ANNALS OF MEDICAL HISTORY

FRANCIS R'PACKARD'M'D'EDITOR [PHILADELPHIA] PUBLISHED QUARTERLY BY PAUL - B - HOEBER 67-69 EAST FIFTY-NINTH STREET * NEW YORK CITY p p f ! mm.. ■ '^ r * T ? ANNALS OF MEDICAL HISTORY

V o l u m e i S p r i n g 1917 N u m b e r i A ...... *y" THE SCIENTIFIC POSITION OF GIROLAMO FRACASTORO [1478 ?—1553]

WITH ESPECIAL REFERENCE TO THE SOURCE, CHARACTER AND INFLUENCE OF HIS THEORY OF INFECTION

By CHARLES AND DOROTHEA SINGER OXFORD, ENGLAND IROLAMO FRAC- has been called the “ academic” period of ASTORO was born the Renaissance and received the most in Verona in 14 7 8 1 complete education available in his day. In and he died in his his youth he attended the University of villa near that city Padua, where he had a number of brilliant in 1553. He came of associates, several of whom exercised con­ an honorable stock siderable influence upon him. Among them which had produced were Gaspare Contarini (1483-1542) who many distinguished physicians. Of one of later, as cardinal, sought, at the diet of these, Aventino Fracastoro, who was prac­ Ratisbon, to effect a reconciliation between tising medicine as early as 1325 we read Catholics and Protestants; Giambattista that he was medica clarissimus arte, astra Rhamnusio (1485-1557), the Italian Hak­ poll novit novitque latencia rerum, utile luyt, who inscribed to Fracastoro his great consilium civibus et dominis.2 Viaggi et Navigationif the fine scholar Andrea Navagero (1483-1529) to whom y I. THE CHARACTER AND WRITINGS OF Teobaldo Manucci dedicated the editio prin- FRACASTOR ceps of Pindar4 and who himself edited for the The subject of our study, Girolamo Aldine press the works of Quintilian, Virgil, Fracastoro, was himself brought up in what Lucretius, Ovid, Terence, Horace and the 1 The date usually given for Fracastor’s birth is in Italia,” Venice, 1915, p. 20. If Massalongo is right 1483. Reasons for referring the event to 1478 are Fracastor must have been rather older than most given by Professor Roberto Massalongo in his students when he attended the University. “ Girolamo Fracastoro e la rinascenza della medicina 2 Giuseppe Biadego, “ Medici veronesi e una

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1 2 Annals of Medical History

Speeches of Cicero; and three distinguished Perhaps the deepest impression on Fra- brethren, townsmen of Fracastoro, whose castor’s mind in these formative days was father, Girolamo Della Torre, a learned made by the conflict between the opposing physician, perhaps determined the student’s schools of Aristotelians that divided the application to his own profession, while one University during the early years of the of the sons, who died at an early age, stimu­ sixteenth century. The two protagonists lated Fracastor to embark on his astro­ were the Bolognese anatomist Alessandro nomical research. Achillini (1463-1518), who had left his own Among such companions Fracastor early University to profess a form of Averroism developed facility as a writer of elegant at Padua, and Pietro Pomponazzi (1462- verse, and although to a later generation 1525), also a physician, who inclined to the the enthusiasm with which his effusions interpretation of Alexander Aphrodisias and were greeted may appear excessive, he yet whose even more heterodox teaching ulti­ gained through their composition a clear­ mately led to his emigration in the reverse ness of style which is not the smallest of his direction from Padua to Bologna. Though excellencies as a scientific writer. But there he is said to have been incapable of inter­ was another fellow student of Fracastor preting Aristotle to his hearers from the for whom was reserved a destiny far greater original Greek, Pomponazzi was yet a very than that of any whom we have named. spirited and original teacher, of great in­ The young Pole, Nicholaus Koppernigk dependence of thought. He was wholly (I473_I543)» had already spent several divorced from the religion of his day and years in the study of Law at Bologna,8 he died repudiating the hope of Christi­ when in 1501 he entered his name as a anity. student of medicine at Padua. Copernicus But Pomponazzi represents a movement remained in the medical school for some of far more importance than any mere four years, and from that period dates his school of Aristotelian interpretation. He dissatisfaction with the Ptolemaic doctrine stands for Naturalism, for the attempt to of a geocentric Universe. Fracastor was him­ explain the World and all that it contains self a keen critic of Ptolemy’s teaching, and on the basis of known or discoverable laws. it seems more than probable that the two That many of the laws considered by him young men had exchanged ideas during the as demonstrated now seem absurdities, that period when they must often have sat side on insufficient evidence he regarded certain by side in the lecture rooms at Padua.6 earthly events as related to the movements During the later part of the sojourn of of the heavenly bodies with the same assur­ Copernicus in Padua, Fracastor was ap­ ance that we now ascribe them to climatic pointed tutor in anatomy (conciliarius ana- or meteorological conditions, these are errors tomicus) and the Polish student, who was in the application of his method that need nevertheless the older of the two, must have not affect our judgment of the importance attended his former classmate’s demonstra­ of his philosophical position. tions.7 Thus Pomponazzi stood for the reign of Iibreria medica del sec. X IV ” in the Atti del reale di Bologna” in “ Monografie storiche sullo studio istituto veneto di scienze, lettere ed arti LXXV, parte Bolognese,” Bologna, 1888. secunda 5723, Venice, 1916. 6 In the dedication of the “ De revolutionibus” to 3 Giambattista Rhamnusio, “ Viaggi et naviga- the Pope (1542) Copernicus says that it is now “ four tioni,” Venice, 1550. nines of years” since the heliocentric system was conceived. This brings its birth at least as far back 4 Aldus Manutius: “ Pindar,” Venice, 1513. as 1506, and he did not leave Padua till 1505. 6 Carlo Malagola, “ Niccolo Coppernico nello studio 7 Antonio Favaro, “ Lo studio di Padova al tempo T he Scientific Position of G irolamo F racastoro 3

natural law as does Fracastor, his assiduous 1549, Pope 1534-1549). Nor was Alessandro pupil, although the latter became in certain Farnese the younger, Cardinal and patron other respects the opponent of his teacher.8 of the arts, to whom Fracastor dedicated Fracastor was himself, however, constitu­ the “ De contagionibus ” and the poem tionally incapable of the controversial at­ “ Joseph,” less influenced by the prevailing titude of Pomponazzi. In the serene de­ humanism or more addicted to theological tachment of his humanism he exhibited no studies than his august relative, the prince opposition, either open or concealed, to the of nepotists who sat in Peter’s Chair. current of Christianity, nor did he shun the Fracastor’s temper of mind, like that of company of clerics. But the churchmen that these men, was widely removed from theo­ Fracastor made his associates were of the logical and scholastic topics. He had, how­ class, common enough in the early sixteenth ever, a nobler motive than the empty and century, in whom Catholic tradition was mainly sensuous classicism that was the almost entirely displaced by the prevailing prevailing note of the intellectual Italians literary paganism. His friend, Cardinal of his day. His greatest preoccupation was Pietro Bembo, the recipient of the poem the extension of knowledge, and he is seen “ Syphilis” and the lover of Lucrezia Borgia, at his best as he applies the philosophical was also a pupil of Pomponazzi, and was teaching of Pomponazzi in seeking to un­ hardly more influenced by Christianity ravel natural laws from the complicated than his great teacher. When Pomponazzi’s skein of natural phenomena. The ponderous treatise on “ The Immortality of the Soul” conceits of his poems were the affectation was condemned by the Lateran Council, of a period when the most skilled writers Bembo used his influence on its author’s were but the “ apes of Cicero.” But intel­ behalf, not out of any principle of tol­ lectually he is a child of the new age and is eration, but prompted by his admiration begotten of the spirit of science in the for the literary and philosophical qualities matrix of humanism. of the work. Bembo’s own compositions Fracastor spent the greater part of his include poems as obscene as any in litera­ life at his villa in the neighborhood of ture, and we find the same Cardinal urging Verona, devoting himself largely to study. Sadoleto to “ avoid the Epistles of St. Paul It is probable that motives of humanity, as lest his barbarous style should spoil your well as interest in the subject, moved him, taste.” as it did Copernicus, to the practice of Hardly less pagan were the two men medicine among the neighboring peasantry. bearing the name Alessandro Farnese, to It is at least certain that his accurate clinical whom other of Fracastor’s works were knowlege can only have been won by pains­ dedicated. Of these Farnese, the elder as­ taking bedside experience. He took much sumed the new-fangled heathen title of interest in geographical discovery, which he Pontifex Maximus when he ascended the followed on specially constructed globes. throne as Paul III to commence his corrupt He was a devoted student of astronomical papal career (Alessandro Farnese, 1468- and mathematical problems. He was a very di Niccold Coppernico,” Padua, 1880. German trans­ Webb’s “ Studies in the History of Natural The­ lation by Curtze in Mittheilungen des Copernicus ology,” Oxford, 1915, p. 313. Pomponazzi’s teaching Vereins jiXr Wissenschajt und Kunst zu Thorn, which thus influenced Fracastor, is set forth Thorn, 1881, p. 49. in his “ De naturalium effectuum admirandorum 8 Recent studies of the philosophy of Pomponazzi causis seu de incantationibus,” Basle, 1567. This are contained in A. H. Douglas, “ The Philosophy volume, however, was not published until long after and Psychology of Pietro Pomponazzi,” Cambridge, the death of its author (in 1525) and of Fracastor 1910, and in a very interesting chapter in C. C. J. (in 1553)- 4 Annals of Medical History constant reader, and it is said that his but very unattractive compilation is favorite authors, Plutarch and Polybius, Mencke’s, dating from 1731.10 Among the were seldom out of his hands. He delighted more important modern accounts are those also in music. He lived in simple fashion, of W. P. Greswell ( 18 0 1) ,11 Giovanni Orto- only occasionally emerging from his com­ Manara, Podesta of Verona (1842),12 Ron­ parative seclusion to visit distinguished chini (1868),13 Antonio Agostini (1883),14 invalids, to give his opinion in difficult William Osier (1906) 15 and Roberto Massa- cases, or to study epidemics of unusual Iongo (1915).16 Perhaps the most valuable interest or gravity. His reputation alike as recent work on Fracastoro is from the hand poet, humanist, physician and astronomer of Professor Giuseppe Rossi, 17 who deals in extended all over the civilized world. He detail with his philosophical position. Other was a man of extremely various and culti­ modern authors who have handled special vated tastes, who took all the knowledge of aspects of Fracastor’s activity are Symonds his day to be his province. Such of his (1882) 18 and Barbarani (1891),19 who dis­ correspondence as has come down to us cuss his claims as a poet, Fiorini (1900),20 reveals a scholarly recluse, of genial and who deals with his attitude towards geo­ even jovial temper withal, whose high graphical science, Crescimanno (1904),21 who personal character, extensive intellectual discourses upon his relationship to the interests and numerous literary friendships spirit of Italian unity, and Dreyer (1906) 22 made him indifferent to worldly advance­ who deals with the interesting topic of the ment. relation of his theory of the Cosmos to the In spite of the distinguished position that Heliocentric doctrine of Copernicus. Fra- Fracastor held in the opinion of his con­ castoro’s work on the venereal plague of the temporaries, the material for a detailed Renaissance has itself given rise to an biography is by no means abundant. The extensive literature and has been translated earliest account is anonymous and is pre­ into practically every European language. fixed to the 1555 edition of his collected Valuable material is contained in the edi­ works.9 It is probably from the pen of Paolo tions of Colognese (1813) ,23 Choulant (1830) ,24 Rhamnusio, a relative of his friend Giam­ Yvaren (1847) 25 and Fournier (1870).26 The battista Rhamnusio. A more comprehensive poem has been translated into English on 9 ‘*Hieronymi F r a c a s t o r ii Veronensis, Opera 16 Roberto Massalongo, “ Girolamo Fracastoro e la Omnia,” Venice (Giunta), 1555. rinascenza della medicina in Italia,” Venice, 1915. 10 F. O. Mencke, “ De vita et moribus scriptis 17 Giuseppe Rossi, “ Girolamo Fracastoro in rela- meritisque. . . . Hieronymi Fracastorii Veronensis,” zione all* Aristotelismo ed alle scienze nel Renas- Leipzig, 1731. cimento,” Pisa, 1893. 11W. P. Greswell, “ M e m o irs o f A n g e lu s , 18 J. A. Symonds, “ The Renaissance in Italy,” Politianus, A. S. Sannazarius, Pietrus Bembus, London, 1882, II, 476-481. Hieronymus Fracastorius. . .,” Manchester, 1801, 19 Emilio Barbarani, “ Girolamo Fracastoro e Ie p. 161. sue Opere,” Venice, 1891. 12 Giovanni Orto Manara, “ Intorno alia casa di 20 M. Fiorini, “ Qualche cenno sopra Girolamo Girolamo Fracastoro nella terra d’lncafli,” Venice, Fracastoro” in the Rivista geograjica italiana, Rome, 1842. 1900. 13 Ronchini, “ Girolamo Fracastoro,” in Atti della 21 G. Crescimanno, “ Fra due poeti medici” (Gio­ Deputazione della Storia patria modenense. Modena, vanni Meli e Girolamo Fracastoro), Catania, 1906. 1868. 22 J. L. E. Dreyer, “ History of Planetary Systems,” 14 Antonio Agostini in “ Protomoteca Veronese,” Cambridge, 1906, pp. 296-301. Verona, 1883. 23 Vincenzo Benini Colognese, “ Della sifilide ov- 15 William Osier in Proceedings of the Charaka vero del morbo gallico di Girolamo Fracastoro,” Club, N. Y., Vol. 2, December 1906, II, 5-20. Milan, 1813. T he Scientific Position of G irolamo F racastoro 5 several occasions. The earliest attempt is reader will find interest rather in the nar­ probably that of Nahum Tate (1686) 27 rative itself than in the form in which it is whose effort is in keeping with the other cast. It is useful and interesting as a com­ productions of one of the worst of the poets pendium of the views held at the time on that have occupied the position of laureate. the origin, nature, symptoms and treatment The other work of Fracastor that has been of the condition which it discusses. While it rendered into our tongue is the poem is a valuable storehouse of information it “Joseph.” The version by Joshua Syl­ cannot be regarded as an original scientific vester28 (1563-1618) has, at least, a certain contribution in the modern sense, and it absurd quaintness to recommend it. displays little of Fracastor’s most remark­ The student of Fracastor will find that able powers. It is rather in his purely the most convenient editions of his works scientific works, and especially in the “ Ho- are the Giunta Opera Omnia of 1555, 1574 mocentrica seu de stellis” (1538) and the or 1584. There is also a small but useful “ De contagionibus et contagiosis morbis” collection of letters printed at Venice in (1546) that we encounter at its best the 156029 and re-edited at Padua in 1739.30 clear cold light of Fracastor’s intellect. In These reveal something of the personal side these works we not only find an acute and of our author. lucid analysis of the problems of which they A number of prints, portraits and statues treat, but we also discern a perception in purporting to reproduce the features of its author of the meaning of the experi­ Fracastor have survived. They differ so mental method many years before the greatly from each other that it is hard to treatises of Francis Bacon and Rene Des­ believe that they represent the same man. cartes. These scientific works of Fracastoro His iconography has been the subject of are replete with suggestions that have a recent study by Klebs.31 11 proved of value, as the course of science has broadened, down to our own time. In a writer of the first half of the six­ 11. fracastor’s contributions to science teenth century we can hardly hope to find By far the best known of Fracastor’s a large number of careful scientific con­ compositions is his poem Syphilis sive de clusions worked out on a detailed basis of morbo gallico, written on the model of observation and experiment. It is only in Manilius, or as some have thought, on that his work on infection that Fracastor rises of the Urania of Giovanni Pontano (1426- to a height that places him among first- 1503).32 This pseudo-classical composition class modern investigators. But in addition was dedicated to Cardinal Pietro Bembo, to this great contribution, he throws out a and was first published at Verona in 1530. number of hints which have since yielded On the artificial style and false imagery of valuable results in other hands. In the ex­ this work his contemporaries lavished the tensive literature that has arisen around his most extravagant praise, but the modern name this purely scientific side of Fra- 24 Ludwig Choulant, “ Hieronymi Fracastorii 28 Joshua Sylvester, “ The Maiden’s Blush,” Lon­ Syphilis sive morbus gallicus,” Leipzig, 1830. don, 1620. 25 Prosper Yvaren, “ La syphilis. Poeme en vers 29“ Lettere di X III huomini illustri,” Venice, Iatins de Jerome Fracastor traduit en vers fran^ais 1560. precede d’une etude historique et scientifique sur 30 “ Hieronymi Fracastorii Carmina,” Padua, 1739. Fracastor,” Paris, 1847. 31 A. C. Klebs, Iconographic notes, Johns Hopkins 26 Alfred Fournier, “ Fracastor La syphilis (1530), Hospital Bulletin, Baltimore, 1915, xxvi, 378— Le mal fran?ais,” Paris, 1870. 380, 1 pi. 27 Nahum Tate, “ Syphilis,” London, 1686. 32 J. A. Symonds, Renaissance in Italy, II, 364. 6 Annals of Medical History

castor’s works has been largely neglected being unable to fit in his own observations in favor of certain other interests which of the relation of the ecliptic to the fixed they present. We therefore endeavor to stars with the records of Ptolemy and other summarise such suggestions and conclusions astronomers. He explains the divergence as in his writings as have since become ab­ due to a movement of the ecliptic itself.36 sorbed into the mass of natural knowledge. (3) After the theory of Copernicus had (1) The thesis of the work “ Homocen- been firmly established through the labors trica” (1538) is to oppose the eccentric or of Galileo and of Kepler, it became custom­ epicyclic view of the movements of the ary to fashion models illustrating the move­ planets as laid down by Hipparchus of ments of the planets. These engines became Nicsea (circa 150 b .c .) and handed on to a vogue in the eighteenth century and the Middle Ages by Claudius Ptolemaeus.33 received in England the name Orrery.37 It It is thus a preparation for the epoch- is probable that the first Orrery was con­ making Heliocentric work of Copernicus,34 structed for Fracastor himself.38 We read of which did not see the light until the great him demonstrating on such “ an instrument astronomer lay on his death-bed in 1543, made according to the newly discovered though preliminary drafts had been made motion of the heavens” in the Discorso at a somewhat earlier date.35 Both the sopra varii viaggi per li quali sono state “ Homocentrica” of Fracastoro and the condotte et si potrian condurre le spetierie, “ De revolutionibus orbium coelestium” of which was published by his friend Rham- Copernicus were dedicated to the same nusio in 1550.39 patron, Pope Paul III. Although it would (4) Fracastor takes a definite place in be absurd to compare the importance of the history of geographical science. He is the two works, they are yet both conceived the first writer to apply the term pole to in the same broad spirit of naturalism, the the globe of the earth itself.40 Again, the seed of which was perhaps sown in the first great Italian collection of voyages was student days of the two men by Pomponazzi dedicated to him and to that work he him­ at Padua. It is likely that Fracastor was self contributed an article on the source of one of the very earliest to embrace the the Nile. The origin of the White Nile he heliocentric theory of his fellow-student. places not very inaccurately in a great lake (2) Fracastor was greatly puzzled at about midway between the tropic of Capri- 33 The astronomical system of Copernicus is 36 Homocentrica, I, 15. described by J. L. E. Dreyer, Ioc. cit. 37 After the Earl of Orrery, brother of Robert 34 Nicholaus Koppernigk “ De revolutionibus Boyle. orbium coelestium. Libri V I,” Nuremburg, 1543. 38 Moving models of the universe, based, however, The first to point out that Fracastoro was in certain on the geocentric system had been known in ancient senses a predecessor of Copernicus was J. S. Bailly Greek times. in his “ Histoire de I’astronomie moderne en 39 The “ Discorso” of Giambattista Rhamnusio is Europe,” pp. 19, 20, Paris, 1805. He is opposed by to be found on p. 398 recto of the 1550 edition of Siegmund Gunther, “ Studien zur Geschichte der the “ Viaggi et Navigationi.” On p. 401 recto of this math, und physikalisch. Geographic,” Halle, 1877, work occurs the phrase quoted, “ uno instrumento Heft I, 37, but supported by Favaro, Ioc. cit. fatto sopra un moto de’ cieli trovato di nuovo.” 35 A “ Commentariolus” or short summary of the The passage was probably written in 1547, possibly work appears to have been written out by Copernicus earlier, but the instrument must have taken some about 1530 while his pupil Rheticus printed a short time to manufacture. We are thus brought very near account of it as “ Narratio prima” at Danzig in to 1543, the date of Copernicus’ book. On the ques­ 1540. Both these works are reprinted by K. Prowe tion of the date and nature of this “ Orrery” see M. in his “ Nicolaus Coppernicus,” 2 vols., Berlin, Fiorini in “ Rivista geografica italiana, ” 1900, pp. 1883-4. 438-445. T he Scientific Position of G irolamo F racastoro 7

corn and the Equator, while he knows that time will be when land now covered by the the Blue Nile gathers its waters in the high­ waves will be habited and tilled, and yet lands of Ethiopia.41 again in future time will be again hidden One of the great difficulties of the early by Ocean.”43 The doctrine of the secular map-makers was the absence of a satisfac­ changes of land and sea had already been set tory system of projection. Globes were not forth in the thirteenth century by the Ara­ only difficult to construct but were of their bian writer Kazrini, whose views must have nature only applicable for very large geo­ been widespread since numerous MSS. of his graphical areas. The “ portolano” charts “ Wonders of Nature” have survived in represented distances actually measured by both Arabic and Persian. Fracastor either travel and were hardly maps in our sense originated the idea anew or, at least, intro­ of the word. The Ptolemy MSS. usually duced it to the West.44 This theory of contain maps of the cylindrical type of geological elevation was seized by several of projection. In one or two works, both Fracastoro’s contemporaries,45 by Hieron- printed and manuscript, an equally clumsy ymo Cardano (1501-1575), by Bernard method, the “ pseudoconic equidistant,” had Palissy the potter (1510-1590), by Andrea been introduced. Cesalpino (1519-1603), by Conrad Gesner It was not until 1569, sixteen years after (1516-1565). These all used the theory to Fracastor’s death; that the Fleming Ger­ explain the presence of fossil marine forms hard Kremer (Gerardus Mercator, 1512- at heights above the sea, and the idea was 1594) produced his first rectilinear map on further elaborated by the Dane, Niels the system now known as Mercator’s pro­ Stensen (Nicolaus Steno, 1638-1686) in the jection.42 In a letter to Rhamnusio dated following century, in a work which laid the May 10, 1549, first published in 1560, foundations of modern geology.46 Fracastoro had suggested the use of this (6) Fracastor was one of the few writers very system and expressed surprise that it of his day who had any idea of the nature had not been adopted by cartographers. of refraction of light. In his application of (5) Fracastor was the first to hold that this conception, though he is sometimes Western European land and water was confused, he is yet in some ways superior to subject to secular changes of elevation, so any of his predecessors, Alhazen (died 1038), that an area now dry and even raised to Roger Bacon (12147-1294), Vitellio (circa mountainous height may once have been 1300), or John of Peckham (died 1292). submerged. “ If a man consider,” he writes, Fracastor’s views were hardly improved “ how islands and mountains come into upon until the researches of Francesco being, he will recognize that time was when Maurolico (about 1575) and Willibrod Snell they were built out from the sea and that van Royen (about 1620). 40 E.g. De sympathia et antipathia rerum, Cap. 7. E. Nordenskiold, “ Facsimile-Atlas,” Stockholm; 41 “ Risposta delloexcellentissimo messer Hieronimo 1889, p. 49. Fracastorio del crescimento del Nilo a messer Gio­ 43 Homocentrica, I, 12. vanni Battista Rhamnusio” in “ Navigationi et 44 Kazrini’s geological doctrine is discussed by R. Viaggi,” Venice, 1550, p. 284 verso. Knox, Anthropological Review, 1863, I, p. 263. 42 Gerhard Kremer (Gerardus Mercator), “ Nova 45 It is encountered in an Irish tract that perhaps et aucta orbis terrse descriptio ad usum navigantium borrowed from Fracastor. See Maura Power, “ An emendate accomodata.” “ Aeditum est opus hoc Irish Astronomical Tract based . . . on Messehalah,” Duisburgi an. D. 1569 mense Augusto.” A map that London, 1914, p. 37. appears to be constructed on the same principle as 46 Nicolaus Steno, “ De solido intra solidum natur- Mercator’s, the work of Claudius Clavus, and dated aliter contento dissertationes, prodromus,” Florence, 1427 is to be found in the library at Nancy. See. A 1669. 8 * Annals of Medical History

(7) Fracastor was probably the first to seem smaller and more remote; if thick suggest the combination of lenses as an aid and dense they appear larger and nearer to vision; and he thus gives the first hint as may be seen in water, glass and crystal. in literature of the construction of a tele­ Thus was discovered the application of scope. We here render the most important those lenses (specillorum) that are called passages in his writings on the subject of ocularia [ = spectacles]. Thus also, objects the refraction of light and the use of lenses. such as oars, that are part in air and part In reading this account, the technical in water, look as though broken,47 for the meaning attached to the word species in part in water appears nearer than it would Mediaeval and Renaissance optics must be if viewed directly through the air. borne in mind. It was held that visible “ Now this factor, which depends upon objects were constantly emitting images of the medium, does not seem to have been themselves or species as they were called. sufficiently considered by those authors These emissions, if they collided with certain who maintain the eccentric [i.e. epicyclic] other emissions of the so-called visual spirit, theory, for they have considered no media which was held to proceed from the retina, other than air and water. Thus Ptolemy, resulted in the production of visual sensa­ for instance, having perceived that the tion. The collision was supposed to take cause of certain phenomena could not be place in the forefront of the eye. The explained as due to the atmosphere, re­ variation in the size of the pupil was re­ jected the medium altogether as a cause of garded as a device for regulating the amount these appearances. We, however, consider and intensity of the collision. that air and water and their kinds are not It must further be remembered that the the only sorts of media through which universe was regarded as composed of a species reach us from the stars, but that series of concentric spheres placed one in­ the heavens themselves and their strata side the other like the skins of an onion. In (partes) provide such media. the center was the earth, around it the “That the heavens are transparent is atmosphere, and around that seven spheres manifest, but that they are denser in or heavens corresponding one to each of the some parts and rarer in others is demon­ seven planets. Beyond the outermost of strated by the stars and by the disc these seven spheres (in which moved the (corpus) of the moon. For there are in the planet Saturn), was the heaven containing spheres (oribus) certain most rare and the fixed stars. In order to reach the earth, subtle strata (partes) through which such the species from a fixed star had therefore species as of the stars pass unaltered to penetrate the seven spheres of the seven (nihil repacta) and there are others, utterly planets and finally the atmosphere. dense, through which the species may in “ We maintain that the planets do not no wise pass, but are wholly reflected really vary in altitude [as some have back. And there are yet other media from claimed] but that they seem to do so for which the species are in part reflected, certain reasons, of which one depends but through which they do in part upon the medium. B y medium is meant penetrate. that transparent body through which the “ Some call this [latter process] refraction, species of visible things reach the vision. distinguishing refraction from reflexion. In If the medium is subtle, all things in it reflexion the incident species do not pene- 47 Cf. Seneca, Quaestiones naturales 1, 3 and 1, 6. It is the refraction of light was to some extent developed doubtful whether Seneca’s ideas of refraction could in the Middle Ages by Alhazen, Roger Bacon, Vitellio have been derived from Aristotle. The conception of and John of Peckham. T he Scientific Position of G irolamo F racastoro 9

trate but are wholly thrown back again. greater than a e and therefore the species In refraction, however, although there in that region have to pass through more may be a degree of reflexion yet the vapors. a species do penetrate and affect vision “ For the directly. Now such parts of the spheres same reason, all (orbium) as refract the species render all stars as they objects larger and nearer. So with the rise northward stars which are subject to such factors appear less to both in the air and also in the heavenly us [i.e.,in Italy] spheres, some of which are denser, some and as they subtler. pass east “As regards the atmosphere we may greater; then observe that in calm winter weather and as they sink southward they are yet especially towards the south the stars look greater and returning on the east less larger, while in summer and towards the again. For with us [in Italy] a star is near north they appear smaller. The influence the horizon when it turns southward and of the heavenly spheres is similar, as it passes eastward near the zenith. we shall show later. “ Let abcd be the earth and fa our “ Now a deep medium makes objects horizon, efgh the sphere of vapors, appear larger and nearer; and the deeper k l the equator k it is the greater its effects, so that the and e a northern further the species come through a dense and f a southern medium, the greater [relatively] appear star. But the the objects. Thus in the same mass of southern star is water, objects at the bottom are relatively near our horizon more enlarged than those at the top.48 So and is seen along if one looks through two lenses (specilla the line fa , the ocularia) placed one in front of the other, all northern star is, objects look much larger and nearer. In the however, nearer same way there are certain stars which, the zenith and seen along the line ea , when near the horizon appear larger and which is less than fa . nearer, but when towards the zenith (in “For a similar reason some of the medio celi) seem smaller and more remote. planets seem larger when they are in For species near the horizon come through quadrature to the sun, so that his species a greater depth of medium, and they come is refracted through a greater part of through more of the atmosphere which is their sphere, a matter of which we shall loaded with the multitude of vapors that treat presently. are ever about the earth than do species “ But (not only the character but) also from the region of the zenith (e medio the position of the medium affects the cell). . . . appearance of the object seen, as may be “ Let efgh be the earth and abcd observed with lenses (in specillis ocular- the sphere of vapors around it. Let be ibus). For if a lens be placed midway be the horizon. Then a star near the between eye and object, it appears much horizon will be seen along the line b e , larger than if the lens is made to approach one at the zenith along a e . But b e is the object or the eye.49

48 This property of water was, of course, well others in the Problemata of Aristotle and by Archi­ known to the ancients and is mentioned among medes, Seneca and Heron of Alexandria. 10 Annals of Medical History

“ Now concerning the differing appear­ ought not therefore to appear incredible ance of the moon, according as it is in that sections of the spheres may have the quadrature or rapid motion [i.e. perigee]. same effect. An instance of this is the In both, it appears larger and nearer and fact that the other planets may appear its appearance varies greatly. . . . The greater in quadrature as I have often moon appears larger and nearer when in observed with Jupiter.” 51 quadrature because the species of the sun The remaining more important scientific falling upon the moon is refracted through conceptions with which Fracastor was con­ a greater part of the sphere than when cerned are contained in his work “ De Con- the moon is in any position other than tagionibus” which we shall presently discuss quadrature. in detail. They may be thus briefly enumer­ “ Let gfdh be the moon’s sphere and ated. let kh represent its depth, the sun being (8) He enunciated clearly, perhaps for the a t a, ab o ve first time, the modern doctrine of the the moon in specific characters of fevers. quadrature at (9) He was among the first to distinguish c or e . Species clearly as a clinical entity the disease now or rays from know as typhus fever. the sun come (10) He laid the true basis of the whole of to the moon modern teaching on the subject of infection along the lines by means of his doctrine of “ seminaria.” bc or those which are re­ h i. fracastor’s theory of infection fracted at l H th ro u gh l c . At the back of all modern views on the Similarly in nature of infectious disease lies the work of t h e other Fracastor. In the words of a younger quad ra tu re contemporary “ it was he who first opened th e y com e men’s eyes to the nature of contagion.” 52 through de or l e , nor can there To Fracastor belongs the credit of finally be any longer lines than these [i.e. re­ and clearly distinguishing the three catego­ fracted through a greater depth of medi­ ries of infection, by contact, by fomites and um] when the moon is in other positions.50 at a distance. His doctrine of infection Wherefore the species of the sun is more arising from and conveyed by hidden germs refracted in quadrature than in any other or seeds has formed the basis of most of the position; wherefore the moon appears best work on the subject in the centuries larger and nearer for the same reason that that have followed. do objects in a depth of water. For generations but little advance was “ /n the same way glasses (specilla ocu- made on his teaching, but at length it laria) may be made of such density that if became incorporated in the work of a school any one looks through them at the moon or mainly composed of Italian writers who, at any star they appear near and hardly led by Francesco Redi (1626-1694), Giovan­ higher than the steeples {turres) and it ni Maria Lancisi (1654-1720), and Antonio 49 Homocentrica, II, 8. 61 Homocentrica, III, 23. 60 This passage is based on a misunderstanding of 62 Hieronymo Mercuriali. Prselectiones Patavii the nature of refraction which he supposes to take habitae 1577 in quibus de peste tractatur. De peste place only when the rays fall vertically on the surface in universam, praesertim vero de Veneta et Patavina. of the medium. Venice, 1577. Cap. X III. T he Scientific Position of G irolamo F racastoro ii

Vallisnieri (1661-1730), took, in the seven­ English Sweat and Leprosy he writes with teenth and eighteenth centuries another discretion and judgment. step towards a scientific demonstration of The doctrine of disease germs or seeds the nature of infection. The third great step which forms Fracastor’s best claim to belongs to the history of modern medicine scientific eminence had dawned upon him and is associated with that group of ideas before 1530. It is foreshadowed in a Lucre- that cluster around the names of Pasteur, tian passage in the “ Syphilis” that was Lister, and Koch. But to Fracastor as to printed in that year. At that date, however, the father of modern rational pathology we he still regarded alteration in the air itself, must always return, and the influence of his “ miasma,” as the main cause of epidemic ideas is discernible even in recent develop­ disease.54 His reputation as a scientific ments of that science. medical writer is more safely based upon For the study of epidemics Fracastor his “ De contagionibus et contagiosis morbis lived in a peculiarly favorable locality and et eorum curatione.”55 which appeared at period. When he was yet a lad of about Venice in 1546. sixteen, the venereal plague was first recog­ The excellences of this work are so numer­ nized in Italy. It was at this period, accord­ ous as to mark an epoch in the history of ing to him, that the disease was given the medicine. It is written in a clear and name of morbus gallicus, a title confirmed straightforward style and is not of inordinate perhaps by the extensive infection that length. Essentially a practical work, yet grew up in Paris two years later, when written in a thoughtful and philosophical matters had reached such a pass that a mood by a physician of experience, it betrays decree was issued requiring all infected an industrious accumulation of clinical data persons to leave the town within twenty- and relies little on mere hearsay. There is four hours.53 In his manhood Fracastor was almost complete freedom from the weari­ the witness of successive waves of plague some list of quotations from the writings of and of epidemic typhus which swept over others through which the reader has to wade the peninsula. He had ample opportunity to in most contemporary treatises. In this as study phthisis and rabies, and in speaking in all his works, the author shows himself of these he shows much knowledge and singularly devoid of superstition, although clinical acumen. Of diseases which came less he naturally shares some of the errors of his directly within his observation such as the time. 63 It has been shown, however, that the term “ mal 64 Quumque animadvertas tam vastse semina Iabis franzoso” was in use as early as the fourteenth Esse nec in terrae gremio, nec in aequore posse, century. See Karl Sudhoff, “ Zur historischen Biologie Haud dubie tecum statuas reputesque, necesse est, der Krankheitserreger,” Heft 5. “ Mai Franzoso in Principium, sedemque mali consistere in ipso Italien in der ersten Halfte des 15. Jahrhunderts. Aere, qui terras circum diffunditur omnes, Ein Blatt aus der Geschichte der Syphilis.” Giessen, Qui nobis sese insinuat per corpora ubique, 1912. See also the same author in Dermatologiscbe Suetus et has generi viventium immittere pestes. Zeitscbrijt, Band X X , Heft 14, 1913, also “ Der Ur- Aer quippe pater rerum est, et originis auctor. sprung der Syphilis. Vortrag gehalten auf dem inter- Idem saepe graves morbos mortalibus affert, nationalen medizinischen Kongress zu London am Multimode natus tabescere corpore molli, August 7, 19 13,” Leipzig, 1913, and “ Ein neues Et facile affectus capere, atque inferre receptos. Syphilisblatt aus dem Ende des 15. Jahrhunderts” Nunc vero, quonam ille modo contagia traxit, in Arch, fur Gesch. der Med., Vol. I, p. 374, Leipzig, Accipe: quid murate queant Iabentia saecla. 1908. Also Paul Richter, “ Ueber Conrad Schellig und Syphilis, Lib. I. sein ‘ consilium in pustulas malas,’ ” in Arch, 65 The “ De sympathia et antipathia rerum” ap­ fur Gesch. der Med., Vol. Ill, p. 135, Leipzig, peared at the same time and in the same volume. 1910. With this work, however, we are not here concerned. 12 Annals of Medical History

The relationship between epidemics as a larity. Those governed by such ideas regard result and infection as a cause is clearly all material things as presenting contagious grasped and philosophically expounded by properties, the infection either passing from Fracastor and is not confused by specula­ one body to another in actual physical tion on the barren topic of miasma, which juxtaposition or at a distance through the proved a snare to many contemporary agency of “ sympathetic” or “ symbolic” writers. The orders of infection are logically magic. Purity and defilement have hardly distinguished. Lastly, the theme of the con­ yet risen to their ritual significance. These veyance of infection by minute particles conditions are as yet a part of daily life and having some of the properties of seeds is follow on natural contact with clean and skillfully developed and interwoven with the unclean objects. Thus to the savage, the humoral pathology. Fracastor had not the phenomena of infectious and contagious modern conception of universal biogenesis. disease are but part of the general order of It is probable, from his philosophic stand­ his world. point, that he would have refused to accept In a higher state of culture, Religion has the usual modern scientific distinction be­ become differentiated from its parent, or tween the organic and the inorganic. It is cousin, Magic. The untoward and unex­ therefore idle to discuss whether he regarded pected events of life—and among these these germs, seeds or semina as living or epidemics take a prominent place— are now non-living since the distinction would not attributed to the intervention of super­ have appeared important to him. In any natural powers. From the earliest historic event, he believed that infectious diseases ages, epidemics have indeed puzzled the could be originated anew. But for this mind and terrified the heart of man. It is heresy, there is little enough in the main the unknown that is most dreaded, and the outline of his views that would need re­ pestilence that walketh in darkness has been construction by an orthodox pathologist of ever more terrible than the arrow that flieth to-day. by day. The Biblical writer strikes a true To appreciate justly the place of the “ De human note when he makes the appearance Contagionibus,, in the history of medical of the very Angel of Death at the threshing thought, it is necessary to consider the floor of Araunah come as a relief to the general current of the teaching on the stricken King of Israel. subject of infection up to the date of its Probably all races that have reached the publication. In the following chapter we level of social complexity implied by formal seek to pass this in rapid review.IV. legislation have exhibited some knowledge of the phenomena of infectious disease. IV. KNOWLEDGE OF THE PHENOMENA OF Babylonians, Hebrews, Egyptians, Indians INFECTION AMONG THE ANCIENTS and Chinese, all had codes adapted to the prevention of infection. The Buddhist to (a) Among Primitive Folk. this day avoids some water-borne diseases To the primitive mind the properties of by drinking only filtered water, lest he all matter appear capable of transference to should sin by consuming the minute creatures contiguous or neighboring substance, even that abound in brooks, rivers and springs: of dissimilar nature. In a kind of savage the Hebrew has for ages escaped a certain logic described by modern folk-lorists under amount at least of tuberculous disease by the term “ Magic,” primitive man exhibits following the law which bids him reject the a crude species of reasoning, based some­ carcasses of cattle with diseased lungs; times on propinquity, sometimes on simi­ and even races very low in the scale of T he Scientific Position of G irolamo F racastoro 13 civilization will measure around the camp a infection was frankly incomprehensible. The space within which the taboo forbids the ancients of the classical period of Greece deposit of excreta. While the religious bases and Rome were as anxious as any modern of such actions may be very foreign to the scientist to seek the immediate real causes modern mood, the actions themselves are of disease. But in those days as in these, not infrequently in close accord with modern setiological literature largely consisted of hygienic doctrine. what were even then felt to be either simply verbal explanations or mere lists of associ­ (b) Knowledge of Injection of the Ancient ated conditions, to be used in the absence Greek and Roman Writers. of better means, for the satisfaction of the To the physicians of Greece and Rome ignorant. Aesculapius, by the bedside a god, epidemics of all kinds were known as became like his modern representative, a common accompaniments of warfare and of sorely puzzled soul when he had gained the natural catastrophes, although infection reflective solitude of his study. proper as we understand it, was seldom The Father of Medicine (circ. 400 b .c .) distinguished by them from that general appears to have had no conception that infection which we call an epidemic. Among epidemic diseases were infectious,56 in the the Greeks the direct influence of the gods sense in which we now use the word. B y him was passing into the background and it was they were regarded as due primarily to recognized that outbreaks of certain types atmospheric conditions. He is reported to of disease followed rather on certain natural have extinguished the plague of Athens by events, such as excessive rainfall, for epi­ lighting fires as an atmospheric corrective, demics had been observed to prevail with a procedure widely adopted in such emer­ special winds and at the changes of the gencies until recent times. It will indeed be seasons. Overcrowding again, and the in­ seen, as we proceed, that all the causes halation of air breathed by others were regarded by the early medical writers as regarded as modes of breeding disease: leading to epidemics were to some extent while unburied corpses, exhalations set free connected with a “ change in the atmos­ by earthquakes and even defective drains, phere.” were all considered dangerous to health. Hippocrates - observed the immense in­ These observations combined with crude fluence of climate on health 57— and urged notions on spontaneous generation were not the study both of permanent and temporary without influence in leading speculation climatic factors. In the doubtfully Hippo­ towards a theory of zymotic disease. cratic treatise “ On the Nature of Man”58 But to most of the Greek and Latin we find a discussion of the phenomena of medical authors whose works have come epidemics,59 where the air is given as the down to us, the mechanism of widespread only possible “ universally acting cause” of 56 The Hippocratic writings seem to present a 68 Pseudo-Hippocrates. “ On the Nature of Man,” contrast in this respect to the somewhat earlier Cap. 9. According to Greenhill and Adams this work Levitical code. It must, however, be noted that comprises fragments by different authors, probably although the regulations of that code, as regards about contemporary with Hippocrates. leprosy, presumably imply a belief in infection, such Cf. also: Humors 14.59 a belief is nowhere stated, and the facts are capable By unknown author Epidemics Bk. 2, §1, 3; of other interpretation. Cp. M. Jastrow. “ The so- about contemporary Bk. 4, §7, §46. called Leprosy Laws.” Jewish Quarterly Review, with Hippocrates. Bk. 6, §5, §7- New Series, IV, 358. Philadelphia 1914. Humors 8. 57 Hippocrates. Airs Waters and Places Caps 1, By various authors Epidemics Bk. 7, § 105. 10, 15, etc. Epidemics Bk. 1. § 1 and 2, Bk. 3. § 3. rather later than Aphorisms 3. Hippocrates. Bk. 5> § 94* 14 Annals of Medical History widespread disease, an idea which deeply der of Aphrodisias,72 and Eustathius Dia­ affected mediaeval beliefs. conus.73 The teaching of the Hippocratic school on The first writer to whom can be traced a the subject of atmospheric conditions was definite and formal belief in the passage of elaborated in the succeeding centuries. Thus specific infectious disease from person to the author of the treatise known as the person is Thucydides (b .c. 471-391). In his Problems of Aristotle recognized certain description of the plague of Athens the phenomena of infection, discussed the vari­ historian definitely commits himself to the ous “ epidemic constitutions” and dwelt view that those who came most intimately especially on the result of a hot sun drawing in contact with the sick were the most liable up mists from the earth.60 Similar views are to contract the disease.74 Very similar views to be found in Lucretius,61 Diodorus Sic­ are found in a long list of writers among ulus,62 Silius Italicus,63 Lucan,64 Manilius,65 whom may be mentioned the author of the and Marcus Aurelius.66 Galen develops the “ Problems of Aristotle” 75 (b .c. 384-322), same theme, noting the effects of climate Lucretius (b .c. 95-55),76 Virgil77 (b .c. 70- both directly on the patient and more in­ a . d . 19), Dion Cassius of Utica78 (circa directly through the degradation of the air b . c. 40), Dionysius of Halicarnassus 79 (died breathed by him.67 Among the potent causes b .c. 7), Livy 80 (b .c. 59-A.D. 17), Diodorus of this degradation, he mentions marshes Siculus 81 (circa b .c. 20), Ovid 82 (b .c. 43- and stagnant water. Oribasius 68 also gives a .d . 18), Seneca83 (circa, a .d . 60), Pliny marshes and fogs among the causes of the Elder84 (a .d . 23-79), Silius Italicus85 fevers, and is followed by Aetius,69 Paul of (a .d . 25-100), Plutarch86 (circa a .d . 80), Aegina,70 Ammianus Marcellinus,71 Alexan- Appian 87 (circa a .d . 120), Eusebius 88(a .d . 60 Problems. §i. cap. 21. 74 Thucydides, History of the Peloponnesian War, 61 Titus Lucretius Carus. De Rerum Natura. Book II, cap. 47 et seq. lib. VI, line iioo et seq. of H. A. J. Munro’s 75 Problems, § VII. Cap. 8. version. 76 Lucretius, De rerum natura VI, especially from 62 Diodorus Siculus. Bibliotheca Historica. Bk. 14. line 1230 onward. §291. 77 Virgil, Eclogues I, 50; Georgies, III. 469. 63 Silius Italicus, Punica, Bk. XIV. 78 Dion Cassius, Roman History. Reign of Augus­ 64 Marcus Annaeus Lucanus, Civiles bellum vel tus, Book 53. (Protulus covers his nose and mouth Pharsalia VI. with his hand to let the company know that it was 65 Marcus Manilius. Astronomicon. unsafe to breathe the same air as Largus, who had 66 Marcus Aurelius Antoninus. Meditations. Bk. accused his friend Gallus.) IX, cap. 2. 79 Dionysius of Halicarnassus. Romanorum anti- 67 Galen. Commentary 1 on Epidemics of Hip­ quitatum. Lib. X . cap. 53. pocrates, lib. 1; Ad Glaucum de methodo medendi 80 Livy Patavinus, Res gestae populi Romani, preface and lib. 1; De diff. feb. lib. 1, cap. 6; de Bk. 25. methodo medendi bk. 1, cap. 11 ; com. 3. on Hipp. 81 Diodorus Siculus, Bibliotheca historica, Bk. 14. de humoribus, and Com. 2 on Hippocrates “ De §291. natura hominis.” Cap. 4. 82 Ovid. Metamorphoseon, Lib. VII. 551. 68 Oribasius, Synopsis VI. 24. 83 Seneca, De tranquillate animi, § 7. 69 Aetius. Contractae medicinae tetrabibli. Bk. 1. 84 Pliny the Elder, Naturalis Historia, X X III. 80. sermo 3. Cap. C L X II, C L X III: Bk. 2. sermo 1, 85 Silius Italicus, Punic Wars, Bk. 14. sermo 5. cap. XCIV . 86 Plutarch, Symposiaca problemata, Decas IV, 70 Paulus Aegineta, Bk. 2, § 35. Problem 7. 71 Ammianus Marcellinus, Res gestae, Bk. X IX , 87 Appian of Alexandria. Historia Romana. Lib. cap. 4. X , cap. 1. 72 Alexander Aphrodiseus, Aphorisms 65, 159. 88 Eusebius Pamphili, Bishop of Caesarea in 73 Eustathius Diaconus, Commentary on Homer’s Palestine. Historia ecclesiastica, Lib. VII. cap. 21, Iliad. § LXI. quoting “ Paschal Epistle of Dionysius.” T he Scientific Position of G irolamo F racastoro 15

264-340), Gregoras Nicephoras89 (died a . remember that infection formed with them d . 394), St. John Chrysostom90 (347-407 only a minor factor in the production of a .d .), Evagrius of Epiphania91 (a .d . 536- disease. Its existence was admitted, but 594), and Vegetius92 and many others.93 far more stress was laid on the physical The popular writings of Isidore of Seville conditions in which epidemics arose than on (died a .d . 636) may be regarded as the the passage of the condition from person to medium through which the doctrine of person. Thus in the description that Lucre­ contagion passed from classical antiquity tius gives of the plague (De Rerum Natura into mediaeval and barbarian Europe.94 VI) although some 200 lines are devoted to Aretseus the Cappadocian 95 who lived in the subject and the atmospheric influences the second century of the present era is the are fully discussed, the passage of the disease earliest writer known to us who extended from person to person is dismissed in a few the theory of infection, so as to distinguish words. With the ancients, in fact, it was definitely between the conveyance of a always “ miasma” rather than contagion disease by contact or at a distance. “ A that was feared. man,” he says, “ may be seized with rabies Before leaving these medical writers of from respiring the effluvia of the tongue of Greece and Rome we may consider certain a dog, without having been bitten.” Al­ of their pathological theories, which were though the observation on which he bases involved in their conception of the nature his view is inaccurate, he was thus on the of infection and contagion. These concep­ road to a more correct conception of con­ tions dominated medical thought until the tagion. Coelius Aurelianus makes a similar seventeenth century and their influence lay distinction for hydrophobia,96 elephanti­ heavy on Fracastor and may be traced even asis 97 and perhaps for plague. Galen had a in modern times. clear view of the distinction between infec­ The Hippocratic school recognized the tion and contagion and regarded as infec­ four humors, blood, phlegm, black bile and tious consumption 98 as well as those other yellow bile and the corresponding qualities, diseases which gave rise to fetid respiration. heat, cold, dryness and moisture. Hippoc­ Aetius (sixth century) 99 believed in the rates himself attributed diseases, including contagion of “ elephantiasis” and Paul of epidemics, to a disturbance in the distribu­ Aegina 100 recommended the segregation of tion and quality of the humors, due most patients from this disease since it is “ no often to atmospheric changes. An observant less easily communicable than the plague.” physician could not fail to note the element Thus the doctrine of infection was well of putridity in many infectious conditions, known to the classical writers of Greece and especially in the group associated with Rome. Nevertheless it is important to various forms of septic throat or “ cyn- 89 Gregoras Nicephoras. History of Byzantium. tion X X X V I. “ On the Plague, from the works of Bk. 16, Chap. 1, § 798. Rufus,” Vol. I, p. 277 et seq. 90 St. John Chrysostom. In Joan. Orat. 57. 94 Thus Isidore of Seville De natura rerum. De 91 Evagrius Scholasticus. Historia ecclesiastica, Pestilentia XXXIX, 2, is taken from Lucretius VI, Cap. 29 (contagion among various other puzzling 1100. phenomena). 95 Aretaeus Cappadox, The Causes and Symptoms 92 Renatus Vegetius. Ars veterinaria sive mulo of Acute Diseases, Book I, Ch. 7. medicina, Lib. Ill, Caps. 2, 23. 96 Coelius Aurelianus. Celerum passionum. Book 93 For a masterly review of the doctrine of con­ III, Ch. 9 and 13. tagion in the classical period of Greece and Rome 97 Ibid. Tardarum passionum, Book I, Ch. 1. the reader may be referred to Francis Adams’ “ The 98 Galen, De diff. febr. 1. 4. Seven Books of Paulus Aegineta.” 3 vols., London, 99 Aetius, Sermo X III, Cap. 120. 1844. See especially commentary on Book II, Sec- 100 Paulus Aegineta, Book 4, §1. i6 Annals of Medical History

anche,” as it was called, andjwith various (c) Knowledge of Infection among Arabian forms of skin eruption in which a pustular Writers. element was liable to supervene. The term The medical theories of the Mediaeval and “ putridity” or “ fermentation” of the hu­ Renaissance periods were derived from two mors became a sort of epidemiological main sources. Firstly, they were formed by master-key, the use of which continued Greek medical works in more or less defec­ right down to the nineteenth century. Thus tive Latin translations. Secondly, they were the learned and eloquent Sir Thomas Wat­ molded by Arabian writings which were son wrote in 1848: themselves, in the main, little but corrupted versions of the Greek works from which “ The ancients attributed various dis­ they ultimately derived. Latin translations orders to a fermentation of the animal of these Arabian writings filtered into fluids. The cause of fever, according to Europe continuously from the eleventh to Hippocrates was some morbid matter in the sixteenth century. In spite of the the blood. This matter, by a process of revived interest in Greek among scholars of concoction, was brought, in a certain the fifteenth century, Arabian influence by number of days, into a state in which it no means passed into abeyance. The relative was ready for expulsion from the body. importance of Greek and Arabian writers . . . The doctrine thus enunciated by the at the time may be gathered from the father of physic is very nearly the same following table of the number of editions with that which Liebig is teaching in the of various medical writers, printed before nineteenth century.” 1 the year 1500.

This doctrine of fever and contagion as Hippocrates o related to a putridity or fermentation of the Dioscorides 2 Greeks humors had thus lasted for over twenty- Galen 1 two centuries before it was appreciably Rhazes 14 modified by the workers who have given us Mesue 18 Arabians our modern theories on the subject. Avicenna 21 It was early recognized, however, that not all infectious diseases were associated with Nor must it be considered that the in­ demonstrable putrescence. The explanation fluence of the Arabians stopped even with was that the change, confined to the hu­ the close of the fifteenth century. Further mors, need not necessarily exhibit itself editions of Mesue were issued during the externally, although it could convey its own next 100 years and the work was used in the nature to the circumambient air and thus formation of the first London Pharmacopeia, infect others. Fevers were therefore divided issued in the reign of James I; while the into putrid and non-putrid, a simple clas­ Canon of Avicenna served as a text-book sification that was adopted by Cullen in and continued to appear in ponderous folio the eighteenth century and has persisted editions until the wane of the seventeenth into modern times. The distinction of the century. It is therefore necessary to consider tertian and quartan group of malarial in­ the Arabian doctrines of contagion in order fection from either of the above categories to estimate the influences on Renaissance was, however, usually recognized. medical conceptions.2

1 Sir Thomas Watson. “ Lectures on the Principles was devoted to the subject of fermentation and and Practice of Physic,” London, 1843. Vol. II, p. paved the way for Pasteur. 669. A large part of Justus von Liebig’s early work 2 For the analysis of the views held by Moham- T he Scientific Position of G irolamo F racastoro i 7

Little is known of Arabic views in the mountains or the desert and there they pre-Mohammedan era on the subject of remained until the pestilence had spent its epidemics. It would seem that such phe­ force. nomena were regarded as due to the direct However much the doctrine of pre­ and baleful influence of the Djinn, no destination may be a Mohammedan dogma, attempt being made to analyze their nature its practical application has varied accord­ further. With the advent of the Mussulman ing to the theological complexion of place period this was changed. Mahomet himself and period. Wise action such as that of Omar appears to have halted between two views. would especially appeal to such sects as the During the early years that he had spent as a heretical Qadarites of Basra and their herdsman he had remarked that disease successors. These people considered that seemed to be conveyed from one animal to Allah, while determining the more sweeping another, rather than imposed on the whole and important world movements, did not group from without. This observation, how­ exercise the same minute surveillance over ever, when extended to human epidemics the smaller details of life and thus they was with difficulty reconciled with his later tended to become more anti-fatalistic. Under faith in the direct intervention of Allah in the reign of Motawahkil Jaafar Abu’I Farl all human affairs. The confusion or perhaps (847-881) and his successors, there was a fusion of ideas is found throughout Arabic fatalistic reaction and many lives were medical literature. It is well illustrated in sacrificed to the fanatical interpretation of the “ Book of the Pest” by the celebrated the doctrine of predestination. The sale author, al-Bokhari (810-870 a .d .): even of medical books containing heretical views was strictly forbidden. The works of “ The owner of a sound flock should not Galen, however, fortunately escaped the go near an infected flock. . . . If you per­ ban, perhaps owing to their strongly ex­ ceive that the pest reigns in a land, enter pressed teleological views. They thus sur­ not therein, but if you are in an infected vived to earn the approval of the orthodox country, pass not out therefrom. . . . The and to form the basis of Arabic medicine, so plague is a punishment from Allah and that Galen, the unbeliever, came to occupy a inflicted by his will. It has been created somewhat similar place in the affections of in pity for the sake of the true believers the followers of the crescent, that Virgil, the and it proceeds not from man. Therefore worthiest of the heathen, earned among the any man [to whom that fate may come] Christians. should die calmly in his own country Passing from the general tendencies that knowing well that he endures what Allah influenced Arabic medicine, we may con­ has preordained; for him the plague is a sider the views on infection that arose martyr’s crown.” 3 among its professors. Already in the seventh The advice thus offered was not in fact century the Christian Ahron of Alexandria always applied by the Mohammedan hosts. regarded epidemics as a result of the consti­ Thus on the approach of an epidemic, Omar tution of the air, a view clearly derived ben al-Khattab and the generals who suc­ from Greek sources. Rhazes (died 932), in ceeded him dispersed their soldiers in the spite of his clinical acumen, contributed medans on the subject of contagion we are largely sive research into the Arabian literature. We hap­ indebted to Dr. E. Seidel. “ Les Idees des Arabes du pened, however, to be in Germany on the outbreak moyen-age sur la contagion” in La Revue medicale of war in August, 1914, when our notes were seized d’Egypte, 1912, and “ Die Lehre von der Kontagion by the authorities, who have hitherto refused to bei den Arabern” in the Archiv Jiir Gesch. der Med., relinquish them. VI, 1913. We had ourselves made a somewhat exten- 3 Quoted from Seidel, Ioc. cit. 18 Annals of Medical History little to the subject of contagion though he body and of corruption of the air without introduced the element of “ fermentation” 4 than on any contagious element of disease, also of Greek origin. He mentions among and thus reproduced the well-known views the diseases “ which are transmitted from of the ancients on the subjects of epidemics,11 one person to another” lepra (? elephan­ and served to stereotype them for many tiasis), itch, consumption and “ pestilential centuries. fever.” These are infectious “ when one is As to the existence of contagion, the shut up in a narrow house with those western Avenzoar (died in Spain, 1162) was afflicted thereby or when one sits upon their more definite than his Bokhariote predeces­ windward side.” Ophthalmia and smallpox sor Avicenna. Avenzoar12 thus gives to he considered as also sometimes contagious.5 contagion a chief place among the causes of The earliest Arabic writer in whom a lepra” : definite advance on these views is to be “ There occurs at times in the bodies of found is the Persian Haly Abbas (Ali ben men a very bad cancer which is lepra: . . . Abbas—died 994). His works were trans­ and this arises mostly from nearness to lated and printed 6 but their popularity was lepers and intercourse with them.” rather before than after the period of the invention of printing, when they became Again, as to the influence of air he says,13 almost entirely superseded by the writings citing Hippocrates that: of Rhazes and Avicenna. Haly Abbas dis­ “ Hot and moist air is injurious because tinguishes clearly enough between wind- in this state the air is more apt to receive borne diseases and those which are simply the putrefaction of others; and those of “ infectious.”7 In the latter group he places the same kind (as the infected) are more leprosy (goudham), scabies, phthisis, small­ especially apt to receive this putrefac­ pox, and ophthalmia— all diseases that are tion.” conveyed by intercourse with an infected person.8 Again 14: As regards influence on European medical “ If, in the course of an epidemic, some thought, the most important of all Arabic persons die suddenly, the cause is the writers is Avicenna (980-1037), whose pon­ putrefaction and the malignity of the air. derous Canon enjoyed a vogue from the For it is possible to live for some days twelfth to the seventeenth century and has without food or drink, but not for one probably been read more than any other hour without air suitable to be breathed.” text-book of medicine. Avicenna following In the same chapter he clearly enunciates Galen recognized the contagious quality of the miasma doctrine. “ lepra.”9 He regarded “ varioli” and “ mor- billi” as “ of all diseases the most con­ “ But corruption of the air, pestilence tagious.” 10 He laid, however, far more stress and epidemics are caused by stagnant on the factors of “ fermentation” within the waters without flow, which teem with 4 Rhazes, Liber de Pestilentia (i.e. mainly Variola), 9 Avicenna, Liber canonis, Lib. 4, fen. 3, tr. 3. cap. 1. cap. 1. 5 Ibid. AI Mansor. Lib. IV. cap. 24. 10 Ibid. Lib. 4, Fen. 1, Tr. 4, cap. 6. 6 At Venice in 1492 and at Lyons in 1523. 11 Ibid. Lib. 4, fen. 1, tr. 4, cap. 1. 7 Haly Abbas, lib. V, ch. 10 and n of the Latin 12 Avenzoar, The Tzir, Lib. II, Tr. VII, cap. 12. edition of 1523. 13 Ibid. Lib. Ill, tractatus III, cap. 1. 8 Seidel, Ioc. cit., quoting from the Arabic. We are 14 Ibid. Lib. Ill, tractatus III, cap. 2. unable to verify this statement from the Latin translations. T he Scientific Position of G irolamo F racastoro 19

fecal substances and effervesce, putrefy the visit must be rapid and accompanied by and smell, thus giving birth to fevers, every precaution.” He proceeds with a agues and mortal apostemata. . . . This philosophical and rational exposition of his epidemic which arises from the putre­ views on infections, and deals with objec­ faction of evil waters is worse than all tions not only on theoretical grounds but others.” also on the basis of experience. Averrhoes (died in Spain in 1198) in his A writer of the distinction of I bn al “ CoIIiget” takes a view of the nature of Khatib must have had many disciples, and contagion practically identical with that of when the stores of unexplored Arabic Avenzoar, and his medical work contains no medical works come more fully within the marked original elements. Indirectly, how­ purview of the Western reader, his theories ever, he did much to establish a rational and views will probably be found to be no doctrine of contagion by his effective phil­ isolated phenomenon. osophic opposition to determinism. This (d) Knowledge of Injection in Mediaeval enthusiastic follower of Aristotle thus suc­ Europe. ceeded in founding a school of thinkers who sought the direct physical causes of disease In no age and in no part of the world and epidemics just as for other natural have epidemics had a larger influence upon phenomena, and thus paved the way for the social conditions than in Western Europe methods of modern science. The doctrine of between the middle of the fourteenth and Averrhoes took root in Mohammedan Spain, the beginning of the sixteenth century. notwithstanding persecution, and with the That stretch of time opens with the appall­ eminent writer I bn al Khatib (1313-1374), ing visitation of the Black Death of 1347-9, who endeavored to completely liberate and closes with the epidemic outbreaks of prophylactic methods from the dead weight typhus, syphilis and plague that swept of philosophical determinism, we reach the repeatedly over the continent from 1490 to high-water mark attained by the Arabian 1540. Between these two larger groups of writers in this respect. As, however, I bn al visitations were many others of which the Khatib’s work was not translated or printed individuality is sometimes obscured by their until the nineteenth century,15 his views frequency and tendency to overlap. Time exercised little influence in Europe. He is and again influenza, plague, typhus, small­ especially interesting because he clearly pox, syphilis and sweating sickness devas­ believed the doctrine of fomites and is thus tated the overcrowded mediaeval towns, to be ranked among the predecessors of often spread by movements of armies or Fracastor. For prophylactic treatment of social upheavals, or associated with famines, the plague he advises, first “ a disinfection earthquakes, floods or other disasters. of the circumambient air by good cold The general medical ideas of the period smells, by flowery perfumes, etc.,” and were derived mainly from Arabian sources, secondly “ the avoidance of the places where but in part more directly from Greek one may suspect corruption from those sick medicine. In the matter of such immediate and dead of the disease, their clothes, vessels and vital importance as epidemics, however, and utensils, avoidance of entry into an the Middle Ages were not quite so devoid infected house or of approach to the neigh­ of originality nor so wholly dependent on borhood of the sick, or, if this is impossible, outside sources as in most other branches of 15 See M. J. Miiller in Sitzungsbericbte der konig- medicine. licben bayerischen Akademie der Wissenscbaften zu The repeated onset of epidemics gave rise Muncben, June, 1863. to a semi-original plague literature, mostly 20 Annals of Medical History in the form of tractates a few folios in clearly represented in verses of the school of length. This tractate literature was so ex­ Salerno, of the tenth or eleventh century,17 tensive and popular that there is no large where it is urged that in smallpox, “ Children general manuscript collection in Europe that should avoid touching the contagium of the does not contain examples. All languages are disease: (a) the sick person, (b) the breath represented. The mass of these plague trac­ of the sick, (c) the clothes, the coverings, tates are in Latin, but examples are known the garments and such clean bodies as he in English, French, Provencal, German, may have infected with his hand.” Italian, Flemish, the Scandinavian lan­ A belief in the three types of contagion guages, Hebrew, Arabic, Bohemian, Spanish is implied in a number of writings which and Portuguese. This tractate literature, appeared in the fourteenth and fifteenth which needs more extended study, yields us centuries. Thus in a “ plague regimen” put the best picture of the mediaeval beliefs as together by Cardo of Milan in 1378 we read to the nature of contagion. Many of the that one “ must take the greatest care in plague tracts point out that the ancients had approaching a plague patient since the air far less experience of the pestilence than was itself is contagious,” deriving this quality afforded to more modern writers, and that from the sufferer.18 Again Bartolommeo contemporary works were therefore more Santa Sofia (circa 1464) assures us that “ a valuable than the classics of medicine in man may carry the plague even though he regard to the treatment of this disease.16 have it not,” 19 and from an official publica­ In the medical literature of Greek and tion of the town of Nuremberg issued in Arabian origin the idea of contagion is never 1496 to guard against the spread of syphilis, so much emphasized as in some of the we learn that clothes were regarded as plague tractates written between 1350 and capable of carrying that infection.20 1500. There was indeed a gradual strength­ Views such as these are reflected in the ening of the belief in infection throughout writings of Boccaccio whose Decameron, the Middle Ages. Furthermore the distinc­ which first appeared about 1350, is based on tion between infection by contact and in­ the isolation of its actors during the Black fection at a distance that had been but Death of 1348. Boccaccio in his introduction lightly touched by the ancient writers, “ to the ladies,” writes that: assumes progressively a more and more “ The disease, by being communicated important role until finally at the hands of from the sick to the well, seemed daily Fracastor the whole group of ideas is sub­ to get ahead, and to rage the more, as mitted to a true scientific analysis. fire will do by laying on fresh com­ The three methods of infection, by con­ bustibles. Nor was it given by conversing tact, through the air and by means of only, or coming near the sick, but even fomites, seem to have been recognized in by touching their clothes, or anything the earlier Middle Ages. The conception is that they had touched. . . . Such I say 16 The plague tractate literature has been recently 1913, X X IV , 70—83. S. de Renzi, “ Flos medicinae studied by Dorothea Waley Singer, “ Some Plague Scholae Salerni,” Naples, 1889. Tractates,” Trans, of Royal Society of Med. His­ 18 Karl SudhofF, “ PestschriFten aus den ersten 150 torical Section, 1916, and K. SudhofF whose “ Pest- Jahren nach der Epidemie des ‘schwarzen Todes,’ schriften aus den ersten 150 Jahren nach der 1348, Archiv fixr Gescbichte der Medizin, Bd. V, 5, Epidemie des ‘ schwarzen Todes,’ 1348,” has been 1913, p. 319. 19 Ibid., p. 352. in progress in the Archiv fur Gesch. der Med. since 20 Karl SudhofF, “ Die ersten Massnahmen der 1910. Stadt Niirnberg gegen die Syphilis in den Jahren 17 A. C. Klebs, “ The Historic Evolution of Variola­ 1496 und 1497,” Archiv fur Dermatologie und tion,” Johns Hopkins Hospital Bulletin, Baltimore, Syphilis, CX VI, Heft 1, 1913, p. 3. T he Scientific Position of G irolamo F racastoro 21

was the quality of the pestilential matter, how, in my father’s time at Venice, a as to pass not only from man to man, but, suspected mattress was put by in a what is more strange and has been often gentleman’s house, and seven years later known, that anything belonging to the the mistress of the house ordered it to infected, if touched by any other creature be split open, and the servant who did would certainly infect and even kill that this was straightway seized with the creature in a short space of time. One plague.” instance I took particular notice of, name­ ly that the rags of a poor man just dead, The same four factors are repeated more being thrown into the street, and two hogs definitely by Widman who, writing in 1501, coming by at the same time and rooting tells us 22 amongst them and shaking them about in their mouths, in less than an hour turned “ That we have to consider in pestilence, round and died on the spot. These ac­ First, Susceptibility (passi dispositio) and cidents, and others of the like sort, oc­ what bodies are subject to pestilence. casioned various fears and devices amongst Secondly, the strength of the acting cause those people that survived, all tending to and what is the infective agent in the air, the same uncharitable and cruel end: in what way and with what force it acts. which was to avoid the sick, and everything At what season this evil quality is in the that had been near them, expecting by air which so strongly tends to the cor­ that means to save themselves.” ruption of the human frame. . . . Thirdly, whether there is actual contact or merely About the end of the fifteenth and the proximity of the agent to the patient, for beginning of the sixteenth century, great it appears that air may become pestilential stress was laid on these different methods in the same manner [as another object]. . . . by which infectious disease might be con­ And Fourthly, there is the question of the veyed, although the conception was often duration of exposure.” obscured by the importance attached to the factors of predisposition and of atmospheric Benedetti and Widman are typical writers influence. Thus in 1497, Alessandro Bene- of the period, whom we have selected to detti21 writes that: show what conceptions were available to Fracastor before the publication of his great “ Four factors by which bodies affect work. each other [with the plague] have to be An obscure writer, Remacle Fuchs of considered: (1) the actual strength of the Limburg (1510-1587), discloses an outlook infection, (2) the disposition of the on infection which even more definitely patient, (3) the nearness of the two bodies, approaches that of Fracastor. His work on and (4) the duration of exposure. . . . And the morbus gallicus or “ Spanish disease,” as so it comes about that while some are he called it, appeared in 1541.23 We may smitten down, others linger on in sickness quote him also as giving the contemporary and yet others recover. . . . It is indeed pathology of fevers and illustrating the remarkable how linen garments especially usual stress laid on obstruction of the can long preserve the pest. I have heard humors. Fuchs tells us: 21 Alexander Benedictus, “ De observatione in said to have been one of the first physicians in pestilentia,” Venice, 1497, ch. III. Europe to have openly advocated the use of mercury 22 Johannes Widman, called also Salicetus and in syphilis. Mechinger, Meichinger and Mochinger, “ Tractatus 23 Remacle Fuchs of Limburg, Morbi hispaniol, de pestilentia,” Tubingen, 1501, Ch. 1. Widman is quem alii gallicum alii neapolitanum appellant, 22 Annals of Medical History

“ The disease can be contracted merely V. THE CONTENTS OF THE “ DE CONTAGION- by contact and mutual intercourse, but IBUS” OF FRACASTOR. above all by sleeping constantly with “ The Different Types of Infection.” (Book infected persons or by touching their 1, Chapter 2.) garments, underclothes or linen which “ The essential types (prima differentia) of have come into contact with the ulcerated contagion are three in number: places. For the corrupted humors, passing through the porosities of the tissues, are (1) Infection by contact only. carried by the force of the pulse to the (2) Infection by contact and by fomites surface of the skin. And if, owing to their as scabies, phthisis, arese, leprosy (elephan­ adhesiveness and density, the humors tiasis) and their kind. I call fomites such cannot be insensibly exhaled, they corrupt things as clothes, linen, etc., which although the skin by their acid and biting quality not themselves corrupted, can nevertheless and give rise to ulcers from which flow foster the essential seeds (seminaria prima) virulent matter. This clings to neighbor­ of the contagion and thus cause infection. ing parts and corrupts and infects every­ (3) Finally there is another class of infec­ thing disposed to putrefaction. So dis­ tion which acts not only by contact and by eases, such as lepra, scabies, variola and fomites but can also be transmitted to a pestilential fever and putrid abscesses distance. Such are the pestilential fevers, pass from one person to another.” phthisis, certain ophthalmias, the exanthem that is called variola, and their like.” The distinction of the degrees of infection Remade Fuchs speaks also of the “ semi- is, as we have seen, by no means original narium” of disease, a word which he uses to to Fracastor, although the admirable clear­ translate the oiropafonbv of Galen.24 ness with which he classifies and discusses The doctrine of the three degrees of them is all his own. Notably the conception infection received full official recognition in of fomites is encountered in many earlier Paris during the pestilence of 1533, when a writings. The actual term fomes, however, police ordinance was printed and posted may have been introduced by Fracastor him­ over the town containing instruction for the self to express the special substance or carrier conduct of the citizens as well as of the in which the germs of disease may lurk. officials. In this ordinance the conveyance The word is used by Virgil to mean a from house to house of all substances likely “ touchstone” or “ tinder.” It is from the to act as fomites, such as bedding and same root as fovere which, meaning original­ clothes of the sick, was strictly forbidden. ly “ to keep warm,” came to imply in poetic Special medical attendants were appointed usage “ to keep warm for the winter,” “ to for the plague-stricken and were prohibited hibernate,” and so “ to lie hidden or latent,” from attending those suffering from other a shade of meaning which our author has diseases lest they might convey the infec­ transferred to his own special use of the tion.25 Thus the idea of the various degrees word. of infection and especially of infection by fomites was familiar both to medical men Infection by Contact Alone. (Book 1, and even to the laity before Fracastor Chapter 3.) formulated his doctrines in 1546. “ The infection which passes between curandi per Iigni indici quod Guayacum vulgo 25 This ordinance, a copy of which is now in the dicitur decoctum exquisitissimum methodus . . . British Museum, has been translated and in part Paris, 1541. Quotation from Chapter VI. published by Charles Singer. Annals of Tropical 24 Remacle Fuchs, Ioc. cit., ch. 1. Medicine and Parasitology, Vol. VI, p. 392, 1912. T he Scientific Position of G irolamo F racastoro 23

fruits is markedly of this kind, e.g. as elements. qualities. from one cluster of grapes to another and fire is hot and dry—rare from apple to apple. . . . The putrefaction air is hot and moist—intermediate that thus passes from one fruit to another water is cold and moist—intermediate is really a dissolution of the combination earth is cold and dry—dense (■mistionis) of innate heat and moisture These combinations thus form a series by the process of evaporation. with fire, exhibiting especially the quality of The humidity [thus set free] softens rarity at one end and earth exhibiting and relaxes the parts and makes them especially the quality of density at the other. separable, and the heat effects the sep­ In each element, therefore, occurs a definite aration. . . . I regard the particles of heat “ commistio,” dissolved only by the separa­ and of moisture separately, or in the case tion of one of the essential “ qualities” from of moisture, perhaps in combination as its fellow. This “ commistio” or as it is the essential germs of the resulting putre­ sometimes termed “ complexio” is made faction (esse principium et seminarium more complex by the fact that in matter as ejus putrejactionis) I speak here of the we encounter it, all the four elements are particles oj humidity in combination because themselves supposed to be mixed in various in the evaporative process of putrefaction, proportions. it often happens that the very minute Qualities such as moisture and heat were particles mingle themselves and thus thus regarded as having an existence apart generate new corruptions. This mingling from the material in which they exhibited or commistion is indeed especially favor­ themselves. The Mediaeval and Renaissance able for the propagation of putrefactions scientist was not as accustomed as we are to and infections.” distinguish vital from purely chemical phe­ The word mistio or commistio is a techical nomena. He therefore did not hesitate to term of mediaeval science and is of Aris­ import the same ideas directly into the totelian origin. It is used to denote the realm of physiology. The quality heat was manner and proportion in which the qualities thus identified with the warmth of living or the elements are mingled in any body. bodies. This warmth or innate heat was This must not be taken to imply a belief in given off, as needed, from the place of its “ elements” in the modern sense of the word, origin and storage, the heart. For health, a a conception which perhaps first finds no definite relationship and combination be­ place in scientific literature earlier than the tween heat and moistness (among other works of Robert Boyle in the seventeenth qualities) was considered necessary. If this century.26 In earlier writings, the concept of combination and relationship broke down, the elements implies rather the separable disease resulted. At death, the innate heat qualities or attributes which can be traced departed, a conception intimately related to back to Aristotle’s sets of opposing qualities. the “ abdication of the Archeus” of later (1) heat and (2) cold, (3) dryness and (4) writers. The sodden state of the tissues of a moisture, to which were sometimes added corpse was in like manner regarded as a (5) rareness and (6) density. From the com­ dissolution of the relationship of moisture patible binary combination or mistio of the and innate heat. A similar but less marked first four of these six qualities were derived dissolution of the same relationship was the four elements fire, air, water and earth. supposed to be exhibited in the oedematous Thus: and watery limbs of the dropsical or as a 26 Robert Boyle, “ The Sceptical Chymist,” First diathesis in moist and phlegmatic persons. edition, London, 1661. In other conditions, again, the qualities of 24 Annals of Medical History hotness and dryness were considered to be tion by fomes, on the other hand, he pre­ in excess. Such were phthisis and continued supposes invisible particles which convey fevers in which the patient wasted while the condition and which are capable of his temperature was raised. All these con­ lurking in the recesses of a pervious sub­ ceptions can be easily traced back to their stance. It is to these that he applies the Greek origins. term “ semina.” If we seek for a parallel in modern scientific conceptions we may per­ Infection by Means of Fomites. (Book i, haps compare the action of these to cat­ Chapter 4.) alytic action, provided always that we “ It may be questioned whether the in­ remember that Fracastor does not draw the fection by a fomes is of the same nature distinction between chemical action and the (principium) [as infection that acts only action of living organisms which is a com­ by actual contact]. The nature of infec­ monplace with us. tion by a fomes appears, indeed, to be different since having left its original focus Injection at a Distance. (Book 1, Chapters (primo infecto) and passed into a fomes it 5- 7-) may there last for long unchanged. It is, “ It is well known that the pestilential indeed, wonderful how the infection of fevers, phthisis and many other diseases phthisis or pestilential fevers may cling are liable to seize on those who live with to bedding, clothes, wooden articles, and the infected, although they have come objects of that kind for two or even three into no direct contact with them. It is no years, as we have ourselves observed. small mystery by what force the disease “On the other hand those minute par­ thus propagates itself. . . . For this type ticles given off by a body affected with of contagion appears to be of quite a putrefaction do not appear to preserve different nature and to act on a quite their virulence for long and on that ac­ separate method to the others. . . . Thus count are not to be regarded as of identical a patient with ophthalmia may give his essential nature (idem principium) either disease to another by merely looking at with those of fomites or with those that him (per vocatas species et simulacra act by contact alone. . . . Not all sub­ rerum). . . This well illustrates the rapid stances are liable to become fomites, but and almost instantaneous penetrative only those that are porous and more and power of this type of contagion . . . more or less calorific, for in their recesses which may be compared to the poisonous the seeds of contagion can lurk hidden glances of the catablepha.” and unaltered either by the medium itself The catablepha is one of the few instances or by external causes, unless these are in which our author describes an event excessive, e.g. they cannot withstand fire. which we should regard as miraculous. The Thus, iron, stone, and cold, impervious description of the creature doubtless reached substances of this kind, are hardly likely him through Pliny 27 where we read: to act as fomites; on the other hand linen, cloth and wood are much more apt to do “ In the eastern part of Ethiopia is the SO. yy source of the Niger and, as many think, of Fracastor here regards the “ seeds of the Nile also. There dwells a savage beast disease” as comprising two distinct groups. called the Catoblepas, small in size and Infection by contact, he has already ex­ slow of movement, and with a head of plained as comparable to what we may call disproportionate greatness and only with coarse chemical action. In the case of infec­ 27 C. Plinius Sec. Naturalis historia, V III, 21. T he Scientific Position of G irolamo F racastoro 25

difficulty borne so that it carries it always halitus of an onion—which we can ap­ on the ground. The animal has eyes which preciate by the sense of smell—can produce are fatal to mankind, for all on whom it a watery discharge from the eye, why should looks fall suddenly dead. The basilisk has not the halitus of an ophthalmia, acting the same power.” similarly at a distance, produce a purulent discharge? Furthermore many such sub­ Before the invention of the microscope stances may have the properties of poisons and the resulting discovery of minute living or of remedies. Men may be suffocated by things it was just such analogies that vapors or they may be revived from faint­ afforded suggestions for the mysterious ing by the minute particles that make up conveyance of infectious disease. Through­ subtle and acrid smells. There is this differ­ out the sixteenth and the following century, ence between such exhalations and those of the works of the ancients, as well as travel­ disease; the former act at once, the latter ers’ tales of newly discovered countries, after an interval or incubation period. Here were ransacked again and again to provide Fracastor has an hypothesis ready: such analogies for the process of infection. The last hours of many a wretched sufferer “ One method of penetration of the seeds must have been embittered by the sordid of infection is by propagation and genera­ fear of his companions lest a touch or even tion (sobolem). For the seeds attach them­ a glance or a word from him might convey selves to those humors with which they some dread disease.28 The kindred belief in have an affinity and produce others like the evil eye lingers yet in Fracastor’s to themselves, until at last the whole mass country. and body of the humors is affected. In the passage above quoted, Fracastor Another method is by attraction and meets with the first great difficulty of the entering by inspiration or by dilatation of germ theory, the passage of infection from the vessels. For when the admixed semi- one body to another through intervening naria are sucked in with the breath, though space. He hastens to assure us, however, that it is easily inhaled it is not so readily “ the causes of infection acting at a distance exhaled and may thus adhere to the need not be referred to occult influences” humors and even the spirits which, and proceeds to elaborate a suggestion as to expelling that which is contrary and how “ the seeds of contagion may be carried inimical, send them to the heart.” to a distance and on to the world at large” The Affinities (Analogic) of Infections. (Chapter 7). This doctrine we may call the (Book 1, Chapter 8.) theory of halitus or doctrine of exhalation. It was very popular in the sixteenth century “ The affinities (analogise) of infections and was further elaborated by Hieronymo are numerous and interesting. Thus there Cardano (1501-1576) and Andrea Cesalpino are plagues of trees which do not affect (1519-1603). The theory supposes that all beasts and others of beasts which leave bodies, and especially the more moist and trees exempt. Again among animals there volatile, are constantly giving off particles are diseases peculiar to men, oxen, horses that may make themselves appreciable to and so forth. Or, if separate kinds of living the senses as vapors or odors. If the creatures are considered, there are diseases affecting children and young people from 28 A good collection of stories concerning the which the aged are exempt and vice versa. miraculous conveyance of disease by glances, etc., may be found in a work by the learned Alexander Some again only attack men, others Ross, the opponent of Sir Thomas Browne, entitled women, and others again both sexes. “ Microcosmography,” London, 16. There are some men that walk unharmed 26 Annals of Medical History

amid the pestilence while others fall. preliminary stage in which there is a Again there are infections which have certain amount [of the same preliminary affinities for special organs. Thus oph­ type] of putrescence. It is, however, latent thalmia affects only the eye. Phthisis has because putrefactions which take place in no effect upon that most delicate organ the living animal do not make themselves but acts especially upon the lungs. AIo- immediately apparent. It is an observed pecise and Arese confine themselves to the fact, however, that dogs which are becom­ head.” ing rabid are usually seized with febrile symptoms. If, therefore, we regard the Is Infection a Sort of Putrefaction? (Book matter inductively (si igitur in omnes i, Chapter 9.) contagiones inductio fiat), we shall consider “ We here consider whether all infection that all infections may be reduced ulti­ is a sort of putrefaction and also whether mately to putrefaction. . . . Furthermore, putrefaction is not itself infectious. . . . all putrefactions are liable to produce Now with Rabies have we not infection putrefactions of like kind to themselves, without any putrefaction? Again, when and, if all infection is putrefaction, in­ wine becomes vinegar have we not infec­ fection in the ordinary sense of the word is tion without putrefaction? For, if left to nothing else than the passage of a putrefac­ putrify, it is later that it becomes fetid tion from one body to another either con­ and undrinkable—the sure signs of putre­ tiguous with it or separated from it.” faction—and thus differs from vinegar The use of the word generation in six­ which is pleasant to take and is indeed teenth century science is often puzzling. resistant to putrefaction. The term is constantly used by chemists But it must be remembered as regards and alchemists, e.g. Paracelsus, Campanella putrefaction that sometimes there is but and Comenius, without any thought of a simple dissolution of the combination attributing specifically living properties. (mistio) of humidity and innate heat with­ The conception is adopted from the Aris­ out any new generation—we then speak totelian system in which generation is the of it as simple putrefaction. Sometimes on equivalent of the coming of a thing into the other hand, in the process of this being and is the opposite of decay or cor­ dissolution, there is a true animal genera­ ruption which is the passing of a thing out tion or generation of some substance of being, both being regarded as varieties of definitely organized and arranged (gen- motion, a term that also had for Aristotelians eratio aliqua provenit aut animalis aut a meaning wider than is now given it.29 We alterius quod formam unam et certam habet must therefore note again that a vitalistic et mistionis rationem, ac digestionem suam). interpretation must not be placed on the When there is simple putrefaction, there word generation as used by Fracastor. is no new generation but a fetor and a horrible taste arise . . . but when, on the In What Respects Infections Resemble Poi­ other hand, there is production of a new sons and in What They Differ. (Book 1, Chap­ generation, there is neither the abominable ter 11.) smell nor taste but a definite redistribu­ tion of the qualities (digestio ordoque “ There are certain infections which partium pro certa forma). As with wine resemble . . . poisons, since, like them, . . . so also with milk and with phlegm, their venom lies insidiously latent until, the first stage of putrescence is acidity. 29 Aristotle, “ De motu animalium,” Sect. 5, and Similarly with Rabies, we must suppose a the “ De corruptione et generatione.” T he Scientific Position of G irolamo F racastoro 27

having reached the heart they kill the they have the power to propagate and animal and on this account certain fevers reproduce their own kind.” are frequently called venomous. But there In order to explain the first origin of a is really a great distinction between them. fever, Fracastor associates with his view of Poisons cannot in themselves produce pu­ putridity of the humors, the current theory tridity, nor can they reproduce in a second of “ obstructions” of the humors. The body such seeds and essence oj their nature humors in health were represented as as may be in that primarily affected. Those perpetually flowing, and many pathological who are poisoned do not infect others. appearances such as abscesses, pulmonary Now of poisons there are two kinds. tubercles, lymphatic nodules and fibrotic The one acts through its spiritual quality. areas were interpreted as due to the inter­ Such is the poison of most serpents and ruption of the flow and the consequent glance of the Catablepha. The other acts humoral change, which led to their solid­ through its material quality.” ification. Concerning Other Differentiae of Infections. “ As has been said there is a power in these (Book i, Chapter 12.) seeds that they may multiply and propagate their like. Those causes then which pro­ “ It is manifest that the seeds of con­ duce obstructions, plethoras and corrup­ tagion arise first in ourselves. This takes tions of the humors by which they place not only in scabies, achores, and become fouled, putrified and occluded phthisis but even in the pestilential fevers. give rise to seeds that can convey the The production of these is as follows: the infection to others, whether the same corrupted humors being obstructed are causes and dispositions be acting in those delayed and finally stopped, they give others or not, whence they may carry the rise to these seeds. That these [seeds] are same contagion to a second and third. the carriers of the contagion we have said But the essence and seminaria of con­ above, and that they are the first origin tagion may also come to us from an of the disease there can be no doubt. It extrinsic source. Thus we see diseases is a more vexed question whether in one spreading in the population as a whole. secondarily affected, there is the same Epidemics as they are called, of which putrefaction of obstructive and corruptive some, though not contagious, may affect origin or no. For if not how do the new many cities or regions and are then called seeds arise which enable a third person to communes; others again of these are con­ be infected? But if this putrefactive pro­ tagious and pass from one to another cess does ensue, how can it arise when the without atmospheric disposition, these same causes are not acting in the second are called non communes.” body that were acting in the first? . . . To this it must be answered that there Thus Fracastor also declares his belief in is indeed produced in the second body an the spontaneous generation of the semina or obstructive and corruptive putrefaction rather he assumes it as a matter of course. . . . and that this process is produced by Since no question of universal biogensis the clogging effect (inhaesionem) of the such as that professed to-day had or could same seeds. Thus the essence (principium) have reached Fracastor, the whole question and seeds of the disease were exactly the as to whether he regarded his “ seeds of same in the second body as in the first disease” as living or not has very little and it may be considered that the force meaning. The lower animals were regarded of the disease lies in those seeds, since by him and his contemporaries as frequently 28 Annals of Medical History

“ generated” from mud and slime, a belief It should perhaps be considered often referred to Aristotle but which could whether any contagions are derived from be traced with more reason far beyond him the heaven and from the stars since and back to the realm of primitive belief. astrologers have often foretold future dis­ For writers of the sixteenth century the gap eases and epidemics. At any rate it that was later recognized between the appears that they foretold the syphilis organic and inorganic world did not exist, or morbus gallicus many years before it and the cleavage between materialists and appeared.” vitalists had therefore not assumed any definiteness. It may be at first startling to find a belief The chapter continues with an interesting in astrology expressed by one so tempera­ reference to an epidemic of typhus and mentally sceptical as Fracastor. It must be another of foot and mouth disease. remembered, however, that in the first half of the sixteenth century the influence of the “ That pestilence which swept through planets on human affairs was the working Greece and is described by Thucydides hypothesis of the advocates of Naturalism. was contagious and so were those which It was a view of Nature that stood in broad have in our time appeared in Italy and opposition to the theocratic teaching of are by some called lenticulae, by others Christianity. The theory thus occupied a puncticula. We may refer also to the place among the naturalistic school some­ extraordinary infection of the year 1514 what similar to that filled by the Theory of which broke out in cattle which appeared Evolution in the last third of the nineteenth first at Friuli and thence spread to our century. district. The beast would first refuse food Thus closes the first book of the De without any reason that could be dis­ Contagionibus. With the two remaining cerned in the mouth by the herdsmen, books we are hardly concerned here. The then a roughness with little pustules second describes the varieties of infectious became distinguishable on the palate and disease known to Fracastor and includes throughout the mouth. If the infected phthisis. The third deals with remedies. beast was not segregated without delay We may terminate our extracts with Fra- it would infect the whole herd. Slowly castor’s description of epidemic typhus the tetter (labes) would reach the feet. If which he tells us broke out with especial a change then set in, they almost all virulence in his country in 1505 and 1528, recovered, but if it did not they mostly though it had been known previously in died.” Cyprus and the neighboring isles. His There follows a declaration in the belief description of this disease gives a fair idea of the celestial origin of some epidemics and of his clinical method. a statement of the value of astrology. “ This fever is infectious but it is not “ Of the causes which act from without conveyed through the air (ad distans) nor the most potent is air itself though waters by fomites but by the actual handling of and marshes have also their influence. the sick. The onset as with all pestilential Now it must be remembered that air fevers is insidious (placidus) and mild so varies in quality with heating, cooling, that the patient hardly desires to see a drenching, and drying, and not only so doctor and thus many physicians have but vapors pass into our bodies both been misled looking to an early resolu­ simple and also containing seminaria of tion of the malady. Soon, however, the contagion. . . . signs of a malignant fever put in an T he Scientific Position of G irolamo F racastoro 29

appearance, and after the manner of such hypothesis expounded by Fracastor’s work disease, the patient may not feel marked is to be sought in the atomic theories of febrile symptoms yet constitutional dis­ Democritus and other early Greek writers. turbance (perturbatio interne) becomes This atomistic view of matter was developed obvious. There is prostration and lassi­ by Epicurus and his followers, as well as by tude of the whole body, as though he were their opponents of other schools. In the exhausted. He lies supine, the head aches, hands of Lucretius, atomism is very definite the senses are dulled, the mind wanders, but is associated with a conception of growth the eyes are reddened and he chatters or development in nature, whereby many constantly. things are regarded as arising from “ seeds” “ The urine is at first copious and clear, or semina by the attraction to these semina later it becomes ruddy and turbid like of other material particles. pomegranate wine. The pulse becomes In spite of the opposition to Epicurean­ small and slow, the motions corrupt and ism, of the non-materialistic schools of later fetid. About the fourth or seventh day, Greek thought, views on the atomic nature reddish spots appear on arms, back and of matter were largely absorbed by the chest. Often they are punctiform like flea Gnostics, Basilidians and Neoplatonists: al­ bites or larger and of the size of lentils. though, among all these sects, the philo­ “ There is little or no desire for drink but sophical necessity of deriving the Universe the tongue is covered with sordes. Some in some way from the ultimate divine patients are somnolent, others restless, in essence or logos enforced the addition of the others the conditions alternate. This state element of generation, an idea that is ex­ continues for seven or fourteen days or cluded in the system of Lucretius. Thus even longer. In others, there is reten­ among these mystically inclined sects we tion of urine, a sign of the utmost gravity. find the conception of the material universe Women seldom die of this disease, old as a whole and also its constituent parts people seldomer and Jews never. It chiefly arising in turn from such seeds planted by carries off the youthful and especially the the godhead. In a Gnostic work of the third gentle, contrary to the pestilences which century attributed to Hippolytus, we read rage among the poorer classes. The follow­ how before the Universe yet was: ing are of evil prognosis: “ The seed of the cosmos had all things in “ If the patient feels prostration at the itself; just as the mustard-germ gathers onset of the disease, if, when he be given together in the tiniest point and holds a medicine, the result is out of proportion at the same time—roots, stem, branches, to the dose, if no relief comes from the and leaves, the countless products of the crisis (we have seen a case where three one plant’s germs, when other and still measures of blood burst from the nose many other plants shed in turn their and shortly after the patient yielded up seeds,” and the same writer speaks re­ the ghost). It is an ill sign if there is peatedly in the same phrases as Lucretius retention of urine, if the eruption does not but with a different meaning of “ the seed appear or is but slight or if it is livid and power of the seeds of every kind of thing very spotty. If all or many of these are that is in this material world.” 30 present, a fatal issue is certain.” VI. 30 See E. Miller “ Origenis philosophumena, ” VI. THE SOURCES OF FRACASTOR’s SEMINARIA Oxford 1851 and L. Duncker and F. C. Schneidewin, “ S. Hippolyti Ref. Om. Haer,” Gottingen, 1859. The HYPOTHESIS work is translated by G. R. S. Mead in “ The Quest, ” The ultimate source of the seminaria V, 1, p. 58, Oct. 1913. 30 Annals of Medical History

Such Gnostic or Neoplatonic conceptions ence to the “ seeds” of diseases, and although were seized by St. Augustine (354-430), who these Lucretian seeds were by no means transmitted them to later times. Augustine identical with those of Fracastor, it may be considered that God had deposited in safely assumed that the Renaissance writer matter a hidden treasure of active forces. owed a large element in his conception to These were the seminal principles or rationes his Epicurean predecessor. “ I will explain,” seminalesf1 whose successive germination writes Lucretius, “ the law of diseases ” . . . in the womb of matter produce the different “ I have already shown that there are species of corporeal beings. There was, he seeds of many things helpful to our life, considered, a distinct germ corresponding to and there must also be many that fly each natural kind or species of body.32 This about conducing to death and disease. Augustinian conception lasted right through When these by chance happen to gather the Middle Ages. The saintly mystic St. together and disorder the atmosphere the Bonaventure (died 1274) had recourse to air becomes distempered.” 35 these rationes seminales in order to dis­ Again in another part of the poem the tinguish mere transformations of natural disease of erysipelas is described as arising substances from creation and annihilation,33 from such seeds.36 and the same position was assumed by Fracastor’s “ seeds” of disease combine Albert the Great (1193-1280), who in this some of the qualities of the “ semina” of respect deviated from the Aristotelian notion Lucretius with the “ seeds” of the species of primal matter purely potential. The of things in the patristic writings. It is works of both Bonaventure and Albert were noteworthy that, in setting forth his seminal very frequently printed in Italy in the latter hypothesis, Fracastor does not seem to con­ fifteenth and early sixteenth centuries. sider that he is making any especially But there was another and more direct original contribution. He rather assumes a source of the doctrine of seminaria than knowledge of “ semina” on the part of his either the Church fathers or the scholastic readers and does not attempt to explain doctors that lay open to a sixteenth century their essential nature. It is on this applica­ humanist. The work of Lucretius himself, tion of the theory rather than on the theory neglected throughout the Middle Ages as itself that he spends himself, and it is Fra­ Epicurean and antitheistic, had been dis­ castor’s specific use of the terms “ semina” covered by the scholar Poggio as early as and “ seminaria” which was so pregnant with 1418. The first printed edition of the “ De suggestion in his own and the following rerum natura” appeared at Brescia in 1473 centuries. and it was reprinted in Fracastor’s own city of Verona in i486. Moreover, Navageo, VII. KINDRED HYPOTHESES OF SOME OF Fracastor’s most intimate friend and a fracastor’s CONTEMPORARIES fellow pupil of Pomponazzi, reedited Lu­ cretius for the Venice Aldine edition of 1516. With a Discussion of the Influence of the The atomic theory of Lucretius was thus Doctrine of Seminaria quite familiar to Fracastor.34 Now in the The sources from which we have sug­ De rerum natura we may find actual refer- gested that our author derived his views

31 St. Augustine De gen. ad Iitt., VII, 28. rerum,” Ch. 5. “ De attractione et motu similium 32 See Maurice de Wulf, History of Mediaeval Phi­ ad similia.” losophy translated by P. Coffey, London 1909, p. 93. 35 Lucretius De rerum natura, Lib. VI, line 1090 33 M. de Wulf, Loc. cit., p. 287 and Quaracchi, et seq. in H. A. J. Munro’s edition. edition t 11. p. 198. 36 Loc. cit. Lib. VI, line 660 in H. A. J. Munro’s 34 Cp. Fracastor’s “ De sympathia et antipathia edition. T h e S c i e n t i f i c P o s i t i o n o f G i r o l a m o F r a c a s t o r o 3i were open to others besides Fracastor. Of which they call Humors. [Thus the these we have already mentioned Remacle Elements of the Macrocosm are equated Fuchs of Limburg, who uses the word semi- with the Humors of the Microcosm]. naria in much the same sense as Fracastor Now the Elements (like the Humors) himself. Another contemporary who dwells give naught but only receive. And even on the same theme was Paracelsus (1490- as a woman cannot become pregnant 1541). Life this writer regarded as a per­ without a man, so must the feminine petual germinative process, controlled by an Elements receive from their man as from indwelling spirit or Archeus. Developing the aforesaid Vulcan [i.e. the Elements this idea, Paracelsus attained a sufficiently must act the part of the female Venus clear conception of the method by which towards the seeds which are the male disease is propagated to lead him to speak Vulcan], as this following example show- of the morbific ‘‘ seeds.” eth forth. The apple groweth from its seed Whatever may be the verdict on this and the seed is in the apple, and is the extraordinary man as a pioneer of medical Sperm of Vulcan. But in the Elements it thought, it is certain that he had none of findeth a Matrix, it taketh therefrom the clearness, brevity and skill in classifica­ Nourishment, Substance, Form and its tion of his humanist contemporary Fra­ complete Being and it emergeth therefrom castor, nor had he the same power of con­ according to the nature of its Predestina­ secutively developing a subject. We here tion, as a child emergeth complete from quote a passage involving the theory of out of its mother. “ semina” from his work, “ The Doctor’s Labyrinth.” 37 The chapter gives a fair idea [i.e. the seed of the apple acts as male to of the intricacies and difficulties of his style. the substance or elements of the apple We have added a certain amount of explan­ which are female. It must be remembered atory material derived from other parts of that Paracelsus knew nothing of sex in the same work. plants or of the fertilization of flowers necessary to produce fruits. He sought, how­ Of the Book of the Birth of Diseases, to be ever, like many after him, to bring the Recognized from the True Philosophy. generation of plants, which was for him an apparent case of equivocal generation, into “ One thing further it is necessary to line with the better understood types of explain, namely the origin of diseases sexual generation], according to the content of philosophy. Thus you all know well that the ancients “ Thus diseases are caused not by the set forth the teaching of the four Humors, Elements themselves but by the seeds which how that from them all diseases arise and are sown therein, which accordingly grow in them they take their birth; but they in them into their final being and material. forget withal the veritable origin of disease, . . . He then who would understand that is, from the seeds from which the dis­ Disease will recognize it under the simile eases grow. None the less, I know full well of a tree. One will bear apples, another that man is a Microcosm, wherefore he pears, another nuts and so on. Thus also must have within him the four Elements is the difference between diseases, and thus shall diseases be recognized accord­ 37 The “ Labyrinthus medicorum errantium” first ing to the Humors, that is according to appeared in 1553 after the death of Paracelsus. We have not been able to see the original edition but the Father and not according to the have translated the passage from the version in Mother. The child is truly born of the Huser’s edition, Strassbourg, 1598. Mother, but also of the Father. Who 32 Annals of Medical History

therefore will say or admit that one was suggestive and subtle rather than direct should seek the disease as a Humor and and obvious and we may continually meet judge the Humor to be the Disease?” his phrases quoted, often perhaps uncon­ Another interesting contemporary of Fra- sciously, by the writers of his own and the castor was Jerome Cardan (1501-1576), who succeeding age. His name may for our although he did little directly to develop present purpose be specially associated with the theory of infection, yet made suggestions the belief that the seeds of disease are truly that in the hands of others became exceed­ living. Cardan regarded the inorganic world ingly fertile. Cardan’s conception of matter as animated no less than the organic, while as more or less animated was derived either in his suggestions that all animals were from the Timseus itself or more probably originally worms and that all creation is of from some Neoplatonic author. It was Car­ the nature of a progressive development, a dan who gave a hint to many writers of the view shared to some extent by his contem­ succeeding century who combined his con­ porary Paracelsus,38 we may discern the ceptions of animated matter with the views germinal ideas of some modern philosophic of Fracastor on the semina of disease. The and scientific conceptions.39 early Epicurean thinkers, like modern ma­ Suggestions similar to those of Cardan, terialistic writers, had sought to bridge the but bearing even more directly on the gulf between atoms and living things by subject in hand, were made by Victor de explaining life as due to atomic action. Bonagens (1556), who freely compared the Cardan, the Neoplatonist, like Plato in his generation and conveyance of fevers to Timseus before him and like Leibnitz and the putrefactive processes which produce many after him, got over the difficulty by “ worms” in corpses.40 In dealing with the attributing living qualities to the atoms question of fomites de Bonagens shows themselves. considerable grasp of Fracastor’s theories, The discursive style of Cardan has none and he cites Scabies especially in this con­ of Fracastor’s accuracy, although, when deal­ nection. ing with purely mathematical or physical Among the early writers who contributed questions, he could be incisive enough. In somewhat to develop Fracastor’s theories the writings of Cardan, we should seek in are Thomas Jordan (1576)41 and Johannes vain for the worked-out conclusions that we Marinelli (1577).42 Both of these authors now associate with scientific authorship. not only accepted the theory of seminaria Nevertheless, his volumes of hazy philosophy but also described the seeds as multiplying contain buried in their learned and ingenious themselves in their state as seeds and thus pages a mass of original and suggestive helping to spread the contagion wider. In thought bearing on scientific subjects that the conception of these two writers, there­ is probably not exceeded in importance by fore, the seminaria are more definitely vital any writer of his century. As an author he than in the work of Fracastor. This point 38 The worm-like original of animals is fore­ Ioc. cit. Vol. 11, pp. 67-87, and elsewhere. For the shadowed by Aristotle (Historia animalium, Book vermicular origin of all animals see De varietate, V, eh. 17) and could doubtless be traced forward Lib. VII 76. De subt., Lib. IX. through Neoplatonic and Gnostic channels. 40 Victor de Bonagentibus or de Bonagens “ Decern 39 Cardan’s scientific views are contained mainly problemata de peste,” Venice, 1556. in his De subtilate, first (imperfect) edition Nurem­ 41 Thomas Jordan, Pestis phenomena seu de iis qual berg, 1550, second edition, Paris, 1551, and his De circa febrem pestilentem apparent exercitationes, varietate, 1556. For a careful analysis of the difficult Frankfort, 1576. subject of his views on the essentially living nature 42 Joannes Marinelli, De peste ac pestilenti contagii of all matter see the analysis of Rixner and Siber, liber, Venice, 1577. T h e S c i e n t i f i c P o s i t i o n o f G i r o l a m o F r a c a s t o r o 33 was made by none better than by Francis- of the microscopists of the following century, cus Alphanus (1577)43 who wrote that “ both who interpreted the blood corpuscles, which infection and contagion come primarily from they really did see, in the light of the hypo­ certain minute particles. These particles, thetical corpuscles of Falloppius, Fracastor however, are themselves infected by mediat­ and others. The lines in question in Fal­ ing seeds called by some seminaria. For seeds loppius’ book may be translated as follows: have power to generate that which is similar to themselves and these seminaria [like “ Every contagious disease spreads itself seeds] proceed from one case to another throughout the whole infected substance. generating that disease from which they Thus in phthisis, this force of contagion were derived.” is conveyed by the vapor which comes Further progress was made by another from the lungs. This vapor contains obscure Italian writer, Jacob Trunconi,44 certain minute corpuscles of the blood, who in 1578 published at Florence a work on which issue forth with the breath, and the Pest which showed the influence both of are spread by the circumambient air. Fracastor and of Cardan. Accepting the So they are attracted to the lungs of seminaria hypothesis of Fracastor, he at­ another, and if they thus reach a suitable tributes living qualities to the particles as soil, they infect it and communicate the they are given off by the stricken patients, disease.” and speaks of them as “ breeding” (pul- lulantes) and bringing forth after their kind Fracastor’s works were widely read from and thus playing the part of agents in the the very date of their publication, and his spread of disease. He compares the appear­ brilliant exposition of the essential nature of ance of these “ semina” of disease to the infectious diseases held the field against the breeding of animals in stagnant waters and similar hypotheses of Paracelsus, Cardan, de swamps and thus attributes to them fully Bonagens and others. For three centuries vital function. A hazy follower of Cardan following his death, however, the views along somewhat the same lines as Trunconi generally held were in the main retrograde was the mystical Paracelsist, Roch le Baillif, as compared to his. The great majority of Sieur de la Riviere (died 1603),46 but more writers who quoted him (with or without definite contributions were made by the acknowledgment) were mere copyists who versatile Gabriel Falloppius (1523-1562) added nothing to the conceptions of the whose premature death prevented the fur­ master, and it would be impossible to ther development of his views. In a post­ mention here even a tithe of those sixteenth- humously published work, Falloppius 46 con­ century writers on the plague and other nected the living and exhaled corpuscles infectious diseases who owed their theories more especially with phthisis and syphilis. entirely to Fracastor. Among those of his One passage in this book might indeed be countrymen who comprehended him more interpreted as implying a knowledge of the thoroughly may be mentioned the botanist, corpuscles of the blood. This and similar Pietro Andrea Mattioli (1554),47 who applies passages were a stumbling-block to certain the theory specially to rabies, Giovanni 43 Franciscus Alphanus, Opus de peste et febre noistre quel element Ies excite . . . Paris 1580. maligna necnon de variolis er morbillis quatenus 46 Gabriele Falloppio, De morbo gallico tractatus nondum pestilentes sunt, Naples, 1577 (Ch. V). 1564. Quotation from Ch. X X I. De modo genera- 44 Jacobo Trunconi, De peste and pestilenti morbo tione morbi gallici. An edition of 1563, which we have Iibri quatuor . . . Florence, 1578. not seen, is also known. 45 Roch Ie Baillif, Sieur de la Riviere, Du remade 47 Pietro Andrea Mattioli, Commentarii ad Iibros a la peste charbon et pleurisie et du moyen cog- sex pedacii dioscoridio, Venice, 1554. fol. 34 Annals of Medical History

Francesco Boccalini (1556),48 Hieronymo mesnil (Jul. Palmarius 1576),57 Francis Val- Donzellini (died 1560),49 Giovanni Phillipo Ieriola (died 1580),58 and Francois de Cour- Ingrassia (1510-1580),50 Andrea Gratiolo di celles (1595),59 as well as by the anatomist Salo (1576),51 Thomaso Somenti (1576),52 John Guinter of Andernach (1487-1574)60 Pietro Sali (1583),53 and Diomedes Amico the teacher of Vesalius, and by the Spaniards (I599)-64 Aloysius Toreus (1574)61 and Nicolao Bocan- There is throughout the history of the gelino (1600).62 Especial mention should be subject a recrudescence of theories of the made of Jerome Mercurialis (1530-1603), nature of infection with every large epidem­ the distinguished writer on gymnastics, who ical outbreak. In the last decade of the six­ followed Fracastor very closely. Mercurialis teenth century, eastern Europe was devas­ shows much acumen in discussing the spec­ tated by a widespread outbreak of typhus ificity of the viruses of different contagious fever, and a large literature arose on the diseases as well as in developing the doctrine subject of the “ Febris Ungarica.” The of fomites.63 peculiarly infective properties of this disease With the seventeenth century the views gave a great stimulus to the “ seminaria” of Fracastor became so widely accepted that hypothesis which was lucidly expounded to give a list of the authors who quote him in several works on the Hungarian dis­ or accept his views would be to provide a temper.55 fairly complete medical bibliography of the Fracastor’s doctrines were closely followed period, and as the overwhelming mass of also by the learned French physicians J. A. this literature is mere repetition we may Saracenus (1572),56 Le Paulmier de Grente- here part with our subject. 48 Giovanni Francesco Boccalini, De causis pesti- 86 J. Antonius Saracenus, De peste commentarius Ientialibus urbem Venetani opprimentis, Venice, in quo praeter pestis naturael, praecautionis etiam 1556, 80. atque curationis ipsius uberiorem explicationem, non 49 Hieronymo Donzellini, De natura, causis et pauca quae super eadem materia hoc nostro secula Iegitima curatione febris pestilentie, Venice, 1570. et coelo in contentionem plerumque veniunt obiter 80 Giovanni Philippo Ingrassia, Informazione del strictimque tractantur, Lyons, 1572. pestifero e contagioso morbo il quale afflige et have 87 Le Paulmier de Grentemesnil, De morbi con- afflitta questa citta di Palermo e moltre altre citta tagionis Iibri septem . . . De lue venerea Iibri duo; a Terre di questo Regno di Sicila nell’ Anno 1575 et Paris, 1578. 1576. Data alio invittissimo et Potestissimo Filippo 88 Francis Valleriola, Loci medicinae communes, Re de Spagna, 1576. tribus Iibris digesti; Lyons, 1562. 81 Andrea Gratiolo, Discorso de peste . . . con un 59 Francois de Courcelles, Traite de la peste clair catalogo di tutti Ie Peste piu notabili de tempi et tres utile . . . Sedan, 1595. passati, Venice, 1576. 60 Johan Guinter or Winter of Andernach, De 82 Thomas Somenti, De morbis qui per finitimos pestilentia commentarius in quatuor dialogos, populos adhuc grassantur, et nunc illi ad pestilentes 1565. referendi sint, post prima responsa Mantua allatu, 61 Aloysius Toreus, De febris epidemicae et novae, brevis disputatio, Cremona, 1576. quae Latine puncticularis vulgo tavardillo et pintas 83 Petrus Salius Diversus. De febre pestilenti dicitur, natura, cognitione et medela . . . Burgos. tractatus et curationes quorundam particularium 1574. The book is interesting as identifying the morborum . . . atque annotationes in artem medi- tabardillo with typhus fever. cam . . . Bologna, 1583. 62 Nicolao Bocangelino, De morbis malignis et 84 Diomedes Amico, De morbis communibus liber pestilentibus causis presagiis et medendi methodo . . .Venice, 1596,40. Tractatus tres, Venice, 1599, and . . . Madrid, 1600. An edition in Spanish was De morbis sporadibus opus novum, Venice, 1605, 40. printed in the same year. 88 E.g. the Jesuit Balthasar Conradin, De febris 63 Hieronymo Mercurialis, Praelectiones patavii ungaricae ej usque symptomatum curatione, Passau, habitu 1577 in quibus de peste tractatur. De peste 1594, and Martin Rulandus (filius) De morbo in universam, praesertim vero de Veneta et Patavina. Ungarico, Frankfort, 1600, and other editions. Venice, 1577. THE GREEK CULT OF THE DEAD AND THE CHTHONIAN DEITIES IN ANCIENT MEDICINE

B y FIELDING H. GARRISON, M.D. WASHINGTON, D. C.

“ Mortui placantur sacrificiis, ne noceant.”

T is seldom that the aims of classical cult of the soul is developed at length from philology have been more nobly justi­ the vague traditional lore of the Homeric fied than in Rohde’s “ Psyche,” 1 that poems up to its culmination in Plato. It is remarkableI synthetic work in which one of shown that the Greek doctrine is analogous the most interesting of human cults, the be­ in its origins to the genesis of similar ideas lief of the ancient Greeks in the immortality in all primitive peoples. The savage’s con­ of the soul, has been made to stand out in clusions are drawn from the experience of almost definite outlines from the bare de­ dreams and other unconscious or ecstatic tails, sometimes the most shadowy hints, states, and so it was with the Greeks. in the classical writers. “ Psyche” is to If we contrast Rohde’s exegesis with Greek mythology what Frazer’s “ Golden the famous essay of Lessing,2 the former Bough” is to comparative folklore. Over seems like an expanded series of symphonic the carefully inlaid mosaic of footnotes is variations upon the theme of the elder woven an argument of singular originality writer: “ How did the ancients conceive of and power, revealing in its gifted author dehth?” some of the emotional aspirations of the On the graphic side, Lessing’s work has poet and the artist. been continued and completed in Dr. F. Erwin Rohde (1845-98), of Hamburg, Parkes Weber’s “ Aspects of Death in Art one of the most learned and talented Hellen­ and Epigram” (1914), in which the em­ ists of modern times, was a man who saw blematic concepts of death in poetry, liter­ antiquity in the spirit of Goethe, Schiller, ature and art have been most exhaustively Herder, Winckelmann and Ottfried Muller, and attractively set forth. The intention and one who endeared himself to his pupils of Rohde’s work is psychological. The seri­ and his contemporaries by his charming ous and austere character of his argument personality and his genial, urbane spirit. leaves with one the impression of a clear, His field was the literary and psychological cold, beautifully balanced mind, capable of interpretation of the Greek classics, in which handling the difficult, complex subject with he was unsurpassed. His greatest works are the same large steady grasp of thematic his study of the Greek romances (1870), and material which his fellow townsman Brahms his Psyche (1891-4), in which the Greek displayed in the Haydn variations or the F major symphony. 1 E. Rohde: “ Psyche: Seelencult und Unsterb- Rohde begins with the concept of death Iichkeitsglaube der Griechen.” 3. Aufh, Tubin­ in the Homeric poems. A favorite device of gen & Leipzig, 1903. later poets is to see life and death in an 2 Lessing: “ Wie die Alten den Tod gebildet” inverted order, just the opposite of what we (1769). think them, as in the verse of Euripides, 35 36 Annals of Medical History which Montaigne is said to have inscribed teen years: that appraises life.” Cela juge over the rafters of his library: la vie. But such was not the attitude of Who knows but life itself is only dying, the Homeric Greeks. Matthew Arnold And that which we call death the gate of life. has sensed it in one of his narrative poems:

This thought, which we find again in Words­ From his limbs worth (“ Our birth is but a sleep and a for­ Unwillingly the spirit fled away, getting” ), in Hood (“ Life is dying, and Regretting the warm mansion which it left, Death is living” ), in Shelley— And youth, and bloom, and this delightful world. Death is the veil which those who live call life; So the Greeks evaluated life. “ To turn They sleep, and it is lifted— away from life as a whole,” says Rohde, “ would never have occurred to any Ho­ is also, as we know, the prevailing concept meric Greek. . . . And indeed, only for the of the Christian faith. In medieval times, strong, the wise, the mighty, did the Ho­ as Parkes Weber says, “ a morbid brooding meric world exist. To them, life, existence and a pathological love of death,” over­ upon this earth, was such a certain good that shadowed everything. After the Revival the attainment of all individual joys was of Learning, when Fame was conceived of conditional upon it. No danger, then, that as triumphing over Death, Time over Fame, death, the state which follows life, would Eternity over all, as in Petrarca’s Trionfi,3 ever be confused with life itself.” “ Argue there was the robust attitude of Shake­ not with me concerning death,” cries speare’s Csesar— Achilles to Odysseus in Hades; “ rather Cowards die many times before their deaths; would I choose, being on earth, to be thrall The valiant never taste of death but once. to a man of no estate, of no substance, than This jocund acceptance of death as an to rule here over all the departed dead.”5 ineluctable event in nature we find again in Nothing, Rohde concludes, was so hateful Sir Thomas Browne, in Browning’s “ Pro­ to the Homeric Greeks as death and the spice,” in Whitman’s Lincoln poem and gates of Hades. “ For this very life, this frequently in Swinburne. In Heine, in lovely life in the sunshine, surely ends with Leopardi, the laureate of death, in Musset’s death, come after it what may.” 6 apotheosis of Leopardi, in Matthew Arnold, But the early Greeks by no means re­ in Leconte de Lisle, in the lines in Turge- garded death as the end of all. In Erebos, nieff’s “ Fathers and Sons” which are so Hades and Persephone did not rule over vibrant with emotion, in all the Russian nothing. In the gloomy house of Hades, poets, death is considered, often with charm, the souls of the departed dead were con­ from many curious angles. Weltschmerz, ceived of as eidola, mere indefinite images of maladie du siecle, morbidezza, “ the strange living beings, comparable with smoke (Iliad, disease of modern life,” is over all, and XXII, 100) or shadows (Odyssey, X, 495; what Dr. Keen calls “ the cheerfulness of XI, 207), not formless, but void of strength death,”4 the sense of death as a natural and substance, like figures on a film, exist­ physiological event, is seldom felt. “ One ing in a state of half consciousness, endowed does not find a single man,” says Edmond with feeble chirping voices, and no more de Goncourt, “ who would care to live his vital than the reflections in a mirror. The life again. Hardly will you find a woman Homeric Psyche is not identical with the who would wish to live over her first eigh- “ vital spirit,” which dies out with the death of the body. The Psyche is the alter ego, 8 Parkes Weber: “ Aspects of Death in Art,’* London, 1914, 115 -12 1. 6 Odyssey, X I, 489-494. 4 W. W. Keen: Outlook, N. Y., 1903, LXXV, 446. 6 Rohde, “ Psyche,” 3. ed., 2. G r e e k C u l t o f t h e D e a d a n d C h t h o n i a n D e i t i e s i n A n c i e n t M e d i c i n e 3 7

the Doppelganger, the invisible “ astral once in Hades, return to the upper world body” of the living being. Like the Greek was impossible, and they were forgotten by concept of life as a breath (pneuma), this is the living (Iliad, XXII, 389). Thus, the one of the commonest conceptions of primi­ cult of the dead in Hades, and that of the tive people everywhere.7 In Homer, the xdovioL, the gods of earth and the under­ departed souls are shut up in the house of world, were identical among the early Hades, girt by Oceanus and Acheron, never Greeks, although they became widely sep­ to return. But this restriction was condi­ arated in later time. tioned by the rite of cremation. In the Apart from the shadow life in the prison twenty-third Iliad, the ghost of Patroclus of Hades, the Greeks, as we know, conceived upbraids Achilles for neglecting to give his of favored souls as snatched away to the body its “ due of fire,” and counsels him to Elysian Fields in the Islands of the Blessed, proceed with the necessary rites, that his at the far ends of the flat earth, beyond soul “ may pass through the gates of Oceanus. In the later Eleusinian cult, this Hades.’’ “Far off the spirits banish me, hope was held out to all who had been ini­ the phantoms of men outworn, nor suffer tiated into these nocturnal mysteries, which me to mingle with them beyond the River, in all probability represented the abduction but vainly I wander along the wide-gated of Persephone by Hades, their marriage in dwelling of Hades.” Achilles then burns the the lower regions, and the wanderings of the body in the night on a funeral pyre heaped Earth Goddess, Demeter, in search of her up with flayed sheep and oxen, and the bodies daughter. The gods could also confer per­ of twelve Trojan youths, put to the sword. sonal immortality during lifetime, as with Bloody sacrifices to the dead in the night Tithonus, Ganymede, Iphigenia at Tauris or were in the nature of a chthonic rite, one Menelaus, whom Zeus rendered immortal commonly dedicated to the gods of the as being his son-in-law through his marriage underworld. Apart from these, such sac­ with Helen, in other words, through no rifices were only offered on the graves of merits of his own, but simply as “ Helena’s deified heroes who had died for their coun­ husband.” 9 So, too, Calypso, in the island try. Among the primitive Greeks, ritual of Ogygia, desired to render Odysseus im­ incineration was apotropaic, designed to mortal as a mark of divine favor, and Aphro­ lay the ghosts and avert the wrath of the dite, as Hesiod relates, made Phaethon a departed, and springing in part from that “ god-daemon.10 Another species of im­ fear of the return of the dead which char­ mortality was conferred by the gods through acterizes primitive man.8 Only by fire were causing favored beings to be swallowed up the dead appeased (Iliad, VII, 440), but in the bowels of the earth, wherein they con- 7 Rohde, op. cit., 2-8. over the graves were originally designed to prevent the 8 Incineration, among the Persians, Teutons, Slavs deceased from resuming his (astral) body, as also and Asiatic or Ionian Greeks, was essentially the to prevent the destruction of his physical body. Incin­ custom of a nomadic people to whom burial was un­ eration, in the Homeric period, had the same purpose, thinkable, since it exposed the dead body to the con­ and, for this reason, the burial of weapons and fune­ vulsions of nature and the depredations of wild ani­ ral gifts with the dead disappears with incineration. mals, and deprived it of the customary food offer­ When burial was revived in the post-Homeric period ings. The urns containing the ashes of the dead (8th-7th centuries B.C.), the Krepect were again buried were carried with the wandering tribe, or buried in with the dead. In time, the fear of the return of the a hillside, as with the heroes who died on the windy dead gradually merged into a desire to attract them, plains of Troy. Through the Neolithic, Cretan and even to the extent of having meals in common with Mycenaean periods, coffinless burial in rockhewn departed spirits. crypts (shaft-burial) or bee-hive tombs was the rule. 9 Rohde, op. cit., I, 80. The piles of stone (scopelism) or rough monuments 10 Rohde, I, 135, footnote 1. 3 « Annals of Medical History

tinued to live on eternally as chthonian 1245 et secl-)> Apollo derived his prophetic or beings. Thus, in Pindar and the dramatists, iatromantic powers: there are countless references to the Argive Glitt’ring in the burnished shade, hero and seer, Amphiaraus, of the race of By the laurel’s branches made, Melampus, who, being pursued in battle by Where th’ enormous dragon lies, Periclymenus, was saved from a spear thrust Brass his scales, and flame his eyes, by a thunderbolt of Zeus and carried with Earth-born monster, that around Rolling guards th’ oracular ground: horses, chariot and charioteer into the Him, while yet a sportive child depths below.11 In Boeotia, the architect In his mother’s arms that smiled, Trophonius, being pursued by enemies, was Phoebus slew, and seized the shrine likewise swallowed by the earth and made Whence proceeds the voice divine; immortal.11 12 Likewise Caeneus, one of the On the golden tripod placed, Lapithae, being belabored with trunks of Throne by falsehood ne’er disgraced, Where Castalia’s pure stream flows, trees by the Centaurs, stamped upon the He the fates to mortal shows. ground with his foot and disappeared into the earth.13 The same subterranean im­ In the Theogony of Hesiod (453-491), we mortality befell Althaimenes, the founder read that Rhea gave birth to Zeus in a cave of the Greek island cities, and his son Am- in Crete, in order to prevent him from being philochus.14 The idea recurs in the legends swallowed by his father Kronos: about Charlemagne, Frederick Barbarossa, Him did vast Earth receive from Rhea King Arthur, Holger Danske, and in the in wide Crete to nourish and to bring up. many fanciful beings of German, Moham­ Thither came Earth carrying him swiftly medan and Mexican mythology.15 Amphi­ through the black night to Lyctus first, araus had an oracle at Cnopia near Thebes; and took him in her arms and hid him in Trophonius in a cave near Lebadea. The a remote cave beneath the secret places sacrifices made to them in the night were of the holy earth on thick-wooded Mount those rendered to the chthonian or earth Aegeum. gods. In their chthonian aspect, the gods usually appeared as serpents, or attended This cave, fabled to lie in the mountain by serpents, and so Trophonius appeared in crag of Dicta or on Mount Ida, near Knossos his Lebadean cave. Another attribute of has since been found. At the mouth of the the chthonian or cave-gods was divination Idsean cave is a colossal rock-hewn altar; through their oracles. In the temple of in the bottom of the Dictaean cave, a stea­ Apollo Pythoktonos at Delphi, the god, as tite libation table was discovered.16 In snake- or dragon-slayer, sat upon a mound Homer, Minos, the son of Zeus, is repre­ (omphalos) under which was buried the sented as holding converse with his father serpent Python, son of the earth goddess at this Cretan cave every nine years.17 In Gaia, and from the slaying of Python, as his investigations of the Minoan civilization we read in Euripides (Iphigenia in Tauris, in the palace at Knossos (1903), Sir Arthur

11 Rohde, I, 1 13. (alienatio mentis) in which the soul left the body to 1213 R 0hde, I, 115. identify itself with godhead, thus conferring the 14 Rohde, I, 116. power to predict the future, interpret the past, per­ 15 Rohde, I, 124. form cathartic rites, banish demons and check 16 Sir Arthur J. Evans: The Mycenaean Tree and epidemic diseases. Of these seers, Epimenides of Pillar Cult, London, 1901, 1; 15—17. Crete, who abode in the cave of Dictaean Zeus 17 Crete was the ancient home of the class of seers for many years, to emerge as prophet, cathart- or visionaries, who, like Abaris, Aristeas, Hermo- ist and healer, was the archetype. Rohde, II, 89- timus and Empedocles, attained to states of ecstasy 99. G r e e k C u l t o f t h e D e a d a n d C h t h o n i a n D e i t i e s i n A n c i e n t M e d i c i n e 3 9

Painted terra-cotta pillars, surmounted by Female votary, surmount­ doves, from sanctuary of dove goddess in the ed by dove, from shrine of palace at Knossos. Each column is a separate the Double Axes in the religious entity (uranic or celestial aspect). In Palace at Knossos. This the Minoan Age, objects of worship were usually terra-cotta figurine shows aniconic, as a rule trees, large stones or columns the transition from the ani­ of stone. (See, Sir Arthur Evans: Mycenaean conic idol to the icon. Tree and Pillar Cult, London, 1901).

Faience figure of the Snake Goddess (probably the Magna Mater of Crete in her chthonic aspect). One of the Faience figure of female votary from same sanc­ temple repositories from the Central tuary. (From: Ann. Brit. School, Athens, 1901-2, Palace Sanctuary (Knossos). viii, 29; 99: 1902-3, ix, 75; 77.) 40 Annals of Medical History

Evans discovered several clay seal impres­ “ The snake’s head rising above the sions of a warrior god and goddess, attended summit of the tiara in the present figure by lions, which perhaps represent Dictsean naturally recalls the urseus as seen above Zeus and Rhea in their chthonian aspect. the heads of Egyptian divinities and royal The snake, the special symbol of the personages. A winged serpent or asp by xdbvLOL, appears in the remarkable faience itself appears as the representative of figures of the goddess and her female votary Nekhebet, identified by the Greeks with which were found in the temple repositories Eileithyia, the Goddess of Childbirth, and of the palace. The figure of the goddess is of her twin sister the ‘ Nurse’ Uatchet or 34.2 cm. (133^ inches) in height, sur­ Buto. Its connexion with the Egyptian mounted by a high tiara of purplish-brown Mother Goddess Hathor derives a special color. About this is coiled a snake, the importance from the fact that, as I have head of which projects above the tiara while elsewhere shown, the Hathoric staff with the tail end is plaited about the hips. Two two serpents coiled around its foot supplies other snakes are interlaced around the hips the prototype of the rayed pillars with simi­ and diagonally across the shoulders and lar snakes on Cypro-Mycensean signets, in down the arms. The votary grasps a twisted association with a Goddess whose attri­ snake in either outstretched hand. Goddess butes are lions and doves. and votary are attired in garments of high­ “ Of the influence, at least of the formal ly fashionable cut, a tight fitting jacket creations, of Egyptian religious art on bodice, with decorations of volute patterns, that of Minoan Crete there can be no a double apron or polonaise, and a bell­ doubt. . . . The ankh itself was adopted shaped skirt, which, in the votary, consists by Minoan symbolism. Neither can there of seven-terraced flounces apparently over be any hesitation in regarding the Cow a “ foundation.” In her description of these and Calf reliefs found in the same Temple costumes of 4,000 years ago, Lady Evans Repository with the Snake Goddess and observes of the molding of the figures that her votaries as taken over from the service “ the lines adopted are those considered of Hathor. . . . But the argument can ideal by the modern corset maker rather hardly be carried beyond this point. than those of the sculptor.” The bell-shaped Taken as a whole neither the Snake God­ skirts, effect of the pronounced hips and dess nor her votaries present any special steatopygy of the primitive woman, are Egyptian characteristics. As a matter of identical in shape with the garments of the fact they are clad in the last fashions of late neolithic period figured on the walls the Knossian Court. of the prehistoric caves of Cogul and “ The pronounced matronly forms of Alpera, and which are still worn by the the Goddess seem to point to her as a peasant women of Northern Albania. The Great Mother, and resemble those of the hieratic gestures and the grasping of ser­ female member of the divine pair whose pents by both goddess and her votary is cult is so well illustrated throughout the strongly suggestive of the snake dance of Palace, including the Repository in which the Hopi (Moqui) Indians for the purpose of the figure itself was found. It may be rain making, and may imply all that is con­ added that the sacral value of the girdle, tained in the generic concept of “ making emphasized here both by the plaited medicine.” The snake is, in fact, the snakes that encompass the loins of the chthonic symbol of medicine. Of the divinity and by the appearance of the mythologic significance of these figures, Sir girdle as a separate votive object, points Arthur Evans observes: to a Goddess of Maternity. The snake form G r e e k C u l t of t h e D e a d a n d C h t h o n ia n D e i t i e s i n A n c i e n t M e d i c i n e 4 1 of Nekhebet, the Egyptian Eileithyia, has session. In the case of the images the also a comparative value in this connex­ snakes are seen coiling up the cylindrical ion. Nor must it be forgotten that some base, which seems to represent the earlier of the oldest religious traditions of the columnar form of the cult object. spot that survived to Classical times refer “ It is hardly necessary to point out that not only to the cult of the Mother God­ a Mother Goddess has essentially a dess Rhea, whose grove and the ruins of chthonic side. Demeter, daughter of Rhea, whose shrine were pointed out near the whose early connection with Crete comes later Knossos, but to Eileithyia whose out in the Homeric hymn, is herself, in her cave sanctuary opened on the side of a character of Erinys, a Snake Goddess. The rocky height above its ancient haven, the Cretan Eileithyia is a cave divinity. It is, mouth of the Amnisos. moreover, interesting to notice that the “ Of the special cult aspect presented by indigenous Nature Goddess of the Island, the Snake Goddess and her votaries no who retained her Eteocretan names, Dic- other hint has as yet been supplied by the tynna and Britomartis, to Classical times, Palace remains. It is possible that we have was also identified with Hekate. here to deal with a specially chthonic as­ “ This indigenous Goddess, of whom pect of the cult of the same Mother God­ Rhea as well as Artemis may often be re­ dess whose worship is otherwise so well garded as the Hellenised equivalent, be­ illustrated here. Or, on the other hand, the longs to the very ancient class of Virgin Snake Goddess may represent an associ­ Mothers. She presides over human births ated divinity, a o-iV/^os, having a shrine and fosters the young both of land and of her own within the larger sanctuary. sea. Like Artemis, she combines the at­ “ In either case the snakes must by all tributes of nurture and of the chase. On analogy be taken to show the chthonic Cretan coins we see her in the place of character of the worship here represented. Rhea, guarded by the Corybantes, with It is an obvious feature of primitive cult the infant Zeus at her bosom. . . . The seal that, just as the bird descending on the impressions of the figure of a Warrior sacred object or person is the outward and Goddess attended by lions bring us very visible sign of its possession by a celestial near to Rhea; and the companion piece, spirit, so the serpent approaching from the showing the Warrior God, can hardly be crevices of the earth becomes, as at Del­ other than an early version of the Cretan phi, the sign of its spiritual possession ‘ Zeus’. from the Underworld. The two chief cult “ The general associations in which the images as yet found in the Palace illus­ figure of the Snake Goddess and her vo­ trate these alternative sources of inspira­ taries were found, are thus seen to illus­ tion in an interesting way. In the one case trate certain broad aspects of the ancient a dove is seen settled on the head of the Cretan cult, of which a living tradition image. In the case of the present figure the survived to historical time. The last exam­ snake’s head appears in the same position. ples especially, the lion-guarded Goddess, The parallel, indeed may be carried a step namely, and her male satellite fit on to the further if we compare the semi-aniconic typical cult of the Palace and of Minoan images of Gournia and Prinias with the Crete as a whole. It may therefore be pref­ triple columns of the terracotta sanctuary erable to regard the Snake Goddess not found on the East side of the Knossian as a separate religious entity but rather as Palace. In the case of the columns the set­ a chthonic version of the same matronly tled dove again witnesses the divine pos­ divinity otherwise so well represented on 4 2 Annals of Medical History

this and other Minoan sites.” (Ann. Brit­ well-being of man. Among the Homeric ish School Athens, London, 1902-3, IX, Greeks, who burned their dead that the 74-87.) soul of the departed might enter the gates The chthonian gods were first investi­ of Hades, these gods became associated with gated by the celebrated Hellenist Ottfried the underworld, acquired infernal functions, Muller, who differentiated their cult from thirsted for the blood of human sacrifice, that of the Olympian deities. That the were feared for their power to wreak evil chthonian or infernal and the uranic or upon mankind, were never addressed celestial are only different aspects of identi­ directly by name but pleno titulo, with flat­ cal gods in their capacity for evil or good is tering appellations, and were placated by the theory of another philologist, H. D. Mul­ apotropaic rites or piacular sacrifices con­ ler. To discuss the complex details of this ducted at dead of night. With these matter would lead us too far, but the key deities, as we have seen, were18 associated to its comprehension lies in the fine ob­ (in the older cult) the ara^ot, perturbed servation of Walter Pater that the Greeks, spirits of the dead who had not been cre­ a self-willed, composite people, of diverse mated, the awpoi, souls of those who, through racial strains, existing in independent island fatal accident or suicide, had died before and city states, combining only in wartime, their appointed time, the Pioavaroi., souls of “ had not a religion but religions, a theology stillborn infants, and the immortalized with no central authority, no link on his­ or deified heroes who, through divine favor, toric time, liable from the first to an un­ had been either snatched up to Olympus or observed transformation.” Apart from the carried into the bowels of the earth. The worship at the great national temples, caves of cave-gods, such as Dictaean or there existed a vast network of local Idean Zeus or Zeus Trophonius, were polytheism, each community having some regarded as the sites of chthonic oracles, particular god or gods of its own. In this (Psychomanteia) and deep clefts in the way, gods of identical function came to be earth as entrances to Hades (Psycho- worshipped under different names, many pompeia)19. Thus the xdbvioi presided different gods acquired identical or over­ variously over agriculture, divination and lapping functions, some gods were poly­ some aspects of medicine. Hesiod, in morphic or, at least, passed through many “ Works and D ays” (465), counsels the strange metamorphoses in course of time, Boeotian farmer to “ pray to Zeus of the and sundry gods were suppressed or dis­ Earth” before plowing. In the Iliad placed in their own localities by other gods. (IX, 457) the same god (Hades, Aidoneus) Nearly all the Olympian gods had medical is styled Zeus Katachthonios. Later, he functions, could visit plagues and epidemics becomes Pluto or Klymenos.20 Demeter upon mankind or avert them at need, and so Chthonia and Persephone (Kore), goddess of also the Among the Cretans, the death and “ the poppied sleep,” were wor­ Mycenaean and the pre-Homeric Greeks, shipped at Hermione, Eleusis and through who, like neolithic man, buried their dead, the Peloponnesus. At Delos and Amorgos, the chthonian gods, identical with Frazer’s Zeus Eubuleus, Demeter, and Kore were “ Spirits of the Corn and the Wild,” were jointly worshipped; in Cnidos, Hades, originally gods of the earth and agriculture, Demeter, Kore, Epimachos, and Hermes promoters of fertility of the soil, growth of Psychopompos, the conductor of souls to crops, fecundity in women, and the general Hades (Odyssey, XXIV, 1-9). The earth 18 Rohde, II, 411-413. 20 See K. Lehrs: Populare Aufsatze, 2. AufL, Leip­ 19 Rohde, I, 213. zig, 1875, 288. G r e e k C u l t o f t h e D e a d a n d C h t h o n i a n D e i t i e s i n A n c i e n t M e d i c i n e 4 3

goddess Gaia, Hecate (Gorgo, Mormo, Gaia and to the Heroes. In Plutarch, The­ Lamia, Enodia, Empusa), who with her seus is purified and freed from the stain nightly swarm of dogs, Ataphoi, Aoroi (pLaapa) of murder by sacrifice to Demeter and Biothanatoi, brought on terror and and Zeus Meilichios. On votive tablets disease, Cerberus, the guardian of Hades, from the Piraeus and elsewhere, Zeus the Erinnyes, the Harpies, the Keres Meilichios, like Aesculapius, was represented (goddesses of doom), Thanatos himself, and worshipped in the form of a serpent. were all numbered among the x&b tot.21 Another chthonian existence which ap­ That such beings inspired fear and to peared in serpent form was the dyatfos balpov the extent of being seldom addressed di­ the “ good daemon” of the Greek house­ rectly by name is comprehensible. In the hold, often mentioned by Attic writers, poets and dramatists, Persephone, in her an analogue of the lars familiaris of the chthonic aspect, is always addressed or re­ Romans, and in its original form (Rohde ferred to as “ The Maiden” (Kore). So, surmises), the soul of the paterfamilias.23 too, Aischylus entitles his tragedy, not In certain Vatican MS. investigated by “ The Erinnyes” but “ The Eumenides.” Rohde, Archigenes describes a species of At the beginning n on-poisonous of the Choep- snakes as dyatfo- horae of Aeschy­ bcupoves. T h ese lus, when Electra were worshipped invokes jointly in Alexandria as Hermes Psycho- “ the good house- pompos and the spirits in serpent shade of her guise.” 24 This father Agamem­ brings us to the non, Hermes is cult of Aescula­ styled Xdovios; the pius as a chthon­ name of Aga­ Zeus Meilichios in serpent form (chthonic aspect). Attic ian deity and the memnon is not votive tablet in bas-relief (4th century b .c.) from the significance of Piraeus (Old Museum, Berlin). From Eugen Hollander’s mentioned. The “ Plastik und Medizin,” Stuttgart, F. Enke, 1912, p. 37. t h e snake in ch th o n ian cult, medicine. as something fearsome and awful, is but To understand Rohde’s peculiar inter­ dimly shadowed forth in the classical writers. pretation of the AEscuIapian myth, let us In expiation of the crime of murder, certain consider briefly what he says about Erech- deities were invoked who were euphemis­ theus and Hyacinthus.25 In Homer’s tically styled Zeus Meilichios or Zeus catalogue of the ships, it is related of Apotropaios, and these deities, as Ottfried Erechtheus that the earth bore him, but Muller showed, were invariably chthonian.22 Athena reared him and placed him in her To the apotropaic gods, an animal was costly temple at Athens, where he was sacrificed (as a kind of scapegoat) in place worshipped with annual sacrifices of steers of the murderer. In the Hippocratic treatise and sheep. In the Odyssey, Athena re­ de insomniis, those suffering from bad turning to Athens, enters “ the compact dreams sacrifice to the apotropaic deities, to house of Erechtheus,” which later became

21 Rohde, I, 205-212. to Athena apotropaia and Apollo apotropaios. 22 Rohde, I, 273, footnote 1. The opposite of Zeus 23 Rohde, I, 254. arroTpoTraLos, the averting god, is Zeus irposTpoTraios, 24 Rohde, I, 254, footnote 2. the avenging god. Erythraean inscriptions also refer 25 Rohde, I, 135-141. 44 Annals of Medical History an Erechtheion, in which the two were favor, a buried mortal suppressed and worshipped in common. In a crypt of supplanted by a god. Achilles, a mortal this temple, Erechtheus was supposed to hero in Homer, was worshipped as a god in live on eternally in chthonic form as a Epirus, Astypalsea and Erythrsea; at Elis, serpent. A later tradition describes him as he was revered as a hero with mantic “ buried” in one place or another. Here powers, and, at his annual festival, women we have three characteristic stages in the mourned over his empty “ grave” at sunset. progress of a tradition: an ancient chthon- ian god, living in the depths of the earth, is transformed into a mortal hero rendered immortal by an Olympian goddess, sharing her temple; finally, a mortal hero again, he is buried in the same place. So, too, in the temple of Apollo at Amyclse in Laconia,

Votive stone to Zeus Meilichios (Berlin Museum), showing the worship of the god in his chthonic aspect. From Hollander, op. cit., p. 117. Aesculapius was also worshipped in chthonic form and as “ Heros Iatros.” According to the elder Pliny and Ovid, the cult of Aesculapius as Votive relief tablet to Zeus Meilichios from the a medical divinity was transplanted from Piraeus (National Museum, Athens). From Hol­ Epidaurus to Rome in the form of a lander’s “ Plastik und Medizin,” p. 118. huge serpent (“ in serpente deus” ). the bronze statue of the god surmounted an In the cult of AEscuIapius, the tradition altar under which Hyacinthus was said to undergoes the same transformations. In lie buried. The decorations on the altar his original form, he is an ancient Thes­ depicted, not the tender Amyclaean youth salian earth divinity, a local daemon, who beloved of Phoebus, but a mature, bearded combined healing powers with the gift of man. As in the Python legend, we have prophecy. In Homer, he is a mortal hero, here an ancient earth-god suppressed and who learned medicine from Chiron, and displaced by the Hyperborean deity, prob­ whose sons, Machaon and Podalirius, figure ably, Rohde thinks, “ after the Dorian as actual military surgeons in the Iliad. invasion of the Achaian land. ” The changes Struck by a thunderbolt of jealous Zeus, rung upon tradition are the same: an he is snatched to the skies and rendered aboriginal earth god, a beautiful youth immortal.26 In statue, coin or bust, changed into a flower through a god’s /Esculapius is made to resemble Zeus, in 26 Rohde, I, 141-145. “ Aisculapius, ut in deum surgat, fulminatur.” Minucius Felix, X X II, 7. G r e e k C u l t o f t h e D e a d a n d C h t h o n i a n D e i t i e s i n A n c i e n t M e d i c i n e 4 5

token of his uranic or celestial aspect. certain diseases, may have given color to Sophocles was actually heroized, acquired the notion that the creature was possessed a hero-cult, because he once entertained of daemonic powers.31 Max Hofler calls the god Atsculapius in his house.27 In attention to the fact that the Greek word Athens, a Hero-Physician ("Hpcos iarpos) 6is (from which root o^tfaX/^s is also was worshipped at a special shrine, near derived) implies “ the gazing animal,” the the Theseion (Demosthenes).28 Finally, creature that is always looking at one.32 Aesculapius becomes a mortal again, and The fact that the snake lives in holes in the his “ grave” is shown in various places.29 ground gave it a natural association with Machaon acquires a grave and a shrine at the chthonian underworld, and made it the Gerenia, on the Laconian coast. Podalirius logical guardian and genius loci of temples, has a grave and “ Heroon” near Mount shrines, oracles and healing springs. Parkes Garganus in Apulia, where incubation Weber says that “ the harmless snakes, (temple sleep) is practised by the sick, which at the present time abound in the hot and rams are sacrificed. His son, Polemoc- caverns and natural or artificial galleries rates, had a shrine at Eua in Argolis. where thermal springs arise in the Pyrenees, Alexanor, brother of Polemocrates, had are probably the same as those connected a Heroon at Titane near Sicyon. Aristo- with the worship of Asclepios (AEscuIapius) machus, another Heros Iatros, had a in Greece and Rome.” 33 The size, strength healing oracle at Marathon. And so with and dangerous character of the Asiatic and all the Asclepiads.30 The original chthonic African pythons may well have suggested character of Aesculapius is suggested by a giant transformed or a metamorphosed the fact that the snake was not only sacred god. In the several votive tablets to the to him and associated with him, but, as apotropaic snake-god Zeus Meilichios, in with the cave-gods and the heroes, x^ vlol the museums at Athens and Berlin (Plate both, he himself appeared in serpent form. II), the huge pythons are represented as The cock sacrificed to him by Socrates on awe-inspiring. The elder Pliny, in his leaving the world was a chthonic offering. Natural History (XXIX, 22), relates that The snake of the Epidaurian temple is the the Aisculapian cult was introduced into aya&6s Saipoov, the “ good daemon ” of Rome from Epidaurus in this chthonic the household cult, a cult which was later form, and that, in consequence, the rearing transplanted to Rome with the worship of of tame snakes in private houses soon Aesculapius, as we shall see. The staff, became an obnoxious fashion among the entwined with a serpent, was the symbol of Roman dames: Serapis, Hermes and AEscuIapius. Doubt­ “ The AEscuIapian snake was first less the strange aspect of the serpent, its brought to Rome from Epidaurus, but at cold eye and the fascination attributed to the present day it is commonly reared in it, its darting tongue, its capacity for chang­ our houses even; so much so, indeed, that ing its appearance by rapid coiling and if the breed were not kept down by the uncoiling, its swift progression and attack, frequent conflagrations it would be im­ the death-dealing powers of the poisonous possible to make head against the rapid species, its supposed value as a remedy in increase of them.” 27 Rohde, I, 176, footnote 6. 28 Rohde, I, 173, footnote 3. 32 M. Hofler: Die volksmedizinische Organother- 29 Rohde, I, 142-143. 30 Rohde, I, 185-186. apie, Stuttgart, 1908, 142. 31 See E. Hollander, “ Die Schlange,” “ Plastik und 33 F. Parkes Weber: “Aspects of Death in Art Medizin,” Stuttgart, 1912, 87-95. and Epigram,” 2. ed., London, 1914, 386. 4 6 Annals of Medical History

The introduction of the AEscuIapian cult, equivalents of the chthonian Hades and which was occasioned by a devastating Persephone were Orcus, also called Dis, epidemic in 293 b .c ., gradually displaced Viduus or Consus, and Libitina (Lubentia, the worship of Febris, Mephitica, Angeronia, Lubia). To Orcus and Mania (the mother Fluonia, and the other Roman household of the Lares), Tarquinius Superbus insti­ gods of medicine. Ovid (Metamorphoses, tuted the sacrifice of children during the XV, 626-744) indulges poetic license to the Compitalia; but after the expulsion of the extent of conceiving, at great length, how Tarquins, the consul Lucius Junius Brutus Aesculapius himself proceeded from Epi- substituted garlic and poppies as offerings daurus to Rome in the form of a gigantic to these gods.35 serpent—how, upon the advent of a ghastly It is a curious fact that the apotropaic pestilence, the oracle of Apollo directed the medicine of the ancients was directly con­ stricken Romans to seek the aid of Apollo’s nected with the omnipresent idea of the son, how the embassy proceeded to Epi- efficacy of invisible efHuvia, the impercep­ daurus, how Aisculapius appeared to them tible evaporation from substances. Em­ in a dream, announcing that he would pedocles instances the hounds following the change himself into a^serpent, how the god scent, and Lucretius the drying or moisten­ revealed himself to them in the temple ing of garments at the seaside, the gradual next morning in this form— wearing away of a ring on the finger, of Cum cristis aureus altis pavements, ploughshares, statues, seaside In serpente deus praenuntia sibila misit— cliffs by gradual attrition, the salt taste in how he condescended to sail with them to the mouth at the seaside, as showing “ the Rome, weighing down the ship with his existence of efHuvia streaming unceasingly immense bulk, and how, upon arriving, from all bodies” (Heidel). Fumes of he resumed his heavenly aspect, ended the pitch, asphalt and sulphur were thought to pest and became health-bringer to the city— purify. Juniper branches which supplied part of the incense of ancient sacrifices, Et finem specie caeleste resumpta Luctibus imposuit venitque salutifer urbi. were burned in the Middle Ages to disinfect houses of the plague. Hemp (Cannabis In commemoration of this event, the indica), which Herodotus (I, 202, IV, 75) Romans gave the eastern corner of an island says was burned by the Messagetse and in the Tiber (now the Isola S. Bartolommeo) the Scythians in order to intoxicate them­ the form of the bow of a ship, shaped out selves with its fumes, formed one of the by a fagade of travertine, the mast being mediaeval substitutes for surgical anesthesia represented by an obelisk, and the prow by inhalation. Long before the Middle being decorated with a bust of Aisculapius, Ages, Dioscorides (IV, 81) stated that with the staff and chthonic snake. In anesthesia could be produced by inhalation what remains of the ancient travertine, of mandragora wine. Professor William the bust has been sawn off flush with the A. Heidel, in his study of the “ /mtecedents surface. The staff and serpent remain, of Greek Corpuscular Theories, ” 36 gives and were photographed in 1867, although an admirable summary of the matter on now covered with sand and slime. 34 the mythological side: In the ancient Roman Pantheon, the “ The primitive Greek saw in nature the 34 Hollander: “ Plastik und Medizin,” Stuttgart, play of daemonic beings: the religion of the 1912, 90-92. 35 Kissel: Janus, Breslau, 1848, III, 600-603. people, however much glossed over by the 36 Heidel: Harvard Stud. Class. PhiloL, 19 11, Homeric and post-Homeric tradition, was XXII, 111-172. at bottom one of magic and of occult G r e e k C u l t o f t h e D e a d a n d C h t h o n i a n D e i t i e s in A n c i e n t M e d i c i n e 4 7

powers. Spirits were everywhere, and spir­ and at the sacramental meal of the Mys­ its were believed to be chiefly of chthonic teries are all pungent or aromatic, as are origin. The evidence, which is to be found also the herbs laid beneath the dead at in the handbooks, need not here be re­ funerals. peated. Every one is acquainted with such “ But it is a bad rule that does not work facts as that mephitic vapors were the ob­ both ways. The same exhalations which jects of worship;37 that Plutonia, Charo- are welcome to one being will prove to be nia, or hell-gates, where vapors or hot- unwelcome to another. What is one dae­ springs issued from the earth, were sa­ mon’s poison is another’s meat. Thus ex­ cred,38 because the exhalations were re­ halations or effluvia of various kinds are garded as spirits,—spirits of the dead. It the chief apotropaic and purificatory was to these spirits that women looked for means employed in the most diverse cir­ fertility39 and mankind for increase of cumstances. . . . flocks and herds and for the fruitfulness of “ Sunlight, as the power of a superior the soil. From Hades, we are told, or from god, is itself purifying; fire again is the the dead, come not only the souls of the purifying and apotropaic agency par ex­ living, but also life, nourishment, growth, cellence, as possessing the most evident and the seeds of fruitfulness.40 The spirits and most various emanations. Loud noises of the winds are earth-born, and lord it and the means, chiefly metallic, of pro­ over the surface of the earth.41 It is to the ducing them, are considered especially ef­ occult influences which they exercise that fective; but hardly less the effluvia which tabooed objects owe their sacredness.42 strike the sense of smell. ‘ The daemons The Pythia derived her inspiration partly love not the reek of torches.’44 The purifi­ from the aroma of the laurel, chewed and catory use of sulphur is known to Homer.45 burned, partly from the vapors issuing During the great plague at Athens they from the fissure above which her tripod burned ‘ sweet-smelling wood.’46 Almost all was placed. Smoke and aromatics were cathartic simples known to the materia quite generally regarded as producing ‘ en­ medica of the Greeks possess a strong odor, thusiasm’ or possession by the godhead.43 rank or aromatic; wines are diuretic, dia- Aromatics, which possess the power of choretic, or constipating according as they throwing off continuous streams of effluvia are aromatic or not; flatulent (Tn'ea/mro^s) without perceptible diminution, had great food was tabooed by the Pythagoreans significance to Greek thought, although it and Empedocles.47 The efficacy of olive oil has been generally overlooked. The Foun­ as a daily unguent and at burial was no tain of Youth in Ethiopia, described by doubt partly due to its aromatic proper­ Herodotus, was, like the incense, the ties; hence also the use of it, or of wine, in pleasant savor, and the ambrosia on which the first bath given to the infant, and sub­ the gods fed, aromatic and so ethereal as sequently in Christian baptism. Nor to be ahhost comparable to a vapor-bath; should we overlook the extensive use of the foods partaken at the wedding-feast fumigations by Greek physicians; such as 37 Frazer: Adonis, Attis, Osiris (Golden Bough, pt. 43 Rohde, II, 60. IV), London, 1914, I, 203-206. 44 Plato, Phaon, apud Athen., 10, 58, 442A. 38 Rohde, I, 213, footnote 1. 45 Iliad, XVI, 228; Odyssey, XX II, 481. 39 Rohde, I, 246-249. 46WeIImann: Fragmente der griechischen Aerzte, 40 Hippocrates: De diseta, 92 (Littre, VI, p. I, 109. 658). 47 Rohde, II, 162, footnote 6; 164, footnote 1; 181, 41 Rohde, I, 247. footnote 2. Hippocrates: De diaeta, II, 45 (Littre, 42 Farnell: Cults of the Greek States, III, 132. VI, 542). 4 8 Annals of Medical History

the internal fumigation of women after articles of food which are unwholesome to childbirth, and as an emmenagogue.48 men in disease. Of sea substances, the sur­ Finally, water, a universal means of puri­ mullet, the blacktail, the mullet, and the fication, doubtless owed its power in part eel; for these are the fishes most to be to the abundant evaporation, which con­ guarded against. And of fleshes, those of nected it on the one side with the fructify­ the goat, the stag, the sow, and the dog: ing spirits which give fertility, and on the for these are the kinds of flesh which are other side with apotropaic functions.” aptest to disorder the bowels. Of fowls, the cock, the turtle, and the bustard, and such Max Flofler has shown, in a very exhaus­ others as are reckoned to be particularly tive way, that the chthonian deities exerted strong. And of potherbs, mint, garlic and a strange influence upon Greek pharma­ onions; for what is acrid does not agree cology and therapeutics. The very opening with a weak person. And they forbid to lines of the Iliad bring us in touch with the have a black robe, because black is ex­ legendary aetiology and prophylaxis of pressive of death; and to sleep on a goat’s pre-Hippocratic medicine—the pestilence skin, or to wear it, and to put one foot visited upon the Grecian host by the wrath upon another, or one hand upon another; of Apollo, and the elaborate transactions for all these things are held to be hin­ and sacrificial ritual required to avert it. drances to the cure. All these they enjoin From what is known of the chthonian with reference to its divinity.49.. . B y such deities, we can better understand the sayings and doings, they profess to be pos­ significance of the Ffippocratic treatise sessed of superior knowledge, and deceive “ On the Sacred Disease,” the strongest mankind by enjoining lustrations and brief for a rational pathology before the purifications upon them, while their dis­ time of Galen. The locus classicus (in course turns upon the divinity and the Francis Adams’ translation) is as follows: godhead. And yet it would appear to me “ They who first referred this disease to that their discourse savors not of piety, as the gods, appear to me to have been just they suppose, but rather of impiety, and such persons as the conjurors (payoi), as if there were no gods, and that what purificators (/ca#apr

tc u ) and charlatans (dXafom) now are, pious and unholy. This I will now explain. who give themselves out for being exces­ For, if they profess to know how to bring sively religious, and as knowing more than down the moon, and darken the sun, and other people. Such persons, then, using the induce storms and fine weather, and rains divinity as a pretext and screen of their own and droughts, and make the sea and land inability to afford any assistance, have unproductive, and so forth,50 whether they given out that the disease is sacred, add­ arrogate this power as being derived from ing suitable reasons for this opinion, they mysteries or any other knowledge or con­ have instituted a mode of treatment which sideration, they appear to me to practice is safe for themselves, namely, by apply­ impiety, and either to fancy that there are ing purifications and incantations, and no gods, or, if there are, that they have no enforcing abstinence from baths and many ability to ward off any of the greatest 48 Diels: Anonymi Londinensis, 37, 30 et seq. fiends” (the Babylonian sibtu); in Euripides (Her­ 49 In Plato (Phaedrus, 244), diseases are said to cules Fureus, 907) it is “ Tartaric disquietude.” originate iraXaioov en pripiparoip— which may mean 50 It is interesting to note that all this comes within “ from ancient wrath” (of unburied dead of past the scope of the North-American Indian’s concept of generations) “ or from ancient bloodshed.” In Soph­ “ making medicine,” the special function of the med­ ocles (Trachinise, 1235), insanity is a “ possession by icine-man. G r e e k C u l t o f t h e D e a d a n d C h t h o n i a n D e i t i e s i n A n c i e n t M e d i c i n e 49

evils. How, then, are they not enemies to crimes,52 and of malefactors, or who have the gods? For if a man by magical arts and been enchanted by men, or who have done sacrifices will bring down the moon, and any wicked act; who ought to do the very darken the sun, and induce storms, or fine reverse, namely, sacrifice and pray, and, weather, I should not believe that there bringing gifts to the temples, supplicate was anything divine, but human, in these the gods. But now they do none of these things, provided the power of the divine things, but purify; and some of the purifi­ were overpowered by human knowledge cations they conceal in the earth, and and subjected to it. But perhaps it will be some they throw into the sea, and some said, these things are not so, but, men they carry to the mountains where no one being in want of the means of life, invent can touch or tread upon them.63 But these many and various things, and devise many they ought to take to the temples and contrivances for all other things, and for present to the god, if a god be the cause of this disease, in every phase of the disease, the disease. Neither truly do I count it a assigning the cause to a god. Nor do they worthy opinion to hold that the body of remember the same things once, but fre­ man is polluted by god, the most impure quently. For, if they imitate a goat, or by the most holy; for were it defiled, or did grind their teeth, or if their right side be it suffer from any other thing, it would be convulsed, they say that the mother of the like to be purified and sanctified rather gods is the cause. But if they speak in a than polluted by god. For it is the divinity sharper and more intense tone, they re­ which purifies and sanctifies the greatest semble this state to a horse, and say that of offenses and the most wicked, and Poseidon (Neptune) is the cause. Or if any which proves our protection from them. excrement be passed, which is often the And we mark out the boundaries of the case owing to the violence of the disease, temples and the groves of the gods, so that the appellation of Enodia (Hecate) is ad­ no one may pass them unless he be pure, hibited; or, if it be passed in smaller and and when we enter them we are sprinkled, denser masses, like bird’s, it is said to be with holy water, not as being polluted, but from Apollo Nomius. But if foam be emit­ as laying aside any other pollution which ted by the mouth, and the patient kick we formerly had. And thus it appears to with his feet, Ares (Mars) gets the blame. me to hold, with regard to purifications. But terrors which happen during the But this disease seems to me to be nowise night, and fevers, and delirium, and jump­ more divine than others; but it has its na­ ings out of bed, and frightful apparitions, ture such as other diseases have, and a and fleeing away,— all these they hold to cause whence it originates, and its nature be the plots of Hecate, and the invasions and cause are divine only just as much as of the Heroes,51 and use purifications and all others are, and it is curable no less than incantations, and, as appears to me, make the others, unless when, from length of the divinity to be most wicked and most time, it is confirmed, and has become impious. For they purify those laboring stronger than the remedies applied. Its under this disease, with the same sorts of origin is hereditary, like that of other dis­ blood and the other means that are used eases.” in the case of those who are stained with 52 Rohde, II, 69-80, 405-407. 61 See, also, the Hippocratic De insomniis; for 53 The sacrificial offerings (/catfapaia) of the rite of the Greek ritual of purification in case of murder, purification or the water of lustration became and its relation to therapeutics, see Rohde, I, 259- Ka&ap/jLaTa (rejects) after the ceremony and were 300. thrown away (Rohde, II, 79, footnote 1). 50 Annals of Medical History

The writer of this Hippocratic treatise paic shrubs, laurel, myrtle, whitethorn, makes a clean sweep of all the superstitions squills, hellebore, mallow, asphodel, figs, which were the basis of Greek therapy in and such ingredients of sacrificial incense the period between Homer and the Periclean as juniper, made up a kind of sacred age. The centric feature of this therapy botany, set apart for ritual purification, was the idea of catharsis, lustration or and only partaken of by the worshippers purification by priests, seers or magicians during the act of sacrifice.54 Hesiod says from “ miasms” cast upon the soul or the that asphodel, mallow and squills (plants body by angered gods, spirits of the un­ dedicated to the Chthonioi) were only eaten burred dead (Ataphoi), spirits of dead by very poor and ignorant people.55 In the heroes, daemons, spirits of the untimely purely religious cult, the sharing of the dead (Aoroi), and spirits of the unborn dead sacrificial cakes and other altar offerings (Biothanatoi). As with primitive savage was regarded as entering into communion man, priest, soothsayer (Mantis) and mage with the god or as part of the mystic were originally one and the same. The ceremony of “ eating the god,” which parturient woman, the new born child and Frazer found common to so many primitive the dead were “ unclean,” and medicine peoples.56 In these apotropaic rituals, was either cathartic, designed to cast out the priests and the worshippers acted these malign influences, apotropaic, designed openly and ex officio; but apart from the to avert them, or hilastic, designed to priesthood, the cathartists and magicians propitiate angered gods and departed souls. sought in secret to enlist the aid of the If a “ hero” slaughtered an enemy or exer­ Chthonioi and the spirits of the departed cised bloody revenge upon the murder of a by similar rites. Thus arose a kind of relative, he was conscious of no moral ritual therapy, in which certain plants and qualms, of the kind sensed by the Athenians the parts of certain animals gradually came when they ceased to bear arms, but of the to be used as actual therapeutic devices. need for “ purification” from the evil in­ In Dioscorides, Pliny, the magic papyri and fluence (txiaafjia) arising from his contact with the Abraxas, as Hofler shows, artemisia is the dead and supposed to emanate from “ the blood of Hephaistus,” camomile the his person; furthermore, he sought pro­ blood of Hestia, cedar resin the blood of tection from the revengeful deities of the Kronos, juniper the blood of Saturn, Ver­ underworld. In the second Iliad, the bena officinalis the blood of Hermes.57 Greeks avert the pestilence sent by Apollo The fumes of incense, ashes and rejects of through the sacrifice of oxen, of which they sacrifice acquired therapeutic values. The partake in a huge barbecue. In the Odyssey fox, wolf, dog, weasel, cow, ram, goat, lion, (XXII, 481-494), after slaughtering the mouse, and certain birds, fishes and reptiles, suitors, Odysseus fumigates the house with being all animals dedicated to the Chthonioi, sulphur (lustration). The things inter­ made up an extensive animal therapy, dicted by the professional cathartists in based largely upon these associations. That their dietetic treatment of the “ sacred this therapy was mainly an associative disease” —the fish, goat, sow, dog, cock, as therapy is obvious from the painstaking also the potherbs—were sacred to the researches of Hofler, who shows that each chthonian gods. The animals sacrificed to remedy became, in some sort, an open secret, them were usually inedible and black (or justified by its mythologic associations. otherwise uniform) in color. The apotro- 56 Sir J. G. Frazer: Spirits of the Corn and the Wild 54 See Rohde, passim, and Hofler, 14, etc. (Golden Bough, pt. V), London, 1912, II, 48-108. 65 Hesiod: Works and Days, 41. 57 Hofler, op. cit, 17-20. G r e e k C u l t o f t h e D e a d a n d C h t h o n i a n D e i t i e s i n A n c i e n t M e d i c i n e 5 1

In the ancient Thargelian festivals of the The Greeks had no more to do with the mod­ Ionic cities, a town was “ purified” by ern theory of animal extracts than had the selecting as scapegoats (Pharmakoi) two repulsive prescriptions of the Dreckapotheken vagabonds who were flogged with squills or the early London Pharmacopoeias. From and agnus castus and driven into the sea,58 a careful analysis and tabulation of 1254 just as the catharmata (rejects of lustration therapeutic prescriptions of the ancients or penitential sacrifice) were scattered (including those of the Northern races), at crossroads or cast into the water. Hofler shows that the different parts of the But even as the drug ((frappcucov) was sacred animal body were never employed exclu­ in a good and a bad sense, through its asso­ sively to heal diseases of the same parts in ciation with the chthonic idea of atonement the human body, but haphazard, according or propitiation by means of a substitute to the tenets of the chthonian cult.60 or scapegoat ((frappaKos),™ so this empirical In other words, Greek organotherapy was therapy became more and more detached homoeopathic magic in Frazer’s sense,61 but from the priestly cult of the shrines and hardly isotherapy, in the sense of “ like Asclepieia. Of the innumerable simples cures like.” and animal remedies recommended by Dios- In accepting Hofler’s conclusions, we corides and Pliny, it is obvious that but should not lose our respect for Greek few have any pharmacologic rationale in therapy, bearing in mind that Galen was the sense of Schmiedeberg and Cushny. one of the greatest rational therapeutists Black hellebore (Helleborus niger), with who ever lived, and that Dioscorides con­ which the seer Melampus purged the tains almost every sample known, up to the daughters of Proitus of their insanity and days of analytic and synthetic chemistry. which Hippocrates used as a rational purge, Further, Hofler’s sweeping inclusion of the was originally sprinkled about to “ purify” spirits of the dead among the Chthonioi houses and hearths; but white hellebore must be modified and corrected. In the (Veratrum album) which was employed as Friedlander Festschrift, Paul Stengel62 shows an emetic, was never associated with the that the Greek cult of the dead, while heart. The strangest animal remedies were originally apotropaic, became in time purely employed against sterility and to promote pietistic, a quiet, intimate family cult, like fecundity in women, the point d’appui of that of our All Souls’ Day.63 The chthonian Greek gynecology. Furthermore, the gods were appeased by piacular sacrifices, chthonic animal remedies were used in the that is by propitiatory or penitential offer­ most varied and capricious way in the ings. The sacrificial offerings to the dead were treatment of visceral disease, a subject nutritive libations without which they would of which the ancients knew little or nothing. days,” when all the dead returned (the Roman mun- 58 Rohde, II, 78, footnote 2. dus patet), when the temples of the gods were closed 69 Hofler, 26. and all business suspended. Hawthorn leaves were 60 Hofler, 279-291. chewed at dawn and the doorposts were smeared with 61 See Frazer’s chapter, “ The homoeopathic magic pitch, the fumes of which were apotropaic; private of a flesh diet” in “ Spirits of the Corn and the Wild,” familial offerings were made and libations of wine London, 1912, II, 138-168. poured out; on the last day of the feast, which was 62 P. Stengel: Chthonischer und Totenkult. Fest- dedicated to Hermes Psychopompos, pots containing schr. z. 50 jahr. Doktorjubil. L. Friedlander, Leipzig, cooked fruits and seeds of the earth were set apart 1895, 414-432. “ for the dead.” Like the “ Ilicet” which dismissed a 63 The Greek equivalents were the Genesia, birth­ Roman funeral, the feast terminated with the day festivals of the dead, and the feast of all souls, words: “ Away, ye Keres! the Anthesteria are over” which formed part of the Dionysian Anthesteria, (#opa£e Kijpes, ovk er’ ’AvdecrTrjpia), Rohde, I, 234- early in the spring. These were regarded as “ impure 239- 52 Annals of Medical History starve, always poured over the grave it­ cupid with an inverted extinguished torch self with averted countenance, and any good (Lessing). The skeleton frequently appears, which accrued to the offerer was of secon­ on antique gems and wine-cups, but merely dary importance. The Chthonioi required as a memento mori, never as an image of human sacrifice, or the substitution of death.66 Some of these skeletons are even certain non-edible animals as scapegoats, tipsy (Parkes Weber). The mediaeval or else sacrificial cakes made of the burnt figurations of death as a skeleton may, as products of the soil, or nephalia (mixtures Parkes Weber suggests, have come from of water, milk and honey), but no wine. the late Roman idea of representing larvae Sacrifices to the dead were seldom human, as skeletons or skin-and-bone figures;67 but usually required female or castrated but it is also highly probable that the animals, and always included wine. skeletons in the Dance of Death of the Sacrifices to the Chthonioi and the Heroes younger Holbein may have been derived were made at dead of night on low lying from the innumerable manuscript illus­ altars. And the cult remained immemorially trations of anatomy which began to be the same. Sacrifices to the dead were made common in the period. Many of these originally at night, later in broad day, represented shriveled or hastily dissected always upon a grave, and their apotropaic skeletal preparations, what Sudhoff terms intention finally resolved itself into in­ the Lemur engestalt. In the passacaglia timate familial piety. In the ancient cult, which forms the last movement of Brahms’ the dead were shrouded in royal purple, E minor symphony, a movement which the color of the Chthonioi. Max Kalbeck interprets as expressing the In the graphic and plastic arts, as Lessing, sovereignty of Death (Thanatos Basileus), and after him Parkes Weber have shown, the Holbein idea, Hermes Psychopompos the ancient figurations of death were usually with the divinity of the inverted torch, form serene and beautiful. In the Iliad, Hypnos the leading motive of the lovely interlude in and Thanatos, Sleep and Death, are twin E major.68 brothers; the one figured on antique gems But what Frazer calls “ the perils of the as a youth with wings attached to his soul” were sensed by the ancient Greeks temples, the other, as he appears in the in a way far removed from the sublime Alcestis of Euripides, a winged figure clad ne me perdas of Mozart’s Requiem or in black with drawn sword.64 Hermes even the sentiment of Plato. In Swin­ Psychopompos, the conductor of souls, is burne’s “ Ilicet, ” which dramatizes the the Cyllenian Mercury of the Odyssey, sensations of a pagan funeral, we get the with the golden wand, the winged golden feeling of primitive man about the necessity sandals and kerykeion (caduceus). The of bloody human sacrifice to the dead: soul (Psyche) is figured as a butterfly, sometimes resting on the shoulder of Yea, for their sake and in death’s favor Hermes,65 suggesting the animula, vagula, Things of sweet shape and of sweet savor blandula, of Hadrian, or the charming image We yield them spice and flower and wine; of Flaubert, comme une psyche curieuse, Yea, costlier things than wine or spices, comme une ame vagabonde. On the Roman Whereof none knoweth how great the price is, memorial tablets and gems, Death is a And fruit that comes not of the vine. 64 For a picture of a bas-relief representing Alcestis 66 Parkes Weber, 18 (Boscoreale wine cup), 338-357. between Hermes and Thanatos (British Museum), 67 Parkes Weber, 48. see Parkes Weber, op. cit., 382. 68 Max Kalbeck: Johannes Brahms, Berlin, 1912, 65 Parkes Weber, 362, 388-390. III, 476-83. G r e e k C u l t o f t h e D e a d a n d C h t h o n i a n D e i t i e s i n A n c i e n t M e d i c i n e 5 3

From boy’s pierced throat and girl’s pierced bosom promise of the future they held in their Drips, reddening round the blood-red blossom, grasp were bound up with the fact.” 70 The slow delicious bright soft blood, Rohde tells of even darker rites.71 In Bathing the spices and the pyre, Bathing the flowers and fallen fire, the Choephorae of Tischylus (439) and Bathing the blossom by the bud. the Electra of Sophocles (445), Clytacm- nestra is hinted to have cut off the hands Repulsive, sadistic even, as these lines and feet of the murdered Agamemnon and may seem to our modern taste, they yet suspended them around his neck (/zao-xaXicr- stand for something figured on scores of pos), lest dead hands return (as in Mau­ antique gems,69 something which undoubt­ passant’s grisly “ La Main”) to wreak edly thrilled the primitive Greek with vengeance. “ By way of lustration” (kcl-kL awe. Concerning this, Havelock Ellis says: \ovTpoiAeschylus (Fr. seek to shut out Death and Pain. It is 354), the wounds of the murdered body the feeble shrinking from Death and the were sucked thrice by the slayer and eject­ flabby horror of Pain that mark the final ed from * the mouth in three successive stage of decay in any civilization. Our spurts. But these are traits of the raw ancestors, too, offered up human sacrifice primitive which we can stomach for a on their altars, and none can say how much moment but upon which it is not good of their virility and how much of the to dwell. 69 See A. Furtwangler, Die antiken Gemmen, 70 Havelock Ellis: Impressions and Comments, Leipzig, 1900, or the figurations of human sacrifice Boston, 1914, 247. from the same in Hofler, op. cit., 10 -n . 71 Rohde, I, 322-326.

THE THREE CHARACTERS OF A PHYSICIAN

Enricus Cordus. 1486-1535.

Tres medicus habet facies, unam, quando rogatur Angelicam; mox est, cum juvat, ipse Deus. Post ubi curato, poscit sua praemia, morbo. Horridus apparet, terribilisque sathan.

Three Jaces wears the doctor: when first sought An angel’s! — and a god’s, the cure half wrought: But when, that cure complete, he seeks his fee, The Devil then looks less terrible than he. VOLTAIRE’S RELATION TO MEDICINE*

B y PEARCE BAILEY, M.D.

NEW YO RK

N idealizing the great men whose dis­ udice, superstition, all backed by the might coveries have transformed what, a short of church and state. Society, inevitably time ago, was little more than a specu­ averse to reality, placed, as long as it could, lativeI system of philosophy, into a science these deadly taboos across the path of what­ whose bounds are fixed only by the limiting ever might bring it and reality face to face. qualities of humanity, it should be remem­ It was only as, little by little, opinions bered that the followers of Hippocrates are ceased to be matters reviewed by the police, not the only ones who merit gratitude for and when investigation was no longer re­ what they accomplished for medicine. Med­ garded as offensive to God, that the prob­ ical growth implies more than the work of lems of medicine, so long waiting solution, gifted doctors alone. All who have could be brought into the light to be striven for human development studied. have furthered this art which The broader vision which joins or crosses every thread made this development pos­ of social fabric and which sible came from the men has always been more than outside of our profession a system of healing. quite as much as from Medicine must be the those within it; and it was last barrier but one be­ these allies of ours espe­ tween man and the fates. cially who risked their lives It stands at the entrance in the struggle for the es­ and exit of life and, since tablishment of tolerance. it seems nearest the mys­ They fought our battles, tery, it has always been and their names must be patiently looked to to dis­ placed with the names of close what lies behind that actual medical craftsmen F ran co is M a r ie A ro u et d e V o lt a ir e strange curtain which rises (1694- 1778). who, in wresting secrets and drops so abruptly. It from Nature, made com­ is so bound up in our souls with the arts and mentary give place to observation and con­ humanities, that its history is inseparable trolled fancy by experiment. Euripides and from the history of all human thought and Petrarch and Bacon and Luther, each in his behavior. Its records, at first sight seeming own way and according to his lights, helped to mark a development and ascendancy to break down the barriers which kept men’s quite its own, are really the records of the eyes from the truth; each helped to mold pub­ desires and fears and beliefs universal to lic opinion to a point where scientific medicine humanity; and neither they nor the men became possible. Some did the work which who helped make them can be understood resulted ultimately in advantage to our art by themselves. without having touched on medical subjects As long as thought was not free, medicine, at all; others, like Athanasius Kircher in common with other branches of learning, (1602-1680), the Jesuit priest, the earliest had to struggle with tradition, dogma, prej­ microscopist; like Antony van Leeuwenhoek *Read at a meeting of the Harvard Medical History Club, Boston, Mass., November 1, 1916. 54 V oltaire’s R elation to M edicine 55

(1632-1723), the wealthy brewer’s son of an original thinker. His genius was of a Delft, who gave the first accurate figura­ different order from Franklin’s, whose most tions of bacteria, who demonstrated the casual glance at a subject resulted in some capillary anastomosis between arteries and entirely new benefit to it. But he assembled veins, who presented twenty-six microscopes from all parts of the earth stray bits of in­ to the Royal Society and contributed many formation, fused them together and pre­ papers to it; like Descartes (1596-1650), who, sented them as a whole, in his own way. in establishing the physical theory of vision, Thanks to his special talent he was able to laid the foundation of ophthalmology; men give to the world views on medical topics such as these threw light on our problems saner than those held by most of the physi­ through solving problems of their own. cians of the times. Among the men who figured in shaping He is represented as the ruthless icono­ medical history in more ways clast, bitter and sarcastic and than one, must be counted unforgiving. But he has a way Voltaire. It would be super­ of tempering his invectives fluous to add one word here with a naive or witty word as to what Voltaire’s wit which reveals a funda­ and fancy and satire ac­ mental belief in the complished to estab­ good intentions of hu­ lish truth in the manity; and many world as a principle. incidents in his life, But it seems not un­ of which I recall two, reasonable to suggest indicate quite plainly that in fighting for to me that as a man general tolerance, he he was of an essential­ did more to advance ly kindly nature. Ap­ our profession than preciating Marmon- some of its own mem­ tel’s verses, he urged bers who, however this young man, a distinguished, com­ total stranger to him, promised with the to come to Paris from old dogmas. It may the Limousin, with be remembered that the assurance that Sir Thomas Browne M a r m o n tel, whose Moral Tales delighted the the Controller Gen­ salons of Paris. (1605-82), in writing eral of Finance, M. to correct “ Vulgar Errors, ” was proved hope­ Orri, would take care of him. But when the lessly enmeshed in them himself. But Vol­ future author of the Moral Tales arrived in taire, in addition to being a social reformer, Paris, Orri was no longer in favor and could did much to spread actual medical learning. do nothing for him. While he was staggering As an encyclopedist he was obliged to treat under this blow, Voltaire said to him, “ I of medical subjects, and he gave himself have not invited you here to abandon you. a wide range; throughout all he wrote on I will suffer you to have no other creditor these topics appears an uncanny sagacity than Voltaire.” And in another and more which led him to champion those explana­ intimate relationship, Voltaire’s gentleness tions of human behavior which, as it turns of character for those he really loved seems out, have best stood the test of time. Per­ to have been unmistakable. This was when haps it cannot be said of him that he was he discovered that Madame du Chatelet 5 6 Annals of Medical History had been untrue to him. After hours of ashes of kings reposed and the highest unhappiness and despair, when she came subjects in the kingdom felt it an honor to him and asked his forgiveness, he said to to assist in bearing thither his body.” her, “ Madame, everything you do is right,” and really forgave her. His British experiences seem to have He seems to have been born with a mania vitalized the main springs of his mind and for liberty which his early troubles only to have given direction to his energy. But deepened. Thrown into the Bastile more he was too accurate an observer of human than once, banished from France for years, nature to confuse political with intellectual he never really, except for tactical purposes, freedom. He knew, as well as Le Bon, how changed his views on oppression and or­ the crowd is made up; he saw that democ­ ganized dishonesty. racy was a dream and realized that During the XVIII century, the few govern. But he saw Great Britain was the only also, and just as unerringly, European country which that the advancement of had curtailed the arbitrary humanity depended on powers of Royalty. In learning. France Louis XV was There was no lack of able to forbid the pub­ proof in his time of the lication of the famous terrible penalties men encyclopedia, and many were forced to pay for writers were persecuted expressing the most ab­ without reason and with stract ideas. It may be scant mercy. It seemed remembered that in the that there was an un­ century in which Vol­ mistakable advantage taire was born the to learning in England French Parliament is­ as compared with its sued a decree which position in France, and forbade all persons, un­ Voltaire was incited to der pain of death, to work for a similar in­ hold or to teach any tellectual enfranchise­ method contrary to the L ad y M a r y W o r t le y M o n tag u, through ment for his country­ whose determination inoculation was intro­ ancient and approved men. duced into England. authors. This decree It was during his visit came about from the to England as a young man, that he came visit of two chemists to Paris who au­ to realize how much France was remaining daciously recognized five elements differ­ behind in the development of true wisdom. ent from the four elements of Aristotle, While there, he attended the stately funeral and who further failed to agree with the of Newton, and, as Parton informs us, categories and substantial forms of the master. They were tried, their books “ In extreme old age his eye would were solemnly burned and they were ban­ kindle and his countenance light up ished. But Parliament passed the Act re­ when he spoke of having lived in a land ferred to in order to show that it did not where a professor of mathematics, solely propose to deal so leniently with similar because he was great in his vocation, offenders in the future. Regarding this could be buried in a temple where the incident Voltaire says, “ Respect for tradi­ V oltaire’s R elation to M edicine 57 tion has hindered intellectual progress for There was no clinical instruction until centuries and was extended in the case of 1745, and quackery and imposture of all Aristotle to the most servile credulity.” kinds flourished like weeds in a garden badly The same Parliament of Paris which kept. The insane were regarded as menag­ avenged the insult by the chemists to erie animals to be viewed in some places on Aristotle, forbade the use of quinine and the payment of a fee. Until the middle of emetics. Against prejudices such as these the century in Germany, surgeons were Voltaire made war to the end of his days. called “ Feldscheerer, ” because their duties In our boyhood, we heard chiefly of Vol­ included shaving the officers; and in France taire as the ruthless atheist who wanted to surgeons were separated from barbers and destroy religion. As a matter of fact, he wig-makers only in 1743, following by twen­ attacked everything, whether military or ty years the establishment of the Academy ecclesiastical or political or social, in which of Surgery, which was accomplished by he saw domination and oppression, with Voltaire’s friend, Francois de L. La Peyronie pretence and quackery tagging inevitably (1678-1747) of Montpellier. The great behind them. “ Fanaticism,” he writes, “ is physicians were well-to-do and often culti­ a mental disease as contagious as smallpox. vated men, but far less inspiring than in the Once it has eaten into the brain, it is almost preceding century. Medicine itself was in incurable.” And elsewhere he says, “ The a rather chaotic condition, as few members world is full of quacks, in medicine, in of the profession had profited in an all theology, in politics, in philosophy,” and around way by its most advanced teaching. he asked to be saved from such men as Mes- But in spite of the fact that medicine was mer. The ideas which he stood for and sterile in his time, throughout all that Vol­ scattered (and he was the most read author taire wrote about physicians and medicine of his day), and which were thought as out­ it is easy to recognize the witty author as rageous for so long, are now largely current. their loyal admirer and defender. Physi­ They had, perforce, to become so before cians whom he thinks unworthy he attacks, medicine could come to its own. sometimes with scant justice; but every­ The century in which he passed his adult where through his writings shines his un­ years was poorer in great medical men than failing belief in this oldest of arts, and his the preceding one. Harvey and Malpighi admiration for its prophets. and Redi and Sylvius and Willis and Syden­ He had much to say about doctors, past ham had done their work and joined the and contemporaneous. Against Gerhardt immortals. In Voltaire’s own century, the Van Swieten (1700-1772), first physician to work of Pinel and Jenner was accomplished Maria Theresa, who opposed the introduc­ after his own was finished; of Voltaire’s tion into Vienna of certain books on philos­ contemporaries, Von Haller, of whom it was ophy (one of them Voltaire’s) and who also, said that the only things that he lacked like his teacher Boerhaave, opposed in­ were the faults common to great men, stands oculation against smallpox, Voltaire directed out now as the chief towering figure; Boer- the following satirical verses: haave was the teacher acclaimed every­ Un certain charlatan, qui s’est mis en credit where, and John Hunter was revolutionizing Pretend qu’a son example, on n’ait jamais d’esprit. surgery in England. But it was chiefly a Tu n’y parviendras pas, apostat d’Hippocrate, century of progress in the collateral sciences Tu guerirerais plutot Ies vapeurs de ma rate. of botany and chemistry, as is shown by Va cesser de vexer Ies vivants et Ies morts such names that stand out in it as those of Tyran de ma pensee, assassin de mon corps. Linnaeus, Priestley and Lavoisier. Tu peux bien empecher Ies malades de vivre. Annals of Medical History

Tu peux les tuer tous, mais mon pas un bon Iivre. et tous les besoins ont existe avant Ie Tu les brules, Jerome; et de tes condamnes secours.” La flamme, en m’eclairant, noircit ton vilain nez. “ Moliere made no mistake in ridiculing Of Simon-Andre Tissot (1728-97) the physicians,” he said, “ for, for a long time, famous practitioner of Lausanne who be­ out of every hundred doctors, ninety were came widely known through his popular quacks. But it is just as true that a good writings on onanism, on the hygiene of doctor can often save life and limb. Men literary men, and on the diseases of men of who pass their lives restoring health to the world, Voltaire writes to a woman others would be superior to all the great friend,—“ He has never cured anybody and ones of the earth and would resemble is more ill than everybody while he writes divinity. To conserve and repair is almost his little medical books.” as fine as to make. For five hundred years But much of the evil he says against the Romans had no doctors; being occu­ doctors was justified or put out in the spirit pied solely with killing they made no at­ of pure fun. “ I know nothing more laugh­ tempt to save life. What, then, did they able,” he writes a friend, “ than a doctor do at Rome when they had putrid fever or who does not die of old age.” And again, bubonocele or pneumonia? They died.” In “ Illness more cruel than Kings persecutes writing concerning Van Dale, the Dutch me. It only needs doctors to finish me off.” physician, he said: “ The Devil should not As a matter of fact, he believed in them. try his tricks on a clever physician. Those “ The first to bleed or purge happily a familiar with nature are dangerous for the patient with apoplexy; the first to conceive wonder-workers. I advise the Devil always the idea to put a bistoury into the bladder to apply to the faculty of theology—not to for the purpose of extracting a stone and the medical faculty.” then to close the wound up again, the first He had the keenest appreciation of the who knew how to keep gangrene from some Greeks, and of Harvey, and of Boerhaave, part of the body—these men were almost and of men of their kind, and he speaks divine and not at all like the physicians with affection of the various men who described by Moliere. You may see fevers attended him in his illnesses. He resents and ills of all kinds being cured without it Rousseau’s ungrateful treatment of Cabanis, being proved whether nature or the doctor a surgeon of great reputation, who passed worked the cure. You see diseases whose sounds on the author of the “ Social Con­ outcome cannot be foretold; twenty doctors tract.” “ It seems that ingratitude holds are mistaken until the one who has the a high place in the philosophy of Jean finest intelligence, the clearest vision, dis­ Jacques,” Voltaire exclaims. Voltaire knew covers the nature of the disease. It is, Haller and appreciated his rare talents, therefore, an art and the superman knows though he thought him stiff and unbending, the fine points of it. Thus La Peyronie and said of him that his “ Protestant zeal made the diagnosis that a certain courtier makes intolerance a fashion in the Canton must have swallowed a sharp bone which of Berne.” There was ill-feeling on both resulted in an ulcer and endangered his life; sides. Casanova, the Venetian charlatan Boerhaave found the cause of the cruel and and gossip and “ bomme a bonnes fortunes,” hidden disease of the Count Vassenaar. relates that after a visit to the Swiss savant There is, therefore, a true art of medicine; he visited Voltaire, to whom, in his mischief­ but in every art, then, are Virgifs and Mal- making way, he brought up the name of vius.” And elsewhere he says, “ Les mala­ Von Haller. “ There,” exclaimed Voltaire, dies sont plus anciennes que la medecine “ is a great man—one we must all bow to.” V oltaire’s R elation to M edicine 59

“ I am sorry,” Casanova replied, “ to inform He forgives J. B. Morin (1583-1656), who you that Von Haller entertains no such cast the horoscope of Louis XIV. “ He was opinion of you.” “Well,” Voltaire a savant in spite of the prejudices of the answered, “ the fact is that in all probability times,” he exclaims. Of G. Patin (1602- we both are mistaken.” 1672) he says that he was more famous for To Doctor Doran, who invented bougies, his letters than for his medicine. “ This he sent his compliments though he did not man seems to prove that those who hastily need him. He summons L ’ EcIuse, surgeon write up current events are misleading dentist of the King of Poland (formerly a historians.” It is the letters of Patin, who concert hall singer), to repair the “ irrepar­ was Dean of the Paris Faculty, which able teeth” of his niece. He recounts with Garrison cited as showing the “ sterile great satisfaction that it was Lilio, a inefficiency of the internists of the Roman physician, and not Greg­ seventeenth century.” ory X III, who reformed the Through Voltaire’s works calendar. “ It wasn’t so allusions to medicine and with the Greeks,” Voltaire physicians abound. In adds; “ with them the writing of physicians, glory of the invention he says, “The small remains with the art- number of great phy­ IS t. sicians who came to In sending his por­ Rome were slaves. trait in 1775 t0 Dr* J. Thus, to the Grand B. Silva (1682-1742), Seigneurs of Rome, first doctor to the a doctor became a Queen, who had at­ luxury like a chef. tended him, he in­ Every rich man had cluded these verses: in his suite, perfu­ At the shrine of Epidau- mers, bathers, musi­ rus it was etiquette cians and doctors. The to bring celebrated Musa, An image of the person physician to Augus­ whom the gods had tus, was a slave. He cured or saved; So to Silva, who in mas­ was given his freedom tering death has like V on H a l l e r , the great man without humor. and made a Roman a god behaved, K n ig h t, and from We should offer the same thing. then on, medical men became persons of O Modern Esculapius, I owe my days to you importance. When Christianity became And you look upon your handiwork in seeing me established, various councils forbade monks anew. to practice medicine, which was just the He tells us that Theophraste Renaudot opposite which should have been done if (1586-1653) the founder of the Gazette de good to the human race was to be gained. France,1 published thirty-four years (1631) How fortunate it would have been if monks before the first Oxford Gazette, was a doctor. had been made to study medicine and to cure the ills of humanity for the love of God. 1 These early gazettes, like the Roman Acta Diurna, contained official announcements of current events. Having nothing but Heaven to gain, there Renaudot’s information came directly from Rich­ would have been no quacks. They might elieu. have poisoned infidels, but this would have 6o Annals of Medical History been good for the church. Perhaps then Throughout all his writings one may find Luther would never have robbed our holy perspicacity and common sense in his father, the Pope, of the half of Christian recommendations as to the conduct of life Europe; for at the first fever of the Augustin and the care of body and mind. When well Luther, a Dominican could have given him himself, he praised hygiene above remedies pills. You may say he would have refused and was an advocate of the Natura Victrix to take them; but perhaps they could have formula. Under the heading of “ Medicine” found a way of making him.” in the philosophical dictionary, the doctor He abhorred the ceremonials that were says to the Princess: and still seem, in a way, inseparable from “ Let Nature be your doctor in chief. It the practice of medicine, as he abhorred is she who does everything. Of all those shams of all kinds. “ I have always had a who have extended their life to one hundred secret aversion for that Swiss doctor of years, not one belongs to the faculty. The yours,” he wrote a friend. “ I despise a man King of France (Louis XV) has already who dares not tell you what remedy it is buried forty of his physicians.” that he is giving you. The absurd quackery The Princess replies: of diagnosticating diseases by temperaments “ In truth I hope to bury you too.” and by urine is the shame of medicine and Voltaire relates many anecdotes which of reason.” And elsewhere he says, “ How throw light on some of the quasi-medical foolish it is that we know what the cook customs of the times. One of them shows gives us for supper, and don’t know what a the distinction between social position and doctor gives us when we are ill.” justice. Constantin, a midwife, performed When in 1778 he died at the age of eighty- a criminal operation on a lady of the court four, his organs were all normal, only “ dry,” so unskillfully that the patient was fatally as the autopsy report has it. But he was injured. She was in great suffering, and frequently ill, as may be expected of a body her lover, when he saw her, wishing to lodging a mind to which repose is unknown, relieve her sufferings, became possessed of and he wrote much about illness. what might now seem an access of kindly “ I regard long illnesses as a kind of zeal, and killed her by breaking open her death which separates us from the rest of head. He fled and was banished, but later, the world and makes it forget us. I am after arranging an advantageous marriage trying to get used to this first kind of for the King’s brother, was again welcomed death so that the second shall not frighten at court. But for the unfortunate midwife me so much.” there was no such mercy. She was hanged “ It is the lot of old age to be ill and and thrown into quicklime. “ There would these little warnings are the clock strik- have been no use in coming to visit her,” ings which announce that very soon there says the sprightly Patin, “ there was nothing will be no more time for us. Animals have left to recognize her by.” the advantage of humans; no clock sounds Regarding witchcraft he relates that the their hour and they die without guessing Marechale d’Ancre, an Italian friend of it; they have no theologians to tell them Marie de Medicis, whose husband, Concini, the four ends of life or to pester their last had been murdered with at least the conni­ moments with impertinent ceremonies; it vance of Louis X III, called a Hebrew doctor costs them nothing to be buried and no one called Montalto from Italy to see her, contests their wills. But we have the best having first complied with the recognized of them after all, for they know only formula in such matters by obtaining per­ habit while we have friendship.” mission from the Pope. At that time, it V oltaire’s R elation to M edicine 6 i

may be remembered, Paris physicians did was right about this; and that appendicitis, not have as good reputations as the Italians, and kindred abdominal diseases were the it being these latter who were reputed as real cause of many of the reputed cases of masters of all the arts. It was claimed poisoning. against the Marechale that this Montalto He understood fully the contagion which was a magician and that he had sacrificed robs crowds of their wits. It is true that a white cock at the Marechale’s. At any he had almost unparalleled opportunities for rate, he could not cure the lady of her observing examples of hysteria in the con- vapors, which were so compelling that vulsionists as they were called, who, in^the instead of believing herself a witch, she XVIII century flocked to the tomb of the conceived the counter idea that she was Diacre de Paris, or the saint Paris, in the bewitched herself. She then had the remote little cemetery of St. Medard. weakness to summon two exorcist The miracles that were worked priests from Milan, who said there were looked upon by masses for the vaporous lady the simple people as a rec­ and assured her she was ognition by the Almighty cured. But when, in ad­ of the cult launched by dition to the charges the unhappy Jansen, against her of magic, who died w ith o u t she had questions put knowing what a fuss to her regarding the his earnestly conceiv­ death of Henry IV, ed book was to kick husband of Maria de up. Singing, dancing, Medicis, she collapsed. groaning, grunting, Having laughed at the barking, mewing, hiss- accusations of magic, ing, declaiming, she wept when ques­ prophesying, with the tioned about the dead ordinary motor ac­ king and made a bad companiments of im p ressio n on the feeling, reached such judge. She was be­ a height in this hither­ headed and cast into to quiet churchyard the flames. Voltaire that the king found opposed with violence S il v a , physician to the Faculties of Paris and it necessary to close it Montpellier. and with ridicule the —or, as a wit put it, idea so popular in his time, of the fre­ “ By order of the king; God is forbidden quency with which people were disposed to perform miracles in this place.” of by poison. The most celebrated of Voltaire wrote much about these oc­ women poisoners who experimented with currences, and analyzed them as did Col­ poison on the sick she visited in the lins,2 who described them anew in 1908. hospitals, and who was beheaded and One of Voltaire’s burlesques took the burned for her crimes in 1676, Madame de form of the following verse, relative to this Brinvilliers, has more crimes accredited to famous tomb: her than she committed, he says. He holds The deity, to lighten France’s night the same opinion in regard to Catherine de Within this tomb encloses all its might. Medicis. It is only in recent years that it Hither the blind come hurrying; and then has become increasingly probable that he 2 N. Y. Medical Record, July 4, 1908. 62 Annals of Medical History

With hands that grope their way, return again. 445,000 pilgrims for three days—but per­ The halt come limping to this tomb, and all haps that is an encouragement to vaga­ Crying hosanna, dance and leap—and fall. bondage more than an act of charity, as The listening deaf approach—and hear no sound. “ La Pucelle” —9—III—63. pilgrims are usually tramps. Of all hos­ pitals, the Hotel Dieu of Paris receives In Voltaire’s time, hospitals were in an daily more poor patients than any other. overcrowded and unsanitary condition; filth There are often from 4000 to 5000 at a was everywhere, contagion flourished, and, time. In this case, the number defeats the as Bass says of them, “ even physicians purpose of the charity. At the same time declined hospital service as equivalent to a it is the receptacle of all terrible human sentence of death.” Voltaire perceived the miseries and the temple of the true virtue menace of the huge which tries to succor Hotel Dieu and want­ them. It would be ed it split up into a well to bear in mind number of smaller pa­ the contrast between vilions, scattered in a fete at Versailles, different parts of the between an opera at city. Of hospitals in Paris, where all the general he said: delights and magnif­ “ There is hardly icence are united with a city in Europe to­ such art, and of a day without hos­ hospital where all the pitals. Turkey has suffering, despair and them for animals, death are crowded to­ which seems an ex­ gether with such hor­ travagant charity. ror. Large cities are It would be better like that. In the char­ to forget animals itable institutions, the and save more men. drawbacks are often The great mass of greater than the ad­ charitable institu­ vantages. A proof of tions proves a truth the abuse connected to which little at­ with them is that tention is paid—it the poor devils whom M a r q u is e d e B rinvilliers trying out her poisons they take there are is this, that man­ on the patients in the Hotel Dieu. kind is not so bad as afraid to be there. It it is painted; that, in spite of all the false is especially bad when the town gets too opinions that he holds, in spite of the big, when there are four or five patients horrors of war, which change a man into in one bed,3 when a poor fellow gives the a brute, it is easy to believe that this scurvy to the neighbor from whom he animal is really kind and only ugly when catches the smallpox. The futility and aroused, like other animals. The trouble even the danger of medicine under these is that he is teased too much. Modern circumstances is proved. It has often been Rome has almost as many houses of proposed to split up the Hotel Dieu into charity as antique Rome had triumphal several better situated hospitals—but the arches and other monuments of conquest. 3 Beds were built with the purpose of accommodat­ The Trinite in Rome once maintained ing several people at once. V oltaire’s R elation to M edicine 63 money is never forthcoming. It is easy to “ Such a man is not destitute of ideas; get it to send men out on the border to he has them, like every one else when be killed— but then there is none left to awake and often when sleeping. One save them with.” might ask how this immortal spiritual mind, the brain’s tenant, receiving all its Voltaire’s most striking characteristic as ideas by the senses, never delivers a sane an author in general is his modernity, and judgment. It sees objects just as the minds this is particularly remarkable in that it of Aristotle and Plato and Locke and continues into matters scientific. It seems Newton saw them. It hears the same less surprising that Euripides should have sounds and has the same sense of touch. seen into the real hearts of men through the How does it happen, then, that it collects veils of symbolism that such an extravagant surrounded human cus­ mess, without being able toms in ancient Greece, to make use of the per­ than it is that a French ceptions it receives in wit and playwright and common with the philos­ letter writer should have ophers? If this simple so unerringly picked out and everlasting sub­ the truth from the many stance is subserved by medical systems of his the same instruments as time. serve the minds which ■f Much that he says are lodged in the brains about medical subjects of the wisest of men, could be incorporated why does it not reason in textbooks to-day. He as they do? was dead before Pinel “ I will admit at once, (1745-1826) wrote his if my madman sees red first book, and yet in and the wise men see the article on madness blue; if, when these lat­ in the Philosophical Dic­ ter hear music, my mad­ tionary may be found the man hears an ass bray­ same prophetic teach­ ing; if, when they are ings which have made at church, my madman Pinel immortal as the Le diacre de Paris. fancies himself at the savior of the insane. play; if, when they hear “ What is madness? It is having incoher­ ‘ yes,’ he hears ‘ no’— why then his mind ent thoughts and conduct. Madness, dur­ might think the opposite of what theirs ing the waking state, is a disease which do. But my madman has the same per­ prevents a man from thinking and acting ceptions as they have and there is no as other people do. No longer capable of evident reason why his mind, having been directing his affairs, they are taken from furnished with all the tools by the senses, him; Society excludes him for not being should not make use of them. able to hold the ideas which suits it; if “ Close reflections make one suspect that he is dangerous, he is shut up; if violent, the faculty of thinking, the divine gift to he is restrained. Sometimes he is cured by man, is subject to derangement like the baths, by blood letting, or by a chosen other senses. A lunatic is a sick man whose regimen. brain suffers, as the gouty man is one who 64 Annals of Medical History

is ill in hands and feet; he thought with like me to engage a place for you in his brain as he walked with his feet, with­ it?” ’ out understanding his incomprehensible And by way of appendix he adds: power of walking any more than he un­ “ I am distressed that Hippocrates pre­ derstood his incomprehensible power of scribed asses’ blood for insanity, and still thinking. There is a gout of the brain as more that the ‘ Manuel des dames’ says well as of the feet. Finally, after all that poor people become sane when they reasoning, perhaps faith alone can con­ catch the itch. These are pleasing receipts; vince us that a simple and immaterial they appear to have been invented by the substance can be ill. patients.” ‘ ‘The physicians say to an insane patient, ‘ M y friend, you have lost common sense. Voltaire wrote much about syphilis, the Your mind is as pure and as spiritual as grand pox, as he called it. He draws ours, but ours is well situated, while yours distinction between it and leprosy and is not. For yours, the windows are shut— believed, as many of the best informed still it lacks air and suffocates.’ The patient, do, that syphilis originated in America. in a sane moment, might answer, ‘ M y Two things prove this, he says: friend, you assume the question; my “ First, that quantities of authors, phy­ windows are as wide open as yours are, sicians and surgeons of the XVI century as .1 see the same things and hear the attest the truth of it. Second, the silence same words; so it follows that my mind of all physicians and poets of antiquity, makes good use of the senses, or that it is who did not know this disease and never itself a perverted sense, a deteriorated pronounced its name. This seems very quality, or my mind itself is insane, or conclusive. Physicians, from Hippocrates else I have no mind at all.’ down, could not have failed to describe “ One of the doctors might answer, ‘ M y the disease, to name it, to see remedies dear friend, perhaps God has created un­ for it. The poets, as mischievous as the balanced minds as he has created balanced doctors are industrious, would have ones.’ To which might be answered, ‘ If I spoken in their satires, of the clap, the believed that I would be madder than I chancre, the bubo, all the things which am now. Come, you who know so much, precede and follow this awful malady. tell me why I am mad.’ If the doctors You will find no word in Horace, in Catul­ have a little sense left, they will reply, lus, in Martial, in Juvenal, which has the ‘ I do not know at all.’ In a moment of slightest relation to it, although they write lucidity, the madman might say to that, freely of all the effects of dissipation. It is ‘ Poor fellows—you who do not know the certain that the smallpox was not known cause of my trouble and cannot cure it, to the Romans till the VI century, and tremble lest you become just like me—or that the American pox was not brought perhaps worse. You are of no better stock to Europe until the end of the XV than Charles VI of France, Henry VI of century, and that leprosy is as different England, or the Emperor Venceslas, all of from both of them as it is from St. Vitus’ whom lost the faculty of reasoning in the dance. same century. Your minds are not better In 1496, the Parliament of Paris passed than those of Blaise Pascal, Jacques a decree which read that all affected with Abbadie, and Jonathan Swift, all three of the great pox who were not citizens of whom died mad. The last of these at least Paris, should leave town within twenty- founded a hospital for us. Would you four hours or be hanged. The decree was V oltaire’s R elation to M edicine 6 5

neither Christian nor legal nor reasonable; Before Harvey, practically all views had but it proves that the pox was regarded been molded on Aristotle’s theory that the as a new menace, which had nothing to male parent furnished the body of the do with leprosy, since they did not hang future embryo, while the female only nour­ lepers who slept in Paris. Men can give ished and formed the seed. leprosy to each other through dirt, but as It was argument based on the denial of for the pox, it is Nature that has made the maternal relationship that secured the this present to America. We have already acquittal of the accused in ZEschylus’s reproached this Nature, so good and so “ Furies.” Apollo defended Orestes charged bad, so clear-sighted and so blind, for with murdering his mother, Clytemnestra, having defeated its object by poisoning by saying: the source of life, and we still lament being unable to find a solution for this Not the true parent is the woman’s womb That bears the child—she doth but nurse the seed terrible difficulty.” , New sown: the male is parent—she for him The societies for prophylaxis of venereal As stranger for a stranger, hoards the germ diseases might turn to their profit the Of life, unless the gods its promise blight, And proof hereof before you will I set. conversation between the surgeon and his Birth may from fathers, without mothers be: questioner in “ L’Homme aux quarante See at your side a witness of the same, Ecus.” The surgeon replies to the question Athena, daughter of Olympian Zeus as to how syphilis may be gotten rid of: Never within the darkness of the womb Fostered, nor fashioned, but a bud more bright “ There is only one way, and that is for Than any Goddess in her breast might bear. all the princes of Europe to form a league, (Trans, by Morshead.) as in the days of Godfrey of Bouillon. A crusade against syphilis would surely be In 1677 Leeuwenhoek communicated to more sensible than those directed in old the Royal Society of London the discovery times against Saladin, Melecsala and the which his pupil Hamen had made, by means Albigenses. It would be better to form an of the microscope, of the living spermatozoa. agreement for the purpose of stamping Leeuwenhoek believed that the moving ele­ out this enemy common to all humanity, ments of the semen might be germs which than to be always busy watching for the enter the egg and become embryos. Op­ right moment to devastate the earth and ponents to this theory called them para­ cover the fields with dead, for the purpose sites, a view which is responsible for a part of filching from one’s neighbor two or of their name. three cities or a few villages. I am speak­ It was not until after the death of Vol­ ing against my own interest, for war and taire that Spallanzani proved by ingenious the pox make my fortune.” experiments that the spermatozoa were necessary for fertilization. So Voltaire was It was inevitable that the speculation and not the only one at sea when, in 1777, he experiments on a subject like generation, devoted the ninth dialogue of Evhemere to which were active in his time, should have this topic. Evhemere represents a philoso­ excited the human Voltaire. Harvey, under pher of Syracuse, and Callicrate serves him the stimulus of his teacher, Fabricius, did as interlocutor, or “ end man.” an enormous amount of work on animals along these lines, and in 1651 published his Callicrate — I have always been as­ book “ Excitationes de generatione” and, as tounded that Hippocrates, Plato and Voltaire puts it, took for his devise “ Omnium Aristotle, all of whom had children, did ab ove.” not agree as to how Nature worked this Annals of Medical History perpetual miracle. They all say that the being that the former set and the latter do two sexes cooperated in that each fur­ not. A woman is a white hen in Europe, nished some fluid; but Plato, putting and a black one in Africa. theology ahead of nature, of course, con­ Callicrate—Then the mystery is cleared siders nothing but the harmony of the up! number three, the engender, the engen­ Evhemere— Not at all. Recently all has dered, and the female in whom the been changed again. We do not come from generation takes place. That constitutes an egg after all. It seems that a Batavian a harmonious proportion for Plato, even (Leeuwenhoek) has, with the microscope, if the accoucheur fails to grasp it. Aris­ seen in the seminal fluid of men a race of totle limits himself to saying that the little beings, fully formed and running female produces the material about with great activity. Many of the embryo and the male curious men and women have determines its form. That since tried the same experi­ does not help us much. ment and become persua­ Tell me, has no one ded that the question of seen Nature at work, generation is solved. as sculptors are seen They thought they saw making figures from little men in the semen clay or from marble of their fathers. But or from wood? unfortunately, the Evhem ere—The very activity with sculptor works in which the little men the open but Na­ swam has discredited ture in the dark. them. How could men AH that we knew who ran about so ac­ up till now was that tively in a drop of liq­ the fluid is always uid be expected to re­ spent by the male main for nine months when he copulates, almost motionless ir but that it is some­ their mother’s womb? tim es missing in women. But now a Voltaire was forced M a d am e du C h a t e l e t , mathematician and friend great English phys­ of Voltaire. to leave the question icist, aided by cer­ here. tain Italians, has substituted eggs for “ AH theories,” he said in a letter to the two generating fluids. This great Thieriot, “ as to how we come into the dissector, Harvey, is more credible from world have been overthrown. The only the fact that he has seen the blood thing that has proved changeless is the circulate; something which Hippocrates way people make love.” never saw and Aristotle never sus­ pected. He dissected over one thousand He was no slower than the rest of us, quadruped mothers who had received the for two centuries, less two years, elapsed male fluid—but when he had examined between the discovery of the spermatozoa, hen’s eggs, he conceived the idea that in 1677, and Hertwig’s (1849- ) demon­ everything originates in an egg; the differ­ stration in 1875, that fertilization is effected ence between birds and other species by the entrance of one spermatozoon into V oltaire’s R elation to M edicine 6 7 the egg and the union of its nucleus with Lady Mary Wortley Montagu combined the egg nucleus. determination with charm, but, as Voltaire In Voltaire’s time, smallpox was still a said, she wrote for all peoples who wished terrible scourge. “ Of one hundred people,” to learn. In one of her letters from Constan­ he states, “at least sixty get smallpox; of tinople, she said, “ I would write our London these sixty, ten die and ten retain the doctors if I believed them big enough to marks. Thus this malady kills or disfigures sacrifice their own interest to those of one-fifth of mankind.” humanity. But I fear their resentment, if I Voltaire had this disease when a young should undertake to lessen the revenue that man and wrote his views as to the treatment smallpox brings them. But on returning to of it. Personal experience may have stimu­ London I shall perhaps have zeal enough to lated his interest in the subject, but, open the war.” as far as inoculation was con­ She did, and succeeded, and cerned, his interest was un­ Voltaire reports that the doc­ selfish, as he was firmly of tors instead of opposing in­ the opinion that smallpox oculation, took it up and never came twice to the were better recompensed same person. As he was by royalty for their the first continental to inoculations than they write of the new phys­ would have been had ics from England, so they brought the dead was he also the first to life. real sponsor in Europe Dr. Richard Mead, (1727) for variolation one of the wealthy for smallpox, although possessors of the Gold Dr. La Coste had com­ Headed Cane, first posed a brief note con­ practiced inoculation cerning it before any in England in 1721. writings of Voltaire’s Royalty came to the on the subject saw support of the cause, the light and although especially Queen Car­ the subject had been oline of England, a taken as an inaugural woman whom Vol­ C a t h e r in e II, royal sponsor for inoculation in thesis by J. B. N. Russia. taire admired im­ Boyer (1693-1768) of mensely. The Due Montpellier in 1717. La Coste probably d’Orleans, King of Denmark, King of Swe­ received the idea from reports to the den, and Queen of Hungary all had it done Royal Society in 1714-16' by physicians in their families. who had visited Constantinople. The adop­ Catherine II, Empress of Russia, wrote tion of the practice in England was due Voltaire in 1768, saying that Dr. Thomas to Lady Mary Wortley Montagu, who Dimsdale (1711-1800) of England had come learned it from the Turks and who practiced to Russia. He had inoculated 6000, with it on her children in 1718, while her hus­ only one death, and that death a child of band was Ambassador at Constantinople. three. Catherine was inoculated and had no This courageous action of hers preceded ill effects from the operation. She did not by eighty years Jenner’s transference of the go to bed and saw company every day. Dr. cow-pox from the milkmaid to James Phipps. Dimsdale made inoculations in Petersburg 68 Annals of Medical History

in schools and in specially constructed hos­ cassians are poor and their children are pitals, receiving as his fee ,£10,000 down very pretty and it is with the daughters and an annuity of £500. that their chief trade lies. They supply It is interesting to note that at about the the beauties of the harems of kings and of time that inoculation, or “ buying the small­ others rich enough to buy and maintain pox” as it was called, was gaining in Eng­ such valuable merchandise. They bring land, an epidemic visited Boston, for the up the girls to caress men, to dance and first time in sixteen years. The impassioned to excite, by the most voluptuous artifices, Cotton Mather, who had studied medicine the taste of the supercilious masters for for a time and who was the first American whom they are destined. Every day the elected to the Royal Society (1713), aroused little girls rehearse their lessons with their by the reports of the new method which he mothers, like children who learn the received from England, sent copies of them catechism without understanding any­ to the Boston practitioners, and Dr. Zabdiel thing about it. But smallpox would make Boylston (1679-1766) also a member of the futile all these pains. Royal Society, first introduced (as is. re­ A commercial nation is always alert for corded on his tombstone in Boston), the its interests and neglects no information practice into America. Within six months which might foster its trade. The Circas­ he had inoculated 244 persons. But several sians observed that smallpox practically of his patients died and the Selectmen of Bos­ never came twice to the same person. ton, with true Puritan insight, forbade its fur­ They perceived, further, that benign ther practice, saying “ that the operation smallpox leaves no mark and concluded tends to spread and continue the infection in that if a child of six months or one year a place longer than otherwise it might be.” had benign smallpox it would neither die This fact of the contagiousness of inoculated nor be pockmarked, but would be rid of smallpox was late in attracting the observa­ the disease for the rest of its life. So they tion of Europeans. Voltaire does not speak treated their children in this way. The of it. It was a feature of more importance Turks adopted this custom and it became in America than in Europe, in which latter practically universal in Turkey. Of all continent the ravages of smallpox were so those inoculated in Turkey or England, continuous and so widespread. none die, except the very feeble, none are Inoculation was probably a folk custom pockmarked, and none acquire the disease originally and was prevalent in many primi­ again.” tive people and is still practiced in certain African tribes. But Voltaire’s letter about it He reproaches Louis XV, who died of is no less interesting. smallpox, with not having profited by the examples of others and with not having “ It was an immemorial custom,” he been inoculated. But this reproach is hardly says, “for Circassian women to give justified, as he states elsewhere that this smallpox to their children at the age of monarch had had the smallpox as a boy of six months, by making an incision on the fourteen. arm and by inserting in this incision a Years afterwards, in 1763, when inocula­ pustule from the body of another child. tion, though current, was meeting with The inoculated child served as source of opposition, the Parliament of Paris ordered supply of pustules for other children. that the question as to its value should be Maternal instinct and tenderness intro­ referred to the faculties of theology and duced this custom in Circassia. The Cir­ medicine. In a sarcastic pamphlet, Voltaire V oltaire’s R elation to M edicine 69 says, “ You gentlemen, who are the best Ah, France, it was at last your fate theologians and the best physicians in To ask of England all she knew, Nor need we blush to imitate Europe, you should issue an injunction Those whom we fairly overthrew. against smallpox, just as you have against For equally in all men’s sight Aristotle’s categories, against the circulation The sun performs its daily race, of the blood, against emetics and quinine.” And Truth, impartial, sheds her light Inoculation did not become general in In every age, in every place; France until 1756, and Voltaire was an old Let us—not asking whence they come, man when he addressed the following verses Nor whose the honor and the praise— to that medical friend of his who had done Receive with joy her blessed rays, most to make the practice accepted by the And may the whole world be her home! French, and who had 20,000 successful Besides these subjects, he wrote on fistula, operations to his credit. This was Theodore which killed Richelieu. It was for fistula that Tronchin (1709-81), of Geneva, the same Louis XIV paid the son of the elder Felix one who demonstrated that the “ Colica (d. 1703) in a property worth 50,000 ecus,4 Pictonum” was caused by lead used to in return for the skillful operation he per­ sweeten wine, and who was the first to formed on him. Voltaire also wrote on the show that plumbism might result from stone and on leprosy. He had the vagueness water drawn through lead pipes. The verses of view regarding gonorrhea which lasted were written on the occasion of Tronchin till the time of Ricord (1799-1899). Of gout cutting short a visit to Voltaire to go to he made the remark that “ it confounds the inoculate the king’s grandsons. pretended art of medicine.” He was very

A. M. T ronchin enthusiastic about the first veterinary school founded in France, in 1672, which was the Since your departure yesterday, Renewed is all my suffering, beginning of veterinary medicine in Europe. But I can bear it and be gay He wrote its founder and director, Claude Because I know you went away B. Bourgelat of Lyons (b. 1712) author of To save the grandsons of the king. “ Elements de I’art Veterinaire” (Lyons, Some prejudices serve an end, 1765-69),—“ You are not like those physi­ But others grow like noxious weeds; cians who without hesitation take the place To triumph over these, one needs of God and create a world with a word. You A sage, a man of valiant deeds. have opened a new career by the way of Your clever hands their aid did lend experience.” When, long ago, I told my nation (And youth, perhaps, was my excuse) In his “ Century of Louis XIV,” Voltaire About inoculation. states that surgery, “ the most useful of all the arts,” attained its highest supremacy in Which—thanks to you in common use—- France during Louis’ reign. People flocked Was thought imagination And met with foul abuse there from everywhere to avail themselves Like Newton’s gravitation. of the skill of the surgeons and to obtain I saw the truth, but could not then the instruments which there attained the The world of that same truth convince; highest degree of perfection.5 Nor was I hailed, before or since, A prophet by my countrymen. 4 The ecu did not have a constant value, being worth between 3 and 6 Iivres, a Iivre being the “ How can we,” people said, “ believe equivalent of the franc. The purchasing power of Truths made in England? How suppose the franc then and now is put at 1-10. That any one can good receive 5 It was John Hunter who transferred surgical From those who are our foes?” supremacy to England. 7 0 Annals of Medical History

Voltaire’s varied activities with the stage, “ Bibles, not Virgils,” he says, “ are found with court life, with the wise investment of in the pockets of regicides.” In illustration money, with agriculture, and with practical­ of this he cites the case of Jean Chatel, who ly all the questions of his day, left him time attempted to assassinate Henry IV. The to acquire a discriminating interest in the young man had conceived the idea from history and trend of the medical art, to fix Jesuit priests that he was damned. He his belief in its ideals and to make him wanted to die, and contemplated a bestial jealous of its good name. But the fact that crime in public, with the idea that he would his writings on medical subjects represent be killed at once. He changed this plan to so very small a portion of his works, makes that of assassinating the king, and stabbed surprising the accuracy of his knowledge of him in the mouth. The Protestant d’Aubigne medical subjects, his free and correct use of wrote to Henry IV about this, saying, “ You medical terms, including those of have denied God with your mouth anatomy, and his perception of and he has struck your mouth; medicine’s final promise. take care that you never deny It would be interesting him with your heart.” to know whether his ob­ As to capital punish­ servations and criticisms ment,Voltaire asks if it is covering the theories of reasonable to suppose Newton and Descar­ that men can be taught tes, his views of Locke to hate homicide when and Spinoza and Hel- the magistrates are vetius and other phi­ homicides themselves losophers, his state­ and kill a man with ments in history, his a great show. Should opinions on law and not the criminal make on bees and lawyers good the damage he and actors and au­ has done his country thors and dancers by working for it— came as near to the death makes nothing truth as his medical good.” opinions. He is said To-day the great to have failed to ap­ problem in education preciate Shakespeare; T ro n ch in , most prominent French inoculator. is that of selection, but he seems to have the organization of the had a good line on Aristotle, and I for one am means to find out the faculties of the inclined to accord him the compliment of individual and to adapt education to the believing that he was right oftener than perfecting them. We find Voltaire realizing most men from the very fact that he was this already and saying that education in so often right in matters I happen to know colleges and convents is bad, for the reason about, but which were side issues to him. that there the same things are taught to a His views of crime and punishment have hundred pupils, all with, different talents; not been (improved much since his day. and he makes Candide say, at the end of “ Whoever gives himself a master,” he says, his varied and exciting experiences, that the “ was born to have one.” He saw dementia thing for each one to do is, after all, to in all great crimes, and notes the religious cultivate his own garden. fanaticism associated with so many of them. Regarding the importance of youthful V oltaire’s R elation to M edicine 7 1 impressions in forming character, he puts Guibert, which was used by the French in the mouth of Zaire, the Christian captive officers in this country during our Revolu­ in Jerusalem, reared in ignorance of her tion, and which was later highly prized by faith and country, and beloved by the Napoleon, he wrote: Mohammedan ruler of the region : Fevers, gout and catarrh and a hundred worse ills With a hundred learned charlatans working their ----- the love that encircles and nurtures our youth wills— Molds our feelings and conduct and grasp of the You might think the world evil enough as things are, truth. Without man’s inventing the great art of war.6 A slave to false gods, I had been as sincere As a Christian; in Paris; or Mussulman here. But feeling in this way did not prevent The hands of our parents, their training, tho’ brief, him from realizing that “ the nation best Engrave in our heart every early belief provided with steel will always Which example and custom so often subjugate the one which has retrace more gold and less courage.” And which, it may be, only God Dr. John Moore, a prac­ can efface. 11,560. titioner of London, whose In Chariot he brings letters about his travels out the Socratic doc­ \ gained him some liter­ trine, overthrown by ary reputation, while Aristotle and revived tutor of the young in our days by Freud, Duke of Hamilton that knowledge and visited Voltaire at virtue are the same Ferney in the last thing. Le Marquis, year of Voltaire’s life an overbearing and (1778). He has left a spoiled young man, lively picture which excuses himself to his seems to have escaped mother by saying: the great French­ “ Jesuis fort naturel,” man’s English biog­ to which his mother, raphers. the countess, replies: “ This skeleton,” he writes, “ has a keener Oui, mais soyez and brighter glance aimable— B o u r g e l a t , founder of first veterinary school in Cette pure nature est fort France. of the eye than any insupportable. human being, with Vos pareils sont polis; pour quoi? c’est qu’ils ont eu the vigor of maturity and all the advan­ Cette education qui tient lieu de vertu; tages of the most bubbling youth. In his Leur ame en est empreinte; et si cet avantage face may be read his genius, his pene­ N’est pas la vertu meme, il est sa noble image tration, and his extreme sensibility. He Dompter cette humeur brusque, ou Ie penchant vous maintains a systematic correspondence Iivre, with the whole of Europe, and from it he Pour vivre heureux, mon fils, que faut il? gets the news of all noteworthy events and Savoir vivre. all literary productions as soon as they A balance runs through his opinions which appear. The greater part of his time he is truly remarkable for a man who took such 6 For this and the preceding renditions of the personal prejudices as he did. He hated war, French into English verse the writer is indebted to and relative to a hand-book of tactics by Mrs. Alice Duer Miller. 72 Annals of Medical History spends in his study, reading or being read constructive mental energy. It would be to, and always with his pen in his hand with hard to find a more exacting test of intellect which to make notes or comments.” and courage than that—than to contemplate He must have passed his whole life in the correctly the verities, and still show undis­ way Dr. John Moore describes his last days. mayed the feelings and actions of an opti- With a pen in his hand and with his ist. To stand such a test re­ mind turning from his immediate quires, in addition to the purely surroundings to rove to the intellectual critical qualities, uttermost parts of the earth, the kind of understanding keen for material and crit­ of humanity which is in­ ical for thcdrawingof far- separable from the love reach in g conclusions. of it. Every fact, familiar or Medicine, as well alien, served him for as other branches of thinking. When Wil­ learning, owes its liam Cheselden (1688- chief debt to men like 1752), the English Voltaire, who were at surgeon, and physi­ once brave, knowing cian to Sir Isaac New­ and humble. Voltaire ton, made an artifi­ used to say that his cial pupil on a patient desire was to try and c o n g e n ita lly blind, sow broadcast what thereby supplying he perceived so clear­ him with vision, Vol­ ly himself. He com­ taire was greatly ex­ plained that the fields cited at the discovery were ungrateful, not that it took the pa­ realizing, perh ap s, D r . J ohn M o o r e , who left a lively account of tient some time to Voltaire’s activity during the last year of his life. that only men of fiber acquire the idea of like his own can grasp distance. Apropos of this, he said, “ It is truth firmly and hold it. Judged by the impossible to be unhappy through the events which have had a bearing on the deprivation of things of which one has no conclusions that he drew, he made sing­ idea.” ularly few errors in principle. He seems He possessed, perhaps better than any to have illustrated his own saying: one, the capacity to look things in the face and, in spite of what he saw there, to main­ Le gout conduit pour Ie genie ne fait tain with humility the high level of his jamais de fautes grossieres. AN UNPUBLISHED BRONZE ECORCHE B y EDWARD C. STREETER, M.D. .... BOSTON

F proof were needed of the complete technical excellence, power to portray pres­ concurrence of science with the serious sures and mass beneath contour. It gave figure arts at Florence four hundred reality and firm substance to the represen­ Iyears ago, it could readily be drawn fromtations of form and movement. It brought the most cursory study of the bronze figurine fresh vision and vigor to assail each vital reproduced on this page. This plastic problem. little bronze is scant six inches The new naturalism, aiming measurement, of brassy tex­ at a scientific reproduction of ture and without particular nature, took the Florentine patina; it dates from the first Schools by storm. No “ bot- quarter of the XVI century tega” but felt the vast stir of and is said to be the work of this momentous development. Jacobo Sansovino. With equal The “ Ars et Mysterium” of reason, we should think, it figure-drawing and of form­ could be assigned to Andrea, modeling was revolutionized; Jacobo’s teacher, pu­ her ancient ante-chambers pil of Antonio Pol­ converted into veritable halls laiuolo who was “ the for dissection. Donatello and virtual beginner of Andrea del Castagno witnessed artistic anatomy in anatomies; Pollajuolo and Ver­ Italy.” rocchio, their pupils, performed Whatever attribution we them. From 1450 until the give it, this choice bronze nug­ decline of the school of the get still serves to blazon and Carracci at Bologna, anatomy proclaim a new passion (or is had a more or less secure place it the revival of an old?), name­ in North Italian schools of ly a passion for uncompromis­ Art. Leonardo, Michelange­ ing realism on the part of the lo, and all their spiritual off­ great figure-painters and sculp­ spring. Piero della Francesco, tors of Florence; realism that Luca Signorelli, Andrea Ma- led into paths of purely objec­ tegna, Roselli, Piero di Cosi- tive inquiry. Artists, for the mo, Andrea del Sarto, Pon­ nonce, became anatomists. tormo, Rosso Fiorentino, X V I Century Italian bronze “ Art ceased to be symbolic figurine of an ecorche or Montorsoli, Sebastian del Pi- and became scientific.” Act­ flayed man. Attributed to ombo and scores of others Jacobo Sansovino. ually, at times, more human (Reproduced by permission of Cimpel and might be cited as men who dissections were performed in Wildenstein.) were held in thrall to this the city of Florence by masters of art than new technique at the basis of unclouded by the appointed masters of Medicine. draughtsmanship. Anatomy was a discipline which no worker But only the powerful ones among these “ in the round” could ignore. To such it artists could secure bodies on which to make was the supreme enabling gift. It meant their studies and preparations. Subjects, 73 74 Annals of Medical History too, soon became unserviceable. Scarcity and whose wonderful wax figures were modeled impermanency of material thus led artists for his master Allori. He mentions the lost to adopt the plan of making a sustained and anatomical modelings of the Spanish artist systematic series of drawings of such parts Gaspar Becerra, who redrew the Vesalian as they needed. These current studies of plates for J. Valverde’s Anatomy (and there­ the scale of parts and the essential myologic to added a spirited muscle-man of his own details, i.e. “ omnes musculi sub cute ime- contriving, suggestive of St. Bartholomew). diate Iocati, ” circulated among pupils and Duval gives no data dealing with Italian minor craftsmen. “ I pray you remember figurines of the Renaissance. on coming to Rome,” writes Seb.del Piombo In all, about ten “ musclemen” in this to Michelangelo, “ to bring along some of class of little bronzes are partially described, those drawings of legs, bodies or arms, which or at least known to exist, to-day. Of these, I have wanted this great while, as you are three are in the Berlin Museum, one in the aware.” Such drawings did valiant service, Louvre, two in the Victoria and Albert as did casts in gesso, preparations in wax, Museum, one in the Royal College of Sur­ etc. But results registered in haste, on geons. The one in the v. Rho collection in materials liable to destruction, were further Vienna and this one in the possession of enriched and supplemented by the anatom­ Messrs. Gimpel and Wildenstein account ical notes taken down by sculptors in per­ for nine. Then there is the germane plaque durable bronze. Of the precise way in described by Bode: Berichte X X X III, Abb. which this was done, our little ecorche forms 105. Other pieces doubtless, similar to these, a shining example. exist in private hands. All the great collec­ Life-casts of the human figure were taken tions such as the Morgan, the Pringsheim, even by the Giottesschi, but it remained for and others in southern Germany and Italy, the men of the Cinquecento to develop those should be scrutinized anew. The above list intricacies of labored anatomy found in the by no means exhausts the possibilities. ecorche. We have found that knowledge of Finally it must be admitted that in the the superficial and skeletal muscles was es­ matter of attribution much remains to be sential alike to the sculptor and the maker done. Where experts such as Dr. Bode of little bronzes, for it gave the possessor a and Goldschmidt oscillate perpetually, like neat and quick vein for molding the outer shore birds minus the hind toe, as between form with the utmost finesse. The call for John of Bologna, Francavilla and Prospero the ecorche was insistent, and, we assume, Beresciano, what can an ignorant searcher fairly met. Mathias Duval gives in his do but muddle along as best he can and “ Histoire de L’Anatomie Plastique” (Paris, “ welter in the prevailing chaos” ? 1898) some scattering comments on the bibliography : notable replicas of flayed figures in collec­ tions abroad,—but he is woefully incom­ G oldschmidt (F r it z ). “ Die Italienischen Bron- zen der Renaissance und des Barock.” Berlin, 1914. plete. He fails to mention Marco Agrati’s “ St. Bartholomew” in Milan cathedral, the B od e. “ Bronze statuettes of the Renaissance.” v. S c h lo sser . “ Jahrbuch der k. Sammlungen,” most impressive flayed figure extant. Duval X X X I, S. 104. reproduces the ecorches attributed by tradi­ tion to Michelangelo and Bandinelli, also that of Ludovico Cardi (Cigoli, 1559-1613), BURKE AND HARE AND THE PSYCHOLOGY OF MURDER*

B y CHARLES W. BURR, M.D. PHILADELPHIA.

HE people whose lives I purpose dis­ and a little boy eight or nine years old they cussing are immortal in criminal an­ tempted her with drink and she, nothing nals on account of the number and loath, accepted. While one woman enter­ T the nature of their crimes. Their life historiestained her the other took the boy to her offer abundant material for a clinic in criminal own house and there and then suffocated psychology, and they are the more useful him with the bedclothes. They were paid as subjects for study because of the sim­ for the body two shillings and tenpence, plicity of their characters. They do not and an extra sixpence to her who carried present that tangle of different tendencies, the burden, but they themselves paid by that fighting of different motives, shown going to the gallows. by more complex natures. We are prone Body snatching, we must not call it to associate simplicity with goodness but stealing because there were no property there is a simplicity of evil as well as of rights in a dead body in those days and good and these people possessed it. There the resurrectionists were careful always to are fewer unknown quantities in the leave the grave clothes, began in Edin­ equations of their characters than are burgh from scientific necessity. The govern­ present in people of more complicated ment required that students should dissect mental makeup. The simplest human mind but did nothing to provide material. is complicated enough, but in Burke and Anatomical advance could not be made Hare the solution of the problem as to why save by studying the human body: the they were criminals is a little less hard physicians of continental Europe were mak­ than in men and women of more complex ing great discoveries and the Scottish and higher natures in whom there is a faculty had no intention of being left behind struggle between good and evil before they in the search after knowledge. Montieth succumb wholly to evil. Their vocation proposed, in the last decade of the seven­ was to murder people in order to sell their teenth century, that if he were allowed to bodies to teachers of anatomy. They were have the bodies of poor people dying in not originators of the trade, nor do I know the workhouse who had no one to bury who was, but they were the only, or at all them he would treat the living poor free events the most notorious, wholesalers. and, more than this, do for anatomy in a Years before their appearance on the scene, few years more than had been done in as early indeed as 1752, Helen Torrence Leyden in thirty. His proposal was ac­ and Jean Waldie were executed in Scotland cepted with certain restrictions but the for a similar crime. It seems that these supply of bodies was still too small. To women had promised some students, they help out, and because they were not suf­ themselves being nurses of a sort, to obtain fering from over-refinement and much en­ a body for them. They were unsuccessful, joyed sport of the rougher sort tinctured so one day meeting in the streets a woman with danger to life and limb, medical Read at the meeting of the Section on Medical History of the College of Physicians of Philadelphia, Nov. 21,1916. 7 5 76 Annals of Medical History students became body snatchers and this They never robbed graves; murder was led to such grave scandals that finally much easier and less laborious. Fortu­ a clause was put in the indentures of nately their business career lasted only a students (they served apprenticeships in short time, but it was carried on in a rather those days) binding them not to take part wholesale fashion since confessedly they in violating graves, but I do not think that committed sixteen murders between the physicians, teachers of anatomy at any 12th of February and the 1st of November, rate, ever very seriously sought for, or, 1828. when found, very severely punished the They were led into murdering as an youths who visited graveyards at night occupation by the following almost ac­ with rope and shovel. Every now and again cidental occurrence. Burke, his mistress there were outbursts of popular anger on Helen M’Dougal, Hare and his wife, at account of the desecration of graves and least she figured as such, all lived together about 1725 Monro’s anatomical establish­ in Edinburgh where Hare ran a vagrant’s ment was destroyed by a mob. Not only boarding house. An old pensioner named students but sometimes physicians deprived Donald, a harmless, useless old man, not a the worms of their food and Dr. Pattison criminal but one of the many unfortunates of Glasgow was arrested and tried but who from inborn inability was never able acquitted on legally interesting grounds. to lay by much for old age and hence could It was proven that the body or parts of the not, nor is there evidence he much desired body produced in court were from a woman to, live among the thrifty and clean, boarded who had never had a child while the woman with Hare. He died owing Hare four whose body he was accused of stealing had pounds and Hare decided to get this back been a mother. Though acquitted, public by selling the body. The parish authorities feeling was so strong that he had to emigrate sent a coffin to the house and the body was to America. During the whole time that put in it but Hare and Burke, while left body snatching lasted, until it became alone, ripped up the coffin lid, took out associated with murder, the law-making the body, hiding it in the bed, and replaced body took much less interest in the matter, it by tanner’s bark of which there was regarded it much less seriously, than the aplenty in the yard. They sold the body people. This was partly because, as a rule, to Dr. Knox’s assistants, William Ferguson, the bodies taken were those of the friend­ later Sir William, and Thos. Wharton less and the poverty-stricken who rarely Jones. The fee they received was seven left behind any one who had any interest pounds ten shillings. This was easy money in what became of either their bodies or and being men of criminal instincts and not their souls, though sometimes, especially mere weaklings led astray, the usual excuse if the deceased had had an interesting of criminals, and not being, or at least not disease with interesting lesions, even im­ thinking themselves, the victims of the portant people were not safe in their graves. crimes of respectable society, the most up- Things came to a climax with Burke and to-date and erroneous explanation of crime, Hare. They created a new industry or, at but wanting money and neither of them least, formed the first, and I think the only having any conscience to boast of, they copartnership, the business of which was decided they would take up murder as a the selling of the bodies of people they business because the wage was high and murdered. Others had done this occasion­ the labor light. ally, casually, before, and others did it Their method may be illustrated by an later but they alone made it a business. early case, that of Abigail Simpson. She B urke and Hare and Psychology of M urder 77 was a drunken old hag who lived in the as to say anything that would make the outskirts of Edinburgh. Hare, ever on neighbors suspect he was anything more the lookout for game, saw her on the street, than a highly respectable resurrectionist. thought she was a likely subject, accosted This will give some inkling of their power her, was met in friendly spirit, and took of inhibition, of their real self-control. her home to Log’s house in Tanner’s court After the fight Burke and M’Dougal went (Log was Mrs. Hare’s first husband). Here to live with John Broggan, whose wife was she was plied with liquor and the crew a cousin of Burke’s, but he soon became danced and sang, and swore and drank still friends with Hare again and business re­ more. Next morning Abigail was sick, lations were resumed. very sick, and cried to be taken home to One murder more than all the others her daughter. Instead they gave her, aroused the people of Edinburgh, indeed of pretending kindness and friendliness and all Scotland, in righteous wrath against pity, more whiskey and porter and she these men. It was that of James Wilson, again became helplessly drunk. Now was called Daft Jamie. He was what, in the the time. Hare placed his hand over her old language, before science had given mouth and nose and Burke laid himself long hard names to the different kinds of across her. She made no resistance, and imbeciles, before enthusiastic sociologists soon was dead. They bundled her body had accepted the hypothesis that all things into a chest and afterward sold it to Dr. can be cured by education, and before men, Knox for ten pounds. There is no need to i.e., ordinary unlearned men, had begun to relate the other murders since they were have opinions about everything but still all done in the same way. Men and women, believed that feeble-mindedness, like most often of the outcast class, were first made things, was a visitation of God, just hap­ friends with by offering them a drink or pening so and not produced by inevitable even sometimes a home, and they unsus­ and irremediable causes, was called a picious and very happy that some one in natural. Everybody in Edinburgh knew their hard world had been kind to them, and liked or at least warmly pitied him. drank to stupor and then were suffocated He was a familiar figure in the streets. because that left no wound. Wounds on He was harmless and happy, earning a the body might have led to unpleasant precarious living by fetching and carrying. questions as to how they came there. He was medically interesting (though not There was a break in the partnership to many of the scientific men of his own for awhile. The agreement was that each day) because he was one of those imbeciles was to share in the proceeds of every who have a prodigious memory for useless murder even though only one did it. things, e.g., he knew the number of the Burke was out of town for a time and when street lamps in the town. He also had a he returned found that Hare had more fondness which some of us believe, it may money than he could account for. Hare be because, to use present day slang, we denied that he had been doing business on are “ highbrows,” always indicates mental his own account but Dr. Knox said he had weakness, a passionate love of conundrums. bought a body recently. A fight ensued, He lived in holes and corners, hurting no not on the ground that Hare had not one and hurt by none save the young played fair— that only happens among the barbarians of the street who hooted and criminals of fiction, but because Burke plagued him. He, instinctively knowing wanted money. Bloody and fierce as the discretion was the better part of valor and fight was neither man so far forgot himself “ being too proud to fight,” always ran away 78 Annals of Medical History when they appeared. He was suspicious method has much to recommend it. Our of no one past boyhood, so one day when friends the eugenists ought especially to Mrs. Hare accosted him on the street and approve of it, because certainly the best began to talk to him, he willingly accepted way to prevent bad stock from being prop­ her invitation to go to her home. When agated is to hang or otherwise kill its mem­ they arrived there she offered him drink: bers. This English and Scotch juries did he demurred at first but finally drank to and it is very possible that Great Britain’s drunkenness and Burke and Hare, who relative freedom from crime against the had meanwhile been summoned, smothered person during the Victorian era (a freedom him, not, however, without a long hard in marked contrast to our own noble age and struggle, for he was strong and not com­ glorious country)— an era so full of sound pletely under the influence of drink, and sense, social pomposity, and scientific ra­ sold his body. He enjoyed a brief im­ tionalism now so rapidly fading away, was mortality or, to use more accurate language, in part due to the fact that previous gen­ a transient post-mortem fame, from doggerel erations had let a good bit of blood and so verse peddled on the streets but now hidden, purified the citizenry. dust covered, in the libraries of medical It was a day of public hangings and the antiquarians. place of Burke’s execution was Lilberton’s The murder that led to discovery was Wynd. Crowds watched, during the night that of a woman named Docherty. She before, the building of the scaffold and when disappeared. Inquiries were made and it finally the transverse beam was fixed in was evident that Burke or Hare or both place the multitude gave rousing cheers. had killed her. Several questions con­ As a rule it was difficult to get men to build fronted the city authorities: Could the a scaffold but this time carpenters aplenty, crime be proved against both? Was it more than enough, volunteered. Many better to let one of the guilty persons hours before the time set (Jan. 28th), people escape punishment in order to be sure of gathered in larger and larger numbers. convicting the other by his corroborative Thrifty householders, not averse to making evidence? If one (or rather one couple an honest penny, sold windows overlooking because there was evidence against the the execution place at high prices and people women) only was to be tried which ought stayed in the houses all the night before in it to be? Who was the leader? It was order to be sure they would not lose their decided (and I think quite justly though places. Speculators bought rights to the there was much public anger at the time) use of windows and roofs and resold at a that Burke and M’Dougal were the guil­ profit, reasoning it was an ill wind that tiest or at least the two against whom the brought no one good and that thrift was evidence was strongest. The trial began praiseworthy. The night before was cold, December 24, 1829. Hare was accepted rainy, dismal, but that did not deter the as a state witness. Burke was convicted, crowd from wanting to be in time to get a M’Dougal given a verdict of not proven. good place to see justice done and a man It was not a day of indecent delay be­ suffer. On the morning of the execution tween verdict and execution: courts of ap­ the rain ceased and the crowd increased to peal could not intervene, because they did twenty or thirty thousand. It was not a not exist, and executive act quickly followed serious-minded, quiet crowd; on the con­ judicial word. Soon after the judge sen­ trary it was a merry mob, cracking jokes, tenced a man to hanging the man got hanged laughing, shouting, playing tricks, wanting and there was an end of the business. This to be amused and yet withal bloodthirsty. B urke and Hare and Psychology of M urder 79

At eight o’clock in the morning the march merely upon lucky or unlucky chance, to the gallows started and as soon as the whether saint or devil, wise man or knave condemned man appeared he was met with happens to control. In this case the mob yells and cat calls and demands that Hare was justified in its anger, but its conduct too should hang. Burke seems to have been would have been the same if the man had the most self-contained man there. He been innocent. Not many years before in walked, news reporters say, though they Paris, another mob had cried for blood and perhaps were no more accurate than re­ made obscene jokes and laughed as the tiger porters of to-day, with steady step. He was laughs with a snarl and roared and swore unkempt, dressed in a black suit much too when an innocent man suffered by the guil­ large for him, and lacked lotine not for his sins all the externals neces­ but for his fathers’ and sary for dignity, yet he the mob’s fathers’ sins. seems to have shown Louis X V I went to his dignity, at least the grave no more execrated dignity of self-control. than Burke though by When the rope was ad­ a larger number of less justed to his neck he respectable people. stood composed, un­ Burke being dead the flinching, motionless. mob wanted vengeance With a gesture as of on Dr. Knox. Their an­ impatience, at least on­ ger broke forth and only lookers so interpreted the police prevented it, he gave the signal to murder. let the drop fall. A cry, The day after the ex­ many cries of satiated ecution Burke’s corpse vengeance, greeted the was taken from the lock­ fall which really was up house to the college only a few inches and and placed in one of Dr. did not cause instant Monro’s rooms. Here a death. The crowd sort of private view was waited and watched and first held, Mr. Liston, when several times the Geo. Combe, the phre­ body jerked convul­ nologist, and Sir William sively roars of anger Portrait of Dr. Robert Knox lecturing his class. This picture was made by Edward Forbes, one Hamilton being among broke forth. The con­ of his students. It appeared in the Students’ those present. Mr. Jos­ duct of these people is Maga, and was reprinted in Lonsdale’s “ Life eph, an eminent sculp­ of Knox.” a good example of what tor, made a bust. The to-day we call mob psychology, which is noth­ affair seems to have been quite fashionable. ing more than imitativeness and an uncon­ Some visitors noted with surprise the placidity scious desire to follow a leader: individual of the features of the corpse, forgetting, just initiative and inhibition break down, indi­ as novelists are prone to forget, that in the vidual opinion ceases or rather all succumb palsy of death there is, there must be, to the stronger will of the leader. It does placidity. The cases in which death stiffen­ not matter whether it is a street mob, or, ing comes so quickly as to fix the features in a democracy, a gathering of legislators. in their last expression are rather apocry­ The nature of its acts, good or evil, depends phal. The eye usually sees what it looks 8 o Annals of Medical History

for and the subconscious mind of the aver­ father-in-law, deserted his wife and went to age man expects to find the mark of Cain Scotland about 1818. He became a laborer even in death in the features of a murderer on the Union canal and there by chance or and hence usually finds it. The onlookers fate the actors in the drama all came to­ who made the observation must have been, gether. He met Helen M’Dougal who had as indeed they were, men far above the never been an altogether good person. She common, for they saw what was, not what, had had a child by M’Dougal while his wife from their preconceptions ought to have lived and when she died lived with him and been but was not. Professor Monro dis­ bore his name until he was carried off by sected the body in public and the police typhus. Then she went with Burke. The had to stop a crowd of too enthusiastic stu­ priest tried to induce him to go back to his dents: enthusiastic I fancy not for knowl­ wife but he suffered excommunication rather edge. than do so. Really she seems to have been Monro found the brain normal, but Combe a proper, honest person and a true wife but and the other phrenologists found that something in M ’Dougal held him, that Burke’s character was just what the bumps strange affinity of protoplasm, quite as real, indicated because the bumps indicative of quite as resistless as chemical affinity and badness negatived those indicative of good­ having just as much, or as little, to do with ness. They were consistent enough and intellect or beauty as it has: the thing bru­ clear seeing enough to find bumps of both tality cannot kill nor kindness create. They qualities. went to Edinburgh and lived in “ the Beg­ The most interesting question is, what gars’ Hotel.” He became a cobbler again manner of people were these four who made and M ’Dougal peddled the old shoes he a business of murder. I include the women begged or bought and repaired. The hotel because though M’Dougal wTas dismissed burned down and MacGregor (the historian from court with the verdict of not proven, of Burke and Hare, basing his account large­ and Burke to the end said no word against ly on “ The Westport Murders,” a book her and Mrs. Hare was never tried, there is printed at that time) states he lost among no doubt the women knew what the men other things these books: Ambrose’s “ Look­ were doing and were morally guilty. We ing unto Jesus” ; Boston’s “ Fourfold State, ” can learn something from their lives. “ The Pilgrim’s Progress” ; and Booth’s William Burke, the son of a laborer, was “ Reign of Grace.” MacGregor says these born in county Tyrone in 1792. He had books probably belonged to the M’Dougal some education and his parents were not woman because they were the kind found criminals. In this he followed the rule, for in every Scotch home but that Burke all murderers are more often the offspring of through life was “ of a naturally religious weak than of criminal people. As a youth turn of mind and that in all his after actions, he entered the service of a Presbyterian brutal and godless as they were, the inward pastor as a servant but soon tiring of this, warning voice never left him at peace, ex­ he worked in turn as a baker, a weaver and a cept when his senses were steeped in drink. ” shoemaker. He learned no trade thorough­ Helen M ’Dougal seems to have been re­ ly, and this is characteristic of his mental garded as the principal bad influence in type, and after trying his hand at several he Burke’s life but he never made the old ex­ volunteered in the militia as a fifer or a cuse “ the woman tempted me and I did drummer. After a time the regiment was eat” : whether she was really the stronger disbanded and (now married) he again be­ character and like that greatest murderess came a servant. He quarreled with his in drama, Lady Macbeth, led her man to B urke and Hare and Psychology of M urder 8 i his own destruction remains unsolved. At Margaret Hare was Irish. Log, her hus­ all events the two stuck together till the end, band, a decent man, cut small parts of the almost ten years, notwithstanding fights and Union canal and she, dressed as a man, brawling. Once he beat her almost to death worked like a man. She seems to have been, but still they remained together. In 1827 without knowing it, an early believer in the they went to live with the Hares. emancipation of women. On leaving the Hare was Irish. He also worked on the canal they went to Edinburgh and kept a Union canal and met his mistress there and lodging house for vagrants and he sold lodged at Log’s house. He later became a things in the street. He died. She had an traveling huckster selling fish, crockery, affair with a young man but he left her and and old iron. He was always fighting, al­ she took up with Hare. Her first child by ways drunk and could neither read nor Hare died of neglect, if not by murder, and write. His father was a Protestant, his one other lived. mother a Catholic. He was about twenty- What became of the Hares and M’Dougal five years old at the time of Burke’s trial. after the trial no one knows. Years after A man who saw him says “ he possessed not tales were told that one or the other of them the slightest moral perception of the enor­ had been seen in one place or another but mity of his conduct.” “ His forehead was nothing was sure. low as in all murderers” (this may be an­ The great question in the study of the other example of things being as we see minds of murderers is, Are they a type apart, them because not a few murderers have ma­ separate and distinct from other men, or jestic foreheads, and many passable ones), are they, even as the rest of us, led to “ the eyes watery, curiously shaped and murder by external causes? Before answer­ having a look between a lure and a squint. ” ing the question we must define our term: He was five feet six inches tall and “ a poor What do we mean, what do psychologists silly looking body.” and alienists mean, by murder? We may An anonymous literary professor in the dismiss at once killing in self-defense. But University is quoted as saying that Burke, psychologically speaking we exclude several whom he examined, was an intelligent man, other acts resulting in killing. We of course strong-minded and with understanding above exclude the frankly insane,—the man who, his position though his conduct displayed influenced by delusions of persecution kills, nothing like remorse or contrition. “ His as he thinks, to save himself; the maniac, education,” the professor continues, “ and who in his madness neither reasons nor rank in life, instead of having been by any knows, but kills blindly, and the dement who means of the lowest order, were such as, in is so deprived of reason that he does not the judgment of the world, and on the au­ realize the nature and consequences of his thority of experience, are held of necessity act. Further the sane man who, beside him­ to humanize and inform the mind, and to self with rage, kills is not necessarily a mur­ communicate perfectly just conceptions of derer. He is responsible, it may be, for he moral distinctions. ” This may be a beauti­ should not allow himself to get into a mur­ fully balanced sentence and grammatically derous rage but he is different from the real and rhetorically worthy of a professor of murderer. The murderer from the psychol­ literature but it states untruth as truth. ogist’s point of view is the man who without Rank in life and schooling, and that is what any temporary change in his usual psychic the professor means by education, do not condition can coldly contemplate and leis­ prevent crime nor change potential crim­ urely plan the killing of another for his inals into honest men. own seeming benefit. Such a man psycho­ 82 Annals of Medical History logically is a murderer whether he ever by external qualities, have given examples kills or not. He is in the same class if, of murderers. after planning the act, he must drink to The one quality I have found lacking in give himself physical courage to do it or if all the sane murderers I have ever examined he simply plans and hires some one else to was the moral sense, and by that I mean the carry out his desire. Men of the murderous realization that one owes a duty to others, type are fortunately rare but they consti­ that others have the right to live. They tute a distinct psychologic species of the are, as some one has said, color blind to human race. They are what they are not morals. I have never known a murderer, on account of environment but because of as here defined, who felt remorse or who their inherent nature: They are the vic­ grieved at the dead man’s fate. I have seen tims of their protoplasm. Men are born, more than one who ate and slept well while they do not become, murderers. Social awaiting execution and the man who eats standing has nothing to do with the fre­ and sleeps well is not suffering any emo­ quency or infrequency of their appearance. tional pain. What causes absence of the Wealth does not prevent their entrance moral sense we no more know than we know into the world nor poverty produce them. what produces it. That it is entirely sep­ Education, in the sense of training in self- arate and distinct from intellect I am con­ control and suppression of the emotions, vinced because I have known men who, may help a little in curing or rather making mentally far above the average, lacked it them control, their instincts but book entirely. Further, so far as my experience learning, even carried to extreme erudition, goes, nothing creates it in him who has it not. does not alter a man’s nature one jot or I have more than once studied murderous tittle. Neither intellectual wealth nor intel­ criminals whose environment in childhood lectual poverty is a factor in their produc­ and youth was of the best and yet who went tion. their own terrible way. The only cure for them All classes of men, as they are classified is death and the best treatment execution. HEBREW PRAYERS FOR THE SICK

B y C. D. SPIVAK DENVER, COLO.

H E R E is no doubt in my mind that 1905 “ that of all hygienic measures to of all therapeutic measures with counteract disturbed sleep, depressed spirits which the primitive man used to and all the miserable sequels of a dis­ T defend himself against his greatest enemy—tressed mind, I would undoubtedly give disease, prayer was the oldest, even older the first place to the simple habit of than hemostasis which Weir Mitchel so prayer. >> 3 beautifully described in his poem “ The But whether prayer can no longer do Physician.” 1 We will go a step farther and for the men and women of the present day assert that even unto our day the majority what they have done or supposed to have of mankind turn to prayer first or last in done in the days gone by, it certainly disease, especially in the “ last disease.” The deserves from the medico-historical stand­ prayers may differ in their content, in point careful study and a sympathetic the manner they are offered or to whom consideration. they are addressed, but the orthodox, 1 have limited myself to the simple the agnostic and the infidel are all offering labor of collating the material from the up a prayer for recovery. Wishing is domain of Hebrew lore, beginning with praying, and who, if sick, does not wish the Bible, and following with the material with all the intensity of his soul for recovery? scattered in the two Talmuds, Midrashim, The confidence reposed by the sick in his etc. attending physician is tantamount to a JEHOVAH WOUNDS AND HEALS prayer. To quote Professor James: “ Few men of science can pray, I imagine. Few Jehovah causes “ consumption, burning can carry on any living commerce with ague that shall consume the eyes and cause ‘God.’ Yet many of us are well aware sorrow of the heart” (Leviticus xxvi, 16). how much freer in many directions and abler “ He smites with fever and with an in­ our lives would be were such important flammation and with extreme burning with forms of energizing not sealed up.” 2 In the botch of Egypt and with the emerods fact Dr. Hyslop said before the British and with the scab and with the itch— Medical Association at their meeting in with madness and blindness and astonish-

1 “ The hunt is o’er—the stone-armed spears have With tender doubt the tortured member feels won; And, first of men a healing thought to know, Dead on the hillside lies the mastodon. He finds his hand can check the life’s blood flow.” Unmoved the warriors their wounded leave; The world is young and has not learned to grieve. (“ The Physician.” By S. Weir Mitchel. Transac­ tions of the Congress of American Physicians and “ But one gentler sharer of the fray Surgeons, 1900, p. 91.) Waits in the twilight of the westering day, 2 “ The Varieties of Religious Experience,” by Where ’neath his gaze a cave-man, hairy, grim, Professor James. Groans out the anguish of his mangled limb. 3 Quoted in “ Psychological Phenomena of Chris­ “ Caught in the net of thought the watcher kneels, tianity,” by Cutte. (1909, p. 412.) 84 Annals of ISAcdical History merit of heart (Deut. xxviii, 22, 27, 28). harrowing. He curses the day he was born, He makes the “ plagues wonderful, of long and the night in which he was conceived. continuance and sore sicknesses” (Ibid. 59). “ When I lie down I say, When will I He can bring “ all the diseases of Egypt” arise, and the night be gone? and I am (Deut. xxvii, 60) and moreover he can full of tossings to and fro unto the dawning bring “ every sickness and every plague of the day. M y flesh is clothed with which is not written in the book of the worms and clods of dust, my skin is broken Law” (Deut. xxviii, 61). Jehovah therefore and become loathsome” (Job vii, 4, 5). is looked upon as the efficient cause of But Job prays not. He rages and fumes. disease. He can consequently remove the He cries out, “ I will not refrain my mouth; cause, for he says “ I wound and I heal” I will speak in the anguish of my spirit; (Deut. xxxii, 39). It is natural that one I will complain in the bitterness of my stricken with disease should appeal to soul— Why hast thou set me as a mock Jehovah for relief. against thee so that I am burden to myself?” (Job. vii, 11, 21). His wife too seems not THE SHORTEST PRAYER ON RECORD to believe in the efficacy of prayer. For The text of only one prayer for the sick not only does she herself not pray and does is recorded in the Pentateuch. When not counsel her husband to pray, but on Miriam spoke against Moses her brother the contrary she encourages him in his because of the Ethiopian woman whom he defiance: “ Dost thou still retain thine had married, the anger of the Lord was integrity? Curse God and die” (Job ii, 9). kindled and behold Miriam became leprous, DAVID IS PRAYERFUL white as snow. Aaron appealed to Moses on her behalf and begged “ Let her not be The sweet singer David is the antithesis as one dead, of whom the flesh is half of Job. He believes in the Lord and in his consumed when he cometh out of his ability to heal him of all disease. The mother’s womb” (Num. xii, 12). And following prayers for recovery are incom­ Moses made a prayer which is the shortest parable for loftiness of style, for the sim­ on record. It consists of five short words: plicity of expression, for the graphic de­ “ El no rfa na la,” “Oh God, do thou heal scription of disease and for the childlike her, I beseech thee” (Num. xii, 13). confidence in Jehovah:

PRAYING FOR RECOVERY THE PSALMIST’S CONFIDENCE IN JEHOVAH’S Abraham prayed for the recovery of POWER OF HEALING Abimelech (Gen. xx, 17). David prayed “ Into thine hand I commit my spirit— for the recovery of his little son (II Sam. Have mercy upon me, O Lord, for I am in xii, 16). Elisha prayed for the recovery trouble: mine eye is consumed with grief, of a boy (II Kings iv, 33). Hezekiah yea, my soul and my body. For my life prayed for his own recovery (II Chron. is spent with grief and my years with xxxii, 24). There are recorded in the Bible sighing; my strength faileth because of hundreds of cases of death, but no mention mine iniquity and my bones are consumed” is made of any prayers having been recited (Ps. xxxi, 6, 10, 11). for their recovery. “ Yea, though I walk through the valley of the shadow of death, I will fear no evil; JOB IS PRAYERLESS for thou art with me; thy rod and thy Job is the personification of misery, staff they comfort me” (Ps. xxiii, 4). and the description of his sufferings is “ Blessed is he that considereth the poor: Hebrew Prayers for the Sick 85 the Lord will deliver him in time of trouble. over it and it is gone, and the place thereof The Lord will preserve him and keep him shall know it no more” (Ps. ciii, 1, 3, 5, alive—The Lord will strengthen him upon 15, 16). the bed of languishing; thou wilt make all “ Hide not thy face from me in the day his bed in sickness” (Ps. xli, 2, 3, 4). when I am in trouble; incline thine ear unto me: in the day when I call answer me DESCRIPTIVE PRAYERS speedily. For my days are consumed like “ 0 Lord, rebuke me not in thy wrath; smoke, and my bones are burned as a neither chasten me in thy hot displeasure. hearth. My heart is smitten and withered For thine arrows stick fast in me, and thy like grass; so that I forget to eat my bread. horn presseth me sore. There is no sound­ By reason of the voice of my groaning my ness in my flesh because of thine anger, bones cleave to my skin” (Ps. cii, 4, 5, 6). neither is there any rest in my bones because “ For my sighing cometh before I eat of my sin—My wounds stink and are and my roarings are poured out like water” corrupt because of my foolishness—For (Job iii, 24). my loins are filled with loathsome disease, “ O Lord my God, I cried unto thee and and there is no soundness in my flesh. thou hast healed me. O Lord, thou hast I am feeble and sore broken: I have roared brought up my soul from the grave; thou by reason of the disquietness of my heart— hast kept me alive that I should not go my heart panteth, my strength faileth me; down to the pit” (Ps. xxx, 3, 4). as for the light of mine eyes, it also is gone FIGURATIVE PRAYERS from me” (Ps. xxxviii, 1-10). “ Have mercy upon me, 0 Lord, for I “ Praise ye the Lord—He healeth the am weak; 0 Lord, heal me, for my bones broken in heart, and bindeth up their are vexed—I am weary with my groaning, wounds” (Ps. cxlvii, 1, 3). all the night make I the bed to swim, “ He (the Lord) keepeth all his bones; I water the couch with my tears” (Ps.vi, not one of them is broken” (Ps. xxxiv, 21). “ The Lord raiseth them that are bowed 3. 7)- “ Their soul abhorreth all manner of down” (Ps. cxlvi, 8). food, and they draw near unto the gates of “ Consider and hear me, O Lord my God; death. Then they cry unto the Lord in lighten mine eyes lest I sleep the sleep of their trouble and he saveth them out of death” (Ps. xiii, 4). their distress. He sent his word and A PHILOSOPHIC PRAYER healeth them” (Ps. cvii). “ Lord make me to know mine end and “ The sorrows of death compassed me the measure of my days what it is, that I and the pains of hell gat hold of me— For may know how frail I am. Behold thou thou hast delivered my soul from death, hast made my days as a handbreadth, mine eyes from tears and my feet from and mine age is as nothing before thee. falling. I will walk before the Lord in the Verily, every man at his best state is land of the living” (Ps. cxvi, 3, 8, 9). altogether vanity, Selah” (Ps. xxxix, 5, 6). “ Bless the Lord my soul, and all that is THE PRAYER OF YOUTH within me bless his holy name—who healeth “ I said, O, my God, take me not away all thy diseases; who redeemeth thy life in the midst of my days” (Ps. cii, 24). from the pit—who satisfieth thy mouth with good things so that thy youth is THE PRAYER OF OLD AGE renewed like the eagles—As for man, his “ Cast me not off in the time of old age; days are as grass, as the flower of the field forsake me not when my strength faileth” so he flourisheth. For the wind passeth (Ps. Ixxi,^9). LARYNGOLOGY AND OTOLOGY IN COLONIAL TIMES

B y STANTON A. FRIEDBERG, M.D. CHICAGO, ILL.

HROUGH the kindness of Dr. Dr. Wilson was licensed to preach in 1754, Fielding H. Garrison, of Washing­ and two years later was installed as pastor ton, I have in my possession a man­ of two congregations, one at Lewis and the T uscript which contains so much of valueother to at Cool Spring, Maryland. A few the history of early American medicine that years later another congregation was added I have considered it a duty to present at at Indian River. Coincident with the as­ length in a separate paper the subjects that sumption of his ministerial duties he en­ are of special interest to those of us en­ gaged in the practice of medicine, and in gaged in the practice of laryngology and addition gave instruction at a nearby acad­ otology. No attempt will be made to enter emy in Hebrew, Latin, Greek, and the into a close analysis of the matter present­ learned sciences. Although so busily oc­ ed, my object being only to place in a per­ cupied for nearly twenty-nine years, time manent state the information contained in was not lacking for him to participate in the work with the hope that it may be of the solution of important religious as well some benefit to future historians. as the grave political questions preceding The author of, or at least the sponsor for, the Revolution. the manuscript was Matthew Wilson, a Viewed in any light, he was indeed a re­ minister and at the same time a physician, markable man. To quote Thacher,2 “ the an association of professional activities that joint functions of minister of the Gospel we would consider unique at present but and physician were sustained and dis­ which we find occurring very frequently in charged by him with an ability and popu­ our early history. Although a native of larity which evinced he was a man of ex­ Chester County, Pennsylvania, where he traordinary talents, attainments, and en­ was born January 15, 1734, he found the ergy. His ardent industry and the com­ field for his active career in Lewis, Dela­ prehensiveness of his mind reduced every ware, where he lived until his work was obstacle, and embraced every object of ended March 30, 1790. knowledge. He wrote an able compend of His education was directed by Dr. Fran­ medicine, which was called a Therapeutic cis Alison, a minister of prominence, a Alphabet. Commencing with the classifica­ patron of learning, and a man of great in­ tion of Sauvages, it contained the diseases tellectual force and power. As rector of in alphabetical order, with definitions, the University of Pennsylvania, his name, symptoms, and method of cure. It was pre­ I believe, may be found on the first Ameri­ pared for the press, used by himself, and can medical diploma.1 There is no evidence transcribed by his students, but never pub­ that Dr. Wilson possessed a degree in medi­ lished.” cine. B y his biographers it is stated that It is from this Therapeutic Alphabet that his medical studies were pursued under the I have taken the material that will be pre­ tutelage of the Rev. Dr. McDowell, like­ sented. The book itself is a small, thick wise a man of great versatility and of con­ volume, bound by hand, and made up of siderable influence in his day and time. over three hundred leaves. It is very evi­ L aryngology and Otology in C olonial T imes 87 dent that a number of individuals took part their Technical and English names; in the transcription as is shown in the varia­ with many new and old successful Remedies, tions of penmanship, spelling, punctuation, important Precognita, Crises & Presages; Containing a concise yet full History & and corrections. The construction of the text Theory of all the Principal Diseases, with a----- vulgar also varies; in some places the style seems and Medical Recipes adapted to the Middle States of N. almost modern while in others we have America. the quaintness common to writers of that By Matthew Wilson D.D. Presbyter & period. Several of the articles have the Physician at Lewes, about 2Q years. signature, M. Wilson, appended. As is Nullius addictus jurare in Verba Magistri. " Hor. stated in “ The Preface by the Editors,” To every candid Reader. Wilson himself wrote the articles on the principal diseases, but the definitions of the As America, in any Northern Latitude, is more lesser complaints were generally trans­ than ten Degrees colder than the same Latitudes in the Old World; so in experience it is very certain that the lated by his pupils from Vogellius, Cullen, Diseases, even of the same Name are very different: Linnaeus, Brooks, and Sauvages. Regret The Physical Writers, therefore, in Europe do often is expressed that on account of the multi­ lead young American Physicians into fatal Mistakes. plicity of the author’s business, time did — To prevent this & be of some use to my Country was not permit him to examine into the cor­ the Design of permitting the present Publication, in rectness of these translations by a com­ this rough unpolish’d Dress. M . W ilso n . parison with his own notes. There are two title pages, the second In selecting the various subjects of Iaryn- being separated from the first by a number gological and otological interest the text of intervening pages upon which are writ­ has been closely followed with here and ten the preface, praecognita and prognos­ there an addition or change in punctuation tics. The title pages differ only in minor to render the meaning clearer. It will be details, with the exception that at the lower noted that most of the articles are short part of the second occurs the statement and concise. Definitions of diseases with that “ it is now transcribed from M.W., their cross references are given in order D.D. Notes, &c., by Thomas B. Chrag- that a proper conception may be had of head & other students. A.D., 1787, Janu­ the exact comprehensiveness of the medi­ ary, 29.” From this date it may be seen cal knowledge of Dr. Wilson and his pupils. that the contents of the manuscript are the The prevalence and importance of the dif­ result of an experience extending over the ferent diseases may be judged by the years from 1756 to 1787, truly the most amount of space devoted to their descrip­ epoch-making period in the life of the col­ tion and treatment. A reference to the onies. Had the intention to print the work various throat conditions will show the been carried out it would have been the lack of anatomical and pathological dis­ first book on the practice of medicine pub­ tinctions common to the medical knowl­ lished by an American author. edge of the period. In the account of the The title page reads as follows: “ Throat Disorder in America,” the dis­ Multum in parvo ease which is now recognized as diphtheria, being a new the work of Douglas is mentioned. In a Therapeutic—Alphabet or note under “ Quinsy Malignant” is the A Pocket-Dictionary, oj statement of an Epidemic Cynanche in Medicine, Midwifery, & Surgery; which New York physicians found a new extracted from Short Medical Notes on about membrane in the larynx. This undoubt­ Nine Hundred Diseases, in both edly refers to the work of Samuel Bard and 8 8 Annals of Medical History

Richard Bayley. A full description of early posthumate—The last Symptoms are Op­ American literature on the throat distem­ pression great of the upper Part of the Chest, per may be found in Elsberg’s “ Laryn­ difficult breathing, a deep hollow hoarse gology in America.” 3 Wright in his his­ Cough—livid Countenance—Then Death. tory 4 has analyzed carefully the steps in —N. Some walk about till near Dying, the progress of the differentiation of the their Danger not apprehended by their various throat diseases from the earliest Friends—Some die the 4 or 5 day—others times down to the present day. the fourteenth—The putrefaction is so great that nature cannot excite a Fever, THE THROAT DISORDER IN AMERICA. when they die suddenly of a Mortification. Cure: It was long at first fatally treated This dire contagious, putrid & nervous as an Angina, with the usual Evacuations— Disease began in N. England a .d. 1735 And it is still fatal when Physicians are & gradually moved on Westward, thro’ unacquainted with the manner of treating most Part of North America. Children & this uncommon Malady.—All Evacuants young People were more generally affected, in general are Fatal—Bleeding—Blister­ yet some Old Persons have died of it.— It ing—Purging—Sweating hasten fatal Mor­ prevails most among the Poor and Scorbu­ tifications. And what is surprising tho’ so tic, who feed much on Pork & live in wet putrid Cold-Air, & Jesuits Barks are per­ & low Grounds.—In Some Families it nicious.—All Flesh Meats, Fish, & Spirits spreads like the Plague—Others at the are very hurtful. At last it was discovered same Season take it without Opportunity by Dr. Douglas of Boston that the only of Contag (ion)—Some have it very mildly Way to cure it is by confining the Sick to & none die, & yet I have heard of 4 Chil­ Bed in a gently moderate Warmth for dren dying in one House in a Few Days.— many Days—Giving very small Doses of It will often keep in a Neighbour (hood) Snakeroot, but not to sweat, but only a for some years— Some have it more than gentle Diaphoresis with Sage Tea, for some once. Some seem to have it long hatching, time after all the Symptoms Disappeared. before it breaks out as appearing by the N. It has also been found when mild to Languishing Scorbutic Habit, Corrosive be attended with a Miliary Eruption on Humors &c. the Skin.—Hence Calomel join’d with Cam- Symptoms.—The common attending Fe­ phire has been thought to answer the same vers (but seldom Nausea or Vomiting) End as these Eruptions. putrid Heat, but moist & seldom parch’d. N. All greasy Applications are hurtful. —A frequent irregular Pulse—Countenance N. Gargles are useful of Sumack Bur- dejected—Lowness of Spirits—The Tongue ries, Snakeroot &c a little Allom dissolved much furr’d, wc continues to the Tonsils & in it.—Gargle before Swallowing.— Throat.—When milder the Tonsils only N. Wash ye sores wt Tinct. of Myrrh swelled, wt white spots, at most an Inch & Alloes wt Honey. Diameter—thrown off from Time to Time N. Externally Poultices of Rue & bitter in Cream colour’d sloughs— When these Herbs. Sal Ammon wt. sharp Vinegar. come off the Tonsils appear deeply pitted N. Some have had Sores in other Parts, & corroded—The Sloughs soon renew again even ye Privates, & less in the Tonsils, & —Sometimes the Throat is swollen inter­ were relieved in the same Way. nally & Externally, and frequently mor­ N. Wine freely to a Glass every few tify—But generally the Swelling does not Hours has cured some very low in Nervous endanger Suffocation—Sometimes they im- Fevers— L aryngology and Otology in C olonial T imes 89

See Putrid Fevers, Typhus, Scarlatina, (at Indian River) after great numbers had Biliosa &c. died. This scarcely failed, only blowing Acataposis:—Is a difficulty of swallow­ Allum Powder in the Throat &c. ing. Vide Angina. Anosmia:—Is a defect of Smelling. See Aglutitio:—Is a deprav’d swallowing. Nervosi Morbi. Vide Angina. Antipathia:—Is a particular Aversion Ageustia or Agehustia:—Is a diminish­ to an Object of Sight, Smell, or Taste, ed or deprav’d taste. Vide gastritis. so as to be thrown into grievous Symp­ Angina—Quinsy:—Is a pain, Tumor, in­ toms by them, as Col. Robertdeau at a cat flammation of the Fauces, with a contin­ & Mrs. Boyd at the smell of Tar & mySelf ual, inflammatory nervous or putrid Fever; at Cod Fish. attended with a difficulty of Breathing or The Cure is commonly Death. Swallowing or fear of Suffocating. Vid. Aphonia: — Is a deprav’d Voice and Cynanche. the same wt Paraphonia. This may be There are five species enumerated. The from many Causes. If from Cold see Ca- Best Rule is to treat according to the Fever. tarrhus. If from a Fright see Hysteria. If If inflammatory: Bleed the Arms & under from Lues Venerea, see Scorbutis. If from the Tongue, blow Allum often in the any other Cause, remove the Cause. But Throat—Purge wt Glysters, Give Nitre, if from ill-configuration of the Parts, it Steams of hot Vinegar—, Puke wt White seems incurable. Vitriol, Anodynes etc. See under Quinsy Aphthae; Thrush: — Are little whitish ye Theory. If Putrid, Dont Bleed, but Ulcers affecting all parts within the Mouth Puke & Suit the symptoms. Contrayerva & sometimes the Pudendum. is good, blow Allum, Poultis wt Jews Ears, The Cure:—Vomit Infants wt the vinum or Rue or Horehound Leaves, & a little Antimonii gut. 5-12 in Breast Milk. Vide Milk, Stew’d with Salt & Vinegar. Inter­ Erysipelas from which it differs only by nally Vin Antimon, Camphor, Bathe wt the Weather. Saponacious Liniment, Gargle wt Tincture Juice of Horehound mixt with Honey & of Myrrh or Acid Elix; Use Barks & Snake- give a little often. Give also Cathartics, root with Wine, Exercise, Milk in Decoc­ Alteratives, Antisceptics, Astringents in­ tion of Alder. wardly. Externally wash with Juice of Gentle Sudorifics, Check Purging, Some Green Persimmon & Loaf Sugar, or rusty Syringe the Throat with Acet. Egyptiacum Nails and Vinegar, or with Horse Radish &c. If nervous & Suffocative the Mucus Root Juice or Strong Tea of Oak Moss wt is thickened to a membrane, (Endemic a little Honey, and Allum to wash the sores here), it is cured wt Mercury by thinning &c. Vide Mouth Sore. N.B.: Onion Juice the Mucus, by its accrimony with Anyo- cures it by sending it to the Skin in dan­ dynes, Sudorifics; Salivation does it no gerous cases. harm. Bathe with Volatiles, Saponacious Balsams &c. Convulsiva—Vide Angone History & Theory of the Thrush. cujus est species. See Sore Throat. Aphthae:— for which there is no English Angone:—Is a Spasmodic, sharp choak- Name, unless Sore Mouth or Thrush, ing of the Fauces without an inflammation. is a frequent and fatal Disease, especially Vide Asthma. among Infants, & pregnant Women in this Cure; By a Dose of Opium, Camphor, Place, tho’ little considered or understood. Volatile & Traumatic Balsam mixt together. These are small, round, superficial Ulcers, Repeat if needfull, this Cured an Epidemic on the inside of the Mouth, which Boer- 9° Annals of Medical History haave found on Accute inquiry to be the mour is inspissated, and cannot be Driven Exulcerations of the Excretory Ducts of thro’ the Ducts, but Adheres and blocks the Glands, which separate Salivery Hu­ up the Opennings into the Mouth, as may mours & convey them to the Mouth. Now be seen through a Microscope. Nine days this Fluid rendered too thick and Viscid are said to bring the Crisis of this Fever— stops up the Extremities & Causes them but sometimes it goes much longer. to inflame, in all parts where ever these The Aphthae or Thrush are Seldom Ob­ Excretory Ducts should discharge them­ served in hot Countries except in some In­ selves as the Lips, Gums, Cheeks, Tongue, fants; for being more thin and lax, they Palate, Fauces, Uvula, Throat, Stomack, are more disposed to perspire & Sweat. & Intestines. In low and Marshy Ground, Sweats & Urine carry off the Apthae, if & in hot & rainy Seasons, Infants & Old copious & render them mild. Hence all People are most affected by the Apthae. diets, drinks, & nursing which interrupt these are always detrimental. Van Swieten, The Prolegomena or Causes. (If I recollect the Author) Observes when Continual putrid Fever, wt a Diarrhea, Apthae don’t appear, as in Hot Countries, or Dysentery, perpetual Nausea, Vomiting, then Miliary Spots white & red, are fre­ loss of appetite, Febrile Anxiety, Pain at quently to be seen on the Skin; and con­ the Pit of the Stomack, often returning; jectures that the Humor deposited is the great Weakness; considerable Evacuations; same. The Miliary Eruptions and Apthae Stupor, & Heaviness, but perpetual Drowsi­ attend the same Diseases & such accute ness & pain about the Stomack. Those that Fevers as have the same disagreeable appear at first with one Pustle, and are smell of Vapid Vinegar. afterwards white & Pellucid like pearls, He remarks the miliary Eruptions or unequal, are mild & safe. Those which first Pustules are filled with similar pelucid appear in the Throat like New Bacon with Liquor, perfected above the Cuticle, & a white thick crust, beginning in the after they dry up, that they scale off, & Stomack, & slowly Ascending to the mouth, are often renew’d as in the Apthae. Both these are Opaque because of thickness, & are preceded by Anxiety about the Heart, very dangerous. Those which appear over Weakness, Slight but continual dosing, & the whole mouth wt a hard firm thick tena­ unequal intervals. If the Apthae & Miliary cious kind of Crust, turning brown, yellow, spots sudently disappear, there is great or livid, are very often Fatal. But those danger of their oppressing the Stomack & which break out in the same way, & then Heart. N. Then there is no hope, but by turn black, are worst of all, & commonly expelling the Apthae again outward to the take life. The sooner the Separation the Skin. Stupor, & Heaviness presage the better; the longer before they fall off, the Apthae; sometimes they thicken The Duc­ more dangerous to the Patient. The Salival tus Communis, & Pancreas, (not having Juices are discharged, thro’ the whole in­ the way clear into the Duodenum) by a ternal surface of the Mouth, in order to be thick Apthous Crust; there is great Anx­ mix’d with the Aliments in Mastication; iety, about the Precordia. But when the there are also numberless mucous Cryptae, obstructing Crust is removed, we need not or Cells in the back of the Tongue, Tonsils, wonder that the accumulated bile, breaks Velum of the Palate, Pharynx, and Gula, loose; Hence the severest gripes in the which excrete thick Mucus for the Lubri­ Bowels, almost Excorriated, & hence dan­ cation of those parts. But the eruptive gerous Diarrhoeas & Dysenteries arise. Aphthae happen when this Mucous Hu­ Hence on giving a Purge a fatal Hyper- L aryngology and Otology in C olonial T imes 91 catharsis may suddenly arise from the tas. See Sauvages ingenious Treatise of Acrid Bile & Pancreatic Juice, rushing into Mutitas. the excorriated Bowels. N. a Salivation Balbuties:—Is a Stammering & Loosing follows the Thrush, before the Dilated Ves­ Letters in Speaking. Vide Psellotis. See sels can recover their former size. kinds of it in Sauvages Chap. vi. Now the Stomack & Intestines being in Battarismus:—Vide Balbuties. the same State, it is no wonder that the Blaesitas:—A depraved Pronunciation body is exhausted like a Consumption of the Letters S & R. Vide Traulotis. after it by the Purging &c. N. Apthae of Black Dry Tongue: — Worst Presage the Mouth in Pregnant Ladies may cause in Fevers owing to a Deficiency of Abortion by destroying digestion, and ab­ Lymph, or when the larger Vessels, sur­ sorbing of the Chyle. But she needs nour­ charged with Blood, press & stop the ishment for two bodies, of which the smaller. Hence the Tongue, Index of the weaker, the Foetus, dies. Stomack, is dry and gangrenous. See putrid N. A Hickup at the beginning is worse Fevers. than at the End of the Apthae, as denot­ Bronchocele or Goitre:—Is a large swell­ ing the Stomack lined with thick Apthae. ing which is formed on the fore part of the N. Cold Applications in this Disease are Neck, between the Skin & the Wind Pipe, Dangerous. & sometimes hangs from the Neck like Cure: Whey, Vapour Baths, Weak Pan­ a large Bladder; It contains atheromat­ ada, Gargarisms, Glysters, Corroborating ous, steatomatous, fleshy, or honey-like healing drinks, as Alder & Mallows, & Matter. See Encysted Tumors. Soot, M. in Tea with Milk. Jellies con­ Bronchotomy, the Operation:—This Ope­ stantly on the Tongue &c &c. with the ration is chiefly useful in the Angina, when Remedies first Mentioned. the Throat is exceedingly enlarged by Apogeusis:— Is a defect of Taste. the Tumor of the Thyroid Gland & Part Vide Ageustia. Find the Cause and try to adjoining, called, Bronchocele, which press­ remove it. ing on the Trachea, prevents the free Apophlegmatizantia:—Provokers of Spitt­ Course of the Air to & from the Lungs. It ing. These stimulate the Glands of the is an incision made in the Aspera Arteria Palate, Fauces, and Salival ducts, & purge to admit the Air to the Lungs to preserve off the viscid Phlegm. They are proper Life, in a violent compression of the in defects of Taste, Hardness of Hear­ Larynx. ing, to drive viscid humours from the Frightful Cautions have been laid down Head, in Catarrh & Obstructions of the by Writers, for fear of dividing the recur­ Fauces. They are preservative Agt. con­ rent nerves, or the great Blood Vessels. tagious Diseases. V. Salivantia. Tobacco But there is scarce any danger at all; for chew’d or Smok’d, Chewing Hickory Bark, they lie quite out of the reach of any In­ Ginger, Mistletoe, Mercury &c. strument in a tolerable cautious Hand. Arcditas:—Is a dryness of the Skin, The Manner is simply this; Pinch up Nostrils, Mouth & Tongue from a dissipa­ the skin a little below the Tumor, but as tion of the Watery Juices by the febrile near it as you can if it be low; & make an Heat; while the impervious Blood distend­ Incision quite thro’ the Skin, three quar­ ing the Vessels make the skin rough & dry. ters of an Inch long. It is commonly in the Vid. Typhus, Sore Throat &c. 3rd or 4th Ring of the Trachea, but the Asaphia (Aphasia?):—A Defect of the Tumor will not sometimes permit you to Voice. Vide Aphonia, Cophosis, Muti- choose the Place. Then part the lips of the 92 Annals of Medical History

Wound, make a small transverse Incision & often produces mild Consumption, called into the wind-pipe & immediately intro­ the Deffluxion on the Lungs. duce a Silver Cannula, near half an Inch Catarrhs are distinguished according to long, wt a couple of little Rings at the top an old Verse: of it, thro’ which pass a Ribband to pass “ Si fluat ad pectus dicatur rheuma Catarrhus; round the Neck to keep it fast in the Ad fauces, Bronchus, ad Nares esto Coryza.” Wound. N. After the Patient is cured of the Besides an obstructed Perspiration, some Quinsy, & can breathe by the natural pass­ other causes may produce Catarrh, as the age you may wtdraw the Tube, which Stoppage of usual evacuations, or Natural leaves only a Simple Wound and requires Secretions as of Urine &c., or as Weaken­ only a superficial application. ing digestion as only to produce a Watry Chyle & Blood, when its fluid Parts will Capistrum:—A Spasm closely & immov­ escape more easily by the Numerous Glands ably shutting up the Mouth. See Spasmus about the Head. Prognostics here are easy, Maxillae inferiorii. See Opium. if the Catarrhal Matter, is but little, & not Catarrhus— Catarrh:— Is perhaps the most Acrid & discharged only by the Nose, the common Disease in our County, yet the least Cure is easy. If discharged by the Throat examined or understood. When People are it is more difficult. But when it is very taken wt it, they only say they are very poorly, Acrid, & falls in a copious Manner on the & have catched a bad Cold, & no further Lungs, especially in one advanced in Years, Notice is taken of it, ’till it frequently ends or who is liable to Cough, Asthma, or Con­ in dangerous Pleurisies, Peripneumonies, sumption, it is both very difficult & dan­ Consumption &c. It may be defined “ An gerous. Unusual Defluction of Lymph, Serum or Cure in general; Softning the Serous hu­ Mucus, from the Glands about the mours, drinking large Draughts of Hy- Head, Jaws & Throat, exciting a Cough, dromel warm, or Tissots Elder Flowers, distressing & frequent. It is attended wt Balsam Traumatic, Vomits, Blisters, Ano­ Hoarseness generally & an inflammatory dynes wt Camphor, Antimon, Vin., Flan­ Fever.” nel Shirts, Cough Mass, Volatiles, Issues, The cause is called taking Cold, tho’ in Smoking Tobacco.—See Peripneum. Ca­ fact it is more frequently by Violent Heat; tarrh., See the Theory of Opium. More however, it is generally caused by a Diminu­ particularly The Diet should be soft, tion of insensible Perspiration, the out­ smooth, & balsamic; most Authors agree ward Skin being exposed to the Air, Where­ to give a gentle Vomit at first, if the by a Plethora arising, the great Author of strength will permit, and if the Patient be Nature has provided an internal Perspira­ Phlethoric or Asthmatic Bleeding may be tion by the Mucous Cryptae of the Skin necessary, but in no other Case. It will be of the Mouth, Fauces, Bronchiae, Lungs, necessary to give gentle Purges as &c. But too great quantities collected in these, by the Heat of the Parts becoming Infus. Sena...... § ii; Viscous, are cast off, after they have Mannae...... § i caused much trouble & Irritation by Sal Glauber...... § ss Coughs, Sneezing, & Running at the Nose, Aq. Nux Muschatae...... 5 ij until more be collected, which stuffs up, & M.S. Potio Mane Sumanda. often rattles in the Breast. This frequently If there be Restlessness, & Anxiety, give produces wt is called the Catarrhal Fever a gentle Anodyne, with large Draughts of L aryngology and Otology in C olonial T imes 93

Rosemary or Bran Tea &c. made into Hy- under Phthisis. See Syrup of Horehound dromel & a Stronger Purge of Rusl’s Pills under Tussis from a French Physician. or of Soap & Alloes. Catarrhus Stiffocativus:— Is a very difficult When the Cough is troublesome: Respiration, Attended wt ‘a sudden Inter­ ception of the Senses & Motion, snoring & intermitting Pulse. See Pnigma, Bleed, Conserv. Rosar, Syrup. Balsam, Vomit, Bathe, purge, Barks of Alder, Tea Syr. e. mecon...... aa3 i of common Scotch Thistle &c. See Asthma, Spt. Vitriol, tenuis...... q.s. Angina. ad Ievem Aciditatem, m. cap. cochi., Cionis:— Is a painful thickness of the subinde, urgente Tussi, Uvula & Palate. See Angina & Sore Throat. or else, Clamor:— Is an anxious Exaltation of the Voice; often in Mania. V Clangor:— Is a Sharp screeching Voice. Terr, japan...... 5 ij See Paraphonia. See Sauvages. Bal. tolutan...... 3 j cog. in Aq. font...... 3 xii ad 3 viij Coryza:— Is an extraordinary Running colat, add of a thin Serum from ye Nose or a Catarrh Syr. e mecon...... 3 ij of the Nostrils. See the Latin Verse under M. cap. cochi...... ij Catarrhus. h. s. et urgente Tussi Cough:— See Tussis, Pertussis, Catarrhus. After removing the cause, it may be Syrup of Horehound or Sulphur & the Yolk necessary to thicken the Juices & restrain of an Egg, or take Barbadoes Tar, Honey & the Flux of sharp Acrimonious Matters. ye Yolk of an Egg &c. Cynanche:—Quinsy: Is an inflamma­ 3 tory & sometimes putrid Fever; attended Conserv. Rosar...... 3 i wt pain & Redness in ye Fauces, a diffi­ Bals. Cocatalli...... 3 ij cult swallowing & Breathing wt a Sense Sperm. Citi, Terr, japonic...... Sa3 i Oliban pulv...... 3 iss. of Straightness in ye Fauces. See Angina, Syrup. Balsam., q. s. m.f. Electar. & Quinsy. If Inflammatory: Blood under Dos. q. n. m. Tongue, in ye Arm or Feet. Bathe Feet in warm water, blow Alum or Nitre into ye In the meantime Cupping & Blistering Throat often. Apply a Chin Stay of Bals. & Issues may be applied to the side or part Sapon. or Camphorated Spts., purge by affected, according to the Symptoms. Also Mouth & wt Glysters. Blister if pain in ye to divert the Defluction from falling on Head. Gargle the Throat with Oak Oose the Lungs, let him use freely Diuretics & or persimmon bark wt 01. Vitriol & Honey, Diaphoretics for some time. Snuff Honey. Apply Poultises of Jews Ears R or Horehound, plantane & Vinegar. If Therac, Androm, Oliban...... 51 3 ss. putrid; Mercury is called a Specific. V. Gum Ammoniaci, croci...... aa gr. v Malignant quinsy. Syrup q. s. f. Bolus, to be taken three times Dysphagia:—A difficulty of Swallowing a day. wtout any remarkable difficulty in Breath­ Lime Water & Milk & Tar Water, & Tea ing. Vide Angina. of Pine Buds, or Pine saw dust, or ground­ Epistaxis:— Is a Profusion or Haemor­ ing, & Sassafras will make good, common rhage of blood from ye Nostrils, wt pain Drink, not much inferior to the above ele­ & heviness of ye Head, Redness of ye Face. gant Forms from London. See Treatise Vid. Hemorrhagia, Haemorr. Nar. &c. 94 Annals of Medical History

Original Epistaxis:— is a Haemorrhage omitted, untill ye Child has some Reason to from a Plethora. Symptomatic Epistaxis: suffer it to be done. On wc see Van Swieten, are ist from internal Causes: Febrile Haem­ Sharp. It is pretty common for ye Roof of ye orrhage, critical Haemorrhage, insalutary Mouth to admit of Reunion. Fissures of ye Haemorrhage. 2nd: From external Causes; Palate often close in some years. Separate ye common Haemorrhage, Haemorrhage by Fip from ye upper Jaw; divide ye Frenulum Feeches &c. wc connects it to ye Gums. If ye Dentes Cure: Bleed Feet, Purge, Sweat over Incisorii too much projected, cut ym out bath of Cedar Tops, Epithem in each Nos­ in Infants. Cut off ye callous Lips wt Scis­ tril of Pulv. Alumen, on Tint &c. sors ye whole length, but take Care to Fauces:— Pain’d or inflamed; See Angina. make ye Wound in Straight Lines. Then Glossagra:— Is a Rheumatism of ye Tongue bring ye two Lips of ye wound exactly to­ and is a Species of Rheumatismus. Q. Vide. gether, & pass a couple of pins, one pretty Glossocele:— Is a spasmodic, violent & near ye Top & ye other as near ye bottome, sharp Extrusion of ye Tongue. thro’ middle of both edges of it, & secure Glossocoma:— Is a spasmodic, violent & ym in yt Situation by twisting a Piece of sharp Revulsion or hauling in of ye Tongue. Wax’d thread, across & round ye pins 7 or 8 times. Then cut off ye points, lay a small Gravido:— Cold in ye Head; Is a kindred Bolster of Plaster under ym, to prevent Catarrh of ye Nostrils wt a painful uneasi­ their Scratching. Wn only ye lower Part ness & heaviness of ye Head, hoarse Voice of ye Hare Lip can be brought into Con­ & difficult Breathing, Vid.Catarrhus, Frigus. tact, one Pin is Sufficient. The practice of Cure: Thrust roots of ye Thin Yellow bolstering ye Cheek upward does more in­ rind of an Orange up each Nostril, hold ye jury to ye Patient, yn good to ye Wound. Head over Steam of hot Infusions. Dress superficially as often as is Necessary H iccup:— Seems to be a Convulsion of for Cleanliness. In 8 or 9 Days ye parts ye Oesophagus drawing ye Diaphragm up­ generally are found united, yn gently ex­ wards, whilst it is suddenly seized wt a tract the Pins & apply dry Lint and Ad­ convulsive Paroxysm & drawing down­ hesive Plaster. This method may be use­ wards & proceed either from Repletion ful in some Fistulae &c. Silver Pins & of Inanition. See Singultus. Steel Points suit ye Pomp of ye Great, but Hoarseness:— See Catarrhus, Pertussis, &c. common Pins Answer ye End fully as well. Himantosis:—Is a greater Fength or See Cullen on Copper. Slenderness of ye Palate yn usual wt Pain. Lagostoma:—The Upper Lip divided. See Hypostaphyle:— Is a Prolapse or Produc­ Lagocheilos. tion of ye Palate wn it is either relax’d, in­ Leptophonia:—Is a fault of ye Voice flamed, ulcerated, incrassated, attenuated or which is very Weak. See Paraphonia. forked. V. Scorbutus. Blow Allum or Nitre M um ps:—Species of Angina. Q. Vid. on it. Wash Acid Elixir, Honey &c. Poultis wt Wormwood & Vinegar. Give Ischnophonia:— Is a Fault of Pronuncia­ them Antimonial Essence freely. Avoid tion in wc one Syllable can’t join another Greasy things internally & externally. quickly. V. Psellimus. Mouth Sore:—See Scorbutus, Parotis, Labium Leporinum:— Hare Fip. See La- Parulis, Apthae. Wash wt a Decoction gocheilos. of Hyssop, Sage, Oak Moss, mixt in honey Lagocheilos:— Hare Fip. Is a Deformity in & a little Allum. Horse Radish Root Juice which ye Fip is divided by Chasms or Fissures. & Honey. Purge wt Mullein Juice. Bathe See Fab. Feporin. The Operation should be the Head wt Rum, Glyster Saline, Tea of L a r y n g o l o g y a n d O t o l o g y i n C o l o n i a l T i m e s 95

Black courrants. Rhubarb in Soot Tea, attended wt a convulsive & Suffocating Syrup of Mulberries &c. Cough; a sonorous inspiration and Expira­ Mutitas:— Is an Impotency in pro­ tion; & oftentimes a Vomiting. nouncing Articulated or joined words. See Cure:—Lobs Tincture 3 i bis vel ter die Aphonia. in Juice of Pennyroyal 5 ss, M. Purge once Nejrendis:— Is a Deformity in wc ye a Week. Mistletoe & Garlic, or Wild Onion Teeth is out of the Head. Teas freely; Baum de Vie Pt. vij, Tinct. Noma:— Is an Ulcer wc does not con­ Canthar Pt. j. m. is also good; Glyster sume & eat ye Afflicted Part alone, but all daily. ye Neighboring Parts. See Cancer, Ulcus. N. B .: After a Dose of Train Oil & Onion Odaxismus:—Is a pain of ye Gums yt Juice ye Whoop no more. Infants have whilst Teething. See Den- N. B.: Our Epileptic Pills; Tar Water is titis. good after it. Tea of Scots Thistle, Electar. Oesophagismus:—Is a Spasm of ye Oes­ of Sulph., Honey & Yolk of Egg, m. ophagus wc detains ye Food in ye Gullet Polypus of Ye Nose:—Is an Excresence after Swallowing it, attended wt great filling ye Cavity of one or both Nos­ Pain. See Spasms. trils, almost suffocating, or at least making Oxyphonia:— Is a shrill Voice, such as Respiration difficult, arising from ye La­ is commonly uttered in Wailing & Lam­ minae Sangiosae Membrane. There are entation. See Paraphonia. several Species. Some resembling ye Hyda- Ozaena:—Is a putrid Ulcer of ye Nos­ tides of ye Liver, as in some Dropsies; trils, from wc a stinking Mucus distills. Some like Ganglions of Nerves, wc borrow See Ulcus. Wn it is venerial, see Syphilis; their Coats from its Vessels. Those wc are if not, Tobacco Ointment or Honey of soft like Serum are form’d of Water, con­ Roses wt a little red Precipitate; See tained in Cysts; these are too tender to be Polypus. extracted; but should be left to harden, Palate Diseased:—See Hypostophyle. wc in time ye commonly do. If ye are Palsy of ye Gullet:—See Oesophagis­ Viscid, tho’ ye cannot be drawn out at mus. once by ye Roots yet at several attempts Palsy of ye Mouth:—Gargle wt Sage ye may be brought away in Bits. There is Juice, purge well, chew, mustard. another sort neither so soft as to be squiezed Palsy of ye Tongue:—See Paraglossa. to Pieces, nor so hard & brittle as to crum­ Paraglossa:—A Swoln Tongue. ble, nor adhere to ye Membrane. This is Paraphonia:—A Deprav’d sound of ye ye favourable Kind, yt suits for Extrac­ Voice. Remove the Cause if possible. tion by ye Forceps. But there is another Chew Ginger &c. See Aphonia. See Pr. Kind, & ye worst of all, wc is hard & Scir- Sauvages. rhus, adhearing so as to tear rather yn Parotis:— Is a Swelling of ye Parotid Separate, wc often ends in a Cancer wc Gland (See Boils, Syphilis). Inflammation See. of Glands behind ye Ears after an imper­ The Polypus sometimes grows large as fect Crisis. Suppurate wt Leeks & treat as to alter ye Bones of ye Face. When ye Poly­ Phlegmon, Q. Vide. pus appears in ye Throat, Surgeon Sharp Parulis:—A Tubercle on ye Gums, giving advises to extract it yt way because ex­ much Pain, & of ye Inflammatory Kind. perience has taught, it is more easy to be See Phlegmone. Separated, wn pulled yt Way. Pertussis:—See Chin-Cough. The Whoop­ Operation on the Polypus. Let ye Pa­ ing or Chin-Cough Is a Contagious Disease, tient lie Supine 2 or 3 hours to bring it fur­ 96 Annals of Medical History ther down before ye Operation. Extract it used for some Years wt amazing Success by a Pair of Forceps, yt will take a good & instances. Also take a Tea Cup of honey hold, introduc’d into ye Nostrils an inch & & as much Good Vinegar & 12 of boiling half, to make more sure of its roots. Then hot Sage or Alder or Rosemary Tea, & let twisting ym a little from one Side to an­ him drink abundantly till he Sweats. Take other, continue in yt action, while you pull away very gradually ye Body of ye Poly­ Crumb of Bread...... 5 iij Sweat Oil or fresh Butter...... 5 i pus. If it breake, you must repeat ye Ex­ M ilk...... q. s. traction so long as any remains, unless at­ tended with a Violent Hemorrhage; wc An Onion beaten, boil into a Poultis & often happens if ye Polypus is Schirrous. apply hot to ye Throat & keep it hot. Wn But be not Alarm’d ye Vessels presently ye inner Membrane of ye Larynx is in­ collapse. Dry Lint, or Lint dipt in some flamed, ye Danger is greater. Give 20 Styptic will readily stop it. We prevent its grains of Nitre in every hour in his Hydro- future Growth by Vitriol in Toddy on mel if he can Swallow. If a redness appear Lint wn applied. The Cauteries & Setons on ye Neck & Breast, ye patient oft re­ of some are very good. covers. Another sort of Quinsy, & much Psellimus:— Is a stammering in Speech, more common, is wn one of ye Tonsils or a fault in pronouncing some Letters, grows red, & swelled, & painful, & ye Pain Words, or Syllables. commonly extends to ye Ear on ye same Psellotis:— Is a Fault in Pronunciation, Side. In a day or two ye Disease attacks wn one Syllable or Letter is left out or taken ye Glands of ye other Side, ye first disap­ away. pearing. These must be treated according Quinsies or Sore Throat: See Angina. Are to ye Pulse. And if ye Pulse be hard & Various but always mean a Sense of Pain in quick Phlebotomy is necessary, & if ye ye Throat impeding in some Degree Swallow­ Redness, Swelling of ye Throat, & difficulty ing or Breathing or both. The first Division is of Breathing do not abate, bleed again; If respecting Tumour. A Quinsy wtout Swelling ye Pulse be natural omit Bleeding; ye is calledCatarrhusSuffocativus by Some. Wn Hydromel, Nitre, Powder blown & Purges there is a Tumour it is again very various, or Glysters, (wt Syrrup of Black Currants Aqueous, Scirrhus, Inflammatory, Convul­ called a Specific) and Nitrous Decoctions sive, Catarrhus, Oedmatous, Purulent, Can­ &c are Sufficient. cerous, & Gangrenous. All these must be N. If these Disorders are neglected too treated differently according to ye Causes long, or ye inflammation is too great, yn & Symptoms. See ye Original Diseases In- Suppuration ensues, wc is known if ye red flamatio, Oedema, Cancer, &c. Wn inflam­ Tumour last above 3 Days unabated. Then matory it is called Cynanche, ye Breath use emollient Gargles perpetually, wt Poul- much interupted, ye Voice much sharpen’d, tises, Glysters &c. In ye Cynanche & some ye Anxiety considerable &c. There is great Quinsies, to save life, Heister used safely danger Indeed & Death sometimes ensues to open one or more of ye Cartilaginous in 8 hours or less. Rings, so that, even that is not dangerous. For Cure: Bleed a large quantity imme­ Only beware of ye Blood Vessels. Keep ye diately, apply Cupping Gourds or Glasses Canula in ’till ye inflammation cease. To around ye Neck. Give a good purge imme­ know Wn stop ye orifice of ye Canula wt diately. Immediately blow Powder of Alum ye Finger, & if ye Patient can breathe easy, or Nitre on ye Palate, Larynx &c. & repeat by ye Mouth, take out the Tube, & heal as often as needful. It is a Remedy I have up ye Wound. Support wt nourishing L a r y n g o l o g y a n d O t o l o g y i n C o l o n i a l T i m e s 97

Glysters. Embrocate wt Volatile Liniments. purge then, Acrid, excoriating Stools. Pulse Give Powder of Camphor & Nitre, Drink small, frequent, irregular, worst in ye Hydromel, Gruel, Panada &c. (See Bron- Evening. Great Debility, Delirium & Coma. chotomy). On ye Second Day, sometimes later, Efflores­ For ye Gangrenous Quinsy or putrid cences appear on ye Skin, patches of a red Sore Throat (V. Gangrena, Cancer, Ty­ colour first on ye Face, yn over ye whole phus). Medicines not only Vegetable Acids, Skin, wt wc ye Fingers are stiff and swell. but Fossils too, as Spt. Sulph. Nitr., Spt. This usually continues 4 Days before Dis- Vitriol, Spt. Sal Marine wt Honey of Red quamation, but still ye Fever remains. Rose &c. constringe ye Vessels & prevent Ulcers in ye Throat livid & black, breath ye too great Expansion, repel ye imper­ foetid, Gangrenous Symptoms, Fever pu­ vious particles, in ye larger Trunks & cure trid, some die on ye 2d (?) Day, but more or prevent putrid Gangrines. Sydenham & on ye Seventh; Putrification Continues Swieten used these as Gargles. along ye whole Alimentary Canal wt Diar­ The Ancients used Alum, Flax, Oris, & rhoeas. Large Swellings of ye Lymphatic Stercora of Animals. The Farmers of Zea­ Glands of ye Neck, wc sometimes suffocate, land are fam’d for curing Quinsies by Respiratory Organs hurt too. Wn ye Ulcers touching ye Uvula often wt White Vitriol, are more mild, ye Efflorescence disqua- Sal. Ammoniac, & Crude Alom, to ye mates after 3 or 4 Days. The Cure comes great relief of ye Patient. At first I puke by gentle Sweats on or before ye Seventh wt White Vitriol gr. 25. Give Salts every Sleep & Appetite return &c. day. I Keep up ye Vis Vitae. I would Cures: Avoid Bleeding & Purges. Attend Gargle wt Strong Oose of Persimmon Root to Septic Tendency. Antiseptic Gargles, & Bark, Honey & Alom. I give ye Bark a Injections. Neutral Antiseptics as Cortex. Teaspoonful every 2 hours wt Spt. Sal Emetics both by Vomit & Nausea. Wn Amoniac 3 j in each Dose in Wine. I give Tumours, Blisters, Flux, Essence, Throat Antimonial Wine 3 j thrice a Day. I have Powder; Anasarcal Drink; Volatiles; See Mist. Sal. Tart. Guaiacum, Camphire, Cancer Poultises &c. Nitre & Sal Amoniac aa 3 j in Spt. Vin. Scarify: Cup between the Shoulders & ! iij often wt Success. Poultis wt Rue Jews repeat it; Shun Antimon. Purges: Use gen­ Ears, Horehound & Lees. tle EmmoIIient Glysters; Blister ye Shoul­ Quinsy Malignant: Cynanche Maligna; ders; Also round ye Throat. For ye putres­ Cullen. History or Description; It is Con­ cent Diathisis Cortix & Serpentaria; For tagious; Seldom Sporadic, i.e. Endemic. ye Diarrhoea, Anodynes & Antihysteric Affecting few People in a Season. Com­ Mixture. Throat Powder; Our Anasarcal monly Epidemic, attacks all Ages & Con­ Drinks. Bathe Neck wt Fucus & Rum, m., stitutions, but more commonly ye Young Haustus Cardiacus; Camphor & Volatiles. & infantile & infirm. It first Shews itself Apply ye White of an Egg & good Mustard in a Pyrexia, Cold Shiverings, Sickness, & red Pepper to ye Pain of ye Throat. Anxiety, Vomiting, yn Stiffness of ye Neck, Pulv. Antispasmodic. Antiseptic Drops in Uneasy Fauces, Hoarse Voice, ye internal ye Ears, also internally. Poultises of Lees Fauces of a dep red & some Tumour, & Rue from Ear to Ear. Deglutition is seldom painful. White Ash N. B. A fatal Epidemic Cynanche was Colour’d Spots wc Spread & Unite in thick found by Prof. Monro & by ye New York Sloughs over ye Fauces; These falling off Physicians to have a new membrane in ye discover Ulcerations. A Coryza of thin larynx, of wc ye only cure was Mercurials Acrid & foetid Matter attend; Infants &c. 9 8 Annals of Medical History

Ranula:— Is an Encysted Tumour seated may arise from a Phlegm or Mucous ac- upon ye Frenum of ye Tongue, containing a cummulated & hardend adhereing to ye thick tobaccous Matter. Trachea & Bronchia, like ye membrane Raucedo:— Hoarseness. Is a rough & ob­ discover’d by Dr. Monroe (& wc has been scure Voice, wc cannot be heard unless by discovered here in a putrid contagious those standing very near. Quinsy, at New York, many Years since) Cure:—Swallow slowly ye Juice of Horse difficulty seperable from ye Larynx. For Rhadish Root, Chew peruvian Bark & Gin­ Cure I would bathe ye Throat often wt ger, Figs, Starch, Liquorice, Oily draught, ye Saponacious Balsam. Put his Feet in Balsamics &c. Lohoch Pectorale; hot Water; if plethoric, bleed. Puke wt Antimonial Wine. Mix a little Camphire V Sperm. Citi. & White Soap...... aa 3 ij in Sweat Oil and add Honey, wt a few The Yolk of an Egg, 01. Lin...... § iss Drops of wc moisten ye Throat, removes Syr. Althae...... 5 iii ye Mucous Membrane and removing ye M.S. Lohoch; rub ye Soles of ye Feet wt Hogs Spasm wt Lobb’s Tincture, or a Grain of Lard before ye Fire. See Pectoralis. Opium, carefully dissolved in Soot Tea Renchus:— Is a Sound uttered thro’ ye i viij by Spoonfuls till better. I would Nose. See Stertor. recommend Onion Tea, Saline Glysters, & Rhenophonia: — A Speaking thro’ ye a Plaster of Turpentine & Camphor be­ Nose. Is a nasal Voice wc is not altogether tween ye Shoulders. uttered from ye Nostrils. Thrush:— See Aphthae, Purge wt Rhu­ Rhachmos:— Is a sterterous Sound wtin barb. Glyster 2 a day, wash ye Mouth often ye Fauces. See Stertor. wt Strong Tea of Sage, Hysop & Alder wt Screatus:— Is Sonorous Evacuation of honey & Alom mixt. Melasses wt Juice of Mucus from ye Fauces. Horse Radish Root is good. Sternutatio:— Sneezing. Is a Convulsive Tooth Ache:— See Odontalgia: Blow To­ Agitation of ye Membranes of ye Nose wt bacco Smoke in ye Ear of ye affected Side an impetous Inspiration of Air, & presently & put Oil of White Oak in ye Tooth made making ye like Expulsion thro’ ye Nostrils by burning ye twigs on a Cold Ax, or Pewter wt a Sound. dish. Suffocatio:— Is a Suppression of the Tortura:— Is a bending of ye Mouth to Breathing or Respiration, from a continued one Side. contraction, or narrowness of ye Fauces or Traulotis:— Is a vitious Pronouncing of ye Trachea, wtout a Fever; a Symptom of Letters S & R (See Blaesitos). Asthmas, Hysterics, Some Quinsies. Also Chinese Cure:— ff. Pomegranate Rind See Dyspnoea, Orthopnoea, Ephialtes &c, wt Pepper four Seeds beat & apply as &c. Snuff. But if from Cold Blood, ye Smell to Suffocatio Stridula:— A Disorder in Chil­ a Composition of Sal. Ammoniac & Lime dren called here & in I reland ye Hives, in Scot­ Water tied up in a Rag. If from atrophy, land ye Croup, & in some Places Chock or ye drink Wine wt some Frankincense in­ Stuffing. In England ye rising of ye Light (See fused in it &c. Vomit, Cold Baths, Snuff ye Pennsylvania Journal No. 1410). It seems ye Dew from Mallows Leaves. Drink a to be a Species of Asthma attended wt very Decoction of Primrose. Wash ye Head wt Violent Symptoms. The Infants are seized wt a Decoction of Sage, Mustard Seed gr. 30 a Sudden & great Difficulty of Breathing, wc every Morning. is soon Mortal unless relieved. It seems to be Vociferatio:—Is a painful & exalted Ex­ Nervous & Spasmodic. It is probable yt clamation of ye Voice, to harden ye Body. L a r y n g o l o g y a n d O t o l o g y i n C o l o n i a l T i m e s 99

Uvula Relaxed:—Blow in Alom, Nitre great Restlessness & Anxiety, Pain, Red­ &c. Infusion of Mustard Seed. Decoction ness, Heat & Fever, like other Inflamma­ of Water Dock. tions (wc see) proceading from Suppres­ sion of Perspiration, exposing ye Head, to EAR. cold Water or Air wn Sweating. Cure in Relatively little space is devoted to aural this case must be by Bleeding ye Arm or conditions. This is not surprising when we Jugulars, Cupping the Neck, giving Anti- stop to realize that real interest in otology monial Wine & Hydromel, Powder of Cam­ received its first great stimulus only about phor & Nitres. Fomenting the Ear wt ye the middle of the last century through the Steams of Warm Water Or applying ye work of Wilde, Kramer and others. An in­ Ear to a Jug filled wt a Decoction of Cedar teresting side light may be found in the Tops or Camomel &c.—Bathing ye Feet article on Otitis. The rules of Dr. Graham in Warm Water—And all around ye Ear are given and commented upon with an wt Volatile Liniment &c. &c. If it cannot underlying spirit of combativeness and be dispersed yn it will be best Suppurated antagonism. James Graham was perhaps by Juice of roasted Onions & a drop of Sweet one of the earliest ear quacks, in the true Oil often applied in ye Ear.—If it break & sense of the word, in America. He flour­ run white & laudable Pus, wash it a little ished in Philadelphia about 1773. Bass5 wn needful wt Honey & Rum, & dress wt. gives the following notice copied from the Onion Juice & Honey mixt till well. New York Gazette; and the Weekly Mer­ 2. A Defluxion of an Acrimoneous hu­ cury, July 19, 1773: “Doctor Graham, mour, this has not ye great heat, burning Oculist and Aurist, is arrived in this City, & pulsation, but is painful from Irritation. from Philadelphia, and may be consulted See Opium. Blow tobacco Smoke thro an at his apartments at Capt. Fenton’s op­ inverted Pipe into ye Ear wc eases ye Pain. posite Trinity Church, in the disorders of Then gently Syringe, wt a Decoction of the Eye and its appendages; and in every wild Cherry Bark.—Mix Camphire in Sweat species of deafness, hardness of hearing, Oil & drop into it daily—or Syringe wt ulcerations, noise in the Ears, etc. Persons Warm Wine or drop Rosemary & Sage born Deaf and Dumb, and those labour­ Juice in ye Ear often—Drink Barks & ing under any impediment in their Speech, Guiacum in Decoction. by applying personally, will probably be 3. Ear Ach from Worms, Wn there is assisted. The Doctor intends to sail for felt a sharp shooting Pain, a gnawing, & England in a few months; those, there­ horrible Noise in ye Head, as wn a Flea fore, who have occasion for assistance, or any insect, has made its Way to ye Drum must apply immediately.”—His London of ye Ear.—In this Case a Drop in ye Ear career, with his Temple of Health, Celes­ of Sweat Oil, or Brandy, or Juice of Worm­ tial Bed and Elixir of Life, makes an inter­ wood, or even Warm Milk quickly destroys, esting tale but like many other famous or dislodges ye Insect, wn it will come out quacks his end was obscure.6 on ye Cotten, or be cautiously extracted. Otitis, The Ear-ach is, an inflamma­ 4. Ear Ach from Morbific Matter trans­ tion of ye Ear. Otites, Diseases of ye Ear lated, as in ye Decline of Malignant Fevers are internally & externally, especially ye & generally a favourable symptom, tho’ it former attended wt very Severe Pain, may cause Deafness. This may be eased Head-ach & Alienations of Mind (See De­ by ye smoak of Tobacco, Camphorated lirium) a Loss of Sleep, & sometimes Con­ Oil & Onion Juice. vulsions &c. See Odontalgia. It occasions 5. Tinnitus Aurium, a tingling Noise in 100 Annals of Medical History in the Ears, often attends Nervous & Malig­ drinking Sage, Sasafras & Fennel Seeds nant Fevers & is also frequently a chronic Tea.—(4) His Accoustic Essence is each Disorder, & very troublesome, & often end­ Ear & yn wt Force s(n)ufhng it up ye Nos­ ing in e(n)tire Deafness, wc is seldom trils as long.—But Juice of Ground ivy, cured, & if relieved a while is apt to return Rue, Rosemary & Garlic % ii in hot Tar again. See Phrenismus. Water would be perhaps better. 6. Deafness and Thickness of Hearing (5) Then his Caephalic snuff wc was n o' differ only in degrees. Sounds unless very better yn Powder of ye Bark of Myrtle loud make little impressions on them. Root, or white Hellbore & Ginger, was This distressing Mallidy is seldom cured, often to be taken, yt ye must sneeze, keep­ because ye fine Organs of Hearing cannot ing ye mouth shut, & ye Nostrils pressed be seen, nor their Disorders well ascer­ together.— tain’d, in living subjects & ye dead have (6) His Etherial Essence (not so good as no use for it. It is however sometimes oc­ camphorated Spirits) were applied to ye casioned by hard Wax in the Meatus Ears & volatiles to ye nose for 5 minutes. Auditorius, & other pituitous Matter. This (7) His warm Drops for Deafness (per­ may be relieved by gently syringing the haps Sweat Oil camphorated) 5 or 6 on Ears with Warm Water. Lint in each Ear. If ye Tympanum &c be too tight Sweat (8) Pen(e)trating Spirits 3 i (Juice of Oil & Camphor, or Onion Juice in ye Ears Horse Rhadish Root is better) on ye Tongue on Cotten will have a good Effect, as I applied to ye Palate & keeping ye Mouth have often found. But if it be too lax & shut long after. debilitated, washing ye Ear with strong (9) All these were done at night & re­ Decoction of Wild Cherry Tree Bark, or peated next morning, three times ye first black Alder Bark, or Wine wt sage & Rose­ Week & only twice a Week after. mary stewed in it, may do good. Steams (10) Twice a Week ye Legs & Feet were of Rue, Rosemary & Garlic, thro’ a Funnel beathed wt warm Water. Semicupia of may be safely tried. Many have tried ye Decoction of Cedar Tops had been better. Fumes of Amber & Olibanum, & Spirit Sal (11) He embrocated the Head some­ Ammoniac, but it should be wt Caution. times wt perhaps ye Volatile Liniment.— Some have applied Musk, Amber & Civit This was a Prescription for one born Deaf in a Dossil of lint in ye Ears, wc seems but by some mischance did not fully suc­ rational to affect the sluggish Nerves— ceed tho’ it made a considerable change. Some use Galls of Eels & Partridges & even N.B. I once knew a Deafness cured by put­ Fumes of Sulphur, But the(se) appear to ting on Cotton some drops of a hot Pickle me improbable & dangerous.—Some com­ of Allom Salt applying it in ye Ear often. mend ye Eggs of Ants in Onion Juice as Auditus:—See Cophosis & Surditas, & almost infallible, but I have never ven­ the Theory under Otalgia. tured it. Some try Salivation by Mercurial Cophosis:—A difficulty or Impotency of Unction as the last probable Remedy. hearing or perceiving Sounds from some Dr. Graham ye Otistis Rules by wc He Impediment wtin or wtout the Labirinth pretended to cure inveterate Deafness were of ye Ear. See Surditas. Try Camphorated these (i) Bleed the Jugular 1 xiij every io Oil, Juice of Sage &c. Electricity has suc­ Days for three times.—(2) Three Emetic ceeded in Nervous Cases. Bleeding or Boluses given one ye Day after each Bleed­ Blistering in inflammatory. If Ulcers in­ ing.—(3) A Mixture Night & Morning ject Tinct. of Myrrh & Honey. Insects, (perhaps Tinctura Sacra & Amara mixt) remove by Oil.

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Buzzing in Ears: See Otalgia & Tinnitus Salt in ye Ear. Camphor dissolved in Sweat Aurium. Oil. Some drop Juice of Ground Ivy. Dullness of Hearing: See Cophosis. Susurrus: Is ye perception of Sound J \ Ears pain’d; See Otalgia, Surditas, Vermes. not existing or a buzzing in the Ear & Dis­ Epiphlogisma:—Heat of some part, as if order in ye Sensation of hearing. See V made by a burning Coal, attended wt pain. Otalgia. ^ If in the Ear it is called Pyrosis. Tinnitus Aurium:—Tingling of ye Ears. Giddiness: See Vertigo. See Otalgia. Put a clove of garlick dipt in Hearing (Dullness of) : See Cophosis. Honey in ye Ear, alternately 8 or 10 nights. ^ Hearing (Diseases of): See Otitis. Vertigo:—Is an Imagination in wc all k . Nystagmus: is an involuntary Spasm of things appear to a man to be turned wt ly e Eye or Lid. himself. See Epilopsia. A Otophlatos: An Excretion of an ill-scent- Chinese Cure. 9. Pomegranate Rind wt ed Humidity from behind ye Ears. This Pepper, four Seeds, beat & apply as Snuff. was one Year in Sussex, endemic & fatal But if from Cold Blood, ye Smell to a among many Children, who had Agues Compositon of Sal Ammoniac & Lime & Fevers before. The Agues ceasing Water tied up in a Rag. If from atrophy, ye Children were swelled, bloated, Oede- ye drink Wine wt some Frankincense in­ matious, & their Faces Cadaverous. Sores fused in it &c. Vomit, Cold Baths, Snuff came behind ye Ears & several turn’d to ye Dew from Mallows Leaves. Drink a Cancer & Gangrenes. At length we suc­ decoction of Primrose. Wash ye Head wt ceeded in curing it in ye same manner. See a Decoction of Sage. Mustard Seed gr. 30 %/Cancer. every Morning. 4) Otopuosis:—Is an Efflux of Pus from ye 4 eEar, or a sordid Catarrh of ye Ear. See bibliography . Otalgia. Otorrhea: Is an Efflux of Blood from ye 1. Packard: The History of Medicine in the Ear. See Otalgia & Haemmorrhagia. United States, page 161. Paracusis:—Is a difficulty of hearing 2. Thacher: American Medical Biography. articulated Voices, no Words distinctly. 3. Jonathan Wright: History of Laryngology. . Elsberg: Laryngology in America. Trans. See Cophosis, Otalgia. 4 Am. Lar. Assn. Vol. I. Surditas:—Surdity or Deafness: Is an 5. Bass-Henderson: History of Medicine, p. 824. abolished Hearing (See a Treatise under 6. Foster: Famous Quacks, Medical Pickwick, Otalgia). Drop a Strong infusion of Allom Dec. 1916. 3o EDITORIAL

It hardly seems necessary to write a in medicine, and that the material from formal introductory note to a publication those sources which has been heretofore such as that of which the first number scattered throughout various medical publi­ now appears. After much preliminary labor cations may thus be presented in a more and discussion of plans, a number of suitable form. New books on the history of those who are interested in the furtherance medicine will be reviewed, and a department of the study of medical history in this of notes and queries will be established country decided that the time was ripe for which should prove of great use. It remains the undertaking. There is at present no to be seen whether the demands for the periodical published in the English language journal will be such as to justify its exist­ devoted exclusively to medical historical ence. It is hoped that those interested in literature, although at no time has more the study of medical history in their country interest and assiduity been displayed in will realize the advantages offered by such such studies. It is believed that the Annals a publication and give their active support will justify the expectations of those who to the Annals by contributing to its columns have endeavored to put it forth. No effort and by swelling the list of its subscribers. will be spared to maintain it on the highest It will be noticed that no advertisements plane. It is hoped that it will furnish the are published. This materially lessens the medium of publication for the transactions income from the publication but enhances of many of the societies which have been its dignity. Let us add,— it also increases so active in recent years in historical work the necessity for a large subscription list.

THE LEGEND OF THE MANDRAGORA Mandragora officinarum or mandrake, when pulled from the earth, and that those belongs to the order of Solanacea, and is who heard these cries were rendered insane. one of the potato family. Its forked root This is alluded to by Shakespeare when is very thick and fleshy. By the ancients Juliet, pausing ere she drinks the sleeping it was much used as a narcotic, especially potion in contemplation of the horrors of during surgical operations. Its forked root, the vault, says: which somewhat resembles the forking of Juliet What with loathsome smells human legs, caused it to be esteemed, And shrieks like manrakes torn out according to the doctrines of signatures, as of the earth, an aphrodisiac, and it was one of the That living mortals hearing them run commonest ingredients of love philters. It mad. was believed to utter shrieks and cries Romeo and Juliet, Act IV, Sc. 3. 102 T h e L e g e n d o f t h e M a n d r a g o r a 103

Furness1 gives several instances in refer­ in the minds of the English people. The fol­ ence to this belief. “ In Webster’s ‘Duchess lowing is the description of the mandrake of Malfy,’ 1623: ‘I have this night dug up in the Anglo-Saxon version: a mandrake, and am grown mad with it.’ Mandragora (Mandrake. Atropa Man­ Again, in the ‘Atheist’s Tragedy,’ 1611: dragora). ‘The cries of mandrakes never touch’d the ‘ 1. This wort, which is named pavbpaybpas, ear With more sad horror.’ In ‘A Christian is great and illustrious of aspect, and it Turns Turk,’ 1611: ‘I’ll rather give an ear is beneficial. Thou shalt in this manner take to the black shrieks of Mandrakes.’ In it. When thou comest to it, then thou shalt ‘Aristippus or the Jovial Philosopher’: recognize it by this, that it shineth at night ‘This is the mandrake’s voice that undoes altogether like a lamp. When first thou me.9 99 seest its head, then inscribe (Latin text In order to avoid the danger of hearing surround)3 thou instantly with iron, lest it its cries it was advised that to extract it flee from thee; its virtue is so great and so from the earth, a string should be attached famous that it will immediately flee from to the plant, and the other end tied to a an unclean man when he cometh to it, dog. The latter was then made to run, hence, as we said before, do thou “ inscribe” dragging the plant up by its roots. it with iron; and thou shalt delve about it Furness gives the following quotation so that thou touch it not with the iron, but from BuIIeine’s “ Bulwark of Defence against thou shalt earnestly with an ivory staff Sickness,” 1575: delve the earth. And when thou seest its “ Therefore they did tye some dogge or hands and feet, then tie thou it up. Then other Iyving beast unto the roote thereof take the other end and tie it to a dog’s wyth a corde, and digged the earth in neck, so that the hound be hungry; next compasse round about, and in the mean cast meat before him so that he may not tyme stopped their own ears for fear of the reach it, except he jerk up the wort with terrible shriek and cry of the Mandrack. him. Of this wort it is said that it hath so In whych cry it doth not only dye itselfe, great might, that whatsoever thing diggeth but the feare thereof kylleth the dogge or it up shall soon in the same manner be beast which pulleth it out of the earth.” deceived, i.e. shall fall down dead.4 There­ J. F. Payne2 has given a most interesting fore as soon as thou see that it be jerked resume of the Herbarium Apuleii Platonici, up, and have possession of it, and wring as translated into Anglo-Saxon in the the juice out of its leaves into a glass eleventh or twelfth century. The Latin ampulla (or pitcher), and when need come work of Apuleius (not the same as Apuleius upon thee that thou shouldst therewith who wrote the “Golden Ass”), was written help any man, then help thou him in this about the fifth century, some think in manner. Africa. It was evidently one of the “ Leech- 2. For headache, and in case that a man doms” or medieval textbooks most revered may not sleep, take the juice, smear the amongst the Anglo-Saxons and to it is forehead; and the wort also in the same man­ probably largely due the popular dissemin­ ner relieveth the headache; and also thou ation of the fallacies about the mandragora wonderest how quickly the sleep cometh. 4. For podagra, though it be very severe, 1 Variorum Edition, “ Romeo and Juliet.” 2 The Fitz-Patrick Lectures for 1903, “ English with iron. The Latin word is circumducere, meaning Medicine in Anglo-Saxon Times,” Oxford, 1904. to make a line around or outside it with iron. 3 It is evident that the Anglo-Saxon translation 4 In the Latin text the word d ecip ere, which is was an error, since the herb was not to be touched evidently a mistake for decidere—fall down dead, die. 104 Annals of Medical History take of the right hand of this wort and also call Circeium, and two kinds there be of it, of the left, of either hand by three pennies’ the white which is supposed the male; and weight; reduce to dust; give to drink in the black which you must take for the wine for seven days; (the patient) will be female. . . . It may be used safely enough healed, not only so that the swelling is for to procure sleep, if there be good regard allayed, but it also healeth the tugging of had in the dose. . . . Also it is an ordinarie the sinews and wonderfully healeth both thing to drink it . . . before the cutting or the evils. cauterizing, pricking or lancing of any 5. For witlessness, that is, for devil- member to take away the sence and feeling sickness (demoniacal possession), take from of such extreme cures. And sufficient it is the body of the same wort mandragora by in some bodies to cast them into a sleep weight of three pennies, administer to drink with the smel of Mandrage, against the in warm water, as he may find convenient; time of such Chirurgery.” soon he will be healed. Gerard in his “ Herbal” (1597) describes 7. If any one see some grave mischief in the mandrake as occurring in two distinct his house, let him take this wort mandra­ species, the male and female, in which gora, as much as he may then have, into mistake he probably followed Dioscorides. the middle of the house; he banisheth all Furness in his “ Romeo and Juliet” gives evils out of his house.5 from Halliwell the following quotation from Payne states that the Latin edition con­ the Works of Sir Thomas More, 1557: tains the following statements as to its anaes­ “ Whereas the Latine text hath here thetic properties which is omitted in the somnia speculantes Mandragore, I have trans­ Anglo-Saxon version: lated it in Englishe, our minds all occupied “ If any one has to have a limb amputated, wyth mad fantasticall dreames, because or burnt, or cut, let him drink an ounce and Mandragora is an herbe, as physicions saye, a half in wine, and he will sleep so long that that causeth folke to slepe, and therein to the limb may be cut off without pain or have many mad fantasticall dreames.” feeling.” Shakespeare refers to the groans of the This direction is contained in the Latin mandragora in the second part of “ Henry edition printed by Philip de Lignamine V I ” when the Queen is talking to Suffolk. about 1840, and Payne thinks it is perhaps Suffolk. “ Would curses kill, as doth the earliest notice in a Latin book of surgical the mandrake’s groan.”—Henry VI, anaesthesia, though the original observation part II, Act III, Sc. 2. came from Dioscorides. The term mandrake was often applied in Payne adds that John de Vigo speaks of contempt of the physical appearance of a its use for this purpose but says it is not man. Thus Falstaff alluding to the diminu­ without great danger. Dr. Payne’s book tive stature of his page says,— contains a number of illustrations from the “ Thou whoreson mandrake, thou manuscript copies of Apuleins showing the are fitter to be worn in my cap than to method of pulling up the mandrake by wait at my heels.” — Henry IV , Part attaching a dog to it by a string. II, Act I, Sc. 2, 17. In his notes on Othello, Furness gives In allusion to the vicious propensities from Staunton the following quotation from engendered by it and also having reference Holland’s “Pliny,” Book XXV, chapter 13, to the appearance of the root, Falstaff, “ This herbe Mandragoras, some writers speaking of Justice Shallow says: 8 This doubtless refers to evil spirits. A.-S.L. i. “ When a’ was naked, he was for all 1245. the world, like a forked radish, with a T h e L e g e n d o f t h e M a n d r a g o r a 105

head fantastically carved upon it with Shall ever medicine thee to that a knife: a was a forlorn, that his di­ sweet sleep mensions to any thick sight were in­ Which thou owd’st yesterday. visible: a’ was the very genius of Othello, Act III, Scene 3. famine; yet lecherous as a monkey, When Archidamus is telling Camilla of and the whores called him mandrake.” the welcome that the Count of Bohemia — Henry IV , Part II, Act III, Sc. 2, will extend to that of Sicily when it shall 333- pay its promised visit, he tells him that the Bucknill6 directs attention to the fact Bohemians can hope to vie with the mag­ that Shakespeare refers to the herb six nificence of the entertainment which the times and that on the two occasions when Sicilians have given them, but, he adds: its real medicinal properties are the occasion “ We will give you sleepy drinks, of its mention, the Latin term mandragora that your senses, unintelligent of our is used; the vulgar appellative, mandrake, insufficience, may, though they cannot being employed on the occasions where the praise us, as little accuse us.” — The vulgar superstitions are alluded to. Winter’s Tale, Act I, Scene 2. The use of mandragora as a somnifacient is referred to twice by Shakespeare. Sir Thomas Browne7 says that the idea In “ Anthony and Cleopatra,” the Queen that the root of the mandragora resembles bemoans the absence of Anthony. a man “ is a conceit not to be made out by ordinary inspection, or any other eyes, than Cleopatra. Charmian. such as, regarding the clouds, behold them Charmian. Madam. in shapes conformable to pre-apprehen­ Cleopatra. Ha, ha! give me to drink sions.” He states subsequently the opinion Mandragora. universally held at his time that there is Charmian. Why, Madam? really no distinction of sex in the vegetable Cleopatra. That I might sleep out world, consequently there could not be a this great gap of time. My Anthony is male and female mandragora plant. As away.—Anthony and Cleopatra, Act I, Wilkins points out in a note, the sexual Scene 5. differences in plants were not clearly defined, though suspected by Ray and others, until In “ Othello” when Iago is hatching his foul Linnaeus published his “ Fundamenta et plot we find the other reference, and with Philosophia Botanica” in 1732, in which it an allusion to poppy (or opium) for the he clearly explained the difference in same purpose. function of the stamens and pistils. He disregards altogether the traditional state­ Iago. Look where he comes. Not poppy ments that the mandragora grew under nor mandragora, gallows and places of execution, being there Nor all the drowsy syrups of the generated from drippings of fat and blood world from the dead, and that it gave vent to a shriek when pulled from the earth. 6 “ The Medical Knowledge of Shakespeare,” page 218. 7 “ Pseudodoxia Epidemica,” Book II, Chapter VI. BOOK REVIEWS T h e C u r e s o f t h e D is e a s e d . In F o r r a in e At­ books. The learned essay on some of the t e m p t s o f t h e E n g l is h N a t io n , London, 1598. ancient poet-physicians by which the strictly Reproduced in facsimile, with introduction and Notes, by Charles Singer, Oxford, at the bibliographical portion of the book is pre­ Clarendon Press, 1915. 50c. faced, not only displays the erudition of the author but also the poetic instinct which This little book is a reprint of what is be­ has guided him in his labors. In 1874 “ Le lieved to be a unique copy of a pamphlet in Parnasse Medical Francais” was compiled the British Museum. In the preface Singer by Cherean. So far as the reviewer knows proves that its author, who has concealed this is the only attempt at a complete col­ his name by the use of the initials G. W., lection of the medical poetry of any nation was George Whetstone, a singular literary which has thus far been attempted, and Dr. genius who flourished in Elizabethan times. Dana observes that it contains no really He also proves that it is the pamphlet re­ good poetry. It is to be hoped that if Dr. ferred to by Hakluyt as having been seen by Dana carries out the plan at which he hints, him in manuscript form before publication. of compiling an anthology of medically The work is intended as a guide to be used originated poetry, that its contents will be by Englishmen on their voyages, at that chosen with the discrimination of which we time so frequent, into tropical countries. know he is capable, and that the plan of The diseases of which the cure is considered including every poem written by a physi­ are the calenture, or sunstroke, tabardilla, cian, simply because its author was a medi­ under which the author describes a very cal man, will not be followed. Dr. Dana deadly fever which was probably yellow mentions so many physicians’ names who fever but may have been typhus, the es- have written poetry that was worth while, pinlas, or prickly heat, cameras de sangre, that there is no doubt that a large volume or tropical dysentery, erysipelas, and scurvy. would be required to contain only selected The publication is of particular interest at portions of their writings. The great bulk of this time when so much interest has been so-called poetry written by physicians can awakened in the study of tropical diseases. be cheerfully left in the limbo of forgotten P a c k a r d things. Let us trust that Dr. Dana will carry out his project and give us a volume in P o e t r y a n d t h e D o c t o r s. A Catalogue of Poetical which Anglo-Saxons may read with pride the Works Written by Physicians with Biographical Notes and an Essay on the Poetry of Certain real poetic achievements of such men as Ancient Practitioners of Medicine. Illustrated Holmes, Chivers, and Weir Mitchell not to with Translations from the Latin and by Repro­ mention the present poet laureate. ductions of the Title Pages of the Rarer Works. P a c k a r d By Charles L. Dana, A.M., M.D., LL.D., The Elm Tree Press, Woodstock, Vermont. $5.00 T h e G ro w th o f M e d ic in e . From the Earliest Times to About 1800. By Albert H. Buck, M. D.; All those who are interested in the literary Yale University Press, New Haven, 1917. $5.00. side of the medical profession owe a debt of gratitude to Dr. Dana for the publication It is an ambitious undertaking to survey of these delightful browsings among his the growth of medicine in one comprehensive B o o k R e v i e w s 107

treatise and naturally particular attention even be of practical value as in an instance can be given only to the broader aspects and in which a physician considered that he had special details must be chosen with discre­ made a significant discovery which he was tion. In this work there is the effort to give eager to give to the world. A friend pointed a general account of the development of our out to him that he had been forestalled by art in a form attractive to the general med­ Celsus nineteen hundred years ago. ical reader. The work does not go beyond This work opens with a short discussion the end of the eighteenth century. of the beginnings of medicine and then takes There are three main parts, dealing with up the subject of Oriental Medicine in which Ancient Medicine, Mediaeval Medicine, and with much superstition there was a surpris­ Medicine during the Renaissance. These ingly large amount of sense. For the ac­ are convenient divisions in the telling of the count of Grecian Medicine there is more story and these periods of development are material available and naturally Hippoc­ further divided into epochs. The author rates claims considerable attention. These laments, and those of us who are interested sections give an excellent summary of the in medical history join with him in this, the state of medicine in Greece and explain its lack of knowledge of medical history. It is association with the schools of Alexandria of interest to speculate how much we of this and of Rome. Much interest belongs to the generation owe to the workers in each of formation of the various sects and the rea­ these periods. When we follow the course sons for their development are set out. of the stream of medical knowledge through Greek learning was carried far and wide and its many wanderings the wonder is that the the story shifts from Greece to Alexandria continuity endured in spite of the many and then to Rome where Galen stood pre­ things which tended to check it. Ask eminent as the figure destined to dominate senior students or many practitioners how medical thought for many centuries. The much they owe to Arabian Medicine and introduction of Grecian medicine to Rome the majority would not even understand the and the authoritative position so long occu­ question. A query as to our debt to Greek pied by Galen had a tremendous influence Medicine would perhaps be illuminated only on medical thought. by a knowledge of the fact that Hippocrates The second part deals with Mediaeval once lived. Quote to them the saying that medicine and gives a clear account of the “ Except the blind forces of Nature, nothing Arab Renaissance, perhaps one of the most moves in this world which is not Greek in surprising periods in the history of medicine. its origin,” and a polite incredulity would The author gives us explanations as to why be the probable result. For such this work many of the changes came about and these should be particularly useful, especially as are fully as interesting as the historical facts the author has endeavored to trace reasons themselves. The School at Salerno comes in addition to giving facts. in as a connecting link with the development To many the past is a sealed book, the in Europe during the Renaissance. In the sources of knowledge have no interest for account of this period we find names which them and while they may not think that are more familiar and the course of progress knowledge will die with them, yet they can be given more in detail. The account consider that its birth and their own coin­ of the development of surgery in the various cide very closely. This has been termed “ an countries of Europe occupies considerable inept derision and neglect of the ancients” space and is complete. Dr. Buck takes the from which we may be delivered by some view that the use of Latin in medical publi­ knowledge of history. Such knowledge may cations was a hindrance to development. It 108 Annals of Medical History hampered medicine more than surgery, for forth and its use explained. A very excel­ the physician using Latin was saturated lent preface describes the necessity which with a reverence for authority, mostly in had arisen for the development of some the person of Galen, while the surgeon uniform system of nomenclature, and the trusted more to his own observation. This steps by which it was developed. Vesalius may have been in the mind of Sydenham complained in his time of the disorder in when he gave his celebrated advice (as the the study of anatomy which resulted from somewhat doubtful story goes) as to the the great number of existing terms, and best reading in the study of medicine. that many different names were used by There are many points which might be the various authors to designate a given discussed if space permitted. The author structure. A rapid sketch is given of the must have had difficulty in choosing his evolution of the terms in ordinary use by material; there is so much of interest and anatomists, and the confusion caused by side paths constantly attract. But he has lack of method and uniformity is well illus­ kept well to the straight road. He refers trated. Thus approximately fifty different to the incident of St. Paul being bitten by names were given to the corpus pineale, a viper without hurt. It must have been a before the latter cognomen was definitely temptation to discuss the nature of the assigned to it in the BNA. The difficul­ Apostle’s “ thorn in the flesh.” The work ties encountered by the German Anatomic can be highly commended for its interest Society from the time when it first took up and style and as an excellent contribution its labors in 1887 until they were terminated to the study of medical history. It is more at the meeting of Basle in 1895 were tre­ for the beginner than for the veteran student mendous. The Preface is followed by a and this does not imply any criticism— much translation of the article by Wilhelm His the contrary. The book is well printed in giving an account of the methods pursued clear type and has a number of excellent by the Committee and recounting some of illustrations. It is published by the Yale its chief troubles, such as the question of University Press on the Williams Memorial the application of personal names to ana­ Publication Fund. M c C r a e . tomical structures, on which His confesses he leaned strongly towards the retention A n a t o m ic a l N a m e s , E s p e c ia l l y t h e B a s l e N om­ of many, and which was met by a compro­ in a A n a t o m ic a (“ BNA ”). By Albert Chauncey mise, giving objective names to every part Eycleshymer, B.S., Ph.D., M.D. Head of De­ but where personal names were very widely partment of Anatomy, University of Illinois, as­ sisted by Daniel Martin Schoemaker, B.S., M.D., used, adding them in brackets. Another Prof, of Anatomy, St. Louis University, with important point was the consideration of Biographical Sketches by Roy Lee Moodie, A.B., the anatomy of the various specialties. Ph.D., Assistant Professor of Anatomy, Univer­ The work was finally accomplished in a sity of Illinois. William Wood & Co., N. Y., 1917. manner which, as with all human endeavor, has found critics, but yet is satisfactory to No greater boon could be conferred on the great body of the profession. the American student of anatomy than the The book is accompanied by a series of publication of this most excellent work on biographical sketches of the anatomists of anatomical nomenclature, wherein the so- the world with bibliographical addenda of called Basle Nomina Anatomica (“ BNA” ), great value. It concludes with one of the the now universally recognized standardi­ best compiled indexes that it has ever been zation of the scientific names for the struc­ the pleasure of the present reviewer to go tures and organs of the body is fully put through. P a c k a r d .