languages and exercised a great influence^ as<br />
is evident from the productions of several Spanish artists. |<br />
Certain anatomists, also, produced valuable anatomical<br />
drawings. The picture which VAROLiUS made of the<br />
base of the brain displays contours, correct indeed if also<br />
rather coarse, and was obviously intended for teaching.J<br />
BERENGER of Carpi was, according to the testimony of<br />
BENVENUTO CELLINI, not only an experienced physician and<br />
anatomist, but also a skilful draughtsman. He embellished J<br />
his anatomical works with woodcuts, which kept in view the<br />
interests of the artists as much as those of the doctors^<br />
So too, the myology of CANNANI and the anatomical;?!<br />
writings'of CHARLES ESTIENNE (STEPHANUS), EUSTACHIUSJ<br />
and VOLCHER KOYTER, who himself made many anatomical<br />
drawings, of the Spaniard VALVERDE DE HAMUSCO, and<br />
again of GUIDI (VlDIUS), JACQUES GUILLEMEAU, FELIX<br />
PLATTER, SALOMON ALBERTI, GIULIO CASSERIO, and<br />
ADRIAN VAN DEN SPIGEL were all provided with illustra-?<br />
tions.<br />
Besides the anatomical drawings, which doubtless were<br />
* CHOULANT op. cit. S. 39 e* seq.<br />
t A. W. BECKEH : Kunst und Kiinstler des 16 Jahrhunderts, Leipzig 1863,<br />
Bd. i, 341. iv > l6 3-<br />
X CHOULANT, op. cit. 3. 69.
MEDICAL TEACHING.<br />
3 2 5<br />
of great value in the education of doctors, and besides<br />
the theoretical lectures, the means of teaching most *<br />
resorted to consisted of practical demonstrations for which<br />
opportunity was afforded by the dissection of corpses.<br />
These demonstrations were, in the course of the 16th<br />
century, introduced at all universities with which medical<br />
faculties were associated. At first they were performed in<br />
this manner:—the professor delivered from the chair<br />
descriptions and explanations of the various parts of the<br />
body, while the dissection itself was being made by a<br />
surgeon or a barber. The learned doctors were frequently<br />
of opinion that their dignity would be lowered if they<br />
meddled personally with dissection of corpses. When<br />
VESALIUS was studying at Paris anatomical teaching was,<br />
at that place, entirely in the hands " of ignorant beard-<br />
shavers," as he says,* " who confined themselves to showing<br />
the muscles of abdomen in a torn and shamefully mangled<br />
state, but did not demonstrate any other muscles or any<br />
bones ; still less did they review, in any regular manner,<br />
the arteries, veins, or nerves." GUINTER of Andernach,t<br />
who taught anatomy in Paris, held aloof from practical<br />
work. VESALIUS says of him that he never used the<br />
knife for any other purpose than that of cutting up roast<br />
meat.<br />
The Italian anatomists adopted a more correct method, in<br />
performing the dissections themselves. It was no doubt<br />
chiefly owing to this circumstance that nearly all the great<br />
anatomical discoveries of that period proceeded from Italy.<br />
The anatomical schools of that country were the best<br />
in the world. All the prominent anatomists of the 16th<br />
century received their education at them; among their<br />
professors are found the most glorious names in the history<br />
of science. In electing teachers there was no condition im<br />
posed as to their being natives of Italy; but the ablest<br />
* VESALIUS : Epist. dedicat. to De corp. hum. fabrica.<br />
f Concerning this teacher see E. TURNER in the Gaz. hebdom. de Med.,<br />
Paris 1881, No. 27, 28, 32.
326 RECENT TIMES.<br />
teaching power was accepted from any and every^ountry<br />
Many Dutchmen and Germans were teachers Of anatomy<br />
in Italian academies. At the suggestion of A. BENEDETTI *<br />
an anatomical theatre was founded at Bologna in the year<br />
1490. Similar institutions on the same plan arose also<br />
later in Padua (1548), Amsterdam (1555) and at other<br />
academies* A great drawback to the development of,,<br />
anatomical teaching was occasioned by the scarcity of subjects,<br />
a state of things which was only very gradually K<br />
improved. Even VESALIUS declared that he had so seldom<br />
had an opportunity of dissecting the uterus of a pregnant<br />
woman that he was really quite ignorant of the differences<br />
existing between it and the same organ in a similar condi- A<br />
tion in the canine race.f As a student in Paris and afterwards<br />
at Louvain he, with his companions, visited they<br />
churchyards by night in order to dig up and collect humaff<br />
bones; once he is said on such an expedition to have |<br />
mounted the gallows and to have taken down the<br />
- skeleton of the criminal who had been hanged there.:j.<br />
It was the same in other places as well. FELIX<br />
PLATTER narrates how he when a student at Mont-<br />
' ,•'•>. pellier, along with friends,..among whom was a "daring<br />
'% monk of the Augustine Monastery," dug up bodies<br />
\\ Vby night in the churchyard "after having had a good<br />
"fcdeep drink," and Clandestinely conveyed the bones into the<br />
" ; 'town.§ Not only the students, however, but the professors. *<br />
also, complained of the scarcity of subjects. RONDELET of<br />
Montpellier is said for this reason to have even dissected the<br />
body of his own son who hadtdied. It is further said of him<br />
that when his colleague FONTANO was lying very ill he<br />
begged to be allowed, after his death, to devote his body to<br />
anatomical purposes. || Certainly in the statutes of the<br />
-
MEDICAL TEACHING. 327<br />
medical faculties rules were laid down that every year one or<br />
more anatomical demonstrations should take place, and that<br />
the authorities should provide the bodies required. But the<br />
authorities were not always equal to their duties in this<br />
respect and, even when this was the case, the material used<br />
for study was scarcely sufficient for teaching purposes, and<br />
still less did it supply the wants of anatomical investigators<br />
in the pursuit of their researches.<br />
It was therefore not unnatural that, baffled in obtaining<br />
material in a legal way, anatomists sought to provide it in<br />
another. Purchase and theft of bodies became consequently<br />
a not uncommon practice and one regarded by the magis<br />
trates with a certain toleration, when the objects in view were<br />
connected with science. But it seems to have been some<br />
times carried on too openly and also to have led to abuses<br />
with which it was necessary to interfere. In 1550 the<br />
people of Padua demanded that the laws against the dese<br />
cration of graves and the stealing of bodies should be more<br />
^strictly administered.* Religious now took the place of<br />
social prejudices in opposing the practice of dissection.<br />
Only through the good will of intelligent magistrates<br />
and the powerful support of the distinguished lords who<br />
interested themselves in anatomy, was it possible for<br />
investigators to find the material necessary for their<br />
studies. FALLOPIUS had the opportunity, in a single year,<br />
of dissecting seven human bodies; REALDO COLOMBO<br />
brought the number up to 14T FELIX PLATTER states<br />
that in the course of thirty years' work he dissected more<br />
than 50 bodies;| a number unusually large for that time.<br />
VESALIUS during his successful activity in the academies<br />
of Padua, Pisa and Bologna had as many subjects as he<br />
wished; they were delivered to him from the scaffolds and<br />
from^ the hospitals. The judges had the kindness to<br />
* CORRADI op. cit. p. 642.<br />
f R. COLOMBO op. cit. xv, p. 262.<br />
J F. PLATERUS: De corp. hum. structura et usu, Basil. 1583, in the dedication<br />
after the title-page.
328<br />
RECENT TIMES.<br />
choose a mode of death for the condemned, proposed by^<br />
VESALIUS, with the object of preserving the bodies uninjured,<br />
or they put off the executions at his desire till<br />
such time as a scarcity of bodies prevailed. This obliging<br />
disposition was carried so far that when VESALIUS, wishing<br />
to solve the, at that time, undecided problem * as to the ;4<br />
existence of the hymen virginitatis, was in a state of embarrassment<br />
as to where he could get a suitable female ;,.|<br />
subject, COSMO DE MEDICI placed at his disposal the<br />
corpse of a pious nun who had died a short time before. Jf<br />
As a result of this, as HYRTL remarks, it was possible to<br />
give its due weight to this important attribute of virginity,<br />
which it had hitherto been impossible to do, since the<br />
bodies of the maidens brought from the gallows as a rule :<br />
were no longer in possession of this structure.<br />
Practical teaching in anatomy consisted chiefly in the<br />
demonstration of parts of the body; the students only :jj<br />
exceptionally had the opportunity of taking part in dissections<br />
themselves. It can be seen however from the<br />
statutes of the medical faculties that the number of<br />
dissections made every year for* the purpose of educating;<br />
the doctors gradually increased. In 1519 the rule was<br />
made that every year a body should be publicly dissected, |<br />
since without anatomical dissection a knowledge of the^<br />
human body and its diseases was unattainable.! A similar -|<br />
order is found in the statutes which the Duke ULRICH pro- •<br />
mulgated for Tubingen.<br />
In Prague not only were anatomical studies in a very j<br />
low condition, but the whole university had sunk into dis- 1<br />
repute. The Priest JACOB in 1517 called it at the Teynkirchea<br />
"rusty ornament."J Medicine had almost ceased to<br />
be taught there in the 15th and 16th centuries. Anatomical<br />
demonstrations were- first introduced at this university by i<br />
JOHANN JESENSKY (JESSENIUS) who at the conclusion of<br />
* H.TOLLIN in the Biolog. Centralbl. v, 347.<br />
t ZARNCKE: Statutenbiicher der Uni\Tersftijtt Leipzig, 1861, S. 39.<br />
X W. TOMEK: Geschichte der Prager Universitat, 1849.
MEDICAL TEACHING. 3 2 9<br />
the 16th century undertook there a professorship of medicine.*<br />
Things were not much better in Vienna during the first<br />
half of the 16th century. Only after AlCHHOLTZ assumed<br />
the teaching of anatomy were public dissections held there<br />
at least once in every winter. But these were afterwards<br />
discontinued. Then in 1567 the medical students requested<br />
that a dissection should once again be made, since this had<br />
not been done for many years. Their petition was, how<br />
ever, refused ; they therefore repeated it the following<br />
year, but with the same result; only in 1571 was their<br />
wish gratified.f<br />
About 1542 VESALIUS performed the first dissection of a<br />
human subject in Basel. The skeleton of it is still pre<br />
served, along with that prepared by FELIX PLATTER, in<br />
the anatomical museum of that university.J The latter<br />
undertook in the years 1559, 1563, and 1571 public dissec<br />
tions in the presence of the doctors, surgeons, and other<br />
spectators. Regular anatomical demonstrations were, how<br />
ever, only introduced after C. BAUHIN had been made pro<br />
cessor of anatomy and botany.<br />
In Edinburgh the Corporation of Surgeons obtained per<br />
mission in the year 1505 to dissect the body of an executed<br />
-criminal once a year.<br />
The statutes of the medical faculty of Montpellier of the<br />
year 1534 contain detailed information as to how the<br />
students were to proceed in dissecting, and how much they<br />
were to pay for the privilege. In 1598 an anatomical<br />
theatre was founded there and a prosector appointed with<br />
a stipend of 100 thalers.§ In Paris the post of prosector<br />
. was instituted as early as 1576 : it was filled by a surgeon<br />
who carried out the practical arrangements, while a bache-<br />
* J. HYRTL : Geschichte der Anatomie in Prag, Prag 1841, p. 11.<br />
f ROSAS op. cit. ii, 85, 89, 104.<br />
X His in the Correspond.-Blatt der Schweizer Arzte, 1879, S. 121 et seq.<br />
§ DUBOUCHET in the Gaz. hebd. d. scienc. me'd. de Montpellier, 1887, No. ir<br />
-and 17.—ASTRUC op. cit. p. 66 et seq..
RECENT TIMES.<br />
lor of medicine who was distinguished for his anatomical<br />
knowledge, had to compile from literature, and deliver<br />
orally, the theoretical explanations. The latter bore the<br />
title of Archidiaconus. The prosector had a very dependent<br />
position. He was under the supervision of the<br />
professor of anatomy who, as was said in the statutes<br />
of 1598, must take care that the prosector does not idle<br />
about, but occupies himself diligently with anatomical<br />
dissections and demonstrations (non sinat dissectorem<br />
divagari, sed contineat in officio dissecandi et demon<br />
strandi). It was further resolved, that every year at least<br />
two public dissections should take place. At the same<br />
time, the authorities were directed never to hand over a<br />
body for anatomical purposes without the cognizance of<br />
the dean of the medical faculty, and in delivering bodies<br />
up to have regard first to the requirements of the pro- I<br />
fessors and doctors of medicine and, only in the event of<br />
these resigning all claims to them, to let the surgeons<br />
have them* The expenses connected with the anatomical<br />
demonstrations were in all cases borne by the spectators,!<br />
that is to say by the students, whereas the theoretical,<br />
lectures of the professors since the beginning of the 16th<br />
century were given gratis.<br />
Practical teaching in materia medica and the treatment<br />
of diseases was adopted by the universities long after*<br />
that in anatomical dissection. The students learnt the<br />
properties of drugs and the methods of compounding<br />
them in the apothecaries' shops. In 1536 it was ordained<br />
by law in Paris "that the bachelors of medicine shoukL<br />
accompany the doctors in their visits to the apothe?-|<br />
caries' shops, in order that they might be able to inform<br />
themselves concerning drugs." J Already at that time<br />
* D. PUYLON: Statuts de la faculte' de medecine en i'universite de Paris 1672,.<br />
Art. 56 and supplement Art 5.—A. PINET : Lois, de"crets. reglements et circulaires<br />
cone, les facultgs et les gcoles pr^paratoires de medecine, Paris 1880, i><br />
Art. 56, supplement Art. 8.<br />
f Cf. CERVETTO op. cit. p. 139.<br />
X PHILIPPE op. cit. S. 153.
MEDICAL TEACHING. 33 r<br />
there were apothecaries' shops in nearly all towns. They<br />
were furnished with distilling apparatus, fire places and<br />
furnaces for chemical and pharmaceutical operations,<br />
druggists' wares and various surgical utensils, which were<br />
there stored for sale* By an edict-of Louis XII. of the<br />
year 1514 the apothecaries of Paris were liberated from<br />
association with the grocers, with whom they had hitherto<br />
been joined in a guild. Whoever devoted himself to the<br />
business of an apothecary was obliged, in accordance with<br />
the statutes issued by FRANCIS I., to have received a good<br />
school-education and to have learrit as much as would'<br />
enable him to understand the text-books written in the Latin<br />
tongue and the pharmacopoeias ; and then to have gone<br />
through a four-years' training in an apothecary's shop.<br />
In Paris an arrangement was made that during the space<br />
of a year students of pharmacy should attend two lectures<br />
in every week upon the apothecary's art which should be<br />
given by a specially competent and respectable member of<br />
the medical faculty. The examination was held before a<br />
commission composed of doctors and apothecaries and<br />
consisted of a theoretical and a practical part; in the<br />
latter the candidate was obliged to show knowledge and<br />
experience on the subject of medicinal plants and, as a final<br />
test of his ability, to make up five prescriptions.f<br />
Clinical instruction also lay outside the scheme of uni<br />
versity teaching. The students of medicine betook them<br />
selves, for this, to their teacher or to some other doctor busily<br />
engaged in practice who was able to give them opportuni<br />
ties either amongst his private patients or at a hospital at<br />
which he was employed, of observing the sick and of learning<br />
how to treat them. At some academies the professors<br />
were required by law to give their pupils the necessary<br />
introduction. At Vienna, Heidelberg, Wiirzburg, Ingol-<br />
stadt and other places they were charged to take their<br />
* H. PETERS: AUS pharmaceutischer Vorzeit, Berlin 1886, S. 25 et seq., u 1<br />
et seq.<br />
f PHILIPPE op. cit. S. 165 et seq.
332 RECENT TIMES.<br />
pupils occasionally to the bedsides of their patients provided<br />
that the latter were not annoyed by such a proceeding. In<br />
Basel, the medical officer of the town, who also held the .<br />
appointment of teacher of practical medicine and was head<br />
of the town hospital, was bound to afford the students of<br />
medicine access to this hospital and to demonstrate to<br />
them the patients who were being treated there* In,<br />
Paris the bachelors of medicine were allowed to engage in<br />
practice under the supervision and as the representatives<br />
of the members of the faculty.f<br />
But there was no systematic introduction to the treat- i<br />
ment of the sick; this want could not be supplied by<br />
occasional observations and casual experiences. Not only<br />
the doctors, as for example, the Swedish court-physician<br />
W. LEMNius,J y saw this, but intelligent laymen as well.j<br />
The philosopher P. RAMUS in 1562 in a letter to CHARLES ,<br />
IX. of France, in which he proposed various reforms in the<br />
system of education, asked that institutions should be<br />
arranged for clinical teaching.§ This idea had already at<br />
that time been carried into effect, namely in Padua.<br />
GIAMBATTISTA DA MONTE (MONTANUS), who taught there<br />
at the same time as VESALIUS, is said to have employed the<br />
clinical method of teaching as early as the year 1543d!<br />
But after his death in 1551 this arrangement ceased and<br />
was only renewed in 1578. About this time the professors<br />
ALBERTINO BOTTONI and MARCO ODDO—of whom one<br />
conducted the division for men and the other that for<br />
women in the hospital of St. Franciscus—began to give.<br />
* O. BECKER : Zur Geschichte der medicin. Facultat in Heidelberg, 1876.—<br />
A. v. KOLLIKER: Zur Geschichte der medicin. Facultat in Wiirzburg, 1871.—<br />
F. MIESCHER : Die medicin. Facultat in Basel, i860, S. 32 et seq.—W. VISCHER:<br />
Gesch. d. Univ. Basel, Basel i860.<br />
f PINET op. cit. and PUYTON op. cit. Art. 59.<br />
X P. FRANK op cit. vi, 2, S. 189.<br />
§ CH. JOURDAIN: Histoiie de 1'university de Paris au 17 et au 18 siecle,<br />
Paris 1862-66, T. i, p. 3.<br />
|| G. CERVETTO: Di Giambattista da Monte e della medicina italiana nel<br />
secolo xvi, Verona 1839, p. 51.
MEDICAL TEACHING. 333<br />
clinical instruction at the request of the German students ;<br />
moreover the corpses of the patients who died in the<br />
hospital were opened, if the time of year was suitable, in<br />
order that the students should have pointed out to them<br />
the sites and causes of disease (sed cum in fine Octobris<br />
coeli constitutio frigidior esset, professores cad aver a<br />
aperiunt et loca ajfecta auditoribus demonstrant). Unfortunately,<br />
the necropsies were forbidden after a short<br />
time, since improprieties had occurred and parts of bodies<br />
had been secretly conveyed away from the institution.*<br />
With the deaths of BOTTONI and ODDO the zeal of teachers<br />
and pupils relaxed and instruction was at last chiefly confined<br />
to investigation of the pulse and urine. The attempts<br />
to place teaching in medicine upon a practical basis had,<br />
however, to yield, in the curricula of the medical faculties,<br />
to the theoretical lectures which claimed the place of<br />
chief importance. According to the statutes of the medical<br />
faculty of Wiirzburg of the year 1587, there were there<br />
three professorial chairs of medicine. The incumbent of the<br />
first, the Professor of the Theory of Medicine, had to read<br />
publicly in the first year the primam primi libri Avicennae<br />
et libros Galeni de morborum differentiis, causis et symptomatibus<br />
; in the second year, the Galeni artem medicinalem<br />
cum Hippocratis prognosticis; in the third year, to<br />
lecture de pulsibus et urinis according to ACTUARIUS,<br />
de victus ratione in morbis acutis after HIPPOKRATES,<br />
Galeni de alimentorum facultatibus and to read Avicennae<br />
tertiam primi; the Professor of the Practice of Medicine had<br />
in the first year to comment upon general therapeutics, and<br />
to discuss blood-letting and purging and the nature of fever<br />
according to AVICENNA; in the second and third years the<br />
subjects of his lectures were special pathology and thera-<br />
* A. COMPARETTI : Saggio della scuola clinica nello spedale di Padova 1793,<br />
p. 6 et seq.—C. NEUBERT in d. Beitragen zur prakt. Heilkunde, her. v. Clarus u.<br />
Radius, Leipzig 1836, ii, 148 et seq.—On the other hand, P. A. O. MAHON<br />
(Histoire de la medecine clinique, Paris 18C4) brings forward nothing upon<br />
clinical teaching.
334 RECENT TIMES. •I<br />
peutics of individual diseases. The Professor of Surgery<br />
had in the first year to speak de tumoribus according to<br />
GALEN, in the second, on ulcers and wounds after GALEN,<br />
HIPPOKRATES, and the Arabs, and in the third, on fractures<br />
and dislocations according to GALEN and HIPPOKRATES,<br />
Besides this, in summer he had to treat the subject of<br />
materia medica and to demonstrate the officinal plants, and<br />
in winter to teach anatomy and physiology. The list of<br />
lectures was more accurately settled by the professors in the<br />
midsummer holidays so that it could be committed to paper i<br />
and published in the catalogue with the arrangement of<br />
lectures of the other faculties.* In an official report, which<br />
was drawn up in 1569 upon the lectures delivered by the pro-<br />
\iifi fessors of medicine at Heidelberg, it is said: 1. Professor<br />
lf- :•-. ••>•*' CURIO is reading de generibus morborum ex Galeno, is<br />
explaining Hippocratis de morborum signis, and has an<br />
audience of three or four. 2. Professor ERASTUS gives no<br />
lectures, as he is attending the fair at Frankfort-on-the-<br />
Main. 3. Professor SiEGMUND MELANCHTHON is lecturing<br />
upon the art of medicine according to GALEN, and has<br />
some five pupils.f This report casts a light also upon;the<br />
numbers belonging to the medical faculties at that time.<br />
They appear very small compared with to-day. Medicine<br />
was seldom represented at Leipzig by more than from foijr<br />
to six persons. The academy at Basel numbered, in 1,556,<br />
two professors and two students of medicine.J At Erfurt,<br />
between the years 1392 and 1520, only five doctors of<br />
medicine were created, as against 120 of theology and 40'<br />
of law. Many Germans frequented universities abroad^,<br />
especially those of Paris, Bologna, Padua, and Montpellier.<br />
In Padua there were, in the year 1564, about 200 Germans<br />
studying law.§ Medical students sought out by preference<br />
* A. v. KOLLIKER op. cit. S. 58. F. v. WECELE : Geschichte der University<br />
Wiirzburg, 1885, ii, 191-199.<br />
f J. F. HAUTZ op. cit.<br />
X PLATTEH op. cit. S. 169.<br />
§ MEINERS: Geschichte der Entstehung u. Entwickelung der hohen Schulen,<br />
Gottingen 1802.
MEDICAL TEACHING. 335<br />
Montpellier and Padua, as is apparent from numerous<br />
biographies of celebrated physicians of the 16th century.*<br />
A doctor of Gottingen, in 1420, left a legacy of 600 florins<br />
on the interest of which a poor student of medicine was to<br />
be maintained for four years at Montpellier.f FELIX<br />
PLATTER also betook himself thither from Basel to complete<br />
his medical studies.<br />
THE MEDICAL PROFESSION AND ITS ATTITUDE<br />
TOWARDS THE MOVEMENTS OF THE<br />
SIXTEENTH CENTURY.<br />
THE medical examinations were of the same pattern as<br />
before. But the academical degrees sank much in value, in. •<br />
consequence of the easy terms upon which they were,'.;<br />
granted at many academies. As early as the year 1502<br />
complaints were made that " horse-dealers, traders in cattle,<br />
and other common people, who have not the slightest<br />
acquaintance with ARISTOTLE and are ignorant of even the<br />
first elements of grammar " obtained the title of Magister in<br />
the philosophical faculty of Paris.J At some French' *<br />
universities the degree of Doctor of Medicine was even<br />
sold for money. King FRANCIS I. on this account felt himself<br />
obliged to extend his recognition to the medical<br />
diplomas of Paris and Montpellier only.§ In Padua the<br />
singular custom arose of the candidates bringing with them<br />
assistants to the examination who whispered to them the<br />
answers to the questions which were put. The convenience<br />
of the candidates was still further consulted if, as AUGUSTIN<br />
LEYSER states, the questions with the answers annexed<br />
* MELCHIOR ADAM: Vitae Germanorum Medicorum, Heidelberg 1620.—A.<br />
BUDINSZKY : Die Universitat Paris und die Fremden an derselben im Mittelalter,<br />
Berlin 1876,8. 115 et seq.<br />
t SCHMIDT: Gottinger Urkundenbuch ii, 20.<br />
X BUL£US : Hist. Universitat. Paris 1673,T. vi, p. n.<br />
§ H. TOLLIN in VIRCHOW'S Archiv 1880, Bd. 8o, S. 66, and in the Biol.<br />
Ccntralblatt, Bd. v, S. 341.
, # ' 'f<br />
336 RECENT TIMES.<br />
_ _ ^ ; MiP<br />
were previously written out and supplied to them* Then,<br />
too, it must be remembered that the title of doctor was<br />
conferred not only by the universities but also by the<br />
Pope and the Emperor. In the 14th century even the ;<br />
Counts Palatine obtained the right to grant the title of<br />
doctor just as they were also competent, as is<br />
well known, to legitimate bastards. To such a state,<br />
of affairs the caustic description which PETRARCH has<br />
left of the ceremony of taking the doctor's degree<br />
might sometimes fitly apply. " Now the young man appears,<br />
puts on an air of importance and mutters some unintelligible<br />
stuff while the people stare at him with astonishment,<br />
and his friends congratulate and applaud him. The bells<br />
are rung, trumpets sounded, rings and kisses exchanged,!,<br />
and the round cap of the Master is placed on his head.<br />
Whereupon he, who had mounted the ceremonial chair a<br />
blockhead, descends from it a wise man. This is a meta-A<br />
morphosis of which, OviD knew nothing."* Many students<br />
refused to take the degree of doctor at all on account of<br />
the expense and of the small estimation in which it was<br />
held. In this, perhaps, lies the explanation of the failure to |<br />
trace the diplomas of several celebrated doctors such as 1<br />
J. SYLVIUS, VESALIUS, M. SERVET, J, THIBAULT and 1<br />
others. |<br />
The surgeons were as a rule excluded from the privilege J<br />
of obtaining the degree of doctor of medicine. In Italy* t<br />
only, where the separation of surgery from "the rest of J<br />
medicine was at no time so complete as in other countries, |<br />
an exception was made to this rule. In France also the |<br />
surgeons received a scientific education. The College de j<br />
St. C6me, in 1545, obtained the right to grant academical 1<br />
degrees. Its students had to study for four years and at-1<br />
tend lectures not only on surgery but also on anatomy,"*<br />
*^ y,-<br />
* C. MEINERS: Uber die Verfassung und Verwaltung deutscher Universitaten, |<br />
Gottingen 1801, i, 328 et seq.; and C. MEINERS: Geschichte der Entstehung U.<br />
Entwickelung der hohen Schulen, i, 188.<br />
f PETRARCA : De vera sapienta, Dial. i. (Op. ed. Basil. 1554, p. 365).
THE MEDICAL PROFESSION.<br />
337<br />
materia medica, and many other subjects. Unfortunately,<br />
at this period also, petty jealousies and quarrels continued<br />
to exist between the surgical faculty, as the College de St.<br />
C6me may be called, and the medical faculty, to the injury<br />
of science in general. The doctors gave themselves pains<br />
to provide the surgeons with opponents endowed with<br />
privileges equal to their, own, in the so-called barber-<br />
surgeons: they, with this object, took care that the latter<br />
should acquire a larger amount of general and technical<br />
knowledge. Although this led to many unsatisfactory<br />
occurrences between the two classes of practitioners it<br />
had yet this good effect that the possibility was afforded to<br />
highly-gifted members of the inferior class of surgeons<br />
of becoming operating surgeons in our sense of the<br />
words. The example of an AMBROISE PARE shows how<br />
much surgery and with it medicine in general owes to this<br />
circumstance. It is only fair to say that the members of<br />
the faculty of medicine in their procedure had not this<br />
laudable end in view but washed rather to lower the credit<br />
of surgery and make its representatives their humble<br />
servants, willing to recognize their own intellectual superi<br />
ority. This way of looking at the subject is clearly indi<br />
cated by the words of M. SERVIN who wrote in 1607,<br />
"que la science n'est pour ceux qui n'ont que la main,<br />
qu'ils doivent laisser a juger aux mddecins."* When one<br />
of the professors, ROBERT LE SECQ, in an examination of<br />
surgeons in the year 1606, alluded to physiology and<br />
entered upon the subject of the action of the muscles, the<br />
mechanism of respiration and many other matters, the<br />
faculty of medicine entered a protest, on the ground that<br />
these things were points of controversy in science.f In<br />
Germany and other countries surgery seldom raised itself<br />
above a handicraft. It was only taught at some univer<br />
sities/' At Vienna, a Professor of Surgery was appointed<br />
with the annual stipend of 52 florins.J The German<br />
* D. PUYLON : Statuts de la faculte' de me'decine, Paris 1672.<br />
t HAZON op. cit. X ROSAS op. tit. ii, 51.<br />
Z
338<br />
RECENT TIMES.<br />
surgeons arose almost exclusively from the position of<br />
barbers or bagnio-keepers. They learnt from a master the<br />
treatment of wounds and ulcers, of fractures and dislocations,<br />
and obtained afterwards some further training in<br />
hospitals and in military medical service. Some, such as<br />
HIERONYMUS BRUNSCHWYG, HANNS VON GERSDORF and<br />
FELIX WORTZ acquired considerable operative ability.<br />
The scarcity of educated doctors, which prevailed in<br />
Germany, and the numerous wars and pestilences which, j<br />
that country had to endure in the 16th century, caused j<br />
surgeons to be looked upon as indispensable; it must also<br />
be remembered that besides the treatment of external ailments<br />
that also of diseases affecting the sexual organs fell •<br />
into their hands. Since they frequently surpassed the<br />
physicians in practical dexterity and experience, were in a<br />
position of nearer social relationship with the people, andjf<br />
demanded smaller sums of money for their services, much<br />
favour was shown them. Many were employed as private<br />
medical attendants at the courts of princes, in the public<br />
service, or in prominent positions in the medical service of j<br />
the army. ^<br />
The doctors took a lively share in the intellectual movej<br />
ments of the 16th century. Then, as always, the grea|<br />
majority of them embraced the cause of freedom. It was<br />
but natural that PARACELSUS, inclining as he did to radicalism,<br />
should follow with enthusiasm all currents of thought<br />
which were opposed to existing authorities, and that he<br />
should long to see them increase into a devastating flood.<br />
But men of reflection and cool judgment were also led by<br />
their convictions into- the camp of the Reformation, and<br />
this because they saw that its limits did not exceed the<br />
boundaries marked out by a process of natural development.<br />
The captains of Protestantism bestowed upon<br />
medicine a lively interest. MARTIN LUTHER caused<br />
his son PAUL to study medical science; the latter<br />
afterwards was employed as a physician-in-ordinary at<br />
Gotha, Berlin, and Dresden, and also became known as
THE MEDICAL PROFESSION. 339<br />
a medical author. The son-in-law of MELANCHTHON<br />
CASPAR PEUCER, was Professor of Medicine at Wittenberg ;<br />
his nephew SIEGMUND, at Heidelberg. ADAM VON BODENbTEIN<br />
the son of the theologian KARLSTADT, practised<br />
medicine at Basel. CRATO VON CRAFFTHEIM by the<br />
advice of MARTIN LUTHER exchanged the study of<br />
theology, which he had begun under LUTHER'S guidance,<br />
for that of medical science; in this he gained great<br />
success and performed distinguished services at Vienna<br />
as doctor-in-ordinary to three emperors. He was the chief<br />
tfigure of Protestantism at Breslau and afterwards its most<br />
zealous representative at the court of Vienna.* His<br />
colleague, also, DIOMEDES CORNARUS (HAGENBUTT) doctordn-ordinary<br />
to the Emperor MAXIMILIAN II. probably<br />
belonged to this faith. At Vienna in 1584 three doctors<br />
shortly before dying declared themselves to be opposed to<br />
the confessional, and a fourth forbade the tolling of bells<br />
at his funeral, and demanded that his corpse should be<br />
interred in unconsecrated ground. CASPAR PlRCHPACH<br />
doctor of medicine, when in 1268 he filled the post of<br />
i Rector of the university of Vienna, was instrumental in<br />
.getting the requirement of the statutes that the academical<br />
teachers should subscribe to the Roman Catholic Faith set<br />
asfde, and the word Catholicae replaced by Christiana?<br />
(fidei). It was at the same time decided that, those who<br />
subscribed to the Augsburg Confession might be admitted<br />
to the degree of Doctor.f Even in Ingolstadt, the headquarters<br />
of the reaction in favour of the Church, several<br />
professors of the medical faculty embraced a freer opinion<br />
in religious matters : they were on this account through the<br />
influence of the fesuits, who soon after came into considerable<br />
power there, deposed from their offices.^ At the<br />
conclusion of the 16th century the intellectual movements<br />
* J. F. A. GILLET: Crato von Crafftheim u. seine Freunde, Frankfurt-a-<br />
M. i86o,ii, 14.<br />
t PAULSEN : Geschichte des gelehrten Unterrichts, S. 272.<br />
+ PRANTL op. cit. i, 319.
34°<br />
RECENT TIMES.<br />
with which it commenced, had nearly everywhere achieved<br />
victory. In so far as they bore a revolutionary character<br />
they were certainly unsuccessful; but they attained<br />
their goal while confining their activity within the bounds<br />
of reasonable reform. Their chief success lay in the<br />
fact that even those opposed to them were compelled to<br />
recognize their propriety, inasmuch as they abandoned the<br />
paths they had trodden hitherto and found new roads to<br />
advance in. Nowhere indeed had the ploughshare of<br />
intellectual work traced deeper furrows than on the soil of<br />
the natural sciences and of medicine. Yet the significance<br />
of this activity must be sought for not so much in what<br />
was achieved, as in what the future of scientific inquiry<br />
promised.<br />
Enlightened spirits, like FRANCIS BACON Lord VERU-<br />
LAM, began to recognize what- an important part was<br />
assigned to the natural sciences in the development of<br />
civilization. This distinguished English statesman and<br />
philosopher, who, as it were, represented in himself the<br />
total of the intellectual efforts of the 16th century, declared<br />
that induction from experience and experiment could alone<br />
give a solution to the questions which scientific investigators.<br />
were striving to understand. Though himself not in a<br />
position to enrich science by new discoveries, he nevertheless<br />
pointed out to her the paths which led to them. He<br />
certainly foresaw correctly the inter-dependence of many<br />
phenomena, the clear comprehension of which was reserved<br />
for later centuries. Thus he already gave plain utterance' \<br />
to the conjecture that the atmosphere subserves the •<br />
nutrition of plants, that colour is a modification of light, !<br />
and heat a form of motion, and that some day it would be |<br />
possible to produce mineral waters artificially.* He referred j<br />
to the value of vivisection, to the importance of pathologi-1<br />
cal anatomy, and of statistics of the results of the treat- -<br />
ment of disease. But his most meritorious services lay ia|<br />
* H. v. BAMBERGER: Uber BACON VON VERULAM, Wiirzburg 1865, S 15,21 ;<br />
et seq.
THE SEVENTEENTH CENTURY. 341<br />
the domain of theoretical knowledge: he brought the<br />
method of investigation to such a clear and complete<br />
development as, before his time, had never been accomplished.<br />
BACON was neither the shallow vain prattler,<br />
without any originality of thought, that he has been represented<br />
by some, nor the creative genius out of whose head<br />
science sprang in complete beauty, that others have<br />
depicted him. He was, as it were, a hand on'the face of a<br />
clock pointing out to us the progress made by time.<br />
THE EXPERIMENTAL DIRECTION TAKEN BY THE<br />
NATURAL SCIENCES, PHYSICS, AND CHEMISTRY<br />
DURING THE SEVENTEENTH CENTURY.<br />
THE expectations raised by the startling progress of the<br />
natural sciences in the 16th, were most abundantly fulfilled<br />
in the following, century. If men had hitherto confined<br />
themselves to observing facts in nature and to taking a<br />
firm mental grasp of the existence of things, they now<br />
began to investigate their causes and to fathom their<br />
reciprocal relations. They desired to become acquainted<br />
with the processes of organic life in their development and<br />
with this object they instituted experiments by which they<br />
might imitate the workings of nature by artificial means.<br />
Experiment advanced into the foreground and gave a<br />
characteristic colouring to the mode of thought of the 17th<br />
century. No path of intellectual activity was more influenced<br />
by this than that of the natural sciences and medicine.<br />
They have to thank this bias in favour of experiment for<br />
the stimulus which led to new investigations and by it<br />
they attained to that certainty of doctrine which is of the<br />
essence of science. Physics, chemistry and physiology<br />
those subjects, in fine, which are principally founded on<br />
experiment—were at this period enriched with a great<br />
number of discoveries. A new period of their history<br />
began. Mineralogy, botany, zoology and anatomy also
342<br />
RECENT TIMES.<br />
made important progress. Crystallography was advanced<br />
by the observations of NICHOLAS STENO and GULIELMINI<br />
upon the markings and construction of crystals and the<br />
immutability of their angles. ROBERT BOYLE noticed the ,<br />
crystallization of bismuth out of the molten flux of the I<br />
furnace, and the Danish doctor ERASMUS BARTHOLINUS,j<br />
discovered double refraction in Icelandic calcspar (1670), a<br />
subject more closely investigated by HUYGENS and which<br />
had an important bearing upon the undulatory theory of<br />
light*<br />
At the same time botany was experiencing important<br />
changes. While the knowledge of the different species of 1<br />
plants was increased by numerous works upon the floras<br />
of particular regions and countries, the various attempts to ,J<br />
classify plants according to the similarity of their organs<br />
into families and groups contributed to the more accurate<br />
study of their structure. But the foundation of phytotomy<br />
by MALPIGHI and GREW, their excellent investigations<br />
into the minuter structure of plants, and especially their<br />
labours upon the blossoms, fruits, and seeds of plants,<br />
together with the experimental demonstration of sexuality ^<br />
in the vegetable kingdom by R. J. CAMERARIUS, first*j<br />
rendered it possible to formulate a system corresponding to ?<br />
the demands of science. LiNN^US, who accomplished this*<br />
task, gave a definite and complete form to botany by the<br />
methodical arrangement and characterization of his genera<br />
and species combined with his persistent use of the binary<br />
nomenclature: the discovery of a natural system being<br />
reserved to satisfy the just requirements of future times-f<br />
With the application of the magnifying-glass and micro<br />
scope to scientific investigations, a new world of life<br />
was opened to zoology of the existence of which none<br />
had hitherto entertained a presentiment. LEEUWENHOEK<br />
discovered infusoria, described certain rotifera, observed<br />
* F. v. KOBELL: Geschichte der Mineralogie, Miinchen 1864, S. 8 et seq. J<br />
f J. SACHS : Geschichte der Botanik. Miinchen 1875, S. 84 et seq., 246 etseq.,<br />
41 7 et seq.
THE SEVENTEENTH CENTURY. 343<br />
the faceted eyes of insects, and studied the origin and<br />
development of several of the lower forms of animal life.<br />
MALPIGHI imparted valuable information upon the structure<br />
and composition of the organs of the animal body and, even<br />
thus early, gave utterance to the thought that the compli<br />
cated structure of the more highly developed organisms is<br />
analogous to the more simple structure of the lower forms<br />
of life, and by such is to be explained. He even came<br />
tolerably near the discovery of the animal cell, while<br />
ROBERT HOOKE drew attention to the cellular structure of<br />
plants. The zootomical labours of SWAMMERDAM, whose<br />
accuracy is evidenced by his investigations on numerous<br />
mollusca, on the uro-genital organs of the frog, on the<br />
anatomy of the bee, etc., served naturally to throw much<br />
light on the views of men of science, as did also the<br />
observations of F. REDI upon generation, as a result of<br />
which he made the statement that in decomposing meat no<br />
maggots develop if flies are kept away. Supported by<br />
these results, JOHN RAY, J. T. KLEIN, LINNAEUS and others<br />
were able to facilitate the study of animals by classifying<br />
them systematically, and to represent zoological science<br />
in a comprehensive way.*<br />
Physics and chemistry however experienced at this<br />
period transformations of the highest significance. When<br />
chemistry, by the influence of PARACELSUS and his dis<br />
ciples, was diverted from alchemy and turned into the<br />
direction of materia medica, it started afresh with a vigour<br />
which promised to be full of benefit to itself and to medi<br />
cine alike. A large number of new medicines were dis<br />
covered, and the technical methods of preparing them were<br />
improved in manifold ways. Perhaps no less important<br />
was the effect which chemical views and knowledge exerted<br />
on physiology and pathology. A certain number of doctors<br />
saw in every occurrence in the organism processes of fer<br />
mentation and decomposition, and were willing to explain<br />
moft phenomena of the body in health and disease by<br />
V. CARUS: Geschichte der Zoologie, Miinchen 1872, S. 386 et seq.
344<br />
RECENT TIMES.<br />
means of chemical reactions. This intro-chemical bent was<br />
sometimes carried too far, for under its influence mpn im- j<br />
posed upon themselves problems, the solutions of which<br />
were not discoverable, owing to the slight development ,<br />
reached by chemistry at that time. But these views had<br />
this great merit, that they accustomed doctors to the thought<br />
that they might expect but little from 'speculation, much<br />
however, if not everything, from an examination cf facts.<br />
Chemistry owed to the perception of this circumstance<br />
many discoveries and an important enlargement of its sub<br />
ject matter.<br />
The doctor LlBAVlUS invented the method of preparing<br />
sulphuric acid from sulphur and saltpetre, and recognized |<br />
that the product was identical with that formed from metallic :<br />
sulphates or alum. He first produced the bichloride of tin -|<br />
>;<br />
by the distillation of bichloride of mercury (corrosive sub- J<br />
limate) with tin, and was acquainted with the process of ><br />
colouring the glassy flux by the addition of gold. TURQUET<br />
DE MAYERNE taught the preparation of benzoic acid cry- |<br />
stalsby sublimation. J. B. VAN HELMONT, also, enriched '<br />
chemistry bv a multitude of new facts. He stated the pro-;|<br />
position that only such metals are separated from a solution j<br />
as were previously contained in it, giving thus the death-J<br />
blow to the goldmaker's art. He discovered carbonic acid |<br />
gas, and introduced into chemistry the conception of gases<br />
as being of the nature of air, but not identical with atmos-J<br />
pheric air. The attempt which he made to study the parts<br />
played by soil, water, and air in the nutrition of plants I<br />
affords clear proof of the experimental method of his inquiry. J<br />
In the writings of GLAUBER, who furnished more accurate^<br />
information upon sulphate of soda and numerous other salts, ;<br />
we already find a crude, but promising, appreciation of :<br />
chemical affinity*<br />
A deeper foundation was here laid by ROBERT BOYLE^j<br />
who, by his corpuscular theory, sought to explain the separation<br />
of chemical combinations into their constituent parts<br />
* KOPP op. cit. i, in, 114, 120 et seq., 130.
THE SEVENTEENTH CENTURY 345<br />
and the union of these parts with those of other combinations<br />
by the attractions and repulsions which they exerted<br />
upon one another. W r ith BOYLE commenced the time of<br />
the study of chemistry for its own sake, when it was no<br />
longer looked upon as mere means of finding the philosopher's<br />
stone, as was the case with the Alchemists, or of<br />
furnishing new medicines as was the case with the Iatrochemists.<br />
He discovered phosphoric acid, chloride of<br />
copper, fuming sulphide of ammonium, and was the first to<br />
observe the opposite reactions of acids and alkalies respectively<br />
with certain vegetable colours. From him is derived<br />
the practice of impregnating strips of paper with vegetable<br />
colouring matter and using them as reagents. BOYLE<br />
rendered great services by founding analytical chemistry,<br />
and by applying chemistry to the purposes of the arts.*<br />
Among those who took an important part in building up<br />
the structure of scientific chemistry we find the following:—<br />
KUNKEL, BECHER, W. HOMBERG, LEMERY, STAHL, F-<br />
HOFFMANN, the last of whom gave his chief attention to<br />
the chemical investigation of mineral springs and found<br />
sulphate of magnesia in the mineral water of Seidlitz ;<br />
MARGGRAF, who founded the beetroot sugar industry;<br />
DU HAMEL, who drew attention to the difference between<br />
soda and potash, taught how to prepare soda and referred<br />
to its existence in the ashes of plants growing on the sea<br />
•coast; H. CAVENDISH, whose researches on hydrogen<br />
(which he unfortunately took for the much-sought-for, but<br />
non-existent, phlogiston), and on the properties, specific<br />
.gravity, and the absorbability in water, oil, and alcohol<br />
respectively of carbonic acid gas deserve mention here ;<br />
BERGMANN, who worked at the doctrine of chemical affinity ;<br />
and, finally, SCHEELE, who did good work in organic<br />
•chemistry, discovered lactic and uric acids, besides various<br />
vegetable acids, and also advanced inorganic chemistry by<br />
the discovery of several new elements, such as chlorine and<br />
manganese. Many of these were also doctors, and conse-<br />
* KOPP op. cit. i, 165 et seq.
34 6 RECENT TIMES.<br />
quently devoted special attention to the relations of<br />
chemistry to medicine.<br />
Unfortunately the progress of chemistry was hampered J<br />
by erroneous opinions which had been preconceived, and J<br />
which had developed into dogmas generally accepted.!<br />
Thus people assumed that the process of combustion is j<br />
dependent upon the presence of a material called phlogiston,<br />
and the greater or less combustibility of a body, upon the |<br />
quantity of this burning-material contained in it. The J<br />
phlogistic theory—according to the analogy of which the j<br />
origin of the acids was ascribed to an acid material, the so- \<br />
called primitive acid, and that of the caustic alkalies to a.<br />
caustic material—was paramount in men's minds for nearly<br />
a century, and was only exploded by LAVOISIER.<br />
A luckier star presided over the destiny of physics * for J<br />
philosophers were here not influenced in their judgment by J<br />
untenable and baseless hypotheses, but used all their|<br />
intellectual powers in collecting material which could be|<br />
employed in building up a firm structure of doctrine.<br />
GALILEO whose achievements in astronomy, and whose ^<br />
martyrdom for his convictions are better known than his-1<br />
service to physics, discovered the laws of falling bodies and J<br />
of the pendulum. He recognized the importance of the pro-j<br />
position of the parallelogram of forces and sought by its<br />
help to determine the course of projectiles. Concurrently<br />
with STEVINUS he worked also at hydrostatics and hydrodynamics.<br />
" If any single person can lay claim to the<br />
honour of founding such a many-branched science as thati<br />
of physics," says POGGENDORFF (op. cit. p. 268), "that<br />
honour is, without hesitation, GALILEO'S; for he laid thej<br />
foundation of scientific mechanics, which runs like a nerve<br />
through almost every part of physics." As early as 1597'<br />
GALILEO constructed a thermometer, with the production of<br />
which instrument R. FLUDD, SANCTORIUS, and C. DREBBEL,<br />
' also occupied themselves. GALILEO'S highly gifted pupil<br />
TORRICELLI determined the laws of the outflow of liquids<br />
* J. C. POGGENDORFF, Geschichte der Physik, Leipzig 1879, S. 204 et seq. 1
THE SEVENTEENTH CENTURY. 347<br />
through tubes, invented the barometer (1643) and explained<br />
that the rise and fall of the mercury are due to changes of<br />
atmospheric pressure. PASCAL made some irrefutable<br />
statements on this subject and pointed out that with the<br />
help of the barometer the difference in height between<br />
two places can be determined. MARIOTTE, J. PECQUET,<br />
and SINCLAIR rendered these ideas more complete and<br />
brought the practical application of them nearer. PASCAL<br />
constructed a wine-barometer, while BERTI and O. V<br />
GUERICKE enclosed water instead of mercury in the tube-<br />
OTTO VON GUERICKE, burgomaster of Magdeburg and<br />
formerly engineer of the fortress of Erfurt, devised the<br />
air-pump and considerably astonished the princes assembled<br />
in the imperial diet at Regensburg in 1654, by the experi<br />
ments he performed with it. He made excellent observa<br />
tions on the weight of air and constructed the first<br />
manometer for measuring the density and weight of the<br />
atmosphere. He also referred to the fact that in spaces<br />
from which the air has been removed no sound can be pro<br />
duced and no combustion take place.s His observations<br />
were completed by BOYLE, who studied more closely the<br />
elasticity of air and discovered the law, erroneously named<br />
after MARIOTTE, that the volumes of equal weights of air<br />
stand in inverse ratio to the pressures to which they are<br />
subjected. About the same time attempts were made to<br />
determine the velocity of sound. GASSENDI asserted that<br />
it travels 1,473 * eet i n a second. MERSENNE came somewhat<br />
nearer the truth in estimating the number of feet at<br />
1,380. Even if the results they arrived at were incorrect,<br />
they nevertheless hit upon the right method of investiga<br />
tion and this was already an extraordinary advance. Even<br />
a NEWTON was unable to avoid every source of error; he<br />
calculated the velocity of sound at 906 Paris feet in a<br />
second, not making a sufficient allowance, as LAPLACE has<br />
pointed out, for the influence of temperature.<br />
The most important advances were made in optics,<br />
favoured, and, to some extent indeed, rendered for the first
348<br />
RECENT TIMES.<br />
time possible, by the invention of various instruments<br />
which took place at that time. The telescope enabled the ",<br />
eye to see into the distance : the microscope opened out f<br />
into view the world of small things. By these two optical %<br />
aids the power of human vision was strengthened in an<br />
unexpected manner and paths were opened to investiga- j<br />
tion, which had before been beyond the boundaries of<br />
human knowledge. The seat of these inventions was<br />
Holland. It is doubtful to whom priority belongs in these<br />
discoveries : but it appears that the brothers JANSSEN, who<br />
in the beginning of the 17th century lived in Middelburg<br />
as glass cutters, have the best claims, at least in respect of<br />
the compound microscope.<br />
It is not my business to go more closely in this place<br />
into the history of this discovery and it is also unnecessary -<br />
since it has already been discussed by HARTING in a fairly<br />
exhaustive manner.* The extraordinary importance of the<br />
microscope in the study of natural sciences cannot be<br />
described in words.<br />
The instruments were gradually improved and rendered<br />
more complete in numberless ways. The discovery of the<br />
reflecting telescope by JAMES GREGORY, that of the<br />
micrometer (crossed threads) by ROBERT HOOKE, the<br />
construction for the first time by M. HALL of achromatic<br />
lenses by a combination of crown and flint glass, etc., were<br />
added afterwards.<br />
Even then men ventured to attack the difficult problems<br />
of light and colour. The great philosopher DESCARTES<br />
(CARTESIUS), to whom mathematics owes the recognition<br />
of the meaning of the negative roots of equations and the<br />
foundation of analytical geometry, sought for an explanation<br />
of the rainbow and in this way worked out the law of incident<br />
and reflected rays, and the angles formed by them, i<br />
SNELL established the relations between different media<br />
and the refraction of light in them, and GRIMALDI dis-<br />
* P. HARTING: Das Mikroskop, ins deutsche iibers. v. THEILE, iii. TheiL<br />
Braunschweig 1866.
THE SEVENTEENTH CENTURY. 349<br />
covered diffraction or inflection of light as well as its dis<br />
persion or splitting up into its constituent colours. The<br />
last-mentioned, and HOOKE in even greater degree, when<br />
he published his observations on the colours of thin films,<br />
had suspicions of the undulatory movement of light which<br />
HUYGENS, supported by the phenomenon of double refrac<br />
tion, raised by his undulatory theory into one of the facts of<br />
science. It is true that it had to wait more than a century<br />
before receiving general recognition; for NEWTON had<br />
asserted that light consists of concrete particles which are<br />
emitted from luminous bodies with great velocity, and his<br />
authority w r as so powerful that all attempts which were at<br />
variance with it were unavailing, for a time, to make truth<br />
victorious. Not till 1815 did success crown the persevering<br />
efforts of FRESNEL and ARAGO to secure a general accept<br />
ance for the undulatory theory.<br />
The first contributions, also, upon the phenomena of<br />
polarization — observed indeed by NEWTON but which<br />
he was unable to explain intelligibly — date from the<br />
end of the 17th century. On the other hand, in his<br />
experiments upon the dispersion of sunlight, undertaken<br />
by him after the method already adopted by GRIMALDI and,<br />
before GRIMALDI, by the Prague doctor MARCUS MARCI of<br />
Kronland, NEWTON arrived at the important result that<br />
white light is composed of an infinite number of coloured<br />
rays of different refrangibility and that to each degree of<br />
refrangibility a particular colour corresponds. NEWTON'S<br />
views upon the origin and essence of colours were not<br />
correct; it appears that L. EULER in 1746 was the first who<br />
had correct coherent notions on this subject. Many more<br />
discoveries in physics belong to the 17th century,—dis<br />
coveries which have advanced civilization very greatly in<br />
many directions. HOOKE improved the watch by inventing<br />
the spiral spring, and HUYGENS was the first to construct a<br />
pendulum-clock.<br />
The Marquess of WORCESTER, Captain SAVERY, MORE-<br />
LAND, PAPIN and others studied the power of steam very
35°<br />
RECENT TIMES.<br />
carefully and contrived machines for making a practical test<br />
of its value ; an operation which had at first to contend<br />
with many inconveniences. Thus the opening and shutting<br />
of the stopcocks of the injecting-pipe and steam-pipe had<br />
to be done by hand. But one day a clever fellow, to whom ^<br />
this duty was entrusted, remarked that the turning of the<br />
cocks tallied with the movement of the beam. He there- +|<br />
upon bound them together with string and saw that the 1<br />
machine forthwith worked by itself. PAPIN even proposed<br />
to make use of steam power for driving ships.<br />
So also the first observations of electrical phenomenal<br />
date from this period* The Englishman GILBERT, who ''[<br />
discovered telluric magnetism, found that electricity is pro-1<br />
duced by friction, but cannot be generated in all bodies j<br />
and is distinct from magnetism. O. V. GUERICKE, by \<br />
the help of an apparatus constructed by himself and which*!<br />
led up directly to the electrical machine, observed besides^<br />
the already known electrical attraction, other phenomena<br />
of which nothing was previously known, namely<br />
electrical repulsion, and light and crackling sounds pro-|<br />
duced by electrical means. Then the English philosopher<br />
WALL in 1698 described the real electric spark and com-?|<br />
pared it and the crackling sounds, arising under electrification,<br />
with lightning and thunder.<br />
STEPHEN GRAY in 1729 established by experiment the I<br />
distinction between conductors and non-conductors of<br />
electricity; he pointed out that electricity may be com- \<br />
municated from one body to another and that, for this,<br />
direct contact is not always required, but that approximation<br />
is sufficient; he moreover referred to the fact that in<br />
the electrification of bodies it is not a question of their mass<br />
but of the extent of surface presented by them; he was<br />
also the first to electrify water and the human body and for<br />
this purpose even made use of the insulating stool. Soonc<br />
after this DUFAY made the important discovery that there;<br />
* E. HOPPE: Geschichte der Elektricitat, Leipzig 1884.
THE SEVENTEENTH CENTURY. 351<br />
are two distinct kinds of electricity one of which clings to<br />
glass and the other to resin. Upon this followed improvements<br />
of the apparatus for generating electricity brought<br />
about by BOSE, J. H. WlNKLER and others and which led<br />
to the construction of the electrical machine; the discovery<br />
of the Leyden Jar made almost simultaneously<br />
by. MUSSCHENBROEK at Leyden and Baron KLEIST in<br />
Pomerania; the discovery of atmospheric electricity by LE<br />
MONNIER; the invention of the lightning conductor by<br />
BENJAMIN FRANKLIN; and the construction of the first<br />
electrometer by JOHN CANTON.<br />
Finally, certain other advances in physics must be mentioned<br />
here, which belong to the same period. The thermometerwas<br />
improved at the instigation of FERDINAND II. of the<br />
Medici family. Already the differential thermometer was<br />
invented. AMONTONS, who devised the hygroscope and<br />
studied the influence of heat on the barometer, constructed<br />
the first effective air-thermometer. By graduating and<br />
adding a scale to the thermometer, for which FAHRENHEIT<br />
of Danzig deserves special credit, its practical applicability<br />
was largely extended. At Florence, the first observations<br />
on specific heat were made ; it was called heat-capacity.<br />
ALF. BORELLI threw more light upon the phenomena of<br />
capillarity, a subject known to LEONARDO DA VlNCi.<br />
But all these things yielded in importance to ISAAC<br />
NEWTON'S discovery of general gravitation,* by which the<br />
infinitely complicated movements of the heavenly bodies<br />
were explained through the all-binding laws of mathematics<br />
and physics and the proof was given that such laws hold<br />
good for the entire universe. This conception exerted the<br />
greatest influence in the emancipation of man's intellect<br />
from the dominion of mystic transcendental powers, giving<br />
it a grasp which seemed to reach beyond the boundaries of<br />
this world. Even if NEWTON had rendered no other ser-<br />
* W. WHEWELL ; History of the Inductive Sciences (Germ, trans.), Stuttgart<br />
1840, ii, 158 el seq.
2 RECENT TIMES.<br />
35<br />
vices to physics, the theory of gravitation was enough to' |<br />
place his name among the first in the history of this ,<br />
science. He was one of the greatest mathematicians and<br />
physicists that ever lived. If we wish to indicate in one<br />
word the intellectual tendency of that time, fruitful as it<br />
was, to an uncommon degree, in results and discoveries<br />
bearing upon physics, we need only recall the name of<br />
NEWTON—its most prominent representative.<br />
What a mighty revolution in thought had been effected<br />
in the interval of time between GALILEO and NEWTONl, J<br />
The natural sciences, which still in the 16th century were<br />
oppressed and controlled by the ruling authorities, regarded ,|<br />
with indifference or disdain by the public, cherished and.'^<br />
actively" advanced only by a few, stood now in the focus of<br />
intellectual interest and were permitted fearlessly to draw ?<br />
within the range of their investigations the highest proV :<br />
blems of man's existence.<br />
Natural philosophy proceeded to its tasks with the fiery<br />
zeal of youth and the successes achieved, rapid as they<br />
were and exceeding all expectations as they did, seemed to<br />
justify the hope that no limit was fixed to its progress.<br />
When this hope was not fulfilled and insurmountable<br />
obstacles opposed themselves to human knowledge, industry<br />
slackened and work began to stop. Men turned.|<br />
again to other efforts which promised greater results than •<br />
the pursuit of the natural sciences. To the victorious<br />
advances made by the natural sciences in the 16th and 17th<br />
centuries there succeeded in the 18th century a retreat or<br />
at least a halt. This period contributed no essential increase<br />
to the sum of knowledge, but, under the influence<br />
of a tendency in men's minds towards encyclopaedic literature,<br />
led to a collecting and sifting of such results as had<br />
been gained—a proceeding useful and necessary for their<br />
further development.
MICROSCOPICAL INVESTIGATION. 353<br />
MICROSCOPICAL INVESTIGATION IN ANATOMY<br />
AND EXPERIMENT IN PHYSIOLOGY.<br />
THE 16th century witnessed the splendid triumphs of<br />
anatomists, who investigated the structure of the human<br />
body; physiological experiment, which created a science<br />
founded on facts, impressed its mark upon the 17th century.<br />
Anatomy was an established science already in the 16th<br />
century, in its essential outlines at least, and so far as was<br />
possible by investigation with the unaided eye. The<br />
following periods had the tasks assigned to them of testing<br />
the scientific results already won, of correcting and of completing<br />
them by examination of details, and of extending and<br />
enlarging them. Investigation acquired by the aid of the<br />
magnifying glass and the microscope a depth and a solidity<br />
hitherto unattainable. The anatomists devoted their attention<br />
chiefly to the finer structure of organs, a study more<br />
successfully pursued by means of the newly-discovered<br />
optical instruments.<br />
LEEUWENHOEK possessed the best microscope of his time,<br />
constructed by himself. It magnified 160-270 times, whereas<br />
the instruments used by other investigators magnified at'<br />
most 143 times.' LEEUWENHOEK described the tubular<br />
structure of the bones, and noticed the bone-corpuscles,<br />
which afterwards were rediscovered and more accurately<br />
described by PURKINJE.* He referred also to the enamel<br />
of the teeth, while other particulars of their structure were<br />
explained by MALPIGHI. CLOPTON HAVERS discovered<br />
the canals in bones, which still bear his name ;f DU HAMEL<br />
studied the formation of bony tissue, and recognized that<br />
it is developed by the help of the periosteum out of<br />
cartilage, the vessels bringing the formative material<br />
required according to the pattern laid down in cartilage;<br />
J. T. KLINKOSCH, of Prague, taught the origin of bone<br />
* P. J. HAAXMANN in the Nederl. Tijdschr. v. Geneesk 1871, ii, 1-86.<br />
f CL. HAVERS: Observationes de ossibus, Amstelod. 1731, p. 63.<br />
A A
354<br />
RECENT TIMES.<br />
from connective tissue, while HALLER held fast to its<br />
development from cartilage and considered the change to<br />
proceed from the vessels which surround with bony tissue<br />
the primordial bone-granules discovered by him.<br />
At the same time the macroscopical knowledge of<br />
osteology was also enriched. NATHANIEL HIGHMORE<br />
discovered the antrum in the upper jaw; OLAUS WORM<br />
described the sutural bones named after him, but known<br />
already to EUSTACHIUS; T. KERCKRING studied the<br />
development of the skeleton in the foetus ; and FRIEDRICH ,<br />
RUYSCH drew attention to the differences between the<br />
male and female skeleton, especially to the distinction<br />
in the form of the pelvis and thorax in the two sexes. The<br />
knowledge of the ligaments was improved by the careful |<br />
work of JOSIAS WEITBRECHT.* The structure of the skinwas<br />
investigated by MALPIGHI, of whom the rete mucosum ]<br />
reminds us to the present day, and by LEEUWENHOEK, who I<br />
observed the smooth scales of the epidermis, the changes<br />
in the skin produced by the formation of callosities and 1<br />
scars, and the deposit of pigment in the coloured races of<br />
men. C. V SCHNEIDER afforded some information upon<br />
the structure and function of the nasal mucous membrane.!<br />
The structure of muscular tissue occupied the attention of<br />
A. BORELLI, R. HOOKE, and above all of NICHOLAS STENO,<br />
who referred to the similarity of its construction in man<br />
and the lower animals, and pointed out that vessels and<br />
nerves enter muscles, and that the latter are composed ^<br />
of fasciculi, and are surrounded by an investment which I<br />
sends processes between the fasciculi. LEEUWENHOEK<br />
noticed the transverse striation of muscular fibres, and<br />
taught that the growth of muscles results not from-an<br />
increase in number but from an increase in size of the<br />
primitive fasciculi. He declared that muscular tissue is<br />
* Jos. WEITBRECHT : Syndesmologie, Deutsche Ausgabe, Strassburg<br />
1779779t K. F. H. MARX, in the Abhandlungen d. kgl. Ges. d. Wiss. zu Gottingen,<br />
Bd. 19, 1873.
MICROSCOPICAL INVESTIGATION.<br />
built up of little spheres. R. HOOKE considered the bodies<br />
observed to be prisms.<br />
The study of angeiology was facilitated in an extraordinary<br />
degree by the newly-discovered process of injection*<br />
in the improvement of which SWAMMERDAM and<br />
•RUYSCH rendered the greatest services. For injections<br />
they used coloured, easily coagulating, resinous liquids.<br />
RUYSCH, of whom it is said that he possessed the hands of<br />
.a fairy and the eyes of a lynx, was able thus to determine<br />
the presence and distribution of blood vessels in parts of the<br />
body which had previously been considered non-vascular.<br />
He described also the bronchial vessels and the coronary<br />
vessels of the heart; KERCKRING discovered on the portal<br />
vein of the horse the vasa vasorum, and LEEUWENHOEK<br />
threw light upon the structure of the vascular coats. The<br />
anatomy of the heart was illustrated by STENO, LOWER,<br />
and VlEUSSENS. To their work the labours of WlNSLOW<br />
and.SENAC were added at a later period.<br />
The lungs were carefully examined by MALPIGHI ; he<br />
stated that they are composed of little sacks the partitions<br />
between which are richly provided with vessels.f GLISSON<br />
gave an exemplary description of the anatomy of the liver, J<br />
while MALPIGHI devoted his attention to the spleen and<br />
was also the first to recognize that glands are built up of<br />
acini.§ JAMES DOUGLAS, whose name has been preserved<br />
in the history of anatomy through other observations which<br />
he made, described the relative position of organs in the<br />
abdominal cavity. The Swiss doctors PEYER and BRUNNER<br />
discovered the glands of the intestinal canal, G. WlRSUNG<br />
the ductus pancreaticus, STENO the duct of the parotid<br />
gland, WHARTON that of the submaxillary gland and<br />
•QUIRINUS RIVINUS those of the sublingual gland. MAL-<br />
* BURGGR-EVE op. cit. p. 294 et seq.<br />
t De pulmonibus epist. duae in MALPIGH'I : Op. omnia, London 1686, iii, 133<br />
•et seq.<br />
, »-»<br />
+ F. GLISSON: Anatomia hepatis, Amstelod. 1659.<br />
§ M. MALPIGHI : De structura glandularum conglob., London 1697.
356 RECENT TIMES.<br />
PIGHI, BELLINI and BERTIN investigated the structure of<br />
the kidneys; while the knowledge of the sexual organs t<br />
was advanced by W. COWPER who described the gland<br />
named after him but known previously, by REINIER DE<br />
GRAAF who described the follicles of the ovary, by D.<br />
SANTORINI who submitted the corpora lutea to a more<br />
careful examination, and especially by WILLIAM HUNTER<br />
who made public the best observations upon the anatomy<br />
of the testis and the first correct representations of the<br />
changes undergone by the uterus during pregnancy.<br />
Neurology remained on a lower level. STENO frankly ':<br />
confessed that he knew nothing of the structure of the :<br />
brain and opined that other anatomists were in much the, J<br />
same position. He looked forward to nerve fibres being J<br />
traced through the substance of the brain, but was himself;!<br />
at the same time conscious of the difficulty of this invest!-j<br />
gation and doubted whether such a thing would ever be ^<br />
accomplished without special apparatus* WILLIS, the J<br />
discoverer of the nervus accessorius, SYLVIUS, and HUM-1<br />
PHREY RIDLEY furnished their contemporaries with good J<br />
descriptions of the brain; J. J. WEPFER illustrated the<br />
distribution of its blood-vessels; ViEUSSENS noticed the :<br />
pyramids and the olivary bodies of the medulla oblongata,|<br />
and made the discovery that the dura mater receives nerve 1 *<br />
fibres from the trigeminus ;\ LANCISI drew attention to.<br />
the distribution of fibres in the corpus callosum and<br />
examined the structure of the pineal gland; MALPlGHr<br />
made some remarks upon the distribution of the grey and*]<br />
white substance of the brain and observed the passage<br />
into the brain of collections of fibres from the spinal cord.J<br />
With regard to the more minute structure of the substance^<br />
of the brain no clear view was arrived at. As a rutef<br />
anatomists embraced the hypothesis that the grey sub-|<br />
* W. PLENKERS in the Maria-Laacher Stimmen 1884, vii, H. 25, 26.—TH.<br />
PUSCHMANN in the Vienna Neue Freie Presse 1886, 26 November.<br />
f R. VIEUSSENS: Neurographia universalis, Lugd. 1685, p. 82, 170.<br />
X M. MALPIGHI : De cerebro in Op. omnia iii, 1 et seq.
MICROSCOPICAL INVESTIGATION. 357<br />
stance of the brain is composed of blood vessels and small<br />
follicles from which white nerve fibres arise. The peripheral<br />
nerves were more minutely described and several<br />
ganglia were discovered as, for example, the Gasserian<br />
ganglion on the nervus trigeminus*<br />
The anatomy of the sense-organs was worked at with<br />
greater success. RUYSCH discovered that part of the<br />
choroid coat of the eye named after him ; LEEUWENHOEK<br />
described the structure of the lens as being of fibres united<br />
into membranes; MEIBOM in 1666 pointed out the glands<br />
imbedded in the substance of the tarsal cartilages and<br />
STENO described the lachrymal apparatus ;t POURFOUR<br />
DU PETIT discovered the canal running between the two<br />
layers of the membrana hyaloidea of the vitreous humour<br />
round the margin of the lens capsule. ZlNN drew attention<br />
to the zonula ciliaris; DEMOURS observed the membrane<br />
bearing his name on the posterior surface of the<br />
cornea. DUVERNEY, VIEUSSENS, VALSALVA, CASSEBOHM,<br />
COTUGNO and others occupied themselves with the anatomy<br />
of the organ of hearing, while the structure of the organs<br />
of voice and especially of the larynx was illustrated by<br />
the investigations of DRELINCOURT, SANTORINI and WRIS-<br />
BERG.<br />
Physiological inquiry achieved the greatest success. The<br />
age of experiment, as we may call the 17th century, brought<br />
about a complete revolution in the views hitherto held on<br />
this subject, and raised physiology into a science. The<br />
discovery of the circulation of the blood formed the foundation<br />
stone upon which the structure of this science was<br />
erected. Already SERVET and REALDO COLOMBO had<br />
taught that the blood passes from the right side of the<br />
heart through the pulmonary artery and the pulmonary<br />
veins to the left side of the heart; but WILLIAM HARVEY<br />
* A. B. R. HIRSCH: Paris quinti nervorum encephali disquisitio anatomica,<br />
Vienn. 1765, p. 20.<br />
+ H. MEIBOM: De vasis palpebrarum novis, Lugd. Batav. 1723, p. 135 et<br />
seq.
•358<br />
RECENT TIMES.<br />
was the first to furnish the proof of this, inasmuch as he<br />
caused water to flow by this route from the pulmonary<br />
artery into the left heart. It seems but an easy step to<br />
have ascribed an analogous course to the blood in the other<br />
vessels of the body. But the doctrine which then prevailed,<br />
that the arteries chiefly contained air and only but<br />
a little blood and that the blood flowed in a centrifugal<br />
direction in the veins as well as in the arteries, was opposed<br />
to the acceptation of this view. HARVEY corrected these<br />
mistakes* He opened arteries under water and saw that<br />
no bubbles of air rose to the surface. He cut into them<br />
and observed what a quantity of blood they contained. He.<br />
studied moreover the mechanism of the then recently.discovered<br />
valves of veins and made attempts to blow air into<br />
the trunks of veins provided with valves. In this manner<br />
hed iscovered that the valves are so formed that they impede'<br />
and check the blood-stream from the trunks to the peri-,<br />
phery but on the other hand offer every facility to its flow<br />
in the opposite—that is to say the centripetal—direction. 1 ,*<br />
Assuming this to be true, the question arose—from whence,I<br />
comes the blood in the minute ramifications of the veins?<br />
As it was impossible to think that the arterial blood is completely<br />
used up in the organs, the explanation presented<br />
itself spontaneously that it passes from the arteries into<br />
the veins as had been established to be the case in the<br />
pulmonary circulation.<br />
The exact way in which this passage is made was first<br />
explained by MALPIGHI, who discovered the capillaries,<br />
and was the first to observe with the microscope the passage<br />
of the blood from the arteries into the veins.<br />
HARVEY held fast to the erroneous view that the liver is<br />
the seat of the formation of blood. The true conditions of<br />
this matter were not known until the discovery of the<br />
lacteals by GASPARE ASELLI, of the ductus thoracicus by<br />
JEAN PECQUET, and of the lymphatic vascular system by<br />
O. RUDBECK and T. BARTHOLINUS, nor until the establish-<br />
* W. HARVEY: Works ed. by R. WILLIS, London 1847.
MICROSCOPICAL INVESTIGATION. 359<br />
ment by these observers of the importance of the vessels<br />
above mentioned in the preparation of the blood.<br />
A series of investigations on the vascular system, on<br />
the blood, its composition, elaboration, movement, etc.,<br />
was soon added to the discovery of the circulation of<br />
the blood. A. BORELLI was the first to formulate<br />
the thought that the vascular system resembles a hydraulic<br />
apparatus, and he attempted to calculate the force with<br />
which the blood flows through the vessels. It must be<br />
confessed that he arrived at inaccurate results, for the<br />
circumstances which have to be considered in this<br />
investigation were then not sufficiently known. Thus, for<br />
instance, his estimation of the resistance offered by the<br />
continually narrowing arteries was unduly high.* WILLIAM<br />
COLE hereupon drew attention to the fact that the sum of<br />
the transverse sections of the vessels increases with their<br />
distance from the heart, and that the vascular system may<br />
be represented as a cone, the base of which is the periphery<br />
of the body and the apex the heart.f BELLINI showed that<br />
the blood flows with less velocity in proportion as the<br />
vessels become more and more divided into branches.<br />
STEPHEN HALES sought to determine the force of the<br />
blood-pressure and the velocity of the blood-current by a<br />
series of experiments, and introduced for this purpose a<br />
glass tube into the divided artery of a living animal, so<br />
that he might observe how high the blood was raised in it. J<br />
MOLYNEUX and LEEUWENHOEK observed under the micro<br />
scope the velocity of the blood-current.§ The Irish doctor,<br />
ALLEN MOULIN, made the first attempt to determine the<br />
quantity of blood contained in the body. He opened the<br />
hearts of animals by vivisection, and from the quantity of<br />
blood which they contained, and from the velocity of the<br />
* ALF. BORELLI : De motu animalium, Lugd. Bat., 1685, i, p. 94 et seq.<br />
t WILL. COLE: De'secretione animali, Genev. 1696,0. 7, p. 26.<br />
X STEPHEN HALES: Haemostatique ou la statique des animaux ; a French<br />
transl., with notes by DE SAUVAGE, Geneva 1744, of "Statical Essays."<br />
§ Philos.Transactions, London 1685, No. 177, p. 1236.
360 RECENT TIMES.<br />
blood-current, he calculated the quantity of blood contained<br />
in the body. By this somewhat imperfect method he arrived<br />
at the result that the weight of the blood constitutes about<br />
the twentieth part of the body-weight.* The discovery of<br />
the blood-corpuscles, which were first detected by MAL<br />
PIGHI, threw great light upon the composition of the blood.<br />
They were described by SWAMMERDAM as egg-shaped<br />
structures, by MALPIGHI as coralloidal strings, and by<br />
LEEUWENHOEK, who studied their form in different classes<br />
of animals, as small, oval, flattened spheroids. HEWSON<br />
thought that they contained each a small vesicle, and expressed<br />
an opinion that they originated chiefly in the<br />
spleen.<br />
VlEUSSENS and CHIRAC were then already contemplating<br />
a chemical examination of the blood. A. BADIA and<br />
MENGHINI showed conclusively that the blood contains<br />
iron. F. QUESNAY—who, as the founder of the physio- J<br />
cratic system, rendered the highest services to political J<br />
economy—taught that the blood contains the following |<br />
constituent parts:—1. Water; 2. Albuminous matters<br />
which coagulate by heat, and when putrid develop an<br />
alkaline, acrid quality ; 3. Fats which solidify in the cold,<br />
but at a higher temperature are fluid, and generate a rancid |<br />
acridity; 4. Gelatinous matters; and 5. Bitter saponaceous |<br />
substances.t HEWSON continued to investigate the<br />
physical and chemical properties of the blood, and gave<br />
very great attention to the subject of its coagulation, the<br />
causes of which he was at pains to work out by means of<br />
various experiments.^ An opportunity was often afforded |<br />
during venesection of observing that blood takes on a<br />
redder colour when it comes into contact with air ; and the<br />
ancients even were aware of the fact that arterial blood is<br />
* Philosophical Transactions, London 1687, Decemb., No. 191, p. 433 «f<br />
seq.<br />
t F. QUESNAY: Essai physique sur l'economie animale, Paris 1747, ii, .34*2<br />
et seq., iii, 31 el seq.—HAESER op. cit. ii, 592.<br />
X WILL. HEWSON : On the Blood, G>.rm. transl., Niirnberg, 1870.—E. 1<br />
BRUCKE : Vorlesungen iiber Physiologie, Wien 1885, i, 81 et seq.
MICROSCOPICAL INVESTIGATION. 361<br />
•of a clearer colour than venous blood. The Iatrophysicists<br />
such as MALPIGHI, PITCAIRN, and others explained the<br />
phenomenon by saying that in consequence of the inspired<br />
air the blood is subjected to a finer division, while the Iatrochemists<br />
ascribed a chemical influence to the air. The<br />
attempts to come to a conclusion as to what constituent<br />
part of the air it is which produces this effect w-ere naturally<br />
unsuccessful. R. BATHURST and N. HENSHAW expressed<br />
an opinion that it was the same substance that has a prominent<br />
place in the composition of nitric acid. The real<br />
-action of air upon blood was more closely examined by D.<br />
MlSTlCHELLi. He inflated the lungs of dying animals with<br />
air, and in this way was able, not only to cause the blood to<br />
change colour, but at the same time to revive the movements<br />
•of the heart.* About the same time PEYER and HARDER<br />
instituted experiments with the hearts of dead animals<br />
and of men who had been hanged, and restored cardiac<br />
movements by inflating the lungs with air.f<br />
SANTORIO, who made himself known by the invention of<br />
various physical instruments,^ wished to determine the<br />
relation between the ingesta and excreta of the body, and<br />
with this object during 30 years submitted the nourishment<br />
he took and the refuse material which passed from him to<br />
-accurate weighing; he then compared the results with his<br />
body-weight, and found that a portion of the nourishment<br />
taken leaves the body in the invisible form of gas and vapour<br />
(perspiratio insensibilis).\ DENYS DODART repeated these<br />
-experiments, and remarked that with increasing age the<br />
visible excretory products are increased. The processes<br />
of digestion, nutrition, and secretion were judged of in<br />
•quite different ways by the Iatrophysicists and the Iatrochemists.<br />
While the former embraced the opinion that<br />
* Philosophical experiments and observations of ROB. HOOKE, etc., published<br />
•by W. DERHAM, London 1726, p. 372 et seq.<br />
t PEYER : Parerga anatom. et medica, Genev. 1681, p. 198.<br />
X K. SPRENGEL op. tit. iv, 422 et seq.<br />
§ SANCT. SANCTORIUS: De statica medicina, Venet. 1614, Sect. 1.
362 RECENT TIMES.<br />
the stomach exercises a subdividing, triturating effect upon<br />
the food, the latter thought that in consequence of the<br />
chemical powers of the saliva, the gastric juice, the pancreatic<br />
juice, and the bile the food is converted into a pap.<br />
The ingenious experiments upon digestion, which SPALLAN-<br />
ZANI and CARMINATI afterwards instituted, showed how far<br />
both agencies enter into the question* Similar diversity<br />
of views prevailed in reference to such subjects as the<br />
secretion and nutrition of organs and tissues ; but there<br />
was no doubt that the explanations of the Iatrophysicists ,/*•<br />
in reference to blood-pressure, to the form, ramification, ;<br />
and tortuosity of vessels, and to the porosity of the<br />
capillaries, started from a firmer basis of facts than did*<br />
those of the Iatrochemists.<br />
The discovery of the circulation of the blood turned the<br />
attention of inquirers to the subject of animal motion in<br />
p-eneral. NICHOLAS STENO made the first attempt to %<br />
explain muscular action by the laws of mechanics, which J<br />
are of such general validity.f He took this opportunity of<br />
publishing his observations on the changes, of form and<br />
consistence which the muscles undergo in contraction and J<br />
relaxation.<br />
Some years after, in 1680, A. BORELLfS celebrated work, j<br />
De Motu Animalium, appeared, in which the complicated^<br />
movements executed by particular muscles were analyzed.^<br />
In it the author compared the bones and the muscles<br />
attached to them to physical apparatus for demonstrating<br />
levers. To determine the strength of a muscle he sus- j<br />
pended weights to it until its fibres were torn. STENO|<br />
even made the observation that muscular tissue has the<br />
power of being stimulated to movement independently of<br />
the influence of vessels and nerves, though DE MARCHETTIS<br />
* SPALLANZANI : Versuche iiber das Verdauungsgeschaft des Menschen und.<br />
Verschiedener Thierarten, Deutsche Ubers., Leipzig 1785.<br />
t Nic. STENONIS elementorum myologies specimen seu musculi descriptio-<br />
geometrica, Flor. 1667.<br />
X op. cit. i, p. 19 etseq.
MICROSCOPICAL INVESTIGATION. 363<br />
had admitted independent irritability only for the muscular<br />
tissue of the heart and intestine. It was established<br />
by experiments on frogs and tortoises that power of<br />
movement exists after removal of the brain. STENO drew<br />
attention to the part played by the blood in muscular<br />
action; he ligatured the descending aorta in the frog, and<br />
showed that paralysis of the muscles of the posterior part<br />
of the body ensues. BAGLIVI also sought for the cause of<br />
the inherent contractility of muscular tissue in the blood,<br />
and considered the nerves to be only the exciters of move<br />
ment; and he made on this occasion certain remarks which<br />
may be taken as alluding to the distinction between plain<br />
and transversely striated muscular fibres* MAYOW, on<br />
the other hand, attached great importance to the influence<br />
of the atmospheric air upon the activity of muscle. GLISSON<br />
regarded irritability as a propertyf belonging to matter in<br />
general; WlLLlS considered it to belong only to muscles.<br />
Afterwards A. HALLER, as the result of a great number<br />
of researches and vivisections, established on a firm basis<br />
the different degrees of sensibility and irritability possessed<br />
by the various tissues and organs of the body. He came<br />
to the conclusion that sensibility is associated with the<br />
existence of nerves and irritability with that of muscular<br />
tissue.<br />
The nerves were held to be filled with a fluid, and<br />
GLISSON even spoke of currents flowing to and fro in<br />
nerves. Clearly, these have only the name in common<br />
with those electrical currents which at the present day are<br />
known to manifest themselves in nerves. In the explana<br />
tion of the action of nerve force the Iatrophysicists and<br />
the Iatrochemists were opposed to one another ; for while<br />
the former, with NEWTON, assumed the presence of vibra<br />
tions, of tensions, and relaxations, the latter considered<br />
* G. BAGLIVI: De fibra motrice et morbosa in his Opera omnia medicopract.<br />
et anatom., Antwerpen 1719.<br />
f GLISSON: De ventriculo et intestinis, Amstelod. 1677, p. 168 et seq.<br />
according to G. H. MEYER in HAESER'S Archiv, Jena 1843, v > P- 1 et seq.
3 6 4<br />
RECENT TIMES.<br />
the force in question to be attended with chemical changes<br />
in the nerve-contents. Those who were dissatisfied with j<br />
both explanations, had recourse to the hypothetical " vital<br />
spirits," which gave the wished-for answer to all questions. |<br />
The brain was generally accepted as the centre of intellectual<br />
activity. WILLIS ventured even to localize the |<br />
different psychical faculties in particular parts of the brain; ,<br />
thus he seated sensation in the corpora striata, memory in /<br />
the medullary substance, and the animal functions in the . |<br />
cerebellum. R. WHYTT came to the conclusion after J<br />
numerous vivisections that the capacity for movement is<br />
preserved for some time after death, and referred to the fact<br />
that decapitated frogs " move in a co-ordinated manner,<br />
and, as it were, with intelligence." He concluded from<br />
this that the brain cannot be the only centre of ^<br />
intellectual activity* CALDANI made attempts to j<br />
investigate the physiological functions of the spinal cord,<br />
and with this object destroyed different parts of it.<br />
The great astronomer KEPLER drew the outlines of a<br />
correct theory of vision, remarked upon the difference in<br />
the curvatures of the anterior and posterior surfaces of the ]<br />
lens, explained that this organ is by no means the seat of<br />
vision, as had hitherto been thought, but serves the purposefj<br />
of refracting the incident rays of light into the direction<br />
required. He followed the course of these rays until they<br />
impinge upon the retina,t and pointed out that myopia and j<br />
hypermetropia depend upon abnormalities in the refracting<br />
media, and that with suitable spectacles, fitted with concave<br />
or convex glasses, a correct image of an object is produced.<br />
Father SCHEINER, of Vienna, completed these investigations,<br />
and showed by the experiment named after him that<br />
an object is only clearly seen when removed to a certain<br />
definite distance from the eye. He at the same time<br />
* ROB. WHYTT : An essay on the vital and involuntary motions cf animals,>i<br />
Edinburgh 1751, p. 344 f t seq., 384 et seq.— R. WHYTT : Physiological essays,<br />
Edinburgh 1755, p. 107 et seq.-, 214 et seq.<br />
t POGGENDORFF op. cit., S. 168 et stq.
MICROSCOPICAL INVESTIGATION. 365.<br />
observed that the pupils contract when the eyes are fixed<br />
upon near objects. The Prior of the Monastery of St.<br />
Martin, E. MARIOTTE, made the discovery that the place<br />
where the optic nerve enters the globe is insensible to rays<br />
of light*<br />
The foundation of the physiology of hearing was laid<br />
by CLAUDE PERRAULT, the famous physician and architect,<br />
the builder of the Louvre at Paris. He was the first to see<br />
the nerve-fibres distributed upon the lamina spiralis of the<br />
cochlea, and declared them to be the seat of the sense of<br />
hearing.t He also recognized the part played by the<br />
labyrinth and the semi-circular canals in the conduction of<br />
sound. DUVERNEY followed the distribution of the auditory<br />
nerve in the internal ear more closely, and rendered PER-<br />
RAULTS results more conclusive on certain points. Then<br />
followed VALSALVA'S excellent work.<br />
CLAUDE PERRAULT also attempted to throw light upon the<br />
origin of the voice, while drawing attention to the structure<br />
of the larynx. DENYS DODART was of opinion that vocal<br />
sounds are produced by the constriction or widening of the<br />
glottis in association with the passage of air to and fro.<br />
ANTOINE FERREIN recognized the fact that vibrations of the<br />
vocal cords are of the greatest importance in phonation.J<br />
P. CAMPER tried to explain the different character of the<br />
voice in various classes of animals by the differences in the<br />
structure of their vocal organs. AMMANN, W. V. KEMPELEN,<br />
and KRATZENSTEIN studied the physiology of speech, and<br />
constructed the first specimens of an apparatus for imitating<br />
human articulation. The papillae of the tongue were<br />
declared by MALPIGHI and BELLINI to be concerned with<br />
* Lettres ecrites par MARIOTTE, PECQUET ft PERRAULT sur le sujet d'une<br />
nouvelle de'couverte touchant la veue par MARIOTTE in the Recueil de pleusieurs<br />
traitez de mathematique de l'Acad. Royale des Sciences, Paris 1676.<br />
t CEuvres diverses de physique et de mechanique, Leyden 1721, Vol. i, p.<br />
247 et seq. (du bruit, partie iii).<br />
X Histoire de l'Acad. Royale des Sciences avec les me'moires, etc., Paris 1700,<br />
p. 244 et seq.; 1706, p. 136 el seq.; 388 et seq.; 1707, p. 66 et seq. ; 1741, p.<br />
409 etseq.
2,66 RECENT TIMES.<br />
the sense of taste. MALPIGHI located the sense of touch<br />
in the papillae of the skin. BOHN referred to the distinction<br />
between the senses of touch and of temperature, and the<br />
Genevese philosopher, BONNET, already raised the question<br />
whether the tongue possesses different nerves for every<br />
kind of flavour, and the ear different fibres for every<br />
note*<br />
Amongst the most weighty questions engaging the atten- '%<br />
tion of the natural philosophers of the 17th and 18th<br />
centuries may be reckoned the theory of the generation and<br />
development of the animal embryo. Here, too, it was<br />
WILLIAMHARVEY who gave to these investigations a firm $<br />
basis in enunciating the proposition, Omne animal ex ovo.<br />
He taught that the embryo developed from the ovum which<br />
took its origin from the mother, the semen of the male only<br />
setting the process in motion. The opinion was maintained<br />
that during coition the ovum is released from the ovary;<br />
but KERCHRING remarks that women had told him that an*<br />
ovum may be expelled at each menstruation.f The ovum<br />
theory was put on a still firmer foundation by SwAMMER- i<br />
DAM, MALPIGHI, and REDI, who gave a wider significance<br />
to the HARVEIAN dictum by changing it into Omne vivum<br />
ex ovo, and even applied it to plants. This doctrine sus- |<br />
tained a great shock in consequence of the discovery of-'the i<br />
spermatozoa, which J. HAM was the first to notice in 1677.<br />
LEEUWENHOEK confirmed this observation, and described |<br />
the spermatozoa as extraordinarily small creatures, each •<br />
provided with a tail and a rounded head, and engaged in<br />
continual movement; and in view of these facts he put ,1<br />
forward the hypothesis that the spermatozoa and not the ova<br />
form the real germs of the embryo. HARTSOEKER thought |<br />
he recognized a resemblance between the spermatozoon and i<br />
the human form, and looked upon each as a primitive "J<br />
embryo. The witty LEIBNITZ even spoke of the immortality<br />
of spermatozoa. ANTONIO VALLISNERI put an end J<br />
* Letter of BONNET to HALLER, in HAESER. op. cit. ii, 596.<br />
t TH. KERCKRING: Anthropogenia ichnographica, Amstelod. 1671, p. 3.
MICROSCOPICAL INVESTIGATION. 367<br />
to these dreams by confirming the -view of the high import<br />
ance of the ovum for the development of the human<br />
embryo; and yet he committed the error of considering the<br />
spermatozoa as an unessential accidental constituent of the<br />
semen, and of declaring them to be without effect in<br />
generation. This view was also countenanced by BUFFON,<br />
HALLER, and others, and obtained almost universal accept<br />
ance. SPALLANZANI was the first once more to submit to a<br />
closer investigation the problem of the real cause of im<br />
pregnation, and with this object undertook a series of<br />
experiments in artificial impregnation with the spermatic<br />
fluid of the male.* HALLER afforded valuable information<br />
upon the development of the embryo, especially upon the<br />
formation of the vascular system. The fcetal circulation<br />
was thoroughly explained by DuVERNEY.<br />
Most philosophers gave credence to the old theological<br />
theory of development, according to which the germs of<br />
organic beings are preformed from the time of the creation<br />
of the first, and lie embedded in one another like a series of<br />
boxes, each enclosing a smaller one. This view of things<br />
was replaced by the doctrine of Epigenesis, in which<br />
CASPAR FRIEDRICH WOLFF, as the result of a great number<br />
of careful observations, delivered his opinion that organs<br />
have not existed in their mature shape from the beginning<br />
of things, but that the particular parts of the body assume<br />
gradually their fully-developed form as the result of a series<br />
of differentiations.! With great penetration he referred to<br />
the analogous development of plants and animals, and in<br />
this connection even pointed to the doctrine of metamor<br />
phosis in the vegetable kingdom further developed by<br />
GOETHE. He also made the observation that the nervous<br />
system, the alimentary canal, and the vasculo-muscular<br />
* SPALLANZANI : Versuche uber die Erzeugung der Thiere und Pflanzen,<br />
Deutsche Ubers., Leipzig 1786.<br />
t C.F.WOLFF: Theoria generationis, Halle 1759.—C. F. WOLFF: Uber die<br />
Bildung des Darmkanals im bebruteten Huhnchen, Berlin 1812 S sv 12K<br />
148.<br />
S '
368 RECEN<strong>T'</strong>TIMES.<br />
structures arise from . distinct embrybnic layers. He<br />
declared the ultimate constituents of the body to be<br />
spherules or vesicles. May we not look upon this as a<br />
foreboding of the discovery of the cell ?<br />
PROGRESS IN THE OTHER BRANCHES OF<br />
MEDICAL SCIENCE DURING THE SEVENTEENTH<br />
AND EIGHTEENTH CENTURIES.<br />
THE opposition between the Iatrophysicists and the Iatro- ; ,<br />
chemists was manifested as much in pathology as in ,<br />
physiology. They sought to explain diseases, on the one<br />
hand by mechanical disturbances such as stagnation of the ,*<br />
blood or of the contents of the nerves, on the other hand J<br />
by chemical processes such as fermentation and decom- :f<br />
position. Prominent thinkers among the doctors, like i'<br />
BORELLI, PlTCAIRN, HELMONT, SYLVIUS, WlLLIS, BOER-,'j<br />
HAAVE and F HOFFMANN built upon these theories f<br />
elegant structures of pathological doctrine, the instability<br />
of which became apparent as science advanced. The<br />
deficiencies and mistakes and especially the one-sidedness<br />
manifested by some of these medical systems led to the<br />
blending of them with dynamic hypotheses : PARACELSUS J<br />
had previously made this attempt and HELMONT and<br />
WlLLIS had repeated it. But the dynamic theory, which<br />
in many respects recalled the doctrines of the Pneumatists|<br />
of antiquity—remodelled however, of course, in conformity<br />
with the Christian faith—was at first only employed to<br />
explain the ultimate causes of organic phenomena. STAHL<br />
developed it into an animism which suggested the view<br />
that all scientific investigation in medicine must be superfluous.<br />
The same conclusion, at least in respect of the<br />
theoretical foundation of medicine, was arrived at by those,<br />
doctors who, like SYDENHAM, dissatisfied with attempts to<br />
reconcile theory with practice, despaired of the solution of<br />
the problem, and declared the final goal of their efforts to
Mft'<br />
OTHER BRANCHES OF MEDICAL SCIENCE. 369<br />
be an art of healing resting upon experience. The artificial<br />
systems of the schools, founded on ingenuity and<br />
imagination, enjoyed but a short existence and resembled<br />
soap bubbles with their changing prismatic hues, dazzling<br />
for a moment with the richness of their colour and gone<br />
the next without leaving a trace behind. Of this period,<br />
only the knowledge which experience gained or scientific<br />
observation disclosed, has remained a possession of later<br />
times, forming one among the many building-stones in the<br />
firm structure of medical science.<br />
A rich clinical literature advanced the knowledge of<br />
disease as seen in individual cases, and turned the attention<br />
of doctors to groups of symptoms,—a subject which<br />
had been little, if at all, studied before. At the<br />
same time diagnosis was improved by the introduction<br />
of new appliances, and a scientific advance in morbid<br />
anatomy was prepared for by the collection of reports of<br />
pathological changes noted at post-mortem examinations.<br />
SYLVIUS described the deposit of tubercles in the lungs,<br />
and considered consumption to be due to the purulent<br />
breaking up of such deposits * WlLLIS drew a picture of<br />
diabetes mellitus and remarked upon the sweet taste of the<br />
urine in this disease which he was unable to account for f<br />
WERLHOF gave the first description of purpura haemorrhagica.%<br />
The earliest communications upon the subject of<br />
rickets date also from the 17th century: the symptoms of<br />
this disease were sketched in outline by B. REUSNER, but<br />
more thoroughly portrayed by WHISTLER, A. DE BOOT,<br />
and GLISSON. During the same period we find various<br />
reports upon the endemic incidence of cretinism, which<br />
PARACELSUS had already observed in certain Alpine<br />
localities, and also the earliest treatises upon the epidemic<br />
* FR. DE LE BOE SYLVII Opera Medica, Traject. ad Rhenum et Amstelod.<br />
1695, p. 692 et seq.<br />
'" TH. WILLIS : De minis in Op. omnia, Amstelod. 1663, p. 333 et seq.<br />
X P- G. WERLHOF: Opera Medica ed. WICHMANN,- Hannover 177c,'ji u<br />
624,761. ,,s ' ' y '<br />
B B
37°<br />
RECENT TIMES.*,<br />
appearance of syphilitic affections known,in Scotland under<br />
the name of Sibbens and under that of Radesyge in<br />
Scandinavia.<br />
Remarkable progress in certain directions was also made<br />
during this period in the diagnosis of disease, but its full<br />
significance was certainly not recognized until later. On<br />
the examination of the urine as a means of diagnosis<br />
SOLANO DE LUQUES, T. BORDEU and others imparted some<br />
new and valuable information although they also made<br />
many singular and even ridiculous statements upon the<br />
same subject. Other means of diagnosis also began to be<br />
used. SANTORIO made use of the thermometer to determine<br />
the temperature of the body, and BOERHAAVE, COCK-<br />
BURN and others made extensive use of that instrument in<br />
their practice* ANTON DE HAEN in this way established<br />
the fact that in the rigors of fever the temperature of the<br />
body is not reduced, as was then generally assumed to be<br />
the case, but, on the contrary, raised: he also first drew<br />
attention to the remarkable phenomenon of post-mortem .<br />
elevation of temperature, and observed that the subjective<br />
feeling of warmth by no means always corresponds to the<br />
real temperature, and that the temperature of paralyzed<br />
limbs is lower than that of healthy ones.f<br />
Diseases of the heart excited great interest. LANCISI<br />
connected pulsation in the jugular veins, with dilatation of<br />
the right side of the heart resulting from incompetence of<br />
the tricuspid valve.J ALBERTINI remarked very appropriately<br />
that the difficulty of diagnosis in heart disease<br />
depends in great measure upon the fact that in it pathological<br />
conditions of various kinds coexist and he advised<br />
that in examining the heart the hand of the doctor should<br />
be laid upon the cardiac region of the patient.§ By far<br />
* WUNDERI.ICH: Das Verhalten der Eigenwarme in Krankheiten, Leipzig<br />
1870.<br />
t TH. PUSCHMANN : Die Medicin in Wien, 1884, S. 19.<br />
X LANCISI : De motu cordis et aneurysmatibus, Lugd.. Batav. 1740, p. 306,<br />
pars, ii., cap. 6, prop. 60.<br />
§ ALBERTINI : Opuscula ed. M. H. ROMBERG, Berol. 1828.<br />
a
OTHER BRANCHES OF,MEDICAL SCIENCE. 371<br />
. "'4lfc'Mfyj.<br />
the greatest acquisition which diagnosis owes to this<br />
period, was the discovery of the art of percussion by the<br />
Viennese doctor AUENBRUGGER* Unfortunately this<br />
remained almost unnoticed : only in the 19th century did<br />
it become, as C. G. LUDWIG of Leipzig said in the year<br />
1763, "a torch which brought light into the gloom which<br />
hrooded over the diseases of the thorax."<br />
Morbid anatomy also made a great step in advance.<br />
Men ceased to look upon pathological changes observed in<br />
the dead body as nothing but curiosities which satisfied the<br />
spectacular cravings of collectors ever ready to grasp at<br />
rarities, and began to suspect, and to examine into, their<br />
•connection with clinical symptoms. W HARVEY declared<br />
that a man can learn more from the necropsy of one human<br />
being who has died of consumption than he can from the<br />
dissection of ten who have been killed by hanging.<br />
BENEVIENI, T. BARTHOLINUS, BONET, RIDLEY, LANCISI,<br />
VALSALVA and others deposited in their writings a number<br />
of valuable observations. WEPFER made the first attempt<br />
to set free the subject of cerebral diseases from the chaos<br />
•of mystical-transcendental speculation in which it was lost,<br />
and to explain such diseases by pathological changes<br />
in the brain. He observed the seat of apoplectic lesions<br />
healed into cicatricial tissue and described the affection<br />
named afterwards by FOTHERGILL " a painful affection of the<br />
face" i.e. tic douloureux. In the 18th century FONTANA<br />
made the important discovery that the "staggers" in<br />
sheep is a disease caused by hydatids in the brain.<br />
The pathology of the vascular system owed substantial<br />
progress to the labours of VlEUSSENS, LANCISI and SENAC<br />
VlEUSSENS f observed instances of adhesion of the pericar<br />
dium to the heart and described hydrops pericardii and<br />
pericarditis. He portrayed with astonishing clearness<br />
the relations between the pathological changes in the dead<br />
body and the symptoms during life in a case in which he<br />
* AUENBRUGGER: Inventum novum, Vindob. 1761.<br />
f J. PHILIPP in the Janus ii, 580-598. iii, 316-326.
372 RECENT TIMES.<br />
attributed dilatation of the pulmonary veins, oedema of the<br />
lungs, enlargement of the right side of the heart, dropsical<br />
swelling of the feet, and smallness of the pulse, all to<br />
stenosis of the left ostium venosum, i.e., auriculo-ventricular<br />
orifice; and also on another occasion when he ob*<br />
served calcareous degeneration of the aorta ascendens and<br />
of the semilunar valves with insufficiency of the latter and<br />
declared this had resulted in a partial regurgitation of<br />
blood into the left side of the heart and cardiac palpitation.<br />
LANCISI gave more detailed information concerning these<br />
pathological changes especially as to so-called ossification,<br />
that is calcareous degeneration of the valves, and as to dilatation<br />
and hypertrophy of the heart* SENAC first drew<br />
attention to the abnormal position sometimes occupied by<br />
the heart on the right side in consequence of pathological<br />
conditions.! Unfortunately the erroneous views of doctors<br />
firmly resisted the correct interpretation of facts in regard<br />
to the significance of the so-called polypi of the heart,<br />
although KERCKRING had already declared them to be due<br />
to post-mortem changes.^<br />
Pathological anatomy reached the highest point attained<br />
at this period in J. B. MORGAGNI who, in possession of all the<br />
knowledge which had been accumulated in this field, verified<br />
and completed the results gained by numerous observations<br />
of his own and for the first time gave clear and defined<br />
expression to the problems and tasks of this branch of<br />
science.§ In his investigations he also sought the aid of<br />
experiment.|| STEPHEN HALES did likewise and produced<br />
artificial dropsy by injecting water into the vascular system..<br />
HALLER'S labours upon sensibility and irritability were<br />
supported chiefly by experiments on animals and by vivisections.<br />
He knew well the use of these aids and<br />
declared : "• One single experiment of this kind has often<br />
* PHILIPP in the Janus iii, 318 el seq.<br />
X SENAC : Traite de la structure du coeur, Paris 1749.<br />
X TH. KERCKUING: Spicilegium anatomicum, Amstelod. 1670, p. 145.<br />
§ F. FALK: Die pathol. Anatomie des J. B. MORGAGNI, Berlin 1887.<br />
|| PHILIPP in der deutschen Klinik, 1853, No. 45.
OTHER BRANCHES OF MEDICAL SCIENCE. 373<br />
, * • •& • W % #<br />
^F —<br />
removed the disappointments occasioned by the work of<br />
whole years. This cruel proceeding has been of more use<br />
to physiology than almost all the other arts, the co-opera<br />
tion of which has given strength to our science."*<br />
SPALLANZANl's experiments upon the reproduction of lost<br />
limbs in the lower animals excited great attention.f JOHN<br />
HUNTER contributed more than any other to introduce the<br />
experimental method into pathology.<br />
Not only do the first beginnings of experimental pathology<br />
belong to this period but the same may also be said of<br />
bacteriology. LEEUWENHOEK described micro-organisms<br />
of rounded, staff-shaped, thread-like and spiral form which<br />
he asserted that he had found in the human mouth between<br />
the teeth.J In consequence of these discoveries the theory<br />
arose that many diseases are caused by these " animalcules."<br />
This view did not, certainly, admit of demonstration at that<br />
period, but for all that, certain distinguished naturalists<br />
such as LlNN/EUS and PLENCICZ held fast to the doctrine of<br />
contagium animatum.<br />
Valuable preliminary work in founding a science of<br />
hygiene was done by LANCISI who studied the exhalation<br />
from marshes and the means of improving the unhealthy<br />
condition of the Roman Campagna,§ and by PRINGLE who<br />
rendered great service to military sanitation and instituted<br />
investigations upon septic and antiseptic substances.<br />
The pharmacopoeia was enriched by many remedies. The<br />
value of Peruvian bark in fever was recognized ; ipecacuanha<br />
root was found to furnish a powerful emetic and the use of<br />
arsenic was recommended in cancer. Efforts were also<br />
made to arrive at correct views as to the causes of the<br />
beneficial effects of medicines and the most suitable<br />
method of employing them. WlLLIS invited an inquiry into<br />
* Cf. AD. VALENTIN in the Memoir on. A. v. HALLER, Berne 1877, P- 78.<br />
SPALLANZANI : Sopra le riproduzioni animali, Modena 1768.<br />
X F. LOFFI.ER: Vorlesungen iiber die geschichtliche Entwickelung der Lehre<br />
von den Bakterien, Leipzig 1887, Th. i.<br />
§ C. LANGER in den Mitth. d, Ver. d. Arzte in Nieder-Osterreich 1875, N «- 2.
374<br />
RECENT TIMES.<br />
the changes which the drugs bring about in the stomach,<br />
the blood and the different organs. This suggestion was<br />
carried out by WEPFER and, to a greater length afterwards,<br />
by A. STORCK: they performed numerous pharmacodynamical<br />
experiments with various medicinal substances*<br />
TJnder the influence of the discovery of the circulation of<br />
the blood, the first attempts were made to inject medicines<br />
into the veins as well as to replace great loss of blood by<br />
transfusion.t But the unfortunate results of these operations<br />
which depended partly upon the indifferent appliances<br />
and instruments used in performing them soon brought<br />
intravenous injections and transfusion into discredit and by<br />
degrees into oblivion, C. STALPERT VAN DER WiEL<br />
already made use'of a kind of oesophageal tube for artificial<br />
feeding.^ BENNET advanced special therapeutics by recommending<br />
inhalations in phthisis ;§ DOL/EUS by ordering<br />
milk diet in gout; and EDW. BAYNARD and J. FLOYER<br />
by causing patients suffering from high fever to be<br />
immersed in cold water. The two HAHNS, BRANDIS and<br />
CURR1E recommended that cold water should be poured<br />
over patients with typhus and thus gave a stimulus to the<br />
progress of hydro-therapeutics, while the curative employment<br />
of baths was placed on a firm basis by R. BOYLE and<br />
F. HOFFMANN.<br />
Surgery made less progress than the other branches<br />
of medicine during the 17th century. This was caused<br />
partly by the fact that the most gifted representatives of<br />
medical science turned their attention by preference to<br />
chemical and physical investigations which then promised<br />
great results, and also to physiology and microscopical<br />
anatomy ; partly by the continually increasing separation<br />
between internal medicine and surgery, in consequence of<br />
* PUSCHMANN op. cit. S. 35 et seq.<br />
f P. SCHEEL: Die Transfusion des Blutes und Einspritzung in die Adern,<br />
Kopenhagen 1802.—DIEFFEN BACH in RUS<strong>T'</strong>S Handworterbuch, Berlin 1838.<br />
X STALP. v. D. WIEL : Observat. rar. cent, ii, 27 and KRUL in the Weekbl. v.<br />
h. Nederl. Tijdschr. v. Geneesk, 1883, No. 47.<br />
§ CUR. BENNET: Tabidorum theatrum, Lugd. Bat. 1714, Cap. 28.
OTHER BRANCHES OF MEDICAL SCIENCE. 3<br />
which students of medicine held themselves aloof frc<br />
studying the art of treating wounds, while on the oth<br />
hand the practitioners who had received but. empiric<br />
training were fully occupied in learning to understand a<br />
to assimilate to themselves the teachings of the gre<br />
revolution in their art of which the preceding century h<br />
witnessed the commencement, in respect of the metho<br />
used in surgical operations. Certainly there were n<br />
wanting certain improvements in the technical procedur<br />
connected with operations : but no reforming genius lil<br />
AMBROISE PARE, embracing all branches of surgery ai<br />
guiding it into new paths, lived at this time. It was not un<br />
the second half of the 18th century that a new impetus w<br />
given to surgery though this did not show itself so much<br />
the development of the art of operating as in the foundatic<br />
of surgical pathology.<br />
Ligature was but seldom employed for the arrest<br />
haemorrhage, for this demanded more anatomical knoA<br />
ledge than the majority of surgeons possessed. Tl<br />
numerous unsuccessful results which followed the attemp<br />
made in this direction may be partly attributed to tl<br />
rough and incomplete methods employed. Compressic<br />
of the vessels was practised by preference and w;<br />
considerably facilitated by the invention by MOREL<br />
the fillet-and-stick tourniquet in the year 1674. PET<br />
replaced this by the screw-tourniquet in 1718. Digit<br />
compression also came once more into use at the instance<br />
SAVIARD and LOUIS. The Prussian surgeons THEDEN ai<br />
SCHMUCKER recommended the use of the tampon. Besid<br />
these means use was made of the hot iron, of cold, and<br />
various styptic applications. Ligature came to be mo<br />
generally recognized by surgeons only when it was unde<br />
stood what a mistake had been made in including in t<br />
ligature the nerves, veins, and surrounding cellular tisst<br />
and when the practice of ligaturing the isolated artery w<br />
commenced. Even ligature of great arterial trunks, su<br />
as the femoral and axillary was then ventured upon ; W A
376 RECENT TIMES.<br />
NER and ELSE went so far as to perform ligature of the<br />
carotid in the year 1775.<br />
The amputations performed were chiefly those of the<br />
foot, leg, forearm, and hand ; above the elbow and knee<br />
they were practised less frequently. The methods of performing<br />
these operations were somewhat enriched by the<br />
introduction of the double and triple incision, of the<br />
flap-operation, and of the process of cutting the tissues<br />
in the form of a hollow cone, the object aimed at being<br />
the preservation of,enough of the soft parts to form a<br />
covering for the stump. Amputation was, however, performed<br />
more frequently than there was any occasion for.<br />
Thus SCHMUCKER states that in 1738 he saw in the Hotel<br />
Dieu at Paris a patient both of whose legs had been<br />
amputated on account of simple fractures. Conservative<br />
surgeons opposed this abuse which had arisen under<br />
the influence of the French school, and endeavoured to<br />
confine amputation within reasonable limits. The increase<br />
of anatomical knowledge and the improvement in the<br />
technical details of operations encouraged surgeons to perform<br />
exarticulations. A. PAR£ had already practised this<br />
method at the elbow-joint; at the knee it was first performed<br />
by FABRY VON HlLDEN and at the shoulder by<br />
MORAND and LE DRAN. The method of exarticulation in<br />
the tarsus named after CHOPART was made public in 1791.<br />
Exarticulation at the hip-joint was attempted but given up<br />
again on account of the unsatisfactory results attending it.<br />
Resections of certain bones or portions of bones were also<br />
performed ; for instance of the humerus by CH. WHITE,<br />
of the clavicle by CASSEBOHM, while the first successful<br />
excisions of joints were practised by FILKIN (1762) and<br />
PARK (1781) in the case of the knee joint; and by CH.<br />
WHITE (1768) and J. BENT (1771) in the case of the<br />
shoulder.<br />
Trephining was frequently performed for the most trivial<br />
causes ; it is inconceivable, how readily this measure was<br />
resorted to. It was performed 17 times, on PHILIP WILLIAM
OTHER BRANCHES OF MEDICAL SCIENCE. 37<br />
Prince of ORANGE as we are told by C. SOLINGEN. On!<br />
here and there was a voice raised against this dangerot<br />
mania for operations. The first opening of the maxillai<br />
antrum for disease belongs also to this period. Catheterisi<br />
of the Eustachian tube owes its invention to the deaf pos<br />
master GUYOT of Versailles who practised it upon hin<br />
self.* Tracheotomy was recommended and performed nc<br />
•only for the removal of foreign bodies and the relief (<br />
dyspnoea, but also in croup and diphtheria.f CEsophc<br />
gotomy was performed for the first time in the i'8t<br />
century, while gastrotomy was practised as early as th<br />
year 16354 GIOVANNI FANTONl reported the first sue<br />
•cessful extirpation of the spleen. In the subject of herni<br />
the influence of the study of anatomical relations, whic<br />
are of such fundamental importance, began to make itsel<br />
felt. Besides inguinal and umbilical hernia other form<br />
began to be distinguished and attention was drawn t<<br />
femoral hernia and to the pudendal, obturator and sciath<br />
varieties.§ Efforts were made to throw light upon th<<br />
origin of ruptures; HALLER considered congenital hernh<br />
to depend upon embryological conditions. In the treat<br />
ment, trusses were more generally employed especially<br />
after N. LEQUIN had in 1663 introduced the elastic spring<br />
The operation for radical cure was less frequently per<br />
formed and was gradually more and more confined to case:<br />
•of strangulated hernia. Special care was taken to pre<br />
serve the spermatic cord; many surgeons, like DlONIS<br />
held it to be justifiable only in the case of priests to com<br />
bine castration with this operation.<br />
The operation for rectal fistula was brought into con<br />
siderable repute by the fact that LOUIS XIV was oblige*<br />
to undergo it. The Royal illness even exerted a grea<br />
* Machines et inventions, appr. par l'academie royale, Paris 1724, iv, Nc<br />
253.<br />
t B. SCHUCHARDT in LANGENBECK'S Archiv 1887, Bd. 36, H. 3.<br />
1 HAGENS in the Berliner klinischen Wochenschr. 1883, No. 7.<br />
§ J. FANTONI: Opusc. med. Genev. 1738.<br />
'• r tl
378 RECENT TIMES.<br />
influence on politics; MlCHELET has, as is well known,<br />
divided the reign of this Monarch into the periods avant et<br />
apres la fistule* The debates upon the performance of<br />
the operation led to the invention of several fistula-knives<br />
amongst which that of POTT with SAVIGNY'S improvements<br />
was most esteemed. Colotomy with the object of the formation<br />
of an artificial anus in congenital closure of the<br />
natural outlet was performed in 1783 for the first time.<br />
Among the methods of performing lithotomy the sectio<br />
lateralis was most extensively adopted. CHESELDEN<br />
modified the procedure in some measure and FRERE COME<br />
recommended the use of the lithotome cache. The high<br />
incision over the pubes was less frequently employed.<br />
Lithotrity was described by ClUCCl : he made use of a<br />
grooved instrument with toothed blades resembling<br />
ClVlALE's lithotrite and enclosed in a sheath. In the<br />
treatment of urethral stricture the elastic bougies recommended<br />
by DARAN which swelled in the urethra were in<br />
great favour.<br />
HENDRIK VAN DEVENTER, A. J. VENEL and others<br />
sketched out the principles of orthopaedics. About the<br />
same time HENDRIK VAN ROONHUYSE and afterwards<br />
TULP made the first attempts to cure caput obstipum by<br />
dividing the sterno-cleido-mastoid muscle. In 1784 M. G.<br />
THILENIUS performed the first division of the tendo Achillis<br />
for club-foot.<br />
Surgical pathology received valuable additions at the<br />
hands of PERCIVAL POTT who made chronic inflammation<br />
of the joints or tumor albus the object of careful observation,<br />
as he did also the subject of vertebral caries, the<br />
curvature resulting from which disease is named after him;.<br />
while J. L. PETIT drew attention to the suppurative osteomyelitis<br />
which supervenes upon wounds. PETIT and JOHN<br />
HUNTER also studied in greater detail the processes which<br />
occur in the tissues in thrombosis, suppuration, cicatriza<br />
tion and granulation.<br />
* HJ-ESER op. cit. ii, 432.
OTHER BRANCHES OF MEDICAL SCIENCE. 379<br />
Ophthalmology made a great stride at this time, in laying<br />
aside the error, that cataract results from an extra-ocular<br />
humour which is deposited in the form of an opaque pellicle<br />
before the lens, and by adopting the correct view that it<br />
consists of a disease of the lens itself. This discovery<br />
received a splendid confirmation in the method of extraction<br />
by which DAVIEL in 1746 performed the first operation<br />
for removal of the lens. Extraction from this time<br />
forth maintained an established position in ophthalmic<br />
surgery along with the couching operation. The formation<br />
of an artificial pupil constituted a further step in advance;<br />
this was advocated by WOOLHOUSE and first performed in<br />
1728 by CHESELDEN. The procedure consisted of an<br />
incision made in the iris ; the elder WENTZEL modified<br />
this by excising a portion of the iris—performing an iridectomy<br />
in fact.<br />
To this period midwifery owes the beneficent discovery<br />
of the forceps. Long led up to by the instruments which<br />
obstetricians made use of for the extraction of dead<br />
foetuses, they appeared upon the scene finally in the 17th<br />
century and assumed a form calculated to adapt them to<br />
their peculiar ends. The CHAMBERLENS in difficult labours<br />
made use of appliances consisting of levers, or blades of<br />
steel covered with leather. This invention remained a<br />
business-secret until JEAN PALFYN made it public after<br />
introducing many improvements.* It was then further<br />
perfected by DUSE, who introduced the crossing of the two<br />
blades, by the younger GREGOIRE who had them fenestrated<br />
and united by a locking apparatus, and above all by<br />
LEVRET who changed the straight form of the blades into a<br />
curved one, arranged for the locking by means of a moveable<br />
peg, and laid down a statement of the indications<br />
which justified the use of the forceps. To avoid the<br />
dangers of Csesarean section—an operation but rarely performed—a<br />
division through the symphysis pubis was<br />
* J. H. AVELING: The Chamberlens and the midwifery forceps, London<br />
1882.—A. GOFFIN: Jean Palfyn, Bruxelles 1887.
380 RECENT TIMES.<br />
recommended, by which it was hoped, erroneously however,<br />
to increase the width of the pelvis; the bad results of<br />
this operation were soon seen and led to its general condemnation.<br />
On the other hand the procedure first recommended<br />
by CAMERARIUS and SLEVOGT—that namely of<br />
inducing premature labour in the 7th or 8th month in a<br />
case where, in consequence of a narrow pelvis, a child could<br />
not be delivered by the natural passages,—was well received<br />
by obstetricians and maintained its place in gynaeco<br />
logical practice.<br />
To this period belongs also the first treatment of medical<br />
jurisprudence in a scientific spirit as we see for example in<br />
the application of the lung-test to forensic purposes:* the<br />
same may be said of the first beginnings of a system of<br />
medical statistics.!<br />
If we follow the course of the development of medicine<br />
during the 17th and 18th centuries, we recognize in it the<br />
same phases as those which characterize the general march<br />
of civilization during the same period. That spirit of active<br />
investigation, so rich in results, which was displayed in an<br />
indefatigable accumulation of empirical facts, gradually to<br />
a certain extent ceased to manifest itself: it became<br />
apparent that the results gained required to be sifted and<br />
to be looked at in their relations to one another and to the<br />
general intellectual life of man. Like the traveller, who<br />
after a fatiguing march has ciimbed a height, and who<br />
looks back with a proud contentment on the path he has<br />
traversed ; even so the genius of civilization after great<br />
victories won, now halted for a brief rest, before arming<br />
once more for new achievements. In the history of mankind<br />
such a moment had arrived in the 18th century and<br />
the efforts of the Encyclopaedists gave clear expression to<br />
the fact. In medicine too this tendency of men's minds<br />
was noticeable and manifested itself in a series of com-<br />
* BLUMENSTOCK in the Vierteljahrsschr. f. gerichtl. Medicin, 1884, Bd. 38<br />
S. 252-69. Bd. 39, S. 1-12.<br />
f J. GHAETZER : Daniel Gohl und Christ. Kundmann, Breslau 1884.
ART AND PHILOSOPHY 381<br />
positions which dealt chiefly with the history of medicine.<br />
The first prominent representatives of medical historical<br />
literature were DANIEL LECLERC, JOHN FREIND and<br />
JOHANN HEINRICH SCHULZE. It found influential friends<br />
and supporters in BOERHAAVE and especially in HALLER<br />
who rendered imperishable services to the history of medicine<br />
by editing the medical writings of antiquity and by<br />
his bibliographical works. PORTAL, also, who was the<br />
author of a History of Anatomy, WERTHOF, HENSLER and<br />
GRUNER, whose thorough investigations in the history<br />
of diseases have an enduring value, ASTRUC, BALDINGER,<br />
TRILLER, MOEHSEN, ACKERMANN, MESLER and others<br />
bear witness to the fact that the taste for historical<br />
inquiry among the doctors of the 18th century was widely<br />
spread and abundantly fruitful.<br />
THE CHARACTER OF THAT PERIOD IN REGARD<br />
TO ART AND PHILOSOPHY.<br />
THE intellectual life of the 18th, was of a different ch<br />
to that of the preceding, century. This change manifested<br />
itself either in the neglect of experimental inquiry, as was<br />
the case in the natural sciences, or else in an alteration of<br />
direction in work and aims, as was most clearly indicated<br />
by the productions of the painter's art.<br />
The 17th century produced GuiDO RENI, SALVATOR<br />
ROSA, the Spaniards VELASQUEZ and MURILLO, the French<br />
masters NICHOLAS PoussiN and CLAUDE LORRAIN and the<br />
great artists of the Netherlands, RUBENS and REMBRANDT.<br />
The 18th century could place by the side of these but few<br />
artists whose names would not pale in the presence of that<br />
dazzling company of masters. In the place of the classical<br />
beauty of those figures, which have become a pattern to all<br />
time by virtue of the noble simplicity of their design and<br />
the correct appreciation of the harmony of colours shown
382 RECENT TIMES.<br />
in their composition, and which, even when, as in RUBENS'<br />
works, they exhibit a downright naturalism never merely<br />
captivate the eye but always speak to the heart as well,— \<br />
in the place of such works as these appeared others, unwholesomely<br />
surcharged with quaint accessories, in consequence<br />
of the desire of the painters to appear original, the<br />
effect of which was to lead art astray from the true path.<br />
The philosophical ideas and systems which were put forward<br />
at this time afforded a life-like image of the intellectual<br />
struggles and changes of the period. The inductive<br />
philosophy of BACON, founded upon experience and experiment,<br />
which was justified beyond all expectations by the<br />
rapid strides made in the natural sciences and by a multitude<br />
of discoveries and inventions, developed under the influence<br />
of these results upon a basis of materialism to which the<br />
doctrine of pantheism imparted some bias towards idealism.<br />
That belief the unfortunate GIORDANO BRUNO had proclaimed<br />
as his sacred conviction and suffered death for in<br />
the flames. BARUCH SPINOZA also professed the same creed<br />
at a later period, and, expelled from the Jewish community<br />
on account of his freedom in religious thought, endeavoured<br />
to found it on scientific facts and to make it a method of<br />
general application in explaining the phenomena of the<br />
universe. He taught the conformability to law of every<br />
event in nature and the unity of substance which, as he<br />
explained in his appendix to Descartes, manifests itself<br />
outwardly in a twofold form—Spirit and Matter.<br />
JOHN LOCKE went a step further. Accustomed as a<br />
doctor to exclude metaphysics from the field of discussion,<br />
he took up a position on the ground of pure philosophic<br />
empiricism and declared that there are no such things as<br />
innate ideas but that all knowledge is founded on experience.<br />
The human soul, he says, resembles at birth a blank<br />
page on which the perceptions of the senses are impressed<br />
as experiences, until by reflection and by the understanding<br />
—which LOCKE calls the internal sense—they are arranged<br />
into pictures of ideas. He thus brought philosophy once
ART AND PHILOSOPHY. 383<br />
more back into the arms of naturalism inasmuch as he<br />
referred his theory of the acquirement of knowledge to the<br />
investigation of things by means of the bodily senses.<br />
LOCKE'S philosophical views found distinguished advocates<br />
in France in the persons of E. B. DE CONDILLAC and VOL<br />
TAIRE, and in England incited to a scepticism which DAVID<br />
HUME gave powerful expression to, while Germany produced<br />
a mighty opponent to them in LEIBNITZ. The lastmentioned<br />
combined the innate ideas of PLATO with the<br />
outlines of the atomic philosophy of DEMOKRITUS,—with<br />
which G. BRUNO and P GASSENDI had already established<br />
some connection,—and adapted these views to the Christian<br />
doctrines of the wisdom of the Creator and the suitability<br />
of nature to its ends. He assumed the existence of certain<br />
metaphysical points indivisible, without dimensions, and<br />
probably endowed with perception, which he called monads;<br />
he believed that he explained their mutual relations and<br />
their connection with the unity of consciousness by the<br />
fantastical hypothesis of a " pre-established" harmony<br />
settled before the beginning of time.<br />
LEIBNITZ exerted no promoting influence on the development<br />
of the natural sciences or of medicine in particular;<br />
for philosophy, for literature in general, he has perhaps been<br />
credited with greater importance than he deserves. His<br />
system was chiefly confined to Germany where CHRISTIAN<br />
WOLFF was his most zealous apostle. He arranged the<br />
ideas, which LEIBNITZ had jotted down in a loose disconnected<br />
form, into an orderly scheme with the pedantry<br />
of a schoolmaster, and wherever there were manifest gaps<br />
or whenever a too high-flying fancy prevailed he amended<br />
matters by the doctrines of other philosophers.<br />
More coherent and uniform in composition, but at the<br />
same time more daring and more terrifying in its conclusions<br />
was the materialism which made its appearance in France<br />
about the middle of the 18th century. The most radical representative<br />
of this, the French doctor LAMETTRIE, made<br />
an attempt in his " Histoire Naturelle de l'Ame" and his
384 RECENT TIMES.<br />
"L'Homme Machine" to deduce from the material and<br />
corporeal organism even the processes of thought, the<br />
intellectual faculties, and the moral feelings. He disregarded<br />
the transcendental character of the human soul,<br />
appealing, amongst other things, to the fact of psychical<br />
disturbances which depend upon changes in the brain.<br />
Immortality he granted, but only in so far as he held that tj<br />
matter, from which the things of this world are made, does<br />
not perish, but only changes its form and participates afresh -j<br />
in the formation of other bodies. Unfortunately LAMETTRIE<br />
at the same time preached a philosophy of pleasure which<br />
amounted to a shameless glorification of self-indulgence,;!!<br />
and especially of venereal pleasures. The violent attacks^<br />
which he had to sustain were provoked entirely by this circumstance<br />
and were by no means the result of his more<br />
serious philosophical theories. It may well be that during '<br />
his life he did not practise the frivolous cynicism which he *<br />
made so conspicuous a feature of his writings : but even F/ '<br />
A. LANGE who undertook the vindication of LAMETTRIE was *<br />
able to bring forward in his defence nothing more than the 1 ,<br />
claims that he neither sent his children to the foundling<br />
hospital like ROUSSEAU, nor married two brides like SWIFT,<br />
that he had not like BACON been convicted of bribery, and<br />
had never been suspected of forging documents like VOL<br />
TAIRE.* In any case LAMETTRIE by his teachings exerted<br />
an injurious influence upon morals and poisoned many<br />
pure spirits, and he was chiefly to blame if materialistic<br />
philosophy was for a long time identified by ignorant.<br />
people with an unlimited indulgence in sensual gratifica<br />
tions.<br />
The other adherents of materialism, especially those<br />
who have become known under the name of the Encyclopaedists,<br />
sought not so much to secure a scientific founda-^<br />
tion for their philosophical tenets as to wage war against<br />
ecclesiastical and political authorities. The author of the<br />
" Systeme de la Nature " developed the theory of the<br />
i f<br />
* F. A. LANGE : Geschichte des Materialism us, Iserlohn 1876, i, 349.
LEARNED SOCIETIES AND UNIVERSITIES. 385<br />
circular course of life and the intimate interdependence of<br />
the three kingdoms of nature; but he laid, at the same<br />
time, undue, stress upon such subjects as the rationalistic<br />
enlightenment of the people and their right to self-government<br />
These theories no doubt contributed largely to lead on<br />
the mighty revolutions which, at the end of the eighteenth<br />
; century, shook France to its foundations and affected the<br />
whole of Europe, and make it, to some degree, apparent<br />
why many looked upon materialism as the source of<br />
irreligion and the foe of monarchy.<br />
THE LEARNED SOCIETIES AND UNIVERSITIES<br />
IN THE SEVENTEENTH AND EIGHTEENTH<br />
CENTURIES.<br />
THE development of the scientific spirit was es<br />
advanced in the 17th century, as it had been in the 16th,<br />
by the foundation of learned societies and of universities.<br />
In Italy Prince FEDERIGO CESI established in 1603 the<br />
Accademia dei Lincei, so called because its members<br />
required for their investigations the eyes of lynxes and<br />
because the coat of arms of the society bore a lynx on it;<br />
while in 1657 under the patronage of the Medici princes<br />
there arose in Florence the Accademia del Cimento which<br />
gave forth that experiment should be its particular charge.<br />
.Learned societies were formed after this pattern in other<br />
countries also. In Germany, Schweinfurt was the centre of<br />
a society of doctors and natural philosophers which in<br />
1672 was raised to an academy by the Emperor LEOPOLD.<br />
In Paris the Academie des Sciences came into existence<br />
about the year 1666 and in 1793 was converted into the<br />
Ihstitut National. The Royal Society was also founded<br />
in London in the year 1666: its Transactions have<br />
appeared in almost unbroken succession up to the present<br />
day, and form for the history of science one of the most<br />
C C
386<br />
RECENT TIMES.<br />
important arid valuable series of publications extant* .<br />
Upon these followed the Academy of Berlin which was<br />
^established in 1700 through the efforts of LEIBNITZ ; the<br />
-PhilosophicaLSociety of Gottingen in 1733.; the Academy of<br />
St. Petersburg, which was built, certainly, on Russian soil,<br />
but the members of which were chiefly Germans, in 1725;<br />
the Academy of Mannheim in 1755; and that of Munich in<br />
1760.<br />
The scientific life of this period brought forth rich fruit<br />
in England and the Netherlands. Italy too saw the ripen-.<br />
ing of some late harvests, which called to mind the best I<br />
periods of that country's great past. The splendid Court j<br />
of LOUIS XIV. threw upon France broad beams of light \<br />
which rendered conspicuous a surprising quantity of talent<br />
and energy combined with much inward unsoundness.<br />
During the 18th and far into the 19th century, the French •'<br />
people stood at the head of intellectual progress; the'0<br />
learned men and investigators of France not only worked |<br />
strictly as pioneers in the advance of science, but they also :j<br />
•widened its boundaries and increased its subject-matter in<br />
various ways. Germany was checked in political and intel- ,j<br />
lectual development by the miserable religious war, which<br />
laid the land waste during 30 years, and did not until two<br />
centuries later enjoy an assured peace for the full exercise<br />
of her power.<br />
; ^At the end of the 16th century, the academies and<br />
educational establishments in the different countries were<br />
sufficient in number, as a general rule, to satisfy existing<br />
requirements. In England the ancient universities of<br />
Oxford and Cambridge formed the most important centres •<br />
for the higher studies. France centralized scientific study<br />
more and more in Paris. Holland acquired new academies, 5<br />
at Groningen (1614), Utrecht (1634) and Harderwyk (1648).<br />
In Italy universities arose at Parma, Cagliari, Mantua,<br />
Urbino, Piacenza, Sassari, and Milan, some of which»c<br />
indeed, owed their origin merely to the petty jealousies of<br />
* CH. R. WELD: History of the Royal Society, London 1848, 2 Vols.'
LEARNED SOCIETIES AND UNIVERSITIES. 387"<br />
these towns and their rulers. In 1608 a university was<br />
founded at Pamplona, which, nevertheless, remained as<br />
unknown as-the other institutions of this kind in Spain.<br />
Establishments of a kindred nature, which were founded in<br />
Eastern Europe, like those at Tyrnau, in Hungary, after*<br />
wards removed to Pesth, at Klausenburg, in Transylvania,<br />
and. at Kiew and Moscow, did not acquire any particular<br />
notoriety. An academy for Finland was created in 1640, at<br />
Abo, which was moved to Helsingfors in 1828 ; and Sweden<br />
acquired a second university at Lund, in 1668.<br />
The number of academies which during this period arose<br />
in Germany was inordinately great. In part they were called<br />
into existence not by any want felt for an academical education,<br />
but merely through the vanity of the minor territorial<br />
lords, who in the foundation of an academy saw a not too<br />
costly method of advertising their sovereignty and of hearing<br />
themselves extolled in speeches and poems as patrons of<br />
the sciences. When the gymnasium at Herborn in Nassau<br />
was, in 1652, raised into a university it cost the territorial<br />
princes much trouble to find the fee of 4,ioofl. required to<br />
pay for the grant of the Imperial privileges. The town of<br />
Rinteln, when in 1621 it was made the seat of a university,<br />
possessed neither an apothecary's shop nor an inn* The<br />
partition of the Hessian countries among various branches<br />
of the dynasty led in 1607 to the foundation of the<br />
academy at Giessen ; but from 1625 to 1650 it was again<br />
united with the neighbouring sister institution of Marburg.<br />
The University of Strassburg arose out of the academical<br />
gymnasium there, at which, among other branches of<br />
scientific instruction, medicine found a place ; in 1566 and<br />
1621 this university received the Imperial sanction. In<br />
1602 there were at it 70 students of theology, 77 of law,<br />
11 of medicine, and 145 of philosophy, t Afterwards this<br />
seat of learning was less frequented, the number on a<br />
* A. THOLUCK: Das akademische Leben des 17. Jahrhurrderts, Halle 1854,<br />
Bd. i, Abth. 2, S. 96, 303.<br />
t Id. i, 2, 122. '• -'
388<br />
RECENT TIMES.<br />
yearly average amounting to little more than four students<br />
in all the faculties put together; not till 1718 did it once<br />
more raise itself from this depressed condition, when under<br />
the French rule political circumstances assumed a peaceful<br />
aspect* The University of Altdorf arose in a similar<br />
manner in 1622 in the district of the imperial free-town of<br />
Niirnberg.f The gymnasium at Bremen also resembled an<br />
academy; and a professorship of medicine was founded<br />
there in 1610. A similar character was borne by, the<br />
higher educational establishments at Steinfurt and at<br />
Neustadt on the Haardt, that at the former of these towns<br />
being intended for the Grafschaft of Bentheim-Tecklenburg,<br />
and that at the latter for the Palatinate. Those at Hanau<br />
and Lingen also resembled universities. At Duisberg a<br />
university arose in 1655 and one at Kiel in 1665. The<br />
academy at Dorpat owed its foundation in 1632 to King<br />
GUSTAVUS ADOLPHUS, of Sweden ; but it existed only a<br />
few decades and did not awake to renewed life until 1802.<br />
The system of higher education in the Catholic states of<br />
Germany came by degrees completely into the hands of<br />
the Jesuits. Several new institutions, founded at the<br />
instance of this Order, were, even if they received the<br />
rights of a university, essentially only spiritual seminaries.<br />
Thus there arose at Molsheim, in Elsass (Alsace), a<br />
Jesuitical gymnasium which, in 1617, was raised by the<br />
Pope into a university: this in 1702 was transferred to<br />
Strassburg and united with the high school at that place.<br />
At the same time the cathedral school at Paderborn acquired<br />
the character of a university ; the same happened to the<br />
cathedral school at Osnabriick. The academy founded in<br />
1647 at Bamberg gradually developed in like manner into a<br />
complete university. In 1734 the Jesuitical gymnasium at<br />
Fulda was also raised into a university, while the cathedral<br />
school at Miinster did not attain this dignity until 1780.<br />
* F. WIEGER : Geschichte der Medicin in Strassburg, 1885, S. 71.<br />
f G. A. WILLIS: Geschichte und Beschreibung der Universitat Altdorf,<br />
Altdorf 1795 J
LEARNED SOCIETIES AND UNIVERSITIES. 389<br />
To these were added numerous academies in the<br />
countries belonging to the reigning house of Hapsburg.<br />
At Salzburg, learned Benedictines founded an establishment<br />
for the higher teaching, which in 1623 was raised into a<br />
university by the Pope. A like honour was granted to<br />
the Jesuitical gymnasium at Innsbruck, in 1673. So too at<br />
Breslau the Jesuitical college developed, little by little, into<br />
a university and in 1702 was recognized as such. The<br />
establishment at Briinn acquired in 1779 for the first time<br />
the privileges of a university, the high school at Olmiitz<br />
being removed thither and united with it. But only a few<br />
years afterwards it lost this character again and was<br />
changed into a lyceum, which later on was associated with<br />
an establishment for teaching medicine and surgery and<br />
had its seat in Olmiitz.*<br />
The universities of Halle and Gottingen exerted an important<br />
influence on the development of the scientific spirit.<br />
The former was founded in 1694, after the Archbishopric<br />
of Magdeburg, with the lands belonging to it had come<br />
into the possession of Brandenburg. The Great Elector had<br />
already occupied himself with the formation of a kind of<br />
academy which should form a centre for all things worthy of<br />
study; he contemplated providing it with a chemical laboratory,<br />
a physical and technological establishment, a zoological<br />
and botanical garden, workshops, museums, etc., and decreed<br />
that it should be accessible to all desirous of learning,<br />
without distinction of nationality or religious belief.f But<br />
the time was not ripe, nor was money forthcoming for the<br />
completion of a plan of this magnitude and so much in<br />
advance of the rationalistic mode of thought of the 18th<br />
century. The financial means of the university of Halle<br />
were also somewhat limited: its yearly income up to 1786<br />
reached no more than 7,000 thalers, with which it was<br />
necessary to meet the salaries of all the teachers, and<br />
* F. J. RICHTER : Geschichte der Olmiitzer Universitat, Olmiitz 1841.<br />
f ERMAN and RECLAM : Mem. p. servir a l'histoire des refugies francois, T.<br />
iii, p. 293 et seq., Berlin.
39°<br />
RECENT TIMES.<br />
generally speaking, all the expenses of the academy. In<br />
vain did the professors request that the income Of the,<br />
estates formerly belonging to the cathedrals of Magdeburg.,<br />
and Halberstadt should be assigned to them* It was?<br />
owing to the ability of its teachers, amongst whom were?<br />
the jurists STRYX and THOMASIUS, the theologian<br />
FRANCKE, the philologist CELLARIUS, and the doctors<br />
STAHL and F. HOFFMANN, that the university of Halle^<br />
maintained for a long time the first position among the,<br />
German academies. It did not begin to recede fromthis<br />
position until the Hanoverian Government in 1734<br />
founded a university in Gottingen, for the maintenance of<br />
which a.yearly sum of 16,000 thalers was voted. In the,<br />
appointments to professorships and in the regulation of,<br />
studies there prevailed now a freer spirit which strove toaccommodate<br />
itself in every way to the demands of the<br />
time. More respect was paid to the natural sciences here<br />
than in other academies. WERLHOF, who was commissioned<br />
to furnish a preliminary report upon the pro-.<br />
posed foundation of the medical faculty, gave his judg-T<br />
ment upon the subject on the 16th December, 1733, and<br />
proposed that professorships in anatomy, botany, chemistry<br />
with materia medica, and the theory and practice of<br />
medicine, should be established, that a botanical garden<br />
should be laid out, a chemical laboratory constructed, andthat<br />
a hospital should be built and used for the purpose of<br />
teaching, students of medicincf Smaller universities<br />
arose in the 18th century at Erlangen (1743), at Biitzow in<br />
Idecklenburg (1760), at Stuttgart (1781) and at Bonn (1784),<br />
that at Stuttgart having grown out of the Karlsschule, and.<br />
that at Bonn having developed into an academy, from being,<br />
a Jesuitical gymnasium, but existing in its new form hardly-<br />
one year. -, :<br />
I . • - •••<br />
' * J. C. FORSTER : Geschichte der Universitat Halle in ihrem ersten Jahfhunderj-.,<br />
Halle 1799.<br />
' t E.. F. ROSSLER: Die Griii.idung der. Universitat Gottingen, Gottingten<br />
1855- - c '-FF -i ::i
LEARNED SOCIETIES AND UNIVERSITIES. 391"<br />
Germany, with a population which scarcely reached half<br />
that of the present day possessed about twice the number .<br />
of academies she does now. Even from this fact we,<br />
may see - that universities at that time differed in many<br />
respects from those of to-day. They did not subserved<br />
so exclusively the preparation for a particular calling in<br />
life as they do now, but often only offered a completion of<br />
the general education : and they were contented with a<br />
much smaller attendance of students, since the cost of<br />
maintenance was also much smaller than it is now. In<br />
Vienna there were only 25 medical students in the year<br />
1723, in Gottingen from 50 to 80 during the period<br />
between the years 1767-78. Jena, in 1768, numbered 17,<br />
and in 1773, 42 students of medicine. In Altdorf no more<br />
than 386 medical students graduated between 1623-1794.<br />
In Wiirzburg about the middle of last century medical<br />
studies were in an extremely depressed condition. The<br />
Russian Court Doctor, M. A. WEIKARD, says in his autobiography<br />
(Berlin and Stettin, 1784): •'When I began to<br />
study medicine in Wiirzburg with C. C. SlEBOLD and<br />
SENFFT in the year 1761, there had been no pupils for<br />
several years past and consequently no lectures had been<br />
given. A year before two had entered and afterwards the;<br />
number was increased to nine. The teachers, who received<br />
only 200-300 gulden, naturally treated their office as a<br />
secondary matter, and were, moreover, unaccustomed to<br />
scholastic affairs; indeed we had to complain several times<br />
to the Rector Magnificus before we could bring them all<br />
to deliver lectures again. They had to be forced thereto<br />
by admonitions and serious threats. In spite of this they<br />
showed the extremest thrift in their utterances : f requently:<br />
they remained silent for a whole quarter of a year; and yet<br />
for all that the loss was not great."* The attendance at<br />
some foreign academies was greater. ALEXANDER MUNRO,<br />
during the 50 years that he taught at Edinburgh, had 14,000<br />
pupils: the average number of medical students present<br />
* KOLLIKER Op. Clt.S. 21. . . i
39 2 RECENT TIMES.<br />
there during the second half of the 18th century was 400<br />
at a time. At Leyden in the year 1709 the number was<br />
about 300. In Padua, when in 1613 not more than 1,400<br />
students matriculated, it was considered a bad year. Pavia,<br />
in 1782, among 2,000 students numbered 200 medical*<br />
The arrangements of the German medical faculties were of<br />
a less complete and more meagre description than those of<br />
Holland, Italy, and France. On this account many students<br />
of medicine betook themselves to these countries from<br />
Germany, in order to complete their professional education-<br />
Especially the universities of Leyden, Padua, f Montpellier,<br />
and Paris acquired a great reputation in this respect and<br />
were much frequented.<br />
It came about by degrees that France developed into the<br />
chief centre of polite learning and education, such being<br />
unfortunately much neglected at the German universities.<br />
These, in the 16th century, had fulfilled their task and had<br />
afforded as much instruction as at that time was looked<br />
upon as indispensable for a general education of the<br />
higher class. When, however, among the upper classes a<br />
knowledge of the Latin and Greek tongues ceased to be<br />
the principal object, and the discoveries and progress in the<br />
natural sciences pressed other ideas into the foreground,<br />
the curriculum of the German universities no longer satisfied<br />
requirements and people sought in foreign lands what<br />
they could not get at home.J In this manner there arose<br />
differences between these two systems of education—that<br />
for the learned professions, and that in polite literature—<br />
which has, in some degree, endured up to our own time.<br />
The universities were on their guard against accepting<br />
new subjects of education, and, on the other hand, men of<br />
•, # G. FISCHER: Chirurgie vor 100 Jahren, Leipzig 1876, S. 77.<br />
f See the list of the names of the students who matriculated there in<br />
" Dell'.universita di Padova," Padua 1841.<br />
,*v X BIEDERMANN (Deutschland im 18 Jahrhundert, Leipzig 1858, ii, 1, S. 18)<br />
Says,: "Most (of the German universities) had degenerated into exercising<br />
grounds for the exponents of the narrow views of orthodoxy, pedantic booklearning,<br />
and scholastic subtlety."
LEARNED SOCIETIES AND UNIVERSITIES. 393<br />
mark in the political, military, artistic, manufacturing, and<br />
industrial walks of life, who by their residence abroad had<br />
acquired a wider outlook, laughed at the narrow views of<br />
the bookworms who sometimes cut a pitiful figure in con<br />
sequence of the awkwardness of their manners.<br />
A wild and a rough life prevailed at the German univer<br />
sities of that time. " At our German high schools," writes<br />
the doctor LOTICHIUS in 1631, "the attention of the<br />
students is devoted, not to books, but to quarrels ; not to<br />
literary compositions, but to daggers ; not to the pen, but<br />
to the sword and plume; to bloody feuds instead of to<br />
learned discussion; to drinking and riot instead of to<br />
assiduous work ; to the tavern and the brothel rather than<br />
to the study and library."* The fagging of freshmen, a<br />
custom which by usage came to be a regular practice, led<br />
to terrible excesses, to cruelty and even to crime. The<br />
students indulged also in many acts of insolence towards<br />
the townsmen, f The senate of the University of Leipzig<br />
found themselves compelled, in 1625, to forbid the students<br />
"" to disturb weddings, to strike strangers, to insult ladies<br />
and young women by obscene remarks, or to trip them<br />
up." J At Jena, in the year 1660, the students gave actual<br />
battle to the police, in which conflict many were killed.<br />
-Similar excesses also occurred at Ingolstadt.<br />
But it was not surprising if such things did occur among<br />
the students; for the tone which prevailed among the pro<br />
fessors was at times not much better. In 1663 a professor<br />
was punished by the Rector with imprisonment because he<br />
had cudgelled his father-in-law.§ The University of Helm-<br />
•stadt was admonished by the reigning prince not to bring<br />
forward as candidates, at the appointment of professors,<br />
any "who were given to drinking." || Of the University<br />
* Oratio de fatalibus academiarum in Germania periculis in acad. Rintel.<br />
xec. 1631, p. 67 according to MEINERS : Gesch. d. hohen Schulen.<br />
t THOLUCK op. cit. i, x, 264 et seq.<br />
X GEBHARDT in ZWIEDINECK-S*UDENHORS<strong>T'</strong>S Zeitschr., 1887, iv, 955.<br />
§ PRANTL op. cit. i, 500, ;;o3.<br />
|| THOLUCK op. cit. i, 1, 142.
394". RECENT TIMES.'<br />
of Herborn STEUBING states: "Not only was the high;<br />
school completely split up into factions, but, besides this,?<br />
one professor was opposed to another. They not only-,<br />
taunted one another whenever they could in their lectures,;<br />
but even carried on their feuds in the presence of thegoverningbody."*<br />
Relations of this kind existed even a<br />
century later; when in 1760 a professor complained to the<br />
senate of the University of Ingolstadt that he had been.<br />
insulted by the medical faculty, the latter declared:<br />
" that they certainly did consider him—the plaintiff—a low<br />
fellow, on account of his mean practices, but that they had*<br />
no recollection whatever of having at any time called him/ ,<br />
so, officially."t<br />
It was to be expected that a reaction would set in against; ,<br />
this growing barbarism in manners and social intercourse^<br />
The University of Gottingen took the initiative in recom-.<br />
mending its students to adopt polite behaviour. The- .<br />
manners of the French, which had everywhere been adopted.<br />
at the courts of princes, were taken as a pattern. That<br />
Which the students belonging to the higher circles learned 4 ;|<br />
to value soon found favour with the rest. And thus among<br />
a proportion of the students of Germany the praiseworthy<br />
endeavour was made to grace social life by pleasing<br />
formalities. Those possessing the rudeness of manners;<br />
which were displayed at many high schools, chiefly of the<br />
smaller class, regarded this innovation with scorn, characterizing<br />
it as foppery and an unpatriotic aping of foreign,<br />
usages. Even grave historians have shared this view, and<br />
have attached too little importance to the fact that a reform"<br />
in this direction was required. The German race, without?<br />
a doubt, owes very much to the circumstance that it haS.<br />
always been intent upon improving its deficiencies and,<br />
learning alike from friends and from foes.<br />
In the beginning of.the 17th century the general educa^<br />
tion of students embraced the Latin, Greek,, and Hebrew<br />
languages, arithmetic with some mathematics, Church<br />
* THOLUCK op. cit. i, 1, 140. cf PRA"NTL op. cit,, i,.6p%
LEARNED SOCIETIES AND UNIVERSITIES. 39$<br />
history, and the study of ancient authors, which afforded<br />
opportunity of giving some information upon subjects con-.<br />
nected with history, geography, and the natural sciences.<br />
Gradually, however, more scope was given to the lastmentioned<br />
subjects. As early as at the conclusion of that<br />
century we find appearing as regular subjects of instruction<br />
in the curriculum of the gymnasia intended for the sons<br />
of noblemen, the French and English languages, sometimes<br />
even Italian and Spanish, history, geography, physics, and<br />
the natural sciences, with dancing, fencing, and riding.<br />
These sciences and arts were designated by the epithet<br />
" gallant; " just as people were fond of employing the same<br />
expression in other connections as equivalent to " knightly "<br />
or " reserved for the upper classes." LEIBNITZ, SECKEN-<br />
DORFF, THOMASIUS, and other unprejudiced men energetically<br />
demanded that practical science should receive more<br />
attention. But the mother tongue was neglected even<br />
more than this in the German schools. In Pomerania the<br />
teachers at the Latin schools were enjoined in 1690 always<br />
to speak Latin to their pupils and never German, because<br />
the latter language was unstable, troublesome, and inconvenient*<br />
The schoolmaster FRANCKE of Halle complained,<br />
in 1709, that there was seldom to be found a student capable<br />
of writing a German letter without mistakes in spelling.<br />
Here too was a reform urgently demanded.<br />
The modernizing of the schools of learning began in the<br />
18th century, and was accomplished at the expense of the<br />
studies in the ancient languages, which were advantageously<br />
cut down in the curriculum. Some philologists, somewhat<br />
Crazed on the subject, lamented this course, it is true, and<br />
prophesied for Germany a return "to the barbarism of the<br />
middle ages; " a prophecy not fulfilled however unless, as<br />
PAULSEN wittily remarks, we look upon the appearance of<br />
LESSING and KLOPSTOCK as a retrogression in culture.f<br />
* THOLUCK op. cit. i, 1, 173. BIEDERMANN op. cit. ii, 1, 511.<br />
t PAULSEN .op. cit. Si 378.
396 RECENT TIMES.<br />
MEDICAL TEACHING IN THE THEORETICAL<br />
DEPARTMENTS AND IN ANATOMY, BOTANY,<br />
CHEMISTRY, AND MATERIA MEDICA.<br />
THE universities changed but little during the 17th century<br />
in the organization and management of teaching. Even in<br />
the medical faculties theoretical lectures formed the principal ,<br />
method pursued, although the importance of practical demonstrations<br />
was more recognized than before. In the list of<br />
lectures of the University of Wiirzburg for 1604 the following<br />
were announced in connection with the medical<br />
faculty :—1. HERM. BlRKMAN lectures on the three treatises '*<br />
of HIPPOKRATES upon Prognostics. 2. JOH. STENGEL<br />
treats of the diseases of the breast and certain other f<br />
organs. 3. GEORG LEYER deals with the diagnosis and<br />
causes of diseases and their symptoms according to GALEN.*<br />
The professors treated their subjects more after the literary<br />
and historical method of the schools than in the spirit of the<br />
inductive experimentalism of later times.<br />
It was only in the 18th century that there gradually<br />
came about a strict-division of professorships according to<br />
the different subjects taught. This became necessary in<br />
proportion as the development of practical teaching in<br />
medicine demanded an increased amount of special<br />
knowledge in the subjects dealt with. While, heretofore, J<br />
the professors had been able to exchange their chairs ~'\<br />
among themselves without injury to their teaching, inasmuch<br />
as the condition of science permitted of a similar<br />
degree of training in all the subjects, from this time forth<br />
each confined himself to a special department, and was<br />
thus able to make himself a master of that particular<br />
branch. Nevertheless, the smallness of the number of<br />
regular professorships, rendered possible by the inferior j<br />
scientific requirements of the time and demanded by the ><br />
* F. v. WEGELE : Geschichte der Universitat Wiirzburg, Wiirzburg 1885,<br />
ii, 226.
MEDICAL TEACHING. 397<br />
poor financial condition of the universities, brought about<br />
the result that, nearly everywhere, several subjects were<br />
represented at the same time by one professor. Thus, at<br />
most academies, the teaching of botany and chemistry was<br />
united with that of materia medica; in the same way<br />
anatomy was joined to surgery, physiology to anatomy, or<br />
to general pathology. To such a length was this combining<br />
of subjects carried that professors of another faculty—that<br />
of philosophy for example—held lectures upon particular<br />
branches of medical science just as, on the other hand, it<br />
not unfrequently happened that doctors ventured to teach<br />
sciences far removed from their proper sphere. H. CONRING<br />
not only taught medicine in Helmstadt, but philosophy and<br />
politics as well, and was, as O. STOBBE says, " the founder of<br />
the history of German law." MEIBOM lectured upon history<br />
and the art of poetry, as well as upon medicine, and<br />
JOHANN HEINRICH SCHULTZE, besides being professor of<br />
medicine at Altdorf, held the chair of Greek also, and in<br />
Halle, to which town he afterwards removed, that of<br />
elocution and archaeology.<br />
The universities of that time resembled, in this respect,<br />
our gymnasia of to-day, at which, sometimes, a teacher of<br />
mathematics takes over a part of the lectures of the teacher<br />
of philosophy, and vice versa. It was at that time not<br />
required of an academical teacher that he should have<br />
advanced by any work of his own the science upon which<br />
he lectured. Patronage, relationship, personal preferences,<br />
and accidental circumstances of all kinds were often the<br />
causes which led to the conferring of a professorship. The<br />
stipends, for the rest, were sometimes so insignificant that<br />
there were hardly any candidates. At the small academies<br />
they had to be contented, if one of the doctors in the neigh<br />
bourhood declared himself willing to undertake a professor<br />
ship in the medical faculty, which, however, he perhaps<br />
relinquished as soon as the prospect of a lucrative practice<br />
in a larger town was opened to him. It was usual at the<br />
German universities for the teacher to make a treatise or
398 RECENT TIMES. LI<br />
text-book dealing with his subject the foundation of his<br />
lectures. He generally added remarks -of his own to<br />
supplement its contents. The Latin tongue, which the<br />
teacher was obliged to use, was not calculated to allow the<br />
"pupils to arrive at "a comprehensive and profound under^<br />
standing of the subject; it led to misapprehensions, and td<br />
"the habitual use of meaningless phrases, behind which a<br />
pretentious superficiality sought to hide itself.<br />
- It may be easily conjectured that all this must have led<br />
to the worst results in the education of the doctor. |<br />
Lectures, without the help of a book, were seldom given;<br />
at least at the German universities, for such pre-supposed ;<br />
that the teacher was a thorough master of his subject, and J<br />
also that he possessed an extraordinary command of the :J<br />
Latin tongue. Not until the 19th century was the custom of<br />
using Latin, pressing heavily and uselessly as it did upon '>•<br />
teachers and taught alike, at length abolished. The injury |<br />
inflicted by it upon the students, the patients, medical science<br />
generally, and upon the development of German culture<br />
constitutes a crime which can never be expiated.<br />
Practical instruction in medical science lay, as has been |<br />
said, at first outside the University curriculum. It came, how-' |<br />
ever, to be by degrees included; this happened first with- j<br />
anatomy, last with clinical teaching. The progress made '<br />
by anatomical teaching during this period consisted in the<br />
increase of material for study, and the more complete use<br />
made of the same, the foundation of anatomical collections;* I<br />
the establishment of separate professorships and schools •J<br />
for this speciality, and the participation of students in actual-<br />
dissection. The scarcity of human subjects, it is true,<br />
rendered it necessary that bodies of the lower animals, as *<br />
was usual at an earlier period, should frequently be made-*|<br />
use of for anatomical study: yet this circumstance was<br />
attended with many advantages to anatomical training, and ; s;<br />
led to the observation of numerous facts in zootomy, and L<br />
comparative anatomy. Although the number of human'<br />
subjects at the disposal of the schools of anatomy was*'
MEDICAL TEACHING. 399<br />
small, we must recollect that the number of students also<br />
was not large, so that the individual student could clearly<br />
see and note everything. Yet many difficulties were thrown<br />
in the way of anatomical teaching by the neglect of the<br />
authorities to supply the necessary bodies, by the tedious<br />
prolixities and time-killing scribblings of stupid officials,<br />
•which were connected with this matter,* and, above all, by<br />
the prejudices prevailing among the people. In the circles<br />
•of the well-to-do classes these prejudices were certainly less<br />
pronounced; but gave place to a scientific inquisitiveness<br />
with which a kind of cultivated sensuality was not unfrequently<br />
associated. The dissections were looked upon as<br />
racy exhibitions, and spectators crowded to see them ; the<br />
height of the dramatic situation was reached when the<br />
sexual organs were demonstrated, and for this part of the<br />
performance a higher entrance-fee was demanded. When<br />
the reigning Duke of Wiirtemburg received in 1604 the visit<br />
of three Saxon princes, to provide them with an entertainment<br />
he took them to Tubingen, where they assisted at the<br />
dissection of a human subject which lasted for eight days.f<br />
The anatomist WERNER ROLFINK of Jena was appointed to<br />
the Court at Weimar, where, in the presence of princes and<br />
distinguished personages, he had to perform a dissection ;<br />
this formed, as it were, one of the amusements with which<br />
the Duke provided his guests.J<br />
In France it was the fashion to take an interest in science ;<br />
even ladies of high position were not ashamed to divert<br />
themselves at anatomical dissections.<br />
The populace had a different view in this matter.<br />
Amongst them was still preserved that kindly pious super-<br />
.stition which regarded a dissection of the human body as a<br />
crime committed against it. To this was added the fable<br />
which took its origin from remote times, that anatomists,<br />
* PRANTL op. cit. i, 496.<br />
t J. SAXINGER : Uber die Entwickelung des medicin. Unterrichts an der<br />
Tiibinger Hochschule, 1883.<br />
| G. W. WEDEL : Oratio funebr. Rolfincio dicta, Jena 1675.
400 RECENT TIMES.<br />
when they had no dead bodies, made use of living men in<br />
tfeeir investigations. The 'ill-feeling thus engendered was<br />
still more increased by the illegal way in which bodies often<br />
came into the possession of the schools of anatomy. In<br />
Jena criminals condemned to death used to entreat the<br />
favour, before they were^given over to the hangman, that<br />
•stheir bodies should not be delivered to Professor ROLFINK ;<br />
and the country-folk in the district around Jena had the<br />
graves of their friends watched in order to prevent their<br />
bodies being " rolfinked.'J. J. BECHER had to flee from<br />
Wiirzburg in 1661, because he had dissected the body of a<br />
woman who had,been executed.* In Berlin and Lyons the<br />
anatomical schools were stormed by the excited populace,<br />
and the anatomists were roughly handled.f Similar causes<br />
led to the destruction of the dissecting-room at Edinburgh<br />
by the mob in 17254 Even at the present day this prejudice<br />
has hardly disappeared. A few years ago the beneficed<br />
clergy of Vienna proffered a request to the magistrates^<br />
that their corpses should not be dissected.<br />
Fortunately people were not everywhere so narrow^<br />
minded. ' VlEUSSENS had the opportunity at Montpellier op<br />
dissecting over 500 bodies. LiEUTAUD could rely upoft^<br />
1,200 reports of dissections. HALLER states that while "<br />
was teaching in Gottingen (1736-1753) he performed abdt<br />
350 dissections ; the dissecting-room there which was unc<br />
his charge received annually fromc3o to 40 subjects.§ T^e<br />
same favourable conditions obtained at Strassburg; in tha<br />
winter of 1725 thirty bodies, and in that of 1760 as many aj><br />
sixty bodies were dissected at the anatomical department<br />
there. || v At Paris, Leyden, and some Italian academies the<br />
greatest possible desire was shown to provide the anatomical<br />
schools with the necessary material of study. ALBERTINI<br />
* K6LL1KER op. cit. S. II.<br />
f J. P. FRANK: System der medicinishen Polizei, Wien 1817, vi, 2, S. 60<br />
Anm.<br />
X A. GRANT : The Story of the University of Edinburgh, London 1884.<br />
§ A. VALENTIN in the Memoir on A. v. HALLER, Bern* J87*7, S. 72.<br />
|| WlEGER Op, tit. S. 82,
MEDICAL TEACHING. 401<br />
of Bologna stated that, even in families Of good position,<br />
permission was readily granted him to perform a dissection<br />
where it was a question of determining the cause of a<br />
disease. In other places the neglect of anatomical demonstration<br />
was caused not so much by a scarcity of bodies as<br />
by the idleness and ignorance of the professors. In Prague<br />
during a space of 22 years (1690-1712) only three dissections<br />
were performed.* In Vienna during the year 1741<br />
not one single actus anatomicus took place ; when the departmental<br />
professor was blamed by the Government for<br />
this, amongst other excuses he put forward that of not being<br />
supported by a prosector.f The medical faculty of Ingolstadt<br />
even proposed in 1753 to abolish the professorship<br />
of anatomy, considering that it would be best to begin to<br />
learn this science after the completion of medical study,<br />
while engaged in the practice of the profession.! But<br />
arrangements were made in most of the German states in<br />
the 18th century to remedy this constant lack of subjects<br />
which pressed heavily upon the schools of anatomy. In<br />
1716 the electoral government of Saxony decreed that the<br />
Corpses of all criminals condemned to death in the district<br />
of Leipzig should at the request of the medical faculty be<br />
handed over to the dissecting-room without delay. The<br />
jpquirements of the anatomical school at Wittenburg were<br />
Ca|.ed for in the same way. A regulation was made in<br />
1323 that the bodies also of persons who had been drowned<br />
or found dead from any cause—so long as it was not a<br />
question of the " honoratiores"—or of suicides or of<br />
criminals who died in prison should be made use of for the<br />
purposes of anatomy; it w r as further arranged that the<br />
poor people, who were cared for at the public expense in<br />
the infirmaries, should, in the event of their death in such<br />
institutions and of their friends not being able to afford the<br />
expense of burying them, be delivered over to the medical<br />
* HYRTL: Geschichte der Anatomie in Prag, 1841, S. 26.<br />
f ROSAS op. tit. ii, 256.<br />
X PRANTL op. cit. i, 607.<br />
D D
402 RECENT TIMES.<br />
faculties, " but only to be opened for the demonstration of<br />
the viscera, not for complete dissection."* The Prussian<br />
Government also issued orders calculated to provide against<br />
a failure of the material needful for anatomical study.<br />
The dissecting-room at Gottingen received the bodies of<br />
prostitutes and of illegitimate children. In Vienna, after<br />
1749, the hospitals had to provide bodies for anatomical<br />
investigation and demonstration, when no executions took<br />
place.f M. STOLL thought that the material for study<br />
would be much increased if the corpses of bankrupts were<br />
also assigned to this use. The anatomical school at Abo, '!<br />
in Finland, was even allowed to claim the bodies of all ;<br />
those who had received support from the State.<br />
It was during this period that the first special buildings<br />
were erected for anatomical dissection. HAZON has left a<br />
•description of the anatomical theatre which was built in<br />
Paris in the year 1604. The construction of this was<br />
effected within a fortnight: it was very small and by .t<br />
no means solidly built. Only a short time afterwards<br />
another was erected in its place, of larger size and<br />
better suited to the purpose, but which, nevertheless, was^<br />
also exceedingly inadequate. It had, for instance, mm<br />
window but only an air-hole, as HAZON, who attended<br />
lectures there as a student in 1730, informs us, and was<br />
consequently exposed to the cold and wind. At thej<br />
suggestion and under the direction of WlNSLOW, the \<br />
Paris school of anatomy in 1744 became possessed of<br />
a building of free-stone provided with glass windows. |<br />
The institution for anatomical teaching at Leyden was<br />
provided with skeletons of men and of various kinds<br />
of beasts and was roomily arranged. % The guild of<br />
surgeons at Edinburgh founded an anatomical theatre in<br />
1697, in which demonstrations were given, and in 1705 \<br />
i<br />
* J. P. FRANK op. cit. vi, 2, S. 73 et seq.<br />
t ,]. D. JOHN : Lexikon der k. k. Medicinalgesetze, Prag 1798, vi, 712 et seq. j,<br />
X ALB. KYPER : Medicinam rite discendi et exercendi methodus, Lugd. '<br />
Batav. 1643, p. 112. >••
MEDICAL TEACHING.<br />
created a professorship of anatomy. At Wiirzburg an<br />
anatomical theatre was established in 1724 ; it was a domed<br />
building with sky-lights and had water laid on ; the cost of<br />
it was io,ooofl. In the Parnassus Boicus (Miinchen, 1725,<br />
p. 310) mention is made of it thus : " No expense is being<br />
spared in the. improvement of the studium anatomicum et<br />
chirurgicum, and a famous surgeon has been summoned<br />
thither from Paris—Monsieur SlVERT by name—at a high<br />
salary (namely 400 reichsthaler) ; his duties being to<br />
demonstrate the art of surgical manipulation in a skilful<br />
manner, and to teach anatomy or the dissection of the<br />
human body, for which purpose corpses are provided him<br />
out of the splendid hospital: thus he has not long ago completed<br />
an examination of a woman who died insane." In<br />
1788, the anatomical institute at Wiirzburg was enlarged,<br />
two rooms being built, adjoining the amphitheatre, to<br />
deposit the anatomical collection in; to these were added<br />
a hall used by the students in which to practise dissecting,<br />
a room in which the Professor worked, and a kitchen.*<br />
The University of Breslau was furnished with an anatomical<br />
j&gatre in 1745, and that of Konigsberg in 1738 ; in the latter<br />
,la'se thanks to the Professor of Anatomy of the day who<br />
had it built at his private expense.f The anatomical<br />
theatre at Pavia accommodated 400 spectators, was well<br />
lighted and adorned with the portraits of celebrated<br />
anatomists. In the hall adjoining it, which was paved<br />
with broad squares of stone, and was provided with a fireplace,<br />
large boilers, and a constant stream of pure water,<br />
the students practised dissecting.^: Establishments of this<br />
kind were also founded in towns which possessed no<br />
universities, such as Berlin, Bremen, Frankfort-on-the-<br />
Main, Niirnberg and others, and were given up to the use<br />
of the doctors and surgeons. At many places a shed or<br />
some other place of which no use was otherwise made,<br />
* KOLLIKER op. cit. S. 25, 75, 78.<br />
f D. H. ARNOLDT op. tit.—FRANK op. cit. vi, 2, S. 88.<br />
X J. P. FRANK op. cit. \i, 1, S. 327.
4°4<br />
RECENT TIMES.<br />
was assigned for anatomical dissections and demonstra<br />
tions.<br />
In addition to these schools of anatomy, there arose<br />
anatomical museums which were soon recognized as forming<br />
valuable aids to medical teaching. F RUYSCH made a<br />
collection of anatomical preparations which he sold in 1717<br />
to PETER THE GREAT at the enormous price of 30,000<br />
florins. Within ten years he succeeded in making a new<br />
collection the greater part of which became the property<br />
of King JOHN SOBIESKI who paid 20,000 florins for it.<br />
JOHN HUNTER'S famous museum consisted of 14,000<br />
anatomical preparations ; at his death it was bought by the<br />
English Government for £15,000 and was presented to the<br />
Royal College of Surgeons in whose possession it remains<br />
to this day. J. N. LlEBERKUHN'S injected preparations<br />
acquired a great reputation, as did J. G. WALTER'S anatomical<br />
collection, the fruit of 54 years' assiduous labour;<br />
the latter consisted of 2,868 numbered specimens, was<br />
acquired in the year 1803 by the Prussian Government for<br />
100,000 thalers, and formed the foundation of the museum<br />
of human and comparative anatomy at the Berlin University.<br />
Imitations of anatomical preparations were also<br />
executed in wax by skilled artists and served for medical<br />
teaching. Some Italians attained to astonishing ability in<br />
making models of this kind. The Emperor JOSEPH 11.^<br />
bought up a celebrated collection of preparations in wax, j<br />
which had been made in Florence under FONTANA'S direction,<br />
for 30,000 fl.: he had them brought to Vienna and<br />
handed over, for purposes of teaching, to the Military<br />
Medical Academy. But P. FRANKS early drew attention^<br />
to the fact that these wax-models are not so suitable for<br />
teaching anatomy to students of medicine as they are for<br />
giving a general superficial knowledge of the human body<br />
and its different parts to laymen, who always have an<br />
invincible horror Of corpses.<br />
Another important aid to instruction was found in the<br />
anatomical plates and drawings which were either separate,
MEDICAL TEACHING. 405<br />
or bound up with text-books of anatomy. J. REMMELIN<br />
resumed the method, which was formerly practised, of showing<br />
the muscular layers and the viscera by means of pictures<br />
pasted and superimposed on one another ;* a similar practice<br />
was adopted by CLOPTON HAVERS. We owe some excellent<br />
anatomical plates, especially on the distribution of the<br />
nerves, to the painter PiETRO DA CORTONA; the vignette<br />
on the title-page of the edition of 1741 represents the transfusion<br />
of blood. GERARD DE LAIRESSE made the drawings<br />
for the anatomical text-book of G. BiDLOO. The following<br />
were intended chiefly for artists;—the anatomical work of<br />
B. GENGA with the drawings of C. ERRARDS ; the Anatomia<br />
dei pittori of CARLO CESIO, which appeared also in a<br />
German translation; the representation of the muscles of<br />
the body, designed by MARTINEZ the Spanish anatomist<br />
and painter, and remarkable for its faultless proportions ;<br />
the plates of ERCOLE LELLI ; and others. The copper plates<br />
too, which adorned the anatomical writings of W CHESEL-<br />
DEN and D. SANTORINI were conspicuous for their high<br />
artistic value : the latter were held by MORGAGNI to be of<br />
supreme merit. The introduction of coloured drawings of<br />
anatomical subjects constituted a further advance; by this<br />
method the arteries, veins, nerves and different organs<br />
could be more sharply distinguished. This method was first<br />
employed in the wood-cuts with which C. ASELLI enriched<br />
his work upon the lacteal vessels. In the beginning of the<br />
18th century J. C. LE BLON, the miniature-painter, made the<br />
first attempt to produce coloured etchings; in 1721 he<br />
published the first sheet illustrative of anatomy which had<br />
been prepared by this method. But the new invention of<br />
tinted copper engraving became more widely known and<br />
was made use of for anatomical representation first by<br />
JAN LADMIRAL, who provided several treatises of the<br />
anatomists B. S. ALBINUS and F. RUYSCH with illustrations<br />
by this process, and by J. F. GAUTIER D'AGOTY who<br />
made use chiefly of the anatomical preparations of<br />
* CHOULANT : Geschichte der anat. Abbildung, Leipzig 1852, S. 39, 82 etseq.
406 RECENT TIMES.<br />
DUVERNEY as copies. ALBINUS left a thorough descrip,tion<br />
of the way of producing anatomical pictures, giving<br />
valuable advice as to the mistakes to be avoided and<br />
the rules to be observed* He spent out of his own<br />
resources, as he tells us himself, the sum of 24,000 gulden<br />
in the preparation of anatomical plates.f JAN WANDELAER<br />
was associated with him as designer. HALLER also, who<br />
made a collection of anatomical drawings, and W. HUNTER,<br />
whom his contemporaries had to thank for the best representation<br />
of the gravid uterus, were supported by skilful<br />
artists. Finally PlETER CAMPER who understood how to<br />
handle his pencil as skilfully as his dissecting scalpel,<br />
supplied valuable information upon the dimensions of the<br />
cranium, and drew attention to the importance of the facial<br />
angle (named after him " CAMPER'S facial angle") in<br />
estimating the intellectual endowments of the races of |<br />
man.<br />
We possess clear evidence of the manner in which<br />
anatomical instruction was imparted in numerous pictures<br />
of the Dutch school, which represent distinguished doctors<br />
of that period in the act of holding discussions upon.<br />
anatomical or surgical questions surrounded by their.<br />
pupils or colleagues. REMBRAND<strong>T'</strong>S celebrated painting,<br />
" The Lesson in Anatomy," which forms one of the<br />
most important works of this great master, shows the \<br />
Amsterdam anatomist NlCHOLAUS TuLP, who at that<br />
time filled the office of burgomaster, in the act of demonstrating<br />
a human subject to his medical colleagues;<br />
this picture is now in the Royal Gallery at the Hague<br />
and has become very well known by copper engravings.<br />
In another picture REMBRANDT has represented Dr.<br />
DEYMANN, TULP'S successor as teacher, preparing a brain<br />
after removal of the cranial vault. Similar pictures are<br />
preserved in Amsterdam and other places in Holland;<br />
* B. S. ALBINUS: Acad, annotat., Lugd. Bat. 1754, lib. i, Praef. p. 7 et seq.d<br />
lib. vui, p. 30, 50.<br />
t ALBINUS op. cit., lib. iii, p. 73.
MEDICAL TEACHING. 407<br />
among them are found works of AART PiETERSEN, T. DE<br />
KEYSER, MICHAEL VAN MIEREVELD, ADRIAN BACKER, C.<br />
TROOST and T. REGTERS. They were mostly intended<br />
for the Surgeon's Guild at Amsterdam.* To us they offer<br />
a series of important lessons upon the history of medical<br />
teaching and upon the social position which doctors, at<br />
that period, occupied in the Netherlands.<br />
Anatomical teaching was no longer limited as formerly<br />
to demonstrating the organs of the large cavities of the<br />
body, but a detailed examination was given as well to the<br />
muscles, vessels, and nerves. The students were also urged<br />
to participate in anatomical work themselves. HALLER<br />
when a student at Leyden had the opportunity of dissect<br />
ing three corpses under the guidance of his teacher<br />
ALBINUS.f Arrangements were made at the College of<br />
St. Come at Paris, in 1750, for the students to practise<br />
anatomical dissections.j: At Vienna, the talented JOSEF<br />
BARTH introduced the practice of the students performing<br />
their own dissections. STOLL and P. FRANK explained the<br />
necessity of future doctors themselves taking an active<br />
part in dissecting.§ At most universities the anatomists<br />
had also the additional duty of demonstrating and explain<br />
ing the pathological changes as seen in the dead body.<br />
WERLHOF expressly demanded that this should be done, in<br />
the opinion he gave concerning the arrangements of the<br />
medical faculty of Gottingen. This circumstance is more<br />
over rendered evident by the fact that the representative<br />
anatomists of that period, such as LANCISI, VALSALVA,<br />
MORGAGNI, LIEUTAND, PORTAL, SANDIFORT, J. HUNTER,<br />
HALLER and others, laid also the foundations of patho<br />
logical anatomy. Already collections of specimens illustra-<br />
* J. B. TILANUS: Beschrijving der Schilderijen afkomstig van het Chirurgijnsgild<br />
te Amsterdam, Amsterdam 1865.—P. TRIAIRE: Les lecons d'anatomie<br />
et les peintres Hollandais, Paris 1887.<br />
f VALENTIN op. cit. S. 68.<br />
X P. FRANK op. cit. vi, 2 Abth., S. 331, Anm.<br />
§ FRANK op. cit. vi, 2, S. 87.
RECENT TIMES.<br />
tive of pathological anatomy were in process of formation. ,|<br />
Even in the 17th century G. RlVA preserved at Rome a<br />
number of specimens which had come into his possession *<br />
while doctor at the hospital. And afterwards this was<br />
more generally done. S6MMERING possessed a rich<br />
pathological collection, which at the suggestion of BRAM-<br />
BILLA was secured for the Josefinum (Academy of Medicine)<br />
at Vienna at the price of 400 ducats*<br />
Botanical gardens in which medicinal plants were<br />
cultivated and the apothecaries' shops gave opportunities. 5<br />
for instruction in materia medica. The " Jardin des.<br />
Plantes" in Paris was laid out in 1626 at the instigation of<br />
the Royal physician-in-ordinary LABROSSE. A decree of<br />
King Louis XIII. set forth at the same time " that in view<br />
of the fact that pharmaceutical operations are not taught;!<br />
at the medical schools, three doctors be chosen from |<br />
the Faculty of Paris in order to demonstrate to the students Jj<br />
the intimate character of plants and of all drugs, and<br />
to show the mode of preparation of every kind of medicine<br />
according to the simple chemical method, and speci- ;<br />
mens of all the different medicines and of the rarer<br />
natural objects of all kinds be exhibited in a room."f<br />
A yearly sum of 21,000 livres was devoted to the maintenance<br />
of this institution. Investigators of nature, like<br />
TOURNEFORT, the two JUSSIEUS, DUFAY, DAUBENTON, '"'<br />
and above all BUFFON, who worked there, made the<br />
botanical garden of Paris famous throughout Europe. In<br />
the course of the 17th and 18th centuries most universities<br />
were provided with botanical gardens. That at Chelsea, "<br />
presented, in 1686, by Sir HANS SLOANE to the Society of<br />
Apothecaries of London, was especially remarkable for<br />
its rich collection of officinal plants. Botanical gardens^<br />
arose also in the first half of the 17th century at Amsterdam, i<br />
Utrecht, Copenhagen, and Upsala; and at Oxford in 1632,<br />
* RUD. WAGNER : Soemmerings Leben, Leipzig 1844, ii, 89.<br />
t ESQUIROS und WUIL: Die wissenschaftlichen Institute zu Paris, Stuttgart,:<br />
1850, i, S. 28.
MEDICAL TEACHING.<br />
Edinburgh (1680), Cambridge (1702), Harderwyk (1709),<br />
St. Petersburg (1725).<br />
In Germany the following universities had botanical<br />
gardens attached to them at the dates indicated :—Giessen<br />
(1609), Altdorf (1626), Jena (1629), Helmstadt (1634), Kiel<br />
(1669), Halle, Tubingen (1675), Wiirzburg (1695), Wittenburg<br />
(1711), lngoldstadt (1723), Gottingen (1737), Frankfort-on-the-Oder<br />
(1744), Vienna (1749), Greifswald (1765),<br />
Prague(i776), and Salzburg, Marburg and Rostock.<br />
Collections of dried plants were also used to some extent<br />
for the purposes of instruction in botany, as were atlases of<br />
botanical paintings, many of which were surprisingly true to<br />
nature* With the same object in view the students with<br />
their teachers undertook excursions together, which were<br />
called " herbations." Just as in botanical, so also in<br />
chemical teaching, especial regard was had to pharmacy,<br />
theoretical and practical. There were already at that time,<br />
in several universities, professorships of chemistry, and<br />
chemical laboratories in which the art of compounding<br />
pharmaceutical preparations could be learnt. The attitude<br />
of the senate of Innsbruck University, which in 1740<br />
declined to form professorships for botany and chemistry,<br />
was certainly exceptional ; this demeanour the senate<br />
-assumed because they considered that a thorough botanical<br />
training required ten years, " for in this inquisitive age<br />
some new thing in vegetables is perpetually coming to<br />
light," while on the other hand a professorship of chemistry<br />
was too expensive.f<br />
The apothecaries' shops afforded the best opportunity<br />
for instruction in chemistry; the interior arrangements of<br />
these places have been made generally known by H.<br />
PETERS, who in his book has published pictures of the<br />
•apothecary's establishment attached to the Court at Rastadt<br />
in 1700, of that designated the "Star" at Niirnberg in<br />
* H. PETERS op. cit. S. 57.<br />
t J. PROBST : Geschichte der Universitat zu Innsbruck, Innsbruck 1869.
410<br />
RECENT TIMES.<br />
1710, and of that at Klattau in Bohemia in 1733.* The<br />
training of the apothecaries resembled that for a handicraft.<br />
The scientific knowledge required of them was<br />
insignificant.f Thus F HOFFMANN wrote: " An apothecary<br />
must be acquainted with the fact that an acid and an<br />
alkali (i.e., a carbonate) if mixed together effervesce, but it<br />
is quite sufficient if he knows the effect even though he has<br />
nothing to say as to the cause." Another duty fell upon<br />
the apothecaries in addition to making up medicines, that,<br />
namely, of preparing and administering clysters. This<br />
business was very profitable at one time, for LOUIS XIII.<br />
j,"in a single year had 212 clysters given him, in addition to<br />
' 215 purgings. A Canon of Troyes in the space of two<br />
years brought the record up to the inconceivable number of<br />
2,190, a fact which has been preserved for posterity because'<br />
c he refused to pay the fees demanded, and was consequently<br />
sued for them. Clysters were in fact the fashion, and<br />
thY ladies of Paris whispered in strict confidence to one<br />
another that the secret of NlNON DE L'ENCLOS, who preserved<br />
to advanced age her greatly-admired beauty, rested<br />
purely and simply upon the frequent use she made of them-t<br />
CLINICAL TEACHING IN THE SEVENTEENTH<br />
AND EIGHTEENTH CENTURIES.<br />
THE greatest acquisition gained by medical education<br />
this period consisted in the introduction of clinical instruction<br />
into most universities and the adoption of it by them as<br />
one of the subjects in their curriculum, The first attempts<br />
which were made in this direction, as has been mentioned,<br />
in the 16th century at Padua had no lasting effect^and<br />
exerted no visible influence upon the other universities.» Tothe<br />
University of Leyden the credit is due, of having made<br />
* H. PETERS op. cit. S. 78 et seq. «<br />
f F. HOFFMANN : Medicus politicus, Lugd. Batav. 1746, ii, 2, c. 16.<br />
X PHILIPPE op. cit. S. 131 et seq.<br />
1
CLINICAL TEACHING. 411<br />
clinical teaching a permanent institution and of having<br />
transmitted by its students the custom to other places.<br />
The Professors OTTO VAN HEURNE and E. SCHREVELIUS<br />
inaugurated this system about the year 1630 in the In<br />
firmary at Leyden. The method adopted was for the<br />
students first of all to examine the patient on his complaint,<br />
then for each one to state his view upon the nature, causes,<br />
symptoms, prognosis and treatment of the disease, and<br />
last of all for the Professor to confirm the correct opinion,<br />
to confute erroneous ones, and to add any explanation<br />
required. But this procedure did not please the students,<br />
for they ran the risk of having their ignorance exposed by<br />
questions which they could not answer, and O. V HEURNE<br />
found himself obliged reluctantly to give it up and in its<br />
place to undertake the examination of the patients himself<br />
and to follow this up closely with directions for treatment. •<br />
The bodies of the patients who died in the hospital were 'A<br />
opened in order to arrive at certainty as to the cause<br />
and seat of their diseases. An apothecary's shop was also<br />
attached to this hospital where the students could see and<br />
learn how to prepare medicines*<br />
In 1648 ALBERT KYPER, to whom we owe this account,<br />
coming from Konigsberg in Prussia took over the direction<br />
of the clinic at Leyden. After a few years he was<br />
succeeded by F. DE LE BOE (SYLVIUS) who has been<br />
thus described, when engaged in clinical instruction, by his<br />
colleague LUCAS SCHACHT: f " when he came with his<br />
pupils to the patient and began to teach, he appeared com<br />
pletely in the dark as to the causes or the nature of the<br />
affection the patient was suffering from, and at first ex<br />
pressed no opinion upon the case; he then began by ques<br />
tions put to different members of his audience to fish out<br />
[pxtiiscabatur) everything and finally united the facts dis<br />
covered in this manner into a complete picture of the dis-<br />
* ALB. KYPER op. cit. p. 112 et seq., 256 et seq.<br />
f Oratio funebris in obitum F. DE LE BOE SYLVII in Sylvii opera medica,<br />
Amstelod. 1680, p. 931, and NEUBERT op. cit. 1836, ii, 162.
4I2 £** ,,„ RECENT TJMES.<br />
ease in such a way that the students received the impression<br />
that they had themselves made the diagnosis and not learnt<br />
it from him." Under his direction the Leyden clinic<br />
acquired such a reputation that students and doctors came<br />
thither, as SCHACHT says, from Hungary, Russia, Poland,<br />
Germany, Denmark and Sweden, from Switzerland, Italy,<br />
France and England, in fact from every country in Europe.<br />
The clinic of Leyden maintained for a long time the first<br />
rank among institutions of the kind. BOERHAAVE, who<br />
occupied the chief position there till 1738, was known all<br />
over the world and numbered among his pupils HALLER,<br />
G. VAN SWIETEN, A. DE HAEN, PRINGLE, H. D. GAUB,<br />
RIBEIRO SANCHEZ and others, who filled the 18th century •<br />
with their fame. Clinical instruction was given also in<br />
other universities of Holland the infirmaries of which<br />
country were highly praised* by eye-witnesses. At<br />
Utrecht, W VAN DER STRATEN held a clinic : his method<br />
of leading students on to a knowledge of diseases excited<br />
the highest approbation in the mind of KYPER.f An<br />
establishment for clinical teaching was founded in 1715 at<br />
the Hospital of S. Spirito in Rome at the suggestion of<br />
LANCISI. The university at Edinburgh got a hospital (the<br />
Edinburgh Royal Infirmary) in 1738: this since 1746 has<br />
been used for clinical instruction.^<br />
The policlinical instruction in Paris—a system which<br />
had there been practised for centuries—was, in 1644,<br />
incorporated with the curriculum of the medical faculty.<br />
It appears that this measure was adopted at the instance<br />
of THEOPHRASTE RENAUDOT. This clever and enterprising<br />
man, who founded the first loan-office and the<br />
first bureau d'addresse in Paris and who also edited<br />
the first French newspaper—the " Gazette de France,"—<br />
organized in conjunction with some medical colleagues<br />
an institution of the nature of an ambulance for relieving<br />
poor patients gratis. This brought him many rm$£<br />
* Cf. THOLOCK op. cit. i, 2, S. 205. t KYPER op. cit.-p. 2|*J.<br />
X A. GRANT op. cit.
jf r-i . '<br />
1 t<br />
CLINICAL TEACHING. 413<br />
of ill-will from the medical faculty, with which he<br />
lived at continual feud, as he would not fall in with<br />
the exclusive party spirit which animated that body.<br />
To such a point did they carry their opposition that<br />
after the death of his patron the powerful Cardinal<br />
RICHELIEU, RENAUDO<strong>T'</strong>S policlinic, which had been a<br />
source of so much benefit to the poorer population, was<br />
closed.* This resulted in the medical faculty taking the<br />
duty upon itself of maintaining a similar institution. It was<br />
arranged that six doctors, three old and three young, should<br />
be commissioned to examine and supply with medicines<br />
twice every week in the Ecole de Medecine patients able<br />
to get about: the attendance was to be gratis. Surgical<br />
operations they were either to undertake themselves or else<br />
to get a skilful surgeon to perform. In difficult cases they<br />
were bound to hold consultations among themselves: the<br />
Dean of the Faculty was charged to be frequently present<br />
at these. Poor patients not in a condition to come to the<br />
consultation were visited and treated gratis in their dwell<br />
ings. The bachelors, in other words the senior students<br />
of medicine, were obliged to attend the policlinical consul<br />
tations : they were occupied there in writing down the<br />
prescriptions dictated by the doctors and in rendering<br />
other services. They also had to be present at the medical<br />
visits to the Hotel Dieu or some other hospital.t These<br />
policlinical studies lasted for two years. Stationary clinics<br />
were not instituted in Paris until the end of the 18th<br />
century.<br />
Even in Germany the first clinics did not come into<br />
existence before the middle of last century. It is true that,<br />
on the occasion of the foundation of the University of<br />
Gottingen, WERLHOF proposed that a clinic should be<br />
associated with it, but in vain. The circumstances were<br />
similar in the case of the medical faculty of Vienna in<br />
1718. F. HOFFMANN, of Halle, even pronounced a decided<br />
4* GILLES DE LA TOURETTE: Theophraste Renaudot, Paris 1884.<br />
f HAZON op. cit.—SABATIER op. cit.
414<br />
RECENT TIMES.<br />
opinion that no one is properly educated for a doctor by<br />
attendance on medical lectures alone, but that clinical<br />
instruction is a necessary adjunct* The conviction that<br />
the clinic is an indispensable feature of medical teaching<br />
was thus general: but the small amount of power possessed<br />
by the professor of medicine, the indifference of the anthorities<br />
and, above all, want of money resulted in a continual<br />
postponement until later times of the realization of any<br />
schemes there might have been for erecting the necessary<br />
;; establishments.<br />
Vienna was the first German university to institute a<br />
clinic. At the instance of GERHARD VAN SwiETEN in 1753<br />
a clinical department was founded in the so-called City<br />
Hospital; consisting of six beds for men and six for<br />
women ; to supply this with cases the right was reserved<br />
'" of ^removing thither from the other departments of the<br />
establishment, and from the Hospital of the Trinity, any<br />
{,_patients required for clinical instruction. The Dutchman<br />
'^A. DE HAEN was summoned to assume the direction oft the^,<br />
clinic and he organized it throughout after the model of<br />
that of Leyden. " Daily, at an early hour, he appeared at<br />
the hospital and examined the sick in order to inform himself<br />
of any changes which might have taken place in their<br />
condition. At eight o'clock began the clinic, the patients being<br />
examined and handled by the students under his guidance.<br />
In this he followed a plan of teaching much to be recommended<br />
; each of his pupils had to whisper to him the<br />
result arrived at after examination of the case and at the<br />
conclusion DE HAEN imparted the correct diagnosis to<br />
those present in a loud voice, so that those who had made<br />
mistakes could be assured of it without being made to look<br />
foolish. After the clinic, began the prescribing for those<br />
patients who were not being treated in the hospital. The<br />
students attended this function also. Here, as in the<br />
o i<br />
clinic, a register was kept of each patient and the history<br />
of his illness was entered together with the prescriptions<br />
* F. HOFFMANN : Medicus politicus, Halle 1746, i, 1, G.
CLINICAL TEACHING. 415<br />
which were employed. If patients died in the clinic the<br />
autopsy was performed by DE HAEN in the presence of the<br />
students, the results of it were compared with the diagnosis<br />
formed during the course of the disease and the value and<br />
utility of the treatment which had been adopted were dis<br />
cussed."* DE HAEN founded the fame of the Vienna<br />
•clinic. His successor MAXIMILIAN STOLL increased it by<br />
his great success in teaching and attracted to it students<br />
and doctors from every country. Under him it reached<br />
"a degree of perfection which justified it in standing forth.;'<br />
as the unique pattern of all clinical schools."f<br />
The Academy of Sciences at Paris proposed to King<br />
LOUIS XVI. of France a plan for founding a clinic there<br />
modelled on the school directed by STOLL.J The<br />
arrangements of the Vienna school were imitated by the<br />
clinics which arose in the provinces of Austria and in Ger<br />
many. Prague acquired a clinic in 1769 ; under PLENCICZ,<br />
in 1778, the beds were increased in number from 8 to> 50<br />
and an unqualified right was granted of claiming patients, *'<br />
required for teaching purposes, from the other departments "'<br />
of the infirmary.§ BORSIERI, in 1770, introduced clinical ',',;,,<br />
teaching into Pavia; in 1774 it was introduced at Modena.<br />
In Wiirzburg the students of medicine had, long since, been<br />
directed to attend the visits of the doctors to the Julius<br />
Hospital. As early as 1729 clinical teaching was practised<br />
there under BERINGER'S guidance; but it appears not to<br />
have been continued afterwards or only to have taken<br />
place intermittently,|| for, in the "Regulation of Studies"<br />
for 1749, attention had again to be drawn to the high<br />
* Freimiithige Briefe an den Herrn Grafeii von V., Frankfurt-a-M. und<br />
Leipzig 1774, S. 69, ei seq.—TH. PUSCHMANN : Die Medicin in Wien wahrend<br />
der letzten hundert Jahre, Wien 1884, S. 17.<br />
t J. F. C. HECKER: Geschichte der neueren Heilkunde, Berlin 1839, S. 506.<br />
X M. STOLL: Uber die Einrichtung der offentlichen Krankenhauser, Wien<br />
1788, S. 28.<br />
§ SEBALD: Geschichte der medicinisch-praktischen Schulezu Prag, Prag 1796.<br />
|| J. N. THOMANN: Annales instituti medico-clinici Wirceb., Vol. i, p. 24,<br />
Wiirzburg? 1799.
416 RECENT TIMES.<br />
importance of the professors taking students and young<br />
doctors with them in visiting the hospitals and in their<br />
private practice and there making them acquainted with<br />
the treatment of the sick with a view to the perfecting of<br />
their medical education. Clinical teaching of a regular<br />
and systematic character was not introduced into Wiirz<br />
burg till 1769.<br />
In Strassburg, too, after 1738 clinical demonstrations were<br />
occasionally held. GOETHE, when studying there in 1770,<br />
was, as is well known, among those who attended them*<br />
But a right to make use of the clinical material in the City<br />
Hospital was not granted to the Strassburg clinic until long<br />
afterwards.t Gottingen was, in 1764, provided with a<br />
•collegium clinicum by R. A. VOGEL, which, in 1781, was<br />
replaced by a stationary clinic. In Halle, JOHANN JUNCKER<br />
was the first to practise clinical teaching: but a stationary •<br />
clinic set apart for university teaching was not founded there<br />
until18104 Clinics were established at the following places<br />
at the dates indicated : Erlangen (1779), Altdorf (1786), Kiel<br />
(1788), Jena (1791), Tubingen (1793), Leipzig (1798).§ _<br />
At most of the other universities only policlinical institu-j<br />
tions were to be found. Efforts were made in some places;<br />
to induce students to visit the hospitals where they mighthave<br />
the opportunity of observing patients. So, too, in other<br />
countries these methods of teaching had to suffice, in the<br />
absence of clinical teaching proper, that is to say lectures at<br />
the bedside. Education in the practice of the healing art<br />
was materially benefited by the very widely-spread custom<br />
of allowing the older students and the young doctors to<br />
work as practitioners for a considerable time in a hospital,<br />
where they were, by the leading doctors, made familiar with<br />
the requirements of practice. In France and England,<br />
* Aus'meinem Leben in GOETHE'S Weaken, Leipzig 1870, iv, 167. <br />
t F. WIEGER,O£. cit. S. 113 et seq. «H<br />
X P. FRANK op. cit.'vi, 2, S. 221. ^ *^<br />
§ G. W. A. FIKENTSCHER : Geschichte der Universitat Erlangen, N®rnber|<br />
1806, ii, 104. |
CLINICAL TEACHING. 417<br />
where this arrangement exists to the present day, members<br />
of the medical staff of hospitals often took pupils who paid<br />
stipulated fees for the practical instruction which they<br />
received. As J. HUNCZOVSKY states, such opportunities<br />
were afforded at St. Bartholomew's Hospital in London,<br />
in the Seaman's Hospital at Portsmouth, in the Hotel<br />
Dieu at Paris, and at Rouen* In Italy a similar custom<br />
appears to have prevailed. LANCISI, after completing his<br />
course of medical studies, entered the S. Spirito Hospital<br />
at Rome in order to prepare himself for medical practice by<br />
further practical work of several years' duration.-j- He re<br />
commended students of medicine to see numerous patients<br />
and to visit the hospitals, and he advised them to spend<br />
several years in this mode of study.J Again, at the Trinity<br />
Hospital in Vienna, a number of students of medicine were<br />
constantly admitted in the capacity of practitioners.§ In<br />
the town hospital at Bremen also the doctors in authority<br />
gave clinical instruction to the students who took part in<br />
the visits to the patients. || There is no doubt that arrange<br />
ments of this kind prevailed at many hospitals.<br />
The archives of many an institution must contain im<br />
portant information upon this subject; it would be a thank<br />
worthy task to collect and to complete the arrangement of<br />
such material, which, as yet, especially in the case of Ger<br />
many, has been but very imperfectly done. But the facts<br />
already adduced will be found sufficient to prove that the<br />
view reiterated in works on the History of Medicine even<br />
to weariness, that before the establishment of institutions<br />
for clinical teaching young doctors relied simply upon books<br />
* J. HUNCZOVSKY : Medicinisch-chirurgische Beobachtungen auf Reisen<br />
durch England und Frankreich, Wien 1783, S. 7, 62, 84, 162.<br />
f Eus. SGUARIUS: Vita LANCISI in the preface to Lancisii opera vera, Venet.<br />
1739-<br />
J LANCISI : De recta medicorum studiorum ratione instituenda, Rorriae 171s.<br />
§ Nachrichten von dem Krankeri-Spital zur allerheil. Dreifaltigkeit, Wien<br />
1932.<br />
||*KULEN*KAMPFF: Die Krankenanstalten der Stadt Bremen* ihre Geschichte<br />
tandinre jetziger Zustand, Bremen 1884.<br />
E E' ,
418 RECENT TIMES.<br />
and theoretical lectures for their technical knowledge, is incorrect,<br />
at least as a rule of general application. The<br />
circumstance that practical instruction at the bedside<br />
generally lay outside the curriculum of university study,<br />
and was not generally sought for until after the conclusion<br />
of such study and after promotion to the degree of Doctor,<br />
must have contributed to this mistaken view. On the<br />
other hand it may frequently have happened that young<br />
Doctors of Medicine, possessed with a high sense of their<br />
new dignity, were unconscientious and daring enough to<br />
commence practice before they had acquired the practical<br />
skill which it demands ; but the majority recognized the<br />
necessity of practical training, and visited the hospitals J<br />
with this object in view, as is clearly shown in the numerous<br />
biographies and writings of the distinguished doctors of<br />
i<br />
that period.<br />
TEACHING IN SURGERY, OPHTHALMOLOGY, j<br />
AND OBSTETRICS.<br />
ONLY a small place was allotted to surgery in the scheme<br />
of studies at the universities. The students of medicinej<br />
were given a general view of the subject, and the most \<br />
important operations were demonstrated to them upon <<br />
the dead body. HALLER, who, in addition to his other<br />
posts, held for a time the professorship of surgery at<br />
Gottingen, could never, as he says himself, make up his<br />
mind to operate upon a living man, although he had had<br />
considerable practice upon the dead body. Since the<br />
doctors of that time were not called upon to perform<br />
surgical operations, this theoretical teaching might perhaps<br />
suffice to give them a knowledge of the important bearing<br />
of surgery upon internal medicine ; but it was by no means<br />
sufficient to permit them to form a judgment upon surgical<br />
questions. When the doctors were conceded the right of<br />
controlling and advising the surgeons in their work, and
TEACHING IN SURGERY. 419<br />
the latter had the duty imposed on them of consulting the<br />
doctors upon the necessity and the nature of surgical inter<br />
ference, a state of things was created which necessarily led<br />
to quarrels. The doctor was exposed to the risk of making<br />
an exhibition of his ignorance, and the surgeon felt himself<br />
•subjected to a mortification which he did not deserve, in<br />
having to rank below a man who understood but little or<br />
nothing at all of the subject.<br />
F HOFFMANN in the " Medicus Politicus " gives<br />
doctors the reasonable advice that " they should place<br />
themselves on a satisfactory footing with the surgeons,<br />
.should not address them harshly in the presence of patients,<br />
but only admonish them with modesty; moreover they<br />
•should not dispute with them, especially upon surgical<br />
subjects, since the surgeons may be more experienced<br />
in these matters than themselves." But with most<br />
doctors, especially with those who lacked experience,<br />
pride prevailed over prudence, and they looked down upon<br />
surgeons and surgery with haughty disdain. The author<br />
of the book, " The Unworthy Doctor of the Trusty<br />
ECKHART" (Augsburg and Leipzig, 1698), describes these<br />
relations (p. 428 et seq.) : " Your young doctor is indeed a<br />
high-mettled animal, what time the brain is filled with all<br />
manner of vanities and fantasies and will submit to no<br />
manner of influence or control. His opinion is that every<br />
one must give way to him, and must see at once by his<br />
face that he is a physician."<br />
It is certain that the low social position of the surgeons<br />
was founded to a large extent upon the fact that their<br />
general education was very scanty, and the distinction<br />
between them and the bagnio-keepers and barbers was not<br />
strictly defined. In Paris an official union was even<br />
effected between these callings in 1655 ; fortunately this<br />
lasted only until 1699. Under these circumstances the<br />
College de St. Come suffered a loss in importance and<br />
respect. More favourable conditions began to prevail once<br />
more when in 1724 success crowned the efforts of the
420<br />
RECENT TIMES.<br />
Royal, body-surgeons, MARESCHAL and LA PEYRONIE,<br />
who possessed great influence at Court, to establish the<br />
"appointment of five teachers, for anatomy, theoretical and<br />
practical surgery, operative surgery, and midwifery.<br />
The foundation of the Academie de Chirurgie at Paris,<br />
which received the Royal sanction in 1743, contributed<br />
still more to raise the surgical profession. This formed<br />
from that time forth the centre for all the chief representatives<br />
of surgery ; and not only in France, for among its<br />
members it numbered many distinguished surgeons of<br />
other countries. By offering annually prizes for essays on<br />
surgical questions, by material support extended to investigators,<br />
and by editing its transactions, in which valuable<br />
matters of observation and experience were made public,<br />
this body advanced the development of surgery and established<br />
its scientific basis. The Academy was made to rank<br />
as equal with the Faculty of Medicine, was rendered independent<br />
of the latter, and received the right of granting the<br />
degree of Master of Surgery; but this might not be conferred<br />
on anyone who had not attained to the dignity of.<br />
Master of Philosophy.<br />
The Academie de Chirurgie was also in connection with<br />
the College de St. Come, inasmuch as numerous distin- i<br />
guished members of the former were teachers at the latter.<br />
In 1750 a regulation was made that the curriculum for<br />
surgeons who studied in the College de St. Come should be<br />
of three years' duration; practical exercises in anatomy<br />
and in operative surgery were also introduced* The<br />
medical faculty lost almost entirely its influence over the<br />
education of surgeons and was now only represented at the<br />
actual conferring of the degree of Magister. It is true, the<br />
medical faculty opposed by all means in its power this<br />
emancipation of the surgical profession, and sought to prove<br />
by references to history and by the opinions furnished<br />
by the medical faculties of Gottingen and Halle that the<br />
* P. FRANK op. cit. vi, 2, p. 331, note, ou les .eleves feront. eux-memes les dis*<br />
sections et les operations qui leur auront eti enseignees.
TEACHING IN SURGERY. 421<br />
subordination of surgery to medicine had existed from all<br />
time and was necessary and natural: it even went so, far.<br />
as to make the absurd assertion that the possession of a<br />
higher general education is detrimental to surgeons ; but<br />
all in vain. The surgeons maintained the independence<br />
they had struggled after for centuries, and their deeds<br />
proved that they were worthy of it. Only the elite of the<br />
surgeons received their technical training at the Surgical<br />
Academy of Paris; the majority learned surgery like a<br />
handicraft with a master, getting the necessary practice<br />
and skill by frequenting, and acting as surgical practitioners<br />
in, the hospitals. A regulation was made that no<br />
master should have more than one pupil, so that he might be<br />
in a position to devote sufficient attention to his training.<br />
In towns where several surgeons were practising they<br />
formed societies, took duty in the hospitals by turns, and<br />
furthered the instruction of their pupils by means of lectures<br />
and practical demonstrations in anatomy and surgery. At<br />
the beginning of every year each surgical guild submitted<br />
a list of its masters to the Royal body-surgeon who stood<br />
at the head of the surgeons of France.*<br />
In England and Holland the system of higher surgical<br />
education lay entirely in the hands of the surgeons' guilds,<br />
which at a very early period in these countries appeared<br />
as exclusive corporations with defined privileges. Although<br />
CROMWELL in 1656 empowered the College of Physicians<br />
in Edinburgh to deal with surgery because it was simply a<br />
branch of medicine, this arrangement only lasted for a short<br />
time.t The societies of surgeons in London, Edinburgh,<br />
Dublin, Amsterdam, at the Hague and elsewhere, arranged<br />
courses of instruction for students of surgery and took care<br />
that they were able to get a practical education in anatomy<br />
and surgery. JOHN KAY was summoned to London in the<br />
time of HENRY VIII. to instruct surgeons in the performance<br />
* G. FISCHER : Chirurgie vor hundert Jahren, Leipzig 1876, S. 254 et seq.<br />
f Historical Sketch of the Royal College of Physicians of Edinburgh, Edin<br />
burgh 1882.
422 RECENT TIMES.<br />
of operations.* What care the Dutch surgeons devoted to<br />
anatomical dissection is shown by the already mentioned<br />
pictures of the painters of the Netherlands. The students.<br />
had the opportunity of observing patients and seeing<br />
surgical operations in the private practice of their teachers.<br />
and in the service of the hospital.<br />
The German surgeons as a general rule occupied the<br />
position of barbers; only a few rose above this and,<br />
were capable of regarding the treatment of wounds in a<br />
scientific spirit. Whoso adopted this callingf learned in.<br />
the first place from a master of the art, how to shave and<br />
cut hair, to spread plasters, to cup and to bleed. After<br />
this he was shown how wounds and ulcers are treated,.<br />
dislocations reduced and fractures set and cured. Only<br />
such surgeons as had been matured in the school of experi- '|<br />
ence, or specialists who had attained conspicuous skill in<br />
very limited fields of work, ventured upon the higher _'_<br />
surgical operations. The town-surgeon of Zurich was.<br />
ordered in 1716 to invite young surgeons to the operations |<br />
which he performed " that they might have the opportunity. |<br />
of gaining further knowledge in such methods of cure."t<br />
At Wiirzburg the chief surgeon at the Julius Hospital<br />
was commissioned, in 1725, to give instruction in his art at.<br />
the bedside.<br />
In the treatise entitled " The Bold Surgeon of the Trusty '<br />
ECKHART" (Augsburg, 1698) the students of. surgery were \.<br />
advised to study anatomy thoroughly, and, should human subjects<br />
fail, on the bodies of the lower animals, for if learned.<br />
doctors were not ashamed to pursue this study " a saucy<br />
barber's or bathman-fellow's honour will be unscathed."<br />
Further, the advice was given them to visit hospitals and<br />
to attend operations which famous surgeons performed, \<br />
even after their student-life was passed. The remaining<br />
* A. CORRADI op. cit. Ser. ii, Vol. vi, p. 638.<br />
t O. BUCHNER: Aus Giessens Vergangenheit, Giessen 1885, S. 27.<br />
X MEIER-AHRENS : Geschichte des Ziircherischen Medicinalwesens, Basel<br />
1840.
TEACHING IN SURGERY. 423<br />
admonitions given them throw a strong light upon the<br />
social aspect of their condition. Thus: " he is not to brag<br />
about his cures over the tavern tables, or approach a patient<br />
as a pig would a beggar's bag, or treat him in a tyrannical<br />
or wrathful manner. He is not to demand twelve thalers<br />
when he only deserves two. He must not use the knife<br />
without due consideration; for it is a question of human<br />
flesh, not mere slaughtered beef or pork : a man sets a high<br />
value on his skin. When danger threatens he is to call<br />
in doctors and brother-surgeons to consult withal."* M.<br />
G. PURMANN even complained that surgeons, in order to<br />
win patients from one another "perpetrated tricks and<br />
treacherous artifices with the instruments."! The sur<br />
geons of Germany attained a higher position when schools<br />
began to be founded for their education. These were first<br />
intended to train up a body of medical officers for the<br />
military service ; but the want of practitioners soon led to<br />
pupils being taken from the civilian classes. In 1716 an<br />
institution of this kind was founded in Hanover. Berlin in<br />
1713 acquired a theatrum anato?nicum, forming the first<br />
completed portion of an establishment intended for the in<br />
struction of military doctors and " medico-surgeons," which<br />
was opened in 1724 and became associated with the Charite<br />
Hospital, the founding of which followed a few years later.<br />
Six professors and a demonstrator of surgical operations<br />
constituted the teaching staff; the instruction given em<br />
braced not only anatomy and surgery, but also pathology,<br />
.materia medica, botany, chemistry, and even mathematics.<br />
" Following the example of Paris, London, and Amsterdam,<br />
1 Medici and Chirurgi were, in the Charite, to be given<br />
ample opportunity of seeing and practising methods of<br />
treatment for both internal and external diseases."! A<br />
military medical school was founded in Dresden in 1748.<br />
* G. FISCHER op. cit. S. 33 et seq.<br />
t G. PURMANN: Lorbeerkrantz oder Wundartzney, Frankfurt u. Leipzig 1722.<br />
X A. GUTTSTADT : Die naturwissenschaftlichen und medicinischen Staats-<br />
anstalten Berlins, Berlin 1886, S. 344.
424 RECENT TIMES.<br />
The students of these establishments were clever barbers,<br />
who had already served for a considerable time in the army,<br />
or had been busily occupied in the hospitals or in private<br />
practice, and thus were by no means beginners, but men<br />
who already possessed a certain amount of experience in<br />
the healing art. It was intended that in the surgical school<br />
they should receive a scientific professional education, and<br />
thus be able, in future, to take prominent positions as operators<br />
and teachers of surgery.<br />
An arrangement of this kind existed also at the military<br />
medical school of Vienna, which was opened in 1781. This<br />
school, named at a later period after its founder, the<br />
Emperor JOSEPH, was provided in 1785 with a new building<br />
for the purposes of teaching, which was raised at the cost of<br />
one million gulden ; it contained lecture rooms, a library,<br />
scientific collections, arid the residences of the teachers.<br />
The military hospital, which afforded accommodation for<br />
1,200 patients, and contained two wards for the wives of<br />
soldiers when lying-in—a small obstetric department in<br />
fact—was associated with this school* Moreover, in<br />
the vicinity of the establishment a botanical garden<br />
was laid out, and a small chemical laboratory fitted up.<br />
The course of instruction lasted for two years. Thirty of<br />
the ablest military doctors were ordered to attend this<br />
course, and at the end of their studies were promoted to be<br />
regimental surgeons. At the same time the school was the<br />
resort of students who were making their earliest studies<br />
for the surgical profession.<br />
The teaching staff at first consisted of five professors, of<br />
whom one had to teach anatomy and physiology, as well as<br />
that amount of elementary mathematics and physics necessary<br />
for a proper understanding of the former sciences; a<br />
second had to treat of general pathology and therapeutics,<br />
with hygiene ; a third lectured on instruments and bandaging,<br />
conducted the surgical clinic and the practice of<br />
* DE LUCA: Wiens gegenwartiger Zustand unter Josephs Regierung, Wien<br />
1787.
TEACHING IN SURGERY. 425<br />
operations, and represented midwifery and forensic medicine<br />
; a fourth held lectures on internal medicine and conducted<br />
the clinic for internal diseases; while the duty of<br />
the remaining professor was to lecture on botany, chemistry,<br />
and materia medica, and to superintend the botanical!<br />
garden. A prosector was also appointed; he had to get<br />
ready the anatomical preparations required for teaching and<br />
to perform the autopsies on patients who died in the<br />
military hospital.*<br />
In teaching, the words of the Emperor were to serve as<br />
the guiding motto: ' My design is that not merely the outside<br />
of the various sciences dealt with should be taught to<br />
the surgeons who are to be trained here, and that they<br />
should be sent forth hence with nothing but a knowledge<br />
of technical terms and with an over-hurried and<br />
shallow training. I desire rather that they should get a<br />
firm hold of their subjects and, thus provided, return to the<br />
regiments."t An academy, organized after the pattern of<br />
the Academie de Chirurgie at Paris, was in connection with<br />
this establishment; it offered prizes for the solution of<br />
•questions of surgical interest and published the compositions<br />
sent in.J It received, moreover, the rights and dignity<br />
•of a university and could grant the degrees of Magister and<br />
Doctor in Surgery. In this way educated surgeons were<br />
placed in the same social position as representatives of<br />
internal medicine.<br />
Reasonable, unprejudiced doctors welcomed these arrangements<br />
with enthusiasm as being the first step towards<br />
the wished-for reunion of these two important branches of<br />
the healing art.<br />
Professor AUGUST RICHTER of Gottingen gave expression<br />
in the following words to the expectations formed generally<br />
* G. PIZZIGHELLI : Accademia medico-chirurgica Giuseppina, Vienna 1837.<br />
t Allerh. Entschliess. v. 3. April, 1781, im Archiv des k. k. Kriegsminis-<br />
teriums.<br />
X J. A. v. BRAMBILLA: Verfassung und Statuten der Jos. med.-chir. Akademie,<br />
Wien, 1786.—TH. PUSCHMANN op. cit., S. 96 et seq.
426 RECENT TIMES.<br />
on this subject: "All Germany assuredly takes an interest<br />
in the honour of this academy, in the happy issue of its<br />
endeavours, and in the election of its members, for these are<br />
they from whom the surgery of Germany may now expect<br />
direction, guidance, and enlightenment; by the successful or<br />
unsuccessful results of their efforts will the foreigner hence-,<br />
forth appraise the value, positive or negative, of German<br />
surgery as a whole ; among the members of this academy<br />
will the most eminent surgeons of Germany be sought, and<br />
in their performances will every important achievement of<br />
German surgery be looked for."* These hopes were only<br />
fulfilled in a minor degree. The early death of the Emperor ,;<br />
JOSEPH II., by which the academy lost a devoted and<br />
generous patron, the political events and the continual wars<br />
which robbed military doctors of all leisure for scientificwork,<br />
and above all the feeble development and dependent<br />
position of German surgery were the baneful causes which<br />
prevented the attainment of these lofty aims.<br />
Modelled upon the • Josefinum of Vienna, schools -of<br />
medicine and surgery arose at St. Petersburg and Copenhagen<br />
in 1783 and 1785 respectively. In Spain a school*<br />
for the education of naval doctors was founded at Cadiz in<br />
1748, and was placed under the superintendence of a<br />
director and ten teachers.f<br />
Numerous other schools were founded in the 18th<br />
century, and in them barbers and bathmen were, by a<br />
course of instruction of from two to three years' duration,<br />
trained into district medical officers and surgeons. In<br />
Austria these schools were in some instances departments-;<br />
of medical faculties or lyceums, in others separate institutions<br />
in places where there was no university. In other - ,<br />
German countries, establishments of this kind arose at<br />
Frankfort-on-the-Main, Hamburg, Regensburg, Brunswick,<br />
Bruchsal, Celle, Cassel, Gotha, Dillingen, Zurich, and other<br />
* A. G. RICHTER : Chirurgische Bibliothek, Gottingen 1788, Bd. ix, St. 2, S._<br />
191.<br />
t MOREJON op. cit. T. vi, 341.
TEACHING IN SURGERY. 427<br />
places. About the same time greater attention began to<br />
be bestowed upon practical teaching in surgery at the<br />
universities. The clinics, which arose at this time, at first,<br />
indeed, were limited to the treatment of internal diseases ;<br />
all surgical matters which required attention were as a rule<br />
put into the hands of a surgeon, who was subordinate to<br />
the chief of the clinic.<br />
In Holland alone had medical students the opportunity<br />
of assisting in surgical operations at the hospitals. J. J.<br />
RAU, at Leyden, instituted a course of surgical operations<br />
on the dead body, demanding a fee of 100 Dutch<br />
thalers for the same. Many German practitioners, anxious<br />
to acquire practical knowledge in surgery, betook themselves,<br />
therefore, to Holland, as FRIEDRICH HOFFMANN, in<br />
his " Medicus Politicus " (i, 1, 6), advised them to do. In<br />
the same way France and England were also visited with<br />
this object. In Germany the first surgical clinic arose in<br />
the year 1769 at Wiirzburg; CARL CASPAR SlEBOLD<br />
organized it in a highly satisfactory manner, illustrated<br />
the surgical lectures by the demonstration of anatomical<br />
preparations, and introduced the practice of surgical operations<br />
on the dead body.* At "Vienna a surgical clinic was<br />
opened in 1774. Gottingen acquired a similar institution<br />
in 1781 ; Germany's most celebrated teacher of surgery, A.<br />
G. RlCHTER, gave clinical instruction there.<br />
Ophthalmology, too, and midwifery, which, in BOER-<br />
HAAVE'S time, had been taught in association with other<br />
subjects, especially surgery, by degrees met with greater<br />
consideration in the plan of studies. France, England, and<br />
Italy produced some able ophthalmic surgeons ; it is not until<br />
the close of the 18th century that we find several Germans<br />
occupying a position of equal importance. Celebrated<br />
ophthalmic operators were then, like famous tenors at the<br />
present time, summoned from great distances to give illustrations<br />
in their art. N. J. PALUCCI was induced by G. VAN<br />
SwiETEN to come to Vienna, and he there performed the<br />
* F. v. WEGELE op. cit.
428 RECENT TIMES.<br />
operation for cataract in the presence of the students of<br />
medicine and surgery at the Trinity Hospital. The elder<br />
WENTZEL came thither afterwards for a similar purpose,<br />
and it was under his guidance that JOSEPH BARTH was<br />
educated to become an ophthalmic surgeon. The success<br />
of the latter in this field of practice induced the Emperor<br />
JOSEPH to order him to train up two young doctors in<br />
ophthalmology. An extraordinary honorarium of 1,000<br />
gulden was promised him for this service, but he was not<br />
allowed to receive it until his pupils had furnished a<br />
proof of their skill by performing successfully six operations<br />
for cataract. His first pupils were his prosector<br />
EHRENRITTER, who died very young, and ADAM SCHMIDT,<br />
with whom G. J. BEER was afterwards associated, having<br />
been at first employed by BARTH as a designer. These<br />
were the founders of the ophthalmological school of Vienna,<br />
to which the world owes a succession of able ophthalmic<br />
surgeons. At the same time in Gottingen, Jena, Leipzig,<br />
and other places ophthalmology began to be drawn into<br />
the domain of clinical teaching.<br />
'In the 17th century midwifery was still almost exclusively<br />
practised by midwives. They acquired their knowledge<br />
of the subject by personal instruction from an<br />
elderly experienced practitioner of their own sex, and were<br />
examined therein by ladies of good position, or by doctors<br />
of the town where they desired to reside. In Leipzig the<br />
wife of the Burgomaster conducted the examinations of the<br />
midwives; but in most places the doctors and surgeons,<br />
and especially those who held public appointments, undertook<br />
this duty. This led to the latter commencing to teach<br />
the midwives as well,—a very necessary proceeding; for<br />
GERVAIS DE LA TOUCHE states that through the ignorance<br />
of the midwives a large number of women and children<br />
perished annually, and FABRICIUS VON HlLDEN declares<br />
that the midwives had no idea of the structure of the<br />
female sexual organs, or of the duties of the midwife*<br />
* C. J. v. SIEBOLD op. cit. ii, 132 et seq.
TEACHING IN SURGERY. 429<br />
Certain highly-gifted women, like LOUISE BOURGOIS, who<br />
attended MARIA DE' MEDICI, consort of HENRI IV., and<br />
advanced the literature of obstetrics, must be looked upon<br />
as exceptions. In Paris the midwives received a systematic<br />
education. In the Hotel Dieu there was a lying-in institution<br />
in which the obstetric probationers were taught by<br />
the head-midwife. The well-known MARGUERITE DE LA<br />
MARCHE, whose handbook for midwives is among the best<br />
literary productions of that age, worked for some time in<br />
this position.<br />
The course of instruction lasted for three months. During<br />
the second half of this period the probationers had themselves<br />
to perform all the services required during labour.<br />
Only in extraordinary cases was the surgeon of the department—himself<br />
also an obstetrician—called into consultation.<br />
As a general rule women in labour refused to accept the<br />
assistance of a man. This unseasonable modesty derived<br />
support from the ignorance of most of the doctors and<br />
surgeons who had no opportunities of getting experience<br />
in midwifery. This state of affairs was not altered until<br />
such exaggerated prudery was given up* and the help of<br />
the male sex was claimed in cases of labour. The Duchesses<br />
DE LA VALLIERE and DE MONTESPAN, and other ladies of<br />
the French Court, made a beginning. " Their example was<br />
soon copied," writes P DlONlS, " and even women of the<br />
lower classes declared that they would rather have obstetricians<br />
of the male sex than midwives, were they not<br />
deterred by the high fees of the former."t A school of<br />
obstetrics was in 1720 founded at the Hotel Dieu in Paris.<br />
In 1743 a course of instruction in gynaecology was also<br />
started in the surgical school, and in 1754 the medical<br />
faculty even felt itself called upon to create a professorship<br />
of obstetrics.<br />
* On certain other occasions quite different conditions obtained. Fide Les<br />
consultations deMME. DE SEVIGNE, ed. p. P. MENIERE, Paris 1864, p. 21 etseq.<br />
t SIEBOLD op. cit. ii, 189.—SUE d. Jungere; Versuch einer Geschichte der<br />
Geburtshilfe, Deutsche Ubers, Altenburg 1786, S. 99.
430 RECENT TIMES.<br />
Already in the 17th century Holland was in possession of<br />
a system for the regulation of midwives. The females<br />
who devoted themselves to this calling were taught and<br />
examined by surgeons practised and experienced in midwifery.<br />
Among their instructors were men like H. VAN<br />
ROONHUYSEN, F. RUYSCH, and others.<br />
A number of lying-in institutions arose in England<br />
during the 18th century. These were to some extent<br />
made available for the instruction of midwives and students<br />
in the obstetric art. The Westminster Lying-in Hospital,<br />
founded by private charity in 1765 through the exertions of<br />
J. LEAKE, gave young doctors and surgeons the opportunity<br />
-of getting a practical education in midwifery. Again., '<br />
many doctors who conducted lying-in institutions took<br />
pupils, who were trained at these to become obstetricians.*<br />
A professorship of midwifery was founded at the University<br />
of Edinburgh in 1726. At Dublin, the College of Physicians,<br />
and afterwards the College of Surgeons, instituted courses<br />
of instruction in this branch; while the Lying-in Hospital .<br />
founded there in 1746 gained a high reputation.<br />
Germany in the 17th century did not produce one single<br />
male obstetrician of note ; on the other hand, certain midwives<br />
made themselves widely known. " The court midwife<br />
of the electorate of Brandenburg, JUSTINE SlEGE-<br />
MUNDIN, nee DlTTRiCHiN," " the Mother Grete," who also<br />
assisted DOROTHEA SIBYLLA, Duchess of Brieg, as a<br />
"trusty privy counselloress," as SlEBOLD (op. cit. ii,<br />
207) remarks, and had the duty of superintending the<br />
•" maids of honour," they, together with the town midwife of<br />
Brunswick, A. ELISABETH HORENBURG, won for their art a<br />
well-deserved respect by their services, and contributed by<br />
their writings to its extension and advancement. The<br />
obstetric physicians were seldom called into consultation.<br />
The conception which many of them had of their duties<br />
must have filled the breasts of women needing assistance<br />
with fear and dismay. LORENZ HEISTER narrates that<br />
* C. G. BALDINOER'S Medicin. Journal, Gottingen 1787, St; 15.
TEACHING IN SURGERY. 431<br />
they "were sadly wanting in experience of the arts of<br />
turning and extracting the child. When they intended to<br />
perform any operation they came with a hooked instrument,<br />
and in a pitiful and horrible manner tore the child into<br />
many pieces in the mother's womb in cases where, had<br />
they possessed the befitting knowledge, they might easily<br />
have reached it with their bare hands, and thus have prevented<br />
the uterus being lacerated as well as the child and<br />
extracted with it, as it actually was frequently in the<br />
case of these unhappy women."*<br />
Dr. DEISCH was called by the populace " the butcher of<br />
children and women." Augsburg was his slaughter-house.<br />
" He perforated and dismembered without intermission,<br />
whether the children were alive or dead. He practised<br />
decapitation, too. If he had performed turning he w^as<br />
astounded if the child came into the w r orld alive." In<br />
1753 he used sharp instruments 29 times in 61 births,<br />
10 of the mothers perishing. His colleague MlTTEL-<br />
HAUSER, who resorted to similar practices as town<br />
physician of Wiessenfels in Saxony, considered he had<br />
been especially successful if out of ten women whom he<br />
attended only two died.f<br />
In other places matters do not seem to have been at<br />
times much more satisfactory; NICHOLS' choice satire<br />
" The petition of the unborn babies" (London, 1751) in<br />
which they complain of the rough handling they get from<br />
the obstetricians, and the figure of Dr. SLOP in STERNE'S<br />
"Tristram Shandy,"—the accoucheur with his instruments,<br />
all ready for action,—were certainly more than mere products<br />
of the writers' fancy.<br />
We can easily understand how a universal disgust at<br />
this kind of midwifery arose. The progress which this<br />
branch of knowledge made in the 18th century opened<br />
men's minds to a more correct recognition of the laws of<br />
* LOR. HEISTE.R : Medicinische, chirurgische undanatomische Wahrnehmun-<br />
*gen, Rostock 1753, Vorrede.<br />
t SIEBOLD op. cit. ii, 426 et seq.
432 RECENT TIMES.<br />
nature in the act of birth, and to more humane views as to<br />
the part allotted to the accoucheurs' art. The introduction<br />
of regular teaching in obstetrics at the university,<br />
and the increase in the number of lying-in institutions<br />
were conspicuous among the causes which brought about'<br />
this beneficent reform. Besides the theoretical lectures<br />
upon midwifery which at most universities were held in<br />
connection with those on surgery a commencement .was<br />
made in the practical instruction of students. In this,<br />
Strassburg was in advance of all other German Universities:<br />
in 1728, a school for obstetricians was founded in the Lying- f<br />
in Institution there which had already for a considerable<br />
time been made use of for the instruction of midwives*<br />
It was under the direction of FRIED and, as OsiANDER says, >;<br />
was the parent of all other institutions of this kind in<br />
Germany. The pupils practised the manipulations of mid-.,, 5<br />
wifery in the first instance upon a model, then visited *<br />
women in pregnancy and superintended the labours. The<br />
fee which they had to pay their teacher for this course of instruction<br />
was somewhat high : it came to about 100 thalers..<br />
Several of the best obstetric physicians of last century proceeded<br />
from this school; among these was J. G. ROEDERER<br />
who, in 1751, was summoned to Gottingen as Professor of<br />
Midwifery and Director of the recently founded Lying-in<br />
Institution. A school of midwifery was at the same time<br />
opened at the Berlin Charite. In 1786, there were in the<br />
Kingdom of Prussia, without the province of Silesia, as<br />
many as 14 teachers of this branch. So also in other<br />
German countries institutions of a similar kind arose and<br />
at them midwives and students received instruction in<br />
obstetrics, for example at Wiirzburg (1739), Copenhagen<br />
(1760), Cassel (1763), Brunswick (1768), Karlsruhe, Dresden<br />
(1774), Jena (1781), Marburg (1792), Detmold, Mann*<br />
heim, Weimar, Bern (1782), etc.<br />
At Vienna the instruction of midwives was introduced in<br />
1748, and in 1754 a professorship of midwifery was founded;<br />
* WIEGER op. cit. S. 100 et seq. j
THE EIGHTEENTH CENTURY 433<br />
at the university. A special clinic was arranged for this<br />
department in 1789, courses of instruction in obstetrics<br />
having already, since 1774, been held in a hospital, and<br />
cases of this nature having also been received into the<br />
surgical clinic. But at many institutions instruction in<br />
midwifery, like that in ophthalmology, remained until far<br />
into the 19th century associated with instruction in<br />
surgery.*<br />
MEDICAL TEACHING AT THE CLOSE OF THE<br />
EIGHTEENTH CENTURY AND THE POSITION<br />
OF THE MEDICAL PROFESSION.<br />
THE changes which medical teaching underwent in<br />
universities during the period between the beginning of<br />
the 17th and the end of the 18th century were very considerable.<br />
Instead of two or three professors whose teaching<br />
was limited to a few theoretical lectures and only occasionally<br />
concerned itself with practical training in anatomy,<br />
materia medica and the healing art proper, now, at least at<br />
the greater universities, boards of teachers were formed<br />
the members of which represented the various branches of<br />
medicine and had anatomical schools, laboratories, and<br />
clinical establishments at their disposal.<br />
According to the '"' scheme of studies " for the year 1749,<br />
there were then five ordinary professors in the medical<br />
faculty of Wiirzburg. Of these professors the first had<br />
to give the students a concise review of the history of<br />
medicine, to treat of the " Institutes of Medicine " (physiology)<br />
upon a scientific physical basis, to discuss the<br />
causes and effects of health and disease in relation to<br />
anatomy (general pathology) and in this way to smooth the<br />
path to medical practice; the second taught botany and<br />
was director of the botanical garden ; the duty of the third<br />
* A. GUSSEROW: Zur Geschichte und Methode des klinischen Unterrichtsc,<br />
Berlin 1879.<br />
F F
RECENT TIMES.<br />
was to give lectures on chemistry and to show the<br />
methods of compounding medicines in the dispensary<br />
attached to the Julius hospital; the fourth gave lectures on<br />
the special pathology and therapeutics of internal diseases,<br />
took the students to the hospitals and made them familiar ;<br />
with the treatment of the sick ; and the fifth.had to teach<br />
anatomy and surgery : the last-mentioned was assisted by<br />
a prosector, who acted also as chief surgeon and teacher ofi (<br />
obstetrics* *•<br />
The medical staff at Heidelberg had in 1763 four ordinary ^<br />
professors, that of Gottingen in 1784 six, and that of Pavia, ,4<br />
about the same time, eight.t The curriculum, which P<br />
FRANK drew out in 1785-86 for the medical faculty of Pavia, |<br />
shows what demands were made upon the head of a department<br />
at that time.J The natural sciences assumed a<br />
position of higher consideration than before; this is clearly<br />
indicated by a decree of the reigning Prince Bishop of<br />
Wiirzburg in 1782, in which he says: "If in former times<br />
men had reason to consider it a settled truth that physics<br />
formed a subject of study not only very useful but absolutely<br />
indispensable for those who had a mind to devote themselves<br />
to medicine, in our days when physics has assumed<br />
such a greatly improved form still less can we venture to<br />
doubt it; arid although physics may be of less use to theologians<br />
and jurists than to students of medicine, yet the<br />
advantages which future students of theology and law may<br />
expect from mathematics and the so-called practical philo<br />
sophy are at length beyond dispute."§<br />
The medical faculty of Vienna possessed already in 1780<br />
nine regular professorships devoted to the following subjects;—anatomy,<br />
physiology, natural history, chemistry<br />
and botany, general pathology and therapeutics with<br />
materia medica, medicine and clinical teaching, theoretical<br />
* WEGELE op. cit.—KOLLIKER op. cit. S. 75.<br />
+ P. FRANK op. cit. vi, 2, S. 46.<br />
X Ibid. Suppl.—Band i, S. 176 et seq.<br />
§ WEGELE op. cit. ii, 428.
THE EIGHTEENTH CENTURY. 435<br />
surgery, clinical surgery, and midwifery; besides the<br />
professors numerous assistants and a prosector took part<br />
in the teaching, the duty devolving on the professor of<br />
.anatomy to train " a person competent to succeed him in<br />
•course of time, at his own expense."<br />
The Emperor JOSEPH II. took a lively interest in the<br />
system of medical teaching. In a rescript of the 27th<br />
April, 1786, he gave expression in the following words to<br />
his opinions about the curricula of the medical faculties<br />
which had been submitted to him: "That surgery, the<br />
whole of operative surgery and bandaging, can be properly<br />
taught in six months appears to me to be barely possible,<br />
and, in general, I distribute the subjects of medical study<br />
after the following fashion. In the first year, anatomy<br />
associated with physiology in such a way that on exposing,<br />
for instance, a lung in the course of dissection its use and<br />
function in the healthy body may be dwelt upon at the same<br />
time, and so for every muscle in the body it should be<br />
shown what its action is. Both medici and chirurgi must<br />
-complete this year of study. The necessary prosectors<br />
and all else he requires must be provided for the Professor<br />
of Anatomy and Physiology so as to maintain his department<br />
in a fitting state. Also let the medici in the first<br />
year be taught botany and chemistry, and the chirurgi<br />
operations, bandaging, and midwifery. In the second year<br />
the surgeons must learn surgical and medical practice,<br />
devote themselves to clinical work in the hospital, and also<br />
practise midwifery in the hospital, and then have finished.<br />
The physicians, however, must attend lectures on materia<br />
medica, pathology, and all that belongs to the learned profession<br />
of medicine, but in the third year they must give<br />
themselves up entirely to practice and clinical work, and to<br />
treating patients in the hospital. And in this way let able<br />
surgeons be trained for the country and doctors for the<br />
town. I await a further elaboration of the scheme in this<br />
sense.—JOSEPH."*<br />
* Archiv. des k. k. Unterrichtsministeriums zu Wien.
436 RECENT TIMES.<br />
The curriculum which was published soon after this<br />
diverged from these principles mainly in the period of<br />
study for medical and surgical students being fixed at four<br />
years, and a course of studies being arranged applicable<br />
to both classes in most of the departments, the only difference<br />
being that the medici had to spend a longer time on<br />
materia medica, chemistry and internal medicine, while the<br />
chirurg had to enter more deeply into surgery and the<br />
subjects associated with it, and to give proof of this in<br />
examinations.<br />
So in this way at last in Austria and Germany, as was<br />
already the case in other states, surgery had assigned to it<br />
a more dignified position. Physicians and surgeons were ^<br />
recognized as two classes of doctors enjoying an equal,|<br />
rank, in possession of an equally sound education, and f<br />
differing only in the kind of work assigned them. At<br />
the same time there arose an inferior class of practitioners<br />
whose acquirements were of a lower order, and who were<br />
intended chiefly for attendance upon the peasantry. They<br />
practised as doctors for both internal and external diseases.<br />
The opposition which had hitherto existed between<br />
physicians and surgeons was now transferred to the more<br />
highly-educated practitioners on the one hand and the less i<br />
thoroughly trained physician-surgeons on the other. Informing<br />
an opinion upon the state of affairs which was thus 1<br />
produced, we must not forget that a shifting of positionj<br />
had taken place among the factors in question which |<br />
justified many things which would before have been inde-|<br />
fensible and wrong.<br />
It is, then, certain that the surgeons of the 17th century ,<br />
occupied a somewhat low position from an educational<br />
point of view; but have we any reason to suppose that it<br />
was otherwise with the physicians of that period ? In the<br />
eyes of many a clear image of fresh and living nature was<br />
perverted by the distorting atmosphere of a lifeless desert<br />
of unprofitable learning. "They understood their GALEN?<br />
but not their patients," as MONTAIGNE said. The figure of<br />
Dr. DiAFOlRUS, in " Le Malade Imaginaire" of M0LIERE>
THE EIGHTEENTH CENTURY. 437<br />
must have been drawn from life.* The great majority of<br />
doctors sought to impose upon the public by the grandiloquence<br />
of a Graeco-Latin phraseology; their impression<br />
was that, as KANT says, in giving a name to their diseases<br />
they had rendered their patients a service.f They<br />
endeavoured to remove a disease by pills and plasters,<br />
medicines, clysters, and repeated blood-letting; so that at<br />
times it took a good constitution to resist these frequently<br />
inappropriate of preposterous measures. The title of<br />
Doctor of Medicine by no means afforded a guarantee that<br />
the bearer of it possessed medical knowledge. Outside<br />
the universities the right to confer this dignity was assumed<br />
by the EMPEROR, the POPE and his plenipotentiaries, and<br />
the Counts Palatine. At Naples, even during last century,<br />
the D'AVELLINO-CARRACIOLO family enjoyed the privilege<br />
of conferring the degrees of Doctor of Medicine and Doctor<br />
•of Law; they made extensive use of this privilege,—and<br />
.made it correspondingly profitable.<br />
But even at some universities a disgraceful misuse was<br />
made of the privilege of granting the degree of Doctor.<br />
Many professors found in the fees paid a desirable increase<br />
•of income, and sought to allure candidates by making the<br />
least possible demands upon their knowledge. Examinations<br />
were either omitted altogether or reduced to a<br />
mere formality. The theses for the doctorate might be<br />
bought at a fixed price from certain learned contractors<br />
who made a profitable business by the preparation of such<br />
essays.J At Greifswald acobbler in the year 1788 got the<br />
diploma of Doctor of Medicine; on the strength, too, of a<br />
dissertation upon the therapeutic effects of pitch. The<br />
University of Erfurt created 97 Doctors of Medicine in a<br />
•single year while not numbering more than 30 students in<br />
all the Faculties put together. At other universities the<br />
cost connected with the acquisition of the doctor's degree<br />
* M. RAYNAUD : Les medecins au temps de Moliere, Paris 1862.<br />
f IM. KANT : Versuch uber die Krankheiten des Kopfes in der Ausg. sammtl.<br />
Werke von Rosenkrantz u. Schubert, Leipzig 1838, vii, 16.<br />
X Kais. priv. Reich sanzeiger, Gotha 1802, No. 169-170.
438 RECENT TIMES.<br />
was so great that candidates without means had to<br />
renounce it altogether. The consequence was that persons<br />
of this, kind either repaired to places where less money<br />
was demanded or remained content to engage in practice<br />
as licentiates of medicine. At Vienna the advancement to<br />
the doctor's degree cost up to the year 1749 about 1,000<br />
gulden, at Gottingen some 130 thaler in 1765, at Paris 7,000<br />
livres, and at Oxford one hundred pounds* And this degree<br />
did not by any means give special rights in all places.<br />
Besides numerous other practitioners entitled by law to<br />
practise medicine there was no special difficulty experienced<br />
at many places by wandering quacks, rupturecurers,<br />
cutters for stone, and cataract operators in getting<br />
permission to practise their art.<br />
In a showy cortege tricked out with all manner of parti- 1<br />
coloured finery and attended by a harlequin, like the Dr.<br />
ElSENBART immortalized in the popular ballad, these gentry |<br />
roamed about to the annual fairs and Church festivals and<br />
detailed to the public the remarkable cures which they professed<br />
to have performed. With shameless effrontery they<br />
extolled the healing virtues of their medicines against consumption,<br />
deafness, and all the incurable diseases imagin- ; j<br />
able. Many declared that they had the power of at once \<br />
restoring the sight, even if it had been lost for many years ;<br />
others recommended pills to cure barrenness, which according<br />
to their account produced the desired effect even without \<br />
coition. The executioners, who occupied a prominent<br />
position among the quacks, sold human blood which in a<br />
fresh and frothy state was regarded as a remedy for<br />
epilepsy; it was retailed according to a fixed tariffdepending<br />
on the kind of humanity it had flowed from:<br />
dearest was the blood of a virgin or youth ; cheapest, that<br />
of a Jewt However, the wandering operators wrought the<br />
* P. FRANK op. cit. vi, 3, S. 291.<br />
f G. FISCHER op. cit. S. 49 et seq.—Des getreuen Eckharts medicinischer<br />
Maulaffe oder der entlarvte Marktschreier, Frankfurt und Leipzig i?M).—Thi,<br />
Tattler, London 1723, iv, No. 243.—O. BUCHNER op. cit. S. 145 et seq.
•<br />
THE EIGHTEENTH CENTURY. 439<br />
greatest mischief. When in the public squares they exhibited<br />
proofs of their skill to the astonished multitudes<br />
amid the blasts of trumpets and the beating of drums,<br />
which were intended to drown the cries of the unfortunate<br />
patients, none thought of the sad consequences entailed<br />
too often by these surgical manipulations. But does not<br />
the saying of BACON hold good to the present day that<br />
every charlatan and every old woman is regarded as a rival<br />
of the most skilful doctor, and does not scruple to contend<br />
with him for mastery at the bedside of the patient ?<br />
END OF PART III.
IV.—MEDICAL TEACHING IN MODERN TIMES.<br />
THE WIDE OUTLOOK OF THE NATURAL<br />
SCIENCES IN THE NINETEENTH CENTURY.<br />
THE history of modern times begins with the great events<br />
of the last decade of the eighteenth century. The political<br />
and social forms of the present day first took shape during<br />
the French Revolution and amid the intellectual movements<br />
of that time.<br />
The French Revolution was directed less against Monarchy<br />
than against Feudalism, the representatives of which<br />
had abused their high position in unheard-of ways. For<br />
the first time it was recognized to be a grievous injustice.f<br />
that one portion of the population should have to bear all<br />
the burdens of the State, while another enjoyed all the<br />
rights and privileges it had to confer; for the first time the<br />
principle was enunciated that those who maintain the State<br />
are also entitled to have an important influence upon its<br />
management. This thought was universally prevalent,<br />
forming, as it were, a constant residual product in the manifold<br />
political processes of decomposition and change which<br />
were taking place at that time. It led to the Parliamentary<br />
system, which became a legal institution in the nineteenth<br />
century in nearly every civilized country. With the removal<br />
of historical privileges and of the subordination of one class<br />
to another in the State, with the abolition of serfdom, with<br />
the introduction of civic independence, of the principle of<br />
the equality of every individual person before the law, and<br />
of the participation of the masses of the people in the<br />
government, a social revolution was effected of far-reaching,<br />
importance.
THE NATURAL SCIENCES. 441<br />
Contemporaneously with the political emancipation of the<br />
middle-classes began also the increasing activity of the<br />
daily press, the development of journalism, and the popularization<br />
of art and science. An interest in the efforts<br />
made in these directions penetrated into circles which before<br />
had been entirely uninfluenced by them. All nations of<br />
any moral elevation took part in the development of culture,<br />
but especially the French, the English, and the German.<br />
The German face, wdiich already in the eighteenth century<br />
had produced LESSING, HERDER, GOETHE, SCHILLER,<br />
MOZART, BEETHOVEN, KANT, and other enlightened spirits,<br />
•and in poetry and literature, in music and philosophy had<br />
attained a position which commanded respect, by degrees<br />
.assumed the lead in medicine and the natural sciences.<br />
While at first in the history of these branches of knowledge<br />
the names met with are those of Frenchmen and a few<br />
Englishmen, since the middle of the nineteenth century the<br />
men of learning and the investigators of German origin<br />
have acquired a preponderating influence.<br />
It was otherwise with philosophy, for this unfortunately<br />
•in Germany lost touch completely with practical life under<br />
the baneful influence of scholastic pedantry, and has only<br />
rediscovered the lost path in the most recent times. The<br />
.great thinker of Konigsberg had with critical acuteness<br />
indicated the sources, the extent, and the limits of human<br />
thought; but the philosophers following KANT were able to<br />
add but little to his theory of knowledge, and confined themselves<br />
to a further development of his system in this or that<br />
direction. Inasmuch as they attacked directly the question<br />
of the essential nature and ultimate foundation of things—a<br />
•question KANT himself had declared to be superfluous and<br />
unanswerable, limiting inquiry, as he did, to the world of<br />
phenomena—they displaced once more the problems of<br />
philosophy into the mystico-transcendental realms of speculation.<br />
The subtle hypotheses of a FlCHTE who sought an<br />
answer to the enigma of existence in the conception of an<br />
Ego, thus arriving at an unlimited idealism, of a ScHELLING
442 MODERN TIMES.<br />
who preached the identity of nature and spirit, and so<br />
founded " the philosophy of nature," of a HEGEL who saw<br />
complete salvation in the idea of the Absolute, and of a<br />
SCHOPENHAUER who declared the world to be will and subjective<br />
representation, might for a time captivate but could<br />
not permanently convince.<br />
None of these systems have influenced the natural<br />
sciences more than that of "the philosophy of nature."<br />
Distinguished doctors and natural philosophers like BLU-<br />
MENBACH, OKEN, KIELMEYER, I. DOLLINGER, OERSTED,<br />
BURDACH, NEES V. ESENBECK, KIESER, K. G. CARUS, and<br />
others attached themselves to it, finding in it a definite<br />
standpoint from which to view, and form a just estimate of,<br />
the collections of empirical facts which surrounded them.<br />
Like the Romanticism which at that time dominated art and<br />
literature—the true child of an age which was struggling<br />
towards some satisfying conclusion to its efforts, selfcontradictory<br />
and incomplete as they were—so too did the<br />
philosophy of nature pursue throughout noble ends, for<br />
it penetrated into the depths of men's hearts, reminded<br />
medicine of her high ethical functions and gave expression<br />
to the doctrine of the unity of the various natural<br />
\ sciences.<br />
The philosophy of nature, having been injuriously<br />
affected by contact with religious mysticism, at first assumed<br />
a hostile attitude towards experimental inquiry and<br />
chose metaphysics for its arena: in the words of HAMANN<br />
" from a general knowledge of the possible it arrived at<br />
a thorough ignorance of the actual." When natural<br />
philosophy, in a spirit of senile self-glorification, applied its<br />
vague and often antiquated definitions to natural science in<br />
its state of daily progress, the only result was that the<br />
latter became entirely alienated from the former. That<br />
clumsy form of stating a proposition, introduced into-<br />
philosophy chiefly by HEGEL, which, with great labour, in a<br />
newly-made dialect, succeeded in rendering the simplest<br />
things incomprehensible, contributed not a little to the
THE NATURAL SCIENCES. 443<br />
estrangement which grew up gradually in Germany between<br />
natural science and philosophy.<br />
In other countries better conditions prevailed in this<br />
respect. In these philosophy was in close touch with the<br />
sciences and arts of real life and placed her powers at their<br />
disposal with a view to their methodical improvement. In<br />
France Positivism was founded by AUGUSTE COMTE. Like<br />
KANT, to whom in genius he was allied, COMTE had<br />
received a school-training in mathematics and the natural<br />
sciences. Positivism, in harmony with the sudden great<br />
increase of activity which experimental inquiry manifested<br />
at that time in France, excluded metaphysical and<br />
teleological explanations and demanded that every philosophical<br />
speculation and every science should appeal to<br />
our understanding in virtue of support received from facts<br />
corroborated by experience or experiment. Such a<br />
doctrine was bound to be found agreeable by investigators<br />
of nature, and it found among them numerous disciples<br />
and advocates. It was promulgated in Germany by<br />
FECHNER, H. LOTZE, H. CZOLBE and other distinguished<br />
men of science, and material necessary to its secure<br />
foundation was contributed by them. The exact school of<br />
the present day began once more to take account of<br />
philosophy, and one of the greatest investigators of nature',<br />
KARL ROKITANSKY, drew attention to its uses and,<br />
significance in reference to the natural sciences and<br />
medicine. But the philosophers also were well aware that<br />
the positive knowledge of scientific facts must be presupposed<br />
as a self-evident requisite for any intellectual<br />
activity on their part which was to prove fruitful or could<br />
hope to win any serious regard.<br />
At certain universities the chairs of philosophy were<br />
handed over to experts in natural science, such as had<br />
tested the value of observation and experiment, and thus<br />
a clear expression was given to the importance which a<br />
scientific view of nature had acquired in reference to the<br />
development of modern civilization. The civilization of
444<br />
MODERN TIMES.<br />
the present day has been established on the abundance of<br />
newly-discovered facts which have enriched the natural<br />
sciences during the nineteenth century, and in the knowledge<br />
of their mutual relationships and common laws,<br />
which has rendered possible a simplified view of the life of<br />
nature.<br />
In bringing forward certain facts from the history of the<br />
various natural sciences I desire only to indicate the course<br />
of their development in a few words.<br />
Already in the eighteenth century attempts had been<br />
made to classify minerals on a rational basis. Their external<br />
characteristics and resemblances formed the foundation of<br />
the arrangements of LlNN^US and WALLERIUS. On the<br />
other hand AXEL F. CRONSTEDT, the Swede, regarded their<br />
chemical constitution as all-important; ABRAHAM GOTTLOB<br />
WERNER, the Saxon counsellor of mines, then made a<br />
classification of them, founded both upon their chemical<br />
and physical peculiarities, and upon their external form.<br />
To him is due the credit of having defined the limits of<br />
oryktology and geognosy and of having founded the latter<br />
science.<br />
The improvement of the science of crystallography* was<br />
commenced by ROME DE L'ISLE and HAUY and was successfully<br />
carried on by WEISS and MOHS. Others studied<br />
the chemical, optical, and electrical properties of certain<br />
minerals, and also the phosphorescence and phenomena of<br />
polarization observed in them. The appreciation of the<br />
value of chemistry as an aid to mineralogy led to the<br />
intimate association of these two sciences, which proved to<br />
be suggestive and advantageous in many ways.<br />
LEOPOLD VON BUCH did the work of a pioneer in the<br />
subjects of geognosy and geology. At the same time, too,<br />
the subject of the formation of fossils, to which<br />
SCHEUCHZER was the first to direct attention, was<br />
* CUVIER: Geschichte der Fortschritte in den Naturwissenschaften seit 1789,<br />
Deutsche Ubers, Leipzig, 1828, 4 Bde. ;f
THE NATURAL SCIENCES. 445<br />
diligently worked at, and afforded material for the solution<br />
of many questions of geology and anthropology.<br />
In botany various attempts were made to discover a<br />
natural system of plants. ADANSON declared that " nature<br />
everywhere exhibits to us natural groupings," and was of<br />
opinion that classification should not certainly be based<br />
upon the similarities and differences of one particular<br />
organ, but only upon the collective phenomena and<br />
characteristics of the organism. In order to reveal this<br />
system he compared individual plants in respect of their<br />
various organs and arranged them into classes of varying<br />
degrees of affinity according to the greater or less correspondence<br />
between them. His method of classification was,<br />
above all things, wanting in lucidity, and could not, therefore,<br />
gain for itself any approval.<br />
A more correct method was introduced by A. L. DE<br />
JUSSIEU, A. PYRAMUS DE CANDOLLE, ROBERT BROWN and<br />
others: they insisted first of all upon an accurate definition<br />
and delimitation of the families of plants, and did a quantity<br />
of valuable preparatory work in this direction. A. P DE<br />
CANDOLLE, who himself described with great care more than<br />
one hundred families, founded the doctrine of the symmetry<br />
of the plant-form. The investigations of J. GAERTNER<br />
upon the fruits and seeds of plants and R. BROWN'S monographs<br />
were of fundamental importance for morphology.<br />
GOETHE'S doctrine of metamorphosis excited the attention<br />
of philosophers of nature rather than that of men of<br />
science. It was of a confused and indefinite character, and<br />
was first explained scientifically by ALEXANDER BRAUN<br />
who brought forward valuable information upon the form<br />
of the leaf and the development of the plant.* The<br />
anatomy of plants was diligently worked at by BRISSEAU-<br />
MIRBEL, the younger MOLDENHAWER, LINK, MEYEN, HUGO<br />
MOHL and others, who succeeded in giving definiteness to<br />
men's views upon the structure of plants. Their micro-<br />
* WIGAND: Geschichte und Kritik der Lehre von der Metamorphose der<br />
Pflanzen, Leipzig 1846.
446 MODERN TIMES.<br />
scopical formation was also closely examined, and the<br />
discovery that the cell is the unique ultimate element of<br />
their structure gave a new direction to morphological<br />
investigation : it demanded that a greater attention should<br />
be given to histogenesis. This was studied first upon the<br />
lower cryptogams, since the facts to be dealt with in them<br />
were simpler and less difficult to examine; then gradually<br />
the more highly organized plants were taken in hand. The<br />
results thus arrived at cast a remarkable light upon the<br />
origin and growth of organs. MOHL observed various<br />
modes of spore-formation, and in 1835 described an instance<br />
of vegetable cell-partition. SCHLEIDEN in 1838 brought.<br />
forward a theory of cell-formation, which however was disfigured<br />
by so many mistakes that it was soon afterwards<br />
abandoned. Its place was taken by the theory of NAEGELI<br />
which was of a more comprehensive character, gave a<br />
defined image of the different kinds of occurrences and<br />
determined the law which controlled them. In 1839<br />
SCHWANN enunciated the proposition that the animal cell<br />
is analogous to the vegetable cell, and in 1855 UNGER<br />
drew attention to the similarity between the protoplasm of<br />
the vegetable cell and the sarcode of the most lowly<br />
organized animals: this observation received increased<br />
support by investigations made upon the myxomycetes.<br />
These things led to a more correct appreciation of the<br />
puzzling relations between the vegetable and animal king^<br />
doms and also helped to remove the doctrine of the fixity<br />
of species which had for long prevailed as an incontrovertible<br />
dogma. The fecundation of plants was studied by<br />
Du HAMEL who described the way pollination is effected,<br />
and the part which is here played by many insects. This<br />
subject was thoroughly worked at from 1830 onwards, the<br />
processes which take place in the interior of the ovules<br />
being made the subject of careful examination, and sexuality<br />
being proved to exist even in cryptogams.<br />
So, too, the processes of nutrition, of absorption, and<br />
excretion, and of growth were fully described. The move-
THE NATURAL SCIENCES. 447<br />
ments of the sap, on which STEPHEN HALES had already<br />
made some interesting experiments were elucidated chiefly<br />
by DuTROCHET who asserted their connection with the<br />
phenomena of osmosis.<br />
INGENHOUSZ found out that the green parts of plants<br />
under the influence of light absorb carbonic acid gas,<br />
separating and giving out the oxygen and retaining the<br />
carbon which in the form of organic combinations is stored<br />
up in the plants : he thus was the founder of the doctrine<br />
of the respiration and nutrition of plants. SENEBIER<br />
added some investigations upon the influence of light upon<br />
the life of the plant. Numerous works at this time dealt<br />
with the chemistry of the nutrition of plants and with the<br />
movements exhibited by them.*<br />
Their pathology, too, was not overlooked and especially<br />
of recent years has been advanced in an extraordinary<br />
degree. Finally the subject of the geographical distribu<br />
tion of plants assumed a definite shape : this, inasmuch as<br />
it indicated and explained the dependence of the vegetable<br />
world upon climate and soil, acquired high importance for<br />
medical science and especially for the subject of the<br />
geographical distribution of disease.<br />
By the discovery of new species of animals and by the<br />
careful investigation of their anatomical structure zoology<br />
gained not only a great increase of its subject-matter and<br />
improvement in its system of classification but was enabled<br />
with the help of the history of development, of comparative<br />
anatomy and of palaeontology to arrive at broad views of<br />
natural history apparently capable of embracing the whole<br />
range of living and extinct forms of life. BUFFON't already<br />
approached this point of view when he declared that there<br />
is no essential difference between animals and plants, and<br />
that the series of organic life shows one uniform plan.<br />
His popular and clever way of representing the subject, of<br />
interweaving bold hypotheses with abundant facts, stimu<br />
lated men of science to new investigations and aroused far<br />
* SACHS op. til. S. 27G et. seq. -f V. CARUS op. cit. 522 et seq.
MODERN TIMfiS^S-<br />
and wide an interest in matters connected with natural<br />
science among large classes of the educated public.<br />
BUFFON entered also upon the subject of the geographical<br />
distribution of the animal kingdom, and, like LlNN-^US ,<br />
before him, drew attention to the difference between the<br />
species inhabiting the different continents. He concluded v<br />
from the fact that the forms of animal life belonging to-the<br />
Arctic regions of America and Europe are identical, that *<br />
there once existed a connection between the two continents,<br />
or at least that migrations of animals from one to<br />
the other were possible. An acquaintance with the trans- .<br />
oceanic fauna was brought about chiefly by scientific expeditions<br />
to which naturalists were appointed, Thus<br />
SONNERAT described numerous animals inhabiting islands<br />
off the southern shores of Asia ; but the greatest services<br />
in this respect were rendered by the elder FORSTER, j<br />
ALEXANDER VON HUMBOLDT, and LICHTENSTEIN. So.<br />
also a closer study was made of the distribution of animals '%<br />
in the different countries of Europe. PALLAS described , :<br />
several new forms.<br />
In the meanwhile men's knowledge of the species already ^<br />
recognized was enriched by important observations. BONNET ;<br />
was the first to notice the asexual propagation of .aphidesy<br />
or plant-lice. P. CAMPER and J. HUNTER discovered<br />
simultaneously and independently of one another the aircavities<br />
of the bones of birds and the connection of these *<br />
with the lungs. FABRICIUS and afterwards LATR-EILLE"<br />
turned their attention chiefly* to entomology, RUDOLPHI<br />
worked at helminthology, and LAMARCK, O..F. MULLER,*<br />
and EHRENBERG applied themselves to the vast subject of<br />
the infusoria.<br />
Zootomy afforded important information upon the structure<br />
of the various animals, and a comparison of their'*<br />
organization opened up a view which rendered it pos-s<br />
sible to form a comprehensive judgment on this subject.<br />
Comparative anatomy and physiology gained rich accessions<br />
of scientific material through the labours of J. HUNTER,,<br />
F. VlCQ D'AZYR, BLUMENBACH, KlELMEYER, GEOFFROY,
THE NATURAL SCIENCES. 449<br />
ST. HILAIRE, CUYIER, TIEDEMANN, C. G. CARUS, J. F<br />
MECKEL, and J. MULLER, and the advancement of these<br />
sciences was looked upon as the proper object of zootomy.<br />
IGNAZ D6LLINGER wrote in 1814 : "The task of zootomy<br />
is to unfold the structure of animals, and in it to show the<br />
nature of life. The parallels drawn by the zootomist will<br />
be in this wise : he must collect facts and examine as to<br />
« how far they tally with one another or how far they are<br />
opposed; he must compare them with the theory of life<br />
and investigate how one individual Object has been formed<br />
through a series of metamorphoses."* GEOFFROY ST.<br />
HILAIRE laid down leading principles which might serve for<br />
the guidance of investigators.<br />
CUVIER discovered the law of the correlation of parts—<br />
a haw which J. HERMANN had already had a presentiment<br />
of—^-according to which every organic being forms a com<br />
plete whole, particular parts or organs of which cannot be<br />
modified without modifications also occurring in the other<br />
parts or organs.<br />
On the strength of these newly-disclosed facts classifica<br />
tion was ventured upon. BATSCH attempted in the first<br />
place to separate the bony animals from the others ; but<br />
LAMARCK was the first to bring the division into verte-<br />
brata and invertebrata clearly before the world ; this dis<br />
tinction was universally accepted.<br />
The greatest advance made in classification was owing to<br />
CuviER, who founded the doctrine of types. His explana-<br />
: - tion was that in the animal kingdom there are four principal<br />
branches simultaneously existing, or "general plans on<br />
which the animals belonging to them appear to be modelled,<br />
and the subdivisions of which are characterized only by<br />
slight modifications founded upon the development or sup<br />
pression ;of particular parts, no change, however, being<br />
made in the essential nature of the plan." K. E. V. BAER<br />
gave more definiteness to the conception of the type and<br />
.* J. DOLLINGER: Uber den Werth und die Bedeutung der vergleichenden<br />
Anatomie, Wiirzburg 1814, S. 17.<br />
G G
450 MODERN TIMES.<br />
rendered the theory more correct, especially in regard to<br />
the history of development which CuviER had completely<br />
disregarded.<br />
The scientific treatment of development began at this<br />
time to assume a more conspicuous place than heretofore,<br />
and to exert an influence upon the branches of knowledge<br />
allied to it. PANDER published his original and helpful<br />
investigations upon the development of the chick, proving<br />
that the avian body is formed out of three embryonic layers.<br />
K. E. V. BAER made observations upon the other classes of<br />
the vertebrata, and referred to the different processes of<br />
cleavage in the ovum. The changes of the ovum after impregnation<br />
were observed, and its segmentation described<br />
by others also. Moreover, the development of particular<br />
organs, of the brain, for instance, the eye, the Wolffian<br />
bodies, etc., was made the subject of special study. In this<br />
way attention was drawn to the similarity of embryonic<br />
development in the various kinds of animals. JOHN<br />
HUNTER, KIELMEYER, and afterwards OKEN founded the<br />
theory that the embryos of the more highly-organized,.<br />
animals pass through the stages of development of the<br />
lower classes of animals.<br />
The facts in the history of development associated with<br />
pala^ontological discoveries, which rendered it possible<br />
to recognize the differences existing between fossil plants<br />
and animals and the representatives of their species at<br />
the present day, shook men's faith in the immutability of<br />
form in zoology, and prepared the way for the theory of<br />
descent from. other forms. As early as in the year 1804<br />
LAMARCK declared, in referring to hybridization and the<br />
formation of varieties, that it is only because the judgment<br />
of man is accustomed to deal with small periods of time<br />
that a species is conceived by him to be unchangeable, but<br />
that in reality it does change and adapts itself to external<br />
conditions.<br />
In 1830, LYELL published his Principles of Geology in;<br />
which he contended that to explain the changes in the
THE NATURAL SCIENCES. 451<br />
earth's crust it is by no means necessary to assume that<br />
great and stupendous catastrophes have occurred, but that<br />
the forces of nature, slowly but continuously at work<br />
around us, are a sufficient explanation. He referred to the<br />
action of rivers and seas, of springs and glaciers, and compared<br />
the changes of the inorganic world to the minutehand<br />
of a clock, " the advance of which one can see and<br />
hear, while the fluctuations of living creation are hardly to<br />
be seen and resemble the movement of the hour-hand." *<br />
The dogma of fixity of species was gradually abandoned<br />
by most investigators of nature. Men saw that species<br />
do change within certain morphological limits and they<br />
were constrained to adopt the opinion that species had<br />
developed in a similar way into their present forms.<br />
To CHARLES DARWIN belongs the never-to-be-forgotten<br />
merit of having raised the hypothesis into a scientific fact.<br />
Supported by a rich collection of observations he undertook<br />
to fathom the causes which lie at the root of an<br />
explanation of the origin of species, and he came to the<br />
•conclusion that the struggle for existence and natural<br />
selection lead to a survival of the better and fitter<br />
•organisms, followed by a suppression of the conquered and<br />
the gradual perfecting of the conquerors. This theory,<br />
corrected and enlarged at certain points by WALLACE,<br />
NAEGELI and others, formed the foundation of a new<br />
method of contemplating the world of organic nature.<br />
When, soon after, the attempt was made to construct a<br />
history of creation in accordance with the ordinary course<br />
of nature, and when the place of man in relation to the<br />
other inhabitants of the earth was introduced into the<br />
sphere of discussion, the new doctrine excited the vehement<br />
animosity of those who discerned in it an assault upon<br />
religion and upon the dignity of the human race. The<br />
incompleteness of the facts, especially in palaeontology,<br />
and the meagre knowledge which we possess of many processes<br />
in physiology and the history of development did<br />
* O. SCHMIDT: Descendenzlehre und Darwinismus, Leipzig 1873, S. 117.
45 2 MODERN TIMES.<br />
not certainly justify deductions of such magnitude as those<br />
which were sometimes advanced; but these clothed themselves<br />
in the unassuming garb of hypothesis and did not<br />
ask that people should accept them unconditionally, but<br />
rather that they should criticize them freely.<br />
Religion will never have anything to fear at the hands of<br />
science if she ceases to be hostile to freedom of inquiry<br />
and recognizes her true calling to lie in the ethical education<br />
of the human race and in the perfecting of the<br />
spiritual life.<br />
PHYSICS AND CHEMISTRY IN THE LAST<br />
HUNDRED YEARS.<br />
WHILE mineralogy, botany, and zoology were changing<br />
from sciences merely descriptive of objects to sciences<br />
involving explanations of processes, physics and chemistry<br />
also were assuming a new form in consequence of improvement<br />
in the methods of investigation and the number<br />
of new discoveries.<br />
This period in chemistry was inaugurated by the discovery<br />
of oxygen and the abolition of the theory of<br />
phlogiston, and was characterized by the introduction of<br />
the method of quantitative analysis.<br />
In 1774, JOSEPH PRIESTLEY discovered oxygen by heating<br />
red oxide of mercury. At the same time he observed<br />
that the gas so obtained supported breathing and combustion<br />
better than ordinary air; but he was unable to draw<br />
the conclusions which the facts offered. He was a highlygifted<br />
amateur who prosecuted science extensively rather<br />
than deeply. He enriched chemistry with a multitude of<br />
discoveries, and, as KOPP says, did more than professional<br />
men of science to improve our knowledge of the gases*<br />
LAVOISIER was the first to recognize the full significance<br />
of the discovery of oxygen. Two years anterior to it he<br />
* KOPP op. cit. i, 239.
PHYSICS AND CHEMISTRY. 453<br />
furnished an experimental proof that both in the combustion<br />
of metals and in the ignition of phosphorus and sulphur an<br />
increase of weight occurred (contrary to what was postulated<br />
by the phlogiston theory), and that such increase of weight<br />
was due to absorption of air; he was unable to say, however,<br />
whether this absorption was of the air as a whole or of only<br />
a part of it. When, thanks to PRIESTLEY, he became ac<br />
quainted with oxygen, it occurred to him to seek in it the<br />
cause of this phenomenon. After numerous experiments<br />
he came to the conclusion that only one-fifth part of the<br />
atmosphere takes part in combustion and that the air con<br />
sists of one part of oxygen and four parts of a gas which<br />
subserves neither combustion nor respiration. His state<br />
ments upon the composition of air, water, and various acids<br />
were confirmed and rendered more complete on some<br />
points by CAVENDISH * The theory of phlogiston being<br />
thus refuted, several questions asserted themselves which<br />
had hitherto been explained by means of it or by analogous<br />
reasoning.<br />
LAVOISIER, finding oxygen to exist in all the acids which<br />
he examined, pronounced it to be a necessary constituent<br />
part of all these bodies—to be that, in fact, which bad pre<br />
viously been designated " primitive acid ; " he also alluded<br />
to the part which the element plays in the oxidation or so-<br />
called "calcination" of metals. BLACK had already cor<br />
rectly described the nature of caustic alkalies. LAVOISIER<br />
disclosed more thoroughly the importance of oxygen in<br />
respiration and its effect upon the blood, and thus led the<br />
way to a fundamental change in the physiological explana<br />
tion of these processes.<br />
The discovery of oxygen also exerted a great influence<br />
upon pathology and therapeutics. Some doctors discerned<br />
in it the " air of life " upon which health depends. They<br />
thought that certain diseases depended upon the excess or<br />
deficiency of oxygen and they employed it in therapeutics.<br />
* KOPP: Beitrage zur Geschichte der Chemie, Braunschweig 1875, iii, 254<br />
et seq.
454 MODERN TIMES.<br />
LAVOISIER'S doctrines found acceptance first in France,<br />
the country of his birth. Among his disciples were GUYTON<br />
DE MORVEAU wdio rendered a service by introducing a<br />
rational chemical nomenclature, FOURCROY who gave his<br />
attention to medical chemistry, and BERTHOLLET who<br />
found out the composition of ammonia, was the first to<br />
observe the bleaching property of chlorine and recognized<br />
its importance in daily life, discovered chlorate of potash<br />
and fulminate of silver, carefully analyzed hydrocyanic acid<br />
and determined its composition, corrected LAVOISIER'S<br />
mistake in asserting that all acids contain oxygen, founded<br />
the doctrine of chemical affinity referring to the im^-<br />
portance of the quantitative relations which here assert<br />
themselves, and advanced industrial chemistry, especially in<br />
the departments of the manufacture of steel and saltpetre.<br />
KLAPROTH was the first in Germany to support the anti-<br />
phlogistic theory. Chemistry owes to him the discovery of<br />
several elements and the correction of various erroneous<br />
statements which had been made by other investigators..<br />
His analytical labours were characterized by their accuracy,<br />
surpassing in this respect even those of VAUQUELIN, who<br />
about the same time was elaborating mineralogical<br />
chemistry and discovered chromium and glucinum. He<br />
directed his attention also to organic chemistry, and dis<br />
covered, amongst other things, quinic acid.<br />
In the beginning of our own century J. L. PROUST<br />
enunciated the law that chemical combinations always<br />
manifest a definite composition. He also made important<br />
contributions to the chemistry of certain metals and dis<br />
covered grape-sugar.<br />
The Englishman DALTON attempted to explain the<br />
definiteness of chemical combinations by the atomic theory,<br />
in which he assumed that the atoms of the various elements<br />
unite with one another in definite proportions depending<br />
upon their weight; he discovered also the law of multiple<br />
proportions.* The stoichiometrical investigations of<br />
* A. WBRTZ : Geschichte der chemischen Theorien,\Deutsche Ubersetzung*<br />
Berlin 1879, S. 29 et seq.
PHYSICS AND CHEMISTRY. 455<br />
DALTON were confirmed and extended by BERZELIUS, and<br />
also by WOLLASTON, who introduced a classification by<br />
equivalencies instead of that by atomic weights.<br />
This subject received enlargement at the hands of GAY-<br />
LuSSAC who recommended that in analyzing chemical<br />
combinations attention should also be paid to the volumetric<br />
relation of bodies when in the gaseous state. In 1805, he,<br />
in conjunction with ALEXANDER VON HUMBOLDT, discovered<br />
that water is composed of one volume of oxygen<br />
and two volumes of hydrogen. Afterwards he examined<br />
other combinations in the same way and established the<br />
fact that their constituents in the gaseous state stand in<br />
definite relations of volume to one another; he thus laid<br />
the foundation of the theory of volumes. GAY-LUSSAC<br />
published the valuable results of his labours upon the expansion<br />
of gases by heat; upon the density of vapours, for<br />
the determination of which he contrived peculiar methods<br />
of investigation ; upon iodine (which had been discovered<br />
shortly before) and its combinations, and also upon several<br />
combinations of chlorine. He gave the first correct description<br />
of the composition of hydrocyanic acid, explained<br />
the nature of cyanogen, discovered hydriodic acid and<br />
hyposulphuric acid and simplified the examination of many<br />
bodies made use of in daily life<br />
The quantitative analysis of chemical combinations<br />
entered upon a new stage when it became known that<br />
the electrical current decomposes them. NICHOLSON,<br />
CARLISLE, CRUIKSHANK, BERZELIUS and HISINGER made<br />
several interesting observations on this subject, and<br />
HUMPHREY DAVY gave them a theoretical basis. He<br />
pointed out that water is decomposed by means of the<br />
electric current into oxygen and hydrogen, and salts into<br />
acids and bases of which the former bodies in each case<br />
are discharged at the positive, the latter at the negative<br />
pole of the Voltaic battery ; he proved the decomposability<br />
of several compounds, as for instance the fixed alkalies, the<br />
alkaline earths, baryta, strontia, magnesia, lime, etc., and<br />
gave it as his opinion that chemical and electrical effects
456 MODERN TIMES.<br />
are manifestations of the same force; he thought that these<br />
manifestations took the -form of electricity when larger<br />
masses come into contact, that of chemical affinity when<br />
smaller particles met. DAVY'S labours gave the impulse<br />
to a series of electro-chemical investigations which were<br />
instituted by THENARD, the discoverer of peroxide of hydro<br />
gen, and GAY-LUSSAC ; they greatly increased our know<br />
ledge of certain elements, especially potassium and sodium,<br />
and improved the technical methods of research.<br />
At the same time SCHWEIGGER and BERZELIUS elaborated<br />
the theory of electro-chemistry ; the latter proceeded upon<br />
the assumption of the electrical polarity of the atoms of<br />
bodies, and, in conformity with it, asserted that chemical<br />
combinations arise from the juxtaposition of the opposite<br />
poles of the atoms of different bodies.<br />
In 1834 FARADAY discovered the important fact that the<br />
chemical effect varies in quantity directly as the amount of<br />
current electricity producing it. By this he succeeded in<br />
establishing a measure for determining the quantity of<br />
electrical action present in any case. By studying the<br />
effect of electrical action upon, different combinations he<br />
found that the weights of the bodies decomposed by the<br />
electric current correspond with their chemical equivalents.- -}<br />
The whole subject of electro-chemistry thus served to<br />
illustrate the doctrine of chemical affinities.<br />
Much successful work was done in other parts of<br />
chemistry. DAVY corrected the erroneous views about<br />
chlorine, and introduced the conception of hydrogen-acids;<br />
he was moreover the first to draw attention to the intoxi<br />
cating effect of nitrous oxide, a gas discovered by<br />
PRIESTLEY. His investigations upon the pigments of<br />
ancient works of art and upon the means of rendering<br />
legible the manuscripts found at Pompeii also deserve<br />
mention. BERZELIUS did suggestive and original work in<br />
all departments of chemistry and created a school which '<br />
produced a succession of distinguished chemists during the<br />
nineteenth century such as C. GMELIN, MiTSCHERLlCH,
PHYSICS AND CHEMISTRY 457<br />
GUSTAV and HEINRICH ROSE, WOHLER, MAGNUS,<br />
ARFV*EDSON and others. He facilitated quantitative<br />
analysis by bringing the blowpipe into more general use,<br />
discovered and described several elements not kriown before<br />
.and made valuable contributions to animal chemistry.<br />
FARADAY worked at the liquefaction of gases and at the<br />
improvement of the steel and glass manufactures, while<br />
DUMAS instituted experiments upon the specific weights of<br />
various gases. MlTSCHERLlCH formed inorganic substances<br />
synthetically and showed that they were identical with the<br />
minerals occurring native; published the results of impor<br />
tant work upon the combinations of sodium with iodine<br />
and upon the degrees of oxidation of manganese, and, by<br />
his discovery of isomorphism and dimorphism in chemistry,<br />
opened up a branch of the subject having a direct physical<br />
bearing and full of importance for mineralogy. The dis<br />
covery of the fact that bodies differing'in chemical com<br />
position may possess the same crystalline form and may<br />
have their constituent elements replaced by others without<br />
•changing such form, whereas other bodies like sulphur may<br />
exhibit different forms while retaining the same chemical<br />
•composition exerted a great influence upon the further<br />
development of chemistry.<br />
With LlEBlG and W6HLER organic chemistry came into<br />
prominence. A field of work was here opened to scientific<br />
research hitherto scarcely, if at all, cultivated. The study<br />
•of organic combinations, their composition and properties,<br />
and the attempt to produce them artificially, constituted a<br />
series of problems, the solution of which has fully occupied<br />
the chemists of the nineteenth century* Then it came to<br />
be recognized how manifold and far-reaching are the rela<br />
tions between chemistry and practical life, and of what<br />
value that science is in agriculture, in the various handi-<br />
* A. LADENBURG : Vortriige uber die Entwickelungsgeschichte der Chemie<br />
in den letzen hundert Jahren, Braunschweig 1887, S. xijetseq.—H.KOPP:<br />
Die Entwickelung der Chemie in der neueren Zeit, Miinchen 1873, S. 518<br />
•el seq.
458 MODERN TIMES.<br />
crafts and industries, in painting, in war, in dietetics,<br />
physiology, pharmacology, and in the work of the dis<br />
penser. Agricultural chemistry, technological, physiological<br />
and pharmaceutical chemistry have gradually developed<br />
into independent branches, and chemistry in a broad sense<br />
has become the science of everyday life which regulates<br />
and satisfies the wants of man.*<br />
In physics this period was inaugurated by the discovery<br />
of the remarkable electrical phenomena which were rightly<br />
interpreted by VOLTA. This aroused extraordinary interest<br />
and furnished the occasion for a series of labours which<br />
resulted in the improvement of the Voltaic pile, the recog<br />
nition of the effects produced by it and of the conditions<br />
required to produce them, and the discovery of other impor<br />
tant things. The identity of galvanism and electricity was<br />
recognized, and the relative value of the different metals<br />
in giving rise to electrical currents was established. The<br />
observation of OERSTED that the magnetic needle is de<br />
flected by the current was one of fundamental importance;<br />
for the connection between electricity and magnetism was<br />
thus shown. ARAGO and GAY-LUSSAC soon pointed out in<br />
addition that the current not only deflects but magnetizes.<br />
SCHWEIGGER constructed the first galvanometer and<br />
AMPERE discovered the influence exerted by electrical<br />
currents upon one another, tried to give an explanation of<br />
the real nature of magnetism, and was the first to evolve<br />
the idea of the electro-magnetic telegraph. At the same<br />
time the relations between heat and electricity became the<br />
subject of observation and SEEBECK discerned a new source<br />
of electricity in the so-called thermo-electricity. OHM.<br />
discovered the laws which hold good for the conductivity<br />
of wires and for the relation existing between intensity<br />
of current, electromotive force, and resistance, and<br />
reduced them to a mathematical formula which can .be-<br />
easily grasped.<br />
FARADAY was the first to detect induction currents, and<br />
* KOPP : Geschichte der Chemie, i, 27c et seq.
PHYSICS AND CHEMISTRY 459<br />
studied the relations existing between electricity and light.<br />
The improvements in the technical methods of investiga<br />
tion, the invention of suitable instruments and apparatus,<br />
and the scientific data afforded by their help, constituted a<br />
further extension of our knowledge in this direction.<br />
For physiology two discoveries in physics were of the<br />
highest significance, namely, the establishment of the fact<br />
that electrical currents exist in the animal body, and the<br />
discovery of the law of conservation and transformation of<br />
energy. It was proved by the latter that electricity, heat,<br />
and mechanical work can be transformed or resolved into><br />
one another, and are correlated manifestations of the same<br />
energy. In this way was discovered that bond which unites<br />
in common the most important functions of organic life.<br />
The application of electricity to technical purposes, for<br />
instance, to telegraphy, to lighting, to driving machines,<br />
etc., belongs also to the most recent times.*<br />
The close connection which united physics to mathe<br />
matics, and which enabled the latter to be used as a pioneer<br />
for advance as well as a check on the progress already<br />
made, and the conscientious and firmly-grounded method<br />
of experiment secured important results for research in the<br />
other branches of the former science. These were destined<br />
to stand out most conspicuously in the domain of mechanics.<br />
LAPLACE, YOUNG, GAUSS and others undertook the task of<br />
establishing a clear conception of the laws which lie at the<br />
root of various phenomena, such, for example, as capillarity.<br />
Astronomy, meteorology and climatology also owed to these<br />
labours many a suggestion and great extension of their<br />
scientific boundaries.<br />
The development of the theory of heat was affected by<br />
the same influence. Count RUMFORD observed that heat is<br />
produced by friction, and thence laid the foundation of the<br />
mechanical theory of heat.f Observations upon the specific<br />
* E. HOPPE : Geschichte der Elektricitat, Leipzig 1884, S. 118 etseq.<br />
f G. BERTHOLD : Rumford und die mechanische "Warmetheorie, Heidelberg<br />
i87S-
460 MODERN TIMES.<br />
heat of bodies, investigations upon the degree, of expansion<br />
which they undergo through the influence of heat, upon the,<br />
elasticity of steam, and especially the experiments in respect<br />
of the heating-power of fuels claimed the attention of<br />
physicists more and more in proportion as they subserved<br />
the requirements of daily life. The law of the mechanical<br />
equivalent, of heat* cast a strong light upon many of these<br />
questions, and pointed out the way in which a solution<br />
might be found.<br />
Optical science was advanced by the victory of the<br />
undulatory theory of light, and by numerous experiments.<br />
YOUNG made use of the principle of the interference of<br />
light to explain many phenomena, and FRESNEL studied the<br />
diffraction of light. In 1809 MALUS discovered polarization<br />
by reflection, and not long after BREWSTERt drew attention<br />
to biaxial crystals and to the intimate relation between'<br />
optical properties and crystalline structure. He afterwardsc<br />
constructed also the first stereoscope. The chemical effects<br />
of light were, moreover, subjected to a careful examination^<br />
This led to the discovery of photography, with which are<br />
associated the names of DAGUERRE, NIEPCE, and TALBOT.<br />
FRAUNHOFER, like WOLLASTON before him, observed the<br />
dark lines in the solar spectrum ; but KlRCHHOFF was the<br />
first to give an explanation of them.<br />
The discovery of spectrum analysis afforded information<br />
upon the physical nature and chemical composition of the<br />
heavenly bodies, and threw open a new field of research;<br />
The improvements in optical apparatus, especially the invention<br />
of achromatic telescopes [by DOLLOND], as well as<br />
that of achromatic microscopes, which were first constructed<br />
by HERMANN VAN DEYL and FRAUNHOFER between 1807<br />
and 1811, and were afterwards rendered still more complete<br />
through the labours of PLOSSL, SELLIGUE, CHEVALIER<br />
AMICI, OBERHAUSER, HARTNACK, and others, had the<br />
* Determined by JAMES PRESCOTT JOULE.—E. H. H.<br />
t D. BREWSTER : Philos. Transactions, Lond. 1818, p. 199 et seq.
ANATOMY AND PHYSIOLOGY. 461<br />
highest significance for all departments of natural investi<br />
gation.<br />
The science of acoustics was enriched by some valuable<br />
work at the hands of CHLADNI, OHM, and others; but the<br />
scientific foundation of this branch of physics was first<br />
laid in the most recent times, and is chiefly due to the<br />
labours of HELMHOLTZ.<br />
Physics and chemistry have become the sciences pre<br />
eminently ancillary to medicine, and are called to its aid in<br />
physiology as in pathology, in surgery no less than in the<br />
treatment of internal diseases.<br />
MEDICAL SYSTEMS AND THE PROGRESS IN<br />
ANATOMY AND PHYSIOLOGY.<br />
THE doctrine, which gained general acceptance throug<br />
the teaching of HALLER, that sensibility and irritability<br />
form the distinguishing peculiarities of the animal organism,<br />
the new discoveries in chemistry, and above all the<br />
phenomena of galvanism called into existence a number<br />
of medical systems in which the attempt was made by the<br />
aid of these facts to explain the processes undergone by<br />
the human body in health and disease, and to gain a firm<br />
basis for the science of therapeutics.<br />
A certain proportion of doctors discerned, like-the<br />
Methodists of antiquity, in every physiological and patho<br />
logical manifestation a stimulation or a relaxation, the<br />
cause of which was at one time assigned to the action of<br />
the nervous system, as by CuLLEN, at another sought for in<br />
greater or lesser irritability, as by JOHN BROWN and his<br />
adherents. The theory of irritation was extended and<br />
elaborated by C. GlRTANNER, who alleged oxygen to be<br />
the actual principle of irritability, by R6SCHLAUB, who<br />
referred to the influence of the natural disposition or<br />
organization, by BROUSSAIS who substituted "inflammation"<br />
for " stimulation " and tried to support the theory by patho-
462 MODERN TIMES.<br />
logical anatomy, and by RASORI who adapted the theory of<br />
BROWN, intended for the cold torpid natures of the north,<br />
to the conditions of his own southern home. This theory *<br />
became very widely spread, but was as quickly given up *<br />
again as soon as its untenability became manifest. Its position<br />
in reference to scientific research was one of coldness<br />
and indifference and it encumbered practical medicine with<br />
a troublesome polypharmacy which often did more harm<br />
than good.<br />
The vitalistic theory was of more solid worth; it contended<br />
with the irritation theory for dominion in medicine ><br />
and finally wrested victory from it. It took its origin from.<br />
Montpellier, and in many respects recalled the animism<br />
of STAHL; but it differed advantageously from the latter<br />
in the fact that in considering the general principle of life's<br />
which gives rise to order and harmony in the organism, it<br />
by no means neglected the study of the special functions<br />
and component parts of the body, and did not, like it, make"'?<br />
use of the soul to explain all, even the simplest, processes<br />
of life, but only had recourse to it to elucidate the ultimate<br />
active causes at work in the animal organism. It never<br />
succeeded in becoming the chief figure in the picture of<br />
contemporary medicine, but had to be satisfied with<br />
imparting to it its characteristic and predominant colour.<br />
Among its representatives were investigators like<br />
BORDEU, BA.RTHEZ, GRIMAUD, PlNEL, BlCHAT, CHAUSSIER,'|<br />
and others in France, ERASMUS DARWIN in England, ;*•<br />
BLUMENBACH, J. C. REIL, and others in Germany; men<br />
who stood at the head of scientific advance and afforded by<br />
their works the proof that the vitalistic theory w T as not a<br />
barrier to progress. This is, to a large extent, the reason ,<br />
why it still endured when natural philosophy was the prevailing<br />
influence in Germany and the physiological'schoolj<br />
of medicine in France. *<br />
But it led to certain errors, especially in the field of<br />
therapeutics. Those who practised mesmerism and :<br />
homoeopathy maintained that their method of treatment
ANATOMY AND PHYSIOLOGY. 463<br />
acted directly upon the vital powers. If a cure resulted it<br />
was, in the case of the first, chiefly dependent upon the<br />
phenomena of hypnotism, metallo-therapeutics or other<br />
agencies which only in the most recent times have been<br />
subjected to careful observation ; in the case of the second,<br />
to the effects of mechanisms and forces already present in<br />
the body and which exercise a controlling and curative<br />
power. Vitalism got beyond its depth when it strove to<br />
analyze the complicated processes of life into their several<br />
factors and to explain them in accordance with the general<br />
laws of nature.<br />
Experimental research, which all enlightened spirits<br />
since the time of ARISTOTLE had cherished as the unique<br />
source of knowledge, became gradually the order of the<br />
day and men looked askance at the invention of medical<br />
systems in which facts had the smallest, hypotheses and<br />
speculations the largest, share. Whenever, in the medical «<br />
history of the 19th century, research took any special<br />
direction, as for instance towards questions of physiology,<br />
of pathological anatomy, or (in the most recent times) of<br />
hygiene, and in this way influenced the development of the<br />
whole science, it was not owing to an arbitrary love of<br />
systematizing, but rather to the experience which had<br />
been gained that the elaboration of particular branches is<br />
the course most calculated to enrich the science as a<br />
whole.<br />
It is not my purpose here to enumerate all the discoveries<br />
and advances made during our century in the various<br />
branches of medical science. I must confine myself to<br />
citing the great achievements of medicine and not allow<br />
myself to describe the individual stones which enter into<br />
the composite mosaic structure of the science of to-day.<br />
The anatomical formation of the human body was already<br />
fairly well known to science at the beginning of this<br />
period; it was merely a question of filling up some gaps<br />
in the knowledge of special parts, notably in the case of the<br />
vascular and nervous systems and of the sense organs.
464 MODERN TIMES.<br />
So too it was incumbent, upon investigators to get a clear<br />
insight into the minuter structure of the organs now that,,,;;<br />
with the improvement of the microscope' and the introduc-*'|<br />
tion of new technical, aids, this could be attempted with»,|<br />
better prospects of,success.<br />
An endeavour was also made, to regard anatomy.from .<br />
other than the purely descriptive standpoint. The various<br />
parts and organs of the body were considered in order<br />
according to their positions'and.: were studied in their ;*<br />
relations to the structures adjoining them, and the importance<br />
of these relations in regard* to surgery was discussed. .,<br />
While detailed study was thus being given to topographical:|<br />
and surgical anatomy, the influence of development upon<br />
the build and formation of the parts, of the body was the<br />
subject of research ; and in this manner an, opportunity was ;,<br />
given of viewing anatomy from a purely morphological<br />
point of view.. A rich store of material, still continually<br />
increasing, lay already at hand for the study of company<br />
tive anatomy, and now attention began to be turned to<br />
the peculiarities of, and the differences between, the races<br />
of mankind and in this way the ground' began to be pre^<br />
pared for a scientific treatment of. anthropology. 3<br />
Among the most distinguished doctors who lived at the 1<br />
end of last century was T. SOEMMERING. His scientific' •<br />
work extended over all the paths in which contemporary<br />
anatomical research was moving. Even his inauguraldissertation<br />
upon the base of the brain was .a work of<br />
enduring value. He abundantly fulfilled the expectations<br />
which he then aroused. His excellent illustrations of the<br />
eye and the Other sense organs, his luminous description<br />
of the anatomical structure of the human body, his<br />
researches into the corporeal differences between Negroes<br />
and Europeans and his embryplogical writings, have'ad<br />
vanced science in many ways. He even attempted to<br />
explain the origin of malformations by means of the •.history<br />
of development.<br />
Descriptive anatomy has in the course of the last hundred
ANATOMY AND PHYSIOLOGY.<br />
years received valuable contributions to its subject matter<br />
and by its connection with the history of development and<br />
with comparative anatomy has become of much deeper<br />
scientific import.<br />
Osteology was in its macroscopical aspect brought to a<br />
state of comparative completeness. SOEMMERING sought<br />
to lay down the lines of an ideal female skeleton just as<br />
S. ALBINUS had done in the case of the male skeleton; he<br />
employed for this purpose the corpse of a wonderfully<br />
beautiful maiden of twenty years of age who had lived at<br />
Mainz, .and which had been handed over to the anatomical<br />
institution ; he compared this body with the consummate<br />
proportions of antique statuary just as ALBINUS had<br />
based his portraiture on the form of the Belvedere<br />
APOLLO*<br />
In myology care was taken to observe the origin and<br />
insertion of muscles, their relative positions and their<br />
participation in the structure of particular parts of the<br />
' body, and the occurrence of any varieties.<br />
(, The subject of the vessels and nerves was most in need<br />
of improved teaching. The former were successfully<br />
•* worked at by MASCAGNI, G. BRESCHET, J. and C. BELL,<br />
TlEDEMANN, BERRES, V- FOHMANN and others : the most<br />
important progress made in the knowledge of the latter<br />
was due to ANTONIO SCARPA who was the first to describe<br />
• the naso-palatine nerve and who gave fresh information<br />
on the course of the cranial nerves and on the structure of<br />
nerves and of the sense organs; to CHARLES BELL who<br />
published a comprehensive description of the brain and<br />
the nervous system ; to EMIL HUSCHKE and BENEDICT<br />
STILLING whose wonderful labours upon the fasciculation<br />
of the brain and spinal cord formed the starting point for<br />
the more recent investigations on these parts.<br />
The researches into the minuter structure of different<br />
parts of the body led to the foundation by BlCHAT of a new<br />
* RUD. WAGNER : Soemmerings Leben und Verkehr mit seinen Zeitgenossen,<br />
.Leipzig 1844, ii/ 59.<br />
H H
466 MODERN TIMES.<br />
branch of learning, that namely which treats of the tissues. )<br />
Even in his dissertation upon the membranes which corre- ;<br />
sponds somewhat closely with A. BONN'S treatise, on the '"*<br />
same subject, but chiefly in his General Anatomy he argued i<br />
that the body is made up of different kinds of tissues, and ,_<br />
he illustrated their peculiarities and distribution. These .-!<br />
observations were of great importance not only for<br />
anatomy but also for pathology ; for they threw light upon ,<br />
the origin and extension of diseases from a point of view<br />
which had till then not been thought of.<br />
The improvement of optical aids and especially the |<br />
construction of achromatic microscopes rendered possible<br />
a thorough investigation of the minute structure of the <<br />
tissues. The results of these researches to which<br />
SCHWANN'S discovery of the animal cell imparted.a<br />
histogenetic interest affected our knowledge of every<br />
organ of the body and laid the foundation of a storehouse<br />
of learning on the subject of microscopical anatomy, to the<br />
building and extension of which JOHANNES MULLER,<br />
EHRENBERG, PURKINJE, HENLE, R. WAGNER, VALENTIN,<br />
MAX SCHULTZE and nearly all the distinguished anatomists :<br />
of this century have contributed.<br />
For mastering the subject of the origin and development<br />
of the human embryo a valuable store of scientific material<br />
was afforded by the facts known of the general history of<br />
development, of comparative anatomy, and of the generation<br />
of animals. The discovery of the germinal vesicle by<br />
PURKINJE, and of the germinal spot by R. WAGNER,<br />
followed close upon the labours of PANDER and of BAER,<br />
which are spoken of by KOLLIKER as "the best work<br />
that embryological literature of any age or country has to<br />
show."*<br />
Numerous observations were made by celebrated investigators,—among<br />
whom only HEINRICH RATHKE, REICHERT,<br />
T. BlSCHOFF, and R. REMAK can be mentioned here,—<br />
upon the phenomena of generation and upon the gradual<br />
* A. KOLLIKER: Grundriss der Entwickelungsgeschichte, Leipzig 1884, p. 3-
ANATOMY AND PHYSIOLOGY.<br />
formation of the human embryo, and satisfactory answers<br />
were given to most of these uncommonly difficult questions.<br />
Comparative anatomy was worked at with diligence and<br />
with success. J. F. BLUMENBACH collected all the facts<br />
touching on comparative anatomy which had been stored up<br />
in literature by earlier observers, and added to them a<br />
number of observations of his own. It was he who first<br />
undertook the task of determining the anatomical differ<br />
ences between the various races of man,—especially<br />
Europeans, Negroes, and Indians,—and the anthropoid apes,<br />
having regard in this to the conclusions suggested by the<br />
contemplation of the sculpture of ancient times, and by<br />
the dissection of several Egyptian mummies. Amongst his<br />
discoveries was that made during the dissection of the eye<br />
of a seal, namely that the axis of that organ admits of<br />
being readily lengthened or shortened so as to permit the<br />
animal to see clearly in media of such different densities as<br />
air and water.* His far-famed collection of skulls of<br />
various nationalities had a stimulating influence upon the<br />
.study of this important part of ethnology. A series of<br />
important achievements was now effected in the subject of<br />
•comparative anatomy, and this science formed even up<br />
to modern times an inexhaustible field for investigators.<br />
The discoveries, following so quickly on one another, gave<br />
life to zoology, anatomy, and the history of development,<br />
and contributed chiefly to give a firm footing to that<br />
thorough morphological conception of organic life which at<br />
the present day characterizes these branches of knowledge.<br />
The application of anatomy as an aid to the statuary's art,<br />
and its cultivation for surgical purposes at the hands of<br />
MALACARNE, FRORIEP, VELPEAU, ROSENMULLER, T.<br />
BOYER, and others were measures followed bv considerable<br />
results.<br />
Much more conspicuous, however, has been the progress<br />
made by physiology during our century. From being a<br />
* K. F. H. MARX in den Sitzungsber. d. Gdttinger Soc. d. Wissensch. vom 8<br />
Februar 1840, S. 22.
468 MODERN TIMES.<br />
subject still for the most part founded upon speculation<br />
and hypothesis and dominated by mystical, teleological, and ,<br />
vitalistic ideas, it has now become one of the real natural<br />
sciences, the facts of which are supported by mathematical<br />
and physical laws, by chemical processes, and by anatomical<br />
observations, and are susceptible of experimental proof.<br />
The special physiological functions of the human body<br />
have stepped into the place of an ambiguous " vital power,"<br />
an expression once used to cover up great gaps in men's<br />
knowledge of organic life. These physiological functions<br />
have had their significance in relation to the process of life<br />
determined and tested by observation and experiment.<br />
This has been achieved by the help of an improvement m<br />
the details of the methods of research which has been,<br />
rendered possible by the invention and employment of<br />
suitable apparatus, and favoured by the use of greater precision<br />
in the questions put and the answers given, and in<br />
the way seemingly secondary matters have been taken into,<br />
account Experiment came to be appreciated at its fullvalue,<br />
and MAGENDIE, FLOURENS, CLAUDE BERNARD, and;<br />
numerous German investigators prized most highly this.<br />
powerful aid to inquiry.<br />
Chemistry yielded some conclusions upon the composition ^<br />
of the body and its constituent parts. The analysis of the j<br />
various tissues and fluids of the body, especially of the ;<br />
blood and urine, led to a new conception of the human<br />
organism and its functions. .<br />
Some insight was thus gained into the chemistry of ;<br />
nutrition, and into the part played by the albumenoids,<br />
carbohydrates, and fats in the economy of the human body.^<br />
The relations between the income and output of the body,<br />
the metabolic processes, the renewal of the blood, the,<br />
formation of the secretions and excretions, the source of<br />
animal heat, and other matters were specially illustrated by 1<br />
the labours of LlEBiG, W6HLER, DUMAS, GMELIN, and their<br />
pupils and successors.<br />
The subject of digestion was studied more particularly
ANATOMY AND PHYSIOLOGY. 469<br />
by MAGENDIE, GMELIN, J. N. EBERLE, HELM, BEAUMONT,<br />
and BLONDLOT,.whose experiments with gastric juice led to<br />
important results, by CLAUDE BERNARD, who investigated<br />
the action of the pancreatic juice upon fats, and discovered<br />
the glycogenic function of the liver, and by many other<br />
distinguished investigators. DUTROCHET explained the<br />
processes of absorption and elimination by the phenomena<br />
of osmosis discovered by the Abbe NOLLET, and studied the<br />
degrees in which various animal membranes permit diffusion<br />
to take place through them. ANDRAL and GAVARRET,<br />
BECQUEREL, SCHERER, NASSE, LEHMANN, and others<br />
worked at the physiology of the blood.<br />
The chemical composition of the blood, its colouring<br />
matters, its corpuscles, its coagulability, etc., were investigated,<br />
and the physical conditions of its movement in the<br />
vessels, the blood-pressure, the mechanism of the heart<br />
considered as a pump, the phenomena presented by the<br />
heart in all other respects and by the pulse, were, with the<br />
help of suitably constructed apparatus, rendered subjects<br />
of more exact knowledge.<br />
In addition to the labours of E. H. WEBER, VOLKMANN,<br />
FLOURENS, and others, who in this department rendered<br />
distinguished services, mention must also be made here of<br />
the important researches upon the influence of the nervous<br />
system on the movements of the heart and on the vascular<br />
system. EDUARD WEBER referred to the part played by<br />
the vagus in regulating the action of the heart; it was<br />
recognized afterwards that it is here really a question of<br />
the fibres of the accessorius. CLAUDE BERNARD discovered<br />
the vaso-motor functions of the cervical<br />
sympathetic, and probably by this suggested those<br />
researches which led to the discovery of the vaso-motor<br />
centre in the medulla oblongata. The centre for the<br />
respiratory movements, the point vital, was discovered in<br />
1837 by FLOURENS after LEGALLOIS had already drawn<br />
attention to the importance of the medulla oblongata in<br />
regard to the respiratory act.
47° MODERN TIMES.<br />
Other investigators threw light upon the mechanism of<br />
respiration, the functions of the muscles which take partin<br />
it, the interchange of gases in the lungs and the relation<br />
this bears to the colour of the blood; they attempted alsoto<br />
measure the force exerted by the lungs in inspiration<br />
and expiration, as well as the volume of air employed in<br />
these acts. The foundation of spirometric and manometric<br />
measurements of lung capacity, by which some help,<br />
is given in diagnosing pulmonary diseases, was the work<br />
of JOHN HUTCHINSON and WALDENBURG.<br />
The phenomena of motion also aroused earnest attention.<br />
Ciliary movement, which had before been thought to be<br />
limited to the lower animals, was observed by PURKINJE in<br />
the human body also ; molecular movement only came,<br />
under observation in quite recent times. The mechanism.<br />
of human locomotion was well-nigh exhaustively treated by<br />
the brothers EDUARD and WILHELM WEBER.<br />
The discovery of electric currents in muscles directed;<br />
attention to the chemical and physical processes which<br />
take place in the interior of muscles. In the same way,<br />
the electricity of the nerves suggested a multitude of<br />
problems, the solution of which still occupies the minds of<br />
philosophers and investigators* I have already pointed<br />
out how important for forming a judgment upon the acts<br />
performed by the organism is the law of the conservation<br />
and metamorphosis of energy discovered by J. R. MAYER.<br />
In 1811, CHARLES BELL raised into the position of a<br />
scientific fact the anatomical distinction, already suspected<br />
by GALEN, between the motor and sensory nerves, by<br />
bringing forward the proof that the former arise from the<br />
anterior, the latter from the posterior roots on the spinal<br />
cord. He hit upon a discovery of such extraordinary<br />
importance for the physiology of the nerves by a comparative<br />
study of the anatomical and physiological relations<br />
of the cranial nerves and especially of the two roots of the<br />
* E. DU BOIS-REYMONO : Untersuchungen iiber thierische Elektricitat, Berlin<br />
1848, Bd. i, S. 29 et seq.
ANATOMY AND PHYSIOLOGY 471<br />
trigeminus, the analogy of which with the spinal nerves<br />
had already been noticed by SOEMMERING and PROCHASKA.<br />
MAGENDIE, and JOHANNES MULLER in a greater degree<br />
still, confirmed BELL'S discovery by convincing experiments.<br />
The doctrine of reflex movement already advanced by<br />
DESCARTES, and plainly enunciated by PROCHASKA, to<br />
which MARSHALL HALL, in 1833, gave a scientific founda<br />
tion by his observations, and which JOHANNES MULLER<br />
corrected in certain points and demonstrated in a clear,<br />
intelligible manner, now constituted a recognized addition<br />
to science. The functions of the several nerves and the<br />
significance of the different nervous formations, as of<br />
ganglia, for instance, were determined by experiment. Even<br />
a solution of the difficult problems offered in the physiology<br />
of the central nervous system was attempted.<br />
F J. GALL thought that in examining and comparing the<br />
skulls of persons, possessed of definite peculiarities of<br />
intellect or character, he had observed that certain localities<br />
were more prominent than others. Adhering to the old<br />
theory that the faculties of the mind are definitely localized<br />
he inferred that intellectual centres are accurately mapped<br />
out in the brain and can be recognized by the increased<br />
vaulting of the cranial surface at particular spots.<br />
Although he was anxious to support this hypothesis by<br />
anatomical investigations, speculation really had a pre<br />
ponderating influence. His method of localizing and dis<br />
tributing the faculties of the mind was an arbitrary one,<br />
and his assumption that such give any characteristic<br />
indications upon the surface of the skull was an entirely<br />
erroneous one. For all this, he must be credited with<br />
having rendered the service of advancing the anatomical<br />
investigation of the brain and of stimulating men to a<br />
scientific study of the skull, a subject undertaken with<br />
great success by C G. CARUS, HUSCHKE, and others.<br />
It was reserved for the improved methods of research of<br />
modern times to throw some light into the dark places of<br />
cerebral physiology. By the help of these it became
47 2 MODERN TIMES.<br />
possible to trace out carefully the course of the nerve-fibres<br />
in the brain and spinal cord, to determine their distribution<br />
in these organs, and to observe the minuter structure of the<br />
grey substance and the different forms of its cells; while at<br />
the same time by experiments on living animals, which<br />
consisted of effecting a local destruction of, and consequentabolition<br />
of vital functions in, certain parts of the central<br />
nervous system, men sought to determine the normal functions<br />
of such parts. A comparison was made between the<br />
results thus obtained and observations made at the bedside<br />
or in the post-mortem room.<br />
The physiology of the sense organs was also the subject<br />
of assiduous study. The origin of the visual act, the perception<br />
of colours, the importance of that part of the eye<br />
which is sensitive to light, the mechanism of accommodation,<br />
the action of the refractive media, intraocular appearances,<br />
binocular vision, the subject of the horopter, etc., were all.<br />
submitted to thorough examination and rendered intelligible<br />
by the accumulation of numerous facts. In the same<br />
way the senses of hearing, smell, and taste, and tactual<br />
and general sensation were studied individually and made<br />
subjects of scientific knowledge.<br />
Physiological research however has not only succeeded<br />
in rendering an almost complete account of the problem of<br />
the functions and laws of the human organism in health:<br />
it has, in addition, brought forward a number of observations<br />
which have prepared and smoothed the way for an<br />
explanation of phenomena manifested by the body in<br />
disease.<br />
DIAGNOSIS, PATHOLOGICAL ANATOMY AND<br />
EXPERIMENTAL PATHOLOGY, NOSOLOGY<br />
AND MATERIA MEDICA.<br />
PATHOLOGY, the science which deals with disease, has<br />
been marked throughout by stages of development similar;<br />
to those which have characterized physiology. After men
DIAGNOSIS AND PATHOLOGICAL ANATOMY. 473<br />
had come to recognize the hopelessness of attempts to<br />
fathom the essential nature of disease by bold but ill-founded<br />
hypotheses and philosophical speculations, they applied the<br />
analytical method to this subject also and began by making<br />
sure of and examining those concrete facts of which the<br />
whole picture of disease is made up.<br />
The perfecting of the appliances used in diagnosis gave<br />
rise to a deeper and more thorough study of the symptoms<br />
•of disease and the startling advance made in pathological<br />
anatomy held out a promise that valuable conclusions would<br />
be arrived at concerning the changes lying at the root of<br />
such symptoms. By a comparison between clinical obser<br />
vations and notes taken in the post-mortem room, the<br />
development and essential nature of most diseases became,<br />
by degrees, more intelligible.<br />
To physics and chemistry for the most part we owe the<br />
advances made in the art of diagnosis. During last century<br />
percussion was practised only by a few as, for example, by<br />
M. STOLL; it fell almost completely into oblivion and first<br />
under the influence of CORVISART assumed the place which<br />
it deserves among the means of diagnosis used at the bed-<br />
cside. Having had his attention drawn to it by AuEN-<br />
BRUGGER'S almost forgotten treatise, CORVISART tested the<br />
-observations there laid down during a period of twenty<br />
years, corrected and extended them by his own private<br />
-experience and then published his famous work on percus<br />
sion, in which he did full justice to the services rendered<br />
h>y the discoverer. Percussion was rendered more perfect<br />
in many ways by PiORRY, who introduced the plessimeter,<br />
by WlNTRiCH who recommended the employment of a<br />
hammer, by SKODA especially who furnished a correct<br />
-explanation of the various sounds heard on percussion and<br />
show 7 ed a reforming and inventive genius in all directions,<br />
by TRAUBE and others.<br />
Auscultation also at the same time underwent reforma<br />
tion and scientific improvement. Whereas before it had<br />
been only occasionally practised and then by the direct
474 MODERN TIMES.<br />
application of the ear to the body of the patient, since the<br />
time of LAENNEC, who introduced the use of Ihe stethoscope<br />
or mediate auscultation, it became a method systematically<br />
and constantly used as an aid to diagnosis. It became<br />
well-nigh indispensable for examining cases of pulmonary<br />
or cardiac disease being here the most important, at times<br />
the only available, aid to diagnosis.<br />
But other departments of medicine also owed it much;<br />
thus LEJUMEAU DE KERGARADEC and soon after him<br />
MAYOR discovered the sounds of the foetal heart while<br />
auscultating the abdomen of a pregnant woman, and in this<br />
way furnished us with a way of recognizing the presence of<br />
life in the foetus.<br />
Besides these physical means of research to which<br />
must be added mensuration and the use of the clinical<br />
thermometer—a method elaborated in modern times chiefly<br />
by WUNDERLICH—the advance of the art of diagnosis waslargely<br />
contributed to by chemistry and microscopy.<br />
The existence and the severity of many diseases as well<br />
as their aggravation or abatement can be certainly affirmed<br />
only by the chemical proof that definite substances found<br />
in certain excretions—such as albumen or sugar in the<br />
urine—are either contained in a certain proportion or show<br />
a tendency to increase or to diminish in quantity as the<br />
case may be. The chemical analysis of pathological products<br />
acquired high importance in the study of diseases;<br />
particularly in reference to the theory of toxic agencies.<br />
And in no less degree was 'microscopical research in<br />
many cases entitled to respect, since it gave information of<br />
the presence of histological elements of a certain kind,<br />
which justified certain conclusions concerning the nature<br />
of the disease under investigation. A careful observation<br />
of all the symptoms and a scrupulous consideration of all<br />
the conditions bearing on the case constituted the necessary<br />
and proper preliminary to every diagnosis.<br />
The post-mortem appearances and their bearings upon<br />
the symptoms during life were, with a similar object, sub-
DIAGNOSIS AND PATHOLOGICAL ANATOMY. 475<br />
jected to careful study. Pathological anatomy acquired an<br />
unexpected importance in relation to the subject of disease<br />
; it assumed, as it were, the control of, or became a<br />
check upon, diagnosis. It developed first under the influence<br />
of BlCHA<strong>T'</strong>s labours in France: numerous works<br />
dealt with general and special pathology, for illustrating<br />
which a considerable mass of facts had been discovered.<br />
In England, too, under the influence of J. HUNTER'S work,<br />
and in Germany, distinguished anatomists and clinical<br />
observers like P. FRANK, A. R. VETTER, J. F MECKEL,<br />
LOBSTEIN, JOHANNES MOLLER and others directed their<br />
attention to pathological anatomy.<br />
The period of this science's prime however began with<br />
ROKITANSKY who laid under contribution the rich pathological<br />
material of the General Hospital at Vienna.<br />
Possessed of opportunities enjoyed by none of his contemporaries<br />
he was enabled to collect a series of specimens<br />
illustrating natural and obvious types of pathological changes<br />
which included nearly all important diseases. While<br />
ROKITANSKY facilitated the understanding of the subject of<br />
pathological anatomy he at the same time enlarged its<br />
boundaries by a number of discoveries and went deeply into<br />
the investigation of pathogenetic influences. He was not<br />
contented with asking what pathological processes were, but<br />
sought also to discover how and why they arose, and to get<br />
an insight into their cause and development; as WuNDER-<br />
LICH says, he tried to turn pathological anatomy into<br />
anatomical pathology.<br />
Cellular pathology, a system constructed by ViRCHOW<br />
upon the basis of the cellular theory, impelled men more<br />
and more to examine minute pathological changes,—<br />
microscopical elementary forms—and led to the foundation<br />
of pathological histology. It is true that afterwards by the<br />
discovery of many new facts some rotten supports of the<br />
cellular pathology were removed; but the foundations<br />
remained firm and to this day bear the edifice of pathological<br />
teaching.
476 MODERN TIMES.<br />
The stability and precision of the science were extraordinarily<br />
increased by the introduction of experimental<br />
tests into pathological investigations. CLAUDE BERNARD<br />
by injuring a particular part of the medulla oblongata produced<br />
glycosuria. By the administration of phosphorus its<br />
remarkable effect upon bony tissue was recognized and its<br />
connection with what is now known as phosphorus-necrosis<br />
was inferred.<br />
The methodical employment of experiment constituted a<br />
great advance in pathology; it decided many weighty<br />
questions in that science and created " a physiology of man<br />
in sickness," which in conjunction with pathological<br />
anatomy laid the foundations of a "biology of disease"<br />
and proved that the same natural laws prevail both in<br />
pathology and in the physiology of the healthy organism.<br />
Pathology has in this way become one of the true natural<br />
sciences.<br />
The general processes of disease as well as the conditions,<br />
present in the special affections of particular organs ;<br />
were carefully investigated and brought within range of<br />
scientific observation. CORVISART studied the pathological<br />
alterations of the heart and great vessels, a subject workedf<br />
at also by HODGSON, LATHAM, HOPE, STOKES, BOUILLAUD,<br />
SKODA, TRAUBE and others. Later on, the changes in the*<br />
blood were brought within the sphere of observation and<br />
•chlorosis and leukaemia recognized as individual diseases.<br />
G. L. BAYLE published investigations, which attracted<br />
attention, upon pulmonary consumption and its relation to<br />
the appearance of tubercle, and remarked on the similarity<br />
of this deposit in the different organs. ANDRAL, SCHON-<br />
LEIN, TROUSSEAU, who published a treatise on laryngeal<br />
phthisis, and others also studied the same subject, on<br />
which however no certain conclusion was arrived at until<br />
the most recent times, when the discovery was made that<br />
tuberculosis is an infective disease. By his work on the<br />
inflammations of the mucous membranes BRETONNEAU<br />
founded the teachings upon diphtheria, the relations of
DIAGNOSIS AND PATHOLOGICAL ANATOMY. 477<br />
which to catarrh and to croup were explained by later<br />
observers.<br />
The invention of the laryngoscope and its adaptation to<br />
medical practice brought about a complete revolution in<br />
laryngological inquiry, and rendered possible greater precision<br />
in the observation and treatment of diseases of the<br />
larynx.<br />
At the same time endoscopy, a method of observation<br />
previously attempted, led to remarkable results in other<br />
directions. CRUVEILHIER and ROKITANSKY explained the<br />
origin and nature of "simple ulcer" of the stomach;<br />
PETIT, SERRES, P. A. LOUIS, and others established the<br />
diagnosis of the so-called abdominal typhus or enteric<br />
fever, and J. R. BlSCHOF observed the intestinal ulcers<br />
characteristic of that disease.<br />
The pathology of the liver was advanced chiefly by G.<br />
BUDD, ANNESLEY, FRERICHS, and others, and that of the<br />
kidneys by P. RAYER, BRIGHT, and TRAUBE, the last of<br />
whom drew attention to the interdependence of affections<br />
of the kidneys and of the heart. ADDISON first described<br />
the degeneration of the adrenals, and BASEDOW drew a<br />
picture of the group of symptoms constituting the disease<br />
named after him.<br />
Dermatology was scientifically treated by ALIBERT,<br />
BlETT, WlLLAN, BATEMAN, C. H. FUCHS, ERASMUS<br />
WILSON, and F HEBRA, and the subject of venereal<br />
diseases by BAERENSPRUNG, K. W BOECK, RICORD, and<br />
others, while a scientific foundation was given to the study<br />
of nervous affections by VALLEIX, DUCHENNE, ABER-<br />
CROMBIE, ROMBERG, REMAK, and others.<br />
The treatment of the insane, a subject already for some<br />
time regarded as a special branch of medicine, was by<br />
degrees extricated from the chaos of mystical fancies<br />
which surrounded it, and which led people to regard mental<br />
diseases as the consequences of sin, or as the punishments<br />
of God, or, at all events, as purely psychical defects. The<br />
causes of mental aberration were at last sought for in
478 MODERN TIMES.<br />
corporeal lesions. This path, already trodden by PlNEL,<br />
ESQUIROL, and CHIARUGI, was afterwards pursued further,<br />
especially by SPURZHEIM, the disciple of GALL, by REIL,<br />
FOVILLE, and CALMEIL, who by his work on general<br />
paralysis initiated observations upon this disease, by the<br />
two FALRETS, by MOREL, who turned his attention to the<br />
aetiology of derangements of the intellect, by SCHROEDER<br />
VAN DER KOLK, GUISLAIN, JACOBI, C. F. NASSE, and<br />
GRIESINGER. The results of autopsies were next called in<br />
evidence to establish and furnish strict proof of these<br />
views. Nevertheless, success was not met with in making<br />
diagnoses founded upon symptoms tally with the anatomical<br />
facts observed. Such an attempt could not be expected<br />
to succeed until the anatomy and physiology of the central<br />
nervous system had been placed in a clearer light.<br />
More remarkable than the progress in mental pathology<br />
was the improvement in the treatment of the insane. What<br />
a beneficent change has taken place in this since the time<br />
when, at the command of the philanthropic Emperor JOSEPH<br />
II., the " mad house" was built in Vienna, and the patients<br />
there, as at St. Luke's, in London, were exhibited to a<br />
spectacle-loving populace, were caged up in prison with<br />
criminals, and punished for their "mad tricks" by<br />
depriving them of food or by giving them the whip ! It<br />
was one of the greatest achievements of humanity when<br />
PlNEL gained his point with those in power during the<br />
French revolution, and released the insane—those most<br />
unhappy of men—from chains which had been forged by<br />
religious prejudice, and secured by the ignorance of the<br />
doctors. Tender nursing and appropriate medical treatment<br />
were now extended to those afflicted with insanity ;<br />
institutions were founded in which they were protected and<br />
kept under observation. JOHN CONOLLY promulgated the<br />
system of " no restraint," by which mechanical coercive<br />
measures were as far as possible banished from the treatment<br />
of the mentally afflicted, and still further progress<br />
was made in this direction by the foundation of colonies of
DIAGNOSIS AND PATHOLOGICAL ANATOMY. 479<br />
lunatics where, as at Gheel, the patients enjoyed a certain<br />
amount of freedom combined with careful supervision and<br />
nursing, and were provided with work suited to their con<br />
ditions.<br />
In no department of pathology, however, were the<br />
changes greater than in that of infectious diseases. New<br />
forms of disease were now recognized which had previously<br />
escaped observation, and those affections already on the<br />
nosological list were more correctly and accurately dis<br />
tinguished from one another, especially in respect of their<br />
aetiology. The nature of the infective material of disease,<br />
its origin within or without the human body, its develop<br />
ment in different media, its relation to climate, soil, etc.,<br />
the duration of its virulence, and the possibility of its being<br />
transported from place to place were all subjects carefully<br />
investigated.<br />
Asiatic cholera in the 19th century outstepped the limits<br />
of its native land, and spread itself over the globe. The<br />
grievous loss of human life which its presence entailed<br />
rendered it incumbent upon the doctors to examine into<br />
the causes and real nature of this disease. The remarkable<br />
relations existing between its origin and extension on the<br />
one hand, and conditions of the soil on the other, were<br />
the subject of observation. With the discovery of the<br />
comma-bacillus, made not long since, it would seem that the<br />
real and essential cause of the disease has at last been<br />
found.<br />
Yellow fever, which had often been brought to Europe,<br />
was carefully studied, as also were other exotic diseases,<br />
such as beriberi.<br />
The appearance of cerebro-spinal meningitis in an<br />
epidemic form directed public attention to this previously<br />
unknown disease.<br />
At the same time enlightened views began to prevail on<br />
many other diseases. The conception of typhus, a term<br />
at first chiefly of symptomatological significance and lend<br />
ing itself to qualification according to the prevailing
480 MODERN TIMES.<br />
phenomena of the disease, under such forms as abdominal<br />
typhus, brain typhus, pulmonary typhus, and spotted<br />
typhus, underwent a complete revolution as astiological<br />
considerations advanced into the foreground. It was<br />
recognized that three diseases which hitherto had been<br />
comprised under the name of typhus, namely, exanthematic *<br />
typhus, abdominal typhus, and recurrent typhus (or<br />
relapsing fever) are distinct in their origin, in their Jj<br />
extension, and in their essential nature, so that one never<br />
arises out of another.<br />
The exanthematic fevers came also to be more clearly<br />
understood. The relation of measles, German measles,<br />
small-pox, and scarlet fever to one another and to other<br />
affections was closely studied.<br />
The discovery that cow-pox protects, at least for a considerable<br />
time, from small-pox led to one of the most<br />
beneficent discoveries mankind has ever been blessed with. •<br />
The imperishable merit of this discovery belongs to<br />
EDWARD JENNER ; its utility can only be doubted by those<br />
who are ignorant of the history of small-pox.<br />
The pathology of infectious diseases entered upon a new<br />
phase when the parasitic character of a number of these<br />
was recognized. Observations upon certain diseases of<br />
plants, and upon muscardine, a disease of the silkworm<br />
caused by a fungus, examination of the itch-mite, of the .<br />
fungi causing favus, pityriasis versicolor, herpes tonsurans<br />
and other skin diseases, of the different entozoa of the .<br />
human body, the discovery of the trichina spiralis and of<br />
the symptoms produced by it, all led to more attention<br />
being paid to parasites and lowly organized forms of life<br />
and to their pathogenic significance being made the subject<br />
of inquiry. *%<br />
The experience acquired of pellagra and diseases of that<br />
kind arising from the consumption of tainted food, as too,<br />
observations made upon those diseases which are capable<br />
of being transferred from animals to men had a similar<br />
effect. When, in the splenic fever of cattle, in relapsing
DIAGNOSIS AND PATHOLOGICAL ANATOMY. 481<br />
fever, in pyaemia, puerperal fever, erysipelas, osteomyelitis,<br />
and many other diseases, microscopical organisms resem<br />
bling fungi of different kinds were found in the blood and<br />
in certain secretions or tissues, the idea inevitably suggested<br />
itself of ascribing the origin and cause of such diseases to<br />
these bodies.<br />
The scientific proof that these lowly organized forms do<br />
actually stand in a causal relation to particular diseases<br />
was only possible after these organisms had been success-<br />
fe :. fully isolated by special methods of research, inoculated on<br />
healthy animals and found to produce the diseases in<br />
question. These demands have, up to the present, only<br />
•*• been satisfied in splenic fever, relapsing fever, malignant<br />
erysipelas, diphtheria, and Asiatic cholera. But a multitude<br />
of facts and probabilities point to pathogenic bacteria<br />
being the active cause of the origin and spread of tuber<br />
culosis, leprosy, typhus and enteric fevers, scarlet fever,<br />
septicaemia, malarious and many other forms of disease.<br />
The difficulties encountered in carrying on these<br />
inquiries experimentally, especially in the choice of an<br />
animal suitable for inoculation and susceptible to the<br />
diseases, render it evident that results can only be arrived<br />
at slowly. The facts hitherto established have given a<br />
firmer basis to setiology, inasmuch as they have rendered<br />
manifest the really active causes of the diseases and have<br />
consequently indicated both to pathology and to thera<br />
peutics the paths upon which, for the future, they must<br />
travel.<br />
Materia medica has during the latter decades changed<br />
from a study of pharmaceutical wares into a science of<br />
pharmacodynamics which, being in close association with<br />
physiology and experimental pathology, is supported by<br />
clinical experience and experiments on living animals. By<br />
means of it a bridge may here and there be thrown across<br />
the deep chasm which divides the theory and the practice<br />
of medicine.<br />
During the same period the pharmacopoeia has been<br />
I I
482 MODERN TIMES.<br />
enriched by the addition of a great number of remedies.<br />
Chemistry has shown us the way to extract the active<br />
principles of many vegetable and animal substances so that<br />
they may be used in therapeutics, while avoiding undesirable<br />
effects due to the admixture of other bodies with such active<br />
'principles. A number of alkaloids, especially of narcotic<br />
drugs, were thus discovered and introduced into medicine,<br />
for example morphia, in 1804, simultaneously by SERTUR-<br />
NER and SEGUIN; cantharidine, in 1812, by ROBIQUET;<br />
strychnine in 1818 and quinine in 1820, by PELLETIER and<br />
CAVENTON; veratrine, in 1818, by MEISSNER; caffeine,<br />
in 1820, by RuNGE; solanine, in 1821, by DESFOSSES;<br />
conine, in 1830, by GEIGER ; atropine, in 1831, by MEIN ;<br />
'r'aconitia, in 1833, by HESSE; colchicine by GEIGER and<br />
" : F HESSE; cocaine, in 1859, cumarine, curarine, saponine,<br />
'.. pantonine, pilocarpine, pepsine, pancreatine, etc. For<br />
"*" many other remedies such as iodine, discovered, in 1811, by<br />
• COURTOIS in the waste liquors produced in the manufacture<br />
of carbonate of soda; bromine discovered by BALARD, in<br />
^ 1826; iodide of potassium, bromide of potassium, chloro-<br />
C': form, iodoform, chloral hydrate, salicylic acid, and carbolic<br />
acid we have to thank the progress made in chemistry,<br />
whereas others again like kamala, kusso, condurango, etc.,<br />
have been brought to Europe from distant parts of the<br />
world. Their effects upon the healthy and diseased<br />
oro-anism have been studied as well as the most suitable<br />
way of using them.<br />
In regard to the application of remedies the healing art<br />
in the nineteenth century has made important progress;<br />
the introduction of subcutaneous injections by PRAVAZ and<br />
A. WOOD, of treatment by inhalation, and of pulmonary<br />
therapeutics with the excellently adapted apparatus which<br />
supplies the diseased respiratory organs with vapour in<br />
a more or less concentrated state as required, are real<br />
advances in the method of exhibiting curative agents.<br />
The foundation on a scientific basis of balneology, climatology<br />
in relation to disease and its cure, hydrotherapeutics,
SURGERY AND OPHTHALMOLOGY 483<br />
electrotherapeutics and the Swedish gymnastic exercises<br />
are also achievements of our own time.<br />
SURGERY, OPHTHALMOLOGY, OBSTETRICS AND<br />
STATE MEDICINE.<br />
THE startling advance made in pathological anatomy<br />
the light thrown upon pathological theories, in conjunction<br />
with the progress made in physics and chemistry exercised:<br />
a powerful influence upon surgery. The processes of suppuration,<br />
ulceration, cicatrization and regeneration of tissues<br />
and other questions of surgical pathology were made subjects<br />
of precise knowledge by observation and experiment.<br />
The development and diagnosis of pathological new<br />
growths occupied in an equal degree the attention of surgeons<br />
and of pathological anatomists.<br />
Operative surgery also made important advances. This<br />
however did not consist so much in the improvement of<br />
methods of operating or in the invention of new operations<br />
as in the fact that it came to be understood that the task of<br />
surgeons is not to remove diseased parts so much as when<br />
possible and safe to retain them. This idea introduced<br />
the " conservative" surgery of our day. It could only<br />
become realized with the help of anaesthetic inhalations, to<br />
free the patient from pain during the operations and to<br />
prevent the reaction entailed by it upon the organism<br />
and by the invention and introduction of the antiseptic<br />
treatment of wounds by means of which the morbid<br />
•conditions apt to follow operations were avoided and a<br />
successful result insured. These two great achievements<br />
of the healing art of the nineteenth century have completely<br />
transformed the character of surgery. They have endowed<br />
the surgeon with.courage and self-confidence ; for he knows<br />
that the success of his art will no longer be imperilled by<br />
accidents it is impossible to foresee; and the breast of the<br />
patient is filled with hope so that he no longer looks upon
484<br />
'<br />
••-?c.<br />
MODERN TIMES.<br />
the surgeon with fear and horror but regards him rather as<br />
the dispenser of healing and health.<br />
Far back in ancient times and in the middle ages, as I<br />
have mentioned already, narcotic potions, and inhalations<br />
were employed for the alleviation of pain. The imperfect<br />
success of this practice and above all the disastrous results<br />
which ensued make it very probable that but little use was-<br />
made of such methods. After HUMPHREY DAVY had dis<br />
covered the stupifying effect of nitrous oxide gas, experi<br />
ments were made with it which led to its being used during<br />
operations, especially in the field of dentistry. About the<br />
same time the-narcotic properties of ether were discovered,<br />
a substance which was especially submitted to investigation<br />
and recommended by JACKSON. In 1847 FLOURENS by<br />
experiments on animals established the fact that chloroform,<br />
which had been simultaneously discovered by SOUBEIRAN<br />
and J. LlEBIG, is a more desirable narcotic. SlMPSON, the ,<br />
obstetric physician, soon after introduced it into medical i<br />
practice. The advantages possessed by this over other<br />
kindred substances are sufficient to explain the fact of its<br />
having by degrees superseded them*<br />
Many other substances have been used for producing<br />
anaesthesia by inhalation ; chloroform has been associated^<br />
with ether or with injections of morphia in order to increase<br />
or to prolong the narcotic effect, and the production of<br />
local anaesthesia in those parts of the body about to be<br />
operated on by means of cold produced by the ether-spray,<br />
etc., has been recommended. J. CLOCQUET, J. BRAID and,;<br />
others have attempted to perform surgical operations<br />
during hypnotic insensibility. The use of anaesthetic<br />
inhalations rendered the operator free to perform his task<br />
thoroughly and without hindrance. Difficult, prolonged<br />
and very painful operations might now be ventured upon<br />
which before did not admit of being performed.<br />
To obviate dangerous bleeding at or after operations,<br />
* O. KAPPELEU in "Deutsche Chirurgie," her. v. BILLROTH U. LUECKK„<br />
Stuttgart 1880.—MARION SIMS : The discovery of anaesthesia, Richmond 1877.
SURGERY AND OPHTHALMOLOGY. 485<br />
besides ligature and other methods previously used, torsion<br />
again came into vogue. SlMPSON recommended acupres<br />
sure while other surgeons preferred forcible flexion of the<br />
limbs, styptics like liquor fern perchloridi, or else cold or<br />
the cautery in various forms. BRUNNINGHAUSEN sug<br />
gested the idea of previously rendering the part of the<br />
body about to be operated on bloodless by means of a<br />
tightly applied bandage, but it was reserved for a talented<br />
surgeon of the present day to discover a method of accom<br />
plishing this end. The galvano-cautery, the credit of the<br />
introduction of which rests chiefly with MlDDELDORPF,*<br />
and the method of operating invented by CHASSAIGNAC<br />
called ecrasement lineaire, both aimed at effecting the<br />
removal of diseased parts without loss of blood. By the<br />
first method the layer of charred tissue served at the same<br />
time as a covering under which the wound produced by<br />
the operation could cicatrize ; another advantage afforded<br />
: by it was that it was applicable in very vascular tissues<br />
and in parts of the body which are not easily accessible<br />
to the knife or actual cautery. The difficulties which<br />
present themselves in the removal of extensive morbid<br />
growths were by this method materially lessened.<br />
The methods of amputation were but little improved<br />
except for the introduction of the oval amputation by<br />
SCOUTETTEN, of the oblique incision by BLASIUS, of the<br />
elliptical (resembling the last mentioned) by SOUPART,<br />
and of improvements in the flap operation. But greater<br />
care was devoted to the after-treatment than formerly. In<br />
many cases exarticulation was preferred to amputation<br />
through the bone. The removal of the limb at the hip<br />
joint was first performed by LARREY. Exarticulation at<br />
the knee-joint was given a further development by sawing<br />
off the condyles as recommended by SYME and by the<br />
attempt to secure a union between the patella, after sawing<br />
off its articular surface, and the end of the femur. Special<br />
pains were taken to perfect the exarticulations in the<br />
* A. TH. MIDDELDORPF : Die Galvanokaustik, Breslau 1854.
486 MODERN TIMES.<br />
tarsus and at the ankle. Besides CHOPAR<strong>T'</strong>S method in<br />
the mid-tarsal joint, the operation at the tarso-metatarsal<br />
articulation was recommended by LlSFRANC, that immediately<br />
below the astragalus by TEXTOR, and that at the<br />
ankle-joint by SYME and PlROGOFF. The conservative<br />
character of surgery at this period and the anxiety felt<br />
to retain as much of the body as possible were manifested<br />
by the increased favour in which resections were held..<br />
These operations aimed at a total or partial removal of<br />
bones and were practised both in the extremities, on the<br />
spinal column by the removal of a spinous process or a<br />
transverse process, or of the posterior part of a vertebral<br />
arch, on the ribs as in empyema, on the pelvis and<br />
shoulder (especially on the scapula and clavicle) and on<br />
the upper and lower jaw-bones.<br />
The operation of resection of the joints reached a high<br />
degree of perfection. After the first successful attempts<br />
which had been made in the 18th century upon the<br />
shoulder and knee they were performed at other joints, for<br />
instance at the elbow and in the foot first by the elder<br />
MOREAU, and at the hip by A. WHITE. The numerous<br />
wars of these latter decades have afforded abundant<br />
opportunities to practise and improve this method. The<br />
indications for resection were accurately laid down and<br />
extended in some directions, for instance in relation to<br />
orthopaedic requirements. Special modifications of this<br />
procedure were suited to certain cases as the resection of<br />
a wedge of bone in club foot, the so-called temporary<br />
resections in which no permanent removal of bone was contemplated,<br />
subperiosteal resections, and osteotomies of<br />
different kinds.<br />
The treatment of fractures and dislocations was greatly<br />
improved by the introduction of stiffening bandages which<br />
keep the limb motionless while the cure is proceeding.<br />
LARREY for this purpose employed a mixture composed of<br />
albumen, white lead and spirits of camphor; SEUTIN invented<br />
the starch bandage in 1834, and VEIEL recom-
SURGERY AND OPHTHALMOLOGY. 487<br />
mended the glue-bandage. The plaster of Paris bandage<br />
became the most widely recognized and popular: it had<br />
been already known for a long time in the East, and at the<br />
beginning of the 19th century was introduced into Europe<br />
but did not acquire any great reputation until the plaster-<br />
bandages invented by MATHYSEN came into use. Besides<br />
these Tripoli powder, guttapercha, plastic felt and paste<br />
board, silicate of soda, paraffin and stearin were made use<br />
of for splints of this kind. The art of constructing suitable<br />
suspension and extension apparatus and couches for the<br />
sick was learnt with results favourable to the process of<br />
recovery.<br />
When fractures had united in a faulty position the callus<br />
was divided by breaking or cutting so that union might<br />
take place afresh. In ununited fracture endeavours were<br />
made to unite the bones by suturing them or by artificially<br />
inducing inflammation of the fractured ends and by other<br />
means. Myotomy and tenotomy for the relief of deformities,<br />
as for instance in caput obstipum and club foot, were as has<br />
been mentioned performed in earlier times : but the sub<br />
cutaneous operation is an invention of the 19th century.<br />
DELPECH introduced this operation into surgical practice<br />
and the success obtained in it by DUPUYTREN, DlEFFEN-<br />
BACH, STROMEYER and others in different affections secured<br />
for it a permanent place in operative surgery. The cure of<br />
aneurism was attempted by compression, ligature, galvano-<br />
puncture and prolonged flexion.<br />
The subject of hernia was advanced by valuable works<br />
upon its anatomical relations, upon the causes of strangula<br />
tion and other matters. In its treatment, after taxis, atten<br />
tion was directed chiefly to the trusses which were brought<br />
to great perfection : in the radical cure attempts were made<br />
to close the outlet by plastic operations—by drawing in<br />
the scrotal integument or by inducing hypertrophy of the<br />
tissues artificially. To the methods of lithotomy were<br />
added the recto-vesical operation designed by L. J. SANSON<br />
and the sectio vagino-vesicalis recommended by J. CLEMOT.
488 MODERN TIMES.<br />
Great services were rendered to lithotrity by GRU1THUISEN,<br />
CIVIALE, LEROY D'ETIOLLES, N. HEURTELOUP and others<br />
by the invention and improvement of instruments. The<br />
cure of stricture of the urethra was attempted by caustic<br />
bougies, by gradual or forcible dilatation, or by urethrotomy.<br />
The removal of a kidney by operation was first accomplished<br />
by O. SlMON while splenectomy—an operation<br />
undertaken as early as in the 16th century,—since the time<br />
of QuiTTENBAUM has been performed in a methodical<br />
manner, all the.rules of surgical art being observed* The<br />
long-known operation of gastrotomy led to gastrostomy,—<br />
to the establishment of an artificial gastric fistula—a<br />
measure introduced by EGEBERG and SEDILLOT into<br />
surgical therapeutics. Resection of the stomach or<br />
oesophagus, and extirpation of the larynx have only been<br />
ventured upon in our own time.<br />
Rhinoplastic operations in the 17th and 18th centuries<br />
had become entirely forgotten. In 1742 the medical<br />
faculty of Paris declared the accounts left by TAGLIACOZZI<br />
upon the subject to be purely imaginary, and the operative<br />
procedure said to have been adopted by him to be impossible.<br />
Then English journals in 1794 brought the news<br />
that the art of replacing the loss of a nose by means of a<br />
plastic operation was practised in India by the natives.f<br />
European doctors studied the methods of operating in<br />
use, imitated them, and then tried the old Italian procedure :<br />
finally they generalized the operation by directing their<br />
attention to the replacement of the lips and eyelids, to the<br />
closure of abnormal openings, etc. Through the labours of<br />
C. F. GRAEFE, DELPECH, DIEFFENBACH, B. LANGENBECK<br />
and others, plastic operations reached a high degree of perfection.<br />
The transplantation of pieces of skin to replace a<br />
loss of substance as after burns, or of periosteum and bone<br />
for the purpose of making a firm support, and the attempts<br />
* ADELMANN in the Archiv f. Id in. Chirurgie 1887, Bd. 36, H. 2.<br />
f E. ZEIS op. cit. S. 208 el seq.
SURGERY AND OPHTHALMOLOGY. 489<br />
to enclose in a healing wound foreign tissues or substances<br />
are procedures belonging to the most recent times.<br />
Transfusion of blood after great haemorrhage was again<br />
looked upon with favour at the end of the 18th century and<br />
was made the subject of careful investigation by J.<br />
BLUNDELL. PREVOST, DUMAS and other physiologists<br />
who studied the question recommended the transfusion of<br />
defibrinated blood; PANUM advised that human blood<br />
alone should be used. The subject of transfusion came to<br />
be regarded in another light when it was recognized that<br />
the beneficial effect of the operation does not depend upon<br />
the increase of blood but to the heightened intravascular<br />
pressure consequent upon the addition made to the con<br />
tents of the vessels.*<br />
The satisfactory results achieved by operative surgery at<br />
the present day are very largely due to the strictly methodical<br />
employment of antiseptic measures which in the two last<br />
decades have received universal recognition.f With this a<br />
new period began in the history of surgery : how far and<br />
how deeply to influence that science can scarcely be cal<br />
culated precisely.<br />
Special branches of surgery have for the first time met \<br />
with a scientific treatment in the 19th century and have<br />
become separately-taught subjects.<br />
Thus dentistry was by degrees withdrawn from the<br />
hands of ignorant barbers and quacks and placed in those<br />
of doctors who investigated the relation of diseases of the<br />
teeth to the other diseases of the body and established a<br />
scientific treatment of the former.<br />
The diagnosis and treatment of diseases of the ear were<br />
materially advanced by the improvements in the cathateri-<br />
zation of the Eustachian tube introduced by A. CLELAND.<br />
The artificial illumination of the tympanic membrane, the<br />
* E. v. BERGMANN: Die Schicksale der Transfusion im letzten Decennium<br />
Berlin 1883.<br />
f And for which the thanks of mankind at large as well as of the profession<br />
are due to Sir JOSEPH LISTER, Bart.—E. H. H.
49° MODERN TIMES.<br />
auscultation of the middle ear, and the air-douche constituted<br />
further steps of progress in this department in the<br />
establishment of which ITARD, LEON DELEAU, W. R.<br />
WILDE, J. TOYNBEE, as well as W KRAMER and<br />
several other German aurists have rendered distinguished<br />
services.<br />
Ophthalmology has celebrated great triumphs. A clear<br />
insight has been gained into the causes and anatomical<br />
changes of most diseases of the eye, the ophthalmoscope<br />
has become an aid to diagnosis capable of solving the most<br />
difficult questions of pathology, and many new methods of<br />
treatment and operative measures have been added to our<br />
resources. ADAM SCHMIDT was among the first to draw<br />
attention to the relations existing between many diseases<br />
of the eye and diseased conditions of other parts of the<br />
body: he called eye-disease " the elegant diminishing<br />
mirror of diseases of the body." The different forms of<br />
conjunctivitis were accurately defined, and thus the real.<br />
characteristics of the Ophthalmia AUgyptiaca s. militaris—<br />
a disease terrifying to the people by its rapid spread and<br />
malignity—were recognized, iritis and choroiditis were<br />
studied, and attention was drawn to the increase of intraocular<br />
pressure which is the real cause of glaucoma and<br />
for which A. V. GRAEFE recommended iridectomy. In<br />
opacities of the cornea attempts i were made to graft on. to<br />
the place from which the cicatricial tissue had been excised<br />
a piece of glass or part of the cornea of an animal in order<br />
that thus the rays of light might be able to pass : or else an.<br />
artificial pupil was formed. BEER successfully avoided the<br />
evil results of the method of iridectomy introduced by<br />
WENTZEL, by which affections of the lens or its capsule<br />
were frequently induced ; this he achieved by ceasing to<br />
detach the flap of iris -within the anterior chamber (as had<br />
previously been done) and by introducing the procedure of<br />
drawing it out of the corneal wound and cutting it off outside<br />
the eye. This method was afterwards improved and<br />
is practised to this day, whereas other methods of opera-
SURGERY AND OPHTHALMOLOGY. 491<br />
tion conceived with the same object in view such as<br />
iridodialysis have long since vanished from practice.<br />
In the removal of cataract, the aetiology and anatomical<br />
seat of which disease were more closely investigated,<br />
extraction was the method chiefly employed as it appeared<br />
in most cases to be the best and safest operation : another<br />
method in use was couching of the affected lens which<br />
SCARPA combined with discission and which BUCHHORN<br />
advised should be performed through the cornea. The<br />
operation of extraction was materially improved by making<br />
the incision towards the upper part of the cornea, a method<br />
recommended by F JAGER though perhaps practised pre<br />
viously by other ophthalmic surgeons and which eventually<br />
led to linear extraction. The latter operation which had<br />
been previously practised in certain cases, for instance in<br />
shrivelled and soft cataracts, was improved and made<br />
the common property of the profession by A. V. GRAEFE<br />
who made his incision in the upper part of the cornea<br />
and performed an iridectomy as part of the same operation.<br />
Operations on the eye were remarkably facilitated when<br />
mydriatics came into use. HlMLY drew attention to the<br />
dilating effect upon the pupil of hyoscyamus and bella<br />
donna. Other drugs with similar properties were after<br />
wards discovered ; but the alkaloids and especially atropine<br />
were chiefly used.<br />
But there is no doubt that the greatest achievement of<br />
ophthalmology in the 19th century was the discovery of<br />
the ophthalmoscope. This instrument assumed a definite<br />
shape in 1851 though the invention had been led up to by<br />
researches upon the luminous fundus of the eyes of certain<br />
animals which were in possession of a tapetum lucidum, by<br />
observations upon the human retina in cases of absence of the<br />
iris, and by PURKINJE'S experiments. While HELMHOLTZ,<br />
the discoverer of the ophthalmoscope, elaborated nay almost<br />
completely perfected its theory, it was chiefly A. VON<br />
GRAEFE who recognized and demonstrated its importance
492<br />
MODERN TIMES.<br />
for ophthalmic practice. With the help of the ophthalmoscope<br />
it became possible to examine the state of the refractive<br />
media and of the fundus oculi. The meaning of<br />
-amaurosis—which had previously been defined in a jocular<br />
way as a disease " where the patient cannot see anything<br />
at all—nor the doctor either" was now rendered more<br />
intelligible * and the various diseases of the retina could be<br />
differentiated. When the relation of these to certain<br />
general diseases, such as BRIGH<strong>T'</strong>S disease, diabetes mellitus,<br />
etc., was established, the ophthalmoscope acquired<br />
importance as an aid to diagnosis in general medicine.<br />
Midwifery proceeded on its natural course of development,<br />
and by taking into consideration all the physiological and<br />
pathological processes which occur in women, became enlarged<br />
into gynaecology. The opinion came at last to be held<br />
that pregnancy, parturition, and childbed are physiological<br />
conditions, the course of which should be left to the management<br />
of nature, so long as abnormal circumstances do not<br />
•call for the interference of the doctor. LUKAS BOER, who<br />
defended these principles, rejected the so-called preliminary<br />
treatment, which in most cases acted injuriously, and proved<br />
that presentations of the face, breach, knee, and foot do not<br />
always require the art of the doctor, but that spontaneous<br />
birth frequently occurs through the regulative powers of<br />
nature.<br />
The clumsy and complicated instruments of an earlier<br />
day were simplified, and operative midwifery was confined<br />
to those cases in which it was indispensable. It was discovered<br />
how to diagnose a contracted pelvis by methodical<br />
measurements, and how to estimate the influence of changes<br />
of position and diseases of the uterus upon pregnancy and<br />
parturition.<br />
The pathology of the lying-in period was carefully investigated,<br />
especially in regard to puerperal fever, a disease<br />
-upon the pathogenesis of which a startling light was thrown<br />
by the observations of the unfortunate SEMMELWEISS.<br />
* A. HIRSCH : Geschichte der Augenheilkunde op. cit., S. 474.
SURGERY AND OPHTHALMOLOGY 493<br />
The diseases of the uterus, the ovaries, and the neighbouring<br />
parts gave opportunities for operative interference, the<br />
methods of which were now for the first time to be discovered.<br />
Extirpation of the uterus in malignant affectionsof<br />
that organ was already practised by MONTEGGIA,<br />
OSIANDER, and others, and in modern times the operation,<br />
has been perfected in points of technical detail.<br />
The same is true of ovariotomy, which was for the first<br />
time performed by MACDOWELL in 1809, and since then.<br />
has been much improved as an operation. The operativetreatment<br />
of prolapse of the uterus and vagina, as also the<br />
operation for vesico-vaginal fistula—a condition formerlyconsidered<br />
incurable—are also achievements of modern<br />
times, and are chiefly due to the labours of JOBERT DE<br />
LAMBALLE, MARION SIMS, G. SIMON, and other distin<br />
guished gynaecologists of our time.<br />
3 The progress of medicine in the 19th century was not,<br />
however, confined merely to improved methods of treating<br />
the individual sufferer, but it brought home to the conscience<br />
of the public the important relation borne bysanitation<br />
to the State itself. No doubt this was associated<br />
with political development, under the influence of which<br />
the government of the State was reminded of its duty toprotect<br />
society, and in every citizen s breast the sentiment<br />
was aroused that he, as a member of the commonwealth,<br />
had a duty to fulfil towards it, and was interested in its<br />
welfare.<br />
And thus forensic medicine, which was established and<br />
advanced by A. HENKE, MENDE, CHRISTISON, CASPER,.<br />
ORFILA, TARDIEU, and others, and State medicine, the<br />
foundation of which was the work of PETER FRANK, were<br />
added to the list of medical subjects in which instructionwas<br />
given. What the former became for the Law Courts<br />
the latter was intended to be for the Government—the<br />
compendium of all the knowledge required by the medical<br />
specialist when consulted by the authorities. Sanitary<br />
control became expanded into hygiene, or care of the public
494 MODERN TIMES.<br />
health, as the opinion gained ground that not the State<br />
alone, but every individual member of it, is called upon to<br />
avoid diseases and to assist in the increase and maintenance<br />
•of sanitation.<br />
The identity of interests which unites the people and the<br />
government in questions of hygiene, certainly in a great<br />
measure affords an explanation of the fact that during the<br />
last few decades the scientific solution of such problems has<br />
been prosecuted with extraordinary zeal. The influence of<br />
nourishment, clothing, dwellings, soil, climate, temperature,<br />
air, occupation, age, and sex have been carefully investi<br />
gated.. Researches into the causes of the rise and spread<br />
of epidemics, studies upon the ways most conducive to<br />
„ health of laying out graveyards and constructing hospitals,-<br />
.factories, and buildings of all kinds, the supervision of<br />
prostitution, etc., formed other subjects for the public<br />
hygienist to consider.<br />
Much assistance in answering these questions was<br />
afforded, firstly by the history of medicine, which reported<br />
upon the course taken by the great pestilences which swept<br />
through countries in times past and upon the result of<br />
measures adopted to control them ; secondly, by medical<br />
geography, which showed that many diseases occur only, or<br />
•at least chiefly, in certain localities, and which essayed to<br />
explain this fact : and thirdly, by medical statistics which<br />
attempted to sift the accumulated material by the help of<br />
numerical methods, and to draw conclusions from the results<br />
obtained. Chemistry, the use of the microscope, and'the<br />
practice of experiment were all resorted to in research, and<br />
valuable information was certainly gained. Meanwhile<br />
bacteriology directed attention to the material causes of<br />
disease.<br />
The • results achieved by hygiene through these means<br />
during the last few years and the expectations which are<br />
fostered of further manifestations of its power in the future<br />
have created for it in a short time a prominent position<br />
among the various branches of medical science. The task<br />
of warding off diseases appears as great and as beneficent
MEDICAL TEACHING AT THE PRESENT TIME. 495<br />
as that of curing them, and public medicine and private<br />
medicine occupy equally honourable positions. The governments,<br />
in organizing sanitary administration, in appointing<br />
boards of health, and in providing for medical supervision<br />
in certain cases, bear testimony to their recognition of<br />
the truth of this fact and of its continually increasing<br />
significance, and the prophecy of Mr. GLADSTONE that the<br />
doctors are to be the leaders of the people is approaching<br />
its fulfilment.*<br />
MEDICAL TEACHING AT THE PRESENT TIME.<br />
THE changes and improvements in medical teaching during<br />
the last hundred years are not less important than the ,.<br />
results which have been achieved in the prosecution of' the "<br />
study of medical science. When we contemplate the institutions<br />
and medical schools of our own time richly provided<br />
as they are with every kind of appliance to facilitate<br />
teaching, with departments excellently arranged for the<br />
study of normal and pathological anatomy and physiology,<br />
and provided with the necessary apparatus and instruments ;<br />
their laboratories for physics, chemistry and hygiene ; their<br />
well stocked museums and numerous departments for<br />
clinical teaching ; when we look at all these and draw a<br />
comparison with the inadequate beginnings which were<br />
made in.; such things in the last century we recognize at<br />
once,how much has been done since then.<br />
At* the present time the above arrangements are<br />
* Wishing to get a corroboration of this rather sweeping prediction at first<br />
hand, I ventured to trouble Mr. GLADSTONE with a letter asking him if he could<br />
confirm it. I quoted to him the above passage as it stands in the German text.<br />
Mr. GLADSTONE honoured me with a reply as follows :—" So far as regards the "<br />
" exact words cited in your letter I cannot positively say Aye or No, and I"<br />
'rather think that I should in using them have added some qualifying or "<br />
" limiting expressions. But it is certainly the fact that, for a very long time "<br />
:< I have believed the medical profession to be in a state both of absolute"<br />
"advance from the progress of its science—this it may be said is,mere"<br />
;< commonplace—and of relative advance from the particular features attaching "<br />
'to our civilization in its onward movement."—E. H. H.
496 MODERN TIMES.<br />
1 **&%,<br />
considered indispensable for teaching medical students,<br />
whereas then at most academies they were entirely absent .<br />
or at least but ve.ry poorly represented, and scarcely ever<br />
to be found in anything like the completeness of to-day,.<br />
The method of teaching has consequently assumed another<br />
form: practical demonstrations became by degrees of<br />
supreme importance in medical teaching, indeed together<br />
with the necessary explanations, constituted the whole of<br />
it/while theoretical lectures were pressed into the back- ,<br />
ground and by degrees nearly abandoned. The comprehen- ,<br />
siOn of scientific facts and theories is thus extraordinarily<br />
facilitated: for what the senses*take in is impressed not ,.<br />
merely upon the memory but also on the understanding.<br />
It now came about that a division of labour wal intro- \<br />
duced throughout the teaching Of medicine and assumed a<br />
definite form. It was arranged' that the-lecturer should<br />
which he<br />
concern himself exclusively^tirthe ^"MgSL'<br />
represented "and might thns^be^ able to attain to the ability<br />
and- certainty, of jLjeu^uasaJau it. The perfecting of<br />
medical teaching by the establishment of new professorships<br />
demanded by the development of medical science,<br />
its advance in the direction of specialization, and the introduction<br />
and improvement of examinations intended to afford.<br />
aguarantee that young medical men had acquired the knowledge<br />
necessary for their calling, constituted further additions<br />
made to medical education during this period.<br />
It is true that the progress on this path differed widely<br />
in different countries. The condition of general culture,.<br />
the state of medical science in particular, the social stand-<br />
, ing of doctors, historical traditions, and above- all the^<br />
attitude of the State towards the subject of public instruction,<br />
exerted an influence quite opposed to uniformity in<br />
this matter., ?*5|<br />
Amongst rude savages, Caffres, Red Indians, native/"<br />
Brazilians,.etc, medicine-men and magicians are labouring*<br />
to this day to drive away, diseases by means of prayers and*<br />
incantations, and medical knowledge but seldom gets.
%<br />
MEDICAL TEACHING AT THE, PRESENT TIME. 497<br />
beyond the recognition of the ..healing 4 powers of certain<br />
herbs and roots.*<br />
Even amongst civilized people very different conditions<br />
prevail in regard to medical science. The native doctors<br />
in the "countries of Islam practise still for the most part<br />
upon the same principles which were propounded by the<br />
representatives of Arabian medicine in the middle ages<br />
and the Chinese doctors still believe in the untenable<br />
speculations which have received acceptance in their<br />
( country, for thousands of years.t Yet contact with<br />
European medicine and the recognition of its advantages<br />
have led to attempts being made to introduce it into these<br />
lands. At. Constantinople and Cairo medical schools have<br />
been- founded in which European and, by preference,<br />
- French and German- doctors have been installed as<br />
teachers. Th> reform was set in progress in Japan in a<br />
much more thorough way and as it appears with greater<br />
results, there, during the last few years numerous schools of<br />
medicine have arisen, organized entirely after the European<br />
2 " d p ;°;t<br />
d for the n,ost part with a<br />
5 1 " CUltUre gives W *y before the higher<br />
which everywhere presses forward victoriously and makes<br />
mankind happy with the blessings* it brings<br />
In civilized countries the general and special education<br />
or the various callings has come to. acquire a certain<br />
similarity, a fact explained by the easy and rapid way in<br />
which literature serves to transmit advances and achievements<br />
made in the domain of the intellect. Medical )<br />
science exhibits the same phenomenon and the educated [<br />
0, 4 9- iv, 473.. Vj 2, I49J et<br />
BAT,,,: Der Mensch in der Geschichte, Uip2is ,„& {],6 „*£ »"-*•<br />
T r. UABRY: La medecine chez les Chinois Paris i8fi3 n 1 M<br />
m the Med. Rep. Shanghai ,882, No. M. ' 63 '~ D ' J " M A C < % <br />
• S. 64 rt 4. N °'= r -- H - G ^«KH in the Breslauer arztl. Zeitschr. iv,<br />
K K
49§<br />
MODERN TIMES.<br />
doctor in France professes the .same doctrines as his<br />
colleague in Germany, Austria, Italy and other couri nes.<br />
The science of medicine is the same in all civiiizea<br />
coLtries C but the amount of knowledge>*£^J£<br />
representatives in particular states is *ff££ju£ the<br />
external forms which are associated with the teaching ot<br />
external iui rprtain places, for instance in<br />
students are manifold. In certain piac ,<br />
America and England, the arrangement still ex.ts o<br />
doctors taking pupils and framing them up Ike handi<br />
craftsmen to become masters in their art;* but as a general<br />
r f medical knowledge is acquired at s c ^ ^<br />
attainment is made the exclusive task * £ ^ j g *<br />
as medical faculties, joined with schools of other subjects<br />
and made universities or else lead an » ^ » ^ r ^ *<br />
These schools are in many countries conducted or at<br />
these sc Qthers th take up<br />
least supervised by the State w self_admimstered<br />
IffeXeTt tL organization of medical teachm ave<br />
been of great importance in its development as a review<br />
of the exiting conditions in the different countries shows us<br />
The tat of Lirs which has, in this respect, come to exist<br />
among the English, French and Germans will deservedly<br />
cairn our most careful attention, for it shows us ypes of<br />
the various forms exhibited by systems of medical edu a<br />
tion while the medical teaching of other nations cannot fail<br />
to have been powerfully influenced thereby.<br />
ENGLAND.-NORTH AMERICA.<br />
THE customs of the middle ages in regard to medical<br />
teaching have been preserved longest in England.t Here.<br />
* This, however, may be said to be exceptional at the present day in England,,<br />
_ t"",; "PUSCIMA.N : Das medicinische Unterrichtswesen in England in th.<br />
Be J d All* Zeitung, Miinchen ,886, No. 7-9.. This essay which I wr e<br />
!ntr the" fresh impression of personal observation formed a preparation for<br />
the present work.
ENGLAND.—NORTH AMERICA. 499<br />
At rt.ll happens, though far less frequently than it did<br />
formerly, that students of medicine begin their studies by<br />
wth himf PUP ' d0Ct ° r ^ PraCtice * th V "main<br />
of whir n " year '; n ° rder '° get Some " ' Wea<br />
of what mil some day be required of them* In a<br />
method such as this much naturally depends upon the<br />
.nd.v.duahty of the pupil and nearly everything upon he<br />
personal quaht.es of the teacher. If tL pupif is in<br />
dustnous and intelligent and if the teacher has patience<br />
knowledge, and a pleasure in his work, then this y'ea i to<br />
the former one of incalculable advantage for his later<br />
*.ud,es ; otherwise it is lost time and serves at mo to<br />
prov.de h.m with mechanical habits which sometL s<br />
approach charlatanism. "crimes<br />
the same occurs when the first year is nassed in =.<br />
osp.ta as is often the case. The "stude ts" th k "ha<br />
there at least they will have opportunities of observing<br />
, man ^ ^ hope fo ^ . ^ sen, „g<br />
r .dent doctors upon the most important cases. If they<br />
-e not d.sappo.nted in their expectations they n.ay indeed<br />
«,«.«. certa.n dexterity in their intercourse with pat e„,T<br />
wh.ch ,s very useful^ to them in their later clinica and<br />
profess.onal work. But for many other reasons th<br />
-nner of being i„troduced to Jedicalstu" on<br />
wh,ch must raise grave doubts as to its prop iety It<br />
tends to make the student a superficial observe for<br />
h^r^\FF:tFFFF<br />
'ess can they justify the inconveniences to which 11 '<br />
pafents who are under treatment are subjectedI In<br />
iT^iztr-^ in a raedi - ^<br />
preferred to tins grop.ng ,„ the dark. On this account
MODERN TIMES.<br />
it has become more and more usual for students to betake<br />
LteLs at once to a medica, school o.- » ^ * -<br />
0j h 0I rtt ?X^ **« T;<br />
mediZ As the demands made >^« J<br />
raffia Sft^ h r-<br />
hat men of the required ability were appointed to teach.<br />
TLtT entered the" universities, for these up to quite*<br />
^tl^Twere destitute of the arrangements required<br />
for the prosecution of medica, s ud, , The ^ Engl^<br />
universities were r % ^hmg more t^ ^ ^ ^<br />
on an extendedI scale as d ^ M tQ ^<br />
taction was not to educate OB ^ ^ . ^ .<br />
nnt rlnrtors or men ot science, uuu ^<br />
W mathematical studies together with logic and moral,<br />
and mathemat ^ t
ENGLAND.—NORTH AMERICA.<br />
501<br />
where such was obtained : it permitted everyone to practise<br />
medicine and left it to the public to distinguish the good<br />
practitioners from the bad. Under these circumstances<br />
success naturally became the final court of appeal. The<br />
•quacks mistrusting a judgment which offered them so little<br />
security, endeavoured by means of testimonials, in which<br />
•their medical studies and their professional ability were set<br />
forth, to court the popular favour. Various doctors' guilds<br />
and medical schools were prepared to give such testimonials<br />
upon payment of fees, and held examinations, which,<br />
however, were neither arranged on any uniform plan nor<br />
supervised by any central authority, and consequently<br />
gave no guarantee .whatever of the training of the medical<br />
practitioner. Many got diplomas in foreign countries or<br />
endeavoured to procure them by illegal methods; the Arch<br />
bishop of Canterbury had * also the right of conferring the<br />
degree of Doctor of Medicine. It went so far at last that<br />
it was sufficient for anyone to.be recognized as a doctor<br />
if he were presented as such to the authorities bv two<br />
members of a medical guild.<br />
Such a state of things must have resulted in serious dis<br />
advantages to the patients upon whom these practitioners<br />
were "let loose." The imperturbable equanimity of the<br />
English people was at length shaken, and Parliament was<br />
induced to find a remedy. The result of its deliberations<br />
was the Medical Act of 1858, in which it was accurately<br />
defined what Corporations should thenceforth have the<br />
right to hold examinations and grant certificates which<br />
should be recognized as valid. These examinations were<br />
rendered subject to the supervision of the General Council<br />
of Medical Education and Registration of the United King<br />
dom, which body has to take care that the examinations<br />
are conformable to the end in view. Should this not be<br />
the case in any particular instance the General Council<br />
has authority to order a change of examiners, or, if the<br />
cause of complaint is not removed, to take away the<br />
: this is still a prerogative of the See of Canterbury.—E. H. H.
502<br />
MODERN TIMES.<br />
privilege of.'holding examinations from the Corporation in *.<br />
question. , , • • * .<br />
The names of persons who have proved their capacity<br />
for medical practice before a corporate body entitled to j>.<br />
hold examinations are entered in a Register kept by the<br />
General Council and published for general informationonly<br />
legally qualified and registered medical practitioners •<br />
are entitled to sue for fees in a court of justice or to hold<br />
official appointments. The General Council, upon which<br />
other duties connected with the polity of the medical profession<br />
also devolve, consists now of* 30 members 20<br />
elected by the various examining bodies, 5 nominated by<br />
the Crown, and 5 direct representatives of the profession.<br />
The President is chosen by the Council.<br />
By the Medical Act of 1858 a secure foundation was<br />
laid for the further development of systematic medical<br />
education in England and at least the grossest abuses were<br />
abolished. Proposals for reform were evoked by the<br />
defects in the system thus shown to exist; proposals, however,<br />
which were either not at all or but partially carried<br />
out In 1881 a commission of experts was appointed to<br />
consider the question of medical education. On this<br />
occasion distinct expression was given to the need oU<br />
general scientific preliminary training for medical students<br />
the introduction of State examinations was mooted and it<br />
was demanded that only diplomas testifying to the ability<br />
of the holders to practise all branches of medicine, and<br />
not merely special branches, should be granted. But the<br />
majority opposed these suggestions and rejected most<br />
resolutely the idea of absolute uniformity in medical education,<br />
considering it to be an especial advantage of the<br />
English system that within certain limits it allowed freedom<br />
of movement and by the number of the schools produced<br />
a natural diversity of training.f<br />
* By the Medical Act, 1886.—E. H. H.<br />
f Report of the Royal Commissioners appointed to inquire into the Medical<br />
Acts, presented to both Houses of Parliament (Parliamentary Papers for 1882,
ENGLAND,—NORTH AMERICA. !•» c0<br />
At the present time, students of medicine, get their<br />
technical education chiefly at the medical schools, and<br />
universities. Of the former there is no scarcity : twelve<br />
exist in London alone. They are connected with hospitals<br />
and are commonly named after them.<br />
The oldest school is that of St. Bartholomew's Hospital,<br />
the eventful history of which is closely bound up with the<br />
development of medicine in England. The existence of<br />
this institution for the sick dates from 1164 and the<br />
earliest records of medical teaching held there, from 1662.<br />
To its staff belonged WILLIAM HARVEY, the discoverer of<br />
the circulation of the blood, and at a later period the surgeons<br />
PERCIVAL POTT and ABERNETHY*<br />
St. Thomas' Hospital was founded in the 13th century;<br />
with it too a school is connected : in the records of this<br />
institution an apprentice is mentioned as early as in the<br />
year 1551. The present buildings were opened for use in<br />
1871 and by their very convenient arrangements excited<br />
the admiration of experts.<br />
So too St. George's, the Middlesex, the London, Charing<br />
Cross, Westminster, St. Mary's, and Guy's are hospitals<br />
used for medical teaching and have medical schools<br />
attached.f<br />
King's College and University College (not identical<br />
with London University) are also connected with hospitals;<br />
but they differ from the other medical schools in not being<br />
isolated from, but in organic connection with, faculties of<br />
vi '$<br />
Vol. 29). « It would be a mistake to introduce absolute uniformity into medical<br />
education. One great merit of the present system, so far as teaching is concerned,<br />
lies in the elasticity which is produced by the variety and the numbers of<br />
educating bodies."<br />
* N MOORE in St. Bartholomew's Hospital Rep., Lond. 1882, xviii, p. 333.<br />
1846 DELAM0TTE: The R ^ al Hos P ltal °f St- Bartholomew, London<br />
t Bi». GOLDING: Historical account of St. Thomas' Hospital, London<br />
S^wT. 5 S ° N: The HiSt ° ry ° f thC MiddleseX Hos P ital > London<br />
»4?.-W. E. PAGE: St. George's Hospital, London 1866.-B. GOLDING • The<br />
°ng.n, plan and operations of the Charing Cross Hospital, London ,867.
5°4<br />
MODERN TIMES.<br />
law, arts and science, with technical institutions and other<br />
establishments.<br />
There exists also in London a medical school for women<br />
who intend devoting themselves to the profession<br />
In other towns of the United Kingdom medical schools<br />
are to be found, as at Birmingham, Bristol, Leeds, Liver<br />
pool, Sheffield; Dublin, Belfast, Cork, Gal way .Edinburgh,<br />
Glasgow, etc. ; there are also schools which offer instruc<br />
tion in certain departments but not a complete medical,<br />
education ; such are the West London Hospital Preparatory<br />
School and COOKE'S School of Anatomy.<br />
In the British colonies, Canada, and . British India a<br />
number of medical schools are also to be found arranged<br />
after the English pattern : there is a similar establishment<br />
at Valetta in the island of Malta.*<br />
The medical schools of England, like the hospitals to<br />
which they are attached, are as a rule private undertakings.<br />
The State neither pays for their maintenance nor gives any<br />
contribution towards it; as little does it exert any influence<br />
on their organization and administration or upon the educa- (<br />
tion given at them. Consequently attendance at these schools<br />
by no means confers the right to practise. Their teaching<br />
staffs have no authority to hold examinations the passing<br />
of which confers any public rights, but are compelled to<br />
refer their pupils to the medical corporations and examining<br />
bodies for this purpose, the certificates and diplomas of<br />
which constitute the license to practise. The private<br />
character of the medical schools is manifested in their<br />
arrangements, in the way in which they are equipped with,<br />
appliances for teaching according to the taste and choice -<br />
of the teachers, and in other ways. The decision in these<br />
matters rests with the Governors who exercise a super<br />
vision over the affairs of the hospital. With them lies the<br />
duty of appointing the medical and teaching staff. As<br />
these Governors consist chiefly of laymen and have among<br />
* H. B. HARDWICKE: Medical education and practice in all parts of the<br />
world, London 1880.
ENGLAND.—NORTH AMERICA.<br />
505<br />
them no experts or next to none, there is imminent danger<br />
Qf patronage and favouritism being shown in filling up<br />
appointments, the more so that this is not, as in Germany<br />
and Austria, based upon distinguished scientific services<br />
rendered by the candidates or, as in other lands, the result<br />
of competition.<br />
The salaries of the teachers are derived from revenue<br />
brought in by the fees charged at the medical school: only<br />
in special cases, where this, on account of the small number<br />
•of students, is too little, or when it is considered worth<br />
while to secure a celebrated teacher, do the Governors<br />
make an extraordinary vote for this purpose. The tuition<br />
fees are consequently pretty high. Thus at St. Bartho<br />
lomew's 9 guineas are demanded for a course of physio-<br />
^°gy>Pj guineas for materia medica, 4 guineas for botany<br />
or forensic medicine; at St. Thomas' Hospital 4 guineas<br />
are paid for a three months' course of dissecting: but it is<br />
exceptional for a student to take out a card in only one<br />
subject. As a rule he joins all the lectures and demonstra<br />
tions in the order laid down in the curriculum of the school<br />
he is attending and pays a composition-fee smaller or<br />
greater according to whether it is paid at once or by<br />
instalments, but which is approximately within the limits of<br />
£95 and £13° for the whole period of studentship. Special<br />
charges are often made in addition for the use of instruments,<br />
for "parts ; ' for dissection, etc.<br />
The extent to which the different schools are provided with<br />
conveniences for teaching is by no means uniform. Many<br />
have lofty and well-ventilated lecture-theatres, convenient<br />
dissecting-rooms, well-arranged physiological and chemical<br />
laboratories, natural history collections, anatomical and<br />
pathological museums, libraries, and all kinds of con<br />
veniences for clinical teaching. Others are but poorly<br />
provided, and have less to offer in this respect than the<br />
smallest medical faculty in Germany. As a general rule,<br />
the departments for preparatory and preliminary studies<br />
are less complete than those which are more immediately
5° 6 MODERN TIMES.<br />
connected with medical and surgical practice. The utilitarian<br />
spirit which animates the English people is, perhaps,<br />
nowhere so plainly expressed as in those establishments<br />
which aim purely and simply at preparing men for medical<br />
examinations. They resemble the institutions in Germany<br />
which make it their business to provide the general education<br />
demanded of candidates for commissions in the shortest<br />
possible time, and which are known under the name of<br />
Fahnrichspressen (cramming-places for ensigns).<br />
On the other hand, the English universities look upon it<br />
as their highest task to call into existence and to nurture<br />
the taste for scientific pursuits. Whoever studies medicine<br />
in one of them has in view a thorough and profound education<br />
in the preliminary subjects of the natural sciences, and contemplates<br />
taking academical degrees. But it costs a man<br />
much more to maintain himself at the university than it<br />
does at a medical school, and by studying at the university<br />
the total period of student-life is prolonged, and much<br />
expense is incurred in consequence of associating with<br />
rich young men and participating in the amusements in<br />
vogue. The doctors who have resided at the university<br />
and have proceeded to degrees belong by their learning<br />
and their social position to the elite of the profession.<br />
The English universities are no more State institutions<br />
than are the medical schools. Their expenses are met by<br />
the academical fees paid by the students, and by the income<br />
derived from their rich estates. They are administered<br />
and governed by senates composed of public men in a<br />
distinguished position of life, and of academical professors.<br />
Unlike those of the rest of Europe, the English Universities<br />
are institutions not devoted merely to teaching, but<br />
to general training also. Affiliated to them are numerous<br />
colleges and halls—establishments suggestive of monasteries<br />
—where the students live together and are boarded and<br />
assisted in their studies. Oxford possesses 25, Cambridge<br />
20 of these institutions. Some of them in their origin,<br />
reach back into the middle ages. They owe their founda-
ENGLAND,—NORTH AMERICA. 5°7<br />
tion to pious bequests and donations, and are richly pro<br />
vided with pecuniary means. Unfortunately these are not<br />
always expended in a suitable or proper* way. Instead of<br />
serving to advance science and to support poor students,<br />
their chief function is to provide profitable sinecures for the<br />
Master and Fellows—that is to say, the head and officials of<br />
the colleges. If these positions were granted exclusively to<br />
persons who devoted their lives to scientific research, and<br />
whose efforts in this direction were rich in results, large<br />
salaries might, perhaps, be justifiable; but all that is<br />
demanded of the candidates for a fellowship is that they<br />
must possess an academical degree. Favouritism gives the<br />
casting vote in the election to these appointments; that<br />
the clergy should get the lion's share is consonant with the<br />
conditions of English life, which bestow upon the cleric of<br />
the State Church a social power like that which the<br />
Catholic priesthood in the Tyrol is vainly attempting to<br />
usurp. A member of the Senate of the University of<br />
Cambridge complained publicly that the places of authority<br />
in the colleges there were held by clergymen, and that the<br />
fellowships were given away to people who achieve nothing<br />
whatever for science, the university, or their colleges* E.<br />
RENAN says that a small German university, with its<br />
awkward professors and its starving private teachers, does<br />
more for science than all the pomp and wealth of Oxford.<br />
Most of the colleges at Oxford and Cambridge are<br />
ancient buildings and well worth seeing on account of<br />
their architecture and their artistic monuments. With<br />
their towers and archways, their chapels, colonnades and<br />
butteries they call back times long passed away; but the<br />
spirit which animates these establishments is that of<br />
scholasticism. Although it was a British monk who in the<br />
13th century directed the first powerful assault upon this<br />
system it is nevertheless precisely in his native land that<br />
the method of contemplating nature characteristic of the<br />
middle ages has been preserved to this day. Theological<br />
* A few brief remarks on Cambridge University, London 1870.
^08 MODERN TIMES.<br />
dogma dominates the educational system and the whole<br />
intellectual life of the English people and has impressed<br />
upon them a stamp of piety which suits but badly their<br />
freethought in politics and their restless grasping at earthly<br />
possessions. The theological character is impressed even<br />
upon the external appearance, of the professors and<br />
students : seeing them as they pass by in their long<br />
black gowns and biretta-like caps one would almost<br />
imagine oneself transported back to the days when monks<br />
conducted the education of youths.<br />
The students are kept subject to strict discipline. They<br />
are not treated like young men ripe for a certain amount<br />
of freedom and independence but like pupils in need of<br />
continual supervision. Among the students are to be<br />
found persons of various ages but as a general rule the<br />
16th year constitutes the minimum limit* They differ no<br />
less in respect of their knowledge ; while many have hardly<br />
surmounted the. elementary stages of a general education,<br />
others have by their scientific work already attracted the<br />
attention of specialists.<br />
The number of professors is proportionately small, reaching<br />
at Oxford 55, at Cambridge only 40 in all the faculties<br />
together. But there are in addition numerous readers or<br />
lecturers and tutors who work in the university or in the<br />
separate colleges, give lectures, hold classes, or impart<br />
private instruction. At some universities, as members of<br />
them assert, teaching lies chiefly in the hands of these<br />
persons : probably however only in the departments belonging<br />
to general education ; in medicine and the natural<br />
sciences this can hardly be the case. Medical science<br />
however is but partially represented at the English universities,<br />
f But a short while ago there were in hardly any,<br />
more than one or two medical professors ; only in the most<br />
recent times have they been increased in number. And<br />
* The 18th and 19th are the usual years for matriculation.—E. H. H.<br />
+ There is no doubt that the Medical School of Cambridge is now a great<br />
institution and one of which any country might be proud.—E. H. H.
'ENGLAND.—NORTH AMERICA. 509<br />
even by these theoretical teaching, especially of anatomy<br />
and physiology, was attended to more than anything else.<br />
The completion of professional training is effected by<br />
practical instruction in the healing art given in the medical<br />
schools situated at the same place or in the near neighbourhood,<br />
and either incorporated with the university or<br />
at least in relation to it. An opportunity for this<br />
practical training is afforded at Cambridge by Addenbroke's<br />
Hospital, in Oxford by the Radcliffe Infirmary,* at<br />
Durham by the Medical School of Newcastle-upon-Tyne,<br />
while at Manchester Owen's College forms a part of the<br />
university founded there in 1880. The University of<br />
Dublin (Trinity College) which has existed since 1591,<br />
and the Royal University of Ireland, which since 1880 has<br />
taken the place of the Queen's University, are associated<br />
in a similar way with the medical schools and hospitals in<br />
their vicinity.<br />
The connection between the medical faculties and the<br />
universities in Scotland is of a closer nature. The oldest<br />
universities of that country at St. Andrew's, Glasgow and<br />
Aberdeen arose under the influence of the Catholic clergy,<br />
and were governed by them : at St. Andrew's alone there<br />
existed a medical school.<br />
The University of Edinburgh began as a college and, as<br />
the educational establishment of the city, grew in importance<br />
and developed after the pattern of the Academy of<br />
Geneva.f When the medical corporation of the town laid<br />
out a botanical garden and gave instruction in medicine<br />
the obvious course was to associate such teaching with the<br />
college itself. Subsequently the town council of Edinburgh<br />
in 1685 appointed three professors of medicine:.<br />
they were doctors of the city, and lecture rooms were<br />
placed at their disposal but no salaries were given them.<br />
Amongst the first who taught there was ARCHIBALD PlT-<br />
* Oxford and Cambridge men generally attach themselves to London<br />
Hospitals for practical work.—E. H. H.<br />
t A. GRANT : The story of the University of Edinburgh, London 1884.
510 MODERN TIMES.<br />
CAIRN. In 1770 there existed already in the medical<br />
faculty chairs of anatomy, the " institutes of medicine,"<br />
the practice of medicine, midwifery, chemistry,<br />
botany, materia medica and natural history, as also a<br />
department for teaching anatomy, a botanical garden, a<br />
chemical laboratory and a clinic. In 1802 a surgical,<br />
and in 1825 an obstetric clinic were opened. In 1816 a<br />
proposal was made by the town council to appoint a<br />
professor of comparative anatomy and veterinary surgery ;<br />
but this was opposed by the academical senate. In the<br />
course of the 19th century the establishments required to<br />
satisfy the needs of medical teaching have been provided,<br />
as they have also at Glasgow and the other two universities.<br />
Besides the medical faculties there are in Edinburgh and<br />
Glasgow other special schools of medicine independent of<br />
the university.<br />
The University of London is no university at all, but an<br />
institution at which examinations are held and academical<br />
degrees obtained.<br />
The schools in the trans-oceanic countries under British<br />
rule are organized after the English model.<br />
Whoever devotes himself to the study of medicine has to<br />
give a proof that he has received a general education of<br />
a certain kind. If he is a university man the matriculation<br />
examination* suffices for this; if he first attends a '<br />
medical school he has to pass the examination of one of<br />
the numerous bodies commissioned for this purpose, and<br />
which are competent to give certificates recognized as<br />
sufficient. These do not by any means require an equal<br />
degree of knowledge, but a general scheme of subjects<br />
lies at the root of all, though the severity of the test varies<br />
in degree at different places.<br />
The programme of the London University permits us to<br />
form an opinion of the amount of knowledge required, and<br />
* i.e., at the University of London. Oxford and Cambridge men generally<br />
take the B.A. degree before attaching themselves to London medical schools.—<br />
E. H. H.
ENGLAND.—NORTH AMERICA.<br />
this may be taken as the maximum of knowledge demanded<br />
from the examinees* The subjects taken up are as follows<br />
:—i. Latin. 2. One of the following languages at the<br />
candidate's choice: Greek, French, German, Arabic, or<br />
Sanscrit. 3. The English language, history, and modern<br />
geography. 4. Mathematics. 5. Natural philosophy<br />
(physics). 6. Chemistry of the non-metals and botany. In<br />
the Latin examination passages of C^SAR de bello Gallico,<br />
of SALLUST, of CICERO'S easier orations, of LIVY, OVID,<br />
VIRGIL, and HORACE have to be translated into English ;<br />
in Greek, XENOPHON, HOMER, and EURIPIDES are the<br />
authors set, and questions are added upon the grammar and<br />
upon ancient history. The authors and the particular parts<br />
of their writings destined to form the subjects of each<br />
examination are, however, published a year and a half in<br />
advance, so that the candidates may be in a better position<br />
to get "coached" in them. Similar arrangements are<br />
made with regard to examinations in other languages.<br />
The mathematical examination includes decimal fractions,<br />
extraction of square roots, and simple equations, and in<br />
geometry the earlier books of EUCLID. The knowledge of<br />
physics required is of an altogether elementary character,<br />
being confined to the simple laws and facts of mechanics,'<br />
hydrostatics, pneumatics, heat, and optics, with the apparatus<br />
and instruments necessary to display them. In the<br />
chemical examination it is required that the candidate shall<br />
be acquainted with the most important elements and their<br />
properties, the commoner chemical processes, and the composition<br />
of water, air, and of certain bodies of frequent<br />
occurrence.<br />
This is essentially the amount of knowledge which in<br />
England forms the foundation of professional study. Even<br />
this is, however, encroached upon in many places by the<br />
examination in some subjects—languages, for instance (excepting<br />
Latin and English), and also physics and chemistry<br />
—not being compulsory, but at the will and pleasure of the<br />
* Calendar of the University of London 188.-5, P- 53 et seq.
CI 2 MODERN TIMES. .« '<br />
.** •* i'<br />
^candidates, and consequently for the most part falling ;<<br />
through altogether.<br />
If the general education of the English students is"<br />
-•inferior to that of the German, the English training has in * ;<br />
.another respect a great advantage over theirs, inasmuch as ,<br />
the development of the body has its, full importance<br />
assigned to it in England. The English schools are not ;<br />
only careful for the education of the intellectual powers of m<br />
their students, but attend also to the deve^pment of their<br />
bodies in health and strength. The yOung men spend, a<br />
large portion of-every day in the parks and gardens sur- i<br />
rounding many of the colleges. Bodily exercises of all<br />
kinds, cricket and football, wrestling, gymnastics, riding,'<br />
swimming, rowing, etc., preserve their health and strengthen<br />
.their bodily powers. As a result of this the English students<br />
'appear, as a general rule, fresher, healthier, and stronger<br />
than their German brethren, who, after having been obliged<br />
to sit on school forms at the gymnasium for 32 hours in the<br />
week, and having been plagued for the rest of their time<br />
with school tasks and private lessons,, come to the unfver- i<br />
sity tired and weary, and suffering frequently from short<br />
sightedness, weakness of the chest, and other affections. ,<br />
The curriculum of medical studies upon which the pro<br />
fessional education of most English doctors proceeds,<br />
exhibits many differences at the different seats of training,<br />
but shows in every case a marked preference for the so-<br />
called practical subjects. ( Leaving certain universities<br />
out of the question, a relatively small amount of time<br />
and labour is given to the, preliminary and* theoretical<br />
sciences ancillary to medicine. The extensive subject<br />
of physiology -which at" the_ German universities oc<br />
cupies six hours a week throughout a whole year is<br />
got through in 3-4 lectures a week during six months<br />
by, the medical schools, of England.* Practical work in<br />
* But in addition to the lectures on physiology which * the student has to<br />
attend during two winter sessions there are also physiological- demonstrations,<br />
and a course of practical physiology in the summer session : so the subject is<br />
really dealt-with in a satisfactory manner..—E. H. H.
ENGLAND.—NORTH AMERICA. 513<br />
anatomy or dissection is carried on only to a limited<br />
extent, as subjects can only be bought at a high price.*<br />
The_ dealers who used to undertake to supply them<br />
had in former times recourse occasionally to the practice •*•<br />
common' in the middle ages of stealing corpses from the<br />
'churchyard : some of these resurrection-men even perpetrated<br />
crimes, when there was a scarcity of subjects, by<br />
compassing the death of people and selling their bodies to<br />
the dissecting-room. The trial of the murderers BURKE<br />
and HARE at Edinburgh, in which the anatomist ROBERT<br />
•KNOX was involved, brought some horrible details to<br />
light, f It was not till 1832 that the practice of anatomical<br />
dissection in England was made subject to legal rules<br />
and the conditions defined under which it was to be<br />
carried on.<br />
The study of preparations in spirit and of wax models supplements<br />
actual dissection. Instruction in the theoretical<br />
sciences is limited to the elementary principles and most<br />
important' facts, especially in respect of their significance<br />
and use in professional practice. This keen sense of the<br />
practical applicability of acquired knowledge pervades the<br />
entire system of teaching at the medical schools. The<br />
teachers become reconciled to this demand for utilitarian<br />
science and in their lectures always give a prominent place<br />
to the relations borne bythe subject to points of practice ;<br />
by this they succeed in arousing and keeping engaged the<br />
attention of the students. In England the medical student<br />
.from the first day of his studentship is accustomed to<br />
regard medical practice as the goal which is set before<br />
him. Frequently during his first session he attends the<br />
visits to the wards made by the doctors in the hospital.<br />
The latter sessions are entirely devoted to clinical studies,<br />
the students serving in the wards and the different depart-<br />
* The supply, though not so abundant as on the Continent, is adequate.—<br />
E. H.H.<br />
t H. LONSDALE:, A Sketch of the Life and Writings of ROBERT KNOX, the<br />
anatomist,, London 1870. i{~<br />
*®***?L%L
514 MODERN TIMES.<br />
ments of the hospital or attending cases in the neighbourhood,<br />
writing diet-sheets and pr-es-criptions, keeping casebooks,<br />
performing surgical dressings, helping at operations,<br />
etc. When they are engaged on the surgical side of the<br />
hospital they are called " dressers," when on the medical,<br />
'•' clinical clerks." Whoever is unable to get an appointment<br />
of this kind at the hospital adjoining his medical<br />
school, has an opportunity of finding what he wants at<br />
one of the numerous large country hospitals. Students<br />
are only compelled to remain for 2\ years at the medical<br />
school; during the rest of the period of studentship they<br />
are at liberty to work at a hospital in the way mentioned.<br />
According to the Medical Act of 1858, 19 corporations<br />
and societies had the right to hold examinations and to<br />
grant permission to practise. These were the Societies<br />
of Physicians, Surgeons, and Apothecaries in London,<br />
Edinburgh, Glasgow and Dublin, and the medical faculties<br />
of the universities. The scientific and financial demands<br />
imposed upon candidates by these bodies differ as much as<br />
do the titles and degrees conferred. How this comes<br />
about may be rendered clear by the following examples.<br />
The two highest professional Societies of London, the<br />
Royal College of Physicians and the Royal College of<br />
Surgeons have agreed to hold conjoint examinations, after<br />
the satisfactory passing of which the diplomas of the two<br />
Corporations are granted* To be admitted to this examination<br />
the candidate must submit proofs that he has<br />
received instruction in botany, chemistry, materia medica,<br />
and pharmacy, has worked in a chemical laboratory, has<br />
dissected for twelve months, has attended a six-months'<br />
course of lectures on normal human anatomy, another of<br />
the same duration on physiology and histology, and a<br />
three-months' practical course on the two last subjects;<br />
further, that during six months he has attended lectures on<br />
internal medicine and surgery, and, for three months,<br />
lectures on midwifery and gynaecology, that he has<br />
J*^!'* This came into force on Oct. 1st, 1884.—E. H. H.
ENGLAND.—NORTH AMERICA. 515<br />
attended at least 20 labours and has received a systematic<br />
introduction to practical medicine in regard to such matters<br />
as the various methods of diagnosis, the examination of<br />
diseased tissues and of excreta, and the use of apparatus<br />
and instruments employed in these investigations; again,<br />
that he has attended a three months' course of pathological<br />
anatomy, has assisted at post-mortem examinations while<br />
engaged in clinical work, has attended lectures on forensic<br />
medicine for three months, and that, for nine months, he<br />
has been in attendance at the medical and surgical clinics<br />
and altogether has spent two years and a half at a hospital:<br />
he must have been clinical clerk and dresser each for six<br />
months and have acquired practical skill in the perform<br />
ance of vaccination. The candidate's knowledge is tested<br />
by many examinations, some of which are passed during<br />
the period of studentship. The first examination deals<br />
on the one hand with chemistry, physics, materia medica,<br />
pharmacy and medical botany, on the other with elemen<br />
tary anatomy and physiology. For the convenience of<br />
•candidates it may be divided in two portions which are<br />
held at different times : but the whole must, if possible, be<br />
passed during the first year. Six months later the candi<br />
date has to present himself for the second examination,<br />
which includes anatomy and physiology, but a more<br />
advanced knowledge of these sciences is required than in<br />
the first examination. In the third and last examination<br />
the subjects are internal medicine, therapeutics, patho<br />
logical anatomy and general pathology, surgery, surgical<br />
anatomy and pathology, midwifery and gynaecology : some<br />
questions on the subjects of forensic medicine and public<br />
health may be added. This examination, like the first,<br />
may be divided and passed at different times. It must<br />
however not be entered upon earlier than two years after<br />
the second examination. The candidate must be at least<br />
21 years of age. The examinations are partly oral, partly<br />
on paper, and partly again of a practical nature, such as<br />
involves the demonstration of anatomical preparations, the
516 MODERN TIMES.<br />
examination of patients, the performance of operations on<br />
the dead body, etc.<br />
The candidate who passes these three examinations<br />
receives the license of the Royal College of Physicians.<br />
and the membership diploma of the Royal College of<br />
Surgeons.* Equipped with these certificates he presents<br />
himself to the public as a doctor capable in every respect<br />
and equally trained in all branches of his art. Moreover<br />
each of these two qualifications may be granted by the<br />
corresponding corporation on its own account : f the<br />
examination in this case is easier, inasmuch as less importance<br />
is attached by the one examining body to anatomy<br />
and surgery and by the other to chemistry, physics, physiology<br />
and internal medicine.<br />
Other corporations proceed upon the same plan, granting<br />
diplomas in conjunction with other examining bodies or<br />
independently ; but some boards are satisfied more easily<br />
than others. Thus the Royal College of Physicians of<br />
Edinburgh only requires that the candidate should have<br />
dissected for six months, have attended lectures on physiology<br />
for three, the medical clinic for six, and the surgical<br />
for three months. The examination consists of two portions<br />
; in the first, anatomy, physiology and chemistry, and<br />
in the second, materia medica and pharmacy, general<br />
pathology and pathological anatomy, internal medicine,<br />
surgery, midwifery, forensic medicine and clinical medicine<br />
are the subjects in which the candidate's knowledge is<br />
tested.<br />
The Societies of Apothecaries demand of candidates<br />
that, in addition to having studied medicine, they shall<br />
have devoted special attention to the natural sciences and<br />
* Examining Board in England by the R. College of Phys. of ^.ondon and<br />
theR. C. of Surg, of England, London 1884.<br />
•j- The diploma of Member of the R. College of Surgeons is not now granted<br />
apart from the license of the R. College of Physicians except to students who<br />
commenced their professional studies prior to Oct. 1st, 1884. And the same<br />
may be said mutatis mutandis of the license of the R. College of Physicians.—•<br />
E. II. H.
ENGLAND—NORTH AMERICA. 517<br />
to chemistry and pharmacy, and have worked in a dispensary<br />
or a pharmaceutical laboratory. The Societies of<br />
Apothecaries of London and Dublin constitute medical<br />
examining boards.<br />
The apothecaries in England pursue the same course of<br />
study as the doctors and have a license to practise. This<br />
arrangement has probably developed out of the popular<br />
habit—which has existed in all ages—of seeking the first<br />
medical assistance at the hands of the apothecaries*<br />
The candidate has a free choice among the examining<br />
boards; he will probably decide upon that one which is<br />
nearest his home or the place where he has been pursuing his<br />
medical studies, or which makes the most moderate claims<br />
on his knowledge and his purse and is respected by the public.<br />
The Englishman will therefore in most cases try to get an<br />
English diploma, the Scotchman a Scotch, and the Irishman<br />
an Irish one : the more of these a man possesses, the greater<br />
the tribute paid to his knowledge and the greater the trust<br />
reposed in him by his patients. His position is still better<br />
if he is received amongst the members of a privileged<br />
medical corporation, receiving the title of " Member" or<br />
" Fellow" of the same. These titles are granted either<br />
after special examinations or are conferred upon suitable<br />
candidates after election by the Societies. Thus anyone<br />
who wishes to get the title of a Member of the Royal<br />
College of Physicians of London must submit to an<br />
examination which includes the same subjects as the<br />
examination for the license, but goes more deeply into<br />
them. From among the Members of this College the<br />
Fellows are chosen : the latter conduct the affairs of the<br />
College and represent it on public occasions. The Royal<br />
College of Surgeons of Englandf grants the Fellowship to<br />
those who have earned a right to it by passing two<br />
examinations, of which practical subjects, and especially<br />
* The Society of Apothecaries of London grants a diploma in Medicine,<br />
Surgery, and Midwifery registrable under the Medical Act, 1886.—E. H. H.<br />
t Calendar of the Royal College of Surgeons of England, London 1884.
518 MODERN TIMES.<br />
anatomy and surgery, constitute the chief part, and also to<br />
those of its members who by their achievements and their<br />
character appear worthy of this distinction* Most of the<br />
other medical corporations elect their Members without<br />
imposing the condition of an examination : they, in this<br />
way, always have it in their power to select none but the<br />
ablest and most esteemed representatives of their pro<br />
fession.<br />
The universities alone are entitled to grant academical<br />
degrees. The conditions under which these are conferred<br />
differ in different places. Yet, as a general rule, the<br />
principle holds good that university examining boards<br />
attach greater importance to a scientific preliminary training<br />
than is the case in most medical corporations. Some<br />
universities, like Oxford and Dublin, even require that<br />
candidates for medical degrees should already have taken<br />
an academical degree in arts.<br />
Whoever wishes to become a Bachelor of Medicine of<br />
Oxford (Baccalaureus medicinae) must possess the degree<br />
of Bachelor of Arts, which in England has about the same<br />
significance as Doctor of Philosophy in Germany. To<br />
Obtain this degree a course of studies of three years' duration<br />
in Uteris humanioribus is required.t The medical<br />
* The Fellowship of the Royal College of Surgeons is however very rarely<br />
granted as an honorary distinction.—E. H. H.<br />
f To obtain the B.A. degree the candidate must have resided for 12 termswithin<br />
the university. There are three courses of examinations to choose from—<br />
(i) Responsions (or an Extra-University equivalent). Moderations, Divinity<br />
Examination (or an equivalent), and Final Pass Schools in three subjects.<br />
(ii) Responsions, Moderations, Divinity, and Honours in Literae Humaniores,<br />
Mathematics, Theology, Oriental Languages, Modern History, Jurisprudence,<br />
or any of the subjects of the Natural Science |School, viz.,.<br />
Chemistry, Physics, Animal Morphology, Animal Physiology, Botany.<br />
(iii) Responsions with an adciitional subject, Divinity^, the Preliminary<br />
Examinations of either the Jurisprudence or Natural Science Schools<br />
and Honours in one of the Honour Schools mentioned in the precedingparagraph.<br />
Fide " British Medical Journal," Sept. 5, 1891, and the " Oxford University<br />
Calendar."—E. H. H.
ENGLAND.—NORTH AMERICA. 519<br />
studies follow upon this, and last for four years. The. test<br />
required of the candidate for the degree of Bachelor of<br />
Medicine consists of two examinations, of which the first<br />
deals with normal human anatomy, comparative anatomy,<br />
physiology, physics, chemistry, and botany; the second<br />
with theoretical and practical medicine, the diseases of<br />
women and children, materia medica, surgery, midwifery,<br />
forensic medicine, and hygiene, and in addition some<br />
passages are set for translation. from the medical writings<br />
of the ancients, as, for example, from the Hippokratic<br />
collection, from GALEN, ARET^US, or CELSUS, or else from<br />
one of these authors and a medical author of modern times.<br />
The degree of Bachelor of Medicine gives a right to<br />
practise medicine, and only those who possess this degree<br />
can proceed to the Doctorate; this, however, is not granted<br />
until the candidate has passed three years in medical<br />
practice, and has submitted a thesis upon a medical<br />
subject.*<br />
In other universities the tests are of a similar nature.<br />
The London University, the examinations of which have<br />
acquired a great reputation for thoroughness, does not<br />
insist upon the candidate for medical degrees possessing a<br />
degree in Arts, but only requires that such candidate shall<br />
have attained a certain proficiency in the natural sciences.<br />
Here the degree of Bachelor of Medicine is granted after<br />
the following examinations have been satisfactorily passed :f<br />
i. The Preliminary Scientific Examination, in which<br />
physics, inorganic chemistry, botany, and zoology are the<br />
subjects; 2. The Intermediate Examination, which follows<br />
two* years after the last-mentioned, and includes anatomy,<br />
physiology' with histology, materia medica, pharmaceutical<br />
and organic chemistry ; t 3. The Final Examination at the<br />
conclusion o| studentship, in which general pathology<br />
* For which a book published within two years of the candidate's application<br />
for the degree may be substituted.—E. H. H.<br />
t Assuming that the Matriculation Examination has been already passed.<br />
E. H. H.
520 MODERN TIMES.<br />
and therapeutics, hygiene, surgery, internal medicine, mid<br />
wifery, and forensic medicine are dealt with.<br />
These examinations, like those carried on by other<br />
corporations, are partly oral, partly on paper; practical<br />
demonstrations and bedside examinations of patients, etc.,<br />
are also made use of. Here also, as with the other<br />
privileged medical bodies, certificates are required of the<br />
candidates testifying that they have attended certain<br />
lectures and courses of instruction, clinics, and hospital<br />
practice.<br />
The degree of Bachelor of Medicine is the necessary<br />
preliminary to the other medical degrees. The doctorate<br />
is granted after some years have been passed in practice,<br />
and after a further examination in the various branches of<br />
medicine. Even the surgical degrees are only conferred on<br />
those who have passed the examinations required for the<br />
degree of Bachelor of Medicine. The degree of Bachelor<br />
of Surgery is obtained by passing an examination which<br />
deals principally with surgical anatomy and pathology,<br />
operative surgery, and the instruments used. The degree<br />
of Master in Surgery is conferred on anyone who being<br />
a Bachelor of Surgery has spent two to five years in the<br />
practice of surgery, either in a hospital or independently,<br />
and who succeeds in passing a further examination in the<br />
subjects above-mentioned. In the same way most other<br />
university examining bodies in granting surgical degrees<br />
impose the condition that the candidate must be legally<br />
qualified to practise as a doctor. At the Universities of.<br />
Durham and St. Andrew's a rule exists enabling doctors<br />
who have been in practice for 15 years, and are over forty<br />
years of age, to proceed to the degree of Doctor of<br />
Medicine by payment of 50 guineas after a comparatively<br />
very easy examination.<br />
The statistics of the results of examinations afford some<br />
opportunity of forming a judgment upon the importance<br />
and activity of the different examining bodies, and upon<br />
the localities selected by the majority of English doctors in
ENGLAND.—NORTH AMERICA. 52 I<br />
-which to prosecute their studies. We find that in the five<br />
several years, 1876-1880, at the University of Oxford, 6,<br />
10, 5, 6, 7 candidates received the degree of Bachelor of<br />
Medicine, and i, 1, o, 2, 2 that of Doctor of Medicine ;<br />
these numbers at Cambridge were, 13, 7, 9, 13, 16 and 5, 2,<br />
-6, 9, 7; at Durham, 2, 7, 9, 19, 13 and 2, 3, 1, 11, 10, while<br />
o, o, 2, 7, 4, took the degree of Master of Surgery; at the<br />
University of London the degree of Bachelor of Medicine<br />
was conferred on 23, 22, 25, 34, 39, that of Doctor on<br />
11, 8, 6, 12, 18; that of Bachelor of Surgery on 7, 3, 6, 6, 8 ;<br />
and that of Master of Surgery on 1, 1, 0,0, 1; during<br />
these years the Royal College of Physicians of London<br />
granted 90, 97, 68, 108, 79 candidates the license to<br />
practise, made 25, 23, 20, 14, 18 Members, and 12, 9, 13, 12,<br />
12 Fellows; the Royal College of Surgeons of England<br />
conferred the Membership on 406, 393, 361, 420, 404<br />
candidates, and the Fellowship on 29, 36, 21, 18, 30, giving<br />
also the license to practise dentistry to 20, 27, 27, 17, 19<br />
candidates; while the Society of Apothecaries licensed<br />
257, 206, 223, 216, 228 to practise medicine. The<br />
University of Edinburgh during the same period made 86,<br />
108, 115, 98, 134 Bachelors, 20, 34, 30, 33, 29 Doctors of<br />
Medicine, and 80, 100, 106, 98, 129 Masters in Surgery;<br />
at the Glasgow University these three categories were<br />
represented by 58, 62, 59, 57, 74; 23, 20, 11, 12, 16; 54,<br />
.56, 57, 54, 66; at Aberdeen by 41, 34, 57, 51, 48; 32, 46,<br />
30, 25, 35 ; 41, 34, 55, 48, 48 ; at St. Andrew's by 1, 2, 1,<br />
o, 3; 10, 10, 10, 10, 11, the first group in this case representing<br />
both Bachelors of Medicine and Masters of<br />
Surgery. The Royal College of Physicians of Edinburgh<br />
gave its license to 114, 99, 114, 145, 137, and in conjunction<br />
with the Royal College of Surgeons of Edinburgh to<br />
85, 116, 160, 156, 162, further in conjunction with the<br />
Faculty of Physicians arid Surgeons of Glasgow to 22, 13,<br />
21, 27, 30, and the same body made 23, 18, 2^, 19, 20<br />
Members, and 9, 11, 8, 6, 9 Fellows; the Royal College of<br />
Surgeons of Edinburgh elected 27, 31, 30, 41, 44 Fellows;
522 MODERN TIMES.<br />
and the Faculty of Physicians and Surgeons of Glasgow<br />
conferred the license on 63, 34, 55, 71, 73, and the Fellowship<br />
on 15, 23, 10, 3, 5 candidates. The University of<br />
Dublin granted the license in medicine to 3, 2, o, 2, 4, that<br />
in Surgery to 1, 2, o, o, 3 candidates, and created 36, 44,<br />
29, 29, 40 Bachelors, and 20, 17, 14, 15, 10 Doctors of<br />
Medicine, 20, 18, 23, 23, 28 Bachelors, and 8, 5, 3, 3, 1<br />
Masters of Surgery. The Queen's (now Royal) University<br />
of Ireland created 53, 44, 47, 55, 64 Doctors of Medicine,<br />
and 47, 35, 35, 34, 44 Masters of Surgery; the King's and<br />
Queen's College of Physicians in Ireland gave the license.<br />
in midwifery to 99, 8g, 79, 76, 78, and in medicine to 108,<br />
86, 78, 88, 105, and elected 5, 2, o, 3, 4 Fellows; the.<br />
Royal College of Surgeons in Ireland gave the license in<br />
midwifery to ii, 8, 10, 9, 10, and in medicine to 97, 99,.<br />
106, 122, 103, and made 13, 5, 6, 15, 14 Fellows ; the<br />
Apothecaries' Hall of Ireland licensed 22, 24, 23, 34, 42<br />
candidates. These figures show that the number of doctorswho<br />
pass university examinations as compared with the<br />
number getting licenses from the medical corporations isin<br />
England approximately as 1 to 8, in Scotland as 4 to 3,<br />
and in Ireland as 1 to 2.<br />
To distinguish the various degrees and qualifications<br />
short forms are employed as is the case generally with titles,<br />
in England. Thus F.R.C.P means Fellow of the Royal<br />
College of Physicians; M.R.C.S., Member of the Royal<br />
College of Surgeons ; L.S.A., Licentiate of the Society<br />
of Apothecaries; M.B., Bachelor of Medicine; M.S.,.<br />
Master of Surgery; M.D., Doctor of Medicine; to this is<br />
generally added the name of the university from which the<br />
degree has been obtained. The English public knows the<br />
value and significance of the different kinds of medical<br />
diplomas existing in the country, and is reminded upon<br />
these points by the differences in the professional fees,,<br />
which are regulated by custom.*<br />
* Amongst general practitioners the fees are to a large extent regulated by<br />
the house rental of patients.—E. H. H.
ENGLAND.—NORTH AMERICA. 52,3<br />
If England has not always followed the progress made by<br />
other countries in regard to systematic medical instruction,<br />
she, on the other hand, has rendered the great service of<br />
creating the first satisfactory system of sanitary government.<br />
By the Public Health Act of 1875, the whole land<br />
was divided into sanitary districts presided over by local<br />
authorities. These have to take care that drainage, building<br />
operations, public and private privies, the cleansing of<br />
the streets, the drinking water supply, the food, underground<br />
dwelling places, inns, hospitals, graveyards,<br />
factories, etc., are conformable to the principles of public<br />
health, and they elect sanitary officers to supervise and to<br />
take any necessary action in these matters. Whoever<br />
desires an appointment of this kind must be legally<br />
qualified to practise.<br />
At most universities and examining boards examinations<br />
are held and diplomas granted in sanitary science. It is of<br />
advantage for anyone desirous of occupying the position<br />
of medical officer of health to possess such a certificate of<br />
proficiency in sanitary science.<br />
This organization is founded upon the principle of selfgovernment,<br />
and may be expected to yield important<br />
results in a country the people of which have for centuries<br />
been accustomed to manage their own affairs, are in<br />
possession of abundant national wealth, and understand<br />
the advantage of a rational care for the public health.<br />
[Before being permitted to register the commencement of<br />
medical study it is necessary for the student to have passed<br />
a preliminary examination in the subjects of general<br />
education as specified in the following list:—(1.) English<br />
language; (2.) Latin; (3.) Arithmetic, algebra, and EUCLID;<br />
(4.) Elementary mechanics; (5.) Either Greek, French,<br />
German, Italian, logic, botany, zoology, or chemistry. For<br />
the London student these requirements are satisfied by his<br />
passing the matriculation of the University of London, the
524 MODERN TIMES.<br />
examination in arts of the Apothecaries' Society of London<br />
or the professional preliminary examination of the College<br />
of Preceptors. Examinations of British and Colonial<br />
universities are accepted by the General Medical Council if<br />
the above-mentioned subjects are shown to have been included.<br />
Students who propose to obtain medical degrees<br />
in the University of London should pass both the matriculation<br />
and the preliminary scientific examinations before<br />
commencing their regular medical studies.<br />
The following course of study is recommended at one of<br />
the chief Metropolitan schools for a student who enters in<br />
October, intending to obtain the double qualification of the<br />
"Conjoint Board" (L.R.C.P. Lond. and M.R.C.S. Eng.).<br />
It should be premised that the winter session extends from<br />
October 1st to March 31st, and the summer session from<br />
May 1st to July 31st.<br />
FIRST WINTER SESSION.—Lectures, etc.: Anatomy,<br />
Physiology, Chemistry, and Physics. Anatomical and<br />
Physiological Demonstrations. Dissections. Examinations:<br />
"Sessional" at Medical School in December and in<br />
March. Part III. (Elementary Anatomy and Physiology) of •<br />
the First Examination of the " Conjoint Board " in March.<br />
FIRST SUMMER SESSION.—Lectures, etc. : Materia,<br />
Medica, Practical Chemistry, and Practical Physiology.<br />
Examinations: "Sessional" in July, and Parts I. and II.<br />
of the "First Conjoint."<br />
SECOND WINTER SESSION.—Lectures, etc. .• Anatomy<br />
and Physiology, with Demonstrations and Dissections.<br />
Tutorial Class in Anatomy. Hospital Practice, Medical<br />
and Surgical. Examinations: "Sessional" in December<br />
and in March ; " Tests " and " Second Conjoint " in March.<br />
SECOND SUMMER SESSION.—Lectures, etc..- Hospital<br />
-Practice, Medical and Surgical. Midwifery. Practical<br />
Surgery. Examinations: Sessional in July. The course<br />
of instruction in , Elementary Clinical Medicine to be<br />
attended by Candidates for Out-Patient Clinical Clerkships.
ENGLAND.—NORTH AMERICA. 525<br />
THIRD WINTER SESSION.—Lectures, etc.: Hospital<br />
Practice, Medical and Surgical. Medicine, Surgery, and<br />
Surgical Pathology, Practical Surgery, Practical Course of<br />
Pathological Anatomy. Examinations : " Sessional " in<br />
December and March. Clinical Clerkship (if not held<br />
during July, August, and September) and Dressership in<br />
the Out-Patient Departments. Maternity cases may be<br />
attended at any time after the Lectures on Midwifery of the<br />
Second Summer.<br />
THIRD SUMMER SESSION.—Lectures, etc.: Hospital<br />
Practice, Medical and Surgical, with Clerkship or Dressership.<br />
Pathological Anatomy, Forensic Medicine, Ophthalmology.<br />
Examination : " Sessional " in July.<br />
FOURTH WINTER SESSION.—Lectures, etc..- Hospital<br />
Practice, Medical and Surgical, the special departments<br />
and post-mortem examinations. Clerkship or Dressership<br />
in special departments and post-mortem room. Instruction<br />
in Vaccination. Practical Course of Pathological Anatomy<br />
(if not taken in third winter). Clinical Lectures on Medicine,<br />
Surgery, and Diseases of Women. Obstetric Demonstrations.<br />
Diseases of Eye.<br />
FOURTH SUMMER SESSION.—Lectures, etc..- Hospital<br />
Practice, Medical and Surgical, and special departments.<br />
Clinical Medicine, Clinical Surgery, Mental Disease, Public<br />
Health and Sanitary Science. Tutorial Classes in Surgery,<br />
with operations on the dead body. Examination : " Final<br />
Conjoint" in Medicine, Surgery, and Midwifery. NOTE.—<br />
The three subjects may be taken at one examination.*<br />
When to such a scheme of work as this students add, as they<br />
often do, such supererogatory labours as are involved in the<br />
preparation for the very exacting First Fellowship examination,<br />
in the tenure of junior demonstratorships, and in assisting,<br />
general practitioners in dispensing and book-keeping,<br />
it can be easily understood that their time is fully taken up,<br />
and that it behoves them to take care that the mental tension<br />
is j regularly relaxed by appropriate recreation.<br />
* See St. Thomas's Hospital Medical School Prospectus, 1890-91.
526 MODERN TIMES.<br />
Those who desire to get a degree of M.D. have the opportunity<br />
of acquiring it at one of eleven universities in the '<br />
United Kingdom: Oxford, Cambridge, London, Durham,<br />
Victoria, Edinburgh, Glasgow, Aberdeen, St. Andrew's,<br />
Dublin, Royal. The University College of Medicine, Newcastle-on-Tyne,<br />
is affiliated to Durham University. The<br />
colleges of the Victoria University are Owen's College,<br />
Manchester; University College, Liverpool; and Yorkshire<br />
College, Leeds.<br />
The School of physic of Trinity College is the chief<br />
training ground for students of Dublin University; some,<br />
however, instead of studying at this their own school, take<br />
out their courses at the Carmichael College or the College<br />
of Surgeons. The Royal University of Ireland, like the<br />
London University, is a purely examining body.<br />
In spite of these numerous universities the conditions of •<br />
residence and other causes conspire to induce many qualified<br />
practitioners to take the more rapidly procurable medical i|<br />
doctorate of the University of Brussels.<br />
However much or little there may be in a name there i<br />
is no doubt that among the laity in England the letters J<br />
M.D. form a combination to conjure with. The London<br />
.student is at a peculiar disadvantage in regard to graduating<br />
in medicine inasmuch as the only degree-granting body in<br />
London—the London University—has by the duration and ,<br />
severity of the curriculum placed its doctorate out of the<br />
reach of the large majority of students.<br />
On the other hand, as may be seen from the figures on a<br />
previous page, the Scotch student in his own country has<br />
facilities for taking this degree, of which he does not fail to<br />
avail himself, and the same may be said, though to a smaller 1<br />
extent, of the Irish student. A medical graduate of<br />
Glasgow or of the Royal University of Ireland occupief,|<br />
thus in the eyes of the public a favoured position as<br />
compared with a licentiate of the Royal Metropolitan<br />
Colleges or of the Apothecaries' Hall out of all proportion to<br />
the difference in their professional education.
ENGLAND.—NORTH AMERICA. 527<br />
The Report of the Royal Commission on Higher Educa<br />
tion in London gave official sanction to these complaints,<br />
declaring that " the demand for degrees attainable in<br />
London more easily than at present is a legitimate one,<br />
and it is desirable to provide for that want in some<br />
proper manner." The Royal Commissioners were of<br />
•opinion that the doctorate of the London University is an<br />
" honours" degree and that it is desirable that there should<br />
be in London a " pass" degree attainable, while at the<br />
same time they unanimously rejected the application of the<br />
Royal Colleges of Physicians and Surgeons for powers to<br />
confer degrees.<br />
The London student wants a " pass " degree granted on<br />
terms similar to those on which such degrees are given in<br />
Scotland and the provinces. It is quite easy to understand<br />
that the Convocation of London University objects to any<br />
measure which would tend in the slightest degree to<br />
depreciate the value of the degrees of which the graduates<br />
of that University are justly proud.<br />
How the legitimate grievance of the London student will<br />
ultimately be removed is not apparent. A joint request<br />
from such powerful Corporations as the College of<br />
Physicians, the College of Surgeons, and the Society of<br />
Apothecaries, for a Charter empowering them to grant<br />
medical degrees could hardly be refused by Government,<br />
and would solve the difficulty : this combination, is, how<br />
ever, just what it is difficult to secure. The exclusion of<br />
the Society of Apothecaries in any scheme for securing to<br />
the London Medical Corporations an extension of privileges<br />
in the way of granting degrees is to be deprecated as<br />
unjust and impolitic : unjust, as taking no account of the<br />
good work done by that Society in the past or of the<br />
continually improving character of its examinations;<br />
impolitic, for the inevitable result would be the competi<br />
tion, instead of the co-operation, of an examining body<br />
entitled to grant licenses in the three chief branches of<br />
practice.
528 MODERN TIM'ES.<br />
The formation of a Teaching University, independent of<br />
the University of London (and in which King's and<br />
University Colleges would occupy a prominent position), .<br />
has for long been held to be urgently demanded by many<br />
interested in the higher education.<br />
During the present year an important step has been taken<br />
towards satisfying these requirements by the foundation in<br />
and for London of the Albert University by virtue of her<br />
Majesty's prerogative. In it University and King's Colleges<br />
are to be colleges of all faculties, and the ten chief medical<br />
schools of London, including the London Medical School<br />
for Women, are to be colleges of medicine. No medical<br />
degree is to be conferred on any person who shall nof previously<br />
have obtained a qualification for registration under<br />
the Medical Acts. 'The medical schools are to be represented<br />
on the Council by one member for each school, while<br />
King's and University Colleges are to be each-represented<br />
on it by three members; the Council is empowered to<br />
provide for the representation of the Royal Colleges of<br />
Physicians and Surgeons should they signify to the Chancellor<br />
their desire to be so represented, and" is also at<br />
liberty to assign, should it think fit, a place or places to a<br />
member or members nominated by the Society of Apothecaries.<br />
Periods of residence and study, and examinations<br />
at other universities in the Queen's dominions, are to be ,<br />
recognized as equivalent to such periods of study at the.<br />
Albert University as the Council shall determine from time<br />
to time. The growth and development of this youngest<br />
member of the academical family cannot far! to influence<br />
education in general and medical education particularly. „<br />
Certain resolutions were passed by the General Medical<br />
Council on June 5th and 6th, 1890, which will become<br />
obligatory on every medical student who begins his medical<br />
studies after January 1st, 1892. In regard to medical<br />
education they ordain that professional study shall last for<br />
five years ; the first year may be passed at a university or<br />
teaching institution where physics, chemistry, and biology<br />
•¥<br />
•*C . * ;
ENGLAND.—NORTH AMERICA. 529<br />
are taught; the fifth year should be devoted to clinical work,<br />
but of it the student may pass six months as pupil to a<br />
registered practitioner whose opportunities of imparting<br />
practical knowdedge are considered satisfactory by the<br />
medical authorities. The remaining resolutions are framed<br />
with the object of securing for the student a thorough and<br />
complete training in practical and clinical work.<br />
* In regard to professional examination the resolutions<br />
require that the time devoted to the practical part of all<br />
examinations should be extended ; that the examination in<br />
physics, chemistry and biology should be passed before<br />
the beginning of the second winter session; that there<br />
should be three professional examinations (antecedent to<br />
the Final Examination) which should be passed before the<br />
final year intended for clinical work ; that the Final Exami<br />
nation must not be passed before the close of the fifth year<br />
of medical study.<br />
In addition to the twelve Metropolitan Schools having<br />
a complete curriculum (in which number is included the<br />
London Medical School for Women) there are in London<br />
no less than thirty Ancillary Schools of Medicine in which<br />
departmental or preparatory subjects are taught. In the<br />
provinces, Birmingham, Bristol, Cambridge, Newcastle-on-<br />
Tyne, Leeds, Liverpool, Manchester, Oxford and Sheffield<br />
contain hospitals and medical schools.<br />
In Scotland there are four University Schools of Medicine<br />
—Edinburgh, Glasgow, Aberdeen and St. Andrew's. Uni<br />
versity College, Dundee, now forms part of St. Andrew's.<br />
Clinical instruction is given at the Royal Infirmary, Edin<br />
burgh, in medicine and surgery and in the various speciali<br />
ties. Clinical lectures and instruction are also given at the<br />
Edinburgh Eye, Ear and Throat Infirmary. At Glasgow<br />
the Western Infirmary, the Royal Hospital for Sick Chil<br />
dren, the Hospital and Dispensary for Diseases of the<br />
Ear, and the Ophthalmic Institution subserve clinical<br />
instruction. This is likewise imparted at the Aberdeen<br />
Royal' Infirmary and the Aberdeen Royal Lunatic<br />
M-M
53°<br />
MODERN TIMES.<br />
Asylum, in the latter institution during three months in<br />
summer.<br />
The School of Edinburgh enjoys present popularity and<br />
historic renown and attracts not only Scotch but English<br />
and Colonial students in great numbers.<br />
Some of the most prominent members of the staffs of<br />
London Hospitals have been trained and have graduated in<br />
Scotland and the services rendered by them to clinical in<br />
struction in the London schools are of the highest character.<br />
The clinical teaching of the late Dr. MURCHISON at St.<br />
Thomas's Hospital was of European celebrity and in<br />
thorough harmony with the traditions of the Scottish<br />
school.<br />
There are several centres of medical education in Ireland.<br />
Those in Dublin enjoy great repute and are much frequented)<br />
especially the School of Physic of Trinity College and the<br />
Ledwich School, at the latter of which night tuition is given.<br />
The Rotunda Hospital at Dublin constitutes one of the,<br />
most important schools of obstetrics and gynaecology in<br />
the world. The School of the Royal College of Surgeons i<br />
and the Carmichael School have recently improved their<br />
accommodation for students and their appliances for<br />
teaching. At the Mater Misericordiae Hospital, the largest *<br />
in Dublin, at Sir Patrick Dun's Hospital, the Adelaide<br />
Medical and Surgical Hospitals and other hospitals and<br />
dispensaries opportunities are afforded for clinical work<br />
and clinical instruction is given.<br />
In the prosperous town of Belfast the Queen's College<br />
School of Medicine affords facilities for acquiring a first-<br />
rate medical education. Here the courses of instruction are<br />
framed with a view to the requirements of those intending<br />
to present themselves for degrees at the Royal University<br />
of Ireland, but are nevertheless quite fitted for preparation^<br />
for other qualifications. The social and scenic surroundings<br />
are all that could be desired while the cost of education^;<br />
and living is moderate. Cork also possesses a medical,,<br />
school and hospitals affording good opportunities of study,
ENGLAND.—NORTH AMERICA. 531<br />
especially if the student has in view the degrees of the<br />
Royal University.<br />
Anyone who is on the Medical Register is entitled to<br />
practise as a dentist but it is usual and advantageous to<br />
take a special dental diploma and to become L.D.S. or a<br />
Licentiate in Dental Surgery. This qualification can be<br />
obtained by itself but it is better if the student can see<br />
his way to taking the medical and surgical qualification<br />
of the conjoint board in addition. The special studies<br />
required for the dental diploma are: two courses of dental<br />
anatomy and physiology human and comparative; two<br />
courses of dental surgery; two courses of dental mechanics ;<br />
one course of metallurgy; practice of dental surgery in a<br />
recognized school for two years ; and an apprenticeship in<br />
dental mechanics to a competent practitioner.<br />
The conditions of admission into the Army Medical Service<br />
are that the candidate should be between the ages<br />
of twenty-one and twenty-eight, and in good health, that<br />
his.parents should be of unmixed European blood, that he<br />
should possess the double qualification to practise medicine<br />
and surgery, be registered under the Medical Act, and<br />
furnish satisfactory certificates as to character. He has<br />
then to undergo a competitive examination. The subjects<br />
are (i.) Compulsory and (ii.) Voluntary. The former include<br />
anatomy and physiology, surgery, medicine with therapeutics<br />
and diseases of women and children, chemistry and pharmacy<br />
and a practical knowledge of drugs. By this part of the<br />
examination the eligibility of the candidate for admission<br />
into the service is determined. The voluntary subjects are<br />
French, German, comparative anatomy, zoology, natural<br />
philosophy, physical geography, and botany.<br />
The conditions of entrance into the Indian Medical<br />
Service are similar, with the exception that the age limits<br />
are twenty-two and twenty-eight, and it is only required<br />
that the candidates should be natural-born subjects of her<br />
Majesty. Among the voluntary subjects in the examination<br />
for the Indian service Hindustani is included.
532 MODERN TIMES.<br />
The successful candidates now proceed to Netley to go<br />
through a four months' course of instruction in military<br />
surgery, medicine and hygiene. They then pass a final<br />
examination, and their position on the list of those recom<br />
mended for commissions is determined by the combined<br />
results of the competitive and final examinations. The<br />
surgeons of the British Medical Service then pass to Alder-<br />
shot for instruction in ambulance drill and equitation.<br />
A further examination has to be passed on promotion to<br />
the rank of surgeon-major: this is with a view of testing<br />
the surgeon in such branches of knowledge as are essential<br />
to his continued efficiency as a medical officer.<br />
The conditions of admission into the Naval Medical<br />
Service resemble those for the army. After passing the<br />
competitive examination in London the successful candi<br />
date receives a commission as surgeon in the Royal Navy,<br />
and undergoes a course of naval hygiene at Haslar<br />
Hospital.<br />
A further examination has to be passed on promotion to'<br />
the rank of staff-surgeon.<br />
The special departments in the London Hospitals are .<br />
now most ably administered and opportunities are afforded<br />
to students of holding minor appointments in them. In<br />
addition to clinical teaching in the wards, clinical lectures<br />
are given on cases of especial interest by the physicians<br />
• and surgeons at frequent intervals. j<br />
«,:•• The beautifully exhibited and carefully catalogued i<br />
^pathological specimens in the museums afford unrivalled *<br />
-Opportunities for study : while practical research in physi<br />
ology and bacteriology has of late years become an estab<br />
lished feature at many medical schools.<br />
The rapid advance in therapeutics which is a charac<br />
teristic of the present time, has made it desirable that the<br />
qualified practitioner should be placed in a position to<br />
acquaint himself with new methods of treatment, and,<br />
facilities are afforded him for this in the courses of post<br />
graduate lectures which have recently been instituted and
ENGLAND.—NORTH AMERICA. 533<br />
which are delivered by men of eminence in the various<br />
specialities.<br />
The addresses given at the Annual Meetings of the<br />
British Medical Association—held in different cities and<br />
towns of the United Kingdom—as well as the papers read<br />
before branch meetings of the same Association help to<br />
keep the practising doctor abreast of recent inventions and<br />
discoveries bearing upon his work.<br />
The Harveian and Hunterian orations delivered once a<br />
year urbi et orbi while honouring the illustrious dead are<br />
eminently calculated by the high standard of rhetoric and<br />
of learning which frequently characterizes them, to inspire<br />
and instruct the living.<br />
The advances made in the education of doctors in Eng<br />
land within the present century has been accompanied by<br />
a continual improvement in the nursing staff of hospitals.<br />
The cleanliness and order of a ward in an English hospital<br />
are the outcome to a large extent of the high intellectual<br />
and moral standard required and found in the superintend<br />
ing and subordinate nurses. How far this happy result<br />
has been contributed to by the example and teaching of one<br />
devoted lady is a matter well known to her contemporaries<br />
and will not be forgotten by posterity. The lessons learnt<br />
among the sick and wounded of the Crimean war have<br />
borne rich fruit in more peaceful scenes.<br />
Thoroughness and practical efficiency are the distinguish<br />
ing features of English medical teaching of the present *<br />
day: every effort is made to make examinations of an<br />
objective character and high consideration is given to<br />
practical work in all branches. The example set by the<br />
metropolitan and provincial schools tends in an ever-<br />
increasing degree to be followed by the centres of study in<br />
India, by those of Sydney and Melbourne, Quebec and<br />
Montreal.<br />
How our hospitals, supported by voluntary contributions,<br />
liable to abuses as Jhey undoubtedly are, in common with<br />
other human arrangements, impress the foreigner, may be
534 MODERN TIMES.<br />
exemplified by a passage written five years ago by the<br />
author of this work. Speaking of the English hospitals,<br />
he says, "In the erection and maintenance of these institutions<br />
the benevolence of the English people is most<br />
strikingly shown, while a brilliant example is set for the<br />
imitation of other nations."]<br />
The system of medical instruction prevalent in England<br />
has been imitated not only in those parts of the transatlantic<br />
continent which are under her rule, but wherever the English<br />
language and English culture prevail.<br />
In the United States of America medical teaching<br />
is also a matter of private enterprise. Several doctors<br />
living in the same locality unite for the purpose of imparting<br />
instruction in medicine, and give their pupils testimonials<br />
of proficiency. No one makes inquiries as to the<br />
qualifications of the teachers, or as to the result of their<br />
teaching. These schools consequently differ exceedingly<br />
in merit. According to a list made in the year 1882 there<br />
were in the United States at that time 114 medical schools<br />
and 13,321 students.<br />
Some medical schools enjoy, and justly so, a high reputaon.<br />
Such are the New York College of Physicians and<br />
Surgeons, founded in 1791, the University Medical College,<br />
which has existed since 1841, the Bellevue Hospital College<br />
at New York, the Massachusetts Medical College at Boston,<br />
and the Rush Medical College at Chicago. Along with<br />
these, however, there exist others which occupy a low<br />
position both intellectually and morally. The scandalous<br />
traffic carried on by many faculties in doctor's diplomas is<br />
well known. A newspaper of Philadelphia—where the<br />
abuse could be studied at its source—made a few years ago<br />
some incredible revelations upon this subject.* It is, there-<br />
* " A Doctor-Factory making full-fledged physicians for seventy-five dollars '*<br />
in the Philadelphia Record, 28th Feb., 1880.
FRANCE. 535<br />
fore, not a matter for surprise that American degrees in<br />
medicine should be regarded with distrust in Europe, and<br />
placed in the same category as those amiable but meaning<br />
less distinctions which are conferred on people dancing the<br />
cotillon.<br />
The education of the American doctors is, as a general<br />
rule, inferior to that of their European colleagues. Presi<br />
dent ELIOT thus expressed himself in a report (1871-2) :—<br />
" It is fearful to think of the ignorance and incompetence<br />
of most American doctors who have graduated at American<br />
schools. They poison, maim, and do men to death in<br />
various ways, and are unable to save life or preserve<br />
health."* The skilled doctors found, in America are in<br />
many cases of European origin, or at least have studied in<br />
Europe. Yet some departments of medical science, such as<br />
gynaecology and dentistry, have been prosecuted with great<br />
success in the medical schools of North America. More<br />
over, a gratifying endeavour is now everywhere being made<br />
to do away with the existing disabilities, and to introduce<br />
improvements into the system of medical education,<br />
following European models.<br />
FRANCE.<br />
WHILE in England and America, the principle that the<br />
State should not concern itself with things which can be<br />
equally well managed without its aid, is generally followed,<br />
the very opposite is the case in France. There the ruling<br />
powers feel themselves called upon continually to exercise<br />
a strict supervision over everything that takes place. Both<br />
the system of medical teaching and medical practice have<br />
been subjected to minute regulations at the hands of<br />
the authorities. Only in the days of the great revolution<br />
was this principle departed from : at that time, instead of<br />
Revue internat. de l'enseignement, Paris 1882, iv, p. 550.
53^ *' MODERN TIMES.<br />
parental protection degenerating at times into a paltry<br />
pedantry being extended to the profession, an unlimited freedom<br />
was permitted which led in the direction of anarchy.<br />
The doctors took an active part in the mighty political<br />
movements of that time.* Seventeen members of the<br />
profession belonged to the National Assembly, among them<br />
GuiLLOTlN—the inventor of the decapitating machine<br />
named after himt—a politician of very moderate views, and<br />
J. G. GALLOT, P. BLIN, SALLES, BEAUVAIS DE PR^AUX and<br />
others. In the Legislative Body of 1791 there were 22<br />
doctors, among them the celebrated surgeon TENON; in<br />
the National Convention of 1792, 39 seats were occupied<br />
by medical practitioners of whom BARAILLON, PANVILL1ERS,<br />
R. ESCHASSI^RIAUX, A. FOURCROY, M. A. BAUDOT, LEVAS-<br />
SEUR the obstetrician, E. LACOSTE and MARAT were the<br />
best known. When the Terrorists commenced their ghastly<br />
proceedings and celebrated their revolting and sanguinary<br />
orgies, the medical profession had to lament the sacrifice of<br />
numerous victims ; 104 of its members were executed and<br />
328 physicians and 540 surgeons were banished from<br />
France. PIERRE DESAULT, while holding his clinic in the<br />
Hotel Dieu, was seized in the midst of his pupils and cast<br />
into prison. But thanks to the energy of his friend<br />
FOURCROY, who found effective support in the Press,<br />
•DESAULT was soon again set at liberty.<br />
LAVOISIER, the great chemist, was not so fortunate. He<br />
died on the scaffold, although HALLE had in touching words ,<br />
reminded his persecutors of the imperishable services<br />
rendered by him to science. Nous n'avons pas besoin de<br />
savants, was the reply of the president of the Court; the<br />
sentence of death was carried into effect and thereby<br />
France was robbed of one of her greatest men.<br />
Men of learning were not wanted and science was not in<br />
* C. SAUCEROTTE : Les me'decins pendant la revolution, Paris 1887.<br />
t Professor PUSCHMANN requests me (Oct. 1891) to correct this statement. ,<br />
He says "this machine was not invented by GUILLOTIN, having been used<br />
during the middle ages in Germany, Scotland and Italy; he only advised the •<br />
French Parliament to make use of it."—E. H. H.
FRANCE. 537<br />
request. The smoky atmosphere of political fanaticism<br />
stifled the nobler emotions of humanity, and its devastating<br />
flame laid low all higher intellectual aspirations.<br />
The system of. medical education was pressingly in need<br />
of reform. Of the 18 medical schools possessed by France<br />
at the outbreak of the revolution scarcely one-half of them<br />
were known outside the towns in which they were<br />
situated and only those of Paris and Montpellier enjoyed<br />
any great reputation. The arrangements of the French<br />
medical faculties were inferior to those of other countries,<br />
and the French hospitals were on account of their unsanitary<br />
condition positively a by-word of reproach. The legislature<br />
interested itself in these questions.* A Bill introduced<br />
in 1790 contained many admirable suggestions for a reorganization<br />
of medical teaching ; thus it was demanded<br />
that both in teaching and in the examinations the French<br />
tongue should be exclusively used, that there should be<br />
perfect freedom given to the professors in teaching their<br />
subjects, that the lectures should be gratis, that there<br />
should no longer be any fixed duration of studentship, that<br />
the professors should be appointed by competition, etc.<br />
Instead of the 18 medical schools there were to be only<br />
four medical faculties, in Paris, Montpellier, Bordeaux, and<br />
Strassburg, but each of these was to be provided with at<br />
least 12 professorial chairs, and, in addition, in every<br />
department there was to be a lower order of medical<br />
school associated with a hospital.f Unfortunately these<br />
proposals never came to be the subject of debate.<br />
When radicalism came to be the dominant influence in<br />
the State men were no longer satisfied with improving the<br />
existing arrangements, but demanded their complete<br />
abolition. The place previously occupied by reform was<br />
now taken by revolution, qui vint tout renverser depuis le<br />
trone du roi de France jusqu' a I'humble chaire du pro-<br />
* L. LIARD in the Revue internat. de l'enseignement, Paris 1887, T. xiv, p.<br />
409 et seq.<br />
t DREIFUS-BRISAC in the Revue internationale de l'enseignement, Paris<br />
»88i,ii, 555 etseq..
538 MODERN TIMES.<br />
fesseur et la banquette de I'etudiant, as SABATIER says.<br />
By the law of the 18th August, 1792, all universities,.<br />
faculties, and medical schools were abolished; and for this<br />
act next to no compensation was given. In medicine as<br />
in theology, morals, and other things a desire was shown<br />
to retrograde to the primitive condition of mankind. It<br />
was hoped thus to reintroduce the conditions which<br />
obtained in the times of the ancient Greek philosophers ;<br />
all that was really done was to open the gates to superstition<br />
and impudent quackery. The mistakes and deficiencies<br />
of scientific medicine were ridiculously exaggerated and<br />
were made use of for drawing up a heavy indictment<br />
against its representatives. In the National Convention a<br />
speaker rose to the sublime height of declaring that doctors<br />
should be dealt with like priests—both alike being mere<br />
jugglers.* The wars carried on by the Republic soon,.<br />
however, became the means of demonstrating how<br />
necessary and useful doctors are. When it was communicated<br />
to the National Convention that the army had<br />
lost about 600 doctors within 18 months, and that the<br />
troops in the Eastern Pyrenees were almost entirely devoid<br />
of medical assistance, it was decided to reopen some of the<br />
medical schools. By a law of the 14th of Frimaire, year<br />
III. (4th December, 1794) three medical schools were<br />
established at Paris, Montpellier, and Strassburg; they<br />
were called ecoles de sante. They were at first intended<br />
only a former les officiers de sante pour le service des<br />
hopitaux et specialement des hopitaux militaires et de<br />
marine. Every district of the country sent a pupil to these.<br />
military schools of medicine, and there, at the expense of<br />
the State, he studied medicine for three years. At Paris<br />
there were 300 students, at Montpellier 150, and at Strassburg<br />
100.<br />
The need of educated medical practitioners, however,.<br />
soon led to civilian students, not supported by the State,,<br />
being admitted for the purpose of receiving instruction.<br />
In 1796 the medical school at Paris was reorganized and.<br />
* P. FRANK, op. cit., vi, 1, Abth., S. 221.
FRANCE. 539<br />
provided with twelve professorships as follows: (i)<br />
anatomy and physiology; (2) medical chemistry and<br />
pharmacy; (3) medical physics and hygiene ; (4) surgical<br />
pathology; (5) pathology of internal diseases; (6) natural<br />
history in its bearings on medicine; (7) the art of surgical<br />
operations; (8) clinical surgery; (9) clinical medicine -y<br />
(10) clinique de perfectionnement; (11) obstetrics; (12)<br />
history of medicine and forensic medicine. In addition the<br />
director of the establishment gave lectures " upon the<br />
Hippokratic methods of treating acute diseases," and<br />
" upon rare cases of disease collected from history and<br />
practice," while the librarian gave a course of bibliography<br />
and subjected medical literature to a critical review.*<br />
Among the teachers were SABATIER, CHOPART, PiNELr<br />
CORVISART, BAUDELOQUE, LASSUS, and P A. O. MAHON,<br />
the last of whom held the professorship of the history of<br />
medicine. In 1799, it was proposed to create two new<br />
professorships, one of pathological anatomy the other of<br />
"philosophic medicale;" but this suggestion was not<br />
carried into effect. In 1798, an " ecole pratique" was<br />
associated with the institution, and there the students had<br />
t<br />
opportunities of practising dissection. Clinics of various<br />
kinds dealt with their education at the bedside in the<br />
practical treatment of patients, and for some diseases-<br />
sexual disorders for instance—special establishments were<br />
founded. Instruction was given gratis, and by a law of the<br />
22nd of Ventose, year X., was made accessible to everyone ;.<br />
but for the sake of propriety, only medical students were<br />
allowed to attend the clinics.7<br />
The medical school of Paris, under these conditions, rose<br />
rapidly in reputation, and in 1799 numbered 1,500 students.<br />
Examinations in the most important subjects taught ensued<br />
upon the conclusion of the period of study : these, how<br />
ever, were by no means compulsory.<br />
* A. DE BEAUCHAMP: Recueil des lois et reglements sur l'enseignement<br />
superieur, Paris 1880-85.<br />
t E. BEAUSSIRE : La liberte d'enseignement et l'universite sous la troisieme<br />
republique, Paris 1884.
54° MODERN TIMES.<br />
Besides the regular practitioners who had enjoyed a<br />
systematic education at the schools of Paris, Montpellier,<br />
and Strassburg, there existed a great multitude of quacks.<br />
Everyone might practise medicine ; no one had any need of<br />
license or diploma. The state of things which was thus<br />
developed was sharply criticised by FOURCROY—at that time<br />
at the head of all affairs connected with public instruction<br />
—in a report drawn up by him, and dated 7th of Germinal,<br />
year XI. "La vie des citoyens," said he, "est entre les<br />
mains d'hommes avides autant qu'ignorants. L'empirisme<br />
le plus dangereux, le charlatanisme le plus dehonte,<br />
abusentpartout de la credulite et de la bonne foi. Aucune<br />
preuve de savoir et d'habilite n'est exigee. Les campagnes<br />
et les villes sont egalement infectees de charlatans<br />
qui distribuent les poisons et la mort avec une audace que<br />
les anciennes lois ne peuvent plus reprimer. Les pratiques<br />
les plus meurtrieres ont pris la place des principes de Vart<br />
des accouchements. Des rebouteurs et des meges impudents<br />
abusent du titre d'ofificier de sante pour couvrir leur ignorance<br />
et leur avidite ! "*<br />
The law of the 19th of Ventose, year XI. (10th March,<br />
1803), abolished these abuses by making the permission to<br />
practise medicine dependent upon passing satisfactorily certain<br />
examinations which were introduced for this very purpose,<br />
and which included anatomy and physiology, pathology<br />
and nosology, materia medica, pharmacy and chemistry,<br />
hygiene and forensic medicine, midwifery, surgery, and<br />
internal medicine. The student's knowledge of anatomy<br />
was tested by requiring him to put up a preparation, while<br />
the examination in the practice of medicine took place at<br />
the bedside. Two different classes of practitioners were<br />
established, namely—(i.) Doctors of Medicine and Surgery;<br />
and (ii.) Officiers de Sante. Whoever aspired to the diploma<br />
of doctor had to pass through the Lycee training before<br />
applying himself to the study of medicine, and then to<br />
occupy himself with the latter for four years.<br />
* RENE ROLAND: Les meMecins et la loi du 19 Vent6se, an XI, Paris 1883.
FRANCE. 541<br />
The Officiers de Sante formed an inferior class of prac<br />
titioners. They were not bound to furnish any proof of<br />
having received a general education, and they were per<br />
mitted to engage in,medical practice after only three years<br />
study at a medical school. But they also might be excused<br />
any such study, and it sufficed if they spent five years'<br />
working at a hospital, or six years in the service of a doctor.<br />
The examination which they passed dealt with anatomy,<br />
the elements of medicine, materia medica, and surgery, and<br />
was carried on exclusively in French. The doctors were<br />
allowed to settle down anywhere, the Officiers de Sante<br />
only in the country and in the department in which they<br />
were licensed to practise. They were, moreover, obliged in<br />
serious cases of illness and in the greater operations to call<br />
a doctor into consultation.<br />
CARRET, the legislator, apologized for the establishment<br />
of this class of practitioners in the following words : " Les<br />
habitants des campagnes ayant des mceurs plus pures que<br />
celles des villes, ont des maladies plus simples qui exigent<br />
par ce motif moins d'instructions et moins d'apprets."<br />
The Officiers de Sante were trained chiefly at the hospital<br />
schools which came into existence in several towns of<br />
France,, and received a definite organization under the<br />
name of £coles secondaires.<br />
The lower class of apothecaries also received the requisite<br />
instruction at these establishments, while for the pharma<br />
ceutists of the first class three special schools were founded<br />
at Paris, Montpellier, and Strassburg which were, in many<br />
respects, in close relation with the medical schools at those<br />
places. The schools of medicine last mentioned were in<br />
1808 once more promoted to the position of medical facul<br />
ties, and were incorporated with the University of France.<br />
This creation of Napoleon was not a university in our<br />
sense of the word, but, as it were, the headquarters of all<br />
the establishments and boards of education throughout the<br />
country. It was approximately equivalent to what is now<br />
known as a department for the regulation of education. A
54 2 MODERN TIMES.<br />
Grand Master stood at the head of the University of France.<br />
This dignity passed or was changed into that of Minister of<br />
Instruction. A council was appointed to assist him, in the<br />
capacity of consulting authority in educational matters,<br />
while a considerable number of General Inspectors supervised<br />
and controlled the particular schools. The whole<br />
country was divided into 26 university districts, everyone<br />
•of which formed the seat of an academy (or higher<br />
educational establishment), with a Rector, Academic<br />
Council, and Inspectors. This strictly uniform method of<br />
organizing instruction had the great advantage of helping<br />
to strike a balance among the various educational levels in<br />
the different parts of France, and of applying, in educational<br />
matters, the principles of order and equity throughout<br />
the country.<br />
This arrangement was maintained after the overthrow of<br />
the empire, and in the. course of time experienced only<br />
those improvements suggested by the needs of culture or of<br />
the State. Each faculty, from this time forth, conferred<br />
three degrees, those, namely, of Bachelor, Licentiate, and<br />
Doctor. Only the two last, when acquired in the department<br />
of medicine, gave the right to practise. The hospital<br />
schools were only allowed to grant the title of Officier de<br />
Sante. The professorships were obtained by competition,<br />
but in the year 1810 in the case of candidates of known<br />
literary and scientific merit the process of subjecting them<br />
to the prescribed examination, or of making them compose<br />
a thesis, was dispensed with.<br />
The hostile attitude afterwards assumed against LOUIS<br />
XVIII. by the medical faculty of Paris, and the riotous<br />
scenes which ensued thereupon, led to the doors of the<br />
schools being closed in 1822. When thrown open once<br />
more in the following year the faculty was reorganized.<br />
The staff of teachers consisted of 23 professors in ordinary<br />
and 36 agreges, of whom 24 were en exercise and 12 en<br />
stage. In 1824 the Ministry of Public Instruction was<br />
established, and to this the medical faculties and schools
FRANCE. 543<br />
were subordinated. During the next 50 years the organi<br />
zation of medical teaching in France was but little changed.<br />
Only under the third Republic were endeavours made to<br />
render it more extensive and complete.<br />
At the present time France possesses six medical<br />
faculties at Paris, Montpellier, Nancy — established in<br />
1872, after the University of Strassburg had, with the<br />
province of Alsace, been transferred to Germany—at<br />
Lille, Bordeaux, and Lyons (since 1877), where formerly<br />
lower class medical schools existed. Besides these, there<br />
are 18 medical ecoles preparatoires, the present designa<br />
tion of what were formerly called ecoles secondaires.<br />
They are situated at Marseilles, Nantes, Toulouse, Amiens,<br />
Angers, Arras, Besancon, Caen, Clermont, Dijon, Grenoble,<br />
Limoges, Poitiers, Rheims, Rennes, Rouen, Tours and<br />
Algiers, and are partly de plein exercise, that is, with<br />
opportunities for a complete course of medical study and<br />
in part merely preparatory schools. They are differently<br />
equipped in regard to appliances for study and in the con<br />
stitution of the teaching staff. The ecoles de plein exer<br />
cise have at least 17, the others 12, professors in ordinary.<br />
Between the former class and the medical faculties the<br />
only essential difference consists in the fact that they have<br />
not—like the faculties—the power of conferring the degree<br />
of doctor of medicine. But besides this the faculties are<br />
State institutions, whereas the other medical schools bear<br />
a municipal character.<br />
The students of medicine who desire to get legally<br />
qualified to practise attend the faculties or the ecoles de<br />
plein exercise, but are also permitted to pass a portion of<br />
the period of studentship at the ecoles preparatoires; in<br />
like manner the candidates for the position of Officier de<br />
Sante are admitted as students at the faculties, or at the<br />
other medical schools; but while the diploma of Doctor<br />
can be obtained at the faculties only, the qualification of<br />
an Officier de Sante can be got at any medical school.<br />
There is a comparatively small attendance at the ecoles
544 MODERN TIMES.<br />
preparatoires. Of the 21 establishments of this kind which,<br />
existed in 1845, 18 had less than 40 students, six less than<br />
25, and the school at Rheims only 15. A similar state of<br />
affairs exists in the provincial medical faculties; for Paris<br />
monopolizes almost all the higher teaching.<br />
In 1877 there were in France 4,447 medical students, of<br />
whom 3,835 pursued their studies in Paris, while all the*<br />
other medical faculties together numbered no more than<br />
612 students. By the promotion of several preparatory<br />
schools to medical faculties which has been effected in the<br />
last few years this proportion has been to some extent<br />
changed. In 1881-82 Paris had 2,413, Bordeaux 155,<br />
Lyons 165, Montpellier 154, Nancy 83, and Lille 54 medical -v,<br />
students. In addition, 756 candidates for the qualification<br />
of Officier de Sante attended lectures of the various medical<br />
faculties. At the remaining educational establishments V.<br />
there were in all 632 students, of whom 306 were preparing<br />
themselves for the doctorate and 326 for the qualification •<br />
of Officier de Sante. Thus the total number of students of<br />
medicine of both categories reached at that time 4,412, of<br />
whom 3,330 had in view the diploma of Doctor, 1,082<br />
wished to become Officiers de Sante. .%<br />
As early as 1826 a proposal was made to the legislative t,<br />
assembly to abolish the lower class of practitioners,; but<br />
without result. In 1847, a g a i n , the doctors of medicine<br />
presented a petition begging that the Officiers de Sante<br />
(who at the same time applied for an extension of their<br />
privileges) should cease to form a recognized class of<br />
medical men.<br />
Once more, in 1864, an attempt was made to do away<br />
with the institution of Officiers de Sante ; but they found<br />
an advocate in BONJEAN,, who declared " A des malades «<br />
simples et pauvres il faut un meaecin. pauvre et simple<br />
comme eux, qui puisse compren.dre le langage, le besoin de<br />
ses modestes clients, qui, ne dans une condition peu Slevee,"<br />
habitue" des son enfance a la vie sobre des chaumieres}';<br />
ayant conquis son grade a peu de frais, puisse se contenter^
FRANCE. 545<br />
d'une modique retribution. L'officier de sante est dans les<br />
meilleures conditions pour remplir cette mission de modeste<br />
devouement; il se fera d'autant plus aisement le con<br />
fident, le conseiller, le consolateur du pauvre, qu'il en est<br />
presque le compagnon."<br />
For all that, the number of Officiers de Sante in France<br />
diminished year by year. In 1847 there were 7,456 of<br />
them, in 1872 only 4,653, while the number of Doctors<br />
, rose between the same years from 10,643 to 10,766. The<br />
disappearance of this grade of practitioners appears,<br />
therefore, to be only a question of time.<br />
The medical faculty of Paris stands at the head of all<br />
the medical schools; it has the most abundant supply of<br />
material and appliances for teaching, and the best arrange<br />
ment of studies. Its teaching staff consists at the present<br />
time of 33 professors in ordinary (titulaires) and a great<br />
number of agreges, who correspond nearly to the Austrian<br />
professors extraordinary.<br />
Of the professors in ordinary, 1 represents anatomy,<br />
1 histology, 1 physiology, 1 medical chemistry, 1 natural<br />
history in its bearing on medicine, 1 medical physics,<br />
1 pharmacology, 1 general pathology and therapeutics,<br />
1 materia medica, 1 internal and 2 external pathology,<br />
1 pathological anatomy, 1 comparative and experimental<br />
pathology, 1 midwifery and gynaecology, 1 operative<br />
surgery, 1 hygiene, 1 forensic medicine, and 1 the history<br />
of medicine, while 4 conduct the surgical clinic, 4 the<br />
medical clinic, 1 the gynaecological clinic, 1 the clinic for<br />
diseases of children, 1 that for diseases of the sexual<br />
organs, 1 the clinic for diseases of the eye, 1 that for<br />
mental diseases, and 1 that for diseases of the nervous<br />
system. They draw yearly salaries of 15,000 francs, and<br />
are nominated, on being proposed by the faculty, from<br />
among the number of the agreges.<br />
The latter assist and represent the professors in ordinary<br />
in teaching and during the examinations, and, when they<br />
are commissioned to lecture, receive the pay of 6,ooofr. a<br />
N N
546 MODERN TIMES.<br />
year. They are divided into three classes—the agreges<br />
" stagiaires," "en exercise," and " libres." For the first<br />
three years after their election they have neither rights nor<br />
duties, and are called stagiaires. They then are promoted<br />
into the list of active agreges, corresponding in number to<br />
the professors in ordinary ; as agreges en exercise their<br />
duties are to give lectures and to act as examiners, and<br />
they are in receipt of pay. After they have been actively<br />
engaged in these duties for six years or even longer they<br />
become agreges libres, and are no longer obliged to give<br />
lectures or to perform any other services, they receive no<br />
pay, and only enjoy the privilege that they are qualified<br />
like the other agreges for nomination to the position of<br />
Professor in Ordinary.<br />
Preferment to the position of agrege is the result of<br />
competition between numerous candidates, which, however,<br />
takes place only in Paris. This was formerly usual also in<br />
appointments to professorships in ordinary; since 1852,<br />
however, it has been limited to the election of agriges<br />
and of officials of a similar kind. Every legally qualified<br />
doctor who belongs to the French nation and has completed<br />
his twenty-fifth year is at liberty to take part in this<br />
competition. The competitor hands over his scientific<br />
compositions to a Commission, the members of which are<br />
professors and other learned men; he also, being left<br />
entirely to himself and without any aid from books, writes<br />
an essay on a question which has been set him, and, finally,<br />
he delivers a lecture upon a subject which has been sug<br />
gested to him three hours previously. The Commission<br />
then makes a selection from among the candidates in<br />
accordance with their performances, so that the number of<br />
those selected shall not exceed three for each vacant ap<br />
pointment. These have once more to undergo an examinar<br />
tion, which consists of practical research, the delivery of a<br />
lecture, and the composition of a treatise on a given subject,<br />
which has to be prepared within a stated time.<br />
The candidature for the position of agrege is never
FRANCE. 547<br />
undertaken with a view to the representation of one special<br />
department of medical science, but a definite number of<br />
branches are grouped together. The agreges, conformably<br />
to this arrangement, are separated into four divisions: of<br />
these the first includes anatomy and physiology ; the second<br />
the natural sciences, physics, chemistry, and pharmacology ;<br />
the third pathology and therapeutics, internal medicine, and<br />
State-medicine; and the fourth the surgical departments<br />
with midwifery.<br />
In 1884 the teaching staff of the medical faculty of Paris<br />
consisted of 120 professors; at Lyons there were 64; at<br />
Bordeaux, 50; at Douai-Lille, 45; at Montpellier, 43; and<br />
at Nancy, 41. The faculty of Lyons had no less than 25<br />
professors in ordinary.<br />
From all.this it is evident that the medical schools of<br />
France are richly supplied with teachers, and that the<br />
Government spares no expense in providing them. In<br />
Paris the salaries of the professors of the medical faculty<br />
amount in the aggregate to nearly 70o,ooofr. a year, a sum<br />
far in advance of that expended on the medical faculties in<br />
many other countries. The same admirable care is shown<br />
in furnishing the medical faculties with appliances and<br />
aids for teaching. The medical schools of Paris and<br />
Lyons, which I can speak of from personal experience, are<br />
arranged in a most exemplary manner.<br />
Teaching is carried on in Paris partly at the Ecole de<br />
Medecine, where the theoretical lectures of the professors<br />
are delivered, partly at the Ecole Pratique, at which the<br />
establishments for practical work have been centred, and<br />
partly in the various hospitals in which the clinics are<br />
held.<br />
The large airy dissecting rooms, well supplied with water,<br />
good light, and in every respect answering the hygienic<br />
requirements of the present day, contain 682 work-places.<br />
Besides the Director, who is at the same time a Professor<br />
of Anatomy, eight prosectors and twenty-four assistants are<br />
at work there, introducing the students to the art of
548 MODERN TIMES.<br />
dissecting and watching over their progress. Moreover,<br />
each-of the prosectors gives three lectures a week, and each<br />
of the assistants one lecture, the subjects of which are chosen.<br />
in accordance with a plan sketched out by the Director.<br />
These lectures of the prosectors and assistants are in close<br />
connection with one another, and together serve to review<br />
the whole of the science of anatomy; they form the most<br />
important part of the teaching of anatomy. The posts of<br />
prosector and assistant are filled by competitive examination.<br />
Whoever aspires to become a prosector must be a<br />
legally qualified practitioner, and must undergo a written<br />
and oral examination on anatomy, histology, physiology,.<br />
and operative surgery, must put up an anatomical and a.<br />
histological preparation, and must perform two surgical,<br />
operations upon the dead body. The assistantships are alsoconferred<br />
after competition, and are entrusted to older<br />
students who show ability. The students are bound to<br />
appear regularly at the anatomical lectures of the prosectors<br />
and assistants, and also to practise dissection methodically<br />
for three hours daily, and they subject themselves to much<br />
unpleasantness if they neglect these observances.<br />
The practical work in the school of anatomy claims threewinters.<br />
During the first two, normal human anatomy is<br />
studied, during the last winter operative surgery on the<br />
dead body. For this the student pays a fee of 100 francs.<br />
The abundant supply of material for instruction, the<br />
strict manner in which the attendance and work of the<br />
students are looked after, the close connection between<br />
theory and practice, the application of anatomical facts to.<br />
practical medical science and especially to surgery, and<br />
the continual personal instruction given by the teachers.<br />
lead to remarkable results. The medical students of Paris<br />
acquire as a rule a thorough knowledge of anatomy which<br />
has inestimable advantages in regard both to their further<br />
technical training and to their success afterwards in the<br />
practice of their profession.<br />
There exists in Paris a special Anatomical Institute for
FRANCE. 549<br />
the professors, the hospital doctors and their assistants :<br />
this has no connection with the Ecole Pratique intended for<br />
•students but is conducted by a professor of anatomy and<br />
his assistants and is used for making post-mortem exami<br />
nations, for practising operative surgery, and for scientific<br />
research. There are laboratories, museums and work-rooms<br />
for teaching physiology, histology, physics, chemistry and<br />
the natural sciences : the natural history museum and the<br />
botanical garden are made to serve the same purpose.<br />
There are also professorships of physiology and the<br />
natural sciences at the College de France and at the Ecole<br />
Normale— an educational establishment for teachers of<br />
advanced subjects : the professors give lectures, and faci<br />
lities are extended to the students of the medical faculty<br />
to attend them.<br />
The 14 clinics, which are under the direction of the pro<br />
fessors in ordinary and are thus an essential feature of the<br />
official course of instruction, are not centred in one<br />
hospital but are divided amongst the Hotel Dieu, the<br />
Charite, the Pitie, the Clinique d'Accouchements, the<br />
Hopital des Enfants Malades, the Necker, Cochin, and<br />
Salpetriere Hospitals, and the Hopital du Midi. Every<br />
medical student is bound to take part, during the last two<br />
years of his studentship, in the medical visits to one hospital<br />
and to perform the small services which are there assigned<br />
to him.<br />
The directors of the assistance publique assign the<br />
doctors who give in their names to them for this service<br />
to the various hospitals of Paris.<br />
The arrangements at the other medical faculties and<br />
schools of France are of a similar character to those existing<br />
in Paris.<br />
The student of medicine must on beginning his technical<br />
studies show that he has received a satisfactory general<br />
education. He is on this account required to possess the<br />
diploma of Bachelier es Lettres which nearly corresponds<br />
to the "Leaving-Certificate" (Abiturienten-Zeugniss) of the
550 MODERN TIMES.<br />
German gymnasiums, and in respect of his knowledge of<br />
mathematics and the natural sciences to have taken the<br />
degree of Bachelier es Sciences.*<br />
The period of studentship extends over four years; it is<br />
not divided into semesters but into courses of two or three<br />
months' duration which are attended in a prescribed order.<br />
The student is obliged to work practically at physics,<br />
chemistry, and the natural sciences in his first year; at<br />
anatomy, histology, and physiology in the second and<br />
third years; and at pathological anatomy, operative<br />
surgery, and clinical and hospital work in the fourth year.<br />
This period of study at the hospitals is termed stage.<br />
The examinations in the various subjects formerly took<br />
place at the end of each year. This arrangement was however<br />
abolished in 1878 and another adopted in its place,<br />
according to which five examinations have to be passed.<br />
The first includes physics, chemistry, and natural history<br />
and takes place at the end of the first year; the second<br />
embraces anatomy, histology, and physiology and follows<br />
partly in the course of the third year, partly at its conclusion.<br />
The third examination deals with surgical pathology,<br />
midwifery, and operative surgery, and also with general<br />
pathology and the pathology of internal diseases; the<br />
fourth, with hygiene, forensic medicine, therapeutics,.<br />
materia medica and pharmacology : and the fifth involves<br />
the examination of cases in the surgical, medical and<br />
obstetric clinics with their treatment and the performance<br />
of a post-mortem examination. The candidate must also<br />
show his knowledge of normal anatomy by putting up a<br />
preparation, and his surgical skill by the performance of an<br />
operation on the dead body. Finally he is obliged to write<br />
a thesis upon a subject chosen by himself and to submit it<br />
to the Faculty. He is then advanced to the degree of<br />
Doctor of Medicine.<br />
The aspirant to the position of Officier de Sant6 requires<br />
a less advanced general education : he is required to write<br />
* Programme de Vexamen baccalaure'at es sciences, Paris 1885.
FRANCE. 551<br />
a treatise in French without mistakes of spelling and<br />
to answer questions upon the most important facts in<br />
natural science, physics and chemistry. The period of<br />
studentship for Officiers de Sante likewise extends over<br />
four years. The curriculum is nearly the same as for the<br />
future doctors of medicine except that less stress is laid<br />
upon the theoretical side of studies especially in histology,<br />
physiology and pathological anatomy. The examinations<br />
are of a corresponding character, and are limited to the<br />
main points and principles of subjects.*<br />
The French military doctors were formerly educated at<br />
Strassburg, and attended the lectures of the medical faculty<br />
there. In 1872 a rule was made that the military medical<br />
students should be distributed among 11 medical schools<br />
and should receive instruction there with the other medical<br />
students; but in 1883 in place of this two ecoles pre<br />
paratoires du service de sante were founded at Bordeaux and<br />
Nancy for the education of doctors for the army. The<br />
students of these schools participate in the teaching given<br />
by the medical faculties at the places mentioned ; they are<br />
obliged to spend five years in study, and are looked after<br />
and helped in their work by older military medical officers<br />
who act as tutors in the various subjects of study. When<br />
they have finished their studies and have obtained the<br />
degree of doctor they are transferred for the completion of<br />
their professional training to the ecole d'application con<br />
nected with the great military hospital of Val de Grace,<br />
where they serve in the wards for eight months and lay in<br />
a stock of experience in practical medicine.<br />
The system of medical education in France possesses<br />
along with many advantages, among which the excellent<br />
anatomical and clinical training of students must be<br />
especially mentioned, also certain lamentable defects. Thus<br />
it seems strange that, according to the curriculum of study,<br />
the first year of studentship should be devoted entirely to<br />
* Indications sommaires des conditions a remplir pour l'obtention des grades<br />
de docteur en me'de'cine, d' officier.de sante, etc., Paris 1884.
552<br />
MODERN TIMES.<br />
the sciences ancillary to medicine and that attendance<br />
upon lectures on anatomy should not be commenced<br />
until the second year. In this way the study of medical<br />
science itself is confined to three years, a period within<br />
which it does not seem possible to digest and assimilate<br />
:;uch rich intellectual food as is contained in the matter<br />
taught during that time. Then, as the second examination<br />
which deals with anatomy and physiology falls at the end<br />
of the third year, and the student has been till then chiefly<br />
occupied in preparing for it, there remains not much more<br />
than one year for training in practical medicine.<br />
A prolongation of the period sanctioned bylaw is the<br />
natural result of this, and is indeed rendered necessary by<br />
the three last examinations.<br />
A more serious flaw in the system of medical teaching<br />
in France lies in the way in which the teaching staff of a<br />
medical school is selected and made up. Competition, the<br />
form of candidature where all have equal chances, no doubt<br />
affords a better guarantee than do other methods of ap<br />
pointment to vacant offices, against the evils of favouritism,<br />
patronage, and nepotism : moreover in cases where it is a<br />
question of obtaining the position of agrege, or the office<br />
of prosector or assistant, in short an admission to the<br />
active list of university teachers, it is as a general rule quite<br />
justifiable and indeed an excellent way of finding out and<br />
estimating the ability and knowledge of the individual<br />
candidates. But to select only a specified number of<br />
candidates to compete seems to be a method not calculated<br />
to promote the end in view, for it is not possible to make<br />
distinctions quite in harmony with the demands of justice<br />
and equity between numerous candidates of nearly similar<br />
qualifications, and the scientific capacity of the selected<br />
candidates shows marked differences in different years.<br />
As little is it possible to justify the division of those<br />
aspiring to the position of agrege into four groups corre<br />
sponding to the different branches of learning as is the case<br />
at the present day: for many subjects, as for instance the
FRANCE. 553<br />
history of medicine, hygiene, and state-medicine, can with<br />
equal justice be put into one or another division. By the<br />
present arrangement a scientific man who has distinguished<br />
himself in his speciality may fail to get on the active list<br />
of university teachers.<br />
The regulation that the competitive examinations for<br />
the position of professeurs agreges to all the medical<br />
faculties and schools of France must be held in Paris is<br />
especially bad. For by this arrangement the candidates<br />
who are trying for the position of teachers in the provinces<br />
are obliged to make a lengthened stay in Paris, and are<br />
subjected to unnecessary expense; all the medical faculties<br />
and schools, except that of Paris, suffer in their dignity<br />
and interests, inasmuch as the decision upon weighty<br />
questions of appointment is committed into the hands of<br />
persons who are ignorant of the local needs, and finally the"<br />
heavy burden of these competitive examinations is thrown<br />
upon the Paris faculty, and is felt to be the more oppressive<br />
inasmuch as that body has already too many claims upon<br />
its resources in the examination of the crowds of students<br />
resident in the capital. On these grounds it has already for<br />
some time been wished that the competitive examinations<br />
-should be held not in Paris only but at every medical<br />
faculty, that the teaching staff of every-medical school<br />
should have the right of making suggestions as to the<br />
filling up of vacancies in their own body, and that candidates<br />
who in the competition satisfy the examiners should be<br />
qualified for admission not merely to one faculty but to<br />
any medical school in the capacity of teachers, and should<br />
not be obliged to undergo another examination*<br />
In appointing professors in ordinary competition has<br />
-rightly been abolished, for here it is not a question of<br />
persons whose fitness as teachers and investigators it is<br />
necessary to examine into, but of men of learning whose<br />
-scientific performances are things well known in profes-<br />
* Revue internationale de l'enseignement, Paris 1882, T. iii, p. 126, 533.—<br />
DREIFUS-BRISSAC : Rev. int., Paris 1887, T. xiv, p. 469 el seq.
-554<br />
MODERN TIMES.<br />
sional circles. Each medical school must see that it gets<br />
the best ability available to fill these positions. It is, there<br />
fore, inadvisable that the teaching staff should, in the pro<br />
posals which for this purpose they submit to the minister,<br />
be limited to the professeurs agreges who are in office at<br />
their own faculty. Such a rule leads to a local exclusive-<br />
ness in the particular medical school, and to the danger<br />
that an intellectual congelation may supervene in it. It is<br />
just the change of theory and doctrine, produced and<br />
favoured by the free interchange of professors, which keeps<br />
intellectual life fresh and sensitive to every movement<br />
which promises to lead to some desirable end. On the<br />
., other hand it may not unfrequently happen in consequence<br />
" of the present arrangement that a man of remarkable attain--<br />
ments, working at a small academy in France, is deprived<br />
of the opportunity of exercising his talents in a larger sphere<br />
of activity, where he might accomplish great things for<br />
science and for his country.<br />
It therefore appears highly desirable that the faculties.<br />
should, in regard to this matter, be freed from these limita<br />
tions, and that in proposing men to fill vacancies in the<br />
professorships in ordinary, they should be at liberty to take<br />
into consideration, with a view to election, the ordinary<br />
professors and agregfc of all the medical faculties and<br />
schools. In this case, should a man, hitherto not engaged<br />
in academic teaching, appear in any special circumstances.<br />
to be the most suitable candidate for a professorship, the<br />
nomination of such person for the office would be permitted.<br />
This course has exceptionally been adopted, for example,<br />
when the professorship of the History of Medicine, founded<br />
at Paris in 1870, was conferred upon C. DAREMBERG, dis<br />
tinguished for his profound knowledge of the medical<br />
science of the Greeks.<br />
The French should study the arrangements which exist<br />
in regard to these questions in Germany and Austria, and<br />
when these appear worthy of imitation they should intro<br />
duce them into their own country.
AUSTRIA-HUNGARY 555<br />
AUSTRIA-HUNGARY.<br />
IT was not until the 18th century that the system of medical<br />
education in Austria got rid of those features characteristic<br />
of the middle ages, which had exercised a restricting and<br />
narrowing influence upon its development. It had up to<br />
that time rested exclusively in the hands of the doctors'<br />
guild—the union which included all medical men entitled<br />
to practise, and which was designated as the Faculty.<br />
From amongst the members of this society the professors<br />
were chosen, and their election was confirmed by the<br />
University Consistory. The latter, which corresponded<br />
nearly to the University Senate of the present day, had<br />
been dominated by the power of the clergy ever since the<br />
Order of Jesuits had, by the Pragmatic Sanction of 1623,<br />
acquired a preponderating influence in all questions of<br />
education.<br />
The professors of medicine drew but miserable salaries,<br />
and were therefore obliged to support themselves by<br />
medical practice. At the same time their scientific work,<br />
except in the case of a few, was of an insignificant character.<br />
In a report upon the University of Vienna, laid before the<br />
Government in 1688, it is remarked " that in this University<br />
of Vienna for so many years hardly anything has been heard<br />
from its professors of law and medicine, who have neglected<br />
to bring forward or publish any subject connected with<br />
their sciences. The University of Vienna might as well be<br />
asleep, or no such seat of learning exist in Vienna at all.<br />
On the other hand, it is notorious how indefatigable and<br />
industrious the professors at other high schools in Germany<br />
are, what fine books they write, and what useful works they<br />
get printed and published."*<br />
There was a complete lack of the appliances and estab<br />
lishments required for the study of medicine, and even the<br />
* KINK :. Geschichte der Universitat zu. Wien, Wien 1854, i, 398.
556<br />
MODERN TIMES.<br />
I<br />
lectures were given so irregularly that the teachers of<br />
medicine were in 1689 and 1727 reproved by the Government<br />
for their idleness. Various attempts made to remedy<br />
this unsatisfactory state of affairs in 1629, 1687, and 1726<br />
did not meet with success. In 1718, the medical faculty<br />
of Vienna proposed to adopt practical instruction, at the<br />
bedside, at post-mortem examinations, and in the regular<br />
practice of dissection, to erect a collegium chymicum and<br />
lay out a botanic garden, to appoint assistants in the<br />
hospitals, to raise the. salaries of the professors, and to<br />
•summon distinguished teachers from abroad* But the<br />
horror with which a change of system was regarded by the<br />
ruling classes, and the want of sufficient money to pay<br />
for the necessary arrangements prevented the completion<br />
•of these designs.<br />
The great Empress, MARIA THERESA, who amid the<br />
grievous embarrassments and wars which shook her throne,<br />
found time and energy to take thought for improvements<br />
in law and administration, directed her attention to these<br />
matters. She commissioned her private physician,<br />
GERHARD VAN. SWIETEN, who enjoyed her complete confidence,<br />
to investigate the defects in teaching at the Vienna<br />
University.<br />
In a report which he drew up on this subject he referred<br />
to the cause of the existing evils, which he considered to<br />
lie in the dependence of the university upon the Church<br />
and the Guild., He demanded that the State should be<br />
complete master in its own house and should direct and<br />
watch over medical education. The proposals which he<br />
submitted to the Empress met with her approval, although<br />
in giving it she had doubtless to sacrifice some convictions<br />
which had become endeared to her by tradition and train<br />
ing.<br />
In the Edict of Reform, of February 7th, 1749, it was<br />
decreed that thenceforth the professors of medicine should<br />
no longer be appointed by the University Consistory, but<br />
* ROSAS: Geschichte der Wiener Hochschule, Wien 1843,11,232.
AUSTRIA-HUNGARY 557<br />
by the Empress, that their salaries should be increased to<br />
a reasonable amount, and paid out of the Imperial treasury,<br />
and that their duties and teaching as a whole should be<br />
under the control of a director representing the Govern<br />
ment.<br />
G. VAN SwiETEN himself undertook this important office<br />
in Vienna; in other faculties it was entrusted to high<br />
officers of State. They presided also at meetings of the<br />
Guild Colleges, .and at the examinations of doctors,<br />
surgeons, apothecaries, and other practitioners. At the<br />
same time the medical faculties were equipped with the<br />
necessary appliances for teaching. At Vienna a botanic<br />
garden and chemical laboratory were established, and the<br />
regular practice of dissection and clinical teaching was<br />
introduced. The ceremonies connected with taking a<br />
degree, which on account of the ecclesiastical observances<br />
associated with them, had led to the necessity of expending<br />
the considerable sum of 1,000 gulden, and had consequently<br />
compelled many students to take their doctor's degree in<br />
foreign countries, were now simplified and confined to<br />
special occasions, and the whole system of examination<br />
was subjected to closely prescribed regulations. The other<br />
medical faculties of the Empire were soon after this re<br />
organized after the pattern of the Vienna school, and<br />
provided with professorships and the necessary establish<br />
ments. G. VAN SwiETEN advanced to the head of the<br />
entire system of medical education, and acquired an<br />
influence which extended itself over the administration of<br />
teaching in all its branches.<br />
When the Emperor JOSEPH II. ascended- the throne<br />
there commenced a period of innovations in these matters<br />
succeeding one another with great rapidity, occasionally<br />
even pressing too quickly upon each other's footsteps. All<br />
limitations which had rendered it difficult for non-Catholics<br />
to take academical degrees, were abolished, and the degrees<br />
themselves were deprived of their religious character, the<br />
salaries and pensions of the professors were brought into
558 MODERN TIMES.<br />
•conformity with those of other officials, special academical<br />
jurisdiction was done away with, and members of the<br />
university were made amenable to the ordinary law, and<br />
instead of lecture fees, which were discarded, a system of<br />
paying a definite amount every month was introduced into<br />
the universities. All the universities of the monarchy<br />
were made equal in rank, and the same rights and<br />
privileges were accorded to the diplomas and certificates<br />
of them all : a law which, however, a few years later was<br />
modified to the extent of limiting practice in Vienna to<br />
those doctors and advocates who had passed examinations<br />
at the University of Vienna.<br />
The Emperor devoted himself with great zeal to the<br />
improvement of medical teaching and of the educational<br />
establishments connected with it. He lamented the<br />
neglect shown to the study of surgery by the doctors, and<br />
the unsatisfactory training of surgeons, and he recognized<br />
what a great mistake it was to rigidly separate surgery from<br />
internal medicine. He discerned that the best means of<br />
removing the defects of medical teaching lay in the reunion<br />
of these two branches of the general science, and<br />
in the blending together of physicians and surgeons. With<br />
this object he caused to be carefully drawn up a plan of<br />
studies for these two classes of students, which fixed the<br />
period of study at four years, and, with slight modifications<br />
in the two cases, required from both a knowledge of<br />
all branches of medicine.<br />
The promotion of the school for military doctors—the<br />
Josefinum—to a medico-chirurgical faculty with the rights<br />
and rank of a university and its association with a surgical<br />
academy contributed very much to raise the surgical profession,<br />
both scientifically and socially.<br />
There arose at the same time a class of inferior country<br />
practitioners, bound only to a two years' course of study ;<br />
these with the name of surgeons accepted also the social<br />
position hitherto held by that class.<br />
In this manner a complete metamorphosis was brought
AUSTRIA-HUNGARY 559<br />
about in the system of medical education and in the social<br />
relations of the medical profession, the main features of<br />
which have been preserved until modern times. Several<br />
other measures, such as the abolition of the degree of<br />
bachelor and of the inaugural dissertation—for the latter a<br />
practical examination at the bedside being substituted •<br />
formed very appropriate improvements in medical educa<br />
tion. The erection of the General Hospital at Vienna—the<br />
abundant material for instruction afforded by it being made<br />
available for clinical teaching—and, the foundation of the<br />
Military Hospital which was devoted to the same purpose<br />
as the Josefinum, rendered possible the splendid successes<br />
which the Vienna school of medicine has since achieved.<br />
JOSEPH II. also established the Deaf and Dumb Institute,<br />
the Foundling Hospital and the Veterinary Hospital in<br />
Vienna, and caused hospitals to be erected in Prague,<br />
Graz, and other large towns of the empire and to be made<br />
use of for the education of doctors. He also built per<br />
manent military hospitals in Milan, Mantua, Prague, Briinn,<br />
Olmiitz, Pesth, Koniggratz, Lemberg, Hermannstadt and<br />
other places. " Whatever can be devised to cure sick and<br />
wounded humanity, to alleviate suffering and to preserve<br />
life has been a subject never neglected by me; every<br />
individual man has been precious to me," were his words<br />
on taking leave of the army a few days before his death.<br />
The beneficent creations of this Emperor, who even if he<br />
did make mistakes was at all times filled with an earnest<br />
desire to make his people happy, give him a claim upon the<br />
gratitude of mankind. His good deeds have outlasted his<br />
plans and, performances in the field of politics and to this<br />
day bear testimony to the noble prince who lived for his<br />
people non diu sed lotus, as is said on the monument which<br />
has been erected to him in his capital*<br />
The reaction which set in against his political schemes<br />
was also directed against the measures he had taken in<br />
TH. PUSCHMANN : Die Medicin in Wien wahrend der letzten hundert Jahre,<br />
Wien 1884, S. 53 et seq.
560 MODERN TIMES.<br />
the administration of education. "A commission for the<br />
arrangement of studies " was convoked, and was charged<br />
with the task of. leading educational matters once more<br />
back into the old familiar track. Party spirit asserted. ,<br />
itself in medicine, and made an attempt to regain the<br />
influence which it had once possessed in the educationof<br />
doctors. A desire was shown to restore the former relations<br />
between physicians and surgeons, to relegate the latter to a'<br />
dependent and subordinate position and once more to sever<br />
the bond of union between surgery and internal medicine,.<br />
which had been accomplished by the curriculum of 1786.<br />
It was asserted that these two branches of medical science<br />
were too heterogeneous and too extensive for it to be<br />
possible for one man to be master of both in an equal/*<br />
degree. In regard to the Josefinum the objection was<br />
raised that it was too expensive and was certainly not of<br />
equal repute with the medical faculties of the universities.<br />
But its total abolition was not ventured upon: for<br />
the country could not afford to dispense with the only<br />
institution which concerned itself with the supply of<br />
military, doctors in the midst of the prolonged wars in<br />
which Austria was involved at that period. Moreover,<br />
daily experience showed how necessary and important a¥<br />
knowledge of surgery is, and to degrade that science ap-':<br />
peared to be an act by no means suited to the spirit of the _<br />
age. The complaints directed against the Vienna General .<br />
Hospital had more justification. The improvements whicly<br />
were thus brought about proved to be to the advantage of\<br />
that establishment. No alteration was made in the medical<br />
curriculum, although it was in many respects in need of<br />
reform* On the other hand the professors were given<br />
strict instructions as to the way in which they should con^<br />
duct their teaching and the text-books were mentioned^<br />
which were to form the basis of their lectures. The directorate<br />
of studies was abolished, but being reintroduced a<br />
* Freimuthige Betrachtungen viber den medicinischen Unterricht an der<br />
hohen Schule zu Wien, 1795.
AUSTRIA-HUNGARY 561<br />
few years later it formed as before the board of inspection<br />
for the affairs of the faculties and conducted the whole<br />
system of education.<br />
In 1804 the period of study for students of medicine and<br />
of the higher surgery was extended from four to five years<br />
and it was decreed that the first three years should be<br />
devoted to theoretical training, and the last two principally<br />
to attendance at the clinics. At the same time it was<br />
notified that no one should be admitted to the study of<br />
medicine who had not during three years previously<br />
attended^ lectures on ''philosophy" at the university and<br />
'had acquired a satisfactory general education. Every<br />
teacher was obliged to spend at least half-an-hour every<br />
week in satisfying himself by questioning his pupils, that<br />
the substance of his lectures had been understood and<br />
assimilated by them. At the end of every half-year public<br />
examinations of the students were held, and it depended<br />
•upon the result of these whether they should be per<br />
mitted to attend the regular course of lectures for the<br />
following half-year. Moreover, the regulations for the<br />
qualifying examination, held at the conclusion of the<br />
period of studentship, were made more severe and<br />
the examiners were admonished to apply them strictly and<br />
conscientiously.<br />
In 1810 a new medical curriculum was arranged in<br />
which those subjects which had lately been added to the<br />
course of study were included. According to this medical<br />
"students had to attend classes on the following subjects<br />
during the periods specified : 1st year, introductory course<br />
on medico-chirurgical study, natural history in its bearings<br />
on medicine, botany and systematic anatomy; 2nd year,<br />
more advanced anatomy and physiology, general chemistry,<br />
pharmacy and animal chemistry ; 3rd year, general patho<br />
logy and therapeutics, aetiology, semeiology, materia<br />
medica et chirurgica, dietetics, the art of prescribing,<br />
midwifery, general and' special surgery, surgical instru<br />
ments, bandaging and ophthalmology; 4th and 5th years,<br />
O O
562<br />
MODERN TIMES.<br />
special pathology and therapeutics of internal diseases,<br />
veterinary science, forensic and state medicine. During<br />
the last mentioned period attendance at the clinics was<br />
required.<br />
Those who were training for country doctors (Landarzte)<br />
were obliged during the first year to attend the introductory<br />
course on medico-chirurgical study, lectures upon<br />
theoretical surgery, anatomy, physiology, general pathology<br />
and therapeutics, materia medica et chirurgica, dietetics,<br />
the art of prescribing, and bandaging; during the second<br />
year they had to attend courses of operative surgery,<br />
forensic medicine, midwifery and veterinary science, and<br />
to visit the medical and surgical clinics. Their period of<br />
studentship was afterwards prolonged by one year. The ^<br />
students were left at liberty to judge for themselves<br />
whether they should attend the obstetric clinic or not, and<br />
the same was permitted in regard to their attendance upon<br />
lectures on several other subjects. On every subject of<br />
primary importance it was required that on five days in<br />
every week a lecture of one hour's duration should be<br />
o-iven ; twice that time was devoted to instruction given in<br />
the medical and surgical clinics.<br />
Care was also taken that what was taught should be<br />
rendered more easily comprehensible by demonstrations •<br />
and practical work. The students made botanical excur- "i<br />
sions under the guidance of their teachers, worked in the<br />
chemical laboratory, practised dissection of the human ;<br />
body, attended post mortem examinations and performed;;<br />
operations on the dead body. Dissecting rooms were<br />
erected where they were wanted : but the students had to<br />
bear the expense involved in procuring the necessary sub<br />
jects for dissection.<br />
Whoever was a candidate for the degree of Doctor of<br />
Medicine was obliged, first of all, to submit the history of<br />
two cases which he had himself treated in the clinic, then<br />
to undergo an examination on the subjects laid down in<br />
the curriculum, and finally to compose a dissertation and.
AUSTRIA-HUNGARY. 563<br />
• to defend by argument a position taken up on a point of<br />
.medical science.<br />
The examination for the doctorate of surgery differed<br />
from this chiefly in the circumstance that instead of<br />
internal medicine, surgery formed the chief subject and the<br />
candidates had to perform two surgical operations on the<br />
dead body.<br />
When a Doctor of Medicine desired to take the degree of<br />
Doctor of Surgery or vice versa, he had only to pass a<br />
supplementary examination which was concerned with<br />
questions which had been too little dwelt upon in the<br />
previous examination. The demands made upon those<br />
who were satisfied with the title of Master of Surgery<br />
were of a less severe character. And the case was the<br />
.same with the country doctors. A' diploma in ophthalmic<br />
surgery was also granted, but the class of rupture-curers,<br />
:so-called, was abolished.<br />
In 1822 the period of studentship at the Josefinum was also<br />
lengthened to five years for the greater and to three years<br />
for the lesser course, and the curriculum which had been<br />
introduced at the medical faculties was made the founda<br />
tion of the teaching there. The institution consequently<br />
received the right of granting all academic degrees. The<br />
•order of studies for the year 1833 gives evidence of no<br />
essential alteration either in the teaching or in the exami<br />
nations; but ophthalmology received more attention than<br />
previously.<br />
In 1845 a commission of experts was appointed and<br />
took counsel together upon the faults in the system of<br />
medical teaching and made proposals for improvements.<br />
But before any final decision was arrived at the year 1848<br />
was reached, and during it a complete revolution was<br />
effected in these matters. The professors of the Vienna<br />
medical faculty submitted a plan of reform for medical<br />
study,to the newly created Ministry of Education: in it<br />
attention was drawn to the inconvenience of both the<br />
College of Teachers and the Associated Doctors of Vienna
5 6 4<br />
MODERN TIMES.<br />
being designated as the Medical Faculty, and of the pro.<br />
fessors being excluded from the most important offices, as<br />
from those of Rector, Dean and Director of medical studies,.<br />
and being almost entirely unrepresented in the University<br />
Consistory.<br />
They demanded that the professors in ordinary, as in<br />
German universities, should form a college to be in imme-<br />
1 diate correspondence with, and only subordinate to, the<br />
Ministry ; that this college should independently deliberate<br />
upon questions of teaching and despatch other business-;:<br />
should hold examinations and confer academical degrees ;<br />
1 that the professorships shou]d_be filled up not by competition,<br />
butbyimdtato ; thjtth^ap^oint.ments of professors<br />
« ( ~^xMb^rm^nt, and should be forfeited only in con-<br />
SeqJIeJcTofdilto<br />
J duty; that the ordinary and extraordinary professors who<br />
represented subjects laid down in the curriculum should be<br />
properly remunerated by the State, " so that being freed<br />
from the care of having to earn Jtheir own Jbf^ad.tb^yjaagr<br />
be able toappiy their minds to science, and especiallyJa,<br />
the a^ncementot The subjects they represent; " that the<br />
scientific'es'tablishments should be equipped and endowed<br />
in a way suitable to their requirements; that freedomshould<br />
be granted both in teaching and in learning, the ,<br />
teachers not being bound to follow particular text-books nor<br />
the students compelled to attend certain lectures or to get<br />
their professional education exclusively in the schools of<br />
the country ; that the six-monthly examinations should be<br />
abolished ; that the Dean of the faculty should preside at<br />
the medical examinations and the Rector at the conferring<br />
of degrees ; that the Dean should be chosen from among<br />
the number of the professors in ordinary and by them ; that<br />
the connection between the university and the doctor's<br />
guilds should be severed, and the medical corporations<br />
cease to have any influence upon professional education.<br />
Baron E. VON FEUCHTERSLEBEN, the author of the wellknown<br />
"Dietetics of the Mind," who was employed in
AUSTRIA-HUNGARY. 565<br />
teaching psychological medicine at the Vienna University,<br />
was requested to undertake the direction of the Ministry of<br />
Education ; he, however, declined the post of minister,<br />
heing, as he says in his autobiography, " convinced that in<br />
view of the changes of ministry resulting from a representa<br />
tive system, and having regard more particularly to the<br />
circumstances of the time, it was of no use for a minister to<br />
think that he would be at liberty to prosecute any work<br />
without interruption, although such is precisely the indis<br />
pensable condition of success in undertaking a reform of a<br />
broad and sweeping character." He was therefore content<br />
to occupy the position of Under-Secretary of State in the<br />
Ministry of Education, and during the short period of his<br />
official activity brought about a number of important<br />
reform's.<br />
Thus he introduced the teaching of natural science into<br />
the gymnasia; he prolonged by two years the period of<br />
•studentship at these establishments, by arranging that the<br />
course of philosophy, which hitherto students had gone<br />
through at the university, should now be made part of the<br />
studies of the gymnasium ; he succeeded in establishing<br />
freedom for both teachers and students at the universities;<br />
he did away with the competitive method of filling up pro<br />
fessorships, and took care that the appliances for teaching<br />
and the collections of the Josefinum were handed over to<br />
the Vienna medical faculty when the former institution was<br />
abolished.<br />
In 1849 the law for the organization of the academic<br />
authorities was promulgated* according to which the<br />
arrangement of studies was placed under the direction of<br />
the professorial staff of the various universities. The staffs<br />
are composed of all the ordinary professors and of as many<br />
of the extraordinary professors as shall not exceed half the<br />
number of the ordinary, together with two representatives<br />
of the private lecturers, who, however, possess merely con-<br />
G. THAA : Sammlung der fur die osterreichiscben Universitaten giiltigen<br />
Gesetze und Verordnungen, Wien 1871, i, 69 et seq.
566<br />
MODERN TIMES.<br />
sultative functions. The Dean, who is elected from among<br />
the professors in ordinary, presides at their meetings ; he<br />
in many respects takes the place of the former Director of<br />
Studies, a functionary whose office has been abolished.<br />
In Vienna and Prague some remnants of influence were<br />
preserved for the doctors' guilds and medical corporations,<br />
inasmuch as they were still regarded as parts of the<br />
university and were designated as faculties, and received •<br />
the privilege of electing a Dean, who had a seat and vote<br />
in the assembly of professors, and co-operated with them in<br />
the medical examinations. It was not until 1873 that a<br />
complete separation was effected between the doctors'<br />
guilds on the one hand and the faculties and universities<br />
on the other.* The doctors' guilds from this time forth<br />
have been nothing but medical clubs, concerning them<br />
selves with the management of their property, the granting<br />
of pensions, etc., but without any official obligations.<br />
As early as 1848 the abolition of the inferior education<br />
given to the country doctors was mentioned in a ministerial<br />
decree as a measure desirable on principle.t But many<br />
difficulties stood in the way to prevent this being carried<br />
out. People could not help being afraid that if the schools<br />
intended for the education of the country doctors and<br />
inferior class of surgeons were suddenly closed a decided<br />
deficiency in the number of practitioners would be brought<br />
about, and they consequently wished to provide substitutes<br />
in time. Then the courses of instruction which had<br />
hitherto been given at the universities of Vienna and<br />
Prague for the country doctors were discontinued, while<br />
the medico-chirurgical schools at Graz and Innsbruck were<br />
shortly afterwards promoted to actual medical faculties,<br />
and were incorporated with the universities of those places.<br />
The other establishments of this kind which existed at<br />
Salzburg, Olmiitz, Laibach, Lemberg, and other places<br />
were o-radually closed.. With this the lower class educa<br />
tion came to an end.<br />
* THAA op. cit., S. 615 et seq. t THAA op. cit., S. 497
AUSTRIA-HUNGARY. 567<br />
From this time onwards an opportunity for the study of<br />
medicine was afforded only at the universities. At the<br />
present time medical faculties are possessed by the<br />
universities of Vienna, Prague, Graz, and Innsbruck, where<br />
the German language is employed for teaching; by the<br />
newly-created Czech university at Prague; by the Polish<br />
academy at Cracow ; and by the two Hungarian univer<br />
sities at Buda Pesth and Klausenburg; none is possessed<br />
by the high schools of Lemberg, Agram, or Czernowitz.<br />
The Josefinum after being shut up in 1848, and opened<br />
again in 1854, was closed once more in 1870, as it was<br />
thought that with the introduction of general compulsory<br />
military service there would be no lack of military doctors.<br />
This assumption has, however, not been realized, and<br />
perhaps some day the re-establishment of a school for<br />
military surgeons will become a matter of necessity. A<br />
military power of the rank of the Austrian Empire requires<br />
a school for its medical officers, as is shown by the<br />
examples of France, Prussia, and Russia. Its features and<br />
organization may differ from those of the Josefinum, but<br />
its existence is a matter in which the country and the<br />
army are both interested.<br />
The number of existing medical faculties stands in no satis<br />
factory proportion to the extent and population of the Austro-<br />
Hungarian monarchy. The attendance at them is conse<br />
quently large to an extraordinary degree. Of late years the<br />
average number of students at Vienna has been considerably<br />
over 2,000. The cause of this lies partly in the good repu<br />
tation enjoyed by the school and teachers, partly in the<br />
circumstance that many poor students think that, in the<br />
capital, they will find pecuniary support or opportunities of<br />
earning money by giving lectures, etc. PETER FRANK* long<br />
ago lamented the very prevalent custom of giving lectures<br />
in this way—and it is especially prevalent in Vienna—for<br />
by it medical students are withdrawn from their proper<br />
tasks and driven into a kind of work which is without any<br />
* P. FRANK op. cit., vi, 1, S. 336.
568 MODERN TIMES.<br />
value to them in advancing their professional education.<br />
Unless they are extraordinarily gifted they are apt to<br />
suffer shipwreck on these rocks, and never to finish their<br />
studies at all.<br />
It can easily be understood that crowded lecture rooms<br />
and clinics are not conducive to the study of medicine;<br />
for here it is important to see well, and closely to observe,<br />
every object and every patient and to follow the<br />
course of every experiment intelligently. With a view<br />
to remedy the inconvenience resulting from the fact that<br />
the space at disposal is insufficient for the number of<br />
students, it has been suggested to limit their number* but<br />
the difficulty of fixing upon any proper or suitable limit to<br />
the number of students to be admitted and still more the<br />
natural dislike to anything like a forcible suppression of<br />
the popularity of the University of Vienna have not failed<br />
to deter the authorities from trying such an experiment.<br />
The medical faculty of Vienna must not be measured by<br />
a scale adapted for a provincial university. Its history, its<br />
arrangements and its abundant supply of material for teaching<br />
have created for it a world-wide reputation. It forms<br />
one of the few centres which attract representatives of the<br />
various peoples of the monarchy, and by its geographical<br />
position it seems designed to be the means of transmitting<br />
to the East the scientific medicine of Europe, a task of<br />
high import in the history of civilization. The degradation<br />
of the medical school of Vienna would be a crime against<br />
the State, against science, and against humanity.<br />
If there is a want of the necessary space for teaching, it<br />
must be supplied by extending the present premises or by<br />
erecting new buildings. Preventive measures may also be<br />
necessary to keep unsuitable persons away from the<br />
university lest the good corn be choked by weeds. These<br />
ends might be secured by raising the lecture fees, which<br />
are smaller in Austria than in any other country,—not with<br />
a view of increasing the incomes of the professors, but<br />
* TH. BILLROTH: Aphorismen, Wien 1886.
AUSTRIA-HUNGARY. 569<br />
chiefly to enlarge and improve the schools—by making the<br />
examinations more severe, and by other means.<br />
At the same time it is surely desirable that some new<br />
medical schools should be erected to relieve the over<br />
crowding of the medical faculties. This might be done,<br />
for instance, in Salzburg, once the seat of a university,*<br />
where the necessary .buildings and appliances for teaching<br />
exist already in a measure, or at least could be easily<br />
found, and where moreover the enchanting beauty and<br />
magnificence of the surrounding country would attract<br />
students from far and wide, even from abroad; or again in<br />
Briinn or Olmiitz, in Lemberg or Czernowitz, in Agram,<br />
and in one or two places in Hungary. Some of these<br />
towns already possess several faculties, so that they only<br />
want the addition of medical faculties to become complete<br />
universities.<br />
In 1872 new regulations for medical examinations were<br />
published by which separate diplomas for the different<br />
branches of medicine were abolished. Up to that time<br />
there were Doctors of Medicine, Doctors and Masters of<br />
•Surgery, accoucheurs, and oculists, but as early as 1843 it<br />
was decreed that diplomas in surgery, midwifery, and<br />
ophthalmology should be granted only to such candidates<br />
as were already Doctors of Medicine, or if they belonged to<br />
the lower category of doctors to such as had taken the<br />
degree of Master of Surgery. With the abolition of this<br />
lower category of practitioners it was resolved for the<br />
future to educate only one class of doctors enjoying the<br />
same preliminary training, following the same course of<br />
studies, examined by the same rules, and advanced finally<br />
to the title of Doctors of Medicine, with which was asso-<br />
-ciated the. right to practise all branches of their art.<br />
Whoever wishes to be admitted to the study of medicine<br />
must have finished his studies at the gymnasium, and have<br />
passed the " maturity " examination. The period of student-<br />
* J. MAYR : Dieehemalige Universitat Salzburg, 1859.—L. SPATZENEGGER:<br />
Die Salzburger Universitat, Salzburg 1872.
57°<br />
MODERN TIMES.<br />
ship at the university is five years. The examinations are<br />
held partly during that period, partly afterwards. They<br />
begin with examinations in natural history, on the subjects<br />
of mineralogy, botany, and zoology, which can be passed<br />
in the course of the first year. Those only who have<br />
satisfactorily passed these can present themselves for the<br />
professional examinations proper. The first of these latter<br />
includes physics, chemistry, anatomy and physiology. It<br />
consists of a thorough theoretical examination in these<br />
subjects, and involves the putting up or the demonstra<br />
tion of an anatomical and microscopical preparation, the<br />
performance of a chemical analysis, and the explana<br />
tion of physical and physiological apparatus. This<br />
examination must not be entered for before the termi<br />
nation of the second year, while the second and<br />
third rigorosen cannot be passed until after the con<br />
clusion of the period of studentship. The candidate<br />
on entering his name is obliged to submit proofs that<br />
he has attended the medical and surgical clinics each<br />
during four semesters and each during two semesters as<br />
assistant, also that he has attended as assistant, for at least<br />
one semester each, both the obstetric and the ophthalmic<br />
clinics and that he has passed the first rigorosum satis<br />
factorily. The second deals with general pathology and<br />
therapeutics, pathological anatomy and histology, pharma<br />
cology, and internal medicine, and involves a practical<br />
examination on pathological anatomy at the dead body or<br />
with the aid of preparations'; the candidate is also-.<br />
required to examine several patients; and a thorough<br />
investigation is made into his theoretical knowledge<br />
of the above-mentioned four branches of science. The<br />
third rigorosum embraces surgery, ophthalmology,<br />
gynaecology, and forensic medicine, and is divided into<br />
practical examinations at the bedside and in the post<br />
mortem room, that is to say the clinical examination of<br />
patients, bandaging, operations on the dead body, experi<br />
ments with models, etc., together with a theoretical
AUSTRIA-HUNGARY. 571<br />
examination upon the four branches of science forming the<br />
subject of the test.<br />
After the candidate has passed these examinations he<br />
receives the degree of Doctor and a license to practise his<br />
profession.<br />
The professors of the various subjects act as examiners<br />
in the three professional examinations: a commissioner,<br />
nominated by the Government, who is a doctor of medicine<br />
and usually a high official of the sanitary service, is charged<br />
with the duty of watching the examinations in the interests<br />
of the public. The duration and character of the exami<br />
nations and the amount of knowledge required to pass<br />
them have, however, been thoroughly explained and ac<br />
curately laid down*<br />
Doctors who desire to devote themselves to the public<br />
sanitary service are obliged to furnish proofs that after<br />
taking their degree they have held appointments for at<br />
least two years in a public hospital, or have been in<br />
general practice for three years, that they have acquired a<br />
knowledge of psychological medicine and have learned to<br />
vaccinate with skill. They have then to pass an examina<br />
tion in hygiene, sanitary law, forensic medicine, pharma<br />
cognosy, toxicology, chemistry and veterinary regulations :<br />
this examination is partly written, partly oral, and partly of<br />
a practical character.t<br />
Excellent arrangements exist at the Vienna University<br />
for the education of skilful surgical operators. In 1807 a<br />
regulation was made that six students of medicine who had<br />
completed their studies in an exemplary manner should be<br />
employed in the surgical clinic for two years and should<br />
receive instruction in the performance of surgical opera<br />
tions on the dead and living subject. During this period<br />
they drew a yearly stipend' of 300 gulden with residence<br />
found, and they entered into an engagement to practise<br />
their profession in their own country. The rulers of<br />
* THAA, op. cit., Supplem.-Heft, S. 647 et seq., 090 et seq.<br />
t Reichsgesetzblatt 1873, 29th. Marz, Stuck 12.
572 MODERN TIMES.<br />
many of, the crown lands founded similar appointments for<br />
students who were natives of those places and who wished<br />
to settle there again. It was hoped by these means to<br />
train up a class of skilled and experienced surgeons who<br />
afterwards might be able to do good work as university<br />
teachers, as directors and principals of hospitals and<br />
surgical wards, as sanitary officials or as private practitioners<br />
in the different parts of the empire.<br />
At the same time a similar arrangement was instituted at<br />
the Josefinum, so that the army might be supplied with<br />
expert operators.<br />
When a second surgical clinic was founded at the<br />
Vienna medical faculty a number of students was appropriated<br />
to this too for the purpose of being trained as<br />
operators.<br />
Since 1870 these appointments have been made only<br />
for one year: but on the recommendation of the professors<br />
of the surgical clinic they may be extended to two<br />
or three years. The candidates must be doctors of medicine<br />
and must show in an examination on anatomy and<br />
surgery that they have the gifts necessary for the vocation<br />
of an operator. To only a proportion of them is any<br />
stipend paid: the others study at their own expense. At<br />
neither of the two surgical clinics must the number of them<br />
exceed eight.<br />
Similar arrangements were in 1882 made in the obstetric<br />
clinics of the University of Vienna with the object of<br />
insuring the education of skilful operators in the depart<br />
ment of midwifery-<br />
Certain considerations, suggested by the Austrian system<br />
of medical education, have often given rise to discussions<br />
in the Press. In the first place, the lectures and examinations<br />
upon the sciences which are used as a preparation for<br />
the study of medicine occupy more time than appears justifiable<br />
when we consider the curriculum of the gymnasia:<br />
for by this so many hours are given up to instruction in<br />
the natural sciences that the assumption may fairly be
AUSTRIA-HUNGARY. 573<br />
made that the students when they enter the university<br />
bring with them a general preliminary training in the<br />
natural sciences which, at least in mineralogy, botany and<br />
zoology, is so extensive as to make it superfluous to spend<br />
almost the entire first year on these subjects, as is now<br />
frequently done.* The arrangement in virtue of which<br />
these examinations and also the first rigorosum are passed<br />
during the period of studentship is attended with certain<br />
disadvantages ; for many students are induced thereby to<br />
spend time in preparing for them which they ought to<br />
devote to attending lectures.<br />
The custom, usual until recently, of students performing<br />
their military service during the period of their studentship<br />
was conducive to still worse results. They were, it is true,<br />
made military medical pupils at the garrison hospitals,.<br />
being thus employed in the sanitary service; but they were<br />
really quite destitute of the requisite medical knowledge.<br />
They were thus withdrawn from the systematic course of<br />
study without any corresponding advantage accruing either<br />
to themselves or to the army. By the new military law the<br />
students of medicine are bound to serve for six months in<br />
the ranks and for six months as doctors in the military<br />
medical department. The former period can be got over<br />
during studentship-—during one summer semester, the<br />
latter manifestly only after the completion of study. To<br />
avoid the interruption of study caused by the military<br />
service in the ranks it is to be wished that this could be<br />
undertaken either before the beginning or after the end of<br />
the university career. Complaints are made in Vienna<br />
that attendance on the lectures is irregular on the part of<br />
the students and an effort should be made to remove the<br />
causes which lie at the root of this state of affairs. It is<br />
conceivable that the system of assistantships now usual at<br />
the clinical institutions which are attended by hundreds of<br />
students is not of a character calculated to satisfy the<br />
* Betrachtungen uber unser medicinisches Unterrichtswesen, Wien 1886,.<br />
S. 14.
574 MODERN TIMES.<br />
requirements of medical education; some arrangement<br />
similar to the stage in the medical schools of France<br />
and England might be thought of to supply this defect*<br />
Whether, in view of the want of this, the present method<br />
of examination in practical medicine, in which no provision<br />
is made for the prolonged observation and treatment<br />
of patients, is sufficient to enable an examiner to decide<br />
upon the fitness of a candidate for medical practice, is a<br />
matter which may reasonably be doubted.<br />
If after the' last rigorosum there were still another final<br />
examination embracing the most important subjects which<br />
had been taught, it would serve not only as a check upon<br />
the previous examinations but would render it possible to<br />
make a final summing up of the candidate's knowledge.<br />
The Austrian administration of education, eagerly desirous<br />
as it is of improving the system of medical training and of<br />
rendering it complete by the erection of new schools and<br />
the foundation of new professorships, must extend a benevolent<br />
indulgence to these remarks and excuse them on the<br />
ground of the author's interest in the subject which is great<br />
enough to have evoked them.<br />
THE GREATER AND LESSER GERMAN STATES<br />
BEFORE THE FOUNDATION OF THE GERMAN<br />
EMPIRE.<br />
THE condition of political dismemberment into which th<br />
ancient German Empire had fallen, and the autonomy of<br />
the various countries which had composed it led to the<br />
foundation of numerous academies, many of which for long<br />
dragged on a miserable existence. They lacked both<br />
teachers and pupils, and they possessed neither appliances<br />
for teaching nor assured incomes to meet indispensable<br />
requirements. They were therefore not much missed when<br />
* Even P. FRANK (vi, Abth. 2, S. 2G6) was anxious that all members of the<br />
junior medical staff at the Vienna General Hospital should be authorized to<br />
give clinical instruction.
THE GERMAN STATES. 575<br />
they finally succumbed " partly through the effects of<br />
chronic disease, partly as the result of violent suppression<br />
which at times took the form of amalgamation with other<br />
universities."*<br />
This fate befell the university of Biitzow, which in 1789<br />
was united with the academy of Rostock, those of Stuttgart<br />
merged with the Tubingen high school in 1794, of Bonn<br />
abolished the same year, of Koln, Treves, and Mainz,<br />
which came to an end in 1798, of Bamberg, Dillingen,<br />
Fulda, and Duisberg, abolished the first in 1803, the last<br />
three in 1804.<br />
The following towns lost their universities in the years<br />
indicated: Helmstadt, Rinteln, and Altdorf in 1809, Frankfort-on-the-Oder<br />
in 1811, Paderborn in 1815, Erfurt in<br />
1816, Wittenberg andEllwangen in 1817, and Herborn and<br />
Miinster (where, however, a theological and a philosophical<br />
faculty continued to exist) in 1818.<br />
The political revolutions of that period, which introduced<br />
frequent changes in the map of Germany and assigned<br />
different parts of the country now to this and now to that<br />
State, exerted great influence upon the system of medical<br />
education. Certain universities, such as those of Salzburg,<br />
Innsbruck, Wiirzburg, and Freiburg, were subjected to continued<br />
changes of organization, a circumstance by no means<br />
conducive to the development of teaching. These conditions<br />
were not improved until peace was obtained, and the<br />
organization of States established by its means had begun<br />
to assume a permanent form.<br />
Besides the two great powers of Austria and Prussia<br />
there existed from this time forth the kingdoms of Bavaria,<br />
Wurtemberg, and Saxony, the first with its University of<br />
Landshut (which till 1802 was situated at Ingolstadt and in<br />
1826 was removed to Munich), and those of Wiirzburg and,<br />
of Erlangen, the second with its academy at Tubingen, and<br />
the third with high schools at Leipzig and Hanover,<br />
together with the University of Gottingen ; then there were<br />
* J. v. DOLLINGER: Die Universitaten sonst und jetzt, Miinchen 1867.
576 MODERN TIMES.<br />
the grand duchies of Baden, with universities at Heidelberg<br />
and Freiburg, of Mecklenburg with the University of<br />
Rostock, of Hesse, with that of Giessen ; also the electorate<br />
of Hesse, with the University of Marburg, and the Saxon<br />
duchies with the University of Jena, the duchy of Schleswig-Holstein,<br />
united with Denmark, with its high school at<br />
Kiel, and a great number of States without universities.<br />
The system of medical teaching in the various countries<br />
was, in spite of certain local peculiarities, in general of a<br />
fairly uniform character. The methods adopted in Austria<br />
and Prussia, after the period of French ascendency had<br />
been forgotten, served as a model for most of the other<br />
States, though from time to time efforts at originality were<br />
manifested, and were attended with remarkable results.<br />
Accurate information is afforded concerningthe education<br />
of doctors in- Bavaria at the conclusion of last century by<br />
the curricula of medical study drawn up for the University<br />
of Ingolstadt for the years 1774, 1776, 1784, and 1799.*<br />
According to these students who aspired to the degree of<br />
doctor of medicine were required to receive a preliminary<br />
education in " philosophy," and then to undergo a three<br />
years' course of professional study. They were examined<br />
every three months, and the examination immediately preceding<br />
the degree lasted for five hours. After 1788 a<br />
doctorate of surgery as well as of medicine was granted.<br />
But it was not until 1807; after Bavaria had been made a<br />
kingdom, that the degrees were no longer conferred<br />
imperiali et pontificia auctoritate, but regia auctorik<br />
Under the Montgelas Ministry a new organization was<br />
given to the universities of Bavaria which reflected the<br />
modes of thought of the Napoleonic age. By a stroke of<br />
the pen the ancient historical division of the four faculties<br />
was erased, and all subjects of teaching were put into one<br />
or other of two classes, the first including all those branches<br />
of knowledge which can be held to form part of a general<br />
education, the second embracing those subjects which form<br />
* PRANTL op. cit. i, 676 et seq.
THE GERMAN STATES. 577<br />
preparatory discipline for a definite vocation in life. Each<br />
of these classes was divided into four sections. The first<br />
class was made up of (i) philosophy and kindred subjects ;<br />
(ii) mathematics and the natural sciences ; (iii) history; (iv)<br />
ancient and modern languages : the second class consisted<br />
of (i) knowledge necessary for the education of the religious<br />
teachers of the people, i.e., theology; (ii) law; (iii) political<br />
economy and finance ; (iv) medicine.<br />
The teaching staffs were composed of ordinary and<br />
extraordinary professors, and of private tutors "for the<br />
purpose of assisting and of being educated to become<br />
regular teachers."<br />
Each section elected a member to the Senate which con<br />
ducted the affairs of the university. This classification<br />
corresponded with the earlier one in so far that the first<br />
class embraced the subjects represented by the philosophic<br />
faculty, and the second was made up of the other faculties.<br />
It lasted for a few years and then was by degrees replaced<br />
by the older form.<br />
The system of medical education was regulated by the<br />
legislative enactment of the 8th of September, 1808. This<br />
decreed " that no one is to be admitted to medical practice<br />
who has not passed examinations in that department of<br />
medicine in which he wishes to work." At the same time<br />
a rule was made "that the treatment of wounds should for<br />
the future be practised by those persons only who had<br />
learnt the medical science," and the universities were<br />
ordered " not to grant a degree in surgery to anyone who<br />
had not already taken one in medicine."<br />
' The period of studentship at the university lasted three<br />
years. At the conclusion of every semester, examinations<br />
were held on the subjects prescribed in the curriculum. If<br />
they were not passed satisfactorily they had to be submitted<br />
to again. After the termination of study an examination<br />
was held in which several questions had to be answered,<br />
if possible, in Latin, the candidate receiving no assistance;<br />
and a patient had to be examined and treated in the clinic;<br />
P P
578<br />
MODERN TIMES.<br />
finally the candidate's theoretical knowledge on all the<br />
subjects taught was tested. If the candidate aspired to the<br />
degree of Doctor of Surgery as well as Doctor of Medicine<br />
he had also to perform an operation on the dead body and<br />
to apply a bandage. With the composition of an essay<br />
and the defence of theses proposed to him, all demands on<br />
the candidate's knowledge, which preceded the granting<br />
of the degree, were satisfied. This, however, by no means<br />
carried with it a legal right to practise, for the young<br />
doctor had still to improve himself in practical medicine<br />
during two years in the wards of a hospital, or under the<br />
guidance of a busy practitioner, and after that to undergo<br />
an examination which consisted, firstly, of a qualifying<br />
part in which ten questions on internal medicine, surgery,<br />
midwifery, veterinary science, and forensic medicine had<br />
to be answered on paper under strict rules of isolation, a<br />
case of illness to be investigated and questions to be<br />
answered orally; and secondly of a competitive part the<br />
object of which was to select the ablest candidates with a<br />
view to securing them for the service of the State, and<br />
which was limited chiefly to paper work under strict rules<br />
of isolation, upon subjects connected with practical<br />
medicine.<br />
Doctors acquired practical ability as obstetricians in a<br />
lying-in establishment.<br />
Besides doctors of medicine there were "country<br />
practitioners" and surgeons who were taught in special<br />
schools.<br />
A new order of studies and examinations for medical<br />
students was promulgated on the 30th of May, 1843. In<br />
this it was decreed that after a course of two years' study<br />
at the university they should pass the "admission'<br />
examination, which embraced the subjects of zoology,<br />
botany, mineralogy, chemistry, and physics. Then the<br />
special medical studies began, which after three years—<br />
that is, in all, a five years' course of university study—were<br />
terminated by an examination. In anatomy the studenl
THE GERMAN STATES. 579<br />
was required to open one of the great cavities of the body<br />
and to demonstrate the viscera contained therein, also to<br />
describe one preparation dissected by himself, and certain<br />
others illustrating the anatomy of the bones, vessels, or<br />
nerves : in the other branches the examination was oral.<br />
After this followed the biennium practicum, a period<br />
passed principally in the clinics and great hospitals, and<br />
devoted to training in special departments of medicine.<br />
At the conclusion of the biennium practicum the final<br />
examination took place; this superseded the qualifying and<br />
competitive examinations which were abolished. The<br />
candidate who presented himself for this had to furnish<br />
proofs that he had treated three medical and three surgical<br />
cases in the clinic and had attended three confinements,<br />
and he was obliged to submit reports of these cases before<br />
being admitted to the examination.<br />
This consisted of (a) a practical part, viz., performing<br />
three surgical operations on the dead body, applying three<br />
bandages, and carrying out three obstetric operations on a<br />
model; (b) an oral examination on (1) anatomy and physio<br />
logy* ( 2 ) pharmacology and dispensing, (3) general patho<br />
logy and therapeutics, (4) special pathology and thera<br />
peutics of internal diseases, (5) surgery, (6) midwifery,<br />
(7) veterinary science, and (8) forensic medicine and<br />
hygiene; (c) some paper work, the questions set being<br />
upon the eight subjects above mentioned, and the candidate<br />
being isolated. To this were added successively the hand-<br />
ing-in of an essay, the defence of theses, and the granting<br />
•of the degree.<br />
The student was thus obliged to attend the university<br />
for seven years before getting the doctor's degree which<br />
also gave the right to practise. It was sufficient moreover<br />
to entitle him to hold an appointment in the sanitary ser<br />
vice, no further examination being required for this. The<br />
faculties had complete control over the examinations.<br />
The regulation for examinations dated 22nd June, 1858,<br />
substituted for the " admission " examination, one in the
58o MODERN TIMES.<br />
natural sciences which was passed after the first year of<br />
studentship and which like the former embraced zoology,<br />
botany, mineralogy, chemistry and physics. The second<br />
examination, which took place after four years' professional<br />
study and consequently after attendance at the university<br />
for five years, differed from the earlier form in that, besides<br />
on anatomy, the candidate's knowledge was tested practically<br />
on internal medicine, surgery, ophthalmology and<br />
midwifery, he being called upon to treat two medical, two<br />
surgical and one ophthalmic case during eight days, to perform<br />
one ophthalmic and two other surgical operations on the<br />
dead body, to apply two bandages, to examine two pregnant<br />
women, to make two diagnoses, to perform two operations.<br />
on the obstetric model, and to attend-two confinements..<br />
In the oral examination anatomy and physiology formed<br />
independent subjects ; pathological anatomy was associated<br />
with general pathology and the history of medicine with<br />
general therapeutics, while veterinary science, forensic<br />
medicine, and hygiene were omitted.<br />
The biennium practicum was curtailed to one year,.<br />
which was devoted to attending lectures on forensic medicine,<br />
state medicine, the treatment of mental diseases andt<br />
veterinary science, to training in special departments, and<br />
to practical work in the policlinics. Many during this<br />
period also served as assistants in a hospital or with an<br />
official of the sanitary department. The State examinatioa<br />
was held at the end of the " practical year." This took.<br />
place only in Munich and there only once a year. It was.<br />
conducted by a Commission composed of professors,.<br />
medical officials, and practising doctors nominated by the<br />
Ministry, and included (i) special pathology and thera- ^<br />
peutics, (2) surgery, (3) midwifery, (4) psychological medicine,<br />
(5) state medicine, and (6) veterinary science, and.<br />
was both oral and by writing. On passing this the license<br />
to practise was granted*<br />
* Regierungsblatt f. d. Konigreich Bayem i8c8, S. 2189 et seq., 1843, S-<br />
433- 1858, S.-873.
THE GERMAN STATES. 581<br />
After the foundation of the German empire medical study<br />
and examinations were arranged upon a uniform plan in the<br />
different states which composed it. These, however,<br />
retained the right of making legal regulations for the<br />
education of those doctors who were to be employed in the<br />
public sanitary service. For this purpose a law was<br />
promulgated in Bavaria in the year 1876, which ordained<br />
that candidates for the medical appointments in the service<br />
of the State must give proof, both orally and by writing, of<br />
their knowledge of forensic medicine, public hygiene,<br />
sanitary regulations, and psychological medicine. In the<br />
kingdom of Wiirtemberg the students of medicine used<br />
formerly to pass their first examination at the conclusion of<br />
the course of study. It was both oral and on paper; it<br />
took place before the medical faculty of Tiibingen, and was<br />
divided into three parts: (1) on the natural sciences,<br />
including zoology, botany, mineralogy, physics, chemistry,<br />
anatomy, and physiology; (2) on medical subjects<br />
represented by general and special pathology, pathological<br />
anatomy, and therapeutics, and (3) on surgical subjects,<br />
dealing with special surgical pathology, operations, and<br />
topographical anatomy* Upon this followed a year of<br />
wider practical training, devoted to hospital work or to<br />
travelling in pursuit of scientific knowledge, and then the<br />
State examination, which was held by the medical college<br />
of Stuttgart, and consisted of medical, surgical, and obstetric<br />
portions : it was not only conducted orally and on paper,<br />
but was also of a practical character, patients being<br />
examined and treated, and operations performed on the<br />
dead body and on models.<br />
In the Grand Duchy of Baden, also, a license to practise<br />
was acquired by passing a State-examination, for the most<br />
part theoretical, and conducted by a commission, which was<br />
generally composed of members of the medical college.<br />
The doctorate was quite independent of this, and was<br />
* V. A. RIECKE : Das Medicinalwesen des Konigreichs Wiirtemberg, Stuttgart<br />
1856.
582 MODERN TIMES.<br />
conferred by the medical faculties : it constituted little m<br />
than a barren title, and was consequently not sought after<br />
by many practitioners.<br />
In the kingdom of Saxony there were formerly, in addition<br />
to the doctors who had taken degrees and had been<br />
educated at the university of Leipzig, medicinae practici,<br />
surgeons, and accoucheurs, who received instruction at the<br />
Medico-Chirurgical Academy of Dresden, a society which<br />
arose out of the Collegium Medico-Chirurgicum in 1815<br />
and endured until 1864. The medicinae practici were an<br />
inferior class of doctors for internal diseases, and had a<br />
right of settling down only in very closely circumscribed<br />
areas. The surgeons were allowed to practise surgery<br />
anywhere, but midwifery only if they had passed the prescribed<br />
examination. The medicinae practici could get a<br />
license to engage in surgical and obstetric practice on<br />
passing examinations in these departments of medical<br />
science.<br />
Anyone after finishing his studies at the gymnasium and<br />
entering the university for the purpose of studying medicine,<br />
could after two years present himself for the examination<br />
for the degree of Bachelor, which nearly corresponded<br />
to the tentamen physicum of to-day ; he could then at the<br />
conclusion of his studies submit to the "approbation"<br />
examination held by the medical faculty and leading to the<br />
doctor's degree; the latter examination embraced all the<br />
most important subjects which had been taught and made<br />
pretty high claims upon the candidate's knowledge.<br />
In the Saxon duchies there used formerly to be Stateexaminations<br />
which were held by examination commissioners.<br />
in the chief towns of the different countries.<br />
It was not until 1862 that Weimar, Coburg-Gotha and<br />
Altenburg agreed to hand over all business connected with<br />
examinations to the medical faculty of Jena. The qualifying<br />
examination embraced the most important branches of<br />
medical science, was associated with practical work,<br />
clinical demonstrations, etc., and concluded with the con-
THE GERMAN STATES. 583<br />
ferring of the diploma of Doctor, upon the strength of<br />
which the governments of the different States granted a<br />
license to practise.<br />
In the kingdom of Hanover the physicians were trained<br />
at the University of Gottingen, and the surgeons, who stood-<br />
on a lower educational footing, at the Surgeons' School at<br />
Hanover. The former went up for the examination for<br />
the Doctorate after some seven semesters : this dealt with<br />
all the chief departments of medicine but did not give a<br />
right to practise. This license could only be obtained by<br />
passing the State-examination which was held by a com<br />
mission nominated by the Government.<br />
In Mecklenburg* also there existed formerly in addition<br />
to the physicians who were educated, and took degrees, at<br />
the University of Rostock, a class of surgeons who received<br />
a more or less restricted license to practise their art by<br />
passing an examination before the Medical College. The<br />
license, to practise was granted by the government to the<br />
Doctors of Medicine on the strength of their diplomas.<br />
This arrangement of examinations was however altered to<br />
suit the pattern of the examination arrangements in<br />
Prussia even before the German imperial laws were intro<br />
duced.<br />
In the Grand Duchy of Hesse there was only one class of<br />
doctors. The study of medicine was not allowed until<br />
after the conclusion of the studies at the gymnasium.<br />
The medical examinations consisted of the following:—<br />
(i) The examination in natural science; this included<br />
mineralogy, botany, zoology, physics, and chemistry;<br />
(ii) the examination in anatomy, which was theoretical<br />
and practical, and very thorough; (iii) the final exami<br />
nation, which consisted of paper work, clinical work in<br />
the wards, and a part held viva voce, in which all depart<br />
ments of medical science came into consideration, with the<br />
exception of anatomy. Then followed writing an essay,<br />
* DORNBLUTH : Darstellung der medicinischen Polizeigesetzgebung, Schwerin<br />
'834-
584 MODERN TIMES.<br />
taking part in disputations, and finally the doctor's degree,<br />
which carried with it the right to practise.<br />
In those German States which did not possess medical<br />
schools, such as Oldenburg, Brunswick, Hamburg, Liibeck,<br />
etc., there were boards of examiners made up of officials in<br />
the sanitary service and doctors of position, and the right<br />
to practise was granted by them.<br />
PRUSSIA AND THE PRESENT GERMAN<br />
EMPIRE.<br />
THE Brandenburg-Preussen monarchy during the course of<br />
the 18th century gained a prominent position as a political<br />
and military power. The idea of a strong ruling authority<br />
in the State which should be paramount in all departments<br />
of administration, and should conduct affairs with a view<br />
to the common weal broke upon men's minds at an early<br />
date in this country, and was diffused throughout all classes<br />
of the population. The system of medical education was<br />
not uninfluenced by this tendency.<br />
As early as the year 1725 a State-examination was introduced,<br />
and was no doubt necessary on account of the<br />
inconsiderate manner in which medical diplomas were at<br />
that time granted in many places.* It was, however,<br />
limited to anatomy and the description of a case of disease<br />
which had been observed by the candidate. To this was<br />
afterwards added an oral examination upon the most important<br />
parts of medical science. In 1798 the regulation<br />
was made that instead of writing out a case two patients<br />
should be examined in the presence of the examiner and<br />
treated by the candidate for four weeks. The period of<br />
studentship was fixed at a minimum of three years.<br />
A complete organization of medical studies and examinations<br />
was effected in the year 1825. According to this<br />
* L. v. RONNE und H. SIMON : Das Medicinalwesen des Preussischen Staates,<br />
Breslau 1844, i, 344 et seq.
PRUSSIA AND THE GERMAN EMPIRE. 585<br />
several categories of practitioners were distinguished ; fOr<br />
instance the doctors who had received diplomas and who<br />
were entitled either to practise medicine only or medicine<br />
in conjunction with surgery, and surgeons of the first and<br />
second class, who were also entitled to practise midwifery<br />
and ophthalmic surgery if they had passed the necessary<br />
examinations.<br />
The doctors with diplomas were educated at the universities.<br />
On matriculating it was necessary for the student to<br />
furnish a proof that he had completed his course of study at<br />
the gymnasium and had passed the " leaving " examination.<br />
He had then to devote himself during four years to medical<br />
study and during the last year to attendance on the clinics.<br />
There were the following examinations: (1) the tentamen<br />
fhilosophicum which was introduced in 1826, included<br />
logic and psychology, physics, chemistry, mineralogy,<br />
botany and zoology, and was held by the professors of the<br />
faculty of philosophy in the presence of the dean of the<br />
medical faculty; (2) the tentamen medicum and examen<br />
•rigorosum which consisted of a written portion, precautions<br />
being taken that the candidate received no help, and an oral<br />
.examination, and which dealt with every subject which had<br />
been taught: these, if passed successfully, entitled the<br />
candidate to his degree; (3) the State-examination which<br />
took place only in Berlin and gave the right to practise.<br />
While the tentamen medicum was held before the dean<br />
and the rigorosum before the professors of the medical<br />
faculty, at the State-examination " theoretically and practically<br />
educated men of science from all branches of medicine"<br />
were employed as examiners. Professors and other<br />
university teachers were intended to be excluded on<br />
principle from examining, and at most were admitted as<br />
examiners only in subjects which they did not teach. No<br />
member of this Examination-Commission, which was appointed<br />
annually by the Ministry, was at liberty to exercise<br />
his functions longer than two years.<br />
The State-examination was composed of several parts,
586 MODERN TIMES.<br />
' * ' >\ '<br />
of which the 'first dealt with anatomy, the situs viscerum<br />
being demonstrated by the candidate who had also to make<br />
a dissection and to explain preparations which were placed<br />
before him; the second part dealt with internal medicine<br />
and consisted of the examination and treatment of two<br />
patients during 2-3 weeks, to which were added questions<br />
upon other cases of disease, and of an inquiry into the candidate's<br />
knowledge of the art of prescribing; in the third<br />
two cases of surgical interest were examined and treated<br />
in the same way; and the fourth, the final viva voce examination,<br />
once more took all subjects taught into consideration<br />
and served as it were to control the preceding examinations.<br />
Hereupon the license to practise medicine was<br />
granted.<br />
Whoever desired to engage in surgical practice also wasobliged<br />
to submit to another examination in operative<br />
•surgery which was interpolated between the second and<br />
third parts of the State-examination and consisted of the<br />
.•candidate writing a surgical essay, giving proof of his<br />
' knowledge of instruments and of the art of operating,.<br />
.'.Applying a bandage and performing two operations on the<br />
'•dead body. If the candidate passed this examination with<br />
' great credit he .received the diploma of " operator :" if hedid<br />
mot distinguish himself he received the diploma of<br />
medical practitioner and surgeon. The title of "operator"<br />
was abolished in 1855.<br />
The " surgeons of the first class " were not obliged to be<br />
' possessed of such a good general education and had tostudy<br />
for three years at a medical faculty or a medicochirurgical<br />
school ; they were however excused one year<br />
of studentship if they had previously been employed for<br />
two years as surgeons of the inferior category. They<br />
received a license to practise internal medicine and surgery<br />
after passing the State-examination. The latter was regulated<br />
upon the same principles as that for the doctors with<br />
university diplomas, and differed from it only in not presupposing<br />
a knowledge of the natural sciences and in
PRUSSIA AND *THE GERMAN EMPIRE. 587<br />
making less extensive'dlaims ilpon professional knowledge.<br />
It was conducted in the German language whereas the<br />
university doctors sustained a part of their examination in<br />
Latin. The " surgeons of the second class " got the knowledge<br />
required for their calling partly through the instruction<br />
received from a master of their art, partly by serving<br />
at the military hospitals and infirmaries or by attending a<br />
few lectures at a medical faculty or medico-chirurgical<br />
school. At their examination, which was held by the provincial<br />
medical colleges, they were required to answer on<br />
paper, without assistance, three questions upon general<br />
points in physiology, materia medica et chirurgica, and the<br />
art of prescribing, upon the means of resuscitating the<br />
apparently dead, the assistance to be rendered in sudden<br />
accidents, the provisional measures to be taken on the outbreak<br />
of epidemics, etc. ; they were also asked to give • a<br />
demonstration of the situs viscerum, to make a dissection^'<br />
and to explain preparations placed before them, to perform,<br />
a small operation on the dead body, to apply a bandage .<br />
and to diagnose frequently occurring pathological conditions -^.y<br />
such as inflammation, suppuration, hernia, fractures • an
588 MODERN TIMES.<br />
made compulsory for those doctors who possessed no<br />
•surgical diploma. It consisted of answering on paper two<br />
or three questions upon the anatomy and physiology of the<br />
eye, performing some ophthalmic operations upon the dead<br />
body, showing a knowledge of the instruments in use and<br />
undergoing a viva voce examination in ophthalmic science-<br />
Only doctors with university diplomas or surgeons of the v<br />
first class who were authorized to practise all departments<br />
of medicine received appointments in the public sanitary<br />
•service. The former were entitled physici, the latter<br />
forensic surgeons. Candidates for these appointments had<br />
to write four essays on subjects connected with medical<br />
jurisprudence, several months being allowed them for the<br />
task, to perform a dissection in a medico-legal case, to<br />
make a visit of inspection to a druggist's shop, to give<br />
practical proof of their diagnostic and therapeutic skill in<br />
veterinary science, and to pass an examination in Statemedicine.<br />
In 1850 a regulation was made that only such<br />
doctors as had got their qualification in the State-examination<br />
with exceptional merit should be admitted at once to<br />
the examination for the position of physicus, the others<br />
had to wait some years.<br />
This system of examinations, complicated by such a<br />
variety of combinations, was attended by many drawbacks.<br />
It divided doctors into a number of different groups,<br />
rendering disputes difficult to avoid, it degraded the<br />
faculties, vexed the university teachers by making them<br />
the objects of unjust suspicion, inasmuch as it made a point<br />
of excluding them from acting as examiners at the Stateexamination,<br />
while the examining boards which had this<br />
duty cast on them were overworked, persons were nominated<br />
examiners who were but seldom competent or suitable<br />
for the office, and the candidates were oblip-ed to make<br />
a long stay in Berlin, and so put to much expense. These<br />
causes, combined with the advancing development of<br />
medicine, and influenced by the spirit of the age, which<br />
demanded equalization of position and rights, led to a
PRUSSIA AND THE GERMAN EMPIRE. 589<br />
partial change in the system of medical study and exami<br />
nations.<br />
In the years 1848 and 1849 the medical schools of<br />
Breslau, Greifswald, Miinster, and Magdeburg, which had<br />
up to that time served, together with the medical faculties,.<br />
as places for the education of surgeons, and had been<br />
founded only a few decades before, were closed and done<br />
away with, so that for the future no more practitioners of<br />
this kind were produced.<br />
The law of the 8th of October, 1852, ordained that from<br />
that time forth there should be only one class of doctors,<br />
who should be obliged to pass all the examinations, and<br />
consequently be entitled to practise all branches of medicine..<br />
They were to be educated at the university only, and to<br />
pass the tentamen philosophicum, the tentamen medicumy<br />
the examen rigorosum, and, finally, the State-Examination..<br />
The last consisted of the identical parts which had up till<br />
this time composed the examination prescribed for the<br />
doctors with university diplomas and the surgeons ; but<br />
the portion which dealt with clinical surgery was merged<br />
with the examination upon operative surgery and the<br />
examination on midwifery was made a special part of the<br />
State-examination. This consisted therefore of examinations<br />
on anatomy, medicine, surgery and midwifery, and a<br />
final examination to which only those were admitted who<br />
had passed the others creditably. Some changes rendered<br />
necessary by the scientific requirements of the times were<br />
afterwards introduced into this arrangement of examinations.<br />
Thus in 1856 the anatomical examination assumed<br />
another form by the subject of physiology being added to<br />
it, and consisted of an anatomical part devoted to a practical<br />
testing of the candidate's knowledge of osteology and<br />
splanchnology (situs viscerum) together with the preparation<br />
of a dissection to show the course of nerves, and a<br />
physiological part including histology<br />
In 1861 the tentamen philosophicum was abolished and<br />
its place taken by the tentamen physicum, in which
59°<br />
MODERN TIMES.<br />
anatomy, physiology, physics, chemistry, and the descriptive<br />
natural sciences (mineralogy, zoology, and botany)<br />
formed the five subjects on which candidates were examined.<br />
The examination took place under the direction of the dean<br />
of the medical faculty, and was passed after the second<br />
year of studentship. In i860 it was decreed that any<br />
•candidate entering his name for the State-examination<br />
should furnish proofs that he had attended, in the capacity<br />
of assistant, both surgical and medical clinics during two<br />
semesters each. The eXamen rigorosum continued to exist<br />
in an unaltered form as an affair of the faculty and independent<br />
of the State-examination.<br />
At the beginning of* the present century some of the<br />
universities of Prussia appeared superfluous by reason of<br />
the inadequate number of students attending them, and the<br />
vicinity of other .academies more favourably situated.,i phu-s<br />
in 1805 the University of Erfurt with 41 teachers H^m^red<br />
only 21 students, and that of Duisburgwith 12 teachers the<br />
same number of 21 students ; somewhat better attended<br />
were the universities of Frankfort-on-the-Oder with 21<br />
teachers as against 174 students in the year 1797; of<br />
Erlangen with 40teachers and 202 students; of Konigsberg<br />
•with 26 teachers and 346 students, and of Halle with 48<br />
teachers and 762 students. After the universities of Duisburg<br />
and Erfurt had been abolished, and that of Erlangen in<br />
Bavaria had ceased to exist, and Wittenberg had been<br />
united with Halle and Frankfort-on-the-Oder with Breslau,<br />
there remained of the ancient universities only Konigsberg,<br />
Halle, and Breslau; at the last-mentioned a medical faculty<br />
was founded for the first time in 1811. To these were<br />
padded the University of Greifswald, which came under<br />
Prussian rule with Swedish Pomerania, and those of Berlin<br />
a;nd Bonn which, were newly-founded.<br />
, ;;r The University of Berlin assumed a definite form in 1810<br />
•'•'at a time when the State, as a result of the defeats of Jena<br />
'"•and^Auerstadt, was reduced in extent to the half of its<br />
former dimensions, and was partly occupied by foreign
PRUSSIA AND THE GERMAN EMPIRE. 591<br />
troops. It was certainly a remarkable phenomenon that at<br />
such a period of general overthrow the thought of erecting<br />
temples to knowledge should have occurred to men's minds;<br />
it shows what courage—what moral and intellectual power<br />
—these men possessed, and how firmly and surely they<br />
hoped and built upon the hope of the restoration of the<br />
State*<br />
The medical faculty of the University of Berlin was<br />
developed out of the Collegium Medico-Chirurgicum, at<br />
which, in 1806, before the outbreak of the war, there was a<br />
teaching staff of eighteen ordinary and two extraordinary<br />
professors. The faculty took over a portion of the teaching<br />
staff and some of the schools, taking care to improve and<br />
complete the educational establishment by summoning to<br />
their assistance distinguished and learned men like REIL,<br />
Hu-FELAND, RUDOLPHI, and others, and by making some<br />
necessary additions to the schools of science. The establishment<br />
for the education of doctors for the army at Berlin,<br />
which, at the instigation of G6RCKE, had been provided ip<br />
1795 with an excellent organization^ was associated with<br />
the university in such a way that the students of the former<br />
attended the lectures at the latter. These students were<br />
divided into those who were being educated for medical<br />
degrees and those who were passing the course of instruction<br />
required for " surgeons of the first class." With the<br />
abolition of the latter category of doctors, the training of<br />
such for the army came also to an end. The institution<br />
serves at the present day as a boarding-house for students<br />
under the direction of military medical officers. The<br />
students receive from the State lodging and instruction<br />
gratis, and even get pecuniary support, to a certain extent, .<br />
during their studies ; and in return they incur the obligation.<br />
of serving for a certain number of years in the army. The<br />
* RUD. KOPKE: Die Griindung der Friedrich-Wilhelms-Universitat zu Berlin,<br />
Berlin i860.<br />
f J. D. E. PREUSS: Das K. Preuss. medicinisch-chirurgische, Friedrich-.<br />
Wilhelms-Irrstitut zu Berlin, Berlin 1819, S. 28 et seq. .,
59 2 MODERN TIMES.<br />
supervision of the students is given to military medical<br />
officers who are distinguished for talents and ability; they<br />
accompany their pupils to the lectures, go over the subjects<br />
with them again, and thus get an opportunity of making<br />
their own acquirements sounder and more extensive. To<br />
this arrangement the science of our day owes many distinguished<br />
investigators and university teachers.<br />
The youngest of the Prussian universities is that of Bonn,<br />
which -was founded in 1818. It was a want much felt by the<br />
western provinces, widely separated as they are from the<br />
eastern ; the former possessed no academy, with the exception<br />
of the theologico-philosophical school of Minister. The<br />
political events of 1866 brought about an increase in the<br />
number of Prussian universities by the addition of those of<br />
Gottingen, Kiel, and Marburg, which, with Hanover, Sehleswig-Holstein,<br />
and the former electorate of Hessen, came<br />
under the Prussian administration.<br />
When, after-the famous victories of i870,Elshss (Alsace)<br />
was reunited to Germany, the University of Strassburg was<br />
reorganized after the pattern of German uniyersities, and<br />
included in their number. Equipped with abundant material •<br />
for teaching and a distinguished staff of teachers, it has<br />
soon acquired for itself a prominent place among the high<br />
schools of Germany.<br />
With the institution of the North German Confederation,<br />
which was, by the adhesion of the South German States in<br />
1871, expanded into the German Empire, there followed a<br />
uniform organization in medical studies and examinations.<br />
By paragraph 29 of the law regulating trades and professions<br />
of June 21 st, 1869, it was decreed that only the<br />
supreme authorities of those Confederate States which<br />
possessed one or more universities should be entitled to<br />
grant licenses to practise medicine, and then only to persons<br />
who had passed the State-examination.*<br />
This can be passed at any of the universities belonging<br />
* H. EULENBERG : Das Medicinalwesen in Preussen, Berlin 1874,8. 306<br />
et seq.
PRUSSIA AND THE GERMAN EMPIRE. 593<br />
to the German empire. The examining commissioners are<br />
nominated annually by the presiding Ministry ; among them<br />
are found experts in all branches of medicine, the professors<br />
and teachers of the different universities being chosen by<br />
preference, together with a president who conducts and<br />
keeps a watch over the proceedings. The medical colleges<br />
and examination commissions, which had up to this time<br />
held the State examination in the chief towns of the different<br />
Confederate States, ceased to exercise this function, and the<br />
State-examination in medicine was simply changed into a<br />
university examination supervised by State-officials.<br />
Whoever desires to present himself for this examination<br />
must furnish proofs that he has gone through the gymnasium<br />
course of study, passed the tentamen physicum, acted as<br />
assistant at the clinics, and attended four cases of labour.<br />
On the other hand he is no longer obliged, as'was formerly<br />
the case, to undergo the examen rigorosum and to take the<br />
doctorate. It is true the right of granting this, degree, after<br />
passing an examination, has been retained by the faculties ;<br />
but this can now be done as well after as before the State-<br />
examination, arid is nothing more than an ancient custom —<br />
no longer a fOrm prescribed by law.<br />
The State-examination was divided into five parts. The<br />
first included anatomy, 'physiology, and pathological<br />
anatomy, and involved the demonstration of an osteological<br />
and;a splanchnologieal preparation and the dissection of a<br />
" part" to exhibit the nerves ; the candidate was required<br />
to answer questions set him in histology and physiology, and<br />
to put up and describe a histological preparation ; he had<br />
to perform a post-mortem examination and to make a<br />
report of the pathologico-anatomical results arrived at; he<br />
had also to make a histological preparation of diseased<br />
tissue: the second part dealt with surgery and ophthalmo<br />
logy and involved the treatment of two patients by the<br />
candidate during eight days with written reports on the<br />
cases ; he had to answer questions set him on surgical<br />
subjects and perform an operation on the dead body, to<br />
>.Q Q
594<br />
MODERN TIMES.<br />
answer questions on fractures and dislocations, to apply a<br />
bandage and to examine and treat a case of ophthalmic<br />
disease : the third part was concerned with medicine in a<br />
similar way and involved the treatment of two cases of<br />
disease; the candidate had also to answer numerous questions<br />
on materia medica, toxicology, and the art of prescribing<br />
: the fourth part dealt with midwifery and<br />
gynaecology and involved attendance on a case of labour,<br />
the treatment of a woman during the puerperal period, and<br />
the performance of an obstetric operation on the model :<br />
the fifth part consisted of the final viva voce examination<br />
which embraced general and special pathology, surgery,<br />
materia medica and State-medicine or hygiene. The<br />
subjects upon which the candidates were required to<br />
furnish answers were to some extent decided by lot.<br />
Whoever passed the State-examination satisfactorily was<br />
entitled to call himself medical practitioner (Arzt) but not<br />
to assume the title of Doctor of Medicine. If anyone<br />
desires the latter distinction he lias to get it from some<br />
medical faculty. The conditions under which this is<br />
granted differ in different places. The demands on a<br />
candidate's knowledge are represented as a general rule by<br />
an oral examination on the most important branches of<br />
medical science, by the composition of an essay in German,<br />
instead of Latin as was formerly the case, and by the argu<br />
mentative defence of certain theses.<br />
The regulations of June 2nd, 1883, introduced numerous<br />
important alterations into this system of examination. In<br />
the first place it was decreed that mineralogy should be<br />
omitted from the list of subjects for the tentamen physicum,<br />
since all governments and faculties were agreed "that<br />
mineralogy of all branches of natural science is of least<br />
use to the future doctor, and the little it is necessary he<br />
should know about it is taught him in the lectures on<br />
chemistry and materia medica." The examination in<br />
zoology and botany was 'also curtailed, and it was ordered<br />
that only one question should be put upon these two
PRUSSIA AND THE GERMAN EMPIRE. 595<br />
subjects. This was done from the conviction that it is<br />
impossible to assign the sarhe importance in medical study,<br />
or to allow the same title to a place in the medical cur<br />
riculum, to botany and zoology as to physics and<br />
•chemistry, to say nothing of anatomy and physiology:<br />
that moreover it appears unjust to require from a medical<br />
student in his fourth semester satisfactory work in the<br />
•extremely wide field of botany and zoology, in addition to<br />
an adequate knowledge of anatomy, physiology, physics<br />
and chemistry: and that it is impossible for him to satisfy<br />
the demands made upon his knowledge of these two<br />
sciences by a professor who makes one or both of them his<br />
special study, unless indeed he neglects for their sake<br />
branches of knowledge of far higher importance to his<br />
future career. On these grounds it was even proposed to<br />
•exempt medical students from any examination at all in<br />
zoology and botany, or else to have any such examination<br />
conducted not by professors of these sciences but by a<br />
member of the medical faculty.<br />
These considerations led to a resolution to require of the<br />
student only that he should possess in zoology a knowledge<br />
of the outlines of comparative anatomy and physiology,<br />
and in botany a general acquaintance with the system<br />
of classification of the vegetable kingdom, having especial<br />
regard to officinal plants, together with a knowledge of the<br />
outlines of vegetable anatomy and physiology. It need<br />
hardly be said that persons who have taken the degree of<br />
Doctor in the natural sciences at a German university are<br />
excused the examination in these subjects in the tentamen<br />
fihysicum. The tentamen physicum is an oral examination<br />
and does not involve any practical work.<br />
At the same time the conditions for admission to the<br />
State-examination were made more severe and another<br />
method of subdividing it wals introduced. The candidate<br />
must now, when he puts his nairie down for it, furnish proof<br />
that he has devoted at least nine semesters to medical study,<br />
instead of eight as was formerly the case, and that he has
6 MODERN TIMES.<br />
59<br />
acted as assistant in the surgical, medical, and obstetric<br />
clinics for two semesters in each and one semester in the<br />
clinic for diseases of the eye; also that at least foursemesters<br />
have elapsed since he passed the tentamen<br />
physicum. In 1887 it became necessary for him to show<br />
that he had acquired the requisite skill in the performance<br />
of vaccination.<br />
The State-examination is divided into the following<br />
parts: (1) normal anatomy; (2) physiology; (3) pathological<br />
anatomy and general pathology ; (4) surgery and<br />
ophthalmology; (5) internal medicine and therapeutics;:<br />
(6) midwifery and gynaecology; and (7) hygiene. In<br />
anatomy, physiology and pathological anatomy the<br />
examination is carried on by only, one examiner; in theother<br />
subjects by two. The examination appears to havebeen<br />
made rather more severe than formerly in certain<br />
subjects, such as anatomy, surgery, and midwifery. If a<br />
candidate fails in any subject he must present himself for<br />
re-examination within a certain fixed time : if he fails to do<br />
so, he loses all advantage from having passed in the subjects<br />
on which his knowledge had satisfied the examiners.<br />
Some of the regulations in this system of examination"<br />
cannot fail to provoke our criticism. The first to do so isthat<br />
fixing the period of studentship at nine semesters,.<br />
whereas only a few decades previously this period in many<br />
of the Confederate States covered ten semesters. Since<br />
that time medical science has greatly developed in alldirections,<br />
and the demands made upon the knowledge of<br />
doctors have not on that account become less, but on the<br />
contrary have extraordinarily increased. If we wish resettle<br />
a precise period for the duration of studentship, ten<br />
semesters are the least we can demand.<br />
Again, the semester which at present is given up tomilitary<br />
service falls generally in the period of studentship<br />
required by law and is reckoned as part of it: this arrangement<br />
is unjustifiable for while performing their military<br />
duties the students are prevented studying by having other
PRUSSIA AND THE GERMAN EMPIRE. 597<br />
tasks to execute which monopolize all their bodily and<br />
mental powers.<br />
The decree that medical studies must be carried on to<br />
their termination exclusively in the universities of the<br />
German empire excited surprise. Such a regulation could<br />
be easily understood in the case of law students who after<br />
wards become State-officials : but permission should be<br />
granted to those who are destined for the medical pro<br />
fession—a calling of an international character—to visit<br />
foreign universities to complete their education or to<br />
enlarge their intellectual horizon.* It has hitherto been<br />
^uite characteristic of the German race to accept and<br />
assimilate the intellectual achievements of other peoples<br />
and by no means to shut their eyes to them.<br />
The doctorate in Germany takes up a singular position<br />
in relation to the system of medical examinations. Inas<br />
much as it neither confers the right to practise nor is a<br />
•condition upon which admission to the State-examination<br />
depends, it appears to be really superfluous. If the object<br />
is to satisfy the prejudices of the public by preserving<br />
amongst practitioners the title of Doctor it ought to be<br />
granted to everyone who has passed the State-examination.<br />
If it is intended to be a mark of distinction for remarkable<br />
scientific attainments it is desirable that the claims on the<br />
knowledge of those who are candidates for it should be dis<br />
tinctly higher than they are.<br />
It is an extraordinarily happy and suitable arrangement<br />
to intrust the management of the examinations chiefly to<br />
the faculties, the members of which are for the most part<br />
without any doubt elected on account of their special per<br />
sonal acquirements, and at the same time to preserve to the<br />
authorities of the State a proper amount of that influence<br />
which they are empowered and intended to use in the<br />
interests of the public.<br />
Some particular points in the arrangement of the exami<br />
nations could no doubt be improved. Thus it may be<br />
* K. KOESTEU : Die Freiziigigkeit der Studierenden der Medicin, Bonn 1884.
598 MODERN TIMES.<br />
doubtful whether two examiners are required in the subjects<br />
dealing with practical medicine while one examiner is sufficient<br />
in each of the other subjects,lbecause by this arrangement<br />
too great demands are made upon clinical material<br />
but scantily available' in many .places )f again, two equally<br />
qualified examiners are hardly ever to be found at the same<br />
place ; and finally the supervision or control of one examiner<br />
by the other does not appear to be more necessary here<br />
than in the subjects connected: with the theory of medicine.<br />
So 'too the present form of the last part of the Stateexamination<br />
is unsatisfactory. Hygiene has no more claim<br />
to be admitted as a subject for examination than have psychological<br />
medicine, forensic medicine, veterinary science<br />
and other branches of medical study.<br />
On the other hand in spite of these few faults—and the<br />
justice of the criticism has perhaps still to be proved—the<br />
German system of medical education presents so many<br />
advantages that it justly serves as a pattern which other<br />
lands are glad to imitate.<br />
ITALY.<br />
THE system of medical teaching in Lombardy and Venetia<br />
was organized in former times completely after the Austrian ;<br />
model. The medical faculties of Padua and Pavia stood<br />
in intimate relation to the universities of the other<br />
countries belonging to the Austrian crown and gained<br />
from them both inspiration and assistance on the path of<br />
intellectual progress. The princes of the Austrian reigning<br />
house, as is remarked by LODER,* directed " their efforts<br />
towards good organization and satisfactory maintenance of<br />
the public medical institutions."<br />
In the States of the Church, medical study lasted for four<br />
years in accordance with a decree of Pope LEO XII. dated<br />
* E. V. LODER : Uber arztliche Verfassung und Untefricht in Italien .i. J.<br />
1811, Leipzig 1812.
ITALY. 599<br />
1824; after this period had elapsed the Doctorate of Medi<br />
cine could be conferred. Anyone desiring only the degree<br />
of Doctor of Surgery studied one year Jess and occupied<br />
himself principally with the subjects required for his future<br />
calling. The license to practise was not conferred at the<br />
same time as the degree, but the biennium practicum had<br />
first to be passed and was spent in visiting the clinics and<br />
in hospital work.<br />
In Tuscany the custom prevailed that medical students<br />
should attend the Universities of Siena or Pisa during four<br />
years and then betake themselves to Florence to continue<br />
their studies; here, in the institution connected with the,<br />
Ospedale di S. Maria Nuova, they had an opportunity of<br />
getting a more extended and complete education in medi<br />
cine. The lectures which had to be attended at the uni<br />
versity were accurately laid down. Examinations held at<br />
the end of every year were the means of deciding whether<br />
a student should be admitted to the lectures of the follow<br />
ing year. After the conclusion of the period of studentship<br />
the State-examination had to be passed in Florence : it con<br />
sisted of an oral part on theoretical subjects and of a prac<br />
tical clinical part. Then followed the composition and<br />
defence of theses, the promotion to the degree of Doctor,<br />
and the license to practise.<br />
Similar conditions prevailed in other Italian States.<br />
The influence of Austria and France, which made itself<br />
felt in many branches of the administration, was noticeable<br />
also in the arrangements of medical study.<br />
When the national aspirations of Italy were satisfied and<br />
the different parts of that country were united into one<br />
political whole, a uniform organization in medical teaching<br />
became a possibility. It became a reality on the 16th<br />
November, 1859, and was the first stone laid in a great<br />
edifice of culture, the advantages of which are becoming<br />
every day more apparent.<br />
At present Italy possesses 17 universities maintained by<br />
the State, and 4 supported by towns or provinces. The
600 MODERN TIMF.S.<br />
State universities are divided into those of first and second<br />
rank. To the first class belong the academies of Rome,<br />
Naples, Turin, Bologna, Padua, Pavia, Pisa, and Palermo;<br />
to the second those of Genoa, Modena, Parma, Macerata,<br />
Siena, Cagliari, Sassari, Catania, and Messina. The latter<br />
are partly incomplete, that is, are not provided with all the<br />
faculties, and possess fewer professorships and a smaller<br />
number of students than the former. The so-called free<br />
universities are at Perugia, Urbino, Camerino and Ferrara.<br />
We must also mention the Instituto Superiore of Florence,<br />
which is connected with clinical and other medical institu<br />
tions, and offers facilities for the study of medicine.<br />
There is everywhere an absence of the theological<br />
faculty, for the training of the clergy was in 1873 taken<br />
away from the universities and handed over to the epis<br />
copal seminaries.<br />
Four faculties are recognized, namely, the legal, medical,<br />
that representing mathematics and the natural sciences,<br />
and the linguistic-historical. The study of medicine<br />
is continued over six years. The students must on<br />
matriculation give proof of having received a preliminary<br />
education. If they have not passed through the gymnasium,<br />
and the lyceum, which nearly corresponds to the three<br />
upper classes of the gymnasium in Germany, and have<br />
received no equivalent education elsewhere they are<br />
admitted to attend the lectures, but not to the examinations<br />
or to the degree. A plan of studies is recommended to the<br />
students, but its adoption is not made compulsory. They<br />
are examined only in the most important departments of<br />
medical science, and this takes place immediately after the<br />
termination of the course of study. The examination is<br />
held by the professors who teach the subjects examined<br />
upon, two specialists acting as assistants to each professor.<br />
After having in the course of the period of studentship<br />
passed the different special examinations in the subjects<br />
taught, which are both theoretical and also of a practical<br />
nature—dealing for example with descriptive and patho-
SPAIN AND PORTUGAL. 601<br />
logical anatomy, surgery, internal medicine and midwifery<br />
—they receive a license to practise medicine. In order to<br />
get the doctorate the practitioners must compose an essay<br />
and support several theses by argument.<br />
The teaching staffs of the medical faculties are composed<br />
of ordinary and extraordinary professors, who are distin<br />
guished only by the difference in the amount of the stipends /<br />
which they draw ; of incaricati, who are commissioned to<br />
teach some special subject; and of private teachers. The<br />
appointment to the professorships is ordinarily the result j<br />
of competition in written and oral examinations, or merely f<br />
the production by the candidates of any scientific work I<br />
they may have done. In cases where it is a question of a<br />
learned man of acknowledged reputation, candidature is<br />
disregarded, and he is summoned to occupy the professorial<br />
chair.*<br />
SPAIN AND PORTUGAL.<br />
IN Spain, too, the custom of granting the right to practise<br />
particular branches of medicine has been given up. At the<br />
present day there exists but one class of doctors, the<br />
licenciados en medicina y chirurgia, along with persons<br />
•of inferior position w 7 ho render surgical aid, amongst whom<br />
may be numbered the practicantes (surgical assistants) and<br />
the dentistas. Anyone beginning the study of medicine<br />
must furnish proof that he has received a general scientific<br />
preliminary education, and must possess the degree of<br />
Bachiller en artes. Medical study may be pursued through<br />
out at the universities, but this is not compulsory.<br />
Medical faculties exist at the academies of Madrid,<br />
Barcelona, Granada, Salamanca, Santiago de Compostela,<br />
Seville, Cadiz, Valencia, Valladolid and Saragossa. The<br />
•students devote the first year of studentship to the natural<br />
* TOMMASI-CRUDELI in the Riv. Clin, di Bologna, 1876.—Regio decreto N<br />
2621, Roma 1884.<br />
!<br />
i
602 MODERN TIMES.<br />
sciences, physics, and chemistry, and the following six<br />
years to medical subjects. After this they are subjected to<br />
an examination consisting of three parts, the first being<br />
theoretical, and embracing all branches of medicine, and<br />
the two others being of a practical character, and held<br />
partly at the bed-side, partly in the post-mortem room.<br />
The candidate receives on passing this the license to.<br />
practise, but not the degree of doctor. If he desires the<br />
latter he is obliged to study for another year, devoting this<br />
time to the completion of his medical education, and toattending<br />
lectures on the history of medicine, medical<br />
geography,- hygiene, biology and many other subjects i<br />
finally he has to compose an essay and to support theses by<br />
argument. The title of Doctor is only granted to those<br />
practitioners who manifest an active interest in the advance<br />
of science: it affords no advantage in practice, and is<br />
sought for only by those who aspire to professorships or<br />
high positions in the public sanitary service.<br />
Portugal has a medical faculty at Coimbra and two<br />
medico-surgical schools at Lisbon and Oporto. They differ<br />
from one another in the first being more richly supplied<br />
with the means of instruction and with professorships than<br />
the two last and alone having the right to grant the title of<br />
Doctor. The school of Lisbon, by reason of the great<br />
hospital which has been consigned to it for teaching purposes,<br />
enjoys the reputation of giving a superior education<br />
in practical medicine and more particularly in surgery.<br />
There is now only one class of doctors, since the licenciati<br />
minores who had but a limited right to practise have<br />
been abolished. No one is admitted to the study of medicine<br />
until he has shown in an examination that he has<br />
received a certain amount of general education. Attendance<br />
on lectures is compulsory. The curriculum demands<br />
five years' work. Examinations are held at the end of<br />
every year, and upon the result of these promotion into
HOLLAND AND BELGIUM. 603.<br />
a higher class depends. The examinations are both<br />
theoretical and practical and in some respects very strict 1<br />
thus the candidate is required to treat 10 patients during<br />
20 days independently. The result being satisfactory<br />
the license to practise is granted. The title of Doctor is<br />
indicative of a more complete scientific education. It is<br />
required in the case of those, for instance, who are desirous<br />
of teaching at the medical faculty of Coimbra. To get it<br />
the candidate has to pass an examination and write an<br />
essay. The professors are the examiners. The professor<br />
ships are conferred after competition.*<br />
HOLLAND AND BELGIUM.<br />
VARIOUS classes of doctors were formerly educated in<br />
Holland, and were licensed to engage partly in medical,.<br />
partly in surgical practice, and to settle either in the<br />
country only or anywhere they pleased. They acquired<br />
their professional knowledge either at the universities or<br />
at the medical schools which were in connection with cer<br />
tain hospitals. In 1865 a law was passed ordering that,.<br />
from that time forth, doctors should not be licensed to<br />
practise special branches of the healing art, but should<br />
practise medicine as a whole and should possess an uncon<br />
ditional right of settling where they pleased.f At the<br />
same time the hospital schools were abolished and the<br />
education of doctors handed over to the medical faculties.<br />
At the present time Holland possesses the three univer<br />
sities of Leyden, Utrecht and Groningen which are suppor<br />
ted by the State, and the Municipal Academy of Amsterdam<br />
which arose out of the Athenaeum;—a high school the his<br />
tory of which reaches back to 1632,—and which in 1877<br />
was raised into a university.J<br />
* B. A. SERRA DE MIRABEAU : Mcmoria historica e commemorativa da<br />
faculdade de medicina, Coimbra 1872.<br />
t Das Medicinalwesen im Konigreich der Niederlande, Haag 1870.<br />
X Revue internat. de l'enseignement, Paris 1881, i, 77 et seq.
604 MODERN TIMES.<br />
Whoever approaches the study of medicine must have<br />
completed his course of studies at an advanced grammar<br />
school or at the gymnasium, or else must furnish satis<br />
factory evidence that he is in possession of a sufficient<br />
preliminary" education. The period of studentship lasts<br />
generally for six years. The license to practise medicine<br />
is only acquired by passing the State-examination which is<br />
held by Examination Commissioners, teachers from the<br />
different medical faculties being nominated as such. This<br />
is preceded by the first and second examination in natural<br />
science, the first being devoted to physics, chemistry and<br />
botany, the second to anatomy, physiology, histology,<br />
materia medica and general pathology.<br />
The State-examination itself is divided into a theoretical<br />
part which deals with pathological anatomy, pharmaco<br />
dynamics, special pathology and therapeutics, hygiene, the<br />
theory of surgery and of midwifery, and into a practical<br />
part which consists of work at the bedside and in the post<br />
mortem room. Before presenting himself for this the<br />
candidate must show that he has received clinical instruc<br />
tion during two years and has attended at least twelve<br />
labours, of which two have been completed with the aid of<br />
instruments.*<br />
The doctorate of medicine is conferred by the medical<br />
faculties independently of the State-examination ; the can<br />
didates for this are required to have passed the gymnasium<br />
course in Uteris humanioribus. The examinations for the<br />
doctorate have regard not only to professional skill but<br />
also to medical learning; they presuppose a more thorough<br />
general education and go more deeply into the natural<br />
sciences and into the different departments of medicine<br />
itself than the State-examination. On this account the<br />
Doctorate of Medicine carries with it a license to practise.f<br />
* Geneeskundige Wetten, Zwolle 1882, Gesetz vom 28. Dez. 1878.<br />
f Wet van d. 28 April 1876, tot regeling van het hooger onderwijs, Zwolle<br />
1884.
HOLLAND AND BELGIUM. 6oZ<br />
The Dutch system of medical teaching differs essentially<br />
from that of Belgium which shows many points of resem<br />
blance to the French. There are, however, in Belgium<br />
no officiers de sante, no practitioners of an inferior class,<br />
but only one class of doctors educated at the university.<br />
Two out of the four universities of the country, those<br />
namely of Ghent and Liege,* are supported by the State :<br />
the remaining two are not so maintained. The University<br />
of Louvain bears a religious character, and is directed and<br />
maintained by the clergy: the University of Brussels,.<br />
which was created by the Liberal party in 1834, owes its<br />
maintenance to the city and to certain rich patrons.<br />
As a general rule the gymnasium course precedes medical<br />
study which may be completed within seven years. The<br />
medical studies begin with the natural sciences, physics,<br />
chemistry, and philosophy. The curriculum is for the most<br />
part regulated by the examinations, inasmuch as the sub<br />
jects required for one examination are all taken together..<br />
The teaching consequently is so disposed as to form a<br />
practical preparation for the examination as in the medical<br />
schools of England. The first medical examination deals<br />
with descriptive and comparative anatomy, physiology,.<br />
embryology, histology, and pharmacology, is combined with<br />
' practical demonstrations, and is called the candidate's<br />
examination. Three examinations are required for the<br />
Doctorate of Medicine, which carries with it the license to<br />
practise ; the first deals with general pathology and thera<br />
peutics, special medical pathology, and pathological<br />
anatomy; the second is upon surgical pathology, hygiene,.<br />
and forensic medicine; and the third embraces clinical<br />
medicine and surgery, diseases of the eye and of the sexual<br />
organs, and dermatology, together with practical midwifery<br />
and operative surgery, being partly theoretical and partly<br />
practical.<br />
The professors of the faculty are now the only examiners,<br />
whereas formerly commissions for examining were formed,,<br />
* A.LEROY: L'universite'de Liege, 1869.
606 MODERN TIMES.<br />
being composed in such a way that half the members of<br />
every commission belonged to the local faculty, and the<br />
other half were professors of another faculty. The principle<br />
here followed was that of associating the teachers of the<br />
State University with those of the free academies in one<br />
examining board, with the view of securing in this manner<br />
a desirable uniformity in the education of doctors. There<br />
exists also at Brussels a central examining commission, to<br />
which those candidates resort who have no proofs to show<br />
of preliminary scientific education; for admission to professional<br />
study and to the university is free to every one<br />
who can read and write. On a person entering his name<br />
for the medical examinations he is only required to show<br />
that he has attended the surgical and medical clinics during<br />
two years and the obstetric clinic for one year. The<br />
teaching staffs consist of ordinary and extraordinary professors<br />
and agreges speciaux, who are nominated for three<br />
years, and receive a small stipend; these have taken the<br />
place of the former charges de cours.<br />
SWITZERLAND.<br />
FORMERLY every canton had its own laws and regulations<br />
controlling the admission to medical practice. Some<br />
cantons required a State-examination to -be passed, which<br />
was held before an examining commission formed of the<br />
local doctors ; in others a certificate that such had been<br />
already passed in another canton or country, or the production<br />
of a diploma of Doctor of Medicine sufficed; in<br />
some even this was unnecessary, and anyone who asserted<br />
that he possessed the requisite ability was permitted to<br />
engage in practice.<br />
It was not until 1867 that an agreement, ratified by the<br />
Federal Council, was entered into by most of the cantons<br />
by which the medical examinations at the Swiss universities
SWITZERLAND. 607<br />
were recognized as sufficient to confer the right to practise<br />
medicine throughout the country.<br />
Nowhere do there exist so many academies and high<br />
schools in proportion to the population as in Switzerland.<br />
On the one hand there are the universities of Basle, Zurich,<br />
•and Berne,* where teaching is carried on in German; on<br />
the other hand, the university of Geneva and the academies<br />
of Lausanne and Neufchatel, in which the lectures are de<br />
livered in French. The four universities, and since recently<br />
the academy of Lausanne, possess medical faculties. The<br />
universities of Zurich, Berne, and Geneva have only been<br />
founded during the course of the 19th century, and their<br />
medical faculties have been developed out of medical and<br />
surgical schools. They are at the present day in the same<br />
position in regard to teachers and the appliances for teach<br />
ing as their sister-institutions in Germany.<br />
The medical examinations are arranged after the German<br />
pattern, and are held at Basle, Berne, Zurich, Geneva, and<br />
Lausanne. The members of the examination commissions<br />
are selected from the professors of the medical faculties and<br />
from practitioners of proved ability, and are nominated for<br />
the period of four years. The examinations are as follows :<br />
(1) in natural science, comprising physics, chemistry,<br />
botany, and zoology, with comparative anatomy ; (2) the<br />
anatomical and physiological, which is at least as severe as<br />
in Germany; and (3) the special medical examination,<br />
which, like the immediately preceding one, is partly prac<br />
tical, partly oral or on paper, and embraces pathological<br />
anatomy, medicine, surgery, midwifery and gynaecology,<br />
ophthalmology, forensic medicine and hygiene, materia<br />
medica, and mental diseases.t It is noteworthy that the<br />
conditions of admission to the medical examinations are<br />
stricter than in other countries, for the candidate is re<br />
quired to furnish procf that he has attended lectures on the<br />
most important branches of medicine, has taken part in<br />
* ED. MULLER : Die Hochschule Bern von 1834-1884, Bern 1884.<br />
f Verordnung der eidgenoss. Medicinalpriifungen vom 19. Marz 1888.
608 MODERN TIMES.<br />
practical work, and has not Only attended the medical,.<br />
surgical, and obstetric clinics each for two semesters and the<br />
clinic for diseases of the eye for one semester, but also that<br />
he has worked in the clinic for mental diseases" for one<br />
semester, and- has acted as assistant in the policlinic.<br />
The doctor's degree is not connected with this profes-<br />
, sional examination, but is conferred by the medical faculties<br />
on the candidate passing another examination and writing<br />
an essay.<br />
: DENMARK-, NORWAY/ AND SWEDEN,<br />
MEDICAL teaching in •Derfma'rk is organized on the same<br />
plan as in Germany, and Austrja. Medical students on<br />
entering the university of Copenhagen must produce a<br />
^certificate of having passed the "maturity" examination of<br />
a Danish gymnasium • then they apply themselves to the<br />
study of philosophy, the natural sciences, physics and<br />
cheniistry, and are examined in these subjects. , It is only ,<br />
after this that real,medical study begins.<br />
The examinations which have to be passed before a<br />
license to practise is granted take place before the medical<br />
faculty in the presence, of Censors appointed by the<br />
government who deliver judgment upon the candidate's<br />
fitness. The examinations- consist of a part devoted to<br />
paper work, in which the candidate has to write, without *<br />
assistance, of any kind, three essays upon subjects of practical<br />
medicine,;, of a practical'* portion consisting of a dissection,<br />
the examination and treatment of several patients *'<br />
and the performance of an operation on the dead, body J<br />
and of an oral examinatibn^upoh the most important depart-,<br />
ments of medicine. -*<br />
As a general rule it is only those who desire to engage in<br />
academical teaching or to
DENMARK', NORWAY AND SWEDEN. 609<br />
Every doctor of medicine is privileged to give lectures at<br />
the university. The professorships are filled up after competition.<br />
Very much the same system prevails in Norway. Here,<br />
too, it is usual for practitioners to rest satisfied with the<br />
license to practise and, but seldom to aspire to the degree<br />
># of Doctor. The country possesses a university at Chris'tiania<br />
founded in 1811 and.completed in 1815. Matricula<br />
tion takes place only after the satisfactory' completion of<br />
the course of study at a gymnasium. The university studies<br />
-begin in all the faculties with an advanced course upon<br />
subjects of general science : from two to three semesters<br />
are devoted to this/during which time the student has an<br />
opportunity to make up* his mind as'to' the choice of a profession.<br />
The period of" medical studentship lasts commonly for<br />
seven years and is* divided by examination's into three parts.<br />
The first is devoted to zoology, botany, physics, chemistry,<br />
anatomy and physiology ; the second is. occupied with the<br />
studyof pharmacology and. toxicology, general and special<br />
pathology and pathological anatomy 1 , surgical pathology,<br />
ophthalmology and dermatology; during the third the sub<br />
jects engaging attention are clinical practice, forensic medi<br />
cine and hygiene ; the examinations are oral, on paper, and<br />
practical. Anyone, passing these satisfactorily is given a<br />
license to practise.<br />
The doctor's degree' is- only granted for extraordinary<br />
scientific attainments and is associated" with the right of<br />
lecturing at the university. .: In. the year 1,888 there were in<br />
the whole of Norway no more than 14 doctors of medicine.<br />
In Sweden medical instruction is given in the medical<br />
faculties of the universitie's of Upsala and Lund and at the<br />
Medical and Surgical Carolina" Institute which was founded<br />
in 1750 and at the present day is used chiefly for clinical<br />
education. A certificate of having passed.the "maturity"<br />
examination in Uteris humanioribus at the gymnasium is<br />
required from the students,<br />
• R R
6lO MODERN TIMES.<br />
The course of study for medical students is approximately<br />
the same as in the German universities; only in consequence<br />
of the length of the vacations the lectures upon the<br />
various subjects extend over more time. Generally from<br />
nine to ten years intervene between leaving the gymnasium<br />
and beginning medical practice. The student applies himself<br />
in the first place during three semesters to physics,<br />
chemistry, botany and zoology, and is examined in these<br />
subjects. He now passes from the philosophical to the<br />
medical faculty and devotes about four years to the study<br />
of anatomy, physiology, medical chemistry, histology,<br />
pharmacology and general pathology. He is obliged to<br />
dissect and to engage in practical work in the physiological,<br />
chemical, histological and pathological laboratories,<br />
while he is at liberty to please himself in regard to attendance<br />
at the theoretical lectures, which are given gratuitously.<br />
The examination which closes this portion of the period of<br />
studentship embraces the above-mentioned subjects as well<br />
as the history of medicine, and is partly oral, partly practical.<br />
The medical candidate, as he is henceforth called,<br />
devotes the following semester to attending the clinical<br />
institutions — in short to perfecting his education in<br />
practical medicine. He is obliged to direct- his attention<br />
also to various special subjects such as medical psychology,<br />
•the diseases of children and syphilology, to assist in postmortem<br />
examinations in cases of pathological and forensic<br />
interest and to attend the hygienic exercises. The examination<br />
upon these subjects, which is not generally passed<br />
until from three to four years after the " candidate's " examination,<br />
confers, if the result is satisfactory, the right to<br />
engage in practice.<br />
The degree of Doctor of Medicine is only required in the<br />
case of those practitioners who desire to teach at the university<br />
or to get posts in the higher branches of the sanitary<br />
service : it is granted on writing a scientific treatise and<br />
maintaining, in discussion, the positions taken up in it; it<br />
is, however, conferred only by the two universities, not by
RUSSIA. 6ll<br />
the Carolina Institute. On the other hand the last has the<br />
right to hold the " candidates' " and " licentiates' " examinations<br />
and to grant the ordinary license to practise.<br />
RUSSIA.<br />
•So late as last century Russia still drew her doctors fo<br />
most part from foreign countries* There was, however, a<br />
school founded in Moscow for the education of surgeons as<br />
early as the year 1706, in the time of PETER THE GREAT :<br />
this was connected with the hospital there, and possessed an<br />
anatomical theatre and a botanical garden. The first<br />
university with a medical faculty arose also in Moscow,<br />
in the year 1755. On the other hand the university connected<br />
with the Academy of Sciences at St. Petersburg<br />
did not deserve the name, but was nothing more than a<br />
gymnasium, in which some courses of lectures on law were<br />
held; indeed the attendance was but small, the number of<br />
students under the directorship of the Princess DASCHKOW,<br />
an the year 1783 amounting only to two.f During the<br />
19th century the medical faculties of the universities of<br />
Kiew, Charkow, and Kasan have been founded, and in these<br />
teaching is carried on in Russian ; the Polish university of<br />
Warsaw has also been Russianized. The most recent<br />
addition to the Russian universities is that of Tomsk in<br />
Siberia, which was opened for students in September,<br />
1888, and at first possessed only a medical faculty. The<br />
university of Helsingfors, in Finland, and that of Dorpat<br />
also belong to the Russian Empire; in the former the<br />
Swedish, and in the latter the German language prevails.!<br />
* W. M. v. RICHTER: Geschichte der Medicin in Russland, Moskau 1817,<br />
111, 91 et seq.—A. BRUCKNER : Die Arztein Russland bis z. J. 1800, St. Petersburg<br />
1887.-J. TSCHISTOWITSCH : Geschichte der ersten medicinischen Schulen<br />
in Russland, St. Petersburg 1883.<br />
t Count D. A. TOLSTOI in his Contributions towards a Knowledge of the<br />
.Russian Empire, St. Petersburg 1886, p. 217.<br />
X Die deutsche Universitat Dorpat, Leipzig 1882.
612 MODERN TIMES.<br />
To these must be added the Medical and Surgical Academy<br />
at St. Petersburg, where the military medical officers are<br />
trained.<br />
Anyone who intends to follow the medical calling must<br />
have completed the course of study at a gymnasium before<br />
he is admitted to professional study. The period of studentship<br />
lasts five years. In addition to the examinations, which<br />
are held to test the student's knowledge on the subjects<br />
of the lectures they have been attending, there is in the<br />
middle of the period of studentship an examination which<br />
corresponds to the German tentamen physicum ; the examination<br />
for the license to practise takes place at the conclusion<br />
of the course of study, and embraces the most important<br />
departments of medicine, being both oral and of a practical<br />
character.. Those who, having got the license to practise,.<br />
aspire to the Doctorate have their knowledge tested more<br />
severely*<br />
GREECE AND THE CHRISTIAN LANDS OF THE<br />
BALKAN PENINSULA.<br />
THE University of Athens was founded in 1837, during the<br />
reign of King OTHO, and was organized on the German<br />
model. A certificate of having passed the "maturity"<br />
examination of a Greek gymnasium was required before<br />
matriculation. Medical studies generally demand ^ five<br />
years, the first of these being devoted to the ancillary<br />
sciences. The preliminary examination is held at the<br />
conclusion of the first year, and includes physics, chemistry,<br />
and natural history. The examination for the degree of<br />
Doctor deals with normal anatomy, physiology, general<br />
pathology, materia medica, medicine, surgery, midwifery,<br />
forensic medicine, and hygiene, but is not associated with<br />
practical demonstrations. After the degree there follows a<br />
* Allgem. Statut der K. russ. Universitaten vom 23 August 1884, Peters<br />
burg 1884.
FINAL CONSIDERATIONS. 613<br />
year of practical training, and then the practical examina<br />
tion, which consists principally of the treatment of patients,<br />
the performance of operations on the dead body, etc., and,<br />
if passed satisfactorily, confers the right to practise-<br />
There formerly existed in Roumania only a military<br />
medical school, the most gifted pupils of which were sent to<br />
foreign universities to complete their studies. At the<br />
present day the country possesses the two universities of<br />
Bukharest and Jassy, each one of which is provided with a<br />
•medical faculty.* Connected with the former there is a<br />
school of pharmacy. Bukharest also possesses a veterinary<br />
college. The completion of the gymnasium course is a<br />
necessary preliminary to the study of medicine. The<br />
period of studentship at the university lasts five years.<br />
The examinations embrace all departments of medicine,<br />
are both theoretical and practical, and are conducted by the<br />
professors. These concluded satisfactorily, the candidate<br />
receives the doctorate, which carries with it a license to<br />
practise all branches of medicine.<br />
The Servian University of Belgrade as yet has no<br />
medical faculty.<br />
FINAL CONSIDERATIONS.<br />
ON looking at the abundant supply of facts which serve to<br />
throw light on the systems of medical teaching prevalent at<br />
different periods and in various countries the question<br />
naturally suggests itself: " Where is medical education now<br />
carried on in the best and most appropriate way?" The<br />
question, however, as little admits of an answer as does<br />
that which asks which is the best form of government, or<br />
the best religion. While a republic appears most suited<br />
for one nation, and has been preserved by it for centuries,<br />
others require a monarchy, perhaps even despotic rule.<br />
The case is similar with the arrangements for medical<br />
* Revue internat. de l'enseignement, Paris, iv, p. 251 el seq.
614 MODERN TIMES.<br />
education. The condition of general culture, the historical<br />
traditions and the geographical position of the country,<br />
together with the state of its finances and the character of<br />
its population are here matters of great importance.<br />
, It may be permitted, however, to take this opportunity of'<br />
discussing certain general questions, which, even if the<br />
solution of them is unattainable, are fit to engage our atten<br />
tive and serious consideration.<br />
A principle which is of the utmost consequence in the<br />
preliminary education in general knowledge given to those<br />
intended for the medical profession, and one which must<br />
under all circumstances be firmly maintained, is that such<br />
education shall be in no way inferior to that required for the<br />
other learned professions, for theology, for law, for philo<br />
logy, etc. The doctor must possess that measure of general<br />
knowledge which satisfies the highest demands in the country<br />
he lives in. The nature and extent of these demands<br />
depend upon the conception formed of general education,<br />
and this differs and has differed according to place and<br />
time.<br />
Inasmuch as in most civilized countries of the present<br />
day this conception has been developed under the influence<br />
of the humane letters, it follows that the study of antiquity<br />
with the help of the Greek and Latin languages has come<br />
to form the real foundation of general education. It is true<br />
that this system, which was in high favour during the 16th<br />
century, in the 17th and 18th centuries wjs_subjected_to N<br />
considerable limitations. TJie--^dd-en_stimulus jyv^n^J^<br />
the study^^he_n^atm^^sc^ences and the development of<br />
national literatures forced men to give consideration to<br />
otiie<strong>T'</strong>subJects as elements of education. Wherever these<br />
Tiew subjects were not merged into the educational system<br />
till then in vogue there appeared, separating the schools<br />
devoted to ancient and modern learning respectively, a<br />
cleft, which the course of time has enlarged into a chasm. '<br />
The advocates of the former declared that the educational<br />
value of ancient literature depends chiefly upon the forms
FINAL CONSIDERATIONS. 615<br />
of language in which it is conveyed, the study of which, *<br />
sharpens the intellect and exercises the thinking powers.,,<br />
Assuming the correctness of this assumption, the reflection<br />
that eight or nine years of life are devoted to this study<br />
must give us pause. The end aimed at stands in no<br />
reasonable relation to the time spent in reaching it. At<br />
any rate we are at liberty to ask whether the toilsome and<br />
tedious journey over the linguistic rocks of Greek and *,<br />
Latin literature is the only path by w 7 hich the wished-for<br />
goal can be reached. There have existed at all times and<br />
there exist at the present day numberless remarkably<br />
clever people who have never learnt Greek or Latin; and<br />
the converse proposition may be stated with equal truth.<br />
Why should not other branches of knowledge, especially<br />
mathematics, be suitable for developing and sharpening<br />
the intellect ?<br />
The object of a good system of instruction should be to<br />
train the mind and at the same time to pay due attention<br />
to the requirements of life. It is well known that the<br />
classical gymnasia with their arrangement of studies only<br />
partially satisfy this demand.* Most of the objections<br />
which have been raised against them depend upon this<br />
fact. What above all things is demanded at the present<br />
day, is that greater attention should be paid to practical<br />
matters in teaching, for this is to the advantage not only of<br />
the future doctor and man of science but also of the<br />
theologian and lawyer,—-of everyone, in fine, whose calling<br />
comes into touch with practical life. In most countries<br />
these requirements have been taken into account either by<br />
modifying the course of the classical gymnasia through the<br />
adoption of new subjects of instruction or by enlarging<br />
them into schools of a mixed character, with practical<br />
classes added and running side by side with the subjects<br />
* BEZOLD and ESMARCH in the Tiigl. Rundschau 1885, No. 286, 1886, No. 68.<br />
—TH. PUSCHMANN in the Tagl. Rundschau, Berlin 1886, No. 168, 169.—E.<br />
HAECKEL: Realgymnasium and Formalgymnasium in the Tagl. Rundschau<br />
1887, No. 152.—W. PREYER : Naturforschung und Schule, Stuttgart 1887.
6l6 MODERN TIMES.<br />
previously taught. With a view to this the Realschulen<br />
were founded in Germany, some of which have by the<br />
extension of their fields of instruction, taken the new<br />
form of Realgymnasien, and are distinguished from their<br />
classical sister-schools chiefly by the fact that in them the<br />
Greek language has ceased to be taught and the time thus<br />
gained is devoted to the natural sciences, etc.<br />
There is no doubt whatever that the German Realgymna-<br />
sium in its present form affords a better preliminary educa<br />
tion for the study of medicine than does the classical<br />
gymnasium; and yet the students of the former are at<br />
present refused admission to medical study, this privilege<br />
being exclusively reserved for those who have satisfactorily<br />
finished their course at the classical gymnasium.<br />
There have not been wanting attempts to enable students<br />
leaving the Realgymnasien to enter forthwith upon the study<br />
of medicine. The Prussian Government consulted both the<br />
medical faculties and the medical practitioners upon this<br />
subject but the answers received proved by a large majority<br />
to be unfavourable to the Realschulen. Of the nine medical<br />
faculties of Prussia which expressed opinions in i86g on<br />
the desirability of admitting students leaving the Real<br />
schulen to medical study, only four (Gottingen, Greifswald,<br />
Kiel and Konigsberg) voted in favour of the proposal, four<br />
(Berlin, Breslau, Halle and Marburg) voted against it, and<br />
one (Bonn) refrained from voting. Of the 163 medical<br />
societies of Germany which "were requested to pronounce<br />
opinions upon this matter in 1879, three only voted for the<br />
proposal unconditionally, three with certain limitations,<br />
seven others only on the condition that those who had<br />
passed the Realschulen should have equal access to the<br />
other faculties, while the remaining 150 voted against the<br />
proposal, 98 of these, however, on the understanding that<br />
the classical gymnasia should be reformed.<br />
The cause lying at the root of this expression of opinion<br />
was not prejudice in favour of education by means of the<br />
ancient classics but regard for the preservation of the social<br />
i:<br />
ix".
FINAL CONSIDERATIONS. 617<br />
position of the medical profession. This, it might justly be<br />
feared, would be in danger of impairment if it were pro<br />
nounced that for doctors a preliminary education in science<br />
only is necessary, such an education being, according to<br />
views very widely prevalent, of a value inferior to that<br />
which is found necessary in the case of the other learned<br />
professions. Unfortunately in certain places the mistake<br />
was made of not treating this as the only objection<br />
but, at the same time, of bringing an indictment against<br />
the Realschulen by alleging that they had no ideal aims,<br />
and engendered superficial and narrow views in the minds<br />
of their pupils—accusations which naturally met with a<br />
sharp denial from the parties concerned.*<br />
The question of admitting students leaving the Real<br />
gymnasien to the university can only be answered in one<br />
way—by throwing open all the faculties to them and by<br />
recognizing their general education as equivalent to that<br />
given by the classical gymnasia. Justice demands this<br />
course, for the curriculum of the Realgymnasium is as good<br />
as that of the classical sister-institution ; it is also a duty<br />
owed to those youths who are not naturally fitted for the<br />
study of the ancient languages. Can we consider it justi<br />
fiable in the case of one showing a remarkable gift for natural<br />
science and promising to make an excellent doctor, to throw<br />
a stumbling-block in his path because he does not possess<br />
-as much knowledge of the Greek and Latin languages as a<br />
philologist considers necessary for his future profession ?<br />
A uniform plan of general education is certainly very<br />
convenient for systematizing school-teaching, for it serves<br />
as a sort of intellectual cathetometer, showing at a glance<br />
the height of a student's attainments ; necessary or con<br />
formable to nature, it certainly is not. The differences of<br />
inclinations and of talents shows that there is not one<br />
single and only method of intellectual education.<br />
* P. WOSSIDLO in the Padagogischen Archiv, Stettin 1880, H. 2.—E.<br />
SPECK: Die Berechtigung der Realschul-Abiturienten zum Studium der<br />
JVIedicin in the Padagogischen Archiv 1883, H. 9, 10.
6l8 MODERN TIMES.<br />
In many countries the dual system has been introduced<br />
into schools, and opportunities of entering the university<br />
are offered the students of both divisions. In Germany<br />
this is still striven against, although in intelligent and un<br />
prejudiced circles the fact does not fail to be recognized<br />
that uniformity of preliminary education is untenable in the<br />
long run. For some time now the classical gymnasium has<br />
ceased to form the only preliminary school of the educated<br />
classes, for the polytechnic high schools and certain of the<br />
higher grades of official appointments have been made<br />
accessible to those who have passed through the Real<br />
schulen , moreover the Cadet Academies intended for the<br />
training of officers have renounced the classical form of<br />
education and have adopted the curriculum of the Real<br />
gymnasien. The circumstance of granting to the Real<br />
gymnasien a position equal to that of the classical schools.<br />
and of giving equal rights to the students leaving them will<br />
not therefore, as is asserted in many quarters, lead to a.<br />
division among the students, but on the contrary will tend<br />
to unite all classes of educated men on the grounds of a<br />
preliminary education not identical, it is true, but neverthe<br />
less equivalent.<br />
It is manifest that the satisfactory educational results<br />
which were formerly achieved by the grammar school and<br />
the classical gymnasium were dependent not upon the<br />
matter taught but upon the thorough method of teaching<br />
it. The more their plans of study were compelled, in con<br />
sequence of the adoption of new subjects, to fall away from<br />
this principle so much the more frequently were complaints<br />
heard as to the faulty and unsatisfactory education of the<br />
scholars. At the present day these complaints are levelled<br />
against the teachings in all subjects, not excepting the<br />
ancient tongues. This is most pronounced in the case of<br />
the Austrian gymnasia, which, with the object of preserving<br />
the uniformity of preliminary education, have endeavoured<br />
to associate the teachings of the classical schools with<br />
that of the Realgymnasien, and in doing so have to
FINAL CONSIDERATIONS. "$* 619<br />
struggle with difficulties arising out of the polyglot<br />
character of the country.<br />
Persevering work in a limited field of knowledge produces<br />
thoroughness, a quality which must be instilled into the minds<br />
of the young. Whether we use the ancient or the modern<br />
languages, mathematics, or some other science, for the<br />
purpose of attaining this end may perhaps be a matter of<br />
indifference, and should be determined by the requirements<br />
of the time and in accordance with the inclination and<br />
talents of the individual student.<br />
This opportunity may be taken for offering some criti<br />
cisms upon both the- Realgymnasien and the classical<br />
schools. In the first place the overcrowding of the<br />
curriculum with lectures cannot be approved of from the<br />
hygienic point of view. To compel boys and young men<br />
to sit at their desks for thirty-two hours a week, and<br />
perhaps also to spend some hours daily in preparing their<br />
school exercises at home, cannot fail to act injuriously upon<br />
their bodily development. The increasing short-sighted<br />
ness, the pale cheeks and narrow chests of the students<br />
afford convincing evidence of this. In no class of the<br />
gymnasium should the number of lecture hours exceed<br />
twenty-four or twenty-six a week if the bodies of the<br />
students are to be kept healthy and their minds clear.<br />
Boys must be allowed time for recreation, and they must<br />
have the opportunity afforded them of developing their<br />
individual aptitudes* And here the wish may be expressed<br />
that more time should be devoted to gymnastics and bodily<br />
exercise generally at schools than has hitherto been the<br />
case: it must be confessed that much has been done in this<br />
respect of recent years : but much still remains to be done<br />
before the requirements of hygiene are satisfied.<br />
One great mistake in the gymnasia of Germany and the<br />
* *<br />
* Zeitung f. d. hohere Unterrichtswesen Deutschlands, Leipzig 1883, No. 48.<br />
—HASEMANN: Die Uberburdung der Schiiler, Strassburg 1884.—Centralbl. f.<br />
allgem. Gesundheitspflege, her. v. Finkelnburg, Jahrg. iii, H. 7, 8.— Cf. P.<br />
FRANK op. cit. vi, Th. 3, S. 260.
•620 MODERN TIMES.<br />
schools of many other countries lies in the neglect of<br />
objective teaching. They store the memory, exercise the<br />
understanding, and develop the thinking faculties ; but<br />
they forget to arouse the powers of observation and to<br />
sharpen the senses. In so doing they discountenance<br />
means most effective in the education of the mind and of<br />
the highest importance in many callings—that of the<br />
engineer, for example, of the doctor, or of the man of<br />
science. It appears therefore desirable that instruction in<br />
geography, mathematics and the natural sciences should be<br />
combined with practical demonstration, and that the sub<br />
jects dealt with should, as far as possible, be rendered<br />
evident to the senses. Instruction in drawing is here of<br />
especial value. Museums should be enlarged by the addi<br />
tion to them of pictures, models, etc., and in this way the<br />
senses exercised as well as the understanding.*<br />
In many English educational establishments and in many<br />
Swiss and Swedish schools there are workshops for the<br />
mechanical arts, in which students can learn how to .make<br />
use of tools and of their own hands. If these places are<br />
properly conducted they are the source of great pleasure<br />
and of still greater profit to the pupils, as they are the<br />
means of imparling to them a dexterity invaluable in prac<br />
tical life. What a sorry spectacle is afforded by many a<br />
man of learning—judge or priest, as the case may be—who<br />
can scarcely sharpen his pencil without cutting his fingers!<br />
It is noteworthy that such people are almost only to be<br />
found in Germany and those countries in which such<br />
methods of education for the young are entirely neglected.<br />
Finally, the organization of the gymnasia provokes the<br />
question, whether it Can be right and expedient, from an<br />
educational point of view, to associate boys of ten and<br />
young men of nineteen in the same school and to subject<br />
* V. HUETER in the Pad. Arch. 1879, H. 9.—W. FLEMMING in the Pad.<br />
Arch. 1883, No. 7.—J. ROSENTHAL: Die Vorbildung zum Uuiversitats-studium<br />
in the Pad. Arch. 1885, H. 4.—LUNGE in the Zeitschr. des Vereins deutscher<br />
Ingenieure, Bd. 29, S. 854 et seq.
FINAL CONSIDERATIONS. 62 I<br />
them to the same discipline and the same laws. In Southern<br />
Germany and Austria the gymnasium course used to be<br />
divided into two parts, and for each a separate school-<br />
building was provided ; this is still done in Italy.* The<br />
object in view when making the division into an upper and<br />
lower gymnasium is that the course of instruction given<br />
at each of these institutions shall be complete in itself.<br />
This offers the advantage that for those students who have<br />
to leave the gymnasium before finishing the whole course of<br />
study a natural and easy exit is secured; they are pre<br />
served from the anomaly of entering life with a curtailed<br />
and quite insufficient training. At the same time a rational<br />
halting-place on the educational journey is provided for<br />
those who desire to get minor appointments in the official<br />
service, to attend a technical school, etc.<br />
The task of giving the pupils a systematic and prac<br />
tical education in general subjects would thus be entrusted<br />
to the masters of the Unter-gymnasium, by means of a<br />
course of five years' training in the use of the mother tongue,<br />
for which the study of a second language—Latin—is indis<br />
pensable, together with elementary mathematics and the<br />
most important facts and doctrines of religion, history,<br />
geography, and the descriptive natural sciences, drawing<br />
lessons being given with the object of strengthening the<br />
powers of observation; while the authorities of the Ober-<br />
gymnasium would be expected to give clear expression to the<br />
classical or scientific character (as the case might be) of the<br />
instruction afforded by them. The Ober-gymnasium might be<br />
organized in such a manner that the classical and scientific<br />
subjects should run in parallel courses ; all the pupils being<br />
taught together in most of the subjects, such as the mother-<br />
tongue, religion, history and geography, modern languages<br />
and drawing, and only divided in order that one division<br />
should be \taught Latin and Greek and the other mathe-<br />
* An arrangement of this kind was demanded in the Ministerial scheme,<br />
which was made the basis of the discussions on the reorganization of the higher<br />
schools held in Berlin, April 16th to May 14th, 1849.
622 MODERN TIMES.<br />
matics and the natural sciences* Arrangements similar<br />
to these exist, in the Danish, Swedish, and Norwegian<br />
gymnasia. But those who have completed the course of<br />
study at either of the two divisions of the Ober-gymnasium<br />
must be allowed the same privi-leges, and all the faculties<br />
must be accessible to both classes of students alike.<br />
While in most civilized States provision is made by legal<br />
enactments that doctors shall have a preliminary education<br />
in general knowledge, it seems nowhere to have<br />
occurred to legislators how extremely important it is that<br />
only sound and healthy men should devote themselves to<br />
the medical calling. This is explained by the way in which<br />
the education of the body is generally neglected in our<br />
modern civilized life. In the Bavarian medical regulations<br />
of the year 1808 it was decreed "that only such persons<br />
-shall be admitted to the study of .medicine as have their<br />
bodies and senses free from defects." Youths afflicted with<br />
chronic lung disease, heart disorder, and other organic<br />
affections, or any of whose senses had not been developed<br />
or had become defective, were excluded from medical<br />
study; for such persons are at a disadvantage in the<br />
examination and .treatment of the sick and speaking<br />
generally in all professional work, they are prone to succumb<br />
to the various injurious influences they meet with,<br />
and are not in a position to confer the benefits which are<br />
expected of them. For the student and for the practitioner<br />
a healthy and strong frame is most requisite. Disease<br />
sours the disposition and steals away the animal spirits;<br />
how necessary are these to the doctor both for himself and<br />
for others ! The tone of his mind often finds a responsive .<br />
note in the patients he attends.<br />
The course of studies for medical students has, through<br />
custom and the requirements of science, assumed approximately<br />
the same form in different countries. It begins with<br />
the natural sciences—the so-called ancillary sciences of.<br />
* TH. PUSCIIMANN in the Deutschen medicinischen Wochenschrift, Berlin<br />
1883, No. 49.—E. RINDFLEISCII in the Tagl. Rundschau 1887, No. 209.
FINAL CONSIDERATIONS. 623<br />
medicine—and with anatomy and physiology. In other<br />
words, the structure and functions of the human organism<br />
and its place in Nature form the groundwork of medical<br />
study. But the student ought to bring with him from<br />
school as much knowledge of the natural sciences as shall<br />
render it unnecessary for him to apply himself to the<br />
elements of mineralogy, botany, and zoology at the univer<br />
sity; he must here confine himself to reviewing these<br />
sciences in their relations to medicine. Since physics and<br />
chemistry can be only lightly touched upon at the gymna<br />
sium, the student of medicine must go deeply into these<br />
subjects at the university, because there the abundant<br />
material for instruction offers him the best opportunity for<br />
study, .and a knowledge of these matters is indispensable<br />
for the proper understanding of the different branches of<br />
medical science.<br />
Anatomy and physiology form as it were the pillars which<br />
support the whole structure of medical education. These<br />
sciences must be treated with exhaustive thoroughness and<br />
be made the permanent intellectual property of the student<br />
by means of lectures combined with demonstration and<br />
experiment and by giving him opportunities of engag<br />
ing in practical work. The review of anatomical facts from<br />
comparative, topographical, and surgical standpoints gives<br />
an opportunity of checking and confirming knowledge<br />
acquired in the lectures on systematic anatomy and in<br />
actual dissection, while histology completes it in relation<br />
to the more delicate structure of the body which is only<br />
recognizable by assisted vision. If physiology is taught<br />
with reference to its high importance for practical medicine<br />
the interest taken by students in the facts of the science is<br />
greatly increased. The first part of medical study which<br />
deals with the normal relations of the body concludes with<br />
the subject of embryology.<br />
In the study of medicine proper it is of primary import<br />
ance to get an insight into the nature of diseases and morbid<br />
states. The lectures on general and special pathology afford
624 MODERN TIMES.<br />
opportunities for this. Pathological anatomy demonstrates<br />
on the dead body the changes which have taken place as<br />
the result of particular diseases, and experimental pathology<br />
teaches us the original diseases and their mutual relations.<br />
Unfortunately it has come to bethought in many universities<br />
that theoretical lectures on . internal diseases, on<br />
surgery, ophthalmology, midwifery and other parts of practical<br />
medicine are unnecessary. It is quite* true that highly<br />
elaborated discourses going much into detail may be confusing<br />
and wearisome^ to beginners; for such, all that is<br />
wanted is a short, concise review of the most important<br />
facts ; this however is indispensable before the commencement<br />
of clinical teaching although it is in the latter course*<br />
of instruction that the more profound knowledge o'f any<br />
particular subject must be gained. . # . ,<br />
Lectures on materia medica, pharmaco-dynamics, general<br />
therapeutics, dietetics and b*alneology should also precede<br />
the clinical teaching. It is a very suitable arrangement for<br />
students to learn to make up prescriptions with their own<br />
hands in an apothecary's shop or a pharmaceutical laboratory,<br />
as is done at Munich in the Reisingerianum.<br />
The course on diagnosis and the preparatory clinic make<br />
the students acquainted with the methods in use in the in- *<br />
vestigation of disease and show on simple uncomplicated*<br />
cases how maladies may be recognized and treated. The<br />
preparatory clinic fills a gap in the curriculum but is only<br />
indispensably necessary in the great medical schools, and .<br />
indeed only admits of being arranged in places where there<br />
is a great mass of clinical material to be deal£ with and the,number<br />
of students makes it desirable to separate* the",<br />
patients into numerous divisions.<br />
The surgical clinic pre-supposes more particularly a<br />
knowledge of surgical instruments and skill in applying '<br />
bandages ; a student attending this must have been taught<br />
and have himself performed operations on the dead body.<br />
In the clinic for diseases of the eye acquaintance with<br />
the use of the ophthalmoscope is requisite; it is also<br />
'M
FINAL CONSIDERATIONS. 625<br />
necessary for the student to have taken part in a course<br />
of operations on the eye.<br />
•Knowledge of midwifery is gained in the obstetric clinic<br />
and by means of operations performed on the model.<br />
Attendance on the special clinics for mental diseases and<br />
diseases of the nervous system, for diseases of the skin and<br />
of the sexual organs, for laryngeal and aural affections, for<br />
diseases of childhood, etc., must be reserved for the last<br />
semesters of studentship.<br />
The students of the clinics are divided into beginners<br />
whose functions are purely receptive, and into assistants<br />
who are more advanced . students and co-operate in the<br />
examination and treatment of the sick. The latter class<br />
get opportunities for prolonged observation of cases of<br />
disease and thus get accustomed to performing the minor<br />
duties required in the care of the sick.<br />
Policlinical work succeeds to clinical instruction and<br />
forms as it were the bridge which leads to medical practice.<br />
In giving over a portion of the practice amongst the poor<br />
to the policlinical institutions an opportunity is afforded to<br />
the assistant of becoming familiar with the claims which<br />
are made upon a doctor attending a case and of gaining<br />
that certainty of judgment which is necessary tor his<br />
independent practice.<br />
Lectures dealing with forensic medicine, hygiene, sanitary<br />
control, medical legislation, medical statistics, veterinary<br />
science and comparative medicine, medical geography and<br />
the history of medicine belong also to the close of the<br />
student's career.<br />
The two last subjects are at present only taught at a fewuniversities.<br />
While lawyers, theologians, philologists<br />
architects, artists, officers, in short all the higher profes<br />
sional classes, apply themselves diligently to the study of<br />
the history of their science or art,* most doctors think that<br />
• The veterinary surgeons in Germany have since . 88 , been obliged to show<br />
a knowledge of the history of their science, but no similar historical educa<br />
SLrt their dis,inguished coiea - s - ° — s r ^ s<br />
s s
626 MODERN TIMES.<br />
they have nothing to learn from the history of medicine.<br />
They do not know how many discoveries and inventions<br />
have been obliged to be remade, because in the course of<br />
time they had been forgotten : the history of the plastic<br />
operations affords a striking example of this.<br />
But the study of the history of medicine is not only<br />
useful and necessary for medical research; it is also of high<br />
ethical value in the education of students, for it teaches<br />
them reverence and admiration for the intellectual struggles<br />
and achievements of our forefathers, and completes the<br />
educational edifice by the addition of a high watchtower<br />
from which an extensive survey of facts and events<br />
may be made. It is, therefore, the duty of educational<br />
authorities to extend a more favourable recognition to the<br />
claims of this subject than has hitherto been the case.<br />
Only a few decades ago the history of medicine used to be<br />
taught at the universities of Berlin, Breslau, Halle, Konigsberg,<br />
Greifswald, Marburg, Gottingen, Heidelberg, Wiirzburg,<br />
Erlangen, Munich, Strassburg, Berne, Prague, and<br />
Vienna, while at the present time there are at most only two<br />
or three of these universities at which lectures on this subject<br />
are held—or perhaps only announced. Although men like<br />
BRUCKE, DU BOIS-REYMOND, CHARCOT, HELMHOLTZ,<br />
HYRTL, VIRCHOW, WUNDERLICH, ZIEMSSEN and others<br />
have borne testimony to the value and importance of the<br />
history of medicine no attempt is made to direct the<br />
attention of students to the subject, and it is looked upon<br />
as superfluous to train and appoint professors to teach it.<br />
BILLROTH himself, who formerly declared " that the great<br />
medical faculties should make it a point of honour to take<br />
care that lectures on the history of medicine are not missing<br />
in their curricula,"* considers them now merely ornamental<br />
appendages, and is opposed to the professor of this<br />
subject being a member of the College of Medical Professors<br />
in the enjoyment of full rights, because he considers<br />
* TH. BILLROTH : Lehren und Lernen der medicinischen Wissenschaften<br />
Wien 1876, S. 80.—Wiener Klinische Wochenschrift, 1888, No. 36 6 Dec.
FINAL CONSIDERATIONS. 627<br />
that the work of this department of teaching is less than<br />
that of others. But the duties of a German professor are not<br />
confined to teaching: he must also work as an investigator<br />
for the advancement and extension of his science. A wide<br />
and hitherto but little cultivated field of labour is here open<br />
to the historian of medicine.<br />
Medical geography, too, a subject which for teaching<br />
purposes may be combined with the history of medicine,<br />
presents to the teacher and investigator a number of pro<br />
blems which press for solution in view of the increasing<br />
intercourse with foreign lands.<br />
It is difficult to decide how much time should be devoted<br />
to medical education : this depends upon the natural gifts<br />
and the application of students, upon the quantity and<br />
quality of the teachers and appliances for teaching, and<br />
upon many other circumstances. In subjecting a student<br />
to no constraint in his choice of lectures, and leaving him<br />
completely at liberty to get his knowledge how and where<br />
he pleases, it is assumed that, like a reasonable and<br />
prudent man, he will follow the advice which is offered<br />
him by persons of special experience in these matters.<br />
But if from want of intelligence or from carelessness he is<br />
inclined to neglect such advice there is nothing to prevent<br />
his doing so. The result is seen in a defective education,<br />
the opportunity to remedy which he cannot perhaps find, as<br />
the period of his studentship draws to a close. If he does<br />
not make good his deficiencies before he enters medical<br />
practice the patients who fall into his hands have to suffer<br />
accordingly.<br />
Unlimited freedom for the student in choosing what<br />
lectures he shall attend nowhere has such bad results as<br />
in the study of medicine; for here the health and lives of<br />
men are at stake.<br />
In some countries—and among them such as pride<br />
themselves upon their liberal institutions—freedom of this<br />
kind has been discountenanced, and a curriculum has been<br />
Jaid down for medical students, and is closely adhered to.
628 MODERN TIMES.<br />
Even in Germany and Austria this freedom is at least so far<br />
controlled that proof is required from students entering<br />
their names for examination, that they have attended the-<br />
most important clinics during several semesters. It would<br />
be well to issue similar regulations for other departments.<br />
of medical teaching, attendance on which is indispensable<br />
for a doctor's education. Can we imagine anyone learning<br />
anatomy and physiology without the personal assistance of<br />
a teacher? It is highly desirable for students to participate<br />
in the instruction given with regularity and attention, and<br />
to make the matter taught them their own.* In small<br />
universities, where teachers and students are brought more<br />
nearly together, this occurs naturally ; the danger of students<br />
escaping instruction exists chiefly at the great universities-<br />
But so many difficulties surround all systems of control<br />
that they have had to be abandoned.t<br />
The results of teaching are more surely guaranteed if the-<br />
students are induced to take a more active part by means-<br />
of occasional questions asked and answered, as is usual<br />
in subjects associated with practical demonstration. Still<br />
more is this the case if a disputation is held just after<br />
the conclusion of the week's lectures, during which the<br />
students, in the presence of the teacher or his assistants,.<br />
can discuss the subjects which have been lectured upon,<br />
rectify any misconceptions, and be enlightened on things-<br />
which they have not been able to understand. This form<br />
of teaching—more suited to the school than to the academy<br />
—has been preserved at the military medical schools, andl<br />
has even been introduced into the universities, where it is<br />
practised in the schools of philology, history, and law, and<br />
in the scientific clubs and societies. It would serve the<br />
same purpose if students at the end of a course of lectures-<br />
* Formerly, as is the case now, there was no lack of complaint as to the<br />
irregular attendance on lectures. VICQ D'AZYR in his time declared that<br />
"students enter their names for, but do not attend, the lectures." GRUNER'S.<br />
Almanach f. Arzte, Jena 1791, S. 142.<br />
f G. SCHMOI.LER in the Jahrbuch f. Gesetzgebung, Leipzig 1886, H. 2, S-<br />
286 et seq.
FINAL CONSIDERATIONS. 629<br />
on any subject, and consequently while the impression is<br />
•fresh, were permitted to pass an examination held by<br />
the teacher or his representative. The certificates given<br />
-after passing such would bear valuable testimony as to the<br />
way the period of studentship had been passed, and would<br />
•enable the examiners, who have to decide upon the fitness<br />
•of candidates to engage in practice, to form a preliminary<br />
•opinion upon their professional education.<br />
The examination for the license to practise ought to ex<br />
tend over all branches of medicine, and to include all the<br />
subjects with which it is necessary that a practising doctor<br />
-should be familiar. If, after the conclusion of the first part<br />
-of the period of studentship devoted to training in the<br />
natural sciences, an examination is held on natural history,<br />
physics, chemistry, anatomy, and physiology, it ought to be<br />
made a rule that no one shall be admitted to the lectures on<br />
.actual medical subjects before he has passed such examina<br />
tion ; for, failing this, the time he should spend in medical<br />
study is devoted to preparing for the examination in science.<br />
In the examinations which take place after the conclusion<br />
of the period of studentship, and which precede the granting<br />
•of the license, great weight is justly laid on practical proofs<br />
of ability ; the candidate is given the opportunity of showing<br />
that he understands how to make practical use of the medical<br />
•knowledge he has acquired by the demonstration of anato<br />
mical preparations, attendance at necropsies, the examina- *<br />
tion and treatment of patients, the performance of surgical<br />
•and obstetrical operations, etc. The questions which are<br />
set perhaps touch lightly upon the candidate's knowledge<br />
•of other subjects as well; but they depend too much upon<br />
•contingencies to form a satisfactory or sufficient test of his<br />
.general professional education. For this purpose a final<br />
viva voce examination is necessary to act as complementary<br />
to, and as a check upon, the preceding practical examina<br />
tion, and to pass all departments of medicine in review.<br />
There is no doubt that persons who are teachers of the<br />
various subjects of examination are more suited to act as
630 MODERN TIMES.<br />
examiners than persons who are not specially concerned<br />
with these branches of knowledge. Those only who are<br />
masters of a subject know how to put proper questions<br />
upon it and correctly to estimate the value of the answers<br />
given* It is therefore best to entrust the carrying on of<br />
examinations to the teaching-staffs of the medical faculties<br />
and schools. But the Government of the State claims, even<br />
in this department of educational administration, to act as<br />
counsel for society watching the proceedings in its interest,.<br />
and taking care that doctors are educated in such a way as<br />
to be equal to the demands of their calling.<br />
The question at once presents itself whether doctors<br />
should be educated in institutions conducted by the State or<br />
independent of it. The answer is that in every case power<br />
of control over studies and examinations should be conceded<br />
to the State, to be made use of in the interest of the population.<br />
While in the examination for the license to practise,.<br />
the chief question is to determine whether the candidate<br />
possesses the requisite ability for his calling, in granting<br />
the degree of Doctor of Medicine severer demands should<br />
be made on scientific knowledge, and the candidate for this<br />
academical honour should be required to show that his<br />
acquirements exceed those of ordinary practitioners. The<br />
examination, which affords him this opportunity, should<br />
therefore go thoroughly into the various branches of medical<br />
• science, and should touch upon subjects which, like the<br />
history of medicine and medical geography, are disregarded<br />
in the examination for the license, being desirable,<br />
but not indispensable, subjects of medical education.<br />
In the same way Care should be taken that only works of<br />
scientific value are accepted as essays for the doctorate..<br />
The custom of requiring that they should be written in Latin<br />
has been given up nearly everywhere, and rightly so ; for,<br />
as J. V DOLLINGER says,f " in the devious by-paths of the<br />
* PRUNELI.K : Discours des etudes de me'decine, Paris 1816, p. 21.<br />
f J. v. DOLLINGER : Die Universitaten sonst und jetzt, Miinchen 1867, S..<br />
16.
FINAL CONSIDERATIONS. 63 I<br />
impoverished modern form of this idiom, confused ideas and<br />
barren thoughts find safe concealment; commonplaces<br />
intolerable in a German dress appear quite respectable<br />
when seen through a veil of Latin."<br />
If the title of Doctor of Medicine is a distinction, con<br />
ferred for scientific merit and characteristic of the ilite of<br />
the medical profession, it should also be looked upon as an<br />
indispensable prerequisite for everyone who aspires to<br />
occupy a position of importance in the public sanitary ser<br />
vice, in the medical department of the army, or on the staff<br />
of a hospital, or who desires to be a teacher at any medical<br />
faculty or school. The last-mentioned position should, for<br />
the rest, be open to anyone who is able to point to meri<br />
torious services in any sphere of knowledge, and who, in<br />
virtue of these and of his personal character, gives a<br />
guarantee that he will prove to the advantage and honour<br />
of the institution at which he desires to labour.<br />
The necessary requirements of a medical school having<br />
been satisfied by appointing and paying a staff of teachers,<br />
it can prove nothing but desirable and advantageous if men<br />
of training and ability come forward to increase its teaching-<br />
power of their own free will and without claiming remunera<br />
tion. The private teacher (Privat-Docent) is merely given<br />
the right, but must by no means be under an obligation, to<br />
teach, so long as he is not specially commissioned to do so<br />
and to fill up a gap in the curriculum. His work is a pre<br />
paration for the professoriate, to which he may be after<br />
wards called if he distinguishes himself as a teacher and<br />
investigator. But only a few reach this goal: for intellect,<br />
patience, and money are all wanted : and whoever is not<br />
provided with these three things had better renounce the<br />
idea of undertaking a calling which treacherously entices<br />
him with hopes, the fulfilment of which he awaits in vain.<br />
It is quite right that in appointments to vacant professor<br />
ships the claims of the private teachers should be con<br />
sidered in the first place : for thus the danger of appointing<br />
men unsuited or unqualified for the position is avoided. It
632 MODERN TIMES.<br />
is a dangerous thing to entrust such a post to anyone who<br />
has up to that time had no practice or experience in teaching.<br />
The division of professors into ordinary and extra<br />
ordinary as is usual in the universities of Germany and<br />
other countries is less justifiable. The extraordinary<br />
professors are inferior to the ordinary in rank and pay, and<br />
beyond the title have, scarcely any greater privileges than<br />
the private teachers. To this category belong the repre<br />
sentatives of the so-called subordinate departments, certain<br />
teachers whose duty it is to supplement and complete the<br />
instruction in some of the principal departments, and those<br />
private teachers who have received the title of professor as<br />
a reward for their services. There is no doubt that it is an<br />
act of injustice to punish a professor because he devotes<br />
his powers to teaching a subject which is not of primary<br />
importance to the profession. When men who are counted<br />
amongst those who are an honour to science are thus dealt<br />
with it is not only cruel but also unreasonable. Their un<br />
selfish efforts should be recognized and assisted, not<br />
crushed and paralyzed by a mortifying and unjust restraint.<br />
Against making the position of the representatives of the<br />
subordinate departments equal to that of those who teach<br />
the principal subjects, it is urged that the claims upon the<br />
teaching-powers of the two sets of professors differ in<br />
degree: but such things cannot be estimated in the same*<br />
way as the work of day-labourers, according to the number<br />
of hours put in.<br />
It is above all things difficult to determine what depart<br />
ments of medical science can be considered subordinate<br />
in the curriculum. Formerly even midwifery, ophthalmo<br />
logy, and pathological anatomy were so considered.<br />
Opinions are divided as to whether many departments<br />
of medical science, as for example histology, forensic<br />
medicine, dermatology, laryngology, etc., should be con<br />
sidered principal or subordinate subjects. Much will also<br />
depend upon the size of the school: for it is clear that'
FINAL CONSIDERATIONS. 633<br />
medical faculties like those of Paris, Vienna, or Berlin<br />
must not be measured by the same rule that suffices for<br />
small medical schools. In the latter many an arrangement<br />
must be neglected and many a professorial chair left un<br />
occupied which in the former are necessary, nay, indis<br />
pensable. The Frankfort Congress and the Reform<br />
Society of Jena refused to acknowledge the division of<br />
professors into ordinary and extraordinary, and declared that<br />
there should, in reason, be only two classes of academical<br />
teachers, namely, the professors and the private teachers :<br />
the former being commissioned to teach by the school and<br />
being paid for it, the latter doing so of their own free will<br />
and receiving no indemnification for their services. This by<br />
no means prevents certain private teachers being granted<br />
the title of professor in recognition of their labours :,but<br />
they should be promoted to the name only, not to the pro<br />
fessorial rank and rights.<br />
The professors form the College of Teachers, having<br />
direction and charge of the affairs of the faculty or school.<br />
Each member of this college has equal rights in debating<br />
and voting, whether he is the representative of a so-called<br />
chief department or of some narrowly circumscribed<br />
speciality: for in general educational matters every one of<br />
them is competent to form an opinion, and in questions<br />
which concern a particular department all due weight will<br />
be given to the judgment of an expert. The fear that in<br />
consequence of the great number of the members of the<br />
College of Teachers " the interest in the welfare of the<br />
faculty as a whole will be blunted," is entirely unfounded.<br />
The transactions of Parliaments, in which hundreds of<br />
representatives of the people'from all parts of the country<br />
co-operate, show that such joint work is possible " without<br />
loosening the bonds of a common interest." There is far<br />
greater danger that with a numerically small College of<br />
Teachers the deliberations will assume a quasi-domestic<br />
character and be biassed by personal considerations to<br />
such an extent as to be injurious to the general weal.
634 MODERN TIMES.<br />
Differences of opinion are produced among the members<br />
of a College of Teachers by the variety of their intellectual<br />
gifts, by peculiarities of character, and by the scientific<br />
work they may have done : the result of their discussions<br />
is thereby beneficially influenced.<br />
Differences in the stipends of the professors are equally<br />
natural and just, and are influenced by the services they have<br />
rendered to science, the results of their teaching, and the<br />
time they have to devote to it. On the other hand it is<br />
impossible to approve of the extreme diversity in the<br />
income of professors which is produced by the system of<br />
lecture-fees; for the number of the audience depends<br />
chiefly upon whether the subject of the lecture is or is not<br />
one which is of use for examinations, and is but seldom<br />
affected by the merit of the lecturer. If he has to deal with<br />
a science but little popular, he will find himself surrounded<br />
by only a small circle of pupils, even although he possesses<br />
splendid gifts of eloquence, a powerful personality, and a<br />
world-wide fame. The students are bound in the first<br />
instance to apply themselves to those subjects which offer<br />
a secure foundation for their future life-work. To reproach<br />
them, on this account, with a shallow materialism, would<br />
be foolish : for they are, in this, only performing a duty<br />
they owe to themselves and to their families. But it is<br />
quite as senseless to reward or punish the lecturer for cir<br />
cumstances over which he has no influence, by assigning to<br />
him more or less of the money received as lecture fees.<br />
This diversity of payment can hardly be justified by any<br />
difference in the effort expended, as C. HASSE has pointed<br />
out ;* for this is much the same whether the audience con<br />
sists of two or two hundred.<br />
The custom of assigning the lecture-fees to the professors<br />
is also objectionable from an ethical point of view. The<br />
ideal aspect of a teacher's calling is degraded if the com-<br />
* C. HASSE: Die Mangel deutscher Universitatseinrichtungen und ihie Besserung,<br />
Jena 1887, S. 28 et seq.
FINAL CONSIDERATIONS. 635<br />
mercial side of it is brought so prominently into view.<br />
"These fees are represented to us as being merely the<br />
reward which is considered everywhere in society as un<br />
questionably due to a man in the successful exercise of his<br />
talents. But it is a reward not honourable but degrading<br />
to a teacher."*<br />
It is the duty of the State to put an end to this system..<br />
It should require that money received from persons attend<br />
ing educational establishments supported by itself should<br />
be spent on the improvement of such establishments. How<br />
much could be done in increasing the appliances for teach<br />
ing, in the support of scientific work, in the augmentation<br />
of stipends, in short in curing the serious disease from<br />
which, as WALTER PERRY said in the English House of<br />
Commons, the German universities suffer—the want of<br />
money,—if the income derived from the lecture-fees were<br />
so employed ! A wise educational policy will attack this<br />
problem and carry out the necessary reform while sparing<br />
the acquired rights of the individual, thus earning the<br />
thanks of the German people who love their universities<br />
and are acutely sensitive to every cloud which dims the<br />
pure light of their fame.<br />
No human arrangements are free from faults. A strenuous<br />
effort to improve and render perfect what already exists<br />
constitutes the task of life. Where can such endeavours<br />
be more justified or demanded than in dealing with the<br />
education of doctors on whose knowledge and ability the<br />
health and lives of men are so greatly dependent ?<br />
" The most precious capital of states and of society is<br />
man. Every individual life represents a definite value. To<br />
preserve, to maintain it intact as far as possible, up to the<br />
* H.J. v. WESSENBERG: Die Reform der deutschen Universitaten, 2 Aufi%<br />
Wiirzburg 1886, S. 39.—So also P. FRANK (op. tit. \i, Th. r, S. 290 et seq.}<br />
enters a protest against lecture-fees. The arguments brought forward in favour<br />
of them by the Minister Jos. UNGER in the Austrian House of Representatives<br />
on 28 January, 1876, have failed to convince me of the propriety of this arrangement.
636 MODERN TIMES.<br />
•unalterable limits of its duration, is not only a precept<br />
which humanity teaches; it is the duty of every commonwealth<br />
in its own peculiar interest." In these words the<br />
Crown Prince RUDOLPH of Austria, unhappy in his early<br />
death, struck the key-note of a policy which sounds like<br />
the Evangel of times to come.
Abano, P., 213, 282.<br />
Adala, 199.<br />
Abdel-Letif, 163, 174.<br />
Abderrahman, 161.<br />
Abella, 201.<br />
Abercrombie, 477.<br />
Abernethy, 503.<br />
Abu Bekr, 154.<br />
Abulfarag, 156, 162.<br />
Abulkasem, 163, 164, 165, 166, 167.<br />
Achilles, 36.<br />
Achillini, 295.<br />
Ackermann, 381.<br />
Adalberon, 198.<br />
Adala, 200.<br />
Adalbert, 214.<br />
Adanson, 445.<br />
Addison, 477.<br />
Adelmus, 203.<br />
Adhad ed Daula, 173.<br />
^Egidius v. Corbeil, 202, 211, 214.<br />
j^Eneas Sylvius, 288.<br />
iEschrion, 94, 100.<br />
Ae'tius, 152.<br />
Afflacius, 205, 210.<br />
Agathias, 158.<br />
Agenio, O., 245.<br />
Agrate, M., 32-3.<br />
Agricola, G., 293.<br />
Agricola, R., 290.<br />
Ahron, 158.<br />
Aichholtz, 329.<br />
Aigel, J., 2so.<br />
Albert V. of Bavaria, 311.<br />
Alberti, 298, 324.<br />
Albertini, 370, 400.<br />
Albertus Magnus, 282.<br />
Albinus, 94.<br />
Albinus, B. S., 405, 407, 465.<br />
Alcuin, 191, 194.<br />
Alexander of Macedon, 18, 72, 73.<br />
Alexander (of Damascus), 95.<br />
Alexander Severus, 98, 130, 132.<br />
Alexander of Tralles, 152.<br />
Alexander III., Pope, 280.<br />
Alexander VI., Pope, 225.<br />
Alexippos, 68.<br />
Alphonso VIII., 231.<br />
INDEX OF NAMES.<br />
Algizar, 170.<br />
Alhazen, 162.<br />
Ali Abbas, 163, 179.<br />
Ali Ben Issa, 173.<br />
Alibert, 477.<br />
Alkibiades, 51.<br />
Alkinani, 156.<br />
Alkmaeon, 45.<br />
Alcon, 125.<br />
Alphanus, 199, 21c.<br />
Alpini, P., 303.<br />
Amici, 460.<br />
Ammann, 365.<br />
Ammianus, 74.<br />
Ammonios, 80, 113, 116.<br />
Amontons, 351.<br />
Ampere, 458.<br />
Anaxagoras, 46.<br />
Andral, 469, 476.<br />
Andreas, 79.<br />
Andromachus, 106, 132.<br />
Anglicus, Cardinal, 222.<br />
Annesley, 477.<br />
Anselm of Havelberg, 213.<br />
Anthimus, 185.<br />
Antoninus Pius, 112, 129.<br />
Antyllus, ns, 118.<br />
Apollo, 34, 86.<br />
Apollonii, 113.<br />
Apuleius, 151.<br />
Aquapendente, Fab. 298.<br />
Arago, 349, 458.<br />
Aranzio, 297, 307.<br />
Archagathos, 88, 130.<br />
Archelaos. 51.<br />
Archimatthacus, 203, 210.<br />
Arculanus, 240.<br />
Ardem, J., 270, 272.<br />
Aretaeus. no, in, 152,519.<br />
Arfvedson, 457.<br />
Argelata, P. de, 251, 268.<br />
Aristophanes, 39, 50.<br />
Aristotle, 45, 51, 52, 57, 58, 72, 77,.<br />
104, 158, 160, 292, 335, 463.<br />
Arktinos, 35.<br />
Aselli, 358, 405.<br />
Asklepiades, 89-91, 104.<br />
Asklepios, 34-42, 50, si, 86.
638 INDEX OF NAMES.<br />
Asoka, 17.<br />
Astruc, 255, 381.<br />
Athenseus, 92.<br />
Attalus III., 81.<br />
Auenbrugger, 371, 473.<br />
Augustis, Quiricus de, 253.<br />
Augustus, i 29.<br />
Austrigildis, 189.<br />
Avenzoar, 163, 164, 166, 182.<br />
Averroes, 163, 179, 180.<br />
.Avicenna, 163, 166, 179, 240, 333.<br />
Bacchios of Tanagra, 79.<br />
Bachtischua, 158, 172, 181.<br />
Bacon, Roger, 283.<br />
Bacon, Francis,340,341,382, 384,439.<br />
Badia, 360.<br />
Baer, K. E. v., 450, 466.<br />
Baeren>prung, 477.<br />
Baglivi, 363.<br />
Baillou, 311.<br />
Backer, A., 407.<br />
Balard, 482.<br />
Baldinger, 381.<br />
Balthasar de Tuscia, 235.<br />
Baraillon, 536.<br />
Barbarus, 95.<br />
Bartb, Jos., 407, 428.<br />
iBarthez. 462.<br />
Bartholinus, E., 342.<br />
Bartholinus, T., 358, 371.<br />
Bartholomseus, 210.<br />
Bartholomseus Anglicus, 282.<br />
Basedow, 477.<br />
Basil, St., 147, 149.<br />
Bateman, 477.<br />
Bathurst, 361.<br />
Batsch, 449.<br />
Baudeloque, 539.<br />
Baudot, 536.<br />
Bauhin, 307.<br />
Bavarius, 283.<br />
Bayle, 476.<br />
Baynard, 374.<br />
Beaumor.t, 469.<br />
Beauvais, Vincent de, 282.<br />
Beauvais de Pre'aux, 536.<br />
Becher, 345.<br />
Becher, J., 400.<br />
Becquerel, 469.<br />
Beda, 153.<br />
Beer, G. J., 428,490.<br />
Beethoven, 441.<br />
Bell, 465, 470,471.<br />
Bellini, 356, 359, 365.<br />
Belon, 294.<br />
Bencio, H., 283.<br />
Benedetti, A., 274, 303, 311, 326.<br />
Benedictus Crispus, 196.<br />
Benedict, St., 142, 192.<br />
Bccnesch de Waitmuel, 234.<br />
Benevieni, 371.<br />
Bennet, 374.<br />
Bent, 376.<br />
Berengar of Carpi, 245, 295, 324.<br />
Bergmann, 345.<br />
Beringer, 415.<br />
Bernard, 104.<br />
Bernard, CI., 468, 469, 476.<br />
Bernhard, St., 214.<br />
Berres, 465.<br />
Bertapaglia, L., 268.<br />
Bertharius, 192, 196.<br />
Berthollet, 454.<br />
Berti, 347.<br />
Bertin, 356.<br />
Bertuccio, 246.<br />
Berzelius, 455, 456.<br />
Bessarion, 287.<br />
Bichat, 462, 465.<br />
Bidloo, 405.<br />
Biett, 477.<br />
Billroth, 626.<br />
Birkman. 396.<br />
Bischof, J. R., 477.<br />
Bischoff, Th., 466.<br />
Black, 453.<br />
Blasius, 485.<br />
Blin, 536.<br />
Blondlot, 469.<br />
Blumenbach, 103, 442, 448, 462, 467.<br />
Blundell, 489.<br />
Bodenstein, A. v., 339.<br />
Boeck, K. W., 477.' '<br />
Boer, L., 492.<br />
Boerhaave. 368, 370, 381, 412, 427.<br />
Boethus, 95, 125.<br />
Bohemund, 198.<br />
Bonn, 366.<br />
Bonacoiuoli, L., 306.<br />
Bonjean, 544.<br />
Bjniface VIII., Pope, 245.<br />
Bonet, 371.<br />
Bonn, 466.<br />
Bonnet, 366, 448.<br />
Boot, A. de, 369.<br />
Bordeu, 37c, 462.<br />
Borelli, AIL, 351, 354, 359, 362, 368.<br />
Borgia, Lucrezia, 306.<br />
Borgognoni, 268, 271.<br />
Boisieri, 415.<br />
Bose. 35 1.<br />
Botallo, 301.<br />
Boitoni, A., ss3.
Bouilland. 376.<br />
Bourgois, L., 429.<br />
Boyer, 467.<br />
Boyle, Rob., 342, 344, 345, 347, 374.<br />
Braid, 484.<br />
Brambilla, 408.<br />
Branca, 273, 304.<br />
Brandis, 374.<br />
Braun, A., 445.<br />
Breschet, 465.<br />
Bretonneau, 476.<br />
Brewster, 460.<br />
Bright, 477.<br />
Brisseau-Mirbel, 445.<br />
Brissot, P., 307.<br />
Broussais, 461.<br />
Brown, J., 461, 462.<br />
Brown, R., 445.<br />
Briicke, 626.<br />
Briinninghausen, 485.<br />
Brunhilda, 186.<br />
Brunner, 355.<br />
Bruno, G., 382.<br />
Brunus Longoburgensis, 268.<br />
Brunschwyg, H., 338.<br />
Buch, L. v., 444.<br />
Buchhom, 491.<br />
Budd, 477.<br />
Buddha, 16.<br />
Buddhadaso, 17.<br />
Bulaeus, 190.<br />
Buffon, 367, 408, 448.<br />
Burdach, 442.<br />
Burke, 513.<br />
Burzweih, 143.<br />
Buschius, 289.<br />
Cselius Aurelianus, 110, 151.<br />
Caelius Aurelius, 192.<br />
Caesar, 129, 511.<br />
Caesarius v. Heisterbach, 214.<br />
Calcker, Jan van, 324.<br />
Caldani, 364.<br />
Calenda, Costanza, 201.<br />
Calmeil, 478.<br />
Calvin, 315.<br />
Camerarius, 342, 380.<br />
Camper, P., 365, 406.<br />
Canamusali, 167.<br />
Canani, 295, 324.<br />
Candolle, A. P. de, 445.<br />
Canton, J., 351.<br />
Cardanus, Hieronymus, 294.<br />
Carlisle, 455.<br />
Carminati, 362.<br />
Carret, 541.<br />
Carus, K. G., 442, 449, 471.<br />
INDEX OF NAMES. 639<br />
Cascellius, 122.<br />
Casimir, 235.<br />
Casper, 493.<br />
Cassebohm, 357.<br />
Casserio, 298, 324.<br />
Cassiodorus, 142, 191.<br />
Cassius Felix, 151.<br />
Cato, 84, 87, 88, 97, 146, 186.<br />
Cavendish, H., 345, 453.<br />
Caventon, 482.<br />
Cellini, Benvenuto, 324.<br />
Celsus, 80 93, 101, 113, 116, 118, 122,<br />
206, 272, 302, 519.<br />
Celt.es, Conrad, 290.<br />
Cesalpini, 293, 321.<br />
Cesi, Federigo, 385.<br />
Cesio, C.j 405.<br />
Chabas, 19.<br />
Chalid ben Jazid, 157.<br />
Chamberlen, 379.<br />
Chanak, 160.<br />
Charaka, 8-15, 160.<br />
Charcot, 626.<br />
Charlemagne, 159, 190, 19,1, 194.<br />
Charles of Anjou, 261.<br />
Charles IV., Emperor, 225, 226, 234.<br />
Charles V., Emperor, 310.<br />
Charles IX. cf France, 219, 332.<br />
Charmis, 125.<br />
Charondas, 66.<br />
Chassaignac, 485.<br />
Cauliaco, Guidode, 242/246, 25 1, 268,<br />
271, 272, 273, 274, 283.<br />
Chaussier, 462.<br />
Cheiron, 34, 36.<br />
Cheselden, 378, 379, 405.<br />
Chevalier, 460.<br />
Chiarugi, 478.<br />
Childebert, 148.<br />
Chirac, 360.<br />
Chladni, 46 1.<br />
Chopart, 376, 486, 539.<br />
Christison, 493.<br />
Chrysippos, 75.<br />
Chrysolaras, 287.<br />
Chrysostom, St., 146.<br />
Cicero, 1, 85, 286, 511.<br />
Ciucci, 378.<br />
Civialcc'378, 488.<br />
Claudis, 133, 146.<br />
Clelancl, 489.<br />
Clement V., Pope, 217.<br />
Clement VI., Pope, 258.<br />
Clemot, 487.<br />
Clocquet, 484.<br />
Cock burn, 370.<br />
Cole, W., 359.
640 INDEX OF NAMES.<br />
Colombo, R., 298, 323, 327, 357.<br />
Come Frere, 378.<br />
Commodus, 95.<br />
Comte, A., 443.<br />
Condillac, 383.<br />
Conolly, J., 478.<br />
Conrad von Schiverstadt, 235.<br />
Conrad, King, 211.<br />
Conrad, Cardinal, 215, 216.<br />
Conring, 397.<br />
Constantine, 98.<br />
Constantinus African us, 197, 210.<br />
Copernicus, 293.<br />
Copho, 203, 21c.<br />
Corra, 173, 181.<br />
Corradi, A., 246.<br />
Cortona, Pietro da, 405.<br />
Cornarus, D., 339.<br />
Cortesi, 305.<br />
Corvi, G., 282.<br />
Corvisart, 473, 476, 539.<br />
Cotugno, 3 s 7.<br />
Courtois, 482.<br />
Cowper, W., 356.<br />
Crassus, 89.<br />
Cranach, Lucas, 2()o.<br />
Crato von Crafftheim, 339.<br />
Cronstedt. A. v., 444,<br />
Cruikshank, 455.<br />
Cruveilhier, 477.<br />
Cullen, 461.<br />
Cumano, M., 268.<br />
Curio, 334.<br />
Currie, 374.<br />
Cusanus, Nicolas, 294.<br />
Cuvier, 449, 450.<br />
Cyius, 18.<br />
Czolbe, 443.<br />
Daguerre, 460.<br />
Dalton, 454, 455.<br />
Damokrates, 106.<br />
Dante, 282.<br />
Daran, 378.<br />
Daremberg, 291, 554.<br />
Darius, iq, 45, 66.<br />
Darwin, E., 462.<br />
Darwin, Ch., 45 1.<br />
Daschkou, 611.<br />
Daubeuton, a08.<br />
D'Avtcllino-Caraciolo, 437.<br />
Daviel, 379.<br />
Davy, H., 455-45^- 484-<br />
Deisch, 431.<br />
De Keyser, 407.<br />
Deleau, L., 490.<br />
De l'Isle, R., 444.<br />
Delpech, 487, 488.<br />
Demetrios of Apamea, 79.<br />
Demetrius, 132.<br />
Demetrius Pepagomenus, 153.<br />
Dtmokedes, 45, 66.<br />
Demokritos, 47, 90, 383.<br />
Demosthenes, 1 18.<br />
Demours, 357.<br />
Deroldus, 198.<br />
Desault, 536.<br />
Descartes, 348, 382.<br />
Desfosses, 482.<br />
Desiderius, 198.<br />
Despars. J , 282.<br />
D'Estouteville, Cardinal, 28r.<br />
Deventer, H. v., 378.<br />
Deyl, H. van, 4(0.<br />
Deymann, 406.<br />
Dhanvantari, 12.<br />
Diaulos, 126.<br />
DitfTennach, 497, 498.<br />
Diogenes, 46.<br />
Diokles of Karystus, 78.<br />
Dionis, 377, 429.<br />
Dionysias, 50.<br />
Dioskoiides, 107, 151, 191,322.<br />
Dodonaeus, 311.<br />
Dodart, D., 361, 365.<br />
Dollinger, 442, 449.<br />
Dollinger. J. v., 500, 630.<br />
Dolaeus, 374.<br />
Dollond, 460.<br />
Dondi, G. de, 282.<br />
Donatus, 189.<br />
Dorothea Sibylla, 430.<br />
Douglas, J., 355.<br />
Drakon, 5 1.<br />
Drebbel, 346.<br />
Drelincouit, 357.<br />
Dscholdschol, Ibn, 167.<br />
Du Bois-Reymond, 326.<br />
Duchenne, 477-<br />
Dudith, Bishop, 308.<br />
DiArer, Albrecht, 29c, 324.<br />
Dufay, 350, 408.<br />
Dumas, 437. 468, 489.<br />
Dupu)tren, 487.<br />
Durand, 115.<br />
Dus£, 379.<br />
Dutrochet, 447, 469.<br />
Dutthagamini, 17.<br />
Duverney, 357, 365, 367, 4c6.<br />
Eberle, 469.<br />
Ebers, 20, 22, 24.<br />
Echter, Julius, 314.<br />
Egebtrg, 488. '
Ehrenberg, 448, 466.<br />
Ehrenritter, 428.<br />
Eir, 186.<br />
Elinus, 200,<br />
Eliot, 535.<br />
Elisha, 29.<br />
Elolathes, 44.<br />
Else, 376.<br />
Empedokles, 45.<br />
Ennana, 19.<br />
Enricus de Padua, 199.<br />
Epicurus, 104.<br />
Epimarchos, 45.<br />
Epione, 35.<br />
Epiphanius, 74.<br />
Erasistratos, 75-79, 92.<br />
Erasmus of Rotterdam, 290.<br />
Erastu's, 334.<br />
Ermerius, 53.<br />
Eros, 122.<br />
Errands, Ch., 405.<br />
Eschasse'riaux, 536.<br />
Esquirol, 478.<br />
Estienne, Ch., 324.<br />
Eudemos, 79.<br />
Eudemus (philosopher), 95.<br />
Euelpistus, 113.<br />
Euenor, 69.<br />
Euclid, 159, 511.<br />
Euler, L., 349.<br />
Eunapios, 82.<br />
Euripides, 50, 52, 511.<br />
Euryphon, 49.<br />
Eustachius, 296, 298, 324.<br />
Fabiola, 147, 148.<br />
Fabricius, 448.<br />
Fabricius (Fabry v. Hilden), 376,<br />
428.<br />
Fahrenheit, 351.<br />
Falcucci, Nic, 282.<br />
Faloppius, 296, 327.<br />
Falret, 478.<br />
Fannius, 122.<br />
Fantoni, 377.<br />
Faraday, 456, 458.<br />
Fechner, 443.<br />
Ferdinand III. of Spain, 232.<br />
Ferdinand the Catholic, 247.<br />
Ferdinand II., 351.<br />
Ferrein, 365.<br />
Feuchtersleben, v., 564.<br />
Fichte, 441.<br />
Filkin, 376.<br />
Flourens, 468, 469, 484,<br />
Floyer, 374.<br />
Fludd, 346.<br />
INDEX OF NAMES. 641<br />
Fohmann, 465.<br />
Folz, 283.<br />
Fontana, 371, 404.<br />
Fontano, 326.<br />
Forat Ben Schannatha, 157.<br />
Fotster, 448.<br />
Fothergill, 371.<br />
Fourcroy, 4^4,.536, 540.<br />
Foville, 478.<br />
Francke, 390, 395.<br />
Franco, P., 303, 304, 307.<br />
Frank, Peter, 404, 407, 434, 475, 493,.<br />
S&7-<br />
Franklin, 351.<br />
Francis I.. 313, 331, 335.<br />
Fraunhofer, 460.<br />
Freidank, 320.<br />
Freind, 152, 190, 381.<br />
Frerichs, 477.<br />
Freseatorius, 311.<br />
Fresnel, 349, 460.<br />
Fried, 432.<br />
Frederick I., Emperor, 221, 245.<br />
Frederick II., Emperor, 207, 210, 216,<br />
220, 238, 244, 261, 266, 305.<br />
Frederick the Wise, 313.<br />
Froriep, 367.<br />
Fuch?, C. H., 477.<br />
Gaertner, 445.<br />
Galen, 21,30, 53, 77, 78, 81,93-105,<br />
117, 122, 124, 125, 132, 144, 151,<br />
156, 160, 163, 191, 193, 203, 204,<br />
208, 240, 241, 243, 250, 295, 298,<br />
3°2. 333, 334, 396, 436, 47°. 5'9-<br />
Galileo, 346, 352.<br />
Gall, 471, 478.<br />
Gallici, J., 235.<br />
Gallot, 536.<br />
Garbo, Dino di, 225, 240, 282.<br />
Garbo, Tomasso di, 282.<br />
Gaiiopontus, 200, 210.<br />
Gassendi, 347, 383.<br />
Gaub, 412.<br />
Gauss, 459.<br />
Gautier d'Agoty, 405.<br />
Gavarret, 469.<br />
Gay-Lussac, 455, 456, 458.<br />
Gaza, T., 287.<br />
Geber, 162.<br />
Geiger, 482.<br />
Gellius, 74, 126.<br />
Genga, 405.<br />
Georgios of Trebezond, 287.<br />
Gerbert d'Aurillac, 194, 213.<br />
Gersdorf, v., 301, 338.<br />
Gessner, Conrad, 333,<br />
T T
642 INDEX<br />
Gevicka, Nicolaus de, 235.<br />
Gibbon, 147.<br />
Giliani, A., 245.<br />
Gilavun El Mansur, 175.<br />
Gilbertus Anglicus, 282.<br />
Girard, 37.<br />
Girtanner, 461.<br />
Gisulf, iq8.<br />
Givaka, Komarabhakka, 16.<br />
Gladstone, 495.<br />
Glauber, 344.<br />
Glaucon, 192.<br />
Glaukias, 68, 80.<br />
Glisson, 355. 363, 369.<br />
Gmelin, 456, 469.<br />
Golnitz, 228.<br />
Gonguhrolf, 186.<br />
Gorcke, 59 1.<br />
Goethe, 154, 416, 441, 445-<br />
Gordon, 282.<br />
Gorgias, 113.<br />
Graaf, R. de, 356.<br />
Gradibus, de, 251, 283.<br />
Graefe, C. F., 488.<br />
Graefe, A. v., 490, 491.<br />
Grapbeus, Benvenutus, 274.<br />
Gray, S., 350.<br />
Gregoire, 379.<br />
Gregory of Nazianzus, 147.<br />
Gregory of Tours, 149.<br />
Gregory, J., 348.<br />
Grew, 342.<br />
Griesinger, 478.<br />
Griffon, 305.<br />
Grimaldi, 348.<br />
Grimaud, 462.<br />
Gruithiusen, 488.<br />
Gruner, 381.<br />
Guaineri, A., 282.<br />
Guarna, Rebecca, 201.<br />
Guericke, Otto v., 347.<br />
Guglielmus de Bononia, 199.<br />
Guglielmusde Ravegna, 199.<br />
Guidi, 322.<br />
Guillemeau, J., 307, 324.<br />
Guillotin, 536.<br />
Guinter of Andernach, 325.<br />
Guiscard, 198.<br />
Guislarn 478.<br />
Guizot, 185.<br />
Guntram, 189.<br />
Gustavus Adolphus, 388.<br />
Guttenberg, 291.<br />
Guyot, 377.<br />
Hadrian, 129.<br />
Haen, A. de, 370,412, 415.<br />
OF NAMES.<br />
Haeser, 153.<br />
Hahn, 374.<br />
Hadji Khalfa, 159, 179.<br />
Hakim, 161.<br />
Hakim, Biimrillah, 171.<br />
Hales, Stephen, 359, 372, 447.<br />
Halevi, Judah, 212.<br />
Hall, M., 348.<br />
Hall, Marshall, 471.<br />
Halle, 436.<br />
Haller, 197, 354, 3 6 3. 367, 372, 377.<br />
381, 400, 406, 407,412, 418, 461.<br />
Ham, 366.<br />
Hamann, 442.<br />
du Hamel, 345, 353, 446.<br />
Hammer-Purgstall, 173.<br />
Harder, 361.<br />
Hare, 513.<br />
Harting, 348.<br />
Hartmann v. d. Aue, 199, 214.<br />
Hartnack, 460.<br />
Hartsoeker, 366.<br />
Haroun al Raschid, 159.<br />
Harvey, 3-57, 358, 366, 371, 503.<br />
Hassey, C, 634.<br />
Hauy, 444.<br />
Havers, Clopton, 353,405.<br />
Hazon, 402.<br />
Hebra, F., 477.<br />
Hedschadsch, 157.<br />
Hegel, 442.<br />
Henry I. of France, 194.<br />
Henry VI., Emperor, 270.<br />
Henry IV., 219.<br />
Henry VIII., 421.<br />
Heister, Lorenz, 430.<br />
Heliodorus, 115, 116, 117.<br />
Helm, 469.<br />
Helmholtz, 461, 491, 626.<br />
Helmont, 344, 368.<br />
Henke, A., 493.<br />
Henle, 466.<br />
Henshaw, 361.<br />
Hensler, 381.<br />
Heraklides, 8o, 90.<br />
Heraklitos, 46.<br />
Herder, 441.<br />
Heribrand, 193.<br />
Hermann, J., 449.<br />
Hermanus Contractus, 213.<br />
Hermann von Treysa, 235.<br />
Hermes, 122.<br />
Heron, 113.<br />
Herodikas, 63.<br />
Herodotus, 34.<br />
Herophilos, 76, 77, 78, 79.<br />
Hesiod, 34.
INDEX OF<br />
Hesse, 482.<br />
Heurne, Otto v., 411.<br />
Heurteloup, 488.<br />
Hewson, 360.<br />
Hieronymus, 148.<br />
^Highmore, 354.<br />
Hikesias, 79.<br />
Hildegard, St., 196.<br />
Hildegard, 190.<br />
Himly, 491.<br />
Hippokrates, 1, 34,43,45,48-72, 113,<br />
152, 158, 191, 192, 193, 208, 241,<br />
242, 264, 334, 396.<br />
Hisinger, 455.<br />
Hodgson, 476.<br />
Hoffmann, F., 345, 368, 374, 390, 410,<br />
4'3>4i9>427-<br />
Holbein, Hans, 290.<br />
Homberg, W., 345.<br />
Homer, 34, 68, 83, 511.<br />
Honein, 160, 182.<br />
Honestis, C. de, 253.<br />
Honorius III., Pope, 280.<br />
Hook, Rob, 343, 348, 349, 354, 355.<br />
Hope, 476.<br />
Horace, 84, 511.<br />
Horenburg, E., 430.<br />
Hrabanus Maurus, 195, 196.<br />
Hrafn Sweinbiornsson, 187.<br />
Hufeland, 591.<br />
Hugo, 225.<br />
Humboldt, Alex, v., 448, 455.<br />
Hume, D., 383.<br />
Hunczovsky, 417.<br />
Hundt, Magnus, 251.<br />
Hunter, J., 373, 378, 404, 407, 448,<br />
45°, 47S-.<br />
Hunter, W., 356, 406.<br />
Huschke, 465, 471.<br />
Hutchinson, J., 470.<br />
Hutten, U. v., 289, 310.<br />
Huygens, 342, 349.<br />
Hygieia, 35, 42, 86.<br />
Hyginus, 122.<br />
Hyrtle, 328, 626.<br />
Ibn-el-Beithar, 163, 182.<br />
Ibn Tulun, 174.<br />
Ikkos, 63.<br />
Ingenhouss, 447.<br />
Ingigerd, 187.<br />
Ingvar, 187.<br />
Innocent III., Pope, 228, 259.<br />
Ion of Chios, 50.<br />
Isa ben Ali, 167.<br />
Isidor cf Seville, 153.<br />
Ismael ben Elisha, 30.<br />
NAMES. 643<br />
Israeli, 183.<br />
Itard, 490.<br />
Jackson, 484.<br />
Jacobi, 478.<br />
Jacobus Foroliviensis, 240.<br />
Jager, F., 491.<br />
James, St., 150.<br />
Janssen, 348.<br />
Jaso, 35.<br />
Jenner, 480.<br />
Jesensky, 328.<br />
Johann, 193.<br />
Johannes Actuarius, 153, 333.<br />
John of Bohemia, 220.<br />
John Frederick of Saxony, 314.<br />
Joseph II., Emperor, 404, 424, 428,<br />
435-478, 5S7> 559-<br />
Joseph, 197.<br />
Joshua, 197.<br />
Julian, 148, 152.<br />
Julius III., Pope, 317.<br />
Julius, Duke of Brunswick, 314,<br />
Juncker, Joh., 416.<br />
Jussieu, 408, 445.<br />
Justinian, 141.<br />
Kafur, 175.<br />
Kallisthenes, 68.<br />
Kant, 437,441, 443.<br />
Karlstadt, 339;<br />
Karneades, 79.<br />
Kay, John, 421.<br />
Kempelen, 365.<br />
Kepler, 293, 294, 364.<br />
Kergaradec, 474.<br />
Kerckring, 354, 355, 366, 372.<br />
Kesra Nuschirvan, 143, 158.<br />
Ketham, 25 1.<br />
De Keyser, 407.<br />
Kielmeyer, 442, 448, 450.<br />
Kieser, 442.<br />
Kirchhoff, 460.<br />
Klaproth, 451.<br />
Klein, J. T, 343.<br />
Kleist, 351.<br />
Klinkosch, 353.<br />
Klopstock, 395.<br />
Knox, 513.<br />
Kohler, 37.<br />
Kolliker, 466.<br />
Konr, 186.<br />
Kopp, 452.<br />
Koyter, 298, 324.<br />
Kramer, W., 490.<br />
Kratevas, 80.<br />
Kratzenstein, 365.
644<br />
Krinas, 125-<br />
Ktesias, 49.<br />
Kiihlewein, 53.<br />
Kunkel, 345.<br />
Kyper, A., 411, 412.<br />
INDEX OF NAMES.<br />
Labrosse, 408.<br />
Lacoste, 536.<br />
Lactantius, 292.<br />
Ladmiral, J., 405.<br />
Laennec, 474.<br />
Laguna, 304.<br />
Lairesse, Gerard de, 405.<br />
Lamarck, 348, 349.<br />
Lamballe, 493.<br />
Lamettrie, 383.<br />
Lancisi, 356, 370, 371, 372, 407, 412,<br />
417.<br />
Lanfranchi, 270, 271.<br />
Lange, F. A., 384.<br />
Langenbeck, 488.<br />
Laplace, 347, 459.<br />
Larrey, 485, 486.<br />
Laskaris, C, 287.<br />
Lassus, 539.<br />
Latham, 476.<br />
Latini, B., 282.<br />
Latreille, 448.<br />
Lavoisier, 346, 452, 453, 536.<br />
Leake, J., 430.<br />
Le Blon, 405.<br />
Leclerc, D., 381.<br />
Leclerc, L., 177.<br />
Le Dran, 376.<br />
Leeuwenhoek. 342, 353, 354, 3,5,<br />
357,359- 3 66 , 373-<br />
Legallois, 469.<br />
Lehmann, 4(19.<br />
Leibnitz, 366, 383, 386, 395.<br />
Lelli, E., 405.<br />
Lemnius, 332.<br />
Leo XII., 598.<br />
Leo African us, 159, 177.<br />
Leonardo da Vinci, 289, 294, 322,<br />
324, 3? 1 -<br />
Leopold, Emperor, 385.<br />
Leopold V. of Austria, 270.<br />
Lepsius, 20.<br />
Lequin, N., 377.<br />
Leroy d'Etiolles, 488.<br />
Lessing, 395, 441.<br />
Leukippos, 46.<br />
Levasseur, 536.<br />
Lev ret, 379.<br />
Leyer, G., 396.<br />
Leyser, A., 335.<br />
Libanius, 139.<br />
Libavius, 344.<br />
Lichtenstein, 448.<br />
Lieberkdhn, 404.<br />
Liebig, 457,468,484.<br />
Lieutaud, 400, 407.<br />
Link, 445.<br />
Linnaeus, 342, 343, 373, 448.<br />
Lisfranc, 486.<br />
Littre, 53.<br />
Livius Eutychus, 132.<br />
Lobstein, 475.<br />
Locke, J., 382.<br />
Longinus, 152.<br />
Lonicerus, A., 280.<br />
Lorrain, C, 381.<br />
Lotichius, 393.<br />
Lotze, 443.<br />
Louis, 375.<br />
Louis, P. A., 477.<br />
Louis the Pious, 190.<br />
Louis the Simple, 198.<br />
Louis IX. of France, 245.<br />
Louis XI. of France, 320.<br />
Louis XII. of France, 331.<br />
Louis XIII. of France, 408, 410.<br />
Louis XIV. of France, 217, 377, 386.<br />
Louis XVI. of France, 415.<br />
Louis XVIII. of France, 542.<br />
Lower, 355.<br />
Lucian, 116, 127.<br />
Lucius, 95.<br />
Lucretius, 90.<br />
Luder, P., 289.<br />
Ludwig, C. G., 371.<br />
Lurcz, H., 235, 281.<br />
Luther, 285, 319, 338.<br />
Lyell, 450.<br />
Lykurgos, 68.<br />
Lykus, 100.<br />
MacDowell, 493.<br />
Macer Floridus, 196.<br />
Machaon, 35, 36.<br />
Macrizi, 172, 174, 175, 177.<br />
Maggi, 300.<br />
Magendie, 468, 471.<br />
Magnus, 132.<br />
Magnus, 457.<br />
Mahan, 159.<br />
Mahon, P. A. O., 539.<br />
Maimonides, 163, 166, 179, 180, 212.<br />
Malacarne, 467.<br />
Malpighi, 342, 343, 354, 355, 356,<br />
358, 360, 361, 365, 366.<br />
Malus, 460.<br />
Mamun, Al, 159, 160.<br />
Manfred, 211.
Mankah, 160.<br />
Manlius Cornutus, 125.<br />
Mansur, Al, 158.<br />
Mantias, 79.<br />
Marat, 536.<br />
Marbod, 196.<br />
Marcellus Empiricus, 151.<br />
Marche, Marg. de la, 429.<br />
Marchettis, 362.<br />
Marcus Marci of Kronland, 349.<br />
Marcus Antonius, 89.<br />
Marcus Aurelius, 95.<br />
Mareschal, 420.<br />
Marggraf, 345.<br />
Maria Theresa, Empress, 556.<br />
Marianus, 157.<br />
Marileif, 189.<br />
Marinus, 100.<br />
Mariotte, 347, 365.<br />
Maristania, Ibn el, 174.<br />
Martial, 113, 122, 126.<br />
Martianus, 244.<br />
Martin V., Pope, 232.<br />
Martin von Wallsee, 235.<br />
Martinez, 405.<br />
Mascagni, 465.<br />
Masona, 147.<br />
Matthysen, 487.<br />
Mandeville, Sir J., 257.<br />
Maurus, 211.<br />
Maximilian I., Emperor, 313.<br />
Mayer, J. R., 473.<br />
Mayor, 474.<br />
Mayou, 363.<br />
Mazza, 202.<br />
Meckel, 449, 475.<br />
Medici, Cosmo de, 328.<br />
Medici, Lorenzo de, 226.<br />
Medici, Maria de, 429.<br />
Megenberg, K. v., 282.<br />
Meges, 113.<br />
Meghavana, 17.<br />
Meibom, 357, 397.<br />
Mein, 482.<br />
Meissner, 482.<br />
Melanchthon, 285,314,339.<br />
Melanchthon, S., 334, 339.<br />
Meletius, 153.<br />
Mende, 493.<br />
Mendelssohn, 180.<br />
Menekrates, 106.<br />
Menghini, 360.<br />
Menokritos, 69.<br />
Mercuriade, 201.<br />
Mersenne, 347.<br />
Meiue, 159, 172.<br />
Metrodoros, 45, 69, 77.<br />
INDEX OF NAMES. 645<br />
Meyen, 445.<br />
Meyer, E., 106, 170, 181, 190, 196,<br />
197.<br />
Mezler, 381.<br />
Michelangelo, 289, 323.<br />
Michelet, 378.<br />
Middeldorpf, 485.<br />
Miereveld, M. v., 407.<br />
Mistichelli, 361.<br />
Mithridates", 80, 81, 89.<br />
Mitscherlich, 456,457.<br />
Mittelhauser, 431.<br />
Moawiyah,' 156.<br />
Moehsen, 381.<br />
Mohl, H.,445, 446.<br />
Mohs, 444.<br />
Moldenhawer, 445.<br />
Moliere, 436.<br />
Molyneux, 359.<br />
Mommsen, 120.<br />
Mondeville, H. de, 242, 268, 283.<br />
Mondino, 246, 250, 295.<br />
Monnier, Le, 351.<br />
Monro, 391.<br />
Montagna, B., 251.<br />
Montaigne, 436.<br />
Monte, G. da, 332.<br />
Monteggia, 493.<br />
Montespan, de, 429.<br />
Montgelas, 576.<br />
Morand, 376.<br />
Moreau, 486.<br />
Morel, 375, 478.<br />
Moreland, 349.<br />
Morgagni, 372, 405, 407.<br />
Morley, David, 213.<br />
Morveau, Guyton de, 454.<br />
Moses, 26.<br />
Mottawakl, 173.<br />
Moulin, A., 359.<br />
Mozart, 441.<br />
Muhammed, 155, 18c.<br />
Muhammed, Ben Ali Ben Farak, 179.<br />
Miiller, O. F., 448.<br />
Miiller, Johannes, 449, 466, 471, 475.<br />
Mulder, 167.<br />
Munk, 180.<br />
Murillo, 381.<br />
Musa, 129, 133.<br />
Musandinus, 211.<br />
Muscio, 104.<br />
Musculus, 319.<br />
Musschenbroek, 351.<br />
Myrepsus, Nicolaus, 153, 253.<br />
Nachmanides, 212.<br />
Natgeli, 446.
646 INDEX OF NAMES.<br />
Napoleon I., 541.<br />
Nasse, C. F., 478.<br />
Nebsecht, 24.<br />
Nees v. Esenbeck, 442.<br />
Neckam, A., 196.<br />
Nero, 132.<br />
Newton, 347, 349, 352,363.<br />
Nicephorus, 159.<br />
Nichols, 431.<br />
Nicholson, 455.<br />
Nicolaus, 189.<br />
Nicolaus Praepositus, 211, 258, 274.<br />
Nicolas IV., Pope, 216.<br />
Nicolas V., Pope, 288.<br />
Niepce, 460.<br />
Nikander, 80.<br />
Niketas, 153.<br />
Nikon, 93.<br />
Ninon de PEnclos, 410.<br />
Nollet. 469.<br />
Nuftr.J., 307.<br />
Numa, 85, 120.<br />
Numesianus, 94.<br />
Nureddia, 174.<br />
Oberhauser, 460.<br />
Oddo, M., 332.<br />
Odin, 186.'<br />
Oersted, 442, 458.<br />
Ohm, 458, 461.<br />
Oken, 442, 450.<br />
Olympics, 116.<br />
Omar, 156.<br />
Onasilos, 68.<br />
Orfila, 493.<br />
Oribasius, 152, 185.<br />
Origen, St., 142.<br />
Orlandus, 224.<br />
Orosius, 140.<br />
Ortolf of Bavaria, 284.<br />
Oseibia, Ibn Abu, 158, 163, 167, 173,<br />
r hl<br />
is-<br />
Qsiander, 432, 493.<br />
©thman, 154.<br />
Othmar, St., 149.<br />
Otho of Greece, 612.<br />
Ovid, 336, 5 11 -<br />
Paaw, P., 298.<br />
Palfyn, 379.<br />
Pallas, 448.<br />
Pallavicini, 244.<br />
Palucci, 427.<br />
Panakeia, 35, 42.<br />
Pander, 45c, 466.<br />
Pandukabhayo, 17.<br />
Panum, 489.<br />
Panvilliers, 536.<br />
Papin, 35°-<br />
Paracelsus, 308, 309, 338, 343, 368,<br />
3^9-<br />
Pare, 300, 301, 302, 304,307, 375, 376.<br />
Park. 376.<br />
Parrhasios, 323.<br />
Pascal, 347.<br />
Passarotti, 3., 324.<br />
Patroklos, 36.<br />
Paul of Merida, 275.<br />
Paula, 147.<br />
Paulsen, 395.<br />
Paulus iEgineta, 153, 206, 302.<br />
Pecquet, 347, 358.<br />
Pelletier, 482.<br />
Pelops, 94, 100.<br />
Perikles, 50, 289.<br />
Perrault, 365.<br />
Perry, W., 635.<br />
Peter the Great, 404, 611.<br />
Peters, H., 409.<br />
Petit, 375, 378-<br />
Petrarch, 211, 286, 336.<br />
Petroncellus, 210.<br />
Petrus, 189, 198.<br />
Petrus Lemonensis, 220.<br />
Peucer, C, 339.<br />
Peyer, 355, 361.<br />
Peyronie, La, 420.<br />
Pfolspeundt, H., 271, 273.<br />
Phaenarete, 64.<br />
Pheidias, 50.<br />
Philinos, 80.<br />
Philip Le Bel, 242, 268.<br />
Philippos of Akarnania, 68.<br />
Philippe Auguste of France, 202.<br />
Philip the Bold, 245.<br />
Philip William, Prince of Orange, 376^<br />
Philiskus, 112.<br />
Philolaos, 44.<br />
Philo, 106.<br />
Philostratos, 63, 112.<br />
Philoxenos, 79, 113.<br />
Photius, 153, 160.<br />
Piedimonte, Francesco di, 282.<br />
Pindar, 34.<br />
Pinel, 462, 478, 539.<br />
Piorry, 473.<br />
Pirchpach, O, 339.<br />
Pirkheimer, W., 290.<br />
Pirogoff, 486.<br />
Pitcaim, 361, 368, 509, 510.<br />
Placilla, 148.<br />
Platearii, 21 o.<br />
Plato, 50, 52, 54, 56, 60, 61, 62, 63,<br />
6 4, 65, 70, 72, 383.
Platter, 251, 260, 311, 319, 324, 326,<br />
327, 329.<br />
Plencicz, 373, 415.<br />
Pliny, 79, 85, 93, 97, 117, 12c, 123,<br />
124, 125, 151.<br />
Plossl, 460.<br />
Plutarch, 85, 122, 127.<br />
Podaliiios, 35, 36.<br />
Poggendorff, 346.<br />
Pois, Jean de, 281.<br />
Polybos, 51.<br />
Polykleitos, 52.<br />
Polykrates, 66.<br />
Pontus, 200.<br />
Porta, G., 294.<br />
Portal, 381, 407.<br />
Pott, 378, 503.<br />
Pourfour du Petit, 357.<br />
Poussin, Nicholas, 381.<br />
Pravaz, 482.<br />
Praxagoras of Kos, 75.<br />
Prevost, 489.<br />
Priestley, 452, 453.,<br />
Pringle, 373, 412.<br />
Prochaska, 471.<br />
Profatius, 2 16.<br />
Proust, 454.<br />
Prudentius, 140.<br />
Psellus, 153.<br />
Puccinotti, 197.<br />
Purkinje, 352, 466, 491.<br />
Puftnann, M. G., 423.<br />
Pyrrhon, 79.<br />
Pythagoras, 44, 293.<br />
Quatremere, 170.<br />
Quesnay, 360. ,<br />
Quintus, 94, 100.<br />
Quittenbaum, 488.<br />
Rachid Eddin Ibn Aszuii, 179.<br />
Rafael Sanzio, 289, 323.<br />
Ragenifrid, 198.<br />
Ramus, P., 332.<br />
Ranuccius, 224.<br />
Rapallo, Bernardo di, 302.<br />
Rasori, 462.<br />
Rathke, 466.<br />
Rau, J. J., 427.<br />
Ray, J., 343.<br />
Rayer, 477.<br />
Redi, F., 343, 366.<br />
Regters, T., 407.<br />
Reichert, 466.<br />
Reiff, W., 306.<br />
Reil, J. C, 462,478, 591.<br />
Remak, 466, 477.<br />
INDEX OF NAMES. 647<br />
Rembrandt, 381, 406.<br />
Remelin, Joh., 405.<br />
Renan, E., 507.<br />
Renaudot, Th., 412.<br />
Reni, G., 322, 381.<br />
Renzi, S. de, 197, 199. 201, 261.<br />
Reoval, 189.<br />
Reuchlin, 290.<br />
Reusner, 369.<br />
Rhazes, 118, 163, 166, 173, 182, 240,<br />
320.<br />
Richardus, 146.<br />
Richelieu, 413.<br />
Richer, 193, 198.<br />
Richter, A. G., 425, 427.<br />
Ricord, 477.<br />
Ridley, H., 356, 371.<br />
Ristorio dArezzo, 282.<br />
Riva, G., 408.<br />
Rivinus, Q., 355.<br />
Robiquet, 482.<br />
Rochlitz, Dedo v., 270.<br />
Rodolfus, 199.<br />
Roederer, 432.<br />
Roschlaub, 461.<br />
Roslin, E., 306.<br />
Roger, 174.<br />
Rokitansky, 443, 475, 477.<br />
Rolando, 205.<br />
Rolfink, W., 400.<br />
Romberg, 477.<br />
Rondelet, 294, 326.<br />
Roonhuyse, H. v., 378, 430.<br />
Rosa, Salvator, 381.<br />
Rose, 457.<br />
Rosenmiiller, 467.<br />
Rossi, de, 323.<br />
Rousseau, 384.<br />
Rousset, 304.<br />
Rubens, 381.<br />
Rudbeck, 358.<br />
Rudolph, Crown Prince, 636.<br />
Rudolphi, 448, 591.<br />
Rueff, J., 306.<br />
Rufus, 49, 100, 101, 110, 203.<br />
Ruggiero, 205.<br />
Rumford, 459.<br />
Runge, 482.<br />
Ruysch, F., 354, 355, 357. 404, 405,<br />
43°-<br />
Sabatier, 538, 539.<br />
Sabinus, 314.<br />
Sabur Ben Sahl, 172.<br />
Saladin of Asculum, 253.<br />
Saleh ben Baleh, 160.<br />
Saliceto, Gulielmus de, 244, 268.
648 INDEX OF NAMES.<br />
Salimbeni, 244.<br />
Salisbury, J. de, 214, 228, 241.<br />
Salles, 536.<br />
Salomonus Ebrasus, 199.<br />
Salvianus, 140.<br />
Samachschari, 169.<br />
Sanchez, R., 412.<br />
Sanctorius, 346, 361, 370.<br />
Sandifort 407.<br />
Sanson, 487.<br />
Santo, Mariano, 302.<br />
Santorini,356, 357, 405.<br />
Sarto, Andrea del, 323.<br />
Satyrus, 94, 100.<br />
Savary, 349.<br />
Saviard, 375.<br />
Savigny, 378.<br />
Savonarola, 282.<br />
Scarpa, 465, 491.<br />
Schacht, L., 411, 412.<br />
Schaprout, Chasdai, 212.<br />
Scheele, 345.<br />
Scheiner, 364.<br />
Schelling, 441.<br />
Scherer., 469.<br />
Scheuchzer, 444. ••:'<br />
Schiller, 441.<br />
Schleiden, 446.<br />
Schtnid, K., 196.<br />
Schmidt, Ad , 428, 490.<br />
Schmucker, 375, 376.<br />
Schneider, C. V., 354.<br />
Schonlein, 476.<br />
Schopenhauer, 442.<br />
Schrevelius, E.,411.<br />
Schroder v. d.,Kolk, 478.<br />
Schultze, M., 466.<br />
Schultze, J. H., 381, 397.<br />
Schwann, 446, 466.<br />
Schwcigger, 456, 458.<br />
Scipio Africanus, 120.<br />
Scottus, Michael, 199.<br />
Scoutetten, 485.<br />
Scribonius Largus, 106.<br />
Seckendorff, 395.<br />
Secq, R. Le, 337.<br />
Se'dillot, 488.<br />
Seebeck, 458.<br />
S6guin, 482.<br />
Seleucus, 112.<br />
Seleukos, Nikator, 78.<br />
Selligue, 460.<br />
Semmelweiss, 492.<br />
Senac, 355, 371.<br />
Senebier, 477.<br />
Seneca, 83, 127.<br />
Senfft, 391.<br />
Serapion, 80.<br />
Serenus Samonicus Qu, 127.<br />
Sergius, 95, 158.<br />
Serres, 477.<br />
Serturner, 482.<br />
Servet, 296, 298, 308, 315, 336, 357.<br />
Servin, 337.<br />
Seth, Simon, 153.<br />
Seutin, 486.<br />
Severus, 95.<br />
Sextius Niger, 106.<br />
Sextus Placitus Payrensis, 151.<br />
Siebold, 430.<br />
Siebold. C. C, 391, 354.<br />
Siegemundin, Justine, 430.<br />
Sigismund, Emperor, 278.<br />
Sigrdrifa, 186.<br />
.Sigurdr, 186.<br />
Simon of Genoa, 118, 237.<br />
Simon, G., 493.<br />
Simon, O., 488.<br />
Simpson, 484.<br />
Sims, Marion, 493.<br />
Sinclair, 347.<br />
Si vert, 403.<br />
Sixtus IV., Pope, 247.<br />
Skoda, 473, 476.<br />
Slevogt, 380.<br />
Sloan, Sir H., 408.<br />
Snell, 348.<br />
Snorri Sturluson, 187.<br />
Sobiesk, J., 404.<br />
Sobki, 182.<br />
Sommering, 408, 464, 465.<br />
Sofia, S. di, 249, 282.<br />
Sokrates, 50, 64, 72.<br />
Solano di Luques, 370.<br />
Solingen, Corn., 377.<br />
Solomon, 28.<br />
Sonnerat, 448.<br />
Sophokles, 50.<br />
Soranus, 52, 119, 140, 151, 193.<br />
Sostratus, 113.<br />
Soubeyran, 484.<br />
Soupart, 485.<br />
Spallanzani, 362, 367. 373.<br />
Spigel, v. d., 298, 324.<br />
Spinoza, 180, 382.<br />
Sprengel, 37, 197.<br />
Spurzheim, 478.<br />
Stahl, 345, 368, 390, 462. •<br />
Stainpeis, M., 240, 251, 255.<br />
Stalpert v. d. Wiel, 374.<br />
Stengel, 396.<br />
Steno, N., 342, 354, 355, 356, 357,<br />
3 6 2, 363.<br />
Stephanus, 157.
Sterne, L., 431.<br />
Stertinius,*L., 125.<br />
Stertinius Xenophon, 131, 133.<br />
Steubing, 394.<br />
Stevinus, 346.<br />
St. Hilaire, G., 449.<br />
Stilling, B., 465.<br />
Stobaeus, 77.<br />
Stobbe, 397.<br />
Storck, A., 374.<br />
Stokes, 47>6.<br />
Stoll, M., 402, 407, 415, 473.<br />
Strabo, 130.<br />
Straten. W. v. d., 412.<br />
Stratokles, 112.<br />
Stratonicus, 94.<br />
Stromeyer, 487.<br />
Stryk, 390.<br />
Suidas, 95.<br />
Susruta, 8-14.<br />
Swammerdam, 343, 355, 360, 366.<br />
Swieten, G. van, 412, 414, 427, 556,<br />
557-<br />
Swift, 384.<br />
Sydenham, 368.<br />
Sylvaticus, M., 251, 282.<br />
Sylvius, 296, 336.<br />
Sylvius (de le Boe), 36B, 369, 411.<br />
Syme, 485, 486.<br />
Symmachus, 113.<br />
Symmachus, Pope, 259.<br />
Tacitus, 184.<br />
Tagliacozzi, 304, 305, 488.<br />
Talbot, 460.<br />
Taranta, 282.<br />
Tardieu, 493.<br />
Tartaglia, 294.<br />
Tenon, 536.<br />
Tertullian, 90.<br />
Teta, 24.<br />
Tetulus Graecus, 199.<br />
Textor, 486.<br />
Thaddaeus Florentinus, 221, 282,320.<br />
Thaun, Phillip de, 196.<br />
Theden, 375.<br />
Themison, 9 1 .<br />
Thenard, 456.<br />
Theodocus, 157.<br />
Theodoric, 142.<br />
Theodore II., 189.<br />
Theodorus Priscianus, 120, 123, 151.<br />
Theokritos, 75.<br />
Theophanes, 116.<br />
Theophanes Nonnus, 153.<br />
Theophilus Protospatharius, 203.<br />
Theophrastos, 106.<br />
INDEX OF NAMES. 649<br />
Theopompos, 48.<br />
Thessalos, 51, 68, 99, 124.<br />
Thibault, 3^6.<br />
Thilenius, 378.<br />
Thomasius, 390, 395.<br />
Thomas Cantimpratensis, 275.<br />
Thrka, 32.<br />
Thukydides, 50.<br />
Tiedemann, 449, 465.<br />
Timon, 82.<br />
Titian, 324.<br />
Touche, G. de la, 428.<br />
Tournefort, 408.<br />
Tornamira, 282.<br />
Torre, della, 282, 322.<br />
Torricelli, 346.<br />
Torrigiano, 282.<br />
Thoth, 20.<br />
Toynbee, 490.<br />
Traube, 473, 476, 477.<br />
Tribunas, 143.<br />
Tiiller, 381.<br />
Trithemius, 290.<br />
Troost, Corn., 407.<br />
Trotula, 201, 206.<br />
Trousseau, 476.<br />
Truchsess, O. v., 314.<br />
Trusianus, 240.<br />
Tryphon, 113.<br />
Tudela, Benjamin von, 202, 213.<br />
Tulp, 378, 406.<br />
Turquet de Mayerne, 344.<br />
Uarda, 24. .^ ., ..<br />
Ulrich, Duke, 328. •'#,&•*£*'.<br />
Unger, 446. ^ , /^ V<br />
Valens, 131.<br />
Valentin, 466.<br />
Valentinian, 131, 1-39, 149.<br />
Valleix, 477.<br />
Valleriola, 311.<br />
Valliere, de la, 429.<br />
Vallisneri, 366.<br />
Valsalva, 357, 365, 371.<br />
Valverde de Hamusco, 324.<br />
Varignana, B , 282.<br />
Varro Terrentius, 93.<br />
Vasco de Gama, 310.<br />
Vauquelin, 454.<br />
VeitI, 486.<br />
Velasquez, 381.<br />
Velpeau, 467.<br />
Venel, 378.<br />
Vesalius, 323, 324, 325, 326, 327, 328,<br />
329, 332, 33(>-<br />
Vespasian, 129.<br />
W W
• 6 •j *"!•' . "F<br />
5 ..VlIDEXQ f?'.NAMES.<br />
Vetter, 475.,- •••. W **,*<br />
Vicq d'Azyr, 448.' ?<br />
Vieussens, 355, 35*6, 35.7, 360, 371,<br />
400. ;<br />
Villanbva, Arnaldus de, 213. 275,<br />
' - fi% 29 3-<br />
Vindicianus, 151. .<br />
Virchbw, T45, 256, 259,475, 626.<br />
ViscoBjjfe G., 225.<br />
Vitalis Ordericus, 190.<br />
VitoX§7.<br />
VogM, R.A., 416. ''"<br />
Volkma-np, 469.<br />
Voltl, 458.<br />
. 701^6,383,384.<br />
T*<br />
h..yf%g n &> R '» 466. .<br />
Waimar, 198.<br />
Walafridus Strabo, 193, 196. *•<br />
Waldenberg, 470.<br />
Wall, 350. ,:,;..,<br />
'.ylallace, 451. ^F<br />
Wallerius, 444,^*<br />
Walter, J. G., 404.<br />
Walter, 251.<br />
Walther, 235.<br />
Wandelaer, J., 406.<br />
^Warner,-375.<br />
**> Weber, Ed., 469, 470.<br />
Weber, E. H., 469.<br />
• Weber, W., 470.<br />
• Weikard, 39 r.<br />
Weiss, 444.<br />
Weitbrecht, 354.<br />
Weschf r, 69.<br />
Wharton, 355.<br />
Whistler, 369.<br />
White, 376, 486.<br />
Whytt, 364.<br />
Young, 460.<br />
Yperman, J., 270, 273.<br />
El'Welid Be'n Abd-el-Malik, 172.<br />
Wentzel, 379,1428, 490.<br />
Zerbi, 295.<br />
Wepfer, J. J., 356, 371, 374. Zeuxis, 79.<br />
Werlhof, 369, 390,407, 413.<br />
Ziemssen, 626.<br />
Werner, A. G., 444.<br />
Zinn, 357.<br />
i-<br />
William of Bavaria, 318.<br />
William the Conqueror, 198.<br />
William of Montpellier, 214.<br />
Winkler, J. H„ 351,<br />
Wilde, W. R., 490.<br />
Willan, 477. ' %<br />
Willis, 356, 363, 364, 36S, 369; 373.<br />
Wilson. E.,.477.<br />
* Winslow, 355, 402.<br />
Wintarus, 196.<br />
Wintrich, 473.<br />
Wirsung, 355.<br />
Wohler, 457, 468.<br />
Wolff, C. F., 367.<br />
Wolff, Christian, 383.<br />
Wollaston, 455, 460.<br />
Wood, A., 482-. • '<br />
Woolhouse, 379. ,.<br />
Worcester, Marquess of, 349.<br />
Worm&O., 354.<br />
Wrisberg, 357.<br />
Wunderlich, 474, 475, 626.<br />
Wurtz,. F., 338.<br />
Wustenfeld, 170, 182.<br />
Xenokrates, 109.<br />
Xenophon, 68, 511.<br />
H. K. Lewis, 136, Gower Street, London.
^-^•^•ftffi"<br />
*-3<br />
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~A> 'F OlTiLk i «£*
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