Part 16

While in later ages the Church completely dominated, then subordinated, and then finally almost terminated the study of the natural sciences, it is yet of no small interest to note the effect of the rise of Christianity upon the study of medicine. It has been well said that the same "cross which brought light to religion cast a gloom over philosophy" (Campbell). Certain it is that the creed and the tenets which were for centuries the mainstay of Christianity, and which did so much for the uplifting of mankind, were made the excuse for the gradual suppression of all tendency toward investigation of natural phenomena, and the monasteries, where scholars congregated, became the graves of scientific thought and study. And so in time knowledge was exiled from Christian domiciles and transplanted to a Mohammedan environment. With Christian mythology and mysticism soon came also Christian demonology, and disease was generally regarded as an evidence of diabolical possession. This gave rise then, as even now, to the imposters who pretended to cure it by exorcism of evil spirits or invocation of divine or superhuman aid. It has always been a sorry time for rational medicine when superstition is rife. Even under the Arabians science flourished to but a limited extent. Their religion forbade the portrayal of any living object, animal or vegetable, consequently their works contained mere descriptions, never any illustration of any kind. This, by the way, is the explanation of their fondness for geometric tracery and of the richness of their ornamental designs. They professed the same horror of the dead body that was later inculcated by the Church and most of them scorned dissection. What wonder then that under Christianity and Islam alike our profession fared badly.

But very little now remains in our terminology to remind us of the period of Arabian supremacy. The Arabic words naphtha, sumach, alkali, alcohol, elixir and _nucha_ (neck) are almost the only ones which have survived the renaissance. How different the monkish Latin sometimes is from the classic may appear in the use of the two words os and bucca for mouth, or os frontis and glabella for the frontal bone.

But this enumeration must not be prolonged unduly. Let us select three or four more examples almost at random and then pass on. But few will associate Christianity with cretinism. The early Christian inhabitants of the Pyrenees were known as _Christaas_, or in French, as to-day, as Chretiens. A mountainous region did for them what it has done in Switzerland for the races of to-day, and dwarfed the intellects of many while their thyroids underwent great enlargement. Such degenerates are known everywhere to-day as cretins, i. e., Christians.

Tarentum was the old Calabrian city later known as Tarento, where during the middle ages the dancing mania appeared in aggravated form. The frenzy was known in consequence as _tarantism_, while the spider whose bite was supposed to cause it was called _tarantula_, and a rapid dance music which alone would suit such rapid movements is still known as the _tarantella_.

Nightmare has reference to the old Norse deity or demigod Mara, who was supposed to strangle people during sleep.

The Sardonic grin has reference to a tradition that in Sardinia was found a plant which when eaten caused people to laugh so violently that they died.

But turn we now from words to those deeds which are reputed to proclaim yet more loudly the manner and the worth of their authors. Where may one look for a profession which shall afford greater opportunities? And where may he find one in which incentives are so small? The world's great rewards have been paid to the great destroyers of our race rather than to its saviors. Do you suppose that if Napoleon had saved as many lives as he lost he would have figured in history with his present lustre? It is true that Lister's discovery has saved many more lives than Napoleon took. If so, the Hôtel des Invalides should, when the time comes, contain Lister's monument and not that of a great murderer.

Personal courage is one of the noblest characteristics which any man can display, particularly so when it combines the moral and the physical type. Public bravery brings nearly always its meed of public recognition. In fact, publicity is often the stimulus to a kind of bravery which without it would hardly respond to the tests. But your really courageous man is he who cares not for a search-light to reveal his deeds, one who dares and does within the quietude of his own environment that from which his weaker brothers would shrink.

The soldier stirred to frenzy by the intensity of his passion will accomplish with but little dread that which might easily baffle the resolution of a reasoning man in a calm mood. The religious fanatic, be he Mussulman or Christian, may permit himself to be rent asunder rather than recant; but his motives are essentially selfish, since he looks forward to the Mohammedan's or the Christian's paradise, and so they are far from altruistic. But for that quiet heroism which shuns publicity, which calls for the highest quality of both mental and physical courage, which looks forward neither to the golden present nor the mystical yet sensuous future, commend me daily, yes hourly, to the sick rooms of patients suffering from diseases which menace the welfare of others, the infectious, the dangerous, the loathsome. One may read of late many stories of army surgeons doing heroic deeds under fire, and one's heart naturally thrills with emotion as he imagines the scenes and wonders what manner of daring may lead a man to risk his life after this fashion. But I submit to you, that brave as is such a deed and worthy of all possible honor, it has been hundreds of times for one exceeded in the actual devotion to duty and the resolution required to brave the elements, or to face death elsewhere than on the battlefield, or to surrender strength or mayhap life itself, or to invite disaster by infection, or to wear out and work out life in the constant grinding altruistic work of doing for others, who perhaps have violated every known sanitary law and forfeited their every right to live.

Here is a theme that might well stir the most eloquent poet or orator that ever lived. How then shall I do it justice? Joanna Bailie has well put it:

"The brave man is not he who feels no fear, For that were stupid and irrational; But he whose nobler soul its fear subdues, And bravely dares the danger Nature shrinks from."

This recognition of our profession was accorded much more unstintingly nearly two thousand years ago, at a time when it was much less deserved, when Cicero wrote (_De Natura Deorum_) "_Homines ad Deos nulla re propius accedunt, quam salutem hominibus dando._" (Men are never more godlike than when giving health to mankind).

But we can hardly delay longer here and at this time with the subject of heroism in medicine. I shall not have completed the matters which I wish to present to you to-day until I invite your attention to a short sketch of the careers of four or five of the men who, during the past two or three hundred years have set the example for men of all times and most climes, whose lives are so replete with that which is interesting, instructive or important that they may be well held up before a graduating class as illustrations of everything which may be advantageously imitated. They belong to that class of whom Longfellow wrote:

"Lives of great men all remind us We can make our lives sublime."

One of those was Jean Fernel, who was born in France about 1497 and died in 1558. I do not know that his life history offers anything so very startling, although he came to be regarded as the most memorable physiologist of his generation, but he adopted a motto which I think we all might well select for our own, and it was because of this motto that I have mentioned his name at this point. It was this: "_Destiny reserves for us repose enough._" If each of you will take this individually to himself he will find in it stimulus enough for all kinds of hard work.

The first of the eminently great men now to be mentioned in this connection was Herman Boerhaave, born in 1668 and died in 1738. He enjoyed the reputation of being perhaps the most eminent physician who ever lived. The eldest son of a poor clergyman with a large family, he was originally intended for theology, and with this in view studied philosophy, history, logic, metaphysics, philology and mathematics, as well as theology. A mere accident, resulting from intense party spirit and doctrinal differences, prevented his devoting his life to theology, and he turned next to mathematics and then to chemistry and botany, subsequently studying anatomy and medicine. He graduated in 1693 and began at once to practice in Leyden, with such success that he was early offered the position of ordinary surgeon to the king, which, however, he had the moral courage to decline. Subsequently he taught medicine and botany, to which chairs was also added later that of chemistry. This fact of itself will show to you something of the condition of medical science of that day, when one man could teach chemistry, botany and medicine. His rarest talents, however, were developed in the direction of clinical instruction, and in this particular field he won such repute that hearers were attracted to Leyden from all quarters of the world and in such numbers that no university lecture-room was large enough to contain them. His practice grew in extent and remunerativeness in pace with his reputation, and when he died he left an estate of two millions. So famous was he that it is said of him that a Chinese official once sent to him a letter addressed simply "To the Most Famous Physician in Europe." That he had fixed convictions and practices may be better understood from the fact that so little difference did he make between his patients that he kept Peter the Great waiting over one night to see him, declining to regulate his visiting list by the means or position of his patients.

Boerhaave was universally regarded as a great student and a great physician, but it was probably his qualities as a man which led to the astonishing extent of his reputation. Essentially modest, not disputatious nor belligerent, he had a remarkable influence over the young men who came near him, while he had a habit of speaking oracularly or in aphorisms, which are not always so profound as they sound and yet often make a man's dicta celebrated. Save that he introduced the use of the thermometer and the ordinary lens in the examinations of his patients, his teachings do not form any really new system. In the classification of men he would be regarded as a great eclectic, in the purer sense of the term. Probably his greatest service to medicine was in the permanent establishment of the clinical method of instruction, and perhaps his next greatest real claim to glory is the character of the instruction and the inspiration which he gave to two of his greatest scholars, viz.: Haller and Van Swieten. He was not the founder of a school. He left no great nor memorable doctrines for which others should contend, but he left a name for studiousness, honest and logical thinking, which was a priceless heritage for the university with which he was connected.

The next great scholar to whose life and works I would invite your attention for a moment, is Morgagni, born in Italy in 1682, died in 1772. He was a pupil of Valsalva, whose assistant he became at the age of nineteen. Brought up in this way, as it were in the domain of anatomy, it is not strange that he devoted his attention throughout his life especially to the anatomical products of disease. It matters little to us now that he was wont to regard these products as the causes of disease and thus neglected their remote causes. He it was who taught us to apply to pathological anatomy the same scrupulous attention to tissue alterations and changes which the ordinary anatomist would note in dissecting a new animal form. He was scarcely the founder of the science of pathological anatomy, for this credit belongs to Benivieni, but he did very much to popularize the study and to show its importance. More than this, he wrote a work which for his day and generation was colossal. It bore the title "_De Sedibus et Causis Morborum per Anatomen Indagatis._" It consisted of five books. The first appeared in Venice in 1761. This proved a perfect mine of information to which one may often turn even to-day, and read with wonder the observations published one hundred and fifty years ago. They stamp Morgagni as a great scientist as well as anatomist. His industry will be indicated by the fact that even after he became blind he did not cease to work.

Perhaps the most wonderful figure in the whole history of modern medicine is that of Albrecht von Haller, of Berne, born 1708, died 1777, and often known as the Great. No more versatile genius than his has ever adorned our profession. A most precocious child, he developed remarkable abilities in the direction of poetry and music, as well as medicine, and the only wonder is that he lived to such a ripe old age, enjoying the fruits of his labors, having displayed throughout his entire life an industry and productiveness which were most remarkable. Before he reached the age of ten he had written a Chaldee grammar, a Greek and Hebrew vocabulary, and a large collection of Latin verses and biographies. During the next few years he translated many of the Latin authors, and wrote an original epic poem of some four thousand verses on the Swiss Confederacy. All of this work he had completed by the age of twenty-one. It is not strange that among those who knew of his precocity he was generally known and regarded as a "wonder child." It will thus be seen, too, that medicine was but one of the many subjects of his study. He studied a year in Tübingen, where the riotous living of his fellow students repelled him; then he went to Leyden, falling there under the influence of the illustrious Boerhaave. How much he drew from this source no man may accurately say at present, but a more brilliant example he certainly could not have had. He finished his studies in Leyden before he was twenty and then traveled through England and France, but was compelled to flee from Paris to escape arrest for hiding cadavers in his room for purposes of dissection. This will prove an evidence of taste for study if not of taste in other directions.

Suddenly developing a passion for mathematics, he went to Basle and worked so hard as to almost ruin his health. This necessitated a trip to the mountains and here his interest in botany was aroused and indirectly that in medicine continued. Soon after he returned to Berne to take up the practice of medicine. Here he studied and worked so hard as to arouse a suspicion of his sanity, but he kept up his health by frequent trips to the Alps in search of flowers. His fondness for botany and his taste for poetry seemed to grow with equal pace and he seems to have been among the first of modern students to appreciate the beauty and grandeur of Swiss mountain scenery. When he was twenty-five years of age appeared the first edition of his poems, many editions appearing later. Here in Berne also he published so many essays on botany, anatomy and physiology that widespread attention was attracted to his eminent learning, and he was called to fill the chair of anatomy and botany in the new university of Göttingen, where he spent seventeen years of extraordinary mental activity, publishing countless papers and at the same time continuing his poetic and his nomadic habits. He established in Göttingen a great botanic garden, founded scientific societies, published five books on anatomy, all elaborately illustrated, printed a series of commentaries on Boerhaave's lectures, and is said to have contributed altogether thirteen thousand articles relating to almost every branch of human knowledge. It is not strange that the fame of the University of Göttingen depended largely upon Haller's reputation.

But Haller developed a clear case of nostalgia, and after being fêted by the nobility, honored by almost every monarch in Europe, and receiving every honor that universities and philosophic societies confer, he resigned from his chair in Göttingen and returned to Berne, to his _fatherland_. Here, amid his old home surroundings, he worked for twenty years more at the same tremendous rate, discharging diverse duties of state and private citizenship, founding and promoting industries and asylums, and serving constantly upon commissions of all kinds. While thus engaged appeared that phenomenal work, his great Treatise on Physiology, so full of original observations that it has been stated that should discoveries which have been re-discovered since Haller be collected they would fill several quarto volumes. The physiological institute of Berne is to-day known as the _Hallerianum_, as it should be, for it is distinctly the product of his genius. He died at a ripe age, after having performed an incredible amount of work, the greatest scholar of his own or perhaps of any century, revered and honored, faithful to the last and exhibiting in his last moments that "philosophic calmness of the cultivated intellect" of which Cicero loved to write. It is related of him that on his deathbed he kept his fingers on his own wrist, watching the ebbing away of his own existence and waiting for the last pulsation from his radial artery. Finally he exclaimed, "I no longer feel it," and then joined the great majority.

Perhaps Haller's greatest contribution to physiological lore was his doctrine of irritability of tissues. It took the place of much that had caused previous discussion and is accepted to-day as explaining, as nearly as we can explain, numerous phenomena.

In this same great wonder-century lived also John Hunter, the greatest of England's medical students, the most famous surgeon of his day and the most indefatigable collector in natural history and natural science that ever lived. He was born in 1728 and died in 1783. He was led to study medicine by the fame of his illustrious brother William, and began his studies by acting as prosector for him. He soon became a pupil of Cheselden, perhaps the most famous English surgeon of his generation. Hunter developed very early those extraordinary powers of observation and that originality in investigation which later made him so famous. Early in his medical career he came for a time under the influence of Percival Pott. This was at a time when surgery had emerged from barbarism and when the French Academy of Surgery had erected it into the dignity of a science. He entered St. George's Hospital in 1754 as a surgeon's pupil. Later he became a partner with his brother in the latter's private school of anatomy, but John, being a poor lecturer, was distinguished by his services in the dissecting-room rather than in the amphitheater. The customs of his time and the jealousies of the various medical factions then existing in London led to numerous acrimonious disputes, in the literary part of which William Hunter, who was much the more cultured student, took the lead, while John, who lacked in scholastic ability and had much less education, was relied on to supply the anatomical data. John was painfully aware of his deficiencies in literary culture and is said once to have replied to the disparaging remarks of an opponent: "He accuses me of not understanding the dead languages, but I could tell him that on the dead body which he never knew in any language living or dead."

It was in this way that he was led into unseemly encounters with the Munros, of Edinburgh, and with his late teacher, Pott. The same sort of dispute finally separated the two brothers, and they parted company after a very unseemly exhibition of jealousy and fraternal discord.

After studying human anatomy for several years, John Hunter became profoundly impressed with the need for much larger knowledge of comparative anatomy, but about this time ill health compelled a temporary change and so he went into the army as a staff surgeon. This was at the time when Europe was engaged in the sanguinary Seven Years' War, and so it happened that Hunter had ample opportunity for studies and observations in military surgery--at the siege of Belleisle and later in the war in the Peninsula. Here he made many of those observations on gunshot wounds which he published at various periods later and which helped to make him famous.

He resumed his work in London in 1763, and here again he had to undergo a long trial of those qualities of passive fortitude and active perseverance under difficulties which were his prominent characteristics. His personal needs were small but his scientific requirements were large, and to these latter he devoted every guinea which he could earn in his small but slowly growing practice. His own manners were so brusque, and he was so lacking in the refinement of many of his colleagues and competitors, that it took rare mental qualities to force him to the front, to which he nevertheless rapidly advanced. Bacon has said, "He that is only real had need of exceeding great parts of virtue, as the stone had need be rich that is set without foil," and this was never more true than in John Hunter's case. His leisure hours were never unemployed. He obtained the bodies of all animals dying in the public collections in London and so began to form that enormous collection which became known later as the Hunterian Museum. As his means afforded it he built and added to his accommodations and carried on those vast researches into animal anatomy and physiology to which the balance of his life was devoted. Although his practice gradually increased and he became in time the most famous surgeon and consultant in London, he used, nevertheless, to spend three or four hours every morning before breakfast in dissection of animals, and as much of the rest of the day as he could spare. Pupils and students who wished to consult him had to come early in the morning, often as early as four o'clock, in order to find him disengaged. He had that rare ability to do a maximum of work with a minimum of sleep which has been so conspicuous in the case of Virchow. Before he died, Hunter attained to a large competence, and his anatomical collection, consisting of some ten thousand preparations, made largely with his own hands, was purchased after his death by the Government, for seventy-five thousand dollars, and presented to the College of Surgeons where it forms the chief part of the so-called Hunterian Museum.

Hunter's principal claims to greatness obtain in this, that he not only brought the light of physiology to bear upon the practice of our art, but by his writings and teachings and especially by his example led men to follow along the paths he cleared for them. It is no small claim to glory to be known by such pupils as Hunter had. By these, by his colossal industry in building up his museum, and by his writings, he will ever be known as the most prominent figure in the medical history of Great Britain.