Part 17

The fifth man in this quintette of geniuses which I am presenting to you to-day was Francis Xavier Bichat, who was born in France in 1771, and died in 1802. Although he was thirty-one years old at his death, his career was so phenomenal, almost meteoric, that it deserves to be held up as showing what one can do in the early period of his life, if he will but work. As one reads of his originality and talent one is led almost insensibly to compare them with those of some of the world's famous musicians who, also, have died in early manhood after giving to the world their immortal works, e. g., Schubert, Mozart and Mendelssohn. Bichat was the son of a physician and applied himself early to medical studies in Nantes, Lyons, Montpellier and finally in Paris, where he became the pupil and trusted friend of Desault, then the greatest Parisian surgeon. When Desault died, in 1795, this young man began lecturing for him, at the age of twenty-four. He displayed a wonderful, almost feverish scientific activity, more particularly in the direction of general and pathological anatomy. He was the originator of the phrase which he made famous: "Take away some fevers and nervous troubles, and all else belongs in the domain of pathological anatomy." Coming upon the stage shortly after Morgagni left it, he was able by his genius, his logical acumen and his graces of speech and manner, to give an attractiveness and importance to this subject which it had hitherto lacked.

It was his great service to more clearly differentiate closely related diseased conditions and to insist upon a study of post-mortem appearances in connection with previously observed clinical phenomena. He also established the tendency of similar tissues to similar anatomical lesions. In fact our view of what we call general tissue systems we in reality owe to him, since without use of the microscope he distinguished twenty-one kinds of tissue, which he studied under the head of general anatomy, while he held that descriptive anatomy had to do with their various combinations.

To Bichat was largely due the overthrow of purely speculative medicine because he placed facts far in advance of theories and ideas. Books he said are or should be merely "memoranda of facts." That he made many such memoranda will appear from the fact that before his untimely death he had published nine volumes of essays and treatises, nearly all bearing on the general subject of anatomy, normal and morbid. He also had not only his limitations but his faults. He strangely denied the applicability of so-called physical laws to body processes, he minimized the importance of therapeutics, and he sought to place the vitalistic system upon a realistic basis. Nevertheless he set an example not only for the young men of France, but of all times and climes, which should be often held up before them.

And so I have thus placed before you five bright and shining illustrations of what brains and application can accomplish, selected from different lands in order to show that medicine has no country, and from a previous century in order that you may the better realize how meagre was their environment in those days as compared with that which you enjoy. Perhaps you will say, "there were giants in those days." True, but the race has not entirely died out. While Spencer and Virchow live one may not call the race extinct, nor can the times which have produced such men as Helmholtz, DuBois-Reymond, Darwin, Huxley, Leidy or Marsh, fail to still produce an occasional worthy successor.

But it is time now to draw this rather rambling discourse to an end. The effort has been partly to attract your attention to some of the side lights by which the vista of your futures may be the more pleasantly illumined, and partly, by placing before you brief accounts of the careers of some of your illustrious predecessors, to show that eminence in medical science inheres in no particular nationality nor race, neither comes it of heredity nor by request. Like salvation it is available to all who fulfill the prerequisites. It is a composite product of application, direction, fervor in study, logical powers of mind, honesty of purpose, capability of observation, alertness to improve opportunities, all combined with that somewhat rare gift of tact, which last constitutes the so-called personal equation by which many humanitarian problems are solved. _Study nature for facts; study lives of great men for inspiration how to use them._

"Were a star quenched on high For ages would its light, Still traveling downward from the sky, Shine on our mortal sight. So when a great man dies For years beyond our ken, The light he leaves behind him lies Upon the paths of men."

If then you regulate your mental habits by such a code other habits will of necessity fall into the proper line. The only other admonition I would give you in parting is summed up in these beautiful lines of our own Bryant:

"So live that when thy summons comes to join The innumerable caravan which moves To that mysterious realm where each shall take His chamber in the silent halls of death, Thou go not like the quarry slave at night, Scourged to his dungeon, but sustained and soothed By an unfaltering trust, approach thy grave Like one who wraps the drapery of his couch About him and lies down to pleasant dreams."

That the sentiment is not new, however, will appear in this other and ancient version which Sir William Jones has thus rendered from the Persian:

"On parent knees, a naked newborn child, Weeping thou satst while all around thee smiled, So live that, sinking to thy last long sleep, Calm mayst thou smile while all around thee weep."

X

THE CAREER OF THE ARMY SURGEON[7]

[7] Commencement Address at the Army Medical School, Washington, D. C., May 29, 1909.--From "_The Military Surgeon_," July, 1909.

The experience of listening to a so-called Commencement Address under these peculiar circumstances is doubtless as novel to you as is to me its preparation. So different is this occasion from that usually spoken of as Commencement Day, that it taxed my judgment as much as it did my ability to--as it were--"meet the indication," and to try to say the appropriate thing. It behooves me to remember that this is in effect not an address to a class of students just entering a learned profession, but an effort on the part of one on the borderland of experiences gathered from a civil surgeon's work, yet enjoying a quasi military title, with strong ties and leanings--to some extent inherited--toward the course of the army surgeon and the fascinations of the soldier's life. Self-evident it is that you need no admonition which I could give, for the very fact of your presence here indicates that your selection by your superior officers stamps their approval of your ability as well as your character.

Time has wrought vast changes in the personnel of the army medical corps, as in every other branch of the service. From the days of Xenophon, with his selection of the best material afforded, to the dark middle ages with practically no provision, then to the later centuries with their menial barbers and barber surgeons, and then the very gradually improved conditions which bettered the service, down to the present time, when the best is none too good, there has been that same evolution which has characterized all the rest of mankind's surroundings and man's realization of his public and private duties. From the days when the first duty of the so-called army surgeon was to minister to his commanding general, and when the private soldier received but the scantiest if any attention, we have arrived at that time when the good health of the entire army is the aim and pride of the medical corps, and when public opinion demands for every enlisted man a degree of watchful care greater than many parents bestow upon their own families. The line officer of to-day can no longer afford to disregard the advice of his medical officers, and camp sanitation is now of even greater importance than operative technique, because preventable sickness and the incapacity caused by disease are recognized as far more to be dreaded than the bullets of the enemy.

Public estimate of our duties to the sick and wounded has varied largely during different epochs. Thus Homer makes Nestor say:

"A surgeon skilled our wounds to heal, Is more than armies to the public weal."

Homer also lauded the services of the two sons of Aesculapius, whom he deified as the grandest of heroes and the wisest of surgeons, and thus wrote of them at the siege of Troy, twelve hundred years before the birth of Christ:

"Of two great surgeons, Podalirius stands This hour surrounded by the Trojan bands, And great Machaon, wounded, in his tent Now wants the succor which so oft he lent."

Again he thus describes an operation:

"Patroclus cut the forky steel away; While in his hand a bitter root he pressed, The wound he washed and styptic juice infused; The closing flesh that instant ceased to glow, The wound to torture, and the blood to flow."

Contrast the tender mercies thus described with an incident occurring during one of the exciting experiences of Ambroise Paré, who one day, during a battle, saw three desperately wounded soldiers placed with their backs against a wall. An old campaigner inquired, "Can those fellows get well?" "No," answered Ambroise. Thereupon the old campaigner went up to them and cut all their throats, "sweetly and without wrath." Note, if you will, the expression, "sweetly and without wrath," since it implies a primitive form of humanity in providing euthanasia for the hopelessly wounded.

While it has been from time immemorial the custom to attach surgeons to various armies, some idea of prevailing notions of antiquity may be gained from the statement that Xenophon had but eight field surgeons with his 10,000 troops. In his army the sick and wounded were cared for in adjoining villages, or, when on the march, were carried in the rear of the troops, being cared for by women from "the baggage." Whether these women were the "vivandieres" of those days I do not quite make out, nevertheless they must have been much the same thing.

In the days of Rome's greatest glory each cohort of 420 men had four surgeons, while each legion of ten cohorts had one legionary physician. In the navy there was also one physician to each trireme; nevertheless the wounded on land or sea received scant attention, although it is interesting to read that each soldier carried with him the most necessary bandages ready for use, an emergency packet supposed to be quite modern.

A few hundred years later, in the Eastern Empire, the Emperor Maurice ordered that throughout every division of from two hundred to four hundred cavalry eight or ten of the strongest men be selected, in order to bring to the rear those who were severely wounded, to supply them with water, and to collect the weapons lying upon the field. These mounted cavalrymen received a small reward for each person rescued. Three hundred years later this arrangement was continued in operation by Leo VI. Wherever it was possible the sick and wounded soldiers were cared for by monks or by sisters, in the numerous hospices and institutions which abounded throughout the East, and although the care was often of the worst the efforts made were in the right direction. Holy oil, laying on of hands, supplication, and the use of holy relics constituted a large part of the treatment in vogue; nevertheless these remedies were not quite so injurious as some of the other and more disgusting ones whose use prevailed in those days.

Without doubt the two army surgeons who during the last 500 years achieved more fame than any of their colleagues were Ambroise Paré, and Baron Larrey. Such commanding figures were they, not only in their professional work, but in the general influence which they wielded alike upon sovereign and common soldier, that they will ever be regarded as among the most memorable characters of common history. Paré died in 1590, Larrey in 1842. Each was passed along from one ruler or commander to his successor, and each was regarded as about the most priceless legacy which could be thus transmitted.

Paré's name has always been most conspicuously mentioned in connection with the history of the introduction of the ligature as a substitute for the cautery iron or boiling oil, previously in use for the checking of hemorrhage, and for his teaching concerning the nature of gun-shot wounds, which had been previously and universally considered as necessarily poisoned wounds; but his new practice and his new views in these respects were but a small part of the general services which he rendered. It is not worth while to try to even epitomize here to-day the history of the ligature; though while its introduction has been widely credited to Paré, you must not forget that it was in use many centuries before his time, and was frequently mentioned by the early writers. What Paré really did was, first, to abolish a barbarous and unscientific method of dealing with hemorrhage, and then to re-introduce or promote the employment of the ligature as a far preferable substitute, more humane, more clean, and more desirable. And so rather than do scant justice by incomplete reference to Paré's actual contributions to knowledge I prefer rather to speak of the other side of this great man's character, and to remind you of some of the many ways by which he secured such marvellous influence over those around him, and made his remarkable personality of the greatest use. As he passed through one campaign after another his reputation became more and more firmly established, and inspired surgeons the world over with the desire to visit him. In almost his every act his sagacity was conspicuously displayed, while, whenever they were called for, his personal courage and absolute lack of fear were equally apparent.

Deprived of the benefits of early and liberal training he probably, on that very account, developed his power of thought, his memory and his analytical powers all the more keenly, inasmuch as these were made to take the place of what he might have learned from books.

The following anecdote will serve to illustrate, for instance, the general esteem in which he was held. In October, 1552, the army of Charles V. was besieging the city of Metz, and Charles himself came to take command. In the beleaguered city were gathered the nobility and the bluest blood of France, while at the head of the defending forces was the Duke of Guise. The imprisoned soldiers and civilians suffered alike from the onslaughts of the enemy, the rigors of a frightful winter, the lack of food, and the presence of disease. The Duke had established two hospitals for the soldiers, which he put in charge of the barber surgeons of the city, and furnished them with money with which to procure supplies, but owing to the wretched incompetence of these same barber surgeons nearly all the wounded perished, and the horrible suspicion arose that the soldiers were being poisoned. The Duke sent word to the King of France that the place could hold out for ten months, but that they needed more medicines. The King then sent for Paré, gave him money, ordered him to take all the medicines and other supplies he deemed necessary, and further aided him by bribing an Italian captain to permit the celebrated surgeon, in some way, to enter the besieged city. Braving all dangers, and being finally successful, Paré entered Metz two months later. He had at this time been with the armies for at least sixteen years, and was known by sight to officers and soldiers alike. On the day after his arrival the Duke of Guise dramatically presented him, on the ramparts, to all his officers, who embraced him, and hailed him with loud acclaim, while by the soldiers he was received with shouts of triumph. "We shall not die," they exclaimed, "even though wounded, for Paré is among us." The effect of this great surgeon's appearance was to give new vigor to the defenders, and to it was due the fact that the city was saved.

In his time Paré met with success such as to-day would be pronounced most extraordinary. He inspired the wounded with utmost confidence, and displayed, always and everywhere, remarkable firmness. Not the least notable feature in his personal history is it that he should have so long retained favor at court with such outspoken independence of character.

Equally reputable among army surgeons of the past, and one of the most commanding figures in history, medical or other, was Baron Larrey. For more than fifty years he was an army surgeon, and for a great part of that period he stood really closer to Napoleon than almost any of the men whom the latter attached to his person by one or another of those traits that made him such a remarkable figure. That one of the greatest murderers and one of the greatest life-savers of all time should have been so closely drawn to each other, constitutes one of the most noteworthy incidents of history. Alike in many respects, so unlike in so many others, it is one of the most creditable features of Napoleon's career that he should have accorded to Larrey that recognition which he early gave and never withdrew. Never was such tribute more signally deserved nor worthily bestowed. Though he passed through twenty-six campaigns, "from Syria to Portugal, and from Moscow to Madrid," and though his wonderful courage never failed him under the most trying surroundings of carnage and conflict, it may still be questioned whether it did not take a higher degree or order of courage to face Napoleon in his tent, or tell him plain truths in the Tuilleries.

The history of campaigning affords innumerable incidents illustrating heroism under fire, or equally trying circumstances, and it is difficult and perhaps unjust to single out a few for individual mention. Bravery is confined to no epoch and to no race; it is simply a God-given trait, not by any means possessed by all men. Take, for instance, one incident in the career of Larrey. During the landing of the English on the shores of Aboukir Bay, when General Silly had his knee crushed by a bullet, Larrey appreciated that immediate amputation was imperative, and gaining consent performed it, in three minutes, under the enemy's fire. Just as he was finished the English cavalry charged upon them; in his own words, "I had scarcely time," he said, "to take the wounded officer on my shoulders and carry him rapidly toward our army which was in full retreat. I spied a series of ditches across which I passed, while the enemy had to go around by a more circuitous route. Thus I had the happiness to reach the rear guard of our army before this corps of dragoons reached us. I arrived at Alexandria with this honorable, wounded officer, where I completed his cure."

Perhaps under no circumstance did Larrey's courage and zeal show to better advantage than in the awful retreat from Moscow. For example, after the terrible battle of Borodino, Larrey made two hundred amputations, practically with his own hands, where there were neither couches nor coverings of any kind, when the cold was so intense that the instruments often fell from the benumbed fingers of the surgeons, and when food consisted of horse flesh, cabbage stalks and a few potatoes. And all this while the savage Cossacks were hovering around equally ready to kill both surgeons and patients. Soon after came the passage of the Beresina, with its attendant horrors. General Zayonchek, over sixty years of age, had his knee crushed, and was in need of immediate amputation, which Larrey performed under the enemy's fire, amid the falling snow, with no shelter except a cloak, held by two officers over the patient while the operation was being performed. The General recovered, and died fourteen years later as Viceroy of Poland.

It was after this passage of the Beresina by the Imperial Guard that it was discovered that all the requisites for the sick and wounded had been left behind and on the other side. Larrey at once recrossed the river, and found himself amidst a furious, struggling crowd, in danger of being crushed to death, when suddenly the soldiers recognized him. Immediately they took him up in their arms, crossed the river with him, crying, "let us save him who saved us," and forgot their own safety in their regard for him whose merciful kindness they had so often experienced.

Another incident in Larrey's career: Ever faithful to Napoleon, his adored master, through victory or reverse, Larrey stood one night with a small group of medical men gazing over the field of Waterloo, and upon the wounded and dying who lay groaning around him. Suddenly they were charged by a squadron of Prussian Lancers, at whom Larrey fired his pistols and galloped away, but was overtaken by the Prussians, who shot his horse, sabred him, and left him for dead. After a while he recovered his senses, and tried to make his way across lots to France, but was again captured by another detachment of cavalry, who robbed him of everything, and then took him to headquarters, where it was ordered that he be shot. Think of such a fate for one who had saved so many lives! But the order would have been carried out promptly had not one of the Prussian surgeons recognized Larrey, having attended his lectures several years previously. Accordingly he was brought before Bülow, and finally before Marshall Blücher, whose son had been wounded and captured by the French in the Austrian Campaign, and whose life had been saved by Larrey's exertions. You may imagine that it did not take long to reverse that order for execution.

Praise from Napoleon was most rare, but of Larrey he made this remark in his will, along with a bequest of 100,000 francs, "He is the most virtuous man I have ever known."

Let us mention a few other instances. For example, Surgeon Thomson, who during the Crimean war, after the battle of the Alma, volunteered, with his servant, John McGrath, to remain behind on the open, unsheltered field, with five hundred Russians so wounded as to be disabled or even at the point of death. For three days and nights these two Englishmen remained practically alone upon that field, covered only with dead and dying, among foreign foes, none of them able to help themselves, or even to speak in a language that could be understood.

At the battle of Inkerman Assistant Surgeon Wolesley had established his field hospital in that awful place of slaughter, the Sandbag Battery. When its defenders were reduced to 150 men, and were forced to leave it, most of them retreated in one direction to find, only thirty paces away, a Russian battalion blocking their path. There was not one competent officer left, so this surgeon took command. Seizing a bayonet because he had no sword, he spoke hurriedly to the men, and explained that their next fight was not merely for victory, but for their own lives; then he led them in a charge that tore so fiercely through the Russian detachment that but half of them reached the other side alive.

During the South African campaign the papers recorded (but how few read of it?) the fate of Surgeon Landon, who was shot through the spine while ministering to the wounded on Majuba Hill. Paralyzed below the waist, he had himself propped up, and continued his work as best he could until his strength failed, when he said, "I am dying; do what you can for the wounded."