Medicine

MEDICINE

PART I.—SYNOPTICAL VIEW OF MEDICINE.

MEDICINE , the subject-matter of one of the learned professions, includes, as it now stands, a wide range of scientific knowledge and practical skill. The history of its growth from small beginnings in Greece is traced in the second section of the present article; it remains here to give a synoptical view of medicine, including its scientific or philosophical position, its subdivisions or ramifications as an art and discipline, and its relations to the body politic.

Scientific Position of Medicine.— The science of medicine is the theory of diseases and of remedies. While the notion of disease is necessarily or inevitably correlated with the notion of health, there is no necessary and invariable relation, but, on the other hand, a merely conventional association, between a disease and a remedy. That part of the science of medicine which corresponds to the theory of remedies is not therefore in a position scientifically inferior to the theory of diseases; for each article of the materia medica—apart from a few inert substances—has a certain effect on the organism in health and in disease, which is ascertainable with scientific precision. Those properties and actions of drugs are the subject of pharmacology and toxicology; the circumstances under which the several articles of the materia medica become remedial are the subject of therapeutics, and therapeutics is dependent for its scientific position upon the completeness of the theory of diseases, or pathology.

Disease is the correlative of health, and the word is not capable of a more penetrating definition. From the time of Galen, however, it has been usual to speak of the life of the body either as proceeding in accordance with nature (κατά φvσι,v, secundum nal·uram) or as overstepping the bounds of nature (παρά φvσιv, praeter naturam'). Taking disease to be a deflexion from the line of health, the first requisite of medicine is an extensive and intimate acquaintance with the norm of the body. The normal condition of the body is capable of being determined without ambiguity; it is the absence from its structures and functions of every disease hitherto known. The structure and functions of the body form the subject of anatomy and physiology.

Physiology is, strictly speaking, the science of that which is κατά φvσιv, or secundum naturam, and it is usual to say that the theory of diseases is based upon physiology. But, although all that was implied in the Hippocratic term φvσις (natιιra) may be claimed as the subject-matter of physiology, yet, in the ordinary connotation of the term, physiology divides the empire with anatomy. To physiology the functions of the body are usually assigned, and to anatomy its form and structure. But, as a matter of fact, the structures and functions of the organism are not separable; structure is correlated to function, whether active, dormant, or extinguished, and in like manner function is the twin notion of structure. In the ultimate analysis neither term means anything without the other, and both together mean life. It is owing mostly to its name that physiology is supposed to have a preponderant interest for the theory of disease; the word anatomy is not well adapted to carry its own half of the structure* and-function dualism. Both in the historical development and in the logical connotation, anatomy is as much associated with the living and moving body as physiology itself; but its etymology has always been against it, and it has become more and more difficult to retain for anatomy anything beyond the technicalities of the dissecting-room. The subject of general anatomy has for the most part disappeared from modern text-books, its place being taken by histology, which deals with the minute structure of the simple tissues, and, in a wider acceptation, with the finer anatomy of all the organs and parts of the body. Histology, like anatomy, has had a somewhat technical or descriptive rôle assigned to it; and it is now mainly under physiology that the processes, activities, or living mechanisms of the body fall to be considered. The development of the body as a whole, and of its several tissues and organs, forms the subject of embryology; many of the physiological types of diseased processes, especially the cellular, are discoverable in the embryological period. For the-period of development, no arbitrary separation has been attempted hitherto between structure and function, and embryology is, in theory at least, as much physiological as anatomical. The development of function is a legitimate and even desirable subject of scientific study, and a more distinctive place is probably awaiting it in the future; but so indissoluble does the union of structure and function present itself in the period of genesis and growth that the function has hardly as yet come to be abstracted from the structure, or the structure from the function.

The theory of disease rests, therefore, upon physiology, with its more or less technical adjuncts. Pathology is all that physiology is, with the engrossing and difficult element of perturbation, deflexion, or shortcoming added. By virtue of this element of deviation from the line of health, pathology is a discipline apart, with an abundant literature of its own, and with separate academical institutes and chairs. But pathology is also a discipline apart by virtue of concepts proper to itself. A great part of the theory of disease deals with changes or defects of structure and perturbations or failings of function, which may be intricate or difficult to analyse, but are still well within sight of the line of health. Such are the common diseases of the organs and systems—the inflammations, catarrhs, degenerations, hypertrophies, and functional derangements without lesion of the respiratory, circulatory, nervous, genito-urinary, locomotor, and cutaneous systems. Constitutional or general diseases belong also to the province of perturbations from the physiological course,—such diseases as chlorosis, leukaemia, diabetes, gout, rheumatism, scurvy, rickets, Addison’s disease, exophthalmic goitre, and the febrile state. Again, congenital deficiencies or malformations, non-cancerous tumours, and the repairing of injuries exemplify no other laws than those of development and growth.

But with those examples the catalogue of physiological diseases is exhausted. We are left with a vast residue of diseases, which have always bulked largely in the popular mind, and have carried the most terrible associations with them. Such are the pestilences or diseases of peoples: — the plague, sweating sickness, cholera, yellow fever, typhus fever, relapsing fever, typhoid fever, diphtheria, small-pox, measles, scarlet fever, influenza, dengue. Such also are the cancers, consumptions, leprosies, and other loathsome infections. This enormous residue is more than the half of disease, and the definition of disease or the scheme of pathology is brought to a test in finding room within its scientific categories for such maladies as those. The popular imagination in all countries has personified them; medicine in its metaphysical period has regarded them as entities or things in themselves; and it remains to be seen in what way or to what extent medicine in its scientific period will bring them within the category of perturbations of the physiological life.

In considering, for a moment, where to place cancer in the pathological scheme, we shall arrive at a point of view from which the relation of the acute and chronic infections (or contagions) to diseases of the physiological order may be contemplated at least provisionally. Taking cancers, in a generic sense, to mean tumours that have acquired or are possessed of malignancy, we find that such tumours have many points in common with simple tumours,—that they have grown out of the tissues of particular organs or parts under particular (functional) circumstances, and that they may, in general terms, be traced back to that point at which they left the line of health (see Pathology). The tracing back of tumours along the physiological track is often difficult and laborious; but there is no tumour of the body whose origins are not at length discoverable within the limits of physiological action. That which makes any tumour a cancer is something over and beyond; it is a remarkable acquired property of reproducing its structure in manifold copies, or of infecting the organism of which it is itself a part. The tumour thus becomes a semi-independent power within the body; it may be said, in a political figure, to have acquired autonomy, or to have become imperium in impei'io. A due consideration of such a phenomenon as the infectiveness or cancerousness of some tumours will satisfy one that there are concepts in pathology which carry the investigator entirely beyond physiological bounds or out of sight of the line of health, which bring him face to face with the notion of a disease as a thing in itself, and which thus constitute a peculiar subject-matter. There is nothing that we know among biological phenomena altogether analogous to the semiindependence which an integral part of the body, or condition of the body, manifests towards the organism as a whole, and that, too, strictly in respect of its acquired devious or rebellious habit. The familiar definition of disease, morbus est vita praeter naturam, which embodies the notion of divergence from the line of health, makes no provision for an acquired autonomy of a morbid state; and that definition has to be supplemented by another, which will recognize the possibility of a disease becoming a thing in itself. The old definition of Van Helmont, morbus est ens reale subsistens in corpore, appears to satisfy the requirement; but that definition, although it grew out of the phenomena of disease as observed in fevers, was made too general, and has now associations that are too exclusively ontological and metaphysical. The supplementary definition should be as far as possible in the terms of the principal definition; and we shall provide best in the pathological scheme for such a disease as cancer if, in addition to tho formula morbus est vita prseter naturam, we construct a secondary formula, morbus est vivum in vivo.

The notion of autonomy acquired by a morbid state implies, naturally, a pre-autonomous stage of the disease, which had been a mere perturbation of the norm of tho body, capable of being measured by the physiological standard. The autonomous stage and the pre-autonomous stage, which may be demonstrated, in individual cases, for cancers, are a philosophical necessity for all other infective diseases that are marked by morphological features, or by structural characters rooted in and growing out of the proper textures of the body. Thus the peculiar skin eruption of small-pox, which is communicable from person to person, along with a distinctive course of fever, must have had pre-autonomous antecedents (not altogether historically vague) in certain casual conditions of the skin and associated constitutional disturbance, which had recurred and become inveterate, and had so attained to a degree of individuality or a point of autonomy at which they began to be propagated as an organic unit. Again, a second group of infections, exemplified by glanders, bovine tubercle, and syphilis, are rooted in deeper textural processes, which must have been at one time (and may still be) set up by the casual operation of ordinary causes, and at length became the occasion of infective mimicry. It is not so easy to picture (and it is not difficult, with a modern dominant school, to ignore) the casual morbid conditions or ordinary physiological perturbations out of which powerful infections like cholera, typhoid fever, or yellow fever may have arisen; but if the rise and consolidation of their autonomy be a subtle or even untraceable history, yet there are diseases, such as dysentery and erysipelas, which are apt to occur both as casual or spontaneous conditions and as specific infections side by side. Ophthalmia is an example of a purulent catarrh which is constantly arising de novo in Egypt from local causes in a non4nfective manner, and yet has become, on at least one memorable occasion, a powerful and widespread infection for British troops returning from that country and for the home garrisons for many years subsequently. Infective pneumonia in cattle, and more rarely in man, is an analogous case. In such an episode we observe the actual rise of the disease-autonomy. Again, all the infective diseases have degrees of intensity, at one extreme of which there must occur the vanishing point of their infective property; and those gradations of infectiveness are nowhere more noticeable than in the relation of cholera to choleraic diarrhoea. Further, the remarkable group of climatic fevers are not communicable from person to person (see Malakia) ; in that respect, and for the reason that the liability of the patient is anything but exhausted by one attack, they are examples of fevers without autonomy. There is not one of the infections that may not be profitably studied from the point of view of its autonomy, and of its more or less obscure pre-autonomous stage. That is a point of view from which even the pestilences and other specific diseases may be regarded as coming within the physiological categories. The large residue of diseases, which are more than perturbations of the physiological life, may still be joined by natural descent to the class of simple perturbations, if we can show for them how their autonomy was acquired, or what was their origin as diseasespecies.

There is an established place in the history of medicine, and there ought therefore to be room in the definition of <lisease, for epidemic outbreaks of purely psychical diseased states, such as the dancing madness (Tanzwuth), and the boys’ crusades; the epidemic diffusion of such morbid states is best approached from the point of view of an acquired autonomy (fixed idea) and an infective mimicry.

The physiological definition of disease, morbus est vita prater naturam, affords no place for parasitic diseases. However, the supplementary formula that has been proposed to meet the case of diseases existing autonomously in the body, morbus est vivum in vivo, will meet the case of parasitic diseases also. According to many pathologists of the present generation, the whole class of pestilences, fevers, and specific infections generally are caused by certain species of minute parasites invading the body; according to one form of that hypothesis the distinctive characters or specific marks (morphological and other) of those diseases are neither more nor less than the appropriate effects wrought upon the textures and fluids of the body by the respective species of parasites. In this way the great group of infective diseases, which are apt to be the stumbling-block of a scientific definition and logical scheme of disease, are easily disposed of by placing them beside the otherwise insignificant group of parasitic diseases. Whether all or any of those diseases are due in a sense to the invasion of parasites, or wholly caused by parasites, are questions that naturally fall to be settled by a careful sifting of a mass of evidence which has already proved to be peculiarly rich in opportunities for mistake. It may be expected that the facts of infective parasitism and the facts of acquired disease-autonomy will in the end find their place in a common theory of specific diseases, which might be expressed in terms of the physiological formula morbus est vita praeter naturam with the rider morbus est vivum in vivo.

The theory of remedies, which forms the second division of the science of medicine, is chiefly based upon pharmacology or toxicology. If pharmacology be considered as not co-extensive with toxicology, it will be taken tobe in great part pharmacographia, or the systematic description of articles of the materia medica—their source, preparation, physical properties, and the like. Toxicology is in its general sense the investigation of the physiological action of drugs, a science which is largely dependent upon experiments on the lower animals; in a more technical sense toxicology relates to the effects of poisons and the art of detecting them (see Poisons). The physiological action of drugs is the key to their therapeutical action. Therapeutics has been defined as “the discovery of the means by which a system of forces competent to eliminate any given perturbation may be introduced into the economy.” The adaptation of remedies to diseases is, however, greatly wanting in precision, and continues to be in large part empirical and traditional. It may be objected to the above definition that all diseases are not reducible to the category of “perturbations,” and that there is a certain scientific justification for the doctrine of specifics. Besides the articles of the materia medica proper, agencies such as electricity, baths, sea-voyages, and changes of climate generally, enter into the consideration of therapeutics, and two of those form the subject of special departments, viz., electro-therapeutics and hydropathy. Regimen and diet are also important factors in the treatment of disease; according to a contention of Hippocrates, it was in the dietetic needs of mankind that the medical art had its origin.

Subdivisions of Medicine as an Ai t and, Discipline.— The medical art (ars medendi) breaks away at once from the unity of the theory of disease. While there is but one body of pathological doctrine for either sex, for every period of life, and for every region and part of the organism, the practical art divides itself into departments and subdepartments. The most fundamental division is into internal and external medicine, or into medicine proper and surgery. The treatment of wounds, injuries, and deformities, with operative interference in general, is the special department of surgical practice (the corresponding parts of pathology, including inflammation, repair, and removable tumours, are sometimes grouped together as surgical pathology); and where the work of the profession is highly subdivided, surgery becomes the exclusive province of the surgeon, while internal medicine remains to the physician. A third great department of practice is formed by obstetric medicine or midwifery, and with obstetrics there is usually associated gynaecology, or the diseases peculiar to women. Diseases of children are the subject of a voluminous separate literature. Dermatology (diseases of the skin) is an important province of practice which, like the diseases of women and children, pertains as much to medicine as to surgery. The greatest of the so-called special departments of practice is ophthalmology (diseases and injuries of the eye). Laryngology is a department that owes its existence mainly to the invention of the laryngoscope, its special province being the treatment of the inflammations (ordinary and specific), tumours, and the like, to which the larynx is liable in common with other parts. Diseases of the ear (otology) form even a more restricted department of practice, owing to the comparative inaccessibility of the chief part of the organ of hearing. The congenital condition of deaf-mutism may or may not be taken as falling within the province of the last-mentioned subdivision. Dentistry or odontology is extremely limited in the range of its subject-matter; but it affords great opportunities for refinements of technical skill, and it is given up to a distinct branch of the profession.

The care of the weak-minded and the insane (psychological medicine) is an integral part of medical practice, inasmuch as it is concerned with diseases of the nervous system and with numerous correlated states of other organs; but it occupies a unique place by reason of the engrossing interest of the subjective phenomena. Habitual drunkenness is also a subject of special treatment.

' A state of war, actual or contingent, gives occasion to special developments of medical and surgical practice (military hygiene and military surgery). Wounds caused by projectiles, sabres, &c., are the special subject of naval and military surgery; while under the head of military hygiene we may include the general subject of ambulances, the sanitary arrangements of camps, and the various forms of epidemic camp sickness.

The administration of the civil and criminal law involves frequent relations with medicine, and the professional subjects most likely to arise in that connexion, together with a summary of causes célèbret, are formed into the department of medical jurisprudence. It is the practice in Great Britain to call independent medical evidence on both sides of a cause, whether the proceedings be civil or criminal.

The system of life assurance is based upon the co-operation of the medical profession. Heredity, constitution, and diathesis are here the chief subjects of general consideration, while prognosis is the skilled faculty specially called into play.

Relations of Medicine to the Body Politic.— The statutes of the United Kingdom which have direct relation to medicine are (1) those relating to the public health; (2) those relating to lunacy (and habitual drunkenness); (3) those relating to the status of the medical profession, to dentists, and to pharmaceutical chemists; (4) those relating to restrictions on the “practice” of anatomy and physiology. There are, besides, several statutes in which medicine is concerned indirectly,—such as the Poor Laws, the Prisons Acts, the Shipping Acts, the Registration of Births and Deaths Act, the Sale of Food and Drugs Act, the Sale of Poisons Act, the Factory and Workshops Act, the Artisans’ Dwellings (Metropolitan) Act, the Rivers Pollution Prevention Act, the Contagious Diseases (Animals) Act (1878), and the Public Health (Water) Act.

1. Most of the statutes relating to the public health in England and Wales were consolidated by an Act of 1875, the Acts relating to the metropolis being excepted; there are separate statutes of about the same period for Ireland and Scotland. The system of administration is by local sanitary authorities, in correspondence with the local government boards in London and Dublin and the board of supervision in Edinburgh. The board in London has a medical department, consisting of a chief medical officer, assistant medical officer, and inspectors, while the Dublin and Edinburgh boards are professionally advised on a somewhat different system. The sanitary authorities throughout the United Kingdom are divided into rural, urban, port, and metropolitan (sanitary and nuisance); they are formed out of pre-existing bodies, either the corporations of cities and towns, the improvement commissioners, or the local authorities. A medical officer of health is attached to most of the several sanitary authorities, or to the combined sanitary authorities of a large district; his duties include making reports on the death-rate and the causes of mortality, the denunciation of nuisances and unwholesome dwellings, workshops, &c., inquiries into the local causes or favouring circumstances of epidemic outbreaks of disease, measures to prevent the spread of contagion (by disinfection, isolation, and otherwise), and other more occasional duties arising under a variety of statutes. Each sanitary authority is required by law to appoint an inspector of nuisances, who practically carries out the instructions of the medical officer when there is one.

The Vaccination Acts (consolidated 1871) are an important part of the public health law of the kingdom; they are administered by the local government board, for the most part through the agency of the medical profession at large, but in some populous parishes also by means of public vaccination stations. Prosecutions under the Acts are instituted by the parochial authorities. The practice formerly (and not unsuccessfully) resorted to of inoculating with the small-pox has been, made a criminal offence; but there is still much uncertainty as to the theory of vaccination, and, in particular, as to the relation of vaccinia to variola.

Other statutes which were not consolidated in the Public Health Act of 1875 are the Burials Act, the Contagious Diseases Act, and the Quarantine Act. The first of these is administered by a department of the home office, with a medical inspector. The second (1866 and 1869) relates, under a too general title, to the regulation of prostitution in certain garrison towns, the surgeons under the act being appointed by the board of admiralty or the secretary of state for war, and the administration otherwise carried out by the police.

The quarantine laws stand in the somewhat anomalous position of statutes which it is not thought desirable to repeal, while yet they are stripped bare of all their executive machinery. The Quarantine Act can be set in motion, as occasion arises, by an order of council; not only, however, is there no official medical advice at the disposal of the privy council, upon which action under the act might be taken, but there is not even the framework remaining (except the ghost of a quarantine station on the Motherbank between Portsmouth and the Isle of Wight) of the once considerable quarantine establishment, by which the provisions of the Act might be enforced. On the other hand, port sanitary authorities enjoy certain limited powers under the Public Health Acts of isolating vessels arriving with contagious sickness on board. A quarantine at British ports has not been put in force for many years, opinions being divided as to the abstract efficacy and suitableness of quarantine measures to prevent the importation and diffusion of plague, cholera, or yellow fever (see Quarantine).

Numerous instances having occurred of the extensive diffusion of scarlet fever, typhoid fever, and diphtheria by means of milk, the privy council has issued an order, under the Contagious Diseases (Animals) Act of 1878, called the Dairies, Milkshops, and Cowsheds Order, with the object of enforcing extreme cleanliness in the premises and appurtenances of the milk, trade, and particularly of guarding against the well-known liability of milk to take up effluvia existing or arising near it. The order of council having remained inoperative, it is proposed to deal with the matter by a new Act of Parliament, to be administered by the local government board. While cows’ milk has thus been recognized by the sanitary law as a carrier of certain of the human contagia, the milk of diseased cows, and more especially of tuberculous cows, continues to be sold with impunity, the alleged, communication of tubercular disease from the cow to man being difficult to prove to the satisfaction of the legislature. The want of constant supervision of the slaughter-houses is thought by many to be a serious defect in the sanitary law of the country; and there is no doubt that much flesh of diseased animals (especially the tuberculous) is sold merely as inferior meat.

Public Health Law of the United States.— Questions of public health in the United States come under the common law and the statute law. In the larger part of the Union they are subject to the common law only; in a certain number of the States there is statute law; and there has been since 1879 a national board of health and a quarantine law established by Act of Congress. Generally speaking, the public health procedure of the United States suffers from the want of organization. Decisions at common law relate chiefly to nuisances, and to the recovery of damages for loss caused by the same. The first attempt at statute law was an Act of 1866 creating a metropolitan sanitary district and board of health for the city of New York; in 1869 a board of health was created by the State legislature for Massachusetts; the District of Columbia obtained its board of health in 1870; and other States have followed at intervals, so that there are now at least nineteen State boards of health, New York State and Pennsylvania having health boards only for their respective capitals and other individual towns. Besides the municipal boards in those States, there are very few others for towns in the Union, and still fewer for counties. The powers and activity of the boards of health are very various; the Massachusetts board has powers amounting to that of a court, while the function of several of the State boards is hardly more than advisory. The sanitary statutes made by the State legislatures are in some cases very numerous. Wherever questions of quarantine for yellow fever have arisen, as in Louisiana (New Orleans), Georgia, and Alabama, the State board of health has acquired vigour and has enlisted popular support, in the capitals at least; but in most of the States laissez faire is the ordinary feeling towards the board and its operations. The medical profession in each State is the most powerful force, and the State medical society is not unfrequently in a semi-official connexion with the sanitary board; on the other hand, it is alleged that the unfortunate sectarian differences in medicine (represented chiefly by homoeopathy) have on several occasions prevented the formation of a State board of health, or have tended to paralyse the action of a board already existing. It is a charge also against boards of health, or at least against those in the great political centres, that their efficiency is apt to be impaired by the introduction of irrelevant political considerations in such matters as the making of appointments. The first step towards a national public health law was gained by the Act (approved 3d March 1879) “to prevent the introduction of infectious or contagious diseases into the United States, and to establish a national board of health.” The board consists of seven members appointed by the president and of four officials detached from the public departments of State. Its duties are “to obtain information upon all matters affecting the public health, to advise the several departments of the government, the executives of the several States, and the commissioners of the District of Columbia, on all questions submitted to them, or whenever, in the opinion of the board, such advice may tend to the preservation and improvement of the public health.” Quarantine was to be a special object of the board’s attention, especially the establishment, if possible, of a federal quarantine system which would preserve the legitimate commercial interests of the several States and their seaports. A quarantine law passed in 1879 provides that all vessels coming from any foreign port where contagious or infectious diseases exist shall obtain a bill of health from the consular officer of the United States at th⅛port of sailing. One of the principal functions of the national board of health hitherto has been to institute scientific inquiries into the nature and causation of diseases of national importance, such as malarial fever. Among the acknowledged desiderata in the national sanitary law of the United States are a uniform carrying out of the practice of vaccination—there is no vaccination law in certain States, and in others it is imperfectly applied—and a uniform system of registration of births and deaths. See Bowditch, Public Hygiene in America, together with a Digest of American Sanitary Law (by Pickering), Boston, 1877; Billings, Introduction to Hygiene and Public Health, edited by Buck (Eng. ed., London), and in the Transactions of the Internat. Medical Congress, London, 1880, vol. iv., sect. “Public Health.”

Public Health Law of other Countries.— In France there is a council of health for each district, composed of medical practitioners, pharmacists, engineers, and other experts, its function being purely advisory with respect to nuisances, unwholesome dwellings, schools, food, drugs, epidemics, and the like. The executive power rests with the prefect (to be carried out by the police), and is often not put in motion even when advice is tendered. In Paris there are two heads of executive, the prefect of the Seine and the prefect of police. The minister of agriculture and commerce is responsible to the chambers. In Prussia there is a certain amount of bureaucratic care of the public health under the ministry for ecclesiastical, educational, and medical affairs. The minister is advised by a scientific commission (Wissenschaftliche Deputation für das Medicinalwesen) ; and there is a subordinate board for each province, and a medical officer for each district or town (Kreisphysikus, or Stadtphysikus). Numerous offences against the public health are defined in the code, and penalties fixed (see Eulenberg’s work, taken from official sources, Das Medicinalwesen in Preussen, Berlin, 1874).

2. The lunacy laws have been fully treated of in a special section of the article Insanity (⅛.v.). By an Act of 1879 habitual drunkards have been placed in a position somewhat analogous to that of lunatics, and there are now existing certain licensed asylums for their detention.

3. The Acts relating to the status of the medical profession are known as the Medical Acts. The principal measure, passed in 1858, created a body of twenty-four, called the general council of medical education and registration; by a subsequent Act the council received a charter of incorporation, so that it might draw up, and become the publisher and proprietor of, a list and description of officinal drugs, which should be called the British Pharmacopoeia, and should supersede previous pharmacopoeias. The principal duty of the medical council is to keep a register of qualified medical practitioners. The preamble of the Act by which the medical register was created asserts the desirability of those in want of medical aid being able to distinguish qualified from unqualified practitioners; and those whose names are on the register are alone presumably qualified. To be a registered medical practitioner confers a certain positive legal status (right to sue for fees, hold appointments, give certificates, &c.); but there is nothing in the English law to prevent any person whomsoever from practising medicine and taking fees, provided he does not assume misleading titles. Those who are entitled (on payment of five pounds) to have their names inserted in the medical register are graduates in medicine or surgery of the universities of the United Kingdom, licentiates, members, or fellows of the Royal Colleges of Physicians or Surgeons in London, Dublin, and Edinburgh, licentiates or fellows of the Faculty of Physicians and Surgeons of Glasgow, and licentiates of the Apothecaries’ Halls of London and Dublin. The council consists of the representatives of those bodies, of six crown nominees, and the president. The medical council possesses certain judicial and executive powers over the names on its register; if, after due inquiry, a registered practitioner be judged by the medical council to have been guilty of infamous conduct in any professional respect, the medical council may, if they see fit, direct their registrar to erase the practitioner’s name from the register. The medical council keeps also a register (unpublished) of medical students; whoever has passed a recognized β examination in arts, and has forwarded a certificate signed by a teacher of medicine that he has bona fide begun the study of medicine, is entitled to have his name entered in the register of students of medicine, with the date of his commencement. The object of the students’ register is merely to provide a common and convenient record of the date of commencement of medical study, and, by implication, of the fact that the examination in arts has been passed.

The medical council owes its title of a “council of education” to certain powers possessed by it of visiting the examinations of the universities and corporations, and certain ill-defined powers of visiting the medical schools. The council may, if they see fit, report to the privy council any deficiencies that they may have discovered in the teaching or examining, and the privy council may proceed to further steps. But, beyond publishing the reports of their visitations, the medical council do not appear to have had occasion to put the machinery in force. The state has not otherwise interfered to prescribe the subjectmatter or the minimum standard of medical education, although there has been at least one unsuccessful attempt by the Government of the day to establish a uniform minimum. By an Act of 1876 parliament has interposed to affirm the principle that women are entitled to become registered practitioners of medicine.

Under the Dentists’ Act of 1878 the profession of dentistry acquired a legal status corresponding to that of the medical profession, the general medical council having charge of its register also.

Pharmaceutical chemists are now licensed under an Act passed in 1876; since that date licences are granted only to those who pass either the minor or the major examination of the Pharmaceutical Society of Great Britain, a Pharmacy Act for Ireland (1876) having corresponding provisions.

The Medical Profession in other Countries.— In the United States there are usually no restrictions upon the practice of medicine, and in only a few of the States has the medical profession any legal standing. The ordinary medical title is that of doctor of medicine, and that degree is conferred by a large number of institutions after a curriculum of study that varies much in length, and after examinations that are equally various as tests of proficiency. In France the medical profession is divided into two grades: those in the higher grade are all doctors of medicine of the faculties of Paris, Lille, Nancy, Bordeaux, Lyons, or Montpellier; those in the lower grade are officiers de santé. In Germany the right to practise is conferred by a state licence granted on passing the staats-examen-, the examination, which is almost entirely oral and practical, may be passed in stages at any one of the universities in the empire, the professors of anatomy, physiology, and pathological anatomy being practically ex officio examiners, while the other examiners are very frequently also professors in the medical faculty. The staats-examcn is usually passed before the candidate seeks the degree of doctor of medicine; that degree is almost always taken by those who j>ass the examination for the state licence, and it is usually conferred after a more or less formal examination of the candidate before the medical faculty, and on the approval of his thesis. In Austria, the right to practise is carried by the degree of doctor of medicine; there is no separate state licence, and no examination except that of the medical faculty of the universities (see Billroth’s Lehren and Lernen der medicinischen Wissenschaften, Berlin, 1876). In most Continental countries there are penalties directed in effect against practising medicine without the state licence, or the university degree equivalent thereto, and in France the law now extends to resident foreign practitioners who have qualified only in their own country. The regulations for the practice of pharmacy in Germany and other Continental countries have long l>een of a very stringent kind. The training and licensing of midwives is also under state control.

4. Lastly, the state has interposed to restrict the “practice” of anatomy and physiology. By the Anatomy Act of 1832 (amended in 1871) licences are required for schools of anatomy, as well as licences for teachers, “to practise anatomy.” Licensed teachers of anatomy are empowered to receive subjects for dissection under certain conditions. The Act is administered by the home office, with a staff of four inspectors of anatomy, one for the metropolis, one for provincial medical schools in England, and one each for Ireland and Scotland. The Act restricting the practice of physiology is the Vivisection Act of 1876; it is intended for the protection of vertebrate animals liable to be employed alive in physiological experiments, and it resorts to a controlling machinery of licence and inspection similar to that of the Anatomy Act, and under the same Government department. (c. c.)

PART II.—HISTORY.

The history of medicine falls naturally under two heads, or might be conceivably written from two different points of view. It might be a history of the medical profession or a history of medical doctrine,—in other words, the history of medicine in its relation to society or in its relation to science. We shall here deal chiefly with the history of medical knowledge, remembering also that the histories of anatomy, of physiology, and of surgery are dealt with in the articles referring to those subjects. But a still more trenchant limitation is necessary to preserve the unity of the subject. Attention can be given to so much only of the history as is directly antecedent to and leads up to the medical science of modern Europe. For this purpose, the history of medicine must start with the earlier period of Greek civilization.

Medicine as Portrayed in the Homeric Poems.— In the state of society pictured by Homer it is clear that medicine has already had a history. We find a distinct and organized profession; we find a system of treatment, especially in regard to injuries, which it must have been the work of long experience to frame; we meet with a nomenclature of parts of the body substantially the same (according to Daremberg) as that employed long afterwards in the writings of Hippocrates: in short, we find a science and an organization which, however imperfect as compared with those of later times, are yet very far from being in their beginning. The Homeric heroes themselves are represented as having considerable skill in surgery, and as able to attend to ordinary wounds and injuries, but there is also a professional class, represented by Machaon and Podalirius, the two sons of Asclepius, who are treated with great respect. It would appear, too, from the Aethiopis of Archinus (quoted by Weicker and Haeser) that the duties of these two were not precisely the same. Machaon’s task was more especially to heal injuries, while Podalirius had received from his father the gift of “recognizing what was not visible to the eye, and tending what could not be healed.” In other words, a rough indication is seen of the separation of medicine and surgery. Asclepius appears in Homer as a Thessalian king, not as a god, though in later times divine honours wer« paid to him. There is no sign in the Homeric poems of the subordination of medicine to religion which is seen in ancient Egypt and India, nor are priests charged, as they were in those countries, with medical functions,—all circumstances which throw grave doubts on the commonly received opinion that medicine derived its origin in all countries from religious observances.

Although the actual organization of medicine among the Homeric Greeks was thus quite distinct from religion, the worship of Asclepius (or Aesculapius) as the god of healing demands some notice. This cult spread very widely among the Greeks; it had great civil importance, and lasted even into Christian times; but there is no reason to attribute to it any special connexion with the development of the science or profession of medicine. Sick persons repaired, or were conveyed, to the temples of Asclepius in order to be healed, just as Jn modern times relief is sought by a devotional pilgrimage or from the waters of some sacred spring, and then as now the healing influence was sometimes sought by deputy. The sick person, or his representative, after ablution, prayer, and sacrifice, was made to sleep on the hide of the sacrificed animal, or at the feet of the statue of the god, while sacred rites were performed. In his sleep (incubatio, cγκoi-pycrtç) the appropriate remedy was indicated by a dream. Moral or dietetic remedies were more often prescribed than drugs. The record of the cure was inscribed on the columns or walls of the temple; and it has been thought that in this way was introduced the custom of “recording cases,” and that the physicians of the Hippocratic school thus learnt to accumulate clinical experience. But the priests of Asclepius were not physicians. Although the latter were often called Asclepiads, this was in the first place to indicate their real or supposed descent from Asclepius, and in the second place as a complimentary title. No medical writing of antiquity speaks of the worship of Asclepius in such a way as to imply any connexion with the ordinary art of healing. The two systems appear to have existed side by side, but to have been distinct, and if they were ever united it must have been before the times of which we have any record. The. theory of a development of Greek medicine from the rites of Asclepius, though defended by eminent names, must accordingly be rejected.

Development of Medicine in Greece.— It is only from non-nιedical writers that anything is known of the development of medicine in Greece before the age of Hippocrates. The elaborate collections made by Daremberg of medical notices in the poets and historians illustrate the relations of the profession to society, but do little to prepare us for the Hippocratic period. Nor is much importance to be attached to the influence of the philosophical sects on medicine except as regards the school of Pythagoras. That philosopher and several of his successors were physicians, but we do not know in what relation they stood to later medical schools. We must therefore hasten onward to the age of Pericles, in which Hippocrates, already called “the Great,” was in medicine as complete a representative of the highest efforts of the Greek intellect as were his contemporaries the great philosophers, orators, and tragedians. The medical art as we now practise it, the character of the physician as we now understand it, both date for us from Hippocrates. The justification of this statement is found in the literary collection of writings known by his name. Of these certainly many are falsely ascribed to the historical Hippocrates of Cos; others are almost as certainly rightly so ascribed; others again are clearly works of his school, whether from his hand or not. But which are to be regarded as the “genuine works” is still uncertain, and authorities are conflicting. There are clearly two schools represented in the collection,—that of Cnidus in a small proportion, and that of Cos in far the larger number of the works. The latter was that to which Hippocrates belonged, and where he gave instruction; and accordingly it may be taken that works of this school, when not obviously of a different date, are Hippocratic in doctrine if not in actual authorship.

Hippocratic Medicine.— The first grand characteristic of Hippocratic medicine is the high conception of the duties and status of the physician, shown in the celebrated “Oath of Hippocrates” and elsewhere,—equally free from the mysticism of a priesthood and the vulgar pretensions of a mercenary craft. So matured a professional sentiment may perhaps have been more the growth of time and organization than the work of an individual genius, but certainly corresponds with the character universally attributed to Hippocrates himself. The second great quality is the singular artistic skill and balance with which the Hippocratic physician used such materials and tools as he possessed. Here we recognize the true Greek σωφpaσwη. But this artistic completeness was closely connected with the third cardinal virtue of Hippocratic medicine,—the clear recognition of disease as being equally with life a process governed by what we should now call natural laws, which could be known by observation, and which indicated the spontaneous and normal direction of recovery, by following which alone could the physician succeed. In the fourth place, these views of the “natural history of disease” (in modern language) led to habits of minute observation and accurate interpretation of symptoms, in which the Hippocratic school was unrivalled in antiquity, and has been the model for all succeeding ages, so that even in these days, with our enormous advances in knowledge, the true method of clinical medicine may be said to be the method of Hippocrates.

The actual science of the Hippocratic school was of course very limited. In anatomy and physiology little advance had been made, and so of pathology in the sense · of an explanation of morbid processes or knowledge of diseased structures there could be very little. The most valuable intellectual possession was a large mass of recorded observations in individual cases and epidemics of disease. "Whether these observations were systematic or individual, and how they were recorded, are points of which we are quite ignorant, as the theory that the votive tablets in the temples supplied such materials must be abandoned.

Though the Hippocratic medicine was so largely founded on observation, it would be an error to suppose that dogma or theory had no place. The dominating theory of disease was the humoral, which has never since ceased to influence medical thought and practice. According to this celebrated theory, the body contains four humours,—blood, phlegm, yellow bile, and black bile, a right proportion and mixture of which constitute health; improper proportions or irregular distribution, disease. It is doubtful whether the treatise in which this theory is fully expounded (τrep'ι φvσιoς αr0pω7roυ) is as old as Hippocrates himself; but it was regarded as a Hippocratic doctrine, and, when taken up and expanded by Galen, its terms not only became the common property ’of the profession, but passed into general literature and common language. Another Hippocratic doctrine, the influence of which is not even yet exhausted, is that of the healing power of nature. Not that Hippocrates taught, as he was afterwards reproached with teaching, that nature is sufficient for the cure of diseases; for he held strongly the efficacy of art. But he recognized, at least in acute diseases, a natural process which the humours went through,—being first of all crude, then passing through coction or digestion, and finally being expelled by resolution or crisis through one of the natural channels of the body. The duty of the physician was to foresee these changes, “to assist or not to hinder them,” so that “the sick man might conquer the disease with the help of the physician.” The times at which crises were to be expected were naturally looked for with anxiety; and it was a cardinal point in the Hippocratic system to foretell them with precision. Hippocrates, influenced as is thought by the Pythagorean doctrines of number, taught that they were to be expected on days fixed by certain numerical rules, in some cases on odd, in others on even numbers,—the celebrated doctrine of “critical days.” This false precision can have had no practical value, but may have enforced habits of minute observation. It follows from what has been said that prognosis, or the art of foretelling the course and event of the disease, was a strong point with the Hippocratic physicians. In this they have perhaps never been excelled. Diagnosis, or recognition of the disease, must have been necessarily imperfect, when no scientific nosology, or system of disease, existed, and the knowledge of anatomy was quite inadequate to allow of a precise determination of the seat of disease; but symptoms were no doubt observed and interpreted skilfully. The pulse is not spoken of in any of the works now attributed to Hippocrates himself, though it is mentioned in other works of the collection.

In the treatment of disease, the Hippocratic school attached great importance to diet, the variations necessary-in different diseases being minutely defined. Medicines were regarded as of secondary importance, but not neglected, two hundred and sixty-five drugs being mentioned at different places in the Hippocratic works. Blood-letting was known, but not greatly practised. The highest importance was attached to applying all remedies at the right moment, and the general principle enforced of making all influences—internal and external—co-operate for the relief of the patient. The principles of treatment just mentioned apply more especially to the cure of acute diseases; but they are the most salient characteristics of the Hippocratic school. In chronic cases diet, exercise, and natural methods were chiefly relied upon.

The school of Cnidus, as distinguished from that of Cos, of which Hippocrates is the representative, appears to have differed in attaching more importance to the differences of special diseases, and to have made more use of drugs. A treatise on the diseases of women, contained in the Hippocratic collection, and of remarkable practical value, is attributed to this school.

The above sketch of Hippocratic medicine will make it less necessary to dwell upon the details relating to subsequent medical schools or sects in ancient times. The general conception of the physician’s aim and task remained the same, though, as knowledge increased, there was much divergence both in theory and practice,— even opposing schools were found to be developing some part of the Hippocratic system. Direct opponents or repudiatore of the authority of Hippocrates were rare, all generally appealing to his authority. But, insensibly, the least valuable part of the Hippocratic work, the theory, was made permanent; the most valuable, the practical, neglected.

Post-Hippocratic Medicine.— After Hippocrates the progress of medicine in Greece does not call for any special remark in such a sketch as this, but mention must be made of one great name. Though none of Aristotle’s writings are strictly medical, he has by his researches in anatomy and physiology contributed greatly to the progress of medicine. It should also be remembered that he was of an Asclepiad family, and received that partly medical education which was traditional in such families, and also himself is said to have practised medicine as an amateur. Moreover, his works on natural history doubtless furthered the progress among the Greeks of sciences tributary to medicine, though the only specimens of such works which have come down to us from the Peripatetic school are those of Theophrastus, who may be considered the founder of the scientific study of botany. Among his encyclopaedic writings were some on medical subjects, of which fragments only have been preserved. The Peripatetic school may have been more favourable to the development of medicine, as of other departments of natural knowledge, than any other; but there is no evidence that any of the philosophical schools had important influence on the progress of medicine. The fruit of Aristotle’s teaching and example was seen later on in the schools of Alexandria.

The century after the death of Hippocrates is a time almost blank in medical annals. It is probable that the science, like others, shared in the general intellectual decline of Greece after the Macedonian supremacy; but the works of physicians of the period are almost entirely lost, and were so even in the time of Galen. Galen classes them all as of the dogmatic school; but, whatever may have been their characteristics, they are of no importance in the history of the science.

Alexandrian School of Medicine.— The dispersion of Greek science and intellectual activity through the world by the conquests of Alexander and his successors led to the formation of more than one learned centre, in which medicine among other sciences was represented. Pergamum was early distinguished for its medical school; but in this as in other respects its reputation was ultimately effaced by the more brilliant fame of Alexandria. It is here that the real continuation and development of Hippocratic medicine can be traced.

In one department the Alexandrian school rapidly surpassed its Greek original, namely, in the study of anatomy The dissection of the human body, of which some doubtful traces or hints only are found in Greek times, was assiduously carried out, being favoured or even suggested perhaps by the Egyptian custom of disembowelling and embalming the bodies of the dead. There is no doubt that the organs were also examined by opening the bodies of living persons,—criminals condemned to death being given over to the anatomists for this purpose.

Two eminent names stand in the first rank as leaders of the two earliest schools of medicine which arose in Alexandria, Herophilus and Erasistratus.

Herophilus was a Greek of Chalcedon, a pupil of the schools both of Cos and of Cnidus. He was especially noted for his profound researches in anatomy (see vol. i. p. 802), and in the knowledge and practice of medicine he appears to hâve been equally renowned. He professed himself a close adherent of Hippocrates, and adopted his theory of the humours. He also made extensive use of drugs, and of bleeding. The reputation of Herophilus is attested by the fact that four considerable physicians wrote works about him and his writings, and he is further spoken of with the highest respect by Galen and Celsus. By the general voice of the medical world of antiquity be was placed only second to Hippocrates.

Erasistratus was the contemporary and rival of Herophilus. Little is known of his life, except that he spent some time at the court of Seleucus Nicator at Antioch before coming to Alexandria, and that he cultivated anatomy late in life, after he had taken up his abode in the latter city. His numerous works are also almost entirely lost, fragments only being preserved by Galen and others. Erasistratus, instead of following Hippocrates as Herophilus did, depreciated him, and seems to have been rather aggressive and independent in his views. He appears to have leaned to mechanical explanations of the symptoms of disease, as was especially the case with inflammation, of which he gave the first rational, though necessarily inadequate, theory.

The two schools composed of the followers of Herophilus and Erasistratus respectively long divided between them the medical world of Alexandria. The names of many prominent members of both sects have been preserved, but it would be useless to repeat them. The Herophilists still reverenced the memory of Hippocrates, and wrote numerous commentaries on his works. They produced many eminent anatomists, but in the end seem to have become lost in theoretical subtleties, and to have maintained too high a standard of literary cultivation. The school of Erasistratus was less distinguished in anatomy than that of Herophilus, but paid more attention to the special symptoms of diseases, and employed a great variety of drugs. It was longer-lived than that of Herophilus, for it still numbered many adherents in the 2d century after Christ, a century after the latter had become extinct.

The Erasistrateans paved the way for what was in some respects the most important school which Alexandria produced, that known as the empiric, which, though it recognized no master by name, may be considered to have been founded by Philinus of Cos (280 b,c.), a pupil of Herophilus; but Serapion, a great name in antiquity, and Glaucias of Tarentum, who traced the empirical doctrine back to the writings of Hippocrates, are also named among its founders. The most striking peculiarity of the empirics was that they rejected anatomy, regarding it as useless to inquire into the causes of things, and thus, as they contended, being the more minute in their observation of the actual phenomena of disease. They professed that their whole practice was based upon experience, to which word they gave a special meaning. Three sources, and three only, could experience draw from :—observation, history (i.e., recorded observation), and judgment by analogy. These three bases of knowledge were known as the “tripod” of the empirics. It should not, however, be forgotten that the empirics read and industriously commented on the works of Hippocrates. They were extremely successful in practical matters, especially in surgery and in the use of drugs, and a large part of the routine knowledge of diseases and remedies which became traditional in the times of the Roman empire is believed to have been derived from them. In the 2d century the school became closely connected with the philosophical sect of the Sceptics, whose leader, Sextus, was an empirical physician. It lived and flourished far beyond this time, when transplanted to Rome, not less than in its native Alexandria, and appears to be recognizable even up to the beginning of the Middle Ages.

If we look at the work of the Alexandrian schools in medicine as a whole, we must admit that the progress made was great and permanent. The greatest service rendered to medicine was undoubtedly the systematic study of anatomy. It is clear that the knowledge of function (physiology) did not by any means keep pace with the knowledge of structure, and this was probably the reason why the important sect of the empirics were able entirely to dispense with anatomical knowledge. The doctrines of Hippocrates, though lightly thought of by the Erasistra-teaus, still were no doubt very widely accepted, but the practice of the Hippocratic school had been greatly improved in almost every department,—surgery and obstetrics being probably those in which the Alexandrian practitioners could compare most favourably with those of modern times. We have now to trace the fortunes of this body of medical doctrine and practice when transplanted to Rome, and ultimately to the -whole Roman world.

Roman Medicine.— The Romans cannot be said to have at any time originated or possessed an independent school of medicine. They had from early times a very complicated system of superstitious medicine, or religion, related to disease and the cure of disease, borrowed, as is thought, from the Etruscans; and, though the saying of Pliny that the Roman people got on for six hundred years without doctors was doubtless an exaggeration, and not, literally speaking, exact, it must be accepted for the broad truth which it contains. When a medical profession appears, it is, so far as we are able to trace it, as an importation from Greece.

The first Greek physician whose name is preserved as having migrated to Rome was Archagathus, who came over from the Peloponnesus in 218 b c.; but there were probably others before him. When Greece was made a Roman province, the number of such physicians who sought their fortunes in Rome must have been very large. The bitter words of Μ. Porcius Cato, wflιo disliked them as he did other representatives of Greek culture, are evidence of this. The most eminent of these earlier Greek physicians at Rome was Asclepiades, the friend of Cicero (born 124 b.c. at Prusa in Bithynia). He came to Rome as a young man, and soon became distinguished both for his medical skill and his oratorical power. He introduced a system which, so far as we know, was his own, though founded upon the Epicurean philosophical creed; on the practical side it conformed pretty closely to the Stoic rule of life, thus adapting itself to the leanings of the better stamp of Romans in the later times of the republic. According to Asclepiades all diseases depended upon alterations in the size, number, arrangement, or movement of the “atoms,” of which, according to the doctrine of Epicurus, the body consisted. These atoms were united into passages (7r0p0ι) through which the juices of the body were conveyed. This doctrine, of which the developments need not further be followed, was important chiefly in so far that it was perfectly distinct from, and opposed to, the humoral pathology of Hippocrates. In the treatment of disease Asclepiades attached most importance to diet, exercise, passive movements or frictions, and the external use of cold water,—in short, to a modified athletic training. He rejected the vis medicatrix naturae, pointing out that nature in many cases not only did not help but marred the cure. His knowledge of disease and surgical skill were, as appears from the accounts given by Celsus and Coelius Aurelianus, very considerable. Asclepiades had many pupils, who adhered more or less closely to his doctrines, but it was especially one of them, Themison, who gave permanence to the teachings of his master by framing out of them, with some modifications, a new system of medical doctrine, and founding on this basis a school which lasted for some centuries in successful rivalry with the Hippocratic tradition, which, as we have seen, was up to that time the prevailing influence in medicine.

This system was known as methodism, its adherents as the methodici or methodists. Its main principles were that it was useless to consider the causes of a disease, or even the organ affected by the disease, and that it was sufficient to know what was common to all diseases, viz., their common qualities (communitates, κοινότητες). Of these there were three possible forms—(1) relaxation, (2) contraction of the minute passages or πόροι, and (3) a mixed state, partly lax, partly constricted. The signs of these morbid states were to be found in the general constitution of the body, especially in the excretions. Besides this it was important only to consider whether the disease was acute or chronic, whether it was increasing, declining, or stationary. Treatment of disease was directed not to any special organ, nor to producing the crises and critical discharges of the Hippocratic school, but to correcting the morbid common condition or “community,” relaxing the body if it was constricted, causing contraction if it was too lax, and in the “mixed state” acting according to the predominant condition. This simple rule of treatment was the system or “method” from which the school took its name.

The methodists agreed with the empirics in one point, in their contempt for anatomy; but, strictly speaking, they were dogmatists, though with a dogma different from that of the Hippocratic school. Besides Themison, its systematic founder, the school boasted many physicians eminent in their day, among whom Thessalus of Tralles, a half-educated and boastful pretender, was one of the most popular. He reversed the Hippocratic maxim “art is long,” promising his scholars to teach them the whole of medicine in six months, and had inscribed upon his tomb ίατρονίκης, as being superior to all living and bygone physicians.

In the 2d century a much greater name appears among the methodists, that of Soranus of Ephesus, a physician mentioned with praise even by Tertullian and Augustine, who practised at Rome in the reigns of Trajan and Hadrian. Soranus is known by a work, still extant in the Greek original, on the diseases of women, and also by the Latin work of Coelius Aurelianus, three centuries later, on acute and chronic diseases, which is based upon, if not, as some think, an actual translation of, the chief work of Soranus, and which is the principal source of our knowledge of the methodic school. The work on diseases of women is the only complete work on that subject which has come down to us from antiquity, and shows remarkable fulness of practical knowledge in relation to its subject. It is notable that an important instrument of research, the speculum, which has been reinvented in modern times, was used by Soranus; and specimens of still earlier date, showing great mechanical perfection, have been found among the ruins of Pompeii. The work on acute and chronic diseases is also full of practical knowledge, but penetrated with the theories of the methodists.

The methodic school lasted certainly for some centuries, and influenced the revival of medical science in the Middle Ages, though overshadowed by the greater reputation of Galen. It was the first definite product of Greek medicine on Roman soil, but was destined to be followed by others, which kept up a more or less successful rivalry with it, and with the Hippocratic tradition.

The so-called pneumatic school was founded by Athenaeus, in the 1st century after Christ. According to its doctrines the normal as well as diseased actions of the body were to be referred to the operation of the pneuma or universal soul. This doctrine, crudely transferred from philosophical speculation, was intended to reconcile the humoral (or Hippocratic) and solidist (or methodic) schools; but the methodists seem to have claimed Athenaeus as one of themselves.

The conflicts of the opposing schools, and the obvious deficiencies of each, led many physicians to try and combine the valuable parts of each system, and to call themselves eclectics. Among these were found many of the most eminent physicians of Graeco-Roman times. It may be sufficient to name Rufus of Ephesus, and Archigenes, who is mentioned by Juvenal.

Although no system or important doctrine of medicine was originated by the Roman intellect, and though the practice of the profession was probably almost entirely in the hands of the Greeks, the most complete picture which we have of medical thought and activity in Roman times is due to a Latin pen, and to one who was, in all probability, not a physician. A. Cornelius Celsus, a Roman patrician, who lived probably in the first century, appears to have studied medicine as a branch of general knowledge. Whether he was a practising physician or not has been a matter of controversy. The conclusion supported by most evidence seems to be that he practised on his friends and dependants, but not as a remunerative profession. His well-known work, De Medicina, was one of a series of treatises intended to embrace all knowledge proper for a man of the world. It was not meant for the physicians, and was certainly little read by them, as Celsus is quoted by no medical writer, and when referred to by Pliny is spoken of as an author, not a physician. There is no doubt that his work is chiefly a compilation; and Daremberg, with other scholars, has traced a large number of passages of the Latin text to the Greek originals from which they were translated. In the description of surgical operations the vagueness of the language seems sometimes to show that the author had not performed such himself; but in other parts, and especially in his historical introduction, he speaks with more confidence; and everywhere he compares and criticizes with learning and judgment. The whole body of medical literature belonging to the Hippocratic and Alexandrian times is ably summarized, and a knowledge of the state of medical science up to and during the times of the author is thus conveyed to us which can be obtained from no other source. The work of Celsus is thus for us only second in importance to the Hippocratic writings and the works of Galen; but it is valuable rather as a part of the history oi medicine than, as the subject of that history. It forms no link in the general chain of medical tradition, for the simple reason that the influence of Celsus (putting aside a few scanty allusions in mediaeval times) commenced in the 15th century, when his works were first discovered in manuscript or committed to the press. Since then, however, he has been almost up to our own times the most popular and widely-read of all medical classics, partly for the qualities already indicated, partly because he was one of the few of those classics accessible to readers of Latin, and partly also because of the purity and classical perfection of his language.

Of Pliny, another encyclopaedic writer, a few words must be said, though he was not a physician. In his Natural History we find as complete a summary of the popular medicine of his time as Celsus gives of the scientific medicine. Pliny disliked doctors, and lost no opportunity of depreciating regular medicine; nevertheless he has left many quotations from, and many details about, medical authors which are of the highest value. He is useful to us for what he wrote about the history of medicine, not for what he contributed. Like Celsus, he had little influence on succeeding medical literature or practice.

We now come to the writer who, above all others, gathered up into himself the divergent and scattered threads of ancient medicine, and out of whom again the greater part of modern European medicine has flowed. Galen (see vol. i. 803 and x. 23) was a man furnished with all the anatomical, medical, and philosophical knowledge cf his time; he had studied all kinds of natural curiosities, and had stood in near relation to important political events; he possessed enormous industry, great practical sagacity, and unbounded literary fluency. He had, in fact, every quality necessary for an encyclopaedic writer, or even for a literary and professional autocrat. He found the medical profession of his time split up into a number of sects, medical science confounded under a multitude of dogmatic systems, the social status and moral integrity of physicians degraded. He appears to have made it his object to reform these evils, to reconcile scientific acquirements and practical skill, to bring back the unity of medicine as it had been understood by Hippocrates, and at the same time to raise the dignity of medical practitioners.

Galen was as devoted to anatomical and, so far as then understood, physiological research as to practical medicine. He worked enthusiastically at dissection, though, the liberty of the Alexandrian schools no longer existing, he could dissect only animals, not the human body. In his anatomical studies Galen had a twofold object,—a philosophical, to show the wisdom of the Creator in making everything fit to serve its purpose, and a practical, to aid the diagnosis, or recognition, of disease. The first led him into a teleological system so minute and overstrained as to defeat its own end; the second was successfully attained by giving greater precision and certainty to medical and surgical practice in difficult cases. His general physiology was essentially founded upon the Hippocratic theory of the four elements, with which he combined the notion of spirit (pneuma) penetrating all parts, and mingled with the humours in different proportions. It was on this field that he most vehemently attacked the prevailing atomistic and materialistic views of the methodic school, and his conception of the pneuma became in some respects half metaphysical. His own researches in special branches of physiology were important, but do not strictly belong to our present subject.

The application of physiology to the explanation of diseases, and thus to practice, was chiefly by the theory of the temperaments or mixtures which Galen founded upon the Hippocratic doctrine of humours, but developed with marvellous and fatal ingenuity. The normal condition or temperament of the body depended upon a proper mixture or proportion of the four elements—hot, cold, wet, and dry. From faulty proportions of the same arose the intemperies (“distempers ”), which, though not diseases, were the occasions of disease. Equal importance attached to faulty mixtures or dyscrasiae of the blood. By a combination of these morbid predispositions with the action of deleterious influences fromwithout all diseases were produced. Galen showed extreme ingenuity in explaining all symptoms and all diseases on his system. No phenomenon was without a name, no problem without a solution. And, though it was precisely in his fine-spun subtlety that he departed farthest from scientific method and practical utility, it was this very quality which seems in the end to have secured his popularity and established his pre-eminence in the medical world.

Galen’s use of drugs was influenced largely by the same theories. In drugs were to be recognized the same elementary qualities—hot, cold, moist, dry, &c.—as in the human body; and, on the principle of curing by contraries, the use of one or other was indicated. The writings of Galen contain less of simple objective observation than those of several other ancient physicians, all being swept into the current of dogmatic exposition. But there is enough to show the thoroughness and extent of his practical knowledge. Unfortunately it was neither this nor his zeal for research that chiefly won him followers, but the completeness of his theoretical explanations, which fell in with the mental habits of succeeding centuries, and were such as have flattered the intellectual indolence of all ages. But the reputation of Galen grew slowly; he does not appear to have enjoyed any pre-eminence over other physicians of his time, to most of whom he was strongly opposed in opinion. In the next generation he began to be esteemed only as a philosopher; gradually his system was implicitly accepted, and it enjoyed a great though not exclusive predominance till the fall of Roman civilization. When the Arabs possessed themselves of the scattered remains of Greek culture, the works of Galen were more highly esteemed than any others except those of Aristotle. Through the Arabs the Galenical system found its way back again to Western Europe. Even when Arabian medicine gave way before the direct teaching of the Greek authors rescued from neglect, the authority of Galen was increased instead of being diminished; and he assumed a position of autocracy in medical science which was only slowly undermined by the growth of modern science in the 17th and 18 th centuries.

But the history of medicine in Roman times is. by no means the same thing as the history of the fate of the works of Galen. For some centuries the methodic school was popular at Rome, and produced one physician, Coelius Aurelianus, who must be pronounced, next to Celsus, the most considerable of the Latin medical writers. His date was in all probability the end of the 4th or beginning of the 5th century. The works bearing his name are, as has been said, entirely based upon the Greek of Soranus, but are important both because their Greek originals are lost, and because they are evidence of the state of medical practice in his own time. The popularity of Ccelius is evidenced by the fact that in the 6th century an abridgment of his larger work was recommended by Cassiodorus to the Benedictine monks for the study of medicine.

Before quitting this period the name of Aretaeus of Cappadocia must be mentioned. So little is known about him that even ħis date cannot be fixed more closely than as being between the second half of the 1st century and the beginning of the 3d. His works have been much admired for the purity of the Greek style, and his accurate descriptions of disease; but, as he quotes no medical author, and is quoted by none before Alexander of Aphrodisias at the beginning of the 3d century, it is clear that he belonged to no school and founded none, and thus his position in the chain of medical tradition is quite uncertain. Alexander of Aphrodisias, who lived and wrote at Athens in the time of Septimius Severus, is best known by his commentaries on Aristotle, but also wrote a treatise on fevers, still extant.

Ancient Medicine after Galen.— The Byzantine school of medicine, which closely corresponds to the Byzantine literary and historical schools, followed closely in Galen’s footsteps, and its writers were chiefly compilers and encyclopaedists. The earliest is Oribasius (326-403), whose date and position are fixed by his being the friend and court physician of Julian the Apostate. He was a Greek of Pergamum, educated in Alexandria, and long resident in Byzantium. His great work Svvαγωγαι ιaτpικal, of which only about one-third has been preserved, was a medical encyclopaedia founded on extracts from Hippocrates, Galen, Dioscorides, and certain Greek writers who are otherwise very imperfectly known. The work is thus one of great historical value but of no originality. The next name which requires to be mentioned is that of Aetius (550 A.D.), a compiler who closely followed Oribasius, but with inferior powers, and whose work also has an historical but no original value. A higher rank among medical writers is assigned to Alexander of Tralles (525-605), whose doctrine was that of an eclectic. His practical and therapeutical rules are evidently the fruit of his own experience, though it would be difficult to attribute to him any decided advance in medical knowledge. But the most prominent figure in Byzantine medicine is that of Paul of Aegina (Paulus Aegineta), who lived probably in the early part of the 7th century. His skill, especially in surgery, must have been considerable, and his ’Ιατρικά gives a very complete picture of the achievements of the Greeks in this department. Another work, on obstetrics, now lost, was equally famous, and procured for him, among the Arabs, the name of “the Obstetrician.” His reputation lasted through the Middle Ages, and was not less in the Arabian schools than in the West. In this respect Paulus is a most important influence in the development of medicine. His great work on surgery was early translated into Arabic, and became the foundation of the surgery of Abulcasis, which in turn (to anticipate) was one of the chief sources of surgical knowledge to Europe in the Middle Ages. The succeeding period of Byzantine history was so little favourable to science that no name worthy of note occurs again (though many medical works of this period are still extant) till the 13th century, when we meet with a group of writers;—Demetrius Pepagomenus, Nicolaus Myrepsus, and Johannes, called Actuarius, who flourished under the protection of the Palaeologi. The work of the last has some independent merit; but all are interesting as showing a fusion of Greek and Arabian medicine, the latter having begun to exercise even in the 11th century a reflex influence on the schools of Byzantium. Something was borrowed even from the school of Salerno, and thus the close of Byzantine medicine is brought into connexion with the dawn of science in modern Europe.

In the West the period after Galen affords little evidence of anything but a gradual though unvarying decline in Roman medicine. Ccelius Aurelianus, already referred to as the follower of Soranus, must be mentioned as showing the persistence of the methodic school. An abridgment of one of his writings, with the title of A urelius, became the most popular of all Latin medical works. As a writer he was worthy of a better period of medical literature. Little else was produced in these times but compilations, of the most meagre kind, chiefly of the nature of herbals, or domestic receipt-books; among the authors of which it may be sufficient to name Serenus Sammonicus (3d century), Gargilius Martialis (3d century), and Marcellus Empiricus (5th century). Certain compilations still extant bear the falsely-assumed names of eminent writers, such as Pliny and Hippocrates. A writer with the (perhaps assumed) name of Apuleius Platonicus produced a herbal which held its ground till the 15th century at least, and was in the 9th translated into Anglo-Saxon. These poor compilations, together with Latin translations of certain works of Galen and Hippocrates, formed a medical literature, meagre and unprogressive indeed, but of which a great part survived through the Middle Ages till the discovery of printing and revival of learning. It is important to remember that this obscure stream of tradition flowed on, only partially affected by the influx of Arabian, or even the early revival of purer classical learning.

Arabian Medicine.— The rise of the Mohammedan empire, which influenced Europe so deeply both politically and intellectually, made its mark also in the history of medicine. As in the parallel case of the Roman conquest of Greece, the superior culture of the conquered race asserted its supremacy over their Arab conquerors. After the Mohammedan conquests became consolidated, and learning began to flourish, schools of medicine, often connected with hospitals and schools of pharmacy, arose in all the chief seats of Moslem power. At Damascus Greek medicine was zealously cultivated with the aid of Jewish and Christian teachers. In Baghdad, under the rule of Hârün el Rashid and his successors, a still more flourishing school arose, where numerous translations of Greek medical works were made. The names of Mesua, or Yahyâibn Mâsawaih (ob. 213 a.h., 857-8 a.d.), celebrated for his knowledge of drugs, and Honein ibn Ishak el ’Ibadi (ob. 873) or Joannitius, the translator and commentator of Hippocrates and Galen, belong to this period. Certain writings of Joan-ιιitius, translated into Latin, were popular in the Middle Ages in Europe, and were printed in the 16th century. At the same time the Arabs became acquainted with Indian medicine, and Indian physicians lived at the court of Baghdad. The Islamite rulers in Spain were not long behind those of the East in encouraging learning and medical science, and developed culture to a still higher degree of perfection. In that country much was due to the Jews, who had already established schools in places which were afterwards the seats of Moslem dominion. From the 10th to the 13th century was the brilliant period of ∕irabian medicine in Spain.

The classical period of Arabian medicine begins with Rhazes (Abri Bakr Mohammed ibn Zakariyâ el-Râzf, 313 A.H., 925-26 A.D.), a native of Ray in the province of Dailam (Persia), who practised with distinction at Baghdad; he followed the doctrines of Galen, but learnt much from Hippocrates. He was the first of the Arabs to treat medicine in a comprehensive and encyclopaedic manner, surpassing probably in voluminousness Galen himself, though but a small proportion of his works are extant. Rhazes is deservedly remembered as having first described small-pox and measles in an accurate manner. Haly, 7.c.,' t Ali ibn el- t Abbhs (ob. 994), a Persian, wrote a medical text-book, known as the “Royal Book,” which was the standard authority among the Arabs up to the time of Avicenna, and was more than once translated into Latin and printed. Other writers of this century need not be mentioned here; but the next, the 11th century, is given as the probable though uncertain date of a writer who had a great influence on European medicine, Mesua the younger of Damascus, whose personality is obscure, and of whose very existence some historians have doubted, thinking that the name was assumed by some mediaeval Latin writer. The work De Simplicibus, which bears his name, was for centuries a standard authority on what would now be called materia medica, was printed in twenty-six editions in the 15th century and later, and was used in the formation of the first London pharmacopoeia, issued by the College of Physicians in the reign of James I. Either to the 10th or the 11th century must be referred the name of another Arabian physician who has also attained the position of a classic, Abu’l Kâsim, or Abulcasis, of El-Zahra, near Cordova in Spain. His great work, Altasrif y a medical encyclopaedia, is chiefly valued for its surgical portion (already mentioned), which was translated into Latin in the 12th century, and was for some centuries a standard if not the standard authority on surgery in Europe. Among his own countrymen the fame and position of Abulcasis were soon eclipsed by the greater name of Avicenna (Ibn Sinà).

Avicenna (see vol. iii. p. 152 sq.) has always been regarded as the chief representative of Arabian medicine. He wrote on philosophy also, and in both subjects acquired the highest reputation through the whole of Eastern Islam. In Mohammedan Spain he was less regarded, but in Europe his works even eclipsed and superseded those of Hippocrates and Galen. His style and expository power are highly praised, but the subject-matter shows little originality. The work by which he is chiefly known, the celebrated tt canon,” is an encyclopaedia of medical and surgical knowledge, founded upon Galen, Aristotle, the later Greek physicians, and the earlier Arabian writers, singularly complete and systematic, but is thought not to show the practical experience of its author. As in the case of Galen, the formal and encyclopaedic character of Avicenna’s works was the chief cause of his popularity and ascendency, though in modern times these very qualities in a scientific or medical writer would rather cause him to become more speedily antiquated.

In the long list of Arabian medical writers none can here be mentioned except the great names of the Hispano-Moorish school, a school both philosophically and medically antagonistic to that of Avicenna. Of these the earliest is Avenzoar, or Abumeron, that is, Abù Merw.4n ’Abd el-Malik Ibn Zohr (1113-62), a member of a family which gave several distinguished members to the medical profession. His chief work, Al-Teysîr (facilitatio), is thought to show more practical experience than the writings of Avicenna, and to be less based upon dialectical subtleties. It was translated into Latin, and more than once printed, as were some of his lesser works, which thus formed a part of the contribution made by the Arabians to European medicine. His friend and pupil Averroes of Cordova (q.v. ∖ so well known for his philosophical writings, was also an author in medical subjects, and as such widely read in Latin. The famous Rabbi Maimonides (<2 ’.v.) closes for us the roll of medical writers of the Arabian school. His works exist chiefly in the original Arabic or in Hebrew translations; only some smaller treatises have been translated into Latin, so that no definite opinion can be formed as to their medical value. But, so far as is known, the independent and rationalistic spirit which the two last-named writers showed in philosophy did not lead them to take any original point of view in medicine.

The works of the Arabian medical writers who have now been mentioned form a very small fraction of the existing literature. Three hundred medical writers in Arabic are enumerated by Wüstenfeld, and other historians have enlarged the list (Haeser), but only three have been printed in the original; a certain number more are known through old Latin translations, and the great majority still exist in manuscript. It is thus evident that the circumstance of having been translated (which may have been in some cases almost an accident) is what has chiefly determined the influence of particular writers on Western medicine. But it is improbable that further research will alter the general estimate of the value of Arabian medicine. There can be no doubt that it was in the main Greek medicine, modified to suit other climates, habits, and national tastes, and with some important additions from Oriental sources. The greater part is taken from Hippocrates, Galen, Dioscorides, and later Greek writers. The Latin medical writers were necessarily unknown to the Arabs; and this was partly the cause that even in Europe Galenic medicine assumed such a preponderance, the methodic school and Celsus being forgotten or neglected. In anatomy and physiology the Arabians distinctly went back; in surgery they showed no advance upon the Greeks; in practical medicine nothing new can be traced, except the description of certain diseases (e.g., small-pox and measles) unknown or imperfectly known to the Greeks; the only real advance was in pharmacy and the therapeutical use of drugs. By their relations with the further East, the Arabs became acquainted with valuable new remedies which have held their ground till modern times; and their skill in chemistry enabled them to prepare new chemical remedies, and form many combinations of those already in use. They produced the first pharmacopoeia, and established the first apothecaries’ shops. Many of the names and many forms of medicines now used, and in fact the general outline of modern pharmacy, except so far as modified by modern chemistry, started with the Arabs. Thus does Arabian medicine appear as judged from a modern standpoint; but to mediaeval Europe, when little but a tradition remained of the great ancient schools, it was invested with a far higher degree of originality and importance.

It is now necessary to consider what was the state of medicine in Europe after the fall of the Western empire and before the influence of Arabian science and literature began to be felt. This we may call the pre-Arabian or Salernitan period.

Medicine in the Early Middle Ages: School of Salerno. •—In medical as in civil history there is no real break. A continuous thread of learning and practice must have connected the last period of Roman medicine already mentioned with the dawn of science in the Middle Ages. But the intellectual thread is naturally traced with greater difficulty than that which is the theme of civil history; and in periods such as that from the 5th to the 10th century in Europe it is almost lost. The chief homes of medical as of other learning in these disturbed times were the monasteries. Though the science was certainly not advanced by their labours, it was saved from total oblivion, and many ancient medical works were preserved either in Latin or vernacular versions. The “Anglo-Saxon Leechdoms” of the 11th century, published in the Master of the Rolls series of mediaeval chronicles and memorials, admirably illustrate the mixture of magic and superstition with the relics of ancient science which constituted monastic medicine. Similar works, in Latin or other languages, exist in manuscript in all the great European libraries. It was among the Benedictines that the monastic study of medicine first received a new direction, and aimed at a higher standard. The study of Hippocrates, Galen, and other classics was recommended by Cassiodorus (6th century), and in the original mother-abbey of Monte Cassino medicine was studied; but there was not there what could be called a medical school ; nor had this foundation any connexion (as has been supposed) with the famous school of Salerno.

The origin of this, the most important source of medical knowledge in Europe in the early Middle Ages, is involved in obscurity. It is known that Salerno, a Roman colony, in a situation .noted in ancient times for its salubrity, was in the Gth century at least the seat of a bishopric, and at the end of the 7th century of a Benedictine monastery, and that some of the prelates and higher clergy were distinguished for learning, and even for medical acquirements. But it has by recent researches been clearly established that the celebrated Schola Salernitana was a purely secular institution. All that can with certainty be said is that a school or collection of schools gradually grew up in which especially medicine, but also, in a subordinate degree, law and philosophy were taught. In the 9th century Salernitan physicians were already spoken of, and the city was known as Ci citas Hippocratica. A little later we find great and royal personages resorting to Salerno for the restoration of their health, among whom was William of Normandy, afterwards the Conqueror. The number of students of medicine must at one time have been considerable, and in a corresponding degree the number of teachers. Among the latter many were married, and their wives and daughters appear also in the lists of professors. The most noted female professor was the celebrated Trotula in the 11th century. The Jewish element appears to have been important among the students, and possibly among the professors. The reputation of the school was great till the 12th or 13 th century, when the introduction of the Arab medicine was gradually fatal to it. The foundation of the university of Naples, and the rise of Montpellier, also contributed to its decline.

The teachings of the Salernitan doctors are pretty well known through existing works, some of which have only recently been discovered and published. The best-known is the anonymous rhyming Latin poem on health, Regimen Sanitatis Salerni, professedly written for the use of the “king of England,” supposed to mean Robert, son of William the Conqueror; it had an immense reputation in the Middle Ages, and was afterwards many times printed, and translated into most European languages. This was a popular work intended for the laity; but there are others strictly professional. Among the writers it may be sufficient to mention here Gariopontus; Coρho, who wrote the Anatome Porci, a well-known mediaeval book; Joannes Platearius, first of a family of physicians bearing the same name, whose Practica, or medical compendium, was afterwards several times printed; and Trotula, believed to be the wife of the last-named. All of these fall into the first period before the advent of Arabian medicine. In the transitional period, when the Arabian school began to influence European medicine, but before the Salernitans were superseded, comes Nicolaus Praepositus, who wrote the Antidotarium, a collection of formulae for compound medicines, which became tL·e standard work on the subject, and the foundation of many later compilations. An equally popular writer was Gilles de Corbeil (Aegidius Corboliensis), at one time a teacher at Salerno, afterwards court physician to Philip Augustus of France, who composed several poems in Latin hexameters on medical subjects. Two of them, on the urine and the pulse respectively, attained the position of medical classics.

None of these Salernitan works rise much above the rank of compilations, being founded on Hippocrates, Galen, and later Greek writers, with an unmistakable mixture of the doctrines of the methodists. But they often show much practical experience, and exhibit the naturalistic method of the Hippocratic school. The general plan of treatment is dietetic rather than pharmaceutical, though the art of preparing drugs had_reached a high degree of complexity at Salerno. Anatomy was as little regarded as it was in the later ancient schools, the empiric and methodic, but demonstrations of the parts of the body were given on swine. Although it cannot be said that the science of medicine was advanced at Salerno, still its decline was arrested at a time when every other branch of learning was rapidly falling into decay; and there can be no doubt that the observation of patients in hospitals, and probably clinical instruction, were made use of in learning and teaching. The school of Salerno thus forms a bridge between the ancient and the modern medicine, more direct though less conspicuous than that circuitous route, through Byzantium, Baghdad, and Cordova, by which Hippocrates and Galen, in Arabian dress, again entered the European world. Though the glory of Salerno had departed, the school actually existed till it was finally dissolved by an edict of the emperor Napoleon I. in the year 1811.

Introduction of Arabian Medicine: The Scholastic Period.— About the middle of the 11th century the Arabian medical writers began to be known by Latin translations in the Western world. Constantinus Africanus, a monk, was the author of the earliest of such versions (1050 A.D.); his labours were directed chiefly to the less important and less bulky Arabian authors, of whom Haly was the most noted; the real classics were not introduced till later. For some time the Salernitan medicine held its ground, and it was not till the conquest of Toledo by Alρhonso of Castile that any large number of Western scholars came in contact with the learning of the Spanish Moors, and systematic efforts were made to translate their philosophical and medical works. Jewish scholars, often under the patronage of Christian bishops, were especially active in the work. In Sicily also the Oriental tendencies of Frederick Barbarossa and Frederick II. worked in the same direction. Gerard of Cremona, a physician of Toledo (1114-87), made translations, it is said by command of Barbarossa, from Avicenna and others. It is needless to point out the influence of the crusades in making Eastern ideas known in the Western world. The influence of Arabian medicine soon began to be felt even in the Hippocratic city of Salerno, and in the 13th century is said to have held an even balance with the older medicine. After this time the foreign influence predominated; and by the time that the Aristotelian dialectic, in the introduction of which the Arabs had so large a share, prevailed in the schools of Europe, the Arabian version of Greek medicine reigned supreme in the medical world. That this movement coincided with the establishment of some of the older European universities is well known. The history of medicine in the period now opening is closely combined with the history of scholastic philosophy. Both were infected with the same dialectical subtlety, which was, from the nature of the subject, especially injurious to medicine.

At the same time, through the rise of the universities, medical learning was much more widely diffused, and the first definite forward movement was seen in the school of Montpellier, where a medical faculty existed early in the 12th century, afterwards united with faculties of law and philosophy. The medical school owed its foundation largely to Jewish teachers, themselves educated in the Moorish schools of Spain, and imbued with the intellectual independence of the Averroists. Its rising prosperity coincided with the decline of the school of Salerno. Montpellier became distinguished for the practical and empirical spirit of its medicine, as contrasted with the dogmatic and scholastic teaching of Paris and other universities. In Italy, Bologna and Padua were earliest distinguished for medical studies,—the former preserving more of the Galenical tradition, the latter being more progressive and Averroist. The northern universities contributed little,— the reputation even of Paris being of later growth.

The supremacy of Arabian medicine lasted till the revival of learning, when the study of the medical classics in their original language worked another revolution. The medical writers of this period, who chiefly drew from Arabian sources, have been called Arabists (though it is difficult to give any clear meaning to this term), and were afterwards known as the neoterics.

The medical literature of this period is extremely voluminous, but essentially second-hand, consisting mainly of commentaries on Hippocrates, Galen, Avicenna, and others, or of compilations and compendia still less original than commentaries. Among these may be mentioned the Conciliator of Peter of Abano (1250-1315), the Aggregator of Jacob de Dondi (1298-1359), both of the school of Padua, and the Pandectae Medicinae of the Salernitan Matthaeus Sylvaticus (pb. 1342), a sort of medical glossary and dictionary. But for us the most interesting fact is the first appearance of Englishmen as authors of medical works having a European reputation, distinguished, according to the testimony of Haeser, by a practical tendency characteristic of v the British race, and fostered in the school of Montpellier.

The first of these works is the Compendium Medicinae, also called Laurea or Rosa Anglicana, of Gilbert (Gilbertus Anglicus, about 1290), said to contain good observations on leprosy. A more important work, the Practica seu Lilium Medicinae, of Bernard Gordon, a Scottish professor at Montpellier (written in the year 1307), was more widely spread, being translated into French and Hebrew, and printed in several· editions. Of these two physicians tho first probably, the latter certainly, was educated and practised abroad, but John Gaddesden, the author of Rosa Anglica seu Practica Medicinae (between 1305 and 1317), was a graduate in medicine of Merton College, Oxford, and court physician. His compendium is entirely wanting in originality, and perhaps unusually destitute of common sense, but it became so popular as to be reprinted up to the end of the 16th century. Works of this kind became still more abundant in the 14th and in the first half of the 15th century, till the wider distribution of the medical classics in the original put them out of fashion.

In surgery this period was far more productive than in medicine, especially in Italy and France, but the limits of our subject only permit us to mention Gulielmus de Saliceto of Piacenza (about 1275), Lanfranchi of Milan (died about 1306), the French surgeon, Guy de Chauliac (about 1350), and the Englishman, John Ardern (about 1350). In anatomy also the beginning of a new epoch was made by Mondino de Liucci, or Mundinus (1275- 1326), and his followers. Some advance was made in chemistry by the celebrated Arnold de λ illanova (1235- 1312), whose medical writings (if the Breviarium Practices be rightly ascribed to him) rise above the rank of compilations. Finally, in the 13th and especially the 14th century, we find, under the name of consilia, the first mediaeval reports of medical cases which are preserved in such a form as to bo intelligible. Collections of consilia were published, among others, by Gentilis Fulgineua before 1348, by Bartolomeo Moιιtagnana (died in 1470), and by Baverius de Baveriis of Imola (about 1450). The last-named, we can say from experience, contains much that is interesting and readable.

Period of the Revival of Learning.— The impulse which all departments of intellectual activity received from the revival of Greek literature in Europe was felt by medicine among the rest. Not that the spirit of the science, oι of its corresponding practice, was at once changed. 1 lie basis of medicine through the Middle Ages had been literary and dogmatic, and it was literary and dogmatic still; but the medical literature now brought to light, including as it did the more important works of Hippocrates and Galen, many of them hitherto unknown, and in addition the forgotten element of Latin medicine, especially the work of Celsus, was in itself far superior to the second-hand compilations and incorrect versions which had formerly been accepted as standards. The classical works, though still regarded with unreasoning reverence, were found to have a germinative and vivifying power that carried the mind out of the region of dogma, and prepared the way for the scientific movement which has been growing in strength up to our own day.

Two of the most important results of the revival of learning were indeed such as are excluded from the scope of this brief sketch, namely, the reawakening of anatomy, which to a large extent grew out of the study of the works of Galen, and the investigation of medicinal plants, to which a fresh impulse was given by the revival of Dioscorides and other ancient naturalists. The former brought with it necessarily a more accurate conception of physiology, and thus led up to the great discovery of Harvey, which was the turning-point in modern medicine. The latter gave rise, on the one hand, to the modern science of botany, on the other to a more rational knowledge of drugs and their uses. At the same time, the discovery of America, and increased intercourse with the East, by introducing a variety of new plants, greatly accelerated the progress both of botany and pharmacology.

But it was not in these directions that improvement was first looked for. It was at first very naturally imagined that the simple revival of classical and especially of Greek literature would at once produce the same brilliant results in medicine as in literature and philosophy. The movement of reform started, of necessity, with scholars rather than practising physicians,—more precisely with a group of learned men, whom we may be permitted, for the sake of a name, to call the medical humanists, equally enthusiastic in the cause of letters and of medicine. From both fields they hoped to expel the evils which were summed up in the word barbarism. Nearly all mediaeval medical literature was condemned under this name; and for it the humanists proposed to substitute the originals of Hippocrates and Galen, thus leading back medicine to its fountain-head. Since a knowledge of Greek was still confined to a small body of scholars, and a still smaller proportion of physicians, the first task was to translate the Greek classics into Latin. To this work several learned physicians, chiefly Italians, applied themselves with great ardour. Among the earliest were Nicolaus Leonicenus of Vicenza (1428-1524), Giovanni de Monte or Montanus (1498-1552), and many others in Italy. In northern Europe should be mentioned Gulielmus Copus (1471- 1532) and Gunther of Andernach (1487-1584) better known as Guinterius Andernacensis, both for a time professors at Paris; and, among the greatest, Thomas Linacre (about 1460-1524; see Linacre). A little later Janus Cornarius or Hagenbut (1500-58) and Leonard Fuchs (1501-66) in Germany, and John Kaye or Caius (1510- 72) in England, carried on the work. Symphorien Cham-pier (Champerius or Campegius) of Lyons (1472-1539), a contemporary of Rabelais, and the patron of Servetus, wrote with fantastic enthusiasm on the superiority of the Greek to the Arabian physicians, and possibly did something to enlist in the same cause the two far greater men just mentioned. Rabelais not only lectured on Galen and Hippocrates, but edited some works of the latter; and Servetus, in a little tract Syruporum universa ratio, defended the practice of Galen as compared with that of the Arabians. The great Aldine press made an important contribution to the work, by editiones principes of Hippocrates and Galen in the original. Thus was the campaign opened against the mediaeval and Arabian writers, till finally Greek medicine assumed a predominant position, and Galen took the place of Avicenna. The result was recorded in a formal manner by the Florentine Academy, sometime shortly before 1535: “quae, excusso Arabicae et barbarae servitutis medicae jugo, ex professo se Galenicam appellavit et profligato barbarorum exercitu unum totum et solum Galenum, ut optimum artis medicae authorem, in omnibus se sequuturam pollicita est.” Janus Cornarius, from whom this is quoted, laments, however, that the Arabians still reigned in most of the schools of medicine, and that the Italian and French authors of works called Practica were still in high repute. The triumph of Galenism was therefore not complete by the middle of the 16th century. It was probably most so, and earliest, in the schools of Italy and in those of England, where the London College of Physicians might be regarded as an offshoot of the Italian schools. Paris was the stronghold of conservatism, and Germany was stirred by the teachings of one who must be considered apart from all schools—Paracelsus. The nature of the struggle between the rival systems may be -well illustrated by a formidable controversy about the rules for bleeding in acute diseases. This operation, according to the Arabian practice, was always performed on a vein at a distance from the organ affected. The Hippocratic and also Galenic rule, to let blood from, or near to, the diseased organ, was revived by Brissot (1470- 1522), a professor in the university of Paris. His attempt at reform, which was taken to be, as in effect it was, a revolt against the authority of the Arabian masters, led to his expulsion from Paris, and the formal prohibition by the parliament of his method. Upon this apparently trifling question arose a controversy which lasted many years, occupied several universities, and led to the interposition of personages no less important than the pope and the emperor, but which is thought to have largely contributed to the final downfall of the Arabian medicine.

Paracelsus and Chemical Medicine.— Contemporary with the school of medical humanists, but little influenced by them, lived in Germany a man of strange genius, of whose character and importance the most opposite opinions have been expressed. The first noticeable quality in Paracelsus (c. 1490-1541) is his revolutionary independence of thought, which was supported by his immense personal arrogance. Himself well trained in the learning and medical science of the day, he despised and trampled upon all traditional and authoritative teachings. He began his lectures at Basel by burning the books of Avicenna and others; he afterwards boasted of having read no books for ten years; he protested that his shoe buckles were more learned than Galen and Avicenna. On the other hand, he spoke with respect of Hippocrates, and wrote a commentary on his Aphorisms. In this we see a spirit very different from the enthusiasm of the humanists for a purer and nobler philosophy than the scholastic and Arabian versions of Greek thought. There is no record of Paracelsus’s knowledge of Greek, and as, at least in his student days, the most important works of Greek medicine were very imperfectly known, it is probable he had little first-hand acquaintance with Galen or Hippocrates, while his breach with the humanists is the more conspicuous from his lecturing and writing chiefly in his native German.

Having thus made a clean sweep of nearly the whole of the dogmatic medicine, what did Paracelsus put in its place 1 Certainly not pure empiricism, or habits of objective observation. He had a dogma of his own,—one founded, according to his German expositors, on the views of the Neo-Blatonists, of which a few disjointed specimens must here suffice. The human body was a “microcosm” which corresponded to the “macrocosm,” and contained in itself all parts of visible nature,—sun, moon, stars, and the poles of heaven. To know the nature of man and how to deal with it, the physician should study, not anatomy, which Paracelsus utterly rejected, but all parts of external nature. Life was a perpetual germinative process controlled by the indwelling spirit or Archeus; and diseases, according to the mystical conception of Paracelsus, were not natural, but spiritual. Nature was sufficient for the cure of most diseases; art had only to interfere when the internal physician, the man himself, was tired or incapable. Then some remedy had to be introduced which should be antagonistic, not to the disease in a physical sense, but to the spiritual seed of the disease. These remedies were arcana, —a word corresponding partly to what we now call specific remedies, but implying a mysterious connexion between the remedy and the “essence” of the disease. Arcana were often shown to be such by their physical properties, not only by such as heat, cold, <fcc., but by fortuitous resemblances to certain parts of the body; thus arose the famous doctrine of “signatures,” or signs indicating the virtues and uses of natural objects, which was afterwards developed into great complexity. Great importance was also attached to chemically prepared remedies as containing the essence or spiritual quality of the material from which they were derived. The actual therapeutical resources of Paracelsus included a large number of metallic preparations, in the introduction of some of which he did good service, and, among vegetable preparations, the tincture of opium, still known by the name he gave it, laudanum. In this doubtless he derived much advantage from his knowledge of chemistry, though the science was as yet not disentangled from the secret traditions of alchemy, and was often mixed up with imposture.

German historians of medicine attach great importance to the revolt of Paracelsus against the prevailing systems, and trace in his writings anticipations of many scientific truths of later times. That his personality was influential, and his intrepid originality of great value as an example in his own country, is undeniable. As a national reformer he has been not inaptly compared to Luther. But his importance in the universal history of medicine we cannot estimate so highly. The chief immediate result we can trace is the introduction of certain mineral remedies, especially antimony, the use of which became a kind of badge of the disciples of Paracelsus. The use of these remedies was not, however, necessarily connected with a belief in his system, which seems to have spread little beyond his own country. Of the followers of Paracelsus some became mere mystical quacks and impostors. Others, of more learning and better repute, were distinguished from the regular physicians chiefly by their use of chemical remedies. In France the introduction of antimony gave rise to a bitter controversy which lasted into the 17th century, and led to the expulsion of some men of mark from the Paris faculty. In England “chemical medicine” is first heard of in the reign of Elizabeth, and was in like manner contemned and assailed by the College of Physicians and the Society of Apothecaries. But it should be remembered that all the chemical physicians did not call Paracelsus master. The most notorious of that school in England, a certain Anthony, never quotes Paracelsus, but relies upon Arnold de Villanova and Raymund Lully. From this time, however, it is always possible to trace a school of chemical practitioners, who, though condemned by the orthodox Galenists, held their ground, till in the 17th century a successor of Paracelsus arose in the celebrated Van Helmont.

Consequences of ike Revival of Ancient Medicine.— Tho revival of Galenic and Hippocratic medicine, though ultimately it conferred the greatest benefits on medical science, did not immediately produce any important or salutary reform in practical medicine. The standard of excellence in the ancient writers was indeed far above the level of the 1G th century; but the fatal habit of taking at second hand what should have been acquired by direct observation retarded progress more than the possession of better models assisted it, so that the fundamental faults of mediaeval science remained uncorrected.

Nevertheless some progress has to be recorded, even if not due directly to the study of ancient medicine. In the first place the 15th and 16th centuries were notable for the outbreak of certain epidemic diseases, which were unknown to the old physicians. Of these the chief was the “sweating sickness” or “English sweat,” especially prevalent in, though not confined to, the country whence it is named. Among many descriptions of this disease, that by John Kaye or Caius, already referred to, was one of the best, and of great importance as showing that the works of Galen did not comprise all that could-be known in medicine. The spread of syphilis, a disease equally unknown to the ancients, and the failure of Galen’s remedies to cure it, had a similar effect.

In another direction the foundations of modern medicine were being laid during the 16th century, namely, by the introduction of clinical instruction in hospitals. In this Italy, and especially the renowned school of Padua, took the first step, where De Monte (Montanus), already mentioned as a humanist, gave clinical lectures on tho patients in the hospital of St Francis, which may still be read with interest. Pupils flocked to him from all European countries; Germans are especially mentioned; a Polish student reported and published some of his lectures; and the Englishman Kaye was a zealous disciple, who does not, however, seem to have done anything towards transplanting this method of instruction to his own country. Inspections of the dead, to ascertain the nature of the disease, were made, though not without difficulty, and thus the modern period of the science of morbid anatomy was ushered in.

Medicine in the 17 th century.· —The medicine of the early part of the 17th presents no features to distinguish it from that of the preceding century. The practice and theory of medicine were mainly founded upon Hippocrates and Galen, with ever-increasing additions from the chemical school. But the development of mathematical and physical science soon introduced a fundamental change in the habits of thought with respect to medical doctrine.

These discoveries not only weakened or destroyed the respect for authority in matters of science, but brought about a marked tendency to mechanical explanations of life and disease. When Harvey by his discovery of the circulation furnished an explanation of many vital processes which was reconcileable with the ordinary laws of mechanics, the efforts of medical theorists were naturally directed to bringing all the departments of medicine under similar laws. It is often assumed that the writings and influence of Bacon did much towards introducing a more scientific method into medicine and physiology. . But, without discussing the general philosophical position or historical importance of Bacon, it may safely be said that his direct influence can be little traced in medical writings of the first half of the 17th century. Harvey, as is well known, spoke slightingly of the great chancellor, and it is not till the rapid development of physical science in England and Holland in the latter part of the century, that we find Baconian principles explicitly recognized.

The dominant factors in the 17th century medicine were the discovery of the circulation by Harvey (published in 1628), the mechanical philosophy of Descartes and the contemporary progress of physics, the teaching of Van Helmont and the introduction of chemical explanations of morbid processes, and finally, combined of all these, and inspiring them, the rise of the spirit of inquiry and innovation, which may be called the scientific movement. Before speaking in detail of these, we may note that by other influences, quite independent of theories, important additions were made to practical medicine. The method of clinical instruction in hospitals, ' commenced by the Italians, was introduced into Holland, where it was greatly developed, especially at Leyden, in the hands of the celebrated Sylvius. It is noteworthy that concurrently with the rise of clinical study the works of Hippocrates were more and more valued, while Galen began to sink into the background.

At the same time the discovery of new diseases, unknown to the ancients, and the keener attention which the great epidemics of plague caused to be paid to those already known, led to more minute study of the natural history of disease. The most important disease hitherto undescribed was rickets, first made known by Arnold de Boot, a Frisian who practised in Ireland, in 1649, and afterwards more fully in the celebrated work of Glisson in 1651. The plague was carefully studied by Diemerbroek (De Peste, 1646) and others. Hodges, of London, in 1665 seems to have been the first who had the courage to make a post-mortem inspection of a plague patient. Bennet wrote an important work on consumption in 1654. During the same period many new remedies were introduced, the most important being cinchona bark, brought to Spain in the year 1640. The progress of pharmacy was shown by the publication of Dispensatories or Pharmacopoeiae, such as that of the Royal College of Physicians of London in 1618. This, like the earlier German works of the same kind (on which it was partly founded), contains both the traditional (Galenical) and the modern or chemical remedies.

Van Helmont.— The medicine of the 17th century was especially distinguished by the rise of systems; and we must first speak of an eccentric genius who endeavoured to construct a system for himself, as original and opposed to tradition as that of Paracelsus. Van Helmont (1578- 1644) was a man of noble family in Brussels, who, after mastering all other branches of learning as then understood, devoted himself with enthusiasm to medicine and chemistry. By education and position a little out of the regular lines of the profession, he took up in medicine an independent attitude. Well acquainted with the doctrines of Galen, he rejected them as thoroughly as Paracelsus did, aud borrowed from the latter some definite ideas as well as his revolutionary spirit. The archeus of Paracelsus appears again, but with still further complications,—the whole body being controlled by the archeus influus, and the organ of the soul and its various parts by the archei insiti, which are subject to the central archeus. Many of the symptoms of diseases were caused by the passions and perturbations of the archeus, and medicines acted by modifying the ideas of the same archeus. These and other notions cannot be. here stated at sufficient length to be intelligible. It is enough to say that on this fantastic basis Helmont constructed a medical system which had some practical merits, that his therapeutical methods were mild and in many respects happy, and that he did service by applying newer chemical methods to the preparation of drugs. He thus had some share, though a share not generally recognized, in the foundation of the iatro-chemical school, now to be spoken of. But his avowed followers formed a small and discredited sect, which, in England at least, can be clearly traced in the latter part of the century.

Discovery of the Circulation of the Blood.— The influence of Harvey’s discovery began to be felt before the middle of the century. Its merits were recognized by Descartes, among the first, nine years after its publication. For the history of the discovery, and its consequences in anatomy and physiology, we must refer to the article Harvey. In respect of practical medicine, much less effect was at first noticeable. But this example, combined with the Cartesian principles, set many active and ingenious spirits to work to reconstruct the whole of medicine on a physiological or even a mechanical basis,—to endeavour to form what we should now call physiological or scientific medicine. The result of this was not to eliminate dogma from medicine, though it weakened the authority of the old dogma. The movement led rather to the formation of schools or systems of thought, which under various names lasted on into the 18th century, while the belief in the utility or necessity of schools and systems lasted much longer. The most important of these were the so-called iatro-ρhysical or mechanical and the iatro-chemical schools.

Iatro-Physical School.— The iatro-physical school of medicine grew out of physiological theories. Its founder is held to have been Borelli of Naples (1608-79), whose treatise De motu animalium, published in 1680, is regarded as marking an epoch in physiology. The tendency of the school was to explain the actions and functions of the body on physical and especially on mechanical principles. The movements of bones and muscles were referred to the theory of levers; the process of digestion was regarded as essentially a process of trituration; nutrition and secretion were shown to be dependent upon the tension of the vessels, and so forth. The developments of this school belong rather to the history of physiology, where they appear, seen in the light of modern science, as excellent though premature endeavours in a scientific direction. But the influence of these theories on practical medicine was not great. The more judicious of the mechanical or physical school refrained, as a judicious modern physiologist does, from too immediate an application of their principles to daily practice. Mechanical theories were introduced into pathology, in explanation of the processes of fever and the like, but had little or no influence on therapeutics. The most important men in this school after Borelli were Steno (1638-86), Baglivi (1673-1707), and Bellini (1643-1704). An English physician, Cole (1660-1700), is also usually ranked with them. One of the most elaborate developments of the system was that of Pitcairn, a Scottish physician who became professor at Leyden (1652-1713), to be spoken of hereafter.

Iatro-Chemical School. — The so-called iatro-chemical school stood in a much closer relation to practical medicine than the iatro-physical. The principle which mainly distinguished it was not merely the use of chemical medicines in addition to the traditional, or, as they were called in distinction, “Galenical” remedies, but a theory of pathology or causation of disease entirely different from the prevailing “humoral” pathology. Its chief aim was to reconcile the new views in physiology and chemistry with practical medicine. In some theoretical views, and in the use of certain remedies, the school owed something to Van Helmont and Paracelsus, but took in the main an independent position. The founder of the iatro-chemical school was Francis de le Boë, called Sylvius (1614-72), belonging to a French family settled in Holland. Sylvius was for fourteen years professor of medicine at Leyden, where he attracted students from all quarters of Europe. He made a resolute attempt to reconstruct medicine on the two bases of the doctrine of the circulation of the blood and the new views of chemistry. Fermentation, which was supposed to take place in the stomach, played an important part in the vital processes. Chemical disturbances of these processes, called acridities, Ac., were the cause of fevers and other diseases. Sometimes acid sometimes alkaline properties predominated in the juices and secretions of the body, and produced corresponding disturbances. In nervous diseases disturbances of the vital “spirits” were most important. Still in some parts of his system Sylvius shows au anxiety to base his pathology on anatomical changes. The remedies he employed were partly Galenical, partly chemical. He was very moderate in the use of bleeding.

The doctrines of Sylvius became widely spread in Holland and Germany; less so in France and Italy. In England they were not generally accepted, till adopted with some modifications by Thomas Willis the great anatomist (1622-75), who is the chief English representative of the chemical school. Willis was as thorough-going a chemist as Sylvius. He regarded all bodies, organic and inorganic, as composed of the three elements—spirit, sulphur, and salt, the first being only found abundantly in animal bodies. The “intestine movement of particles” in every body, or fermentation, was the explanation of many of the processes of life and disease. The sensible properties and physical alterations of animal fluids and solids depended upon different proportions, movements, and combinations of these particles. The elaborate work Pharmaceutice Rationalis, based on these materials, had much influence in its time, though it was soon forgotten. But some parts of Willis’s works, such as his descriptions of nervous diseases, and his account (the earliest) of diabetes, are classical contributions to scientific medicine. In the application of chemistry to the examination of secretions Willis made some important steps. The chemical school met with violent opposition, partly from the adherents of the ancient medicine, partly from the iatro-mechanical school. Towards the end of the 17th century appeared an English medical reformer who sided with none of these schools, but may be said in some respects to have surpassed and dispensed with them.

Sydenham and Locke.— Thomas Sydenham (1G24-89) was educated at Oxford and at Montpellier. He was well acquainted with the works of the ancient physicians, and probably fairly so with chemistry. Of his knowledge of anatomy nothing definite can be said, as he seldom refers to it. His main avowed principle was to do without hypothesis, and study the actual diseases in an unbiassed manner. As his model in medical methods, Sydenham repeatedly and pointedly refers to Hippocrates, and he has not unfairly been called the English Hippocrates. He resembled his Greek master in the high value he set on the study of the “natural history of disease”; in the importance he attached to “epidemic constitution,” that is, to the influence of weather and other natural causes in modifying disease; and further in his conception of the healing power of nature in disease, a doctrine which he even expanded beyond the teaching of Hippocrates. According to Sydenham, a disease is nothing more than an effort of nature to restore the health of the patient by the elimination of the morbific matter. The extent to which his practice was influenced by this and other a priori conceptions prevents us from classing Sydenham as a pure empiric, but he had the rare merit of never permitting himself to be enslaved even by his own theories. Still less was his mind warped by either of the two great systems, the classical and the chemical, which then divided the medical world. Sydenham’s influence on European medicine was very great. His principles were welcomed as a return to nature by those who were weary of theoretical disputes. He introduced a milder and better way of treating fevers, especially small-pox, and gave strong support to the use of specific medicines, especially Peruvian bark. He was an advocate of bleeding, and often carried it to excess. Another important point in Sydenham’s doctrine is his clear recognition of many diseases as being what would be now called specific, and not due merely to an alteration in the primary qualities or humours of the older schools. From this springs his high appreciation of specific medicines.

One name should always be mentioned along with Sydenham—that of his friend John Locke. The great sensational philosopher was a thoroughly trained physician, and practised privately. He shared and defended many of Sydenham’s principles, and in the few medical observations he has left shows himself to be even more thorough-going than the “English Hippocrates.” It is deeply to be regretted in the interests of medicine that he did not write more. It is, however, reasonable to suppose that his commanding intellect often makes itself felt in the words of Sydenham. One sentence of Locke’s in a letter to W. Molyneux sums up the practical side of Sydenham’s teaching.

“You cannot imagine how far a little observation carefully made by a man not tied up to the four humours [Galen], or sal, sulphur, and mercury [Paracelsus], or to acid and alcali [Sylvius and Willis] which has of late prevailed, will carry a man in the curing of diseases though very stubborn and dangerous; and that with very little and common things, and almost no medicine at all.”

We thus see>that, while the great anatomists, physicists, and chemists, men of the type of Willis, Borelli, anti Boyle, were laying foundations which were later on built up into the fabric of scientific medicine, little good was done by the premature application of their half-understood principles to practice. The reform of practical medicine was effected by men who aimed at, and partly succeeded in, rejecting all hypothesis and returning to the unbiassed study of natural processes, as shown in health and disease.

Sydenham showed that these processes might be profitably studied and dealt with without explaining them; and, by turning men’s minds away from explanations and fixing them on facts, he enriched medicine with a method more fruitful than any discoveries in detail. From this time forth the reign of canonical authority in medicine was at an end, though the dogmatic spirit long survived.

The 18i7⅛ century.— The medicine of the 18th century is notable, like that of the latter part of the 17th, for the striving after complete theoretical systems. The influence of the iatro-physical school was by no means exhausted; and in England, especially through the indirect influence of Newton’s great astronomical generalizations, it took on a mathematical aspect, and is sometimes known as iatro-mathemacical. This phase is most clearly developed in Pitcairn (1652-1713), who, though a determined opponent of metaphysical explanations, and of the chemical doctrines, gave to his own rude mechanical explanations of life and disease almost the dogmatic completeness of a theological system. His countryman and pupil, George Cheyne, who lived some years at Bath, published a new theory of fevers on the mechanical system, which had a great reputation. Their English contemporaries and successors, Freind, Cole, and Meacζ leaned also to mechanical explanations, but with a distrust of systematic theoretical completeness, which was perhaps partly a national characteristic, partly the result of the teaching of Sydenham and Locke. Freind (1675- 1728) in his Emmenologia gave a mechanical explanation of the phenomena of menstruation. He is also one of the most distinguished writers on the history of medicine. Cole (see above) published mechanical hypotheses concerning the causation of fevers which closely agree, with those of the Italian iatro-mechanical school. More distinguished in his own day than any of these was Richard Mead (1673-1754), one of the most accomplished and socially successful physicians of modern times. Mead was the pupil of the equally popular and successful John Radcliffe (1650-1714), who had acquired from Sydenham a contempt for book learning, and belonged to no school in medicine but the school of common sense. Radcliffe left, however, no work requiring mention in a history of medicine. Mead, a man of great learning and intellectual activity, was an ardent advocate of the mathematical doctrines, “It is very evident,” he says, “that all other means of improving medicine have been found ineffectual, by the stand it was at for two thousand years, and that, since mathematicians have set themselves to the study of it, men already begin to talk so intelligibly and comprehensibly, even about abstruse matters, that it is to be hoped that mathematical learning will be the distinguishing mark of a physician and a quack.” His Mechanical Account of Poisons, in the first edition (1702), gave an explanation of the effects of poisons, as acting only on the blood. Afterwards he modified his hypothesis, and referred the disturbances produced to the “nervous liquor,” which he supposed to be a quantity of the “universal elastic matter” diffused through the universe, by which Newton explained the phenomena of light, i.e., what was afterwards called the luminiferous ether. Mead’s treatise on The Power of the Sun and Moon over Human Bodies (1704), equally inspired by Newton’s discoveries, was a premature attempt to assign the influence of atmospheric pressure and other cosmical causes in producing disease. His works contain, however, many original experiments, and excellent practical observations. James Keill (1673-1719) applied Newtonian and mechanical principles to the explanation of bodily functions with still greater accuracy and completeness; but his researches have more importance for physiology than for practical medicine.

Boerhaave.— None of these men founded a school,—a result due in part to their intellectual character, in part to the absence in England of medical schools equivalent in position and importance to the universities of the Continent. An important academical position was, on the other hand, one of the reasons why a physician not very different in his way of thinking from the English physicians of the age of Queen Anne was able to take a far more predominant position in the medical world. Hermann Boerhaave (1668-1738) was emphatically a great teacher. He was for many years professor of medicine at Leyden, where he lectured five hours a day, and excelled in influence and reputation, not only his greatest forerunners, Montanus of Padua and Sylvius cf Leyden, but probably every subsequent teacher. The hospital of Leyden, though with only twelve beds available for teaching, became the centre of medical influence in Europe. Many of the leading English physicians of the 18th century studied there; Van Swieten, a pupil of Boerhaave, transplanted the latter’s method of teaching to Vienna, and founded the noted Vienna school of medicine. As the organizer, and almost the constructor, of the modern method of clinical instruction, the services of Boerhaave to the progress of medicine were immense, and can hardly be overrated. In his teaching, as in his practice, he avowedly followed the method of Hippocrates and Sydenham, both of whom he enthusiastically admired. In his medical doctrines he must be pronounced an eclectic, though taking his stand mainly on the iatro-mechanical school. The best known parts of Boerhaave’s system are his doctrines of inflammation, obstruction, and “plethora.” By the last-named especially he was long remembered. His object was to make all the anatomical and physiological acquisitions of his age, even microscopical anatomy, which he diligently studied, available for use in the practice of medicine. He thus differed from Sydenham, who took almost as little account of modern science as of ancient dogma. Boerhaave may be in some respects compared to Galen, but again differed from him in that he always abstained from attempting to reduce his knowledge to a uniform and coherent system. Boerhaave attached great importance to the study of the medical classics, but rather treated them historically than quoted them as canonical authorities. It almost follows from the nature of the case that the great task of Boerhaave’s life, a synthesis of ancient and modern medicine, and the work in which this is chiefly contained, his celebrated Institutions, could not have any great permanent value. Nearly the same thing is true even of the Aphorisms, in which, following the example of Hippocrates, he endeavoured to sum up the results of his long experience.

Hoffmann and Stahl.— We have now to speak of two writers in whom the systematic tendency of the 18th century showed itself most completely.

Friedrich Hoffmann (1660-1742), like Boerhaave, owed his influence, and perhaps partly his intellectual characteristics, to his academical position. He was in 1693 appointed the first professor of medicine in the university of Halle, then just founded by the elector Frederick III. Here he became, as did his contemporary and rival Stahl, a popular and influential teacher, though their university had not the European importance of Leyden. Hoffmann’s “system” was apparently intended to reconcile the opposing “spiritual” and “materialistic” views of nature, and is thought to have been much influenced by the philosophy of Leibnitz. His medical theories rest upon a complete theory of the universe. Life depended upon a universally diffused ether, which animals breathe in from the atmosphere, and which is contained in all parts of the body. It accumulates in the brain, and there generates the “nervous fluid” or pneuma,— a theory closely resembling that of Mead on the “nervous liquor,” unless indeed Mead borrowed it from Hoffmann. On this system are explained all the phenomena of life and disease. Health depends on the maintenance of a proper “tone” in the body,—some diseases being produced by excess of tone, or “spasm”; others by “atony,” or want of tone. But it is impossible here to follow its further developments. Independently of his system, which has long ceased to exert any influence, Hoffmann made some contributions to practical medicine; and his great knowledge of chemistry enabled him to investigate the subject of mineral waters. He was equally skilful in pharmacy, but lowered his position by the practice, which would be unpardonable in a modern physician, of trafficking in secret remedies. Some of these are even to this day sold for the benefit of the orphanage at Halle.

George Ernest Stahl (1660-1734) was for more than twenty years professor of medicine at Halle, and thus a colleague of Hoffmann, whom he resembled in constructing a complete theoretical system, though their systems had l·.ttle or nothing in common. Stahl’s chief aim was to oppose materialism. For mechanical conceptions he substituted the theory of “animism,”—attributing to the soul the functions of ordinary animal life in man, while the life of other creatures was left to mechanical laws. The symptoms of disease were explained as efforts of the soul to rid itself from morbid influences, the soul acting reasonably with respect to the end of self-preservation. The anima thus corresponds partly to the “nature” of Sydenham, while in other respects it resembles the archeus of Van Helmont. Animism in its completeness met with little acceptance during the lifetime of its author, but influenced some of the iatro-physical school. Stahl was the author of the theory of “phlogiston” in chemistry, which in its day had great importance.

Haller and Morgagni.— From the subtleties of rival systems it is a satisfaction to turn to two movements in the medicine of the 18th century which, though they did not extinguish the spirit of system-making, opened up paths of investigation by which the systems were ultimately superseded. These are physiology in the modern sense, as dating from Haller, and pathological anatomy, as dating from Morgagni.

Albrecht von Haller (1708-77) was a man of even more encyclopaedic attainments than Boerhaave. He advanced chemistry, botany, anatomy, as well as physiology, and was incessantly occupied in endeavouring to apply his scientific studies to practical medicine, thus continuing the work of his great teacher Bcerhaave. Besides all this he was probably more profoundly acquainted with the literature and bibliography of medicine than any one before or since. Haller occupied in the new university of Göttingen (founded 1737) a position corresponding to that of Boerhaave at Leyden, and in like manner influenced a very large circle of pupils. The appreciation of his work in physiology belongs to the history of that science; we are only concerned here with its influence on medicine. Haller’s definition of irritability as a property of muscular tissue, and its distinction from sensibility as a property of nerves, struck at the root of the prevailing hypothesis respecting animal activity. It was no longer necessary to suppose that a half conscious “anima” was directing every movement. Moreover, Haller’s views did not rest on a priori speculation, but on numerous experiments. He was among the first to investigate the action of medicines on healthy persons. Unfortunately the lesson which his contemporaries learnt was not the importance of experiment, but only the need of contriving other “systems” less open to objection; and thus the influence of Haller led directly to the theoretical subtleties of Cullen and John Brown, and only indirectly and later on to the general anatomy of Bichat. The great name of Haller does not therefore occupy a very prominent place in the history of practical medicine.

The work of Giovanni Battista Morgagni (1682-1771) had and still preserves a permanent importance beyond that of all the contemporary theorists. In a series of letters De sedibus et causis morborum per anatomen indagatis, published when he was in his eightieth year, he describes the appearances met with at the post-mortem examination as well as the symptoms during life in a number of cases of various diseases. It was not the first work of the kind. Bonet had published his Sepulcretum in 1679; and observations of post-mortem appearances had been made by Montanus, Tulp, Vieussens, Valsalva, Lancisi, Haller, and others. But never before was so large a collection of cases brought together, described with such accuracy, or illustrated with equal anatomical and medical knowledge. Morgagni’s work at once made an epoch in the science. Morbid anatomy now became a recognized branch of medical research, and the movement was started which has lasted till our own day.

The contribution of Morgagni to medical science must be regarded as in some respects the counterpart of Sydenham’s. The latter had, in neglecting anatomy, neglected the most solid basis for studying the natural history of disease; though perhaps it was less from choice than because his practice, as he was not attached to a hospital, gave him no opportunities. But it is on the combination of the two methods, that of Sydenham and of Morgagni, that modern medicine rests; and it is through these that it has been able to make steady progress in its own field, independently of the advance of physiology or other sciences.

The method of Morgagni found many imitators, both in his own country and in others. In England the first important name in this field is at the same time that of the first writer of a systematic work in any language on morbid anatomy, Matthew Baillie (1761-1823), who published his treatise in 1793.

Cullen and Brown.— It remains to speak of two systematic writers on medicine in the 18th century, whose great reputation prevents them from being passed over, though their real contribution to the progress of medicine was not great—Cullen and Brown.

William Cullen (1712-90) was a most eminent and popular professor of medicine at Edinburgh. The same academical influences as surrounded the Dutch and German founders of systems were doubtless partly concerned in leading him to form the plan of a comprehensive system of medicine. Cullen’s system was largely based on the new physiological doctrine of irritability, but is especially noticeable for the importance attached to nervous action. Thus even gout was regarded as a “neurosis.” These pathological principles of Cullen are contained in his First Lines of the Practice of Physic, an extremely popular book, often reprinted and translated. More importance is to be attached to his Nosology or Classification of Diseases. The attempt to classify diseases on a natural-history plan was not new, having been commenced by Sauvages and others, and is perhaps not a task of the highest importance. Cullen drew out a classification of great and needless complexity, the chief part of which is now forgotten, but several of his main divisions are still preserved.

It is difficult to form a clear estimate of the importance of the last syι⅜ematizer of medicine, John Brown (1735- 88), for, though in England he has been but little regarded, the wide though short-lived popularity of his system on the Continent shows that it must have contained some elements of brilliancy, if not originality. His theory of medicine professed to explain the processes of life and disease, and the methods of cure, upon one simple principle, — that of the property of “excitability,” in virtue of which the “exciting powers,” defined as being (1) external forces and (2) the functions of the system itself, call forth the vital phenomena “sense, motion, mental function, and passion.” All exciting powers are stimulant, the apparent debilitating or sedative effect of some being due to a deficiency in the degree of stimulus; so that the final conclusion is that “the whole phenomena of life, health as well as disease, consist in stimulus and nothing else.” Brown recognized some diseases as sthenic, others as asthenic, the latter requiring stimulating treatment, the former the reverse; but his practical conclusion was that 97 per cent, of all diseases required a “stimulating” treatment. In this he claimed to have made the most salutary reform because all physicians from Hippocrates had treated diseases by depletion and debilitating measures with the object of curing by elimination. It would be unprofitable to attempt a complete analysis of the Brunonian system; and it is difficult now to understand why it attracted so much attention in its day. r I o us at the present time it seems merely a dialectical construction, having its beginning and end in definitions, the words power, stimulus, &c. 9 being used in such a way as not to correspond to any precise physical conceptions, still less to definite material objects or forces. One recommendation of the system was that it favoured a milder system of treatment than was at that time in vogue; Brown may be said to have been the first advocate of the modern stimulant or feeding treatment of fevers. He advocated the use of “animal soups” or beef tea. Further he had the discernment to see that certain symptoms, such as convulsions, and delirium, which were then commonly held always to indicate inflammation, were often really signs of weakness.

The fortunes of Brown’s system (called, from having been originally written in Latin, the Brunonian) form one of t ιe strangest chapiters in the history of medicine. In Scotlanc, Brown so far won the sympathy of the students that riotous conflicts took place between his partisans and opponents. In England his system took little root. In Italy, on the other hand, it received enthusiastic supp>ort, and, natural y, a corresponding degree of opposition. The most important adherent to Brown’s system was Rasori (1763-1837), who taught it as professor at Pavia, but afterwards substituted his own system of contra-stimulus. The theoretical differences between this and the “stimulus” theory need not be expounded. The practical difference in the corresponding treatment was very great, as Rasori advocated a copious use of bleeding and of depressing remedies, such as antimony. Joseph Frank, a German, professor at Pavia, afterwards of Vienna, the author of an oncyclopaedic work on medicine now forgotten, embraced the Brunonian system, though he afterwards introduced some modifications, and transplanted it to Vienna. Many names are quoted as partisans or opponents of the Brunonian system in Italy, but scarcely one of them has any other claim to be remembered. In Germany the new system called forth, a little later, no less enthusiasm and controversial heat. Girtanner first began to spread the new ideas (though giving them out as his own), but Weikard was the first avowed advocate of the system. Röschlaub (1768-1835) modified Brown’s system into the theory of excitement (Erregungstheorie) , which for a time was extremely popular in Germany. The enthusiasm of the younger Brunonians in Germany was as great as in Edinburgh or in Italy, and led to serious riots in the university of Göttingen. In America the system was enthusiastically adopted by a noted physician, Benjamin Rush, of Philadelphia, who was followed by a considerable school. France was not more influenced by the new school than England. In both countries the tendency towards positive science and progress by objective investigation was too marked for any theoretical system to have more than a passing influence. In France, however, the influence of Brown’s theories is very clearly seen in the writings of Broussais, who, though not rightly classed with the system-makers, since his conclusions were partly based upon anatomical investigation, resembled them in his attempt to unite theory and practice in one comprehensive synthesis. The explanation of the meteoric splendour of the Brunonian system in other countries seems to be as follows. In Italy the period of intellectual decadence had set in, and no serious scientific ardour remained to withstand the novelties of abstract theory. In Germany the case was somewhat different. Intellectual activity was not wanting, but the great achievements of the 18th century in philosophy and the moral sciences had fostered a love of abstract speculation; and some sort of cosmical or general system was thought indispensable in every department of special science. Hence another generation had to pass away before Germany found herself on the level, in scientific investigation, of France and England.

Before the theoretic tendency of the 18th century was quite exhausted, it displayed itself in a system which, though in some respects isolated in the history of medicine, stands nearest to that of Brown,—that, namely, of Hahnemann (see Homoeopathy). Hahnemann (1753-1844) was in conception as revolutionary a reformer of medicine as Paracelsus. He professed to base medicine entirely on a knowledge of symptoms, regarding all investigation of the causes of symptoms as useless. While thus rejecting all the lessons of morbid anatomy and pathology, he put forward views respecting the causes of disease which hardly bear to be seriously stated. All chronic maladies result either from three diseases—psora (the itch), syphilis, or sycosis (a skin disease), or else are maladies produced by medicines. Seven-eighths of ail chronic diseases are produced by itch driven inwards. (It is fair to say that these views were published in one of his later works.) In treatment of disease Hahnemann rejected entirely the notion of a vis medicatrix naturae, and was guided by his well-known principle “similia similibus curantur,” which he explained as depending on the law that in order to get rid of a disease some remedy must be given which should substitute for the disease an action dynamically similar, but weaker. The original malady being thus got rid of, the vital force would easily be able to cope with and extinguish the slighter disturbance caused by the remedy. Something very similar was held by Brown, who taught that “indirect debility” was to be cured by a lesser degree of the same stimulus as had caused the original disturbance. Generally, however, Hahnemann’s views contradict those of Brown, though moving somewhat in the same plane. In order to select remedies which should fulfil the indication of producing symptoms like those of the disease, Hahnemann made many observations of the action of drugs on healthy persons. He did not originate this line of research, for it had been pursued if not originated by Haller, and cultivated systematically by Tommasini, an Italian “contra-stimulist;” but he carried it out with much elaboration. His results, nevertheless, were vitiated by being obtained in the interest of a theory, and by singular want of discrimination. Hahnemann’s doctrines met with much opposition on the part of the medical profession, and he was hence led to state his case to the “lay” public as a sort of court of appeal; and thus matters of science were made the theme of much popular controversy. This expedient, in which Hahnemann had been in a small degree anticipated by Brown, contributed largely to the success of his system. The appeal flattered a prevalent belief in the right of private judgement, even in technical and learned subjects. Hahnemann was thus able to take up the position (and not without justification) of a victim of professional prejudice. The anomalous position into which professional scorn and extra-professional popularity brought him produced a distinct deterioration in the character of his work. In his second period he developed the extraordinary theory of “potentiality” or dynamiza-tion,—namely, that medicines gained in strength by being diluted, if the dilution was accompanied by shaking or pounding, which was supposed to “potentialize” or increase the potency of the medicine. On this extraordinary principle Hahnemann ordered his original tinctures to be reduced in strength to one-fiftieth; these first dilutions again to one-fiftieth; and so on, even till the thirtieth dilution, which he himself used by preference, and to which he ascribed the highest “potentiality.” It is hardly necessary to point out that even the lower dilutions involve quantities which no analysis can weigh, measure, or even recognize. The still greater eccentricities of Hahnemann’s later works need not be recounted. From a theoretical point of view Hahnemann’s is one of the abstract systems, pretending to universality, which modern medicine neither accepts nor finds it worth while to controvert. In the treatment of disease his practical innovations came at a fortunate time, when the excesses of the depletory system had only partially been superseded by the equally injurious opposite extreme of Brown’s stimulant treatment. Hahnemann’s use of mild and often quite inert remedies contrasted favourably with both of these. Further he did good by insisting upon simplicity in prescribing, when it was the custom to give a number of drugs, often heterogeneous and inconsistent, in the same prescription. But these indirect benefits were quite independent of the truth or falsity of his theoretical system.

Positive Progress in the ∖ ⅛th Century.— In looking back on the repeated attempts in the 18th century to construct a universal system of medicine, it is impossible not to regret the waste of brilliant gifts and profound acquirements which they involved. It was fortunate, however, that the accumulation of positive knowledge in medicine did not cease. While Germany and Scotland, as the chief homes of abstract speculation, gave birth to most of the theories, progress in objective science was most marked in other countries,—in Italy first, and afterwards in England and France. We must retrace our steps a little to enumerate several distinguished names which, from the nature of the case, hardly admit of classification.

In Italy the tradition of the great anatomists and physiologists of the 17th century produced a series of accurate observers and practitioners. Among the first of these were Antonio Maria Valsalva (1666-1723), still better known as an anatomist; Giovanni Maria Lancisi (1654-1720), also an anatomist, the author of a classical work on the diseases of the heart and aneurisms; and Ippolito Francisco Albertini (1662-1738), whose researches on the same class of diseases were no less important.

In France Jean Baptiste Sénac (1693-1770) wrote also an important work on the affections of the heart. Sauvages, otherwise F. B. de Lacroix (1706-67), gave under the title Nosologie. Methodica a natural-history classification of diseases; Jean Astruc (1684-1766) contributed to the knowledge of general diseases. But the state of medicine in that country till the end of the 18th century was unsatisfactory as compared with some other parts of Europe.

In England the brilliancy of the early part of the century in practical medicine was hardly maintained to the end, and presented indeed a certain contrast with the remarkable and unflagging progress of surgery in the same period. The roll of the College of Physicians does not furnish many distinguished names. Among these should be mentioned John Fothergill (1712-80), who investigated the “putrid sore throat” now called diphtheria, and the form of neuralgia popularly known as tic douloureux. A physician of Plymouth, John Huxham (1694-1768), made researches on epidemic fevers, in the spirit of Sydenham and Hippocrates, which are of the highest importance. William Heberden (1710-1801), a London physician, called by Samuel Johnson ultimτιs Romanorum, “the last of our learned physicians,” left a rich legacy of practical observations in the Commentaries published after his death. More important in their results than any of these works were the discoveries of Edward Jenner (7.v.), respecting the prevention of small-pox by vaccination, in which he superseded the partially useful but dangerous practice of inoculation, which had been introduced into England in 1721. The history of this discovery need not be told here, but it may be pointed out that, apart from its practical importance, it has had great influence on the scientific study of infectious diseases. The name of. John Pringle (1707-82) should also be mentioned as one of the first to study epidemics of fevers occurring in prisons and camps. His work entitled Observations on the Diseases of an Army was translated into many European languages, and became the standard authority on the subject.

In Germany the only important school of practical medicine was that of Vienna, as revived by Van Swieteu (1700-72), a pupil of Boerhaave, under the patronage of Maria Theresa. Van Swieten’s commentaries on the aphorisms of Boerhaave are thought more valuable than thé original text. Other eminent names of the same school are Anton de Haen (1704-76), Anton Störck (1731-1803), Maximilian Stoll (1742-88), and John Peter Frank (1745-1821), father of Joseph Frank beforementioned as an adherent of the Brownian system, and like his son carried away for a time by the new doctrines.

This, the old “Vienna School,” was not distinguished for any notable discoveries, but for success in clinical teaching, and for its sound method of studying the actual facts of disease during life and after death, which largely contributed to the establishment of the “positive medicine” of the 19 th century r .

One novelty, however, of the first importance is due to a Vienna physician of the period, Leopold Λveubrugger (1722-1809), the inventor of the method of recognizing diseases of the chest by percussion. Avenbrugger’s method was that of direct percussion with the tips of the fingers, not that which is now used, of mediate percussion with the intervention of a finger or plessimeter; but the results of his method were the same, and its value nearly as great. Avenbrugger’s great work, the Inventum Novum, was published in 1761. The new practice was received at first with contempt and even ridicule, and afterwards by St<>ll and Peter Frank with only grudging approval. It did not receive due recognition till 1808, when Corvisart translated the Inventum Novum into French, and Avenbrugger’s method rapidly attained a European reputation. Surpassed, but not eclipsed, by the still more important art of auscultation introduced by Laennec, it is hardly too much to say that this simple and purely mechanical invention has had more influence on the development of modern medicine than all the “systems” evolved by the most brilliant intellects of the 18th century.

.Early Part of the ∖ ⅛tlι Century.— It is not possible to carry the history of medicine, in a sketch such as this, beyond the early years of the 19th century, both because the mass of details becomes so large as to require more minute treatment, and because it is difficult as we approach our own times to preserve the necessary historical perspective. It was, however, in this period that what we regard as the modern school of medicine was formed, and took the shape which it has preserved to our own days. The characteristic of the modern school is the adoption in medicine of the methods of research of physical science, and the gradually declining importance attached to theory and abstract reasoning,—hypotheses, though not neglected, being used as means of research rather than as ultimate conclusions. Its method may therefore be called the positive method, or that of rational empiricism. The growth of the new school was first seen in two European countries, in France and England, and must be separately followed in the two. Germany entered the field later.

Rise of the Positive School in France. — The reform of medicine in France must be dated from the great intellectual awakening caused by the Revolution, but more definitely starts with the researches in anatomy and physiology of Marie Francois Xavier Bichat (1771-1802). The importance in science of Bichat’s classical works, especially of the Anatomie générale, cannot be estimated here; we can only point out their value as supplying a new basis for pathology or the science of disease. Among the most ardent of his followers was François Joseph Victor Broussais (1772-1838), whose theoretical views, partly founded on tlιose of Brown and partly on the so-called vitalist school of Bordeu and Barthez, differed from these essentially in being avowedly based on anatomical observations. Broussais’s chief aim was to find an anatomical basis for all diseases, but he is especially known for his attempt to explain all fevers as a consequence of irritation or inflammation of the intestinal canal (gastro entérite). A number of other maladies, especially general diseases and those commonly regarded as nervous, were attributed to the same cause. It would be impossible now to trace the steps which led to this wild and long since exploded theory. It led, among other consequences, to an enormous misuse of bleeding. Leeches were his favourite Instruments, and so much so that he is said to have used 100,000 in his own hospital wards during one year. He was equalled if not surpassed in this excess by his follower Bouillaud, known for his important work on heart diseases. Broussais’s system, to which he gave the name of “Médecine Physiologique” did much indirect good, in fixing attention upon morbid changes in the organs, and thus led to the rise of the strongly opposed anatomical and pathological school of Cυrvisart, Laennec, and Bayle.

Jean Nicolas Corvisart (,1755-1821) has already been mentioned as the translator and introducer into France of Avenbrugger’s work on percussion. He introduced some improvements in the method, but the only real advance was the introduction of mediate percussion by Piorry in 1828. The discovery had, however, yet to be completed by that of auscultation, or listening to sounds produced in the chest by breathing, the movements of the heart, &c. The combination of these methods constitutes what is now known as physical diagnosis. René Théophile Hyacinthe Laennec (1781-1826) was the inventor of this most important perhaps of all methods of medical research. Except for some trifling notices of sounds heard in certain diseases, this method was entirely new. It was definitely expounded in an almost complete form in his work De Γauscultation médiate, published in 1819. Laennec attached undue importance to the use of the stethoscope, and laid too much weight on specific signs of specific diseases; otherwise his method in its main features has remained unchanged. The result of his discovery was an entire revolution in the knowledge of diseases of the chest; but it would be a mistake to forget that an essential factor in this revolution was the simultaneous study of the condition of the diseased organs as seen after death. Without the latter, it is difficult to see how the information conveyed by sounds could ever have been verified. This increase of knowledge is therefore due, not to auscultation alone, but to auscultation combined with morbid anatomy. In the case of Laennec himself this qualification takes nothing from his fame, for he studied so minutely the relations of post-mortem appearances to symptoms during life that, had he not discovered auscultation, his researches in morbid anatomy would have made him famous. The pathologico-anatomical method was also followed with great zeal and success by Gaspard Laurent Bayle (1774— 1816), whose researches on tubercle, and the changes of the lungs and other organs in consumption, are the foundation of most that has been done since his time. It was of course antecedent to the discovery of auscultation. Starting from these men arose a school of physicians who endeavoured to give to the study of symptoms the same precision as belonged to anatomical observations, and by the combination of both methods made a new'era in clinical medicine. Among these were Chomel (1788— 1858), Louis (1787-1872), Cruveilhier (1791-1874), and Andral (1797-1876). Louis, by his researches on pulmonary consumption and typhoid fever, had the chief merit of refuting the doctrines of Broussais. In another respect also he aided in establishing an exact science of medicine by the introduction of the numerical or statistical method. By this method only can the fallacies which are attendant on drawing conclusions from isolated cases be avoided; and thus the chief objection which has been made to regarding medicine as an inductive science has been removed. Louis’s method was improved and systematized by Gavarret; and its utility is now universally recognized. Space does not permit us to trace further the history of this brilliant period of French medicine, during which the superiority of the school of Paris could hardly be contested. We can only mention the names of Bretonneau (1771- 1862), Rostan (1790-1866), D’Alibert (1766-1837), Rayer (1793-1867), and Trousseau (1801-1866), the eloquent and popular teacher.

English Medicine from 1800 to 1840.—The progress of medicine in England during this period displays the same characteristics as at other times, viz., a gradual and uninterrupted development, without startling changes such as are caused by the sudden rise or fall of a new school. Hardly any theoretical system is of English birth; Erasmus Darwin (1731-1802), the grandfather of the great Charles Darwin, alone makes an exception. In his Zoonomia (1794) he expounded a theory of life and disease which had some resemblance to that of Brown, though arrived at (he says) by a different chain of reasoning.

Darwin’s work shows, however, the tendency to connect medicine with physical science, which was an immediate consequence of the scientific discoveries of the end of the 18th century, when Priestley and Cavendish in England exercised the same influence as Lavoisier in France. The English school of medicine was also profoundly stirred by the teachings of the two brothers William and John Hunter, especially the latter,—who must therefore be briefly mentioned, though their own researches were chiefly concerned with subjects lying a little outside the limits of this sketch. William Hunter (1718-1783) was known in London as a brilliant teacher of anatomy and successful obstetric physician; his younger brother and pupil, John Hunter (1728-1793), was also a teacher of anatomy, and practised as a surgeon. His immense contributions to anatomy and pathology cannot be estimated here, but his services in stimulating research and training investigators belong to the history of general medicine. They are sufficiently evidenced by the fact that Jenner and Baillie were his pupils.

The same scientific bent is seen in the greater attention paid to morbid anatomy (which dates from Baillie), and the more scientific method of studying diseases. An instance of the latter is the work of Robert Willan (1757-1812) on diseases of the skin,—a department of medicine in which abstract and hypothetical views had been especially injurious. Willan, by following the naturalhistory method of Sydenham, at once put the study on a sound basis; and his work has been the starting point of the most important modern researches. About the same time William Charles Wells (1757-1817), a scientific investigator of remarkable power, and the author of a celebrated essay on dew, published observations on alterations in the urine, which, though little noticed at the time, were of great value as assisting in the important discovery made some years afterwards by Bright.

These observers, and others who cannot be mentioned here, belong to the period when English medicine was still little influenced by the French school. Shortly after 1815, however, when the Continent was again open to English travellers, many English doctors studied in Paris, and the discoveries of their great French contemporaries began to be known. The method of auscultation was soon introduced into this country by pupils of Laennec. John Forbes in 1824, and William Stokes of Dublin in 1825, published treatises on the use of the stethoscope. Forbes also translated the works of Laennec and Avenbrugger, and an entire revolution was soon effected in the knowledge of diseases of the chest. James Hope and Peter Mere Latham further developed this subject, and the former was also known for his researches in morbid anatomy. The combination of clinical and anatomical research led, as in·the hands of the great French physicians, to important discoveries by English investigators. The discovery by Richard Bright (1789-1858) of the disease of the kidneys known by his name, has proved to be one of the most momentous of this century. It was published in Deports of Medical Cases, 1827-31. Thomas Addison takes, somewhat later, a scarcely inferior place. The remarkable physiological discoveries of Bell and Marshall Hall for the first time rendered possible the discrimination of diseases of the spinal cord. Several of these physicians were also eminent for their clinical teaching,—an art in which Englishmen had up till then been greatly deficient.

Although many names of scarcely less note might be mentioned among the London physicians of the early part of the century, we must pass them over to consider the progress of medicine in Scotland and Ireland. In Edinburgh the admirable teaching of Cullen had raised the medical faculty to a height of prosperity of which his successor, James Gregory (1758-1821), was notunworthy. His nephew, William Pulteney Alison (1790-1859), was even more widely known. These great teachers maintained in the northern university a continuous tradition of successful teaching, which the difference in academical and other circumstances rendered hardly possible in London. Nor was the northern school wanting in special investigators, such as John Abercrombie, known for his work on diseases of the brain and spinal cord published in 1828, and many others. Turning to Ireland, it should be said that the Dublin school in this period produced two physicians of the highest distinction. Robert James Graves (c. 18J0-1853) was a most eminent clinical teacher and observer, whose lectures are regarded as the model of clinical teaching, and indeed served as such to the most popular teacher of the Paris school in the middle of this century, Trousseau. William Stokes (1804-1878) was especially known for his works on diseases of the chest and of the heart, and for his clinical teaching.

German Medicine from 1800 to 1840.—Of the other countries of Europe, it is now only necessary to mention Germany. Here the chief home of positive medicine was still for a long time Vienna, where the “new Vienna school” continued and surpassed the glory of the old. Joseph Skoda (born 1805) extended, and in some respects corrected, the art of auscultation as left by Laennec. Karl Rokitansky (1804-1878), by his colossal labours, placed the science of morbid anatomy on a permanent basis, and enriched it by numerous discoveries of detail. Most of the ardent cultivators of this science in Germany in the next generation were his pupils. In the other German schools, though some great names might be found, as Romberg (1795-1873), the founder of the modern era in the study of nervous diseases, the general spirit was scholastic and the result barren, till the teaching of one man, whom the modern German physicians generally regard as the regenerator of scientific medicine in their country, made itself felt. Johann Lucas Schönlein (1793-1864) was first professor at Würzburg, afterwards at Zurich, and for twenty years at Berlin (from 1839-1859). Schonlein⅛ positive contributions to medical science were not large; but he made in 1839 one discovery, apparently small, but in reality most suggestive, namely, that the contagious disease of the head called favus is produced by the growth in the hair of a parasitic fungus. In this may be found the germ of the startling modern discoveries in parasitic diseases. His systematic doctrines founded the so-called “natural history school;” but his real merit was that of the founder or introducer of a method. In the words of Haeser, “Schönlein has the incontestable merit of having been the first to establish in Germany the exact method of the French and the English, and to impregnate this method with the vivifying spirit of German research.” The name of Schönlein thus brings us to the threshold of the modern German school of medicine,— the most scientific and exact in Europe, and in its spirit strikingly in contrast with the theoretical subtlety of German systematists in the last century.

Literature. — The earliest work of authority on the history of medicine is that of Daniel le Clerc (Histoire de la Médecine, Geneva, 1696; Amsterdam, 1704,1723, &c.), which ends with Galen. Frcind’s History of Physick (London, 1725-26, 2 vols.) carries on the subject from Galen to the beginning of the 16th century. The first complete history is that of Kurt Sprengel (Versuch einer pragmatischen Geschichte der Arjneikunde, Halle, 1792; 3d edition, Halle, 1821-28, 5 vols.; also in French, Paris, 1815). Beside these may be mentioned Hecker, Geschichte der Heilkunde, Berlin, 1822, and Gesch. der neueren Heilkunde, Berlin, 1839; Ch. Daremberg, Histoire des sciences médicales, Γaris, 1870, 2 vols.; Edward Meryσn, History of Medicine, London, 1861 (left unfinished, vol. i. only having appeared). The most recent and complete text-book is Haeser’s Lehrbuch der Geschichte der Medicin und der Epidemischen Krankheiten (3d edition, Jena, 1875-79, 3 vols., in course of completion), to which the preceding sketch is very largely indebted.

In special departments of the subject the authorities are the following :—For classical medicine: Celsus, De Medicina ; Littré, Oeuvres d'Hippocrate, Paris, 1839-61, 10 vols, (especially vpl. i.); Francis Adams, Genuine W orks of Hippocrates translated, with a Pre liminary Discourse, London (Syd. Soc.), 1849, and Paulus Aegineta, translated, with a Commentary, London (Syd. Soc.), 1844; Daremberg, La Médecine dans Homère, Paris, 1865, and La Médecine entre Homère et Hippocrate, Paris, 1869; and W. A. Greenhill’s articles “Galen,” “Hippocrates,” &c., in Smith’s Classical Dictionary, 1844. For Arabian medicine: Wüstenfeld, Geschichte der Arabischen Aer∑te und Naturforscher, Göttingen, 1840; and Lucien Ledere, Histoire de la Médecine Arabe, Paris, 1876, 2 vols. For Salernitan medicine: Collectio Salernitana, edited by De Renzi, Daremberg, &c., Naples, 1852, 5 vols.; Regimen Sanitatis, with introduction by Sir A. Croke, Oxford, 1830; and Daremberg, I.'École de Salerno, Paris, 1861. For medicine in England: John Aikin, Biographical Memoirs of Medicine in Great Britain, to the time of Harvey, London, 1780; Lives of British Physicians, London, 1830 (chiefly by Dr Macmichael, partly by Dr Bisset Hawkins and Dr H. H. Southey); and Munk, Roll of the Royal College of Physicians of London, 2d ed., 1878, 3 vols. For the modern schools: Hirschei, Geschichte des Brown'- sehen Systems und der Errcgungs Theorie, Leipsic, 1846; Bouchut, Histoire de la Médecine et des Doctrines Médicales, 2 vols., Paris, 1873 (comparison of ancient and modern schools); Buckle, History of Civilization in England, 1858-61. (J∙ F. P. )