History of Medicine

History of Medicine

The history of medical science, considered as a part of the general history of civilization, should logically begin in Mesopotamia, where tradition and philological investigation placed the cradle of the human race. But, in a condensed article such as this, there are important reasons which dictate the choice of another starting point. Modern medical science rests upon a Greek foundation, and whatever other civilized peoples may have accomplished in this field lies outside our inquiry. It is certain that the Greeks brought much with them from their original home, and also that they learned a great deal from their intercourse with other civilized countries, especially Egypt and India; but the Greek mind assimilated knowledge in such a fashion that its origin can rarely be recognized.

MYTHICAL, HOMERIC, AND PRE-HIPPOCRATIC TIMES

Greek medical science, like that of all civilized peoples, shows in the beginning a purely theurgical character. Apollo is regarded as the founder of medical science, and, in post-Homeric times, his son Æsculapius (in Homer, a Thessalian prince) is represented, as the deity whose office it is to bring about man's restoration to health by means of healing oracles. His oldest place of worship was at Tricca in Thessaly. The temples of Æsculapius, of which those at Epidaurus and Cos are the best known, were situated in a healthy neighbourhood. The sick pilgrims went thither that, after a long preparation of prayer, fasting and ablutions, they might, through of mediation of the priests, receive in their dreams the healing oracles. This kind of medical science already shows a rational basis, for the priests interpreted the dreams and prescribed a suitable treatment, in most cases purely dietetic. Important records of sicknesses were made and left as votive-tablets in the temples. Side by side with the priestly caste, and perhaps out of it there arose the order of temple physicians, who, as supposed descendants of the god Æsculapius, were known as the Asclepiadae, and formed a kind of guild or corporation. This separation of offices must have occurred at an early time, for even in Homer we find lay physicians mentioned, especially "the sons of Æseulapius", Machaon and Podalirius. In the vegetable drugs of Egyptian origin mentioned in Homer we recognize the early influence of the country of the Pharaohs upon Greek medical science. The schools of the philosophers likewise exerted no small influence upon development, medical problems being studied by Pythagoras of Samos, Alcmaeon of Crotona, Parmenides of Elea, Heraclitus of Ephesus (sixth century B.C.), Empedocles of Agrigentum, and Anaxagoras of Clazomenae (fifth century B.C.). The earliest medical schools were at Cyrene in Northern Africa, Crotona, Cnidus and Cos. From Cnidus came Euryphon and also Ctesias the geographer, who was at first physician in the army of Cyrus and, after the battle of Cunaxa (401 B.C.), to Artaxerxes Memnon. Of greater interest is the medical school adjoining the shrine of Æseulapius at Cos, for from it arose the man who first placed medicine upon a scientific basis, and whose name is even today well known to all physicians, Hippocrates.

HIPPOCRATES AND THE SO-CALLED CORPUS HIPPOCRATICUM

Tradition knows seven physicians named Hippocrates, of whom the second is regarded as the most famous. Of his life we know but little. He was born at Cos in 460 or 459 B.C., and died at Larissa about 379. How great his fame was during his lifetime is shown by the fact that Plato compares him with the artists Polycletus and Phidias. Later he was called "the Great" or "the Divine". The historical kernel is probably as follows: a famous physician of this name from Cos flourished in the days of Pericles, and subsequently many things, which his ancestors or his descendants or his school accomplished, were attributed to him as the hero of medical science. The same was true of his writings. What is now known under the title of "Hippocratis Opera" represents the work, not of an individual, but of several persons of different periods and of different schools. It has thus become customary to designate the writings ascribed to Hippocrates by the general title of the "Hippocratic Collection" (Corpus Hippocraticum), and to divide them according to their origin into the works of the schools of Cnidus and of Cos, and of the Sophists. How difficult it is, however, to determine their genuineness is shown that even in the third century before Christ the Alexandrian librarians, who for the first time collected the anonymous scrolls scattered through Hellas, could not reach a definite conclusion. For the development of medical science it is of little consequence who composed the works of the school of Cos for they are more or less permeated by the spirit of one great master. The secret of his immortality rests on the fact that he pointed out the means whereby medicine became a science. His first rule was the observation of individual patients, individualizing in contradistinction to the schematizing of the school of Cnidus. By the observation of all the principles were gradually derived from experience, and these, uniformly arranged, led by induction to a knowledge of the nature of the disease, its course, and its treatment. This is the origin of the famous "Aphorismi", short rules which contain at times principles derived from experience and at times conclusions drawn from the same source. They form the valuable part of the collection. The school of Cos and its adherents, the Hippocratics, looked upon medical science from a purely practical standpoint; they regarded it as the art of healing the sick, and therefore laid most stress on prognosis and treatment by aiding the powers of nature through dietetic means, while the whole school of Cnidus prided itself upon its scientific diagnosis and, in harmony with money with the East, adopted a varied medicinal treatment. The method which the school of Cos established more than 2000 years ago has proved to be the only one, and thus Hippocratic medial science celebrated its renascence in the eighteenth century with Boerhaave at Leyden and subsequently with Gerhard van Swieten at Vienna. In his endeavour to the truth the earnest investigation often reaches an impassable barrier. There is nothing more tempting than to seek an outlet by means of reflection and deduction. Such a delusive course may easily become fatal to the physicist; but a medical system, erected upon the results of speculative investigation, carries the germ of death within itself.

THE DOGMATIC SCHOOL

In their endeavour to complete the doctrine of their great master, the successors of the Hippocratics fell victims to the snares of speculation. In spite of this, we owe to this so-called "dogmatic school" some fruitful investigation. Diocles Carystius advanced the knowledge of anatomy, and tried to fathom the causal connection between symptom and disease, in which endeavours he was imitated by Praxagoras of Cos, who established the diagnostic importance of the pulse.

Unfortunately, there already began with Aristotle (38-22 B.C.) that tendency -- later rendered so fatal through Galen's teaching - to regard organic structure and function not in accordance with facts but from the teleological standpoint.

THE ALEXANDRIAN PERIOD

The desire to give to medicine a scientific basis found rich nourishment in the ancient civilized soil of Egypt under the Ptolemies. Herophilus of Chalcedon (about 300 B.C.) and Erasistratus of Iulis (about 330-240 B.C.) are mentioned in this connection. As anatomists, they were the first systematic investigators, and, following Hippocrates, they tried to complete clinical experience by exact methods. This tendency was opposed by the empires, whose services lay solely in the field of drugs and toxicology. Erasistratus as well as Philinus, the empiric, attacked the doctrine of humors (humoral pathology), which developed out of the Hippocratic tendency. The former alone was a serious opponent since, as an anatomist, he looked for the seat of the disease in the solid parts, rather than in the four fundamental humors (blood, mucus, black and yellow gall) and their different mixtures.

THE METHODIZERS

One of the opponents of humoral pathology was Asclepiades of Prusa in Bithynia (born about 124 B.C.). He tried to use in medicine the atomistic theory of Epicurus and Heracleides of Pontus. He taught that health and disease depend upon the motion of the atoms in the fine capillaries or pores, which, endowed with sensation, pass through the entire body. With Themison as their leader, the followers of Asclepiades simplified his doctrine by supposing disease to be only a contraction or relaxation, and later only a mixed condition (partly contracted, partly relaxed) of the pores. This simple and convenient explanation of all diseases without regard to anatomy and physiology, taken in conjunction with its allied system of physical dietetic therapeutics, explains why this doctrine enjoyed so long a life, and why the works of the methodist, Caelius Aurelianus of Sicca in Numidia (beginning of fifth century A.D.), were diligently studied down to the seventh century.

GALEN

Departure from the Hippocratic observation of nature led physicians to form numerous mutually opposing sects. A man of great industry and comprehensive knowledge, Galen of Pergamum (about A.D. 130-201), tried to rescue medical science from this labyrinth. He chose the path of eclecticism, on which he built his (as he thought) infallible system. Whatever sense-perception and clinical observation left obscure, he tried to explain in a speculative manner. That this system of teaching could hold medicine in bondage until modern times shows the genius of the master, who understood how to cover up the gaps by brilliancy of style. Galen took the entire anatomical knowledge of his time, and out of it produced a work the substance of which was for centuries regarded as inviolable. His anatomy was to a large extent based upon the dissection of mammals, especially of monkeys, and, like his physiology, was under teleological influence. His presentation of things lacks dispassionateness. Instead of explaining the functions of organs on the basis of their structure, Galen chose this reverse method. His anatomy and physiology were the most vulnerable part of his system, and an earnest re-examination of these fields must necessarily have shaken his entire scheme of teaching. Galen expressed the greatest respect for Hippocrates, published his most important works with explanatory notes, but never entered into the spirit of the school of Cos, although he adopted many of its doctrines. Galen is the culminating point and end of ancient Greek medical science. In his vanity he thought he had completed all investigation, and that his successors had only to accept without effort what he had discovered. As will be shown in the following paragraph, his advice was, unfortunately for science, followed literally.

PEDANIUS DIOSCURIDES

Pedanus Dioscurides, who was from Anazarbe and lived in the time of Nero and Vespasian, may be mentioned here as the most important pharmaceutical writer of ancient times. He simplified greatly the pharmacopoeia, which had then assumed unwieldy dimensions, and freed it from ridiculous, superstitious remedies. Our modern pharmacology is based on his work, Ta ton tylikon biblia.

CORNELIUS CELSUS

Cornelius Celsus (about 25-30 B.C. to A.D. 45-50) is the only Roman who worked with distinction in the medical field, but it is doubtful whether he was a physician. His work, "De re medica libri viii", which is written in classical Latin, and for which he used seventy-two works lost to posterity, gives a survey of medical science from Hippocrates to imperial times. Very famous is his description lithotomy. Celsus was altogether forgotten until the fifteenth century, when Pope Nicholas V (1447-55) is said to have discovered a manuscript of his works.

BYZANTINE PERIOD

In Byzantine times medicine shows but little originality, and is of small importantance in the history of medical development. The work handed down to us are all compilations, but as they frequently contain excerpts from lost works they are of some historical value. The notable writers of this period are: Oreibasios (325-403), physician in ordinary to Julian the Apostate; and Aetius of Amida, a Christian physician under Justinian {597-66). A little more originality than these men exhibited was shown by Alexander of Tralles (525-605), and Paulus Ægineta of the first half of the seventh century, of whose seven books, the sixth, dealing with surgery, was greatly valued in Arabian medicine. Paulus lived at Alexandria, and was one of the last to come from its once famous school, which became extinct after the capture of the city by Omar in 640. At the end of the thirteenth century Nicolaus Myrepsus, living at the court in Nicaea, made a collection of prescriptions which was extensively used. In the time of Emperor Andronicus III (1328-42) lived a highly gifted physician, Joannes Actuarius, and the mention of his writings closes the account of this period.

ARABIAN MEDICINE

Arabian medical science forms an important chapter in the history of the development of medicine, not because it was especially productive but because it preserved Greek medical science with that of its most important representative Galen. It was, however, strongly influenced by oriental elements of later times. The adherents of the heretic Nestorius, who in 431 settled in Edessa, were the teachers of the Arabs. After the expulsion these Nestorians settled in Dschondisapor in 489, and there founded a medical school. After the conquest of Persia by the Arabs in 650, Greek culture was held in great esteem, and learned Nestorian, Jewish, and even Indian physicians worked diligently as translators of the Greek writings. In Arabian Spain conditions similarly developed from the seventh century. Among important physicians in the first period of Greek-Arabic medicine -- the period of dependence and of translations -- come first the Nestorian family Bachtischua of Syria, which flourished until the eleventh century; Abu Zakerijja Jahja ben Maseweih (d. 875), known as Joannes Damascenus, Mesue the Elder, a Christian who was a director of the hospital at Bagdad, did independent work, and supervised the translation of Greek authors, Abu Jusuf Jacub ben Ishak ben el-Subbah el-Kindi (Alkindus, 813-73), who wrote a work about compound drugs, and the Nestorian Abu Zeid Honein ben Ishak ben Soliman ben Ejjub el 'Ibadi (Joannitius, 809-about 873), a teacher in Baghdad who translated Hippocrates and Dioscurides, and whose work "Isagoge in artem parvam Galeni", early translated into Latin, was much read in the Middle Ages. Wide activity and independent observation -- based, however, wholly upon the doctrine of Galen -- were shown by Abu Bekr Muhammed ben Zakarijia er-Razi (Rhazes, about 850-923), whose chief work, however, "El-Hawi fi'l Tib" (Continens) is a rather unsystematic compilation. In the Middle Ages his "Ketaab altib Almansuri" (Liber medicinalis Almansoris) was well known and had many commentators. The most valuable of the thirty-six productions of Rhazes which have come down to us is "De variolis et morbillis", a book based upon personal experience. We ought also to mention the dietetic writer Abu Jakub Ishak ben Soleiman el-Israili (Isaac Judaeus, 830-about 932), an Egyptian Jew; the Persian, Ali ben el Abbas Ala ed-Din el-Madschhusi (Ali Abbas, d. 994) author of "El-Maliki" (Regalis dispositio, Pantegnum). Abu Dshafer Ahmed ben Ibrahim ben Abu Chalid Ihn el-Dshezzar (d. 1009) wrote about the causes of the plague in Egypt. A work on pharmaceutics was written by the physician in ordinary to the Spanish Caliph Hisham II (976-1013), Abu Daut Soleiman ben Hassan Ibn Dsholdschholl.

Of the surgical authors, Abu'l Kasim Chalaf ben Abbas el-Zahrewi of el-Zahra near Cordova (Abulkasem, about 912-1013) alone deserves mention, and he depends absolutely on Paulus Ægineta. While he received scant attention at home, since surgery was little cultivated by the Arabs, his work, written in a clear and perspicuous style, became known in the West through the Latin translation by Gerardus of Cremona (1187), and was extensively used even in later days. Arabian medicine reached its culmination with the Persian Abu Ali el-Hosein ben Abdallah Ibn Sina (Avicenna, 980-1037), who based his system entirely upon the teaching of Galen and tried in various ways to supplement the latter. His chief work, "El-Kanûn" (Canon Medicinae), written in a brilliant style and treating all branches of medical science, soon supplanted in the West the works of the Greeks and, until the time of the Humanists, served as the most important textbook for physicians, but in Arabian Spain his fame was small. One of his chief rivals was Abu-Merwan Abd el-Malik ben Abul-Ala Zohr ben Abd el-Malik Ibn Zohr (Avenzoar, 1113-62) from the neighbourhood of Seville. His friend, the philosopher and physician Abul-Welid Muhammed ben-Ahmed Ibn Roshd el-Maliki (Averroës, 1126 -98), of Cordova, is regarded as the complement of Avicenna. His book was also popular in the West and bears the title "Kitâbel-Kolijjat" (Colliget). With the decline of Arabian rule began the decay of medicine. In the Orient this decline began after the capture of Cordova in 1236, decay becoming complete after the loss of Granada in 1492. The predominance of Arabian medicine, which lasted scarcely three centuries, seriously delayed the development of our science. A brief survey of this period shows that the Arabs bent in slavish reverence before the works of Aristotle and Galen without examinig them critically. No other Greek physician obtained such a hold on the Arabs as Galen, whose system, perfect in form, pleased them in philosophy. Nowhere did dialectics play a greater part in medicine than among the Arabs and their later followers in the West. Independent investigation in the fields of exact science, anatomy, and physiology was forbidden by the laws of the Koran. Symptomatology (semiotics) at the bedside, especially prognosis, based on the pulse and the of the urine, were developed by them with an equally exaggerated and fruitless subtlety. Much, and perhaps the only credit due to them is in the field of pharmaceutics. We are indebted to them for a series of simple and compound drugs of oriental and Indian origin, previously unknown, and also for the polypharmacy of later times. Until the discovery of America the Venetian drug-trade was controlled by Arabian dealers.

CHRISTIANITY'S SHARE IN THE DEVELOPMENT OF MEDICAL SCIENCE

As long as the cruel persecution the Church lasted throughout the Roman Empire, it was impossible for Christians to take direct part in the development of medical science. But provision had been made for medical aid within the community, because the priest, like the rabbi of small Jewish communities in the late Middle Ages, was also a physician. This is clear from the story of the two brothers, Sts. Cosmas and Damian, who studied medicine in Syria and were martyred under Diocletian. The exercise of practical charity under the direction of deacons of the churches gave rise to systematic nursing and hospitals. In recent times it has, indeed been alleged that the existence of hospitals among the Buddhists, even in the third century before Christ, and their existence in ancient Mexico at the time of its discovery is demonstrable, and that hospitals had their origin in general philanthropy; but nobody denies that the nursing of the sick, especially during epidemics, had never before been so widespread, so well organized, so self-sacrificing as in the early Christian communities. Christianity tended the sick and devised and executed extensive schemes for the care of deserted children (foundling, orphans), of the feeble and infirm, of those out of work and of pilgrims. The era of persecution ended, we find large alms-houses and hospitals like that of St. Basilius in Caesarea (370), those of the Roman Lady Fabiola in Rome and Ostia (400), that of St. Samson adjoining the church of St. Sofia in Constantinople in the sixth century, the foundling asylum of Archbishop Datheus of Milan in 787, and many others. In 1198 Pope Innocent III rebuilt the pilgrims' shelter, which had been founded in 726 by a British king, but had been repeatedly destroyed by fire. He turned it into a refuge for travellers and a hospital, and entrusted it to the Brothers of the Holy Ghost established by Guy de Montpellier. Mention must also be made here of the religious orders of knights and the houses for lepers of later times. The great hospitals of the Arabs in Dschondisapor and Bagdad were built after Christian models. The celebrated ecclesiastical writer Tertullian (born A.D. 160) possessed a wide knowledge of medicine, which, following the custom of his time, he calls a "sister of philosophy". Clement of Alexandria, about the middle of the century, lays down valuable hygienic laws in his "Paedagogus". Lactantius in the fourth century speaks in his work "De Opificio Dei" about the structure of the human body. One of the most learned priests of his time, St. Isidore of Seville (d. 636), treats of medicine in the fourth book of his "Origines S. Etymologiae". St. Benedict of Nursia (480) made it a duty for the sciences, and among them medicine, as aids to the exercise of hospitality. Cassiodorus gave his monks direct instructions in the study in medicine. Bertharius, Abbot of Monte Cassino in the ninth century, was famous as a physician. Walafrid Strabo (d. 849), Abbot of Reichenau the oldest medical writer on German soil, describes in a poem (Hortulus) the value of native medicinal plants, and also the method of teaching medicine in monasteries. We must mention, furthermore, the "Physica", a description of drugs from the three kingdoms of nature, written by St. Hildegarde (1099-1179), abbess of a monastery near Bingen-on-the-Rhine. The curative properties of minerals are described by Marbodus of Angers, Bishop of Rennes (d. 1123), in his "Lapidarius".

How diligently medicine was studied in the monasteries is shown by the numerous manuscripts (many still unedited) in the old cathedral libraries and by those which were taken from the suppressed monasteries and are now to be found in the national libraries of various countries. Priests who possessed a knowledge ot medicine served as physicians-in-ordinary to princes as late as the fifteenth century, although they were forbidden to practice surgery by the Fourth Synod of the Lateran (1213). Thus, Master Gerhard, parish priest in Felling, who founded the Hospital of the Holy Ghost at Vienna (1211), was physician-in-ordinary to Duke Leopold VI of Austria, and Sigismund Albicus, who afterward became Archbishop of Prague (1411), held the same office at the court of King Wenzel of Bohemia (1391-1411). From this time, we constantly meet with priests possessing a knowledge of medicine and writing on medical subjects. The popes, the most important patrons of all the sciences, were friendly also to the development of medicine. That they ever at any time forbade the practice of anatomical investigation is a fable. Pope Boniface VIII in 1299-1300 forbade the practice then prevalent of boiling the corpses of noble persons who had died abroad, in order that their bones might be more conveniently transported to the distant ancestral tomb. This prohibitory rule had reference only to cases of death in Christian countries, while in the Orient (e.g. during the Crusades) the usage seems to have been tacitly allowed to continue.

FIRST UNIVERSITIES IN THE WEST

Having voluntarily undertaken the education of the young in all branches of learning, the monasteries were aided in their endeavours by both Church and State. The foundation of state schools is the work of Charlemagne (768-814), whose activity, especially in the Germanic countries, was stimulated by the decree of the Synod of Aachen (789), that each monastery and each cathedral chapter should institute a school. According to the Capitulary of Charlemagne at Diedenhofen (Thionville) in 806, medicine was commonly taught in these schools. At the diocesan school in Reims, we find Gerbert d'Aurillac, later Pope Sylvester II (999-1003), long active as a teacher of medicine. Simultaneously with the rise of the cities there sprang up higher municipal schools, as for instance the Burgerschule at St. Stephan's in Vienna (about 1237). Out of the secular and religious schools, the curriculum of which institutions comprised the entire learning of the times, the first universities developed themselves partly under imperial and partly under papal protection, according as they sprang from the lay and the cathedral or monastic schools.

SCHOOL OF SALERNO

This is regarded as the oldest medical school of the West. Salerno on the Tyrrhenian Sea, originally probably a Doric colony, was from the sixth to the eleventh century under the rule of the Lombards, and from 1075 to 1130 under that of the Normans. In 1130 it became a part of the Kingdom of Naples and Sicily. The origin of the school is obscure, but, contrary to former belief, it was not a religious foundation, though very many priests were engaged there as teachers of medicine. Women and even Jews were admitted to these studies. Salerno was destined to cultivate for a long time Greek medical science in undimmed purity, until the twelfth century saw the school fall a victim to the all-powerful Arab influence. One of its oldest physicians was Alpuhans, later (1058-85) Archbishop of Salerno. With him worked the Lombard Gariopontus (d. 1050), whose "Passionarius" is based upon Hippocrates, Galen, and Caelius Aurelianus. Contemporary with him was the female physician Trotula who worked also in the literary field, and who is said to have been the wife of the physician Joannes Platearius. Perhaps the best known literary work of this school is the anonymous "Regimen sanitatis Salernitanum" a didactic poem consisting of 364 stanzas, which has been translated into all modern languages. It is said to have been dedicated to Prince Robert, son of William the Conqueror, upon his departure from S. Salerno in 1101. An important change in the intellectual tendency of the "Civitas Hippocratica", as this school called itself, was brought about by the physician Constantine of Carthage (Constantinus Africanus), a man learned in the Oriental languages and a teacher of medicine at Salerno, who died in 1087 a monk of Monte Cassino. While hitherto the best works of Greek antiquity had been known only in mediocre Latin translations, Constantine in the solitude of Monte Cassino began to translate to translate from the Arabic, Greek authors (e.g. the "Aphorisms" of Hippocrates and the "Ars parva" of Galen), as well as such Arabic writer as were accessible to him (Isaak, Ali Abbas). As he brought to the knowledge of his contemporaries first-class Greek authors, but only secondary Arab writers, the study of the former became more profound, while on the other hand an interest was awakened in the hitherto unknown Arabic literature. His pupils were Bartholomaeus, whose "Practica" was translated into German as early as the thirteenth century, and Johannes Afflacius (De febribus et urinis). To the twelfth century, when Arabian polypharmacy was introduced, belong Nicolaus Praepositus (about 1140), whose "Antidotarium", a collection of compounded pharmaceutical formulae, became a model for later works of this kind, and Matthaeus Platearius, who, towards the end of the century, wrote a commentary on the above-named "Antidotarium" (Glossae) and a work about simple drugs (Circa instans). Similar productions appeared from the hand of an otherwise unknown Magister Solernitanus. Maurus, following Arabian sources, wrote on uroscopy. Here must be also mentioned Petrus Musandinus (De cibis et potibus febricitantium), the teacher of Pierre Giles of Corbeil (Ægidius Corboliensis), who later became a canon and the physician-in-ordinary to Philip Augustus of France (1180-1223), and who even at this day began to complain about the decay of the school.

Its first misfortune dates from the death of King Roger III (1193), when the army of King Henry VI captured the city. The establishment of the University of Naples by Frederick II in 1224, the preponderance of Arabian influence, and the rise of the Montpellier school, all exerted so unfavourable an influence that by the fourteenth century Salerno was well-nigh forgotten. Salerno is the oldest school having a curriculum prescribed by the state. In 1140 King Roger II ordered a state examination to test the proficiency of prospective physicians, and Frederick II in 1240 prescribed five years of study besides a year of practical experience. When we consider the proximity of Northern Africa, that the neighbouring Sicily had been under Saracenic rule from the ninth to the eleventh century, and that the Norman kings, and to a far greater degree Frederick II, gave powerful protection to Arabian art and science, it seems wonderful that this oasis of Graeco-Roman culture endured so long. Down to the twelfth century this school was ruled by a purely Hippocratic spirit, especially in practical medicine, by its diagnosis and by the treatment of acute diseases dietetically. Arabian influence makes itself felt first of all in therapeutics, a fact which is easily explained by the proximity of Amalfi, where the Arabian drug-dealers used to land. Local conditions (resulting from the Crusades) explain how surgery, especially the treatment of wounds received in war, was diligently cultivated. In Rogerius we find a Salernitan surgeon armed with independent experience, but showing, nevertheless, reminiscences of Abulhasem. His "Practica Chirurgiae" dates from the year 1180. Although Salerno finally succumbed to Arabian influences, this school did not hand down to us a knowledge of the best Arabian authors.

SPAIN AS THE TRANSMITTER OF ARABIAN MEDICINE

Its focus was the city of Toledo, which was taken from the Moors in 1085 by Alfonso VI of Castile and Leon. Here Archbishop Raimund (1130-50) founded an institution for translations, in which Jewish scholars were the chief workers. Here lived Gerard of Cremona (1114-87, properly Carmona, near Seville), the translator of Rhazes and Avicenna. A later translator of Rhases (about 1279) was the Jew Faradsch ben Salem (Faragius), who was educated at Salerno.

THE SCHOLASTIC PERIOD

When in the twelfth century all the Aristotelean works gradually became known, one of the results was the development of Scholasticism, that logically arranged systematic treatment and explanation of rational truths based upon the Aristotelean speculative method. Even though this tendency led to the growth of many excrescences in medicine and confirmed the predominance of Galen's system, also largely based on speculation, it is wrong to hold Scholasticism responsible for the mistakes which its disciples made in consequence of their faulty apprehension of the system, because Scholasticism, far from excluding the observation of nature, directly promotes it. The best proof of this is the fact that the most important scholastic of the thirteenth century, St. Albertus Magnus, was likewise the most important physicist of his time. He thus imitated his model, Aristotle, in both directions. The famous scholastic Roger Bacon (1214-94), an English Franciscan, lays chief stress his theory of cognition upon experience as far as the natural sciences are concerned, and this with even greater emphasis than Albertus Magnus.

Albertus Magnus

Albertus Magnus (Albert Count of Bollstädt, 1193-1280) was a Dominican. For medical science his works about animals, plants, and minerals alone concern us. Formerly a work called "De secretis mulierum" was wrongly attributed to him. Albertus's most eminent service to medicine was in pointing out the way to an independent observation of nature. The following books were to a certain degree based upon the writings of Albertus: the encyclopedic works on natural history of the Franciscan Bartholomaeus Anglicus (about 1260), of Thomas of Cantimpre (1204-80), canon of Cambrai, of Vincent of Beauvais (d. 1264), the "Book of Nature" by Kunrad von Megenberg (1307-74), canon of Ratisbon, and the natural history of Meinau composed towards the end of the thirteenth century at the Monastery of Meinau on the Lake of Constance. In the medical schools the influence of scholasticism made itself felt, but this influence was always favourable. The scholastic physician, the philosopher at the bedside, with his compendious works of needy contents, with his endless game of question and answer, must not, however, be misjudged; he preserved interest in the observation of nature and was, as is freely conceded, a skilful practitioner, although he laid excessive stress upon formalism, and medicine in his hands made no special progress.

BOLOGNA

Bologna was the principal home of scholastic medicine, and, as early as the twelfth century, a medical school existed there. The most famous physician there was Thaddeus Alderotti (Th. Florentinus,1215-95), who even at that time gave practical clinical instruction and enjoyed great fame as a physician. Among his pupils were the four Varignana, Dino and Tommaso di Garbo, and Pietro Torrigiano Rustichelli -- later a Carthusian monk -- all well-known expounders of the writings of Galen. Indirect disciples were Pietro de Tussignana (d. 1410), who first described the baths at Bormio, and Bavarius de Bavariis (d. about 1480) who was for a long time physician to Pope Nicholas V.

Bologna and the Study of Anatomy

Bologna has stained incomparable glory from the fact that Mondino de Liucci (about 1275-1326), the reviver of anatomy, taught there. There, for the first time since the Alexandrian period (nearly 1500 years), he dissected a human corpse, and wrote a treatise on anatomy based upon personal observation -- a work which, for nearly two and a half centuries, remained the official textbook of the universities. Although Mondino's work which appeared in 1316, contains many defects and errors, if nevertheless marked an advance and incited men to further investigation.

PADUA

Padua, the famous rival of Bologna, received a university in 1222 from Frederick II. Just as the University Of Leipzig originated in consequence of the migration of students and professors from the University of Prague in 1409, so Padua came into existence through a secession from Bologna. Bologna was soon surpassed by the daughter institution, and, from the foundation of the University of Vienna in 1365 until the middle of the eighteenth century, Padua remained a shininng model for the medical school of Bologna. The first teacher of repute was Pietro d' Abano (Petrus Aponensis, 1250 to about 1320), known as the "great Lombard" -- an honorary title received during his residence at the Universlty of Paris. On account of his too liberalistic opinions and his derision of Christian teaching in his "Conciliator differentiarum", his chief medical work, he was accused of being a heretic. From this period also date the "Aggregator Brixiensis" of Guglielmo Corvi (1250-1326), a work in even greater demand in later times, and the "Consilia" of Gentile da Foligno (d. 1348), who, in 1341, performed the first anatomical dissection in Padua. The fame of the school of Padua was greatly advanced by the family of physicians, the Santa Sophia, which about 1292 emigrated from Constantinople, and whose most famous members were Marsilio (d. 1405) and Galeazzo (d. 1427). The latter, one of the first teachers in Vienna (about 1398-1407), and later professor at Padua, wrote in Vienna a pharmacopoeia which indicates absolutely independent observation in the field of botany. His antithesis and contemporary was Giacomo dalla Torre of Forli (Jacobus Foroliviensis, d. 1413), professor at Padua, known for his commentary on the "Ars parva" of Galen. Giacomo de Dondi (1298-1359), author of the "Aggregator Paduanus do medicinis simplicibus", tried to disengage a salt from the thermal waters of Abano, near Padua. As anatomist and practitioner we must mention Bartholomaeus de Montagnana (d.1460), and the grandfather of the unfortunate Savonarola, Giovanni Michele Savonarola (1390-1462), author of the "Practica Major", who worked along the same lines.

MONTPELLIER

The earliest information about the medical school of this place dates from the twelfth century. Like Salerno, Montpellier developed great independence as far as the other schools were concerned, and laid the greatest stress upon practical medicine. With the decay of Salerno, Montpellier gained in importance. The chief representative of this school is the Spaniard, Arnold of Villanova (1235-about 1312). His greatest merit is that, inclining more towards the Hippocratic school, he did not follow unconditionally the teachings of Galen and Avicenna, but relied upon his own observation and experience, while employing in therapeutics a more dietetic treatment as opposed to Arabian tenets. To him we are indebted for the systematic use of alcohol in certain diseases. A very doubtful merit is his popularizing of alchemy to the study of which he was very much devoted. Other Montpellier representatives of purely practical medicine are Bernard of Gordon (d. 1314; "Lilium medicinae", 1305) a Scot educated in Salerno; Gerardus de Solo (about 1320; "Introductorium juvenurn"); Johannes de Tornamira (end of the fourteenth century, "Clarificatorium juvenum"), and the Portuguese Valeseus de Taranta ("Philonium pharmaceuticum et chirurgicum", 1418). The medical school of Paris, founded in 1180, remained far behind Montpellier in regard to the practice of medicine.

SURGERY IN THE AGE OF SCHOLASTICISM

Surgery exhibited during this period in many respects a more independent development than practical medicine, especially in Bologna. The founder of the school there was Hugo Borgognoni of Lucca (d. about 1258). A more important figure was his son Teodorico, chaplain, penitentiary, and physician-in-ordinary to Pope Innocent IV, later Bishop of Cervia. In his "Surgery", completed in 1266, he recommends the simplification of the treatment of wounds, fractures, and dislocations. Guilielmo Saliceto from Piacenza (Guil. Placentinus), first of Bologna, then at Verona, where he completed his surgery in 1275, shows great individuality and a kneen diagnostic eye. Similarly his pupil Lanfranchi strongly recommended the reunion of surgery and internal medicine. Lanfranchi, banished in 1290 from his native city, Milan, transplanted Italian surgery to Paris. There the surgeons, like the physicians of the faculty, had, since 1260, been formed into a corporation, the College de St. Cosme (since 1713 Academie de Chirurgie), to which Lanfranchi was admitted. His "Chirurgia magna" (Ars completa), finished in 1296, is full of casuistic notes and shows us the author as an equally careful and lucky operator. The first important French surgeon is Henri de Mondeville (1260-1320), originally a teacher of anatomy at Montpellier whose treatise, although for the most part a compilation, does not lack originality and perspicuity. The culminating point in French surgery at this period is marked by the appearance of Guy de Chauliac (Chaulhac, d. about 1370). He completed his studies at Bologna, Montpellier, and Paris; later he entered the ecclesiastical state (canon of Reims, 1358), and was physician-in-ordinary to popes Clement VI, Innocent VI, and Urban V. From him we have a description of the terrible plague which he witnessed in 1348 at Avignon. His "Chirurgia magna" treated the subject with a completeness never previously attained, and gave its author during the following centuries the rank of a first-class authority. Among contemporary surgeons in other civilized countries we must mention John Ardern (d. about 1399), an Englishman, who studied at Montpellier and lived subsequently in London, famous for his skill in operating for anal fistulæ, and Jehan Yperman of the Netherlands (d. about 1329), who studied in Paris under Lanfranchi. Besides these surgeons where is no doubt that there were then in Italy many a number of itinerant practitioners who offered their services at fairs; as, specializing usually in certain operations (hernia and lithotomy), they often possessed great skill, and their advice and assistence of a wrong tendency in medicine, but they sought by people of the upper classes.

SIGNS OF IMPROVEMENT: HUMANISM

A short of the survey of the scholastic period gives us the following picture: On the appearance of Arabic literature in Latin translations, Hippocratic medicine was driven from its last stronghold, Salerno. Then came the rule of Arabism, of the system of Galen in Arabic form equipped with all sorts of sophistic subtleties. The works of Rhazes and Avicenna possessed the greatest authority. The latter's "Canon", written in clear language and covering the entire field of medicine became the gospel of physicians. The literature of these times is rich in writings but very poor in thought; for people were content when the long-winded commentaries gave them a better understanding of the Arabs, whom they deemed infallible. A good many things were incomprehensible, first of all the names of diseases and drugs, which translators rendered incorrectly. A comparative investigation of the Greek authors was practically impossible, as both their works and a knowledge of the Greek language had disappeared from among the Romance nations. Thus it happened that special books had to be written from which were learned foreign words and their meanings. The "Synonyma Medicinae" (Clavis sanationis) by the physician Sirnon of Genoa (Januensis, 1270-1303) and the "Pandectae medicinae" of Matthaeus Sylvaticus (d. 1342), both of which were alphabetically arranged, were in vogue. Woe to the physician who dared to doubt the authority of the Arabs! Only men of strong mind could successfully carry out such a dangerous undertaking. The influence of scholasticism in medicine was manifold. It encouraged the observation of nature at the bedside and logical thinking, but it also stimulated the love of disputation, wherein the main object was to force a possibly independent idea into the strait-jacket of the ruling system, and thus avoid all imputation of medical heresy. Signs of improvement are noticed first in anatomy (Mondino) and subsequently in surgery, which is based upon it.

The impulse to follow a new path came, however from without, first of all from a study of the Greek language, and then directly through the famous poet Francesco Petrarca (1304-74), the zealous patron of humanistic studies and thus of the Renaissance. Petrarch's instructor in the Greek language was the monk Barlaam, who procured for his pupil, Leontius Pilatus, a position as public teacher of the language in Florence in 1350. In later times, especially after the fall of Constantinople in 1453, numerous Greek scholars came to Italy. With the spread of a knowledge of Greek and the enthusiasm for the Hellenic masterpieces in art and science, there arose also an interest in classical Latin and a diligent search for manuscripts of Graeco-Roman antiquity, and efforts along these lines were, as is well known, energetically supported by the popes. The West now became acquainted with the works of the old Greek pre-Aristotelean philosophers and physicians in their original tongue, a fact which marks the beginning of the fall of the Arabian teaching. Petrarch fought as champion along the whole line of battle, especially against scholasticism and the medicine of that period. There is no doubt that his zeal was exaggerated in many respects. He blames the physicians of his time because they philosophize and do not cure. Medicine, he says is a practical art and, therefore, may not be treated according to the same methods for the investigation of truth as philosophy. The greatest misfortune had been the appearance of Arabism with all its superstitions (astrology, alchemy, uroscopy). On the other hand, he speaks with great respect of surgery; the reason for this is patent, since he was a friend of the most important surgeon of his time, Guy de Chauliac. There is no doubt that there were then in Italy many excellent physicians who, like Petrarch, recognized the existence of a wrong tendency in medicine, but they were far too weak to break the fetters of Arabism. The road to improvement had already been pointed out by Mondino, the anatomist of Bologna, but a complete change of view did not occur until the sixteenth century.

THE BLACK DEATH OF THE FOURTEENTH CENTURY

Associated with the name of Petrarch is the memory of the most terrible epidemic of historic times. The Black Death (bubonic plague with pulmonary infection), originating in Eastern Asia, passed through India to Asia Minor, Arabia, Egypt, Northern Africa, and directly to Europe by the Black Sea. In Europe the epidemic began in 1346, and spread first of all in the maritime cities of Italy (especially Genoa) and Sicily, in 1347 it appeared in Constantinople, Cyprus, Greece, Malta, Sardinia and Corsica, and, towards the end of the year, at Marseilles; in 1348 in Spain Southern France (Avignon) Paris, the Netherlands, Italy, Southern England and London, Scbleswig-Holstein and Norway, and in December, in Dalmatia and Jutland; in 1349 in the Austrian Alpine countries, Vienna, and Poland; in 1350 in Russia, where in 1353 the last traces disappeared on the shores of the Black Sea. The entire period was preceded by peculiar natural phenomena, as floods, tidal waves, and abnormally damp weather. Petrarch, who witnessed the plague at Florence, declared that posterity would regard the description of all its horrors as fables. The loss of human life in Europe, the population of which is estimated to have been 100 millions, is said to have amounted to twenty-five millions. The disease usually began suddenly and death occurred within three days, and often after a few hours. Physicians were quite powerless in face of the enormous extent of the pestilence. Great self-sacrifice was shown by the clergy, especially by the Franciscans, who are said to have lost 100,000 (?) members through the epidemic. Concerning this terrible period we have reports from the jurist of Piacenza, Gabriel de Mussis; from Cantacuzenus and Nicephorus about the epidemic in Constantinople; from Boccaccio and Petrarch (Florence), from the physician Dionysius Colle of Belluno (Italy) the Belgian Simon of Covino (Montpellier), Guy de Chauliac (Avignon), and also from some Spanish physicians. Less voluminous accounts are to be found in the chronicles of the different countries. Europe has since been repeatedly visited by the plague, which has, however, never been so violent nor extended so widely. The last great epidemics occurred in Central Europe in 1679 and 1713.

HUMANISM AND MEDICAL SCIENCE IN THE FIFTEENTH AND SIXTEENTH CENTURIES

The terrors of the Black Death, and the conviction which it brought of the powerlessness of current medicine, undoubtedly helped to effect a gradual change. The greatest influence, however, was exerted by the humanistic tendency which had found many adherents, especially among physicians. The desire after general cultivation in the natural sciences was substantially promoted by the great voyages of discovery made towards the end of the fifteenth century. It is worthy of mention that, at a time when the gifted Christopher Columbus was still ridiculed as a dreamer by the learned, the Florentine astronomer and physician, Toscanelli, and the house-physician of the Franciscan monastery of Santa Maria de Rabida, Garcia Fernandes, both heartily encouraged him and gave him material aid. The scientific endeavours for the reform of medicine are characterized by the activity of the translators, by the critical treatment and explanation of old authors, and by independent investigation especially in the field of botany. Concerning translations, those which had reference to the Hippocratic writings were of prime importance. Among the translators and commentators of these works we find Nicola Leoniceno of Vicenza (1428-1524), the Spaniard Franciscus Valesius (end of the sixteenth century), the Frenchman Jacques Houllier (Hollerius, 1498-1562), Johann Hagenbut of Saxony (Cornarus 1500-58), the two Paris professors, Jean de Gorris (Gorraeus, 1505-77), and Louis Duret (1527-86), and Anutius Foesius (1528-91), a physician of Metz. As investigators of Pliny there are Ermolao Barbaro (1454-93), later Patriarch of Aquileia, and Filippo Beroaldo (1453-1505). Students of other authors were Giovanni Manardo of Ferrara (1462-1536; Galen, Mesue), the Paduan professor Giovanni Battista de Monte (Montanus, 1498-1552; Galen, Rhazes, Avicenna), and the Englishmen Thomas Linacre (1461-1524), and John Kaye (1506-73), Wilhelm Copus, town physician of Basle (1471-1521), and Theodore Zwinger of Switzerland (1533-88), all students of Galen. As may be seen, the system of Galen still formed the central point of medical studies, but it must be regarded as an advance that people now read his works in the original or in accurate translations, not as before in their Arabic form, for in this way many changes and conflicting views introduced by the Arabs were detected. But the full beauty of the Hippocratic works could not be appreciated as long as Galen reigned supreme.

The first fruit of Humanism in medicine was primarily of a purely formal nature, the main stress being now laid upon philological subtleties and elegant diction. No longer content with prose, authors often recorded their thoughts in verse. Petrarch had blamed the physicians of his time because they knew how to construct syllogisms, but did not know how to cure; and now the place of the philosophizing practitioners was taken by the poet physicians. A more satisfactory sign of the times is the great number of medical botanists whose works show more or less independent investigation, and always regard the needs of the physician at the bedside. Among these we must mention the town physician of Bern, Otto Brunfels (d. 1534), Leonard Fuchs (1501-66) professor at Ingolstadt, Hieronymus Tragus (Bock) of Heiderbach (1498-1554), and his pupil Jacobus Theodorus Tabernaemontanus (d. 1590). The most important, however, is the Zurich physician Conrad Gesner (1516-65; Tabulae phytographicae), who was the first to experiment vvith tobacco brought from America. Only Andrea Cesalpini, professor art that Spienza in Rome, can be regarded as his equal. The interest taken in study of natural science in Germany by Hapsburg emperors, Ferdinand I (1522-64) and Maximilian (1564-76), was of great advantage to it. The physician-in-ordinary to the Archduke Ferdinand of Tyrol, Petrus Andreas Mathiolus of Siena (1500-77), published a translation of Dioscurides with a commentary, a work which was most highly valued until recent times. The special favour of Maximilian II was enjoyed by Rembert Dodoens (Dodonaeus) of Mechlin (1517-85), and by the founder of scientific botany, Charles de l'Ecluse (Clusius) of Antwerp (1525-1609). The latter was appointed professor in Leyden, and for a time lived in Vienna, where he found zealous followers in the physicians Johann Aicholtz (d. 1588) and Paul Fabricus (d. 1589).

PROGRESS IN ANATOMY: ANDREAS VESALIUS

From the time of Mondino, anatomy had been diligently cultivated at the universities, especially in Italy. In Bologna, Giovanni de Concoreggi (d. 1438) issued a work on anatomy. As commentators of Mondino we must mention Alessandro Achillini (1463-1512) and Jacopo Berengerio da Carpi (about 1470-1530). Anatomy made special progress because of the artists. Thus Raphael Sanzio (1488-1520) already makes use of the human skeleton when making his sketches, so as to give his figures the proper posture. We possess numerous anatomical descriptions and sketches by Leonardo da Vinci (1442-1519) which were intended partly for all anatomy planned by Marcantonio della Torre (Turrianus, 1473-1506), and partly for a work of his own. The great Michelangelo (1475-1564) left sketehes of the muscles and in 1495, in the monastery of Santo Spirito at Florence, made studies for a picture of the Crucified with cadavers as models.

As an indication of how much the popes endeavoured to advance the study of anatomy we may recall that the priest Gabriel de Zerbis for a time taught anatomy in Rome (towards the end of the fifteenth century) that Paul III (1534-49) appointed the surgeon Alfonso Ferri to teach this subject at the Sapienza in 1535, that the physician-in-ordinary of Julius III (1550-55), Giambattista Cannani, crowned his anatomical studies by discovering the valves in the veins; that Paul IV (1555-9) called to Rome the famous Realdo Colombo the teacher of Michelangelo, and that Colombo's sons dedicated their father's work, "De re anatomica", to Pope Pius IV (1559-1565). Foremost among the universities stood Padua, the stronghold of medical science whence was to issue the light which disclosed the weakness of Galen's system. In Padua, where Bartolomeo Montagna (d. 1460) performed no less than fourteen dissections, there existed since 1446 an anatomical theatre which in 1490 was rebuilt under Alessandro Benedetti (1460-1525). en reigned supreme. Of the anatomists who worked outside of Italy we may mention Guido Guidi (Vidus Vidius) of Florence (d. 1569), until 1531 professor at Paris; his successor Francois Jacques Dubois (Sylvius, d. 1551) and Gunther von Andernach (1487-1574), professor at Louvain. The two latter were the teachers of the great reformer of anatomy, Andreas Vesalius (q.v.).

Vesalius (b.1514), studied at Louvain, Montpellier and Paris, then became imperial field-surgeon. His eagerness to learn went so far that he stole corpses from the gallows to work on at night in his room. He soon became convinced of the weakness and falsity of the anatomy of Galen. His anatomical demonstrations on the cadaver, which he performed in several cities and which attracted attention, soon earned him a call to Padua where he had recently graduated and where, with some interruptions, he taught from 1539 to 1546. His chief work, "De corporis humani fabrica libri vii", which appeared at Basle in 1543, brought him great fame, but likewise aroused violent hostility, especially on the part of his former teacher, Sylvius. The supreme service of Vesalius is that he for the first time, with information derived from the direct study of the dead body, attacked with keen criticism the hitherto unassailable Galen, and thus brought about his overthrow, for soon after this serious weaknesses in other parts of Galen's medical science vvere also disclosed. Vesalius is the founder of scientific anatomy and of the technique of modern dissection. Unfortunately, he himself destroyed a part of his manuscripts on learning that his enemies intended to submit his work to ecclesiastical censure. While engaged on a pilgrimage, he received word in Jerusalem of his reappointment as professor in Padua, but he was shipwrecked in Zant and died there in great need on 15 October, 1565.

The authority of Galen was, however, still so deeprooted among physicians that Vesalius found opponents even among his own more intimate pupils. Nevertheless, the path which he had pointed out was further explored and anatomy enriched by new discoveries. His immediate successors as teacher in Padua were, in 1546, Realdo Colombo (d. 1569), later professor in Rome, the discoverer of the lesser circulation of the blood (pulmonary circulation); from 1551 the versatile Gabriele Fallopio (1523-62), an admirer of Versalius, who among other things described the organ of hearing; Girolamo Fabrizio of Acquapendente (Fabr. ab Aquapendente, 1537-1619), who worked in the field of embryogeny and studied carefully the valves in the veins, and finally Giulio Casserio (1561-1619), who published a series of anatomical charts. A similar undertaking was planned by Bartolommeo Eustacchi at the Sapienza in Rome, but he died before the completion of the work in 1574. Pope Clement XI (1700-21) caused his physician-in-ordinary, Giovanni Maria Lancisi, to print the rediscovered copper plates and to supply them with an explanatory text. Adrian van den Spieghel of Brussels (Spigelius, 1578-1625) worked on the anatomy of the liver and to the nervous system. In comparison with the excellent productions of Italy, the anatomical activity of Germanic countries appears slight. It was considered sufficient at the universities, if a surgeon now and then dissected a corpse, while a physician explained the functions of different organs. The only laudable exceptions were two physicians who rendered services both to anatomy and botany -- Felix Platter (1536-1614), professor in Basle, and his successor, Kaspar Bauhinus (1560-1624), the discoverer of the valve in the caecum named after him (Bauhin's valve).

THE OPPONENTS OF GALEN AND THE ARABS

Violent attacks upon ancient traditions were not confined to the domain of medicine, but also found expression in the general upheaval caused hy Humanists, by the discovery of new countries, by the opening up new sources of knowledge, by the dissemination of education through the invention of printing, and by the schism of the Church brought about by Luther. Authority, both ecclesiastical and civil, had been considerably weakened. The investigations of Vesalius probably dealt the most serious blow to the teaching of Galen, but it was neither the first nor the only one; for even before Vesalius' critics had attacked the theories of Galen and the Arabs, although not quite so energetically as the anatomists attacked them. The chief representatives of these times down to the end of sixteenth century can be classed respectively into anti-Galenists or anti-Arabists and positive Hippocratics. The climax of this revolution was reached on the appearance of Theophrastus Paracelsus and his adherents although the Italian schools remained uninfluenced by this. The physician and philosopher, Geronimo Cardano of Milan (1501-76), attacked principally Galen's explanation of the origin of catarrhs of the brain, and also the validity of the therapeutical principle, Contraria contrariis curantur. Similar was the tendency shown by Bernadino Telesio of Piacenza (1508-88), Giovanni Argenterio of Piedmont (1513-72), and the chancellor of Montpellier, Laurent Joubert (1529-83), while Jean Fernel (1485-1558), made an attempt to modernize the system of Galen in accordance with the results of anatomical investigation.

A lively exchange of opinions was caused by the controversy on bleeding, which was begun by the Paris physician Pierre Brissot (1478-1522). Brissot assailed the Arabian doctrine that inflammatory diseases, especially pleurisy, should be treated by bleeding on the side opposite to the seat of inflammation, and favoured the Hippocratic doctrine of bleeding as near as possible to it. The controversy was decided in favour of the Hippocratics, who did not discard the doctrines of Galen as long as they agreed with Hippocratic views, but rejected the principles of Galen as modified by the Arabs. This is clearly shown by the importance attached to the state of the pulse and of the urine, upon which the Arabs laid much more stress than the Greeks. Of the great number of positive Hippocratics let us call attention to the above-mentioned de Monte, who introduced clinical instruction in Padua; to his successors Vellore Trincavella (1496-1568), Albertino Bottoni (d. about 1596), Marco degli Oddi (d. 1598), Giovanni Manardo (1462-1526), Prospero Alpino (1533-1617); to the Spaniards, Cristobal de Vega (1510 to about 1580) and Luis Mercado (1520-1606); to the Frenchman Guillaume Baillou (Ballonius, 1538-1616); to the Netherlanders, Peter Foreest (1522-97) and Jan van Heurne (1543-1601), who will be mentioned subsequently; Franz Emerich (1496-1560), the organizer of clinical instruction at Vienna; Johann Crato of Crafftheim (1519-85), and Johann Schenck von Grafenberg (1530-98). Epidemiological works were written by Antonio Brassavola (1500-55) on syphilis; Girolamo Fracastoro (1483-1553) on petechial fever and syphilis, Girolamo Dorzellini (d. 1558), and Alessandro Massaria (1510-98) on plagues; Jan van den Kasteele (about 1529) on "the English sweat"; and the Viennese physician, Thomas Jordanus (1540-85), on purple or petechial fever.

THEOPHRASTUS PARACELSUS -- HIS ADHERENTS AND OPPONENTS

Theophrastus Bombast of Hohenheim (Paracelsus), the son of a physician, was born near Einsiedeln, Switzerland, in 1493. In 1506 he went to the University of Basle; from Trithemius he learned chemistry and metallurgy in the smelting houses at Schwaz (Tyrol), and he visited the principal universities of Italy and France. In 1526 he became town physician of Basle, and could as such give lectures. His first appearance is characteristic of him. He publicly burned the works of Avicenna and Galen and showed respect only to the "Aphorisms" of Hippocrates. He was the first to give lectures in the German language. But as early as 1528, he was compelled, on account of the hostility he evoked, to leave Basle secretly. After this he travelled through various countries working constantly at his numerous writings, until death overtook him at Salzburg in 1514. Paracelsus, like a blazing meteor, rose and disappeared; he shared the fate of those who have a violent desire to destroy the old without having any substitute to offer. Passing over his philosophic views, which were based upon neo-Platonism, we find practical medicine indebted to him in various ways, e.g. for the theory of the causes of disease (etiology) for the introduction of chemical therapeutics, and for his insistence on the usefulness of mineral waters and native vegetable drugs. He exaggerates indeed the value of experience. His classification and diagnosis of diseases are quite unscientific, anatomy and physiology being wholly neglected. He thought that for each disease there should exist a specific remedy, and that to discover this is the chief object of medical art. With him diagnosis hung upon the success of this or that remedy, and because of this he named the diseases according to their specific remedies. Directly repudiated by the Italian schools, Paracelsus found adherents mainly in Germany, among them being the Wittenberg professor Oswald Croll (about 1560-1609). He also found numerous friends among the travelling physicians and quacks. His teachings met with the most hostile reception from the Paris faculty. Although the further progress of anatomy and physiology indicated clearly to physicians the right path, we meet even in the eighteenth and nineteenth centuries with two men who start directly from Paracelsus: Samuel Friedrich Hahnemann (1755-1843), the originator of homeopathy, and Johann Gottfried Rademacher (1772-1850), advocate of empiricism.

SURGERY IN THE SIXTEENTH CENTURY: AMBROISE PARÉ

The first fruits of the progress in anatomy were enjoyed by surgery, especially since most Italian anatomists were practical surgeons. After the introduction of firearms in war, the treatment of gunshot wounds was especially studied. While surgery had always enjoyed a high rank in Italy and France, in Germany it was in the hands of barbers and surgeons unconnected with the universities and poorly educated; hence it is readily understood why the best surgeons lived in the cities nearest the Romance countries, especially Strasburg. With the member of the Teutonic Order, Heinrich von Pfolspeundt ("Bündth Ertzney", 1460), the most important representatives were the Strasburg surgeons, Hieronymus Brunschwig (d. about 1534), and Hans von Gersdorff ("Feldtbuch der Wundtartzney", 1517). Their equal was a somewhat younger man, Felix Würtz of Basle (1518-74). We are indebted to the French field-surgeon Ambroise Paré for a marked change in the treatment of gunshot wounds and arterial hemorrhage. He abandoned the Arabic method of work with a red-hot knife, declared that supposedly poisoned gunshot wounds were simple contused wounds, and proceeded to bandage them without using hot oil. He was the first to employ the ligature in the case of arterial hemorrhage. Next to him in importance stands Pierre Franco (about 1560), known as the perfecter of the operation of lithotomy and that for hernia. Gaspare Tagliacozzi of Bologna (1546-99) deserves credit for reintroducing and improving the ancient plastic operations. In the sixteenth century the Caesarean operation (Sectio caesarea, laparotomy) was performed on living persons.

DISCOVERY OF THE CIRCULATION OF THE BLOOD: WILLIAM HARVEY AND HIS TIME

Galen's theory, according to which the left heart and the arteries contained air, the blood being generated in the liver, had long been regarded as improbable, but in spite of every effort no one had as yet discovered the truth about circulation. The solution of this problem, which brought about complete fall of Galen's system and a revolution in physiology, came from the English physician William Harvey of Folkstone (1578-1657), a pupil of Fabricius ab Aquapendente. Harvey's discovery published in 1628, that the heart is the centre of the circulation of the blood must return to the heart, at first received scant notice and was even directly opposed by Galen's adherents; but further investigation soon made truth victorious. Even as early as 1622, Gaspare Aselli (1581-1626) found the chyle vessels, but correct explanation was possible only after the discovery of the thoracic duct (ductus thoracius) and its opening into the circulation by Jean Pacquet (1622-74) and Johann van Horne (1621-70), and of the lymphatic vessels by Olaus Rudbeck (1630-1702) and Thomas Baltholinus (1616-80). A new field of investigation was opened by the invention of the microscope, by which Marcello Malpighi (1628-94) discovered the smaller blood-vessels and the blood corpuscles. From Harvey's time starts a series of important anatomists and physiologists, among them the Englishmen Thomas Wharton (1614-73; glands) and Thomas Willis (1621--75; brain); the Netherlanders Peter Paaw (1564-1617), his pupil Nikolas Pieterz Tulp (1593-1678), both teachers of anatomy at Leyden, and Antony van Leeuwenhoek (1632-1723) and Johann Swammnerdam (1647-80), microscopists, Reinier de Graaf (1641-73; ovary); Nikolaus Steno of Copenhagen (1638-86), and the Germans, Moriz Hofman (1621-98) and George Wirsung, who investigated the pancreas.

IATROPHYSICISTS AND IATROCHEMISTS

The doctrine of the circulation is based to a large extent upon the laws of physics. Consequently among a number of physicians, influenced by the works of Alfonso Borelli (1608-78) on animal motion, there was a marked effort to explain all physiological processes according to the laws of physics (iatrophysicists). Opposed to them was a party, which, influenced by the progress in chemistry, sought to make use of it for explaining medical facts (iatrochemists). This tendency goes back to Paracelsus and his adherent Johann Baptist von Helmont (1578-1644). Helmont, who was an important chemist (the discoverer of carbonic acid), recognized the importance of anatomy, and deserves credit for his work in therapeutics, although his failure to appraise the needs of his time prevented his doctrine from influencing the development of medicine. Iatrophysics was cultivated mainly in Italy and England; iatrochemistry in the Netherlands and Germany. The chief adherent of iatrophysics in Italy was Giorgio Baglivi (d. 1707), professor at the Sapienza in Rome; in practical medicine, however, he held mainly to Hippocratic principles, while the Englishman, Archibald Pitcairn (1652-1713), tried to follow out iatrophysics to its utmost consequences.

Owing to the greater progress made in physics, iatrochemistry found fewer followers, and that it took root at all is the service of its chief representative Franz de le Boë Sylvius (1614-72), who in 1658 became professor of practical medicine at Leyden. At the school there, founded in 1575, Jan Heurne had already tried to establish a clinic after the Paduan model, but it was not till 1637 that his son Otto was able to carry out his scheme. The immediate successors of the latter, Albert Kyper (d. 1658), and Ewald Schrevelius (1576-1646), continued this institution in the Hippocratic spirit. Before Sylvius began to teach there, the Leyden clinic had already gained worldwide fame. One of the first adherents of Harvey, Sylvius, depending in part on Paracelsus and Belmont sought to explain physiological processes by suggesting fermentation (molecular motion of matter) and "vital spirits" as moving forces. Through "effervescence" acid and alkaline juices are formed, and through their abnormal mixture hyperacidity and hyperalkalinity (i.e., sickness) originate. This simple doctrine, supported by the clinical activity of Sylvius, found numerous adherents especially in Germany, but it made just as many opponents among the iatrophysicists who were able to refute in part these untenable hypotheses. The two theories are, however, not absolutely opposed to each other, for both physics and chemistry offer the means necessary for an explanation of physiological processes and may form the basis for the construction of an exact medical science. At this time, however, physics and chemistry (especially the latter) were still too little developed for this purpose and therefore the endeavour to create a system is much more apparent among the iatrochemists. Fortunately, the two parties found a common point of union in practical medicine, where the doctrines of the Hippocratic school were predominant.

PIONEERS IN PRACTICAL MEDICINE: THOMAS SYDENHAM AND HERMANN BOERHAVE

Both renounce all systems, and lay most stress upon the perfection of practical medicine. Thomas Sydenham (1624-89), physician at Westminster and known as the "English Hippocrates", laid down the principle that, just as in the natural sciences so in medicine the inductive method should be authoritative. The main object of medicine, healing, would be possible only when the chances Iying at the root of disease and the laws governing its course had been investigated. Then also would the proper remedies be found. Following the idea of Hippocrates, he seeks the cause of disease in the change of the fundamental humours (humoral pathology). The activity of the physician was mainly to assist "nature". A man of the same intellectual build as Sydenham was Hermann Boerhave (1668-1738), the most famous practitioner of his time, who in 1720 became clinical professor at Leyden. Being an iatrophysicist, he regards Hippocratism as able to live only if the results of investigation in anatomy, physiology, physics, and chemistry are properly used. He tries to explain most physiological processes as purely mechanical. In contradistinction to the two professors of Halle, Friedrich Hoffmann (1660-1742) and George Ernst Stahl (1660-1734), of whom former supposed the ether (Leibniz's doctrine of monads) and latter the "soul" to be moving power, Boerhave did not care at all about any moving force that might possibly be present. With his death Leyden lost its importance as a nursery of medicine. His illustrious pupil and commentator, Gerhard van Swieten (1700-72), was called as teacher to Vienna in 1745, and there laid the foundation of the fame of the school whose most important representatives are Anton de Haen (1704-76) and his successor as teacher, Maximilian Stoll (1742-88). Under the eye of van Swieten and de Haen but without recognition from them, a simple hospital physician, Leopold Auenbrugger (1722-1809), published his epoch-making discovery that, by striking or rapping on the chest (percussion) disease of the lungs and heart may be diagnosed from the various sounds elicited by such percussion. An important member of the Vienna school was Johann Peter Frank (1745-1821), director of the general hospital, who was celebrated as a practitioner and as the author of a work, unequalled until then (System einer vollstandigen medizinischen Polizey", 1779-1819).

Among important practitioners outside of the school of Leyden were: the papal physician-in-ordinary, Giovanni Maria Lancisi (1654-1720), who established a clinic in Rome after the model of Leyden; Giovanni Battista Borsieri (Burserius de Kanifeld, 1725-85), professor at Pavia; James Keill (1673-1718); Richard Mead (1673-1754); John Freind (1675-1728), smallpox); John Pringle (1707-82) and John Huxham (1694-1768), investigations in epidemiology; John Fothergill (1712-80); diphtheria and intermittent fever). Albrecht von Haller developed an important school in Göttingen as van Swieten school were: Paul Gottlieb Werlhof (1699-1767; intermittent fever) and Johann Georg Zimmermann (1728-95).

ANATOMY IN THE EIGHTEENTH CENTURY

During this period normal and pathological anatomy were more cultivated than microscopy. The greater number of investigators that we have to consider won fame in the field of surgery. Starting from the school of Leyden the following deserve mention: Govert Bidloo (1649-1713) and Bernhard Sigmund Albinus (1697-1770; anatomical charts); in Amsterdam, Friedrich Ruysch (1638-1721), and Pieter Camper (1722-89), the inventer of craniometry and of the elastic truss for hermia; in Italy, Antonio Maria Valsalva (1666-1723; eye and ear) and Giovanni Domenico Santorini (1681-1737); in Paris, the Dane Jakob Benignus Winslöw (1669-1760; topographical anatomy); in England James Doug!as (1675-1742; peritoneum); Alexander Munroe (1732-1817; bursa mucosa), and William (1718-83) John Hunter (1728-93) both known also as surgeons; finally in Germany, the anatomist, surgeon, and botanist, Lorenz Heister (1683-1758), Johann Gottfried Zinn (1727-59; eye); Johann Nathanael Lieberkuhn (1711-65; intestine); Heinrich August Wrisberg (1739-1808; larynx), and Samuel Thomas Sommering (1755-1830). Abnormal anatomical changes in organs had been recorded since the time of Vesalius, but these were for the most part merely incidental observations and nobody had tried to trace systematically the connection between them and the symptoms occurring in the living body. The best survey of the achievements of the earlier centuries is offered in Theophil Bonet's "Sepulchretum anatomicum" (1709). As the scientific founder of pathological anatomy we must mention Giovanni Battista Morgagni (1682-1771), professor at Padua, whose famous work, "De sedibus et causis morborum" (1761), usually contains, besides the results of post-mortem examinations, a corresponding history of the diseases. This field was cultivated in France especially by Joseph Lieutaud (1703-80) and Vicq d' Azyr (1748-94), and in Leyden by Eduard Sandifort (1742-1814). Germany had an important investigtor in the days before Morgagni viz. Johann Jakob Wepfer in Schaffhausen (1620-95). In Vienna, autopsies on those who died in the clinic were first regularly made by Anton de Haen. For a strictly systematic treatment of the whole field we are indebted to the London physician, Matthew Baillie (1761-1823), who published the first pictorial work on pathological anatomy.

SURGERY IN THE SEVENTEENTH AND EIGHTEENTH CENTURIES

The eminent surgeons of the seventeenth century are: Cesare Magati (1579 to about 1648) professor in Ferrala and later a Capuchin monk who simplified the treatment of wounds; Marc' Aurelio Severino (1580-1656; treatment of abscesses, resection of ribs); the already mentioned anatomist, Fabrizio ab Aquapendente (re-introduction of tracheotomy, improvement of herniotomy); Antonio Ciucci (about 1650, re-introduction of lithotripsy); in France, Bartholomaeus Saviard (1656-1702; digital compression of arteries) Jacques Beaulieu (1651-1714), a travelling surgeon and later a hermit (Frère Jacques), who improved the method of lateral lithotomy, and helped people for a "God-bless-you"; in Amsterdam, Abraham Cyprianus (about 1695; lithotomy). The most important German surgeon is Wilhelm Fabry of Hilden (Fabricius Hildanus, 1560-1634; simplified treatment of wounds, amputation); next to him Johann Schultes (Schultetus, 1595-1646), author of "Arma mentarium chirurgicum", and Matthias Gottfried Purmann (1648-1721; field surgery). Of English surgeons Richard wiseman, (about 1652; amputation, compression of aneurisms), John Woodall (about 1613), and Lowdham (about 1679) are the most eminent.

In the eighteenth century surgery was essentially stimulated by the numerous wars: in France also through the establishment of an academy in 1731 by Georges Maréschal (1658-1736) and François Gigot de la Peyronie (1678-1747). Of Frenchmen we must also name Jean Louis Petit (1674-1750), the inventor of the screw tourniquet, Henri François le Dran (1685-1770; lithotomy, lacerations of scalp), Pierre Joseph Boucher (1715-93; amputation); Toyssaint Bordenave (1728-82; amputation), Antoine Louis (1723-92, operation for harelip, bronchotomy, simplification of instruments), Pierre Joseph Desault (1744-95, founder of the Paris surgical clinic, ligature of vessels, treatment of aneurism, dislocations, fractures), François Chopart (1743-95, methods of amputation), and finally the monk and lithotomist Frère Côme (Jean de St. Cosme, Baseilhac, 1703-81), the inventor of the lithotome-caché. The founder of modern English surgery is William Cheselden (1688-1752; lateral lithotomy, artificial pupil). Samuel Shalp (about 1700-78) wrote a text-book; William Bromfield (1712-92), invented an artery-retractor and the double gorgeret; and Percival Pott (1713-88) established the doctrine of arthrocace (malum potti). The most eminent and versatile surgeon is the already-mentioned John Hunter (treatment of aneurisms, theory of inflammation, gunshot wounds, syphilis. Surgery was on a much lower plane in the Germanic countries. For the better training of the Prussian military surgeons and on the proposal of Surgeon-General Ernst Konrad Holtzendorff (1688-1751), there was founded in Berlin a Collegium medico-chirurgicum in 1714; later in 1726 the Charité school, and in 1795 the Pepinière academy. Surgery made great progress through Johann Zacharias Platner (1694-1747) at Leipzig; Johann Ulrich Bilguer (1720-96) and Christian Ludwig Mursinna (1744-1833) at Berlin, Karl Kasper Siebold (1736-1807) at Würzburg, and especially through August Gottlob Richter (1742-1812) at Göttingen (surgical library). A school for military surgeons was founded at Vienna in 1775 at the suggestion of Anton Störck (1731-1803), ten years after which was established the Josephinum academy under the direction of the army Surgeon-in-chief Johann Alexander von Brambilla (1728-1800).

STUDY OF PHYSIOLOGY: ALBRECHT VON HALLER AND HIS TIME

The great discoveries in the field of gross and minute (microscopic) anatomy naturally impelled men to investigate also the vital functions, but the results of the efforts of both iatrophysicists and iatrochemists were far from satisfactory, since scientific aid was sadly lacking. Physiology for the first time received systematic treatment at the hands of the versatile scholar, Albrecht von Haller of Bern (1708-77), professor in Gottingen from 1737 to 1753 (Elementa physiologiae, 1757-66). Haller, a pupil of Albinus and Boerhave, was the first to recognize the importance of experiments on animals. We are indebted to him for the best description of the vascular system and for studies in haemodynamics, in which field, however, the English clergyman, Stephen Hales (d. 1761), had already broken the soil. He correctly recognized the mechanism of respiration without being able to investigate its physiological importance (exchange of gases), since Joseph Priestley did not discover oxygen until 1774. He disproved the view that there was air between the lungs and the pleura by a simple experiment on animals. Haller became best known through the discovery of irritability and sensibility. When external stimuli are applied to tissues, especially muscles, the latter react either by contracting and moving (irritability), or by experiencing sensation or sense of pain (sensibility) or at times by both. Sensibility disappears when the corresponding nerve is cut, while irritability persists independent of the nerves and even continues some time after death. This theory met with great opposition especially among the practical physicians (Anton de Haen), who did not, however, take the trouble to repeat the experiments on animals. Even though Haller knew neither the central cause of the two phenomena, nor the correct structure of the tissues, it nevertheless stands to his credit that he was the first to point out the facts and open up new roads for physiology. Haller's investigation was generally welcomed, especially in Italy by Abbate Lazzaro Spallanzani (1729-99), the first scientific opponent of spontaneous generation. His experiments along the lines of artificial fertilization of frogs' eggs, and concerning digestion are famous. Felice Fontana (1730-1805), repeating the experiments concerning irritability, reached the same results as Haller. William Hewson (1729-74) studied the qualities of the blood (coagulation). The most important German physiologist after Haller is Kasper Friedrich Wolff (1735-94), known for his investigations in the field of evolution and for pointing out the fact that both animals and plants are composed of the same elements, which he called little "bubbles" or "globules". Joseph Priestley's discovery of "dephlogisticated air" (1774), as oxygen was then called, was of the highest importance in the development of the theory of respiration, of the process of tissue-decomposition, of formation of the blood, and of metabolic phenomena.

MEDICAL SYSTEMS IN THE EIGHTEENTH CENTURY

The three great discoveries in the second half of the century (oxygen, galvanism, and irritability), contrary to what one might expect, led scientists astray, and gave rise to systems whose foundations were of a purely hypothetical nature. Especially interesting are the neuro-pathological theories, connected to some extent with irritability. William Cullen (1712-90) accepting irritability as his starting-point, supposes a "tonus" or fluid inherent in the nerves (Newton's ether), whose stronger or weaker motions produce either a spasm or atony. In addition "weakness" of the brain and "vital power" played a great part in his explanation of diseases. Cullen's pupil, John Brown (about 1735-88), modified this doctrine by explaining that all living creatures possess excitability, located in the nerves and muscles, which are excited to activity by external and internal influences (stimuli). Diseases occur according to increase or dimunition of the stimuli causing increased excitability, (sthenia) and weak stimuli diminished excitability (asthenia). Death is caused either by an increase of excitability with a lack of stimuli, or by exhaustion of excitability from too strong stimuli. Brown's theory was little noticed in England and France, but in Germany it was highly lauded. Christoph Girtanner (1760-1800) and Joseph Frank (1771-1842) spread its fame. Out of this Brunonianism Johann Andreas Röschlaub (1768-1835) developed the so-called (theory of excitability which was so energetically opposed by Alexander von Humboldt and Christian Wilhem Hufeland (1762-1836). Giovanni Rasori (1762-1837), building also on Brown's theory, developed his contra-stimulistic system, namely that there are influences which directly diminish excitement (contra-stimuli) or remove existing stimuli (indirect contra-stimuli); he, therefore, distinguishes two groups of diseases -- diathesis of the stimulus and that of the contra-stimulus.

Another group of systematizers, the Vitalists, basing their views upon Stahl's doctrine of the soul (Animism) and Haller's irritability, consider vital energy to be the foundation of all organic processes. The chief representatives of Vitalism, a system developed especially in France and later predominant in Germay, are: Theophile Bordeu (1722-76), Paul Joseph Bartilez (1734-1806), Philippe Pinel (1755-1826), Johann Friedrich Blumenbach (1752-1840) and Johann Christian Reil (1759-1813). But, while these physicians adhered to Hippocratism in practice and (e.g. Reil) were eminently active in developing anatomy and phlysiology, the same may not be said of the three Germans, Mesmer, Hahnemann, and Rademacher, who were the last followers of Paracelsus. The doctrine of animal magnetism (Mesmerism), established by Friedrich Anton Mesmer (1734-1815), is connected with Vitalism in so far as Mesmer presupposes a magnetic power to exist in the body, and accordingly tries, at first by means of magnets and later by touching and stroking the body, to effect an interchange of forces, a transfusion or cure. Mesmer through his manipulations very likely induced real hypnotic sleep in many cases. His doctrine, however, which at first met with a sharp rebuff and was subsequently characterized in many circles as a fraud, was degraded by his immediate followers to somnambulism and clairvoyance, and in later times it became altogether discredited from having fallen into the hands of quacks. Nevertheless, mesmerism forms a basis for hypnotism, which in 1841 was established by James Braid.

Homeopathy, founded by Samuel Friedrich Christian Hahnemann, seems to have the promise of a long lease of life. Hahnemann regards disease as a disturbance of vital energy. The latter in itself has no power to heal, for a cure can take place only when a similar set of symptoms. The best way to produce such a disease is to give highly diluted drugs which are capable of producing a similar set of symptoms. The rest of this "drug-disease" is destroyed by the vital energy, which is possible only when the doses are small. As chief principle, therefore, Hahnemann sets up the doctrine that like cures like. Since he denies the posssibility of investigating the nature of disease, and completely disregards pathological anatormy, it is necessary to know all simple drugs which produce a set of symptoms similar to those of the existing disease. With his pupils Hahnemann undertook the task of testing the effects of all simple drugs, but the result of this gigantic piece of work could not be absolutely objective, since it is based upon the purely subjective feeling of the experimentalists. Never before had a physician built a system upon so many purely arbitrary hypotheses as Hahnemann. Paracelsus also had declared war upon the old medicine, and had attributed little value to anatomical and physiological investigation, which, however, was still in its initial period of development; but, with his reverence for Hippocrates, he neverthelss ranks higher than Hahnemann, who is the representative of empiricism and the despiser of all the positive successes which medicine had previously attained. Hahnemann's more sensible pupils did not follow their master blindly, but regarded his method as that which under the most favourable circumstances it may be, viz., a purely therapeutical method that does not disregard clinical science. To this rational standpoints together with eclecticism, homeopathy owes its long life and wide dissemination. One service of physicians of this school is that they simplified prescriptions, and appreciatively studied obsolete, but nevertheless valuable vegetable drugs. Hahnemann's pupil, Lux, extended homeopathy to isotherapy, which in modern times celebrated its renascence in organotherapy. Widely removed from scientific progess was the "empirical medical doctrine" of Johann Gottfried Rademacher (1772-1850), which is today completely discredited. Starting from the doctrine of nostrums of Paracelsus, he names the diseases according to the effective drug (e.g. nux-vomica strychina, liver disease), and classifies diseases as universal and organic in accordance with universal and organic drugs. His therapeutics was a purely empirical one, uninfuenced by pathology or clinical diagnosis.

SOME SPECIAL BRANCHES OF MEDICINE AT THE END OF THE EIGHTEENTH CENTURY

Obstetrics

Down to the sixteenth century obstetrics was almost exclusively in the hands of midwives, who were trained for it as for a trade. Only in rare cases was a surgeon called in. All the achievements of ancient times seemed forgotten, and it was only after anatomical studies had been resumed and surgery had made some progress that things began to improve. The most important accounts of the condition of ancient operative obstetrics are found in the Hippocratic writings (position of the child, version or turning, dismemberment of the fetus, parturition chair for facilitating delivery) and in later times in the works of Soranus of Ephesus (second century A.D.; protection of the perinaeum), Galen, Celsus, A¨tius, and in those of the female physician Trotula of Salerno. The oldest book on midwifery in the Middle Ages (Rosengarten) was written by Eucharius Röslin (d. 1526), who, in addition to numerous drugs assisting delivery, mentions "version". Version was put into practice again by Ambroise Paré. In the sixteenth century attempts were made to perform the Caesarean operation on the living (Jakob Nufer, a Swiss, c. 1500); in ancient times it was done only after the death of the mother. The first work about this operation was published by the Paris surgeon, François Rousset (1581). In the domain of practical obstetrics, Giulio Casare Aranzio (1530-89) was the first to point out those malformations of the pelvis which exactly indicated the necessity for the Caesarean section. Much was done to extend the study of this branch of medicine by the works of Jacques Guillemeau (1560 to about 1609), Scipione Mereurio (1595, German translation by Gottflied Welsch, 1653), François Mauriceau (1637-1709), Pierre Dionis, and Guillaume Manquest de la Motte (1655-1737), pelycologists. The splendid development of obstetrics in France explains why male assistance was more and more sought there, especially after Jules Clement had been called in 1673 to the court of Louis XIV. The most important accoucheur in the Netherlands was Hendrik van Deventer (1651-1724; axis of the pelvis, placenta praevia, asphyxia neonatorum). In Germany Siegemundin, the most famous German midwife, published in 1690 a text book based upon wide experience (Chur-Brandenburgische Hoff-Wehe-Mutter).

In the first half of the seventeenth century Hugh Chamberlen invented the obstetrical forceps, selling it to Dutch physicians about 1688. Jean Palfyn of Ghent (1650-1730) constructed independently a similar instrument (Main de Palfyn), which he submitted to the Paris Academy about 1723. After various improvements by Lorenz Heister, Dussé, and Gregoire, the forceps passed into general practice. The most important accoucheurs of the eighteenth century were: in France, André Levret (1703-1780; inclination of the pelvis, forceps, combined examination), Francois Louis Joseph Solayrés de Renhac (1737-72; mechanism of delivery), Jean Louis Baudelocque (1746-1810; pelvimetry), opponent of artificial premature delivery and symphyseotomy; in England, Fielding Ould (1710-89; mechanism of delivery, perforation), William Smellie (1697-1763; mechanism of delivery, use of forceps, pelvimetry), William Hunter (1718-93) opponent of the forceps and the Caesarean operation, Thomas Denman (1733-1815), the first to recommend artificial premature delivery, and William Osborn (1732-1808), opponent of symphyseotomy and of the Caesarean section. The well-founded doubts which in preaseptic times many accoucheurs entertained concerning the Caesarean operation, led to so-called symphyseotomy (Jean René Siegualt, 1768) which by widening the pelvis would permit delivery of the fetus. This operation, which from the very outset met with vigorous opposition in England, is now forgotten. The introduction of scientific obstetrics in Germanic countries was comparatively late. Special schools for midwives were instituted, in 1728 at Strasburg (Johann Jakob Fried, 1689-1769), in 1751 at Berlin (Johann Friedrich Meckel, 1724-74) and Göttingen (Johann Georg Röderer, d. 1763), and in 1754 at Vienna (Johann Nep. Crantz, 1756; Valentin von Lebmacher, 1797; Raphael Steidele, 1816). While the Parisian midwives belonged to the Collège de S. Côme as early as 1560 and received a methodical training, those in Gerrnany could receive only private instruction. Examination by physicians mentioned at Ratisbon since 1555 and at Vienna since 1642.

Ophthalmology

Ophthalmology gained importance much later than obstetrics. In addition to inflammation of the eye and operations on the eyelid, the Hippocratic writings mention amblyopia, nyctalopia, and glaucoma. Celsus describes an operation for cataract (sclerotico-nyxis). Galen gives us the beginnings of physiological optics. The slight ophthalmological knowledge of the Greeks was borrowed by the Arabs, but their lack of anatomical knowledge prevented all progress. No improvement set in until after the rise of anatomy under Vesalius. Fortunately, this branch had been almost completely in the hands of travelling physicians (cataract operators), but henceforth surgeons with a fixed abode (e.g. Ambroise Pare, Jacques Gulliemeau) began to turn their attention to it. In Germany Georg Bartisch (about 1535-1606), "Court eye specialist" at Dresden, wrote the first monograph, a work very highly valued even in later days. Among other things he mentions spectacles for curing squint, eyeglasses and, among operations is the first to describe extirpation of the pupil. The invention of convex spectacles is by some attributed to the Dominican Alexander da Spina (d. 1313), by others to Salvino degli Armati of Florence (d. 1317). Concave glasses did not appear until the sixteenth century.

The foundations for further progress in ophthalmology were laid by the anatomists and physicists of the seventeenth century. In the first group let us mention the works of Friedrich Ruysch (choroid), van Leeuwenhoek (lens) Heinrich Meibom (1678-1740; glands of the eyelids), and Stenon (lachrymal apparatus). Investigations of physicists were of great importance, especially those of the two astronomers, Johann Keppler (1571-1630) and the Jesuit Christoph Scheiner (1575-1659), concerning accommodation, refraction of light, and the retinal image; Rene Descartes (1596-1650; comparison of the eye with the camera obscura, accommodation); Edmund Marriott (d. 1684; blind spot, choroid); Isaac Newton (1642-1727; dispersion of light and origin of colours). In the eighteenth century, besides anatomy and physiology, the practical side of ophthalmology was also cultivated. Among anatomists were Winslow, Petit, Zinn, Demours (cornea and sclerotic); Buzzi and Sommering (retina); La Hire, J. H. Hoin, Camper, and Reil (lens). The theory of the sensibility of the retina to light, established by Haller, was further developed by Porterfield and Thomas Young (1773-1829). The latter also described astigmatism and colour-blindness, and discovered that accommodation depended upon a change in the shape of the lens. Boerhave was the first to give clinical lectures on ophthalmology. From him we have the exact definition of myopia and presbyopia. Gray cataract (cataracta) was first located in the lens by Francois Quarré and Remi Lasnier, a view which was corroborated by the anatomist, Werner Rolfink (1599-1673). Francois Pourfour du Petit (1644-1741), Lorenz Heister, and others also worked on cataract in 1745. Of other practitioners we must mention: Brisseau (theory of glaucoma), William Cheselden (1668-1752; articial pupil), Baron Wenzel the elder (1780; iridectomy), Charles de St. Yves (ablatio retinae, asthenopia, staphyloma, strabismus), John Taylor (1708-60; operation to correct oblique vision, ceratoconus), Dominique Anel (cathederism of the lachrymal fistula, 1713), G.E. Stahl, Boerhave, Jonathan Wathen, Lorenz Heister, Johann Zacharias Platner (1691-1747), and August Gottlob Richter (studies on the lachrymal fistula).

Pharmaceutics, Mineral Waters, Cold Water Cures

Pharmacy had remained the most backward of all the branches of medicine, for it was longest under the influence of the Arabs. A large part of the drugs came from the Orient to Venice and Flemish harbours. Besides simple drugs there were also a great many compound remedies. But, in the latter class, there was great confusion resulting from the many adulterations, and from the fact that not only did individual authors give different compositions for the same remedy, but also under the same name an entirely different preparation was understood by different authors. The most famous panacea, which dated from Roman imperial times and was used as late as the eighteenth century, was theriac, a mixture consisting of numerous ingredients, among them being the flesh of vipers. This composition originally came from the Orient, but was made later at Venice, Augsburg, and Vienna. To get some order into the treasury of drugs and to enable apothecaries to compound their remedies, the college of physicians in Florence published a pharmacopoeia (Riceptario) in 1498. The oldest work of this kind in Germany was written by Valerius Cordus, a Nuremberg physician (Dispensatorium, 1546); then followed the Dispensatorium of Adolph Occo in 1564, written at the request of the city of Augsburg, the Dispensatorium of Cologne in 1565, and finally in 1572 a similar work in Vienna, which, however, was not printed. Not until 1618 did Vienna receive a dispensatorium prepared from that of Augsburg, which had become a model for all Germany.

The Oriental trade in drugs was greatly facilitated by the discovery of the sea route to the East Indies. Uninfluenced by exotic remedies of scholastic medicine, popular medicine offered poor people, in addition to repulsive and superstitious remedies, a series of valuable remedies, derived from native plants and minerals. A long-known and popular remedy for syphilis was mercury, introduced into scientific therapeutics by Paracelsus. To his adherents we are indebted for the use of preparations of antimony and arsenic, a popular remedy for skin diseases since ancient times. The first-mentioned preparations gave rise to a violent struggle on the part of the Paris faculty, which opposed every form of progress. Guaiac wood, regarded as a specific remedy for syphilis, was brought from America in the sixteenth century. The most important drugs introduced in the seventeenth century were ipecacuanha and Peruvian bark. The latter, coming from Peru, became known in Europe between 1630 and 1640. No remedy has had such a beneficial effect, but none has met with such opposition on the part of many physicians as this, because its effect (reduction of fever without subsequent intestinal evacuation) was a direct contradiction of Galenic doctrine. Peruvian bark was introduced generally into therapeutics only after a long struggle, principally because important men like Sydenham advocated it. The latter as well as the Leyden school under Boerhave discontinued to a large extent the old Arab drugs, preferring in general simple remedies with a corresponding dietetic treatment. Besides the improvement in lead preparations by Thomas Goulard (1750; aqua Goulardi), we may mention the pharmacological investigations of cornium, aconite, stramonium, etc., by Anton Storck (1731-1803), in Vienna. Hahnemann's services in investigating native medicinal plants have been previously mentioned.

The impulse to study mineral springs was in modern times given by Paracelsus. The majority of the modern European watering places of worldwide fame were already known to the Romans, but their curative properties were too little valued during the Middle Ages. Petrus de Tussignana wrote, about 1336, concerning the famous thermae of Bormio; Giacomo de Dondi in 1340 about Abano; the Vienna physician Wolfgang Windberger (Anemorinus) in 1511, about the sulphur springs at Baden near Vienna; Paracelsus about Pfafers, St. Moritz in the Engadine, Teplitz. Karlsbad in Bohemia was much frequented towards the close of the sixteenth century, as were Vichy and Plombieres. Helmont, who was the first to prove the existence of carbonic acid and of fixed alkalies, wrote about Spa. Highly meritorious also was the work in this field of Johann Phillip Seip (Pyrmont) and of Friedrich Hoffmann, who wrote about Spa, Selters, Schwalbach and Karlsbad, and taught the preparation of Seidlitz salt (Bittersalz), artificial Rarlsbad, and of artificial mineral waters.

Cold-water cures were introduced in ancient Rome for the first time by Asclepiades, but they were soon forgotten. In sporadic cases cold water was employed therapeutically in later times, e.g. by Rhazes for smallpox, by Edward Baynard in 1555 against the plague by John Floyer (1649-1734) for mania, and by several others. Cold water was not used systematically until the eighteeth century. The brothers Johann Sigismund and Johann Gottfried, and their father Sigismund Hahn (1662-1742), who in 1737 made extensive experiments during an epidemic of petechial fever in Breslau, may be regarded as the founders of the cold water cure. The work of John Sigismund (Unterricht von der kraft und Wirkung des kalten Wassers) is the best known, and laid the foundation of modern hydrotherapeutics. Towards the end of the eighteeth century Johann Dietrich Brandis obtained good results in the treatment of febrile diseases by means of tepid lotions. The subsequent development of hydrotherapeutics was largely influenced by the results obtained by William Wright (1736-1819), and James Currie (1750-1805) in the epidemics of petechial fever in the years 1787-92.

VACCINATION -- EDWARD JENNER

Even in the oldest times people seem to have possessed an efficient preservative against one of the most destructive epidemics, smallpox (variola). From remote antiquity the Brahmins of Hindustan are said to have transferred the smallpox poison (secretion of the pustules) to healthy persons by incising the skin with the object of protecting them against further infection by causing a local illness. In China people stopped up their noses with the incrustations of smallpox. A peculiar transfer with a needle (inoculation) was in use among the Circassians and Georgians. This so-called Greek method became generally known in Constantinople towards the end of the seventeenth century, and was introduced into England by Lady Wortley Montague wife of the English ambassador, who had had her own son successfully vaccinated in 1717. Despite the loud approval of the court and aristocracy, inoculation met with violent resistance from the physicians and clergy. Carelessness, quackery, and its ill-repute caused the method to be forgotten, until in 1746 Bishop Isaac Maddox of Worcester, by popular teaching and the establishment of institutions for inoculation, once more proclaimed its value. Among physicians who favoured inoculation were Richard Mead (1673-1754). Robert and Daniel Sutton (1760, 1767), Thomas Disdale (1767). Théodore Tronchin (1709-1781), and Haller. In Austria it was introduced by van Swieten, at whose suggestion Maria Theresa, in 1768, called to Vienna the famous naturalist Jan Ingen-Housz (1730-99), in spite of the opposition of the clinical professor de Haen. In the meantime another opponent of inoculation appeared. In countries devoted to cattle-raising it was observed that those who came in contact with cows suffering from smallpox frequently fell sick and had pustules on their fingers, but such persons were immune against the human smallpox. This incited the physician Edward Jenner (1749-1823) to further experimentation, which he continued for twenty years. On 14 May, 1796, he performed his first inoculation with the lymph of cowpox (vaccination), an experiment of worldwide importance. Jenner's discovery was everywhere received with enthusiastic approval. The first vaccinations on the continent were performed at Vienna by Jean de Caro in in 1799, and by his contemporaries Alois Careno (d. 1811) and Paschalis Joseph von Ferro (d. 1809); in Germany, by Germany, by Georg Friedrich Ballhorn (1772-1805) and Christian Friedrich Stromeyer (1761-1824); in France, by Rochefoucauld-Liancourt. Protective inoculation with vaccine has been introduced into almost every civilized state in the course of the nineteenth century, partly from free choice and partly by laws enforcing compulsory vaccination.

MEDICINE IN THE NINETEENTH CENTURY

The powerful political position of France in the first thirty years of the nineteenth century finds medicine in an especially high state of development in that country. After this period followed the golden period of the Vienna school and in a wider sense, of German medicine. The development of modern medicine is the work of all civilized nations; yet all will regard Rudolf Virchow unqualifiedly as the chief worker. Not to encroach upon the domain of the special articles, let us summarize in a few brief words the most important achievements of recent times: in anatomy, theory of tissues -- Bichat; in pathological anatomy and pathology cellular, pathology -- Virchow; in physiology -- Johannes Müller, in practical medicine, auscultation - Laënnec, Skoda; in surgery, treatment of wounds -- Joseph Lister; narcosis -- Jackson, Simpson; obstetrics, cause of puerperal fever Semmelweiss; in ophthalmology -- Albrecht von Grafe and (speculum oculi) Helmholtz; in bacteriology and serotheraphy -- Pasteur, Koch, and Behring. The subject of skin diseases was most ingeniously elaborated by Ferdinand Hebra.

General Anatomy

A splendid basis for the further development of modern medicine was laid by Marie François Xavier Bichat (1771-1802), through his investigation of the vital qualities of tissues. What Haller had tried to do for the muscles, Bichat attempted to accomplish for all the tissues of the body. Bichat was the first to promulgate the idea that each tissue might by itself become diseased, and that the symptoms of diseased organs depend upon tissue changes. Gilbert Breschet (1784-1845) worked on the lympathic vessels and the history of developments and Isidore Geoffrey Saint-Hilaire (1772-1884) on comparative anatomy. Of Italian and English anatomists are to be mentioned: Paolo Mascagni (1752-1815; lymphatic vessels, comparative anatomy), Antonio Scarpa (1747-1832; structure of the bones, organs of sense), the brothers John and Charles Ball, the latter (1774-1842) known also as a physiologist (brain, nerves); and Robert Knox (1793-1862; comparative anatomy). Germany performed the greatest services in perfecting anatomy and allied branches. The first to be named in this connection is Theodor Schwann (1810-82), the discoverer of the cell as the fundamental element of the body of plants and animals. Johann Ev. Purkynje (1787-1869) worked along the same lines, and Rudolph Albert Kolliker (b. 1817; pensioned 1901) followed close in their wake. Work in comparative anatomy was done by Johann Friedrieh Blumenbach (1752-1840), Iganz Blumenbach (1752-1850), Ignaz Döllinger (1770-1841), Karl Asmund Rudolphi (1771-1832), and Johann Friedrich Meckel (1781-1833). Friedrich Gustav Jakob Henle (1809-85), and Wilhelm Menke (1834-96) were prominent teachers of general anatomy and histology, Friedrich Tiedemann (1781-1861) was an eminent brain anatomist, while Nikolaus Rüdinger (1832-96; injection of carbolic for the preservation of corpses in the dissecting room), Friedrich Sigmud Merkel (b. 1845; topographical anatomy) and Wilhelm His (b. 1831; history of development), must also be mentioned.

Following the reform of studies under van Swieten in 1749, anatomy was cultivated in Vienna more than ever before. The more important men were Lorenz Gasser (professor 1757-65; trigeminus), Joseph Barth (technique of injection), George Prochaska (1749-1820; muscle and nerves), Franz Joseph Gall (1758-1828), the well-known phrenologist and founder of the modern the theory of cerebral localization, and Joseph Berres (1796-1844); microscopic anatomy). The founder of the modern anatomical school of Vienna was the highly gifted Joseph Hyrtl (1811-94); technique of injection and corrosion, organ of hearing, comparative and topographical anatomy), known as a pre-eminent teacher, investigator, and a man of noble character. Karl Langer (1819-87; mechanism of the joints), Karl Toldt (b. 1840 histology, anthropometry) and Karl Wedl (1815-91; normal and pathological histology) are others of this School. The professors at present teaching this subject in the Austrian universities still belong chiefly to the school of Hyrtl-Langer. In North America anatomy was cultivated especially in Philadelphia where besides the school founded in 1764, there existed from 1820 to 1875 a private institution established by John Balentine O'Brien Lawrence (d. 1823), "The Philadelphia School of Anatomy". In 1775 Japan became acquainted for the first time with the anatomical knowledge of Europe through a translation of a work by the German Johann Adam Kulmus which had appeared in 1725. A diligent study of anatomy and of medicine in general began when the University of Tokio was established in 1871.

Pathological Anatomy

Pathological anatomy was placed upon a new basis by Bichat's theory of the tissues, and it was later greatly advanced by physiology, physiological chemistry, and by improved means of investigation (compound achromatic objective lens of the microscope). The increased attention, which clinical physicians bestowed on this subject, exercised no small influence on its progress. Among these must be especially mentioned Laënnec, who defined tuberculosis and studied the pathological anatomy of lung diseases, especially of phthisis. Numerous though the able investigators were who performed meritorious services in perfecting this branch, the development of modern pathological anatomy will forever be intimately connected with the names of the pioneers, Rokitansky and Virchow. The first pathological prosectorship at Vienna was held by Alois Rudolph Vetter from 1796 to 1803, well known as the author of the first German work on pathological anatomy. In 1832, after the death of Joseph Wagner, Karl Rokitansky (1804-78; later Freiherr von) became prosector and professor. He was educated in the views of Johann Friedrich Meckel (1781-1833), Johann Georg Christian Freidrich Martin Lolstein (1777-1835), but particularly of Gabriel Andral of Paris (1797-1876), a leading representative of humoral pathology. Rokitansky's training was thus based upon the French school, but he subsequently brought about a still closer connection between anatomical and physical diagnostics. His endeavour to become acquainted with the entire course of development of pathological changes was greatly assisted by the valuable material for dissecting which the metropolis afforded. His excellence is seen in his descriptions of pathological changes; he replaced the previous symptomatic pictures of disease by creating an anatomical pathology and anatomical types of disease. He was not so successful in establishing his doctrine of crasis based upon humoral pathology and just here Virchow's fruitful activity begins.

Rudolf Virchow (1821-1902), professor in Berlin and a pupil of Johannes Müller and Johann Lucas Schönlein, early became acquainted with the cellular doctrine of Schwann. Virchow is the creator of cellular pathology, which today is universally recognized, a pathology based strictly upon natural science which definitively extinguished Hippocratic speculative humoral pathology. According to Virchow, there is life in the smallest units of the body in the cells which increase by fission (omnis cellula e cellula). He applied his doctrine to the various tissues, and showed their behavior under normal and abnormal conditions of life. Diseases thus represent a reaction of the sum of the cells which form the body against harmful influences, the causes of diseases. Virchow's chief work" Die Cellularpathologie" appeared in 1858. Greater attention was now paid not alone to pathological anatomy, but to its sister sciences, pathological chemistry, experimental pathology, and bacteriology. The chief representatives of experimental pathology were: in France, Claude Bernard (1813-78), Charles Edouard Brown-Séquard (1818-95), and Etienne Jules Marey (b. 1830); in Germany, Ludwig Traube (1818-76), Rudolph Virchow, and Julius Cohnheim (1839-84); in Vienna, Salomon Striker (d.1898) and Philip Knoll (1841-1900). Experiments on animals are extensively made today in this field of investigation.

Bacteriology, Theory of lmmunity, Serotherapy, Disinfection

The first to suspect that living beings invade the organism and exist in the blood and pus was the learned Jesuit Athanasius Kircher (1671), although there is no doubt that the "little worms" observed by him were really blood-corpuscles. With the help of his improved microscope Leeuwenhoek discovered a number of bacteria. The idea that infectious diseases were caused by a living contagion invading the body from without was first expressed in 1762 by the Vienna physician Markus Antonius Plenciz (d. 1786). Otto Friedrich Müller, in 1786, was the first to doubt that the microscopical living beings, then comprised under the name of infusoria, really belonged to the animal kingdom. In 1838, Christian Gottfried Ehrenberg gave a description of the finer structure of the "infusoria" but it was Ferdinad Cohn, who in 1854 first ascertained with certainty that bacteria belonged to the vegetable kingdom. From the studies that were now made concerning the vital qualities of these infinitesimal living beings of the vegetable kingdom, Louis Pasteur (1822-95) definitely settled the controversy about spontaneous generation (generatio œquivoca), and proved the materialistic view to be without foundation. What Plenciz had only suspected was now clearly formulated by Henle, who defined the conditions under which bacteria are to be regarded as direct causes of disease. The untiring activity of Robert Koch (d. 1910) from about 1878 succeeded in bringing bacteriology to such a state of development that it could be made of service to practical medicine. Apart from ascertaining the bacterial origin of cholera and tuberculosis, Koch's greatest achievements are the improvement of the microscope (Abbé, Zeis), the method of colouration and pure cultures.

Jenner's success with the lymph of cowpox, a weakened poison as a protection against a full poison, as well as the old experience that those who had once recovered from an infectious disease usually became immune from new infection, led savants to look for the cause of the phenomena. In 1880 Pasteur, on the basis of his experiments concerning chicken cholera, looked for the cause in the exhaustion of the nutritive material necessary for the bacteria in the body (theory of exhaustion), while Chauveau believed in a residue of metabolic products which prevented a new settlement of bacteria or new infection (retention theory). The investigation of Metschnikoff, and in 1889 of Buchner, advanced the idea that blood-serurn possesses a certain hostility to bacteria. In 1890 Von Behring proved that the blood-serum of animals which has been made immune against diphtheria, if injected into another animal, would make the latter also immune against diphtheria. That element in the serum hostile to bacteria he called antitoxin. The introduction of antitoxin into the therapeutics of diphtheria in 1892 was so far the greatest practical success of bacteriology. Efforts were naturally made to secure by similar methods protection against other infectious diseases, efforts only partly crowned with success (tetanus, plague, cholera, snake poison). Following Jenner's method of producing immunity by means of living, weakened causes of infection, Pasteur (1885) found a protection against lyssa, while Haffkine made experiments in 1895 to combat cholera with killed germs, and in 1897 similar experiments with the plague. From 1891 dates Koch's experimentation with extracts of bacteria against tuberculosis. By means of preparations of pure bacteria-cultures, made according to Koch's method, it became possible to devise exact methods for destroying bacteria. In the field of the modern theory of disinfection, Koch also worked as a pioneer, not only in precisely defining the difference between prevention of development and the killing of bacteria, but also by subjecting physical and chemical disinfectants to new tests. The modern steam sterilizers are based upon the discovery of Koch that steam under the ordinary pressure of the atmosphere is sufficient to kill even resistant lasting forms. He pointed out the ineffectiveness of alcohol, glycerine, and other substances upon the spores of anthrax, and the diminished effect of carbolic acid in an oily or alcoholic solution. Von Behring's experiments showed a diminution of power of some disinfectants in the presence of albumen, concerning which Kr¨nig and Paul made a special study.

Physiology

Physiology is indebted for its perfection to the progress of minute anatomy (doctrine of tissues) to the improved means of investigation (microscope, chemical and physical apparatus), but especially to the fact that experiments on animals (vivisection) were once more extensively made. The principal physiologists of the past century were in France and in Germany. François Magendie (1783-1855), opposing Bichat (vitalism), maintained that there is no uniform vital energy, and that the vital qualities of the different organs are to be explained upon a physical and chemical basis and by means of experiments. His investigations in haemodynamics and the functions of the nervous system (roots of the spinal column), in which he supplemented the work of Charles Bell (Law of Bell-Magendie) are very important. Marie Jean Pierre Flourens (1794-1867) is known by his studies in disturbances of co-ordination, nutrition of the bones, and localization of the centre of respiration in the medulla oblongata, and François Achille Longet (1811-71) by his work on the functions of the anterior and posterior columns of the spinal cord, the innervation of the larynx, the nerves of the brain, and the law of the contraction of the muscles. The most famous French physiologist, a pioneer in the field of physiological chemistry, is Claude Bernard (glycogenic function of the liver, the consumption of glycogen through work of the muscles, the discovery of vascular nerves, the chemistry of the bile and the urine, theory of diabetes mellitus, assimiliation of sugar, atrophy of the pancreas, the power of the pancreatic juice to digest albumen, and the theory of animal heat). The physiology of the circulation was elaborated by Etienne Jules Marey (b. 1830; blood pressure, mechanism of the heart and the invention of the sphygmograph). The relation of muscles and nerves to electricity was studied by Guillaume Benjamin Duchenne (1806-75), awhile Charles Edouard Brown-Séquard (1818-94), the founder of modern organo-therapeutics, investigated the reflex irritability of the spinal cord, the blood, respiration, and animal heat. In Great Britain were Marshall Hall (1780-1857; theory of reflex action), William Bowman (1816-92, structure of the striated muscles, and theory of the secretion of urine), Alfred Henry Garrod (1846-79; sphygmography physics of the nerves), Augustus Volney Waller (1816-70; diapedesis of the red corpuscles of the blood, studies on nerve-fibres and ganglia, Waller's degeneration) and William Prout (1785-1869; discovery of free hydrochloric acid in the gastric juice).

The Bohemian Johann Evangelist Purkyje (1787-1869) founded at Breslau the first German physiological institute. His most important studies were concerned with the physiology of the organs of sense, especially of sight, the physiology of the muscles and nerves, the ciliary movement of the epithelium of the mucous membrane, the structure of the nerve-fibre (axis-cylinder) of the ganglia, the glands secreting gastric juice, the sympathetic nervous system, and the history of development (discovery of the germinal spot). Fundamental work in physiological physics was done by the brothers Weber, Ernest Heinrich (1795-1878), and Eduard Friedrich Wilhelm (1806-71), both physicians, and the physicist Wilhelm Eduard (1804-91); mechanism of the human organs of walking (Wilhelm and Eduard), experiments in irritability by means of induction currents, and the irritation of the pneumogastric and sympathetic nerves and its influence upon the heart (Ernst and Eduard). Physiological chemistry is represented by Friedrich Tiedemann and Leopold Gemlin (1788-1853; digestion, absorption and assimilation the importance of the lymphatic system for absorption), Friedrich Wohler (1800-82; artificial preparation of urea), and Karl Bogislav Reichert (1811-83; crystallization of blood pigment). We must also mention the nerve physiologist Rudolf Wagner (1805-64), discoverer of the tactile corpuscles. The greatest credit for developing modern physiology is due to the school of the versalile Johannes Müller (1801-58). Müller's importance comparable to that of Albrecht von Haller, is due on the one hand to the results of his own investigations (studies on the physiology of the organs of sense, the sympathetic nervous system, the theory of reflex action, the production of voice in the larynx, and the description of the cartilage-nucleus), and on the other hand to his activity in all branches of physiology and in his grasp of the entire field of physiological knowledge. The most important investigators of the century in the domain of histology, physiological chemistry, and physics, were pupils of Müller. Besides the above-mentioned investigators, Schwann, Kölliker, and Virchow, attention may be called to Robert Remak (1815-65; description of the marrowless nerve fibres, of the course of the fibres in the brain and the spinal cord); sympathetic nerve system, nerves of the heart, metabolism).

The doctrine of metabolism was advanced by the famous chemist, Justus Freiherr von Liebig (1803-73; excretion of nitrogen in the form of urea, importance of uric acid, albumen as a source of muscular strength), Theodor Ludwig Wilhelm Bischoff (1807-32; urea) and Karl von Voit (b. 1831; metabolism of nitrogen and organic albumen). The latter, together with Max von Pettenkofer (1818-1901), made numerous experiments in the change of gases in man during rest and work. Georg Meissner (b. 1829; Schwann (discoverer of pepsin), Karl Gotthelf Lehmann (1812-65; pepton). The chemistry of blood was investigated by Ernest Felix Josef Hoppe-Seyler (1825-65; blood pigment, blood gases, chemistry of cell and tissue), Jules Robert Meyer (1814-78; mechanism of heat), Hermann Ludwig Ferdinand von Helmholtz (1821-94; physiological optics), and Emil du Bois-Reymond (1818-96; animal electrical phenomena, physics of the muscles and nerves). Just as versatile as Johannes Müller were Karl Friedrich Wilhelm Ludwig (1816-95; physiology of the circulation and excretions, theory of the functions of the kidneys, endosmosis, discovery of the nerves of secretion) and Ernest Wihelm Ritter von Brucke (1819-92; studies of the ciliary muscle as a muscle of accommodation, theory of colours, physiology of the voice, structure of the muscle-fibres, biliary capillaries, digestion, absorption). Karl von Vierordt (1818-83) is associated with the chemistry of respiration and the counting of the blood corpuscles; Adolf Fick (1829-1901) with physiology of the muscles and nerves; Moritz Schiff (1823-16) with the nervous system, discovery of the harmful results of the extirpation of the thyroid gland, function of the base of the brain and the cerebellum; Rudolf Heidenhain (1834-97) with the physiology of the glands; Alexander Rollett (b.1834) with the glands of the stomach, blood; Eduard Friedrich Wilhelm Pfluger (b. 1829) with the gases of the blood, processes of oxidation in the body; Ewald Hering (b. 1834) with the theory of self-regulation of the act breathing sensitiveness of retina to colours, and Theodor Wilhlem Engelman (b. 1834), with electro-physiology, motion of the ciliary epithelium, physiology of the heart and of the organs of sense. The localization of the brain was investigated especially by Gustav Fritsch (b. 1838), Eduard Hitzig (b. 1838), Leopold Goltz (1835-1902), and Sigmund Exner (b.1846). Of eminent physiologists outside of Germany we may mention the Dutchmen Franz Cornelis Donders (1818-89); physiological optics, determination of refraction) and Jakob Moleschott (1822-93; metabolism and doctrine of foods).

Owing to the progress of the theoretical auxiliary sciences, practical medicine reached a high state of development, especially in diagnosis, but also to a certain extent in therapeutics. A general revolution was effected by the establishment of physical diagnosis. Auenbrugger's epoch making discovery, percussion (1761), passed over in silence by van Swieten and de Haen, the leading spirits of the Vienna school, and mentioned only in timid fashion by Maximilian Stoll, might have been altogether forgotten, if Jean Nicolas Corvisart de Marest (1755-1821), after an objective examination, had not translated Auenbrugger's "Inventum novum" into French, and published it in 1808 with a commentary. René Theophile Hyacinthe Laënnec (1781-1826) enriched the physical method of examination by the invention of auscultation (noting the different tones and noises in the chest by placing the ear against it). His pupil Pierre Adolphe Piorry (1794-1879) perfected percussion (definition of the borders and outlines of the organs, invention of the plessimeter, improvement of the stethoscope). Laënnec's invention attracted attention but slowly. His chief opponent was Francois Joseph Victor Broussais (1772-1838), but in England John Forbes (1787-1861) and William Stokes (1804-78), and in Germany, Christian Friedrich Nasse (1778-1851), Peter Krukenbeg (1787-1865), Johann Lukas Schönlein (1793-1864), and others assumed a friendly attitude. Auscultation and percussion came into general use in the Germanic countries much later than in England and France but they were then brought to great perfection by the Vienna physician Joseph Skoda (1805-81), who in 1839 treated physical diagnosis scientifically and fundamentally (auscultation and percussion). The new methods made possible the exact clinical diagnosis of diseases of the heart and the lungs to a degree never previously imagined. Besides Laënnec and Skoda must be mentioned among the great number of investigators: Jean Baptiste Bouillaud (1796-1881), and James Johnson (1777-1845), who investigated affections of the heart and rheumatism of the joints. August Fancois Chomei (1788-1855; pericarditis and rhumatism), James Hope (1801-41; valvular insufficiency), Hermann Lebert (1813-78), Johann Oppolzer (1808-91), Felix Niemeyer (1820-71), Ludwig Traube (1818-76), Heinrich von Bamberger (1822-88), and Adalbert Duchek (1824-82).

Among therapeutical aids the introduction of digitalis purpurea by Traube deserves special mention. M.J. Oertel (d. 1897), tried to cure certain affections (fatty degeneration of the heart obesity) by means of dietetic mechanical treatment (Terrainkur); and the brothers August and Theodor Schott established the so-called Nauheim method (carbonic acid baths and gymnastics). Great credit in connection with the dignosis of lung disease is due to M. Anton Wintrich (1812-82; pleuritis), Karl August Wunderlich (1815-78; range of temperature in pneumonia) Leon Jean Baptiste Cruveilhier (1791-1875; pneumonia in children), Theodor Jürgensen (infectious nature of pneumonia), Robert Bree (1807; bronchial asthma), Biermer (1870), Leyden (1875; crystals of asthma) and Curschmann (1883; spirals). The subject of pulmo nary tuberculosis was profoundly treated by Gaspard Laurent Bayle (1774-1816; 1810 (discovery of miliary tuberculosis, tuberculosis a general disease); Virchow defined the anatomic character of tuberculosis; Villemin in 1865-8 proved its contagiousness, and his experiments were re-examined and confirmed among others by Lebert (1866), Klebs (1868), Baumgarten (1880), Teppeiner (1877), and Weichselbaum (1882). With the discovery of the tubercle bacillus by R. Koch in 1882, the path to the suppression of tuberculosis was indicated. Cornet in 1888 showed the danger of the sputum, which resulted in prohibition of spitting and the placing of cuspidors with disinfecting solutions. In 1890 Koch appeared with his remedy tuberculin, which he improved in 1897 and 1901. In 1902 Behring began his experiments on cows to secure immunity. Of late the treatment on tuberculosis is chiefly dietetic. Diagnosis and therapeutics of the diseases of the larynx were greatly advanced by the invention of the laryngoscope in 1860 (Ludwig Turck 1810-68, Vienna; and Johann Nepomuk Czermak, 1828-73). The taking of temperature, which was diligently cultivated by de Haen and later by James Currie (1733-1819), was systematically done for the first time by Friedrich Wilhelm Felix von Barensprug (1822-64), Traube, and Wunderlich. In the treatment of metabolic diseases we must mention the noteworthy zeal of Friedrich Theodor von Frerichs (1819-85).

Diagnosis and therapeutics of diseases of the stomach were advanced by the introduction of the pump invented by the English surgeon Bush in 1822, an instrument recommended and used since 1869 by Adolf Kussmaul (d. 1902), in enlargement of the stomach, and for the examination of the stomach with a speculum. Faradization was employed by Karl Friedrich Canstatt in 1846, Duchenne, and later by Kussmaul (1877), the stomach catheter was used for diagnostic purposes by Wilhelm Leube in 1871. The subject of typhlitis and perityphlitis was investigated among others by Puchelt (1829), Burne, Smith, Bamberger, and Oppolzer, diseases of the kidneys by Richard Bright (1827), Pierre François Oliver Rayer (1793-1867), Johnson (1852), Julius Vogel (1814-80) and Hermann Senator (1896); diseases of the bladder by Josef Grunfeld (1872), Trouvé (1878) Max Nitze (1879; endoscopy), Rovsing (1890, 1898), Krogius (1890, 1894), Guyon, Leube, and Robert Ultzmann (inflammation of the bladder, formation of stone). The development of modern diagnosis and the therapeutics of nervous diseases are connected with the names of eminent physiologists and clinical physicians. Of the latter we may mention Moriz Heinrich Romberg (1795-1873), Wilhelm Griessinger (1817-68), Duchenne, and the universal Jean Martin Charcot (d. 1893). Faradization (1831), as a therapeutical means specially against lameness, was introduced by Duchenne in 1847. Among special studies of individual diseases were: on tabes dorsalis by Romberg, Duchenne, Armand Trousseau (1801-66), Nikolaus Friedreich (b. 1882), Leyden (d. 1910), Karl Friedrich Westphal (b. 1833), Charcot, and Alfred Fournier, who in 1876 pointed out the connection between tabes and lues; on myelitis by Brown-Séquard, Oppolzer, Friedreich, Westphal, Charcot. A peculiar complex of symptoms was described for the first time by Robert James Graves (d. 1853), later (1840) by Karl von Basedow (Basedow's Disease). The picture of neurasthenia was given for the first time in detail in 1869 by Georg Beard; Weir-Mitchell together with Playfair proposed for it the so-called fattening cure.

Psychiatry

As to progress in psychiatry, there is now a more humane conception of the care for the insane compared with that obtaining in former times. This movement originated principally in England (Thomas Arnold, d. 1816; William Perfect, b. 1740; Alexander Crichton, 1763-1856), and France (Philippe Pinel, 1755-1826; Jean Etienne Dominique Esquirol, 1772-1840), and found in Italy in Vincenzo Chiarugi (d.1822) and in Germany in Johann Christian Reil (1759-1813), zealous supporters. With this movement came a general and profounder study of the subject stimulated by the results of pathological anatomy, more judicious therapeutics conscious of its aim, proper physical occupation of the insane, and the discontinuance of the isolation system. Special attention is paid to the etiology and therapeutics of diseases occurring most frequently, cretinism, hysteria, progressive paralysis, as well as to psychosis of intoxication, alcoholism, morphinism, etc. Hydro-therapeutics, which is especially effective in the case of neurosis and psychosis, was much cultivated by Anton Frohlich (1760-1846) and the two laymen, Eucharius Ferdinand Oertel and the Silesian, Vincenz Priessnitz (1790-1851). It was treated scientifically by Wilhelm Winternitz, who wisely reduced within due bounds a great deal of the harshness in the laymen's hydrotherapy.

Modern dermatology begins with the endeavours of Johann Jakob Plenk (1738-1807) at Vienna to establish a classification of skin diseases on a basis of external clinical appearance. Work of a similar nature was done by Anne Charles Lorry (1777), Robert Willan (1798), Thomas Bateman (1815), all of whom introduced simplifications into Plenk's system, Laurent Beilt (1781-1840), and Camille Melchior Gibert (1797-1866). Jean Louis Alibert (1766-1837) made a classification according to pathological principles, while Pierre François Oliver Rayer used anatomy and physiology as a basis. The pathological-anatomical method, introduced by Julius Rosenbaum (1807-74) was established by Ferdinand Hebra in Vienna (1816-80). Its chief merits consist in creating a classification of twelve groups, valid in its substantial form even today, in a definition of the general course of the disease, and in simplifying therapeutics. His chief special studies are concerned with itch, lepra, and eczema. With him we must mention Friedrich Wilhelm Felix von Barensprung (1822-64, eczema marginatum, erythrasma caused by fungus, and herpes zoster) and his successor, Georg Lewin (1807-78) worked along the same lines as Hebra (parasitical and constitutional skin diseases, erythema induratum). Hebra's most important pupils are Heinrich Auspitz (1835-86; venous stagnation, soap therapeutics), Moriz Kaposi (1837-1902; pigment sarcoma, sarcoid swellings), and Ernst Ludwig Schwimmer (1837-98; neuropathic dermatosis). For a number of valuable special investigations we are indebted to Tilbury Fox (1836-79; impetigo contagiosa, dermatitis herpetiformis), and on lepra to D.C. Daniellssen (1815-94) and Karl Wilhelm Boeck (1808-75). In recent times we notice an endeavour to define more closely the course of the disease, a movement started by Paul Gerson Unna in Hamburg (b.1850; histodermatology, histotherapy, bacteriology of acne, eczema, impetigo, and favus.

Ophthalmology

Ophthalmology, as an independent branch, was established in Germany first at Vienna and Göttingen. In Vienna the anatomist Josef Barth (1755-1818) gave ophthalmological lectures as early as 1774, but two of his pupils, Johann Adam Schmidt (1759-1809; studies on iritis xerophthalmus and the lachrymal organs) and Georg Josef Beer (1763-1821; method of extraction of cataract, staphyloma, pannus), were the first to receive special professorships, the former in 1795 at the military academy and the latter at the university. Of Beer's school may be mentioned among others Konrad Johann Martin Langenbeck (1776-1851; ceratonyxis, formation of the pupil, amaurosis, entropium), Karl Friedrich von Grafe (1787-1840; teleangiectasis in the eye), Friedrich Jager (1784-1871; upper cutting of the cornea in the operation for cataract), Johann Nepomuk Fischer (1787-1847; pyaemic inflammation of the eye), and finally the most eminent English ophthalmologist of his time, William Mackenzie (1791-1868; choroiditis, accommodation, asthenopy, scotoma). A contemporary of Beer was Carl Himly of Göttingen (1772-1837; introduction of mydriatics). Among his pupils were Friedrich August von Ammon (1799-1861; iritis) and Christian Georg Theodor Ruete (1810-67), who deserves credit chiefly for the introduction into practice of the speculum oculi. In ltaly the progress of ophthalmology begins with Antonio Scarpa (1747-1832; staphyloma of the cornea). We must also mention Paolo Assalini (1759-1840; extraction of cataract, artificial pupil, Egyptian inflammation of the eye, 1811), Giovanni Battista Quadri, the first professor in Naples (1815) and likewise the professors of the clinics established at Padua and Pavia in 1819, Anton von Rosas (1719-1855), a pupil of Beer, and Franz Flarer, (trichiasis iritis, 1841). In England, besides Mackenzie, John Cunningharn Saunders (1773-1810) of the German school, John Vetch (Egyptian inflammation of the eye, 1807), George James Guthrie (artificial pupil, extraction of cataract, 1818), and William Lawrence (1785-1867), author of a textbook, deserve mention. In North America are George Frick of the Viennese school, author of a textbook (Baltimore, 1823), and Isaac Hays of Philadelphia. More than anywhere else was German influence felt in France, and here we must mention in the first place the pupils of Jager: Viktor Stöber (1803-71), professor at Strasburg, and Julius Sichel of Paris (1802-58; choroiditis, glaucoma, cataract, staphyloma). Besides these we have Carron du Villards, a pupil of Scarpa and author of a textbook (1838), and Desmarres.

Helmnholtz, Arlt, and Grafe are regarded as the founders of modern ophthalmology. Hermann Ludwig Ferdinand von Helmholtz (1821-94) opened an entirely new field for diagnosis by inventing the speculum oculi in 1851. Just as important is his theory of accommodation and sensation of colours. Ferdinand von Arlt of Vienna (1812-87), an eminent operator (trichiasis symblepharon) and teacher, founder of ophthalmopathology, recognized the true cause of myopia (elongation of the eye-ball) and introduced a chart of letters, later improved by Snellen. Albrecht von Grafe (1828-70) of Berlin, a pupil of Arlt but in many respects outshining his master, is known principally through his work on the connection between brain and blindness, on glaucoma, iridectomy, and linear extraction of the lens. Besides the above-mentioned Donders we must call attention to Alexander Pagenstecher (1827-79; operation for cataract), Eduard Jager von Jaxthal (1818-84; letter chart), Karl Stellwag von Carion (1823-1904; defects of accommodation, innervation of the iris), Julius Jacobson (1828-89; diphtheritis conjunctivae), Otto Becker (1828-90; pathological topography of the eye, lens), Josef Ritter von Hasner (1819-92; forensic injury of the eye), Ludwig Mauthner (1840-94; optical defects of the eye, glaucoma), Albrecht Nagel (1833-95; strychnia in the case of amblyopia), Rudolf Berlin (1833-97; word-blindness), Richard Forster (1825-1902; perimeter, glaucoma, general diseases and maladies of the eye), William Bowman (1816-92; diseases of the lachrymal sac), George Critchett (1817-82; iridodesis), Cornelius Agnew, New York (1830-88; strabismus, paracentesis of the cornea, canthoplastics), the Russian Alexander Ivanoff (1836-80; inflammation of the retina and the optic nerves, glass eye), and Victor Felix Szokalski (1811-91; textbook). The introduction of local anesthesia by means of cocaine in 1884 by Rudolf Koller of Vienna, greatly facilitated operation on the eye.

Obstetrics

One of the most eminent obstetricians was Lukas Johann Boër of Vienna (1751-1835), who upon the request of the emperor studied in Paris and London from 1785 to 1788. He represented the so-called "waiting method", using instruments as rarely as possible, taught rational dietetics during pregnancy and confinement, and was the first to employ electricity for reviving asphyxiated children. Work of a similar nature was done by his contemporary, Wilhelm Josef Schmitt (1760-1824; forceps operation in the longitudinal position, methods of examination mechanism of parturition). In contradistinction to Boer, Friedrich Benjamin Osiander (1759-1822) represented the most extreme operative tendencies while Adam Elias von Siebold (1775-1828) took a middle course. Mechanism of parturition and pelyeology was treated by Ferdinand Franz August von Ritgen (1787-1867) and Franz Karl von Nagele (1778-1851); physiology of pregnancy by Franz Kiwisch von Rotterau (1814-52) and Johann Christian Gottfried von Jörg (1779-1856). The founder of the modern theory of labour pains is Justus Heinrich Wigand (1769-1817). A new period of development begins in 1847 with James Young Simpson (1811-70) the inventor of the English forceps and cranioclast; he was the first to employ narcosis (first with ether and in the same year also with chloroform) for women in labour, but at present this is done only in case of operations. Of far greater importance is the simultaneous discovery of the cause of puerperal fever (pyaemia) by Ignaz Philipp Semmelweiss of Vienna (1818-65). He introduced the practice of disinfecting hands and instruments with a solution of chloride of lime, and thereby reduced the mortality of lying-in women from 9.92 to 1.27 percent. This most important discovery that external infection causes puerperal fever was used in general practice only at a late period. Propositions similar to those of Semmelweiss had been made as early as 1843 by Oliver Wendell Holmes of Boston, but they were not known in Europe. Important advances in modern times are marked by descriptions of the narrow pelvis by Gustav Adolph Michaelis (1798-1848) and Karl Konrad Theodor Litzmann in 1851, and of the oblique oval pelvis by Litzmann in 1853; artificial premature birth in the case of such a pelvis by Spiegelberg in 1870; the manual removal of the placenta in 1853, and prophylaxis against blemorrhoea of the newly born by Crede in 1884; axial traction forceps by Chassagny in 1861; combined turning by Braxton hicks in 1860-3; the mechanism of delivery by Hofmeier in 1888; pregnancy of the oviduct by Veit in 1884; extra-uterine pregnancy by Werth in 1887; asphyxia of the newborn by Schwartz in 1858 and by Schultze in 1864. The classical Caesarean operation, as previously performed, consisted in opening but leaving in the uterus, whereupon death usually resulted from sepsis. Porro of Pavia in 1875 performed it, therefore, with the subsequent removal of the uterus and ovaries, and thus obtained much more favourable results. With the perfection of antiseptic, or rather aseptic, treatment in modern times, the classical Caesarean operation is being again performed. The total removal of the ovaries (ovariotomy) on account of their degeneration was performed for the first time in 1809 by Ephraim MacDowell at Danville, Kentucky, the technique of the operation being perfected by Hutchinson in 1859, Spencer Wells and Marion Sims in 1873, Freund in 1878, and Czerny in 1879. Total extirpation of the uterus is performed especially in the case of cancer.

Surgery

Of all the branches of medicine, surgery made the greatest progress, first in France and England, later also in Germany. Side by side with the renowned surgeon-in-chief, of the Napoleonic armies, Jean Dominique Larry (1766-1842), we have, as the most versatile, Guillaume Dupuytren (1777-1835); next to him Philibert Joseph Roux (1780-1854, resections), Jacques Lisfranc (1790-1847; exarticulations), Alfred Armand Louise Marie Velpeau (1795-1868; treatment of hernia by injection of iodine), Jacques Mathurin Delpech (1777-1832; studies about phagedaenas, gangraena nosocomialis tenotomy of the tendo Achillis), Jean Zuléma Amussat (1796-1856; lithotripsy), Auguste Vidal (1803-56, varicocele), Joseph François Malgaigne (1806-65; fractures and dislocations) Auguste Nélaton (1807-73; lithotomy) Edouard Chassaignac (1805-79, écrasement linéaire, drainage), and Charles Gabriel Pravaz (1791-1853; orthopaedia subcutaneous injection). Of English surgeons we must mention the brothers Bell, John (collateral circulation after ligation) and Charles (operative surgery); John Abernethy (1763-1831; ligation); James Syme (1799-1870; exarticulation of the hip joint); the famous surgeon, Astley Patson Cooper (1768-1841; textbook), and William Lawrence (1785-1867). In America we may note the chief surgeon of the War of Independence, John Collins Warren (1753-1815), Philipp Syng Physick (1760-1837; new formations), Willard Parker (1800-84; cystotomy), and Frank Hastings Hamilton (1813-86; fractures and dislocations). Passing to the German surgeons let us mention first of all Vincenz von Kern of Vienna (1760-1829; open treatment of wounds) his successor, Joseph von Wattman (1789-1866; lithotomy), and Franz Schuh (1805-65; new formations, hernia); in Germany Louis Strohmayer (1804-76; myotomy, tenotomy, resections), Johnnn Friedrich Dieffenbach (1794-1847; plastic operations), and Albert Theodor Middeldorpf (1824-68; galvanocautery).

A new epoch of progress begins in 1846 with the introduction of narcosis. The discoverer of the narctic effect of ether is the American physician and chemist, Charles Jackson (1805-80), who together with William Morton, made experiments upon his own person. The first narcosis was undertaken in 1846 by Warren, and in the same year in London by Robert Liston. Simpson first employed ether in an obstetric operation in 1847, but soon afterwards introduced into practice chloroform. In modern times a mixture of ether and chloroform is generally used. Besides general narcosis we must also mention local anesthesis (evaporation of ether, injection of cocaine, bromoethyl). Of still greater importance than narcosis was the treatment of wounds with carbolic acid by the Englishman Lister in 1867 (antiseptic treatment of wounds). In the course of time carbolic acid was replaced by other antiseptic method (careful protection of the field of operation against infecting germs). A third achievement of modern times is operating with an artificial absence of blood (operations on the extremities), mentioned for the first time by Friedrich Esmarch in 1873. Narcosis and antiseptics now make possible a series of daring operations, before impossible, with essentially better chances of success. In the recent development of German surgery Bernhard von Langenbeck (1810-87), known especially as a military surgeon, holds a leading position. Of his school we have among others Adolf von Bardeleben (1819-95), author of a textbook, Karl Thiersch, (1822-95; transplantation), Johann Nepomuk von Nussbaum (1829-90; transplantation of bones, extension of nerves), Theodor von Billroth (1829-94; extirpation of the larynx and struma, resection of the pylorus) and Richard von Volkmann (1830-89; surgery of the joints). A very important means of locating foreign bodies (e.g. projectiles), in the human body, and for the examination of fractures is the Röntgen rays discovered by William Karl Röntgen in 1895 (Röntgen photography).

LEOPOLD SENFELDER