History of Medicine

The history of medical science, considered as a part of the
general history of civilization, should logically begin in
Mesopotamia, where tradition and philological investigation placed
the cradle of the human race. But, in a condensed article such as
this, there are important reasons which dictate the choice of
another starting point. Modern medical science rests upon a Greek
foundation, and whatever other civilized peoples may have
accomplished in this field lies outside our inquiry. It is certain
that the Greeks brought much with them from their original home,
and also that they learned a great deal from their intercourse
with other civilized countries, especially Egypt and India; but
the Greek mind assimilated knowledge in such a fashion that its
origin can rarely be recognized.

MYTHICAL, HOMERIC, AND PRE-HIPPOCRATIC TIMES

Greek medical science, like that of all civilized peoples, shows
in the beginning a purely theurgical character. Apollo is regarded
as the founder of medical science, and, in post-Homeric times, his
son �sculapius (in Homer, a Thessalian prince) is represented, as
the deity whose office it is to bring about man's restoration to
health by means of healing oracles. His oldest place of worship
was at Tricca in Thessaly. The temples of �sculapius, of which
those at Epidaurus and Cos are the best known, were situated in a
healthy neighbourhood. The sick pilgrims went thither that, after
a long preparation of prayer, fasting and ablutions, they might,
through of mediation of the priests, receive in their dreams the
healing oracles. This kind of medical science already shows a
rational basis, for the priests interpreted the dreams and
prescribed a suitable treatment, in most cases purely dietetic.
Important records of sicknesses were made and left as votive-
tablets in the temples. Side by side with the priestly caste, and
perhaps out of it there arose the order of temple physicians, who,
as supposed descendants of the god �sculapius, were known as the
Asclepiadae, and formed a kind of guild or corporation. This
separation of offices must have occurred at an early time, for
even in Homer we find lay physicians mentioned, especially "the
sons of �seulapius", Machaon and Podalirius. In the vegetable
drugs of Egyptian origin mentioned in Homer we recognize the early
influence of the country of the Pharaohs upon Greek medical
science. The schools of the philosophers likewise exerted no small
influence upon development, medical problems being studied by
Pythagoras of Samos, Alcmaeon of Crotona, Parmenides of Elea,
Heraclitus of Ephesus (sixth century B.C.), Empedocles of
Agrigentum, and Anaxagoras of Clazomenae (fifth century B.C.). The
earliest medical schools were at Cyrene in Northern Africa,
Crotona, Cnidus and Cos. From Cnidus came Euryphon and also
Ctesias the geographer, who was at first physician in the army of
Cyrus and, after the battle of Cunaxa (401 B.C.), to Artaxerxes
Memnon. Of greater interest is the medical school adjoining the
shrine of �seulapius at Cos, for from it arose the man who first
placed medicine upon a scientific basis, and whose name is even
today well known to all physicians, Hippocrates.

HIPPOCRATES AND THE SO-CALLED CORPUS HIPPOCRATICUM

Tradition knows seven physicians named Hippocrates, of whom the
second is regarded as the most famous. Of his life we know but
little. He was born at Cos in 460 or 459 B.C., and died at Larissa
about 379. How great his fame was during his lifetime is shown by
the fact that Plato compares him with the artists Polycletus and
Phidias. Later he was called "the Great" or "the Divine". The
historical kernel is probably as follows: a famous physician of
this name from Cos flourished in the days of Pericles, and
subsequently many things, which his ancestors or his descendants
or his school accomplished, were attributed to him as the hero of
medical science. The same was true of his writings. What is now
known under the title of "Hippocratis Opera" represents the work,
not of an individual, but of several persons of different periods
and of different schools. It has thus become customary to
designate the writings ascribed to Hippocrates by the general
title of the "Hippocratic Collection" (Corpus Hippocraticum), and
to divide them according to their origin into the works of the
schools of Cnidus and of Cos, and of the Sophists. How difficult
it is, however, to determine their genuineness is shown that even
in the third century before Christ the Alexandrian librarians, who
for the first time collected the anonymous scrolls scattered
through Hellas, could not reach a definite conclusion. For the
development of medical science it is of little consequence who
composed the works of the school of Cos for they are more or less
permeated by the spirit of one great master. The secret of his
immortality rests on the fact that he pointed out the means
whereby medicine became a science. His first rule was the
observation of individual patients, individualizing in
contradistinction to the schematizing of the school of Cnidus. By
the observation of all the principles were gradually derived from
experience, and these, uniformly arranged, led by induction to a
knowledge of the nature of the disease, its course, and its
treatment. This is the origin of the famous "Aphorismi", short
rules which contain at times principles derived from experience
and at times conclusions drawn from the same source. They form the
valuable part of the collection. The school of Cos and its
adherents, the Hippocratics, looked upon medical science from a
purely practical standpoint; they regarded it as the art of
healing the sick, and therefore laid most stress on prognosis and
treatment by aiding the powers of nature through dietetic means,
while the whole school of Cnidus prided itself upon its scientific
diagnosis and, in harmony with money with the East, adopted a
varied medicinal treatment. The method which the school of Cos
established more than 2000 years ago has proved to be the only
one, and thus Hippocratic medial science celebrated its renascence
in the eighteenth century with Boerhaave at Leyden and
subsequently with Gerhard van Swieten at Vienna. In his endeavour
to the truth the earnest investigation often reaches an impassable
barrier. There is nothing more tempting than to seek an outlet by
means of reflection and deduction. Such a delusive course may
easily become fatal to the physicist; but a medical system,
erected upon the results of speculative investigation, carries the
germ of death within itself.

THE DOGMATIC SCHOOL

In their endeavour to complete the doctrine of their great master,
the successors of the Hippocratics fell victims to the snares of
speculation. In spite of this, we owe to this so-called "dogmatic
school" some fruitful investigation. Diocles Carystius advanced
the knowledge of anatomy, and tried to fathom the causal
connection between symptom and disease, in which endeavours he was
imitated by Praxagoras of Cos, who established the diagnostic
importance of the pulse.

Unfortunately, there already began with Aristotle (38-22 B.C.)
that tendency -- later rendered so fatal through Galen's teaching
- to regard organic structure and function not in accordance with
facts but from the teleological standpoint.

THE ALEXANDRIAN PERIOD

The desire to give to medicine a scientific basis found rich
nourishment in the ancient civilized soil of Egypt under the
Ptolemies. Herophilus of Chalcedon (about 300 B.C.) and
Erasistratus of Iulis (about 330-240 B.C.) are mentioned in this
connection. As anatomists, they were the first systematic
investigators, and, following Hippocrates, they tried to complete
clinical experience by exact methods. This tendency was opposed by
the empires, whose services lay solely in the field of drugs and
toxicology. Erasistratus as well as Philinus, the empiric,
attacked the doctrine of humors (humoral pathology), which
developed out of the Hippocratic tendency. The former alone was a
serious opponent since, as an anatomist, he looked for the seat of
the disease in the solid parts, rather than in the four
fundamental humors (blood, mucus, black and yellow gall) and their
different mixtures.

THE METHODIZERS

One of the opponents of humoral pathology was Asclepiades of Prusa
in Bithynia (born about 124 B.C.). He tried to use in medicine the
atomistic theory of Epicurus and Heracleides of Pontus. He taught
that health and disease depend upon the motion of the atoms in the
fine capillaries or pores, which, endowed with sensation, pass
through the entire body. With Themison as their leader, the
followers of Asclepiades simplified his doctrine by supposing
disease to be only a contraction or relaxation, and later only a
mixed condition (partly contracted, partly relaxed) of the pores.
This simple and convenient explanation of all diseases without
regard to anatomy and physiology, taken in conjunction with its
allied system of physical dietetic therapeutics, explains why this
doctrine enjoyed so long a life, and why the works of the
methodist, Caelius Aurelianus of Sicca in Numidia (beginning of
fifth century A.D.), were diligently studied down to the seventh
century.

GALEN

Departure from the Hippocratic observation of nature led
physicians to form numerous mutually opposing sects. A man of
great industry and comprehensive knowledge, Galen of Pergamum
(about A.D. 130-201), tried to rescue medical science from this
labyrinth. He chose the path of eclecticism, on which he built his
(as he thought) infallible system. Whatever sense-perception and
clinical observation left obscure, he tried to explain in a
speculative manner. That this system of teaching could hold
medicine in bondage until modern times shows the genius of the
master, who understood how to cover up the gaps by brilliancy of
style. Galen took the entire anatomical knowledge of his time, and
out of it produced a work the substance of which was for centuries
regarded as inviolable. His anatomy was to a large extent based
upon the dissection of mammals, especially of monkeys, and, like
his physiology, was under teleological influence. His presentation
of things lacks dispassionateness. Instead of explaining the
functions of organs on the basis of their structure, Galen chose
this reverse method. His anatomy and physiology were the most
vulnerable part of his system, and an earnest re-examination of
these fields must necessarily have shaken his entire scheme of
teaching. Galen expressed the greatest respect for Hippocrates,
published his most important works with explanatory notes, but
never entered into the spirit of the school of Cos, although he
adopted many of its doctrines. Galen is the culminating point and
end of ancient Greek medical science. In his vanity he thought he
had completed all investigation, and that his successors had only
to accept without effort what he had discovered. As will be shown
in the following paragraph, his advice was, unfortunately for
science, followed literally.

PEDANIUS DIOSCURIDES

Pedanus Dioscurides, who was from Anazarbe and lived in the time
of Nero and Vespasian, may be mentioned here as the most important
pharmaceutical writer of ancient times. He simplified greatly the
pharmacopoeia, which had then assumed unwieldy dimensions, and
freed it from ridiculous, superstitious remedies. Our modern
pharmacology is based on his work, Ta ton tylikon biblia.

CORNELIUS CELSUS

Cornelius Celsus (about 25-30 B.C. to A.D. 45-50) is the only
Roman who worked with distinction in the medical field, but it is
doubtful whether he was a physician. His work, "De re medica libri
viii", which is written in classical Latin, and for which he used
seventy-two works lost to posterity, gives a survey of medical
science from Hippocrates to imperial times. Very famous is his
description lithotomy. Celsus was altogether forgotten until the
fifteenth century, when Pope Nicholas V (1447-55) is said to have
discovered a manuscript of his works.

BYZANTINE PERIOD

In Byzantine times medicine shows but little originality, and is
of small importantance in the history of medical development. The
work handed down to us are all compilations, but as they
frequently contain excerpts from lost works they are of some
historical value. The notable writers of this period are:
Oreibasios (325-403), physician in ordinary to Julian the
Apostate; and Aetius of Amida, a Christian physician under
Justinian {597-66). A little more originality than these men
exhibited was shown by Alexander of Tralles (525-605), and Paulus
�gineta of the first half of the seventh century, of whose seven
books, the sixth, dealing with surgery, was greatly valued in
Arabian medicine. Paulus lived at Alexandria, and was one of the
last to come from its once famous school, which became extinct
after the capture of the city by Omar in 640. At the end of the
thirteenth century Nicolaus Myrepsus, living at the court in
Nicaea, made a collection of prescriptions which was extensively
used. In the time of Emperor Andronicus III (1328-42) lived a
highly gifted physician, Joannes Actuarius, and the mention of his
writings closes the account of this period.

ARABIAN MEDICINE

Arabian medical science forms an important chapter in the history
of the development of medicine, not because it was especially
productive but because it preserved Greek medical science with
that of its most important representative Galen. It was, however,
strongly influenced by oriental elements of later times. The
adherents of the heretic Nestorius, who in 431 settled in Edessa,
were the teachers of the Arabs. After the expulsion these
Nestorians settled in Dschondisapor in 489, and there founded a
medical school. After the conquest of Persia by the Arabs in 650,
Greek culture was held in great esteem, and learned Nestorian,
Jewish, and even Indian physicians worked diligently as
translators of the Greek writings. In Arabian Spain conditions
similarly developed from the seventh century. Among important
physicians in the first period of Greek-Arabic medicine -- the
period of dependence and of translations -- come first the
Nestorian family Bachtischua of Syria, which flourished until the
eleventh century; Abu Zakerijja Jahja ben Maseweih (d. 875), known
as Joannes Damascenus, Mesue the Elder, a Christian who was a
director of the hospital at Bagdad, did independent work, and
supervised the translation of Greek authors, Abu Jusuf Jacub ben
Ishak ben el-Subbah el-Kindi (Alkindus, 813-73), who wrote a work
about compound drugs, and the Nestorian Abu Zeid Honein ben Ishak
ben Soliman ben Ejjub el 'Ibadi (Joannitius, 809-about 873), a
teacher in Baghdad who translated Hippocrates and Dioscurides, and
whose work "Isagoge in artem parvam Galeni", early translated into
Latin, was much read in the Middle Ages. Wide activity and
independent observation -- based, however, wholly upon the
doctrine of Galen -- were shown by Abu Bekr Muhammed ben Zakarijia
er-Razi (Rhazes, about 850-923), whose chief work, however, "El-
Hawi fi'l Tib" (Continens) is a rather unsystematic compilation.
In the Middle Ages his "Ketaab altib Almansuri" (Liber medicinalis
Almansoris) was well known and had many commentators. The most
valuable of the thirty-six productions of Rhazes which have come
down to us is "De variolis et morbillis", a book based upon
personal experience. We ought also to mention the dietetic writer
Abu Jakub Ishak ben Soleiman el-Israili (Isaac Judaeus, 830-about
932), an Egyptian Jew; the Persian, Ali ben el Abbas Ala ed-Din
el-Madschhusi (Ali Abbas, d. 994) author of "El-Maliki" (Regalis
dispositio, Pantegnum). Abu Dshafer Ahmed ben Ibrahim ben Abu
Chalid Ihn el-Dshezzar (d. 1009) wrote about the causes of the
plague in Egypt. A work on pharmaceutics was written by the
physician in ordinary to the Spanish Caliph Hisham II (976-1013),
Abu Daut Soleiman ben Hassan Ibn Dsholdschholl.

Of the surgical authors, Abu'l Kasim Chalaf ben Abbas el-Zahrewi
of el-Zahra near Cordova (Abulkasem, about 912-1013) alone
deserves mention, and he depends absolutely on Paulus �gineta.
While he received scant attention at home, since surgery was
little cultivated by the Arabs, his work, written in a clear and
perspicuous style, became known in the West through the Latin
translation by Gerardus of Cremona (1187), and was extensively
used even in later days. Arabian medicine reached its culmination
with the Persian Abu Ali el-Hosein ben Abdallah Ibn Sina
(Avicenna, 980-1037), who based his system entirely upon the
teaching of Galen and tried in various ways to supplement the
latter. His chief work, "El-Kan�n" (Canon Medicinae), written in a
brilliant style and treating all branches of medical science, soon
supplanted in the West the works of the Greeks and, until the time
of the Humanists, served as the most important textbook for
physicians, but in Arabian Spain his fame was small. One of his
chief rivals was Abu-Merwan Abd el-Malik ben Abul-Ala Zohr ben Abd
el-Malik Ibn Zohr (Avenzoar, 1113-62) from the neighbourhood of
Seville. His friend, the philosopher and physician Abul-Welid
Muhammed ben-Ahmed Ibn Roshd el-Maliki (Averro�s, 1126 -98), of
Cordova, is regarded as the complement of Avicenna. His book was
also popular in the West and bears the title "Kit�bel-Kolijjat"
(Colliget). With the decline of Arabian rule began the decay of
medicine. In the Orient this decline began after the capture of
Cordova in 1236, decay becoming complete after the loss of Granada
in 1492. The predominance of Arabian medicine, which lasted
scarcely three centuries, seriously delayed the development of our
science. A brief survey of this period shows that the Arabs bent
in slavish reverence before the works of Aristotle and Galen
without examinig them critically. No other Greek physician
obtained such a hold on the Arabs as Galen, whose system, perfect
in form, pleased them in philosophy. Nowhere did dialectics play a
greater part in medicine than among the Arabs and their later
followers in the West. Independent investigation in the fields of
exact science, anatomy, and physiology was forbidden by the laws
of the Koran. Symptomatology (semiotics) at the bedside,
especially prognosis, based on the pulse and the of the urine,
were developed by them with an equally exaggerated and fruitless
subtlety. Much, and perhaps the only credit due to them is in the
field of pharmaceutics. We are indebted to them for a series of
simple and compound drugs of oriental and Indian origin,
previously unknown, and also for the polypharmacy of later times.
Until the discovery of America the Venetian drug-trade was
controlled by Arabian dealers.

CHRISTIANITY'S SHARE IN THE DEVELOPMENT OF MEDICAL SCIENCE

As long as the cruel persecution the Church lasted throughout the
Roman Empire, it was impossible for Christians to take direct part
in the development of medical science. But provision had been made
for medical aid within the community, because the priest, like the
rabbi of small Jewish communities in the late Middle Ages, was
also a physician. This is clear from the story of the two
brothers, Sts. Cosmas and Damian, who studied medicine in Syria
and were martyred under Diocletian. The exercise of practical
charity under the direction of deacons of the churches gave rise
to systematic nursing and hospitals. In recent times it has,
indeed been alleged that the existence of hospitals among the
Buddhists, even in the third century before Christ, and their
existence in ancient Mexico at the time of its discovery is
demonstrable, and that hospitals had their origin in general
philanthropy; but nobody denies that the nursing of the sick,
especially during epidemics, had never before been so widespread,
so well organized, so self-sacrificing as in the early Christian
communities. Christianity tended the sick and devised and executed
extensive schemes for the care of deserted children (foundling,
orphans), of the feeble and infirm, of those out of work and of
pilgrims. The era of persecution ended, we find large alms-houses
and hospitals like that of St. Basilius in Caesarea (370), those
of the Roman Lady Fabiola in Rome and Ostia (400), that of St.
Samson adjoining the church of St. Sofia in Constantinople in the
sixth century, the foundling asylum of Archbishop Datheus of Milan
in 787, and many others. In 1198 Pope Innocent III rebuilt the
pilgrims' shelter, which had been founded in 726 by a British
king, but had been repeatedly destroyed by fire. He turned it into
a refuge for travellers and a hospital, and entrusted it to the
Brothers of the Holy Ghost established by Guy de Montpellier.
Mention must also be made here of the religious orders of knights
and the houses for lepers of later times. The great hospitals of
the Arabs in Dschondisapor and Bagdad were built after Christian
models. The celebrated ecclesiastical writer Tertullian (born A.D.
160) possessed a wide knowledge of medicine, which, following the
custom of his time, he calls a "sister of philosophy". Clement of
Alexandria, about the middle of the century, lays down valuable
hygienic laws in his "Paedagogus". Lactantius in the fourth
century speaks in his work "De Opificio Dei" about the structure
of the human body. One of the most learned priests of his time,
St. Isidore of Seville (d. 636), treats of medicine in the fourth
book of his "Origines S. Etymologiae". St. Benedict of Nursia
(480) made it a duty for the sciences, and among them medicine, as
aids to the exercise of hospitality. Cassiodorus gave his monks
direct instructions in the study in medicine. Bertharius, Abbot of
Monte Cassino in the ninth century, was famous as a physician.
Walafrid Strabo (d. 849), Abbot of Reichenau the oldest medical
writer on German soil, describes in a poem (Hortulus) the value of
native medicinal plants, and also the method of teaching medicine
in monasteries. We must mention, furthermore, the "Physica", a
description of drugs from the three kingdoms of nature, written by
St. Hildegarde (1099-1179), abbess of a monastery near Bingen-on-
the-Rhine. The curative properties of minerals are described by
Marbodus of Angers, Bishop of Rennes (d. 1123), in his
"Lapidarius".

How diligently medicine was studied in the monasteries is shown by
the numerous manuscripts (many still unedited) in the old
cathedral libraries and by those which were taken from the
suppressed monasteries and are now to be found in the national
libraries of various countries. Priests who possessed a knowledge
ot medicine served as physicians-in-ordinary to princes as late as
the fifteenth century, although they were forbidden to practice
surgery by the Fourth Synod of the Lateran (1213). Thus, Master
Gerhard, parish priest in Felling, who founded the Hospital of the
Holy Ghost at Vienna (1211), was physician-in-ordinary to Duke
Leopold VI of Austria, and Sigismund Albicus, who afterward became
Archbishop of Prague (1411), held the same office at the court of
King Wenzel of Bohemia (1391-1411). From this time, we constantly
meet with priests possessing a knowledge of medicine and writing
on medical subjects. The popes, the most important patrons of all
the sciences, were friendly also to the development of medicine.
That they ever at any time forbade the practice of anatomical
investigation is a fable. Pope Boniface VIII in 1299-1300 forbade
the practice then prevalent of boiling the corpses of noble
persons who had died abroad, in order that their bones might be
more conveniently transported to the distant ancestral tomb. This
prohibitory rule had reference only to cases of death in Christian
countries, while in the Orient (e.g. during the Crusades) the
usage seems to have been tacitly allowed to continue.

FIRST UNIVERSITIES IN THE WEST

Having voluntarily undertaken the education of the young in all
branches of learning, the monasteries were aided in their
endeavours by both Church and State. The foundation of state
schools is the work of Charlemagne (768-814), whose activity,
especially in the Germanic countries, was stimulated by the decree
of the Synod of Aachen (789), that each monastery and each
cathedral chapter should institute a school. According to the
Capitulary of Charlemagne at Diedenhofen (Thionville) in 806,
medicine was commonly taught in these schools. At the diocesan
school in Reims, we find Gerbert d'Aurillac, later Pope Sylvester
II (999-1003), long active as a teacher of medicine.
Simultaneously with the rise of the cities there sprang up higher
municipal schools, as for instance the Burgerschule at St.
Stephan's in Vienna (about 1237). Out of the secular and religious
schools, the curriculum of which institutions comprised the entire
learning of the times, the first universities developed themselves
partly under imperial and partly under papal protection, according
as they sprang from the lay and the cathedral or monastic schools.

SCHOOL OF SALERNO

This is regarded as the oldest medical school of the West. Salerno
on the Tyrrhenian Sea, originally probably a Doric colony, was
from the sixth to the eleventh century under the rule of the
Lombards, and from 1075 to 1130 under that of the Normans. In 1130
it became a part of the Kingdom of Naples and Sicily. The origin
of the school is obscure, but, contrary to former belief, it was
not a religious foundation, though very many priests were engaged
there as teachers of medicine. Women and even Jews were admitted
to these studies. Salerno was destined to cultivate for a long
time Greek medical science in undimmed purity, until the twelfth
century saw the school fall a victim to the all-powerful Arab
influence. One of its oldest physicians was Alpuhans, later (1058-
85) Archbishop of Salerno. With him worked the Lombard Gariopontus
(d. 1050), whose "Passionarius" is based upon Hippocrates, Galen,
and Caelius Aurelianus. Contemporary with him was the female
physician Trotula who worked also in the literary field, and who
is said to have been the wife of the physician Joannes Platearius.
Perhaps the best known literary work of this school is the
anonymous "Regimen sanitatis Salernitanum" a didactic poem
consisting of 364 stanzas, which has been translated into all
modern languages. It is said to have been dedicated to Prince
Robert, son of William the Conqueror, upon his departure from S.
Salerno in 1101. An important change in the intellectual tendency
of the "Civitas Hippocratica", as this school called itself, was
brought about by the physician Constantine of Carthage
(Constantinus Africanus), a man learned in the Oriental languages
and a teacher of medicine at Salerno, who died in 1087 a monk of
Monte Cassino. While hitherto the best works of Greek antiquity
had been known only in mediocre Latin translations, Constantine in
the solitude of Monte Cassino began to translate to translate from
the Arabic, Greek authors (e.g. the "Aphorisms" of Hippocrates and
the "Ars parva" of Galen), as well as such Arabic writer as were
accessible to him (Isaak, Ali Abbas). As he brought to the
knowledge of his contemporaries first-class Greek authors, but
only secondary Arab writers, the study of the former became more
profound, while on the other hand an interest was awakened in the
hitherto unknown Arabic literature. His pupils were Bartholomaeus,
whose "Practica" was translated into German as early as the
thirteenth century, and Johannes Afflacius (De febribus et
urinis). To the twelfth century, when Arabian polypharmacy was
introduced, belong Nicolaus Praepositus (about 1140), whose
"Antidotarium", a collection of compounded pharmaceutical
formulae, became a model for later works of this kind, and
Matthaeus Platearius, who, towards the end of the century, wrote a
commentary on the above-named "Antidotarium" (Glossae) and a work
about simple drugs (Circa instans). Similar productions appeared
from the hand of an otherwise unknown Magister Solernitanus.
Maurus, following Arabian sources, wrote on uroscopy. Here must be
also mentioned Petrus Musandinus (De cibis et potibus
febricitantium), the teacher of Pierre Giles of Corbeil (�gidius
Corboliensis), who later became a canon and the physician-in-
ordinary to Philip Augustus of France (1180-1223), and who even at
this day began to complain about the decay of the school.

Its first misfortune dates from the death of King Roger III
(1193), when the army of King Henry VI captured the city. The
establishment of the University of Naples by Frederick II in 1224,
the preponderance of Arabian influence, and the rise of the
Montpellier school, all exerted so unfavourable an influence that
by the fourteenth century Salerno was well-nigh forgotten. Salerno
is the oldest school having a curriculum prescribed by the state.
In 1140 King Roger II ordered a state examination to test the
proficiency of prospective physicians, and Frederick II in 1240
prescribed five years of study besides a year of practical
experience. When we consider the proximity of Northern Africa,
that the neighbouring Sicily had been under Saracenic rule from
the ninth to the eleventh century, and that the Norman kings, and
to a far greater degree Frederick II, gave powerful protection to
Arabian art and science, it seems wonderful that this oasis of
Graeco-Roman culture endured so long. Down to the twelfth century
this school was ruled by a purely Hippocratic spirit, especially
in practical medicine, by its diagnosis and by the treatment of
acute diseases dietetically. Arabian influence makes itself felt
first of all in therapeutics, a fact which is easily explained by
the proximity of Amalfi, where the Arabian drug-dealers used to
land. Local conditions (resulting from the Crusades) explain how
surgery, especially the treatment of wounds received in war, was
diligently cultivated. In Rogerius we find a Salernitan surgeon
armed with independent experience, but showing, nevertheless,
reminiscences of Abulhasem. His "Practica Chirurgiae" dates from
the year 1180. Although Salerno finally succumbed to Arabian
influences, this school did not hand down to us a knowledge of the
best Arabian authors.

SPAIN AS THE TRANSMITTER OF ARABIAN MEDICINE

Its focus was the city of Toledo, which was taken from the Moors
in 1085 by Alfonso VI of Castile and Leon. Here Archbishop Raimund
(1130-50) founded an institution for translations, in which Jewish
scholars were the chief workers. Here lived Gerard of Cremona
(1114-87, properly Carmona, near Seville), the translator of
Rhazes and Avicenna. A later translator of Rhases (about 1279) was
the Jew Faradsch ben Salem (Faragius), who was educated at
Salerno.

THE SCHOLASTIC PERIOD

When in the twelfth century all the Aristotelean works gradually
became known, one of the results was the development of
Scholasticism, that logically arranged systematic treatment and
explanation of rational truths based upon the Aristolean
speculative method. Even though this tendency led to the growth of
many excrescences in medicine and confirmed the predominance of
Galen's system, also largely based on speculation, it is wrong to
hold Scholasticism responsible for the mistakes which its
disciples made in consequence of their faulty apprehension of the
system, because Scholasticism, far from excluding the observation
of nature, directly promotes it. The best proof of this is the
fact that the most important scholastic of the thirteenth century,
St. Albertus Magnus, was likewise the most important physicist of
his time. He thus imitated his model, Aristotle, in both
directions. The famous scholastic Roger Bacon (1214-94), an
English Franciscan, lays chief stress his theory of cognition upon
experience as far as the natural sciences are concerned, and this
with even greater emphasis than Albertus Magnus.

Albertus Magnus

Albertus Magnus (Albert Count of Bollstadt, 1193-1280) was a
Dominican. For medical science his works about animals, plants,
and minerals alone concern us. Formerly a work called "De secretis
mulierum" was wrongly attributed to him. Albertus's most eminent
service to medicine was in pointing out the way to an independent
observation of nature. The following books were to a certain
degree based upon the writings of Albertus: the encyclopedic works
on natural history of the Franciscan Bartholomaeus Anglicus (about
1260), of Thomas of Cantimpre (1204-80), canon of Cambrai, of
Vincent of Beauvais (d. 1264), the "Book of Nature" by Kunrad von
Megenberg (1307-74), canon of Ratisbon, and the natural history of
Meinau composed towards the end of the thirteenth century at the
Monastery of Meinau on the Lake of Constance. In the medical
schools the influence of scholasticism made itself felt, but this
influence was always favourable. The scholastic physician, the
philosopher at the bedside, with his compendious works of needy
contents, with his endless game of question and answer, must not,
however, be misjudged; he preserved interest in the observation of
nature and was, as is freely conceded, a skilful practitioner,
although he laid excessive stress upon formalism, and medicine in
his hands made no special progress.

BOLOGNA

Bologna was the principal home of scholastic medicine, and, as
early as the twelfth century, a medical school existed there. The
most famous physician there was Thaddeus Alderotti (Th.
Florentinus,1215-95), who even at that time gave practical
clinical instruction and enjoyed great fame as a physician. Among
his pupils were the four Varignana, Dino and Tommaso di Garbo, and
Pietro Torrigiano Rustichelli -- later a Carthusian monk -- all
well-known expounders of the writings of Galen. Indirect disciples
were Pietro de Tussignana (d. 1410), who first described the baths
at Bormio, and Bavarius de Bavariis (d. about 1480) who was for a
long time physician to Pope Nicholas V.

Bologna and the Study of Anatomy

Bologna has stained incomparable glory from the fact that Mondino
de Liucci (about 1275-1326), the reviver of anatomy, taught there.
There, for the first time since the Alexandrian period (nearly
1500 years), he dissected a human corpse, and wrote a treatise on
anatomy based upon personal observation -- a work which, for
nearly two and a half centuries, remained the official textbook of
the universities. Although Mondino's work which appeared in 1316,
contains many defects and errors, if nevertheless marked an
advance and incited men to further investigation.

PADUA

Padua, the famous rival of Bologna, received a university in 1222
from Frederick II. Just as the University Of Leipzig originated in
consequence of the migration of students and professors from the
University of Prague in 1409, so Padua came into existence through
a secession from Bologna. Bologna was soon surpassed by the
daughter institution, and, from the foundation of the University
of Vienna in 1365 until the middle of the eighteenth century,
Padua remained a shininng model for the medical school of Bologna.
The first teacher of repute was Pietro d' Abano (Petrus Aponensis,
1250 to about 1320), known as the "great Lombard" -- an honorary
title received during his residence at the Universlty of Paris. On
account of his too liberalistic opinions and his derision of
Christian teaching in his "Conciliator differentiarum", his chief
medical work, he was accused of being a heretic. From this period
also date the "Aggregator Brixiensis" of Guglielmo Corvi (1250-
1326), a work in even greater demand in later times, and the
"Consilia" of Gentile da Foligno (d. 1348), who, in 1341,
performed the first anatomical dissection in Padua. The fame of
the school of Padua was greatly advanced by the family of
physicians, the Santa Sophia, which about 1292 emigrated from
Constantinople, and whose most famous members were Marsilio (d.
1405) and Galeazzo (d. 1427). The latter, one of the first
teachers in Vienna (about 1398-1407), and later professor at
Padua, wrote in Vienna a pharmacopoeia which indicates absolutely
independent observation in the field of botany. His antithesis and
contemporary was Giacomo dalla Torre of Forli (Jacobus
Foroliviensis, d. 1413), professor at Padua, known for his
commentary on the "Ars parva" of Galen. Giacomo de Dondi (1298-
1359), author of the "Aggregator Paduanus do medicinis
simplicibus", tried to disengage a salt from the thermal waters of
Abano, near Padua. As anatomist and practitioner we must mention
Bartholomaeus de Montagnana (d.1460), and the grandfather of the
unfortunate Savonarola Giovanni Michele Savonarola (1390-1462),
author of the "Practica Major", who worked along the same lines.

MONTPELLIER

The earliest information about the medical school of this place
dates from the twelfth century. Like Salerno, Montpellier
developed great independence as far as the other schools were
concerned, and laid the greatest stress upon practical medicine.
With the decay of Salerno, Montpellier gained in importance. The
chief representative of this school is the Spaniard, Arnold of
Villanova (1235-about 1312). His greatest merit is that, inclining
more towards the Hippocratic school, he did not follow
unconditionally the teachings of Galen and Avicenna, but relied
upon his own observation and experience, while employing in
therapeutics a more dietetic treatment as opposed to Arabian
tenets. To him we are indebted for the systematic use of alcohol
in certain diseases. A very doubtful merit is his popularizing of
alchemy to the study of which he was very much devoted. Other
Montpellier representatives of purely practical medicine are
Bernard of Gordon (d. 1314; "Lilium medicinae", 1305) a Scot
educated in Salerno; Gerardus de Solo (about 1320; "Introductorium
juvenurn"); Johannes de Tornamira (end of the fourteenth century,
"Clarificatorium juvenum"), and the Portuguese Valeseus de Taranta
("Philonium pharmaceuticum et chirurgicum", 1418). The medical
school of Paris, founded in 1180, remained far behind Montpellier
in regard to the practice of medicine.

SURGERY IN THE AGE OF SCHOLASTICISM

Surgery exhibited during this period in many respects a more
independent development than practical medicine, especially in
Bologna. The founder of the school there was Hugo Borgognoni of
Lucca (d. about 1258). A more important figure was his son
Teodorico, chaplain, penitentiary, and physician-in-ordinary to
Pope Innocent IV, later Bishop of Cervia. In his "Surgery",
completed in 1266, he recommends the simplification of the
treatment of wounds, fractures, and dislocations. Guilielmo
Saliceto from Piacenza (Guil. Placentinus), first of Bologna, then
at Verona, where he completed his surgery in 1275, shows great
individuality and a kneen diagnostic eye. Similarly his pupil
Lanfranchi strongly recommended the reunion of surgery and
internal medicine. Lanfranchi, banished in 1290 from his native
city, Milan, transplanted Italian surgery to Paris. There the
surgeons, like the physicians of the faculty, had, since 1260,
been formed into a corporation, the College de St. Cosme (since
1713 Academie de Chirurgie), to which Lanfranchi was admitted. His
"Chirurgia magna" (Ars completa), finished in 1296, is full of
casuistic notes and shows us the author as an equally careful and
lucky operator. The first important French surgeon is Henri de
Mondeville (1260-1320), originally a teacher of anatomy at
Montpellier whose treatise, although for the most part a
compilation, does not lack originality and perspicuity. The
culminating point in French surgery at this period is marked by
the appearance of Guy de Chauliac (Chaulhac, d. about 1370). He
completed his studies at Bologna, Montpellier, and Paris; later he
entered the ecclesiastical state (canon of Reims, 1358), and was
physician-in-ordinary to popes Clement VI, Innocent VI, and Urban
V. From him we have a description of the terrible plague which he
witnessed in 1348 at Avignon. His "Chirurgia magna" treated the
subject with a completeness never previously attained, and gave
its author during the following centuries the rank of a first-
class authority. Among contemporary surgeons in other civilized
countries we must mention John Ardern (d. about 1399), an
Englishman, who studied at Montpellier and lived subsequently in
London, famous for his skill in operating for anal fistul�, and
Jehan Yperman of the Netherlands (d. about 1329), who studied in
Paris under Lanfranchi. Besides these surgeons where is no doubt
that there were then in Italy many a number of itinerant
practitioners who offered their services at fairs; as,
specializing usually in certain operations (hernia and lithotomy),
they often possessed great skill, and their advice and assistence
of a wrong tendency in medicine, but they sought by people of the
upper classes.

SIGNS OF IMPROVEMENT: HUMANISM

A short of the survey of the scholastic period gives us the
following picture: On the appearance of Arabic literature in Latin
translations, Hippocratic medicine was driven from its last
stronghold, Salerno. Then came the rule of Arabism, of the system
of Galen in Arabic form equipped with all sorts of sophistic
subtleties. The works of Rhazes and Avicenna possessed the
greatest authority. The latter's "Canon", written in clear
language and covering the entire field of medicine became the
gospel of physicians. The literature of these times is rich in
writings but very poor in thought; for people were content when
the long-winded commentaries gave them a better understanding of
the Arabs, whom they deemed infallible. A good many things were
incomprehensible, first of all the names of diseases and drugs,
which translators rendered incorrectly. A comparative
investigation of the Greek authors was practically impossible, as
both their works and a knowledge of the Greek language had
disappeared from among the Romance nations. Thus it happened that
special books had to be written from which were learned foreign
words and their meanings. The "Synonyma Medicinae" (Clavis
sanationis) by the physician Sirnon of Genoa (Januensis, 1270-
1303) and the "Pandectae medicinae" of Matthaeus Sylvaticus (d.
1342), both of which were alphabetically arranged, were in vogue.
Woe to the physician who dared to doubt the authority of the
Arabs! Only men of strong mind could successfully carry out such a
dangerous undertaking. The influence of scholasticism in medicine
was manifold. It encouraged the observation of nature at the
bedside and logical thinking, but it also stimulated the love of
disputation, wherein the main object was to force a possibly
independent idea into the strait-jacket of the ruling system, and
thus avoid all imputation of medical heresy. Signs of improvement
are noticed first in anatomy (Mondino) and subsequently in
surgery, which is based upon it.

The impulse to follow a new path came, however from without, first
of all from a study of the Greek language, and then directly
through the famous poet Francesco Petrarca (1304-74), the zealous
patron of humanistic studies and thus of the Renaissance.
Petrarch's instructor in the Greek language was the monk Barlaam,
who procured for his pupil, Leontius Pilatus, a position as public
teacher of the language in Florence in 1350. In later times,
especially after the fall of Constantinople in 1453, numerous
Greek scholars came to Italy. With the spread of a knowledge of
Greek and the enthusiasm for the Hellenic masterpieces in art and
science, there arose also an interest in classical Latin and a
diligent search for manuscripts of Graeco-Roman antiquity, and
efforts along these lines were, as is well known, energetically
supported by the popes. The West now became acquainted with the
works of the old Greek pre-Aristotelean philosophers and
physicians in their original tongue, a fact which marks the
beginning of the fall of the Arabian teaching. Petrarch fought as
champion along the whole line of battle, especially against
scholasticism and the medicine of that period. There is no doubt
that his zeal was exaggerated in many respects. He blames the
physicians of his time because they philosophize and do not cure.
Medicine, he says is a practical art and, therefore, may not be
treated according to the same methods for the investigation of
truth as philosophy. The greatest misfortune had been the
appearance of Arabism with all its superstitions (astrology,
alchemy, uroscopy). On the other hand, he speaks with great
respect of surgery; the reason for this is patent, since he was a
friend of the most important surgeon of his time, Guy de Chauliac.
There is no doubt that there were then in Italy many excellent
physicians who, like Petrarch, recognized the existence of a wrong
tendency in medicine, but they were far too weak to break the
fetters of Arabism. The road to improvement had already been
pointed out by Mondino, the anatomist of Bologna, but a complete
change of view did not occur until the sixteenth century.

THE BLACK DEATH OF THE FOURTEENTH CENTURY

Associated with the name of Petrarch is the memory of the most
terrible epidemic of historic times. The Black Death (bubonic
plague with pulmonary infection), originating in Eastern Asia,
passed through India to Asia Minor, Arabia, Egypt, Northern
Africa, and directly to Europe by the Black Sea. In Europe the
epidemic began in 1346, and spread first of all in the maritime
cities of Italy (especially Genoa) and Sicily, in 1347 it appeared
in Constantinople, Cyprus, Greece, Malta, Sardinia and Corsica,
and, towards the end of the year, at Marseilles; in 1348 in Spain
Southern France (Avignon) Paris, the Netherlands, Italy, Southern
England and London, Scbleswig-Holstein and Norway, and in
December, in Dalmatia and Jutland; in 1349 in the Austrian Alpine
countries, Vienna, and Poland; in 1350 in Russia, where in 1353
the last traces disappeared on the shores of the Black Sea. The
entire period was preceded by peculiar natural phenomena, as
floods, tidal waves, and abnormally damp weather. Petrarch, who
witnessed the plague at Florence, declared that posterity would
regard the description of all its horrors as fables. The loss of
human life in Europe, the population of which is estimated to have
been 100 millions, is said to have amounted to twenty-five
millions. The disease usually began suddenly and death occurred
within three days, and often after a few hours. Physicians were
quite powerless in face of the enormous extent of the pestilence.
Great self-sacrifice was shown by the clergy, especially by the
Franciscans, who are said to have lost 100,000 (?) members through
the epidemic. Concerning this terrible period we have reports from
the jurist of Piacenza, Gabriel de Mussis; from Cantacuzenus and
Nicephorus about the epidemic in Constantinople; from Boccacio and
Petrarch (Florence), from the physician Dionysius Colle of Belluno
(Italy) the Belgian Simon of Covino (Montpellier), Guy de Chauliac
(Avignon), and also from some Spanish physicians. Less voluminous
accounts are to be found in the chronicles of the different
countries. Europe has since been repeatedly visited by the plague,
which has, however, never been so violent nor extended so widely.
The last great epidemics occurred in Central Europe in 1679 and
1713.

HUMANISM AND MEDICAL SCIENCE IN THE FIFTEENTH AND SIXTEENTH
CENTURIES

The terrors of the Black Death, and the conviction which it
brought of the powerlessness of current medicine, undoubtedly
helped to effect a gradual change. The greatest influence,
however, was exerted by the humanistic tendency which had found
many adherents, especially among physicians. The desire after
general cultivation in the natural sciences was substantially
promoted by the great voyages of discovery made towards the end of
the fifteenth century. It is worthy of mention that, at a time
when the gifted Christopher Columbus was still ridiculed as a
dreamer by the learned, the Florentine astronomer and physician,
Toscanelli, and the house-physician of the Franciscan monastery of
Santa Maria de Rabida, Garcia Fernandes, both heartily encouraged
him and gave him material aid. The scientific endeavours for the
reform of medicine are characterized by the activity of the
translators, by the critical treatment and explanation of old
authors, and by independent investigation especially in the field
of botany. Concerning translations, those which had reference to
the Hippocratic writings were of prime importance. Among the
translators and commentators of these works we find Nicola
Leoniceno of Vicenza (1428-1524), the Spaniard Franciscus Valesius
(end of the sixteenth century), the Frenchman Jacques Houllier
(Hollerius, 1498-1562), Johann Hagenbut of Saxony (Cornarus 1500-
58), the two Paris professors, Jean de Gorris (Gorraeus, 1505-77),
and Louis Duret (1527-86), and Anutius Foesius (1528-91), a
physician of Metz. As investigators of Pliny there are Ermolao
Barbaro (1454-93), later Patriarch of Aquileia, and Filippo
Beroaldo (1453-1505). Students of other authors were Giovanni
Manardo of Ferrara (1462-1536; Galen, Mesue), the Paduan professor
Giovanni Battista de Monte (Montanus, 1498-1552; Galen, Rhazes,
Avicenna), and the Englishmen Thomas Linacre (1461-1524), and John
Kaye (1506-73), Wilhelm Copus, town physician of Basle (1471-
1521), and Theodore Zwinger of Switzerland (1533-88), all students
of Galen. As may be seen, the system of Galen still formed the
central point of medical studies, but it must be regarded as an
advance that people now read his works in the original or in
accurate translations, not as before in their Arabic form, for in
this way many changes and conflicting views introduced by the
Arabs were detected. But the full beauty of the Hippocratic works
could not be appreciated as long as Galen reigned supreme.

The first fruit of Humanism in medicine was primarily of a purely
formal nature, the main stress being now laid upon philological
subtleties and elegant diction. No longer content with prose,
authors often recorded their thoughts in verse. Petrarch had
blamed the physicians of his time because they knew how to
construct syllogisms, but did not know how to cure; and now the
place of the philosophizing practitioners was taken by the poet
physicians. A more satisfactory sign of the times is the great
number of medical botanists whose works show more or less
independent investigation, and always regard the needs of the
physician at the bedside. Among these we must mention the town
physician of Bern, Otto Brunfels (d. 1534), Leonard Fuchs (1501-
66) professor at Ingolstadt, Hieronymus Tragus (Bock) of
Heiderbach (1498-1554), and his pupil Jacobus Theodorus
Tabernaemontanus (d. 1590). The most important, however, is the
Zurich physician Conrad Gesner (1516-65; Tabulae phytographicae),
who was the first to experiment vvith tobacco brought from
America. Only Andrea Cesalpini, professor art that Spienza in
Rome, can be regarded as his equal. The interest taken in study of
natural science in Germany by Hapsburg emperors, Ferdinand I
(1522-64) and Maximilian (1564-76), was of great advantage to it.
The physician-in-ordinary to the Archduke Ferdinand of Tyrol,
Petrus Andreas Mathiolus of Siena (1500-77), published a
translation of Dioscurides with a commentary, a work which was
most highly valued until recent times. The special favour of
Maximilian II was enjoyed by Rembert Dodoens (Dodonaeus) of
Mechlin (1517-85), and by the founder of scientific botany,
Charles de l'Ecluse (Clusius) of Antwerp (1525-1609). The latter
was appointed professor in Leyden, and for a time lived in Vienna,
where he found zealous followers in the physicians Johann Aicholtz
(d. 1588) and Paul Fabricus (d. 1589).

PROGRESS IN ANATOMY: ANDREAS VESALIUS

From the time of Mondino, anatomy had been diligently cultivated
at the universities, especially in Italy. In Bologna, Giovanni de
Concoreggi (d. 1438) issued a work on anatomy. As commentators of
Mondino we must mention Alessandro Achillini (1463-1512) and
Jacopo Berengerio da Carpi (about 1470-1530). Anatomy made special
progress because of the artists. Thus Raphael Sanzio (1488-1520)
already makes use of the human skeleton when making his sketches,
so as to give his figures the proper posture. We possess numerous
anatomical descriptions and sketches by Leonardo da Vinci (1442-
1519) which were intended partly for all anatomy planned by
Marcantonio della Torre (Turrianus, 1473-1506), and partly for a
work of his own. The great Michelangelo 1475-1564) left sketehes
of the muscles and in 1495, in the monastery of Santo Spirito at
Florence, made studies for a picture of the Crucified with
cadavers as models.

As an indication of how much the popes endeavoured to advance the
study of anatomy we may recall that the priest Gabriel de Zerbis
for a time taught anatomy in Rome (towards the end of the
fifteenth century) that Paul III (1534-49) appointed the surgeon
Alfonso Ferri to teach this subject at the Sapienza in 1535, that
the physician-in-ordinary of Julius III (1550-55), Giambattista
Cannani, crowned his anatomical studies by discovering the valves
in the veins; that Paul IV (1555-9) called to Rome the famous
Realdo Colombo the teacher of Michelangelo, and that Colombo's
sons dedicated their father's work, "De re anatomica", to Pope
Pius IV (1559-1565). Foremost among the universities stood Padua,
the stronghold of medical science whence was to issue the light
which disclosed the weakness of Galen's system. In Padua, where
Bartolomeo Montagna (d. 1460) performed no less than fourteen
dissections, there existed since 1446 an anatomical theatre which
in 1490 was rebuilt under Alessandro Benedetti (1460-1525). en
reigned supreme. Of the anatomists who worked outside of Italy we
may mention Guido Guidi (Vidus Vidius) of Florence (d. 1569),
until 1531 professor at Paris; his successor Francois Jacques
Dubois (Sylvius, d. 1551) and Gunther von Andernach (1487-1574),
professor at Louvain. The two latter were the teachers of the
great reformer of anatomy, Andreas Vesalius (q.v.).

Vesalius (b.1514), studied at Louvain, Montpellier and Paris, then
became imperial field-surgeon. His eagerness to learn went so far
that he stole corpses from the gallows to work on at night in his
room. He soon became convinced of the weakness and falsity of the
anatomy of Galen. His anatomical demonstrations on the cadaver,
which he performed in several cities and which attracted
attention, soon earned him a call to Padua where he had recently
graduated and where, with some interruptions, he taught from 1539
to 1546. His chief work, "De corporis humani fabrica libri vii",
which appeared at Basle in 1543, brought him great fame, but
likewise aroused violent hostility, especially on the part of his
former teacher, Sylvius. The supreme service of Vesalius is that
he for the first time, with information derived from the direct
study of the dead body, attacked with keen criticism the hitherto
unassailable Galen, and thus brought about his overthrow, for soon
after this serious weaknesses in other parts of Galen's medical
science vvere also disclosed. Vesalius is the founder of
scientific anatomy and of the technique of modern dissection.
Unfortunately, he himself destroyed a part of his manuscripts on
learning that his enemies intended to submit his work to
ecclesiastical censure. While engaged on a pilgrimage, he received
word in Jerusalem of his reappointment as professor in Padua, but
he was shipwrecked in Zant and died there in great need on 15
October, 1565.

The authority of Galen was, however, still so deeprooted among
physicians that Vesalius found opponents even among his own more
intimate pupils. Nevertheless, the path which he had pointed out
was further explored and anatomy enriched by new discoveries. His
immediate successors as teacher in Padua were, in 1546, Realdo
Colombo (d. 1569), later professor in Rome, the discoverer of the
lesser circulation of the blood (pulmonary circulation); from 1551
the versatile Gabriele Fallopio (1523-62), an admirer of
Versalius, who among other things described the organ of hearing;
Girolamo Fabrizio of Acquapendente (Fabr. ab Aquapendente, 1537-
1619), who worked in the field of embryogeny and studied carefully
the valves in the veins, and finally Giulio Casserio (1561-1619),
who published a series of anatomical charts. A similar undertaking
was planned by Bartolommeo Eustacchi at the Sapienza in Rome, but
he died before the completion of the work in 1574. Pope Clement XI
(1700-21) caused his physician-in-ordinary, Giovanni Maria
Lancisi, to print the rediscovered copper plates and to supply
them with an explanatory text. Adrian van den Spieghel of Brussels
(Spigelius, 1578-1625) worked on the anatomy of the liver and to
the nervous system. In comparison with the excellent productions
of Italy, the anatomical activity of Germanic countries appears
slight. It was considered sufficient at the universities, if a
surgeon now and then dissected a corpse, while a physician
explained the functions of different organs. The only laudable
exceptions were two physicians who rendered services both to
anatomy and botany -- Felix Platter (1536-1614), professor in
Basle, and his successor, Kaspar Bauhinus (1560-1624), the
discoverer of the valve in the caecum named after him (Bauhin's
valve).

THE OPPONENTS OF GALEN AND THE ARABS

Violent attacks upon ancient traditions were not confined to the
domain of medicine, but also found expression in the general
upheaval caused hy Humanists, by the discovery of new countries,
by the opening up new sources of knowledge, by the dissemination
of education through the invention of printing, and by the schism
of the Church brought about by Luther. Authority, both
ecclesiastical and civil, had been considerably weakened. The
investigations of Vesalius probably dealt the most serious blow to
the teaching of Galen, but it was neither the first nor the only
one; for even before Vesalius' critics had attacked the theories
of Galen and the Arabs, although not quite so energetically as the
anatomists attacked them. The chief representatives of these times
down to the end of sixteenth century can be classed respectively
into anti-Galenists or anti-Arabists and positive Hippocratics.
The climax of this revolution was reached on the appearance of
Theophrastus Paracelsus and his adherents although the Italian
schools remained uninfluenced by this. The physician and
philosopher, Geronimo Cardano of Milan (1501-76), attacked
principally Galen's explanation of the origin of catarrhs of the
brain, and also the validity of the therapeutical principle,
Contraria contrariis curantur. Similar was the tendency shown by
Bernadino Telesio of Piacenza (1508-88), Giovanni Argenterio of
Piedmont (1513-72), and the chancellor of Montpellier, Laurent
Joubert (1529-83), while Jean Fernel (1485-1558), made an attempt
to modernize the system of Galen in accordance with the results of
anatomical investigation.

A lively exchange of opinions was caused by the controversy on
bleeding, which was begun by the Paris physician Pierre Brissot
(1478-1522). Brissot assailed the Arabian doctrine that
inflammatory diseases, especially pleurisy, should be treated by
bleeding on the side opposite to the seat of inflammation, and
favoured the Hippocratic doctrine of bleeding as near as possible
to it. The controversy was decided in favour of the Hippocratics,
who did not discard the doctrines of Galen as long as they agreed
with Hippocratic views, but rejected the principles of Galen as
modified by the Arabs. This is clearly shown by the importance
attached to the state of the pulse and of the urine, upon which
the Arabs laid much more stress than the Greeks. Of the great
number of positive Hippocratics let us call attention to the
above-mentioned de Monte, who introduced clinical instruction in
Padua; to his successors Vellore Trincavella (1496-1568),
Albertino Bottoni (d. about 1596), Marco degli Oddi (d. 1598),
Giovanni Manardo (1462-1526), Prospero Alpino (1533-1617); to the
Spaniards, Cristobal de Vega (1510 to about 1580) and Luis Mercado
(1520-1606); to the Frenchman Guillaume Baillou (Ballonius, 1538-
1616); to the Netherlanders, Peter Foreest (1522-97) and Jan van
Heurne (1543-1601), who will be mentioned subsequently; Franz
Emerich (1496-1560), the organizer of clinical instruction at
Vienna; Johann Crato of Crafftheim (1519-85), and Johann Schenck
von Grafenberg (1530-98). Epidemiological works were written by
Antonio Brassavola (1500-55) on syphilis; Girolamo Fracastoro
(1483-1553) on petechial fever and syphilis, Girolamo Dorzellini
(d. 1558), and Alessandro Massaria (1510-98) on plagues; Jan van
den Kasteele (about 1529) on "the English sweat"; and the Viennese
physician, Thomas Jordanus (1540-85), on purple or petechial
fever.

THEOPHRASTUS PARACELSUS -- HIS ADHERENTS AND OPPONENTS

Theophrastus Bombast of Hohenheim (Paracelsus), the son of a
physician, was born near Einsiedeln, Switzerland, in 1493. In 1506
he went to the University of Basle; from Trithemius he learned
chemistry and metallurgy in the smelting houses at Schwaz (Tyrol),
and he visited the principal universities of Italy and France. In
1526 he became town physician of Basle, and could as such give
lectures. His first appearance is characteristic of him. He
publicly burned the works of Avicenna and Galen and showed respect
only to the "Aphorisms" of Hippocrates. He was the first to give
lectures in the German language. But as early as 1528, he was
compelled, on account of the hostility he evoked, to leave Basle
secretly. After this he travelled through various countries
working constantly at his numerous writings, until death overtook
him at Salzburg in 1514. Paracelsus, like a blazing meteor, rose
and disappeared; he shared the fate of those who have a violent
desire to destroy the old without having any substitute to offer.
Passing over his philosophic views, which were based upon neo-
Platonism, we find practical medicine indebted to him in various
ways, e.g. for the theory of the causes of disease (etiology) for
the introduction of chemical therapeutics, and for his insistence
on the usefulness of mineral waters and native vegetable drugs. He
exaggerates indeed the value of experience. His classification and
diagnosis of diseases are quite unscientific, anatomy and
physiology being wholly neglected. He thought that for each
disease there should exist a specific remedy, and that to discover
this is the chief object of medical art. With him diagnosis hung
upon the success of this or that remedy, and because of this he
named the diseases according to their specific remedies. Directly
repudiated by the Italian schools, Paracelsus found adherents
mainly in Germany, among them being the Wittenberg professor
Oswald Croll (about 1560-1609). He also found numerous friends
among the travelling physicians and quacks. His teachings met with
the most hostile reception from the Paris faculty. Although the
further progress of anatomy and physiology indicated clearly to
physicians the right path, we meet even in the eighteenth and
nineteenth centuries with two men who start directly from
Paracelsus: Samuel Friedrich Hahnemann (1755-1843), the originator
of homeopathy, and Johann Gottfried Rademacher (1772-1850),
advocate of empiricism.

SURGERY IN THE SIXTEENTH CENTURY: AMBROISE PARE

The first fruits of the progress in anatomy were enjoyed by
surgery, especially since most Italian anatomists were practical
surgeons. After the introduction of firearms in war, the treatment
of gunshot wounds was especially studied. While surgery had always
enjoyed a high rank in Italy and France, in Germany it was in the
hands of barbers and surgeons unconnected with the universities
and poorly educated; hence it is readily understood why the best
surgeons lived in the cities nearest the Romance countries,
especially Strasburg. With the member of the Teutonic Order,
Heinrich von Pfolspeundt ("B�ndth Ertzney", 1460), the most
important representatives were the Strasburg surgeons, Hieronymus
Brunschwig (d. about 1534), and Hans von Gersdorff ("Feldtbuch der
Wundtartzney", 1517). Their equal was a somewhat younger man,
Felix W�rtz of Basle (1518-74). We are indebted to the French
field-surgeon Ambroise Pare for a marked change in the treatment
of gunshot wounds and arterial hemorrhage. He abandoned the Arabic
method of work with a red-hot knife, declared that supposedly
poisoned gunshot wounds were simple contused wounds, and proceeded
to bandage them without using hot oil. He was the first to employ
the ligature in the case of arterial hemorrhage. Next to him in
importance stands Pierre Franco (about 1560), known as the
perfecter of the operation of lithotomy and that for hernia.
Gaspare Tagliacozzi of Bologna (1546-99) deserves credit for
reintroducing and improving the ancient plastic operations. In the
sixteenth century the Caesarean operation (Sectio caesarea,
laparotomy) was performed on living persons.

DISCOVERY OF THE CIRCULATION OF THE BLOOD: WILLIAM HARVEY AND HIS
TIME

Galen's theory, according to which the left heart and the arteries
contained air, the blood being generated in the liver, had long
been regarded as improbable, but in spite of every effort no one
had as yet discovered the truth about circulation. The solution of
this problem, which brought about complete fall of Galen's system
and a revolution in physiology, came from the English physician
William Harvey of Folkstone (1578-1657), a pupil of Fabricius ab
Aquapendente. Harvey's discovery published in 1628, that the heart
is the centre of the circulation of the blood must return to the
heart, at first received scant notice and was even directly
opposed by Galen's adherents; but further investigation soon made
truth victorious. Even as early as 1622, Gaspare Aselli (1581-
1626) found the chyle vessels, but correct explanation was
possible only after the discovery of the thoracic duct (ductus
thoracius) and its opening into the circulation by Jean Pacquet
(1622-74) and Johann van Horne (1621-70), and of the lymphatic
vessels by Olaus Rudbeck (1630-1702) and Thomas Baltholinus (1616-
80). A new field of investigation was opened by the invention of
the microscope, by which Marcello Malpighi (1628-94) discovered
the smaller blood-vessels and the blood corpuscles. From Harvey's
time starts a series of important anatomists and physiologists,
among them the Englishmen Thomas Wharton (1614-73; glands) and
Thomas Willis (1621--75; brain); the Netherlanders Peter Paaw
(1564-1617), his pupil Nikolas Pieterz Tulp (1593-1678), both
teachers of anatomy at Leyden, and Antony van Leeuwenhoek (1632-
1723) and Johann Swammnerdam (1647-80), microscopists, Reinier de
Graaf (1641-73; ovary); Nikolaus Steno of Copenhagen (1638-86),
and the Germans, Moriz Hofman (1621-98) and George Wirsung, who
investigated the pancreas.

IATROPHYSICISTS AND IATROCHEMISTS

The doctrine of the circulation is based to a large extent upon
the laws of physics. Consequently among a number of physicians,
influenced by the works of Alfonso Borelli (1608-78) on animal
motion, there was a marked effort to explain all physiological
processes according to the laws of physics (iatrophysicists).
Opposed to them was a party, which, influenced by the progress in
chemistry, sought to make use of it for explaining medical facts
(iatrochemists). This tendency goes back to Paracelsus and his
adherent Johann Baptist von Helmont (1578-1644). Helmont, who was
an important chemist (the discoverer of carbonic acid), recognized
the importance of anatomy, and deserves credit for his work in
therapeutics, although his failure to appraise the needs of his
time prevented his doctrine from influencing the development of
medicine. Iatrophysics was cultivated mainly in Italy and England;
iatrochemistry in the Netherlands and Germany. The chief adherent
of iatrophysics in Italy was Giorgio Baglivi (d. 1707), professor
at the Sapienza in Rome; in practical medicine, however, he held
mainly to Hippocratic principles, while the Englishman, Archibald
Pitcairn (1652-1713), tried to follow out iatrophysics to its
utmost consequences.

Owing to the greater progress made in physics, iatrochemistry
found fewer followers, and that it took root at all is the service
of its chief representative Franz de le Bo� Sylvius (1614-72), who
in 1658 became professor of practical medicine at Leyden. At the
school there, founded in 1575, Jan Heurne had already tried to
establish a clinic after the Paduan model, but it was not till
1637 that his son Otto was able to carry out his scheme. The
immediate successors of the latter, Albert Kyper (d. 1658), and
Ewald Schrevelius (1576-1646), continued this institution in the
Hippocratic spirit. Before Sylvius began to teach there, the
Leyden clinic had already gained worldwide fame. One of the first
adherents of Harvey, Sylvius, depending in part on Paracelsus and
Belmont sought to explain physiological processes by suggesting
fermentation (molecular motion of matter) and "vital spirits" as
moving forces. Through "effervescence" acid and alkaline juices
are formed, and through their abnormal mixture hyperacidity and
hyperalkalinity (i.e., sickness) originate. This simple doctrine,
supported by the clinical activity of Sylvius, found numerous
adherents especially in Germany, but it made just as many
opponents among the iatrophysicists who were able to refute in
part these untenable hypotheses. The two theories are, however,
not absolutely opposed to each other, for both physics and
chemistry offer the means necessary for an explanation of
physiological processes and may form the basis for the
construction of an exact medical science. At this time, however,
physics and chemistry (especially the latter) were still too
little developed for this purpose and therefore the endeavour to
create a system is much more apparent among the iatrochemists.
Fortunately, the two parties found a common point of union in
practical medicine, where the doctrines of the Hippocratic school
were predominant.

PIONEERS IN PRACTICAL MEDICINE: THOMAS SYDENHAM AND HERMANN
BOERHAVE

Both renounce all systems, and lay most stress upon the perfection
of practical medicine. Thomas Sydenham (1624-89), physician at
Westminster and known as the "English Hippocrates", laid down the
principle that, just as in the natural sciences so in medicine the
inductive method should be authoritative. The main object of
medicine, healing, would be possible only when the chances Iying
at the root of disease and the laws governing its course had been
investigated. Then also would the proper remedies be found.
Following the idea of Hippocrates, he seeks the cause of disease
in the change of the fundamental humours (humoral pathology). The
activity of the physician was mainly to assist "nature". A man of
the same intellectual build as Sydenham was Hermann Boerhave
(1668-1738), the most famous practitioner of his time, who in 1720
became clinical professor at Leyden. Being an iatrophysicist, he
regards Hippocratism as able to live only if the results of
investigation in anatomy, physiology, physics, and chemistry are
properly used. He tries to explain most physiological processes as
purely mechanical. In contradistinction to the two professors of
Halle, Friedrich Hoffmann (1660-1742) and George Ernst Stahl
(1660-1734), of whom former supposed the ether (Leibniz's doctrine
of monads) and latter the "soul" to be moving power, Boerhave did
not care at all about any moving force that might possibly be
present. With his death Leyden lost its importance as a nursery of
medicine. His illustrious pupil and commentator, Gerhard van
Swieten (1700-72), was called as teacher to Vienna in 1745, and
there laid the foundation of the fame of the school whose most
important representatives are Anton de Haen (1704-76) and his
successor as teacher, Maximilian Stoll (1742-88). Under the eye of
van Swieten and de Haen but without recognition from them, a
simple hospital physician, Leopold Auenbrugger (1722-1809),
published his epoch-making discovery that, by striking or rapping
on the chest (percussion) disease of the lungs and heart may be
diagnosed from the various sounds elicited by such percussion. An
important member of the Vienna school was Johann Peter Frank
(1745-1821), director of the general hospital, who was celebrated
as a practitioner and as the author of a work, unequalled until
then (System einer vollstandigen medizinischen Polizey", 1779-
1819).

Among important practitioners outside of the school of Leyden
were: the papal physician-in-ordinary, Giovanni Maria Lancisi
(1654-1720), who established a clinic in Rome after the model of
Leyden; Giovanni Battista Borsieri (Burserius de Kanifeld, 1725-
85), professor at Pavia; James Keill (1673-1718); Richard Mead
(1673-1754); John Freind (1675-1728), smallpox); John Pringle
(1707-82) and John Huxham (1694-1768), investigations in
epidemiology; John Fothergill (1712-80); diphtheria and
intermittent fever). Albrecht von Haller developed an important
school in G�ttingen as van Swieten school were: Paul Gottlieb
Werlhof (1699-1767; intermittent fever) and Johann Georg
Zimmermann (1728-95).

ANATOMY IN THE EIGHTEENTH CENTURY

During this period normal and pathological anatomy were more
cultivated than microscopy. The greater number of investigators
that we have to consider won fame in the field of surgery.
Starting from the school of Leyden the following deserve mention:
Govert Bidloo (1649-1713) and Bernhard Sigmund Albinus (1697-1770;
anatomical charts); in Amsterdam, Friedrich Ruysch (1638-1721),
and Pieter Camper (1722-89), the inventer of craniometry and of
the elastic truss for hermia; in Italy, Antonio Maria Valsalva
(1666-1723; eye and ear) and Giovanni Domenico Santorini (1681-
1737); in Paris, the Dane Jakob Benignus Winsl�w (1669-1760;
topographical anatomy); in England James Doug!as (1675-1742;
peritoneum); Alexander Munroe (1732-1817; bursa mucosa), and
William (1718-83) John Hunter (1728-93) both known also as
surgeons; finally in Germany, the anatomist, surgeon, and
botanist, Lorenz Heister (1683-1758), Johann Gottfried Zinn (1727-
59; eye); Johann Nathanael Lieberkuhn (1711-65; intestine);
Heinrich August Wrisberg (1739-1808; larynx), and Samuel Thomas
Sommering (1755-1830). Abnormal anatomical changes in organs had
been recorded since the time of Vesalius, but these were for the
most part merely incidental observations and nobody had tried to
trace systematically the connection between them and the symptoms
occurring in the living body. The best survey of the achievements
of the earlier centuries is offered in Theophil Bonet's
"Sepulchretum anatomicum" (1709). As the scientific founder of
pathological anatomy we must mention Giovanni Battista Morgagni
(1682-1771), professor at Padua, whose famous work, "De sedibus et
causis morborum" (1761), usually contains, besides the results of
post-mortem examinations, a corresponding history of the diseases.
This field was cultivated in France especially by Joseph Lieutaud
(1703-80) and Vicq d' Azyr (1748-94), and in Leyden by Eduard
Sandifort (1742-1814). Germany had an important investigtor in the
days before Morgagni viz. Johann Jakob Wepfer in Schaffhausen
(1620-95). In Vienna, autopsies on those who died in the clinic
were first regularly made by Anton de Haen. For a strictly
systematic treatment of the whole field we are indebted to the
London physician, Matthew Baillie (1761-1823), who published the
first pictorial work on pathological anatomy.

SURGERY IN THE SEVENTEENTH AND EIGHTEENTH CENTURIES

The eminent surgeons of the seventeenth century are: Cesare Magati
(1579 to about 1648) professor in Ferrala and later a Capuchin
monk who simplified the treatment of wounds; Marc' Aurelio
Severino (1580-1656; treatment of abscesses, resection of ribs);
the already mentioned anatomist, Fabrizio ab Aquapendente (re-
introduction of tracheotomy, improvement of herniotomy); Antonio
Ciucci (about 1650, re-introduction of lithotripsy); in France,
Bartholomaeus Saviard (1656-1702; digital compression of arteries)
Jacques Beaulieu (1651-1714), a travelling surgeon and later a
hermit (Fr�re Jacques), who improved the method of lateral
lithotomy, and helped people for a "God-bless-you"; in Amsterdam,
Abraham Cyprianus (about 1695; lithotomy). The most important
German surgeon is Wilhelm Fabry of Hilden (Fabricius Hildanus,
1560-1634; simplified treatment of wounds, amputation); next to
him Johann Schultes (Schultetus, 1595-1646), author of "Arma
mentarium chirurgicum", and Matthias Gottfried Purmann (1648-1721;
field surgery). Of English surgeons Richard wiseman, (about 1652;
amputation, compression of aneurisms), John Woodall (about 1613),
and Lowdham (about 1679) are the most eminent.

In the eighteenth century surgery was essentially stimulated by
the numerous wars: in France also through the establishment of an
academy in 1731 by Georges Mareschal (1658-1736) and Fran�ois
Gigot de la Peyronie (1678-1747). Of Frenchmen we must also name
Jean Louis Petit (1674-1750), the inventor of the screw
tourniquet, Henri Fran�ois le Dran (1685-1770; lithotomy,
lacerations of scalp), Pierre Joseph Boucher (1715-93;
amputation); Toyssaint Bordenave (1728-82; amputation), Antoine
Louis (1723-92, operation for harelip, bronchotomy, simplification
of instruments), Pierre Joseph Desault (1744-95, founder of the
Paris surgical clinic, ligature of vessels, treatment of aneurism,
dislocations, fractures), Fran�ois Chopart (1743-95, methods of
amputation), and finally the monk and lithotomist Fr�re C�me (Jean
de St. Cosme, Baseilhac, 1703-81), the inventor of the lithotome-
cache. The founder of modern English surgery is William Cheselden
(1688-1752; lateral lithotomy, artificial pupil). Samuel Shalp
(about 1700-78) wrote a text-book; William Bromfield (1712-92),
invented an artery-retractor and the double gorgeret; and Percival
Pott (1713-88) established the doctrine of arthrocace (malum
potti). The most eminent and versatile surgeon is the already-
mentioned John Hunter (treatment of aneurisms, theory of
inflammation, gunshot wounds, syphilis. Surgery was on a much
lower plane in the Germanic countries. For the better training of
the Prussian military surgeons and on the proposal of Surgeon-
General Ernst Konrad Holtzendorff (1688-1751), there was founded
in Berlin a Collegium medico-chirurgicum in 1714; later in 1726
the Charite school, and in 1795 the Pepini�re academy. Surgery
made great progress through Johann Zacharias Platner (1694-1747)
at Leipzig; Johann Ulrich Bilguer (1720-96) and Christian Ludwig
Mursinna (1744-1833) at Berlin, Karl Kasper Siebold (1736-1807) at
W�rzburg, and especially through August Gottlob Richter (1742-
1812) at G�ttingen (surgical library). A school for military
surgeons was founded at Vienna in 1775 at the suggestion of Anton
St�rck (1731-1803), ten years after which was established the
Josephinum academy under the direction of the army Surgeon-in-
chief Johann Alexander von Brambilla (1728-1800).

STUDY OF PHYSIOLOGY: ALBRECHT VON HALLER AND HIS TIME

The great discoveries in the field of gross and minute
(microscopic) anatomy naturally impelled men to investigate also
the vital functions, but the results of the efforts of both
iatrophysicists and iatrochemists were far from satisfactory,
since scientific aid was sadly lacking. Physiology for the first
time received systematic treatment at the hands of the versatile
scholar, Albrecht von Haller of Bern (1708-77), professor in
Gottingen from 1737 to 1753 (Elementa physiologiae, 1757-66).
Haller, a pupil of Albinus and Boerhave, was the first to
recognize the importance of experiments on animals. We are
indebted to him for the best description of the vascular system
and for studies in haemodynamics, in which field, however, the
English clergyman, Stephen Hales (d. 1761), had already broken the
soil. He correctly recognized the mechanism of respiration without
being able to investigate its physiological importance (exchange
of gases), since Joseph Priestley did not discover oxygen until
1774. He disproved the view that there was air between the lungs
and the pleura by a simple experiment on animals. Haller became
best known through the discovery of irritability and sensibility.
When external stimuli are applied to tissues, especially muscles,
the latter react either by contracting and moving (irritability),
or by experiencing sensation or sense of pain (sensibility) or at
times by both. Sensibility disappears when the corresponding nerve
is cut, while irritability persists independent of the nerves and
even continues some time after death. This theory met with great
opposition especially among the practical physicians (Anton de
Haen), who did not, however, take the trouble to repeat the
experiments on animals. Even though Haller knew neither the
central cause of the two phenomena, nor the correct structure of
the tissues, it nevertheless stands to his credit that he was the
first to point out the facts and open up new roads for physiology.
Haller's investigation was generally welcomed, especially in Italy
by Abbate Lazzaro Spallanzani (1729-99), the first scientific
opponent of spontaneous generation. His experiments along the
lines of artificial fertilization of frogs' eggs, and concerning
digestion are famous. Felice Fontana (1730-1805), repeating the
experiments concerning irritability, reached the same results as
Haller. William Hewson (1729-74) studied the qualities of the
blood (coagulation). The most important German physiologist after
Haller is Kasper Friedrich Wolff (1735-94), known for his
investigations in the field of evolution and for pointing out the
fact that both animals and plants are composed of the same
elements, which he called little "bubbles" or "globules". Joseph
Priestley's discovery of "dephlogisticated air" (1774), as oxygen
was then called, was of the highest importance in the development
of the theory of respiration, of the process of tissue-
decomposition, of formation of the blood, and of metabolic
phenomena.

MEDICAL SYSTEMS IN THE EIGHTEENTH CENTURY

The three great discoveries in the second half of the century
(oxygen, galvanism, and irritability), contrary to what one might
expect, led scientists astray, and gave rise to systems whose
foundations were of a purely hypothetical nature. Especially
interesting are the neuro-pathological theories, connected to some
extent with irritability. William Cullen (1712-90) accepting
irritability as his starting-point, supposes a "tonus" or fluid
inherent in the nerves (Newton's ether), whose stronger or weaker
motions produce either a spasm or atony. In addition "weakness" of
the brain and "vital power" played a great part in his explanation
of diseases. Cullen's pupil, John Brown (about 1735-88), modified
this doctrine by explaining that all living creatures possess
excitability, located in the nerves and muscles, which are excited
to activity by external and internal influences (stimuli).
Diseases occur according to increase or dimunition of the stimuli
causing increased excitability, (sthenia) and weak stimuli
diminished excitability (asthenia). Death is caused either by an
increase of excitability with a lack of stimuli, or by exhaustion
of excitability from too strong stimuli. Brown's theory was little
noticed in England and France, but in Germany it was highly
lauded. Christoph Girtanner (1760-1800) and Joseph Frank (1771-
1842) spread its fame. Out of this Brunonianism Johann Andreas
R�schlaub (1768-1835) developed the so-called (theory of
excitability which was so energetically opposed by Alexander von
Humboldt and Christian Wilhem Hufeland (1762-1836). Giovanni
Rasori (1762-1837), building also on Brown's theory, developed his
contra-stimulistic system, namely that there are influences which
directly diminish excitement (contra-stimuli) or remove existing
stimuli (indirect contra-stimuli); he, therefore, distinguishes
two groups of diseases -- diathesis of the stimulus and that of
the contra-stimulus.

Another group of systematizers, the Vitalists, basing their views
upon Stahl's doctrine of the soul (Animism) and Haller's
irritability, consider vital energy to be the foundation of all
organic processes. The chief representatives of Vitalism, a system
developed especially in France and later predominant in Germay,
are: Theophile Bordeu (1722-76), Paul Joseph Bartilez (1734-1806),
Philippe Pinel (1755-1826), Johann Friedrich Blumenbach (1752-
1840) and Johann Christian Reil (1759-1813). But, while these
physicians adhered to Hippocratism in practice and (e.g. Reil)
were eminently active in developing anatomy and phlysiology, the
same may not be said of the three Germans, Mesmer, Hahnemann, and
Rademacher, who were the last followers of Paracelsus. The
doctrine of animal magnetism (Mesmerism), established by Friedrich
Anton Mesmer (1734-1815), is connected with Vitalism in so far as
Mesmer presupposes a magnetic power to exist in the body, and
accordingly tries, at first by means of magnets and later by
touching and stroking the body, to effect an interchange of
forces, a transfusion or cure. Mesmer through his manipulations
very likely induced real hypnotic sleep in many cases. His
doctrine, however, which at first met with a sharp rebuff and was
subsequently characterized in many circles as a fraud, was
degraded by his immediate followers to somnambulism and
clairvoyance, and in later times it became altogether discredited
from having fallen into the hands of quacks. Nevertheless,
mesmerism forms a basis for hypnotism, which in 1841 was
established by James Braid.

Homeopathy, founded by Samuel Friedrich Christian Hahnemann, seems
to have the promise of a long lease of life. Hahnemann regards
disease as a disturbance of vital energy. The latter in itself has
no power to heal, for a cure can take place only when a similar
set of symptoms. The best way to produce such a disease is to give
highly diluted drugs which are capable of producing a similar set
of symptoms. The rest of this "drug-disease" is destroyed by the
vital energy, which is possible only when the doses are small. As
chief principle, therefore, Hahnemann sets up the doctrine that
like cures like. Since he denies the posssibility of investigating
the nature of disease, and completely disregards pathological
anatormy, it is necessary to know all simple drugs which produce a
set of symptoms similar to those of the existing disease. With his
pupils Hahnemann undertook the task of testing the effects of all
simple drugs, but the result of this gigantic piece of work could
not be absolutely objective, since it is based upon the purely
subjective feeling of the experimentalists. Never before had a
physician built a system upon so many purely arbitrary hypotheses
as Hahnemann. Paracelsus also had declared war upon the old
medicine, and had attributed little value to anatomical and
physiological investigation, which, however, was still in its
initial period of development; but, with his reverence for
Hippocrates, he neverthelss ranks higher than Hahnemann, who is
the representative of empiricism and the despiser of all the
positive successes which medicine had previously attained.
Hahnemann's more sensible pupils did not follow their master
blindly, but regarded his method as that which under the most
favourable circumstances it may be, viz., a purely therapeutical
method that does not disregard clinical science. To this rational
standpoints together with eclecticism, homeopathy owes its long
life and wide dissemination. One service of physicians of this
school is that they simplified prescriptions, and appreciatively
studied obsolete, but nevertheless valuable vegetable drugs.
Hahnemann's pupil, Lux, extended homeopathy to isotherapy, which
in modern times celebrated its renascence in organotherapy. Widely
removed from scientific progess was the "empirical medical
doctrine" of Johann Gottfried Rademacher (1772-1850), which is
today completely discredited. Starting from the doctrine of
nostrums of Paracelsus, he names the diseases according to the
effective drug (e.g. nux-vomica strychina, liver disease), and
classifies diseases as universal and organic in accordance with
universal and organic drugs. His therapeutics was a purely
empirical one, uninfuenced by pathology or clinical diagnosis.

SOME SPECIAL BRANCHES OF MEDICINE AT THE END OF THE EIGHTEENTH
CENTURY

Obstetrics

Down to the sixteenth century obstetrics was almost exclusively in
the hands of midwives, who were trained for it as for a trade.
Only in rare cases was a surgeon called in. All the achievements
of ancient times seemed forgotten, and it was only after
anatomical studies had been resumed and surgery had made some
progress that things began to improve. The most important accounts
of the condition of ancient operative obstetrics are found in the
Hippocratic writings (position of the child, version or turning,
dismemberment of the fetus, parturition chair for facilitating
delivery) and in later times in the works of Soranus of Ephesus
(second century A.D.; protection of the perinaeum), Galen, Celsus,
A�tius, and in those of the female physician Trotula of Salerno.
The oldest book on midwifery in the Middle Ages (Rosengarten) was
written by Eucharius R�slin (d. 1526), who, in addition to
numerous drugs assisting delivery, mentions "version". Version was
put into practice again by Ambroise Pare. In the sixteenth century
attempts were made to perform the Caesarean operation on the
living (Jakob Nufer, a Swiss, c. 1500); in ancient times it was
done only after the death of the mother. The first work about this
operation was published by the Paris surgeon, Fran�ois Rousset
(1581). In the domain of practical obstetrics, Giulio Casare
Aranzio (1530-89) was the first to point out those malformations
of the pelvis which exactly indicated the necessity for the
Caesarean section. Much was done to extend the study of this
branch of medicine by the works of Jacques Guillemeau (1560 to
about 1609), Scipione Mereurio (1595, German translation by
Gottflied Welsch, 1653), Fran�ois Mauriceau (1637-1709), Pierre
Dionis, and Guillaume Manquest de la Motte (1655-1737),
pelycologists. The splendid development of obstetrics in France
explains why male assistance was more and more sought there,
especially after Jules Clement had been called in 1673 to the
court of Louis XIV. The most important accoucheur in the
Netherlands was Hendrik van Deventer (1651-1724; axis of the
pelvis, placenta praevia, asphyxia neonatorum). In Germany
Siegemundin, the most famous German midwife, published in 1690 a
text book based upon wide experience (Chur-Brandenburgische Hoff-
Wehe-Mutter).

In the first half of the seventeenth century Hugh Chamberlen
invented the obstetrical forceps, selling it to Dutch physicians
about 1688. Jean Palfyn of Ghent (1650-1730) constructed
independently a similar instrument (Main de Palfyn), which he
submitted to the Paris Academy about 1723. After various
improvements by Lorenz Heister, Dusse, and Gregoire, the forceps
passed into general practice. The most important accoucheurs of
the eighteenth century were: in France, Andre Levret (1703-1780;
inclination of the pelvis, forceps, combined examination),
Francois Louis Joseph Solayres de Renhac (1737-72; mechanism of
delivery), Jean Louis Baudelocque (1746-1810; pelvimetry),
opponent of artificial premature delivery and symphyseotomy; in
England, Fielding Ould (1710-89; mechanism of delivery,
perforation), William Smellie (1697-1763; mechanism of delivery,
use of forceps, pelvimetry), William Hunter (1718-93) opponent of
the forceps and the Caesarean operation, Thomas Denman (1733-
1815), the first to recommend artificial premature delivery, and
William Osborn (1732-1808), opponent of symphyseotomy and of the
Caesarean section. The well-founded doubts which in preaseptic
times many accoucheurs entertained concerning the Caesarean
operation, led to so-called symphyseotomy (Jean Rene Siegualt,
1768) which by widening the pelvis would permit delivery of the
fetus. This operation, which from the very outset met with
vigorous opposition in England, is now forgotten. The introduction
of scientific obstetrics in Germanic countries was comparatively
late. Special schools for midwives were instituted, in 1728 at
Strasburg (Johann Jakob Fried, 1689-1769), in 1751 at Berlin
(Johann Friedrich Meckel, 1724-74) and G�ttingen (Johann Georg
R�derer, d. 1763), and in 1754 at Vienna (Johann Nep. Crantz,
1756; Valentin von Lebmacher, 1797; Raphael Steidele, 1816). While
the Parisian midwives belonged to the Coll�ge de S. C�me as early
as 1560 and received a methodical training, those in Gerrnany
could receive only private instruction. Examination by physicians
mentioned at Ratisbon since 1555 and at Vienna since 1642.

Ophthalmology

Ophthalmology gained importance much later than obstetrics. In
addition to inflammation of the eye and operations on the eyelid,
the Hippocratic writings mention amblyopia, nyctalopia, and
glaucoma. Celsus describes an operation for cataract (sclerotico-
nyxis). Galen gives us the beginnings of physiological optics. The
slight ophthalmological knowledge of the Greeks was borrowed by
the Arabs, but their lack of anatomical knowledge prevented all
progress. No improvement set in until after the rise of anatomy
under Vesalius. Fortunately, this branch had been almost
completely in the hands of travelling physicians (cataract
operators), but henceforth surgeons with a fixed abode (e.g.
Ambroise Pare, Jacques Gulliemeau) began to turn their attention
to it. In Germany Georg Bartisch (about 1535-1606), "Court eye
specialist" at Dresden, wrote the first monograph, a work very
highly valued even in later days. Among other things he mentions
spectacles for curing squint, eyeglasses and, among operations is
the first to describe extirpation of the pupil. The invention of
convex spectacles is by some attributed to the Dominican Alexander
da Spina (d. 1313), by others to Salvino degli Armati of Florence
(d. 1317). Concave glasses did not appear until the sixteenth
century.

The foundations for further progress in ophthalmology were laid by
the anatomists and physicists of the seventeenth century. In the
first group let us mention the works of Friedrich Ruysch
(choroid), van Leeuwenhoek (lens) Heinrich Meibom (1678-1740;
glands of the eyelids), and Stenon (lachrymal apparatus).
Investigations of physicists were of great importance, especially
those of the two astronomers, Johann Keppler (1571-1630) and the
Jesuit Christoph Scheiner (1575-1659), concerning accommodation,
refraction of light, and the retinal image; Rene Descartes (1596-
1650; comparison of the eye with the camera obscura,
accommodation); Edmund Marriott (d. 1684; blind spot, choroid);
Isaac Newton (1642-1727; dispersion of light and origin of
colours). In the eighteenth century, besides anatomy and
physiology, the practical side of ophthalmology was also
cultivated. Among anatomists were Winslow, Petit, Zinn, Demours
(cornea and sclerotic); Buzzi and Sommering (retina); La Hire, J.
H. Hoin, Camper, and Reil (lens). The theory of the sensibility of
the retina to light, established by Haller, was further developed
by Porterfield and Thomas Young (1773-1829). The latter also
described astigmatism and colour-blindness, and discovered that
accommodation depended upon a change in the shape of the lens.
Boerhave was the first to give clinical lectures on ophthalmology.
From him we have the exact definition of myopia and presbyopia.
Gray cataract (cataracta) was first located in the lens by
Francois Quarre and Remi Lasnier, a view which was corroborated by
the anatomist, Werner Rolfink (1599-1673). Francois Pourfour du
Petit (1644-1741), Lorenz Heister, and others also worked on
cataract in 1745. Of other practitioners we must mention: Brisseau
(theory of glaucoma), William Cheselden (1668-1752; articial
pupil), Baron Wenzel the elder (1780; iridectomy), Charles de St.
Yves (ablatio retinae, asthenopia, staphyloma, strabismus), John
Taylor (1708-60; operation to correct oblique vision,
ceratoconus), Dominique Anel (cathederism of the lachrymal
fistula, 1713), G.E. Stahl, Boerhave, Jonathan Wathen, Lorenz
Heister, Johann Zacharias Platner (1691-1747), and August Gottlob
Richter (studies on the lachrymal fistula).

Pharmaceutics, Mineral Waters, Cold Water Cures

Pharmacy had remained the most backward of all the branches of
medicine, for it was longest under the influence of the Arabs. A
large part of the drugs came from the Orient to Venice and Flemish
harbours. Besides simple drugs there were also a great many
compound remedies. But, in the latter class, there was great
confusion resulting from the many adulterations, and from the fact
that not only did individual authors give different compositions
for the same remedy, but also under the same name an entirely
different preparation was understood by different authors. The
most famous panacea, which dated from Roman imperial times and was
used as late as the eighteenth century, was theriac, a mixture
consisting of numerous ingredients, among them being the flesh of
vipers. This composition originally came from the Orient, but was
made later at Venice, Augsburg, and Vienna. To get some order into
the treasury of drugs and to enable apothecaries to compound their
remedies, the college of physicians in Florence published a
pharmacopoeia (Riceptario) in 1498. The oldest work of this kind
in Germany was written by Valerius Cordus, a Nuremberg physician
(Dispensatorium, 1546); then followed the Dispensatorium of Adolph
Occo in 1564, written at the request of the city of Augsburg, the
Dispensatorium of Cologne in 1565, and finally in 1572 a similar
work in Vienna, which, however, was not printed. Not until 1618
did Vienna receive a dispensatorium prepared from that of
Augsburg, which had become a model for all Germany.

The Oriental trade in drugs was greatly facilitated by the
discovery of the sea route to the East Indies. Uninfluenced by
exotic remedies of scholastic medicine, popular medicine offered
poor people, in addition to repulsive and superstitious remedies,
a series of valuable remedies, derived from native plants and
minerals. A long-known and popular remedy for syphilis was
mercury, introduced into scientific therapeutics by Paracelsus. To
his adherents we are indebted for the use of preparations of
antimony and arsenic, a popular remedy for skin diseases since
ancient times. The first-mentioned preparations gave rise to a
violent struggle on the part of the Paris faculty, which opposed
every form of progress. Guaiac wood, regarded as a specific remedy
for syphilis, was brought from America in the sixteenth century.
The most important drugs introduced in the seventeenth century
were ipecacuanha and Peruvian bark. The latter, coming from Peru,
became known in Europe between 1630 and 1640. No remedy has had
such a beneficial effect, but none has met with such opposition on
the part of many physicians as this, because its effect (reduction
of fever without subsequent intestinal evacuation) was a direct
contradiction of Galenic doctrine. Peruvian bark was introduced
generally into therapeutics only after a long struggle,
principally because important men like Sydenham advocated it. The
latter as well as the Leyden school under Boerhave discontinued to
a large extent the old Arab drugs, preferring in general simple
remedies with a corresponding dietetic treatment. Besides the
improvement in lead preparations by Thomas Goulard (1750; aqua
Goulardi), we may mention the pharmacological investigations of
cornium, aconite, stramonium, etc., by Anton Storck (1731-1803),
in Vienna. Hahnemann's services in investigating native medicinal
plants have been previously mentioned.

The impulse to study mineral springs was in modern times given by
Paracelsus. The majority of the modern European watering places of
worldwide fame were already known to the Romans, but their
curative properties were too little valued during the Middle Ages.
Petrus de Tussignana wrote, about 1336, concerning the famous
thermae of Bormio; Giacomo de Dondi in 1340 about Abano; the
Vienna physician Wolfgang Windberger (Anemorinus) in 1511, about
the sulphur springs at Baden near Vienna; Paracelsus about
Pfafers, St. Moritz in the Engadine, Teplitz. Karlsbad in Bohemia
was much frequented towards the close of the sixteenth century, as
were Vichy and Plombieres. Helmont, who was the first to prove the
existence of carbonic acid and of fixed alkalies, wrote about Spa.
Highly meritorious also was the work in this field of Johann
Phillip Seip (Pyrmont) and of Friedrich Hoffmann, who wrote about
Spa, Selters, Schwalbach and Karlsbad, and taught the preparation
of Seidlitz salt (Bittersalz), artificial Rarlsbad, and of
artificial mineral waters.

Cold-water cures were introduced in ancient Rome for the first
time by Asclepiades, but they were soon forgotten. In sporadic
cases cold water was employed therapeutically in later times, e.g.
by Rhazes for smallpox, by Edward Baynard in 1555 against the
plague by John Floyer (1649-1734) for mania, and by several
others. Cold water was not used systematically until the eighteeth
century. The brothers Johann Sigismund and Johann Gottfried, and
their father Sigismund Hahn (1662-1742), who in 1737 made
extensive experiments during an epidemic of petechial fever in
Breslau, may be regarded as the founders of the cold water cure.
The work of John Sigismund (Unterricht von der kraft und Wirkung
des kalten Wassers) is the best known, and laid the foundation of
modern hydrotherapeutics. Towards the end of the eighteeth century
Johann Dietrich Brandis obtained good results in the treatment of
febrile diseases by means of tepid lotions. The subsequent
development of hydrotherapeutics was largely influenced by the
results obtained by William Wright (1736-1819), and James Currie
(1750-1805) in the epidemics of petechial fever in the years 1787-
92.

VACCINATION -- EDWARD JENNER

Even in the oldest times people seem to have possessed an
efficient preservative against one of the most destructive
epidemics, smallpox (variola). From remote antiquity the Brahmins
of Hindustan are said to have transferred the smallpox poison
(secretion of the pustules) to healthy persons by incising the
skin with the object of protecting them against further infection
by causing a local illness. In China people stopped up their noses
with the incrustations of smallpox. A peculiar transfer with a
needle (inoculation) was in use among the Circassians and
Georgians. This so-called Greek method became generally known in
Constantinople towards the end of the seventeenth century, and was
introduced into England by Lady Wortley Montague wife of the
English ambassador, who had had her own son successfully
vaccinated in 1717. Despite the loud approval of the court and
aristocracy, inoculation met with violent resistance from the
physicians and clergy. Carelessness, quackery, and its ill-repute
caused the method to be forgotten, until in 1746 Bishop Isaac
Maddox of Worcester, by popular teaching and the establishment of
institutions for inoculation, once more proclaimed its value.
Among physicians who favoured inoculation were Richard Mead (1673-
1754). Robert and Daniel Sutton (1760, 1767), Thomas Disdale
(1767). Theodore Tronchin (1709-1781), and Haller. In Austria it
was introduced by van Swieten, at whose suggestion Maria Theresa,
in 1768, called to Vienna the famous naturalist Jan Ingen-Housz
(1730-99), in spite of the opposition of the clinical professor de
Haen. In the meantime another opponent of inoculation appeared. In
countries devoted to cattle-raising it was observed that those who
came in contact with cows suffering from smallpox frequently fell
sick and had pustules on their fingers, but such persons were
immune against the human smallpox. This incited the physician
Edward Jenner (1749-1823) to further experimentation, which he
continued for twenty years. On 14 May, 1796, he performed his
first inoculation with the lymph of cowpox (vaccination), an
experiment of worldwide importance. Jenner's discovery was
everywhere received with enthusiastic approval. The first
vaccinations on the continent were performed at Vienna by Jean de
Caro in in 1799, and by his contemporaries Alois Careno (d. 1811)
and Paschalis Joseph von Ferro (d. 1809); in Germany, by Germany,
by Georg Friedrich Ballhorn (1772-1805) and Christian Friedrich
Stromeyer (1761-1824); in France, by Rochefoucauld-Liancourt.
Protective inoculation with vaccine has been introduced into
almost every civilized state in the course of the nineteenth
century, partly from free choice and partly by laws enforcing
compulsory vaccination.

MEDICINE IN THE NINETEENTH CENTURY

The powerful political position of France in the first thirty
years of the nineteenth century finds medicine in an especially
high state of development in that country. After this period
followed the golden period of the Vienna school and in a wider
sense, of German medicine. The development of modern medicine is
the work of all civilized nations; yet all will regard Rudolf
Virchow unqualifiedly as the chief worker. Not to encroach upon
the domain of the special articles, let us summarize in a few
brief words the most important achievements of recent times: in
anatomy, theory of tissues -- Bichat; in pathological anatomy and
pathology cellular, pathology -- Virchow; in physiology --
Johannes M�ller, in practical medicine, auscultation - La�nnec,
Skoda; in surgery, treatment of wounds -- Joseph Lister; narcosis
-- Jackson, Simpson; obstetrics, cause of puerperal fever
Semmelweiss; in ophthalmology -- Albrecht von Grafe and (speculum
oculi) Helmholtz; in bacteriology and serotheraphy -- Pasteur,
Koch, and Behring. The subject of skin diseases was most
ingeniously elaborated by Ferdinand Hebra.

General Anatomy

A splendid basis for the further development of modern medicine
was laid by Marie Fran�ois Xavier Bichat (1771-1802), through his
investigation of the vital qualities of tissues. What Haller had
tried to do for the muscles, Bichat attempted to accomplish for
all the tissues of the body. Bichat was the first to promulgate
the idea that each tissue might by itself become diseased, and
that the symptoms of diseased organs depend upon tissue changes.
Gilbert Breschet (1784-1845) worked on the lympathic vessels and
the history of developments and Isidore Geoffrey Saint-Hilaire
(1772-1884) on comparative anatomy. Of Italian and English
anatomists are to be mentioned: Paolo Mascagni (1752-1815;
lymphatic vessels, comparative anatomy), Antonio Scarpa (1747-
1832; structure of the bones, organs of sense), the brothers John
and Charles Ball, the latter (1774-1842) known also as a
physiologist (brain, nerves); and Robert Knox (1793-1862;
comparative anatomy). Germany performed the greatest services in
perfecting anatomy and allied branches. The first to be named in
this connection is Theodor Schwann (1810-82), the discoverer of
the cell as the fundamental element of the body of plants and
animals. Johann Ev. Purkynje (1787-1869) worked along the same
lines, and Rudolph Albert Kolliker (b. 1817; pensioned 1901)
followed close in their wake. Work in comparative anatomy was done
by Johann Friedrieh Blumenbach (1752-1840), Iganz Blumenbach
(1752-1850), Ignaz D�llinger (1770-1841), Karl Asmund Rudolphi
(1771-1832), and Johann Friedrich Meckel (1781-1833). Friedrich
Gustav Jakob Henle (1809-85), and Wilhelm Menke (1834-96) were
prominent teachers of general anatomy and histology, Friedrich
Tiedemann (1781-1861) was an eminent brain anatomist, while
Nikolaus R�dinger (1832-96; injection of carbolic for the
preservation of corpses in the dissecting room), Friedrich Sigmud
Merkel (b. 1845; topographical anatomy) and Wilhelm His (b. 1831;
history of development), must also be mentioned.

Following the reform of studies under van Swieten in 1749, anatomy
was cultivated in Vienna more than ever before. The more important
men were Lorenz Gasser (professor 1757-65; trigeminus), Joseph
Barth (technique of injection), George Prochaska (1749-1820;
muscle and nerves), Franz Joseph Gall (1758-1828), the well-known
phrenologist and founder of the modern the theory of cerebral
localization, and Joseph Berres (1796-1844); microscopic anatomy).
The founder of the modern anatomical school of Vienna was the
highly gifted Joseph Hyrtl (1811-94); technique of injection and
corrosion, organ of hearing, comparative and topographical
anatomy), known as a pre-eminent teacher, investigator, and a man
of noble character. Karl Langer (1819-87; mechanism of the
joints), Karl Toldt (b. 1840 histology, anthropometry) and Karl
Wedl (1815-91; normal and pathological histology) are others of
this School. The professors at present teaching this subject in
the Austrian universities still belong chiefly to the school of
Hyrtl-Langer. In North America anatomy was cultivated especially
in Philadelphia where besides the school founded in 1764, there
existed from 1820 to 1875 a private institution established by
John Balentine O'Brien Lawrence (d. 1823), "The Philadelphia
School of Anatomy". In 1775 Japan became acquainted for the first
time with the anatomical knowledge of Europe through a translation
of a work by the German Johann Adam Kulmus which had appeared in
1725. A diligent study of anatomy and of medicine in general began
when the University of Tokio was established in 1871.

Pathological Anatomy

Pathological anatomy was placed upon a new basis by Bichat's
theory of the tissues, and it was later greatly advanced by
physiology, physiological chemistry, and by improved means of
investigation (compound achromatic objective lens of the
microscope). The increased attention, which clinical physicians
bestowed on this subject, exercised no small influence on its
progress. Among these must be especially mentioned La�nnec, who
defined tuberculosis and studied the pathological anatomy of lung
diseases, especially of phthisis. Numerous though the able
investigators were who performed meritorious services in
perfecting this branch, the development of modern pathological
anatomy will forever be intimately connected with the names of the
pioneers, Rokitansky and Virchow. The first pathological
prosectorship at Vienna was held by Alois Rudolph Vetter from 1796
to 1803, well known as the author of the first German work on
pathological anatomy. In 1832, after the death of Joseph Wagner,
Karl Rokitansky (1804-78; later Freiherr von) became prosector and
professor. He was educated in the views of Johann Friedrich Meckel
(1781-1833), Johann Georg Christian Freidrich Martin Lolstein
(1777-1835), but particularly of Gabriel Andral of Paris (1797-
1876), a leading representative of humoral pathology. Rokitansky's
training was thus based upon the French school, but he
subsequently brought about a still closer connection between
anatomical and physical diagnostics. His endeavour to become
acquainted with the entire course of development of pathological
changes was greatly assisted by the valuable material for
dissecting which the metropolis afforded. His excellence is seen
in his descriptions of pathological changes; he replaced the
previous symptomatic pictures of disease by creating an anatomical
pathology and anatomical types of disease. He was not so
successful in establishing his doctrine of crasis based upon
humoral pathology and just here Virchow's fruitful activity
begins.

Rudolf Virchow (1821-1902), professor in Berlin and a pupil of
Johannes M�ller and Johann Lucas Sch�nlein, early became
acquainted with the cellular doctrine of Schwann. Virchow is the
creator of cellular pathology, which today is universally
recognized, a pathology based strictly upon natural science which
definitively extinguished Hippocratic speculative humoral
pathology. According to Virchow, there is life in the smallest
units of the body in the cells which increase by fission (omnis
cellula e cellula). He applied his doctrine to the various
tissues, and showed their behavior under normal and abnormal
conditions of life. Diseases thus represent a reaction of the sum
of the cells which form the body against harmful influences, the
causes of diseases. Virchow's chief work" Die Cellularpathologie"
appeared in 1858. Greater attention was now paid not alone to
pathological anatomy, but to its sister sciences, pathological
chemistry, experimental pathology, and bacteriology. The chief
representatives of experimental pathology were: in France, Claude
Bernard (1813-78), Charles Edouard Brown-Sequard (1818-95), and
Etienne Jules Marey (b. 1830); in Germany, Ludwig Traube (1818-
76), Rudolph Virchow, and Julius Cohnheim (1839-84); in Vienna,
Salomon Striker (d.1898) and Philip Knoll (1841-1900). Experiments
on animals are extensively made today in this field of
investigation.

Bacteriology, Theory of lmmunity, Serotherapy, Disinfection

The first to suspect that living beings invade the organism and
exist in the blood and pus was the learned Jesuit Athanasius
Kircher (1671), although there is no doubt that the "little worms"
observed by him were really blood-corpuscles. With the help of his
improved microscope Leeuwenhoek discovered a number of bacteria.
The idea that infectious diseases were caused by a living
contagion invading the body from without was first expressed in
1762 by the Vienna physician Markus Antonius Plenciz (d. 1786).
Otto Friedrich M�ller, in 1786, was the first to doubt that the
microscopical living beings, then comprised under the name of
infusoria, really belonged to the animal kingdom. In 1838,
Christian Gottfried Ehrenberg gave a description of the finer
structure of the "infusoria" but it was Ferdinad Cohn, who in 1854
first ascertained with certainty that bacteria belonged to the
vegetable kingdom. From the studies that were now made concerning
the vital qualities of these infinitesimal living beings of the
vegetable kingdom, Louis Pasteur (1822-95) definitely settled the
controversy about spontaneous generation (generatio
&oeligquivoca), and proved the materialistic view to be without
foundation. What Plenciz had only suspected was now clearly
formulated by Henle, who defined the conditions under which
bacteria are to be regarded as direct causes of disease. The
untiring activity of Robert Koch (d. 1910) from about 1878
succeeded in bringing bacteriology to such a state of development
that it could be made of service to practical medicine. Apart from
ascertaining the bacterial origin of cholera and tuberculosis,
Koch's greatest achievements are the improvement of the microscope
(Abbe, Zeis), the method of colouration and pure cultures.

Jenner's success with the lymph of cowpox, a weakened poison as a
protection against a full poison, as well as the old experience
that those who had once recovered from an infectious disease
usually became immune from new infection, led savants to look for
the cause of the phenomena. In 1880 Pasteur, on the basis of his
experiments concerning chicken cholera, looked for the cause in
the exhaustion of the nutritive material necessary for the
bacteria in the body (theory of exhaustion), while Chauveau
believed in a residue of metabolic products which prevented a new
settlement of bacteria or new infection (retention theory). The
investigation of Metschnikoff, and in 1889 of Buchner, advanced
the idea that blood-serurn possesses a certain hostility to
bacteria. In 1890 Von Behring proved that the blood-serum of
animals which has been made immune against diphtheria, if injected
into another animal, would make the latter also immune against
diphtheria. That element in the serum hostile to bacteria he
called antitoxin. The introduction of antitoxin into the
therapeutics of diphtheria in 1892 was so far the greatest
practical success of bacteriology. Efforts were naturally made to
secure by similar methods protection against other infectious
diseases, efforts only partly crowned with success (tetanus,
plague, cholera, snake poison). Following Jenner's method of
producing immunity by means of living, weakened causes of
infection, Pasteur (1885) found a protection against lyssa, while
Haffkine made experiments in 1895 to combat cholera with killed
germs, and in 1897 similar experiments with the plague. From 1891
dates Koch's experimentation with extracts of bacteria against
tuberculosis. By means of preparations of pure bacteria-cultures,
made according to Koch's method, it became possible to devise
exact methods for destroying bacteria. In the field of the modern
theory of disinfection, Koch also worked as a pioneer, not only in
precisely defining the difference between prevention of
development and the killing of bacteria, but also by subjecting
physical and chemical disinfectants to new tests. The modern steam
sterilizers are based upon the discovery of Koch that steam under
the ordinary pressure of the atmosphere is sufficient to kill even
resistant lasting forms. He pointed out the ineffectiveness of
alcohol, glycerine, and other substances upon the spores of
anthrax, and the diminished effect of carbolic acid in an oily or
alcoholic solution. Von Behring's experiments showed a diminution
of power of some disinfectants in the presence of albumen,
concerning which Kr�nig and Paul made a special study.

Physiology

Physiology is indebted for its perfection to the progress of
minute anatomy (doctrine of tissues) to the improved means of
investigation (microscope, chemical and physical apparatus), but
especially to the fact that experiments on animals (vivisection)
were once more extensively made. The principal physiologists of
the past century were in France and in Germany. Fran�ois Magendie
(1783-1855), opposing Bichat (vitalism), maintained that there is
no uniform vital energy, and that the vital qualities of the
different organs are to be explained upon a physical and chemical
basis and by means of experiments. His investigations in
haemodynamics and the functions of the nervous system (roots of
the spinal column), in which he supplemented the work of Charles
Bell (Law of Bell-Magendie) are very important. Marie Jean Pierre
Flourens (1794-1867) is known by his studies in disturbances of
co-ordination, nutrition of the bones, and localization of the
centre of respiration in the medulla oblongata, and Fran�ois
Achille Longet (1811-71) by his work on the functions of the
anterior and posterior columns of the spinal cord, the innervation
of the larynx, the nerves of the brain, and the law of the
contraction of the muscles. The most famous French physiologist, a
pioneer in the field of physiological chemistry, is Claude Bernard
(glycogenic function of the liver, the consumption of glycogen
through work of the muscles, the discovery of vascular nerves, the
chemistry of the bile and the urine, theory of diabetes mellitus,
assimiliation of sugar, atrophy of the pancreas, the power of the
pancreatic juice to digest albumen, and the theory of animal
heat). The physiology of the circulation was elaborated by Etienne
Jules Marey (b. 1830; blood pressure, mechanism of the heart and
the invention of the sphygmograph). The relation of muscles and
nerves to electricity was studied by Guillaume Benjamin Duchenne
(1806-75), awhile Charles Edouard Brown-Sequard (1818-94), the
founder of modern organo-therapeutics, investigated the reflex
irritability of the spinal cord, the blood, respiration, and
animal heat. In Great Britain were Marshall Hall (1780-1857;
theory of reflex action), William Bowman (1816-92, structure of
the striated muscles, and theory of the secretion of urine),
Alfred Henry Garrod (1846-79; sphygmography physics of the
nerves), Augustus Volney Waller (1816-70; diapedesis of the red
corpuscles of the blood, studies on nerve-fibres and ganglia,
Waller's degeneration) and William Prout (1785-1869; discovery of
free hydrochloric acid in the gastric juice).

The Bohemian Johann Evangelist Purkyje (1787-1869) founded at
Breslau the first German physiological institute. His most
important studies were concerned with the physiology of the organs
of sense, especially of sight, the physiology of the muscles and
nerves, the ciliary movement of the epithelium of the mucous
membrane, the structure of the nerve-fibre (axis-cylinder) of the
ganglia, the glands secreting gastric juice, the sympathetic
nervous system, and the history of development (discovery of the
germinal spot). Fundamental work in physiological physics was done
by the brothers Weber, Ernest Heinrich (1795-1878), and Eduard
Friedrich Wilhelm (1806-71), both physicians, and the physicist
Wilhelm Eduard (1804-91); mechanism of the human organs of walking
(Wilhelm and Eduard), experiments in irritability by means of
induction currents, and the irritation of the pneumogastric and
sympathetic nerves and its influence upon the heart (Ernst and
Eduard). Physiological chemistry is represented by Friedrich
Tiedemann and Leopold Gemlin (1788-1853; digestion, absorption and
assimilation the importance of the lymphatic system for
absorption), Friedrich Wohler (1800-82; artificial preparation of
urea), and Karl Bogislav Reichert (1811-83; crystallization of
blood pigment). We must also mention the nerve physiologist Rudolf
Wagner (1805-64), discoverer of the tactile corpuscles. The
greatest credit for developing modern physiology is due to the
school of the versalile Johannes M�ller (1801-58). M�ller's
importance comparable to that of Albrecht von Haller, is due on
the one hand to the results of his own investigations (studies on
the physiology of the organs of sense, the sympathetic nervous
system, the theory of reflex action, the production of voice in
the larynx, and the description of the cartilage-nucleus), and on
the other hand to his activity in all branches of physiology and
in his grasp of the entire field of physiological knowledge. The
most important investigators of the century in the domain of
histology, physiological chemistry, and physics, were pupils of
M�ller. Besides the above-mentioned investigators, Schwann,
K�lliker, and Virchow, attention may be called to Robert Remak
(1815-65; description of the marrowless nerve fibres, of the
course of the fibres in the brain and the spinal cord);
sympathetic nerve system, nerves of the heart, metabolism).

The doctrine of metabolism was advanced by the famous chemist,
Justus Freiherr von Liebig (1803-73; excretion of nitrogen in the
form of urea, importance of uric acid, albumen as a source of
muscular strength), Theodor Ludwig Wilhelm Bischoff (1807-32;
urea) and Karl von Voit (b. 1831; metabolism of nitrogen and
organic albumen). The latter, together with Max von Pettenkofer
(1818-1901), made numerous experiments in the change of gases in
man during rest and work. Georg Meissner (b. 1829; Schwann
(discoverer of pepsin), Karl Gotthelf Lehmann (1812-65; pepton).
The chemistry of blood was investigated by Ernest Felix Josef
Hoppe-Seyler (1825-65; blood pigment, blood gases, chemistry of
cell and tissue), Jules Robert Meyer (1814-78; mechanism of heat),
Hermann Ludwig Ferdinand von Helmholtz (1821-94; physiological
optics), and Emil du Bois-Reymond (1818-96; animal electrical
phenomena, physics of the muscles and nerves). Just as versatile
as Johannes M�ller were Karl Friedrich Wilhelm Ludwig (1816-95;
physiology of the circulation and excretions, theory of the
functions of the kidneys, endosmosis, discovery of the nerves of
secretion) and Ernest Wihelm Ritter von Brucke (1819-92; studies
of the ciliary muscle as a muscle of accommodation, theory of
colours, physiology of the voice, structure of the muscle-fibres,
biliary capillaries, digestion, absorption). Karl von Vierordt
(1818-83) is associated with the chemistry of respiration and the
counting of the blood corpuscles; Adolf Fick (1829-1901) with
physiology of the muscles and nerves; Moritz Schiff (1823-16) with
the nervous system, discovery of the harmful results of the
extirpation of the thyroid gland, function of the base of the
brain and the cerebellum; Rudolf Heidenhain (1834-97) with the
physiology of the glands; Alexander Rollett (b.1834) with the
glands of the stomach, blood; Eduard Friedrich Wilhelm Pfluger (b.
1829) with the gases of the blood, processes of oxidation in the
body; Ewald Hering (b. 1834) with the theory of self-regulation of
the act breathing sensitiveness of retina to colours, and Theodor
Wilhlem Engelman (b. 1834), with electro-physiology, motion of the
ciliary epithelium, physiology of the heart and of the organs of
sense. The localization of the brain was investigated especially
by Gustav Fritsch (b. 1838), Eduard Hitzig (b. 1838), Leopold
Goltz (1835-1902), and Sigmund Exner (b.1846). Of eminent
physiologists outside of Germany we may mention the Dutchmen Franz
Cornelis Donders (1818-89); physiological optics, determination of
refraction) and Jakob Moleschott (1822-93; metabolism and doctrine
of foods).

Owing to the progress of the theoretical auxiliary sciences,
practical medicine reached a high state of development, especially
in diagnosis, but also to a certain extent in therapeutics. A
general revolution was effected by the establishment of physical
diagnosis. Auenbrugger's epoch making discovery, percussion
(1761), passed over in silence by van Swieten and de Haen, the
leading spirits of the Vienna school, and mentioned only in timid
fashion by Maximilian Stoll, might have been altogether forgotten,
if Jean Nicolas Corvisart de Marest (1755-1821), after an
objective examination, had not translated Auenbrugger's "Inventum
novum" into French, and published it in 1808 with a commentary.
Rene Theophile Hyacinthe La�nnec (1781-1826) enriched the physical
method of examination by the invention of auscultation (noting the
different tones and noises in the chest by placing the ear against
it). His pupil Pierre Adolphe Piorry (1794-1879) perfected
percussion (definition of the borders and outlines of the organs,
invention of the plessimeter, improvement of the stethoscope).
La�nnec's invention attracted attention but slowly. His chief
opponent was Francois Joseph Victor Broussais (1772-1838), but in
England John Forbes (1787-1861) and William Stokes (1804-78), and
in Germany, Christian Friedrich Nasse (1778-1851), Peter Krukenbeg
(1787-1865), Johann Lukas Sch�nlein (1793-1864), and others
assumed a friendly attitude. Auscultation and percussion came into
general use in the Germanic countries much later than in England
and France but they were then brought to great perfection by the
Vienna physician Joseph Skoda (1805-81), who in 1839 treated
physical diagnosis scientifically and fundamentally (auscultation
and percussion). The new methods made possible the exact clinical
diagnosis of diseases of the heart and the lungs to a degree never
previously imagined. Besides La�nnec and Skoda must be mentioned
among the great number of investigators: Jean Baptiste Bouillaud
(1796-1881), and James Johnson (1777-1845), who investigated
affections of the heart and rheumatism of the joints. August
Fancois Chomei (1788-1855; pericarditis and rhumatism), James Hope
(1801-41; valvular insufficiency), Hermann Lebert (1813-78),
Johann Oppolzer (1808-91), Felix Niemeyer (1820-71), Ludwig Traube
(1818-76), Heinrich von Bamberger (1822-88), and Adalbert Duchek
(1824-82).

Among therapeutical aids the introduction of digitalis purpurea by
Traube deserves special mention. M.J. Oertel (d. 1897), tried to
cure certain affections (fatty degeneration of the heart obesity)
by means of dietetic mechanical treatment (Terrainkur); and the
brothers August and Theodor Schott established the so-called
Nauheim method (carbonic acid baths and gymnastics). Great credit
in connection with the dignosis of lung disease is due to M. Anton
Wintrich (1812-82; pleuritis), Karl August Wunderlich (1815-78;
range of temperature in pneumonia) Leon Jean Baptiste Cruveilhier
(1791-1875; pneumonia in children), Theodor J�rgensen (infectious
nature of pneumonia), Robert Bree (1807; bronchial asthma),
Biermer (1870), Leyden (1875; crystals of asthma) and Curschmann
(1883; spirals). The subject of pulmo nary tuberculosis was
profoundly treated by Gaspard Laurent Bayle (1774-1816; 1810
(discovery of miliary tuberculosis, tuberculosis a general
disease); Virchow defined the anatomic character of tuberculosis;
Villemin in 1865-8 proved its contagiousness, and his experiments
were re-examined and confirmed among others by Lebert (1866),
Klebs (1868), Baumgarten (1880), Teppeiner (1877), and
Weichselbaum (1882). With the discovery of the tubercle bacillus
by R. Koch in 1882, the path to the suppression of tuberculosis
was indicated. Cornet in 1888 showed the danger of the sputum,
which resulted in prohibition of spitting and the placing of
cuspidors with disinfecting solutions. In 1890 Koch appeared with
his remedy tuberculin, which he improved in 1897 and 1901. In 1902
Behring began his experiments on cows to secure immunity. Of late
the treatment on tuberculosis is chiefly dietetic. Diagnosis and
therapeutics of the diseases of the larynx were greatly advanced
by the invention of the laryngoscope in 1860 (Ludwig Turck 1810-
68, Vienna; and Johann Nepomuk Czermak, 1828-73). The taking of
temperature, which was diligently cultivated by de Haen and later
by James Currie (1733-1819), was systematically done for the first
time by Friedrich Wilhelm Felix von Barensprug (1822-64), Traube,
and Wunderlich. In the treatment of metabolic diseases we must
mention the noteworthy zeal of Friedrich Theodor von Frerichs
(1819-85).

Diagnosis and therapeutics of diseases of the stomach were
advanced by the introduction of the pump invented by the English
surgeon Bush in 1822, an instrument recommended and used since
1869 by Adolf Kussmaul (d. 1902), in enlargement of the stomach,
and for the examination of the stomach with a speculum.
Faradization was employed by Karl Friedrich Canstatt in 1846,
Duchenne, and later by Kussmaul (1877), the stomach catheter was
used for diagnostic purposes by Wilhelm Leube in 1871. The subject
of typhlitis and perityphlitis was investigated among others by
Puchelt (1829), Burne, Smith, Bamberger, and Oppolzer, diseases of
the kidneys by Richard Bright (1827), Pierre Fran�ois Oliver Rayer
(1793-1867), Johnson (1852), Julius Vogel (1814-80) and Hermann
Senator (1896); diseases of the bladder by Josef Grunfeld (1872),
Trouve (1878) Max Nitze (1879; endoscopy), Rovsing (1890, 1898),
Krogius (1890, 1894), Guyon, Leube, and Robert Ultzmann
(inflammation of the bladder, formation of stone). The development
of modern diagnosis and the therapeutics of nervous diseases are
connected with the names of eminent physiologists and clinical
physicians. Of the latter we may mention Moriz Heinrich Romberg
(1795-1873), Wilhelm Griessinger (1817-68), Duchenne, and the
universal Jean Martin Charcot (d. 1893). Faradization (1831), as a
therapeutical means specially against lameness, was introduced by
Duchenne in 1847. Among special studies of individual diseases
were: on tabes dorsalis by Romberg, Duchenne, Armand Trousseau
(1801-66), Nikolaus Friedreich (b. 1882), Leyden (d. 1910), Karl
Friedrich Westphal (b. 1833), Charcot, and Alfred Fournier, who in
1876 pointed out the connection between tabes and lues; on
myelitis by Brown-Sequard, Oppolzer, Friedreich, Westphal,
Charcot. A peculiar complex of symptoms was described for the
first time by Robert James Graves (d. 1853), later (1840) by Karl
von Basedow (Basedow's Disease). The picture of neurasthenia was
given for the first time in detail in 1869 by Georg Beard; Weir-
Mitchell together with Playfair proposed for it the so-called
fattening cure.

Psychiatry

As to progress in psychiatry, there is now a more humane
conception of the care for the insane compared with that obtaining
in former times. This movement originated principally in England
(Thomas Arnold, d. 1816; William Perfect, b. 1740; Alexander
Crichton, 1763-1856), and France (Philippe Pinel, 1755-1826; Jean
Etienne Dominique Esquirol, 1772-1840), and found in Italy in
Vincenzo Chiarugi (d.1822) and in Germany in Johann Christian Reil
(1759-1813), zealous supporters. With this movement came a general
and profounder study of the subject stimulated by the results of
pathological anatomy, more judicious therapeutics conscious of its
aim, proper physical occupation of the insane, and the
discontinuance of the isolation system. Special attention is paid
to the etiology and therapeutics of diseases occurring most
frequently, cretinism, hysteria, progressive paralysis, as well as
to psychosis of intoxication, alcoholism, morphinism, etc. Hydro-
therapeutics, which is especially effective in the case of
neurosis and psychosis, was much cultivated by Anton Frohlich
(1760-1846) and the two laymen, Eucharius Ferdinand Oertel and the
Silesian, Vincenz Priessnitz (1790-1851). It was treated
scientifically by Wilhelm Winternitz, who wisely reduced within
due bounds a great deal of the harshness in the laymen's
hydrotherapy.

Modern dermatology begins with the endeavours of Johann Jakob
Plenk (1738-1807) at Vienna to establish a classification of skin
diseases on a basis of external clinical appearance. Work of a
similar nature was done by Anne Charles Lorry (1777), Robert
Willan (1798), Thomas Bateman (1815), all of whom introduced
simplifications into Plenk's system, Laurent Beilt (1781-1840),
and Camille Melchior Gibert (1797-1866). Jean Louis Alibert (1766-
1837) made a classification according to pathological principles,
while Pierre Fran�ois Oliver Rayer used anatomy and physiology as
a basis. The pathological-anatomical method, introduced by Julius
Rosenbaum (1807-74) was established by Ferdinand Hebra in Vienna
(1816-80). Its chief merits consist in creating a classification
of twelve groups, valid in its substantial form even today, in a
definition of the general course of the disease, and in
simplifying therapeutics. His chief special studies are concerned
with itch, lepra, and eczema. With him we must mention Friedrich
Wilhelm Felix von Barensprung (1822-64, eczema marginatum,
erythrasma caused by fungus, and herpes zoster) and his successor,
Georg Lewin (1807-78) worked along the same lines as Hebra
(parasitical and constitutional skin diseases, erythema
induratum). Hebra's most important pupils are Heinrich Auspitz
(1835-86; venous stagnation, soap therapeutics), Moriz Kaposi
(1837-1902; pigment sarcoma, sarcoid swellings), and Ernst Ludwig
Schwimmer (1837-98; neuropathic dermatosis). For a number of
valuable special investigations we are indebted to Tilbury Fox
(1836-79; impetigo contagiosa, dermatitis herpetiformis), and on
lepra to D.C. Daniellssen (1815-94) and Karl Wilhelm Boeck (1808-
75). In recent times we notice an endeavour to define more closely
the course of the disease, a movement started by Paul Gerson Unna
in Hamburg (b.1850; histodermatology, histotherapy, bacteriology
of acne, eczema, impetigo, and favus.

Ophthalmology

Ophthalmology, as an independent branch, was established in
Germany first at Vienna and G�ttingen. In Vienna the anatomist
Josef Barth (1755-1818) gave ophthalmological lectures as early as
1774, but two of his pupils, Johann Adam Schmidt (1759-1809;
studies on iritis xerophthalmus and the lachrymal organs) and
Georg Josef Beer (1763-1821; method of extraction of cataract,
staphyloma, pannus), were the first to receive special
professorships, the former in 1795 at the military academy and the
latter at the university. Of Beer's school may be mentioned among
others Konrad Johann Martin Langenbeck (1776-1851; ceratonyxis,
formation of the pupil, amaurosis, entropium), Karl Friedrich von
Grafe (1787-1840; teleangiectasis in the eye), Friedrich Jager
(1784-1871; upper cutting of the cornea in the operation for
cataract), Johann Nepomuk Fischer (1787-1847; pyaemic inflammation
of the eye), and finally the most eminent English ophthalmologist
of his time, William Mackenzie (1791-1868; choroiditis,
accommodation, asthenopy, scotoma). A contemporary of Beer was
Carl Himly of G�ttingen (1772-1837; introduction of mydriatics).
Among his pupils were Friedrich August von Ammon (1799-1861;
iritis) and Christian Georg Theodor Ruete (1810-67), who deserves
credit chiefly for the introduction into practice of the speculum
oculi. In ltaly the progress of ophthalmology begins with Antonio
Scarpa (1747-1832; staphyloma of the cornea). We must also mention
Paolo Assalini (1759-1840; extraction of cataract, artificial
pupil, Egyptian inflammation of the eye, 1811), Giovanni Battista
Quadri, the first professor in Naples (1815) and likewise the
professors of the clinics established at Padua and Pavia in 1819,
Anton von Rosas (1719-1855), a pupil of Beer, and Franz Flarer,
(trichiasis iritis, 1841). In England, besides Mackenzie, John
Cunningharn Saunders (1773-1810) of the German school, John Vetch
(Egyptian inflammation of the eye, 1807), George James Guthrie
(artificial pupil, extraction of cataract, 1818), and William
Lawrence (1785-1867), author of a textbook, deserve mention. In
North America are George Frick of the Viennese school, author of a
textbook (Baltimore, 1823), and Isaac Hays of Philadelphia. More
than anywhere else was German influence felt in France, and here
we must mention in the first place the pupils of Jager: Viktor
St�ber (1803-71), professor at Strasburg, and Julius Sichel of
Paris (1802-58; choroiditis, glaucoma, cataract, staphyloma).
Besides these we have Carron du Villards, a pupil of Scarpa and
author of a textbook (1838), and Desmarres.

Helmnholtz, Arlt, and Grafe are regarded as the founders of modern
ophthalmology. Hermann Ludwig Ferdinand von Helmholtz (1821-94)
opened an entirely new field for diagnosis by inventing the
speculum oculi in 1851. Just as important is his theory of
accommodation and sensation of colours. Ferdinand von Arlt of
Vienna (1812-87), an eminent operator (trichiasis symblepharon)
and teacher, founder of ophthalmopathology, recognized the true
cause of myopia (elongation of the eye-ball) and introduced a
chart of letters, later improved by Snellen. Albrecht von Grafe
(1828-70) of Berlin, a pupil of Arlt but in many respects
outshining his master, is known principally through his work on
the connection between brain and blindness, on glaucoma,
iridectomy, and linear extraction of the lens. Besides the above-
mentioned Donders we must call attention to Alexander Pagenstecher
(1827-79; operation for cataract), Eduard Jager von Jaxthal (1818-
84; letter chart), Karl Stellwag von Carion (1823-1904; defects of
accommodation, innervation of the iris), Julius Jacobson (1828-89;
diphtheritis conjunctivae), Otto Becker (1828-90; pathological
topography of the eye, lens), Josef Ritter von Hasner (1819-92;
forensic injury of the eye), Ludwig Mauthner (1840-94; optical
defects of the eye, glaucoma), Albrecht Nagel (1833-95; strychnia
in the case of amblyopia), Rudolf Berlin (1833-97; word-
blindness), Richard Forster (1825-1902; perimeter, glaucoma,
general diseases and maladies of the eye), William Bowman (1816-
92; diseases of the lachrymal sac), George Critchett (1817-82;
iridodesis), Cornelius Agnew, New York (1830-88; strabismus,
paracentesis of the cornea, canthoplastics), the Russian Alexander
Ivanoff (1836-80; inflammation of the retina and the optic nerves,
glass eye), and Victor Felix Szokalski (1811-91; textbook). The
introduction of local anesthesia by means of cocaine in 1884 by
Rudolf Koller of Vienna, greatly facilitated operation on the eye.

Obstetrics

One of the most eminent obstetricians was Lukas Johann Bo�r of
Vienna (1751-1835), who upon the request of the emperor studied in
Paris and London from 1785 to 1788. He represented the so-called
"waiting method", using instruments as rarely as possible, taught
rational dietetics during pregnancy and confinement, and was the
first to employ electricity for reviving asphyxiated children.
Work of a similar nature was done by his contemporary, Wilhelm
Josef Schmitt (1760-1824; forceps operation in the longitudinal
position, methods of examination mechanism of parturition). In
contradistinction to Boer, Friedrich Benjamin Osiander (1759-1822)
represented the most extreme operative tendencies while Adam Elias
von Siebold (1775-1828) took a middle course. Mechanism of
parturition and pelyeology was treated by Ferdinand Franz August
von Ritgen (1787-1867) and Franz Karl von Nagele (1778-1851);
physiology of pregnancy by Franz Kiwisch von Rotterau (1814-52)
and Johann Christian Gottfried von J�rg (1779-1856). The founder
of the modern theory of labour pains is Justus Heinrich Wigand
(1769-1817). A new period of development begins in 1847 with James
Young Simpson (1811-70) the inventor of the English forceps and
cranioclast; he was the first to employ narcosis (first with ether
and in the same year also with chloroform) for women in labour,
but at present this is done only in case of operations. Of far
greater importance is the simultaneous discovery of the cause of
puerperal fever (pyaemia) by Ignaz Philipp Semmelweiss of Vienna
(1818-65). He introduced the practice of disinfecting hands and
instruments with a solution of chloride of lime, and thereby
reduced the mortality of lying-in women from 9.92 to 1.27 percent.
This most important discovery that external infection causes
puerperal fever was used in general practice only at a late
period. Propositions similar to those of Semmelweiss had been made
as early as 1843 by Oliver Wendell Holmes of Boston, but they were
not known in Europe. Important advances in modern times are marked
by descriptions of the narrow pelvis by Gustav Adolph Michaelis
(1798-1848) and Karl Konrad Theodor Litzmann in 1851, and of the
oblique oval pelvis by Litzmann in 1853; artificial premature
birth in the case of such a pelvis by Spiegelberg in 1870; the
manual removal of the placenta in 1853, and prophylaxis against
blemorrhoea of the newly born by Crede in 1884; axial traction
forceps by Chassagny in 1861; combined turning by Braxton hicks in
1860-3; the mechanism of delivery by Hofmeier in 1888; pregnancy
of the oviduct by Veit in 1884; extra-uterine pregnancy by Werth
in 1887; asphyxia of the newborn by Schwartz in 1858 and by
Schultze in 1864. The classical Caesarean operation, as previously
performed, consisted in opening but leaving in the uterus,
whereupon death usually resulted from sepsis. Porro of Pavia in
1875 performed it, therefore, with the subsequent removal of the
uterus and ovaries, and thus obtained much more favourable
results. With the perfection of antiseptic, or rather aseptic,
treatment in modern times, the classical Caesarean operation is
being again performed. The total removal of the ovaries
(ovariotomy) on account of their degeneration was performed for
the first time in 1809 by Ephraim MacDowell at Danville, Kentucky,
the technique of the operation being perfected by Hutchinson in
1859, Spencer Wells and Marion Sims in 1873, Freund in 1878, and
Czerny in 1879. Total extirpation of the uterus is performed
especially in the case of cancer.

Surgery

Of all the branches of medicine, surgery made the greatest
progress, first in France and England, later also in Germany. Side
by side with the renowned surgeon-in-chief, of the Napoleonic
armies, Jean Dominique Larry (1766-1842), we have, as the most
versatile, Guillaume Dupuytren (1777-1835); next to him Philibert
Joseph Roux (1780-1854, resections), Jacques Lisfranc (1790-1847;
exarticulations), Alfred Armand Louise Marie Velpeau (1795-1868;
treatment of hernia by injection of iodine), Jacques Mathurin
Delpech (1777-1832; studies about phagedaenas, gangraena
nosocomialis tenotomy of the tendo Achillis), Jean Zulema Amussat
(1796-1856; lithotripsy), Auguste Vidal (1803-56, varicocele),
Joseph Fran�ois Malgaigne (1806-65; fractures and dislocations)
Auguste Nelaton (1807-73; lithotomy) Edouard Chassaignac (1805-79,
ecrasement lineaire, drainage), and Charles Gabriel Pravaz (1791-
1853; orthopaedia subcutaneous injection). Of English surgeons we
must mention the brothers Bell, John (collateral circulation after
ligation) and Charles (operative surgery); John Abernethy (1763-
1831; ligation); James Syme (1799-1870; exarticulation of the hip
joint); the famous surgeon, Astley Patson Cooper (1768-1841;
textbook), and William Lawrence (1785-1867). In America we may
note the chief surgeon of the War of Independence, John Collins
Warren (1753-1815), Philipp Syng Physick (1760-1837; new
formations), Willard Parker (1800-84; cystotomy), and Frank
Hastings Hamilton (1813-86; fractures and dislocations). Passing
to the German surgeons let us mention first of all Vincenz von
Kern of Vienna (1760-1829; open treatment of wounds) his
successor, Joseph von Wattman (1789-1866; lithotomy), and Franz
Schuh (1805-65; new formations, hernia); in Germany Louis
Strohmayer (1804-76; myotomy, tenotomy, resections), Johnnn
Friedrich Dieffenbach (1794-1847; plastic operations), and Albert
Theodor Middeldorpf (1824-68; galvanocautery).

A new epoch of progress begins in 1846 with the introduction of
narcosis. The discoverer of the narctic effect of ether is the
American physician and chemist, Charles Jackson (1805-80), who
together with William Morton, made experiments upon his own
person. The first narcosis was undertaken in 1846 by Warren, and
in the same year in London by Robert Liston. Simpson first
employed ether in an obstetric operation in 1847, but soon
afterwards introduced into practice chloroform. In modern times a
mixture of ether and chloroform is generally used. Besides general
narcosis we must also mention local anesthesis (evaporation of
ether, injection of cocaine, bromoethyl). Of still greater
importance than narcosis was the treatment of wounds with carbolic
acid by the Englishman Lister in 1867 (antiseptic treatment of
wounds). In the course of time carbolic acid was replaced by other
antiseptic method (careful protection of the field of operation
against infecting germs). A third achievement of modern times is
operating with an artificial absence of blood (operations on the
extremities), mentioned for the first time by Friedrich Esmarch in
1873. Narcosis and antiseptics now make possible a series of
daring operations, before impossible, with essentially better
chances of success. In the recent development of German surgery
Bernhard von Langenbeck (1810-87), known especially as a military
surgeon, holds a leading position. Of his school we have among
others Adolf von Bardeleben (1819-95), author of a textbook, Karl
Thiersch, (1822-95; transplantation), Johann Nepomuk von Nussbaum
(1829-90; transplantation of bones, extension of nerves), Theodor
von Billroth (1829-94; extirpation of the larynx and struma,
resection of the pylorus) and Richard von Volkmann (1830-89;
surgery of the joints). A very important means of locating foreign
bodies (e.g. projectiles), in the human body, and for the
examination of fractures is the R�ntgen rays discovered by William
Karl R�ntgen in 1895 (R�ntgen photography).

LEOPOLD SENFELDER
Transcribed by Joseph P. Thomas

Cordially dedicated to Mary Ann Thomas

From the Catholic Encyclopedia, copyright � 1913 by the
Encyclopedia Press, Inc. Electronic version copyright � 1996 by
New Advent, Inc.

Taken from the New Advent Web Page (www.knight.org/advent).

This article is part of the Catholic Encyclopedia Project, an
effort aimed at placing the  entire Catholic Encyclopedia 1913
edition on the World Wide Web. The coordinator is Kevin Knight,
editor of the New Advent Catholic Website. If you would like to
contribute to this  worthwhile project, you can contact him by e-
mail at (knight.org/advent). For  more information please download
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