Medicine
From LoveToKnow 1911
MEDICINE. - The science of medicine, as we understand it, has for its province the treatment of disease. The word "medicine" (Lat. medicina: sc. ars, art of healing, from mederi, to heal) may be used very widely, to include Pathology, the theory of the causation of disease, or, very narrowly, to mean only the drug or form of remedy prescribed by the physician - this being more properly the subject of Therapeutics (q.v.) and Pharmacology. But it is necessary in practice, for historical comprehensiveness, to keep the wider meaning in view.
Disease (see Pathology) is the correlative of health, and the word is not capable of a more penetrating definition. From the time of Galen, however, it has been usual to speak of the life of the body either as proceeding in accordance with nature (Kara Ou6cv, secundum naturam) or as overstepping the bounds of nature (irapa OvQCV, praeter naturam). Taking disease to be a deflexion from the line of health, the first requisite of medicine is an extensive and intimate acquaintance with the norm of the body. The structure and functions of the body form the subject of Anatomy (q.v.) and Physiology. The medical art (ars medendi) divides itself into departments and subdepartments. The most fundamental division is into internal and external medicine, or into medicine proper and surgery. The treatment of wounds, injuries and deformities, with operative interference in general, is the special department of surgical practice (the corresponding parts of pathology, including inflammation, repair, and removable tumours, are sometimes grouped together as surgical pathology); and where the work of the profession is highly subdivided, surgery becomes the exclusive province of the surgeon, while internal medicine remains to the physician. A third great department of practice is formed by obstetric medicine or midwifery (see Obstetrics); and dentistry, or dental surgery, is given up to a distinct branch of the profession.
A state of war, actual or contingent, gives occasion to special developments of medical and surgical practice (military hygiene and military surgery). Wounds caused by projectiles, sabres, &c., are the special subject of naval and military surgery; while under the head of military hygiene we may include the general subject of ambulances, the sanitary arrangements of camps, and the various forms of epidemic camp sickness.
The administration of the civil and criminal law involves frequent relations with medicine, and the professional subjects most likely to arise in that connexion, together with a summary of causes celebres, are formed into the department of Medical Jurisprudence.
In preserving the public health, the medical profession is again brought into direct relation with the state, through the public medical officers.
History Of Medicine Medicine a Portrayed in the Homeric Poems. - In the state of society pictured by Homer it is clear that medicine has already had a history. We find a distinct and organized profession; we find a system of treatment, especially in regard to injuries, which it must have been the work of long experience to frame; we meet with a nomenclature of parts of the body substantially the same (according to Daremberg) as that employed long afterwards in the writings of Hippocrates; in short, we find a science and an organization which, however imperfect as compared with those of later times, are yet very far from being in their beginning. The Homeric heroes themselves are repre sented as having considerable skill in surgery, and as able to attend to ordinary wounds and injuries, but there is also a professional class, represented by Machaon and Podalirius, the two sons of Asclepius, who are treated with great respect. It would appear, too, from the Aethiopis of Archinus (quoted by Welcker and Haser) that the duties of these two were not precisely the same. Machaon's task was more especially to heal injuries, while Podalirius had received from .his father the gift of "recognizing what was not visible to the eye, and tending what could not be healed." In other words, a rough indication is seen of the separation of medicine and surgery. Asclepius appears in Homer as a Thessalian king, not as a god, though.in later times divine honours were paid to him. There is no sign in the Homeric poems of the subordination of medicine to religion which is seen in ancient Egypt and India, nor are priests charged, as they were in those countries, with medical functions - all circumstances which throw grave doubts on the commonly received opinion that medicine derived its origin in all countries from religious observances.
Although the actual organization of medicine among the Homeric Greeks was thus quite distinct from religion, the worship of Asclepius (or Aesculapius) as the god of healing demands some notice. This cult spread very widely among the Greeks; it had great civil importance, and lasted even into Christian times; but there is no reason to attribute to it any special connexion with the development of the science or profession of medicine. Sick persons repaired, or were conveyed, to the temples of Asclepius in order to be healed, just as in modern times relief is sought by a devotional pilgrimage or from the waters of some sacred spring, and then as now the healing influence was sometimes sought by deputy. The sick person, or his representative, after ablution, prayer and sacrifice, was made to sleep on the hide of the sacrificed animal, or at the feet of the statue of the god, while sacred rites were performed. In his sleep (incubatio, 1yuou / 7 ra) the appropriate remedy was indicated by a dream. Moral or dietetic remedies were more often prescribed than drugs. The record of the cure was inscribed on the columns or walls of the temple; and it has been thought that in this way was introduced the custom of "recording cases," and that the physicians of the Hippocratic school thus learnt to accumulate clinical experience. But the priests of Asclepius were not physicians. Although the latter were often called Asclepiads, this was in the first place to indicate their real or supposed descent from Asclepius, and in the second place as a complimentary title. No medical writing of antiquity speaks of the worship of Asclepius in such a way as to XVIII. 2 a imply any connexion with the ordinary art of healing. The two systems appear to have existed side by side, but to have been distinct, and if they were ever united it must have been before the times of which we have any record. The theory of a development of Greek medicine from the rites of Asclepius, though defended by eminent names, must accordingly be rejected.
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Development of Medicine in Greece
It is only from non medical writers that anything is known of the development of medicine in Greece before the age of Hippocrates. The elaborate collections made by Daremberg of medical notices in the poets and historians illustrate the relations of the profession to society, but do little to prepare us for the Hippocratic period. Nor is much importance to be attached to the influence of the philosophical sects on medicine except as regards the school of Pythagoras. That philosopher and several of his successors were physicians, but we do not know in what relation they stood to later medical schools. We must therefore hasten onward to the age of Pericles, in which Hippocrates, already called "the Great," was in medicine as complete a representative of the highest efforts of the Greek intellect as were his contemporaries the great philosophers, orators and tragedians. The medical art as we now practise it, the character of the physician as we now understand it, both date for us from Hippocrates. The justification of this statement is found in the literary collection of writings known by his name. Of these certainly many are falsely ascribed to the historical Hippocrates of Cos; others are almost as certainly rightly so ascribed; others again are clearly works of his school, whether from his hand or not. But which are to be regarded as the "genuine works" is still uncertain, and authorities are conflicting. There are clearly two schools represented in the collection - that of Cnidus in a small proportion, and that of Cos in far the larger number of the works. The latter was that to which Hippocrates belonged, and where he gave instruction; and accordingly it may be taken that works of this school, when not obviously of a different date, are Hippocratic in doctrine if not in actual authorship.
Hippocratic Medicine
The first grand characteristic of Hippocratic medicine is the high conception of the duties and status of the physician, shown in the celebrated "Oath of Hippocrates" and elsewhere - equally free from the mysticism of a priesthood and the vulgar pretensions of a mercenary craft. So matured a professional sentiment may perhaps have been more the growth of time and organization than the work of an individual genius, but certainly corresponds with the character universally attributed to Hippocrates himself. The second great quality is the singular artistic skill and balance with which the Hippocratic physician used such materials and tools as he possessed. Here we recognize the true Greek But this artistic completeness was closely connected with the third cardinal virtue of Hippocratic medicine - the clear recognition of disease as being equally with life a process governed by what we should now call natural laws, which could be known by observation, and which indicated the spontaneous and normal direction of recovery, by following which alone could the physician succeed. In the fourth place, these views of the "natural history of disease" (in modern language) led to habits of minute observation and accurate interpretation of symptoms, in which the Hippocratic school was unrivalled in antiquity, and has been the model for all succeeding ages, so that even in these days, with our enormous advances in knowledge, the true method of clinical medicine may be said to be the method of Hippocrates.
The actual science of the Hippocratic school was of course very limited. In anatomy and physiology little advance had been made, and so of pathology in the sense of an explanation of morbid processes or knowledge of diseased structures there could be very little. The most valuable intellectual possession was a large mass of recorded observations in individual cases and epidemics of disease. Whether these observations were systematic or individual, and how they were recorded, are points of which we are quite ignorant, as the theory that the votive tablets in the temples supplied such materials must be abandoned.
Though the Hippocratic medicine was so largely founded on observation, it would be an error to suppose that dogma or theory had no place. The dominating theory of disease was the humoral, which has never since ceased to influence medical thought and practice. According to this celebrated theory, the body contains four humours - blood, phlegm, yellow bile and black bile, a right proportion and mixture of which constitute health; improper proportions or irregular distribution, disease. It is doubtful whether the treatise in which this theory is fully expounded is as old as Hippocrates himself; but it was regarded as a Hippocratic doctrine, and, when taken up and expanded by Galen, its terms not only became the common property of the profession, but passed into general literature and common language. Another Hippocratic doctrine, the influence of which is not even yet exhausted, is that of the healing power of nature. Not that Hippocrates taught, as he was afterwards reproached with teaching, that nature is sufficient for the cure of diseases; for he held strongly the efficacy of art. But he recognized, at least in acute diseases, a natural process which the humours went through - being first of all crude, then passing through coction or digestion, and finally being expelled by resolution or crisis through one of the natural channels of the body. The duty of the physician was to foresee these changes, "to assist or not to hinder them," so that "the sick man might conquer the disease with the help of the physician." The times at which crises were to be expected were naturally looked for with anxiety; and it was a cardinal point in the Hippocratic system to foretell them with precision. Hippocrates, influenced as is thought by the Pythagorean doctrines of number, taught that they were to be expected on days fixed by certain numerical rules, in some cases on odd, in others on even numbers - the celebrated doctrine of "critical days." This false precision can have had no practical value, but may have enforced habits of minute observation. It follows from what has been said that prognosis, or the art of foretelling the course and event of the disease, was a strong point with the Hippocratic physicians. In this they have perhaps never been excelled. Diagnosis, or recognition of the disease, must have been necessarily imperfect, when no scientific nosology or system of disease existed, and the knowledge of anatomy was quite inadequate to allow of a precise determination of the seat of disease; but symptoms were no doubt observed and interpreted skilfully. The pulse is not spoken of in any of the works now attributed to Hippocrates himself, though it is mentioned in other works of the collection.
In the treatment of disease, the Hippocratic school attached great importance to diet, the variations necessary in different diseases being minutely defined. Medicines were regarded as of secondary importance, but not neglected, two hundred and sixty-five drugs being mentioned at different places in the Hippocratic works. Blood-letting was known, but not greatly practised. The highest importance was attached to applying all remedies at the right moment, and the general principle enforced of making all influences - internal and external - co-operate for the relief of the patient. The principles of treatment just mentioned apply more especially to the cure of acute diseases; but they are the most salient characteristics of the Hippocratic school. In chronic cases diet, exercise and natural methods were chiefly relied upon.
The school of Cnidus, as distinguished from that of Cos, of which Hippocrates is the representative, appears to have differed in attaching more importance to the differences of special diseases, and to have made more use of drugs. A treatise on the diseases of women, contained in the Hippocratic collection, and of remarkable practical v alue, is attributed to this school.
The above sketch of Hippocratic medicine will make it less necessary to dwell upon the details relating to subsequent medical schools or sects in ancient times. The general conception of the physician's aim and task remained the same, though, as knowledge increased, there was much divergence both in theory and practice - even opposing schools were found to be developing some part of the Hippocratic system. Direct opponents or repudiators of the authority of Hippocrates were rare, all generally appealing to his authority. But, insensibly, the least valuable part of the Hippocratic work, the theory, was made permanent; the most valuable, the practical, neglected.
Post-Hippocratic Medicine
After Hippocrates the progress of medicine in Greece does not call for any special remark in such a sketch as this, but mention must be made of one great name. Though none of Aristotle's writings are strictly medical, he has by his researches in anatomy and physiology contributed greatly to the progress of medicine. It should also be remembered that he was of an Asclepiad family, and received that partly medical education which was traditional in such families, and also himself is said to have practised medicine as an amateur. Moreover, his works on natural history doubtless furthered the progress among the Greeks of sciences tributary to medicine, though the only specimens of such works which have come down to us from the Peripatetic school are those of Theophrastus, who may be considered the founder of the scientific study of botany. Among his encyclopaedic writings were some on medical subjects, of which fragments only have been preserved. The Peripatetic school may have been more favourable to the development of medicine, as of other departments of natural knowledge, than any other; but there is no evidence that any of the philosophical schools had important influence on the progress of medicine. The fruit of Aristotle's teaching and example was seen later on in the schools of Alexandria.
The century after the death of Hippocrates is a time almost blank in medical annals. It is probable that the science, like others, shared in the general intellectual decline of Greece after the Macedonian supremacy; but the works of physicians of the period are almost entirely lost, and were so even in the time of Galen. Galen classes them all as of the dogmatic school; but, whatever may have been their characteristics, they are of no importance in the history of the science.
Alexandrian School of Medicine
The dispersion of Greek science and intellectual activity through the world by the conquests of Alexander and his successors led to the formation of more than one learned centre, in which medicine among other sciences was represented. Pergamum was early distinguished for its medical school; but in this as in other respects its reputation was ultimately effaced by the more brilliant fame of Alexandria. It is here that the real continuation and development of Hippocratic medicine can be traced.
In one department the Alexandrian school rapidly surpassed its Greek original - namely, in the study of anatomy. The dissection of the human body, of which some doubtful traces or hints only are found in Greek times, was assiduously carried out, being favoured or even suggested perhaps by the Egyptian custom of disembowelling and embalming the bodies of the dead. There is no doubt that the organs were also examined by opening the bodies of living persons - criminals condemned to death being given over to the anatomists for this purpose.
Two eminent names stand in the first rank as leaders of the two earliest schools of medicine which arose in Alexandria, Herophilus and Erasistratus.
Herophilus (335-280 B.C.) was a Greek of Chalcedon, a pupil of the schools both of Cos and of Cnidus. He was especially noted for his profound researches in anatomy (see i. 802), and in the knowledge and practice of medicine he appears to have been equally renowned. He professed himself a close adherent of Hippocrates, and adopted his theory of the humours. He also made extensive use of drugs and of bleeding. The reputation of Herophilus is attested by the fact that four considerable physicians wrote works about him and his writings, and he is further spoken of with the highest respect by Galen and Celsus. By the general voice of the medical world of antiquity he was placed only second to Hippocrates.
Erasistratus (d. 280 B.C.) was the contemporary and rival of Herophilus. Little is known of his life, .except that he spent some time at the court of Seleucus Nicator at Antioch before coming to Alexandria, and that he cultivated anatomy late in life, after he had taken up his abode in the latter city. His numerous works are also almost entirely lost, fragments only being preserved by Galen and others. Erasistratus, instead of following Hippocrates as Herophilus did, depreciated him, and seems to have been rather aggressive and independent in his views. He appears to have leaned to mechanical explanations of the symptoms of disease, as was especially the case with inflammation, of which he gave the first rational, though necessarily inadequate, theory.
The two schools composed of the followers of Herophilus and Erasistratus respectively long divided between them the medical world of Alexandria. The names of many prominent members of both sects have been preserved, but it would be useless to repeat them. The Herophilists still reverenced the memory of Hippocrates, and wrote numerous commentaries on his works. They produced many eminent anatomists, but in the end seem to have become lost in theoretical subtleties, and to have maintained too high a standard of literary cultivation. The school of Erasistratus was less distinguished in anatomy than that of Herophilus, but paid more attention to the special symptoms of diseases, and employed a great variety of drugs. It was longer-lived than that of Herophilus, for it still numbered many adherents in the 2nd century after Christ, a century after the latter had become extinct.
The Erasistrateans paved the way for what was in some respects the most important school which Alexandria produced, that known as the empiric, which, though it recognized no master by name, may be considered to have been founded by Philinus of Cos (280 B.C.), a pupil of Herophilus; but Serapion, a great name in antiquity, and Glaucias of Tarentum, who traced the empirical doctrine back to the writings of Hippocrates, are also named among its founders. The most striking peculiarity of the empirics was that they rejected anatomy, regarding it as useless to inquire into the causes of things, and thus, as they contended, being the more minute in their observation of the actual phenomena of disease. They professed that their whole practice was based upon experience, to which word they gave a special meaning. Three sources, and three only, could experience draw from: observation, history (i.e. recorded observation), and judgment by analogy. These three bases of knowledge were known as the "tripod" of the empirics. It should not, however, be forgotten that the empirics'read and industriously commented on the works of Hippocrates. They were extremely successful in practical matters, especially in surgery and in the use of drugs, and a large part of the routine knowledge of diseases and remedies which became traditional in the times of the Roman empire is believed to have been derived from them. In the 2nd century the school became closely connected with the philosophical sect of the Sceptics, whose leader, Sextus (200 B.C.), was an empirical physician. It lived and flourished far beyond this time, when transplanted to Rome, not less than in its native Alexandria, and appears to be recognizable even up to the beginning of the middle ages.
If we look at the work of the Alexandrian schools in medicine as a whole, we must admit that the progress made was great and permanent. The greatest service rendered to medicine was undoubtedly the systematic study of anatomy. It is clear that the knowledge of function (physiology) did not by any means keep pace with the knowledge of structure, and this was probably the reason why the important sect of the empirics were able entirely to dispense with anatomical knowledge. The doctrines of Hippocrates, though lightly thought of by the Erasistrateans, still were no doubt very widely accepted, but the practice of the Hippocratic school had been greatly improved in almost every department - surgery and obstetrics being probably those in which the Alexandrian practitioners could compare most favourably with those of modern times. We have now to trace the fortunes of this body of medical doctrine and practice when transplanted to Rome, and ultimately to the whole Roman world.
Roman Medicine
The Romans cannot be said to have at any time originated or possessed an independent school of medicine. They had from early times a very complicated system of superstitious medicine, or religion, related to disease and the cure of disease, borrowed, as is thought, from the Etruscans; and, though the saying of Pliny that the Roman people got on for six hundred years without doctors was doubtless an exaggeration, and not, literally speaking, exact, it must be accepted for the broad truth which it contains. When a medical profession appears, it is, so far as we are able to trace it, as an importation from Greece.
The first Greek physician whose name is preserved as having migrated to Rome was Archagathus, who came over from the Peloponnesus in 218 B.C.; but there were probably others before him. When Greece was made a Roman province, the number of such physicians who sought their fortunes in Rome must have been very large. The bitter words of M. Porcius Cato, who disliked them. as he did other representatives of Greek culture, are evidence of this. The most eminent of these earlier Greek physicians at Rome was Asclepiades, the friend of Cicero (born 124 B.C. at Prusa in Bithynia). He came to Rome as a young man, and soon became distinguished both for his medical skill and his oratorical power. He introduced a system which, so far as we know, was his own, though founded upon the Epicurean philosophical creed; on the practical side it conformed pretty closely to the Stoic rule of life, thus adapting itself to the leanings of the better stamp of Romans in the later times of the republic. According to Asclepiades all diseases depended upon alterations in the size, number, arrangement or movement of the "atoms," of which, according to the doctrine of Epicurus, the body consisted. These atoms were united into passages (iropot) through which the juices of the body were conveyed. This doctrine, of which the developments need not further be followed, was important chiefly in so far that it was perfectly distinct from, and opposed to, the humoral pathology of Hippocrates. In the treatment of disease Asclepiades attached most importance to diet, exercise, passive movements or frictions, and the external use of cold water - in short, to a modified athletic training. He rejected the vis medicatrix naturae, pointing out that nature in many cases not only did not help but marred the cure. His knowledge of disease and surgical skill were, as appears from the accounts given by Celsus and Caelius Aurelianus, very considerable. Asclepiades had many pupils who adhered more or less closely to his doctrines, but it was especially one of them, Themison, who gave permanence to the teachings of his master by framing out of them, with some modifications, a new system of medical doctrine, and founding on this basis a school which lasted for some centuries in successful rivalry with the Hippocratic tradition, which, as we have seen, was up to that time the prevailing influence in medicine.
This system was known as methodism, its adherents as the methodici or methodists. Its main principles were that it was useless to consider the causes of a disease, or even the organ affected by the disease, and that it was sufficient to know what was common to all diseases, viz. their common qualities (communitates, KocvorJr€s). Of these there were three possible forms - (1) relaxation, (2) contraction of the minute passages or ropoc, and (3) a mixed state, partly lax, partly constricted. The signs of these morbid states were to be found in the general constitution of the body, especially in the excretions. Besides this it was important only to consider whether the disease was acute or chronic, whether it was increasing, declining or stationary. Treatment of disease was directed not to any special organ, nor to producing the crises and critical discharges of the Hippocratic school, but to correcting the morbid common condition or "community," relaxing the body if it was constricted, causing contraction if it was too lax, and in the "mixed state" acting according to the predominant condition. This simple rule of treatment was the system or "method" from which the school took its name.
The methodists agreed with the empirics in one point, in their contempt for anatomy; but, strictly speaking, they were dogmatists, though with a dogma different from that of the Hippocratic school. Besides Themison, its systematic founder, the school boasted many physicians eminent in their day, among whom Thessalus of Tralles, a halfeducated and boastful pretender, was one of the most popular. He reversed the Hippocratic maxim "art is long," promising his scholars to teach them the whole of medicine in six months, and had inscribed upon his tomb iaTpovLKc, 7 r, as being superior to all living and bygone physicians.
In the and century a much greater name appears among the methodists, that of Soranus of Ephesus, a physician mentioned with praise even by Tertullian and Augustine, who practised at Rome in the reigns of Trajan and Hadrian. Soranus is known by a work, still extant in the Greek original, on the diseases of women, and also by the Latin work of Caelius Aurelianus, three centuries later, on acute and chronic diseases, which is based upon, if not, as some think, an actual translation of, the chief work of Soranus, and which is the principal source of our knowledge of the methodic school. The work on diseases of women is the only complete work on that subject which has come down to us from antiquity, and shows remarkable fullness of practical knowledge in relation to its subject. It is notable that an important instrument of research, the speculum, which has been reinvented in modern times, was used by Soranus; and specimens of still earlier date, showing great mechanical perfection, have been found among the ruins of Pompeii. The work on acute and chronic diseases is also full of practical knowledge, but penetrated with the theories of the methodists.
The methodic school lasted certainly for some centuries, and influenced the revival of medical science in the middle ages, though overshadowed by the greater reputation of Galen. It was the first definite product of Greek medicine on Roman soil, but was destined to be followed by others, which kept up a more or less successful rivalry with it, and with the Hippocratic tradition.
The so-called pneumatic school was founded by Athenaeus, in the 1st century after Christ. According to its doctrines the normal as well as diseased actions of the body were to be referred to the operation of the pneuma or universal soul. This doctrine, crudely transferred from philosophical speculation, was intended to reconcile the humoral (or Hippocratic) and solidist (or methodic) schools; but the methodists seem to have claimed Athenaeus as one of themselves.
The conflicts of the opposing schools, and the obvious deficiencies of each, led many physicians to try and combine the valuable parts of each system, and to call themselves eclectics. Among these were found many of the most eminent physicians of Graeco-Roman times. It may be sufficient to name Rufus or Ephesus (2nd century A.D), and Archigenes (fl. A.D. 90), who is mentioned by Juvenal.
Although no system or important doctrine of medicine was originated by the Roman intellect, and though the practice of the profession was probably almost entirely in the hands of the Greeks, the most complete picture which we have of medical thought and activity in Roman times is due to a Latin pen, and to one who was, in all probability, not a physician. A. Cornelius Celsus, a Roman patrician, who lived probably in the ist century, appears to have studied medicine as a branch of general knowledge. Whether he was a practising physician or not has been a matter of controversy. The conclusion supported by most evidence seems to be that he practised on his friends and dependants, but not as a remunerative profession. His well-known work, De medicina, was one of a series of treatises intended to embrace all knowledge proper for a man of the world. It was not meant for the physicians, and was certainly little read by them, as Celsus is quoted by no medical writer, and when referred to by Pliny, is spoken of as an author not a physician. There is no doubt that his work is chiefly a compilation; and Daremberg, with other scholars, has traced a large number of passages of the Latin text to the Greek originals from which they were translated. In the description of surgical operations the vagueness of the language seems sometimes to show that the author had not performed such himself; but in other parts, and especially in his historical introduction, he speaks with more confidence; and everywhere he compares and criticizes with learning and judgment. The whole body of medical literature belonging to the Hippocratic and Alexandrian times is ably summarized, and a knowledge of the state of medical science up to and during the times of the author is thus conveyed to us which can be obtained from no other source. The work of Celsus is thus for us only second in importance to the Hippocratic writings and the works of Galen; but it is valuable rather as a part of the history of medicine than as the subject of that history. It forms no link in the general chain of medical tradition, for the simple reason that the influence of Celsus (putting aside a few scanty allusions in medieval times) commenced in the 15th century, when his works were first discovered in manuscript or committed to the press. Since then, however, he has been almost up to our own times the most popular and widely read of all medical classics, partly for the qualities already indicated, partly because he was one of the few of those classics accessible to readers of Latin, and partly also because of the purity and classical perfection of his language.
Of Pliny, another encyclopaedic writer, a few words must be said, though he was not a physician. In his Natural History we find as complete a summary of the popular medicine of his time as Celsus gives of the scientific medicine. Pliny disliked doctors, and lost no opportunity of depreciating regular medicine; nevertheless he has left many quotations from, and many details about, medical authors which are of the highest value. He is useful to us for what he wrote about the history of medicine, not for what he contributed. Like Celsus, he had little influence on succeeding medical literature or practice.
We now come to the writer who, above all others, gathered up into himself the divergent and scattered threads of ancient medicine, and out of whom again the greater part of modern European medicine has flowed. Galen was a man furnished with all the anatomical, medical and philosophical knowledge of his time; he had studied all kinds of natural curiosities, and had stood in near relation to important political events; he possessed enormous industry, great practical sagacity and unbounded literary fluency. He had, in fact, every quality necessary for an encyclopaedic writer, or even for a literary and professional autocrat. He found the medical profession of his time split up into a number of sects, medical science confounded under a multitude of dogmatic systems, the social status and moral integrity of physicians degraded. He appears. to have made it his object to reform these evils, to reconcile scientific acquirements and practical skill, to bring back the unity of medicine as it had been understood by Hippocrates, and at the same time to raise the dignity of medical practitioners.
Galen was as devoted to anatomical and, so far as then understood, physiological research as to practical medicine. He worked enthusiastically at dissection, though, the liberty of the Alexandrian schools no longer existing, he could dissect only animals, not the human body. In his anatomical studies Galen had a twofold object - a philosophical, to show the wisdom of the Creator in making everything fit to serve its purpose; and a practical, to aid the diagnosis, or recognition, of disease. The first led him into a teleological system so minute and overstrained as to defeat its own end; the second was successfully attained by giving greater precision and certainty to medical and surgical practice in difficult cases. His general physiology was essentially founded upon the Hippocratic theory of the four elements, with which he combined the notion of spirit (pneuma) penetrating all parts, and mingled with the humours in different proportions. It was on this field that he most vehemently attacked the prevailing atomistic and materialistic views of the methodic school, and his conception of the pneuma became in some respects half metaphysical. His own researches in special branches of physiology were important, but do not strictly belong to our present subject.
The application of physiology to the explanation of diseases, and thus to practice, was chiefly by the theory of the temperaments or mixtures which Galen founded upon the Hippocratic doctrine of humours, but developed with marvellous and fatal ingenuity. The normal condition or temperament of the body depended upon a proper mixture or proportion of the four elements - hot, cold, wet and dry. From faulty proportions of the same arose the intemperies (" distempers"), which, though not diseases, were the occasions of disease. Equal importance attached to faulty mixtures or dyscrasiae of the blood. By a combination of these morbid predispositions with the action of deleterious influences from without all diseases were produced. Galen showed extreme ingenuity in explaining all symptoms and all diseases on his system. No phenomenon was without a name, no problem without a solution. And, though it was precisely in his fine-spun subtlety that he departed furthest from scientific method and practical utility, it was this very quality which seems in the end to have secured his popularity and established his pre-eminence in the medical world.
Galen's use of drugs was influenced largely by the same theories. In drugs were to be recognized the same elementary qualities - hot, cold, moist, dry, &c. - as in the human body; and, on the principle of curing by contraries, the use of one or other was indicated. The writings of Galen contain less of simple objective observations than those of several other ancient physicians, all being swept into the current of dogmatic exposition. But there is enough to show the thoroughness and extent of his practical knowledge. Unfortunately it was neither this nor his zeal for research that chiefly won him followers, but the completeness of his theoretical explanations, which fell in with the mental habits of succeeding centuries, and were such as have flattered the intellectual indolence of all ages. But the reputation of Galen grew slowly; he does not appear to have enjoyed any pre-eminence over other physicians of his time, to most of whom he was strongly opposed in opinion. In the next generation he began to be esteemed only as a philosopher; gradually his system was implicitly accepted, and it enjoyed a great though not exclusive predominance till the fall of Roman civilization. When the Arabs possessed themselves of the scattered remains of Greek culture, the works of Galen were more highly esteemed than any others except those of Aristotle. Through the Arabs the Galenical system found its way back again to western Europe. Even when Arabian medicine gave way before the direct teaching of the Greek authors rescued from neglect, the authority of Galen was increased instead of being diminished; and he assumed a position of autocracy in medical science which was only slowly undermined by the growth of modern science in the 17th and 18th centuries.
The history of medicine in Roman times is by no means the same thing as the history of the fate of the works of Galen. For some centuries the methodic school was popular at Rome, and produced one physician, Caelius Aurelianus, who must be pronounced, next to Celsus, the most considerable of the Latin medical writers. His date was in all probability the end of the 4th or the beginning of the 5th century. The works bearing his name are, as has been said, entirely based upon the Greek of Soranus, but are important both because their Greek originals are lost, and because they are evidence of the state of medical practice in his own time. The popularity of Caelius is evidenced by the fact that in the 6th century an abridgment of his larger work was recommended by Cassiodorus to the Benedictine monks for the study of medicine.
Before quitting this period the name of Aretaeus of Cappadocia must be mentioned. So little is known about him that even his date cannot be fixed more closely than as being between the second half of the 1st century and the beginning of the 3rd. His works have been much admired for the purity of the Greek style, and his accurate descriptions of disease; but, as he quotes no medical author, and is quoted by none before Alexander of Aphrodisias at the beginning of the 3rd century, it is clear that he belonged to no school and founded none, and thus his position in the chain of medical tradition is quite uncertain. Alexander of Aphrodisias, who lived and wrote at Athens in the time of Septimius Severus, is best known by his commentaries on Aristotle, but also wrote a treatise on fevers, still extant.
Ancient Medicine after Galen
The Byzantine school of medicine, which closely corresponds to the Byzantine literary and historical schools, followed closely in Galen's footsteps, and its writers were chiefly compilers and encyclopaedists. The earliest is Oribasius (326-403), whose date and position are fixed by his being the friend and court physician of Julian the Apostate. He was a Greek of Pergamum, educated in Alexandria, and long resident in Byzantium. His great work Evvaywyai tar pucai, of which only about one-third has been preserved, was a medical encyclopaedia founded on extracts from Hippocrates, Galen, Dioscorides (fl. A.D. 50) and certain Greek writers who are otherwise very imperfectly known. The work is thus one of great historical value but of no originality. The next name which requires to be mentioned is that of Aetius (A.D. 550), a compiler who closely followed Oribasius, but with inferior powers, and whose work also has an historical but no original value. A higher rank among medical writers is assigned to Alexander of Tralles (525-605), whose doctrine was that of an eclectic. His practical and therapeutical rules are evidently the fruit of his own experience, though it would be difficult to attribute to him any decided advance in medical knowledge. But the most prominent figure in Byzantine medicine is that of Paul of Aegina (Paulus Aegineta), who lived probably in the early part of the 7th century. His skill, especially in surgery, must have been considerable, and his 'Ia. rpucci gives a very complete picture of the achievements of the Greeks i n this department. Another work, on obstetrics, now lost, was equally famous, and procured for him, among the Arabs, the name of "the Obstetrician." His reputation lasted through the middle ages, and was not less in the Arabian schools than in the West. In this respect Paulus is a most important influence in the development of medicine. His great work on surgery was early translated into Arabic, and became the foundation of the surgery of Abulcasis, which in turn (to anticipate) was one of the chief sources of surgical knowledge to Europe in the middle ages. The succeeding period of Byzantine history was so little favourable to science that no name worthy of note occurs again (though many medical works of this period are still extant) till the 13th century, when we meet with a group of writers: Demetrius Pepagomenus, Nicolaus Myrepsus and Johannes, called Actuarius, who flourished under the protection of the Palaeologi. The work of the last has some independent merit; but all are interesting as showing a fusion of Greek and Arabian medicine, the latter having begun to exercise even in the 11th century a reflex influence on the schools of Byzantium. Something was borrowed even from the school of Salerno, and thus the close of Byzantine medicine is brought into connexion with the dawn of science in modern Europe.
In the West the period after Galen affords little evidence of anything but a gradual though unvarying decline in Roman medicine. Caelius Aurelianus, already referred to as the follower of Soranus, must be mentioned as showing the persistence of the methodic school. An abridgment of one of his writings, with the title of Aurelius, became the most popular of all Latin medical works. As a writer he was worthy of a better period of medical literature. Little else was produced in these times but compilations, of the most meagre kind, chiefly of the nature of herbals, or domestic receiptbooks; among the authors of which it may be sufficient to name Serenus Sammonicus (3rd century), Gargilius Martialis (3rd century) and Marcellus Empiricus (5th century). Certain compilations still extant bear the falsely-assumed names of eminent writers, such as Pliny and Hippocrates. A writer with the (perhaps assumed) name of Apuleius Platonicus produced a herbal which held its ground till the 15th century at least, and was in the 9th translated into Anglo-Saxon. These poor compilations, together with Latin translations of certain works of Galen and Hippocrates, formed a medical literature, meagre and unprogressive indeed, but of which a great part survived through the middle ages till the discovery of printing and revival of learning. It is important to remember that this obscure stream of tradition flowed on, only partially affected by the influx of Arabian, or even the early revival of purer classical learning.
Arabian Medicine
The rise of the Mahommedan Empire, which influenced Europe so deeply both politically and intellectually, made its mark also in the history of medicine. As in the parallel case of the Roman conquest of Greece, the superior culture of the conquered race asserted its supremacy over their Arab conquerors. After the Mahommedan conquests became consolidated, and learning began to flourish, schools of medicine, often connected with hospitals and schools of pharmacy, arose in all the chief seats of Moslem power. At Damascus Greek medicine was zealously cultivated with the aid of Jewish and Christian teachers. In Bagdad, under the rule of Harun el Rashid and his successors, a still more flourishing school arose, where numerous translations of Greek medical works were made. The names of Mesua, or Yalhya ibn Masawaih (d. A.D. 857-858), celebrated for his knowledge of drugs, and Honein ibn Ishaq el `Ibadi (d. 873) or Joannitius, the translator and commentator of Hippocrates and Galen, belong to this period. Certain writings of Joannitius, translated into Latin, were popular in the middle ages in Europe, and were printed in the 16th century. At the same time the Arabs became acquainted with Indian medicine, and Indian physicians lived at the court of Bagdad. The Islamite rulers in Spain were not long behind those of the East in encouraging learning and medical science, and developed culture to a still higher degree of perfection. In that country much was due to the Jews, who had already established schools in places which were afterwards the seats of Moslem dominion. From the 10th to the 13th century was the brilliant period of Arabian medicine in Spain.1 The classical period of Arabian medicine begins with Rhazes (Abu Bakr Muhammad ibn Zakariya el-Razi, A.D. 925-926), a native of Rai in the province of Dailam (Persia), who practised with distinction at Bagdad; he followed the doctrines of Galen, but learnt much from Hippocrates. He was the first of the Arabs to treat medicine in a comprehensive and encyclopaedic, manner, surpassing probably in voluminousness Galen himself, though but a small proportion of his works are extant. Rhazes is deservedly remembered as having first described small-pox and measles in an accurate manner. Hali, i.e. `Ali ibn el-'Abbas, a Persian, wrote a medical textbook, known as the "Royal Book," which was the standard authority among the Arabs up to the time of Avicenna (A.D. 980-1037) and was more than once translated into Latin and printed. Other 1 See Dozy, Cat. Cod. Or. Lug. Bat. ii. 296.
writers of this century need not be mentioned here; but the next, the 11th century, is given as the probable though uncertain date of a writer who had a great influence on European medicine, Mesua the younger of Damascus, whose personality is obscure, and of whose very existence some historians have doubted, thinking that the name was assumed by some medieval Latin writer. The work De simplicibus, which bears his name, was for centuries a standard authority on what would now be called materia medica, was printed in twenty-six editions in the 15th century and later, and was used in the formation of the first London pharmacopoeia, issued by the College of Physicians in the reign of James I. Either to the 10th or the 11th century must be referred the name of another Arabian physician who has also attained the position of a classic, Abu'l Qasiin or Abulcasis, of El-Zahra, near Cordova, in Spain. His great work, Altasrif, a medical encyclopaedia, is chiefly valued for its surgical portion (already mentioned), which was translated into Latin in the 16th century, and was for some centuries a standard if not the standard authority on surgery in Europe. Among his own countrymen the fame and position of Abulcasis were soon eclipsed by the greater name of Avicenna.
Avicenna has always been regarded as the chief representative of Arabian medicine. He wrote on philosophy also, and in both subjects acquired the highest reputation through the whole of eastern Islam. In Mahommedan Spain he was lees regarded, but in Europe his works even eclipsed and superseded those of Hippocrates and Galen. His style and expository power are highly praised, but the subject-matter shows little originality. The work by which he is chiefly known, the celebrated "canon," is an encyclopaedia of medical and surgical knowledge, founded upon Galen, Aristotle, the later Greek physicians, and the earlier Arabian writers, singularly complete and systematic, but is thought not to show the practical experience of its author. As in the case of Galen, the formal and encyclopaedic character of Avicenna's works was the chief cause of his popularity and ascendancy, though in modern times these very qualities in a scientific or medical writer would rather cause him to become more speedily antiquated.
In the long list of Arabian medical writers none can here be mentioned except the great names of the Hispano-Moorish school, a school both philosophically and medically antagonistic to that of Avicenna. Of these the earliest is Avenzoar or Abumeron, that is, Abu Merwan `Abd al-Malik Ibn Zuhr (beginning of 12th century), a member of a family which gave several distinguished members to the medical profession. His chief work, Al-Teysir (facilitatio), is thought to show more practical experience than the writings of Avicenna, and to be less based upon dialectical subtleties. It was translated into Latin, and more than once printed, as were some of his lesser works, which thus formed a part of the contribution made by the Arabians to European medicine. His friend and pupil AvERROES of Cordova (q.v.), so well known for his philosophical writings, was also an author in medical subjects, and as such widely read in Latin. The famous Rabbi Maimonides (A.D. 1135-1201) (q.v.) closes for us the roll of medical writers of the Arabian school. His works exist chiefly in the original Arabic or in Hebrew translations; only some smaller treatises have been translated into Latin, so that no definite opinion can be formed as to their medical value. But, so far as is known, the independent and rationalistic spirit which the two last-named writers showed in philosophy did not lead them to take any original point of view in medicine.
The works of the Arabian medical writers who have now been mentioned form a very small fraction of the existing literature. Three hundred medical writers in Arabic are enumerated by Ferdinand Wiistenfeld (1808-1899), and other historians have enlarged the list (Haser), but only three have been printed in the original; a certain number more are known through old Latin translations, and the great majority still exist in manuscript. It is thus evident that the circumstance of having been translated (which may have been in some cases almost an accident) is what has chiefly determined the influence of particular writers on Western medicine. But it is improbable that further research will alter the general estimate of the value of Arabian medicine. There can be no doubt that it was in the main Greek medicine, modified to suit other climates, habits and national tastes, and with some important additions from Oriental sources. The greater part is taken from Hippocrates, Galen, Dioscorides and later Greek writers. The Latin medical writers were necessarily unknown to the Arabs; and this was partly the cause that even in Europe Galenic medicine assumed such a preponderance, the methodic school and Celsus being forgotten or neglected. In anatomy and physiology the Arabians distinctly went back; in surgery they showed no advance upon the Greeks; in practical medicine nothing new can be traced, except the description of certain diseases (e.g. small-pox and measles) unknown or imperfectly known to the Greeks; the only real advance was in pharmacy and the therapeutical use of drugs. By their relations with the farther East, the Arabs became acquainted with valuable new remedies which have held their ground till modern times; and their skill in chemistry enabled them to prepare new chemical remedies, and form many combinations of those already in use. They produced the first pharmacopoeia, and established the first apothecaries' shops. Many of the names and many forms of medi cines now used, and in fact the general outline of modern pharmacy, except so far as modified by modern chemistry, started with the Arabs. Thus does Arabian medicine appear as judged from a modern standpoint; but to medieval Europe, when little but a tradition remained of the great ancient schools, it was invested with a far higher degree of originality and importance.
It is now necessary to consider what was the state of medicine in Europe after the fall of the Western Empire and before the influence of Arabian science and literature began to be felt. This we may call the pre-Arabian or Salernitan period.
Medicine in the Early Middle Ages: School of Salerno
In medical as in civil history there is no real break. A continuous thread of learning and practice must have connected the last period of Roman medicine already mentioned with the dawn of science in the middle ages. But the intellectual thread is naturally traced with greater difficulty than that which is the theme of civil history; and in periods such as that from the 5th to the 10th century in Europe it is almost lost. The chief homes of medical as of other learning in these disturbed times were the monasteries. Though the science was certainly not advanced by their labours, it was saved from total oblivion, and many ancient medical works were preserved either in Latin or vernacular versions. The Anglo-Saxon Leechdoms 1 of the 11th century, published in the Rolls series of medieval chronicles and memorials, admirably illustrate the mixture of magic and superstition with the relics of ancient science which constituted monastic medicine. Similar works, in Latin or other languages, exist in manuscript in all the great European libraries. It was among the Benedictines that the monastic study of medicine first received a new direction, and aimed at a higher standard. The study of Hippocrates, Galen, and other classics was recommended by Cassiodorus (6th century), and in the original mother-abbey of Monte Cassino medicine was studied; but there was not there what could be called a medical school; nor had this foundation any connexion (as has been supposed) with the famous school of Salerno.
The origin of this, the most important source of medical knowledge in Europe in the early middle ages, is involved in obscurity. It is known that Salerno, a Roman colony, in a situation noted in ancient times for its salubrity, was in the 6th century at least the seat of a bishopric, and at the end of the 7th century of a Benedictine monastery, and that some of the prelates and higher clergy were distinguished for learning, and even for medical acquirements. But it has by recent researches been clearly established that the celebrated Schola salernitana was a purely secular institution. All that can with certainty be said is that a school or collection of schools gradually grew up in which especially medicine, but also, in a subordinate degree, law and philosophy were taught. In the 9th century Salernitan physicians were already spoken of, and the city was known as Civitas hippocratica. A little later we find great and royal personages resorting to Salerno for the restoration of their health, among whom was William of Normandy, afterwards the Conqueror. The number of students of medicine must at one time have been considerable, and in a corresponding degree the number of teachers. Among the latter many were married, and their wives and daughters appear also in the lists of professors. The most noted female professor was the celebrated Trotula in the 11th century. The Jewish element appears to have' been important among the students, and possibly among the professors. The reputation of the school was great till the 12th or 13th century, when the introduction of the Arab medicine was gradually fatal to it. The foundation of the university of Naples, and the rise of Montpellier, also contributed to its decline.
The teachings of the Salernitan doctors are pretty well known. through existing works, some of which have only recently been discovered and published. The best-known is the rhyming Latin poem on health by Joannes de Meditano, Regimen sanitatis Salerni, professedly written for the use of the "king of England," supposed to mean William the Conqueror; it had an immense reputation in the middle ages, and was afterwards many times printed, and translated into most European languages. This was a popular work intended for the laity; but there are others strictly professional.
1 Derived from the Anglo-Saxon laece, a physician, and dom, a law.
Among the writers it may be sufficient to mention here Gariopontus; Copho, who wrote the Anatome porci, a well-known medieval book; Joannes Platearius, first of a family of physicians bearing the same name, whose Practica, or medical compendium, was afterwards several times printed; and Trotula, believed to be the wife of the last-named. All of these fall into the first period before the advent of Arabian medicine. In the transitional period, when the Arabian school began to influence European medicine, but before the Salernitans were superseded, comes Nicolaus Praepositus, who wrote the Antidotarium, a collection of formulae for compound medicines, which became the standard work on the subject, and the foundation of many later compilations. An equally popular writer was Gilles de Corbeil (Aegidius Corboliensis), at one time a teacher at Salerno, afterwards court physician to Philip Augustus of France, who composed several poems in Latin hexameters on medical subjects. Two of them, on the urine and the pulse respectively, attained the position of medical classics.
None of these Salernitan works rise much above the rank of compilations, being founded on Hippocrates, Galen and later Greek writers, with an unmistakable mixture of the doctrines of the methodists. But they often show much practical experience, and exhibit the naturalistic method of the Hippocratic school. The general plan of treatment is dietetic rather than pharmaceutical, though the art of preparing drugs had reached a high degree of complexity at Salerno. Anatomy was as little regarded as it was in the later ancient schools, the empiric and methodic, but demonstrations of the parts of the body were given on swine. Although it cannot be said that the science of medicine was advanced at Salerno, still its decline was arrested at a time when every other branch of learning was rapidly falling into decay; and there can be no doubt that the observation of patients in hospitals, and probably clinical instruction, were made use of in learning and teaching. The school of Salerno thus forms a bridge between the ancient and the modern medicine, more direct though less conspicuous than that circuitous route, through Byzantium, Bagdad and Cordova, by which Hippocrates and Galen, in Arabian dress, again entered the European world. Though the glory of Salerno had departed, the school actually existed till it was finally dissolved by an edict of the emperor Napoleon I. in the year 1811.
Introduction of Arabian Medicine: The Scholastic Period
About the middle of the 11th century the Arabian medical writers began to be known by Latin translations in the Western world. Constantinus Africanus, a monk, was the author of the earliest of such versions (A.D. roso); his labours were directed chiefly to the less important and less bulky Arabian authors, of whom Haly was the most noted; the real classics were not introduced till later. For some time the Salernitan medicine held its ground, and it was not till the conquest of Toledo by Alphonso of Castile that any large number of Western scholars came in contact with the learning of the Spanish Moors, and systematic efforts were made to translate their philosophical and medical works. Jewish scholars, often under the patronage of Christian bishops, were especially active in the work. In Sicily also the Oriental tendencies of Frederick Barbarossa and Frederick II. worked in the same direction. Gerard of Cremona, a physician of Toledo (1114-1187), made translations, it is said by command of Barbarossa, from Avicenna and others. It is needless to point out the influence of the crusades in making Eastern ideas known in the Western world. The influence of Arabian medicine soon began to be felt even in the Hippocratic city of Salerno, and in the r3th century is said to have held an even balance with the older medicine. After this time the foreign influence predominated; and by the time that the Aristotelian dialectic, in the introduction of which the Arabs had so large a share, prevailed in the schools of Europe, the Arabian version of Greek medicine reigned supreme in the medical world. That this movement coincided with the establishment of some of the older European universities is well known. The history of medicine in the period now opening is closely combined with the history of scholastic philosophy. Both were infected with the same dialectical subtlety, which was, from the nature of the subject, especially injurious to medicine.
At the same time, through the rise of the universities, medical learning was much more widely diffused, and the first definite forward movement was seen in the school of Montpellier, where a medical faculty existed early in the 12th century, afterwards united with faculties of law and philosophy. The medical school owed its foundation largely to Jewish teachers, themselves educated in the Moorish schools of Spain, and imbued with the intellectual independence of the Averroists. Its rising prosperity coincided with the decline of the school of Salerno. Montpellier became distinguished for the practical and empirical spirit of its medicine, as contrasted with the dogmatic and scholastic teaching of Paris and other universities. In Italy, Bologna and Padua were earliest distinguished for medical studies - the former preserving more of the Galenical tradition, the latter being more progressive and Averroist. The northern universities contributed little - the reputation even of Paris being of later growth.
The supremacy of Arabian medicine lasted till the revival of learning, when the study of the medical classics in their original language worked another revolution. The medical writers of this period, who chiefly drew from Arabian sources, have been called Arabists (though it is difficult to give any clear meaning to this term), and were afterwards known as the neoterics.
The medical literature of this period is extremely voluminous, but essentially second-hand, consisting mainly of commentaries on Hippocrates, Galen, Avicenna and others, or of compilations and compendia still less original than commentaries. Among these may be mentioned the Conciliator of Peter of Abano (1250-1315), the Aggregator of Jacob de Dondi (1298-1359), both of the school of Padua, and the Pandectae medicinae of the Salernitan Matthaeus Sylvaticus (d. 1342), a sort of medical glossary and dictionary. But for us the most interesting fact is the first appearance of Englishmen as authors of medical works having a European reputation, distinguished, according to the testimony of Haser, by a practical tendency characteristic - of the British race, and fostered in the school of Montpellier.
The first of these works is the Compendium medicinae, also called Laurea or Rosa anglicana, of Gilbert (Gilbertus Anglicus, about 1290), said to contain good observations on leprosy. A more important work, the Practica seu lilium medicinae, of Bernard Gordon, a Scottish professor at Montpellier (written in the year 1307), was more widely spread, being translated into French and Hebrew, and printed in several editions. Of these two physicians the first probably, the latter certainly, was educated and practised abroad, but John Gaddesden (1280?-1361), the author of Rosa anglica seu Practica medicinae (between 1305 and 1317), was a graduate in medicine of Merton College, Oxford, and court physician. His compendium is entirely wanting in originality, and perhaps unusually destitute of common sense, but it became so popular as to be reprinted up to the end of the 16th century. Works of this kind became still more abundant in the 14th and in the first half of the 15th century, till the wider distribution of the medical classics in the original put them out of fashion.
In surgery this period was far more productive than in medicine, especially in Italy and France, but the limits of our subject only permit us to mention Gulielmus de Saliceto of Piacenza (about 1275), Lanfranchi of Milan (died about 1306), the French surgeon, Guy de Chauliac (about 1350) and the Englishman, John Ardern (about 1350). In anatomy also the beginning of a new epoch was made by Mondino de Liucci or Mundinus (1275-1326), and his followers. The medical writings of Arnald de Villanova (c. 1235-1313) (if the Breviarium practicae be rightly ascribed to him) rise above the rank of compilations. Finally, in the 13th and especially the 14th century we find, under the name of consilia, the first medieval reports of medical cases which are preserved in such a form as to be intelligible. Collections of consilia were published, among others, by Gentilis Fulgineus before 1348, by Bartolomeo Montagnana (d. 1470), and by Baverius de Baveriis of Imola (about 1450). The last-named contains much that is interesting and readable.
Period of the Revival of Learning
The impulse which all departments of intellectual activity received from the revival of Greek literature in Europe was felt by medicine among the rest. Not that the spirit of the science, or of its corresponding practice, was at once changed. The basis of medicine through the middle ages had been literary and dogmatic, and it was literary and dogmatic still; but the medical literature now brought to light - including as it did the more important works of Hippocrates and Galen, many of them hitherto unknown, and in addition the forgotten element of Latin medicine, especially the work of Celsus - was in itself far superior to the second-hand compilations and incorrect versions which had formerly been accepted as standards. The classical works, though still regarded with unreasoning reverence, were found to have a germinative and vivifying power that carried the mind out of the region of dogma, and prepared the way for the scientific movement which has been growing in strength up to our own day.
Two of the most important results of the revival of learning were indeed such as are excluded from the scope of this brief sketch - namely, the reawakening of anatomy, which to a large extent grew out of the study of the works of Galen, and the investigation of medicinal plants, to which a fresh impulse was given by the revival of Dioscorides (A.D. 50) and other ancient naturalists. The former brought with it necessarily a more accurate conception of physiology, and thus led up to the great discovery of Harvey, which was the turningpoint in modern medicine. The latter gave rise, on the one hand, to the modern science of botany, on the other to a more rational knowledge of drugs and their uses. At the same time, the discovery of America, and increased intercourse with the East, by introducing a variety of new plants, greatly accelerated the progress both of botany and pharmacology.
But it was not in these directions that improvement was first looked for. It was at first very naturally imagined that the simple revival of classical and especially of Greek literature would at once produce the same brilliant results in medicine as in literature and philosophy. The movement of reform started, of necessity, with scholars rather than practising physicians - more precisely with a group of learned men, whom we may be permitted, for the sake of a name, to call the medical humanists, equally enthusiastic in the cause of letters and of medicine. From both fields they hoped to expel the evils which were summed up in the word barbarism. Nearly all medieval medical literature was condemned under this name; and for it the humanists proposed to substitute the originals of Hippocrates and Galen, thus leading back medicine to its fountain-head. Since a knowledge of Greek was still confined to a small body of scholars, and a still smaller proportion of physicians, the first task was to translate the Greek classics into Latin. To this work several learned physicians, chiefly Italians, applied themselves with great ardour. Among the earliest were Nicolaus Leonicenus of Vicenza (1428-1524), Giovanni de Monte or Montanus (1498-1552), and many others in Italy. In northern Europe should be mentioned Gulielmus Copus (1471-1532) and Gunther of Andernach (1487-1584), better known as Guinterius Andernacensis, both for a time professors at Paris; and, among the greatest, Thomas Linacre (about 1460-1524; see Linacre). A little later Janus Cornarius or Hagenbut (150o-1558) and Leonhard Fuchs (1501-1566) in Germany, and John Kaye of Caius (1510-1572) in England, carried on the work. Symphorien Champier (Champerius or Campegius) of Lyons (1472-1539), a contemporary of Rabelais, and the patron of Servetus, wrote with fantastic enthusiasm on the superiority of the Greek to the Arabian physicians, and possibly did something to enlist in the same cause the two far greater men just mentioned. Rabelais not only lectured on Galen and Hippocrates, but edited some works of the latter; and Michael Servetus (1511-1553), in a little tract Syruporum universa ratio, defended the practice of Galen as compared with that of the Arabians. The great Aldine Press made an important contribution to the work, by editiones principes of Hippocrates and Galen in the original. Thus was the campaign opened against the medieval and Arabian writers, till finally Greek medicine assumed a predominant position, and Galen took the place of Avicenna. The result was recorded in a formal manner by the Florentine Academy, sometime shortly before 1 535: "Quae, excusso. Arabicae et barbarae servitutis medicae jugo, ex professo se Galenicam appellavit et profligato barbarorum exercitu unum totum et solum Galenum, ut optimum artis medicae authorem, in omnibus se sequuturam pollicita est." Janus Cornarius, from whom this is quoted, laments, however, that the Arabians still reigned in most of the schools of medicine, and that the Italian and French authors of works called Practica were still in high repute. The triumph of Galenism was therefore not complete by the middle of the 16th century. It was probably most so, and earliest, in the schools of Italy and in those of England, where the London College of Physicians might be regarded as an offshoot of the Italian schools. Paris was the stronghold of conservatism, and Germany was stirred by the teachings of one who must be considered apart from all schools - Paracelsus. The nature of the struggle between the rival systems may be well illustrated by a formidable controversy about the rules for bleeding in acute diseases. This operation, according to the Arabian practice, was always performed on a vein at a distance from the organ affected. The Hippocratic and also Galenic rule, to let blood from, or near to, the diseased organ, was revived by Pierre Brissot (1470-1522), a professor in the university of Paris. His attempt at reform, which was taken to be, as in effect it was, a revolt against the authority of the Arabian masters, led to his expulsion from Paris, and the formal prohibition by the parliament of his method. Upon this apparently trifling question arose a controversy which lasted many years, occupied several universities, and led to the interposition of personages no less important than the pope and the emperor, but which is thought to have largely contributed to the final downfall of the Arabian medicine.
Paracelsus and Chemical Medicine. - Contemporary with the school of medical humanists, but little influenced by them, lived in Germany a man of strange genius, of whose character and importance the most opposite opinions have been expressed. The first noticeable quality in Paracelsus (c. 1490-1541) is his revolutionary independence of thought, which was supported by his immense personal arrogance. Himself well trained in the learning and medical science of the day, he despised and trampled upon all traditional and authoritative teachings. He began his lectures at Basel by burning the books of Avicenna and others; he afterwards boasted of having read no books for ten years; he protested that his shoe-buckles were more learned than Galen and Avicenna. On the other hand, he spoke with respect of Hippocrates, and wrote a commentary on his Aphorisms. In this we see a spirit very different from the enthusiasm of the humanists for a purer and nobler philosophy than the scholastic and Arabian versions of Greek thought. There is no record of Paracelsus' knowledge of Greek, and as, at least in his student days, the most important works of Greek medicine were very imperfectly known, it is probable he had little first hand acquaintance with Galen or Hippocrates, while his breach with the humanists is the more conspicuous from his lecturing and writing chiefly in his native German.
Having thus made a clean sweep of nearly the whole of the dogmatic medicine, what did Paracelsus put in its place? Certainly not pure empiricism, or habits of objective observation. He had a dogma of his own - one founded, according to his German expositors, on the views of the Neoplatonists, of which a few disjointed specimens must here suffice. The human body was a "microcosm" which corresponded to the "macrocosm," and contained in itself all parts of visible nature, - sun, moon, stars and the poles of heaven. To know the nature of man and how to deal with it, the physician should study, not anatomy, which Paracelsus utterly rejected, but all parts of external nature. Life was a perpetual germinative process controlled by the indwelling spirit or Archeus; and diseases, according to the mystical conception of Paracelsus, were not natural but spiritual. Nature was sufficient for the cure of most diseases; art had only to interfere when the internal physician, the man himself, was tired or incapable. Then some remedy had to be introduced which should be antagonistic, not to the disease in a physical sense, but to the spiritual seed of the disease. These remedies were arcana - a word corresponding partly to what we now call specific remedies, but implying a mysterious connexion between the remedy and the "essence" of the disease. Arcana were often shown to be such by their physical properties, not only by such as heat, cold, &c., but by fortuitous resemblances to certain parts of the body; thus arose the famous doctrine of "signatures," or signs indicating the virtues and uses of natural objects, which was afterwards developed into great complexity. Great importance was also attached to chemically prepared remedies as containing the essence or spiritual quality of the material from which they were derived. The actual therapeutical resources of Paracelsus included a large number of metallic preparations, in the introduction of some of which he did good service, and, among vegetable preparations, the tincture of opium, still known by the name he gave it, laudanum. In this doubtless he derived much advantage from his knowledge of chemistry, though the science was as yet not disentangled from the secret traditions of alchemy, and was often mixed up with imposture.
German historians of medicine attach great importance to the revolt of Paracelsus against the prevailing systems, and trace in his writings anticipations of many scientific truths of later times. That his personality was influential, and his intrepid originality of great value as an example in his own country, is undeniable. As a national reformer he has been not inaptly compared to Luther. But his importance in the universal history of medicine we cannot estimate so highly. The chief immediate result we can trace is the introduction of certain mineral remedies, especially antimony, the use of which became a kind of badge of the disciples of Paracelsus. The use of these remedies was not, however, necessarily connected with a belief in his system, which seems to have spread little beyond his own country. Of the followers of Paracelsus some became mere mystical quacks and impostors. Others, of more learning and better repute, were distinguished from the regular physicians chiefly by their use of chemical remedies. In France the introduction of antimony gave rise to a bitter controversy which lasted into the 17th century, and led to the expulsion of some men of mark from the Paris faculty. In England "chemical medicine" is first heard of in the reign of Elizabeth, and was in like manner contemned and assailed by the College of Physicians and the Society of Apothecaries. But it should be remembered that all the chemical physicians did not call Paracelsus master. The most notorious of that school in England, Francis Anthony (1550-1623), never quotes Paracelsus, but relies upon Arnald de Villanova and Raimon Lull. From this time, however, it is always possible to trace a school of chemical practitioners, who, though condemned by the orthodox Galenists, held their ground, till in the 17th century a successor of Paracelsus arose in the celebrated J. B. Van Helmont.
Consequences of the Revival of Ancient Medicine
The revival of Galenic and Hippocratic medicine, though ultimately it conferred the greatest benefits on medical sciences, did not immediately produce any important or salutary reform in practical medicine. The standard of excellence in the ancient writers was indeed far above the level of the 16th century; but the fatal habit of taking at second hand what should have been acquired by direct observation retarded progress more than the possession of better models assisted it, so that the fundamental faults of medieval science remained uncorrected.
Nevertheless some progress has to be recorded, even if not due directly to the study of ancient medicine. In the first place the 15th and 16th centuries were notable for the outbreak of certain epidemic diseases, which were unknown to the old physicians. Of these the chief was the "sweating sickness" or "English sweat," especially prevalent in, though not confined to, the country whence it is named. Among many descriptions of this disease, that by John Kaye or Caius, already referred to, was one of the best, and of great importance as showing that the works of Galen did not comprise all that could be known in medicine. The spread of syphilis, a disease equally unknown to the ancients, and the failure of Galen's remedies to cure it, had a similar effect.
In another direction the foundations of modern medicine were being laid during the 16th century - namely, by the introduction of clinical instruction in hospitals. In this Italy, and especially the renowned school of Padua, took the first step, where Giovanni De Monte (Montanus), (1498-1552), already mentioned as a humanist, gave clinical lectures on the patients in the hospital of St Francis, which may still be read with interest. Pupils flocked to him from all European countries; Germans are especially mentioned; a Polish student reported and published some of his lectures; and the Englishman Kaye was a zealous disciple, who does not, however, seem to have done anything towards transplanting this method of instruction to his own country. Inspections of the dead, to ascertain the nature of the disease, were made, though not without difficulty, and thus the modern period of the science of morbid anatomy was ushered in.
Medicine in the 17th Century
The medicine of the early 17th century presents no features to distinguish it from that of the preceding century. The practice and theory of medicine were mainly founded upon Hippocrates and Galen, with everincreasing additions from the chemical school. But the development of mathematical and physical science soon introduced a fundamental change in the habits of thought with respect to medical doctrine.
These discoveries not only weakened or destroyed the respect for authority in matters of science, but brought about a marked tendency to mechanical explanations of life and disease. When William Harvey by his discovery of the circulation furnished an explanation of many vital processes which was reconcilable with the ordinary laws of mechanics, the efforts of medical theorists were naturally directed to bringing all the departments of medicine under similar laws. It is often assumed that the writings and influence of Bacon did much towards introducing a more scientific method into medicine and physiology. But, without discussing the general philosophical position or historical importance of Bacon, it may safely be said that his direct influence can be little traced in medical writings of the first half of the r 7th century. Harvey, as is well known, spoke slightingly of the great chancellor, and it is not till the rapid development of physical science in England and Holland in the latter part of the century, that we find Baconian principles explicitly recognized.
The dominant factors in the r 7th-century medicine were the discovery of the circulation by William Harvey (published in 1628), the mechanical philosophy of Descartes and the contemporary progress of physics, the teaching of Van Helmont and the introduction of chemical explanations of morbid processes, and finally, combined of all these, and inspiring them, the rise of the spirit of inquiry and innovation, which may be called the scientific movement. Before speaking in detail of these, we may note that by other influences quite independent of theories, important additions were made to practical medicine. The method of clinical instruction in hospitals, commenced by the Italians, was introduced into Holland, where it was greatly developed, especially at Leiden, in the hands of Francis de la Bo gy, called Sylvius (1641-1672). It is noteworthy that concurrently with the rise of clinical study the works of Hippocrates were more and more valued, while Galen began to sink into the background.
At the same time the discovery of new diseases, unknown to the ancients, and the keener attention which the great epidemics of plague caused to be paid to those already known, led to more minute study of the natural history of disease. The most important disease hitherto undescribed was rickets, first made known by Arnold de Boot, a Frisian who practised in Ireland, in 1649, and afterwards more fully in the celebrated work of Francis Glisson (1597-1677) in 1651. The plague was carefully studied by Isbrand de Diemerbroek, in his De Peste (1646), and others. Nathaniel Hodges of London (1629-1688) in 1665 seems to have been the first who had the courage to make a post mortem inspection of a plague patient. Christopher Bennet (1617-1655) wrote an important work on consumption in 1654. During the same period Many new remedies were introduced, the most important being cinchona-bark, brought to Spain in the year 1640. The progress of pharmacy was shown by the publication of Dispensatories or Pharmacopoeiae such as that of the Royal College of Physicians of London in 1618. This, like the earlier German works of the same kind (on which it was partly founded), contains both the traditional (Galenical) and the modern or chemical remedies.
Van Helmont
The medicine of the 17th century was especially distinguished by the rise of sytems; and we must first speak of an eccentric genius who endeavoured to construct a system for himself, as original and opposed to tradition as that of Paracelsus. J. B. Van Helmont (1578-1644) was a man of noble family in Brussels, who, after mastering all other branches of learning as then understood, devoted himself with enthusiasm to medicine and chemistry. By education and position a little out of the regular lines of the profession, he took up in medicine an independent attitude. Well acquainted with the doctrines of Galen, he rejected them as thoroughly as Paracelsus did, and borrowed from the latter some definite ideas as well as his revolutionary spirit. The archeus of Paracelsus appears again, but with still further complications - the whole body being controlled by the archeus influus, and the organ of the soul and its various parts by the archei insiti, which are subject to the central archeus. Many of the symptoms of diseases were caused by the passions and perturbations of the archeus, and medicines acted by modifying the ideas of the same archeus. These and other notions cannot be here stated at sufficient length to be intelligible. It is enough to say that on this fantastic basis Helmont constructed a medical system which had some practical merits, that his therapeutical methods were mild and in many respects happy, and that he did service by applying newer chemical methods to the preparation of drugs. He thus had some share, though a share not generally recognized, in the foundation of the iatro-chemical school, now to be spoken of. But his avowed followers formed a small and discredited sect, which, in England at least, can be clearly traced in the latter part of the century.
Discovery of the Circulation of the Blood
The influence of Harvey's discovery began to be felt before the middle of the century. Its merits were recognized by Descartes, among the first, nine years after its publication. For the history of the discovery, and its consequences in anatomy and physiology, we must refer to the article Harvey. In respect of practical medicine, much less effect was at first noticeable. But this example, combined with the Cartesian principles, set many active and ingenious spirits to work to reconstruct the whole of medicine on a physiological or even a mechanical basis - to endeavour to form what we should now call physiological or scientific medicine. The result of this was not to eliminate dogma from medicine, though it weakened the authority of the old dogma. The movement led rather to the formation of schools or systems of thought, which under various names lasted on into the 18th century, while the belief in the utility or necessity of schools and systems lasted much longer. The most important of these were the so-called iatro-physical or mechanical and the iatro-chemical schools.
Iatro-Physical School
The iatro-physical school of medicine grew out of physiological theories. Its founder is held to have been G. A. Borelli (1608-1679), whose treatise De motu animalium, published in 1680, is regarded as marking an epoch in physiology. The tendency of the school was to explain the actions and functions of the body on physical, and especially on mechanical, principles. The movements of bones and muscles were referred to the theory of levers; the process of digestion was regarded as essentially a process of trituration; nutrition and secretion were shown to be dependent upon the tension of the vessels, and so forth. The developments of this school belong rather to the history of physiology, where they appear, seen in the light of modern science, as excellent though premature endeavours in a scientific direction. But the influence of these theories on practical medicine was not great. The more judicious of the mechanical or physical school refrained, as a judicious modern physiologist does, from too immediate an application of their principles to daily practice. Mechanical theories were introduced into pathology, in explanation of the processes of fever and the like, but had little or no influence on therapeutics. The most important men in this school after Borelli were Nicolaus Stensen (Steno), (1638-1686), Giorgio Baglivi (1669-1707) and Lorenzo Bellini (1643-1704). An English physician, William Cole (1635-1716), is also usually ranked with them. One of the most elaborate developments of the system was that of Archibald Pitcairne (1652-1713), a Scottish physician who became professor at Leiden, to be spoken of hereafter.
Iatro-Chemical School
The so-called iatro-chemical school stood in a much closer relation to practical medicine than the iatrophysical. The principle which mainly distinguished it was not merely the use of chemical medicines in addition to the traditional, or, as they were called in distinction, "Galenical" remedies, but a theory of pathology or causation of disease entirely different from the prevailing "humoral" pathology. Its chief aim was to reconcile the new views in physiology and chemistry with practical medicine. In some theoretical views, and in the use of certain remedies, the school owed something to Van Helmont and Paracelsus, but took in the main an independent position. The founder of the iatrochemical school was Sylvius (1614-1672), who belonged to a French family settled in Holland, and was for fourteen years professor of medicine at Leiden, where he attracted students from all quarters of Europe. He made a resolute attempt to reconstruct medicine on the two bases of the doctrine of the circulation of the blood and the new views of chemistry. Fermentation, which was supposed to take place in the stomach, played an important part in the vital processes. Chemical disturbances of these processes, called acridities, &c., were the cause of fevers and other diseases. Sometimes acid sometimes alkaline properties predominated in the juices and secretions of the body, and produced corresponding disturbances. In nervous diseases disturbances of the vital "spirits" were most important. Still in some parts of his system Sylvius shows an anxiety to base his pathology on anatomical changes. The remedies he employed were partly galenical, partly chemical. He was very moderate in the use of bleeding.
The doctrines of Sylvius became widely spread in Holland and Germany; less so in France and Italy. In England they were not generally accepted till adopted with some modifications by Thomas Willis the great anatomist (1621-1675), who is the chief English representative of the chemical school. Willis was as thorough-going a chemist as Sylvius. He regarded all bodies, organic and inorganic, as composed of the three elements - spirit, sulphur and salt, the first being only found abundantly in animal bodies. The "intestine movement of particles" in every body, or fermentation, was the explanation of many of the processes of life and disease. The sensible properties and physical alterations of animal fluids and solids depended upon different proportions, movements and combinations of these particles. The elaborate work Pharmaceutice rationalis (1674), based on these materials, had much influence in its time, though it was soon forgotten. But some parts of Willis's works, such as his descriptions of nervous diseases, and his account (the earliest) of diabetes, are classical contributions to scientific medicine. In the application of chemistry to the examination of secretions Willis made some important steps. The chemical school met with violent opposition, partly from the adherents of the ancient medicine, partly from the iatro-mechanical school. Towards the end of the 17th century appeared an English medical reformer who sided with none of these schools, but may be said in some respects to have surpassed and dispensed with them.
Sydenham and Locke. - Thomas Sydenham (1624-1689) was educated at Oxford and at Montpellier. He was well acquainted with the works of the ancient physicians, and probably fairly so with chemistry. Of his knowledge of anatomy nothing definite can be said, as he seldom refers to it. His main avowed principle was to do without hypothesis, and study the actual diseases in an unbiassed manner. As his model in medical methods, Sydenham repeatedly and pointedly refers to Hippocrates, and he has not unfairly been called the English Hippocrates. He resembled his Greek master in the high value he set on the study of the "natural history of disease"; in the importance he attached to "epidemic constitution" - that is, to the influence of weather and other natural causes in modifying disease; and further in his conception of the healing power of nature in disease, a doctrine which he even expanded beyond the teaching of Hippocrates. According to Sydenham, a disease is nothing more than an effort of nature to restore the health of the patient by the elimination of the morbific matter. The extent to which his practice was influenced by this and other a priori conceptions prevents us from classing Sydenham as a pure empiric; but he had the rare merit of never permitting himself to be enslaved even by his own theories. Still less was his mind warped by either of the two great systems, the classical and the chemical, which then divided the medical world. Sydenham's influence on European medicine was very great. His principles were welcomed as a return to nature by those who were weary of theoretical disputes. He introduced a milder and better way of treating fevers - especially small-pox, and gave strong support to the use of specific medicines - especially Peruvian bark. He was an advocate of bleeding, and often carried it to excess. Another important point in Sydenham's doctrine is his clear recognition of many diseases as being what would be now called specific, and not due merely to an alteration in the primary qualities or humours of the older schools. From this springs his high appreciation of specific medicines.
One name should always be mentioned along with Sydenhamthat of his friend John Locke. The great sensational philosopher was a thoroughly trained physician, and practised privately. He shared and defended many of Sydenham's principles, and in the few medical observations he has left shows himself to be even more thorough-going than the "English Hippocrates." It is deeply to be regretted in the interests of medicine that he did not write more. It is, however, reasonable to suppose that his commanding intellect often makes itself felt in the words of Sydenham. One sentence of Locke's, in a letter to William Molyneux, sums up the practical side of Sydenham's teaching: "You cannot imagine how far a little observation carefully made by a man not tied up to the four humours [Galen], or sal, sulphur and mercury [Paracelsus], or to acid and alcali [Sylvius and Willis] which has of late prevailed, will carry a man in the curing of diseases though very stubborn and dangerous; and that with very little and common things, and almost no medicine at all." We thus see that, while the great anatomists, physicists and chemists - men of the type of Willis, Borelli and Boyle - were laying foundations which were later on built up into the fabric of scientific medicine, little good was done by the premature application of their half-understood principles to practice. The reform of practical medicine was effected by men who aimed at, and partly succeeded in, rejecting all hypothesis and returning to the unbiassed study of natural processes, as shown in health and disease.
Sydenham showed that these processes might be profitably studied and dealt with without explaining them; and, by turning men's minds away from explanations and fixing them on facts, he enriched medicine with a method more fruitful than any discoveries in detail. From this time forth the reign of canonical authority in medicine was at an end, though the dogmatic spirit long survived.
The r8th Century
The medicine of the i 8th century is notable, like that of the latter part of the 17th, for the striving after complete theoretical systems. The influence of the iatro-physical school was by no means exhausted; and in England, especially through the indirect influence of Sir Isaac Newton's (1642-1727) great astronomical generalizations, it took on a mathematical aspect, and is sometimes known as iatro-mathematical. This phase is most clearly developed in Archibald Pitcairne (1652-1713), who, though a determined opponent of metaphysical explanations, and of the chemical doctrines, gave to his own rude mechanical explanations of life and disease almost the dogmatic completeness of a theological system. His countryman and pupil, George Cheyne (1671-1743), who lived some years at Bath, published a new theory of fevers on the mechanical system, which had a great reputation. Their English contemporaries and successors, John Freind, William Cole, and Richard Mead, leaned also to mechanical explanations, but with a distrust of systematic theoretical completeness, which was perhaps partly a national characteristic, partly the result of the teaching of Sydenham and Locke. Freind (1675-1728) in his Emmenologia gave a mechanical explanation of the phenomena of menstruation. He is also one of the most distinguished writers on the history of medicine. Cole (1635-1716) (see above) published mechanical hypotheses concerning the causation of fevers which closely agree with those of the Italian iatro-mechanical school. More distinguished in his own day than any of these was Mead (1673-1754), one of the most accomplished and socially successful physicians of modern times. Mead was the pupil of the equally popular and successful John Radcliffe (1650-1714), who had acquired from Sydenham a contempt for book-learning, and belonged to no school in medicine but the school of common sense. Radcliffe left, however, no work requiring mention in a history of medicine. Mead, a man of great learning and intellectual activity, was an ardent advocate of the mathematical doctrines. "It is very evident," he says, "that all other means of improving medicine have been found ineffectual, by the stand it was at for two thousand years, and that, since mathematicians have sot themselves to the study of it, men already begin to talk so intelligibly and comprehensibly, even about abstruse matters, that it is to be hoped that mathematical learning will be the distinguishing mark of a physician and a quack." His Mechanical Account of Poisons, in the first edition (1702), gave an explanation of the effects of poisons, as acting only on the blood. Afterwards he modified his hypothesis, and referred the disturbances produced to the "nervous liquor," which he supposed to be a quantity of the "universal elastic matter" diffused through the universe, by which Newton explained the phenomena of light - i.e. what was afterwards called the luminiferous ether. Mead's treatise on The Power of the Sun and Moon over Human Bodies (1704), equally inspired by Newton's discoveries, was a premature attempt to assign the influence of atmospheric pressure and other cosmical causes in producing disease. His works contain, however, many original experiments, and excellent practical observations. James Keill (1673-1719) applied Newtonian and mechanical principles to the explanation of bodily functions with still greater accuracy and completeness; but his researches have more importance for physiology than for practical medicine.
Boerhaave
None of these men founded a school - a result due in part to their intellectual character, in part to the absence in England of medical schools equivalent in position and importance to the universities of the Continent. An important academical position was, on the other hand, one of the reasons why a physician not very different in his way of thinking from the English physicians of the age of Queen Anne was able to take a far more predominant position in the medical world. Hermann Boerhaave (1668-1738) was emphatically a great teacher. He was for many years .professor of medicine at Leiden, where he lectured five hours a day, and excelled in influence and reputation not only his greatest forerunners, Montanus of Padua and Sylvius of Leiden, but probably every subsequent teacher. The hospital of Leiden, though with only twelve beds available for teaching, became the centre of medical influence in Europe. Many of the leading English physicians of the 18th century studied there; Gerard Van Swieten (1700-1772), a pupil of Boerhaave, transplanted the latter's method of teaching to Vienna, and founded the noted Vienna school of medicine.
As the organizer, and almost the constructor, of the modern method of clinical instruction, the services of Boerhaave to the progress of medicine were immense, and can hardly be overrated. In his teaching, as in his practice, he avowedly followed the method of Hippocrates and Sydenham, both of whom he enthusiastically admired. In his medical doctrines he must be pronounced an eclectic, though taking his stand mainly on the iatro-mechanical school. The bestknown parts of Boerhaave's system are his doctrines of inflammation, obstruction and "plethora. ' By the last named especially he was long remembered. His object was to make all the anatomical and physiological acquisitions of his age, even microscopical anatomy, which he diligently studied, available for use in the practice of medicine. He thus differed from Sydenham, who took almost as little account of modern science as of ancient dogma. Boerhaave may be in some respects compared tO Galen, but again differed from him in that he always abstained from attempting to reduce his knowledge to a uniform and coherent system. Boerhaave attached great importance to the study of the medical classics, but rather treated them historically than quoted them as canonical authorities. It almost follows from the nature of the case that the great task of Boerhaave's life, a synthesis of ancient and modern medicine, and the work in which this is chiefly contained, his. celebrated Institutions, could not have any great permanent value. Nearly the same thing is true even of the Aphorisms, in which, following the example of Hippocrates, he endeavoured to sum up the results of his long experience.
Hoffmann and Stahl
We have now to speak of two writers in whom the systematic tendency of the 18th century showed itself most completely.
Friedrich Hoffmann (1660-1742), like Boerhaave, owed his influence, and perhaps partly his intellectual characteristics, to his academical position. He was in 1693 appointed the first professor of medicine in the university of Halle, then just founded by the elector Frederick III. Here he became, as did his contemporary and rival Stahl, a popular and influential teacher, though their university had not the European importance of Leiden. Hoffmann's" system "was apparently intended to reconcile the opposing" spiritual "and" materialistic "views of nature, and is thought to have been much influenced by the philosophy of Leibnitz. His medical theories rest upon a complete theory of the universe. Life depended upon a universally diffused ether, which animals breathe in from the atmosphere, and which is contained in all parts of the body. It accumulates in the brain, and there generates the" nervous fluid "or pneuma - a theory closely resembling that of Mead on the" nervous liquor,"unless indeed Mead borrowed it from Hoffmann. On this system are explained all the phenomena of life and disease. Health depends on the maintenance of a proper" tone "in the body - some diseases being produced by excess of tone, or" spasm "; others by" atony,"or want of tone. But it is impossible here to follow its further developments. Independently of his system, which has long ceased to exert any influence, Hoffmann made some contributions to practical medicine; and his great knowledge of chemistry enabled him to investigate the subject of mineral waters. He was equally skilful in pharmacy, but lowered his position by the practice, which would be unpardonable in a modern physician, of trafficking in secret remedies.
George Ernest Stahl (1660-1734) was for more than twenty years professor of medicine at Halle, and thus a colleague of Hoffmann, whom he resembled in constructing a complete theoretical system, though their systems had little or nothing in common. Stahl's chief aim was to oppose materialism. For mechanical conceptions he substituted the theory of" animism "- attributing to the soul the functions of ordinary animal life in man, while the life of other creatures was left to mechanical laws. The symptoms of disease were explained as efforts of the soul to rid itself from morbid influences, the soul acting reasonably with respect to the end of self-preservation. The anima thus corresponds partly to the" nature "of Sydenham,