But not only do we profit by the high ideals and the inspiration of great lives which we derive from the past, but it is of the greatest practical benefit to trace the history of great researches. Let us review for a few moments that which led to the discovery of the circulation of the blood. Before the days of Harvey-in the previous century-the lesser or pulmonary circulation had been clearly enunciated by Servetus and Realdus Columbus, and both lesser and greater circulations had been described by Cæsalpinus. But these views seem to have been purely theoretical; there is no evidence that they were based upon direct observation or experiment, and they made no impression on contemporary sentiment. The old Galenic doctrine was still held by Harvey's teacher, the great anatomist of Padua, Fabricius ab Apuapendente, at the beginning of the seventeenth century. The blood was still supposed to pass in part by invisible pores through the septum of the ventricles, and this was the only connection acknowledged between the venous and the arterial blood. There were, in fact, two distinct and independent circulations: the venous blood, with its natural spirits derived from the liver, passing out from the right ventricle along the veins to the tissues, and the thin arterial blood, containing the innate heat of the heart and the vital spirits derived from the lungs, in like manner proceeding from the left ventricle, both by a to-and-fro movement. The idea held of the action of the heart was just the reverse of the truth. The active period (the systole) corresponding with the impulse was supposed to be that of dilatation, when the air and blood were assumed to be drawn into the left and right ventricles, respectively, by the suction force thereby exerted. Harvey did away entirely with the "spirits," because he could find no evidence of their existence in his researches. He denied the pores in the septum of the heart for the same reason, and taught that all the blood passes through the lungs. He ascertained the action of the auricles and ventricles, with their respective valves. He realized that the active period of the heart was that of contraction upon its contents, and that the blood was thereby driven into the arteries, producing the pulse. He calculated carefully the amount of this blood passing out from the heart at each systole, and thus found that in a few minutes as much must pass as is contained in the whole body; that is, that all the blood passes through the heart. It was also obvious that the amount was far greater than that which is absorbed by the veins from the food and drink, previously considered its sole source, and that the far greater part must be blood which has passed from the arteries to the veins in the tissues, in some such hidden manner as it does in the lungs. Harvey never saw the capillaries, either in the lungs or elsewhere; he had only a logical evidence of their existence. Their discovery was reserved for Malpighi and the microscope. Fact after fact arose to confirm Harvey's views that the heart was emptied when the vena cava was tied, and filled to distention when the aorta was tied; that a moderate ligation of a limb made it swell with venous blood, but a tight one kept the blood from entering by compressing the arteries; that the whole of the blood in the body could be drained away by opening a vein; that the valves of the veins (discovered by his master, Fabricius, but misinterpreted by him) were designed to prevent reflux of blood in its passage onward to the heart. Harvey's solution of the circulation was a purely mechanical one, based on patient anatomical examination and comparison of various animals, on the adoption of some explanation for what he saw, and the confirmation of this explanation by repeated dissection, vivisection and experiment-in other words, on true Hippocratic principles. Who will say that it is a matter of indifference whether such a work be brought to the attention of students or not? Again, medical literature is a mine of neglected and overlooked discoveries. Take, for example, club-foot, both the true nature and successful treatment of which were known to Hippocrates, but were lost for many ages after his death. Says Adams :10 "In all the works on ancient surgery, I verily believe there is not a more wonderful chapter than the one which relates to club-foot. In it he has not only stated correctly the true nature of this malformation, but he has also given very sensible directions for rectifying the deformity in early life. Now, it appears to me a lamentable reflection, as proving that valuable knowledge, after being discovered, may be lost again to the world for many ages, that not only did subsequent authorities, down to a very recent period, not add anything to the stock of valuable information which he had given on the subject, but the important knowledge which he had revealed to the profession came to be disregarded and lost sight of, so that, until these last few years" [he refers to the introduction of tenotomy by Strohmeyer and Delpech] "talipes was regarded as one of the opprobia medicina." Hippocrates was also acquainted with dis 'See Foster. Loc. cit. 10 Loc. cit. Vol. 2, page 559. location of the acromial end of the clavicle, the knowledge of which was entirely lost until within the eighteenth century." According to Celsus, lithotripsy, which held so prominent a place in the surgery of the latter part of the last century, was invented and practiced by Ammonius of Alexandria, about B. C. 230.12 Heliodorus, about A. D. 100, was well acquainted with torsion of arteries, a particular mode of operating for the radical cure of hernia by excision of the sac, and excision of stricture of the urethra-all of which have been proclaimed as marvelous discoveries in later days.13 You all remember the statement of the late Dr. T. Gaillard Thomas, which formed the theme of my predecessor's Presidential Address last year, that more had been done for the advancement and growth of medicine in the last half of the last century than in all the preceding ages from the days of Hippocrates. Yet hear the acknowledgment of the author of the statement in his well-known work on "The Diseases of Women;"1 "Some of the most valuable contributions to modern gynecology will be found to be foreshadowed, or even plainly noticed, by the writers of a past age, and afterward entirely overlooked;" and he cites as examples the use of the uterine sound, sponge-tents, dilatation of the constricted cervix, and even the speculum itself. The history of the last-named instrument, upon which modern gynecology is based, is exceedingly instructive. Employed habitually by Paul of Ægina in the latter half of the seventh century, A. D., and furnishing him with an excellent knowledge of diseases of the uterus, it was forgotten by his successors until rediscovered by Récamier and introduced to the profession in 1818. But it is probable that we may learn equally as much from the follies, omissions and failures of the past as from its successes and achievements. Experience will always be fallacious and judgment difficult, and it is not likely that error can ever be avoided. It is well for us to realize that the future may pluck many a feather from even our ambitious wings, who plume ourselves on our attainments. It is not impossible that some Praxagoras of Cos may hereafter open the abdomen for the relief of obstruction of "Baas (J. H.): Outlines of the History of Medicine. Trans. by H. E. Handerson. New York, 1889. "Celsus. De Medicina, vii, 26. Billings (J. S.). In: System of Surgery. Edit. by F. S. Dennis. Phil., 1895. Vol. 1, page 30. "Thomas (T. G.). A Practical Treatise on the Diseases of Women. 6 Ed. Phil., 1891. Page 17. the bowels 2,200 years before men shall think the example worth following; that some Celsus may confound veins and arteries, although this same Praxagoras shall have known of their differences 400 years earlier; that some Aretæus shall have heard a "bruit" in heart disease, but the hint lie dormant many centuries; that this same close observer shall describe the crossing of the nerves and its effects 1,400 years before a Willis appears to beat it into men's brains; that men shall believe that arteries contain only air, although experience be continually teaching that they contain blood; that they shall believe that there are pores in the septa of the heart, although the utmost effort of vision fail to detect them; that some Massaria shall rather be wrong with Galen than right with anyone else; that men shall have practiced ligation of arteries for hemorrhage for centuries before a Paré teach them to apply it in amputation; that surgery shall be turned over to the barbers; that mesmerism and hypnotism shall have another periodic discovery under some new name; that some Sylvius shall teach that the whole art of medicine consists in the administration of acids and alkalies, some Cullen that all pathology is referable to spasm, some Broussais that we must seek it only in inflammation; that some Auenbrugger's epochmaking discovery of percussion shall have to wait for the coming of a Corvisart; that some Brown shall slay his thousands with whiskey and opium, some Rasori his ten thousands with the lancet and tartar emetic; that those will be found to combat blindly the unanswerable logic of the germ theory, and even to persist in their opposition when the germs themselves shall be placed before their eyes; that they shall fight against the obstetrical forceps, cinchona and antiseptics. We may smile at the suggestion of such possibilities, the list of which could be very much lengthened, yet some of them have actually occurred not so very long ago; and what has been, or its like, will with certainty of fate be again. He only is wise who realizes this fact, listens to the wholesome confessions of the past and is ever on his guard. Let us now sum up some of the advantages of the study of medical history that have been pointed out in this address: 1. It teaches what and how to investigate. 2. It is the best antidote we know against egotism, error and despondency. 3. It increases knowledge, gratifies natural and laudable curiosity, broadens the view and strengthens the judgment. 4. It is a rich mine from which may be brought to light many neglected or overlooked discoveries of value. 5. It furnishes the stimulus of high ideals which we poor, weak mortals need to have ever before us; it teaches our students to venerate what is good, to cherish our best traditions, and strengthens the common bond of the profession. 6. It is the fulfilment of a duty-that of cherishing the memories, the virtues, the achievements, of a class which has benefited the world as no other has, and of which we may feel proud that we are members. Having now shown the value-nay, I should rather say the necessity of the study of medical history, I shall conclude with a few words regarding its teaching. So important a branch should receive the highest consideration. It should be taught in no desultory fashion, but as thoroughly as any other. There should be a full chair of the history of medicine in every university. A systematic course of reading should be required in addition to the lectures, which should be not less than sixteen to twenty in number. It should be made a subject of examination, for all experience proves that in no way can the attendance of the students be enforced. The time is near at hand when the standing of universities will be judged by their attitude to this branch, and when it will be assigned a front rank in the curriculum. FROM HIPPOCRATES TO GALEN.* By E. J. KEMPF, M.D., For thousands of years medicine was an undigested collection of experimental notions, vaguely described, disfigured by tradition, and often made useless by superstition and ignorance. The earlier medical history is entirely legendary, and to Greek writers must be given the credit of compiling and systematizing the most interesting and most significant remains of the history of medicine of antiquity. In the description of medicine as pictured in the Homeric Poems, we find that Chiron, the Centaur, introduced the art of medicine among the Greeks, and educated Esculapius, a Thes *This paper was read before the Dubois County (Indiana) Medical Society, and is published by request of the Society. |