ANNALSOF MEDICALHISTORY VOLUMEII SPRING,SUMMER,AUTUMN AND-WINTER ANNALSOF 1/ EDITOR:FRANCISR.PACKARD,M.D.,Philadelphia,Pa. ASSOCIATEEDITORS HORACEMANCHESTERBROWN,M.D.Milwaukee HARVEYCUSHING,M.D..Boston CHARLESLDANA.M.D..New York GEORGEJ:XX:K,M.D.St.Louis *MORTIMERFRANK,M.D.Chicago FIELDINGH.GARRISON,M.D..Washington *ABRAHAMJACOBI,M.D..New York HOWARDA.KELLY,M. D..Baltimore ARNOLDC.KLEBS,M.D.Washington *SIRWILLIAMOSLER,M.D...Orlord WILLIAMPEPPER,M.D.Philadelphia LEWISSTEPHENPILCHER,M.D. DAVIDRIESMAN,M.D... CHARLESSINGER,M.D. EDWARDC.STREETER,M.D.. CASEYA.WOOD,M.D.... *Deceased. Brooklyn .Philadelphia .. . Orlord .Boston Oicago VOLUME11 NEWYORK PAULB.HOEBER,PUBLISHER 67-69EAST59thSTREET COPYaiGBT192"0. BYPAULB.HOEBER 774640 'i'l.'II/ ~ , /,J-._1~ ~,J. . { . .I .I 'I ,,..._. .I ANNALS OF MEDICAL HISTORY VOLUME11 CONTENTS SPRINGNUMBER ANATOMISTSINSEARCHOFTHESouLGeorgeW.Corner THEMEDICALGoDSOFANciENTIRANWalterA. Jayne. THE"PuLMOTOR"OFTHEEIGHTEENTHCENTURYJ.CollinsWarren THEBIRTHPLACEOFTHEHUNTERSFieldingH.Garrison TwoCHAPTERsINTHEHISTORYOFLARYNGOLOGY ANDRHINOLOGY MoDERNCoMMENTARIESoNHIPPOCRATES ADESCRIPTIVELisToFTHEINCUNABULAINTHELI-BRARYOFTHECoLLEGEOFPHYSICIANSOF JamesJ.Walsh.. JonathanWright.. PHILADELPHIACharlesPerryFisher EDITORIALS RE.NE:THEOPHILEHYACINTHUENNEC(I78I-I826) HENRYE.HANDERSON's"GILBERTUSANGucus"FrancisR.Packard. HISTORICALNOTEs CuRRIE's"JouRNAL" l...ocALHISTORY PASTEURDRAMATIZED BooKREVIEWS WiUiamOsler.... ....FrancisR.Packard. .FrancisR.Packard. WEBER.AsPECTSOFDEATHANDCoRRELATEDASPECTSOFUFEINART, EPIGRAM,ANDPoETRY Goon.BENJAMINRusHANDHisSERVICESTOAMERICANEDuCATION MooRE.THEHISTORYoFST.BARTHOLOMEw'sHosPITAL CoRRESPONDENCE PACKARD.THESTERILITYOFUTHERINEDEMEDICI SUMMERNUMBER PHOTOGRAVUREOFABRAHAMJAcOBIFROMAPHoTOGRAPHBYDoRISU. PAGE I 8 I4 2I 23 34 79 79 JAEGER...........Frontispiece 'AMEMORIESOFJosEPHLISTERSt.ClairThomson...93 THEOxFoRDPHYs1cGARDEN.D'Arcy Power...109 MooERNCoMMENTARIESoNHIPPOCRATEs.JonathanWright....126 THERisEANDEARLYHISTORYoFCLINICALJNG....Daf1id Riesman.... NAPOLEON's-futPATBouLOGNE Wn.LIAM0sLER,THEMAN.. Reginald Fitz.. .....HaroeyCushing... V CONTENTS SIRWILUAM0sLER,ATRIBUTEHowardA.KeUy . 0sLER'sINFLUENCEoNMEDICALLIBRARIESINTHE UNITEDSTATESJohnRuhrilh.. SIRWILUAM0sLER'sCoNTRIBUTioNsToMEDICAL LITERATURE PRESENTATIONTOSIRWILLIAM0sLER,F.R.s... ADDITIONSTOTHELISTOFINCUNABULAINTHELI-BRARYOFmECoLLEGEOFPHYSICIANS,PHILA-DELPHIA EDITORIALS FieldingH.Garrison CharlesPerryFisher .FieldingH.Garrison Fielding H.Garrison ABRAHAMJACOBI(I83G-1919) MEMORIALNoTICE:MoRTIMERFRANK LoRDLISTERFrancisR.Packard. LASociETE D'HISTOIREDELAMtDE-CINE...FrancisR.Packard. HISTORICALNoTES ExHIBITIONsATmECLASSICALAssociATION........... FALLNUMBER PoRTRAIToFWILLIAMPAuLCRILLONBARTON ANCIENTPoEMSoNINFANTHYGIENE wALTERHARRIS,ASEVENTEENTH-CENTURYPEDIA-TRIST....... NEwOBSERVATIONSINPALEOPATHOLOGY JEANPAULMARAT,PHYSICIAN,REVOLUTIONIST, ..... JohnFoote. JohnRuhrilh Roy L. Moodie .. .. . PARANOIACCharlesW.Burr. ANAP.PRECIATIONoFHENRYBENCEJoNES,M.D., Pu.D.JacobRosenbloom THEFINANCESOFFELIXPLATTER,PROFESSOROF .. ... ... ... PAGE 168 194 200 208 211 COJJer 213 228 241 MEDICINEATBALECharlesGreeneCumston265 WILLIAMPAuLCRILLONBARTON,SuRGEONUNITED STATESNAVY,APIONEERINAMERICANNAVAL MEDICINEFrankLesterPleadwell.267 EDITORIALS APHYSIOLOGICALRoMANCE FrancisR.Packard..302 1 ERCoNGREsDEL'HsToiREDEMmEcrNE302 BIOGRAPHYOFSIRWILLIAM0sLERHarveyCushing.303 BooKREVIEWS PINOANDRocA.BREVESAPUNTESPARALAHISTORIADELAMEDICINA;sus PROGREsosENGuAYAQUIL304 VI CONTENTS WINTERNUMBER PoRTRAITOFDANIELTuRNER................. Scul.PruREANDPAINTINGASMoDESOFANATOMICAL IU.USTRATIONFieldingH.Garrisonand PAGE C011er Edward C.Streeter305 THEQuiNTESSENCEINRABELAIS..DouglassW.Montgomery.330 THOMASPHAERJobnRubrilb.334 STATEMENTSOFMEDICALINTERESTFROMTHEUFE OFBENVENUTOCELUNIJ acobRosenbloom DANIELTURNERANDTHEFIRSTDEGREEOFDocroR OFMEDICINECoNFERREDINTHEENGUSHCoL-ONIESOFNoRTHAMERICABYYALECoLLEGEIN 1723..........JobnE.Lane...367 A NEGLECTEDNAME:lsAAcSENTER~William Abbatt...381 ONALATINTRANSLATIONoFT H ~CoMPLETEWoRKS OFGALENBYANDREAI..AGUNA,M.D.,THE SPANIARD,STRASSBURG,1004.....D. FraserHanis...384 EDITORIALS AGROUPOFBooKSDEAUNGWITHTHEHISTORY OFMEDICINEINENGLAND.Francis R.Packard..391 DR.GEORGESCi.EMENCEAUFrancis R.Packard.392 EDITORIALNoTE393 HISTORICALNOTEs ANOTEONTHEHISTORYOFVARIOLATIONFielding H.Garrison..394 THELEGALCoNTROLOFTHESALEOFNOSTRUMS ANDPoisoNsINFRANcEDuRINGTHEEIGHT-EENTHCENTURYCharlesGreeneCumston.396 BooKREVIEWS NtAs.DR.JoHNRAocuFFE,ASKETCHoFHtsLIFE,wiTHANAccoUNTOF HISFELLOWSANDFOUNDATIONS400 RocKwEu..R.uiBUNGREcou.ECTIONs,ANAUTOBIOGRAPHY400 BoUTAREL.I..AMioECINEDANSNoTRETHEATRECoMIQUE,DEPUISsEs 0RIGINESJUSQU' AUXVISIECLE402 RoBINSON.THEDoNQuixOTEoFPsYCHIATRY403 vu ANNALSOF MEDICAL HISTORY PUBLISHEDQUARTERLY EDITOR FRANCISR.PACKARD,M.D.,PHILADELPHIA,PA. ASSOCIATE EDITORS HARVEY CUSHING,M.D. CHARLES LDANA,M.D. GEORGE DOCK,M.D. FIElDING H.GARRISON,M.D. ABRAHAM JACOBI,M.D. HOWARD A.KEU.Y,M.D. ARNOLD C.KLEBS,M.D. SIR WIUIAM OSLER,M.D. WIUIAM PEPPER, M.D.. LEWIS STEPHEN PILCHER, M.D.. DAVIDRIESMAN,M.D.... CHARLES SINGER, M.D.... EDWARD C. STREETER, M.D.. SPRINGNUMBER March,1919 NEWYORK Boston New York St. Louis Washington New York Baltimore Washington Oxford .Philadelphia ..Brooldyn .Philadelphia Oxford ..Boston PAULB.HOEBER,PUBLISHER 67-69-71EAST 59th STREET COPTaiGHT01919, BYPAULB.HOEBER PUBLISHER'SNOTE Owingtotbeexigenciesoftbewar.VolumeIof ANNALSOFMEDICALHISTORY,whilebearingthe dateof1917,wasnotcomplekduntilearlyin1919. ForthisreC&SonVolume11willbearthedaleof1919. SubscriberswiUnotethatthereare noissues for1918. ANNALS OF MEDICAL. HISTORY CONTENTS PAGE ANATOMISTSINSEARCHOFTHESouL GeorgeW.CornerI THE MEDICAL GoDS OF ANCIENTIRANWaiterA. Jayne8 THE"PuLMOTOR, OF THEEIGHTEENTHCENTURY. J.CollinsWarren. 14 THE BIRTHPLACE OFTHEHuNTERSFieldingH.Garrison21 TwoCHAPTERSINTHEHISTORYoFLARYNGOLOGYAND RHINOLOGYJames J.Walsh 23 MoDERN CoMMENTARIESoNHIPPOCRATES.JonathanWright 34 ADESCRIPTIVELISTOFTHEINCUNABULAINTHELIBRARY OFTHECoLLEGEOFPHYsiCIANSOFPHILADELPHIACharles Perry Fisher44 EDITORIALS.79 HISTORICALNoTES CuRRIE's"JouRNAL" LoCALHISTORY PASTEURDRAMATIZED BooK REviEWS WEBER.AsPECTSOFDEATHANDCoRRELATEDAs-PECTSoF LIFEINART,EPIGRAM,ANDPoETRY GooD.BENJAMINRusHANDHis SERVICESTOAMER-ICANEDuCATION MooRE.THEHisTORYOFST.BARTHOLOMEw's HosPITAL CoRRESPONDENCE PACKARD:THE STERILITYOF CA THERINEDEMEDICI 8.s 86 91 oap.l add. arepuiUhedoaJywUhcbeundencmcliDctb.ccbqareClllltribuCiedadu.inly rocbeANNALSOFMEDICAL HISTORY.Mamcripcaof&ndforp.Wiarioa, boob for rwft.w,md .U oorttifaadeaCII nlatias rocbeedirorialm__,_c .houJdbe .wr-d rocbeP.diror, Dr. Prada R. Pacbrd,South1p &re., Pbiledelphia, PL nprdiaa IU!.ripcio111, npriDa, md .U 11111a.nnprdiag cbe &u.m- -.--c of cbe ANNALS OF MEDICAL HISTORY .bould beaddn.ed rocbe Pu!Uher, Pml B.S.. ,P &re., N- Yorlt CA,. TheANNALS OP MEDICAL HISTORY it publiehed quen.ly:Apcil, July, OcroLer, cbe oar .._ o.,;pW.tg-....__ The d.aipcioD price itper year.SiDgleDUIIIl.s la.oo. &and --.1 d.. m.mer, J- a, 1917, cbePole 08ice, NewYodt. N- Yodt. aadw cbe of M-eh 31&]9. Cop,riahr. 1919. t., Pml B.Hoeer. ANNALS OF MEDICAL. HISTORY VoLUMEuSPRING1919NuMBER1 ANA TO MISTSINSEARCHOFTHESOUL ByGEORGEW.CORNER,M.D. Universityof California BERKELEY,CAL. VENlay aboutus intheinfancyof our race. When the mind's eyeof thetribesman firstopenedupona worldof mystery,to himthehauntsof goodandevilspirits laynofartherawaythanthejunglejust beyondhishut.Thejungleexplored,the riverfollowedtoitshead,mountainsum-mits stillremaineduntrodden,andherefor awhiledweltthegods.Olympusatlast ascendedandfoundtobeavacantpeak, themountain:-climbercamedown,his disappointmentforgotten,totellof gazing acrossavast oceanand of the BlessedIsles whichseemedtolietherein,beyondthe settingsun;andwhenmarinersreturned without newsof suchfarshores,there were stillthestarsandthesun-god'schariotof fire,beyond the reach of any mortal traveler. Sowiththeinwardmysteryofman's life;atfirstamerewraithoffancyorof fear,avagueimageofthebodyitin-habited,thespiritcouldwanderinde-pendentlyoftheflesh,andoftentimes mustbeconfinedbybondsoflinento preventitsimminentescapethroughthe gashofadesperatewound,orbeheld downwithweightsof ironuponthehead. Butevenhere,asintothejungle,the explorercame,andbegananunending searchforanever-recedinggoal,asearch whichlikethatotherledatfirstthrough regionsnearesthome;fortwothousand yearsthe pioushands of anatomists sought the springs of lifeinthe tissuesof animals, andevenattemptedtofindinthebodies ofthedeadtheorganicseatofman's immortality. Thefirstcivilizeddissectorswerethose Sumerianpriestsandharuspiceswhodrew auguriesfromthevisceraofsacrificial animals.Inthiswidespreadrite it wasthe liverespeciallyinwhichtheomenswere sought;whileintheearlierthoughtof the raceswhichpracticedit,Assyrians,He-brews,andGreeks,theliverwasalso consideredtheseatof life,of heat,andof whatever higher faculties distinguished man fromthe andanimalsfromlower I 2AnnalsofMedicalHistory nature.ThePsalmistliterallysaid"The liveroftherighteousmanshallbemade fat."..."My livershallsingpraiseto Theeandnot: besilent."Thelearned studies of Professor Jastrow suggest, indeed, thatitwasbecauseoftheimportance attached to this organ as of sacred function, thattheriteofliver-searchingbecameso generalandfinallyled,itsoriginalsignifi-canceforgotten,totheimmolationof ani-malswiththe moreelevatedconceptionof vicarioussacrifice.Howinthefirstplace the liver earned such important rank among the tissues,takesusperhapsinto too dark aregionof primitive symbolism,but where thephilologistdidnottread,acasual wandererinthisfieldmayrashlyenter. Primitiveman,openingtheabdomen of abeast,sawmuchthat explaineditself. Thestomach,theintestines,thekidneys, bespoketheirownfunctionsbytheirvery contentsortheirconnections,andbeing understood,werenocauseforwonder. Buttheliver-largestandheaviestmass ofall,blood-hued,andasitseemed, the sourceofalltheveins;withspreading lobesandthestrangelycoloredvesselof gall-offeredaninvitingmystery,and couldnot failto be the seat of facultiesless ignoblycomprehensiblethanmereemunc-tionordigestion.Wasitnot,then,the sourceoftheblood,of bodilywarmth,of life itself? Centurieslater,withthe practiceof dis-section as a scientific method,other regions oftheanimalbodywerelaidbare,and heartand begantopresentnew mystery and new opportunity for the seeker ofsouls.IntheHippocraticwriting"De corde,"therightcavitiesof theheartare representedasreceivingthebloodfrom theliveranddrivingit outagainthrough theveins;buttheleftventricle(found empty after death)containsthe vitalprin-ciple or pneuma, which is to be sent through-outthebodybythearteries.Theheart isthusthecentralorganoflifeandthe ofunderstanding.OtherearlyGreek investigators, as Alkmaion of Croton, began tohaveglimmeringsoftheimportance of thebrain;buteventheseneworgans couldnot entirely dispossessthe liverfrom itsoldplaceofhonor.Newphilosophies, likenewreligions,builduponthe old. Thereweremetaphysiciansaswellas anatomistsatworkupontheproblemof fleshandspirit;andtheresoongrewup thathalf-shrewd,half-falsedoctrinewhich issoclearlyexpressedby Aristotle,adoc-trinewhichwasstilltaughtasfactinthe Middle Ages, and survives in the etymology, thoughlostto thethought,of thepresent day. Life is of triple nature (says Aristotle); theplantsofthefieldarenourishedand grow;beastsfeelandmove;manreasons andremembers,andknowsthatheexists. Possessorsofthreefoldfaculties,welive and move and have our being,and foreach faculty an organ is set apart. As the ancients knew, the liver is the place of the vegetative soul,drawingnourishmentfromthestom-ach,andsendingitthroughthehepatic veintotheheart,whereitsmoresubtle portionsarerefinedtoformthesensitive soul,whoseoutwardmotionsarefeltin allthepulses.Overtheselesserorgans presidesthebrain,seatof theintellectual faculties,the"animalsoul."Ablowupon the head,injuryof thebrain,mayabolish foratimeallconsciousness,butthevital sparkremainsalightuntilthelastbeat of the heart. Theanatomicaltheoriesuponwhichall thiswasbasedwerehardlymodifieduntil theRenaissance,exceptthatdiscoveryof the bile-formingfunctionof the livermade that organmore or lesscomprehensible and sodeprivedit of itsremainingshare of the soul.Theheart,needlesstosay,retains its old place of honor,if not in the scientific sense,atleastinthespeechofromance andofworship.Buriedinourlanguage arecurioustracesofthisandevenolder philosophies;thuswesay"frenzy"ofan ANATOMISTSINSEARCHoFTHESouL 3 ailmentofthemind,butthephrenic nervesandvesselsarethoseofthedia-phragm-a relicof apre-Aristotelianview thatthediaphragm,placedbetweenliver and heart, was itself the seat of the intellect. Thehigherfunctionsonceestablishedin thebrain,thesearchwasnarrowed,and everyrecessofthecraniumwasinvaded. AtAlexandria,inthethirdcenturybefore Christ,ErasistratusandHerophilusadded to other great achievements an exact study of the humanbrain.Thefirstwasthe dis-covererofthemeningealcoverings,and placedinthemtheintellectualfaculty, butlatertransferredittothecerebellum, partly,wemaysuppose,becauseofits marvelousstructurestillcalledarborvitre, butalsobecausehehadseenthegrave resultsof damagedonetothecerebellum inanimals.Herophiluswentdeeper,dis-covered the ventricles of the cerebral hemi-spheres,andgaveto themthe sameinter-pretation,whence perhaps arose the quaint medirevaldivision of the brain-cavities into cellsofimagination,reason,andmemory. But most striking guessof all wasStrato's of Lampsacus,whofound,so Plutarch tells, theparsprincepsanimreinthemiddleof theforehead,betweentheeyebrows.We neednoflightof fancytoimaginehisjoy andawe,whomusthavebeenthefirst todrivechiselintothefrontalsinuses. In the very substance of the skull,between brainandeye,wherethoughtandvision meet,thosedarkcavernsmightwellhave seemedtohimtheabidingplaceof man's inner self. ButtheinnerselfoftheseGreekswas ingeneralnomorethanwhatwevaguely meanbythewordlife,withoutclear implicationof anythingimmaterial.When thecomingofChristianity,ontheother hand,broughtbackinanoblerformthat conceptionofthesoulasanimmortal entity, asa temporary dweller inthe house of flesh,whichisfoundalike in the thought ofthesavageandinthespeculationsof Plato,itfreedthe soulfromthe trammels of bodyforeternity, yet it hound the spirit subjecttothefleshduringthespanof earthlyexistence;andhereinitraiseda strangenewproblemfortheanatomists of the soul. TheChristianFathersdidnotseeknew organsforthenewsoul;anatomywas stagnant,andtheywenttopaganGalen forphysicians'loreastrustinglyasto theirsacredcodicesfortexts.Tomany, indeed,theintellectualoranimalsoul, alreadyfirmlyseatedinthebrain,was itselftheimmortalessence,though others imaginedthisafourthentityforwhich Galen couldhave given them noneworgan hadtheysoughtone;wherefore,with Augustine,theyletit bediffusedthrough-out thebody.Thusit wasnottowardthe science of completed form the Latin Fathers turned,huttoembryology,fortheywere greatlytroubledtoknowinwhatmanner thesoulcomesatfirsttojointhebody. WhethercreatedanewbyGod,orhaving waitedfromthebeginningamongagreat throngoftheotherunborn;whetherin-heritedfromtheparents,orgiventothe childat themomentof itsfirstbreath,or infusedintotheunbornembryo,were questionsof vast argument. InthedebateTertullianandAugustine wereforemost;butitiscuriousthatwith alltheirinsistenceuponspiritualities,the onlyevidencetheyhadtoprovethepres-enceof the soulinthe embryobefore birth wasbaseduponsuchpurelycorporeal groundsasthe earlydevelopmentof brain andheartandtheexistenceofmuscular movementsinutero.Thereisaquaint accountoftheformationoftheembryo whichappearsinalongseriesof books,lay andecclesiastical.Aquinastookitfrom Augustine,whoknewit perhaps fromsome forgottenphysicianofthethirdcentury; DantefromAquinas,andversifieditin hisPurgatory.HenrideMondevilleput it in a book of surgery, and fromhim Thomas AnnalsofMedicalHistory VicarygaveitEnglishwords:"Thusis the childe bred foorth in four degrees... thethirdedegreeis,whentheprincipals be shapen,asthe Hart,lyver,andBrayne: thefourthandlaste,aswhenalthe other membersbeperfectlyshapen,thenitre-ceyveththesoulewythlifeandbreath; andthenitbeginnethtomoueit-selfe alone:soistherxlvj.dayesfromthe daye of conception vnto the daye of ful perfection andreceyvingofthesoule,asGodbest knoweth." Itisobviousthattheembryologyof Augustinefindsapracticalapplicationin thequestionofinfantdamnation;the spiritisalmosteightmonthsaprisoner liabletothepenaltiesofunchristened death,butwithouf opportunityofrescue by baptism. Here is no place for the tender-hearted-orfortheanatomist.Yetto thisday,whenbirthisimpendingin any householdoftheChurch,thephysician mustbepreparedtoutterthehallowed formula,andintimesof emergency,when two lives are committed to the hands of the surgeon,theretakesplaceadramatic repetitionoftheimmemorialbattlefor souls.Theunorthodoxphysicianwhohas witnessedortakenpartinoneofthese suddentragedieswillbedriventomarvel atthepowerofanancientdogmainthe modernhospital;thebasinofsterilesalt solutionbecomes,bymiraclesoffaith,a baptismalfont,andsolemnadjurationof Father, Son, and Holy Spirit issues from the swathed figure of a nursing Sister. But those whobelievemustalmosthavehearddin ofwarfareandhaveseentheglitterof archangels' panoplies. Wehave had more than ahint that in all times past the search for the soul has followed thesamepath,everynewseekerpassing . overthefamiliargroundtraversedbyhis predecessors,thinkingtheobjectofhis hopelayinsomeplacebeyond,stillmys-terious and unexplored. Yet at first thought notime wouldseemlesslikelyto witnessa renewal of the old search than the middle of theseventeenthcentury,norwouldany manseemlesslikelyto pursueit than one whoseverymethodsofreasoningwere foundedupon an attempt to abandon older ground.In1543Vesalius'"Fabrica"had brokenanatomy'sage-oldchainsoftra-dition,andeighty-fiveyearslater Harvey's discoveryofthecirculationthrewher shacklestotheground.Afterthisthe pulse-beat was not mysterious, and no more is heard of a soul in the heart or the arteries. It wasotherwisewiththenervoussystem, however,fornoteventhegeniusof Vesal could fathom the problem of muscles moving atthecommandof thewill,nortellhow apin-prickgetsintoconsciousness.More-over,therewasnothing,asyet,inthe new anatomy to replace or even to discredit theGalenicdoctrineof theanimalspirits, whichtaughtthatinthebrainthemore volatilepartsof thebloodarefilteredout andsentebbingandflowingthroughthe nerves(believedtobehollow)tocarry sensationandvolitionbackandforth.It wasinthe mindsof manythat somewhere inthebrain,atthestarting-placeof this livingtide,mustbethecentralpointof existence;forallhisoriginality,Rene Descartestoowasmovinginthewell-troddenpathwhenhemadehisfamous assumptionthatthepinealglandisthe seatofthesoul.Hisreasonsarehardly morethanErasistratusorStratomight havegiven:theremustbesomepointat whichbodyandsoularejoined;it must beasinglestructure,andinthemiddle plane of the body, in order that impressions coming fromdouble organs,like the eyes or ears, may be combined into a single thought; thepinealglandistheonlyorganin the brainwhichhisdissectionshadshownto besoplaced;itliesinthethirdventricle, intheveryspotwherethespiritsofthe anterior cavities meet those of the posterior, anditiswellprotectedfromoutward harm. ANATOMISTSINSEARCHoFTHESouL s That Descartes'emphasisuponthe mid-dleoftheheadwasinaccordwiththe notionsof thetimeswemightbringmany thingsto show.The most amusing illustra-tionwhichcomestomindisinabookon hermeticsandastrologybyRobertFludd, Doctorof Medicineat Oxford,"De super-naturali,naturali,prreternaturali,etcon-tranaturalimicrocosmihistoria,"1619.In afull-pageengravingisshownaman's headandhandin profile, withdottedlines theorgansofthefivesenses with mystic circles representing the material world.Uponthetemplesaretwocircles inscribedsensativa,imaginativa,andinthe ovalwheretheyoverlap,thesentencehie animaest.Upontheocciputaretwoother circles,memorativaandmotiva,andagain hieanimaest.Inthemiddleofthehead (notfarabovetheregionofthepineal gland)areconcentriccircles,mens,intel-lectus,ratio;overlappingcircles,cogitativa andaestimativa,andforthethirdtime hieanimaest;butfromthismiddlesoul therearedottedlinesleadingheavenward toradiantnichesmarkedwithnamesof angelsandarchangels,powersandprin-cipalities,thronesand dominationsand the Personsof the Trinity. BartholinandWharton,twoof thebest anatomistsofthetime,offeredprompt objectiontothepinealglandtheory,on groundsnomoresubtlethanDescartes' own.First,theyurged,thislittlebody,no morethantwentygrainsinweight,istoo small to containallthe imagesof the soul. More to the point istheir second objection, thattheexternalnervesdonotarisefrom theglandulapinealis,butfromthespinal marrow, and thus anatomical study does not showhowtheanimalspiritscanpassinto themfromastructuresodeeplyplaced. The third objectionisbased on the entirely untrue,butmorestrikingnotionthatthe cerebrospinalfluidofthethirdventricle isrefusematterfromtheprocess of refine-ment of animal spirits, and hence Descartes waslocatingthesoulinaplaceofexcre-ments.Otheranatomistsdiscoveredthe frequent presence of small gritty concretions inthepinealbody,whichsomehowmade thatstructuremoresordid,lessfittobe the seat of agreat function. Thesecriticismsdidnotinvalidatethe methods,butonlytheresultsof thegreat philosopher'sanatomy;andthereseemsto havebeensomethingfascinatingabout the Cartesianrulesfordiscoveringthesoul thatsetallhisfriendsdissectingaswell. TwoEnglishrelicsof theirsearchsurvive underthedustoflibraries,whichseems toliethickestuponbooksofoutworn philosophy.SirKenelmDigbyfoundtime, amidalifeof experimenting in alchemy,of privateeringintheMediterranean,of pro-motingthemostpreposterousof allsecret nostrums,writingcook-books,and of duel-ing,tovisitDescartesandtowritetwo thick treatises, "Of Bodies," and "Of Man's Soul,"whichareverytreasuriesofver-bosityandofquestion-begging.Sucha man,fromprideofintellectalone,could notfailtotakepartinthesearch,and his solutionwastheseptumpellucidum,the membraneorpartitionofcerebralsub-stance whichdividesthe rightfromthe left lateral ventricle of the hemispheres. Digby's reasons, from first to fifthly, are too palpably likeDescartes',butthelasttwoareofa quaintnessworthyquoting:"Sixthly,it isseatedintheveryhollowof thebrain: whichofnecessitymustbetheplaceand receptacle,wherethespeciesandsimili-tudesof thingsreside;andwheretheyare movedandtumbledupanddown,when wethinkofmanythings.Andlastly,the situationweputourheadin,whenwe thinkearnestlyofanything,favoursthis opinion:forthenwehangourheadfor-wards,asitwereforcingthespeciesesto settletowardsourforehead;thatfrom thencetheymayrebound,andworkupon this diaphanous substance." Dr.HenryMore's"Treatise onthelm-I THEMEDICALGODSOFANCIENTIRAN ByWALTERA.JAYNE,M.D. DENVER,COLORADO (PERSIA) INancientIran,diseasewithits treatmentwasadefinitepart of the religioussystem.Medicaldoctrines and practices weredetermined by the sacredbooksandwereunderthecontrol and directionof the priesthoodandphysi-cians.ThereligionofZoroasterprevailed inIran,dating froman early period, and in its development was highly moral and lofty, oneof themostinterestingof theancient world. This system was dominant and prom-isedtospreadovertheOrient,evento Europe,whentheravagesfollowingthe conquestofAlexandertheGreat(330 B.c.)checkeditandeffectuallybrokeits power.The"Avesta,"theLivingWord, the sacredbookof Iran,isnowbut arem-nantof theoriginal,andistheholyscrip-tures of the Parsecs of India.It wasavolu-minousworkintheearlydays,inscribed withpainstaking care onthousands of cow-hidesandonbricksinlettersof gold,and wasreligiouslyguardedinthe "Stronghold ofRecords,"thetreasuries,andtemples. Very much of it was destroyed by the orders of Alexander,and the Mohammedans,after theirconquestinthe7thCenturyA.D., burned all of the remainder that wasfound. The "Avesta" inits present formis,there-fore, a reconstruction from traditions and the memoriesofdevotees.Theportioncalled theGathasbearsinternalevidence,how-ever,inphraseologyanddialect,ofbeing more intimatelyrelatedto the original,and partsofitmaybeasurvival,atleastin form.The "Avesta" isdivided into several booksandtreatsof thelifeof Zarathustra (Zoroaster)andhisteachings;preceptsfor sanctityandareligiouslife;historyor cosmology;thelaw,moralandcivil;the liturgy;andthebookcalledthe"Vendi-8 dad,"theLawagainstDemons.Thislast bookisofespecialinteresttophysicians, asitrelatesalmostentirelytodisease. ChaptersXX-XXIIarestrictlymedical. Thesalientfeatureofthereligionof Zoroasterisadualism,twocreatorsand twocreations.Eachcreator has a following, creaturesemanatingfromtheirprincipal, partakingoftheirrespectivecharacters, depositoriesof theirrespectivepowersand attributes,agentswithvariedfunctions tocarryoutthecreator'swillandto assistinwagingtheincessantwarfarein whichtheirprincipalsareengaged.Ahura Mazda(Ormazd),above allothers,the god ofLight,theomniscientandwisecreator of the universeand allgoodthings,benefi-centintheextreme,issupportedbysix AmeshaSpentas,the"ImmortalHoly Ones," representingjusticeandpiety,who formhis court. Occupying an auxiliary place are the Yazatas,the "Venerable Ones,"his angelswhoare,forthemostpart,ancient Aryangodswhohavefadedorhavebeen demotedinfavorofZoroaster.Tothese areopposedinunremitting,malevolent, bitterconflictAngraMainyu(Ahriman), theEnemySpirit,thePrincipleofEvil, called"Druji,"(Deception),ignorantand shortsighted,whocreateddarkness,sin, disease,suffering,andevilofeverykind. With him are six Arch-fiends,the antitheses of theAmeshaSpentas,whoarehiscom-mandersanddirect the activities of untold hordesofdiabolical,evilspirits.These spiritsofevilseektoovercomeOrmazd, enslavehim,andbyeverymeansintheir powertheyendeavortocreateconfusion in all his good works, to destroy them. They introduce allevilinto the world and attack man to hisdetriment and destruction.Man MEDICALGoDsoFANCIENTIRAN 9 everhasapartinthisstruggle,aidingthe oneor opposingthe other accordingtohis moral attitude.Each work is an act of war-fareforthegoodorforthe bad.This con-flict between the representatives of good and of evilcontinueswithout cessationthrough eonsoftimeuntileventuallytheworld undergoesanordeal,asofmoltenmetal, bywhichit ispurified.Thereafterevilwill beeliminated and Ahura Mazda and good-nesswillreignsupreme. Asisthereligionsoisthemythologyof ancientIranessentiallydualisticandma-teriallyinfluencedbyitsneighbors,of Mesopotamiaononesideandmoredefi-nitelybytheIndiaontheother.Many ofthesemythsareapparentlyofAryan origin,andcomparedwiththoseofthe Vedastheyshowamarkedsimilarityin themeandform,onlypersonalitiesand detailsvary.Forthemostparttheyare trulyIndo-lranian.Thesemythsallcenter aboutthethemeof thestrugglesbetween theagenciesof goodandevil,mostlycon-cerningcreationandthevaliant endeavors : ofKingsandancientheroestosecurefor theearthandformankindthelight,rain, andotherblessingsofNatureagainstthe opposingforcesofevil,ofdragonsand tyrants.Thesecosmicandterrestrialcon-flictsareofteninastorm-cloudamidthe ragingelements,onamountain,orina cavernwiththunderbolt,wind,andfireas weaponsfortheconfusionanddestruction of the demons. Themyth of thecreationof thevegeta-blekingdom,furnishinglaterallmedici-nalplants,isof specialinterest.Ameretat (LongLifeorImmortality),oneofthe AmeshaSpentas,whohadallplantsunder herguardianship,poundedthemallvery small and mixed them with water. The dog-star, Sirius,whowasagoodgeniusin Iran, madethatwaterrainovertheearth andplantssprangup,likehaironthe headof man.Tenthousandgrewtoover-cometen thousand producedincavernsby evilspirits,andthesetenbecamean hundred thousand.From these germscame theTreeofAllSeedswhichgrewinthe middleofthedeepseaVourukasha.Near to this tree,the Gaokerena(Ox-Horn)tree, themiraculousAllHealer,developed.This treewasnecessarytoavertdecrepitude and forthe renovation of the Universe that immortalitymightfollow.TheEvilSpirit, Ahriman,setalizardintheseatoinjure thetree,butOrmazd,tokeepthatlizard away,createdtenkar-fishwhichcircle rounditconstantly,watchthelizardand guardthetreefromharm.Theyareboth fedspirituallyandwillwatcheachother untilthewholeUniverseisrenovated. TheGaokerenatreeistheWhiteHaeoma, amanifestationofthemysticalhaeoma plant,initsterrestrialformtheyellow haeoma.Thehaeomaisthe plant of lndo-lraniansacrificefromwhichthefamous drink,thehaeoma,ismadewhichgives strength and immortality to godsand men. Thisplantisnamedinthe"Avesta" (Y asna IX-XI), and the preparation of the drink,withritualisticceremonies,isde-scribed .. Itispersonified,madeadivinity, andisinvokedbyprayersandhymnsto drive diseaseand death away.1 Muchof the"Avesta"ismythicaland legendary.Itpraisesandglorifiesancient Iraniankingsandheroes.Thisportionis attributedtopre-Zoroastriansages.Fir-dausiinhisgreatPersianepic,"Shih-namah"orBookofKings,writtenabout A.D.1025,relatesmanyoldtraditionsof Iran,andinhistoricalformcelebratesthe mythical deeds of ancient kingsand heroes, includingthoseofthehealinggodsand heroes, Thrita, Thraetaona (called Faridiin), and Airyaman. Alldiseasewassupposedtobe governed bythesamedualisticdoctrineasreligion andmythology.Beingan attack or posses-sionbyspiritsofevil,thepowerof good 1 Camoy,"Mythologyof AllNations,"Vol.VI, p.263. 12AnnalsofMedicalHistory cavern on Mount Damavand for athousand yearsandtookpossessionofhispalace, reigningpeacefullyforfivehundredyears. Firdausi,inhisShah-namah,underthe name of Faridun, relates this heroic conflict. Thraetaonaiscreditedwithbeingthein-ventorofmedicine,agreathealeranda master magician.Asidefromthis,tradition . sayslittleofhim.InmodernIranthe ancientThritaandThraetaonabecome fusedinthe nationalheroFaridun.Bythis namealsoheisknownasanaverterof disease,of allevilandbadinfluences.His nameappearsinthemedico-magicalfor-mulreandstillplaysanimportantpartin the magic of the Parsees. AIRYAMAN(ARYAMAN) Airyaman,anlndo-lranian deity,iscele-brated in the "Avesta" as a benevolent god, ahealerparexcellence.Heisapparently thepersonificationofprayer,andinthis capacitywasamosteffectivehealer,since byprayerorconjurationthesoulshared inthepurificationandaperfectcurere-sulted.AhuraMazdacallsuponhimfor cooperation,inexpelling diseaseanddeath. Heperformedtheriteofpurificationso effectivelywithhismagicformulreand prayersofpraisethathecaused99,999 diseasestocease.Heisconstantlycalled the"treedesire."2 Laterhebecomesthe tutelarygeniusof physicianstowhomhe givesmiraculouspowersofhealing.Heis mentionedintheVedas,andalthoughhis roleisnotdefined,issometimesincluded intheIndiantriad,Varuna,Mitra,and Airyaman. YIMA Yima(Vedic,Yama),averyancient Indo-Iranianhero,mentionedinthe "Avesta"asTheBrilliant,thesonof Vivanghvant,whofirstofferedthehaeoma toAhuraMazda.Hewasaspiritualand materialeducatorofman,theheroofan extensivemythoftheearlydevelopment of the world.HeiscelebratedbyFirdausi, 1 Darmsteter; S.B.E.,p.219. inhisShah-namah,underthenameof Jamshid.In the goldenageof Yima he was chief of aremoterealminwhichthere was neither cold nor suffering. He subjugated the daevasandalltheirimps.Herehereigned forfrom700to1000years,andfor300 yearsofthistimemanneverlookedon death.The"Vendidad"describeshimas taking the path of the sun to open the earth tomankind,andheiscalledtheLordof Settlers.Thelifeof Yimaandthatof the dragon, Azhi Dahaka, appear to run parallel. AzhiDahaka,thestorm-cloudmonster, soughttoinjurethesettlersof Yima,and theyengagedinastruggle.Yimahad committedsomesin.TheGathisstate that hehadfedhissubjects withforbidden foodto make themimmortal.Firdausi says that,"hismindbegantodwell,onwords offalsehoodandofuntruth."Because Yima"divergedfromthe path ofjustice" helosthisgloryandhiskingdom,and wasfinally put to death by the dragon, who thenextendedhisdevilishpowerover theAryanworld.LaterFaridunovercame Azhi Dahaka and succeeded to the kingdom. Jamshidisalsoglorifiedasbeingacon-structorandtheoriginatorofcastes.Fir-dausiascribestohimmedicalknowledge andskill,andJamshidissaidtohave known: "Next to Ieechcraft and thehealing of the sick, Themeansofhealth,thecourseof maladies." HAEOMA Haeoma(Vedic,Soma),anIranian deity fromprimevaltimes...themystical WhiteHaeoma,identifiedwithGaokerena orGokart tree,mayormaynothavebeen thesameasthehaeomaplantof the later "Avesta."It ismentionedinthebookof the"Avesta"calledtheY asnaandfrom it wasmade the sacred drink,the Haeoma, whichgavestrengthandimmortalityto godsandmen.This drink waspreparedby -MEDICALCoosOFANCIENTIRAN 13 thepriestsaccordingtotheHornY asht3 with ritual prayers and ceremonies by press-ingthejuicefromthetwigsof theplant, filteringandmixingit withmilk,honey,or other liquid. It was exhilarating, gave a sense of power and ability, and produced intoxica-tion.It wasatonetimethe subjectof or-giasticsacrificeandwasbanishedbythe Gathas.Inalatertimeitreappeared,but withouttheseobjectionablefeatures.Viv-anghvantfirstofferedthedrinktoAhura Mazda, and it was from his son Voku Manah that it receiveditshealing power.Boththe drinkandtheplantwerepersonifiedand worshipedasdivinitiesandinvokedto driveawaydiseaseanddeath.Adropof Haeoma was placed onthe lipsof the dying faithful.It grew in inaccessible places on the mountainsandwasbroughttoearthby divinebirds.Italsohadthepowerof slayingdemons,andof bestowingspiritual light andblessingsuponman. MITHRA Mithra(Vedic,Mitra),anlndo-Iranian godofgreatantiquity,andwhetherof Aryan,IranianorVedicorigincannotbe determinedwithanycertainty.'Hewas intimatelyassociatedwiththeVedicgod Varuna.Theyrepresentedmorallight,law andorder.Theywerethe"Guardiansof HolyOrder";theyhated,droveawayand punishedfalsehood.TheeyeofMitraand Varunawasthesun.Mitrahadtheoccult powerbywhichthedawnappeared,the suncrossedthe sky,thecloudsobscuredit andrainfellupontheearth.Apartfrom Varuna,theVedicMitrawasafaint personality.4 IntheIranianmyth,Mithra hadadefinitesolarnature.Atfirsthewas thegodofimmateriallightandlater,by analogy,ofthesun.Hewasalsothegod of faithfulcontracts.It issaidthatMithra oncemeasuredhisstrengthwiththesun, a YasnaIX-XI. Keith,"MythologyofAllNntions,"Vol.VI, p.20. withwhomhelatermadeacompactof friendship,andthesealliesthereaftersup-ported eachother inallevents.He wasthe logicalsonofAhuraMazdaandwasthe mostimportantY azata.AmongtheIran-ianshewasthegodof theplightedword, theprotectorofjustice,thegodwhogave victoryinbattlesagainstthefoesof Iran, the defender of the worshipersof truth and righteousness. 6 ThecultofMithrawasearlyidentified withoccultismandmysticceremonies. These ceremonieshadmanypointsincom-monwiththose of the Christians;baptism, communion with bread, and wine; ointments ofhoney,etc.,whichresembledtheoint-ment of confi:rmation.The sacraments were consideredb;neficialforthecureofthe bodyaswell3cSforthe sanctification of the soul.Bread,wine,waterofbaptism,oint-mentswereregardedasmysticremedies, andallthemedicineofthegodMithra waspurelymystic.In the baptism of blood, the T aurobole,the patient wasledbeneath openplanksandthebloodof abullabove filteredthroughandfell,inamystic sense, likea beneficent rain. The cure consisted not in the blood,but inthe symbol, the passion ofMithra.Thebull,representingthe god, shedhisbloodforthefaithfulsick;an instance of divine abnegationinaprimitive religion.ThecultofMithra,popularand powerfulinIran,spreadrapidlytoGreece and over the RomanEmpire,carrying with ittheoccultismandmysterieswhichhad characterized it inPersia.The Romans saw Mithra'sastrologerspassingwholenights on the tops of their towers, and his magicians practicedtheirmysteriesontheslopesof theAventineandonthebanksofthe Tiber. 6 Thecultencounteredbitterhatred andtheoppositionofallChristians,and thestrugglecontinuedinthemoreremote quartersintotheMiddleAges. Carnoy,Ibid.Vol.VI,p.287. Bruzon,"LaMedecineet lesReligions,"p.137. THE"PULMOTOR"OFTHEEIGHTEENTHCENTURY ByJ.COUJNSWARREN,M.D. BOSTON,MASS. INthejustpublishedhistoryofthe HumaneSocietyoftheCommon-wealthofMassachusetts,oneofthe oldestcharitableinstitutionsinthe United States, isan account of an apparatus designedforthe purposeof theinflationof theintestinalcanalbytobaccosmokeas ameansof resuscitationof theapparently drowned.Tothepublic,andeventothe medicalpractitioner of to-day,the storyof such amode of treatmentwould seem to be almostbeyondtheboundsofcredulity. Fromwhat mythicaltraditionsof the past couldsuchadevicehavebeenderived,or whatcouldpossiblybethephysiological action of such aremedy are questions which naturally suggestthemselves. Anystudentofthemedicalliterature of the seventeenth andeighteenth centuries isfamiliar with the prominence given to the clysterinthetripodofmedicaltherapeu-tics.Venesection,emeticsandtheclyster were the three most potent means of reach-ingthetissuesandfluids of thebodyina morbidstateandthusclearingoutwhat werethencalledthe"peccanthumors." Theimportanceattachedtothelastof thistrinityisshown at an early date, forwe findthatScultctus,inhisworkonsurgery (1671),considersthe apparatusdevisedfor thispurpose worthyof aminute description andafull-pageillustration. Itwasataboutthisperiodthatthe writingsofMoliercservedtoaccentuate thistherapeuticcustom,oratallevents torecordthe prominent place whichit held inthetreatmentofdisease.Bethatasit may,theclysterhelditsown conspicuously amongtheheroicmeasuresinflictedon sufferinghumanityforthebetterpartof twocenturies. Among the earliest records1 we have of the 1 Thetherapeuticvalueoftobaccowasthus 14 remedialqualitiesof tobaccosmokeisthat quotedbyPia fromthe history of a Journey toAmerica,inwhichitisstatedthatthe savages("d'Acadie")haveasingular methodofresuscitatingtheapparently drownedwhohaveswallowedagreatdeal of water.Theyfillananimal'sbladder, or a largesegmentofintestinetiedatoneend, withtobaccosmoke andattachit toatube FIG.I. Fig.1showsthefumigator;amachineforinjectingthe smokebywayof clysterinthosedesperatecaseswhichre-quirethe applicationof thisremedy.It consists of apairof bellowstothemuzzleofwhichisfittedametalboxa providedwitharing,inthemiddleofwhichitmaybeun-screwedandagainclosed,afterbeingfilledwithtobacco and setonfire.Thepiptcoftheflexibletubthisintrn-duct.-dintothefundamentandthusbynwnnsof thebdlows d the smokeisforcedintothertctum. THEPuLMOTOROFTHEEIGHTEENTHCENTURYIj which is then introduced into the fundament of thepatient.Bythismeansthesmokeis injecteduntiltheabdomenbecomesdis-tended.Theythenhang the patient bythe feettothebranchof atreeandthesmoke isthusenabledbyitspressuretoforcethe water,whichthepatienthasswallowed, out of hismouth. InFranceReaumur(I683-I757),who, bytheway,isnotgenerallyrecognizedas havingbeenamemberofthemedical profession,wasthefirsttointroducethe useoftobaccosmokeinthisway.He suggestedthatthiscouldbeaccomplished bybreakingoffthestemofapipeand blowingthesmokethroughit.Itisduly recordedthatoneofhiscolleaguesinthe Academytestifiedtotheproperandsatis-factory effect of this remedy. His article \Vas publishedinI 7 40.Incidentallyitmaybe mentioned that he recommended rollingthe patient to and froin an open barrel,adevice whichoweditsusefulnesstotheeffectit hadinproducingartificialcontractionand expansionof thethoraciccavity,although therestorationofthisfunctionwasnot evidently recognized as an important feature at that time. InHollandtheliteratureonthissubject seemedtohavebeenmoreabundantthan inothercountries,asmightnaturaliybe supposedfromitsgeographical character. ThereportsoftheSocietyofAmsterdam arefilledwithmanyaccountsof theuseof describedbyLobeliusin1576.Speakingofitsuse bytheinhabitantsoftheWestlndieshesays, ..."For youseemanysailorswhohavereturned fromthat countrywhocarry little funnelsmadeof a coiledpalmleaf,orofreeds,intooneendofwhich areplacedcurled,brokenup anddriedleaves of this (nicotiana)plant.Theysetlighttoit,anddrawing it intotheirmouthsasmuchastheycan,theysuck inthesmokebyinhalation.Theyarethereby enabledto endurehungerandthirst tomaintainthe strength andto exhilarate their spirits.They declare thatitsoothesthebrainwithapleasantformof intoxication and it certainly gi:vesrise to anincredible quantity of spittle."TbeQuar/er{vRe1'iew,July 1913, p.139,London. thisremedy.Gobius,adistinguishedDutch surgeon(inhisbook"AdversariaVarii Argumenti"),employedtobaccosmokein this way for constipation, colic, and strangu-latedhernia.Itisstatedthathepracticed inacountrywheretheinsufflationtreat-menthadbeenusedmanyhundredtimes. De Haen had used it two hundred times and formore than one hour at a time, the smoke beingintroducedwithmuchforceandin largequantities,bothinexperimentson animalsandavarietyofhumanailments. LaurenceHeister inhis"lnstitutiones Chi-rurgicae,"Amsterdam,I 7 50,inachapter onClysters,referstotheuseof fumigation forincarcerated hernia, and gives a diagram oftheapparatusbywhichtobaccosmoke canbeblownbythemouthofasurgeon intotheintestine,thesmoke,accordingto theauthor,actingasastimulusinthe intestine andcausing the strangulated loop notonlytoshrinkinsize,buttoretract itselfintotheabdominalcavity.(Fig.2.) Dr.LudwigKnapp( Igo8)inamodern rendering of Cangiamila's work on Theology andMidwifery,1754,mentionsamongthe remediesthisancientauthorlaiddown fortheresuscitationofnew-borninfants apparentlydead,theuseofclystersof tobaccosmoke"to establishthe pcristaltic actionoftheintestinesandthusarouse throughcooperationofthediaphragmthe actionof theheartandlungs."If these arc thewordsoftheauthor,andnotthe translator's, we have here the first indication of the recognition of a physiological purpose intheuseof thisremedy. ChristopherKeil,inhishandbookon Surgery,I 7 4 7,Leipsic,describestheuseof clystersandrecommendslong flexibletub-ingforthe purpose.In afrontispiece inthis workanillustrationisgivenofsuchan apparatus,bywhichanindividualisable toadministertohimself rectalinsufflation. (Fig.3.) Inthelatterhalfoftheeighteenth century(I 772)wefindanorganizationwas AnnalsofMedicalHistory establishedinParisforthepurposeof renderingaidtotheapparentlydrowned. Anearlyreportofthisinstitution2 de-scribesaboxcontainingbottlesfilledwith variousrestorativesanda"machine fumi-gatoire"3withabellowsandacannula.In theintroductiontothereport,itisstated that,atthisperiod,inF ranee,thecities ofParis,Lyons,Tours,Lille,LaRochelle, and elsewhere,havefoundedprivateorgan-istry,anoticebeingdulycirculatedamong the provincial officers.ParagraphI I Iof the directionsspecifiesforcibleinsuffiationinto therectumoftobaccosmoke,eitherbya pipestem,orthroughtheleathersheath of aknifecutopenatthepoint,orbyan ordinarybellows. AnextractfromanAdmiraltyReportof thetownofDunkirk,1777,referstothe fumigatingmachinekeptbythetown FIG.2. izationsforthesamepurpose.The meth-odsgenerallyemployedbythese various organizationstowardstheendofthe eighteenthcenturywererecommended officially(justasartificialrespirationis to-day)by the Maurepas(170I-I781)Min-2 Detaildessuccesdel'establissmentquelaville deParis afaitenfaveurdespersonnesnoyees,1775 3 "A fumigationmachineiskeptateverystation house.The method of using it is as follows:-Half an ounceofsmokingtobacco isplacedintheboxof authoritiesforthispurpose.Incidentally itmaybementionedthatoneof therules laiddownbythisreportwastoforbidthe rollingofabodyinacaskortoholdthe bodyupby thefeet. The Royal American Magazine,February themachineandisslightlymoistened.Thebellows arethenattachedandforcethesmokethrougha longpipe;threequartersofanhourshouldbe employedinadministering the half ounce of tobacco. The bellowsshouldbeblowngently." THEPuLMOTORoFTHEEIGHTEENTHCENTURY 17 177 4,givesDr.Tissot' smethodof restora-tionof theapparentlydrowned.Hereitis stated that inaddition to blowing the warm breathintothepatient'slungs,tobacco smokemay be introducednot onlyinto the fundament, but into the lungs as well. After tobaccohasbeenlightedinthebowlofa pipe,thebowlshouldbewrappedina paperinwhichseveralholesarepricked andthroughtheseholesforcethebreath strongly.It isalsorecommendedbythis authorthatifasurgeonispresentthe jugularveinshouldbeopenedand about twelveouncesof bloodtaken. It maybewellto givehereexamplesof themethodsemployedatthisperiodin twocases. Rene H., 25years old, while bathing,was rescuedfromthe water three-quarters of an hourafterbeingsubmerged.Hewasun-conscious,withoutvoluntarymovements andpulseless,andsupposedtobedead. TakentotheGuardHousethesoldiers treatedhimbyinsufflationof airintothe mouth,rectalfumigationswithtobacco, frictionoftheskin,andapplicationof ammonia to the nostrils,atreatment which extended over twohours,whensignsoflife begantoappear,theeyelidsmovingand the pulsebeingfelt,etc.,andfinallymove-mentsof thebodyandcries.He wasthen carriedtoahousenearbywherewarmth wasapplied. Here he was bled from the arm, insteadofthejugularvein,owingtohis resistance.Tobaccofumigationproduced abundant evacuationof the bowelsandan emeticbroughtupalargeamount of salad andotherfood.Hewasmadetoswallow brandy,whichservedthepurposeofan "antiputridcordial,"andrevivedhim. Hiscomradesnexttookhimtotheirinn and carried out further ministrations advised by the surgeon who bled him. After receiving twopurgings,hereportedonthefourth dayat the City Hall to expresshisgrateful acknowledgments,stating thathehadhad no recollection of what had happened to him. The followingcase isstated to showthat rectalinsufflationcanbeemployed,even whenthenecessarymachineryisnotat hand. A rescued woman's husband, who thought hiswifedead,was told by apassingsoldier smokinghispipeto dryhistears,that his wifewouldsoonberevived.Thengiving the pipe to the husband,heinstructedhim howtointroducethestemintotheanus, thenplacinghismouth,coveredwith perforated paper, to the bowl of the pipe, to blowwithallofhisforce.Atthefifth insufflationof smokealoudrumblingwas heardandthe patientexpelledwaterfrom themouthandamomentlaterregained consciousness. But thismethod,evenat thistime,was notwithoutitscritics,forM.Portal, Professorof Medicine at the RoyalCollege ofFrance,claimedthattheinsufflation impededthecirculationofthevesselsof thevisceraintheabdomenandthorax andthusactedinjuriously.Pia,however, refersinreplytothisobjectiontothe quotation of Heister, which we have already mentioned above,to the effect that tobacco smokeappearsto irritate the intestineand causeadiminutionof itscaliber. InLondonwefindJohnAiken(I77j), using the rectal insufflation of tobacco smoke and preventing the over-heating of the tube bywrappingclothswetincoldwater aroundit.Theuseofthisremedywas recommendedbyhimasa"stimulantto arouse the vitalmotions." Cullen,Edinburgh,I784,inaletterto LordCathcart,says,"withregardtothe stimulants,Imust conclude withobserving that whenabodyhaslaidbut ashorttime inthe water and that therefore its heat and irritabilityarebutlittleimpaired,the applicationofstimulantsalonehasoften beenfoundtobeeffectualforrecovery. But,onthecontrary,whenthebodyhas lainalongtimeinthe water and theheat of it isvery much extinguished, the applica-AnnalsrifMedical1/istory tionofanyotherstimulantsthanthatof tobaccosmoketotheintestinescanbeof verylittleservice-andtheapplicationof othersoughtnevertointerferewiththe measures of recovering heat and the motion of respiration." Goodwyn,(I 788)refers to the application ofdifferentsubstancestotheskin,the stomach, the intestines, the parts of genera-tion,the nose,the fauces,the extremities of the fingersby Jacob Gummer asbasedona mistakenopinionoftheprincipalseatof life. But Kite,I79.5inexperiments on animals renderedinsensiblebysubmersion,givesas hisopinion,undertheheadofother remedies,thatthe"principaloftheseare electricity, particular stimuli adapted to the cliff erentorgansofsenseandirritating medicinesthrownintothestomachand intestines."Here,forthe firsttime,wefind powerful stimulilikethat of electricityused forarousingvitalaction.Butwhilethe surfaceof thebodythushasthebenefitof thenewagencies,theinteriorsurfacesare notneglected.Ouroldfriend"rectalin-suffiation"isstillemployedwithaviewto localstimulation. Butadefinitereactionhadalreadyset in,forwefindthatEdwardColeman, London,inI 79 I,speaksinnouncertain terms as follows:"As tobacco smoke thrown up the rectuminthe formof smoke was one of the firstremediesemployedinsuspended respiration, and as we see, to our regret, that it is still too frequentlymade use of,we shall endeavorbyafewanimadversionsonits effectstoproscribeitscontinuance.... Thehistoryof medicalerrorsscarceaffords amoreblindandobstinateprejudicethan thatwhichstillinducesustoadopta modeofpracticesoobviouslydestructive. Forsmokeandfluidsofallkinds,when giveninlargequantities,willdistendthe intestines,theresultofwhichwillbethat theirmechanicaleffectinpreventingthe easydescentofthediaphragmwillneccs-sarilybeproductiveofmischief."Incon-cludingthisstatement,hespeaksnextof thesympathybetweentheheartandthe stomachasbeing greater thanbetweenthe heartandintestines.Hereevidentlywasa pioneerinmoderntherapeusis I InDr.Willich'sDomesticEncyclopedia, London,I 802,isgiventhelistofarticles containedinaboxdevisedbyKiteand furtheramplifiedbyMr.Redlichof Hamburgh,amongwhichistobefound themachineforinjectingthesmokeof to-bacco.Fig.4Willichshowsclearlyinhis articlethatinflationof thelungsisoneof themeansofrestoringlife."Stimulating clystersconsistingof warmwater andcom-monsaltorastrongsolutionoftartar emetic,orsixouncesofbrandyshouldbe speedilyadministered.Wedonotconsider, hesays,injectionof the smokeof tobacco, or evenclystcrsof that narcotic plant inall instancessafeandproper."4 Thefinaltouchmayhavebeensaidto havebeenplacedonthismodeof practice byDanielLegarc(I80j)who,inan inauguraldissertation,ongraduatingfrom theUniversityofPennsylvania,presented ashisgraduationthesisexperimentsupon animalswiththerectalinsumationof tobacco.After the insumationthe abdomen wasopenedandthechangesinthecir-culationcarefullyobservedinaseriesof cases. He found an increase in the mesenteric arterial circulation,but adiminutionof the peristalticactionof the intestines.Hecon-cludedthatthismethodwasofnovalue asameansof resuscitation. Althoughitisoftendifficultto repressa smileatsomeof themedicaltheoriesof a bygoneperiod,itiswelltopauseinthis instancebeforepassingfinaljudgmentand toaskourselveswhethertheremaynot have been after all some wellfoundedobser-vationswhichservedtoimplantathcra- See"HistoryoftheHumaneSocietyofthe CommonwealthofMassachusetts,"byM.A.De WolfeHowe,p.18. L r I I I -THEPuLMOTORoFTHEEIGHTEENTHCENTURY19 peutic measure so firmlyin the traditions of medicalpractice. Theancientswerewonttoregardthe rectumasthe ultimummoriens.Herethere wassupposedtoexistoneoftheprincipal seatsoflife.Itsoutlet,anextremelysen-sitiveregion,isabundantlysuppliedwith nervesandbloodvesselsandeasilyaccessi-bletorestorativemeasures.Thisfaithin FJG.3 certainsensitivesurfacesastheprincipal sratoflifereferredtobyGummerfore-shadowedonlywhathasquiterecently takentheformof amoderncultknownas "orificialsurgery,"thedilatationofthese highlysensitizedorificesbeingsupposedto exertastrongcurativeinfluenceinmany ailments.Moreover,the levator animuscle, beingcomposedofapowerfulenveloping massofmuscularfiberandbearingan intimate relationship to the lower intestinal canal,hasbeenclassedbymorethanone physiologist of the past as one of the muscles ofrespiration.Itisatleastoneofthe groups of muscle which exert an antagonistic actiontothatkingofrespiratorymuscles, FJG.4 ThisillustrationisreproducedfromWillich'sDomestic Encyclopedia(London,18o2).Figs.1,3and4represent, respectively,bellows to inflate andextract air fromthe lungs; astretcher of wickerworkthatwatermnyeasilyrunoff,and awnrmingmachine of blockt inorenpptrwithdoublcwnlls to containhotwntcr. thediaphragm.Thewell-knowncaseof l' bommea l' anusmusicalewasastriking illustrationofthecoordinatingpowerof these two great muscular groups.May it not 20AnnalsofMeclicalllistory havebeenpossible that a powerful stimulus giventotherectalgroupmayhavebeen transmittedbyreflexactionincertain casestothethoracicgroup?Pressureand heat applied to the abdominalregion,even fromwithin,mayhaveintimesofgreat stresshelped to compressthe thorax and to awakenthe latent forcesinthe diaphragm. modernpulmotor,or the particular method of resuscitationbasedonclaimsof accurate laboratory research, may not eventually take their place among the vagaries of the past? Atallevents,itisperhapsjustaswell that practitioners of medicine to-day should lookuponthisquaintoldcustom,which diedsohard,withanindulgenteyeand, readingbetweenthelines,drawfromit withbecominghumilityamoralonthe mutability of medicalaffairs. Bethatasitmay,itshouldnotbefor-gottenthat thefullnessof timeoftenleads to anewperspective.Who can saythat the COMPIEGNE At aconfluence of riversliesthe townof Compiegne, At the wedding of the waters,River OisewithRiverAisne. And acrossthe verdantvalleylieeverlasting hills Withtheir sunny slopesandgardens andvillagesandmills. Horizon-wide the forestencompassesthe town, Andinher spaciousbosomthe citynestlesdown To dream of formerglories,e'er this devastating war Changed allthe graciousthings that wereforgrievousthingsthat are. A thousand yearsinpassing arebut awatchat night; Athousand recollections of kingsinarmorbright; A thousanddreams come shimmering acrossabendingbow For the true interpretation that only dreams canknow. And on amisty evening,whentrunks of ancient trees Are swaying indistinctlyinthe intermittentbreeze, Iseem to sense the phantoms that crowdthe pleasant ways In restlessreminiscence of the longforgottendays. CARLETONB.McCuLLOCH,M.D. JUNE,191R. I THEBIRTHPLACE OFTHEHUNTERS ByFIELDINGH.GARRISON,M.D. WASHINGTON,D.C. THROUGH the courtesy of Colonel C.C.McCulloch,Librarianof theSurgeonGeneral'sOffice,it isourprivilegetoreproducean interestingphotographof theoldhouseat Long Calderwood,where JohnandWilliam Hunterwereborn.Theinscriptiononthe backofthepictureisinthehandwriting of thelateDr.JohnS.Billingsandreads: "Long Calderwood,thebirthplaceof John showingthatthelairdhimselftilledthe soil."LongCalderwoodisinthesouth-westerncountyofLanarkshire,apartof thecountrywhichhadbeenmuchfought overbytheancientRomans,andinlater wars.HereaboutsthebraveWallacefought andbled;inthiscounty,Mary,Queen of Scots,was defeated at the battle of Lang-sidein1568;Claverhousewasdefeatedby theCovenantersatDrumclog(1679)and FIG.I.LONGCALDERWOOD andWilliamHunter.Rec'dfromDr.An- himselfdefeatedthematBothwellBrig drewFergusofGlasgow,Feb.14,I885,(1679).Intheeighteenthcentury,the J.S.Billings."historicshirewasunusuallyproductiveof LongCalderwood,onasmallestate,medicaltalent.Cullen,Smellie,Matthew sevenmilesfromGlasgow,isdescribedbyBaillie,aswellasthetwoHunters,were Mather,inhisbiographyofthetwoallofthemLanarkshiremen.TheLanark Hunters,as"AgoodstonehouseoftwobranchoftheHunterswasanoffshootof stories,situatedneartheroadleadingtheHuntersofHunterston(Ayrshire),an fromEastKilbridetoBlantyre,quitelikeoldNormanfamilyofthethirteentheen-theresidenceofthelairdofthesmalltury.Asitstands,thisstern,grayhouse, estate.Thehousehastheappearanceofovertwocenturiesold,isrepresentative havingbeenallalongtheabodeof'bein'andtypicaloftheoldgraniteScotch-substantialpeople,andhasbehinditafinetheir intenselove of plainness and simplicity largecourt,enclosedbyfarmbuildings,inexternalities,theirdislikeoftheshowy 21 24 AnnalsofMedicalHistory withpracticallyalltheworldinopposition tohim,ontheoccasionof hispresentation ofthesubjectoftheintubationofthe larynxfordiphtheria andother stenotic af-fections.AsamatteroffactDr.Horace Greenwaslayingthefoundationonwhich O'Dwyer was to build, demonstrating clearly that thelarynxwouldtolerateforeignbod-iestoamuchgreaterdegreethanhad heenthoughtpossible.Bothofthemsuf-fered,butonlyasdidmanyanotherdis-covererinthehistoryof medicineandsci-encefromtheultraconservatismoftheir contemporaries,anditiswellforusto re-memberthatsuchincidentsarcnotme-direvalnordistantinhistory,butoccurin our owntime. Horace Green's workbore fruit,however, inspiteofopposition,andbyhiswritings he laid the foundation of the great specialty. Hiscontemporary,Dr.GurdonBuck,by hisstudiesof conditionsof thelarynxand especiallyhisepoch-makingpaperupon "Edematous LaryngitisandItsTreatment byScarification,"madeanimportantad-vanceforalltheworld.Dr.ErnestKrack-owizer received alaryngoscope fromVienna in1858anddemonstrateditsvalue.Dr. Horace Green predicted that the instrument wouldworkarevolutioninlaryngology,as itdid.AlreadyanAmerican,Dr.Ephraim Cutter,wholaterpracticedinNewYork, haddevisedalaryngoscopeandthedevel-opmentofthespecialtywasassured.As early as1873the firstlaryngological society everorganizedwasestablishedinNew York.In1878the AmericanLaryngological Society was organized inthe city of Buffalo, the maininfluence init being NewYorkers. In1871thefirstclinicdevotedexclusively tothediseasesofthenoseandthroatwas establishedbyDr.LouisElsberg.Dr. GeorgcM.Lefferts,beginningMay1875, collectedabibliographyoflaryngology until188o,whena specialjournalknownas theArchivesof Laryngology,thefirstof its kindinthe world,wasfounded. IntheeightiesDr.JosephO'Dwyer completedtheseriesofexperimentson whichhismethodof intubationisfounded, andaddedoneoftheworld'sgreatprac-ticaldiscoveriestothisspecialty.Dr. O'Dwyer's work wasreallythat of a genius, andhemusteverbeconsideredasoneof the greatmenof Americanmedicine. In the meantime had come the inventions oftheBosworthsawforboneandnasal obstructionsandoftheJarvissnarefor the removalof enlargedturbinates,and the workofDr.Roe,of Rochester,inthe sub-mucous resection and correction of deformed septumandothernasalobstructionsor deviations. The nasal trephine wasinvented byDr.JamesH.Goodwillie,andawhole series of valuable instruments, modifications of preceding less available instruments, were designed.Dr.RufusP.Lincolndevisedthe methodfortheremovalof retropharyngeal fibromatathroughthenaturalpassagesin-stead of byan external wound, whichwould haverequiredextensive,dangerousdis-section, involving serious bleeding and many risks.In1886 Dr. Thomas French, in Brook-lyn,devisedaspecialcameraforphoto-graphingthelarynx,apurposewhichhad beenattemptedoftenenoughbefore,but withoutanysuccess.In1897Dr.Bryson DelavanofNewYorkrecommended,in-steadofcautery,submucouspunctureof anintumescentinferiorturbinateby meansofacataractknife,someofthe vesselsbeingdividedandbecomingoblit-eratedbytheresultantcicatricialtissue. Hehasalsocarriedoutnumerousinvesti-gations,amongthemthetreatmentof atrophicrhinitisbyapplicationsofthe galvaniccurrent andthe valueof the x-ray inthetreatmentofmalignanttumorsof thelarynx.Dr.MorrisAs('hofNew Yorkfinallydevelopedandperfected themeansof securingcorrectionof certain deformitiesofthenasalscptumwhichhad provedseriousobstaclestoanyimprove-mentinanumberofcaseswhereinterfer-I HISTORYOFLARYNGOLOGYANDRHINOLOGY encewithnaturalnasalbreathingwasone of themostimportantfactorsinthe case. 1 Surely that longlistof pioneers and their discoveriesinthisspecialty,comparatively limited,yetsoimportantforhealth,makes itveryclearthatNewYorkwelldeserves aplace of highhonorinthe historyof med-icinefortheworkof the professioninthis department.Thewhole specialtyhasprac-ticallybeencreatedhere,andmodesof treatment,unthoughtof inprecedinggen-erations,havebeenworkedoutandpre-sentedtotheprofessionof the world.This would seemtobe agreatnewdevelopment msurgery. Ithinkthatthereisnothingmorein-teresting,certainlynothingmorevalu-able,thantocallattentiontothefact that thisisnotanew chapter in the history of medicine,but arevivalof anoldone.It throwsgreatlightonthehistoryof medi-cinetohaveourgenerationremindedthat there wasaprecedingphase of laryngology and rhinologyinwhich some excellent work wasdone,instrumentsinvented,opera-tionsdevised,techniqueelaboratedand undoubtedlygreatgoodaccomplished;and yetpracticallyallof thisprogresswasfor-gotten,notforashorttime,butforcen-turies,andthewholeworkhadtobedone overagain.Itwasdone,notintheold worldwhere medicaland surgical traditions mighthavebeenexpectedtoberevived, butinanewcountrypracticallywithout such traditions-here inAmericawherethe practicalgeniusofthepeopleprompted physicianstomaketheirenterprisingand progressivedevelopmentofthissubject. Itdoesnottakeawayanyof thecredit forthoroughoriginalityandprogressive-nessfromtheNewYorkfoundersof this specialtytotellthestoryofsomeofthe details of an older phase of it,foritismost probable that they knew absolutelynothing aboutthehistoricalanticipationoftheir 1 ForotherspecificdetailsseeaddressofDr.D. BrysonDelavan. workandwereintentonlyonsolving,as wellaspossible,theproblemswhichpre-sentedthemselvestothem.Whatissur-prising,of course, is the fact that the medical professionshouldhavemadeamagnificent developmentof laryngologyandrhinology andthenhaveforgottenaboutitorlost sightofitandceasedtopracticeit,until finallythe older knowledge went into desue-tude.Thesamethinghappened,notalone withregardtothisbranchofmedicaland surgicalknowledge,but alsowithregardto agreatmal).yotherthoroughlypractical andextremelyvaluabledevelopmentsin professionalwork,andespeciallyin surgical practice,madebythesamegenerations whichbroughtabouttheinterestingold-timeevolutionof thespecialtyof diseases of thenoseandthroat. For there isno doubt now that the physi-ciansandsurgeonsofthethirteenthand fourteenth centuries, some of whose work in laryngologyandrhinologyIwishtorefer to,wereusinganestheticsandantiseptics, and some of them at leastknew that pus, in-steadofbeinganecessaryaccompaniment ofhealing,isanundesirablecomplication. Theydeveloped,notonlylaryngologyand rhinology,butplasticoperationsforthe repairofmutilatingwoundsoftheface, includingtheremakingofthenose,did trephining forvarious conditions withinthe skull,insistedonlifting up depressedbones inskullfractures,repairedwoundsofthe intestine,developingawholeinteresting techniqueforthispurpose.Theyfashioned variouskindsof metaltubestobeinserted intotheintestinesinorder tomaintainthe patulousness of the viscera during the proc-essof repair,even suggesting the useof the tracheaofananimalforthispurpose,and mademanyothersimilarsurprisingantici-pationsofmodernpracticesupposedtobe entirelyrecentinorigin.Littlewonder, then,sinceallthesethingswerealsofor-gotten,thattheadvancesinlaryngology andrhinologywerelostsightof,butthe AnnalsofMedicalHistory livedat the endof thetwelfthandthebe-ginning of the thirteenth century and prob-ablywrotehis"Practica Chirurgire"about thebeginningofthethirteenthcentury. It isusually presumed that these Salernitan physicianslivingintheMediterranean regionwere deeplyinfluencedby the Arabs, above allsince,according to averyold tra-dition,thefoundersofSalernowerefour physicians of verydifferent origin-a Latin, aGreek,aJew,andanArab.Muchwas madeofthissupposeddependenceonthe Arabsintheolderdays,butGurltpoints out,aftercarefulstudyofRoger'swork, that it aboundsinGrrecisms,not Arabisms, and that evidentlyRoger wasfollowing the oldGreektraditionof surgery.Thisisnot surprisingwhenwerememberthatthe southernpart ofItalyinthe neighborhood ofNapleshadbeenaGreekcolonyfrom very early times and indeed had been known asMagna Grrecia. 2 Rogerhaswrittenaveryinteresting descriptionofinflammationof- thetonsils withitstreatment.Hecallstheseorgans 2 Probablythegreatestinfluenceatworkinthe organizationof theuniversityat Salernoandof the medicalschoolaroundwhichtheUniversitymainly cameintoexistencewastheBenedictineSchoolat Salernowhichhadbeeninexistenceforseveral cen-turies.St.Benedict'sgreatestfoundationwasat MonteCassino,notfaraway,andtheBenedictines hadbeenverymuchinterestedintheschoolin Salerno.Thattheirinfluencecontinuedafterthe foundationof the medicalschoolwillbebestunder-stoodfromthefactthatSalerno'sgreatestwriter andteacheronmedicineintheeleventhcentury wasConstantine Africanus,the great Africanphysi-cianwhohad come to Salerno and to whompatients camefromalloverEurope;hewrotethefirstmod-erntextbooksof medicineinexistence.Constantine andAbbotDesideriusbecamegreatfriends,and indeed,accordingtotradition,itwastheworthy abbotwhoinsisteduponthenecessityof Constan-tine'swriting onthe subject of medicine.He finally succeededingettinghimtodothis,bytakingthe timefromavery busyprofessionallife. Constantinebecamesomuchinterestedinthe purelyintellectuallife of medicinethat after atime hegaveuppracticeandretiredtoMonteCassino branchi,or branci,and saysthat they swell interiorlyandcreate,asitwere,twoal-mond-likebodiesinthe throat.Asaconse-quenceofthisswelling,expectorationis difficultandbreathingisconductedwith anxiety.Forthis,garglingshouldfirstbe used,andifthepatientisnotrelievedre-courseshouldbehadtosurgery.Thenhe describeshowanoperationshouldbedone onthem: "Seatthepatientbeforeyouand presshistonguedowninhisopen mouthwithaninstrument,sothat youcanseethe tonsilswell.Take hold of the affected one firmly with abronze orironhookandinciseit withaprop-erlysharpenedinstrument.Leavethe coverings(thepillarsofthefauces) whichstandnexttothemuninjured however." Thisisofcourseadescriptiononlyof asimpleopeningofatonsillarabscess. \Vhentheinflammationofthetonsilshas tobenearhisfriendtheAbbotDesideriusandto enjoythequietlifeof themonastery.Probablyhe lookedforwardtoyearsoffriendlycompanionship and the satisfactionof mutualintellectualinfluence. Onlyafewyearslater,however,theAbbotDeside-rius,muchagainsthiswillandinspiteofhisre-fusals,waschosenPope,andsoConstantinewas leftinthemonasterywithouthisfriend,the Abbot. Thisseemstohavespurredhimontorenewedin-terestintheintellectuallife,inordertofillupthe voidthus created;besidesthe Pope encouragedhim inhiswriting.Theresultisthat wehaveanumber of worksfromConstantine. Thestoryisinterestingtousherebecauseit makesveryclear thefactthat Benedictine influence must have been strong at Salerno, and that the usual assumptionthatSalernoisanArabianfoundation or waslargelyinfluencedby the Arabs isonly apart of that tradition which came to be so rifeinthe eigh-teenthcentury,namely,thatitwastheArabsand nottheChristianswhowerelargelyresponsiblefor therevivalofinterestintheintellectuallifeafter thecomingofthebarbarianshadsothoroughly interferedwiththecultureoftheRoman Empire. :J -; HISTORYOFLARYNGOLOGYANDRHINOLOGY 92 proceededsofar,however,that simplein-cisionwillnotcurethem,hesuggeststhat withinstrumentsmadeforthispurpose theyshouldbecompletelyremoved.His Latinwordsforthis,"etaradice junditus, evellantur,"whichmaybetranslated literally,"pluckedawayentirelybythe roots,"probablyisresponsibleforouruse oftheexpression,"undersimilarcircum-stances radical operation." Manifestlytherewereanumberofob-servations made on diseases of the throat in Roger'stimeandsowearenot surprised tofind,alittlefartheron,adescription of aseriousconditionneartheepiglottis whichimpededthevoiceandobstructed thetrachea,andwhichcanbecuredonly bysurgicalintervention.Gurltdoesnot hesitatetosaythatinthisRogerwas probablydescribingedemaoftheglottis. Apparentlytheconditionhadbeenrecog-nizedandsomemodeof treatingitdis-cussed,thoughinhisbookonsurgery Roger onlyrefersto it indirectly. InelongationoftheuvulaRogersug-gestedfirsttheuseofmedicamentsin powderformandthentheapplicationof gargles. "If however,theuvulacannotbe madetoshrinkinthiswaythenit shouldbe grasped with aforcepsmade forthispurposethe palate where the uvula itself issometimes of smaller diameterand snippedoff.Care should betaken,however,nottotouchthe roots of the uvula." Here evidentlyhewas warningagainstthe radicaloperation,thoughintheremoval ofthetonsilsheencouragedthorough radicalness.Whatisconstantlysurprising inRoger'sworkisthementionof various specialinstruments forthese purposes. AnginawasbyRogerunder thenamesquinancia,andevidentlyhad beenstudiedwithagooddealofcare.It wasdifferentiatedintothreevarietieswith slightlydifferentnames:squinancia,avery severeform;scinancia,amilderform,and finallyquinancia,ofwhichtheprognosis wasalwaysgood.Thesymptomswere practicallyallthesame-difficultyofin-spiration and expiration as well as difficulty inswallowingbothfoodanddrink.Some-timesthevoicewascompletelyinterfered with and the saliva couldnot be swallowed northesputumemitted.The firstformof the disease, squinancia, was located between thetrachea-which,becauseitcarriedair wascalledatthattimetracheaarteria-andtheesophagus,ataplacecalledthe isthmus.IU!prognosiswasveryfataland itscurewastobelefttoGodalone.The secondform,scinancia,muchlesssevereor malignant-Roland'sexactwordis"ma-liciosa "-had for its characteristic lesion the development of pus,partly deepinthe tis-sues but partly on the surface.The descrip-tionevidentlyreferstowhat wecallretro-pharyngealabscess,thesevereformbeing retro-esophagealabscess.Rogersuggests thattheretropharyngealabscesscanbe rupturedwiththefingerorwithsomein-strument,andthatitisalways wellto do thisassoonaspushasformed.Hesaid thathehadcuredsomepatients withhis ownhand in this way. Thisformof theaffectionhesuggested mightbetreatedasfollows:Heconfesses thatitissomethingof anexperimentand usesthe word"experimentum." "Takeof saltbeef,halfcooked,of thesizeandshapeof achestnutora filbert, 1 andhavingfasteneditfirmly byalongsilkencordhavethe patient swallowitandthenletthe physician pullitoutsuddenlyandviolently (cumviolentia)inorderthattheab-scessmayberuptured." Old-fashionedfilbertSwerelargerthanours. 30 AnnalsofMedicalHistory Quinanciawastobetreatedbygargles, applications,venesectionfromthesub-lingualvein,andthesemethodswereto beusedat firstalsointheotherformsof the affection. InthesamechapterRogertreatsof goiterandsuggestsvariousapplications, butconsidersalsointhesevereformsthe necessityforextirpation.He warnsagainst anyattempttoremovelargegoiters,but suggeststhatatemporaryligatureof the goitermightbemadeandthenasubse-quent radicalremoval.Evidently afavorite palliativemodeoftreatmentofhiswas cauterizationwiththehotironandsome-timesevenpenetrationofthegoiterin that way. WhileRogeristhefirstofthewestern surgeonswhowroteatreatise onthissub-ject,hewasvery soonfollowedby Roland, apupilwhoseworkcontainsverylittle of importancethatwasnotcoveredbyhis master,butwhoaddssomepersonalcom-mentswhichservetoshowthat menwere thinkingseriouslyaboutagreatmany surgicalproblemsandsolvingthemvery well. Thesetwowerefollowedinafewyears bythe"TextbookoftheFourMasters," sincefamousinthehistoryofmedicine andsurgery.Manifestlywithinthefirst century,probablyindeedwithinthefirst fiftyyearsofwesternsurgicalwriting,it wasrecognizedthat agroupof mencould makeamorecompletetextbookthana singleman.It isusuallythoughtthatthe "Four Masters" were Archimatteo, Petron-cello,Plateario, andFerrario. Of these only Plateario,orPlatearius,isknownapart fromthisbook,forhewasthesonorthe grandsonofPlateariusandTrotula,Pla-tearius having been the Professor of Medi-cineand Trotula theProfessorof Women's Diseasesandtheheadof that department inthemedicalschooloftheUniversityof Salerno,andforseveralgenerationstheir sonsandgrandsonscontinuedto be prom-inentintheteachingstaffofthat school. Thenextimportantwriteronsurgery inItaly,afterRolandandRogerandthe "Four Masters," was Bruno of Longoburgo, whowasborndowninCalabria-theheel of the Italian boot, as the name of his birth-placeattachedtohisChristiannameindi-cates-and whowasprobablyastudent at Salerno.In the Latin literature of the time, forof courseallwroteinLatin,hisname wasBrunusanditisusuallyunderthis name that heisquoted.Though he studied in the south of Italy he practiced and taught in Verona andPadua.Hisbook"Chirurgia Magna" wasfinishedat Padua,ashehim-self declarestowardthe endof it,in Janu-ary,12.52His volume is noteworthy, mainly forthe reason that hewasthe first of these medireval surgeons of the West to quote not onlytheGreeks,buttheArabs.Arabian influencewasanafterthoughtandasub-sidiaryfactor,andnottheoriginofthis medirevalsurgery,asitisoftendeclared to be by those who theorize without weighing the factsof chronology.~ ~ Bruno, to use hisItalian name,has much to sayof the treatment of variousintrana-salpathologicalconditionswhichdisturb breathing.Hedescribesseveralvarieties ofnasalpolypsanddifferentiatesoneof themasa"malignanttumor."Thiswas of darker color, of slight sensibility and was veryhard.Headvisedagainstoperation upon it and suggested that it should not be touched,assurgicalinterventionmerely hasteneditsgrowthandmadethepatient worse. Withregardtotheremovalofpolyps hequotesAbulcasim,orAlbucasis,the Moorishphysician,specialmedicalattend-antof theKhalifei-HakimIll(g61-g76). Albulcasim,whoflourishedinthesecond half of the tenth century, wrote a very com-prehensive medical and surgical work under thetitle"Altasrif"or"Tesrif,"insome thirty books.ThisMoorishphysician,who HISTORYOFLARYNGOLOGYANDRHINOLOGY 3I isquotedbyBruno,suggeststheremoval ofpolypsbydrawingthemdownwitha hook,severingthe connecting portion with a knife,and then shaving off any projection thatmayremain.Thecauterywasused topreventrecurrenceandtoassurethe freedomofthenoseforbreathing.Bruno suggeststhat therootof thepolypshould be cauterized with ahot ironor with some cauterizingmaterial.Headdsthatsome-timesthe useof acauterizingsubstance is quite sufficient to destroy apolyp and pre-vent its recurrence. Brunonext discussesobstructionsof the nasal passageswhichmay occur fromover-growths in the back part of the nose,in the nose andthroatspace.Forthetreatment of these he quotesPaul of JF.gina,the most famousmedicalwriterofthelateGreek time,ofwhosecareerweknowsolittle, however,thatdifferingauthorities place himanywherefromthefourthtothesev-enthcenturyA.D.Paulsuggestedthata ligaturewithknotsatintervalsshouldbe passedthroughatubeintothenoseand thenbroughtoutthroughthe mouthand byto-and-fromotionemployedtocutoff projectinggrowthsatthebackofthe nose.After this,cauterizingmaterialswere tobeusedtopreventrecurrence.Bruno seemstohavebeen quitesatisfiedthat he couldmakethenosepatulousinthisway and greatlyrelieve the patient and prevent the development of complications. It may seem surprising that asurgeon in the middle of the thirteenth century should have somuchsurgical sense,but when it is recalledthatBrunowastheoriginatorof theexpression"unionbyfirstintention," itwillbeeasiertocomprehend.Thatex-pression,sofamiliarinthemodemtimes, has of course no significance in any modern languageexceptwhatislenttoitbythe oldmedirevalLatin,unioperprimamin-tentionem.Brunoknewexactlywhathe wastalkingaboutwhenheusedit,forhe hadseenwoundshealwithoutpusandhe knewthat thiswasthe idealwayforheal-ingtooccur.Hisgreatcontemporary, Theodoric,whosetextbookappearedsome ten years later, declared quite explicitly: " It isnotnecessary,asRogerand Rolandhavetaughtandasmanyof theirdisciplesarestillteachingand asallmoderncsurgeonsprofess,that pusshouldbegeneratedinwounds. No error can be greater than this.Such apracticeisindeedtohindernature, toprolongthe disease,and to prevent theconglutinationandconsolidation of the wound." TheodorichimselfcopiesBrunowith regardtooperationswithinthenose,and hassomethingspecialtosay with regard to nasal repair after injuries.Every possible portionshouldbesavedand ifapartof thenosehangdownthisshouldbere-placedandverycarefullysewed on again. Apledgetofsilksoakedinwarmwine ofproperthicknessandlengthshouldbe insertedintothenostrilsinorder to main-tainthepartsintheirproperplacesjust as far as possible.If the patient's breathing, disturbedbythisprocedure,threatensin anywaytointerferewiththesuccessof the operation, then the pledget of silk should haveagoosequillrunthroughitinorder tofacilitatebreathing.Theoldermedical andsurgicalauthorities,especiallyPaulof }EginaandHippocrates,hadsuggesteda tubemadeof lead,but Theodoricfounda quill much more cleanly and less bothersome. Theodorichasagooddealtosayabout thepossibilitiesofrepairofdisfiguring wounds of the faceand isadistinct pioneer in plastic surgery.His use of strong wine as the onlydressing,hisinsistence onthe ab-senceofmanipulationandhisadvicenot to remove the dry dressing, as it was called-because after atimethe strong wineevap- Howcuriousthisuseoftheword"modern" seems just after the middle of the thirteenth century. AnnalsofMedicalHistory orated, leaving the dressings perfectly dry-gavehimabundant opportunityforsecur-ing suchhealingaswouldprovidethe best results.He didnot hesitate to say,whena surgeonmadeanincisioninahitherto unbrokenpart,thatif pusdevelopedinit that complication wasdueto the surgeon's error-his manipulations wereat fault.For thisreasonheadvisedagainstsewingup woundsofthescalp,thoughhegivesa numberofdetailsoftheprocedurethat should he employed to bring the parts care-fullytogetherand,byproperbandaging and pressure,to keepthem together. Strangeasitmayseem,Theodoricwas abishop as wellasasurgeon and had been amemberoftheDominicanOrder.His textbook of surgerypublishedin the Vene-tianCollectionofsurgicalworksin1498 makesthatfactveryclear.Heisthefirst surgicalwriterwhodefinitelymentionsthe useofananrestheticduringoperations. Hesaysthatitsintroductionwasdueto hisfatherUgo,or Hugh,of Lucca,asheis called,whoisknowntohavebeen agreat surgeon,hut who wrote nothing, and whose fameispreservedonlythroughhisson's writings.UgoofLucca,orHughBor-gognoni,tousethefamilynamethathe a n d ~ h i sthree physician sonsemployed,had been asurgeon to the crusaders about1218 andwaspresentat thesiegeof Damietta. AfterhisreturnhewasmadetheCity PhysicianofBologna,towhomnotonly mattersof healthhutalsoofmedico-legal significance were referred.His appointment andthestatutesgrantinghimpowersare the""firstdocumentsinthehistoryof legal medicine in modern times. Theodoricwroteofhisfather'sexperi-encesandthoseofhisbrothersaswellas hisown.Manyof thesedetailsof surgical techniquehadbeencarefullytreasuredas secretsuptothistimeandtransmittedas family heritages, as among the Asclepiadean familiesin the olden time.Theodoric broke thistraditionandpublishedthemforthe benefitofhumanityinhisownandsub-sequentgenerations.Amongotherthings, hegaveus,particularly,aswehavesaid, themethodofproducingnarcosis,evi-dentlycarefullyworkedout soastomake itpossiblethatextensivesurgicalwork might he done on a patient without hisfeel-ingit,orhuttoaslightdegree,andyet without any seriousrisk of hisnot awaking at the end of the operation. Theodoric'sdescriptionofthemodeof obtaining anesthesia practiced by his father isasfollows: "Havingmadeamixtureofthe wine extracts of opium,hemlock,man-dragora,unripemulberriesandwild lettuce,aspongeshouldheboiledin thisfluiduntilallisboiledaway,and thenwheneveranesthesiaiswanted thisspongeshouldheplacedinwarm waterforanhourandappliedtothe nostrilsuntilthepatientsleeps,when thesurgicaloperationshouldheper-formed.Atitsendanothersponge dipped invinegar shouldhefrequently appliedtothenostrils,orsomeof the juiceof therootofhayshouldhein-jectedintothenostrils,whenthepa-tient willsoonawaken." Amodeof anesthesiaresemblingthisin manyrespectsisdescribedbyGuyde Chauliac after the middle of the fourteenth century, so that there seems to he no doubt thatforseveralcenturiesoperationsin Europeweredoneundertheinfluence of ananestheticandthat the practicewas reasonablysuccessful.It iseasytounder-stand that it wasneither so safe nor so sure as our practice in the matter. The surprise is that it should have existed,and forsolong, andthenhavebeenentirelyforgotten,so thattheveryideaof ananestheticcame as a surprise to the mid-nineteenth century. As a matter of fact the English poet Middle-tonmentions"the pitiesof oldsurgeons" THECHASSEURSo'ALPIN 33 andhowtheyputthemtosleepbefore cuttingthem,andthereareotherliterary passagesto the samepurport;but readers usedto think that these represented poetic licenses or were due to the writers'imagina-tion,thepoet'senthusiasmspurringthem onto tell things that wouldhave been ideal hadtheyexisted,thoughinrealitythey never did. Weknowotherwisenow,andknowing thegenerationsthatpracticedbothanes-thesiaandantisepsiswearenot surprised tofindamongthemdevelopmentsofthe specialtyofthenoseandthroatwhich wouldotherwisehaveseemedalmostin-credible.Howcuriousitis,however,to findthat these two great cyclesof develop-mentof surgery,includingthespecialties, shouldbeseparatedint.heirinitialstages at leastby sevencenturies.The student of historywhocanexplainthereasonforthe intervalbetweenthesetwocyclesofad-vanceknowssomethingabouthumanhis-tory and its philosophy. THECHASSEURSD'ALPIN (The"shocktroops"oftheFrencharmy) See the Chasseursmarching through To the front.To the front. They have Titan's work to do, Bear the brunt! 0'er the top and through the grass, Suffocating with the gas 'Mongst the barbM wire they pass. 'Tis their wont. Last resource in direst need On they go.Forward go. They willdie or they'll succeed O'er the foe. Hand grenade and glassy steel, Down and up,and on they reel. What must be the joy they feel! 'Twas ever so. They are called the troops of shock. Sturdy men.Heroic men. Each attack 'tis theirs to block. Charge again I Counter-charge the Hunnish horde, Purge the pride of Prussia's lord, Cause acost he'llillafford. One forten! Pause while they are passing by, Contemplate.Meditate. 'Tis agoodly company-Venerate. They shall save the Fleurs de Lys, They shall helpus,over seas, Keep our ancient liberties Inviolate. Here across and there amound, Thus they sleep.Silent sleep. Sheltered by the kindly ground. Vigilkeep! For they have not diedinvain, In the grovesof Compiegne. Still their spirits fight again And gloryreap. Traveler, plait alaurel wreath Of agirth,majestic girth. Lay it where they sleepbeneath With Mother Earth. Somay rose and twisting vine With the laurelintertwine, Nature's eververnal shrine To their worth. URLETONB.McCULLOCH,M.D. MAY,1918. MODERNCOMMENTARIESONHIPPOCRATES1 ByJONATHANWRIGHT,M.D. PLEASANTVILLE,N.Y. PARTI PERHAPS it is not the only way, but oneof the waysofjudging of the excellenceof aworkof scienceor literatureistotakenoteofthe discussiontheauthorhaselicitedinless talentedreadersandthestimulationof thefacultiestherebyevidenced.Inthe conceitandbraggadocioofFalstaff,aside fromhisbeingthebuttofjokes,we perceiveheisconsciousofthequalityof hismindwhenhe says heisnot only witty himself,but isthe cause of wit in others. Thereisnostandardoftruthwhereby the accuracyof theoryandpractice of one agecanbejudged by another, though there are underlying general principles which per-sistasmuchperhapsbytheirvagueness andlackof limitationandinclusivenessas bytheirvalidity,but,forthemostpart, timewithersmostspecificfactsasthey wereapprehendedtwothousandormore yearsago.When,however,adiscourse,an oration, apoem,aphilosophical treatise, or anarrativecontinuesforgenerationafter generation,century after century,forages, toexcitethecommentofreaders,asdo, forinstance,thoseofHomer,Herodotus, Hippocrates,Horace,Virgil,weare safein recognizinginthatobjectiveevidencethe proofof aninherentexcellencewhichper-hapsour ownfacultiesdonot revealto us. Subjectivetestimonyisoflittleinterest tous.Wecarenotif theintellectualcrea-tureatoursideadoresIbsen-wemight hate him;or if the maninthe street reads Kiplingto-day-to-morrowhemaylikely nevergivehimathought.Itneednot disturb usif Plato isthought by the young ladyat thelibrarytohavewrittensome-thingonastronomyorifthemanwho preachesinourchurchthinksAristotle wasamonk.Weourselvesmaybeunable togetupanyenthusiasmforeither.But whenwelearnthatallthesemenhave by their wordstapped the ocean of thought in everyeraofcivilizationsincetheylived andat theirmagic touch abundant streams of mental activity have gone forth to enrich theworld,whenweoncerealizewhatan ever living power they still exercise over the best mindswhichhumanity produces,then whatDotty saysaboutIbsenor whatBill Broker thinks ofKipling, that the Reverend Mr.StigginsismistakenaboutAristotle, orthatweourselvesfallasleeporour mindswanderwhenwereadthe"Phae-drus"ofPlatoorthe"Poetics"ofAris-totle,isof noconsequence.It isasubjec-tivity whichhasnothingintheleast to do withthequalityofthewriter'sworks; that wemustjudge of fromwhat wecome toknowofthephenomenawhichthe historyof thought furnishesus. The acknowledgmentof thisasareality iscommonenough,socommonastohave becomeperfunctoryandofcourseocca-sionally a little ostentatious, but it is seldom thesubjectofanalysis.Whyisit,then, thatthesemasterartistscontinuetobe the wellspringsof thought andthe or igin, usuallyunrecognized,ofinspiration?Cer-tainly not because of the factsthey display. Thesearedeniedordiscredited in ashort time;butthrougheveryvicissitudeof 1ThetranslationsofFrancisAdams'Hippocrates,"Genuine Works,''v.1.NewYork;WilliamWood &Co.,andE. Hippocrates,"lEumsParis:J.-B.Bailliere,I83g-1845These volumeshave beenchieftyusedandcomparedwith Greektext. 34 -MoDERNCoMMENTARIESoNHIPPOCRATES 35 theoryandeveryturninthecurrentof thought,oftenveryshallow,theinfluence remainsprofound.Theirlanguageisan unknown tongue to many,at least inso far asthefinershadesof meaningor of sym-metry of formin their more recondite sense areconcerned.Thecharmofrhythmor thesubtletythatgoeswithrhetorical effectisoftenlosttous.Thuswemight proceedinanattempttounderstandwhy suchmenhavedominatedthethoughtsof posterity,but our endeavors at analysis are defeatedandwearedriventoextendthe many definitions of geniusto a pragmatical conclusionthatsuccessinitsage-long demonstrationistheweightiestfactorin ourunderstandingof genius.Inthiscon-nection,however,thatisinclusiveof that boastoftheolddebaucheewhomShake-speare' sarthascreatedforus-theyare the cause of wit inothers. Noremark,preliminarytothestudyof thewritingsof Hippocrates,ismorehelp-fulthantheobservationofLittre,who insubstance pointed out that whileto-day westudydiseaseasanentityandfollow theforcesof eachonefromtheir originto theirpost-mortemmanifestations,Hippoc-ratesstudiedmanandthereactionshe exhibitstohismanifoldenvironment.It is thephenomenonpresentedbymanand whatitindicatesastotheprobableresult asregardsmanwhichheconceivedasthe chiefobjectofmedicalstudy.Itrequires novery deepreflectionto realize that there isamaterialdiscriminationtobemade psychologicallybetweentheconceptof diseaseandtheconceptionofadiseased man.Fortheformerweseek the literature ofmedicinewhichhasappearedio.the last hundred years,forthe latter the litera-turewhich,originatingwithHippocrates, fillsthethousandsofyearswhichhave elapsedsinceheinhistimewrote"On AncientMedicine."Inthisessayandin theonefollowing,"OnAirs,Waters,and Places,"morethaninsomeofhisother treatises,hebringstheremotecausesof diseaseandgeneralphilosophicalconclu-sionsmoreintoprominence.Ontheother hand,intakingup"ThePrognostics"we observe that it isentirely founded on obser-vation.If Hippocratesgatheredthisex-periencefromtherecordsof clinicalobser-vation made by himself and by other priests inthe templesof ..IEsculapius,wefindthat themethodsof observation,whichserved asthe basis of apriestly and magical inter-pretation,servedalsoforthe beginningsof rationalmedicine.Howit came about that historianshaveascribedtoHippocrates thefameofbeingthefirsttoquestion naturewouldfurnishaninterestingand instructive example of howBaconianshave pervertedtheplainindicationsofhistory. EvidencehasshownBabylonianpriests takingmeticulouscareforunnumbered centuriesinrecordingfactsandtheirse-quences,phenomenatheyobservedinthe heavensandinthe entrailsof animals and themundaneevents,importanttoman, whichfollowedtheobservations.They observedandquestionednature,butthey did not reasonright. WhenErmerins,whomAdamsquotes, madetheremarkswhichfollowheonly partlydisclosedthereformwroughtin theranksoftheAsclepiadre,beforethe epochandduringthe time of Hippocrates, whowastheir spokesman: Thereadersmustparticularlykeepbefore theireyesthisoriginandtheantiquityof those writings if they would pass a correct judg-mentonthemeritsof the Asclepiadretowards theartofmedicine.Whatever in their works wehavethepleasureofpossessing,allattest the infancyof the art;manythingsareimper-fect,and not unfrequently do we see them, while in the pursuit of truth, groping,as it were,and proceedingwithuncertainsteps,likemen wanderingaboutindarkness;butyetthe methodwhichthey applied,and towhichthey would seem to have betaken themselvesof their own accord,was so excellentthat nothing could surpassit.Itwasthesamemethodwhich Hippocrates himself always adopted, and which AnnalsofMedicalHistory infine,LordBacon,manyagesafterward, commendedastheonlyinstrumentbywhich truth in medicine canbe found out.-Asa-matterof facttheyinheritedtheir methodfromtherulesofthepracticeof magic,theobservationofthestars,the flightof birdsandtheentrailsof animals. Theyturnedfromtheseobservationsto observationsonthe phenomenaof disease. Theyrecordedonejustastheyrecorded theother,onthewallsof templesandon theirtablets.WhattheAsclepiadrereally didwastoturnawaynotfromhabitsof the observation of nature, which we cherish, butfromirrationalmethodsofthought. Theyreformedtherulesof logic,but they didnotintroducetheinductivemethod; it wasalready hoary with age. AlthoughHippocratescriticisedthe methodsoftheNaturephilosophershe resortedalmostasfreelyasthey to theory building.Dr.Ermerinshimselfbasksin thecomfortfurnishedbytheoriesofvital forcerampantinhisday.Theneovitalism ofthenineteenthcenturyhaditsroots deep in human nature, and it still draws its sustenancefromthatsamefundamental mysterywhichshroudedcosmiclawsfrom the gaze of Babylonian and Baconian alike. The modem man of sciencemustacknowl-edgeitsexistence,butwhenhetriesto shelterhimselffromhisdifficultiesinthe practicalsearchof truth by aresort to the covertofvitalismheentersthetombin whichthehumanmindwasimprisoned before the era of Thales and of Hippocrates. It wasemancipationfromthis and not the introduction of inductive philosophy, which weowetoHippocratesandhisforbears. The inductive philosophy of Bacon was the basisofthemethodthatprimitiveman adoptedwhenhebegantodevelopthe memoryofhiscognitions.Tojudgefrom theconventionalremarksinregardtoit onemightsupposeit hadneverexistedin theworldbeforethetimeof LordBacon, oratleastofHippocrates.Succinctly stated,thismethod,whichhasachieved suchanapparentascendancyinourday, isto proceedfromthe study of the particu-lar to the general,to collate factsby obser-vationandexperimentandfromthemto deducetheconclusionswhicharetobe applied to the conduct of life and the further investigationsof the lawsof nature. Inthequotationfromthethesisof Dr. ErmerinswhichAdamshasmade,it will benotedthatDr.Ermerinscommends HippocratesforbeingaBaconian.Noth-ing,perhaps,ismore diametrically opposed tothedoctrinesofBaconthanthoseof Plato, 1 yetinoneof hisdialogueswefind him claiming Hippocrates' support. Socrates inthe"Phred