differentiation is possible, by noting that tenderness is Confusions arise not merely in pleurisy, empyema absent over the subjectively painful abdominal area and and lower-lobe pneumonias, but also in bronchopneu- that thoracic examination or respiratory symptoms give monia, upper-lobe hepatization (Bennecke7 and Her¬ some clue to the nature of the affection'. Indeed, the rick8) and, as in my second case, pericarditis with clinician customarily, in instances of abdominal pain, effusion. halts till he can exclude the triad of confusions—tabetic In conclusion, it is not my object to canvass the crises, respiratory infections and vertebral disease. entire literature of this subject or to claim that the The pain is variously depicted. Some, as Henoch, clinical picture described is wholly unique, since doubt¬ speak of it as superficial only, yet Raillet describes the less many have experienced the same situation. It is pain as deep and over McBurney's point. Dieulafoy has proper, however, to insist on the following points: found that pain in appendicitis does not begin with full 1. Pneumonia, pleurisy and pericarditis, at their very intensity, as it does in perforation, e. g., of a gastric onset, may present absolutely no symptoms other than ulcer, but this dictum certainly does not always hold. the abdominal findings. Melchior1 places special differential reliance on the con¬ 2. These phenomena of invasion may completely trast between the slight local findings and the severe resemble appendicitis, peritonitis of other etiology, or general symptoms, as the sharp pain, the high fever, the even the collapse of perforation. involvement of the sensorium, involuntary evacuations, 3. Diagnostic errors and unnecessary operations may etc. ; he cites the analogous early appendix symptoms of be unavoidable. Immediate operation is imperative and as an is held that and other typhoid example. It pain the small percentage of error is negligible in comparison abdominal symptoms of this pseudoperitonitic group with the benefits of early operation in genuine indica¬ cease suddenly and characteristically, which is con¬ tions (particularly as 80 per cent, of patients operated sidered differential from appendicitis. Against this on under a mistaken diagnosis, recover). statement, a strong protest must be made, inasmuch as 4. The tenderness does not always remit with deep, every clinician has learned to dread the sudden treacher¬ flat pressure, and that relaxation of the abdominal ous improvement witnessed in appendicitis, when gan¬ parieres, between respirations, is not invariable. grene or rupture relieves the tension of the part involved. 5. The general symptoms do not over¬ It invariably Tenderness and rigidity are frequently described. shadow the local, the latter at times being the more may be local or general. Richardson2 speaks of rigidity salient.9 and universal tenderness. Arron finds that the muscular defense is less than in perityphlitis. Mignon found generalized abdominal rigidity, and Barnard's3 patient THE HISTORICAL COLLECTION OF MEDICAL almost hard abdominal muscles. exhibited spasmodically CLASSICS IN THE LIBRARY OF THE Melchior's exhibited tension of the abdominal patient SURGEON-GENERAL'S OFFICE walls. In my experience moderate abdominal tension is common in pneumonia. FIELDING H. GARRISON, M.D. Immobility in bed is also described by Mirande. In WASHINGTON, D. C. Griffith's4 and Richardson's2 the knees were reports In of size the of to drawn any library problem what do with up. its rarer and costlier books is is seldom described. In Martens'5 three usually solved by stowing Collapse them either in or out of in at first resembled sight, show-cases, drawers, pneumonias, the symptoms perfora¬ and coffers, and in the was till the cupboards Surgeon-General's tion, but operation suspended pneumonic at this has been in force for cleared the In Barnard's6 the Library Washington policy signs diagnosis. report, some years so far as its erotica on the incunabula, elephantines, patient collapsed street; epigastric rigidity, pain and curiosa are concerned. and a and tenderness, the rapid thready pulse, history The recent of the Col. Walter D. Mc- of ulcer led to which revealed neither plan librarian, gastric operation Caw, to put the more medical classics under ulcer nor the disclosed bilateral important peritonitis; autopsy glass, for purposes of safe keeping, has resulted in a col- lower-lobe pneumonia. Barnard comments on the relax¬ lection of unique interest and value, for the nation's ation of the abdominal walls between respirations, which medical library is singularly rich in these literary treas- was lacking in our cases. ures, the accumulation of which is mainly due to the The general symptoms generally in some way suggest untiring zeal and vigilance of Dr. Billings and Dr. a or localization. The general infection respiratory Fletcher in the past. The fact that nearly every volume significance of fever, higher than is usual in appendi¬ in this exhibit is a first edition should interest the med- citis, is emphasized by Griffith, Barnard, Richardson ical bibliophile, and at the same time an arrangement of color and Sprengel. The gray (teint plombé) of the the classics in strictly chronological order affords a bird's skin in appendicitis is important, in Kirmisson's opin¬ eye view of the textual history of medicine to the student ion. Anxiety is especially remarked in one of Griffith's and casual visitor, while giving the specialist chapter patients and in my first one. Headache, severe cerebral and verse, as it were, by enabling him to put his finger toxemia, chills, cough, rate and character of the breath¬ on the particular locus classicus in each case. Then, ing are important. Obstinate constipation is not uncom¬ many of these old medical classics are fine specimens of mon, and initial vomiting, especially in children, or typography in themselves, bearing on title-page or colo¬ even renewed emesis,, may be confusing. phon the stately names of the great printers of the past. 1. Melchior, Edward: Mitt. a. d. Grenzgeb. d. Med. u. Chir., 7. Bennecke: Med. Klin., 1909, No. 7. xxi, part 3, article xxiii, p. 469. 8. Herrick: The Journal A. M. A., Aug. 29, 1903. 2. Richardson: Boston Med. and Surg. Jour., 1902. 9. Aside from the references mentioned in the text, the following 3. Barnard: Lancet, London, Aug. 2, 1902, p. 280. may be referred to : 4. Griffith, J. P. Crozier: Reports of Interesting Cases, Contain- Hampeln: Ztsch. f. klin. Med., xlv, 1902. ing an Article on Peritonitic Pneumonia, Arch. Pediat., June, 1899, Kuttner: Beitr. z. Chem. Phys. u. Path., 1906, li. p. 418; Pneumonia and Pleurisy in Early Life Simulating Appendi- Lowett-Morse: Ann. Gynec. and Pediat., November, 1899. citis, The Journal A. M. A., Aug. 29, 1903, p. 531. Morris: New York Med. Jour., lxix, 1899. 5. Martens: Med. Clin., 1908, No. 49, p. 1857. Palier: New York Med. Jour., lxix, 1899. 6. Lancet, Aug. 2, 1902, p. 280. Printed by permission of the Surgeon-General, U. S. Army.

Downloaded From: http://jama.jamanetwork.com/ by a University of Iowa User on 06/17/2015 In preparing this chronological exhibit, which will, The Surgeon-General's Library possesses an unusually when completed, be provided with a suitable catalogue rich collection of some 900 volumes relating to the Hip- raisonné, it was thought best that the historical collection pocratic Canon, including fifty-two different editions of proper should begin with Greek medicine, for the reason the Opera Omnia, 441 separate treatises, and 408 com¬ that, apart from the works of the Jewish and Arabian mentaries and critical compendiums. Of these, the fol¬ physicians in the Middle Ages, Oriental medicine has lowing are on exhibition : mainly an anthropologie or esoteric interest. The lead¬ 1. The folio Latin text of the Opera Omnia, translated and ing monuments of pre-Hippocratic medicine, including edited by Fabius Calvus, the friend and patron of Raphael, the Ebers Papyrus, the Code Hamurabi, the Charaka and published at Rome under the auspices of Pope Clement VII in This was first Samhita and the Suruta, are, of course, on exhi¬ 1525. the complete edition of Hippocrates to be bition in the library hall, and no one will chal¬ printed. the of these documents. From the 2. The folio editto princeps of the Greek text, published the lenge importance following year (1526) by Aldus at Venice. hieratic of the we a clear idea of writings papyri get 3. The Basel Opera Omnia edited Janus Cornarius and the of the ancient by priest-like dignity physician's calling, printed by Froben (1538), highly prized on account of its the various diseases and the extensive materia medica textual and critical accuracy. known to the ancient Egyptians. From the Code Ham¬ 4. The Greek text and Latin translation of Hieronymus urabi we sense the importance attached to physicians' Mercurialis, printed by the house of Giunta at Venice in 1588. fees even 2,200 years before Christ. From the Suruta, 5. The Frankfort edition of 1595, containing the valuable the great storehouse of Aryan surgery, we learn that to translation and commentary of Anutius Foesius, the most their Brahminical code of ethics the ancient Hindu learned, industrious and able of the Hippocratie commentators lofty before the time of Littré. physicians united a highly specialized knowledge of and of instrumentation that 6. The first Latin text of the aphorisms, edited by François operative procedure surgical Rabelais 1532). was not on the Greeks and Eomans who (Lyons, improved by 7. The tiny Leyden editions of the aphorisms ( 1607 and came after them. skill in has been an Aryan surgery 1628), the first a Plantin imprint, the second a vest-pocket unbroken tradition, even through the Dark Ages, when Elzevir. was most under a ban. But with this surgery single name after that and in the face of the researches of savants The greatest scientific Hippocrates is exception of "the master of those who know," the like Ebers, Joachim, von Oefele, Jolly, Preuss and Bar¬ Asclepiad tels, it is doubtful whether the records of Egyptian, Aristotle (384 to 322 B. C), who gave to medicine the and med¬ beginnings of zoology, comparative anatomy and embry¬ Indian, Chinese, Mesopotamian Babylonian and the use of formal as an instrument of icine can be ranked with the classic texts. ology logic Cuneiform, successor the was his runic and all precision. A worthy of Stagirite hieroglyphic, palm-leaf inscriptions point friend and of Eresos to 286 to one fact, that ancient medicine and the medicine of pupil Theophrastus (370 B. also a and called the whether Accadian or C), physician "protobotanist," primitive peoples, Scandinavian, because he did for the what Slavic or Roman or has been the same vegetable kingdom Hippo¬ Celtic, Polynesian, crates done for and clinical med¬ each an affair had previously surgery throughout space and time—in case of loose of charms and lore and to icine, by collating the plant-lore the woodmen spells, plant psychotherapy, a "De stave off the effect of It and "rhizotomi" into systematic treatise. The supernatural agencies. may Historia Plantarum" of the foundation- interest us to know that the âaâ disease of the Theophrastus, vastly stone of is the Aldine was identical with hookworm infection European botany, represented by Egyptian papyri ; Greek text of 1497 and the Greek and Latin text of that the Chinese had a pulse-lore and practiced acupunc¬ that Finsen's treatment of Stapel (Amsterdam, 1644). ture; red-light small-pox The colonization of Greek medicine in led to was known to ancient as it was to Egypt Japanese physicians brilliant in and but our John of Gaddesden that an Persian developments anatomy surgery, ; early manuscript of the two Alexandrian a fistula like Alexis St. Mar¬ knowledge great anatomists, pictures permanent gastric and the of dissect¬ that Machaon and Podalirius were the first naval Herophilus Erasistratus, originators tin's; is not based on any textual record of their writ¬ and so forth. Yet these are after all ing, surgeons, only was the of is ings, but pieced together by scholarship Marx waifs and estrays of information, and as information and The relics of the empirical not so disconnected facts do not make Hieronymus. principal knowledge, of the second century B. C. are the two hexa¬ a scientific record. Such a record not poison-lore implies only meter poems of Nikander on poisonous animals ("Theri- the isolation and collation of facts, but their interpreta¬ aca") and plants ("Alexipharmaca") which have been tion and the induction of the general laws behind them, in the two Aldines of 1499 and and the has not the preserved 1523, and, in this sense, pre-Hippocratic medicine French versification of these poems by Jacques Grevin slightest claim to be called scientific. Few will dissent, (Plantin imprint, Antwerp, 1568). therefore, from the wise (if somewhat Olympian) view After the destruction of Corinth (146 B. C), Greek Eastern have a of Goethe that antiquities only casual medicine may be said to have to Rome. Before interest: Alterthümer migrated "Chinesische, indische, ägyptische the Greek invasion, the Bomans, as the younger Pliny immer nur Curiositäten." sind tells us, "got on for 600 years without doctors," relying I. THE GREEK AND GR.T3CO-ROMAN PERIOD (460 B. C- mainly on medicinal herbs and domestic simples, super¬ 476 A. D.) stitious rites and religious observances. The proud European medicine began in the age of Pericles and Boman citizen, who had a household god for nearly its scientific advancement centers in the figure of Hip¬ every physiologic function, looked askance on the itin¬ pocrates (460 to 370 B. C), who crystallized the loose erant Greek physician, despising him as a mercenary for knowledge of the Coan and Cnidian schools into system¬ accepting compensation for his services and otherwise atic science, dissociated medicine from theurgy and distrusting him as a possible poisoner or assassin. philosophy, and developed the art of grouping and Apart from the writings of a private litterateur like coordinating symptoms so that the clinical picture of a Celsus, the principal Boman contribution to medicine disease began to emerge of itself as a definite entity. was the splendid sanitary engineering of the architect

Downloaded From: http://jama.jamanetwork.com/ by a University of Iowa User on 06/17/2015 Vitruvius. Greek medicine was finally established on a undoubtedly did much to develop that cocksure attitude respectable footing in Rome through the personality, of mind wnich made his writings the fountain-head of tact and superior ability of Asclepiades of Bithyna (124 ready-made theory, or what the Germans call "polyprag- B. C.) whose fragments are presented in Gumperfs matism." He had an answer ready for every problem, Greek text (Weimar, 1794). a reason to assign for every phenomenon. How the fol¬ Although Roman medicine was almost entirely in lowers of Galen imposed his authority on European med¬ Greek hands, the best account of it that we have was icine for ages is one of the commonplaces of medical his¬ the work of Aurelius Cornelius Celsus, a private gentle¬ tory. Up to the time of Vesalius, European medicine man who lived during the reign of Augustus Caesar, was one vast argumentum ad hominem in which every¬ and wrote encyclopedic treatises on medicine and other thing relating to disease and its treatment was referred subjects for the benefit of the Admirable Crichtons of back to Galen as a final authority, from whom there his day. To moderns, Celsus is the leading authority could be no appeal. After his death European medicine on Grgeeo-Roman medicine and Alexandrian surgery. remained at a dead level for nearly fourteen centuries. Under the Romans military and gladiatorial surgery Galen's true greatness lies in the simple fact that he attained a degree of perfection which the general art gave to medicine that method of putting questions to was not to reach again before the time of Ambroise Paré. Nature and arranging matters so that Nature may answer Celsus is also the standard authority for the weights and them which we call experiment. His experiments on measures used by the Romans, and the Proœmium of his the physiology of the nervous and respiratory systems "De Re Medica" contains the first history of medicine. are truly classical and the only thing of the kind before Of the 105 different editions of Celsus, the Surgeon- Harvey. Of Galen's Opera Omnia, the Surgeon-Gen¬ General's Library possesses sixty-five. The show-case eral's Library possesses the ten different Giunta editions, exhibit includes the Florentine editio princeps of 1478, selected volumes of which are on exhibition, together the Milan imprint of 1481, the rare Giunta of 1524, the with the Aldine of 1526, Linacre's translations of the Aldine of 1525 and the handsome Elzevir of 1657. "De Sanitate Tuenda" (Paris, 1517), and "De Temper- Pedacius Dioscorides, a Cicilian Greek, was an army amentis" (1527) ; and the Simon Colinaeus imprint of surgeon during the reign of Nero {circa 64 A.D.) and the "De Usti Partium" (Paris, 1528), the prototype of utilized his opportunities of travel in the study of plants. all subsequent "Bridgewater treatises." His work is the authoritative source on the materia II. THE BYZANTINE PERIOD (476 TO 732 A. D.) medica of of which he describes about 600 antiquity, The the Eastern did for Euro¬ plants and plant-principles, over a hundred more than solitary thing Empire to the of the seventeenth pean medicine was to preserve something of the lan¬ Theophrastus. Up beginning culture and texts of Greece. century, the best books on medical botany were still guage, literary Although the lasted over a thousand commentaries on the treatise of Dioscorides, Byzantine power years (395 simply to 1453 A. medical is concerned with which is preserved as the Aldine of 1499 (Greek text), D.), history only the names remarkable men who were the Stephanus of 1516 (Latin text), the rare bilingual of four prominent text of Cologne, 1529, and the Italian commentary of phvsicians in the first three centuries of its existence. Of these the courtier Oribasius to 403 A. a Mattioli (Venice, 1544), also excessively rare. (326 D.), Aretseus the who also lived in thé reign friend and physician-in-ordinary to Julian the Apostate Cappadocian, and sometime of is re¬ of Nero, comes nearer than any other Greek to the spirit quaestor Constantinople, chiefly markable as a torch-bearer of rather than as an and method of Hippocrates and is on this account more knowledge modern men. As a he original writer, but his compilations are highly valued readily appreciated by clinician, in he ranks next to the Father of Medicine for the by scholars that always gives his authorities and, graphic so far as is them Medicine is accuracy and of his of disease, of which known, quotes exactly. fidelity pictures indebted to him for a remarkable of the works he has given the classical, first-hand accounts of pneu¬ anthology of his predecessors, many of whom (the great surgeon monia, asthma, diabetes, leprosy, diphtheria (ulcera for otherwise have been lost the first clear differentiation between cere¬ Antyllus, instance) might Syriaca) and A work is bral and His work is in the to posterity. representative of Oribasius the spinal paralysis. preserved he made the use his Greek text of 1554 and in valued Claren¬ epitome of medicine which for of faulty Wigan's son of a don Press edition ("Synopseos ad Eusthasium Filium"), which (Oxford, 1723). rare Aldine is eclectic was Rufus of who large paper (Venice, 1554) exhibited; but Another great Ephesus, the will lived in the of to 117 A. and student of medical history read Oribasius to reign Trajan (98 D.), best in six-volume edi¬ whose literary remains and fragments have been pre¬ advantage Daremberg's splendid served in the Paris text of 1554. tion, with the French translation (Paris, 1851-1876). who in sixth Soranus of Ephesus, a methodist of the second cen¬ Aetius of Amida, lived the century A. D., was a and comes at the tury, A. D., is our leading authority on the gynecology, also royal physician obsequii obstetrics and pediatrics of antiquity. His treatise on court of Byzantium. His work, represented in the midwifery and diseases of women, represented by Dietz's Aldine of 1534, is principally remarkable for the intro¬ Greek text 1838), was the of such duction of such far-Eastern drugs as cloves and camphor (Königsberg, original into the famous books a Röslin's "Rosegarten" (1513) and Ray- pharmacopeia. nalde's "Byrthe of Mankynde" (1545), and most of the Alexander of Tralles (525-605), who is regarded by as of the supposed innovations in these books, such as the obstetric many historians the most remarkable Byzan¬ on account of the of his thera¬ chair or version, have been traced back to Sor¬ tine compilers originality podalic is the editio anus. After Soranus, there were no real additions to peutic procedure, represented by Lyons prin¬ obstetrics before the time of Paré, some 1,500 years later. ceps of his "Practica" (1504). The ancient period closes with the name of the great¬ Paul of .Egina (625-690), the last of the Greek eclec¬ est Greek physician after Hippocrates—Galen (131 to tics and compilers, is represented by the Aldine Greek 201), the founder of medicine. Galen's text of 1528. We may judge how low medicine had experimental his statements in youth and old age were those of a peripatetic. His life sunk at this time by apologetic regard lack on his He was one long Wanderjahr. This roving disposition to any of originality part. frankly

Downloaded From: http://jama.jamanetwork.com/ by a University of Iowa User on 06/17/2015 admits that the ancients have said all that could be said (Acarus scabia) he may be accounted the first parasitol¬ about medicine and that he is only a humble scribe. ogist. His "Teisir," or "Rectification of Health" is pre¬ Paul was, however, a very capable surgeon and the served in the Latin translation of 1490. The Rabbi seventh book of his "Epitome" was the standard work Moses ben Maimón, called Moses Maimonides (1139- on the subject up to the time of Albucasis. 1208), was court-physician to Saladin, and his "Trae- de III. THE MOHAMMEDAN AND JEWISH PERIODS (732- tatus Regimine Sanitàtis" was written for that Sul¬ 1096 A. D.) tan's personal use. The copy on exhibition, the Floren¬ By the swords of Mohammed and his emirs the wild tine imprint of 1478, is one of the rarest of books. outlaw clans of the Asian and African deserts were con¬ IV. THE MEDIEVAL PERIOD (1096-1438) verted into nations capable of acting as military and Medieval medicine began in the School of social but it was not until after his death Salernum, units, long which was founded by the Benedictine Monks in which he founded was when the mighty empire sub¬ the ninth century, and survives in its principal doc¬ divided into caliphates, that the sciences and arts were the written in hexame¬ We call the medical authors of ument, "Begimen Sanitatis," permitted to develop. ter verse (1840), and in the "Antidotarium" of the Mohammedan "Arabic" on account of the period Nicolaus Praepositus, the first formulary and one of language in which they wrote, but in reality most of the first medical books to be printed (Venice, 1741). them were Persian- or Spanish-born, and many of them The principal outcome of the School of Salernum were Jewish. The of the Eastern leading physicians (or was the work of two and Roland of were the three surgeons, Roger Bagdad) Caliphate Persians, Rhazes, as Allbutt "stand like twin breth¬ Abbas and Avicenna. Parma, who, says, Haly ren in the dawn of modern medicine, the Rhazes a ranks with bearing (860-932), great clinician, Hip¬ very names of romance." "Practica," writ¬ and as one of the Roger's pocrates, Aretseus Sydenham original ten in 1180 and reedited is in the of disease. His of by Roland, preserved portrayers descriptions small-pox library collection as a rare and interesting manuscript and measles is the first authentic account in literature, a of the fourteenth century, together with Daremberg's classic text. It is preserved in the original Arabic, with classical edition of the "Glossuhe Latin in edition Quatri Magistrorum." parallel translation, Channing's (Lon¬ vilely "on gray paper with blunt don, 1766). Rhazes' the "El Hawi" printed, type" (Naples, great encyclopedia, 1854). Roger, Roland and the Four Masters were suc¬ or which Haller to other "Continens," preferred any ceeded of who left no of shown in the Latin by Hugh Lucca, record his work Arabic treatise, is translation of behind him, and his disciple Teodorieo Borgognini Feragus (Brescia, 1486). (1205-96), whose treatise is preserved in the surgical Italy ben Abbas, a Persian mage, who died in 994, anthology of Articella was author of the "Almaleki" or "Liber a (editto princeps, Venice, 1490). the Regius," and Theodoric contradicted the text-book which was the canonical treatise on medicine Hugh pseudo-Galenist dogma of "coction" or "laudable and stand out in for a hundred years, when it was superseded by the pus" their as of a rational The ablest "Canon" of Avicenna. It never been in day pioneers a,sepsis. has printed the Italian the Arabic, but is in the Latin transla¬ surgeon of thirteenth century was Guglielmo original preserved called a man well tions of 1492 and 1523. Salicetti, Saliceto, educated in hospi¬ tal and on Avicenna called "the Prince of the battlefield, as well as in respect of univer¬ (980-1036), Physi¬ His exhibited in cians," a convivial Ornarían successful sity training. "Cyrurgia," the editto spirit, eminently of as in as court and vizier to different princeps 1476, stands out a great landmark or sea¬ practice physician mark in the of the to be followed the caliphs, was one who trod the primrose path at ease history craft, by and died in the prime of life from the effect of its "Chirurgia magna" of his pupil Lanfranchi of Milan pleasures. The "Canon" of Avicenna, a huge, unwieldy (editto princeps, Venice, 1490). Lanfranc, also a uni¬ storehouse of which Haller a meth- versity man, was driven by banishment to Paris, where knowledge, styled he became founder French odica inanitas, but which was none the less a great med¬ the of surgery and made a ical text in its day, is preserved in the original Arabic resolute and valiant stand against the medieval schism text (Rome, 1593) and in the Latin texts of 1479, between surgery and medicine. The effect of the work 1483 and 1486. The Giunta edition of 1608 contains of these great surgeons, coincident with the development of sonic striking plates which show that Avicenna knew and the medieval universities—Bologna (1110), Montpel¬ practiced the method of treating spinal deformities by lier (1137), Paris (1176), Oxford (1200), Padua forcible reduction which was reintroduced by Calot in (1222)—and the brilliant false dawn of culture and lib¬ 18!,'(). The collection of pharmacologie treatises by the eralism in the thirteenth century, did much to further eponymous or pseudonymous Mesue junior is of interest the growth of surgical talent in France, England and as one of the earliest known incunabula (Venice, 1471). Flanders. The "Cirurgia" of Pietro Argelata (Venice. The leading medical authors of the Western or Cordo¬ 1480), the reproductions of the text of Henri de Monde- van Caliphate were the surgeon Albucasis and the Jew¬ ville by Pagel (Berlin, 1892) and Nicaise (Paris, 1893), ish physicians Avenzoar and Moses Maimonides. Albuca¬ the "Cirogia" of Guy de Chauliac, \vritten in the lingua sis. a native of Cordova, who died therein 1106, was the franca (Venice, 1480), a rare and curiously illustrated author of a great medico-chirurgical treatise called the fourteenth century manuscript of John of Arderne, and "Altasrif" (or "Collection"), of which the surgical part the facsimile of the "Chirurgie" of Jean Yperman is exhibited in Channing's Arabic text (Oxford, Claren¬ (1295-1351) by Carolus (Ghent, 185.4), are the princi¬ don Press, 1778). It is remarkable as containing the pal landmarks of the period. lirst pictorial representations of surgical instruments Hand in hand with the medieval development of sur¬ and was the leading text-book on surgery in the Middle gery, there necessarily went some effort to improve the Ages up to the time of Saliceto. The greatest of the status of human anatomy. Dissecting, at first rigorously Jewish physicians during the Arabic period was the Cor¬ proscribed by law and sentiment, became more and more dovan Avenzoar, who died in 1161. He was one of the a matter of course, following the decree of Emperor few men of his time who had courage enough to tilt Frederick II in 1240. Payne had divided medieval ana¬ against Galenism and by his description of the itch-mite tomic teaching into three periods: First, the Salenti tan

Downloaded From: http://jama.jamanetwork.com/ by a University of Iowa User on 06/17/2015 (from the ninth to the twelfth century), in which movers in this change for medicine were the greet print¬ instruction was based on the dissection of animals as ers of the Benaissance and the so-called medical human¬ set forth in the "Anatomia Porci" of Copho, one of the ists. The printing houses of the Aldi and Giunti in Jewish instructors at Salerno. Second, the Arabist Venice, Stephanus and Colinams in Paris, Herbst (Opo- period (thirteenth century), in which such dissections rinus) and Froben in Basle, Wynkyn de Worde and were superseded by books and lectures. The leading Wyer in London, Plantin at Antwerp, Elzevir in Ley- authorities of this time were Richard, canon of Wen- den, vied with each other in the issue of stately folios dover, called Richardus Anglicus (1252), whose work and beautiful texts, while such editors and translators is preserved in Töply's text (Vienna, 1902) ; and Henri as Niccolo Leoniceno at Ferrara; Babelais at Meudon, de Mondeville, who, long bjefore Ambroise Paré, prefixed Günther of Andernach at Strasburg, Hagenbut (Cor¬ an anatomic treatise to his surgery, and who improved nante) at Marburg, and Anutius Foesius at Metz did on Wendover's teaching by the use of pictures, diagrams for Hippocrates what Linacre and Caius in England did and a model of the skeleton. The interest of the third for Galen. Linacre's translations of-Galen in particular period centers in the revival of human dissecting by made it clear to physicians of the day that for centuries Mondino de' Luzzi, called Mundinus (1250-1325), the profession had relied on garbled and second-hand whose "Anathomia" is exhibited in the Leipsic edition versions of their favorite author. of Dr. Melerstat (1493). This little horn-book of Mun¬ Some time after the invention of printing, Germany dinus, although full of Galenical errors in regard to the entered the field of medicine with a remarkable array of structure of the human frame, was yet the sole text-book semi-popular treatises, most of them written, contrary on anatomy for over a hundred years. to custom, in the vernacular, the language of the people. Internal medicine during the Middle Ages was essen¬ The earliest of the German incunabula on exhibition is tially scholastic and monastic; that is, its votaries were the "Regiment der jungen Kinder" of Bartholomteus either monks or schoolmen of the type of the great intel¬ Metlinger1 (Augsburg, 1473), a little book on infant lectual leaders of the thirteenth century—Roger Bacon, hygiene which would be the first Benaissance contribu¬ Thomas Aquinas, Duns Scotus and Albertus Magnus. tion to pediatrics were it not preceded by Paolo Bagel- The medieval logicians did good service in sharpening lardo's "De ^Egritiidinibus Infantimi" (Padua, 1472). men's minds and teaching them how to use dialectics as The "Artzneibuch" of Ortollf of Bavaria (Nuremburg, an instrument or weapon, but science itself could not 1477) was an important German text of popular med¬ advance so long as the pitfalls of syllogism were pre¬ icine in its day, and followed, about 1500, by Ortollfs ferred to inductive demonstration of fact. The medieval quaint little "Frauenbuchlein," or popular hand-book for writers on practice of medicine are commonly described lying-in women. A few years later (in 1513), there as Arabists on account of their unswerving fidelity to appeared at Worms the "Bosegarten" of Eucharius Rös- Galenical dogma as transmuted through Mohammedan lin, a work which bears the same relation to Renaissance sources. Characteristic Arabist texts are· the "Liber obstetrics that the "Anathomia" of Mundinus did to Aggregationis" of Jacopo de Dondis (1298-1358), the medieval anatomy. Although majnly a compilation earliest known of medical incunabula, printed at Stras¬ from Soranus of Ephesus as filtered through the manu¬ burg, circa 1470 by Adolf Rusch (the "R" printer) ; script codices of Moschion, it was still the only text-book the "Conciliator Lifferentiarum" (Venice, 1476) of the in the field after a lapse of fourteen centuries. Three first heretic Peter of Abano (1250-1315), the "Breviary of editions were issued simultaneously, all extremely inter¬ Practice" (Pavia, 1488) of Arnold of Villanova (1235- esting for their quaint cuts (already faintly outlined in 1312), and the "Lilium Medicina?" of Bernard de Gor¬ the Moschion codices), for the rechauffe of podalie ver¬ don (Venice, 1496), also exhibited in a rare manuscript sion as originally described by Soranus and for the fact of 1349. Nowise classical, these works are typical of the that Röslin's text was miserably plagiarized by Walther Middle Ages in scholastic subtlety and rigid adherence Reiff2 in 1545, and also translated and reissued by Will¬ to dogma. Two books of this group are of special inter¬ iam Raynalde as "The Byrthe of Mankynde" (London est to English-speaking people—the "Compendium Med¬ 1545). The ordinance issued by the city of Ratisbon icine" (London, 1510) of Gilbertus Anglicus, the lead¬ in 1555 for the direction of midwives ("Begensburger ing spirit of Anglo-Norman medicine, and the "Rosa Hebammenbuch") has been proved by Mr. Felix Neu¬ Anglica" (Pavia, 1492) of John of Gaddesden, a pre¬ mann3 to be the earliest public document of this kind in bendary of St. Paul's, whom some think the original of the vernacular. Chaucer's Doctor of Physic. The former is remarkable The foundations of medical jurisprudence were laid for its account of leprosy and as containing the first in its earliest European text, the "Caroline Criminal reference to the contagiousness of small-pox. The latter Constitutions" (Peinliche Gerichtsordnung) issued by has a remarkable reference to the red-light or Finsen Emperor Charles V in 1533 and exhibited in Schmid's treatment of the same disease, but is otherwise a farrago Middle-High German text (1835). Interesting relics of Arabist quackeries and countryside superstitions. of the great medieval pandemics of syphilis and bubonic are V. THE PERIOD OF THE RENAISSANCE. THE REVIVAL OP plague preserved in the curious tracts of Widman LEARNING AND THE REFORMATION (1438-1600) (1497), Conrad Schelling (1502), Grünpeek (1503), In the transition of civilized mankind from medieval Ulrich von Hütten (1514) and Schmaus (1518). Early German in the the to modern conditions many forces were but botany survives wood-engravings of operative, "Hortus Sanitatis" and the of Brun- undoubtedly the most potent were the invention of gun¬ (1491) herb-books fels and Bock or Ger¬ powder, which gave the coup de grâce to feudalism, and (1530) "Tragus" (1539) ; early the discovery of printing, the greatest agent in uplifting man surgery begins with Haeser's reproduction of the mankind by self-education. The effect of the revival of "Bitndth-Ertzeney" (1460) of Heinrich von Pfols- Greek the scholars who into culture by Byzantine poured 1. An earlier German incunabulum is the Hochenburg "Regimen the Italian after the fall of Sanitatis," printed at Augsburg in 1472. (See Sudhoff's "Deutsche peninsula Constantinople Medizinische Inkunabeln," Leipsic, 1908, p. 8. (1453) was to substitute the spontaneous receptive atti¬ 2. The plagiarist Reiff should not be confused with the Swiss tude of Plato and for the dialectics and obstetrician Jacob Rueff (1500-58), author of the "Trostb\l=u"\chle" Hippocrates (Z\l=u"\rich,1554), a midwifery of sterling character. logic-chopping of Aristotle and the Galenists. Prime 3. Arch. f. Gesch. d, Med., Leipsic, 1911, v.

Downloaded From: http://jama.jamanetwork.com/ by a University of Iowa User on 06/17/2015 peundt, which contains the first reference to gunshot- which contains most of his innovations in chemical wounds as "powder-burns"; the "Buch der Cirurgia" of therapeutics, and his monographs on miners' diseases Hieronymus Brunschwig (Strasburg, 1497) and the ("Von der Bergsucht," Dilingen, 1567) and mineral Fieldbook of Military Surgery by Hans von Gersdorff baths (Basel, 1576), the former one of the few original (Strasburg, 1517), both containing some of the most contributions of his time to internal medicine. In this instructive pictures of early surgical procedure in exist¬ connection we should mention Baillou's account of ence, the latter including unique plates of diseases like whooping-cough (1578) and the original description of leprosy and St. Anthony's fire. The same thing is true the syndrome "mountain sickness" by the Jesuit tra¬ of the µ , das ist, Augendienst of the veler Joseph d' Acosta (1590)6. court oculist Georg Bartisch (Dresden, 1583), the strik¬ After the time of Mundiims, there appeared a number ing illustrations of which give us a complete purview of of anatomic treatises containing the first rude attempts Renaissance eye surgery. The earliest work in this field at pictorial representation of dissected parts. These are was the "De Oculis, Eorumque Egritudinibus et Curis" the so-called "graphic incunabula" of anatomy, of which of Benvenuto Grassi (Ferrara, 1475), and in the ver¬ appropriate woodcuts from Ketham (Venice, 1493), nacular group may be mentioned the little eye book of Peyligk (Leipsic, 1499), Hundt (Leipsic, 1501), Frie¬ Walter Bailey (London, 1586) and the "Traité des sen (Strasburg, 1519), Berengario Carpi (Bologna, Maladies de l'Œil" by Jacques Guillemeau (Paris, 1521, 1522), and Dryander (Marburg, 1537) are dis¬ 1585). played. These tentative efforts at representation, rave The effect of these vernacular writings was to get and curious as they are, pale almost into obscurity beside men's minds away from scholasticism and turn them the cartoons, écorchés and chalk drawings of the great toward realities. This Renaissance tendency reached artists of the period—Luca Signorelli and his pupil its highest development in the earliest of the medical Michael Angelo, Raphael and Leonardo da Vinci. Of leaders of the sixteenth century, Paracelsus, Vesalius chief interest are the reproductions of Leonardo's red- and Paré:—three strong men of aggressive temperament, chalk drawings from the Ambrosien Library at Milan who by shouldering past other men, literally "blazed the and the Royal Library at Windsor. Startlingly modern way," not only for the general advance of medicine, but in their accuracy and display of physiologic knoAvledge, for keen and liberal thinking in all its branches. these impromptu sketches, made beside the dissected Aureolus Paracelsus (1493-1541), the founder of subject, reveal such acquaintance with muscular anatomy chemical pharmacology and therapeutics, was neither as was piossible only to the Greek sculptors, and fully the refined, supersubtle mystic of Browning's poem, nor justify William Hunter's claim that their author was yet the roystering, lying, tippling blackguard and quack¬ "the greatest anatomist of his epoch." The marginal salver of tradition. His influence was far-reaching and notes, which Leonardo has recorded in mirror-writing his real services were great. Far in advance of his time, lest others appropriate his ideas on the physiology of he discarded Galenism and taught meu to accept chemis¬ locomotion, reveal the cautious, secretive spirit of the try as a science ; he attacked witchcraft and the strolling time. The exhibit of pre-Yesalian anatomy includes, of mountebanks who butchered the body in lieu of surgi¬ course, the editto princeps of Albert Diirer's treatise on cal procedure, and be did away with the silly uromancy human symmetry (Nuremberg, 1532). and uroscopy; almost the only asepsist between Monde- Thoroughly as the great artists of the Renaissance ville and Lister, he taught that Nature (the "natural may have studied external anatomy, yet dissecting for balsam") and not officious meddling heals wounds; teaching purposes was still hampered by the théologie he introduced mineral baths and was the first to analyze idea of the sanctity of the human body as the image of them; he made mercury, opium, arsenic, antimony and Godhead and the anatomy of the schools was the anat¬ lead a part of the pharmacopeia, and discovered zinc ; omy of Galen. How far such teaching had progressed his "doctrine of signatures" survives in the essence of may be gathered from the quaint cut on the title-page homeopathy; and in comparing the action of the "arc¬ of the Melerstat Mundinus (1493), in which the scholas¬ ana" or intrinsic principles of drugs to a spark he tic instructor in long robe and barretta, wand in hand, grasped the idea of catalytic action. As a theorist, he gravely expounds Galen by the book from his pulpit- believed in the descent of living organisms from the chair, while below the long-haired barber-servant makes Urschleim or primordial ooze, and some credit him with a desperate shift at demonstrating the viscera of the sub¬ anticipating Darwin in his observation that the strong ject before him. The Faust who was to release the war down and prey on the weak—a fact, unfortunately, science from these trammels and revive the doctrine of within the range of any beggar or footman. ' But none the visum et repertum was Andreas Vesalius (1514-64), of these things can outweigh the influence which Para¬ the most commanding figure in European medicine after celsus exerted on his time through his personality. In Galen and before Harvey. There were plenty of dissec¬ an age when heresy often meant death, he wasted no tors and dissections before Vesalius, but he alone made time in breaking butterflies on wheels, but drove full anatomy what it is to-day—a living, working science. It tilt at many a superstition, risking his neck with the was the effect of his strong and engaging personality recklessness of a border reiver. The importance attached that made dissecting not only viable but respectable. to his name may be gathered from the line in Shakes¬ His career is one of the most romantic in the history of peare's comedy which brackets it with that of Galen4. medicine. Flemish born, but of German extraction, a Paracelsus was great in respect of his own time. He pupil of the ardent and bigoted Galenist, Jacobus Syl¬ does not seem particularly great in relation to our time. vius, Vesalius, in his graduating thesis, showed at first The works of Paracelsus on exhibition are his manual the conventional tendencies of the scholiast, but his introducing the use of mercurials in syphilis (Frank¬ mind was too active, his spirit too keen and independent, furt, 1553), the treatise "De Gradibus" (Basel, 1568). to feed long on the dust of ages, and he soon established a reputation for first-hand knowledge of the dissected 4. In All's Well that Ends Act Sc. where Lafeu Well, II, 3, human even himself so refers to the king's case as incurable, "to be relinquished of the body, teaching the difficult art, artists," and Parolles replies: "So, I say, both of Galen and Para- celsus"\p=m-\meaning,of course, that neither the Galenical nor the 6. d'Acosta,Joseph: Historia natural y moral de las Indias, alchemical school of physicians could help him in any way. Sevilla, 1590.

Downloaded From: http://jama.jamanetwork.com/ by a University of Iowa User on 06/17/2015 essential to surgeon and gynecologist, of recognizing the von Calcar. While written in Latin, the "Fabrica" is palpable structures by an educated sense of touch. Five truly vernacular in the sweeping scorn and violence of years' experience as public prosector at Padua, where he its language in dealing with Galenical or other super¬ made students dissect and inspect the parts in situ, cul¬ stitions. Although it completely disposes of Galen's minated in the magnificent "De Fabrica Humani Cor- osteology for all time, and indeed recreates the whole a work marks an in poris" (1543), which epoch break¬ gross anatomy of the human body, it has never been ing with the past and throwing overboard Galenical tra¬ translated. dition. The effect of a publication so radical on a super¬ The heretic Servetus (1509-53), whom Calvin caused stitious and forelock-pulling age was immediate and to-be burned at the stake for a mere of self-evident. his old turned juggling verbiage, Sylvius, teacher, against a theological quibble, was one of the great martyrs for his brilliant pupil with acrimony and coarse abuse, while "the crime of honest thought." The discoverer of the his own pupil Columbus, an intellectual upstart, sought vraie vérité about the pulmonary circulation, he ranks to cast discredit and derision on him by sharp practice. with Bamon y Cajal as a leader of Spanish medicine. Others were inclined to "damn with faint praise" or The is recorded in his book "The Restitutio in a a discovery joined conspiracy of silence, and, as last straw, he Christianismi" the foundation stone of Unitar- was to subterranean at the instance (1553), subjected persecution of the of which three are of Those were not without their effect ianism, original only copies authority. things known to exist. The rare of 1790 on Vesalius. His a Nuremberg reprint portrait suggests doughty, swarthy, on exhibition is the in the United full-blooded some probably only copy shaggy, nature, like of Lucas Cran- States. ach's worthies—a man to no odds and take ready give The exhibit of anatomic works with so as his confronted him in the contemporaneous none, long opponents Vesalius includes the of his teacher but nowise intended for the rôle of a "Isagoge" (1555) open ; spiritual to whom the of the martyr. In a fit of indignation he burned his manu¬ Sylvius, discovery Sylvian aqueduct scripts, left Padua and accepted the lucrative post of and fissure have been wrongly ascribed, but who discov¬ court physician to Emperor Charles V. He married, ered the valves in the veins before Fabricius and did work in the obscure of nomen¬ settled down, became a courtier, and 'gave up anatomy good province descriptive so that, the tedious years in clature; the treatises of Fallopius (1561), Varolius completely d.uring long Vidius and whose "he could not get hold of so much as a dried (1573), (1611), Eustachius (1714), Madrid, have in skull, let alone the chance of making a dissection." He names been eponymically preserved the struc¬ tures the paid the penalty of il gran rifiuto, when his favorite they discovered; monographs "De Formatu pupil, Gabriele Fai loppio, came to the front as a Fcatu" (Í600) and "De Venarum Ostiolis" (1603) by worthy successor and rumor began to make it clear that Harvey's teacher, Fabricius ab Aquapendente; and the he himself was fast becoming the shadow of a great examples of French and Spanish anatomic illustration name— by Stephanus (1546) and Valverde (1556). The effect of Vesalius on "Vesalius, who's Vesalius? This Fallopius Renaissance surgery is seen It is who dragged the Galen-idol down." in the life-work of Ambroise Paré (1510-90), who made the "Fabrica" and accessible to On the "Observationes Anatómicas'' popular surgeons by receiving Fallopian an of it in the vernacular. Paré's in all the of his if we writing epitome 1561, aspirations youth revived, contribution to on the baneful own enthusiastic greatest surgery hinges may trust his burning, words, language effect which which the of Edith Whar- the Hippocratic aphorism that "diseases fully justifies implications not curable iron are curable fire" exerted on the ton's poem : by by "At least treatment of gunshot wounds, the new feature of Renais¬ I repossess my past, am once again sance surgery. Giovanni di Vigo, physician to Pope No courtier med'cining the whims of kings Julius II, had taught in his "Practica" (1514), that In muffled palace-chambers, but the free such wounds were poisoned burns and therefore should Friendless Vesalius, with his back against the wall, be treated with a first of oil. How And all the world him." dressing boiling against Fare's supply of boiling oil gave out one night in camp In the year 1563, Vesalius set out on a pilgrimage to and how he profited by the experience to the extent of Jerusalem, as a penance, some say, for an accidental letting well enough alone in future is well known. Had human vivisection, more probably^ others think, as a it not been for his "fat of puppy-dogs," a lard or salve, pretext for getting away from his tiresome surroundings. which, from some tenacity of superstitition, he con¬ On his way back in 1564, he received word of an invita¬ tinued to apply, he would have been a true asepsist. As tion to resume his old chair at Padua, just vacated by it is, his relation to the healing power of nature is the death of Fallopius. But his highest wish, to "once summed up in the famous inscription on his statue more be able to study that true Bible, as we count it, "Je le pansay, Dieu le guarit." Paré invented many of the human body and of the nature of man," was not new surgical instruments, made amputation what it is to be realized. The sudden access of an obscure malady to-day by reintroducing the ligature which had fallen left Vesalius to die, solitary and unfriended, on the into abeyance since the time of Celsus; was the first to island of Zante. popularize the use of the truss in hernia and described The exhibit of Vesalius includes his graduating dis¬ fracture of the neck of the femur. In obstetrics, it was sertation, the "Paraphrasis" (Basel, 1537) ; Sir William his description and use of podalic version that made the Sterling Maxwell's facsimile reprint of the "Tabulas procedure viable and practicable. In dentistry, he intro¬ Anatómicas Sex" (Venice, 1538) ; the "Epitome" (Basel, duced reimplantation of the teeth, and his little treatise 1542), an advance specimen abstract of the "Fabrica," on medical jurisprudence (1575) was the first work of remarkable for the plates representing two handsome consequence on the subject prior to the "Methodus Testi¬ specimens of the human race, usually ascribed to Titian ; ficando of Codronchi (1597). finally the "Fabrica" itself (1543), a superb example of Paré is represented by his essay on podalic version the beautiful typography of his friend Oporinus at (1550), his treatise on gunshot wounds (1552), the first Basel, sumptuously illustrated by Titian's pupil, Johan edition of his collective works (1575) and his discourse

Downloaded From: http://jama.jamanetwork.com/ by a University of Iowa User on 06/17/2015 on the mummy and the unicorn (1582), which success¬ listed by Dioscordides in terms of modern botany. The fully disposed of an ancient therapeutic superstition. "Dispensatorium" of Cordus is of interest as the first In connection with Paré, let mention be made of the real pharmacopeia to be published (Nuremberg, 1546). works of his predecessors, Marianus Sanctus Baroli- A striking feature of Benaissance medicine was the tanus, who gave the original account of the "Marian publication of a large number of encyclopedic treatises operation" or median lithotomy (1535) ; the Provençal by many authors, not unlike the "up-to-date" works writ¬ surgeon Pierre Franco, who (1561) rehabilitated the ten on the cooperative plan in our own time. Of these operations for hernia, lateral lithotomy and cataract, we may mention the Aldine "Medici Antiqui Omnes" which had previously been in the hands of stroll4ng (1547), the "Medicee Artis Principes" of Stephanus mountebanks or hereditary in certain -families, like the (1567), the Venetian anthology on mineral waters ("De Collots and Brancas; the "Practica" (Basel, 1563) of Balneis," 1553), the Gesner collection of surgical trea¬ the Swiss surgeon Felix Wurtz, a follower of Paracelsus tises (Zürich, 1555), the Basel encyclopedias of gyne- in the simple treatment of wounds ; Rousset's treatise cology (1566, 1586) and the medical dictionary of on Cesarean section (1581) and Tagliacozzi's revival of Stephanus (1567). rhinoplasty (1597). Wilhelm Fabry of Hilden (1560- No account of sixteenth-century medicine would be 1634), whose statue was unveiled last year in his native complete without a passing reference to "The Metamor¬ town, is usually regarded as the father of German sur¬ phosis of Ajax" (1596) of Sir John Harington (1561- gery. He was a bold and resourceful operator and is 1612), the witty graceless godson of Queen Elizabeth, fairly represented by his treatise on gangrene (Cologne, who was banished from her court for writing it. The 1593), a condition for which he was the first to recom¬ work introduces an important and indispensable im¬ mend amputation above the diseased part. provement in sanitary engineering, but our author's At a respectful distance from the great Renaissance treatment of his theme is entirely in the manner of pathbreakers may be grouped the works of a quartette of Aristophanes, Babelais or the Zähdarm epitaph in "Sar¬ original thinkers—Benivieni (1502), Cornaro (1467- tor Besartus." Those who can read the garrulous whim¬ 1566), Fracastoro (1484-1553) and Valerius Cordus sical old knight as they would the writers of Elizabethan (1515-54). The "De Abditis" of the distinguished comedy will smile over his facetious pages. Florentine Antonio Benivieni (Giunta edition, 1507), Army Medical Museum. has been described by Malgaigne as "the only work on pathology which owes nothing to any one," and as far as mere its author may be (Sir priority goes regarded REPORT OF A CASE OF TRAUMATIC RUP- Clifford Allbutt thinks) as a founder of pathology before Morgagni. Luigi Corna ro's "Trattato della vita sobria" TURE OF THE UMBILICAL CORD (first edition, Padua, 1558) is probably the best treatise WITHIN THE ABDOMINAL WALL on personal hygiene and the "simple life" in existence. AT BIRTH; RECOVERY Girolamo Fracastro, the kindly Veronese, who practiced in the Lago di Gardo region, was at once a physician, M. J. PRESS, M.D. poet, geologist, astronomer and pathologic theorist, and ST. LOUIS shares with Leonardo de Vinci the honor of being the This case is with the that it will first geologist to see fossil remains in the true light. reported hope prove interest on account of its revealed a search He was also the first scientist to refer to the magnetic of rarity by the The that was poles of the earth (1530). His medical fame rests on through literature. fact, also, there that most celebrated of medical poems, "Syphilis sive an uneventful, uncomplicated recovery, though death Morbus Gallicus" which gave the dis¬ from hemorrhage or shock might be expected, is worthy (Venice, 1530), of ease its present name7, and his treatise "De Contagione" notice. (1546), in which he states with wonderful clairvoyance, Labor was normal; presentation right occipito-anterior. As the modern theory of infection by microorganisms the head was born it was noticed that the cord was tightly (seminaria contagionum). wound about the child's neck. Employing the usual amount Valerius Cordus, the Prussian whose of force, an attempt was made to loosen the cord, but it did gifted youth, not and The was delivered death robbed science of one of its most yield ruptured. body quickly early promising an a of and examination revealed rupture of the umbilical cord names, is known to medicine for his discovery sul¬ The of the in but botan¬ within the abdominal wall. edges cord were so phuric ether (oleum dulce vitrioli) 1540; retracted into the abdomen that could not be the of they grasped ists revere him as young Marcellus their science. with forceps. Hemorrhage was not very profuse. The child Greene styles him "the inventor of phytography" and continued crying. points out that the field-work and taxonomy of a well- Under the circumstances, the procedure that seemed most equipped modern botanist were actually done "almost logical and most easily executed was compression. A hard four centuries ago by a German boy in his teens."3 His roll of cotton was hastily applied with an abdominal band commentary on Dioscorides, edited with rather tightly secured. posthumous which ex¬ hand Conrad not describes some The cord measured 35 cm. in length, probably pious by Gesner, only it could not be unwound from about the child's new the ardent search for which plains why 500 species of plants, neck. cost him his but recreates the eventually life, species No blood being detected through the abdominal band, same was not disturbed for hours. There was no further 7. Fracastorius takes the name from Syphilus. a shepherd in the eight poem, who was stricken with the disease for blaspheming Apollo hemorrhage but only a slight oozing for a time. (liber iii, 329-332) : The entire quantity of blood lost was not more than about "Syphilus ostendit turpes per corpus achores, in usual Insomnes primus noctes convulsaque membra 0 drams. The umbilicus healed the manner. Sensit et a primo traxit cognomina morbus, 2837 Dickson Street. Syphilidemque ab eo labem dixere coloni." . 8. See the chapter on Valerius Cordus in "Landmarks of Botan- ical History" by Dr. Edward Lee Greene (Smithsonian Misc. in case is not rare. Collect., v, 54, Washington, 1909, pp. 270-314) , Charming style [Comment.—The reported extremely and irreproachable in scholarship, this work is cordially recom- of the cord intra partum has been observed as the best of and Rupture mended to physicians history early botany in more oft„n in materia medica that has yet appeared. frequently, rarely spontaneous labors,

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