Part 20

There being no temptation to enter these ranks it is not strange that so late even as 1790 good surgeons were rare in Germany; not one in fifty of the barbers really knowing the first principles of the work they were supposed to perform. It came to such a pass that surgeons were compelled to shave and perform other duties of the hairdresser, for no surgeon, however skilled, was allowed to practice as such, unless he was the proprietor of a head-shaving and bathing establishment, with assistants and apprentices, and belonged to the barbers' guild, or unless he was favored by Royal exemption. It was the general lament in Germany, all through the 18th century, that German surgeons were educated in barber shops. Even by the middle of that century the practice of surgery was not considered an honorable business, and those who practiced it were not permitted to carry a sword, neither was a surgeon admitted into society nor tolerated among physicians; moreover when unsuccessful he was bitterly and relentlessly pursued. Under existing conditions the Reichstag either could or would do nothing to alleviate the distressing condition. The physician boasted of his education and treated the surgeon and his craft with disdain, holding that surgery sustained the same relation to medicine that geometry does to higher mathematics and physics. All this time, however, while the physician contented himself with disdaining surgeons he made no attempt to elevate the craft nor to himself study and adorn it. Even by the beginning of the nineteenth century there were scarcely any physicians in Europe who could diagnose a surgical case, while dentistry they claimed called for no more skill than that sufficient for tooth extraction. It was even claimed that so long as the people generally were neglectful of their teeth the physician, or even the surgeon, should be ashamed to concern himself with dentistry.

Von Siebold, in his day, deplored the position of the surgeon; his large military experience had shown him the difficulties with which he had to contend before he could enter society, while his ambitions and high motives were scorned. Even the peasantry were bitterly opposed to all operations. So intense were their feelings that he repeatedly removed his patients to other towns before performing operations. Nevertheless it was true that there were the best of reasons for lack of confidence in any barber who dropped his razor for the purpose of treating a fracture, a hernia or an obstetric case. The State required a barber surgeon to call in a physician in all complicated surgical cases. In such a case the physician demanded the control of the case and reserved to himself the right to judge of what was required. He would not even consider a surgeon who had obtained the doctorate as his equal. Such consultations resulted in little but quarrels and disagreeable scenes. If a village contained no physician the surgeon treated also internal diseases, though he was not allowed to use strong medicines. Every district had its special surgeon who, alone, had charge of several villages where he had the right to keep journeymen and apprentices and to do shaving and cupping. In the Prussian capital city only twenty German and six French surgeons were allowed to practice in 1725, besides the court and private surgeons.

Until 1808 every German surgeon carried on a medico-legal business which was later separated from his surgery. In 1782 there were three classes of surgeons; from the lower one might be promoted to a higher after an examination. In Austria, in 1805, there were doctors of surgery who were required to show a general knowledge of medicine and who had the same rights as the physicians; there were also medical surgeons who could practice under restrictions, and bathkeepers for minor surgery. After the year 1773 barbers and bathkeepers were both spoken of in Austria as surgeons; this was to break up the disputes between them. According to an official feebill holding good in Prussia in 1815, the highest fee that could be charged for an operation was for lithotomy in adults, the maximum limit being about M. 140 ($35), while the majority of operations ranged from M. 20 to M. 50 ($5.00 to $13.00 expressed in U. S. money). Of course this was at a time when the value of money was much greater than now.

As already made plain, it was the Church which by its decrees brought about the separation of surgery from medicine, a condition not existing during the palmy days of Greece and Rome. Even the University of Paris at one time refused to admit a student who had not foresworn the study of surgery, while the denouncement of anatomy and surgery alike was promulgated by both papal bulls and clerical decrees. While many of the physicians considered surgery too burdensome a study, and many others had a severe prejudice against it, the principal cause operating to keep them apart was probably the fact that for surgeons there was absolutely no social position. In 1774 Mederer was made Professor of Surgery in Freiburg, in Breisgau; he delivered his opening address on the wisdom and necessity of combining medicine and surgery. As a result he was persecuted by the public, insulted by students, abused by surgeons and constantly threatened with personal assault. He maintained his position, however, and fought against the prejudice. Twenty-two years later, when he left Freiburg, he referred in his last lecture to his early experience. By this time public opinion had been so changed that the students serenaded him and humbly apologized for what their predecessors had done. Mederer could then see the success of his efforts in that the constitution of France contained a clause combining medicine and surgery, and the Royal Sanitary Commissioners of Vienna had unanimously resolved in favor of such union.

The movement begun by Mederer was continued by men like Richter, Von Siebold, Loder and others. In 1797, or over a hundred years ago, the Electoral Academy of Erfurt offered a prize for the best essay on the subject "Is it necessary and possible to combine medicine and surgery theoretically as well as practically?" Fourteen papers were submitted, of which twelve were in favor of union. Nevertheless the Academy awarded the prize to the only writer who had opposed such union. His reasons for such opposition were most puerile, as were all the arguments subsequently advanced against it. Nevertheless a great step was taken in advance, when the guilds and fraternities of barbers and bathkeepers were abolished, in which good work Vienna, in 1783, took the lead. It was then declared that shaving was the business of the hair-dresser, and that barber surgeons must attend lectures in surgery and anatomy. Bavaria followed in 1804, and four years later, in Prussia, no one was permitted to practice surgery without having studied medicine. The rules of 1786 regulating the respective positions and duties between physicians and surgeons were annulled in 1808, and by 1811 the barber license was no longer essential for the practice of surgery, the privileges of the barber, as such, being abolished, while for his trade only a common license was needed.

XII

THE STORY OF THE DISCOVERY OF THE CIRCULATION

A STUDY OF THE TIMES AND LABORS OF WILLIAM HARVEY[9]

[9] Address delivered at the Annual Commencement of the Medical Department of the University of Chicago, (Rush Medical College), June 13, 1906.

History in general is but a record of the succession of great events or epochs which have moulded the world's affairs. That which is of the greatest import in the life of the individual may count for little in the lives of his contemporaries, and yet it must be said that in the events of to-day there has occurred a great epoch in the life of each of you, presumably the most important as yet in your personal records. This day is then in your personal histories one of the greatest importance. It is desirable, therefore, that your lives be so moulded and influenced by it that you may long hence look back to it and recall its significance.

I do not know what advice I can give you which will be more fruitful of results, than that among your studies you include that of the lives of the great men who have moulded destiny and made the world's history. Their lives were modified by little things, as have been and will be yours, and yet out of small matters grew for them and for us some of the most far reaching effects. Select the really great men of whom you best happen to know and analyze their characters that you may appreciate how they have become great; while if they have, as all great men have, traits of smallness, study even wherein they are small, and how such faults may be avoided.

History runs as does a fairly steady stream, save that every now and then some event abruptly diverts its course or influences its current. It has been so, for instance, with the history of medicine. For the first sixteen hundred years of the Christian era men engaged in the crude practices of our profession, utterly ignorant of the course of the blood, as well as of its purposes. Then appeared upon the scene a man who did his own thinking, who was willing to free himself from the shackles of the past, to observe nature and to reason therefrom. In this way came suddenly upon the world, as it were, an appreciation of the Circulation of the Blood, than which perhaps no event in medical history has been of greater importance or reflected more credit upon its demonstrator.

It is my purpose, then, to-day to try to tell you, in a semipopular way, how William Harvey came to make this great discovery, as well as to give you some idea of the difficulties under which he worked, and of the men and influences that surrounded him, believing that rather than spend a half hour in humorous platitudes which may provoke a smile, but which are quickly forgotten, it is much better to try to implant something which may linger a while in your memories, and sufficiently impress you with the value of observation and inductive reasoning, since if you become thus fully impressed you will be spared in the future many sad errors of speech and even of thought.

Before telling the story of Harvey's life and work let us study for a few moments the general condition of affairs in Europe, in order that we may better understand the men whose influence surrounded him, as well as the spirit of the times and men's habits of thought.

Among the monarchs reigning in various parts of Europe during Harvey's time there were, for instance, in that part of the Empire of the West which was called Germany, Rudolph II, Matthias and Ferdinand. In Sweden reigned King Sigismund, Charles IX, the great monarch Gustavus Adolphus, and Queen Christine. In Prussia the throne had been occupied by Joachim, George William and Frederick William, as electors, this being before the days of the Prussian kings. In Russia the Czars Boris Godunow, Michael Theodore and Alexis had occupied the throne.

France had but recently passed through the inhuman butchery of the massacre of St. Bartholomew and its accompanying persecution of the Huguenots, under Charles IX, who expressed the hope that not a single Huguenot would be left alive to reproach him with the deed, but who died himself soon after the massacre, which is said to have caused him bitter remorse. Charles had been succeeded by his brother Henry III, a weak, fickle and vicious monarch, whose weakness caused him to be embroiled in civil strife, which was only concluded by his own assassination at the hands of a Dominican friar. Then came Henry IV, he of Navarre, afterwards surnamed The Great, who fought the famous battle of Ivry in 1590, and who reigned for twenty-one years, the greatest and most popular sovereign who ever occupied the throne of France. Notwithstanding his noble qualities he did not succeed in preserving his court from many of the contaminations of the age, and in his reign it is said that no less than 4,000 French gentlemen were killed in duels, chiefly arising out of quarrels about women. He was succeeded by Louis XIII, who was still on the throne when Harvey died.

In Harvey's own country James I was occupying the throne when Harvey appeared upon the scene. He was that royal pedant whom the Duke of Sully pronounced "the wisest fool in Europe." After his death, and when Charles I ascended the throne during his twenty-fifth year, in 1625, Harvey was preparing to publish his great work. It was this Charles I who retained as a favorite the worthless scoundrel Buckingham, whose misconduct in Spain prevented the proposed marriage of the king with the Spanish Infanta and brought about the Civil War. It was because of the cost of this war, and of the king's disputes with Parliament regarding the matter, that England was rent between the conflicts of the Cavaliers and the Roundheads, two of the consequences of this intestine strife being the execution of the Earl of Strafford and of Archbishop Laud. The troubles thus engendered finally cost the life of the king himself, who was beheaded in 1649. Harvey even lived to see the first half of the short tenure of office of Cromwell as the Great Protector, and was perhaps fortunate in dying before began the reign of that odious profligate Charles II.

It is worth while to enquire for a moment what was doing on this side of the ocean at this period which we have now under consideration. In 1607 Virginia was settled by the English, in 1614 New York, by the Dutch, in 1620 Massachusetts and, three years later, New Hampshire, by the English Puritans; in 1624 New Jersey, by the Dutch, in 1627 Delaware by Swedes and Finns, in 1630 Maine, by the English, in 1634 Maryland, by Irish Catholics, in 1635 Connecticut, by English Puritans. Thus it will be seen that the active period of Harvey's life was synchronous with the beginnings of our colonial activities. Very little knowledge of what was going on in the then world of science was brought to this country at this period of its existence, however, and it was many years before in these colonies there were any exhibitions of scientific interest save in extremely scattered and sporadic cases.

Among Harvey's literary associates were a number of celebrated English poets, for example,--Marlowe (1593), Spenser (1598), Beaumont (1615), Shakespeare (1615), Herbert (1635), Ben Jonson (1637), Massinger (1639). Lord Bacon died a year or two after the appearance of Harvey's book, while Baron Napier, the inventor of logarithms, had passed away. His contemporaries in Italy, where he had studied, included Tasso (1595) and Galileo (1645). Rubens had died in 1640, Michael Angelo in 1564 and Titian in 1576. In France, Calvin, the practical murderer of Servetus, had passed away in 1564, Beza died in 1605, Descartes in 1650, Pascal in 1662 and Gassendi in 1655. Portugal had produced but one great figure in the 16th century, namely Camoens, who died in 1579. In Spain, Loyola, the ascetic and fanatic founder of the Jesuits, had joined the great majority in 1556; but Cervantes did not die until 1616, Lope de Vega in 1635, Velasquez in 1660 and Calderon in 1667.

In Germany some great figures had but recently disappeared. Paracelsus died in 1541, Copernicus in 1543, Luther in 1546, Hans Holbein in 1554, and Melancthon in 1560. Mercator, who introduced a new method of cartography, died in 1594, Tycho Brahe in 1601, Keppler in 1631, Van Dyck in 1641, Grotius, the great scholar, in 1645, Rembrandt in 1668 and Spinoza in 1677.

In philosophy, scepticism was the prevailing doctrine in the time of Harvey. It had been founded a hundred years previously by Montaigne, and continued by Charron, the chaplain of Queen Margaret of Navarre, who died in 1603, and who declared all religion to be opposed to human reason;--a remarkable attitude for a chaplain to assume. Opposed to the scepticism of Harvey's day was the mystic, Cabalistic or supernatural philosophy especially represented by Böhme, a peasant shoemaker, uneducated and yet wonderfully gifted. He had been the philosophical colleague of that great Meistersinger, Hans Sachs. Later philosophers and thinkers, yet belonging to Harvey's time, were Pascal, the great Jansenist, who discovered the variations of atmospheric pressure at different levels, and Malebranche, who figures prominently in the history of philosophy.

Descartes, who died in 1650, held the pineal gland to be the seat of the soul. He was the discoverer of the laws of refraction of light and furnished the explanation for the rainbow. He attained greatest eminence in mathematics, physics and philosophy, and was one of the inventors of modern algebra. One of his greatest opponents was that noble Jew, Spinoza, whose colleagues had expelled him from the Sanhedrim to the sound of the trombone.

The Italian Dominican Campanella, who died in 1639, considered the foundation of knowledge to be supernatural revelation and its perception by the senses. In spite of these views he came before The Inquisition on a charge of heresy and of cooperation with the Turks, was tortured by the rack, and imprisoned for thirty years.

The mystic or Cabalistic notions of Harvey's day have just been mentioned. Under them we may recognize many degenerate products and amalgamations of the real doctrines of Paracelsus. The doctrines of the Rosicrucians, as well as of Zoroaster and the Cabala, were revived and made to do strange work. There was, for instance, that Sir Kenelm Digby, who died in 1605, a King's chamberlain, who posed among the English as a so-called Rosicrucian. It was he who suggested the famous "_sympathetic powder_," which was to be applied to the weapon by which a wound had been inflicted, after which the _weapon_ was anointed and dressed two or three times a day, while the wound itself was carefully bound up with dressings and left alone for a week. This was perhaps much the better course, but it will show what strange notions prevailed in those days.

What it meant to run counter to ecclesiastical policy and theological dogma appears not only in such tragedies as terminated the lives of Bruno and many other martyrs to science, but in such facts as these; for instance, when in 1624, just when Harvey was preparing to publish his work, some young chemists in Paris, seeing the benefit of the experimental method, broke away from Aristotle and the canons of theological reasoning, the faculty of theology appealed to the Parliament of Paris, which latter prohibited all such researches, under the severest penalties.

This was the time too when such exhibitions as the following were altogether too frequent;--One Quaresimo, of Lodi, came out with a ponderous work entitled "A Historical, Theological and Moral Explanation of the Holy Land," in which he devoted great space to the question of The Dead Sea and the salt pillar supposed to represent Lot's wife, dividing a long chapter upon the subject into three parts, dealing with the method and the locality of this transformation and the question of the existence at that time of her saline remains. Thus, with his peculiar powers of reasoning, he was able to decide the exact point where the saline change took place, and finally showed that the statue _was still in existence_.

Lord Bacon was also an older contemporary of Harvey, having been born in 1561 and dying in 1626, shortly after the appearance of Harvey's great work. His services to analytic science need no description here, but it is worth while to remember that Harvey, like many others, must have come under his influence and have profited by his teachings in logic and analysis.

At about the time when Harvey made known his discovery Bacon was publishing his views of the laws of transmission and reflection of sound. Great man as he was, with a keen foresight into the value of the recent inventions of the compass, gun-powder and printing, he nevertheless was himself so narrow, in some respects, that he placed but little value upon the discovery of Copernicus. He, however, paved the way for one in some respects still greater, namely Isaac Newton, who, however, had scarcely attained man's stature when Harvey died.

How much we owe to the two great Bacons of history one cannot indicate in this short résumé. Roger Bacon (1214-1292) seems to have been the first great thinker along truly scientific lines. He was more than a mere chemist while, as White says, more than three centuries before Francis Bacon _advocated_ the experimental method Roger Bacon had _practised_ it, and in many directions. He did more than anyone else in the middle ages to direct thought into fruitful paths, and only now are we finding out how nearly he reached some of the principal doctrines of modern philosophy and chemistry. Most important of all, his methods were even greater than his results, and this at a time when "theological subtilizing" was the only passport to reputation for scholarship.

It was Avicenna, the Arabian, who perhaps first announced substantially the modern theory of geology, accounting for changes in the earth's surface by suggesting a stone-making force, but the presence of fossils in the rocks had been always a thorn in the sides of the theologians. It was Leonardo da Vinci, that versatile genius in science and art, who, previous to Harvey's generation, suggested true notions as to the origin of fossils, while, in Harvey's time, Bernard Palissy, another artist, vehemently contended for their correctness. Still, even at Harvey's death, neither geology nor paleontology had come anywhere near scientific accuracy.

The _Academia dei Lyncei_, so-called from its seal, which bore the image of a fox, was founded in Rome in 1603. In France The Academy of Science was not founded until 1665, in Germany The Society of Naturalists and Physicians in 1652, and the British Royal Society in 1665.

In matters of general interest it may be worth while to say that in architecture the general style of The Renaissance was changed for the more substantial Barocco, while the more formal and limited style of church music had given away to musical drama, i. e., opera, albeit in very crude form. The first newspaper had appeared at Antwerp in 1605, the first German paper being published in Frankfort in 1615, and The London Weekly News making its first appearance in 1620. Tobacco, which had been brought over by Raleigh in 1560, had come into quite general use, while coffee, tea and chocolate had gained in public esteem. When coffee was first introduced in England it sold for about $28 a pound. The first coffee house appears to have been established in Constantinople, in the middle of the 16th century, while the first coffee house in London was not opened until a century later.

The barbers still retained their ascendency, and the bath keepers had scarcely lost their position next to the barbers. It was not until Harvey had reached a ripe age that the barbers were required in Germany to pass an examination, in which they had to prove not only their knowledge but the legitimacy of their birth, and the fact that they had studied for three years and had worked for three years more as apprentices.