Part 15

The zeal with which gradually the better class of physicians pursued their scientific studies became more and more conspicuous, evidenced in many ways by the hardships with which some of them had to deal, as witness the struggles of many of the great anatomists of those days.

And so in time the clergy disappeared almost entirely from the ranks of public physicians, and after the Thirty Years' War completely lost their supremacy even in literary matters, this being gradually usurped by the nobility and the more educated laymen; but even then knowledge was pursued under difficulties, especially the study of anatomy. It was not until 1658 that a mounted skeleton could be found in Vienna. Strasburg obtained one in 1671. The handling of the dead body, which we regard as so necessary, was in those days avoided as much as possible. The professor of anatomy rarely, if ever, touched it himself, but he lectured or read a lecture while the actual dissection was done with a razor by a barber, under his supervision.

Practical instruction in obstetrics, which would seem almost as important as that in anatomy, was not given in those days; male students only studied it theoretically. In the Hôtel Dieu, in Paris, that part which was devoted to instruction in midwifery was closed against men. It was the midwives in those days who enjoyed the monopoly of this teaching, and upon whom the greatest dependence for obstetrical ability was placed. The physicians proper, or _medici puri_ of the seventeenth century, were individuals of greatest dignity and profoundest gravity, who wore fur-trimmed robes, perukes, and carried swords, who considered it beneath them to do anything more than write prescriptions in the old Galenic fashion. Some continuation of this is seen in the distinction made even to-day in England between the physicians who enjoy the title of doctor and the surgeons who affect to disdain it. These old physicians knowing nothing of surgery, nevertheless demanded to be always consulted in surgical cases, claiming that only by this course could things go right. Still when elements of danger were introduced, as in treating the plague, they were glad enough to send the barber surgeons into the presence of the sick, whom they merely inspected through panes of glass. Very entertaining pictures could be furnished you illustrating the habits of the physicians of two or three hundred years ago in dealing with these contagious cases. The masks and armor which they wore and the precautions which they took would seem to indicate protection rather against the weapons of mediæval warfare. At one time they were advised that if they must go into actual contact with these patients they should first repeat the Twenty-second Psalm. You may find in the old books, if you will hunt for them, curious pictures illustrating the precautions taken a few hundred years ago against the pestilence, of whose nature they knew nothing, and seeing them you may imagine the vague dread and even the abject fear which led the _physici puri_ or physicians to send the barbers in to minister to plague-stricken patients, while they contented themselves with ministering at long range to their needs.

But gentlemen, I fear lest I weary you with a longer rehearsal of mediæval customs and student follies. While they have all passed away some of them have survived either in tradition or in modified form, as will surely have occurred to you while they were rehearsed. You will not fail to note the steady progress of an ethical evolution which has toned down the barbarities and the asperities of the past, and which has substituted a far more ennobling life-purpose and method of its accomplishment than seemed to actuate your predecessors of long ago.

It is small wonder that the students of those days bore an ill-repute with their surrounding neighbors. You may see better now, perhaps, why the medical student even of to-day has to contend with a prejudice against both his calling and himself, a prejudice begotten of the many debaucheries and misdeeds of his predecessors, and, I am sorry to say, even certain excesses of to-day. I do not know how I may more fittingly terminate these remarks than by reminding you that the profession which you students hope to enter has suffered most seriously in time past from the character of the men who have entered it, and that even to-day certain of its members fail to have a proper regard for its dignity. It is axiomatic that those slights and indignities from which we often suffer, and the neglect and indifference of which we often complain, are in effect the result of our own shortcomings, and that we are ourselves largely to blame because of that which does not suit us. I beg you then to remember that even at the outset of student life there should be ever before you such an ideal of intellectual force and dignity, of power, of co-ordination of mind and body, as may keep you ever in the right way, so that when you at last attain your goal you may deserve that sort of benediction which I find in one of Beaumont and Fletcher's plays (_Custom of the Country_, v. iv.):

"So may you ever Be styled the 'Hands of Heaven,' Nature's restorers; Get wealth and honors, and, by your success In all your undertakings, propagate A great opinion in the world."

IX

A STUDY OF MEDICAL WORDS, DEEDS AND MEN[6]

[6] Address in Medicine, delivered June 24, 1902, at Yale University Commencement.

[Reprinted from the _Yale Medical Journal_, July, 1902.]

_Study nature for facts; study lives of great men for inspiration how to use them_

Never have I more earnestly craved the gift of eloquence than on occasions like this, when young men are about to leave the halls in which and the men with whom they have grown into man's estate, in order to assume the solemn and weighty responsibilities not only of their own lives but those as well of others. The day upon which you are thus released from duties of one kind to assume those of another, welcome and joyous though it may be, should nevertheless be interspersed with some serious and earnest thoughts and resolutions. Old Yale sets now her stamp upon you. It will prove a passport to many homes, but must never be abused. It will entitle you to the society of the cultivated and to the respect of scholars everywhere. It will admit you to the ranks of the learned and cause you to be treated with respect and equality by some of the profoundest and most scholarly thinkers the world has even known. Yale has now furnished you with that which her ripe experience has shown to be requisite for young men commencing professional careers. As contrasted with the total of human knowledge its aggregate is not large, but it has not for centuries been the custom for men to grow gray in studies before undertaking to practice medicine, and when your own qualifications are compared with those which we of the passing generation possessed at the corresponding period of our lives, the comparison will furnish at the same time the most startling illustration of the rapid advance of medicine in the past twenty-five years.

Yale has always been eminent for the versatility and originality of her teachers. Her medical history has been so well told during the past year by one of her most honored sons, Dr. Welch, that it is not necessary nor wise to go now into such historical details. The trend of science to-day is along the lines of comparative investigation, and the Bible is by no means the only literary collection which to-day is being subjected to the "higher criticism." The inspiration claimed for the contributors to that great ancient Collection is denied to the writers of great modern works, where, nevertheless, fundamental truth is as requisite for the welfare of the body as in the other for that of the soul. Only by painstaking research, laboriously repeated, do we clear the old paths of the rubbish of centuries or discover totally new ones.

Pathfinders of this description have always abounded in this great institution, drawn by common impulses or attracted by some centripetal force. And though it were perhaps invidious to mention names, I nevertheless must select two of Yale's great teachers whose names are still green in the memory of all men, and ask you to note how the examples they have set and the work they have done may furnish the line of thought in which I wish you to follow me for a little while.

The science of comparative philology would seem to be far removed from that of medicine. Still, it is based upon an ultimate analysis of parts of speech, and men like Professor Whitney were, not only the comparative anatomists, but even the histologists--if I may use the phrase--of words. Comparative philology then is to medical terminology what embryology and comparative anatomy are to a study of the structure of the human body. The philologist loves to dissect words and trace them back through rudimentary stages and roots to their earliest forms. He loves also to study the evolution of an idea as conveyed by a word, and trace atavism or reversion in human speech.

Again you have here at Yale a wonderful collection of extinct animal remains restored with marvellous accuracy to semblance of their original form and appearance. The indefatigable industry and wonderful ability of Professor Marsh and his co-workers have enabled us to form ideographs of the living forms of earlier geologic ages upon this earth, which could not have been furnished had it not been for their remarkable knowledge of morphology and skill in synthesis. Indeed, where have powers of analysis and synthesis been more brilliantly displayed than by these men. It used to be said of Cuvier, the great French comparative anatomist, that if given a tooth from any beast, past or present, he could describe the animal and its habits as well as reconstruct his skeleton, so wonderfully are minute differences perpetuated, and so familiar was he with them.

Let us see, then, if it be possible to take some of our common medical words and by applying to them the methods of Whitney and of Marsh follow them back to their early forms and significances, and then construct from them ideographs of the customs, habits and superstitions of the men who used them. Such a plan systematically carried out might furnish both a fitting and a novel introduction to the history of medicine. Coleridge, you know, said we might often derive more useful knowledge from the history of a word than from the history of a campaign.

Take, for instance, our word _idiocy_. The Greeks, especially the Athenians, were a race of politicians. Private citizens who cared little or naught for office were the _idiotai_, as distinguished from the public officials and office holders. It came about in time that men of such retiring habits and modest tastes were regarded as persons of degraded intellect and taste. And so the _iviwrai_ were considered of inferior intellectual capacity. In other words, the idiot of those days was the man content with private life. How different from the present day when conditions seem so nearly reversed.

Our kindred word _imbecile_ has also present reference to those of feeble, dwarfed or perverted intellect, and refers rather to mental than physical defects, though both must often be associated. But originally the lame and the deformed who were obliged to use artificial support, walked as it was said, _in bacillum_, upon a stick or crutch, and from this expression we derive our word imbecile.

Let us trace, for instance, again, the etymology of our word _palate_. The Latin _palatum_ is the same as _balatum_, that is, the bleating part. The ancient shepherds of the region of the Campagna watched the sheep as they went bleating (_balatans_) over those hills, one of which subsequently became the _Palatine_.

Or take again our word _mania_. It is derived from _unv_ the moon, meaning the moon-sickness, and corresponds to lunacy from _luna_. You see the ancient superstition concerning the influence of the moon abides in the name. This brings up again the old ideas concerning the metal silver which was sacred alike to Diana and the moon, and consequently feminine in sex and attributes. Hence comes the mediæval alchemistic term _lunar caustic_, and hence, too, comes its use in the treatment of epilepsy for which it was formerly much in use, since epilepsy was regarded as a form of mania caused by the evil influence of the moon.

By the way, this may also remind us of the peculiar views of the alchemists of the middle ages, who believed that the property of sex inhered in the metals. They believed, for example, that arsenic was masculine in sex, and so named it from _arsen_, male, and _arsenikos_, masculine. Medical, like comparative philology, is the more or less direct outcome of the earth's physical features as they have influenced the commingling of races and the conquest of nations.

Medicine seems a science of Aryan parentage; in the Sanscrit the literature of medicine is rich; it was cultivated by the Greeks, but it lost much of its original significance by virtue of Roman supremacy, as the Latin races took it over. Under the Arabians it flourished after a fashion. With the revival of Greek learning there was a restoration of much that had been lost, but the supremacy of the Church kept it within extremely narrow limits, though the clericals could not eliminate all the Arabian words which had crept into its terminology. Greek is to-day the language to which we turn for aid when it becomes necessary to invent new terms by which to indicate fresh discoveries or concepts.

The debt of medicine to our Aryan forefathers is great. Surgery was then a dignified branch of the science. Their autoplastic methods were conceived with great ingenuity and carried out with much, albeit with crude skill. The so-called Indian method of reconstructing a nose bears witness to their ability in plastic art. Their itinerant surgeons performed many capital operations; i. e., lithotomy and coeliotomy. There is good reason to believe that Hippocrates knew nothing of practical anatomy, whereas, long before him Susruta urged that all physician priests should dissect the human body in order that they might know its structure; and gave, moreover, directions for the selection of suitable subjects. The Sanscrit writers knew the properties of many plants and of at least five of the metals. Many Greek names of drugs are derived from the Sanscrit, or else they had a common Aryan origin. Thus the Greek equivalents for our words castor, musk, cardamon, chestnut, hemp, mace, pepper, sandal-wood, ginger, nerve, marrow, bone, heart, and head, are unmistakably of much older, i. e., Sanscrit or Aryan stock, several of them coming down in Romanized form, but almost unchanged--e. g., os, cor, moschus, cannabis, castorion.

Although many of the ancient Greeks visited India, it appears that but relatively few words have come to us from this ancient source.

Our word sulphur, though, is of Sanscrit origin, the Greek word _theion_ indicating its divine or god-given purifying power, with possible allusion to its utility in that lower world with which the theologians most often associate it. The Greek word appears in our chemical nomenclature as dithionic, trithionic, etc.

We note also an almost complete absence of Egyptian words, though many cultured Greeks visited Egypt. Nevertheless, the latter looked with small favor on barbarisms of speech, and our word pyramid is one of the very few which they thus adopted. The term surgery is of very distinct Greek origin, and meant handwork as distinguished from the action of internal remedies. Medicine seems to be derived from _medeo_ to take care of, to provide, and physic and physician from _phusis_, i. e., nature. The physici were originally naturalists, or scientists, like Aristotle, medical science being but a part of their study. Campbell in his book ("The Language of Medicine") gives a list of at least two dozen common terms of to-day which were employed by Homer. In addition to these, many other Homeric terms are still in use, but with more or less altered or perverted meanings; for example, æther, when used in the sense of its being a narcotic agency; astragalus, which originally meant a die, since the analogous bones of the sheep were used for dice; amoeba, from _amoibe_, change or alteration, alluding to constant change of shape. Ammon originally meant a young lamb, iris a halo, meconium has reference to the juice of the poppy, from _mekon_, opium; molybdenum was so named from its resemblance to lead, narcosis originally meant numbness; the pleura was the side; the original phial was a saucer; the phalanges were so called because they were arranged side by side as it were in a phalanx; our troche was at first a wheel; and our tympanum was the original Greek drum, the word still persisting in musical terminology. The arteries were so named because they were supposed to contain air, while the veins were the gushers, from _phleo_, to gush or flow. The original confusion of nerves and tendons appears in the term aponeurosis.

Long ago there were two rival medical factions among the Greeks, the Empirics, from _empeirikos_, meaning experimental--who believed there were no philosophic underlying principles of medical science, and that experience alone was the safe guide,--and the Methodists, from _methodos_, who believed it better to follow the _hodos_, or "middle of the road." The present use of the word empiric shows the contempt with which the former came to be regarded.

As cure (_curo_) meant to care for, so did medicus have the same meaning, as already remarked, while the Greek slave, _therapon_, who waited on his master, became later the therapeutist who cared for his ailments. Our word to heal has also a somewhat similar dislocated meaning, since originally it meant protection, i. e., covering. The same root persists in hell, i. e., hades, referring to a certain supposititious locality so well covered that from it there is no escape.

Note, too, the influence of ancient mythology in medical phraseology. Jupiter Ammon, the horned god, is recognized in hartshorn or ammonia. Mars, the god of war, whose symbol is iron, persists in the so-called martial preparations or ferruginous tonics. Venus and Aphrodite naturally appear in venereal and aphrodisiac, while Vulcan's rôle is indicated in the heat to which caoutchouc is subjected in vulcanizing rubber. Mercury appears not only in Roman form as a metal, but in his Greek rôle as Hermes, not to be forgotten when receptacles are hermetically sealed. Let us cut short a longer list by simply noting in passing how the Greek Cupid Eros and his mate Psyche are perpetuated in our terms erotic and psychiatry, while Morpheus, the god of sleep, can never be forgotten so long as morphine is in use. That the wrath of the gods was to be dreaded is indicated in our word plague, from _plege_, meaning a _blow_ from that source, that is their vengeance. You thus see the antiquity of the notion that epidemics were a divine visitation, and not due to bad sanitation.

Melancholia, _melas_ and _chole_, meant originally black bile. In ancient physiology the bile played a very important part, and the results of hepatic insufficiency were not only indicated by this name, but the advantages of the use of calomel were amply emphasized by its name, _kalos_ and _melas_, for it was a beautiful remedy for this blackness. Another condition indicating trouble with the liver, which we call jaundice to-day (from the French _jaunisse_), was known as icterus from _ikteros_, a yellow bird. The poultice which the average housewife of to-day is so fond of using, was originally a _poltos_, or pudding, or perhaps a bean porridge.

In the days of ancient sacrifices one part of the animal was not placed upon the altar as an offering to delight the gods. It was that now known as the _sacrum_, which is usually defined to have been considered the sacred bone. The adjective _sacer_ (sacrum), had not only the meaning generally ascribed to it, but meant also execrable, detestable, accursed. The sacrum meant then rather the part that was not acceptable to those to whom it was offered. The word _calculus_, like the term to calculate, must remind us of the presence of pebbles and their early use in facilitating reckoning, while our common terms testimony, testify, must necessarily recall the ancient sacred but phallic methods of oath-taking. Another superstition connected with deity is perpetuated in the term _iliac passion_, formerly applied to volvulus, or one form of acute bowel obstruction with its violent pain, which has been compared to that produced by the spear-point as part of the suffering upon the cross.

A keen analysis of the situation at the beginning of the Christian Era reveals the subtlety of the Greek character. The names of those organs which called for deep investigation or dissection are taken directly from the Greek, e. g., hepatic, sphenoid, ethmoid, the aorta, while many of the superficial parts have Latin names, e. g., temporal, frontal.

It is to the Greek that all nations almost invariably turn when they seek to fashion new terms with which to characterize or name new discoveries. The Romans showed their appreciation of that which was good when they so readily adopted the science and learning of the Greeks, and were willing to take over even their gods. The Latin races have always been good imitators but poor originators, save perhaps in war and politics. Had they been willing to imitate the Greeks in these their history might have been very different. When the Latin translators of Greek medical literature lacked for a word they cheerfully took the original, sometimes giving it a Latin dress. For instance, that which we now call the duodenum, meaning only twelve, was originally the dodekadaktulon, meaning that it was of a length equal to the width of twelve fingers, while they twisted the name _eileon_, the twisted intestine, into _ileum_. But the names of most diseases, like those of the more concealed parts, they copied almost exactly.