VOLUME 1 NUMBER 2

AN N ALS 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

J o hn S h a w B il l in g s (1838-1913)

ANNALS OF MEDICAL HISTORY

V o lu m e i S u m m er 19 17 N u m b e r 2

EULOGY OF DR. JOHN SHAW BILLINGS

READ BY DR. ABRAHAM JACOBI AT THE MEMORIAL MEETING OF THE NEW YORK

ACADEMY OF MEDICINE, I913

HE death of Dr. John Wm. A. Hammond. A few years of hard Shaw Billings has work on the part of Billings and the liber­ robbed America of ality of Congress made the library grow so one of its greatest that in 1876 the plan of publishing the In­ men. This New York dex Catalogue was matured and in 1880 Academy of Medi­ the first volume was printed. Of this monu­ cine, the representa­ mental work which amazed the world there tive and headquar­ are now thirty-five1 volumes. The same ters of medical fertile genius created the Index Medicus, endeavor in New York, is anxious and eag­ which was continued by Fletcher. er to honor itself by extolling a man who His military labors developed in him an was so prominent in many fields of knowl­ inexhaustible interest in public health and edge, research, and activities that each of in hospital organization. He was the ad­ them would have secured his immortality viser and builder of the Johns Hopkins and both in medical and general history. Indeed other hospitals. He delivered courses on the it is mostly to mere specialistic learning history of medicine in Johns Hopkins Uni­ and labor that many of our famous men versity, was professor of hygiene in the owe their deserved renown. University of Pennsylvania and director of Dr. Billings began his life as a demon­ its new laboratory of hygiene. In 1896 he strator of anatomy in a western college. In became the director of the New York Pub­ the Civil War he served the country as a lic Library. Some weeks ago he left behind surgeon, and finally as a medical inspector him two millions of books and fifty branch of the Army of the Potomac. He then set libraries. For two editions of the U. S. Cen- out to develop the scanty library of the 1 The completion of the second series makes the Surgeon General’s Office established by total now thirty-seven volumes. n o Annals of Medical History sus he was the statistician. Of the Carnegie The multiplicity of his virtues, aims and Institution of Washington he was the chair­ results cannot be expressed in a few sen­ man. tences. We trust, however, that it is not His erudition was stupendous, not only- probable that the light-heartedness and for­ in medicine, but in history and the litera­ getfulness of an ungrateful republic will tures of the world. His vast reading and re­ deal with his memory as with that of less­ tentive memory carried him into all conti­ er men. It is in him that the combination nents and zones, into sciences and trades, of American idealism and creative con­ into chemistry, physics and meteorology. structiveness is best represented, an exam­ Such was the commanding genius with ple to be emulated by all men, both great the measured tones, the pleasant voice, the and small, in all countries. Though Billings humorous remarks, the interest in all that was rarely active in this hall, his perfec­ is human, in social problems, and economic tions are known to us and will be appre­ and political questions. Withal he was gov­ ciated forever. His very life, ever vigorous, erned by unfailing modesty and a cheerful ever modest, ever bountiful, is his eulogy. readiness for self extinction. In his disin­ There is nobody here who is not impover­ terestedness he did not so much as think ished by the loss of his efficiency and influ­ of complaining, when the inauguration, two ence. To those who were personally near to years ago, of his very creation, the Library, him, to the members of his immediate fam­ was not even to be graced by his ever ily, it is for us a sad and honorable duty to thoughtful and forceful eloquence. express our mournful sympathy.

T vooBl 2eainov

What am I? How produced? And for what end? Whence drew I being? To what period tend? Am I th’ abandoned orphan of blind chance, Dropt by wild atoms in disordered dance? Or from an endless chain of causes wrought? And of unthinking substance Born with thought. The purple stream, that through my vessels glides, Dull and unconscious Flows like common tides. The pipes through which the circling juices stray Are not that thinking I, no more than they. This Frame compacted with transcendent skill Of moving joys obedient to my will, Nurs’d from the fruitful Glebe, like yonder Tree, Waxes and wastes, ’tis mine but ’tis not me. New matter still my mouldering Mass sustains The Fabrick chang’d, the Tenant still remains. John Arbuthnot {1675-1743-$). THE HYGIENIC IDEA AND ITS MANIFESTATIONS IN WORLD HISTORY1

B y PROFESSOR KARL SUDHOFF

UNIVERSITY OF LEIPZIG

Translated by DR. FRANK J. STOCKMAN

LIBRARY OF THE SURGEON GENERAL^ OFFICE, WASHINGTON, D. C.

LD familiar childhood recollec­ jection to that old and oft-quoted catch- tions and beautifully contrived phrase anent the “ life comformable to na­ poetic fantasies of ancient and ture.” In fact, it would be possible to de­ modern impress flatter us with vote a whole volume to an account of the theO notion that, at least in the field of many times that the cry “ Back to Nature” hygiene (as was seriously taught, centuries has resounded in its innumerable varia­ ago, of many phases of human knowledge), tions; well nigh every possible view of the the acme of enlightenment and achievement universe and a stately array of marvelous was already attained in man’s earliest in­ philosophizing would necessarily be pre­ fancy; that, in this science, at least, the sented; a lengthy jeweled chain of bril­ beginning of wisdom was synchronous with liant names in the history of human thought the genesis of things in general. would pass in review. Such teachings haunted the science of I shall not commit the heresy of denying chemistry for the longest period. As late each and every justification of this cry, as the seventeenth century, it was assumed even though there is more beating of the thatTubal-Cain was her greatest master, and air on this point than is commonly sur­ that wise Solomon, while building his tem­ mised. I shall be content with demon­ ple, knew more of the mysteries of chemis­ strating that the paradisiacal condition of try than possibly the great Geber, Paracel­ a long life, free from care, with a late un­ sus, Basilius-Tholde2 and Andreas Liba- encumbered old age, was by no means the vius together. rule in prehistoric and ancient times. It is This false idea, as being self-contradic­ true that, as compared with the present, tory, eventually annihilated itself. But those times could boast of superiority in numberless ages ago, our ancestors along some, but by no means in all respects. the Baltic Sea and the Bay of Biscay, or Upon inspecting the many early Egyptian on the Highlands of Pamir, the residents and Nubian crania, for instance, we are along the Euphrates or the Nile, are still astounded at the perfect preservation of supposed to have imparted the most im­ the teeth, although the extensive abrasion portant lessons in hygiene, in healthy liv­ of the masticatory surfaces is rather start­ ing and immunity from disease. Even to­ ling, suggesting simple, suitable fare, but day, some assume that this is incontrover­ mainly of vegetable character, rich in cel­ tible and self-evident. A well informed lulose and with a generous adulteration of man will hardly venture to offer valid ob- sand particles. We become rather thought­

1 Deutsche Revue, Stuttgart, 1911, iv, 40-50. ful, however, on finding in the majority of 2 SudhofF is of opinion that the writings of Basil adult skeletons from Upper Egypt and Valentine are the work of the editor, Johann Tholde. Nubia of five to seven thousand years ago, 112 Annals of Medical History

signs of a disease which to-day appears hovel, depressed below the surface of the only under the most unhygienic condi­ ground to the depth of a meter, only tions, and then hardly to such degree as it gradually (at least in the case of sleeping formerly affected a tremendous majority, quarters), emerging from the pits which even in the third decade of life, causing from the Stone Age to La-Tene constantly ankylosis of the joints and spine with al­ became more and more shallow. A moderate most absolute immobility, so that at an advance, perhaps, but highly important! early age these unfortunate people became Although climate may exert only a helpless dependents. Osteoarthritis de­ minor influence upon the character of formans in that “ Golden Age” afflicted habitation, this is not true in the matter humanity of both sexes with such fre­ of clothing. Enthusiastic as we may be quency and severity as to stagger all power about the light, hygienic clothing of the of imagination in this our own period, so Egyptians, Babylonians, or even of the corrupt with “ refined culture” on the one Greeks, we must nevertheless properly hand and misery on the other. Even then, evaluate the wisdom of the North Alpine constant sojourn along, upon and in the people, whose men were clothed in warm waters, even more perhaps the dwelling and trousers and waist-coat, their women in sleeping upon the damp ground, in wet pits long skirt and jacket. Perhaps the Greeks and caves, was a fruitful source of disease. migrated from the North in similar garb, I have purposely begun with an account and, in a warmer climate and under altered of conditions in the subtropics, where for conditions, learned to know and prize the a long time the cradle of mankind lay be­ light, convenient, Mediterranean or sub­ neath the palm trees. Yet, the hygienic tropic costume of cloth simply thrown about coefficient of life among the early inhabit­ the body—a warning against premature ants of Northern Europe, derived from a generalizations about clothing problems for study of osseous remains, differs but slightly all climates, even when we exclude those of from the results of investigation along the the polar regions! Nile. Less attention has been paid to patho­ Viewed in the light of hygiene alone, logical findings in the archaeological re­ classical antiquity, Greece and Rome, repre­ searches north of the Alps, thus restricting sents a cultural pinnacle of almost incom­ the material to more modest proportions; parable height. but such osseous remains as have been The Greeks, a master people (with a carefully studied exhibit exactly the same substratum of slaves), for the first time in tendency. Rudolph Virchow’s “ cave gout” history, and in a scope and degree never in man and beast has long since been in­ again approached, undertook universal corporated in historic pathology; the primi­ training of boys (in some phratries, of tive Germans, who interred their heroes girls also), with a view to the harmonious in the long stone passages of the “giant development of all the physical faculties chambers,” suffered to an appalling degree and to the attainment of the greatest meas­ (almost ninety per cent of adults) from gouty ure of strength, dexterity and self-confi­ diseases of the bones and joints. Dietetic dence, of physical perfection and beauty. customs along the Nile and the Baltic Sea The system was founded upon daily exer­ were certainly the most diverse, but, in the cise from earliest youth to ripe manhood, manner of abode, perfect parallelism ex­ under the supervision of experienced and isted in one respect, namely that of damp­ practised leaders, who not only strove to ness: whether the habitation were a lake make it viable and successful, but were dwelling over the placid water, or a rustic capable of intelligent specialization, ex­ T h e H y g ie n ic I dea and its M anifestations in World H isto ry ii3 acting from each physical entity the high­ religious and state duty, with their eminent est possible accomplishment, with constant talent for solving great questions, con­ reference to general vigor. The teacher of tributed much to public hygiene. In the gymnastics became the professional “ gym­ days of their world empire, water sup­ nast,” who strove to comprehend the nor­ ply, drainage, road-building, town-planning, mal functions of the body, vying with the food-control, heating, and baths were regu­ medical fraternity, who again studied the lated with a thoroughness which evokes value of gymnastics for a healthy physique our respectful admiration even to-day. In and took from its storehouse of anatomic- the cult of Vesta and Juturna, the Roman physiologic knowledge the plumb line for early evinced an inherent sense of the fun­ estimating the possibilities of each in­ damental necessity for purity of food, which dividual. With the aid of general dietetics, can proudly take its place beside the justly the physicians deduced the norms for the extolled cult of food-hygiene of the Orient. application of gymnastics to the preven­ We shall deal with the latter immediately; tion of bodily ills and as an auxiliary in for Grseco-Roman antiquity, we must again the treatment of general or organic dis­ repeat that, although hygienic requirements orders. Under this beneficent rivalry be­ were partly based on cult-hygiene, these tween professional gymnast and physician, peoples soon outgrew this purposeless in­ gymnastics itself became a scientific sys­ fancy and set themselves conscious hy­ tem of physical exercise and invigoration, gienic goals, devoted themselves to their of hygiene of movement and occupation, attainment in a large genial manner, and such as we to-day, with the aid of modern accomplished results which, in addition to technique and instrumental precision, are constituting a scientific supervision of the intent upon creating anew. life of the individual, will forever merit With this central endeavor of Hellen­ admiration as the first attempt (conceived ism, physical invigoration by daily gym­ and executed with genius) at personal and nastic exercise, the rest of personal hygiene public hygiene with definite aims: indi­ was in great measure associated, viz., care rect prophylaxis by increasing the vigor of the skin by washing and bathing, by and resistance of two whole nations. swimming and massage; physical cleanli­ On the other hand, what is the signifi­ ness, including care of the hair and cloth­ cance of the extolled cult-hygiene of the ing; as well as regulation of diet, rest and Egyptians, Babylonians, and even of the sleep, and of the sexual life. The regulation Jews, who never conceived of hygiene di­ of the latter function in the gymnastic rectly and with intention, the subject ap­ exercises of girls was divorced from prud­ pearing in pre-Hellenic times as something ery and had a definite eugenic aim: vig­ incidental or as an almost negligible side- orous offspring. issue? Modern historic research does not The public officers of Greece were en­ support the legend of a Moses leading his grossed with other questions of hygienic people with deepest wisdom and confident, importance. Town planning, arrangement purposeful clarity over the road of hygiene of streets, sunning of houses, sewage dis­ in religious garb, thousands of years ago; posal and water supply were carefully con­ the theory is as far removed from truth, sidered and purposefully regulated, es­ perhaps, as the assumption of a perfect pecially in the culminating cultural period natural hygienic condition of mankind at of the Age of Tyrants. The Romans, among the start. The hygienic contributions of whom solicitude for the purity of grain and the Western Asiatics (especially of the potable water was recognized almost as a Semites) to humanity are enormous, but 114 Annals of Medical History they lie in a totally different sphere, as we gienic knowledge. The same is true of cult shall perceive. cleanliness which, as has already been A few preliminary words on the negative shown, was not less developed among the side. It is no longer correct to regard the Greeks than among the Orientals along the ritual hygiene of Judaism as a singular Euphrates, Jordan and Nile, upon whom phenomenon, as in former days, when it (including the Jews), the Grecian amplifi­ constituted the only remaining specimen cation of an intentional personal hygiene of an entire cultural cycle, buried under the exerted undoubted influence. Even ritual ruins of centuries, from which it has only uncleanness of woman under special cir­ just been unearthed with many eluci­ cumstances, is ancient property of Greece. dating disclosures. In the midst of the Pope Gregory the Great, in eliminating tides of racial intercourse flowing and this Jewish atavism from Christian cus­ ebbing from the Euphrates to the Nile, tom, performed a liberal and noble service we can imagine the Jewish people exposed to womanhood, by leaving the question of to cultural currents from which it adopted church attendance during menstruation and and adapted much. What are to-day con­ puerperium to the free decision of the in­ sidered fixtures of ancient Semitic cult- dividual, thereby effectively removing the hygiene, originated almost exclusively after whole matter from “ cult-hygiene ”—a land­ the exodus, partly, therefore, after the time mark in the emancipation of woman from during which the people of Israel had been unwarranted guardianship, which cannot exposed for decades to the influence of be commended too highly. But to return racially and intellectually kindred civiliza­ from this digression! tions along the Euphrates and the Tigris. There is no longer any doubt that the To trace externalities of custom to their Jews borrowed circumcision of males from origins is consequently difficult. In the Egypt, while the origin of the custom for period especially represented by the com­ both sexes is traceable to Central Africa. pilation of the Talmud, the Jews had for The fact that the custom bears no subjec­ centuries been influenced in hygienic mat­ tive hygienic impress does not deprive it of ters by Greek science, from which they as­ objective hygienic value, any more than in similated and amplified whatever seemed the case of other customs originating in suitable for adoption. In estimating and entirely different spheres of thought. But evaluating the hygiene of the Jews this fact the hygienic importance of circumcision of should be borne in mind, without in the males is minimized by the proof of the non­ least detracting from their merits; claims existence of syphilis in the Old World in to special originality alone are thereby pre-Columbian times, as is to-day gener­ given a new aspect. ally assumed. To cite congenital anomalies Among all peoples of antiquity, meat diet (e.g., phimosis) as an argument for general was, so far as the domestic animals are con­ circumcision removes the whole question cerned, a sacrificial cult in the first instance; to another sphere. Clitorotomy, of identi­ everywhere, on the Jordan, Tiber and cal religious origin, has to date not been Cephissus a sacrificial inspection was com­ proclaimed a hygienic measure. That Juda­ bined with this, which exhausted itself ism did not adopt this ritual custom of the mostly in sophisms, but also (particularly Egyptians is explained by the fact that, in in Mesopotamia) contributed a fund of the temple cult of the Jews, women origi­ experience which prepared the way for a nally played no role, in fact, were forbidden sanitary meat-inspection, and imparted a entry to the temple. The question here viable, interpretative basis to future hy­ arises, whether at some period in the his­ T h e H y g ie n ic I dea and its M anifestations in W orld H isto ry 1 1 5

tory of Israel, only the priestly tribe was Had Judaism given nothing more to man­ circumcised, or whether from the begin­ kind than the establishment of a weekly ning, circumcision characterized the whole day of rest, we should still be forced to people as sacerdotal. proclaim her one of the greatest benefac­ But let me not be misunderstood! In tors of humanity. the history of hygiene, as well as in the What can be said as to the second history of general culture, these questions thought, direct prophylaxis? of cult-hygiene are of transcendent inter­ Although Greek medicine became of in­ est. None, however, is to be considered a comparable importance in general human landmark equivalent to the gymnastics of progress and bases its title to fame chiefly the Greeks, the hygienic vision of Hellen­ upon the substitution of the investigation ism and the achievements in public sanita­ of natural etiology for the supernatural tion of the Romans. Two of the greatest demonic medicine, which ruled the whole hygienic thoughts of mankind owe their of pre-Hippocratic Orient and Occident origin to S.emitism, especially to her intel­ (Mediterranean and North Alpine) and still lectual prime (Judaism being the bearer, enslaves part of the world, it is a most in­ intermediary and perfecter): the weekly day teresting fact that, despite its theory of of rest and the direct prophylaxis of disease. natural causation, Greek medicine was The first will be immediately evident to blind to the fact of contagion, of direct all, even though it has not yet been transmission of disease. Whence so glaring clearly recognized and proclaimed as a a defect in the face of such keen perception hygienic manifestation of prime import­ of the processes of nature? Thucydides’ ance. Babylonian civilization probably had history of the Athenian plague shows that a precursor of the Jewish Sabbath. In these facts had not entirely escaped the Babylonian astrology, the 7th, 14th, 21st, Greeks, but Greek medicine passed them and 28th days were ill-starred; to these was by, perhaps, because a natural explanation added the 49th (7x7), counted from the seemed impossible, since the populace so beginning of the preceding month. No foods readily satisfied itself with the “ Evil Eye” could be baked or roasted (nor those pre­ and similar imaginations. pared in this manner ingested); change of Along the Euphrates, however, we come clothing, sacrifices, public acts, and medi­ early upon the concept of a chronic, rarely cal treatment were interdicted; in fact curable disease, characterized by cutan­ these days were inauspicious for the execu­ eous changes and capable of transmission tion of any project. Through these numer­ to others. Babylonian culture in fact read­ ous inhibitions, the “ unlucky ” day be­ ily drew the proper conclusion and trans­ came, in part, a public day of rest—in part lated knowledge into action: Those af­ only—and it might seem that from this fected with this disease must be debarred emanated the suggestion of the Jewish from intercourse with the healthy. Who­ Sabbath. But nevertheless, what a wealth ever was defiled by issubbu (leprosy) was of physical and spiritual blessing was poured banished to the wilderness. Details regard­ upon the Jews by this, their holy day, their ing these matters are still wanting in orig­ day of rest! More than any other factor, it inal sources, no matter how often the facts gave them strength to assert themselves transpire through the Assyro-Babylonian among other races; and by contributing tradition. But in the Old Testament, we this hallowed day to Christianity and Is­ have a methodic inspection of a leper by lam, they thus imparted its hygienic bless­ the priest, who, according to the diagnosis, ing upon the greater part of the world. isolated the patient temporarily or per­ 116 Annals of Medical History

manently, and admitted him again to free Egypt, the disease in sluggish epidemic intercourse only after indubitable conva­ form traversed North Africa, crossed the lescence or cure. To be sure, it has never straits of Gibraltar with the continuous been determined (because indeterminate), stream of travelers, and spread over Moor­ whether the zaraath of the third book of ish Spain; at the same time the germs were Moses represents leprosy exclusively; to carried by the constant migrations across see in it a harmless disease, however, de­ the Mediterranean to Italy and Southern grades a serious, austere procedure of one France, across Byzantium to the Balkan of the most outstanding legal codes in his­ and Danube states. The network became tory to a silly farce. Any competent, un­ especially close over Southern Gaul, and prejudiced investigation must lead to one even further into Celtic domain, over which conclusion, viz., that the majority of those a Germanic stratum had been deposited; suffering from the symptoms enumerated here, authentically in the sixth century, the in Leviticus xiii were lepers; the most im­ thought of rending or cutting the threads portant point historically is the fact that of the epidemic which coursed over the the Mosaic Law gave to mankind the idea lands was initially entertained. Enlight­ of the imperative necessity of isolating ened princes of the Church, moved by the those afflicted with a chronic contagious increasing misery of the people, on the disease; in addition, the purification meas­ strength of the sacerdotal code of the Old ures recommended in Leviticus for infected Testament, undertook the task of interfer­ houses constitute the armament of mod­ ing; the shepherdess of the mediaeval peoples ern prevention of epidemic diseases. In this knew her duty. The Council of Lyons (583) connection, it makes little difference to me attempted to restrict the free migration of if the so-called zaraath of houses had no lepers! The edict of Rotharus, King of the relation to leprosy, and that modern prophy­ Lombards, demonstrates what advances laxis is not derived directly from Leviti­ this idea made in sixty years; the acts of cus. (It is neither evident nor probable Charlemagne, one and a half centuries that the place of refuge of the leper King later, show the same trend; the leprosy Azariah-Uzziah represents a Ieprosorium decretals of the third Lateran Council in the mediaeval sense.) The fact remains, (1179) represent, in a measure, the last however, that the whole concept of the word of the Church. Apprehension of lep­ transmission of serious disease by social ers became general routine in the territo­ intercourse with the afflicted, and of the ries of the ecclesiastical and secular princes consequent isolation of the diseased became of France and Germany; isolation camps property of the West by religious route. were established everywhere, gradually in­ When leprosy fell upon the ancient world creasing to thousands. Thither the lepers from the East, and came to the cognizance and suspects were taken, the former civilly of Greek physicians, especially of Alexan­ dead for the rest of life. This system was dria, these met its appearance with an ad­ mercilessly enforced for centuries with per­ mirable establishment of the semeiology, fect success. In this tenacious fight of cen­ without penetrating deeper into epidemio­ turies, the methods of which were bor­ logical questions or recording prophylac­ rowed from the Mosaic Code, the Occident tic segregation measures. Egypt, where in triumphed over leprosy. Guided by this Hellenic times leprosy spread and became intellectual torch, it accomplished the first established, was then its principal sally­ great feat in direct prophylaxis: methodi­ port in the West and is, even to-day, one of cal eradication of leprosy by consistently its most intensive fields of activity. From making the affected individuals harmless T h e H y g ie n ic Id ea and its M anifestations in World H isto ry i i 7

as carriers of the virus. Light from the East Finally, another idea which can be is transformed to pulsating energy by the counted among the great hygienic thoughts European peoples, while the disease swings and contributions of the past, the spirit of its lash unchecked in the Orient. Christian mercy, expressed in form of hos­ The same light, rising for Occidental and pitals for the poor, aged, infirm, and sick; Mohammedan physicians alike, spent its a noble social blossom of young Christian­ luminosity over a second great battle, ity, which sprouted on the Jewish tree, but which constitutes an additional title to developed in self-directed manner from the fame for the Middle Ages: the campaign time of Basil the Great of Csesarea. An against an acute infectious disease, which, idea which, in the early days of Byzan­ like the destroying angel, again coursed tium, was in intimate sympathy with Greek over the Mediterranean from the Orient, medical science, as is evident from regula­ the plague. Stirred by the “ Black Death,” tions governing medical service in the hos­ which arose about the middle of the four­ pitals, preserved from the period of the teenth century, the public officials of Italy Comnenes,3 while in Western Europe it and Southern France, during successive was not until a much later date that heal­ decades into the next century, with Venice ing the sick by actual treatment became and Marseilles as pioneers, created the whole the chief task of hospitals. Nevertheless, system of sanitary control of incoming ves­ their hygienic importance was tremendous, sels, of observation stations, isolation hos­ since hospitals formed only a fraction of pitals and disinfection procedures. All this Christian eleemosynary institutions of was adopted by the Renaissance and is mediaeval and modern times, and served still practiced by modern hygiene, in more definitely as a pattern for the wonderfully definite and rigorous form with relatively developed system of socially benevolent few changes. An energetic attempt to es­ institutions which constitutes one of the tablish order in the infected cities was made, greatest claims of modern times to recogni­ without, however, the consistency and pur­ tion in the field of applied hygiene. It holds posefulness of the prevention of importa­ its own with the scientific contributions tion. Three dates may be cited in this con­ of modern biologic medicine to hygiene, nection : 1374, Venice, being again threatened contributions which are the result of orig­ by importation of the plague, denied en­ inal thought and independent development, try to the city of all infected or suspected no matter how much is unconsciously re­ ships, travelers and freight; 1377, Ragusa, lated to the personal hygiene of the ancient in Dalmatia, rejected all travelers from Greeks; while the biologic concept of the plague districts, who had not sojourned for theory of infection itself must be charac­ a month at one of two designated points, terized as purely modern, since, after all, without developing the disease; 1383, Mar­ it owes the first clear conception to Giro­ seilles erected her first quarantine station, lamo Fracastoro (1546) finding in Ignatius at which, after rigid inspection of the ves­ Philip Semmelweis and Joseph Lister its sels, all travelers and cargoes from stricken great, genially intuitive, practical inter­ or suspicious ships were detained for forty preters, while Louis Pasteur and Robert days, exposed to air and sunshine. These Koch were its master investigators along are the principles of preventive medicine purely scientific lines and thus the best in the Middle Ages, created by physicians equipped to rede its riddles. and authorities in common endeavor, in 3 Referring to the Byzantine family which oc­ amplification of an idea called into being cupied the throne of Constantinople during 1057— by the campaign against leprosy. 1059 and 1081-1185. A PATRONAL FESTIVAL FOR THOMAS WILLIS (1621-1675)

WITH REMARKS BY SIR WILLIAM OSLER, BART., F.R.S.

B y HENRY VIETS, M.D.

NEWTON, MASS.

YE A R L Y festival in honour of it to St. Martin. It was so dedicated be­ a medical worthy is certainly cause Thomas Willis had lived in St. Mar­ an occasion of note, especially if tin’s Lane, London, had died on St. Mar­ it has been held annually for tin’s Day and had acquired his wealth and oneA hundred and eighty three years, and is fame as a seventeenth century practitioner still observed in England, in spite of the in the Royal Parish of St. Martin’s-in-the- War. Last fall, news came to Oxford, Eng­ Fields. The fortune fell to his grandson. land, from the little village of Fenny Strat­ During the life of Browne Willis, a festival ford, Buckinghamshire, that the exercises in was held annually in honor of his grand­ father. When he died he left the following note: “ . . . and I do make it my request . . . that they will with all due solemnity ever keep up and see to the annual celebration of S. Mar­ tin’s Festival . . . in the Church of Fenny Stratford, in the manner as I have solemnized it annually . . . for 26 years, in all which time I have been con­ stantly present and St. Martin’s Church, Fenny Stratford, Buckinghamshire, England. Built * in 173 1 in honor of Thomas Willis by his grandson. heard a sermon.” He also left for an endow­ honor of Thomas Willis would be held as ment fund two old houses near the church. usual on November fourteenth and that The cottages were pulled down a few years Sir William Osier would deliver the “ora­ ago, being no longer fit for occupancy, and tion” of the day. I was fortunately able to the money was invested in a war loan. attend this exercise and I am sure that a The festival itself, as celebrated last year, short account of the proceeding would be has some interesting features, not the least of interest to some of the readers of the of which are the “Fenny Poppers.” The Annals of Medical History. poppers consist of six small iron mugs which The festival had its beginnings in 1734, are filled with powder, placed in a field and three years after Browne Willis had built a fired off, like a cannon, by a fuse. The orig­ little parish church in his home village, in inal poppers of Browne Willis’s time have memory of his grandfather, and dedicated been broken, but some thirty years ago six A P atro nal F e st iv a l for T homas W il l is (1621-1675) 1 19 new ones were made, modeled after the old The Bishop of Buckingham preached a ones and these are fired off yearly by the short sermon. Some sixty good church mem­ church wardens in strict accordance with bers were there with twenty medical men Browne Willis’s wishes. Another feature is from Fenny Stratford and the surrounding the church service which this year was country. It was an impressive service. The held in the little brick church late in the bishop had an appropriate text, “The old afternoon of November 14, 1916. is good,” and one felt that under the The church stands on high ground at guidance of the Church, such an annual the cross roads of the town, one of which is festival spirit would never relinquish. Watling Street, the old After the service, we Roman road. The north wandered across the side is the oldest part, street to a comfortable built in 1726. Just inside old English tavern and the door, the Fenny Pop­ about thirty sat down to pers are kept. Inside the a jolly dinner. Later, in chapel, most of the inter­ the town hall, coffee was est falls on the north served by the ladies of aisle. The ceiling is ex­ the parish. There was an ceptionally fine, being exhibition of a number decorated in colors with of old engravings of the fo rty arm orial shields, church, some old books with a “cave” around it and other objects of in­ of twenty-six more, the terest. crests of all the donors When Sir William Osier of ten pounds or more to was called upon to speak the original building the hall was crowded with fund. These are beauti­ the villagers from miles fully executed and have around. His presence in recently been retouched Fenny Stratford was a under the skillful direc­ red letter day for this tion of Dr. William Brad- little country town. Sir brook, a local antiquarian William Osier was at his with the best interests of best in his talk on “ Willis medical history at heart. the Anatomist,” not a bit The ceiling to-day is one of which was lost on of the best preserved armorial ceilings in these simple country folks and honest prac­ England. The tomb of Browne Willis stands titioners. The spirit of medical history is at the further end of the north aisle. In dear to the heart of many English physi­ a small room beside the altar is hung an cians and most of them pride themselves engraving of Doctor Thomas Willis, dated on being antiquarians. As Sir William Os­ 1742, under which Browne Willis has writ­ ier’s talk was not written, I can only give it ten— as it appeared in the local paper.

In Honour to thy memory, blessed shade, REMARKS OF SIR WILLIAM OSLER Was the foundation of this Chapell laid. Purchased by thee, thy son and I, their heir “As Fenny Stratfordians, you do well to Owe these three mannours to thy art and care. For this, may all thy race, thanks ever pay, cherish the memory of the distinguished And yearly celebrate St. Martin’s Day. family to which the parish is so much be- I 20 Annals of Medical History

holden. It is not always easy to find en­ these three men, all great friends, were thusiasm for an annual festival, but St. in the habit of attending the service of Martin of Tours is a jovial host whose the Church of England twice daily. Wil­ name is associated with all sorts of good lis married for his first wife a sister of living and better company. That the an­ John Fell, the Dean of Christ Church. nual dinner preceded and did not follow Browne Willis’s devotion to the Church the oration suggests a wise provision on was natural— his grandfather had it be­ the part of the Saint to whom a personal fore him. To Willis’s special circle in Ox­ reference stirs my blood when I think of ford belonged a most interesting group some far-away ancestor whose hostelrie in the history of science in England. was so good and whose hospitality, I hope, The awakening of science in England was so free that his guests, in gratitude, had begun in the early part of the 17th called him by the name of his house; the century, and perhaps the first scientific name from which my own name is obvi­ work of first rank to be published in ously derived. It is fitting that the Regius Great Britain, was Gilbert’s De Magneto Professor of Medicine at Oxford should (1600). Harvey’s memorable work on the come here to honour a family to which ‘Circulation of the Blood’ appeared in Thomas Willis, the anatomist, grand­ 1628. Harvey was himself at Oxford dur­ father of their founder, belonged. This ing the period in which Willis was an under­ is the first time, I believe, in the many graduate. Whether they ever met or not years you have held the festival, that my is not known, but whilst there he met chair, the University and the College to a group of men whose lives and works which Willis belonged, have been honoured as the founders of the Royal Society in this way. Another reason for my pres­ have had the greatest influence of any ence is that I happened to be curator of single group of men on the development the Bodleian Library to which Browne of science in this country. Wallis himself Willis was a very generous donor. Then, told the story of the Society’s meetings, I have the great pleasure to be the friend first in London and then in Oxford. of Dr. Bradbrook, your townsman, who Most of the scientific subjects they dis­ has done so much to keep alive the memory cussed had been set on foot really with­ of Browne Willis. This evening I wish to in the previous thirty years, chiefly by speak of Willis, senior, the physician, the remarkable observations of Galileo. whom you all know in the profession, These men, who had an important influ­ and of his circle at Oxford. Thomas Wil­ ence on the subsequent development of lis took his M .B. in 1646, and began his science in this country, deserve to be practice in a house, still existing, known held in remembrance. Seth Ward, who as Beam Hall. He had a special interest was subsequently Bishop of Exeter and in the Church of England, and during of Salisbury, was the centre around the Cromwellian occupation of the city, whom the majority of these scientific the services of the Church were held men revolved. He was ‘a profound states­ twice a day in his house. One of the most man, but a very indifferent clergyman.’ famous pictures hanging in the hall in Wallis, who was also a Cambridge man, Christ Church shows John Fell, John was, more than any single man, the living Dolben and Richard Allestree with a spirit in the formation of the Royal copy of the Liturgy open before them. Society. He was a great mathematician, That picture may have been taken in and, in a most astonishing mathematical Willis’s house opposite Merton, where dream, extracted the figure root from A P atro nal F e st iv a l for T homas W il l is (1621-1625) 121 eight groups of figures—and it was cor­ and became so much interested in the rect. He became Professor of Geometry studies that were in progress with Willis, at Oxford, and his reputation as a math­ Boyle and others that at first he studied ematician extended throughout Europe. medicine; and it is a remarkable fact

S ir W i l l i a m O s l e r

Another man who had quite a great in­ that the distinguished architect was the fluence was Wilkins, Warden of Wad- first in England, probably in Europe, to ham, a very ingenious man with a good invent a method for the transfusion of mechanical head, who was afterwards blood from one human being to another, Bishop of Chester. In Wadham College or from one animal to another. He is is still shown the early meeting room also remembered as the first man who of the Royal Society in Oxford. Perhaps made drawings from the microscope. He the best remembered genius of the group also did many of the drawings for Willis’s is Christopher Wren, who was an un­ works. Another remarkable member of dergraduate at Wadham College in 1649, the group was the Hon. Robert Boyle, 122 Annals of Medical History

son of the Earl of Cork. He was a great downe family. Other remarkable men of exponent of the experimental method, the circle were Sydenham and John and every elementary student of physics Locke, the author of the ‘Essay on the still knows him through Boyle’s law. It Human Understanding,’ which even an is astonishing when one thinks how ordinary woman can read. There is no much Boyle did, how little was the im­ one in the room who would not be im­ pression he made. It was probably due proved by a careful study of this book to the fact that he was rather a rough ex­ over a period of several years. The last perimenter; he had a better mind than man of the circle is Lower, who did a hands. Coordination of head and hand good deal of work for Willis, whose name are necessary for a great experimenter. is remembered by the smallest single But he did a great work in stimulating fragment in the human body. It is research and a good deal of the reputa­ astonishing on how small a cork a man tion of English science on the continent will float down the ages. He did, how­ was due to him. Another extraordinary ever, a great deal of good work, especially character in the group was that genius, in the dissection of the brain. These were Sir William Petty, who made the Down Willis’s friends during the years he was a Survey in Ireland, and was the founder practitioner in Oxford. of the science of political economy. He Willis did two things; he made him­ went to sea at eight or nine years of age, self a good scientific man as far as the and while being nursed in France for a science of that day went, and he made broken leg he began a career of money­ himself a first class practitioner, and making. He went to Paris with no other those two sides of the man are pre­ capital than his native wit, became a doc­ sented in his works. It is not possible tor, and came to Oxford at the time one of in a mixed audience to go into the char­ my predecessors had the fortunate habit of acter of his work, but there are one or fainting whenever he saw a dead body, so two things that will interest you. The first it was impossible for him to do dissection. of his collected works was a ‘Study of Fer­ Petty was made Professor of Anatomy, and mentation.’ From time immemorial, it had joined this circle of Boyle’s, and was a most been one of the great mysteries how certain invaluable member of it. He became well- bodies undergo the extraordinary change known throughout the country as the resus- known as fermentation, and why at the ciattor of Ann Green, a young woman who end of the fermentation there was such a was ‘hanged by the neck until she was good change in the liquid. Willis studied dead,’ and then handed over as a perquis­ this mystery and made it still greater in ite to the Professor of Anatomy, who the pages he devoted to it. But he grasped claimed the bodies of all criminals for one very important thing, the analogy dissection. In spite of the fact that the between a fever and fermentation. He relatives had tugged at the rope, before made the very interesting observation the body was cut down and had jumped that there is no difference between the on her to make sure she was dead, Petty vintner and the physician; when the vat resuscitated her, and she lived for many becomes too full in fermentation the vint­ years and became a very respectable ner draws off some of the liquid, and he member of the community. It was a great said: ‘What is that but what we do with loss to Oxford when Petty went to Ire­ blood fermenting in a fever?’ That was a land; he is of interest to the present good reason for phlebotomy. It was not generation as the founder of the Lans- until 1857 that the problem of fermenta­ A P atronal F estival for T homas W illis (1621-1675) 123 tion was solved by Louis Pasteur, who showed that if one took the tiniest little showed that fermentation is not a pure drop on the point of a needle from a fer­ chemical process, but due to changes ow­ menting fluid and put it into a sugary ing to the growth of living bodies in the solution it would create fermentation; fluid. That is the greatest single dis­ and, in just the same way, the tiniest drop covery as far as the welfare of humanity of blood from an animal suffering from

is concerned, and it has had the farthest anthrax would cause identical changes to reaching influence of any single discovery occur in the blood of another animal; of the century. It revived the parallel there would be a multiplication of the which had been drawn 300 years before germs, a change in the fluid, and at the between fermentation and fever. Fracas- end of the fever produced by the anthrax torius had called attention to it in the 16th one could not induce the fever again by century, and Boyle had said that the man inoculation. That was the foundation of who would solve the problem of fermen­ our modern treatment of infectious disease tation would solve the problem of infec­ and the antiseptic treatment of wounds. tious fevers. Pasteur solved both. He Besides this subject of fermentation, 124 Annals of Medical History ■-

Willis also dealt with intermittent fevers think of the constitutions our ancestors and enteric or typhoid fever. He was had, and of how they withstood the as­ one of the first to describe an epidemic saults of the apothecary. in 1643 the army of Essex besieging It is really a wonderful age to live in, Reading. He reported also on an epidemic more for what the human body misses in 1661. It is interesting to see what he than for what we have. When I look prescribed for typhoid. One would not through the list of drugs that were given care to have typhoid fever and to be and the prescriptions that were then fol­ treated by Willis. The patient would be lowed, I feel that the public has to lucky if he were not bled, dosed with all thank the profession for having got rid the available purges in the Pharmacopoeia, of so many nauseous and horrid drugs. sweated, given two or three active vomits We still have a fair number, not that and blistered on the calves of the legs, the the profession likes to give, but the pub­ abdomen, and probably the back. These lic will have them. In some of Willis’ were five articles of the treatment of prescriptions, there were ten to fifteen dif­ fever that the public at present is ferent ingredients—each worse than the spared. Willis was one of the first to de­ other—besides vomits, purges, sweatings, scribe typhoid fever in epidemic form, and diuretics, cordials and opiates. Syden­ one of the first to give an accurate descrip­ ham and Willis probably owed much of tion of child-bed fever. He was the first their reputation to their knowledge of to give an accurate account of the dis­ how to use opium. Willis wrote, amongst ease known as diabetes, and he recog­ other things, two discourses on the soul nised the saccharine or sugar variety of brutes, which would be a very good from the ordinary form. He is better exercise for any medical student or doc­ remembered to-day by his big work on tor. Altogether, Willis is an interesting the brain. He did a really fine piece of character to contemplate. I have known study on the human brain, and it was him for a good while and I have known the best book of its date on the nervous him far better since I had your kind system, not only in the description of invitation and have had to read Willis’s the anatomy of the brain, but of the large book through, from which I got a anatomy of the nerves, in which he was great deal of information I did not want, greatly helped by Lower’s sections and and have refrained from giving to you. I Wren’s drawings. His classification of the have only picked out a few parts here and nerves of the brain remained in England there, but it has been a pleasant task, and I until my own generation. Willis is remem­ feel a good deal better for it. Willis was a bered particularly by the description of great and a good man, and the 15th Psalm certain blood vessels at the base of the the Chairman has read at the service is most brain known as the circle of Willis. A appropriate. It just suited him. There are great part of Willis’s book is taken up many good descriptions of the upright, with a ‘Pharmaceutica rationale.’ It is as righteous man, but none better than that dead as Willis. It gives me a shudder to in the 15th Psalm, which fits Willis to a ‘t.’ ” MEDICINE AND MATHEMATICS IN THE SIXTEENTH CENTURY

B y DAVID EUGENE SMITH, LL.D.

NEW YORK CITY

O one who gives serious attention One of the most potent causes in this either to the history of medicine case was the general belief, both in ancient or to the history of mathematics times and in the Middle Ages, in the influ­ can fail to be struck by the num­ ence of the stars upon human life. Astrol­ Nber of physicians who have excelled in math­ ogy therefore became the handmaid of ematics and astronomy, and by the number medicine and was looked upon by the in­ of mathematicians who have been skilled in tellectual world as part of the equipment of the healing art. The cases are so numerous the man who aspired to highest rank in the as to surprise even those who would natu­ medical profession. Great stimulus was rally be familiar with the connection be­ given to this idea through a translation of tween the two sciences, and they are by a passage in Hippocrates in which the mas­ no means confined to any single race or to ter speaks of tl delov in disease, a term any particular period. To enter into an ex­ which the early translators rendered by haustive study of the matter would be im­ coeleste instead of divinum and which was possible within the limits of a paper of this thus thought to refer to the influence of character, such a study of the Arab civili­ the heavenly bodies.2 Moreover, there was zation alone being enough to fill a printed much to encourage the belief because of volume.1 All that can be attempted under the manifest curative powers of the sun, of the present circumstances is to consider the influence of the moon upon human some of the causes of the phenomenon and emotions, and of the force of tradition de­ to speak of its development in the century rived from the religious beliefs of the an­ of its greatest prominence, namely, the cients in the power of the stars. To our period from 1500 to 1600. somewhat more scientific minds a little of When we seek for the cause of any oc­ this belief seems warranted; but we of the currence whatever, as of some disease or present fail to comprehend the further be­ of some event in the domain of astronomy lief in horoscopes or to recognize that the or history, we always find that it is by no best scientific minds of a few centuries ago means unique. Various contributing influ­ failed as completely to take our own point ences enter into the situation, and so it is of view. That a man like Caspar Bartho- with the close relationship between the Iinus (1585-1629), father of the mathema- medical and mathematical sciences. tico-medical scholar Erasmus Bartholinus 1 For example, in Wustenfeld’s list of 300 Arabian (1625-1698) and professor of medicine at physicians (“ Geschichte der arabischen Aerzte und the University of Copenhagen, should have Naturforscher, ” Gottingen, 1840) there are the seriously advocated the claims of astrology 3 names of 38 prominent mathematicians, while many only three centuries ago seems to us quite of the others were doubtless interested in the sub­ beyond reason, but such cases were by no jects of astronomy or mathematics. In Suter’s list of 528 Arabian mathematicians (“ Die Mathemati- 2 E. Withington in Little’s “ Roger Bacon Essays,” ker und Astronomer der Araber und ihre Werke,” in Oxford,-1914, page 343. Abhandlungen zur Geschichte der math. VEiss., Leip­ 3 “ Astrologia, seu, de stellarum natura,” Witten- zig, 1900), at least 85 are known to have been phy­ burg (?), 1612, and his “ De astrologia,” Rostochii, sicians. 1616. 125 126 Annals of Medical History means rare at that time or even up to the abounded in error. He stated it to be his close of the eighteenth century. belief that the antiqui had a sort of primi­ To this belief in the power of the stars is tive medical revelation which endured partly due the development of the Greek- through the periods of Chaldean, Greek, Alexandrian sect of iatromathematicians,4 a and Arab ascendency, although dimmed by sect that has its origin in the superstitions the errors and defects of the Latini rustici. of the ancients long before the period of Once the belief is established that astrol­ Hermes Trismegistos.5 The beliefs of these ogy has value in the equipment of the phy­ iatromathematicians, relating chiefly to the sician, it is evident that a certain degree of application of astrology in the domain of proficiency in mathematics will be looked medicine, have been clearly set forth by upon as necessary in his education. He must Sudhoff, particularly as they showed them­ know something of angle measure, must be selves in the fifteenth and sixteenth centu­ able to use astronomical tables, and must ries.6 * These beliefs are to be found in the be fairly well equipped as a computer. This writings of some of the best scholars of ear­ explains in part the relation of mathemat­ lier times, such as the Rabbi ben Esra of ics to medicine in that period in which Browning’s poem, who asserts that a lunar printing first made learning really popular, eclipse at the beginning of an illness has a namely, the sixteenth century. baneful influence, that a solar eclipse pro­ There was also another potent influence longs the period of sickness, and that a leading to the development of the iatro­ conjunction of planets or of the sun and mathematicians, namely, the universal an­ moon is a very dangerous sign. Another cient belief in number mysticism, a belief such writer was the Arab scholar Alcabitius which had not died out in the seventeenth (fl. c. 965)/ whose work on astrology was century and which is not unknown even translated by Johannes Hispalensis and to-day. Deus imparibus numeris gaudet is a commented upon by Johannes de Saxonia.8 phrase as old as the period of the Pythago­ Still another example, and this from the reans, and even to - day the belief that thirteenth century, is seen in the case of “ there is luck in odd numbers” is very Roger Bacon.9 This remarkable man touch­ general. The recognition of the influence of ed all branches of science then known, and the number seven in medical literature, un­ in particular he wrote upon medicine as set til recently almost universal, a recognition forth by the school of Galen and by the due in large part to a work long attributed Arab writer Avicenna.10 Just as he antag­ to Hippocrates himself but probably spuri­ onized the mathematicians of the day, so ous, is an illustration of this belief. The he asserted that contemporary medicine superstitions relating to numbers like three

4 ’l a Tpo/j,ad7]ij,aTLKoi 7 ‘Abdel ‘aziz ibn ‘Otman ibn ‘Alt, Abu’I-Saqr, el- 5 See his ’Iarpojua^/xart/ca in Patricius, “ Nova Qabisi. The transliteration of Arabic names follows de Universis Philosophia” (1593). On his general the Suter list. beliefs in the subject, see “ Die Lehren des Hermes 8 This commentary was printed in Venice in 1485 Trismegistos” by Josef KroII in the Beitrage zur and again in 1521. Geschichte der Philosophic des Mittelalters, Bd. X II. 9 A. G. Little, “ Roger Bacon Essays,” Oxford, 1914. Heft 2-4, Munster i. W., 1914, pp. 206 seq. and 367 See the article by the present writer, on “ The Place seq. of Roger Bacon in the History of Mathematics,” 6 “ Jatromathematiker, vornehmlich im 15. und page 153, and the one by E. Withington, “ Roger 16. Jahrhund.,” in the Abhandlungen zur Geschichte Bacon and Medicine,” page 337, from each of which der Medizin, Breslau, 1902, Bd. II. The term has extracts have been freely made. also been applied to those interested in the general 10 EI-Hosein ibn Abdallah ibn Hosein ibn ‘Ali, use of mathematics in medicine. Abu ‘Ali, el-Seich el-Ra’is, Ibn Sina (980-1037). M ed ic in e and M ath em atics in th e S ix t ee n t h C en t u r y 127

and seven, with their squares, have all the the attributes of a person from the numeri­ appearance of being transmitted from the cal value of his name obtained by adding East, possibly through Pythagoras himself; the numerical values of the letters, a sub­ but at any rate they were powerful enough ject too extensive to admit of discussion at to interest the medical profession for many this time. generations in the mysticism of number. A fourth reason why the medical class in This number mysticism naturally led to the Middle Ages was led to a study of the use of amulets such as the Thibetans mathematics is found in the imagined need and others of the East wear to-day, — for the compounding of drugs in such pro­ plates on which magic squares, the mystic portions as to bring out their dynamidiae. trigrams of the Chinese, and the signs of This need led the physician to the study of the zodiac are engraved. These are closely alligation, as the alchemist and the mint related to various instruments of divina­ master were also led, and it is, of course, even tion in which number played a leading more potent in carrying out the scientific part. This subject is so extensive as to per­ work of to-day. It was very likely this in­ mit only of brief mention at this time, and fluence that led a man like Arnaldo de Vil- a single illustration will serve to show its Ianova (1235-C.1313), or Arnaldo Bachuone, importance.11 Tradition relates that the as­ to study mathematics. Teaching medicine trologer Petosiris dedicated to King Ne- in Barcelona and Paris, physician to Fred­ chepso, of the seventh century b . c ., a erick of Sicily, a prominent practitioner in sphere of wondrous power.1112 To foretell the Rome, Bologna, and other great centers, outcome of the sickness of a patient it was known chiefly for his writings on alchemy, only necessary to add the numbers corre­ Arnaldo was the type of man who would sponding to the Greek letters of the name naturally be led to imagine a close connec­ of the disease, to add to this sum the num­ tion between medicine and number, and be­ ber corresponding to the day of the month tween alchemy and astrology. So whether on which the invalid took to his bed, to di­ the aspiring physician, when Salerno began vide the result by 29 (approximately the to encounter serious rivalry, went to Pa­ number of days in the lunar month), to dua, which leaned to the astrological doc­ note the remainder, and then to consult the trines of Pietro di Abano (c. 1250-1316),14 magic sphere. This sphere was divided into or to Montpellier, which favored the al­ six cells, the upper three being the cells of chemy of Arnaldo, he was sure to come in life and the lower three those of death. contact with some form of mathematics. Whether the patient would live or die was A fifth influence to be noted, even though determined by the group of cells in which this is not the place to discuss it historical­ the remainder was found, and whether the ly, is that of the study of optics, especially recovery would be speedy or slow was de­ on the part of the physician who specialized termined by the particular cell in the in the treatment of the eye. Upon this topic group.13 It will at once be seen that there there is a large literature, beginning promi- is a connection between this superstition 13 See also “ Nechepsonis et Petosiridis fragmenta and that of gematria, the theory of finding magica,” in Philologus, Suppl. VI (1891-1893), pp. 382-383. 11 For further discussion, see Wickersheimer, “ Fig­ 14 Also known as Petrus Aponensis, professor of ures Medico-Astrologiques des IXe, Xe, et X le Medicine at Padua. His “ Astrolabium planum” was Siecles,” in Janus, 1914, Vol. XIX, pp. 157-177. published at Venice in 1502, his “ Geomantia” at 12 This sphere seems, however, not to be older than Venice in 1556, and his “ Opera artis” (on alchemy) the second century b .c . For discussion, see SudhofF, at Paris in 1567. SudhofF gives the dates 12 5 3 - loc. cit. 1319 (?)• 128 Annals of Medical History nently with the Arab scholars and spread­ An illustration of this general combina­ ing thence to the West, particularly in the tion of all the sciences under the guidance thirteenth century, one of the most remark­ of medicine is seen in one of the sumptuous able periods in the world’s intellectual pro­ volumes that came from the Aldine press gress. at the opening of the sixteenth century, A sixth reason why physicians were so written by Georgius Valla, the elaborate commonly led to the study of mathematics title beginning: “ Georgii Valise Placentini is to be found in the general belief in the viri clariss. de expetendis, et fvgiendis rebvs influence of comets upon human health. op vs, in qvo hsec continentvr.” Valla was This is quite independent of the belief in born at Piacenza in 1430 and died at Ven­ astrology, and it proved to be so strong as ice in 1499. He lectured on physics and to attract the attention of a considerable medicine at Pavia and also at Venice, and number of physicians in the sixteenth cen­ translated various writings of the Greeks, tury, and to lead them to a sufficient study both medical and mathematical. His mag­ of mathematics to make use of armillary num opus, above mentioned, treated of spheres and astrolabes for locating the com­ Boethian arithmetic and music, of Eucli­ ets in the heavens. An example of this is dean geometry, of medicine and optics, of found in the case of Fernandez Raxo y Go­ astrology and the astrolabe, of rhetoric, mez (d. 1695), a graduate in medicine at poetry, and law, and of most of the other Valencia, physician to Philip II, and the great branches of human knowledge. Much author of a well-known work on the influ­ of the work is devoted to medicine. Thus ence of comets.15 he has “ De Physiologia Iibri .iiii. . . . It is especially appropriate in this con­ De Medicina Iibri .vii. . . . De Corpo­ nection to mention one more influence lead­ ris commodis, & incommodis Iibri .iii. quo­ ing the physician to the study of mathe­ rum primus totus de anima, Secudus de matics, since this makes the mystic num­ corpore, Tertius uero de urinis ex Hippo- ber seven, and so I refer to the fact that crate, ac Paulo segineta, deq; Galeni quses- medicine was a very natural gateway to tionibus in Hippocratem.” Like all such mathematics in the early universities. A works, this was merely a compendium, but young scholar was offered four great possi­ it established Valla’s reputation as a phy­ bilities in the mediseval period, namely, sician of great scientific learning, and it theology, philosophy, law, and medicine. serves to illustrate the point in question. Of course he might follow out his mental There is much more to say if one desires bent without taking any of these paths, to enter fully into the relations between but these were the enticing ones. If his mathematics and medicine. The story is taste was for science in any of its branches, one of interesting mysticism, of the Greek, the path of medicine was the natural one Roman, and mediseval symbols of drugs and to follow, since, as we have seen, medicine numbers, of tetragrams, of exorcisms, of had as auxiliary sciences astronomy (which skryers, and of all that borderland between was mathematics par excellence in those the region of superstition and that of days) and alchemy, and made not a little science. The story is therefore a long one, use of physics. Scientific training, there­ and lest it might prove unprofitable it is fore, found its path of least resistance better to leave it untouched and to men­ through medicine. tion a few of the great names in the fields

15 “ De Cometis, et prodigiosis eorum portentis Iibri of medicine and mathematics in the six­ quatuor,” Madrid, 1578. A Spanish bibliographer re­ teenth century. marks that “ era mas bien filosofo que astronomo.” This century has been selected because M ed icin e and M athem atics in th e S ix t een t h C en t u r y 129 it combines the seven influences above other leading names among those whose mentioned more completely than was the tastes led to the study of mathematics as case before the year 1500 or has been since well as medicine, and to speak very briefly the year 1600. Before the sixteenth cen­ of their labors. After that it will be quite tury printing had not been sufficiently de­ enough to enumerate, for purposes of refer­ veloped to make it possible to freely dis­ ence, the names of others who, in that cen­ seminate thought, while after the close of tury, cultivated more or less impartially that century superstition began to give way the two sciences under discussion. more rapidly than ever before to scientific It usually happens that a really great inquiry. man attains his dominant position in one Before considering the list of sixteenth line, his other lines of interest being so com­ century mathematico - medical scholars, pletely overshadowed as to be forgotten. many of whom were slavish followers of Of course there are exceptions to this rule, tradition, one name should be mentioned as in the cases of Descartes, Pascal, Leib­ as standing in a class by itself. No list of nitz, and particularly Leonardo da Vinci; medico-mathematical writers would be com­ but in general it is a law that is almost plete without reference to this remarkable axiomatic. For this reason few in the medi­ genius who was neither a medical man nor cal profession will recall the fact that Gali­ a mathematical professor, but who knew leo (1564-1642) was at least a novice in more of anatomy and of mathematics than their guild. This, however, is the case, for most of his contemporaries who were work­ his father withdrew him from the monas­ ing in these fields. The works of Leonardo tery of Vallombrosa, where he had decided da Vinci (1452-1519) in mechanics, in as­ to take orders, and sent him to Pisa to study tronomy, in the study of the infinitely great medicine. His observation of the swinging and the infinitely small, and his familiarity lamp led not only to his study of the law with the writings of the scholars who had of the pendulum but to his use of this de­ made mathematical physics, all show the vice for measuring the frequency of the same remarkable acumen that he revealed pulse.16 His tastes, however, were toward in connection with the study of the heart applied mathematics, and so he secured his and the circulation of the blood. Had Leo­ father’s consent to give up the study of nardo not been one of the world’s greatest medicine and to endeavor to make a name artists he would have been known as one of for himself in his chosen field.17 the world’s greatest anatomists; had not As in the case of Galileo, so with Coper­ the other phases of his genius overshad­ nicus (1473-1543); it is not generally re­ owed his work in mathematical physics, he called that he was a physician, as also would have been known as one of the Canon of the Cathedral at Frauenburg in world’s greatest scholars in this important East Prussia. His mathematical and as­ field. The contributions of Dr. Arnold C. tronomical studies under Peurbach, Regio­ Klebs to our knowledge of his work on the montanus, Domenico Maria, and Brudzew- circulation of the blood were a revelation ski led him to devote his energies to the to most of us who thought that we knew mathematical side of astronomy with an something of Leonardo’s scientific attain­ intelligence that made for the success which ments, while even a brief consideration of the world has long since recognized. his fragmentary work in mathematics will 16 Paolo Frisi, “ Elogio del Galileo,” Milano, 1778, convince anyone of his real ability in this p. 14. field as well. 17 “ Le Opere di Galileo,” Firenze, 1856, torao xv, p.

I now propose to mention a few of the 334- 130 Annals of Medical History

Of all those who achieved a reputation en by him in his own list, are the following: in the fields of mathematics and medicine “ Delle cause, dei segni e dei Iuoghi delle in the sixteenth century, none was more malattie,” “ Picciola terapeutica,” “ Degli notorious, to say the least, than Girolamo abusi dei medici,” “ Delle orine, Iibro quat- Cardano 18 who was born at Pavia in 1501. tro,” and “ Sulla medicina di Galeno,” but He was the illegitimate son of a jurist, a careful modern edition of his works has Facio Cardano, a man who had also taken not appeared, and a systematic search for a degree in medicine, had given some at­ his unpublished manuscripts has probably tention to mathematics, and had edited not been made. Among his works was also Archbishop Peckham’s “ Perspectiva Com­ a commentary on the anatomy of Mundi- m unis,and of a mother who had a repu­ nus. tation that was none too good. Students of Cardano’s own opinion of a medical career heredity may find here a fertile field for is familiar to all who have looked into the speculation, for Girolamo certainly com­ history of medicine, but it may be interest­ bined in his nature some of the highest and ing for others to read. He says, in his gar­ some of the lowest elements. He was at rulous autobiography: “ If I had money to once an astrologer (not a great reproach at earn, I could earn it as a doctor, and in no that time, however) and a serious student other way. But that calling of all others of philosophy; a gambler and a first-class (except the glory that attends it) is com­ algebraist; defender and father of a mur­ pletely servile (tota servilis est), full of toil, derer and at the same time a physicist of and (to confess the truth) unworthy of a high ability; a liar and at the same time a high-spirited man (ingenuo viro indigna), physician of repute; an inmate of a poor- so that I do not at all marvel that the art house and a professor in the University of used to be peculiar to slaves.” 19 Bologna; a victim of blind superstition and The most popular writer on arithmetic, rector of the College of Physicians at Milan; in the Latin language in the sixteenth cen­ a heretic who ventured to publish the horo­ tury was Gemma Regnier or Rainer (1508- scope of Christ and a recipient of a pension 1555). Having been born at Dockum, in from the Pope. While only twenty-one East Friesland, he was known as the Fris­ years of age he taught mathematics at ian, or commonly as Gemma Frisius. He Pavia; at the age of twenty-five he took his was only thirty-two years old when his degree in medicine at Padua, practicing for “ Arithmetics Practice Methodus Facilis” seven years at Sacco. In 1534 he became was published at Antwerp (1540), and so professor of mathematics at Milan, at favorably did this work strike the popular the same time practicing and teaching taste that it went through at least fifty-nine medicine. He died in Rome in 1576. editions in the sixteenth century, not to Cardano’s greatest mathematical work is speak of many later ones. He also wrote on the “ Ars Magna” (1545), a work in which astronomy and geometry, acquiring a high the solution of the cubic equation first ap­ reputation as an author if not as a mathe­ peared, in print, although apparently se­ matician. Soon after publishing his arith­ cured under the pledge of secrecy from metic he took the degree of doctor of medi­ Tartaglia. He wrote, however, numerous cine and then gave up his mathematical other works' on mathematics, physics, phi­ studies. While nothing was published upon losophy, and astronomy, and a number of medicine under his name during his life­ “ oposcoli” on medicine, published and un­ time, there is, in a work printed at Frank- published. Among the medical writings giv- 19 Morley, “Jerome Cardan,” II, 283; “Opera,” I, 18 Jerome Cardan, Hieronymus Cardanus. I3I- M ed ic in e and M athem atics in th e S ix t een t h C en t u r y 131 fort in 1592, a “ Consilia qusedam de arthri- sic,” appeared in 1548 and went through tide” attributed to him. several editions, being as popular in medi­ Among French physicians of the six­ cal circles as were his mathematical works teenth century there stood out prominently in the field of general education. one whom his admirers called the modern His end was not what one would have Galen, Jean Fernel (1497-1558), who re­ expected for a man who had been permit­ ceived his doctorate from the Faculte of ted to dedicate one of his works to “ Prin- Paris in 1530. Four years after receiving his cesse Marie,” over his signature of “ Rob­ degree he became a professor in Paris, and ert Recorde Physicion;” who had adminis­ soon rose to a position of leadership in the tered to the medical needs of Edward VI medical profession. His “ Universa Medi- and of Mary Tudor, and who had written cina” (1567) went through more than thirty the most popular mathematical books that editions. In the field of mathematics he pub­ England had known. He was imprisoned lished two works, “ De proportionibus ” for debt in Southwark Prison, and died (1528) and also two in the field of astron­ there, probably soon after June 28, 1558, omy, the “ Monalosphoerium” and the the date of his will. “ Cosmotheoria.” His work in geodesy was Among the physicians whose mathemati­ also noteworthy, his computation of the cal attainments were much above the aver­ length of a degree of the meridian being age to be found in those who devoted them­ 56,746 toises, although it is really 57,024 selves wholly to the exact science, there toises, — a good approximation for the time. should be mentioned Ludovico Lilio (1510- Of the English scholars who cultivated 1576) who was one of the astronomers called both mathematics and medicine in the six­ by Gregory X III to consider the change of teenth century, Robert Recorde was the the calendar. It was substantially his sug­ most prominent. Born at Tenby, Pembroke, gestion for reform that was adopted. Un­ c. 1510, he studied at Oxford and Cam­ fortunately he died six years before the new bridge, and received his degree in medicine calendar was put into general use, and so at the latter university in 1545. He taught he did not live to see the fruition of his mathematics at Oxford and very likely at labors in this important field. Cambridge, became royal physician, and In Belgium, contemporary with Galileo, wrote on medicine as well as mathematics. there lived the well-known Adriaen van It was in the latter field, however, that he Roomen (1561-1615) who divided his time attained his chief prominence. His arithme­ rather impartially between medicine and tic, “ The Ground of Artes,” appeared be­ mathematics. He lectured on both subjects tween 1540 and 1542 and went through at at Louvain and upon mathematics in Wurz­ least thirty editions, being the most popu­ burg, where he was physician to the bishop, lar work that appeared in England upon the and he was at one time mathematician to subject in the first two centuries of print­ the king in Poland. He is best known in ing. He wrote also “ The Castle of Knowl­ mathematics for his computation of the edge” (1551), a work on astronomy; “ The value of 7r to sixteen decimals,20 but he Whetstoae of Witte” (1557), a work chief­ wrote also upon other geometric subjects.21 ly on algebra, and the one in which the present sign of equality ( = ) first appeared 20 In his “ Ideae mathematicae pars prima,” Ant- in print; and “ The Pathway to Knowledge” verpiae, 1593. 21 In “ Archimedis circuli dimensionum expositio (1551), a work on geometry, written, like et analysis,” Wirceburgi, 1597; “ Mathesis polemica,” the others mentioned, in catechism form. Francofurti, 1605; “ Canon triangulorum sphaeri- His medical work, “ The Urinal of Phy­ corum,” Moguntiae, 1609. 132 Annals of Medical History

Interested in the same line of mathematical high esteem as healers of the body, or who study was his contemporary Adriaen Me- made some name in literary productions tius (1571-1635), or Adriaen Adriaenszoon, which touched upon both of the sciences. who was a professor of mathematics and It will, however, be more helpful to those medicine in the university at Franeker, but who care to study the intimate connection whose writings were all in the line of mathe­ between mathematics and medicine if a list matics and astronomy. He also is well of some of the others who helped to estab­ known for his approximation to the value lish this connection is made accessible to Of 7T.22 them, and such a list, necessarily much Among those of less importance in the abridged, is given as a supplement to this combined fields of medicine and mathe­ fragmentary sketch. matics in the sixteenth century was Jacques Although it has been said above that the Peletier (1517-1582). He was a man of sixteenth century was par excellence the some ability in mathematics,23 but he was century of the iatromathematicians, it must too ready with his pen, and this in too not be thought that later centuries failed to many lines of work, to attain a high stand­ find this same intimate relationship be­ ing. Interested in law, a voluminous writer tween the two sciences. Thus in the cen­ in general literature, principal of the Col­ tury following we find the great Boerhaave lege de Bayeux, physician at Bordeaux, (1668-1738), whose reputation as one of Poitiers, and Lyons, teacher of arithmetic the greatest physicians of his time obscured at Annecy, author of various textbooks on what would otherwise have been an envi­ mathematics—including algebra, geometry, able reputation in the field of applied and arithmetic—it will be seen that he had mathematics. So his contemporaries Eisen- little time for serious work in any of his schmid (1656-1712) and Guglielmini (1655— various fields of activity. 1710) represent the union of the two sub­ Perhaps the most all-round dilettante of jects, since it was the “ Diatribe de figura the sixteenth century to come within our telluris elliptico-sphseroide (16 9 1)” of the field is Henricus Cornelius Agrippa (1486- former that gave rise to the dispute as to 1535). He posed as physician, lawyer, sol­ the elongation of the earth, and the latter dier, philosopher, astrologer, and alchemist was a recognized authority on mathematics in various centers of learning, including as applied to hydraulics. These facts are Cologne, Pavia, Freiburg, Brussels, Bonn, apt to be forgotten both by the historian and Grenoble. His “ De Incertitudine & of mathematics and by the recorder of Vanitate Scientiarum” went through vari­ medical progress, just as when we see the ous editions 24 and shows at least a super­ beautiful colonnade of the Louvre, we for­ ficial knowledge of substantially every get that Claude Perrault (1613-1688) was science, mathematics ranking equally with not merely an architect but was also a phy­ medicine in his general condemnation.25 sician and a mathematician. Not many, too, Such were a few of those who added to recall the fact that the famous Johann (I) mathematical knowledge, who were held in Bernoulli (1667-1748), one of the two broth-

22 His works include “ Doctrinse sphsericse Iibri V ,” en quatre Iivres,” ib., 1554; “ Demonstrationum in Francofurti, 1591, and Franeker, i598;“ Geometrices Euclidis elementa geometrica Iibri sex,” Lugduni, per usum circini nova praxis,” Amstelodami, 1623; 1557. “ Opera arithmetica et geometrica,” Lugduni Batavo- 24 A copy in the writer’s library has the double rum, 1625. date, Lugduni Batavorum, 1643 and 1644. 23 Among his works are “ L’AIg^bre, departie en 25 His “ De occulta Philosophia Iibri I I I ” appeared deuxlivres,” Lyon, 1554; “ L’Arithmetique, departie at Cologne in 1510 and again in 1533. M ed ic in e and M ath em atics in th e S ix t een t h C en t u r y 133 ers who founded the celebrated family of writings were in the line of mathematical mathematicians bearing his name, held a astronomy. His skill as a physician could degree in medicine. His dissertation “ De not save him from death as a result of the effervescentia et fermentatione,, (Basilese, plague. 1690) gave little suggestion that he would A d r ia e n A driaenszoon . See the article. become one of the greatest leaders in spread­ A g r ip p a . See the article. ing the knowledge of the new mathemati­ J u an A g u il e r a , who flourished in Sala­ cal discipline of the calculus throughout manca in the middle of the sixteenth cen­ continental Europe; yet such was the case, tury, was well known as a mathematician, and his productions in mathematics were physician, philosopher, and theologian.27 of highest scientific value. J u an A lem a n practiced medicine in Thus it has been through all the centu­ Spain in the second half of the sixteenth ries, particularly from the ninth to the twen­ century and wrote on astronomy and as­ tieth, that mathematics and medicine have trology.28 found much in common, although the two J u an A l m e n a r , born in Valencia in the periods in which this has been the most latter part of the fifteenth century, took noticeable are the era of the Arab ascend­ his degree in medicine and is described as ency and that of the sixteenth century, to “ el primer espanol que escribio sobre el the latter of which this brief summary chief­ mal venero” (1502). He was much interested ly refers. in astrology, however, “ en la cual Ilego a adquirir gran fama,” and he seems to have A PARTIAL LIST OF THOSE WHO, IN THE SIX­ written a work on astronomy which was TEENTH CENTURY, WERE DISTINGUISHED never printed. IN MATHEMATICS AND IN MEDICINE 26 J o hann A s v e r u s A m psin g (c. 1559 - B e r n a r d A b a t ia (1540-C.1590), physi­ 1642), one of the chief authorities on the cian, mathematician, astronomer, jurist, iatromathematics in the seventeenth cen­ and linguist. tury, a native of the province of Upper A lessa n d r o A c h il l in i (1463-1512 or Yssel. He was a physician of prominence and 1518) was professor of medicine and of wrote a dissertation on iatromathematics.29 philosophy in Bologna and in Padua. His M elc h io r A y r e r (1520-1579), a physi­ “ Opera Omnia” (Venetiis, 1508) contains cian of Niirnberg, well known in his day as numerous contributions to medicine, and a chemist and mathematician, was skillful he wrote also on astronomy and physics, in the making of mathematical instruments. subjects so closely connected with mathe­ B er n a r d in o B a l d in i (1515-1600), pro­ matics as to show the trend of his interests. fessor of medicine in Pavia and of mathe­ J ohann A c r o n iu s, or A tr o c ia n u s (1520- matics in Milan. His writings were chiefly 1564), not only practiced medicine at Basle on astronomy and physics. but was also professor of mathematics and P ie r r e B e a u sa r d (d. 1577), a physician of logic in the university of that city. His of Louvain, and in later life a professor of 26 The list is arranged alphabetically either by the mathematics in the university. While not family name or by the name by which the person is commonly known. It includes the names of many 28 The first edition of his work appeared at Bar­ prominent medico-mathematicians who were living celona in 1580, under the title “ Lunari 6 repertori between 1500 and 1600, but the reader is referred del temps compost per Io molt abil astrolec Joan to Sudhoff’s list for a considerable number of minor Alemany.” names. 29 “ Diss. iatromathica in qua de medicinese et as- 27 His “ Canones astrolabii universalis” appeared tronomise prsestantia indissolubili cojugio disseritur,” in its second edition at Salamanca in 1554. Rostochii, 1629. 134 Annals of Medical History an original genius, he is known for two professor of medicine and anatomy at Up- works of some merit.30 sala, gave much attention to astronomy I sa a c B e e c k m a n (1570-1637), a physi­ and physics, and incidentally to mathe­ cian, director of the Latin school at Dor­ matics.34 drecht, wrote “ Mathematico-physicarum F e d e r ig o C om manding (1509-1575), a meditationum,” Traject. ad Rhen., 1644. physician, became mathematician to Duke L a tta n zio B e n a c c i (1499-1572), physi­ Guido Ubaldi of Urbino and to Cardinal cian and professor of astronomy in Bologna, Ranuccio in Rome, but his greatest contri­ and an astrologer of some repute. butions were in his editions of the mathe­ M ic h a e l B e u t h e r (1522-1587), doctor matical works of Ptolemy, Archimedes, of law and also of medicine, professor of Apollonius, Aristarchus, Euclid, Pappus, poetry and also of mathematics in Greifs- and Heron. These were published in Venice, wald, and finally professor of history at Rome, Bologna, Pisa, and Urbino between Strasburg. He contributed slightly to the 1558 and 1592. His edition of Euclid is par­ literature of the circle and the calendar. ticularly well known. H e in r ic h B r u o e u s (c. 1531-1593), was C o p e r n ic u s . See the article. professor of mathematics in Rome, and af­ J u a n B a p t is t a C u rs a , born in Valencia terwards practicing physician as well as in the second half of the sixteenth century, professor of medicine and of mathematics a doctor of medicine, wrote one work on in the University of Rostock. He wrote mathematical astronomy.35 numerous medical works and at least two J oachim C u r t iu s (1585-1742), a prac­ books on mathematical astronomy. ticing physician in Hamburg, edited Tycho Ola u s E n g e l b e r t i B u r e , or B u r ^e u s Brahe’s “ Oratio de disciplinis mathema- (1578-1655), was a physician at the court ticis” (Hamb., 1621) and wrote “ De certitu- of Gustavus Adolphus, but he was also dine matheseos et astronomise” (ib., 1616). much interested in mathematics and was C y r ia q u e d e M a n g in (c. 1570-1642), a one of the pioneers in mechanical computa­ Paris physician, published his “ Problemata tion.31 duo nobilissima, quorum nec analysin geo- B a l d a ss a r e C a p r a (d. 1626) was a prac­ metricam videntur tenuisse J. Regiomon­ ticing physician at Milan, but his interests tanus et P. Nonius,” etc., in Paris in 1616. were rather in mathematical astronomy.32 F e d e r ig o D e l f in o (1477-1547), a physi­ He was a bitter antagonist of Galileo.33 cian in Venice, became professor of astron­ F acio C ardano (1444-1524), professor omy in the University of Padua, his native of medicine and jurisprudence in Milan, town. His mathematical work is seen in his edited Bishop Peckham’s “ Perspectiva “ Annotationes in Tabulas Alphonsinas.” communis.” He was the father of Cardano J o seph S olomon D elm ed ig o (1591— the algebraist. 1655), a native of Candia, a graduate of G iro lam o C a rd a n o . See the article. Padua, a student under Galileo, a cabalist J ohann C hesnecopherus (1581-1635), in Constantinople, physician to Prince Rad- 30 “ Annuli astronomici instrumenti . . . usus,” 33 So we have Galileo’s “ Difese contra alle ca- Antverpise, 1553; “Arithmetices praxis” Lovanii, Iumnie e imposture de Baldassare Capra,” Venezia, 1573- 1607. 31 “ Arithmetica instrumentalis Abacus ab eo ipse 34 E.g., in his “ De stellis,” and his “ De eclipsi inventus,” Helmst., 1609. solis et Iunee,” Upsala, 1624. 32 “ Considerazione astronomica sopra la nuova 35 “ Discvrso mathematico sobre la natvraleza y Stella del 1604,” Padova, 1605; “ Tyrocinia astro­ significacion de Ios cometas . . . de 1618; Com- nomica,” ib., 1606; “ De usu et fabrica circini cujus- puesto por el doctor Iuan Baptista Cursa, Filosopho dam proportionis,” ib., 1607. y Medico Valenciano,” Valencia, 1619. M ed icin e and M athem atics in th e S ix t een t h C en t u r y *35

ziwill at Vilna, a Rabbi at Hamburg, a T homas F in k e , or F in c k (1561-1656), physician in Amsterdam, and a prolific was court physician to the Duke of Schles­ writer on medicine and mathematics.36 wig-Holstein, and afterward professor of J ohann D r y a n d e r , or E ich m an n (15 0 0 - medicine (1591), of mathematics (1602), 1560), was professor of medicine and mathe­ and of rhetoric in the University of Copen­ matics at the University of Marburg (1535). hagen. His mathematical work also led him He wrote several works on mathematical into the field of astronomy.42 astronomy. J acob F lach (1537-1611) was professor T h ad daus D u n u s, or T addeo D uno of medicine and of mathematics at the Uni­ (1523-1613), was a Zurich physician, born versity of Jena, but he seems to have con­ in Locarno, but he is known only for his tributed nothing to the literature of either two rather obscure mathematical works.37 science. L o r en z E ic h stad t (1596-1660), profes­ E ra sm u s F lo c k (1514-1568), a physician sor of medicine and mathematics in the of Niirnberg, was for a short time (1543- Gymnasium at Danzig, published several 1545) professor of philosophy and mathe­ works on mathematical astronomy. matics in the University of Wittenberg. S a m u e l E is e n m e n g e r , known also as Among his other activities he edited Ptol­ Siderokrates (1534-1585), a practicing phy­ emy’s ‘‘Almagest” (Norimb., 1550). sician, was professor of mathematics at the S imon F orm an (1552-1611), a physician University of Tubingen.38 and an astrologer in London and the author P a u l F a b r ic iu s (1529 or 1519-1588), a of various works on alchemy, magic, and physician of high standing, a professor in astrology. the University of Vienna, was known chief­ G ero nim o or G iro lam o F racasto ro ly for his mathematical tables for use in (1483-1553), a physician in Verona, was astronomy.39 afterwards Papal physician. He wrote on J e a n F e r n e l . See the article. medicine, but also was interested in the A u g e r F e r r ie r (1513-1588), physician mathematics of optics and seems to have to Catharine de Medici, queen of Henri II had some idea of the telescope.43 of France, was quite as much interested in J e a n F ranco (c. 1550-1610), a physician mathematics and astrology as in medi­ of Brussels, wrote an ephemeris of astrolog­ cine.40 ical character, in Flemish, and this was pub­ F ie n u s , or F y e n s (1567-1631), professor lished at Antwerp in 1594. of medicine at Louvain, writer upon medi­ L o ren z F r ie s (c. 1485-1531), a promi­ cal matters, was also known as an astrono­ nent iatromathematician, author of the mer.41 “ Spiegel der Arznei” (1518) and of a work on the astrolabe. He remarks that “ medi- 36 For example, the “ Refuath Tealah” (Healing medicine); “ Or Shibat Ha-yamim” (the Light of the Seven Days) including some discussion of op­ 39 “ Tabulae astronomicae,” Vienna, 1558. tics; “ Bosmat Bat Schelomoh” (Bosmat, daughter 40 “ De diebus decretoriis secundum Pythagori- of Solomon), on mathematics and related subjects; cam doctrinam et astronomicam observationem,” and “ Elim” (Amsterdam, 1629), a work containing an­ Lugduni Batavorum, 1541. swers to various scientific questions propounded by 41 “ De cometa anni 1618,” Antv., 1619. Zerakh ben Nathan and seventy mathematical para­ 42 “ De constitutione philosophiae mathematicae,” doxes. Hafniae, 159 1; “ Geometriae rotundi Iibri X IV ,” Basi­ 37 “ Arithmetices, practices methodus,” Basileae, leae, 1583; “ De hypothesibus astronomicis,” etc., 1546; “ De nonis, idibus et calendis,” ib., 1546. Hafniae, 1593, etc. 38 “ De usu partium coeli in commendationem as­ 43 This is in his “ Homocentricorum seu de stellis, tronomic,” Argentorati, 1567. liber unus,” Venet., 1538. 136 Annals of Medical History cus sine astrorum cognitione perfectus esse professor of mathematics in the University non potest.” of Marburg (1592) and later took his de­ G a l il e o . See the article. gree there in medicine (1606), then becom­ G em m a F r is iu s . See the article. ing professor of chemistry (of “ Chymia- C o r n e l is G em m a F r is iu s (1535-1577), trie”). He was physician at the court of son of the better known Gemma Rainer the Kurfiirst of Hesse.46 (Gemma Frisius), was professor of medicine S ix t u s a b H em m in g a (1533-1581) was and also of astronomy at Louvain. His “ De a physician and mathematician of some arte cyclognomica tomi III, philosophiam prominence in Belgium. He studied in Gro­ Hippocratis, Galeni, Platonis et Aristotelis ningen, Coin, Louvain, and Paris.47 in unam methodi speciem referentes” G eo rg H e n isc h (1549-1618), of Hun­ (Antv., 1569) is well known, and he also garian birth, was a physician and after­ wrote two astronomical works. wards taught logic and mathematics at S imon G r y n e u s the Younger (1539- Augsburg. He wrote numerous works on 1582) was professor of medicine and of mathematics,48 philology, and medicine. mathematics at Heidelberg. His father D a v id H e r l ic iu s (1557-1636), also published the first Greek edition of Ptol­ known as Herlick and Herlitz, a physician, emy’s “Almagest” (Basil., 1538), and was a was professor of mathematics in the Uni­ friend of Luther and Melanchthon. Simon versity of Greifswald from 1585 to 1598. the Younger wrote a work on astronomy,44 He wrote upwards of fifty works, chiefly published in Basle in 1580. on astronomy. I s a a k H a b r e c h t (d. 1633) was a doctor J oachim J ung (1587-1657), professor of of philosophy and of medicine. In his later mathematics at Giessen (1609-1614), of years he became an assistant in mathe­ medicine at Padua (1618), of mathematics matics in the University of Strasburg. He at Rostock (1624-1625), of medicine at published various works of an astronomical Helmstadt (a few months), and again of nature. mathematics at Rostock, alternated as few T h ad d aus H a g e k (15 2 5 -16 0 0 ), also men do between his two favorite sciences. known as Hajek, or Hagecius ab Hayck, His writings cover a wide range, including and as Thaddseus Nemicus, was for a long mathematics,49 astronomy, physics, and bot­ time professor of mathematics in the Caro- any. Iinum at Prague, but later was physician to L il io . See the article. Maximilian II and to Rudolph II. He J o hann M a r c u s M a r c i d e K ro n lan d wrote several works on geometry and as­ (i 595~i 667), for more than forty years pro­ tronomy.45 fessor of medicine at Prag, physician to Em­ M uh am m ed ib n I br a h im ib n JCtsuf, peror Ferdinand III, wrote quite as much, R ad! ed -d in A b I j ‘A b d a l l Ah (d. 1563), known as Ibn el-Hanbal!, a native of Alep­ 46 His sole printed work on mathematics was his “ Disputatio elementorum geometricorum,” Cassel, po, a man well versed in medicine, law, and 1600, but he wrote on medicine and chemistry. mathematics, wrote various works on geom­ 47 He wrote “ Astrologiae ratione, et experientia etry and arithmetic. refutatae liber,” Antverpiae, 1583. J ohann H a rtm a n n (1568-1631) was 48 “ De numeratione multiplici, vetere et recenti,” Aug. Vind., 1605; “ Arithmetica perfecta et demon­ 44 “ De cometis dissertationes novae.” strata,” ib., 1605; “ Commentarius in sphseram Pro- 45 Among them, “ Oratio de Iaudibus geometriae,” cli,” ib., 1609; and others. Pragae, 1557; “ Apodoxis physica et mathematica de 49 “ Geometria empirica,” Rostochii, 1627, with cometis turn in genere, turn imprimis de eo, qui later editions; “ Disputatio de Stoecheosi geometrica,” 1580 . . . affulsit,” Gorlicii, 1581. Hamb., 1634. M ed ic in e and M ath em atics in th e S ix t een t h C en t u r y 137 in a somewhat heterodoxical fashion, on L eo nardo da V in c i. See the article. mathematics as on medicine.50 A dam L o n ic e r u s, or L o n it ze r (1528- P h il ip s v a n L a n s b e r g (1561-1652), a 1586), was professor of mathematics at physician and priest at Antwerp and else­ Niirnberg in 1553 and the following year where, devoted his energies chiefly to he received his doctor’s degree in medicine mathematics51 and astronomy. His “ Opera at Mainz. He wrote on botany, medicine, omnia” appeared at Middelburg in 1663. and mathematics.54 W il h e l m L a u r e m b e r g (1547-1612) was M a n g in . See Cyriaque de Mangin. professor of mathematics and medicine at S imon M a r iu s , or M a y e r (1570-1624), Rostock and wrote on both sciences.52 studied astronomy under Tycho Brahe and P e t e r L a u r e m b e r g (1585-1639), son of Kepler and then took a course in medicine Wilhelm, was even more versatile than his at Padua. His contributions were all in the father, for he studied medicine in Leyden, line of mathematics, including astronomy.55 was professor of philosophy in Montauban, M a y e r . See Marius. of medicine in Montpellier, of physics and M e t iu s . See the article. mathematics in Hamburg, and of poetry C h r isto ph M e u r e r (1558-1616), a mem­ at Rostock. He wrote on astronomy, mathe­ ber of the medical faculty and professor of matics, physics, and various other disci­ mathematics at the University of Leipzig.58 plines, and his influence was what would be J acob M ilic h (1501-1559), or Milichius, expected from one who scattered his ener­ professor of medicine in the University of gies so recklessly. Wittenberg, also taught mathematics there. J o hann W il h e l m L a u r e m b e r g (1590- His commentary on Pliny contains more or 1658), a younger brother of Peter, divided less of astronomy. his interests almost as disastrously. He re­ B u r c k h a r d M ith o b (1504-1565) was ceived his doctor’s degree in medicine at professor of mathematics and of medicine Rheims in 1616, was professor of poetry in the University of Marburg.57 and mathematics at Rostock (1618) and of A n to in e M iza u ld (c. 1520-1578), a prac­ mathematics in the Ritteracademie at So- ticing physician in Paris, wrote a number roe (1623). His writings were chiefly if not of works on mathematical astronomy. wholly mathematical, but not of a high H e n r y d e M o n a n t h e u il, or M onantho- character.53 l iu s (1536-1606), professor of medicine H e in r ic h L a v a t e r (1560—1623), a phy­ (1574) and later (1585) of mathematics in the sician, was professor of physics and mathe­ College royal of France, at Paris. He was a matics in Zurich, the city of his birth. His writings were chiefly on physics and as­ 63 “Logarithmus,” Lugduni Batav., 1628; “Lusus tronomy and were of no particular merit. et recreationes ex fundamentis arithmeticis,” Havn., 1634; “Arithmetica et algebra,” Soroe, 1643; “ In- 50 For example, “ De proportione motus,” Pragae, strumentum proportionum,” etc. Rostochii. 1639, “ De proportione motus figurarum rectilinearum 54 “ Arithmetices brevis introductio,” Francof., et circuli quadratura ex motu,” ib., 1648; “ De Iongi- 1531. tudine s. differentia inter duos meridianos; una cum 85 Among his works were “ Die ersten sex Bucher motu vero Iunae inveniendo ad tempus datae obser­ elementorum Euclidis,” Niirnberg, 1610; “ Hypothe- vations,” ib., 1650; “ Labyrinthus in quo via ad circuli ses de systemate mundi,” 1596. quadraturam pluribus modis exhibetur,” ib., 1654. 56 He wrote “ Analysis arithmetic;® et geometriae ta- 51 “ Triangulorum geometriae, Iibri quatuor” Lug- bulis succinctis,” Lipsiae, 1607, and edited the arithme­ duni Batav., 1591 and Amstelod., 1631; “ Cyclome- tic of Psellus and the optics and catoptrics of Euclid. triae novae Iibri duo,” Middelb., 1616-1628. 57 He wrote “ Annuli cum sphaerici, turn mathe- 52 Among other works he wrote a “ Breviarium geo- matici usus et structura,” Marp., 1536; “ Stereo- metricum et geodaeticum.” metria,” Francof., 1544. 138 Annals of Medical History pupil of Ramus’s. He wrote various works G e r a r d d e N e u f v il l e (d. 1648), pro­ on mathematics and iatromathematics.58 fessor of mathematics and physics (1611) J e a n B a p t is t e M o rin (1583-1656), phy­ in the Gymnasium at Bremen, and later sician to the Bishop of Boulogne and other (1624) of medicine, wrote on mathematics,63 notables, became professor of mathematics astronomy, and physics. at the College royal in Paris in 1630. He A u g u st in u s N iph u s (1473-1546), a phy­ was a voluminous writer, his interests includ­ sician and astrologer in Suessa, Calabria, ing geology, astronomy, theology, astron­ published in 1504, in Venice, an astrological omy, and mathematics.59 work in which he endeavored to combine J o a n n es M o r iso t u s, a physician of the observations of the physician with about the middle of the sixteenth century, those of the astronomer. wrote among other works four books on A ntonio N u n e z d e Z am o ra, a native of arithmetic^60 Salamanca or Zamora, born in the second J acob M u l l e r (1594-1637) was pro­ half of the sixteenth century, lectured at fessor of mathematics (1618) and of medi­ the University in that city on medicine, cine (1620) in the University of Giessen, mathematics, and astrology.64 and later of both mathematics and medi­ P edro N u n e z S a l a c ie n s e (1492-1577) cine at Marburg. He wrote chiefly on mathe­ studied medicine in Lisbon, but gave his matics.61 attention thereafter entirely to mathemat­ M u l l e r . See also Mulerius. ics. He became one of the leading Portu­ N ic o la u s M u l e r iu s (1564-1630), also guese mathematicians of the sixteenth cen­ known as Mulierius, Muliers, and Muller, tury, writing several treatises of consider­ a Dutch physician, was professor of mathe­ able merit.65 matics at the University of Groningen H e r m a n n O b e r m e y e r (1588-1655), a (1614-1621). He wrote a number of works Basle physician, became professor of mathe­ on mathematical astronomy. matics in the University of Basle in 1630. P ie t e r M u l e r iu s (1599-1647), son of His writings were astrological and astro­ the preceding, was a physician and became nomical and were of no value. professor of physics and botany at Gronin­ P e l e t ie r . See the article. gen (1629). He wrote on mathematical as­ K a s p a r P e u c e r (1525-1602) was pro­ tronomy, continuing the Ephemeris begun fessor of mathematics (1554) and then by his father. (1560) of medicine in the University of Wit­ M ic h a e l N e a n d e r (1529-1581) was pro­ tenberg. His position as son-in-law of Me- fessor of mathematics and Greek (1551) in Ianchthon probably gave him more stand­ the University of Jena, and later (1560) ing than would otherwise have been his. professor of medicine.62 62 His “ Synopsis mensurarum et ponderum pon- N e m ic u s. See Hagek. derationisque mensurabilium secundum Romanos, 68 “ Oratio pro mathematicis artibus,” Parisiis, Athenienses,” etc., was published at Basle in 1555. 1574; “ Ludus iatromathematicus,” ib., 1597; “ De He also wrote “ Elementa sphaericse doctrinse,” ib., puncto, primo geometric principio,” Lugduni Bat., 1561. 1600, etc. 63 “ Arithmetica theoretica et practica,” Bremse, 59 “ Trigonometric canonic® Iibri tres,” Parisiis, 1624. 1633. 64 He published two works, the first being “ Prog- 60 Heilbronner, “ Historia Matheseos Universe,” nostico del eclipse del sol que se hizo en ano de 1600,” Lipsiae, 1742, p. 789, quoting Vossius. Salamanca, 1600. 61 “ Compendium geometricum,” Gissae, 1620; 65 Among them, “ Libro de algebra en Arithmetica “ Praxis geometriae universalis,” ib., 1621; “ Arith- y Geometria,” Amberes, 1564-1567; “ Tratado de metices compendium,” Lipsiae, 1631. sphera,” Lisboa, 1537. M e d ic in e and M ath em atics in th e S ix t ee n t h C e n t u r y 139

He was also physician at one of the small P e t e r R y f f (1552-1629) was a practic­ courts. He wrote various works on medi­ ing physician in Basle and became professor cine and mathematical astronomy.66 of mathematics (1586) in the university. He J u a n M a r t in P o bla c io n , a native of wrote several works on mathematics.71 Valencia, took high rank as a physician and F ra n cisco S a n c h ez (1550-1623), born astrologer in the sixteenth century. He at Tuy in the diocese of Braga, a Spanish wrote two works on the astrolabe, one of physician, lived for some time in Mont­ which exists only in manuscript.67 pellier where he was engaged in the prac­ C r ist o b a l P o nce d e L eon (d. 1598) was tice of his profession, finally settling in professor of medicine and also of mathe­ Tolosa. He wrote one work on mathe­ matics in Alcala.68 matics 72 and one on astronomy. He should R a in e r or R a in ie r . See Gemma Frisius not be confused with the great humanist in the article. of the same name, who was born at Brozas R e c o r d e . See the article. in 1523. R e g n ie r . See Gemma Frisius in the ar­ G iu s e p p e S cala (1556-1585), a Sicilian ticle. physician, composed a set of astronomical A m br o siu s R hodius (1577-1633), pro­ tables which was published four years after fessor of mathematics in the University of his death.73 Wittenberg (1608) and author of various V ic to rin S ch o n feld (1525-1591) re­ works on optics, astronomy, and geome­ ceived the degree of doctor of medicine at try,69 gave also much attention to medi­ Marburg in 1557, became professor of cine. There seems to have been another of mathematics in the same university in 1557, the same name, a contemporary, who was and in 1566 became professor of medicine. also interested in medicine and mathe­ He wrote on medicine, mathematics, and matics. astrology.74 G io va n n i A ntonio R o f f e n i (d. 1643), a J acob S ch o n h ein z, one of the earliest doctor of medicine, became professor of iatromathematicians of Germany, and the mathematics in Bologna, but his works earliest in the sixteenth century, published were astronomical and astrological only.70 his “ Apologia astrologiae,” at Niirnberg, A d r ia e n v a n R oom en. See the article. in 1502. J ohann S c h ro ter (1513-1593), a Vien­ 66 Among the latter, “ Elementa doctrin® de cir- nese practitioner, physician to the Imperial culis coelestibus et primo motu,” Viteb., 1551, with various editions; “ De dimensione terr® et geome- and Saxon courts, wrote various mathe­ trice numerandis Iocorum particularium intervallis matical works.75 ex doctrina triangulorum sph®ricorum,” ib., 1554, M ig u e l S e r v e t o (c. 1511-1553), one of with later editions. 67 The published work was entitled “ De vsv as- 71 Among them, “ Questiones geometric® in Eucli­ trolabi,” and appeared in Paris in 1526 and 1527, dis elementa,” Francof., 1600; “ Compendium arith­ later editions in 1546, 1547, 1550, 1553, 1554, and metic® Vrstisii,” Oxoni®, 1626; “ Elementa sph®r® 1556. The unpublished manuscript is a “ Tratado y mundi,” ib., 1627. uso del astrolabio” and is in the Biblioteca Nacio- 72 “ Objectiones & erotemata super Geometricas nal at Madrid. Euclides demonstrationes ad Christopherum Cla- 68 He wrote “ Libro de la ciencia natural del cielo,” vium.” Alcala, 1598. 73 “ Ephemerides ex tabulis Magini,” Venetiis, 69 “ Euclidis elementorum Iibri X I I I ,” Viteb., 1609, 1589. 1634. 74 Among his works are a treatise on epilepsy 70 “ Contra caecam cujusdam Martini Horckii,” (Marburg, 1577) and the “ Prognosticon astrologi- Bononi®, 16 11; “ De Iaudibus v e r® astrologiae,” ib., cum,” which appeared for various years. 1614. 75 Among them, “ De arte numerandi.” 140 Annals of Medical History

the best educated young men of Spain in the works of Albertus Magnus, Vienna the sixteenth century, well trained in Latin, 1523. Greek, Hebrew, philosophy, theology, J e r 6 nimo T o r e l l a , a physician to Fer­ mathematics, and medicine, fell under dinand the Catholic, to Juana of Naples, the ban of the authorities because of his and to other dignitaries in the sixteenth opinions and was executed in his forty- century, was much interested in astrology fourth year. He wrote on geography and and wrote two works on the subject. astrology.76 B arto lo m e d e l V a l l e , a doctor of medi­ Ola u s M a r t in S t e n (1598-1650) was cine in Salamanca, wrote two treatises on professor of astronomy, physics, and medi­ astrology, published in 1619. cine at the University of Upsala. V e sp a s ie n o J ero nim o d e V a r g a s y H e ­ G eo rg T a n s t e t t e r vo n T h an n a u r e d ia , a physician and mathematician, pub­ (1482-1535) was physician to the Emperor lished a “ Tratado de cometas” in Granada Maximilian I, and became professor of as­ in 1619. tronomy in the University of Vienna. He V icto rian o Z a rag o zan a (1545-1602), a edited Peurbach’s ‘‘Tabulae eclipsium,” Spanish physician, was much interested in Regimontanus’s “ Tabulae primi mobilis,” the mathematics of astronomy, and wrote Proclus’s “ Libellum de sphaera,” and several works on the subject, all printed at 76 “ Apologetica disceptatio pro astrologia.” Zaragoza, 1583-1599.

STRUCTURE FOLLOWS FUNCTION

Thus man is the most intelligent of all seen a calf try to gore before its horns had animals, thus the hands are proper instru­ developed, a chicken try to spur although its ments for an intelligent being, since man is feet were soft, and a little pig trying to defend not wiser than the animals because he has itself with its snout, although it had no tusks; hands (as Anaxagoras maintains), but as even a little dog trying to bite without teeth; the judicious Aristotle asserts, he has hands for every animal has in himself, without any precisely because he is the wisest. It is not by previous instruction, an instinctive feeling of means of his hands, in fact, but through his the faculties and functions of his body. . . reason that man learned the arts: the hands It is not through instruction, I opine, that the are an instrument like the lyre to the musician, eagle soars, the duck swims and the snake like the tongs to a blacksmith. . . I f we glides into a hole, for as Hippocrates says: examine newly-born creatures that strive to Animal natures are untaught. Whence it act before the parts of the body are fully formed, seems to me, for the rest, that animals practice it becomes clear that it is not the parts of the certain arts more by instinct than through body which excite the soul to be cowardly, reason. courageous or wise. For example, I have often Galen De usu partium, 1, 3. HISTORICAL DEVELOPMENT OF OUR KNOWLEDGE OF THE CIRCULATION AND ITS DISORDERS1

B y PHILIP S. ROY, M.D.

WASHINGTON, D. C.

HE earliest account of the struc­ blood were seen, according to him, to ex­ ture of the heart is that contained tend from the rudimentary heart to­ in the Hippocratic writings. It is wards the periphery. From these and probably pseudo - Hippocratic, other considerations, Aristotle inferred butT admittedly a work of great antiquity. that both the blood and all its contain­ The heart is described as a strong muscle; the ing vessels owe their first origin to the pericardium as a smooth tunic, containing a heart; and that throughout life the liquid little fluid resembling urine; the auricles, made elsewhere from the food, enters the ventricles, the sigmoid valves and the the heart, there to be perfected into origin of the veins from the heart are men­ blood by the action of the vital innate tioned. The heart is described as the foun­ heat, of which, as we have seen, he held tain-head irrigating all parts of the body, the fiery central hearth to be within the and the left ventricle is held to be the seat heart. Naturally, therefore, he believed of understanding. the blood not to be hot of itself, but to ac­ The first great master dealing with the quire its vivifying heat at the heart, the circulation of whom we have a record is pulsation of which he held to be caused Aristotle, and we constantly find Harvey directly by the seething of the blood referring to him in his great work. Indeed, within. When thus perfected and charged Harvey’s mind seems to have been so im­ with heat, the blood, according to him, pressed by the great masters of antiquity is distributed from the heart through the that in his old age he bade a young student, vena cava as well as the aorta. These “ Go to the fountain-head and read Aris­ great vessels and their subdivisions, Aris­ totle, Cicero and Avicenna.” totle distinguished anatomically, but he From John G. Curtis’s great book, “ Har­ made no serious physiological distinction vey’s Views on the Use of the Circulation between what we call the veins and the of the Blood,” we learn in concise language arteries; and, himself, applied the word what Aristotle knew of the circulation. “ artery” to the windpipe only. As to the cavities and contents of the heart, even “ When an ancient observer looked as to the number of its cavities, he had with the naked eye at the very early em­ obscure, complex, and erroneous ideas, bryo of the fowl, he distinguished at first and of the valves he knew nothing. He only a blood-red point, which pulsated, recognized no essential differences be­ or ‘leapt.’ This, Aristotle judged to be tween the matters distributed by way of the heart containing blood, before any the vena cava and by way of the aorta, blood-vessel had shown itself and before all being, alike, one thing,—blood; blood was visible in any other part. Very though the blood was hotter or cooler, soon, however, two vessels containing thinner or thicker, purer or cruder,t. in 1 Read to the Medical History Club of Washing­ different regions or parts of the body, in ton, D. C., January 27, 1917. different sets of vessels, in different cavi- 142 Annals of Medical History

ties of the heart, or at different times, Therefore, that part of the vena cava in the same place.” 2 which we call the right auricle simply formed a part of the upward pathway of Aristotle, like Plato, knowing nothing of the blood, at a place where some of the the nerves, judges the blood-vessels to be blood left its upward pathway and flowed sensory paths; and blood-vessels connect, through a side opening into the right not only the sensitive flesh, but all the ventricle. Of the fraction of the blood most special sense organs, with the heart. that entered the right ventricle, a part Such is an outline of the reasons why Aris­ went to the lungs simply for their nutri­ totle held the heart to be the life-long seat, tion, by the “ arterial vein”—the pul­ not only of the “ nutritive soul” but of the monary artery of modern parlance—and “ sensory soul” as well. During the Alexan­ a part percolated in a refined condition drian period, Erasistratus (300 B.C.) recog­ through the pores of the septum, from nized the valves, both arterial and auricu­ the right ventricle to the left, to be lar, and believed that they ventilated the worked up there with the vital spirits heart. This was more than four centuries and thus become the basis of the spiritu­ before Galen and more than nineteen cen­ ous blood of the arteries. From the left turies before Harvey. ventricle, this spirituous blood went to Passing from Aristotle to the next great the body at large by way of the arteries. period of medicine, we learn from Curtis There is no evidence that Galen believed the views that Galen held about the heart, any blood to pass from the right to the blood-vessels and the circulating blood. left ventricle otherwise than through the “ According to the more detailed views pores of the septum. As he says, how­ of Galen and his school, the blood was ever, the branches of the ‘venous ar­ perfected and had its central source not tery’ (our pulmonary vein) ‘transmit in the heart but in the liver, to which the thin and pure and vaporous blood in portal vein brought a cruder liquid de­ abundance’ to the lungs for their nutri­ rived from the products of digestion. In tion, we may infer that he held this sup­ the liver, the veins also originated, while ply to be derived from the left ventricle, the arteries originated at the heart. The like that of the rest of the body.” 3 blood left its source in the liver, by way of the roots of the venous system, that Galen seems to have been the first writer is, by the hepatic veins of modern anat­ who positively proved that the blood-ves­ omy. From these it entered the great sels, both veins and arteries, carry blood. venous trunk, the vena cava, a vessel Galen had maintained that the blood which comprised the inferior vena cava, passes from the right to the left ventricle the right auricle, and the superior vena by means of certain hypothetical, invisible cava of our present nomenclature. Upon “ pores.” Vesalius, in 1543, treated this leaving the liver, the blood at once di­ statement in a skeptical or half-credulous vided into two sharply diverging streams, manner. Servetus, in 1553, reasoned that one flowing directly downward through the blood is mixed with air from the lungs the vena cava, the belly, and the lower before passing into the heart. Columbus, extremity; the other flowing directly up­ in 1559, showed, in his vivisections of ani­ ward through the vena cava to the chest, mals, that the pulmonary veins contain the upper extremities, and the head. blood, denied the existence of Galen’s pores, and also held that the blood is cooled and 2J. G. Curtis: “ Harvey’s Views on the Use of the Circulation of the Blood,” New York, 1915, 48. 3 Curtis: op. cit., 56-58. H isto rical D evelo pm en t of Our K now ledge of th e C irculatio n 143 rendered spirituous by mixture with air in the arteries, was distributed to the body the lungs. Sir Michael Foster and others at large and its several parts, in the maintain that Columbus derived his knowl­ same manner as it is sent through the edge from the works of Servetus, and that lungs, impelled by the right ventricle the honor of discovering the pulmonary cir­ into the pulmonary artery; and that it culation belongs to Servetus and not to then passed through the veins and along Columbus. the vena cava, and so round to the left The circulation was but dimly under­ ventricle in the manner already indi­ stood by physiologists until William Har­ cated. And similarly does it come to pass vey on his fiftieth birthday, 1628, in a in the body, through the movement of master-stroke, gave to the world a treatise the blood, that the various parts are which he entitled “ An Anatomical Disser­ nourished, cherished, quickened by the tation Upon the Movements of the Heart warmer, more perfect, vaporous, spiritu­ and Blood-vessels in Animals.” We can not ous, and, I may say, alimentive blood; help regretting that Harvey did not dedicate which, on the other hand, owing to its this great work to a great man, but we find contact with these parts, becomes cooled, it dedicated to Charles I, and this dedica­ coagulated, and, so to speak, effete. It tion concluding with the following words: then returns to its sovereign, the heart, “ Accept, therefore, I most humbly be­ as if to its source, or to the inmost home seech you, most serene King, with your of the body, there to recover its state of wanton kindness and forbearance, this, my excellence or perfection. Here it renews new treatise upon the heart—you who are its fluidity, natural heat, and becomes yourself the new light of this age and in­ powerful, fervid, a kind of treasure of deed its true heart, a prince abounding life, impregnated with spirits, it might with virtue and grace, to whom we will be said with balsam.” gladly refer all the blessings which England Harvey then proceeds with mathemati­ enjoys, all the pleasures in our lives.” cal precision to demonstrate his circulation Aristotle established what Curtis calls theory. He says: “ The primacy of the heart,” regarding it “ Let us assume, either arbitrarily or as the seat of life and the soul, the hearth from experiment, the quantity of blood of animal heat. Harvey gave this primacy which the left ventricle of the heart will to the blood and viewed the heart as only a contain when distended, to be, say two force-pump to keep the blood in motion. ounces, three ounces, or one ounce and It would not be possible in the length of a half—in the dead body I have found this paper to give all of Harvey’s disserta­ it to hold upwards of two ounces. Let us tion on the circulation of the blood, prov­ assume further, how much less the heart ing that it is “ a movement, as it were, in a will hold in the contracted state than in circle.” Harvey said he became convinced the dilated state; and how much blood it that “ the veins on the one hand would be­ will project into the aorta upon each con­ come drained, and the arteries on the other traction;—and all the world allows that ruptured through excessive charge of blood with the systole something is always pro­ unless the blood should somehow find its jected; a necessary consequence, and ob­ way from the arteries into the veins and so vious from the structure of the valves; return to the right side of the heart.” He and let us suppose as approaching the continues, truth, that the fourth or fifth or sixth, or “ I finally saw that the blood, forced even the eighth part of its charge is by the action of the left ventricle into thrown into the artery at each contrac­ 144 Annals of Medical History

tion; this would give either half an ounce, who also popularized the use of letters to or three drachms, or one drachm of blood, denote algebraic quantities. The sign of as propelled by the heart at each pulse equality was devised by Robert Recorde in into the aorta; which quantity, by rea­ “The Whetstone of Witte” (1557), the first son of the valves at the root of the ves­ English treatise on algebra; the sign of divi­ sel, can by no means return to the ven­ sion was not employed in England before tricle. Now in the course of half an hour, 1668, and the sign of inequality much later. the heart will have made more than one In 1640, Harvey’s discovery was given a thousand beats, in some as many as two, hydrodynamic proof in the celebrated “ ex­ three, or even four thousand. Multiply­ periment of Walseus,” viz., that incision in ing the number of drachms propelled by a ligated femoral vein causes the blood to the number of pulses, we shall have spurt in streams from the distal opening and either one thousand half-ounces, or one to ooze in drops from the proximal opening. thousand times three drachms, or a like In 1660, Malpighi demonstrated the cap­ proportional quantity of blood, accord­ illary circulation. Of his discovery of the ing to the amount which we assume as capillaries, Fraser Harris has well said, propelled with each stroke of the heart, “ Harvey made their existence a logical sent from this organ into the artery; a necessity, Malpighi made it a histological larger quantity in every case than is certainty.” contained in the whole body! Upon this supposition, therefore, assumed merely as ANATOMY AND PHYSIOLOGY a ground for reasoning, we see the whole Leonardo da Vinci made the most accu­ mass of blood passing through the heart rate and beautiful drawings of cardiac struc­ from the veins to the arteries, and in like ture of his time. As with Henle, many of manner, through the lungs. But let it be his drawings are architectural in charac­ said that this does not take place in half an ter, bringing out the idea of plan and ele­ hour, but in an hour, or even in a day; any­ vation. The valves are drawn from many way it is still manifest that more blood angles, from above downwards and other­ passes through the heart in consequence of wise, and their relations in three dimen­ its action, than can either be supplied by sions are clearly shown. In one drawing, the the whole of the ingesta, or than can be con­ whole valve is dissected from the underly­ tained in the veins at the same moment.” ing muscle and unrolled in a single plane, If Harvey had expressed these facts in showing its finer structure in a sort of terms of algebra, the scientific world would Mercator’s projection (Arnold Klebs).7 have soon come around to our own view Leonardo understood clearly that “ the that his experiments led him to a mathe­ heart is a muscle, the first in strength and matical or quantitative demonstration of the the most potential among the other mus­ circulation.4 But Smith shows that the plus cles.” His drawings and physiological in­ and minus signs were first introduced in vestigations of the heart were far superior the arithmetic of the Bohemian physician to those of Vesalius. He was the first to de­ Johann Widman (1489),5 and Cajori tells lineate the muscular bands which pass from us 6 that these did not come into general the ventricular walls to the septum, now use before the time of Vieta (1540-1603), 6 F. Cajori: “ History of Mathematics,” New 4 Garrison: “ History of Medicine,” Phila., 2 ed., York, 1897, 150-151. 1917, 234. 7 A. C. Klebs: Boston Med. & Surg. Jour., 1916, 5 Smith: “ Rara Arithmetica,” Boston, 1908, 39. C L X X V , 1; 45, with many illustrations. H isto rica l D evelo pm en t of Ou r K now ledge of th e C irculatio n 14$

described as “ moderator bands,” structures with Lothar Meyer, he investigated the which contain branches of the auriculo- gases of the blood. In 1866, with Cyon, he ventricular bundle of His. investigated the effect of temperature on In 1733, Stephen Hales, an English the heart beat, discovered the depressor clergyman, invented the first manometer nerve of the heart and the erector nerves of or tonometer—a long glass tube fastened the peripheral vessels. In 1867, with Do- inside a horse’s artery; and with this rude giel, he measured the movement of blood instrument made the first measurements of passing in a unit of time, by means of the blood pressure in connection with the ca­ current-clock (Stromuhr). In 1869-70, he pacity of the heart and the velocity of the had Brunton and Schmiedeberg study the blood current.8 The next step was taken by effects of drugs upon the circulation, which Poiseuille, who in 1828 invented the hemo- was the starting point of the pharmacologi­ dynamometer, with which he showed the cal careers of these two distinguished men. relation of blood pressure to respiration, In 1871, his pupil, Bowditch of Boston, de­ and measured the degree of arterial dilata­ duced “ the all or nothing law,” viz., that tion at each heart beat. In 1847 Carl Lud­ the heart muscle will always give a maxi­ wig connected Poiseuille’s instrument with mal contraction, or none at all. In the same a revolving cylinder and thus invented the year Kronecker showed that the heart kymograph and introduced the graphic muscle can not be tetanized. In 1871-73, method into physiology. In 1840 Poiseuille with Dittmar, Ludwig located the vasomo­ stated the celebrated mathematical law or tor center in the medulla. In 1875, with formula for estimating the viscosity of the von Kries, he measured the blood pressure blood and invented the viscosimeter for in the capillaries. In 1880, with Schmidt this purpose. The inhibitory power of the Miilheim, he inaugurated the study of the vagus nerve was discovered by the Weber effect of the injection of peptones into the brothers in 1845, but, in 1870-71, Ludwig blood. In 1883, his pupil Wooldridge be­ and Schmiedeberg showed that the vagus gan the study of the chemistry of coagula­ contains accelerator as well as inhibitory tion of the blood. In 1884, another pupil, fibers. Nearly all our recent knowledge of Gompertz, studied the arrangement of the the physiology of the circulation came orig­ muscular fibers in the heart.9 inally from the laboratory of Ludwig, who The most important work of recent times was once defined as “ the only physiologist on the physiology of the circulation is that who ever did anything.” He invented the of Gaskell, who, in 1882-85, investigated graphic method, the kymograph, the blood the vasomotor nerves of the blood vessels, pump and the Stromuhr or blood current in Ludwig’s laboratory. This research was clock, and devised the method of perfusion the starting point of Gaskell’s great work of excised organs, which has played such a on the vagus nerve, which he showed to be prominent part in physiological experimen­ quiescent rather than inhibitory in its ef­ tation up to the time of Carrel. In 1848, fects upon the heart. The researches of Gas­ Ludwig discovered the ganglionic cells in kell and Engelmann brought out the im­ the auricular septum. In 1850, with Noll, portant fact that the heart muscle is auton­ he showed that the lymph is produced by omous and automatic in its action, its the diffusion of fluids from the blood contractions being regulated to some ex­ through the walls of the capillary vessels tent by the nerves but not caused by them. into the surrounding tissues. In 1857-8, Gaskell invented the term heart-block, pro- 8 Garrison: “ History of Medicine,” 2 ed., Phila., 9 Garrison: “ History of Medicine,” 2 ed., Phila., 1917, 317. 1917, 590-59U 146 Annals of Medical History duced it experimentally and explained its rected by Hammaersten, who showed that causes. Around the name of Gaskell we coagulation is caused by the splitting up of naturally group Waller, Kent, Keith and the fibrinogen and other substances (1875). Flack, His and Tawara. It was Gaskell The role of the hormones, antithrombin and who explained the significance of the cele­ thromboplastin, in the coagulation of the brated “ experiment of Stannius,,, viz., that blood, was investigated by Howell of Bal­ a ligature at the junction of the auricle and timore in 1911 and subsequently. Howell the sinus venosus will stop the heart, while has also investigated the effect of increased a second ligature applied to the auriculo- venous pressure of the heart (1881), the ventricular groove will cause the ventricle life history of the blood corpuscles (1890), to beat again. By means of the polygraph and other problems connected with the cir­ and the string galvanometer Sir James Mac­ culation. His teacher, Newell Martin, also kenzie, Thomas Lewis and other clinicians specialized in the circulation, and studied have made many obscure diseases of the the effect of variations of blood pressure heart stand out as individualities. Cushny and temperature upon the rate of heart used electrocardiograms in checking up beat. Two other American physiologists, the effects of digitalis, and it is now well Stewart of Cleveland, and Porter of Har­ recognized that this drug is a positive dan­ vard, have also made extensive investiga­ ger in certain conditions of the heart. tions in the circulation. In 1880, Sidney Among these may be mentioned angina Ringer of Norwich, England, began to ex­ pectoris, due to changes in the coronary periment with the effects of mixtures of arteries, and heart-block, unless complete. the chlorids of sodium, potassium, calcium The elucidation of the vasomotor mech­ and magnesium in keeping the heart beat­ anism was one of the great triumphs of ing outside the body for a long period of Claude Bernard (1851-3). The anatomical time. These experiments evolved the ideal studies of the heart’s innervation were Ringer’s “ solution” for this purpose, and made by Henle (1841), by Bidder who dis­ showed the importance of calcium salts in covered the ganglionic cells at the auriculo- the maintenance of tissue activity, and ventricular juncture (1852), and by Bezold gave Carrel the means for his remarkable who demonstrated the accelerator nerves and work in experimental surgery, in particular their origin in the spinal cord. The sphygmo- his investigations of the latent life of ar­ graph was invented by Marey (i860). teries (1910), the preservation of portions The first correct investigation of the true of blood-vessels in cold storage for long nature of coagulation of the blood was periods before using them in transplanta­ made by William Hewson in 1771. He tion, and the vast improvements in the showed that, when coagulation is delayed surgery of the vascular system which re­ by chemical means, coagulable plasma can sulted from this technic. be separated from the corpuscles and skimmed off, and that this contains an in­ H E A R T SO UN D S 10 soluble “ coagulable lymph,” which is our Harvey thought that the ebullition of present fibrinogen. This discovery was con­ hot blood distends the auricle, and that firmed by Andrew Buchanan, who extract­ the distention of the ventricle through con- ed fibrin ferment in 1845. This name was given to the substance by Alexander 10 The history of the heart sounds has been inves­ tigated by G. Joseph in the older Janus (Gotha, Schmidt, who supposed that coagulation 1853, II, 1; 345; 565) and latterly by Leonard Hill was due to the combination of fibrinogen in Schafer’s “ Text-Book of Physiology,” Edinb. & and serum globulin. This error was cor­ Lond., 1900, II, 28-33. H isto rica l D evelo pm en t of Our K now ledge of th e C irculatio n 147

traction of the auricle causes the heart­ glison, in 1856, tabulated the views ex­ beat. He said further that, ‘‘When there is pressed up to his time in order to show the delivery of a quantity of blood from what bewildering discordance of opinion the veins to the arteries, a pulse takes place existed.13 Sandborg,14 in 1881, tabulated no and can be heard within the chest.” He less than forty different theories. Before compared this sound to the noise made by the time of Skoda, the French clinicians a horse swallowing. This view was natural­ made no distinction whatever between ly opposed by all the opponents of Har­ heart sounds and heart murmurs, describ­ vey’s theory of the circulation, and one of ing either indifferently as “ bruit” Skoda these, iTmilius Parisanus, a Venetian phy­ cleared up much obscurity by making a sician, declared that the sound described clean-cut distinction between a “ sound” could not be heard at all, or at least “ only and a “ murmur.” C. J. B. Williams, in in London.” Lancisi, Senac, Haller and 1836, showed that the first sound can be others refer to a pulsus cardis, however, heard in the excised heart, even if the auric- which could be heard as well as felt, but uloventricular valves be held open with even Corvisart made no distinction what­ the fingers.15 Ludwig and Dogiel, in 1868, ever between the sound and the impulse, found that the first sound continued, al­ since he only approached his ear to the most unaltered, after successive ligation of chest when he could not sufficiently distin­ the venae cavae, the pulmonary artery and guish the beats by laying his hand upon vein, and the aorta.16 This experiment en­ the thorax. Laennec was the first to note tirely overthrew the view that the first that the heart sounds can be heard in the sound was of simple valvular origin. Schae­ vicinity of the heart, that there are two fer says that the valves can be held back successive sounds, the first dull and longer, by hooks or the finger, yet a systolic sound the second shrill and shorter, separated by continues. A large number of physiological a momentary rest, in the musical sense of experiments of this kind produced the most the term. He ascribed the first sound to the conflicting views as to the origin of the first ventricular contraction, the second to the heart sound, but the difficulty was settled auricular contraction, and he compared the when Einthoven and Geluk, in 1894,17 reg­ latter to the sound made by a dog in lap­ istered the effect of the heart sounds on a ping up water.11 In 1829, A. Turner point­ microphone circuit, by means of a capillary ed out that the second sound occurred not electrometer; the movements of the elec­ at the end but at the beginning of the di­ trometer being photographed on a moving astolic pause, and hence could not be de­ sensitized plate. These photographs showed rived from the auricular systole.12 From this clearly that the sounds are compounded of date, a perfect flood of opinions and con­ several tones, each sound giving rise to a troversies arose as to the cause of the heart succession of vibrations of the mercury sounds. Corrigan, Burdach, Magendie, 13DungIison: “ Human Physiology,” Phila., 1856, Piorry, C. J. B. Williams, Bouillaud, Skoda, I, 140. (Leonard Hill.) Cruveilhier, Barth, Roger, Purkinje, Valen­ 14 Sandborg: “ Resume des etudes sur Ies bruits tin, Hamernik, Canstatt—to mention du coeur,” Christiania, 1881, 6 (Leonard Hill). only a few outstanding names—all venti­ 16 Williams: Rep. Brit. Ass. Adv. Sc., Lond., 1836, lated opinions more or less erroneous. Dun- 269 (Leonard Hill). 16 Ludwig and Dogiel: Ber. d. k. sacbs. Gesellscb. d. 11 Laennec: “ De I’auscultation mediate,” Paris, Wissenscb. Math.-Nat. Cl., Leipz., 1868, XX, 89 1819, II, 210. Cited by Leonard Hill. (Leonard Hill). 12 Turner: Tr. Med.-Cbir. Soc., Edinb., 1829, 226. 17 Einthoven and Geluk: Arcb. f. d. ges. Physiol., Cited by Leonard Hill. Bonn, 1894, LVII, 617 (Leonard Hill). 148 Annals of Medical History meniscus. The same method has been ap­ as a definite cardiac affection. Galen re­ plied to the second sound of the heart, and gards it as a general weakening disease af­ the conclusion is that neither sound is sim­ fecting both heart and stomach. Alexander ple, but each is formed of many component Trallianus and Aetius, the last to mention tones caused by the sudden tension and it, describe it as a gastric disorder. The vibration of the cardiac muscles of the auric- treatment was roborant, and wine the uni­ uloventricular valves, and of the blood, versal remedy, in all the old authors. After augmented by the stroke of the heart beat­ Alexander Trallianus (6th century B.C.) all ing against the chest wall. The constit­ trace of it disappears for six centuries. uent tones of the second sound of the Huxham thought it a nervous fever with heart arise from vibrations of the valves colliquative sweating and chills. Bonet de­ and of the blood columns and the arterial scribes a case (from Zacutus Lusitanus) of walls. syncope cardiaca from a worm or polyp in A third sound of the heart was noted by the heart. Hecker, in his treatise on the E. Barie in 1893, again by A. S. Hirsch- English sweating sickness (1834) regards it felder (1907), and elucidated by Einthoven, as an analogue of this disease (miliary A. J. Gibson and William S. Thayer in fever). In 1835, Seidlitz, of St. Petersburg, 1907. identified it with “ exudative pericarditis.” Landsberg, in his study of 1847, regards it CLINICAL AND PATHOLOGICAL INVESTI­ as a secondary anemia. The symptoms he G A TIO N S 18 enumerates also bear some resemblance to Up to the time of Hippocrates (460-377 those of leukemia.19 At all events, it was B. C.) it was held that the heart could not not an idiopathic disease of the heart. be diseased. Herophilus and Erasistratus, of In 1555, Vesalius diagnosed aortic aneu­ the Alexandrian school (300 B.C.), showed rism of the abdominal and thoracic aorta in the synchronism of the pulse and the heart the living, and proved by opening the chest beat, and likened the heart to a pump. of a strapped animal that a quiescent Galen (131-210 A.D.) expanded the pump heart may be resuscitated by the use of analogy, showed that the arteries contained bellows. In 1534 Massa described cardiac blood, not air, and made special experi­ dilatation and hypertrophy as aneurism. In ments to demonstrate the motor power of 1679, Bonet described fatty infiltration or the heart. degeneration of the heart muscle. In 1672, Aretaeus says: “ If the heart suffers pri­ Vieussens surmised that heart disease was marily, death is not far off/’ In Celsus ap­ the cause of most of the symptoms which pears, for the first time, a mysterious dis­ the physicians of his day grouped as hydro­ order called by the Greeks kardiakon, and thorax or otherwise described as asthma, by the Romans Cardiacus or Morbus Car- palpitation, etc. In 1673 be noted dropsy of diacus. This consisted of an indefinable and the pericardium, again in 1675 (with autop­ incoordinated group of symptoms—pro­ sies), and a little later, a case of pericarditis fuse sweating, fever with thin, weak pulse (with autopsy). In 1685, Vieussens noted a and short, panting respiration, great bodily case of stenosis of the left ostium with dis­ weakness with cold extremities—various­ ease of the mitral valve, and hypertrophy ly attributed to the heart or stomach. of the heart. The quality of the pulse was Aretaeus calls it “ syncope’’ and regards it “ small, weak and entirely irregular.” This description of the pulse of mitral stenosis is 18 See the historical sketches in Ziemssen’s Cyclo­ pedia of the Practice of Medicine, N. Y., 1876, VI, classic. These contributions are all con- passim. 19 Landsberg: Janus, Breslau, 1847, II, 53-124. H isto rica l D evelo pm en t of Ou r K now ledge of th e C irculatio n 149 tained in his treatise of 17 15.20 In 1695 he mainly associated with the great name of described a case of aortic regurgitation Bouillaud,23 who introduced the term, and which remained unnoticed until the time to whom we owe our fundamental knowl­ of Hodgkin and Corrigan.21 Albertini was edge of the condition. He showed the rela­ the first to employ palpitation in order to tion between endocarditis and acute ar­ ascertain the cardiac impulse. In 1707, Lan- ticular rheumatism, sepsis and anemia; also cisi associated asthma with cardiac disease, its relation to valvular lesions and its oc­ saw hypertrophy and dilatation as a com­ currence after the development of such mon cause of sudden death, and described lesions; also the frequent complication of palpitation, difficult respiration and other myocarditis with endocarditis and pericar­ symptoms of the disorder; also described ditis. Virchow investigated the pathological aneurism due to syphilis. He indicated the histology of carditis (1856-62), and bac­ turgescence of the veins of the neck as a teriology made it possible to investigate characteristic symptom of hypertrophy of the causes of the mycotic and malignant the left ventricle, which is not necessarily forms of the disease. Albertini (1661-1738) true.22 In 1761, Auenbrugger introduced showed that the left ventricle is prone to percussion in diagnosis, which was taken hypertrophy, the right ventricle to dilata­ up by Corvisart (1818) and extensively em­ tion. Auenbrugger, and after him Cor­ ployed in the diagnosis of heart disease. visart, applied the term aneurism to hy­ Auenbrugger in his book on percussion pertrophy and dilatation. The two con­ pointed out the increased areas of dullness ditions were first distinguished by Laen­ in pericardial effusion and cardiac hyper­ nec and Bertin. Bright first noted en­ trophy (1761). Corvisart in his revival of largement of the heart in renal disease Auenbrugger’s method diagnosed pericar­ (1827) and Traube (1856) investigated it ditis and separated hypertrophies from dil­ in detail. atations by percussion. Atrophy of the heart was first described The first definite treatise on disease of by Senac (1749). Laennec (1819) regarded the heart was that of Senac (1749) which it as a secondary disease. Bouillaud (1835) was followed by the splendid books of Cor­ divided it into the simple, eccentric and visart (1818), Laennec. (1819-26), James concentric varieties. Hope (1832), Bouillaud (1835), and Stokes Benivieni first noted induration of the (1854). The invention of the stetho­ heart (1529). Rota (1555), Massa (1559), scope by Laennec in 1819 revolutionized and Fernelius (1656) described “ ulcers of the diagnosis of diseases of the chest, in­ the heart.” In 1761 Morgagni gave de­ cluding cardiac disorders, as shown in the tailed accounts of inflammation, induration, first edition of his work (1819). The second ulcers, and rupture. Senac (1749) pointed edition (1823) is not only the greatest work out the base of the heart as the frequent on thoracic diseases ever written, but also site of abscess and induration, and assigned a wonderful collection of original descrip­ adjacent disease (pericarditis) as the cause. tions of new diseases. Hypertrophy and dil­ Laennec (1819) studied myocarditis very atation of the heart were referred to in closely, and first described true fatty de­ Senac’s treatise (1749). Endocarditis is generation, and external deposits of fat causing atrophy of the muscular substance 20Vieussens: “ Traite nouveau de la structure et des causes du mouvement naturel du coeur,” Paris, 23 See the “ Historic Notes” of Th. von Jiirgen- 1715. sen in his memoir on endocarditis in Nothnagel’s 21 J. J. Philipp: Janus, 1847, II, 582-598. “ Practice” (“ Diseases of the Heart” ), Phila., 1908, 22 Ibid., 1848, III, 316-326, 178. 150 Annals of Medical History by pressure. Bouillaud (1835) showed the Iiam Stokes (1846),26 and the memoir of independence of myocarditis from endocar­ W. H. Gaskell ( 1 8 8 1 ) , 27 who produced the ditis and pericarditis. Hamernik (1844) condition experimentally. It was Huchard and Dubini (1844) gave simultaneously the who called the affection “ Stokes-Adams’ first microscopical reports on inflammation disease.” Laennec fully described the sounds of the papillary muscles. Latham (1846) and murmurs of the heart in different dis­ and Craigie (1848) described purulent myo­ eases, and Skoda clearly differentiated the carditis. Rokitansky pointed out the rela­ sounds from the murmurs. The second edi­ tion of myocarditis to aneurism of the tion of Laennec (1826) accounts for dila­ heart, and Virchow described parenchy­ tation, hypertrophy, hardening, softening, matous inflammation. Thomas Bevill Pea­ atrophy, gangrene, displacement, abnormi­ cock, in his “ Croonian Lectures” of 1851, ties, intercommunication, rupture, fatty described overstrain of the heart. J. M. Da degeneration, ossification, tubercle, cancer, Costa described “ irritable heart” in sol­ serous cysts, valvular lesions, polyps and diers of the Civil War (1862-71). Sir Clif­ neuralgia of the heart. The clinical minutiae, ford Allbutt elucidated the effects of over­ which now make up the pictures of these work and overstrain of the heart in those diseases in our textbooks, were added grad­ engaged in occupations requiring great ex­ ually through the labors of Stokes, Graves, ertion (1869-71). Fragmentation of the Adams, Bouillaud, Hope, Corrigan, Sibson, heart fibers was first described by Renaut Andral, Piorry, and many others, followed in 1877. Sir John and Sir William Henry by the new era of Gaskell and Mackenzie. Broadbent have devoted especial study to What we know of the earlier history of val­ pericardial disease, particularly adherent vular disease is contained in Laennec’s pericardium (1895). treatise on mediate auscultation (second Rupture of the heart was first noted by edition, 1826). Aortic regurgitation was Harvey in his second letter to Riolanus noted by Vieussens (1695), Cowper (1649). Morgagni (1761) said it can only (1705);28 in more detail, by Hodgkin occur when the muscular tissue is diseased. (1829),29 and in classical form by Corrigan It is interesting to note that Morgagni him­ (1832),30 with a superb plate showing the self died of this condition. Corvisart first pathological appearances. John Mayow, in described rupture of the chordae tendineae 1669, described mitral stenosis; Vieussens and “ verrucose vegetations” of the valves, gave a good account in 1685; Morgagni, in which he regarded as of venereal origin. 1761, gave several autopsies with clinical This view was opposed by his pupil findings, and with the description of Senac, Laennec. in 1749, this lesion became familiar to clin­ The first great contribution to the heart’s icians. King, in 1837,31 first individualized pathology was made by Morgagni (1761), tricuspid insufficiency, which was first noted who, in his autopsies, found most of the by Morgagni in his autopsies (1761). valvular lesions, and connected them with 25 Adams: Dublin Hosp. Rep., 1827, IV, 396. the clinical manifestations. The mitral le­ 26 Stokes: Dublin Quart. Jour. Med. Sc., 1846. sion is particularly associated with his 27 Gaskell: Phil. Tr., 1881, Lond., 1882, CLXXIII, name. Morgagni was also the first to de­ 933- 1033* scribe heart-block (1761),24 which attained 28 Cowper: Phil. Tr., Lond., May, 1705, No. 299. its present status through the classical 29 Hodgkin: London Med. Gaz., 1828-9, II, 433-443. 30 Corrigan: Edinb. Med. & Surg. Jour., 1832, papers of Robert Adams (1826)25 and Wil- XXXVII, 225-245, 1 pi. 24 Morgagni: “ De sedibus,” Venice, 1761, I, 70 31 T. W. King: Guy’s Hosp. Rep., Lond., 1837, II, (Osier). 132-148, "3jpl. H isto rica l D evelo pm en t of Our K now ledge of th e C irculatio n 151

George Whitley, in 1857,32 gave the earliest with a galvanometer or a Lippmann elec­ complete account of disease of the pulmo­ trometer. This led to the invention of the nary valves. Laennec said that Corvisart ink-polygraph of Sir James Mackenzie, was the first to distinguish by percussion Jaquet’s cardiosphygmograph and the string the purring or cat-like thrill (Jremissement galvanometer of Einthoven (1903).38 With cataire) in valvular disease. Austin Flint, in this instrument and the electrocardiograms 1862, showed that a presystolic murmur obtained from it such conditions as heart- can be produced in cases of aortic insuffi­ block, auricular fibrillation, paroxysmal ciency without mitral lesion.33 Laennec, in tachycardia, pulsus alternans and pulsus spite of the stethoscope, did little to clarify bigeminus were closely analyzed and de­ the diagnosis of mitral disease, which be­ fined by Sir James Mackenzie,39 James gan to assume accuracy in the treatise of Lewis, A. W. Hewlett and others. Mackenzie James Hope (1832). The early history of and Cushny, with its aid, elucidated the pulse-counting (Cusanus, Kepler, Sancto- uses and limitations of digitalis. The English rius, Sir John Floyer) has been given by periodical Heart, founded in London in Weir Mitchell in his “ Early History of In­ 1909, and edited by Thomas Lewis,40 con­ strumental Precision in Medicine” (1892). tains most of these important investiga­ The use of the watch in timing the pulse tions. was due to Louis, Graves and Stokes. Before the latter half of the nineteenth In 1632 the Earl of Clarendon in his century, patients with heart disease were Memoirs, described a case of angina pecto­ usually required to rest and keep quiet. In ris in his own father. Morgagni again de­ his treatise of 1854, William Stokes pointed scribed it in 1761 and in 1772, William He- out that “ the symptoms of debility of berden gave his classical account,34 which the heart are often removable by a regu­ was followed by the investigations of Jen- lated course of gymnastics, or by pedestrian ner and Parry. John Hunter suffered from exercise, even in mountainous countries, the disease for twenty years (1773-93) and such as Switzerland or the Highlands of died from it. At the autopsy Edward Jen- Scotland and Ireland.” Gradually the Swed­ ner found calcification of the coronary ves­ ish movements of Ling and the mechanical sels. The use of amyl nitrite in the treat­ contrivances of Zander were applied, to be ment of angina pectoris was introduced by followed by the slow “ resistance gymnas­ Sir Lauder Brunton (1867).35 tics,” breathing exercises and protein diet In 1881 Gaskell first investigated the of M. J. Oertel (1884), and the combined electrical condition of the heart with a gal­ exercises, rest and carbonated baths (Nau­ vanometer.36 In 1889,37 Augustus D. Waller heim treatment) of Schott (1880).41 first measured and figured the action cur­ The modern doctrine of embolism is al­ rents of the heart by means of electrodes in most entirely the work of Rudolph Virchow contact with the wet skin and connected (1846-56), which was followed by the later

32 Whitley: Guy's Hosp. Rep., Lond., 1857, 3 s., 38 Einthoven: K . Akad. v. Wetensch. te Amst. Proc. Ill, 252-260, 2 pi. Sect, sc., 1903-4, V I, 10 7-115, 2 pi. 33 Flint: Am. Jour. Med. Sc., Phila., 1862, n. s., 39 Sir James Mackenzie: “ The Study of the Pulse,” XLIV, 29: 1886, XCI, 35. London, 1902; “ Diseases of the Heart,” London, 34 Heberden: Med. Tr. Coll. Phys., Lond., 1768-70, 1908. II, 59-67. 40 Thomas Lewis: “ The Mechanism of the Heart 35 Brunton: Lancet, Lond., 1867, II, 97. Beat,” London, 1911; “ Lectures on the Heart,” 36 Gaskell: Phil. Tr., 1881, Lond., 1882, CLXXIII, London, 1915. 933-1033. 41 Schott: Berl. klin. Wochenschr., 1880, XVII, 87 Waller: Ibid., 1889, CLXXX, 169. 357-359* 152 Annals of Medical History researches of Cohnheim, Bernhard Cohn, happens sometimes in the internal arteries, Welch and others. Up to Virchow’s time, especially under the breast, about the John Hunter and Cruveilhier had firmly es­ spleen and mesentery, where the venous tablished the doctrine that phlebitis is the pulsation is often observed” (Osier).46 Am- cause of thrombosis. In 1856 Virchow broise Pare recognized aneurism by anasto­ turned this about by showing that coagu­ mosis, erosion, rupture and injury. “ He lation and other mechanical obstructions of was the first to suggest the relation of the blood-current may initiate thrombosis aneurism to syphilis, and he described the with subsequent phlebitis. Bacteriology es­ noise or blowing sound associated with the tablished the fact that pathogenic micro­ tumor, and the frequency of thrombosis in organisms may set up a phlebitis, in which the sac and the occasional calcification” case thrombosis is again secondary. (Osier). Modern pathologists, while recog­ A case of malformation of the heart was nizing mechanical disturbances of the cir­ reported to the Royal Society by Wilson in culation as an accessory factor in the pro­ 1798. -Meckel studied the resemblances be­ duction of stagnation thrombi, regard a tween these congenital malformations and phlebitis as beginning in the outer coat of the hearts of reptiles, amphibians and crus­ the vein and proceeding inwardly until en- taceans (1802). In 1858 Thomas Bevill Pea­ dophlebitis is established, so that throm­ cock published the first systematic treatise bosis is usually secondary to lesions of the on the malformations of the human heart, veins, the old Hunter-Cruveilhier view. The an outstanding work which was reissued in syphilitic causation of aneurism was later es­ 1866,42 and followed by the great memoir tablished by Lancisi (1728) and Morgagni of Rokitansky on defects of the cardiac (1761), who also gave Valsalva’s mode of septa (1875) and the fine study of Maude treatment.47 William Hunter, in his account Abbott on “ Congenital Cardiac Disease” of arteriovenous aneurism (1775), first (1908).43 separated the true, spurious and mixed Aneurism was not known to Hippoc­ forms. The pathology of aneurism was later rates, but Galen knew of aneurism from investigated by Scarpa (1804), Cruveilhier dilatation and traumatic aneurism, recogniz­ (1849-64), Rokitansky (1850), Hemstedter ing the thrill in the former. Galen recog­ (1873), Koster (1875) and others. Dilation- nized arteriovenous aneurism “ as a se­ aneurism of the aorta was clearly described quel of careless vivisection and cured a case in 1815 by Joseph Hodgson,48 who differen­ of it” (Osier).44 William Hunter described tiated it from ordinary aneurism, observed its it in classic form in 1757.45 In 1555, Vesalius frequency in the arch, its misleading cardiac diagnosed aneurism of the thoracic and symptoms, and its association with aortic abdominal aorta (case of Leonard Velser) insufficiency. Trousseau called the latter and confirmed his diagnosis at the post­ variety “ maladie d’Hodgson.” In 1507 An­ mortem (1557). Fernelius, in his Pathologia tonio Benivieni first noticed cardiac thrombi (1592), first noted that “ aneurism likewise as “ polyps” (fibrinous clots) in the heart (Welch). William Wood of Edinburgh de­ 42 Peacock: “ On Malformations of the Human scribed ball thrombi in the left auricle Heart,” London, 1858. (1814). Recklinghausen, in 1893, described 43 Abbott: “ Mod. Med.” (Osier), Phila., 1908, IV, agglutinative (hyaline) thrombi. Trousseau 323-425. 44 Osier: “ Syst. Med.” (Allbutt), Lond., 1909, VI, 46 Osier: Ibid., 621. 620-621. 47 Osier: Ibid., 621-622. 45 Hunter: “ Med. Obs. and Inq.,” Lond., 1757, I> ^Hodgson: “ Diseases of Arteries and Veins,” 323; 1762, II, 390. London, 1815. H isto rica l D evelo pm en t of Our K now ledge of th e C irculatio n 153 and Werner, in i860, first pointed out the or softness in the coats of the blood-vessels association of thrombosis with chlorosis in and that Asclepiades ascribes “ certain young women. A detailed history of em­ hemorrhages to decay and rupture of the bolism and thrombosis is given in the ex­ arterial coats.” Morgagni and Haller initi­ haustive memoirs of Professor William H. ated the pathological study of the arterial Welch (1909).49 walls. Bichat found arterial disease in seven Of diseases of the blood, chlorosis was out of every ten men over 60. Scarpa men­ described by Johann Lange, in one of his tions “ steatomatous arteries,” Matthew Consilia, as “ morbus virgineus” (1520),50 51 Baillie, coronary atheroma. Peter Frank, Virchow described the form with aortic hy­ Broussais and Bouillaud mistook cadaveric poplasia and contracted heart in girls staining of the great vessels for an arteritis. (1870).81 Hemophilia was first described by The name “ arteriosclerosis” was intro­ John C. Otto, of New Jersey (1803), splenic duced by Lobstein (1833). Bright associ­ anemia by Guido Banti (1882), aplastic ated atheroma with chronic renal disease. anemia by Ehrlich, leukemia by Hughes Gull and Sutton showed that the red con­ Bennett (1845) and Virchow (1845), Pur" tracted kidney of “ Bright’s disease” is pura hsemorrhagica by Werlhof (1735), only part of a general arteriocapillary fi­ pernicious anemia by Addison (1849-55) brosis, and so established the concept of and Biermer (1872), peliosis rheumatica by “ arteriosclerosis.” The introduction of the Schonlein (1837), infantile infectious pur­ sphygmomanometers of von Basch (1887), pura by Henoch (1874), multiple telangi­ Riva Rocci (1896), Leonard Hill, (1897) ectases by Sir William Osier (1901), ery­ and others revolutionized the diagnosis of thremia or polycythemia by Henri Vaquez arteriosclerosis and Bright’s disease. Pa­ (1892) and Sir William Osier (1903). tients were found who had arterial hyper­ Of the vasomotor affections, symmetrical tension without Brightic symptoms or al­ gangrene was described by Maurice Ray­ buminous urine, and this was supposed to naud (1862), erythromelalgia by Sir James be due to idiopathic hypertrophy of the Paget and Weir Mitchell (1872-8), angio­ heart. Von Basch called this condition “ an- neurotic edema by H. Quincke (1882). giosclerosis,” Huchard “ presclerosis,” AII- Of diseases of the blood-vessels, phlebitis butt “ hyperpiesis,” Volhard and Fahr “ be­ was described by John Hunter, periar­ nign essential hypertension,” Janeway calls teritis nodosa by Kussmaul and Maier it “ primary hypertensive cardiovascular (1866), gouty phlebitis by Sir James Paget disease,” 54 and states that its recognition (1875) , obliterative arteritis by Friedlander is entirely due to the sphygmomanometer. (1876) . The modern theory of arteriosclero­ Huchard actually regarded arteriosclerosis sis owes its origin to the memoir of Sir as a “ clinical entity” and described what William Gull and Henry G. Sutton on ar- he regarded as its clinical forms (1909). It teriocapillary fibrosis (1872).52 Allbutt53 is now looked upon as a simple pathological says that Galen noted degrees of hardness lesion incident to various conditions. “ To call arteriosclerosis a ‘disease,’ ” says AII- 49 Welch: “Syst. Med.” (Allbutt), Lond., 1909, butt, “ is not pathology but necrology.” 55 VI, 691-821. 50 Lange: Medicinalium epistolarum miscellanea, 53 This history of arteriosclerosis is derived from Basel, 1554, 74-77- Translated in E. T. Withington’s Sir Clifford Allbutt’s splendid work on “ Diseases of Medical History, Lond., 1894, 290. the Arteries,” London, 1915, I, 3-18, and passim. 51 Virchow: “ Ueber die Chlorose,” Berlin, 1872. 54 Janeway: Tr. Assoc. Am. Pbys., Phila., 1915, 52 Gull and Sutton: Med. Cbir. Tr., Lond., 1871-2, X X X , 34. ' LV , 273-326, 2 pi. 56 Allbutt: op cit., 14. 154 Annals of Medical History

The earliest blood pressure observations on heard, so the internist can trust much to a large scale were made by Richard C. his senses; but as the musician gets to know Cabot in 58 cases (1903). Joseph Erlanger, a complex composition by associating it sub­ Potain, Janeway and others have done consciously with the printed notes, so we much in this field. Janeway says there were can best educate our clinical senses by the only twelve references to blood pressure in electrocardiograms and blood-pressure rec­ 1886; in 1915 he had over a thousand.56 ords. The advantage of the sphygmomanometer In preparing this paper, it has struck me over the fingers and the sphygmograph has forcibly that a large part of our knowledge been well brought out in Allbutt’s work on of the circulation is of English origin. From “ Diseases of the Arteries” (1915). He Harvey’s time, the heart alone has been a points out that every new instrument of sort of specialty with English physicians. precision has been ridiculed by conserva­ In reviewing the history of the circulation tive, old-fashioned physicians as “ pauper­ we can not, however, like the lawyers, re­ izing the senses.” But the truth is that gard this part of our science as broadening these instruments, “ far from pauperizing “ slowly down, from precedent to prece­ our clinical perceptions, have, on the con­ dent;” its development has been fitful and trary, enriched, enlarged and corrected irregular. them.” 57 Gibson of Edinburgh said “ the Let us neither lean too heavily upon the sphygmomanometer had taught him how past for precedent, nor be too confident fallacious the finger may be.” So, too, the about the present or the future. Let eternal polygraph and the string-galvanometer vigilance in studying and caring for our have given us records of the heart’s condi­ clinical cases be our watchword; for some tion which are to the clinician what the of our present errors may be corrected by printed notes on the musical staff are to the accurate, if empirical judgments of the musician. As any one with a good musi­ physicians of the past, even as the experi­ cal ear can whistle or hum a tune he has ences of the past can best be understood 66 Janeway: op cit., 29. and its errors condoned in the light of the 67 Allbutt: op cit., 61. present.

THE SONS OF SYDENHAM

Conspicuous among the physicians of the seven­ he would have been cited with Geynes before the Royal teenth century, great among those of all time, is Syden­ College of Physicians for impugning the infallibility of ham. In early life an officer, one of five brothers who Galen, and would not have recanted. To him everything fought in the army of Parliament, be remained loyal to was observation, experiment. He pointed the way for the memory of the Protector, and his doctor’s garb covered advance in our science, and happy would he have been through life a soldier’s love of action and decision. He if he could have seen the sons of his intellect and endeavor brought us back to the near study of nature, taught us to who, following in his path, have made Medicine what it look at it clearly, to derive our knowledge wholly from it, is; for these sons are Tenner and Bright and Addison, and he stands out in history the very embodiment of the and Corvisart and Andral, and Skoda and Frerichs, insight and practical character of bis race. He had but and the eloquent Trousseau, whose delight it was to little respect for mere authority, and it is to be feared quote him, and our own truth-loving Flint. that, bad be Hved a hundred years before the time be did, J. M. Da Costa (i 8q i) THE JETONS OF THE OLD PARIS ACADEMY OF MEDICINE IN THE NUMISMATIC COLLECTION IN THE ARMY MEDICAL MUSEUM AT WASHINGTON, D. C.

B y ALBERT ALLEMANN, M.D.

URING the early years of the silver or bronze jetons were presented to all Library of the Surgeon General’s the members of the Faculty. The Dean was Office, a number of medical med­ not a professor. He had exclusive charge of als were presented to it by pri­ the administrative business of the Faculty. vateD parties. This led Col. Billings, the But he also kept the minutes of the Trans­ creator of the Library, to the idea of estab­ actions of this learned corporation, and lishing a collection of medical medals. He these minutes, from 1395 to 1792, still exist went to work with his usual energy so that, in manuscript and form a complete history in 1888, he had gathered more than 1500 of the Medical Faculty of Paris. medals and jetons. In that year he gained When the practice of striking jetons at the services of Dr. William Lee of Wash­ the election of a new Dean was initiated is ington, a man well versed in medical his­ not known. The Transactions of the Fac­ tory and numismatic lore, to arrange the ulty mention a jeton as early as 1398, but collection. Dr. Lee made a card catalogue, the older jetons are now all lost and it is describing and interpreting each medal on probable that the custom was not regularly a separate, numbered card. As Col. Billings followed until 1638, when the Faculty de­ had charge of the Medical Museum as well cided to strike jetons regularly on a uni­ as the Library, he placed the medals in the form model at every election of a new Dean. Museum, where they are now exhibited. Jetons are not medals in the full sense of After Billings left the Library in 1895 the the word. They differ from them in that collection was continued from year to year their imprint is flat like that of a coin. Med­ by his assistant, Mr. Myers, so that at pres­ als are cast while jetons are struck. Jetons ent it contains more than 3000 medals. are usually of small size, rarely larger than After Mr. Myers’ death, the addition of our silver half dollar. The French jetons new medals to the collection by purchase have all a diameter of 1% inches. was discontinued for a long time, but Col. These jetons of the old French Academy William O. Owen, the present officer in of Medicine are now very rare. Many are charge of the Army Medical Museum, has entirely lost. The most complete collection taken a renewed interest in the subject and is in the possession of the Bibliotheque has added a number of valuable pieces, in­ nationale at Paris. The Academy of Medi­ cluding those struck off by the Paris mint. cine of Paris possesses 108 pieces. Next in One of the most interesting series of completeness is probably the collection in medals in the Washington collection com­ the Army Medical Museum at Washington prises the jetons of the old Academy of which has no less than 91 of these rare je­ Medicine of Paris. They range from 1638 tons. to 1793, when the corporation was dis­ From 1638 to 1793 there were in all 65 solved by the Government of France. It Deans. Philippe Harduyn, who was Dean was a very old custom of the Paris Medical from 1636 to 1638, was the first to be hon­ Faculty that whenever a new Dean was ored with a jeton of the new model. The elected, which took place every two years, jeton shows on the obverse the coat of 155 156 Annals of Medical History

arms of Harduyn with the legend: Decano The five Deans who succeeded Patin re­ M. Philip. Harduyno de Sainct Jacque. On verted to the old custom of placing their the reverse is the coat of arms of the Medi­ coats of arms on the obverse of their jetons. cal Faculty of Paris, viz.: three storks in a Antoine Morand, who was Dean from 1662 row turned to the left, each one with a to 1664, again placed his own effigy on the laurel branch in his beak. The inscription is: Urbi et Orbi Salus. In exergue: Facult. Medic. Paris. 1638. All the early jetons show merely the coat of arms of the retir­ ing Dean on one side and on the other the coat of arms of the Medical Faculty. Guy Patin (1602-1672) was the first to place his own effigy on the obverse instead of his coat of arms. He was Dean from 1650 obverse of his jeton. From now on the je­ to 1652. The jeton shows Patin’s head to tons regularly show the image of the re­ the right with the legend: M. Guy Patin tiring Dean, and the coat of arms of the Doien. 1652. In exergue: Felix Qui Potuit. Medical Faculty on the reverse is frequent­ ly replaced by other designs. Francois Le Vignon was Dean from 1664 to 1666. The obverse of his jeton bears the inscription: M r-e Fr. Le Vignon. Con- d’ Es- et Doien. As he carries the title Con- seiller d’etat, Moehsen2 supposes that he was body physician to the queen. The re­ verse of the medal shows a bare arm thrust The M. stands Jor Maitre (Magister). In forth from the clouds, the hand throttling the Middle Ages, the Medicinse Doctores three serpents. The legend is: Contero Mon- called themselves “ Magistri in medicina” stra. This refers to the decree of the French and the Deans of the Paris Medical Fac­ Parliament of 1666 which decided the long ulty retained this ancient title long after it had been abandoned by the medical pro­ fession. “ Felix Qui Potuit” is the begin­ ning of a passage in Virgil’s Georgies.1 The reverse shows the usual three storks of the Paris Medical Faculty. Patin is chiefly known by his Lettres, which were published in 1713. He was not an originator of new ideas,—he even opposed Harvey’s controversy among the French physicians great discovery,—but he was a man of an about antimony in favor of those who ad­ independent mind, he despised the hollow­ vocated its value in medicine. ness and formalism of his time and merci­ From 1666 to 1668 the Deanship was lessly exposed the weaknesses of his con­ held by Jean Armand de Mauvillain. His temporaries. jeton shows on the obverse his effigy by Du Four. The reverse presents the giant 1FeIix qui potuit rerum cognoscere causas Atque metus omnes et inexorabile fatum 2 Moehsen, Beschreibung einer Bed. Medaillen- Subjecit pedibus, strepitumque Acherontis avari. samml. Bed. & Leipz., 1773. F rench M ed ica l J etons 157

Polyphemus lying prostrate, while Ulysses Decano. Below are the words: Prsesed. Ord. puts out his eye with a burning torch. The M. Guid. Cresc. Fagon. Archiat. Com. Ult. circumscription reads: Vero Lumine Ccecat. Ma. 1703.3 It seems Fagon owed the honor Polyphemus represents Francois Blondel, of having his bust on Vernage’s jeton to the fact that he was at that time President of the Medical Faculty. Fagon was in 1703 66 years old and Vernage, who was then scarcely forty, honored his older colleague by placing the latter’s effigy on the jeton of his administrative term. While a Dean was usually elected only once for a term of two years quite a num­ who was one-eyed. Blondel was one of the ber held the position for two terms. Be­ chief opponents of antimony but lost his sides Jean Boudin, mentioned above, Ar- lawsuit against the Medical Faculty. Mau- mand Doute (1716- 1720), Francois Geof- villain is chiefly known by the enmity he froy (1726-1730), Jean - Baptiste Boyer bore to Moliere. He fell out with Moliere’s (1756 - 1760), Louis Alleaume (1774 - 1778), wife and the latter took revenge by incit­ and several others were elected twice suc­ ing her husband to ridicule the haughty cessively. Rene Le Thuillier (1768-1774) and Claude Bourru (1788 - 1793) were elect­ ed for three successive terms. None of these men of the old Paris Medi­ cal Faculty gained eminence in medicine. While England, during the same period, produced such men as Harvey, Sydenham, Willis and Mayow, French medicine was barren. “ The physician had become a sterile physician in VAmour Medecin, in which coxcomb,” says Garrison,4 “ red-heeled, one of the four physicians is supposed to long-robed, big-wigged, pompous and dis­ represent Mauvillain. dainful in manners. Among themselves the From 1696 to 1700, the Deanship was physicians were narrowly jealous of their held by Jean Boudin. The obverse of his jeton shows his bust to the right. The re­ verse represents the centaur Chiron leading young Aesculapius to a distilling apparatus. The inscription is: Servat et Docet. In ex­ ergue: Facult. Medic. Paris. Anno 1700. Boudin was the first Dean to hold the po­ sition for two successive terms. Francois Vernage was Dean from 1702 rights and privileges, regarding their fra­ to 1704. His jeton does not show his own ternity as a closed corporation yet eternal­ image but that of Guido Fagon, body phy­ ly wrangling about theories of disease and sician of Louis XIV. The obverse with Fa- gon’s bust carries the legend: Scholse Tutela 3 Prsesedente Ordinario Magistro Guidone Cre­ Prsesens. The reverse shows the arms of scendo Fagon. Archiatrorum Comite. Ultimo Maii. the Paris Medical Faculty and the inscrip­ 1703. tion: M. Fr. Vernage. Paris. Fac. Med. Paris. 4 Garrison, History of Medicine, Phila., 1913. 158 Annals of Medical History current modes of treatment.” The facsim­ a single one of them had been struck off to iles of the jetons accompanying this article commemorate anything more than respect­ afford a striking illustration of this fact. able mediocrity.” 6 This was true of former Claude Bourru was the last Dean of the centuries when men of merit in medical old Medical Faculty of Paris. In 1793 the science were rare and when positions of Revolutionary government of France, which power and influence were entirely due to swept away so many mediaeval spiderwebs birth and wealth. It is not true to-day, for but in its mania for reforms also did away at no time have merit and true worth been with many useful and salutary institutions, more recognized than in our democratic abolished all scientific corporations and so­ age. Of this the French medals struck in cieties, among them the Academy of Medi­ honor of medical men during the 19th cen­ cine of Paris. The practice of medicine was tury give ample proof. The Washington freed from all restriction. It was soon found, collection includes a large number of these however, that the country could not get medals, which have beside their medico- along without a recognized medical pro­ historical importance great artistic value. fession and in 1795 the three so-called Among the men thus honored are Corvisart, Ecoles de sante of Paris, Montpellier and Dupuytren, Larrey, Pinel, Bernard, Chau- Strasbourg were established. Napoleon I, veau, Ollier, Pasteur and many others. 7 the heir of the Revolution, did not restore the Academy of Medicine. The old corpo­ BIBLIOGRAPHY ration had enjoyed great freedom and many C o rlieu— L ’ancienne Faculte de medecine de privileges and had always been very jeal­ Paris, 1900. ous of governmental interference in its in­ K l u y sk e n s— Des hommes celebres dans Ies ternal affairs. This, of course, did not suit sciences et Ies arts. Gand, 1859. an autocratic mind like that of Napoleon. M o ehsen— Beschreibung einer Berliner Medail- Iensammlung. Berlin u. Leipzig, 1773. It was not until 1823, under Charles X, N iv e l e t — Moliere et Guy Patin. Paris, 1880. that the Academy of Medicine of Paris was P revo st— La Faculte de medecine de Paris. Paris, reestablished. But the old custom of strik­ 1900. ing jetons at the election of a new Dean R oubaud— Histoire et statistique de PAcademie was not renewed. This is perhaps to be de­ nationale de medecine. Paris, 1852. plored. It was certainly a beautiful custom, R udolphi— Index numismatum. Berolini, 1823. C o rlieu— Les jetons des doyens de I’ancienne which was imitated by many European Faculte de medecine de Paris. Paris medical, 1887, scientific societies.5 X II, 213. While the old Faculty of Medicine of L acronique— Etude historique sur Ies medailles Paris was barren of men distinguished in et jetons de PAcademie royale de chirurgie, 17 3 1- medical science, the new Academy at once 1793. Bull. Soc. fran?. d’hist. de la med., Paris, 1903, II, 23-79. opened up with a galaxy of illustrious names. In looking over a collection of medi­ 6 Garrison, Med. Pickwick, Saranac Lake, 1915, cal medals Billroth once remarked that “ not I, 2. 7 The photoprints accompanying this article, 6 It would certainly not be out of place if the slightly enlarged, are taken from copper engravings American Medical Association would strike such in Moehsen’s “ Beschreibung einer Berliner Medail- medals at the biennial election of its presidents. Iensammlung,” as it was impossible to make good These medals would form a history of the Associa­ photographs from the actual medals, though most tion in metal. of them are still well preserved. THE HISTORY OF INFECTION1

B y ARNOLD C. KLEBS, M.D.,

WASHINGTON, D. C.

OT only among the Greeks and intelligibly that has preserved it, and this Romans who still are our princi­ idea is neither Roman nor Greek, but sim­ pal schoolmasters, but long be­ ply human. It offers an appropriate word- fore them there existed in human picture for something of daily incidence Nlanguage a term to designate the process of and vital importance. It relates the cause infection. It did not always have exactly the with the effect and thus becomes the word- same significance which it now has. Tradi­ symbol of a primitive setiologic concept. tion preserved for it a certain basic mean­ Words of this kind have a much greater ing; and convention, according to varying vitality than the more artificial nomencla­ necessities and changing interests, modified ture of philosophy and science. its application. This is only the natural vari­ Since we have become acquainted with ation to which all terms are subject and one microorganisms and their role in diseases, of the reasons why it is so difficult for us setiologic research, because of its tangible to enter into the thoughts and activities of object, has exerted a determining influence former generations and fully profit by their on medicine. It has gone almost to the ex­ experiences. treme of making setiology and bacteriology When the Roman used the verb “ infi- synonymous terms. Infection to-day means, cere” it conveyed to him not only the lit­ if we take it in the broad definition of Hek- eral sense of putting one thing into another, toen, “ the entrance into the body of living but with the qualification that the “ in­ agents, capable of multiplication, most fected” object is altered in appearance or commonly microbes, which then cause dis­ effect and chiefly so as to render it unpleas- ease.” The microorganism as the deter­ ing, harmful or corrupted.12 Now, this cor­ mining factor of infectious diseases, the responds in general to our own use of the specificness of the infection and the invari­ word and indeed one might think that we ability of microbic species make this the chose it for that very reason, making it dominant theory of the day in medicine. only more precise and limited. As a matter Its profound influence is felt in private and of fact we had no choice. The term came public life to a degree unparalleled in the down to us gradually through all the in­ annals of human society. So dominant is tervening generations, even preserving its this doctrine that the question is hardly Latin form. It is evidently the importance ever asked: might there not be, apart from of the underlying idea which it expresses the microbe, pathogenic influences of equal if not of greater importance? 1 Subject of an address delivered before the Bio­ Even those who vindicate for modern logical Club of the University of Chicago and the scientific research its freedom from dogma Historical Society of Washington University, St. (Hamilton) adhere to the all-importance of Louis, in December, 1916. the living agent in the causation of disease. 2 The adjective and noun (injectus and infectio) had more the sense of our “ ineffective,” while “ in- The others, the followers of Koch, whose fectivus,” at least in Vitruvius, is the thing altered, labors, they say, have brought the question infected, particularly dyed or colored. to “ a certain and unequivocal conclusion,” 159 160 Annals of Medical History proclaim proudly that the doctrine, even contrary to the admonition that the his­ in its most restricted sense, ought to have torical student should record rather than been long ago “ established as a fixed dog­ interpret. But there can be no doubt that ma” on the basis of historical tradition the endeavor to disentangle from history and by every-day observation.3 Here we the leading and connecting threads adds have in modern times a contrast between zest and vitality to the search and no harm empiricism and dogmatism which in the is done provided true facts are given with­ past has led to so many wasteful and ster­ out distortion. ile conflicts. It is immaterial whether the The Annals have brought in the last basic theory on which both are agreed was number an illuminating study by Dr. and obtained by syllogistic reasoning or by ex­ Mrs. Singer on Fracastoro, the first clear perimental demonstration, neither is con­ exponent of the theory of infection as we cerned with the continuous reality as it now understand the term. The essay shows appears to immediate intuition; for prac­ very well how the mind of a cinquecento tical purposes this is broken up into ele­ scholar, unaided by the microscope and ments, and fixed by verbal symbols (or bacteriologic technique, could formulate images of objects) later to be artificially what we believe has now been determined reconnected.4 as a scientific fact. But there can be no Most of the historical surveys of the doc­ question that the same idea was in the trine of infection are nothing but panegy­ minds of uncounted generations before Fra­ rics of the current doctrine, showing past castoro. To analyze some expressions in errors or an assumed evolution from vague available literature that seem suggestive in unconscious gropings towards that final this direction is the task I have set for my­ perfection represented by modern achieve­ self in the following. ments. While entirely legitimate, this kind of historiography can give only an inade­ BABYLONIA AND ASSYRIA quate understanding of human thought in the past and no clear outlook into the fu­ Civilizations which have endured for ture. The higher task of history is to study such long periods as did those of the ancient critically the ideas of man about living Babylonians and Egyptians must have been nature, in the same way that the biologist founded and advanced by very practical studies the various phenomena of the or­ people. Their efforts and thoughts, while ganism itself, to promote the understand­ in form differing from ours, must have been ing of basic principles. If we study the directed to the realization of very similar records of the past with this aim before us, aims. Their evident success, if nothing else, we perceive that the concept “ infection,” must command our attention, although although assuming, from time to time, for some are inclined to dismiss as supersti­ practical purposes a varying, transitory sig­ tions most of the ideas we encounter among nificance, tenaciously retains a fundamen­ them. Perhaps it would be more profitable tal and primordial relation to disease, pos­ if we used the word “ superstitions” in sibly identical to the one ingestion holds to Lowell’s sense as marking the world’s “ un­ growth and sustenance, or fertilization to finished business.” Are we not apt to over­ the propagation of the species. Such gen­ look the fact that the primitive man, when eralization may be deemed unscientific and he tries to promote his understanding of

3 KoIIe in “ Handbuch der Mikroorganismen” by the world by attaching a name or some KoIIe and Wassermann, 2nd ed. I, 869, 872. figurative symbol to the invisible power 4 See Bergson: Mind and Matter. Lond., 1911. which he feels affects him in some way, T h e H isto ry of I nfectio n 161 does nothing essentially different from what troubled soul, has the sense: “ Let them we are doing all the time? “ Seeing is know­ accept this offering and leave me in ing” guided him as it guides us, and the peace.” superstitious awe of which we hear so much In the divination series the same ideas blinded him far less than is usually thought. prevail. They form a minutely worked out Beneath the complex texture of his myth­ system of prognostics, based partly on ob­ ology we find, if we only look for it, fre­ servation, partly on hypothesis, intended to quent evidence of most minute observation serve individuals as well as the king or and the utilization of experiment.5 state. The elaborate descriptions of the Theurgic and numinal concepts form the birth omina and liver omina have evoked basis of the nosological nomenclature of the great medical interest because they re­ ancient Babylonians and Assyrians. The vealed an unexpected knowledge of ana­ study of cuneiform inscriptions has opened tomical detail. From one of the liver-texts our eyes to anew world. The texts which deal we learn of the mangu-disease, an infection with incantations, divinations, conjurations of the throat which seems to have appeared (exorcisms) and the like contain a great deal as an epidemic, something like diphtheria, of information on medical subjects. The and another of the face which has been priest, who filled the place of the physician, identified as erysipelas.6 There is naturally as so often in history, used these texts as a a great deal of arbitrariness in this nomen­ sort of practical guide book in his daily rou­ clature of diseases in which it is often diffi­ tine. They were to lead him to diagnosis, cult to distinguish whether the demon or prognosis, prophylaxis and treatment of hu­ the disease that he is supposed to have pro­ man ills. The compilation of the most im­ duced, is intended. Still, whether demon portant ones can be traced to the non-semi- or disease, we have quite a number of tic priests and magicians who practiced their names which are thought to specify infec­ craft before the advent of the Semitic Baby­ tious diseases as, for instance: Bennu, sassa- lonians (dated variously between 5000 and tu, sakikku, hatu, mursu, si-ib-tu, ummu, 4000 B .C ., or roughly, before 3000 B.C .). huntu, li’bu and in a class by themselves The excavations of the great library of sidanu and miktu.7 Asurbanipal (668-626 B .C .) at Nineveh While religious cult, just as scientific re­ brought copies of them to light. search, produces a large and somewhat For infectious diseases the most impor­ mysterious nomenclature, the language used tant series is that of incantations against to define personal property in sale or pur­ the special disease demons and fever sick­ chase strives towards clearness and circum­ ness (ekimmu and asakki marsuti) or the scribed precision. The right of the pur­ “ incantations against the appearance of the chaser of a slave to return the same to the dead.” Consciousness of regret and fear, seller at the original price after a certain, evoked by the memories of those that have stipulated period, in case of an illness or passed away, sublimized by the mystery defect which was not obvious at the time of death, these are the principal sources of of sale, was recognized in the famous law the belief in the troublesome ghost. The idea of the entrance of the demon into his 6 Cuneiform Texts, Part xxviii, 43; and for many victim is not always clearly expressed. The further details the works by Jastrow: “ The Civiliza­ incantation, which is really the prayer of a tion of Babylonia and Assyria,” and “ Religion Babyloniens and Assyriens,” in three volumes, which 5 Thus we see, for instance, on various Assyrian contains translations and discussions of numer­ monuments some divinities depicted in the act of ous texts (incantations and divinations). Phila., fertilizing manually the flower of the date palm. 1915. 162 Annals of Medical History code of Hammurabi.7 Slave contracts based Assyriologists derive the word bennu from on this law have come down to us in great a Sumerian ideogram which stands for number not only from Babylonian, but also muscle or tendon, and hence they give as from Assyrian, Persian, near-Asiatic and the literal translation “ the disease of the finally Greek times. Since the diseases are muscles.” In later contracts, made by usually stipulated by a name in these con­ Greeks in Asia Minor, Sudhoff found the tracts and their most striking traits de­ word tepa voaos (“ sacred disease” ) in the fined by the practical exigencies of the same place inserted with one or two other contract, it was hoped that their study names of diseases. This he considers defi­ would perhaps bring out more precise de­ nitely identified with epilepsy and hence tails about the ancient knowledge of a cir­ he concludes that in the Babylonian con­ cumscribed group of diseases. As a matter tracts the word bennu also is meant to of fact it was found that also here accurate designate a disease characterized by spas­ identification offered great difficulty and that modic attacks which incapacitate the vic­ it was much wiser to be satisfied with the tim and by periods of latency might de­ general information obtained. ceive the purchaser. This is quite plausible, It is fairly generally agreed among ex­ but it might be objected that the muscle perts that the two names bennu and sibtu spasm would not necessarily be the most which are found most frequently in these striking symptom of the attack so as to contracts were meant to designate those impose the special name, also that we have diseases or defects whose occurrence could no evidence that epilepsy occurred fre­ invalidate the sale. Non-medical Assyriolo- quently enough to make a special legal pro­ gists were quick to identify them in vari­ vision against it desirable. However this ous ways. Fever and ague (Harper, Jen­ may be, only Assyriologists assisted by sen), syphilis (Ungnad) and lepra were in medical men can decide the matter. There turn proposed8. Sudhoff, by a very inter­ is, however, a disease the enormous fre­ esting and ingenious argument based upon quency of which in antiquity is abundant­ a mass of corroborative evidence, has come ly demonstrated by palseo-pathological find­ to the rather startling conclusion that both ings and which, so far as I know, has never terms together were meant to indicate a been mentioned in connection with bennu— seizure of epilepsy. This would put the I mean osteo-arthritis deformans. From the subject apparently out of consideration in findings in Egyptian mummies we know this place. But epilepsy and other psychotic that it led to marked deformity, such as and neurotic affections have been regarded we see no more, and also that it attacked through long epochs as caused by infection, already relatively young individuals. That and the term psychic infection is occasion­ it might have appealed as a “ rheumatic” ally heard in our own day, so that we may muscle disease any modern sufferer of the be permitted to devote a little time to Sud- trouble will readily testify, and thus the hofPs translation of bennu and sibtu, inas­ terms bennu and rheuma are about on a much as the material he adduces allows par as regards setiologic lucidity. possibly a different interpretation. Whether the word sibtu stands for a dif­ ferent disease from bennu, or whether it 7 2267-2213 B.C. See Sudhoff, Arch. f. Geschichte simply means, as Sudhoff thinks, “ seizure” d. Med. 1910-11, iv, 353. cf. Johns, C. H. W.: or “ attack,” derived from the verb sabatu Assyrian deeds and documents on transfer of property, 3 vols. Cambridge, 1901, iii, 394. “ to grab, to seize,” is still an open ques­ 8 See Kohler and Ungnad: Assyrische Rechtsur- tion. Undoubtedly it has been used in va­ kunden, Leipzig, 1913. rious senses, but it seems quite established T h e H isto ry of I nfectio n 163 that it designates rather a general concept gan.10 The next class is formed by the than a special object and that this corre­ various bugs which as hemiptera, with sponds to the Latin inficere is more than some 50,000 species, threatens to drown likely. Very similarly the Greek eTra

Bible has acquainted us. Of course it has into a separate coffer beside the ark,14 and been intensively studied, but still many to be delivered at the frontier to “ those of puzzles remain to be solved. It was a reve­ Beth-shemesh.” Here once more the ark lation when not long ago, in Crete, traces proves troublesome, killing some 50,000 of a very high (Minoan) culture were people “ because they had looked into the found, one which antedated considerably ark” (vi, 19). This last outbreak of the that of Mycenae, Troy and of classic Greece. plague among the Israelites themselves We have also not yet found out about the would seem to emphasize the authenticity Hittites, and much remains equally uncer­ of the story. It was a plain and recognized tain about the Philistines who seem to have case of infection per fomitem, independent come from Crete. It is in the accounts of of theurgic influence. the wars between the Jews and the Philis­ Another epidemic, several hundred years tines that we find an early reference to our later, is also briefly mentioned in the Bible subject. (11 Sam. ii 3.) When the Israel­ (11 Kings xix, 36). This time the “ Angel of ites were hard pressed by the Philistines the Lord” smote 13,000 Assyrians of the they sent, as a last resort, for the Ark of invading army of Sennacherib (705-681).15 the Covenant to be brought from Shiloh Herodotus (ii, 141) gives more details about to the front. The Philistines speedily cap­ this plague and connects it somehow with tured it and took it in triumph to Ashdod mice. According to an Egyptian tradition, where it was exhibited in the temple of the Assyrians were decimated through the Dagon. The result was that the statue of intervention of the God Ptah in the role of Dagon fell down and broke its hands. Then a pestilence deity. This Ptah had a temple the plague broke out in the town and spread at Thebes where he was represented hold­ along the coast. This “ plague of emerods” ing a mouse in his hand. We see in all these is usually identified with the bubonic tales, the mouse creep in somehow. Offord 14 plague. The subsequent spread of the plague states also that votive mice modeled in is expressly connected with the arrival of silver were found in a river on the Syrian the ark in those three places to which it was coast, near Sidon, and that mice are carved in turn removed. During its sojourn of on Phoenician and Punic monuments. A seven months in Philistia it must have deity of the latter, Eshmun, was, it appears, done a great deal of harm, and at Ekron, equated by the ancients with Aesculapius its last station, it was finally decided on and that his cult was very similar to that the advice of the “ priests and diviners” of the “ Smintheus” who inflicts the pesti­ (vi, 2) to send the ark back to the Israelites lence upon the Greeks before Troy (Iliad, with an appropriate trespass offering. This i, 53). Smintheus is the “ mouse-god” was to consist of five golden emerods and alternative of Apollo. Other gods with mice five golden mice “ according to the number attached to their images or receiving offer­ of the lords of the Philistines.” These ings of mice were A T M , the associate of the offerings, the text states (vi, 5), were to hawk-headed sun god RA of Egypt, the represent “ images of your emerods and Reseph (Dagon?) of the Philistines, Phoeni­ images of your mice that mar the land cians and Cypriotes, according to Offord, . . . to lighten his hand from off you, worshiped also by Hittite and Syrian and from off your Gods, and from off your tribes. land.” 13 These offerings were to be placed 14 Cf. Offord in Science Progress, London, 1916, x, 13 This is the only passage from which a concur­ 570. rent plague of mice might be inferred, (cf. Macalis- 15 Isaiah xxxvii, 36: “ when they arose early in the ter: The Philistines, London, 1914, p. 47.) morning, behold, they were all dead corpses.” T h e H isto ry of In fectio n 165

One should think that the correlation of The Hebrew “ scapegoat” and the Greek plague and mice, evidently noticed in such “ pharmakos” are simply variations in form remote ages, would have impressed the of the underlying idea. bacteriologist earlier, inasmuch as we can More important than the decision of the follow it to the threshold of our times as a question whether the Hebrew recognized historical common-place. When Nicolas the relation between mice or rats and the Poussin in his famous painting, now in the plague is the very clear account given of Louvre, of the “ Pest of the Philistines,” the transmission by fomites and the com­ has rats among the crowd of victims in parative silence about direct transmission front of Dagon’s temple, he found more from individual to individual. From the justification for doing this in practically all sanitary point of view the decision of the the accounts of plague that he might have relative importance of these two factors has consulted, than in the rather meager evi­ a definite significance and as it is still under dence of the Bible. But it would not be discussion it is interesting to note that the sound reasoning to conclude that all this ancient Hebrew apparently decided it in historical evidence must be taken as vague favor of those moderns who oppose the ex­ anticipations of present conceptions. Even treme contagionist stand-point in plague the use of mice or rats as emblems of plague prophylaxis.16 divinities, or their models as votive offer­ The concepts of the insect pests among ings is not necessarily conclusive. One must the Biblical people are largely derived from not forget that all these divinities were the the Babylonians. Thus the fly, the mos­ controlling forces of all kinds of destructive quito and other diptera play also with them calamities, for the prevention or removal of a role in cult and elsewhere. Ekron, which which they were implored. The mouse, all we have already mentioned as one of the by itself, represented one of the most dread­ stations of the Ark in Philistia, held an ed plagues to an agricultural people and ancient and famous shrine dedicated to thus may have been symbolized without Baal-zebub, which name, literally translated, any reference to the plague in man. Aschoff means the “ Lord of flies.” Macalister (Janus, 1900, v) tried to get to the bottom identifies Ekron, not with Akir as is usually of the question why the mouse should have done, but with the modern Dhikerin far­ symbolized the plague. From a comparison ther south, near which still exists Deir edh- of the passages in the Vulgate and the Sep- Dhubban, “ the convent of the fly.” The tuagint he suggested that the votive offer­ shrine of Baalzebub was so famous for its ing might simpfy have attempted to repro­ oracles that the Jewish king Ahaziah, when duce the size and shape of the bubo. ill, sent to consult it, disregarding thereby But from the passage in 1 Sam. vi, 5 it the general prejudice of the orthodox is quite clear that models of both bubo against foreign divinities (11 Kings i). This (emerod) and mouse were offered, each ap­ Baalzebub, who only later in official demon­ parently for a specific purpose. The custom ology became one of the gubernators of of offering in sacrifice to a deity models of the Infernal Kingdom of Lucifer, repre­ organs or of symbols of disease is also very sents, as fly-averter, a very ancient and ancient and, as is well known, persistent in widely prevalent anthropomorphic concep­ our day. It is of great interest and has an tion. He is surely a Babylonian importa­ indirect bearing on our subject because tion, probably even older. He and his fe­ these models were probably thought to draw male counterpart Ashtoreth (Astarte, Ish- away, specifically, the anger of the deity 16 See G. Sticker. Wien. klin. Rundsch., 1898 and from that part of the patient’s anatomy. his exhaustive monograph “ Die Pest,” Giessen, 1908. 166 Annals of Medical History tar), so popular among Assyrians, Phoeni­ corded in the famous chapter xiii of Levit­ cians and Canaanites, proved very tempting icus, a book which is known to date from to the Jews whose leaders painted them so the Babylonian phase of the Jewish people. black that their devilish reputation has long It became the prototype for similar sani­ survived. The deep appeal which these, we tary legislation close to our own times and may call them setiological, divinities exert­ led to the provision of institutions which ed upon the human soul, is a very interest­ we have every reason to admire. It is in­ ing fact to note, as well as the opposition deed the current opinion that the wide which they encountered from the learned. distribution of the Ieproseries throughout It is also known that Hippocrates had to Europe was mainly responsible for the warn his pupils against the demoniacal gradual disappearance of lepra toward the theory of disease. Baalzebub of Ekron end of the Middle Ages. It is difficult to and the BaalBerek (Berith) of Shechem understand how again and again the opin­ (in the Talmud) was known to the Greeks ion can find utterance that these measures as the Bao:X /Ivlav and probably directly were not based on the fundamental recog­ transmitted into their own cult as the Olym­ nition of the infectiousness and transmissi- pian Zeus Apomuios, of whom Pliny speaks bility of the disease, because of the demo- in his Natural History (xxxix, 34), where he nial prepossessions in the minds of the Jew­ also mentions the use of fly ashes in the ish law-givers. It is not my intention to treatment of alopecia “ to drive away the enter into this subject fully although in fly.” 17 All these are only echoes of the Ela­ the concatenation of facts it is one of the mite and Babylonian rites, brought out by strongest links. My desire is to bring out the French excavations at Susa, fixed by facts which are not so clearly self-evident. the fly-emblem already alluded to. The cu­ Morris Jastrow, Jr., has recently discussed rious persistency of the popular association the subject (Jewish Quarterly Rev. IV, 357). of health and fly is illustrated by a pretty His view is that the laws are mainly based story Macalister (I. c.) tells about the heal­ on the demonistic theory of disease which ing spring of St. Michael in Kirkmichael must not be confounded with our own bac­ (Banffshire) which, in popular tradition, terial theories and that the remedies were had always been presided over by a fly and not used against the disease but against the neglect of which as late as 1820 was the demons to whom they were distasteful deplored by an old man who “ in the days — pharmacology gradually evolving out of of his youth enjoyed the pleasure of seeing demonology. This is, of course, one way of the guardian-fly.” Deeply rooted in the looking at the matter, but it fails to go to folk soul is this old and ever-young con­ the core of it. J. H. Alexander, on the other cept of this relation of fly and health; and hand (Med. Press and Circular, London), as we watch the “ burnt-offerings” of heca­ following Clerk Maxwell’s famous example, tombs of trapped flies rising to the skies substitutes in certain ancient accounts bac- from the camp fires of the U. S. Army we teriologic terms for the demonistic ones. do not seem to be so very far from Baby­ Finding them to fit well, he asks whether lonia.18 this is due to mere chance or whether the More closely in concordance with our Ancients did not anticipate to some extent views on infection are the prophylactic laws against the saraath (the collective name for 18 That in our days grave pathogenic possibilities of the fly are recognized is clear from a large special lepra and similar diseases) which are re- literature which has been admirably reviewed by 17 See M . Hoefler: Die volksmedizinische Or- Henry G. Beyer: The dissemination of disease by ganotherapie. Stuttgart, 1908. the fly. N. Y. Med. J., 1910. T he H isto ry of I nfectio n 167

in their crude ideas and beliefs the theories taenia solium and other cestodes may of of modern science. course have occurred also, but for the for­ mer this is not very likely since pork as a EGYPT whole was despised as food. The views the ancient Egyptians enter­ The Egyptian anaemia, still very fatal, tained about diseases and their causes are seems to have been known to the ancient much better known than those of the peo­ Egyptian. At least a description in the ples we have just discussed. The differences Papyrus Ebers has been interpreted in this are in form rather than in substance. I sense. Here it is stated that the fatal dis­ shall content myself to select only a very ease was sent by the God of Death, aaa by few examples out of the rich harvest of name, to both sexes, causing abdominal archeologic research.19 and other pains, bloody discharges. As The disease-making possibility of the its immediate cause the worm Neltu is worm seems to have been uppermost in the named. Scheuthauer, Joachim, Finlayson Egyptian mind in all times. Worm diseases identified this aaa-disease with the fatal being very prevalent, this cannot astonish. ansemia caused by the ankylostoma or un- But that the relation of worm and disease cinaria duodenalis, i.e., our hookworm dis­ should have been established in ancient ease. This restricted identification has late­ time in those cases where only the minutest ly been disputed on very interesting examination can reveal the parasite, would grounds.20 Pfister opposes very rightly the seem remarkable indeed. Herodotus gives tendency of identifying too closely with an account of a regulated inspection of the modern concepts those ancient descriptions meat which was destined for sacrifices. It which covered broad complexes of symp­ shows among other things that the inspect­ toms and not pathologic entities. He dem­ or, the priest, was on the look-out for such onstrates that very similar symptoms are small invaders as the cysticercus. When caused by the schistosoma haematobium in only parts of the animal were sacrificed, that equally fatal disease Bilharziosis, which the rest was available for consumption and attacks in some places as many as 70 to 80 so the inspection may have had a direct per cent of the population (as against 25 hygienic intent. But meat was not the main per cent of ankylostomiasis). That Bilhar­ diet of the Egyptian. Cereals, vegetables ziosis most likely entered into the concept and fruits were the staple foodstuffs, but of the aaa-disease, Pfister sees in the fact to them must be added as of considerable that in the hieroglyphic sign for the aaa- importance the air-dried fish, at least for disease, the phallus is the determinative: the early Egyptian. This latter fact allows O O K —— n us to identify a tape-worm for which there - _ n r— u3 is a hieroglyphic sign: If this is so, it would indeed be good evidence, for as he shows in typical pictures, the ure­ thritis with subsequent enormous tumefac­ i.e., the pend-worm, with tolerable proba­ tion of the penis, as the most striking symp­ bility as the botriocephalus latus, whose tom, would have amply justified the use of cysticercus lives in freshwater fishes. The this determinative. No other than these two worm diseases seem to have been considered 19 For further detail see the brilliant articles by F. von Oefele: Studien liber die altaegyptische Para- 20 E. Pfister: Ueber die aaa-Krankheit der Papy­ sitologie. Arch, de parasitolog., Paris, 1901 and 1902, ri Ebers und Brugsch. Arch. j. Gesch. d. Med., 1912, iv and v. vi, 12. 168 Annals of Medical History and around this of course hinges the whole see the analogies and resemblances with question as to what diseases are comprised in our own, passing over the essential differ­ the aaa-disease, a question which only the ences determined by their closer relationship Egyptologists are competent to decide.21 If to and dependence on the older cultures; and the Egyptians could detect the worm as the we see only the dawn of our civilization and cause of the disease, it is astonishing in­ the birth of our science, of progress. deed, given its small size (about io mm. What profound differences between these length, the schistosoma being a little long­ two “ classics.” The Greek, in his gay, er than the ankylostoma) and the fact that cheerful attitude towards life, exquisitely it is not readily observed in the excretions. receptive to the beauty of form, of color and of thought, casts the forces of nature CLASSICAL ANTIQUITY AND AFTER into beautiful anthropomorphic shapes. The As we leave the era of these remote peo­ same sense for proportion and harmony ples and approach the one we know better which we admire in the artistic products of and recognize as the basis of our culture, his hand characterize equally those of his we seem to notice the gradual development mind. Of much sterner stuff the prac­ of circumscribed, almost tangible, notions tical Roman. He takes himself and life about the subjects which have occupied us. more seriously, he has a purpose: action There we saw man apparently satisfied and power; art and thought are there only with the vague connection of primordial to serve it, they have to be fixed and codi­ ideas, apprehended more by feeling, by in­ fied, made into law. Disease for the Greek tuitive perception, than by reasoning. Here is a disturbance of the beautiful harmony he seems to have discovered systematized of health, he thinks it out on those lines thinking as a new instrument by which he and tries to reestablish the harmony. could with certainty approach the riddles Hence hygiene is the keynote of his medi­ of the material universe and of life, in order cine. The Roman proudly refuses to con­ to satisfy that new craving for knowledge sider disease except when its palpable ex­ which had come over him. We saw how the istence forces him to it. Then only and re­ Babylonian had already begun to classify luctantly he takes the most necessary steps. his observations. Now Greek and Roman There is no such thing as scientific Roman begin to classify their thoughts and to medicine and what was brought in from write them out; not any more as a solemn abroad had soon to adapt itself to Roman religious rite, but for the dissemination ,of ways. But, in general, thought on somatic what they regard as a record of their wider needs, on medicine, formed only a small and more conscious experience. This, broad­ fraction of the philosophy which was en­ ly speaking, marks the principal distinction grossed with seemingly higher ideals, aes- of that epoch which we call classical, as the thetical, logical, and religious in turn. And prototype of our own civilization. All be­ in that small place left for medicine the comes very complex suddenly. Fixed con­ concept of infection was not apt to thrive. cepts based on intricate reasoning multiply To enter into details here would lead us with the individualities of the thinkers. And far astray. And details do not help us much, as we project ourselves into that life, we considered by themselves, outside of that connection which links them as intellectual 21 It is of some interest that RufFer in his micro­ phenomena to primordial concepts. That is scopic examinations of Egyptian mummies found the encapsulated or calcified schistosoma haemato­ a task for future historians. But one curi­ bium, and so demonstrated with certainty the oc­ ous fact becomes apparent already, as we currence of Bilharziosis in ancient Egypt. glance over the period: in times of greater T h e H isto ry of I nfectio n 169 emergencies such as wars and pestilence, and contemptuous attitude he assumed the idea of infection asserts itself in its against all other thinkers in medicine, state of original simplicity. What share has methodists, empirics and pneumatists, one the classical medical thought, with its fund is impressed by the logical sequence of his of analyzed observation and experience, in arguments, by his evident eagerness for this phenomenon? In the Hippocratic writ­ objective examination in the solution of his ings, in those of the Alexandrian school, we problems, but one can not fail to see that still detect the influence of the primitive he juggles with his premisses and assorts concepts, but gradually they separate and his facts just to show the stupidity of the follow different channels. Along with the others and especially that of the “ ass of roaring and sometimes turbid main stream Thessalos,” his chief abomination, and that of scientific thought runs the babbling, lim­ he is not above a feeling of jealousy towards pid brook of popular tradition, in which we those successful practitioners. readily detect the intuitive sources. Here The differences between the opposing and there they approach each other and schools were formal rather than real, in the­ sometimes a little runs from one into the ory at least, but the methodists were more other, but on the whole they proceed apart. ready to adapt themselves to Roman pecul­ The poetr the playwright, the philosopher, iarities which Galen scorned. This is brought those spokesmen of folk medicine, the medi­ out very well by Meyer-Steineg in his essay cal writer less and less, re-affirm the eternal on Thessalos of Tralles 24 where he shows validity of the primitive idea of infection how the Roman always favored popular as whenever they dwell on times of grave against scientific medicine, and how clever­ danger.22 ly this was exploited by Thessalos and, his The history of infection is usually begun methodist confreres. Also how strong this with the period when the animate contagium Roman preference was so that even Galen became demonstrated to the satisfaction of had to submit to it in turn. Both parties in exacting scientists. The cornerstones plant­ the conflict derived their knowledge from a ed are Fracastoro in the sixteenth, Athana­ study of the body and its functions, but sius Kircher in the seventeenth century.23 both in different ways, wherefore they de­ In a certain sense this is true, in another nied scientific consideration to each other. it may be shown that the history of infec­ In common they neglected a broader aeti­ tion as a broad concept of pathogenesis ology. True, Galen had evolved logically ended when the attempt was made to con­ an aetiologic system, but based it almost vert medicine into an exact science. The entirely on an elaboration of Hippocratic supreme effort in this direction is centered humoral concepts and the theory of innate in Galen, the most industrious and ingeni­ qualities. He was too much absorbed by ous prototype of the modern medical scien­ the variegated phenomena in the body and tist. Whenever one examines his great work, too much opposed temperamentally to the and analyzes the reasons for the aggressive superstitious nature of external forces, to 22 From a review of Sir Bampfylde Fuller’s new stress they start into life and take command. Dumb book (“ Man as he is,” London, Murray, 1916), in the and invisible, some are yet our masters in all criti­ Times Literary Supplement of Nov. 23, 1916, which cal times.” I receive as I am reviewing my Mss. I find that he 23 For the details of this period see the painstaking has come to similar conclusions: “ With man as we review by Charles and Dorothea Singer: The De­ know him, living in an artificial state, recollections velopment of the Doctrine of the Contagium Vivum, of his experience count for more and more, and the 1500-1750, Int. Med. Congr. Sect. Hist. Med., 1913, primitive impulses for less and less. They are by no pp. 187-207. means dead. In certain circumstances of strain and 24 Arch. J. Gescb. d. Med., 19 11, iv, 89. 170 Annals of Medical History ever clearly see and admit the fact of in­ pie of Apollo where Chaldean priests hid the fection, or at least its importance. “ Who morbific virus. Nergal, the god from Meso­ does not know, he exclaims, that brine and potamia, still wants his voice heard in the seawater preserve meat and keep it un­ m atter! corrupted (aseptic, acrrjTra), whilst all other This voice arises again and again as we water—the drinkable kind—readily spoils traverse the coming centuries. Hardly per­ and rots it” (dLcupdeipet, re xca 0-17x61).25 26 But ceptible in the scientific writings of the this did not suggest to him any exter­ Middle Ages, though always traceable, it nal origin of this corruption. To him it is a becomes more and more subdued by the spontaneous process, apt to occur also in­ one eager interest of Christian aspiration side the body, just as the innate heat, to use the knowledge of the world for the which according to him has no outside understanding of the Bible. Science be­ source, as Erasistratos thought. Such facts comes the handmaiden of theology: “ Non as he notes them down serve him only to potest intellegi sacra Scriptura sine aliarum support ingeniously his humoral theory. For scientiarum peritia,” wrote Bonaventura.27 sixteen hundred years scientific medicine And when modern historians claim that the speculated and experimented on very simi­ turn of the tide came in those times with lar lines. the introduction of the experimental meth­ The lay writers Celsus, Cato, Varro, od, hailing Roger Bacon and his “ experi­ Columella, Pliny, Vergil, Vitruvius and mental science which neglects argument” others note the fact of infection as a com­ as a sort of savior of science, it can not monplace that needs no argument. Could appeal to one who has heard the far cry for any one express it more clearly than Lucre­ observation, experience and experiment tius in his famous poem, de rerum natura, from the dawn of human thought. It cer­ which had such a great influence on the tainly is difficult to understand how such thought of the Middle Ages? evaluation could ever be deduced from Bacon’s naive belief in the powers of this Primum, multarum semina rerum “ new science” and its master, Pierre de Esse supra docui, quae sint vitalia nobis: E t contra, quae sint morbo mortique, . . . 26 Maricourt.28 Infinitely more important it is to recognize in those times the profound Had Galen seen in this and in Lucretius’ social reorganization which is taking place, morbidus aer and pestilitas anything else but leading to powerful and multiple organiza­ a poet’s license, we would surely have a tions of corporate interests, the mediaeval long treatise from him on the subject, and townships and universities. This is more not only his casual references to the con­ significant even than the setting free of the tagiosity of certain diseases. And still, in purer classical spirit after the capture of spite of Galen’s science which was triumph­ Constantinople, and its influence on arts antly to conquer the world, we find Ammi- and sciences, because for the first time an anus Marcellinus, last but not least of Roman organized popular will asserts itself which historians, telling that the Antoninian plague henceforth cannot be neglected. Already it was caused by soldiers breaking into the tem- shows its creative possibilities in the meas­ ures for the protection of the public health. 25 Galen: On the natural faculties, B. II. 129, No careful student of the decrees of this translation by A. J. Brock. London, Heinemann. N. Y., Putnam, 1916. Loeb’s “ Classic. Lib.” 27 “ Epist. de tribus quaestionibus. ” 26 First, as I have said before, seeds of many 28 See Henry Osborn Taylor’s brilliant article on things are vital to us; and again others that bring Roger Bacon in his “ Mediaeval Mind,” London, disease and death . . . Macmillan, 1914, vol. ii, 514. T h e H isto ry of I nfectio n 17 1 time providing sanitary legislation, quar­ tion, effervescence, germ, etc.” On the antine measures and disinfection against meaninglessness of such terms a mass of various diseases and especially plague, lep­ physicians base their therapeutic proce­ rosy and phthisis, can fail to see how much dures; they use them even in such cases all this is based on the fundamental con­ where a Sydenham or Boerhaave would cept of infection. Imperfect as are all hu­ have been content to observe and describe. man institutions these measures were often For Gatti variola is produced by a foreign excessive and unnecessarily severe. Because body that has entered the organism from of this inherent defect, which our own without. Transmission takes place by con­ measures share, they hardly merited being tact, or through the organs of respiration or held up to ridicule by Koehler at the Inter­ digestion. The “ virus” reproduces and mul­ national Conference on Sanitary Legisla­ tiplies itself. Smallpox is the constant and tion in 1897. It is characteristic of the pre­ definite effect of it, strictly specific. Vario­ vailing historical shallowness that he cited lation is the transmission of the disease the mediaeval decrees against cholera, a dis­ controlled by intelligence instead of acci­ ease which first appeared in Europe only dent. For the purpose of inoculation the 100 years ago.29 virus must be modified. Gatti’s purposeful M any instances might be cited to show attempts at attenuation might still be read how often the lay mind, grasping a funda­ with profit by modern experimenters.30 mental principle, drew instinctively and spontaneously the necessary consequences CONCLUSIONS and it is somewhat depressing to have to acknowledge that so very often this oc­ We are too near our own time to form a curred without the aid of the scientist and broad judgment of our methods and con­ sometimes against his protests. But only cepts. When we review the many fertile the recognition of the fact can indicate the applications made by microorganic biology road to improvement. I shall not try to cite in every-day life, the advances of a pur­ many instances but I cannot refrain from poseful prophylaxis and of sanitary sciences alluding to that last event in the history of generally, to doubt the correctness and infection, sufficiently remote to permit crit­ utility of these efforts would require a hy­ ical analysis, which shows the extraordinary percritical and entirely objectionable atti­ viability of the primordial concept and its tude of mind. And also as regards our mod­ application. I mean the great experiment of ern methods of laboratory investigation, prophylactic variolation during the period of we must agree with Welch, when he said from 1721 to 1840. It is almost forgotten over here at the University of Chicago in 1907, vaccination although neither the one nor that “ we cannot foresee a time when pure­ the other owed its origin to scientific medi­ ly observational and descriptive biological cine. I shall merely repeat what I said be­ studies, which to-day hold the first place, fore about the work of Angelo Gatti in shall not continue to have their value.” 31 It which he gave expression to the thoughts is probably better in the interest of our underlying the movement, against the op­ aims that we should rather over- than position of the Medical Faculty of Paris: First he discusses the aetiology of smallpox 30 A. C. Klebs, Heft 7. Hist. Biologie d. Krankheits­ and turns sharply against such futile terms erreger. Giessen, 1914, also The historic evolution of variolation, Johns Hopkins Hosp. Bull., 1913, as “ fermentation, Ieven, humores, ebulli- xxiv, 69. 29 See G. Sticker in Heft 2, Zur historischen Biologie 31 Welch: The Interdependence of medicine and der Krankheitserreger, Giessen, 1910. other sciences of nature. Science, 1908, Jan. 10. IJ2 Annals of Medical History

under-estimate the absolute value of our causes, but by their very subordination we methods and achievements. In the wider show how difficult it is for us to see in them realm, just as in individual life, an insidious anything but unimportant influences. And dwelling on the past may lead to paralyz­ we forget that it is only the obviousness of ing speculation, self-depreciation and hesi­ one factor and the lacking clearness of the tation. Here as there, such tendencies must other which determine the artificial subor­ be discountenanced. But, on the other hand, dination. Pettenkofer’s x we have found it can not be denied that the taste for self­ but the equally important y and z have yet exaltation, rampant to no small extent, to be supplied in the setiologic formula. merits equal attention, as it may easily lead Shall we desist from this deeper aetiologic to overindulgence and mental indigestion. search because of intrinsic difficulties? The Viewed with this general proviso it may reserved position of Virchow and Cohn- perhaps not be unprofitable to picture heim toward it will be recalled. To them the impressions a future historian might aetiology seemed too vast a subject, involv­ gather from a perusal of our bulky litera­ ing too many different factors and techni­ ture. Would he see that the elaboration of cal methods which could not all be fitted the doctrine of the specificity of cause and into one scientific garment. Hence they per­ effect in infectious diseases, which “ de tout sisted in observational and descriptive Ie temps toutes Iangues ont dit” as Bret- methods. Koch and his school of technical toneau put it, already in 1855, has led us to artists, without any such restraint but also a deeper and more correct comprehension without the broad outlook of their prede­ of these diseases? May he not conclude cessors, were heralded as the founders of a that we have not drawn from it the full new medicine. Their historian, Abel, de­ logical consequences, that we have persist­ scribes the final triumph in these eloquent ently disregarded our negative findings and, words: “ Laboriously, slowly and late, but in overestimating the importance of the at last with certainty, the pure contagionis- positive ones have come to a sterile gener­ tic theory has attained to the sole rulership alization of contagionism? Will he admire in science.” All this in barely forty-five with Sticker the courage of Pettenkofer years and based almost entirely on techni­ when he insisted, in his famous cholera cal and instrumental improvements. The doctrine, less on what he had determined “ sole ruler” is difficult to please, a failure and knew, than on what he did not know to solve some particular problem is invari­ and what needed to be brought out? Or, ably put to faulty or inadequate technic, will he brand him, with Liebermeister, as never to a wrong direction of effort, and the ‘‘a subtle and sometimes humorous dialec­ object of research, may it be the infecting tician,” notwithstanding the solid results organism or its carrier, must remain unal­ obtained as a consequence of Pettenkofer’s terably the same. We look down upon the and others’ sanitary reforms? mediaeval scholar who attempted the solu­ It is worthy of serious reflection whether tion of similar problems by syllogistic struc­ the day is not likely to come when those ef­ tures of thought based upon insufficient forts now occupying the center of the scienti­ facts. We have undoubtedly more facts, fic stage, that is, the search after the specific but can we prove their sufficiency by sub­ microorganism, its minute identification by tleties of experimental research, so often complex experimentation and the prophy­ unrelated to actual exigencies? Multiple lactic and therapeutic application derived facts brought out by inductive research do therefrom, will be relegated to a less con­ not combine, as Francis Bacon expected they spicuous place. We admit contributory would, infallibly leading to really useful gen­ T h e H isto ry of I nfectio n i 73 eralization. Never yet in the world’s his­ ready postulated, as of prime importance, tory has a great progress, a discovery of that all processes within the sphere of liv­ fundamental importance, been achieved by ing bodies just the same as in that of the this method. non-living, must take place according to the There are some signs of a reaction against same fundamental laws; that, therefore, also the present concepts and methods of path­ in pathology, there is no room left for a ology. It is no more a cellular pathology special vital force. in Virchow’s sense. The doctrine of the cell In all these newer tendencies the inter­ as the vital unit, one of the most useful gen­ dependence of medicine and the other natu­ eralizations in biology, does not rule path­ ral sciences becomes ever more clearly visi­ ology any longer. The limits of cellular ble. It will need the work of genius to bring autonomy and the interdependence of the about the needed efficient interaction. We units, only dimly admitted by Virchow, are may have to wait long for such an one. becoming better defined. The concept of Meanwhile the common ground might be the organism as an entity (also in its path­ prepared, and we believe that nothing can ological phenomena) and of its essentially do it so well as organized historical research fluid constitution opens a wide outlook in science, because, in George Sarton’s through the work of W. Roux, Jacques Loeb admirable words: “ Science, divided into and Albrecht. In accord with these modern water-tight compartments, makes us feel concepts, it was one of the pioneers of seti- uneasy;— a world split into selfish and ologic research, Edwin Klebs, who defined quarrelsome nations is too narrow for us. infectious disease as the resultant from the We need the full experience of other coun­ interaction of different bodies, yielding dif­ tries, of other races; we need also the full ferent products and phenomena. And he al­ experience of other ages. We need more air!”

MARSHALL HALL’S PROOL OP REPLEX ACTION

You observe this living frog: its sentient and vomi­ I now destroy the whole spinal marrow with this tory junctions are obvious. I divide the spinal marrow, probe. It is in vain that I pinch the toes; the animal, below the occiput, with these scissors: all is still. the limbs are motionless! There is not a trace of spontaneous motion. The ani­ Could the former excited motions be those of irrita­ mal would remain in this very form and position, bility? I will try the truth of this suggestion by seeing without change, until all signs of vitality were extinct. whether, now that the axis of the excito-motory system But now I pinch a toe with the forceps. You see how is destroyed, with its phenomena, the application of a both posterior extremities are moved. A ll is now slight galvanic shock will prove the subsistence of irrita­ still again; there is no spontaneous motion, no sign bility. You see how instantaneously and forcibly the of pain from the wound made in the neck. It is with­ muscles are simulated to contraction. out sensibility— without volition; the power to move Is not the proof, from these experiments, of the remains— the will is extinct. I now pinch the integu­ distinction between the motions of volition, of the ment. You observe the result— the immediate recur­ excito-motory system, and of these from those of irrita­ rence of excito-motory phenomena. bility perfectly and unequivocally complete? TEXT OF WILLIAM SHIPPEN’S FIRST DRAFT OF A PLAN FOR THE ORGANIZATION OF THE MILITARY HOSPITAL DURING THE REVOLUTION

[Through the courtesy of Colonel William O. Owen, U. S. Army, Curator, Army Medical Museum, Washington, D. C., we are able to print from No. 22, folio 99, papers of the Continental Congress, William Shippen’s first draft of a plan for the organization of the Military Hospital Service during the Revolution. This document, by Shippen and John Cochran, was written out in Shippen’s own handwriting and transmitted to Congress February 14, 1777. The committee report on the same, written out in the handwriting of Benjamin Rush, was then submitted to Congress on February 27, 1777. The heading of the page given in facsimile, “ For the flying Hospitals,” would look at first as if it were an anticipation of the innovation of Baron Larrey. But, as the text shows, camps and hospital wagons only are meant; in other words, the plan proposed was a sort of precursor of our present field hospital, but not the rapidly moving field hospital, with litter-bearers, which Larrey and Percy made accomplished fact.— E ditor.]

FIREE Districts Northern, middle to the Hospital & ye Army as shall be or­ and Southern. dered by ye Dir. Gen. Apothecary and To each one Director General— mates to obey ye Apoth. gen1. His duty, with the advice of A Commissary—whose duty shall be to the general or Commandr-in-Chief, in his procure store and deliver provisions, for­ respective Department. age such other articles as the Director shall To establish a sufficient number of Hos­ judge necessary for ye use of ye hospitals pitals at proper places for receiving the in the purchase of wch he shall frequently sick & wounded of the army & to dispose consult with & be regulated by the prices of the same as he shall think proper— To of the Quartermasff and Commissr gener­ provide & prepare medicines Instruments als. & dressings; Bedding, & other necessary Adjutants to ye Commissary & Store­ furniture, proper Diet & every thing neces­ keeper, a Steward for every 100 sick who sary for the subsistance & comfort of the shall recieve from ye commissary provi­ sick & wounded Soldiery & the officers of sions, distribute them agreable to ye or­ the hospital & to pay the salarys of the ders of the Genl. or Physician & surgeon latter agreeable to establishment of Con­ genl. of his dept. & be accountable to ye gress, together with all other expences of commissary for ye same. the hospital.-. To execute which He shall a matron to every 100 sick who shall be allowed the following officers to be ap­ see the provisions are properly prepared, pointed & discharged by him in such num­ the Wards, Beds, & Utensils shall be kept bers as the necessity of the army may re­ in neat order, & that ye greatest Ocono- quire & the General approve an authentick my be observed in her department. A nurse report of which to be immediately trans­ to every 15 sick at the direction of ye mitted to Congress. matron. Assistant Directors—to superintend the An Hostler or Stabler to receive ye for­ Hospitals to the care of which they shall age from the commissary and to take care be appointed & see that ye same are pro­ of ye Waggon & other horses belonging to vided as before specified agreable to ye the Hospital agreeable to orders he shall instructions of the Director Gen!----- recieve from the Dr. genl. or such other An Apothecary General whose Duty officer of ye Hospital he shall appoint. shall be recieve, prepare & deliver medi­ A Secretary whose Business shall be to cines and other articles of his department keep the accounts of the Hospitals, shall 174 Specimen Page of Shippen Text, 176 Annals of Medical History

recieve and deliver ye monies agreable to For the Flying Hospital ye orders of the Directr GenL— There shall be A Director and Surgeon Clerks for the same.— Genl. whose Duty in subordination to ye Such officers & soldiers as the general Dir. Genl. shall be to superintend & re­ shall think proper to guard ye hospitals & cieve from him a suitable number of large to conduct such as shall be weekly dis­ strong Tents—Beds, Bedd[ing,] Medicine, & charged ye Hospital to their respective Hospital Stores for such sick & wounded per­ regiments & who shall obey the directions sons as cant be transported to ye general of the Direct^ GenL or the Physician and Hospital with safety or may be rendered Surgeon GenL while on this duty. fit for duty in a few days—He shall also There shall be also see that the sick & wounded while in his Two Physician and Surgeon Generals— hospital are properly attended & dressed who must superintend & regulate the prac­ and when able, to be conveyed to ye genl. tice of Physic & Surgery in such Hospitals Hospital for which last purpose he shall be as the Dir. GenL shall appoint them to, & supplied by ye Dir. Genl. with a proper in his absence they shall appoint the Phy­ number of convenient Waggons and Driv­ sicians Surgeons and other officers of said ers.—He shall see that the regimental Sur­ Hospital to such dutys as they shall think geons and mates attend their regiments. proper & shall report weekly to ye Dir. genl. Those who refuse to obey his or ye Dir. or in his absence to ye ass. Dir. the state Genl.’s directions shall be tried and pun­ & number of the sick & wounded of their ished as Congress shall direct. Hospital & the delinquent officers of ye He shall have under him same. They shall also see that those who Stewards to recieve and properly dis­ are fit shall be delivered every week to pense such articles of diet as ye Director the officer of the Guard to be conducted to General shall give or order to be given him ye army. by the Corny of ye Army or Hospital. Senior Physicians & Surgeons who shall Brigade Surgeons—who shall superintend attend, prescribe for & operate upon and the medical department in their respective see properly treated such sick & wounded Brigades, report the state thereof to the as shall be allotted them by ye Dir. genl. Director of ye flying Hospital & see that or either of the Physician & Surgeon genl. the sick & wounded are sent in proper time Second Surgeons to assist ye senior Sur­ & in a proper manner to ye flying Hospitals geon and be under ye same direction. —they shall also attend & prescribe for ye Mates who shall attend the physicians sick and wounded in ye Hospital under ye and Surgeons when they prescribe and op­ Direction of ye Surgeon Genl. erate, shall dress ye wounded, recieve from A suitable number of mates to dress, & the apothecary, mate of ye Hospital & put of Nurses and orderly men ye number to up the medicines & see that they are regu­ be determined and they appointed and paid larly & properly administered to ye pa­ by ye Dir. tients. All the above officers to be appointed & A suitable number of covered and other recieve such Salarys as the Congress shall Waggons to be supplied by ye G. M. G. please to direct. THE BEGINNINGS OF INTRAVENOUS MEDICATION

B y HORACE MANCHESTER BROWN, M.D., F.A.C.S.

MILWAUKEE, WIS.

r i s t o t l e (b .c . 384-322) saw nature and functions of the liver, spleen, the blood of a fish flow from its lungs, and heart, and a thousand other heart into its gills. (“ De Part. things which are but common-places to­ Animalium,” III.) Undoubted­ day, but which were insurmountable ob­ lyA many men who have had the taste and structions to true knowledge up to the disposition for wandering in the sinuous middle of the seventeenth century, would paths of medical investigation, or who have never have been considered, or would many found joy in philosophizing with the an­ centuries ago have been cleared away. cients, have dreamed dreams of speculation The reader may well ask, What has all as to what might have been the position this to do with the subject upon which this of the theory and art of medicine and our paper is supposed to treat? The answer is civilization and religious thought, had Aris­ not difficult. totle but had sufficient imagination to have Nothing that can result from philoso­ gone a step farther and have thought of phizing is ever of any value, until, like the the possibility of the way of the return of result of any other form of mental activity, the blood to the heart. it finds its application ad hominem. The There is no limit to the horizon toward study of the history of medicine is, in the which such dreams might lead; and to most intense degree, the study of the de­ speculate upon the possibilities of such a velopment of civilization, not only as ap­ conception is almost to wander away among plied to community life but as well when the djinn of an Arabian tale, or to intoxi­ applied to the development of the individ­ cate oneself with musings among the Sepi- ual. It is a study of the great struggle of roth of the Kabbalah. mankind as led by its teachers, against the Whatsoever might have been the result destructive forces of nature, and in so far that must of necessity have been the out­ as the teachers have failed in their grasp of come of such a discovery at a period al­ the meaning of things and phenomena about most 2000 years before the time of Harvey, them, in so much has man failed in the it is not beyond the realm of reason to be­ speed of his journey toward better health, lieve that the world would have been spared better mentality, better living and better the degradation of the ignorance of the appreciation of the things of life. Dark Ages, and the erroneous philosophy Throughout the world, up to the time of of St. Thomas Aquinas, founded upon the William Harvey, mankind was struggling physiology of Aristotle, the controversies blindly in a fog of theory, superstition and of the scholastic and dogmatic theologians, fear, toward the light, the first glimmerings the proposition of “ two kinds of truth: the of which came with the coming of the great Philosophical, founded upon proof, and the anatomist Vesalius, the controversialist Ser- Theological, founded upon faith” (See Mat- vetus, the keen observer Fabricius; a glim­ thieu Paris. “ Hist. Maj.,” p. 541, and mering which was to burst into a full efful­ Mosheim. “ Eccl. Hist.,” Part II, Cap. 3.), gence which should illumine the path that the futile discussions as to the nature of science might tread, when Harvey by his and location of the soul, the problems of discovery of the circulation of the blood, generation, metabolism and nutrition: the illumined the leaders of the world of philos­ 177 178 Annals of Medical History ophy and science, and through them gave that on every hand and every day the to the human race those facts which have medical profession here, now, is forced to made all exact medical knowledge possible contend with the erroneous conceptions since his time. that were handed down through the years It has seemed to me in view of the great from Galen, and which still hold not only interest that the medical profession has in the minds of the laity, but also in the taken in the matter of intravenous medica­ acts and thoughts of many men within the tion since the introduction of salvarsan, profession of medicine itself. that a short account of the early history of Erasistratos, of the School of Alexandria, that method of treatment may not be with­ had established the belief in the minds of out interest, and therefore I have to offer medical men and philosophers that the ar­ a somewhat incomplete review of the rec­ teries contained only air. Galen by his fa­ ords relating to infusion of medicaments mous experiment with the hollow reed or and transfusion of blood, during the period a bronze tube (Liber, “ An Sanguis in Ar- between 1490 and 1680. teriis Contineatur,” Cap. 8) had proved It will be necessary to glance first at the the folly of this belief. conditions of knowledge in our profession For Galen, the liver was the source of in relation to the physiology of the blood the blood and the natural spirit, and the and its movement during the centuries pre­ heart was the seat of the essential heat and vious to the discovery of the circulation by of the vital spirit, while the blood mixed Harvey in the year 1613, and his announce­ with air in the left ventricle of the heart ment of his discovery by the publication of and passing to the brain through the ca­ his book in Frankfort in 1628. rotid arteries became perfected in the lateral In the year 201 A.D., there died a man ventricles, so as to produce the animal in Rome, a physician, who had had seven spirit, which was the food of the soul. emperors as his patients and who left be­ The soul was looked upon as a sort of a hind in his writings, an accumulation of triad. The concupiscent soul, the epithu- the knowledge of his predecessors, and a mos, resided in the liver. This was the system of medicine, which was perfect in passive or feminine element, the desiring or its kind, logical in its reasonings, complete acquiring element in the triad. In the and well proportioned in its form and which heart resided the acting soul, the thumos, ruled the medical world for 1400 years; in­ the active, masculine element of the triad fluencing not only the writers on medicine which produced the vital heat and sent it as no other man had influenced them, not throughout the body, and which when re­ only as to the physical welfare of the entire fined became part of the governing soul, world, but also furnishing the Christian the hegemonos, which was the controlling world with a basis for a complete system element of the triad. The natural spirit was of theology, although but little of it was in the liver and veins, the vital spirit was founded upon anything more than specu­ in the heart and arteries, the animal spirit lation, while those parts of it which seem to was in the brain and nerves. be demonstrations of facts were but false­ A certain movement of the blood was hoods and erroneous conclusions due to er­ recognized, and had been since the time of ror in observation. This man was Galen. Hippocrates; but this movement was in If we but stop to consider our own sur­ nowise recognized as a circulation but roundings and relations to our own pa­ rather as a perioidos haematos, a tide-like tients, we are brought to realize that his movement which was compared to the tides influence extends even to ourselves, and of Eripos, in the strait of that name in T h e B eg in n in g s of I ntraven o u s M edication 179

Greece. The blood was produced from the In view of the absence of any speedy means chyle in the liver and then moved back of communication between nations at the and forth in the veins until it was con­ time when this discovery was published, it sumed, a new supply always being pro­ is with astonishment that we observe how duced by the liver. quickly information in regard to it was Some of the blood oozed through certain transmitted throughout Europe. foveae, or supposed porosities in the intra­ Its acceptance by the master minds of ventricular septum of the heart, from the medicine, with but few exceptions, was very right to the left ventricle there to form the rapid. The foundations of medical belief vitalized blood, which, mixed with air, was were shaken as they had never been shaken sent out through the arteries up to their before, and on every side men arose, armed finer filaments which were supposed to be with this first of physiological facts, who nervous in character. Some of this vitalized were only too ready to use it for the pur­ blood went to the brain for further per­ pose of clearing away the banked clouds of fection, but none returned, in a circulating theory which, up to that time, had obscured sense, to the heart. That blood that went the vision of the medical world from any to the lungs was sent to them to nourish sane perception of rational methods of them, or to be cooled by them. treatment of disease. It is necessary that we should recall these Hope was high in every breast that things in order to understand that which through this knowledge disease and its occurred after the discovery of the circula­ cure might be approached with confident tion of the blood. tread. Alas! these hopes were to be dashed Wm. Harvey of Folkstone and London, to the ground because of too sanguine an­ England, lectured to the students upon his ticipations, the result of the lack of other discovery of the circulation at St. Bar­ facts that were to be learned only through tholomew’s Hospital, in the year 1613; this experience, or by the gradual evolution of date should be kept in mind. In the year instruments of precision, used as aids to 1628 his book “ De Motu Cordis” was pub­ the acquirement of collateral and related lished in Frankfort. His discovery was knowledge. quickly accepted in England, Holland and No discovery or discoverer is great in Germany; but such was the temper of enough to be beyond the range of shafts of the time, the respect paid to and the fas­ doubt or envy, and it was so in the case of cination of the opinions of the ancients, Harvey. Hardly had his discovery been that almost an hundred years elapsed be­ noised abroad, before there arose a num­ fore it was admitted in Italy, the southern ber of detractors whose purpose it was to part of France or by the acknowledged prove by what seemed to them sufficient master-teachers in medicine of the Univer­ evidence that the knowledge of the circu­ sity of Paris; for we find a certain Vigerius, lation was as old as civilization. professor of medicine at Montpelier, still An attempt was made to show by the teaching the Galenic ideas as late as 1694, testimony of a work by Pere Halde, put while his colleague of the same faculty, into Latin by Michael Boym and published Dionis, was demonstrating its truth at the by Andreas Cleyer of Cassel, and Batavia Royal Garden in Paris, by command of in Java, that the circulation was under­ Louis XIV and at the same time it was stood by the Chinese at a time 4000 years being denied in the same city, under the before the Christian era, and later Cleyer lingering influence of Riolan, by the Fac­ wrote a book (“ Specimen Medicae Sinicae,” ulty of Medicine of that center of learning. Frankfort, 1682) in one chapter of which, i8o Annals of Medical History

“ Tractatus de Pulsibus,” this claim is sition the meaning of the text as it appears maintained. It will not be without interest in the Douai version of the Vulgate, “ Be­ for any one desiring to go further into this fore the silver cord be broken, and the matter, that the article on Chinese medi­ golden fillet shrink back, and the pitcher be cine by Neuburger, Vol. I, and Renouard crushed at the fountain, and the wheel be broken upon the cistern.” (Eccl. xii, 6.) To the writer it would seem that these men must have been possessed with most marvelous capacity for engendering conceptions based up­ on unwarranted imaginings. #&S 8 Z S & £ S X S 2 X £ lm ml cqnm ct m m ™ Oil* bmbe tmaca.j.q.bit* In investigating this matter it seemed so far beyond possibility that such deductions should be t-*- '■ • ; drawn from this text, that, fearing €tyUmi&ivi.$kfm&ie ^kcdm dn#* w L that a misprint may have led me ©mtrtfecolcrtccmfp ftmgaimcptMcttM MS? ■ / astray, I took pains to discover 9 tgemeftievel mm mi in pm fit what might have been written in mentis etgmnao V ct kfofc pmImm epic the book of Ecclesiasticus, of Jesus

V : :■■■■•: ’ . version. The citation as given in ZWiM.lppiiti.2k f

of that of a leper, will be seen to be dis­ wild cat to be more potent. However, blood tracted and lunatic, evil minded and for­ from the ear of a black cat is most valu­ getful, and his cure is to drink of daisies, able in the treatment of erysipelas. powdered and mixed with water of honey, The ancient pagans advocated the use and to bathe in tepid water, and to copu­ of the blood not only of brutes, but also of late with girls according to the law natu­ human beings in the treatment of epilepsy. ral, and to play with pretty girls and Scribonius Largus (Comp. XVI) says: young boys: and the antidote (bezoar) is “ A simple woman, one of the common peo­ to eat serpents whose heads and tails ple, sold as a valuable remedy and a secret have been cut off with the edge of a palm one, the mixed blood of a turtle and a frond.” pigeon — as much as would flow out — as Pliny (‘‘ Natural History,” fob 498, v. 9) a certain cure for this disease (epilepsy), describes the drinking of the flowing blood which seems to have been as mysterious a of gladiators in the arena “ as if out of liv­ malady then as it is to-day.” ing cups,” for epilepsy. Paulus iEgineta (“ De Re Medica,” Lib. Again Pliny states that “ a man’s own VII, Cap. 3) advises the use of the mixed blood rubbed upon himself will relieve him blood of many animals for this disease and of pain.” (Fob 501, v. 2.) Galen and Dioscorides also, the drinking of Again Pliny, as does Diodorus Siculus, the blood of a weasel, or the blood of a describes the employment of baths of hu­ dog for the cure of the bite of one that was man blood by the Egyptian kings as a rabid. cure for elephantiasis. (Fob 469, v. 49.) Caelius Aurelianus (Lib. I, Chronic., The use of blood as a remedy is men­ Cap. 4, Editio Amsterdam, 1722, fob 314) tioned in many other places in Lib. XXII. ridicules the use of the mixed blood of men, In Thomas Bartholin’s famous book, “ De seals and turtles for the cure of epilepsy, Sanguine Vetito” (Frankfort, 1673), we and says, “ from this remedy none reaches a shall find numberless instances of the use cure.” Among the Norwegians from time of blood as a remedy, many of the stories immemorial the blood of seals and whales being not without humor as, for instance, has been used as a remedy for fits and in that portion in which he treats of the scurvy, and the blood of the reindeer is use of the blood of cats, doves, turtles and used in Lapland for the same purpose. other animals in the treatment of epilepsy, Artseus (Lib. I, “ De Cur. Diut. Morb.,” he tells of a certain girl, an epileptic, at Cap. 4) describes the manner of filling a Breslau, who, after taking cats’ blood, was vial with the blood flowing from the wounds quickly endowed with the characteristics of of the soldiers, that it might be drunk as a a cat. She climbed upon the roofs of the remedy, and says: “ Oh what a mighty houses, imitating the manners of cats in necessity, that any one should be forced thus voice, jumping, scratching, yowling, and to cure one evil by the use of a greater.” even sitting for hours gazing into a hole in Nicolaus Marepsus (Sect. I, “ De Anti- the floor. dotis,” c. 439) advised the use of the mixed Ettmiiller gravely informs us, upon the blood of kids, geese, and male and female authority of Hildesheim (“ Spicilegium,” ducks for a number of diseases affecting VII, p. 609) that if a black cat’s tail be cut the “ spirits.” Celsus (Lib. Ill, Cap. 23) off at the distal third, and the first three deplores the custom of the people who drops of blood that exude be given to an rushed into the arena at the time of the epileptic, it will prove a powerful means gladiatorial games to drink the blood fresh­ for cure, but he considers the blood from a flowing from the jugular veins of the dying 182 Annals of Medical History'

victims, and TertuIIian (“ Apolog.” , IX) was the result of reasoning from the knowl­ asks, “ Where are those who at the shows in edge that the vessels might be injected the Arena, where men are slaughtered, after death, as was done by Mondinus in a drank the flowing blood (but not that from certain degree, as early as 1316, at Bologna. the throat) with eager thirst, that they This process was developed to a greater ex­ might be cured of epilepsy?” Here we tent by Silvius, Eust'achius and Vesalius. have a reference to the danger of taking in It is difficult to believe that the theories any portion of the “ spirit” of the bleeding of Servetus as to the lesser circulation were man in the froth of his blood. There can the outcome of a correct knowledge of the be but little doubt of the use of distillates anatomy of the vessels of the lungs, derived from the blood, for we shall find in the from an examination of injected vessels, al­ 44 De Distillatione” of Hieronymus Rubaeus though at the time he was a fellow student (1585) a full description of its use on pages with Vesalius at Louvain under the teach­ 123-127 et seq., and the distillate of blood ings of Guinter of Andernach he must have was often employed combined with the known something of the method of exhibit­ waters and oils extracted by distillation ing them. from human and other feces for many Whatever may be the truth of this opin­ diseases. ion it is certain that the first record of a One might well quote from Dioscorides, suggestion of any such method or attempt Galen, Alexander of Trales, Benedictus Vic- is to be found recorded as originating in torius, Mizaldus, Levinius Lemnius, Avi­ England in the year 1657. cenna and a long list of others, but what In the transactions of the Royal Society has gone before is quite enough to prove a of England, Vol. I, page 96, there is a multitudinous use of blood as a remedy. statement by Robert Boyle, the celebrated About the use of blood hung always the physicist and chemist of the seventeenth idea that it was the container of the vari­ century, to the effect that early in the year ous spirits, and that therefore it might be, 1657 the idea of the intravenous introduc­ if rightly chosen or confected, of use as a tion of medicines was proposed to him by restorative in cases of maladjustment of Sir Christopher Wren, the famous architect those mythical factors when they were dis­ of the St. Paul’s Cathedral in London. This arranged. Indeed we may well imagine that suggestion seems to have remained with­ in its use, as well as in the employment of out fruition up to the year 1664 when Jo­ the crushed testicles of goats, asses, rab­ hannes Daniel Major, physician and pro­ bits and cocks, there was some sort of fore­ fessor of anatomy and botany at the Uni­ shadowing of the organotherapy of to-day. versity of Kiel, a man who was pronounced What could be more convincing (if prece­ by his contemporaries as “ perquam erudi- dent were a proof) of the value of goats’ tius, sed perquam etiam vagus,” published lymph in the treatment of diminished viril­ his “ Prodromus a se inventae chirurgise ity, than the grave and serious statements infusoriae,” in which he narrates the follow­ of the ancients as to these things of ap­ ing experiments. (Cap. 1, Sec. 4.) plied medicine being arcana or specifics.

Major s Experiments INFUSIONAL SURGERY 1. A large dog was infused with liquid ex­ There can be but little doubt that the tract of opium one ounce. After half an original conception of the possibility of in­ hour he became stupid and torpid, then he troducing remedies into the blood stream fell asleep and would permit needles to be T h e B eg in n in g s of In traveno us M edication 183 thrust through his tongue without resist­ experiments had proved to be of but little ing, hardly noticing them, and after having value, and that the danger of their action slept for two days and one night he recov­ was greater than any benefit derived from ered. them. 2. A dog was infused with (Croci metal- Further experiments were made by many Iorum) oxidised sulphuret of Antimony gr. investigators, and among others a certain 16, in one ounce of water, not fdtered. This physician of Danzig named Fabricius in­ brought on vomiting and the following day jected seven grains of resin of scammony, he died. dissolved in three drachms of the essence 3. In another large dog (a mastiff) a of guaiac, into the median cephalic vein of very small quantity of the same medicine a soldier suffering with lues, having indo­ was infused. Nothing unfortunate hap­ lent ulcers on both legs, a tumor of the pened, and afterwards the same medicine to right arm, horrible pains in the head, as the ordinary dose, namely, one ounce was well as laboring with gummata or nodes given; the dog, like the other, vomited vio­ upon the bones. “ Although the medicine lently. was injected with the greatest care and 4. Then with acids a large number of in­ success,” the effect of all these things was fusions were made, but it was observed that vomiting supervened and the soldier that all these coagulated the blood and died. death quickly supervened; but a few grains After the time of the suggestion by Sir of oil of tartar (liquor potassii subcarbona- Christopher Wren and before the appear­ tis) produced only a bright and very red ance of the book of Major a number of prop­ condition of the blood. ositions in regard to infusion were made in 5. When a decoction of arsenic in com­ England by Dr. Clark, afterward Physician mon water was infused up to one ounce, to King Charles the Second, which are fre­ into a dog, death was brought on. quently noted in the transactions of the 6. In the same manner, when a solution Royal Society. of one half drachm of corrosive sublimate In the year 1665 appeared the three let­ dissolved in water was injected into the ters of Carolus Fracassatus of Pisa, written crural vein of a strong dog, the dog after a to Malpighi, in which are related his ex­ short time passed away. periments having in view the renewal of 7. Another dog was injected in the crural the blood after removal of a certain amount vein with nitre (potassium nitras), and of it, for the purpose of “ preventing its nothing happened. fermentation, or the depression of its qual­ Major made note of the fact that if the ity,” by means of infusion of medicinal sub­ dog were injected in the jugular vein he stances. This series of letters was published died, but that if a common vein were used at Bologna. It is clear that Fracassatus was for the infusion he usually survived. (Were seeking for a specific for epilepsy and that these deaths by air embolism?) he was greatly hampered in his work by A large number of experiments were the fact that when he injected spirit of made upon dogs, cats and other animals for vitriol (sulphuric acid), for some strange the purpose of finding out how far this reason, the blood of his victim always co­ method of medication might be of use for agulated and the aforesaid victim died, and the benefit of mankind. Although some­ post-mortem— mirabili dictu— the blood what intoxicated by his enthusiasm for his was not found to be entirely concreted, but newly discovered method, Major (or Meyer) in the lungs was frothy and slimy, and as was in the end obliged to admit that his the dog died with symptoms of suffocation 184 Annals of Medical History and with frothing at the mouth, as well as direction, it is of interest to note the simi­ with ululations, it was thought that these larity of method and material employed in symptoms confirmed the idea that epilepsy the prosecution of the investigations made was induced by a natural concretion of the by experimenters far removed from each blood similar to that induced by the vitrio­ other, at a time when communication was lic spirit injected. slow, and in the absence of any postal or In the year 1661, Johannes Sigmund EIs- telegraphic arrangements that were in the holz, physician in ordinary to the Elector least degree comparable to those of our era. of Brandenburg, as the result of a dissec­ We find that even before the book of tion (for the purpose of proving the theory Major was sent to the press, dogs and cats of the circulation of the blood) of the body seem to have been almost invariably the of a woman who had been drowned, came victims of the inquisitive surgeon or pri­ to the conclusion that intravascular injec­ vate investigator, for there were many such. tions of medicines ought to be of the great­ In Elsholz’ book is given an account of est and most certain value for the treat­ a gentleman— “ curiousus in sciencia” — ment of all diseases. (His book containing who injected the crural vein of a large dog his observations, “ Chlysmatica Nova,” was with one ounce of plain water and who re­ published in 1667.) ported that for the space of half an hour The same year, Mauritz Hoffmann, Doc­ the dog licked the wound, and then ran tor of Medicine and Public Professor of about without apparent disturbance. Anatomy and Botany at Altdrof, taught Elsholz injected one ounce of Spanish that in cases of melancholia, epilepsy and wine into the veins of a dog, and reported other hypochondriacal diseases, the cure that even a large dose did not seem to pro­ lay in the injection of the blood of a “ florid duce any other effect than to cause a short youth” into the veins of the patient. period of drunkenness. A curious story is related by EttmuIIer Schottus infused a much larger amount of a certain nobleman who lived in upper and states that “ after a few minutes the Lusatia (Lausitz in Austria) in the year dog staggered about in a drunken manner, 1642. Being a great huntsman and hav­ and then fell flaccid upon his side and slept ing a large number of dogs, the kennel- for many hours, snoring like a drunken master found great sport in filling his man” ; and when he injected one ounce of mouth with Spanish wine and then inject­ spiritum vitae aureum (tincture of gam­ ing or blowing it into an opened vein in the boge) as much as would be sufficient for a leg of one of his dogs through a quill. At man, the dog was seen to be feeling badly, other times he used spirits of wine. The to wander about in a state of confusion and wounded vein being then tied, the dogs then after a lapse of seven hours, to have were made drunk, and afforded great amuse­ two very copious dejections. ment to the owner by their inebriated howl- Elsholz himself infused a large dose of ings and actions, and they after a time, like yellow antimonial emetic into a large dog the porter in Macbeth, were “ cozened into at noon of a certain day. The poor beast a sleep” to recover from their unwilling had hiccough and frothing at the mouth, bacchanalia. Whether it was his practice was greatly depressed, and lay torpid with when his dogs were sick to treat them for snoring respiration, and the second hour their diseases in the same way with vari­ after the infusion vomited severely, wan­ ous medicaments, I do not know. dered from one corner of the room to an­ As an evidence of the tendency of the other, and when the night was past was minds of men to run in the same general found dead; but in another dog, when two T h e B eg in n in g s of In traveno us M edication 185 ounces were infused “ the dog vomited up mediately he became furious and with both soul and body.” Daniel Boyle inject­ whining testified to his pain. The abdomen ed one ounce of liquid extract of opium into became inflated and then the subcutaneous a mastiff. The dog slept, anesthetic, for two tissues, after which he died. An autopsy days and nights, and then recovered. showed that there was a general coagula­ In the course of these experiments it was tion of the blood analogous to that found noted that the effect of a drug upon one in the case of the injection of the acid. animal was different from its effect upon An experiment was made to try if by another. Thus Boyle the English scientist drawing off a certain portion of the blood, discovered that the amount of the tincture and substitution for it of a solution of a of opium enough for a dose for a man, was drug, better results might be obtained. enough to drive a cat into a condition of With this object in view, a portion of violent madness like that of rabies; while blood was drawn from a large dog and an the same dose given to a dog had but little equal amount of decoction of arsenic in effect other than to soothe him into a pro­ water was substituted. “ The poor dog died longed slumber, and that afterward the in the greatest misery, with grave symp­ dog grew fat. toms; coughing, vomiting and with a mul­ The injection of a watery solution or di­ titude of dejections both from the bladder lution of nitromuriatic acid into the jugu­ and rectum, and with violent convulsions lar and crural veins of a dog quickly caused of the body and contortions of the eyes.” death, and as we might expect, the body A certain German named Garmannus ex­ being opened, the blood was found to be perimented with the desire to see what coagulated throughout the body in the might be the possibilities of use of the veins, while in the heart the valves were method as a means of introducing antido­ found to be lacerated or ruptured, and tal remedies. First he infused a big cat apoplexy of the lungs was seen to have with a small portion of the spirits of Rhen­ occurred. ish wine, and as usual the cat was made Other experiments were made with spiri- drunk. Shortly afterward a certain number tus nitri (nitric acid) and spiritus vitreoli of drops of liquor narcotici (probably liquid (sulphuric acid) by Fracassatus and Mal­ extract of opium) were superinfused; when, pighi, as well as with oleum sulphuris (sul­ oh, horror! the cat fell down in a stupor as phuretted oil) with the same result. Hel- if dead. A short half-hour elapsed during mont then began a process of deligation of which the cat had a continuous discharge of an area or a limb of a dog, and experiment­ a fluid from the rectum, then a large fluid ed with acids for the purpose of watching evacuation took place, and the cat died. the effect of permitting a slow invasion of One might prolong the description of the the body with the acid. In Helmont’s work many experiments upon animals, through appears a long account of the post-mortem many pages. But, Quid moror? findings in these cases, but it is hardly At the end of his chapter upon animal worth while for us to go into them at experimentation in infusional surgery, an length. It is sufficient to say that the total old writer of the period has said, “ These picture in all these cases is the same in are those attempts to acquire knowledge general, as that of the dog, dead of the in­ which were carried on by the investigators fusion of the nitromuriatic acid. for the benefit of man, upon those martyrs Alkalies were then tried and an ounce of of the anatomists, the dogs and cats.” the oleum tartari (liquor potassii subcar- In Belgium many experiments were made bonatis) was infused into a large dog. Im­ with infusional surgery for the purpose of 186 Annals of Medical History establishing methods, not of medication, the two decades from 1657 to 1677 argued but of means of feeding through the ves­ the question pro and con, reads like a roll- sels, for improving nutrition, and for sus­ call of the great lights of medicine in the taining life by the introduction of nutri­ age when experimental medicine was in its ment into the blood. None of these was infancy. All wrote and each called to his fortunate. aid for authority upon the ancients, Aris­ The first methodical efforts at the treat­ totle, Hippocrates, Celsus, Galen and the ment of disease in man were made by EIs- Alexandrians, but as it were, among the holz in 1664-5. clash of the many weapons of words, a He treated three soldiers, with their con­ sudden “ silence fell upon the multitude.” sent (I suspect from the context, that it Infusorial surgery fell into a state of was forced), by infusion. The first had an innocuous desuetude, and was almost for­ ulcer of the leg. The crural vein was opened gotten, or was considered as one of the at a place near the ulcer and by means of curiosities of medical history. a syphon a small quantity of aqua planta- ginis was injected. TRANSFUSIONAL SURGERY The next was a man suffering from a continued fever. After having been bled It has been shown that the English were from the median vein, while the vein was the first to suggest the investigation of the still open, a teaspoonful of the distilled merits of infusional treatment, and it was water of Carduis Benedictus—our old friend but natural that the next step, transfusion, —was introduced. but a modification of the former, as a re­ The third suffering from a “ scorbutic medial measure should follow, transfusion corruption of the humours,” was, in the being but the child of infusion. In this the same manner as the second, infused with a English were the leaders. portion of the “ water of Cochlearia.” The Perhaps no subject in the history of the results in these cases has not yet been re­ progress of our profession has caused so ported. Fabricius, before mentioned, in­ much discussion as that of the priority of jected the soldier whose case of syphilis the venture of the transfusion of blood. I has already been mentioned. Also he treat­ shall endeavor to cover the ground as con­ ed a servant girl of uncertain age, who was clusively as may be in as few words as pos­ a victim of epilepsy, with an infusion made sible. of six grains of jalap dissolved in the spirit We have vague references to what may of Iillium convallium. After a period of have been attempts at transfusion in the severe vomiting she seemed to be other­ writers of the Augustan period of Roman wise unaffected, and for a number of civilization. Pliny vaguely mentions it, and months remained free from fits. In his re­ a passage of Ovid, in the eighth book of port of the experiment, Fabricius says, the “ Metamorphoses,” seems to indicate “ Whether or not she was entirely cured, I that something of the kind was conceived do not know.” of, but there is nothing definite about it, The discussion of the value of this means as it may also be taken to mean that the of medication raged among the medical blood vessels of the recipient were to be authorities of the world for more than a filled by the drinking of blood. I cannot quarter of a century, and we find as many believe anything that was said by Roussel names ranged upon the one side of opinion in his citations as to there having been true as upon the other. transfusions in the old days, for those of A list of the names of the men who in them that I have investigated are not in T h e B eg in n in g s of I n traveno us M edication 187 the least proofs of any such operation hav­ Frederic Baron Corvo believed it to have ing been done; therefore we may pass over been a drink of a prepared distillate. his pronunciamentos as to the cure of In Leo’s “ Geschichte von Italien,” VoL Naaman, the writings of Herophilus, the IV, p. 618, the historian considers it to case of Tanquilla in the time of Tarquinius have been a transfusion, as does also Pas- Priscus, or those which he finds in Celsus quale Villari. (“ Life of Savonarola.” ) and Pliny, Eubages and Apollo (sic) for Ciaconius and (Enuphrius Panvinus, fol­ they are not there. We may safely start in low Steven Infessura, a contemporary of the month of June, 1490, or 1492 at Rome, the Pope, whose statement will be seen in when blood is said to have been transfused a later paragraph. by a Jewish physician, named Abraham Gregovorius (“ Geschichte der Stadt Rom Meyre of Balmes, into the veins of Pope im Mittelalter,” VoL V II, p. 279) states Innocent VIII. that the blood was transfused. The blood was taken—according to the All of the beforementioned writers refer story—from the veins of three boys of ten in one way or another to Infessura. Let us years of age, to each of whom a ducat was see exactly what he says. paid. It was introduced into the veins of Steven Infessura in his “ Diaria Rerum the Pontiff and he either died or recovered, Romanorum” (quoted in “ Fonti per la accordingly as you read the history of his Storia d’ltalia,” pages 275-6): life in (Enuphrius, or De Cormenin. The fact is that about the year 1490, two years “ Interea in Urbe nunquam cessaverunt before the death of the Pope, he, apparent­ tribulationes et mortes; nam primo tres ly suffering from Bright’s disease, fell into pueri decern annorum,e venis quorum Ju ­ a stupor, and became breathless and pulse­ daeus quidam medicus qui papam sanum less. He was pronounced dead, and the Car­ reddi promiserat sanguinem extraxit, in- dinals gathered together to elect a new continenti mortui sunt. Dixerat namque Pope. However, the good man could not Judaeus se ville sanare pontificem, dum- permit this, and after about 70 hours, re­ modo habere posset certam quantitatem covered consciousness and continued to sanguinis humani et quidem juvenis; rule the Church for a period of two years, quern propterea extrahi jussit a tribus dying in 1492. pueris, quibus post flebotomiam unum It may be well for us to enter a short ducatum pro quodlibet donavit; et paulo distance into a review of what has been post mortui sunt. Judaeus quidem aufu- written upon this subject. The testimony is git, et papa sanitus non est.” most conflicting. This, in English, is about as follows: Rafael Sabatini in his “ Life of Caesar Borgia,” states that the blood was drawn “ Nevertheless the deaths and distress from three boys. Too much was taken. in nowise ceased; for three boys of ten They all died. The Pope, hearing of this, years of age from whose veins a certain was horrified and the Jewish physician fled. Jewish physician, who had promised to De Cormenin (“ History of the Popes”) save the Pope’s life, drew the blood, died states that it was “ a frightful beverage” incontinently. For the Jew said that in and given in the year 1492. order to cure the Pontiff, it was necessary Raynaldus states that the blood was to have a certain quantity of blood, and taken “ in order that the quack, from this that it must be drawn from young peo­ (the blood) might, by chemical art, prepare ple, for which reason it was ordered to a distillate for a draught for the Pontiff.” be drawn from the veins of three boys, to 1 88 Annals of Medical History

each of whom, after the phlebotomy, a This book of Libavius was published at ducat was given, and shortly after they Frankfort in 1615, hence it must have all died. The Jew, of course, fled, and been before that date that the transfusion the Pope was not cured.” described took place, if it was done at all. It is to be remembered that Harvey first There is no assurance that the Holy Fa­ lectured to his students at St. Bartholo­ ther ever received either the transfusion or mew’s Hospital upon his theory as to the the drink. There is nothing in regard to circulation, in the year 1613. (Dezeimeris, any new instrument, no account of any air Diet., Tome 3, Part 1, fob 56.) The book embolism, nothing whatever from which of Libavius, “ Syntagma Arcanorum Medi- either conclusion may with certainty be corum,” was somewhat of a firebrand to drawn. the Galenists, the Hermetics and the fol­ It may be that whatever was done was lowers of Paracelsus, and was at once at­ at the time when the Pope was in the state tacked most virulently, especially by Scheu- of uremic coma, in 1490. nemann, and in reply to this attack he It only remains to investigate as to what published his “ Defensio Syntagmatis,” in was really accomplished. It is hardly prob­ which the passage occurs. After reciting a able that there was any interchange of number of the ridiculous methods of the blood between the boys and the Pontiff. Paracelsians, and citing the miracles of The following facts seem to stand out of Elisha and Elijah, as well as the story of the jumble of reports. There was a Pontiff. David and the young woman who was sent There was a quack doctor, a Jewish phar- to him to restore his vitality (I Kings i, macus. There were three boys who were 3), he says: bled, and who were paid a ducat apiece for “ Sed Elise et Elissei potentia non suc- their blood. They died before they had time cessit MEZENTIO, qui mortuos non to spend the money. The “ Judaeus aufu- restituit applicatis vivis, sed hos occidit. git” before the Pope had a chance to get Ille vero noster quo quseso remedio puta- his drink (or was it a transfusion?), for the bat se ista insperata consequi posse? As- pharmacus did not tarry to confect it. The sit juvenis robustus, sanus, sanguine Pope died. The reader may take his choice spirituoso plenus. Astet exhaustus viri- as to what it was. bus, tenuis, macilentus, vix animam tra- An hundred and twenty years elapse be­ hens. Magister artis habeat tubulos ar- fore we come to anything that seems defi­ genteos, inter se congruentes. Aperiat nite as to transfusion, and that instance is arteriam robusti et tubulum inserat mu- found in a rather satirical collection of niatque: mox et aegroti arteriam findat, statements derived from a thousand sources et tubulum foemineum infigat. Jam duos by a certain Andreas Libavius (1546-1616), tubulos sibi mutuo applicet, et ex sano who, having written an extensive book sanguis arterialis, calens, et spirituosus upon chemistry and chemical medicine, saliet in aegrotum, unaque vitae fontem sought to defend his postulates, against his afferet, omnemque Ianguorem pellet. Sed critics, by gathering together the various quomodo ille robustus non Ianguescet? curiosities of theory in regard to cures, Danda ei sunt bona confortantia et cibi: from every source, and in the course of medico vero helleborum.” this process introduces a perfect descrip­ tion of a transfusion, at a period even be­ Which being put into English is as follows: fore the announcement of the discovery of “ But the powers of Elisha and Elijah the circulation by Harvey. did not descend to MAZENTIUS, since ; ; ; S D / j 7ntagmatis arcan.v^iiym.

P rtfb yU U i. Ja^fco potetnc cx tinclura Philofophorutn cos prxmuniret. Alius Charafterm , antipathiticftm ,1 • coromenJauit: PstracelfitiElixyrexfiptm planet* eq u i& m m ntm vim fxli m paruatn mokm cegunt; ^ r&fe* P er Gamgiabacai,6cftpft*( p e t m u m ia m tanquana pet centrum ex vnoinaliuratransfenepriocipiurnfamtatis? morhornm. An non f a g * lie vtunt,ur p o m u n c u l n ! An nonpcrficarid transplantafitur rnoibi ex paruo m undo in' maguam? Quidni ruifus niagni mundi falubritas in honiinem inuchatur?$agi&fortibus,6 c rebusamans vtuntur, nec raro fudoribus arreptis, 6c Cardcpathia , 6c Uipfebpiane, 6cc. Lucius Vttedim h iu ° R .l Auli pater remedittmfeatcxfttiualiber tin* dtamattmtllemifta. Vt Faulty 6cEbfatf-ep, Reg. 4. 34, appli- 17.T.ii. carunt fc mortuis, & fpiritum,caioremque vitaiem eisreftiiuerupt ,ita& xgrotanubus pofte vi« dentur iani. Imo vt catuli Sc felescolicamtnfe transfttunt, ita vites perfonxanobilibus poteranr. P.tMiikmefocillabatpukhfa,iuuenis,calcnfque,&fpirituofaS«Bd»»f»:.qualiremodioquisfcriex ftigidus nollet incalcreerc,cumid&iuuenes petantTSedE/ia&Eii/itipoteniianonfuccgflitMe- z ,t n t i o , qui mortuos non reltituit apphcatis viuis, IcdBosoccidit. llleveronofter quo qu*fo re- M irabili n medio putaljat fe ifta infperata confequi pofle? A ftt imtitus robujitu , fanm , [anguine jpsrituofo pletnu. m c itHm a- grotot fa- Afttttxhauftut vitibm, tenuis, maalentus, fix m m a m tr ahem. Magifler ariu babeaC tubtdos argenttos tnterfe uandt. congruence. Aperiatantrum robufti, & tubulum infer at, mumatque-. max & a gm t anerurnfindat, & tubu- lam ftrmtr.cum infigat. I .cm duos tubulos (ibt mtttuo applied ,& tx fa n s [unguis arterialis, calm s, &Jj>iritttoftu f a h e t ina g r o t u m , vr.aqtispit*fontem afftret,omntmqut langutrm pellet. Sedquomodo ille robittius non Janguefcet; Pandaeifiintbonaconfprtantia,& cihi:medicoverohelleborumfCapuc ID . Pto- fifes exeti ’ t&iftoorum grandium. bitarsquapifeesm arm texjuapatriainexilm m m ft, 6c in alias tettas lllati ibi tot wines in 8 patriam tam viui&yegetiilntquam intnari,quin&pemiancant,propagcntur, croenfis inferHianr.Si transferee. etiam funt Huuiatiles ccitarum regionum (quales funtin Danubto H u fo n e s ,&c.) ii poffunt omni loco, be carlo communes fieri. Hoc modo Harenga, rbombi ,fo lu , a ft R i ,G e b u , K.-trat, congri, fquiHt, canen, eontba, aTltta.&iimiliaaquatilia cx mari,aut ftagnis marinis poftunt cransferri, & ita curari, vt giauiu mo lint fapotc, virtuteque 6 c fubftancia alia quamndior, [amor, p re L in n nainufqueobnoxiusarfacftionibu*, morbis, petegrini(que eupidiranbus, act quod m ed ia fu m e n d a etiutpere. funt *baUisf

P a g e F r o m t h e W r i t i n g s o f L i b a v i u s . 190 Annals of Medical History

he could not restore the dead to life by transfusion. Rather he seems to be casting application of the living to the dead, but ridicule upon the experiment. on the contrary he killed them. Was he Now who was this man Libavius whose not that man among us who thought statement has been a sort of stumbling that by employing the following most block to the solution of priority in the per­ unusual procedure he might bring about formance of transfusion. One writer speaks that result? ‘Let there be a young man, of him as being “ vir scribendo prolixus, robust, full of spirituous blood, and also sed insignis scopticus et scepticus.” As to an old man, thin, emaciated, his strength his prolixity— I show you a page of his exhausted, hardly able to retain his own writings whereon appears the extract above soul. Let the performer of the operation translated. He surely was energetic and have two silver tubes fitting into each learned, as well as skeptic, and a very good other. Let him open the artery of the business man withal, for we learn from Gar­ young man and put into it one of the rison (“ Hist, of Medicine,” p. 144) that he tubes, fastening it in. Let him immedi­ had at Coburg a large establishment, a ately after open the artery of the old private laboratory, and his quarters were man, and put the female tube into it, furnished with rooms for patients, a gym­ and then the two tubes being joined to­ nasium, baths, enclosed corridors for exer­ gether, the hot and spirituous blood of cise in cold weather, and a well-stocked the young man will pour into the old wine-cellar. He was the great chemist of one, as if it were from a fountain of life, his time and was the discoverer of stannic and all of his weakness will be dispelled. chlorid. His nomenclature of many chemi­ “ ‘Now, in order that the young man cals remains in use to this day. may not suffer from weakness, to him It is certain that Johannes or Giovanni are to be given good care and food, but CoIIe, of Belluno, in Italy, who was Pro­ to the Doctor, hellebore/)” fessor of Medicine at Padua, Physician to Cosimo II of Florence, and who wrote ex­ (I cannot imagine why the Medicus tensively upon Morbus Gallicus, described should need hellebore, but perhaps it was on a method of transfusion in a medical trac­ the principle that a veratrum cock-tail tate at a period anterior to the year 1628, might reduce his blood-pressure after his as his book, in chapter seven of which he exciting experiment.) gives the account, “ Methodus Facile Pro- Contrary to what has been advanced by curandi Tuta, et Nova Medicamenta,” ap­ many historians of medicine, I cannot find peared at Venice in that year. in any of this the slightest intimation that There was a little book published about Libavius. either advocated or performed 1660, in Italy, that bears the title—when this operation of transfusion. A certain Ma- put into English—“ A Pair of Medical zentius seems to have been the man who Scales, in Which Are Weighed Not Only suggests the method. It will be noted that the Infusion of Medicines and Other Novel­ two arteries are to be used. This alone would ties, but also the Favorable and Unfavor­ indicate that Mazentius had no conception able Opinions as to the Transfusion of of the circulation, and that his idea was Blood.” that the blood would rush into the old This book was written by one Francesco man because of the greater pressure of the FoIIi, a native of Poppi, born in 1624. He spirits in the young man. I cannot believe practiced medicine in various cities and with Dr. Garrison (“ History of Medicine,” provinces of Italy and was, about 1650, p. 144) that Libavius was an advocate of called to Florence to become body-physi- T h e B eg in n in g s of I n traveno us M edication 191 cian to the daughter of the Duke, Cosimo compressing the ball the necessary force II. I n his book he shows that he was famil­ was communicated to the venous blood iar with the theory of the transfusion of to make it penetrate, and the quantity blood, that he had developed a technique of blood could be measured. The ideas of his own and had had instruments made incorporated in the construction are the for that purpose. He states that he demon­ same as are demonstrated in the most strated the operation of transfusion in the modern apparatus for direct transfusion year 1654 in the presence of the Grand to-day.” (1880) Duke Frederick II. This would have been 11 years before the operation was done by We are now approaching the date of the Richard Lower, the English surgeon. In the first visual demonstration of the actual flow year 1766, a book was published in Flor­ of the blood from the arterial into the ence entitled “ A Series of Portraits of venous side of the circulatory system, for it Distinguished Tuscan Men.” In this pub­ was not until 1661 that Malpighi saw the lication there appears a portrait of FoIIi passage of the corpuscles of blood through and a pictorial reproduction of the instru­ the capillaries in a frog’s foot, and by that ments invented by him. vision supplied the final link to the chain of FoIIi proposed to employ a silver tube evidence proving the truth of Harvey’s inserted into the artery of the donor, and a theory. cannula of bone into the vein of the recipient, You will remember what I have said in and to connect the two by means of a hol­ an earlier portion of this paper as to the low pipe made from a blood-vessel taken first suggestion of the infusorial surgery by from an animal. This tube was provided Sir Christopher Wren in 1657. During the with a lateral branch that permitted the period following that suggestion the ex­ escape of the air as the blood poured periments along that line were followed, as through it from the artery toward the vein. I have shown you, for a period of eight It would seem that but for his lack of years before any attempt was made to knowledge of hemolysis, FoIIi was practi­ transfuse blood from one animal to an­ cally as well prepared to do the operation other. Then “ in the year 1665, toward the as we are to-day. end of February,” as says the author of I now quote from Roussel. “ The Gold Headed Cane,” “ Richard Lower made this experiment at Oxford; by means “ In France they had not dared to at­ of long tubes, the blood of the vertebral tempt arterial transfusion, for the reason artery of one dog was made to pass into that in opening the carotid artery of the the jugular vein of another, and it appeared donor, his life was inevitably sacrificed. proved that there was no reason to fear In 1653 Robert des Gabets, a monk of any mischief, and that the character or Cluny, demonstrated the possibility nature of one animal was not likely to be of performing intravenous transfusion, changed by injecting into its veins the which he designated ‘communication/ blood of another.” by means of two little tubes of silver Whatever may have gone before, whether which he had manufactured at Ma$on in it be the work of Abraham Meyre of 1651 under the direction of another Balmes, the operation described by Liba- monk, Dom Eloy Pichot. These tubes vius, the efforts of FoIIi, or the instruments were connected by a leather ball the size of the Monks of Cluny, the date of the of a walnut, and each contained a valve demonstration by Lower is the starting to regulate the flow of the blood. B y point of the long series of transfusional ex- 192 Annals of Medical History periments upon animals, by a multitude of well. This did give occasion to many learned men all over Europe, leading up to pretty wishes, as of the blood of a Quaker the triumphant experiment of Dionis of to be let into an Archbishop, and such the Faculty of Montpelier, in Paris, of di­ like; but, as Dr. Croone says, may if it rect transfusion of the blood of an animal takes, be of mighty use to man’s health, into man. for the amendment of bad blood by bor­ But before we go into the matter it will rowing from a better body.” be well to quote once more from “ The Gold Headed Cane” and tell a little story It will be seen that the experimental that is not without interest. (“ The Gold forms of transfusion took three classifica­ Headed Cane,” p. 97.) tions. Dr. Mead is made to say, “ So late as First, From brutes to brutes. the middle of the seventeenth century, Second, From brutes to man. about the time when Lower was making Third, From man to man. at Oxford the daring and original experi­ The particular objects that were be­ ment of transfusion (of the blood), a grave lieved to be worthy of an effort at trans­ dispute arose in Germany as to the posi­ fusion were as follows. (I quote from an old tion of the heart itself. The contest was authority, EttmuIIer): terminated at length by the Professors of “ To correct a vicious condition of the Heidelberg, where the question was agi­ blood. tated: having recourse to the delicate ex­ To prolong the lives of the aged. periment of killing a pig in the presence of The cure of Melancholy delirium. the Margrave of Baden-Durlach, and clear­ The eradication of Scurvy. ly proving to His Highness, who then la­ The cure of Consumption. bored under palpitation of the heart, that The mitigation of Arthritis. it really was situated on the left side of The removal of Epilepsy. the thorax. The amelioration of Scabies and Lep­ “The result of this important discovery rosy. was fatal to the fortunes of His Highness’ The restitution of diminished strength, physician, who, though he stoutly main­ as well in the young weakened by tained by a refinement of courtly flattery disease, as in the aged worn out with that the heart of his master could not have years. a position similar to that of a pig, was dis­ For the alteration of the habits of peo­ missed in disgrace.” ple of evil disposition. In Samuel Pepys’ Diary, under date For the solution of calculi produced by “ Nov. the 14th, 1666,” we find the follow­ a tartarous state of the blood.” ing reference to the work of Lower: It is needless to say that none of these “ Dr. Croone told me that at the meet­ objects was accomplished. Pierre Dionis, ing at Gresham College to-night (which, one of the surgeons to the Dauphin of it seems, they now have every Wednes­ France, son of Louis XIV, after a multi­ day again), there was a pretty experi­ tude of experiences made in the transfusion ment of the blood of one dog let out (till of blood from animal to aninal, with vary­ he died) into the body of another on one ing results, in the month of June, 1667, made side, while all his own run out on the the following experiment. This was the first other side. The first died upon the place, instance, properly recorded, of the transfer­ and the other very well, and likely to do ence of blood directly into the veins of a T h e B eg in n in g s of In traveno us M edication 1 9 3 human being from the arteries of an ani­ and melancholia, after he had been bled to mal. the amount of three ounces. This seems to Thanks to the willingness of a certain have had a good effect upon the patient, strong and robust porter, Dionis was al­ but we do not learn that his improvement lowed, first to remove from the median was permanent. vein of the man 10 ounces of blood, and On November 23rd, 1667, Lower had at­ immediately afterward the vein was con­ tempted the same thing at Arundel House, nected by means of a tube with the crural upon Mr. Arthur Coga, “ a mildly melan­ vein of a Iamb and twenty ounces of blood choly insane man,” with the blood of a was poured into the circulation of the por­ Iamb, without mishap, but without any ter. Dionis paid the man and he at once specially favorable result. The experiment went to an inn and ate and drank. was to have been repeated, but for some The experiment was repeated upon the reason not stated, it never was. After the man a number of times without harmful operation, Coga stated that he felt himself result. It is to be noted that the man was better. in good health. There is no doubt that Lower would The next instance of transfusion was have gone on with his work to the final that of the introduction of blood into a test to transfusion of blood from man to sick man, the result not being as fortunate. man, but that the law and local prejudice The case is well worthy of complete re­ prohibited such an operation. hearsal. The work begun by Lower and Boyle attracted the attention of many philoso­ “ In Paris there was a boy of ten years phers and physicians in England and on of age who was suffering from a long the Continent, and we find them being re­ continued tertian fever, weakened by peated with many variations by King, Coxe continuous clysters and a vast number and others in England, by Dionis and Gayen of bleedings, brought to a state of com­ plete lethargy by the depauperation of in France, by Graaf and others in Germany and Cassini in Bologna. the spirits, and whose life and intellect were reduced to the lowest ebb. For the Reports of all these efforts are to be relief of these conditions, and to im­ found in the Transactions of the Royal So­ ciety. prove the thickness of the blood and to increase its spirituosity, transfusion was Similar experiments were carried on in attempted, but the boy being corrupted Italy at Rome, by Guillelmus Riverius or by his feverishness and his diarrhea, Riva, of Montpellier.1 The following case, three ounces of thick, coarse and black­ reported by him, is not without interest, ish blood were taken from him, and then in that it is probably the first instance eight ounces of blood from the carotid recorded, possibly, of hemolysis. artery of a Iamb were transfused into It is not to be wondered at that, the vein. The boy soon felt better, took since these experiments in infusion and food, moved about and slept during the transfusion were in progress at a time middle of the day; but after 24 hours he when there was no possible chance that was again attacked with diarrhea and there could be any true knowledge of the coma, and died.” 1 The context in the report of this case makes it rather doubtful as to the city at which it was done, In the month of December, 1667, Dionis but it would seem that it was done either by Guillel­ transfused five ounces of the blood of a calf mus Riva, who was a well known surgeon at Rome, into the veins of a man suffering from mania or by Dionis at Paris. 194 ^Annals of Medical History histology of the blood, there should have mal to animal was done by Lower and been accidents of this kind, and that Boyle at that city in February, 1665. through the occurrence of a number of On May 17th, 1665, Lower made his them the method of treatment fell into dis­ demonstration of transfusion by means of repute. The case is as follows: quills, from dog to dog, before the Royal Society in London. “ There was living at that time in Pierre Dionis, at Paris, had been experi­ Paris a certain Swedish Baron named menting in infusional surgery during the Bond, who was sick with a peculiar con­ year 1665 and 1666, and his letter in re­ tinued miliary fever of a light form, gard to his experiments appears in the which was complicated by a colliquative Transactions of the Royal Society, No. 25, diarrhea with bloody discharges from M ay 6th, 1667. He had also done some the bowels, indicating an hepatic com­ work in the way of transfusion on animals, plication. as for instance the transfer of the blood of “ The man had been bled 32 times, but four goats into the veins of a 26-year-old nevertheless his strength was failing and horse, with success. he was approaching death, the disease In the month of June, 1667, Dionis made being so long drawn-out. his first transfusion from an animal to a “ Now when he was in an half-dead healthy man. This experiment was repeat­ condition, a transfusion of a great num­ ed either in Ju ly or August of the same ber of ounces of blood from a calf was year by him, the recipient being a sick boy. made into his veins. In November 23d, 1667, Lower trans­ “The pulse immediately became fused the blood of a sheep into the veins of stronger to the touch, and after two days one Arthur Coga. he was so much improved that he was In December, 1667, Dionis transfused able to speak, but after the lapse of two the blood of a calf into the circulation of more days he suddenly died. An autopsy man suffering from mania and melancholy. having been made, it was found that in The correct description of the method the whole of his body and vessels there employed by Lower in his epoch-making was not to be found blood to the amount demonstration is taken from the records of of a teaspoonfuI.,, the Royal Society of London (Philosophical Was this a case of hemolysis from the Transactions, Vol. I, Monday, Dec. 17th, use of a blood that was lytic to that of the 1666, page 353). recipient? The intervening time between the immission of the blood and the death “ The method observed in transfusing would seem to be too long, yet the possi­ the blood out of one animal into another. bility of hemolysis having taken place is It was first practised by Doctor Lower in not improbable. Oxford, and by him communicated to the As to the question of priority of transfu­ Honorable Robert Boyle, who imparted sion from animal to animal, and animal to it to the Royal Society as follows: man, the matter is made clear in the fol­ “ First take up the carotidal artery of lowing table. the dog or other animal whose blood is It is very likely that experiments both to be transfused into another of the in infusion and transfusion were made as same or a different kind, and separate it early as 1660 by Wren, Richard Lower and from the nerve of the eighth paire, and Boyle, at Oxford. lay it bare above an inch. It is certain that transfusion from ani­ “ Then make a strong ligature on the T h e B egin n in g s of I ntraveno us C irculatio n 195 upper part of the artery, not to be untied mediately as the blood runs into the again; but an inch below, videlicet, to­ dog unstop the other quill, coming out wards the heart, make another ligature of of the upper part of the jugular vein (a a running knot, which may be loosened ligature being first made about his neck, or fastened as there shall be occasion. or else his other jugular vein being com­ Having made these two knots, draw press’d by one’s finger), and let his own two threads under the artery between blood run out at the same time into the two ligatures, and then open the ar­ dishes (yet not constantly, but accord­ tery and put in a quill, and tie the ar­ ing as you perceive him able to bear it, tery upon the quill very fast by those till the other dog begins to cry and faint two threads, and stop the quill with a and fall into convulsions, and at last dye stick. After this make bare the jugular by his side). vein in the other dog about an inch and “ Then take out both the quills out of a half long, and at each end make a liga­ the dog’s jugular vein and tye the run­ ture with a running knot, and in the ning knot fast and cut the vein asunder space betwixt the two running knots (which you may do without any harm to draw under the vein two threads as in the dog, one jugular vein being sufficient the other. Then make an incision in the to convey all the blood from the head vein, and put into it two quills, one into and upper part by reason of a large an­ the descendent part of the vein to re­ astomosis, whereby both the jugular veins ceive the blood from the other dog and meet about the larynx). This done, sew carry it into the heart, and the other up the skin and dismiss him and the dog quill put into the other part of the jugu­ will leap from the table and shake him­ lar vein which comes from the head (out self and run away as if nothing ailed him. of which the second dog’s own blood “ There are many circumstances neces­ must run into dishes). sary to be observed in the performing of “ These two quills being put in and this experiment. . . . Secondly, that tyed fast, stop them with a stick till there you constantly observe the pulse beyond is occasion to open them. the quill in the dog’s jugular vein (which “ All things being thus prepared, tie it acquires from the impulse of the ar- the dogs on their sides towards one an­ terious blood). For if that fails, then ’tis other, so perfectly that the quills may a sign the quill is stopt by some con­ go into each other (for the dogs’ necks gealed blood, so that you must draw out cannot be brought so near but that you the arterial quill from the others, and must put two or three several quills more with a probe open the passage again in into the first two to convey the blood both of them, that the blood may have from one to another). its free course again. For this must be “ After that unstop the quill that goes expected when the dog that bleeds into down into the first dog’s jugular vein the other hath lost much blood his heart and the other quill coming out of the will beat very faintly, and then, the im­ other dog’s artery, and by the help of pulse of the blood being weakened, it two or three other quills put into each will be apt to congeal the sooner, so that other according as there shall be occasion, at the latter end of the work you must insert them into one another. Then slip draw out the quill often and clear the the running knots, and immediately the passage. . . . blood runs through the quills as through “ The most probable use of this experi­ an artery, very impetuously. And im­ ment may be conjectured to be that one 196 Annals of Medical History

animal may live with the blood of an­ the blood of a cowardly dog may not other, and consequently that those ani­ become more tame, or vice versa). mals that want blood or have corrupt “ 2. Whether immediately upon the un­ blood may be supplyed from others with binding of a dog, replenisht with ad­ a sufficient quantity, and of such as is ventitious blood, he will know and fawn good, provided the transfusion be often upon his master, and do the like custo­ repeated, by reason of the quick expense mary things as before; and whether he that is made of the blood/’ will do such things better or worse at some time after the operation. Here the scientific Mr. Boyle comes into “ 3. Whether those dogs that have pe­ the matter with certain, “ Tryals proposed culiarities will have them either abol­ by Mr. Boyle to Dr. Lower to be made ished or at least much impaired by trans­ by him for the improvement of transfusing fusion of blood. blood out of one live animal into another.” “ 4. Whether acquired habits will be (Philosophical Transactions, Monday, Feb­ destroyed or impaired by this experi­ ruary 11, 1667, page 385, Vol. I.) ment. “ The following quseries and tryals “ 5. Whether any considerable change were written long since, and read about is to be observed in the pulse, urine, and a month ago in the Royal Society, and other excrements of the recipient animal so now come forth against the author’s by this operation, or the quantity of his intention, at the earnest desire of some insensible transpiration. learned persons, and particularly the “ 6. Whether the emittent dog being worthy doctor, to whom they were ad­ full fed at such a distance of time before dressed, who thinks they may excite and the operation that the mass of blood may assist others in a matter which to be well be supposed to abound with chyle, the re­ prosecuted will require many hands. At cipient dog being before hungry will lose the reading of these the author declared his appetite, more than if the emittent that of divers of them he thought he dog’s blood had not been so chylous. could foresee the events, but yet judged “ 7. Whether a dog may be kept alive it fit not to omit them, because the im­ without eating by the frequent injection portance of the theories they may give of the chyle of another, taken freshly light to, may make the trials recompense from the receptacle into the veins of the the pains, whether the success favours recipient dog. the affirmative or negative of the ques­ “ 8. Whether a dog that is sick of some tion, by enabling us to determine the disease chiefly imputable to the mass of one or the other upon surer grounds than blood may be cured by exchanging it for we could otherwise do. And this adver­ that of a sound dog; and whether a sound tisement he desires may be applied to dog may receive such diseases from the those other papers of his that consist of blood of a sick one as are otherwise of quaeries or proposed tryals.” an infecting nature. : “ 9. What will be the operation of fre­ The queries themselves follow: quently stocking (which is feasible “ 1. Whether by this way of transfus­ enough) an old and feeble dog with the ing blood the disposition of individual blood of young ones as to liveliness, dul- animals of the same kind may not be ness, drowsiness, squeamishness, &c., and much altered (as whether a fierce dog, vice versa? by being often quite new stocked with “ 10. Whether a small young dog by T h e B eg in n in g s of Intraveno us M edication 197

being often fresh stockt with the blood of his transfused patients, but he proved him­ a young dog of a larger kind will grow big­ self innocent, and the court, while it ac­ ger than the ordinary size of his own kind. quitted him, prohibited further experi­ “ 11. Whether any medicated liquors ments with human beings as subjects, ex­ may be injected, together with the blood, cept with the consent of the Faculty of the into the recipient dog. And in case they University, and then they were to be done may, whether there will be any consider­ only by a registered physician of that able difference found between the sepa­ city. rations made on this occasion and those The many accidents and deaths that fol­ which would be made, in case such medi­ lowed these experiments and the divided cated liquors had been injected with some opinion of the Faculties of the various other vehicle, or alone, or taken in at countries of Europe quickly attracted the the mouth. attention of the different governments to “ 12. Whether a purging medicine be­ the work being done by the experimenters, ing given to the emittent dog a while and in France, transfusion was prohibited before the operation, the recipient dog by an edict of the Parisian Parliament. will be thereby purged, and how. However, experiments upon dogs or other “ 13. Whether the operation may be animals were not frowned upon in that successfully practised in case the inject­ country. ed blood be that of an animal of another Further progress in the investigation of species, as of a calf into a dog, and of the transfusional surgery was brought to a cold animals as of a fish, or frog, or tor­ stand-still in almost all parts of Europe by toise, in the vessels of a hot animal, and a special edict of the Pope at Rome about vice versa. the year 1678. “ 14. Whether the colours of the hair One might go deeply into a consideration or feathers of the recipient animal, by of the various conclusions arrived at by the frequent repeating of this operation the wise ones of that generation as to the will be changed into that of the emittent. value of this method of treatment. “ 15. Whether by frequently transfus­ There seems to have been as many opin­ ing into the same animal of another ions as there were investigators, and no species, something further and more tend­ common opinion among them. This was ing to some degree of a change of species but natural at a period when so much was may be effected at last in animals near of yet to be learned as to the physiology of kin (as spaniels and setting dogs, &c). the blood, chyle and lymph,—their circula­ “ 16. Whether the transfusion may be tion and purposes. practised upon pregnant bitches, at least The whole proposition fell into oblivion at certain times of their gravitation, and and almost a century and a half elapsed what effect it will have upon the whelps.” before interest was again awakened in the question. But that is a matter beyond the In Paris, Dionis was arrested and brought meaning of the title of this essay. I leave it before a court, accused of murder of one of for others to investigate. THE LEGISLATIVE AND ADMINISTRATIVE HISTORY OF THE MEDICAL DEPARTMENT OF THE UNITED STATES ARMY DURING THE REVOLUTIONARY PERIOD (1776-1786)

B y COLONEL WILLIAM O. OWEN, U. S. ARMY

CURATOR, ARMY MEDICAL MUSEUM, WASHINGTON, D. C.

O far as I have been able to acquire appointed as surgeons to their respective regiments it, the original method of caring for provided they appear to be duly qualified upon ex­ the sick and wounded in the Revo­ amination.” lutionary War, which is the begin­ In Thacher’s Military Journal, 1775-1783, ningS of our medical history, was to employ on pages 34-35, we read: individual medical men wherever they might “ On the day appointed, the medical candidates, be found to take care of the sick or wounded sixteen in number, were summoned before the board who happened to fall in some particular fight for examination. This business occupied about four in their locality. hours; the subjects were anatomy, physiology, sur­ Little by little the generals in command, gery and medicine. It was not long after, that I was the Provincial Congresses of the colonies, happily relieved from suspense, by receiving the and the Continental Congress of the Uni­ sanction and acceptance of the board, with some acceptable instructions relative to the faithful dis­ ted Colonies had medical matters forced charge of duty, and the humane treatment of those upon their attention by the numerous bills soldiers who may have the misfortune to require coming in from doctors, here, there, and my assistance. Six of our number were privately everywhere that there had been a battle. rejected as being found unqualified. The examina­ The Provincial Congresses and the Conti­ tion was in a considerable degree close and severe, nental Congress had a number of medical which occasioned not a little agitation in our ranks. But it was on another occasion, as I am told, that a men in their memberships, and in looking candidate under examination was agitated into a over the histories of this date we find con­ state of perspiration and being required to describe stant references to them. Among those who the mode of treatment in rheumatism, among other were found in the legislative bodies of Mas­ remedies said that he would promote a sweat, and sachusetts was Dr. Benjamin Church. He being asked how he would effect this with his pa­ was afterwards sent as a member to the tient, after some hesitation he replied, ‘I would have him examined by a medical committee.’ Continental Congress itself. He and three other doctors formed the first Army Medi­ Thacher was so fortunate as to obtain cal Examining Board of which we can get the office of surgeon’s mate in the provin­ any history, for I find in the Journal of cial hospital at Cambridge, the senior sur­ the Provincial Congress of Massachusetts, geon being Dr. John Warren, brother and 1775, P- 203, that on M ay 8th, 1775, this pupil of the gallant General Joseph Warren, Congress who was slain in the memorable battle on Breed’s Hill. “ Ordered, That the President pro tempore, Doct. Church, Doct. Taylor, Doct. Helten and Doct. “ This gentleman has acquired great reputation in Dunsmore, be a committee to examine such per­ his profession, and is distinguished for his humanity sons as are, or may be, recommended for surgeons and attention to the sick and wounded soldiers, and for the army now forming in this colony.” for his amiable disposition. Having received my ap­ pointment by the Provincial Congress, I commenced and they, my duty in the hospital, July 15th. Several private, “ Resolved, That the persons recommended by but commodious houses in Cambridge are occupied the commanding officers of the several regiments, be for hospitals, and a considerable number of soldiers H isto ry of th e A rm y M ed ica l D epa r tm en t D u rin g th e R evolution 199 who were wounded at Breed’s Hill, and a greater Congress. Buried as they are in these number of sick of various diseases, require all our lengthy archives, such records are valueless attention. Dr. Isaac Foster, late of Charlestown, is for medico-historical purposes. Presented also appointed a senior hospital surgeon; and his student, Mr. Josiah Bartlet, officiates as his mate; here, as purely archivistic material, they Dr. Benjamin Church is Director General of the are but the crude ore of medical history. hospital.” Yet this record is undoubtedly the basic material upon which future historians must I find in Thacher’s Military Journal, rely in their work, which is my reason for 1775-1783, on page 294, the following: presenting it. To the medical officer, these “ January 1st, 1781.— On this, the first day of the records are of exceptional interest; to the new year, an arrangement of our army takes place, according to the late resolve of Congress. The su­ patriot they will not seem dry and unin­ pernumerary regiments are to be incorporated with spiring. those which continue on the new establishment fixed Our military medical history began, as by Congress, and are to be entitled to the same we have seen, in the Colony of Massachu­ privileges and emoluments, which are to be allowed setts Bay. In the Journals of the Continen­ to those who continue to the end of the war. It tal Congress, we trace the prehistory of being optional with me, either to retire or to con­ tinue in service, I shall retain my commission as our present Army Medical Corps, from the surgeon to Colonel H. Jackson’s regiment. We are appointment of Dr. Benjamin Church as encouraged to anticipate more favorable circum­ Director General and Chief Physician of stances, and more liberal compensation, Congress our first Army Hospital, at a salary of four having at length passed several resolves, entitling dollars a day, to the final acts relating to all officers who shall continue in service till the end the reduction of the army in 1783. The of the war, or shall be reduced before that time, as supernumeraries, to receive half pay during life, and subsequent act of June 2, 1784, practically a certain number of acres of land, in proportion to disbanded the U. S. Army, but it was im­ their rank. Besides these pecuniary considerations, mediately followed by acts of June 3, 1784, we are actuated by the purest principles of patriot­ April 7, 1785, October 20, 1786, and October ism; having engaged in the mighty struggle, we are 3, 1787, providing for the levying of troops ambitious to persevere to the end. To be instru­ and officers to guard our Northwestern mental in the achievement of a glorious Independ­ ence for our country, and posterity, will be a source frontier and other localities. These were, of infinite satisfaction, and of most grateful recol­ however, only militiamen. The U. S. Army lection, during the remainder of our days. Notwith­ proper was still non-existent. Following the standing the unparalleled sufferings and hardships, appointment of Major-General Henry Knox which have hitherto attended our military career, as Secretary of War, on March 8, 1785, an scarcely an officer retires without the deepest re­ act of September 29, 1789, authorized the gret and reluctance. So strong is the attachment, and so fascinating the idea of participating with formation of a corps of 700 men, rank and our illustrious commander in military glory, that a file, to guard the western posts. This force separation is like a relinquishment of principle, and had a medical complement of one surgeon abandonment of the great interest of our native and four surgeon’s mates. These forces were country.” enlarged up to their disbandment in the The successive steps in the legislative fall of 1791, and on March 5, 1792, our history of our Army Medical establish­ military forces were reorganized as a “ Le­ ment during the Revolution will be found gion” by Congressional enactment, with in the following pages, which I have care­ Richard Allison, as “Surgeon to the Le­ fully excerpted, from the Journals of each gion,” or Chief Medical Officer on the Gen­ Provincial Congress of the Colony of Mas­ eral Staff, at seventy dollars per month, sachusetts Bay, and from the twenty odd the pay of regimental surgeons (surgeon’s volumes of the Journals of the Continental mates) being forty-five dollars monthly. 200 Annals of Medical History

Major General Anthony Wayne command­ Journal of James Thacher (1826), James ed the whole Legion, and in August, 1794, Mann’s “Military Sketches of the Cam­ fought the decisive battle of Maumee Rap­ paigns of 1812-14” (1816), and “The Medi­ ids against the hostile Indians. The Medi­ cal Department of the United States Army cal Department was enlarged by the acts from 1775 to 1873” by Harvey E. Brown of M ay 28, 1798, and March 2, 1799, which, (1873). It is in the hope of stimulating fur­ at the earnest request of Washington, pro­ ther interest and research that I add the vided for the appointment of James Craik subjoined record. of Virginia as Physician General to both the Army and the N avy. Craik served in this I. FROM THE JOURNALS OF THE PROVINCIAL capacity from July 19, 1798, to June 15, CONGRESSES OF MASSACHUSETTS BAY 1800, when he was mustered out by dis­ (177 5) bandment of these forces. On March 3, April 27, 1775 (A. M.) 160 1813, in the midst of the War of 1812, the Ordered, That Capt. Kingsbury, Doct. Holten and Deacon Stone, are appointed to enquire, and office of Physician and Surgeon General was endeavor to get an exact account of the men killed, created, and on June 11, James Tilton of and wounded, and murdered, in the late scene on Delaware was appointed to this position. the 19th instant. With Tilton’s appointment, the history of M ay 8, 1775, 203. Ordered, That the president pro tempore, Doct. the Medical Corps of our Army, as we now Taylor, Doct. Holten and Doct. Dunsmore, be a know it, begins. committee to examine such persons as are, or may In the pages immediately following, one be, recommended for surgeons for the army now forming in this colony. may find the legislation relating to the Resolved, That the persons recommended by the treasonable action of Church, his trial and commanding officers of the several regiments, be appointed as surgeons to their respective regiments, confinement, the appointment of John Mor­ provided they appear to be duly qualified upon ex­ gan as his successor, the famous act of Ju ly amination. 17, 1776, limiting and defining the author­ May 16, 1775. 232 ity of medical officers, Morgan’s dismissal, The committee reported, that Doct. Benjamin through his disputes with Shippen and the Church was chosen. unsoldierly neglect of duty of Stringer, the May 17, 1775. 236 appointment of Shippen, Rush, and others, Resolved, That Doct. Church be allowed one ser­ vant to attend him in his journey to Philadelphia. Shippen’s trial for malfeasance in office, his acquittal and the resignation of Dr. Wil­ June 2, 1775. 290 Ordered, That Doct. Whiting and Doct. Bailies, liam Brown, Shippen’s resignation, the ap­ be added to the committee which was appointed by pointment of Cochran as Director General, the last Congress, to examine those persons who and his services up to the disbandment of might be nominated for surgeons of the Massachu­ setts army. the Army in 1783. In the different plans June 12, 1775. 321 considered for organization and reorgani­ Ordered, That Doct. Whiting, Doct. Taylor and zation of medical service, in such things as Mr. Parks, be a committee to consider some method the bits of legislation bearing upon pre­ of supplying the several surgeons of the army with medicines. ventive inoculation against small-pox, we (Afternoon) get a clear idea of what Congress was act­ The committee appointed to consider some meth­ ually doing for the medical establishment od for supplying the surgeons in the army with of the Continental Army. medicine, reported: the report was read and accept­ ed, and is as follows, viz.: The main source books for the early his­ The committee appointed to take into considera­ tory of our Army Medical establishment tion a complaint that the surgeons jn the army are not properly furnished with medicines, have at­ have been James Tilton’s “Observations on tended that service,‘and beg leave to report: that Military Hospitals” (1813), the Military whereas, it appears that there isjiot, as yet, a suffi- H isto ry of th e A rm y M ed ica l D epa rtm en t D u rin g th e R evolution 201

cient number of medicine chests provided, to fur- vice, beg leave to report, that they judge it is really nish each regiment with a distinct chest; and where­ expedient to have another established, and they as, the committee of supplies are making provision judge that the house of Doct. Spring, in Watertown, for the supplying of each regiment with such medi­ is convenient for that purpose; and that he is will­ cine chests as soon as possible: therefore, Resolved, ing said house should be improved by the province That the committee of supplies be, and hereby are for that use, but that he cannot at present ascertain directed, immediately to furnish the surgeon of the the damage it may be to him, but is willing to sub­ first regiment at Cambridge, and also the surgeon mit that matter to the judgment of a committee to of the first regiment at Roxbury, each of them, be hereafter appointed by this honorable Congress with a medicine chest, for the present; and that all or the house of assembly. the other surgeons in the army at Cambridge and Roxbury, have free recourse to the said chests, and June 22, 1775. 374, 375, 377 be supplied from them, from time to time, as they Ordered, That Doct. Francis Kittridge be desired shall find occasion, until more ample provision shall to attend the hospital, as a surgeon, till the further be made for them: all which is humbly submitted, order of Congress, and that Mr. Kendall be desired and the committee beg leave to sit again. to inform Doct. Kittridge of his appointment. William Whiting, per order. Ordered, That the colonels of the several regi­ Ordered, That the same committee be appointed ments in the Massachusetts army, be directed to to examine into the medical stores, and make a list recommend, immediately, suitable persons for sur­ of what is necessary for the supplying each regi­ geons and surgeons’ mates. ment, that the same may be laid before the com­ Ordered, That a hospital be provided for the mittee: and that the same committee consider what camp at Roxbury, and that Col. Davis, Doct. Tay­ medicines are necessary, and bring in a list of what lor and Doct. Whiting, be a committee to provide medicines are in the medical store: and that they one accordingly, and to supply the same. be directed to report what instruments are neces­ Resolved, That (the colonels *) in the Massachu­ sary for the surgeons of the army. setts army, be and they are hereby directed, imme­ diately to inform the committee appointed by Con­ June 16, 1775. 341 gress to examine the surgeons for said army, whom Doct. Hall and Doct. Jones were added to the they recommend for the surgeons and surgeon’s committee to examine surgeons for the army. Re­ mates of their respective regiments, and send them solved, That any three of said committee shall be a to said committee for examination, without delay; quorum. except such as have been examined. June 19, 1775. 355, 357, 360^1 June 23, 1775. 378 Doct. Hall, t)oct. Jones and Mr. Bigelow, were The committee appointed to provide a hospital appointed a committee to consider the expediency for the camp in Roxbury, reported as follows: That of establishing another hospital for the sick and they have appointed the house belonging to Joshua wounded of the army, and ordered to sit forthwith. Loring, in said Roxbury, for a hospital, and for the The committee appointed to consider the expedi­ use of said camp. The report was accepted. ency of establishing another hospital for the army, June 24, 1775. 383, 384, 387 reported, that a house belonging to Doct. Spring, of this place, may be had for that purpose, where­ Voted, That there shall be two surgeons and two upon, mates appointed for each hospital, and commis­ Resolved, That said committee be directed to in­ sioned accordingly. quire at what rate, per month, Doct. Spring will let Ordered, That the committee appointed to exam­ the same. ine the surgeons, be desired to report an establish­ Doct. Gunn was appointed to report a resolve on ment for surgeons of hospitals. the proposal made by the committee of safety, rela­ The committee appointed to consider an estab­ tive to the killed and wounded in the late battle. lishment for the surgeons of hospitals, reported: the Upon a motion made, Resolved, that the house of report was accepted, and is as follows, viz.: that it is Mr. Hunt, at Cambridge, be hired for a hospital, their opinion, that the establishment of the chief and that the committee appointed to treat with surgeons should be at the rate of eight pounds per Doct. Spring, be a committee to hire the same. month, and each mate, four pounds, ten shillings, Ordered, That Doct. Church, Doct. Taylor, and per month. Doct. Whiting, be a committee to consider what The committee appointed to hire a house of John method is proper to be taken to supply the hospi­ Hunt, Esq., for a hospital, reported the following tals with surgeons: and that the same gentlemen be proposal, which was accepted, viz.: a committee to provide medicines, and all other Gentlemen:— With respect to the hire of the house necessaries for the hospitals. belonging to John Hunt, Esq., for a hospital, the The committee appointed t© confer with Doct. proprietor only expects such a consideration from Spring, relative to the use of his house for another the colony, as will be a satisfaction for the necessary hospital, reported: the report was read and accept­ damage to the house, expecting proper care will be ed, and is as follows, viz.: taken that the out-houses, &c., be kept in good The committee appointed to consider of the ex­ order. pediency of establishing another hospital for the sick W. Hunt, in behalf of the proprietor. and wounded of the army, having attended that ser­ 1 (each colonel). 202 Annals of Medical History

June 27, 1775. 406 recting how the sick and wounded shall be removed Ordered, That the committee appointed to pro­ to the hospitals. vide hospitals for the army, be directed to provide The committee appointed to devise means for the another hospital, to be appropriated solely for such better accommodation of the sick and wounded of of the army as may be taken with the small pox, the colony army, reported. The report was accepted, and to consider what measures can be taken to pre­ and is as follows, viz.: In order that all the sick and vent the spreading of that distemper, and that wounded in the army may be provided for, and Doct. Rand, and Doct. Foster, be added to the com­ taken care of, in the best way and manner possible, mittee. Resolved, and it is hereby Ordered, that when any person in the army is so ill, either by a wound or June 28, 1775. 415 otherwise, that the surgeon of the regiment, to The form of a warrant for the surgeons was read which the sick or wounded person belongs, finds and accepted, and is as follows, viz.: the sick or wounded as abovesaid cannot be prop­ The Congress of the Massachusetts Bay, to A . B. erly taken care of in the regiment to which he be­ Greeting. longs, said surgeon shall send the sick or wounded Being informed of your skill in surgery, and re­ as abovesaid, to the hospital provided for the use of posing especial trust and confidence in your ability the camps to which they belong, and a certificate and good conduct, we do, by these presents, consti­ of the man’s name, and the company and regiment tute and appoint you the said A. B., to be surgeon to which he belongs; and in that case, the surgeon of the regiment of foot, whereof------is colonel, of the said hospital shall receive said sick or wound­ raised by the Congress aforesaid, for the defence of ed under his care; and in case said hospital shall be­ said colony. You are, therefore, carefully and dili­ come too full, in that case, the surgeon of said hos­ gently to discharge the duty of a surgeon to the pital shall send such of his patients as may with said regiment, in all things appertaining thereunto, safety be removed, to the hospital in Watertown observing such orders and instructions as you shall, and a certificate setting forth the man’s name, what from time to time, receive from the colonel of said company and regiment each belongs to; and in that regiment, according to military rules and discipline case the surgeons of the Watertown hospital shall established by said Congress, or any your superior receive said sick or wounded under his care. officers, for which this shall be your sufficient war- Ju ly 4, 1775- 445> 446, 448 By order of the Congress, Ordered, That Mr. Pickering, Mr. Partridge, and ------President. Mr. Goodwin, be a committee to prepare a letter to Dated at Watertown. General Washington, informing him of the provi­ June 30, 1775. 423, 4 sion this Congress has made for the sick and wound­ The committee appointed to consider some mea­ ed of the army. sures to prevent the spreading of the small pox, Ordered, That Doct. Taylor, Doct. Church, and were directed to sit forthwith. Mr. Johnson, be a committee to bring in a resolve The form of a warrant for surgeons of the hospi­ appointing Doct. (Andrew) Craigie, a commissary tal, was read and accepted, and is as follows, viz.: of medical stores, and that said committee be di­ The Congress of the Colony of the Massachusetts rected to consider what is a proper establishment Bay, t o ------Greeting. for his pay. Being informed of your skill in surgery, and re­ The committee appointed to bring in a resolve posing special trust and confidence in your ability for appointing Mr. Craigie, medical commissary, re­ and good conduct, (we) do by these presents, con­ ported. (The report) was read, and is as follows, stitute and appoint you, the said ------to be a viz.: surgeon of the hospital, established by order of the Resolved, That Mr. Andrew Craigie be, and he is Congress, in ------, for the sick and wounded of the hereby appointed a medical commissary and apothe­ colony army. You are, therefore, carefully and dili­ cary for the Massachusetts army, and that said gently to discharge the duty of a surgeon of said Craigie be allowed five pounds per month, for his hospital, in all things appertaining thereto, observ­ services as abovesaid. ing such orders and instructions as you shall, from Ordered, That the committee for making out com­ time to time, receive from any, your superior offi­ missions make out a warrant for Mr. Craigie, medi­ cers, according to the rules and discipline estab­ cal commissary. lished by said Congress, for which, this shall be Ju ly 5, 1775. 449, 450, 455. your sufficient warrant. By order of Congress, A list of surgeons who have been examined and Dated t h e ------day o f ------A. D. 1775. approved of, by a committee of this Congress, was laid before the Congress, and read, and is as follows: Ordered, That warrants be made out to the fol­ lowing officers, viz.: Doct. Lemuel Cushing, sur­ Doct. David Jones, surgeon; Samuel Blanchard, geon; Doct. Gad Hitchcock, surgeon’s mate; . mate, in Col. Gerrish’s regiment; Aaron Putnam, Doct. Lemuel Howard, surgeon to the Roxbury mate, in Col. F ry’s regiment; Joseph Hunt, mate to Hospital. Doct. Joseph Foster, in Cambridge hospital; Jacob Bacon, mate in Col. Scammon’s regiment; Harris July 1, 1775. 436, 7 Clary Fridges, mate; Edward Durant, surgeon, Col. Ordered, That Doct. Taylor, Mr. Fox, and Capt. Mansfield’s regiment; Josiah Harvey, mate, Col. Bragdon, be a committee to bring in a resolve, di­ Fellow’s regiment; Abraham Watson, Jr. surgeon, H isto ry of th e A rm y M ed ica l D epa rtm en t D u rin g th e R evolution 203

William Vinal, mate, Col. Gardner’s regiment; Doct. bridge, and another to Doct. Isaac Rand, as sur­ John Georges, mate, General Heath’s regiment; geon of the hospital at Roxbury. Doct. Isaac Spafford, surgeon, Col. Nixon’s (regi­ ment);* Doct. John Crooker, surgeon in Col. Scam- July 8, 1775. 470, 472, 476 mon’s regiment; Doct. Walter Hastings, surgeon in A list of surgeons examined by a committee ap­ Col. Bridges’ (regiment); Doct. Timothy Child, sur­ pointed for that purpose, was exhibited to Con­ geon, in Col. Patterson’s (regiment); Doct. Levi gress, and warrants ordered to be made out agree­ Willard, surgeon, in Col. Reed’s (regiment); Doct. ably thereto. Daniel Parker, surgeon, in Col. Walker’s (regiment); Resolved, That three o’clock, in the afternoon, be and Doct. Thomas Kittridge, surgeon, in Col. F ry’s assigned, to consider the expediency of appointing regiment. a surgeon general for the Massachusetts forces. Thereupon, Ordered, That warrants be made out Resolved, That eight o’clock to-morrow morning for them agreeably thereto. be assigned for the consideration of the expediency Resolved, That the order of Congress relative to of appointing a surgeon general of the Massachu­ the date of the warrants for the staff officers, be so setts army. far reconsidered, as that the warrants for the sur­ Ju ly 11, 1775. 488, 489 geons be dated the 28th June, ultimo. Ordered, That Mr. Crane, and Mr. Fox, make out A form of a warrant for a medical commissary, warrants for several surgeons and surgeons’ mates, was read and accepted, and is as follows, viz.: agreeably to a list this day 'exhibited by Doct. Tay­ The Congress of the Colony of the Massachusetts lor, and that such warrants, when made out, be Bay, t o ------Greeting. transmitted to the committee of safety. We, being informed of your skill in medicine, and Resolved, That Doct. Church, Doct. Taylor, and reposing especial trust and confidence in your abil­ Doct. Whiting, be a committee to take into their ity and good conduct, do, by these presents, con­ custody all the medicines, medical stores and in­ stitute and appoint you the s a id ------, to be struments, which are, or may be provided for the medical commissary and apothecary to the army use of the army, by this colony, and to distribute raised by the Congress, for the defence of this col­ them at their best discretion, so that no peculation ony. You are, therefore, carefully and diligently to or needless waste be made of the medicinal stores discharge the duty of a medical commissary and belonging to the public. apothecary in all things appertaining thereto, ob­ serving such orders and instructions as you shall, December 20, 1774. 506 from time to time, receive from any your superior Voted, unanimously, that Doct. Warren, Doct. officers, according to the rules and discipline estab­ Church, and the Hon. John Hancock, Esq., be a lished by said Congress, for which this shall be your committee to inspect the commissaries’ stores, in sufficient warrant. Boston, and report what surgeon’s stores and stores B y order of Congress, of other kind are there. ------, President. February 21, 1775. 509 The committee appointed to prepare a letter to Voted, That Docts. Warren and Church be a com­ General Washington, enclosing a resolution of Con­ mittee to bring in an inventory of what is necessary gress relative to the sick and wounded, reported. in the way of their profession, for the above army The report was accepted, and is as follows, viz.: to take the field. (To bis Excellency General Washington:) This Congress ordered the enclosed resolution to February 24, 1775. 512 be prepared, and sent to Generals Ward and Thom­ Voted, That Doct. Warren, Doct. Church, Mr. as; but by the agreeable event of your excellency’s Gerry, Mr. Cheever, Col. Orne and Mr. Devens, appointment to the chief command of the Ameri­ make inquiry where fifteen doctor’s chests can be can army, and arrival at camp, the propriety of that got, and on what terms, and report at the next step ceases. We mean not to dictate to your excel­ meeting. lency, but presume, that to secure the health of the army, and (to afford) relief for the sick, will natur­ March 7, 1775. 512 ally engage your attention. Every thing in the Voted, That the committee of supplies be direct­ power of this Congress (to do) to enable you to dis­ ed to make a draft on Henry Gardner, Esq., the re­ charge, with ease, the duties of your exalted and im­ ceiver general, in favor of Doct. Joseph Warren and portant station, will be, by us, attended to, with the Doct. Benjamin Church, for five hundred pounds, greatest alacrity. If the enclosed resolution has that lawful money, to enable them to purchase such ar­ tendency, we attain the end intended by transmit­ ticles for the provincial chests of medicine as can­ ting to you the same, and are, with respect, not be got on credit, to be deducted from the pro­ Your Excellency’s most humble servants. vincial tax payable by the town of Boston.

July 7, 1775. 464 April 18, 1775. 517 Voted, Ordered, That a warrant be made out for Doct. That two medicinal chests still remain at Isaac Foster, as surgeon of the hospital at Cam­ Concord, at two different parts of the town; three of said chests at Sudbury, in different parts of the * Material in parentheses was placed in brackets in the town; six do. at Groton, Mendon, and Stow, two in original mss. each town, and in different places; two ditto in 2°4 Annals of Medical History

Worcester, one in each part of the town; and, two consideration, especially as the committee, from in Lancaster, ditto; that sixteen hundred yards of their own knowledge, find the rooms too much Russia linen be deposited in seven parts, with the crowded, and the healths and lives of the soldiers doctor’s chests; that the eleven hundred tents be thereby greatly exposed; and if tents cannot be im­ deposited in equal parts in Worcester, Lancaster, mediately furnished, that some barracks be forth­ Groton, Stow, Mendon, Leicester, and Sudbury. with erected.2 April 21, 1775. 521 June 14, 1775. 566 Voted, That Major Bigelow be applied to, to fur­ Whereas, this committee are informed, that Doct. nish a man and horse to attend the surgeons, and How, of Andover, is prepared to receive (insane pa­ convey medicines agreeably to their directions. tients,) and is well skilled in such disorders as Dan­ iel Adams, of Boston, sent on the 13th instant, to April 29, 1775. 527 the town of Woburn, is affected with, therefore, Re­ Voted, That Doct. Isaac Foster be directed and solved, that the selectmen of the town of Woburn, empowered to remove all the sick and wounded, be, and they hereby are released from keeping said whose circumstances will admit of it, into the hos­ Daniel Adams in the town of Woburn, and they are pital, and to supply proper beds and bedding, cloth­ required to provide a horse and carriage, with pro­ ing, victuals, and furniture, with every other article visions, to forward the said Adams to Andover, the he shall judge proper for said hospital, and that this expense of which will be paid by this colony. be a sufficient order for him to draw on the com­ Resolved, That Daniel Adams, a lunatic, now at missary for such articles as he can supply, and to Woburn, be carried to the town of Andover, and draw orders upon the commissary for the payment committed to the care of Doct. How, and the said of whatever expenses are necessary for procuring Doct. How is hereby desired to take proper care of the above mentioned articles. the said lunatic, at the expense of this colony. April 30, 1775. 530 June 19, 1775. 571 Voted, That Andrew Craigie be appointed to take Resolved, That the house of the Rev. Samuel care of the medical stores, and to deliver them out Cook, of Menotomy, be improved as a hospital for as ordered by this committee; and that the secre­ the colony army; and that Mr. William Eustis be, tary make out his commission accordingly. and hereby is appointed, to the care of the sick and May 7, 1775. 538 wounded in said hospital, till the further order of this committee. Whereas, it appears to this committee, that great Ordered, That Doct. Isaac Foster be, and he here­ uneasiness may arise in the army, by the appoint­ by is directed, to take up and improve as hospitals, ment of surgeons who may not be agreeable to the so many houses in Menotomy, as he may find nec­ officers and soldiers in their respective regiments, essary for the safety of the sick and wounded of therefore, Voted, that it be recommended to the the colony army, and that he employ such person Congress, to allow the colonel of each regiment to or persons as may be necessary to carry such pro­ nominate the surgeon for his regiment; said surgeon visions and other necessaries as may be wanted for to nominate his mate; and unless there is some ma­ the use of the aforesaid sick and wounded; and fur­ terial objection made against them, that they be ac­ ther, that he take such precautions, respecting the cordingly appointed. small pox hospital, as may be necessary for the pre­ May 13, 1775. 544 vention of the spreading of that epidemical disorder Voted, That General Thomas be desired to deliver in the camp or elsewhere. out medicines to such persons as he shall think June 26, 1775. 578 proper, for the use of the sick soldiers at Roxbury, until the surgeons for the respective regiments are Whereas, this committee find the public hospital regularly appointed. in this town has been much neglected, to the great Voted, That the provisions and chest of medicines injury of the patients in said hospital, occasioned belonging to Madam Vassal, now under the care of by the want of some suitable person being placed Col. Starks, be stored as Col. Starks may direct, till there as surgeon, therefore, Resolved, that Doct. further orders: and that the other packages may John Warren, be, and he hereby is appointed, to the pass into Boston or elsewhere. oversight of said hospital, and that he take proper care such provision be made as may be necessary M ay 14, 1775- 545 for the comfortable support of the patients in said Mr. Andrew Craigie, commissary of the medicinal hospital until further orders. stores, &c., was directed and empowered to impress July 15, 1775. 597 beds, bedding, and other necessaries for the sick, as they may be wanting, giving the owners a receipt Complaint having been made to this committee for such articles as he may take for the purpose by the honorable General Ward, and other officers aforesaid. in the army, that several men are dangerously sick, and their lives would be greatly hazarded, except June 13, 1775. 566 The committee earnestly recommend to the hon­ 2 The quartermaster general represented, that there was great want of tents and barracks, and that the least delay in making orable Congress that the representations from the provision for tlje shelter of the troops, would be attended with quarter master general, be taken into immediate injurious consequences. H isto ry of th e A rm y M ed ica l D epa r tm en t D u rin g th e R evolution 205

immediate application of medicine be made to them, July 27, 1775. 209-211 and that the surgeons of some of the regiments had The Congress took into consideration the report applied, but could not obtain any; a sub-committee of the committee on establishing an hospital, and was therefore chosen to visit the hospital, and to the same being debated, was agreed to as follows: see the surgeons, and, upon inquiry, found that That for the establishment of an hospital for an there were no such medicines as are immediately army, consisting of 20,000 men, the following offi­ wanted: therefore, Resolved, that as the lives of some cers and other attendants be appointed, with the part of the army are in great danger, for want of following allowance or pay, viz.: medicines, notwithstanding the commission of the One Director general and chief physician, his pay committee of safety does not admit of direction in per day, 4 dollars.4 this matter, that M r. Commissary Craigie be de­ Four surgeons, per diem each, one and one third sired to procure, at the expense of the colony, such of a dollar. medicines as may be immediately and absolutely One apothecary, one and one third of a dollar. necessary; in consequence of which, the following Twenty (surgeons’) mates, each, two thirds of a order was given Mr. Commissary Craigie: dollar. Sir:— You are hereby desired immediately to sup­ One clerk, two thirds of a dollar. ply the store under your care, with such medicines Two storekeepers, each four dollars per month. as are absolutely necessary for the present relief of One nurse to every 10 sick, one fifteenth of a dol­ the sick in the army.3 lar per day, or 2 dollars per month. Report of the Committee sent to Ticonderoga, Labourers occasionally. Cambridge, July 6, 1775. The duty of the above officers: viz.: Director to furnish medicines, Bedding and all Your committee, being of opinion, that a major other necessaries, to pay for the same, superintend should be appointed under Col. Easton, and one the whole, and make his report to, and receive or­ surgeon to the battalion, and having inquired into ders from the commander in chief. the disposition of the officers and men who have Surgeons, apothecary and mates. To visit and at­ engaged, have appointed John Brown, Esq., as ma­ tend the sick, and the mates to obey apothecary and jor, and Mr. Jonas Fay, as surgeon. the orders of the physicians, surgeons and apothecary. Matron: To superintend the nurses, bedding, &c. All which is humbly submitted, Nurses: To attend the sick, and obey the ma­ WALTER SPOONER, by order.II. tron’s orders. Clerk: To keep accounts for the director and store II. FROM JOURNALS OF THE CONTINENTAL keepers. Storekeeper: To receive and deliver the bedding CONGRESS (1774-83) and other necessaries by order of the director. . . . June 2, 1775. 76 The Congress then proceeded to the choice of The President laid before the Congress a letter officers for the Hospital, when, from the Provincial Convention of Massachusetts Benjamin Church was unanimously elected as di­ which was read and was as follows: rector of, and chief physician in, the hospital. In prov. Congress, Watertown, May 16, 1775. Resolved, That the appointment of the four sur­ Resolved, That Doctr. Benjamin Church be ordered geons and the Apothecary be left to Doctr. Church. to go immediately to Philad°. and deliver to the presi­ That the Mates be appointed by the Surgeons; dent of the Hon^’6. American Congress there now sit­ That the number do not exceed twenty; and ting, the following application to be by him com­ That the number be not kept in constant pay, unless municated to the members thereof: and the s? the sick and wounded should be so numerous as to Church is also directed to confer with the s? Con­ require the attendance of twenty, and to be diminished gress, respecting such other matters as may be as circumstances will admit; for wct> purpose, the necessary to the defence of this colony and particu­ pay is fixed by the day, that they may only receive pay larly the state of the army therein. . . . for actual service. That one Clerk, two storekeepers, and one nurse July 19, 1775. 191 to every 10 sick, be appointed by the Director. Resolved, That a Committee of three be appointed September 14, 1775. 249 to report the method of establishing an hospital. 5 th, sundry letters from General Schuyler,6 The committee chosen, Mr. (Francis) Lewis, Mr. The same being taken into consideration, (Robert Treat) Paine, and Mr. (Henry) Middleton, On motion made, Resolved, That Samuel Stringer, July 24, 1775. 203 EsqF be' appointed director of the Hospital, and chief Physician and surgeon for the Arm y in the The Committee for that purpose app(oin)t? bro’t Northern department. in a report for establishing a hospital. Ordered to That the pay of the sd Samuel Stringer, as Director, lie on the table. Physician, and Surgeon, be four Dollars per day. July 25, 1775. 203. Report read: 4 The original plan provided for a Director General and a Phy­ sician, each to receive four dollars a day. 3 Although the sessions of the committee continued after the 5 Letters dated July 26, 27, 28, and August 6, read in Congress fifteenth day of July, 1775, the journal is not preserved to a later on this day, are in Papers of the Continental Congress, No. 153, date. folios 63, 71, 77, 102. 20 6 Annals of Medical History

That he be authorized and have power to appoint December 8, 1775. 416 a number of surgeon mates under him, not exceed­ On motion, Resolved, That a surgeon be allowed ing four. to each regiment, (in the service of the United That the pay of said mates be 2/3 of a dollar per Colonies;) day. That the pay of a regimental Surgeon be 25 Dol­ *[Tbat the number be not kept in constant pay, lars per (calendar) month. unless the sick and wounded be so numerous as to William Barnet, jun. was unanimously elected require the constant attendance of jour, and to be surgeon of the first or eastern battalion raised in New diminished as circumstances will admit, for which Jersey. reason the pay is fixed by the day, that they may only receive pay for actual service.] December 21, 1775. 442 That the deputy Commissary general be directed Doctor James Holmes was chosen surgeon to to pay Doctr. Stringer for the Medicines he has pur­ Colonel Maxwell’s regiment. chased for the use of the army, and that he purchase and forward such other medicines as General P. January 8, 1776. 38 Schuyler shall, by his warrant, direct, for the use of Resolved, That the provisions heretofore made for said army. an hospital in the northern army, when it was more That M r (Eliphalet) Dyer, M r (Thomas) Lynch, numerous than it is now, is sufficient. MF (John) Jay, MF (John) Adams, and MF (Fran­ January 17, 1776. 61 cis) Lewis, be a Committee to devise ways and means for supplying the continental army with A Petition from Benjamin Church was presented Medicines. to Congress, and read:6 Ordered, That the same be referred to a commit­ September 23, 1775. 261 tee of three. On motion Ordered, That the Committee appoint­ January 18, 1776. 65 ed to devise ways and means of supplying the Arm y with Medicines, do buy a parcel of Drugs in the The committee on the petition of Dr. Church, hands of Mr. Rapalje, which he offers at the prime brought in their report, which being taken into con­ cost. sideration, Resolved, That Governor Trumbull be desired to October 14, 1775. 294-295 give order for the removal of Dr. Church to some On motion made, more comfortable place of confinement than that Resolved, That a director general and chief physi­ where he now is, if such can be found in that colony; cian of the Hospital in Massachusetts bay, be ap­ and that, for the advancement of his health, the pointed in the room of DoctF (Benjamin) Church, said Dr. Church be permitted to ride out, at proper who is taken into custody for holding a correspond­ seasons, under a trusty guard, who will be careful ence with the enemy. to prevent his carrying on any correspondence, or Resolved, That the Congress will, on Monday next, doing any act prejudicial to the safety and welfare proceed to the election of a director general and of the United Colonies. chief physician of the Hospital, in the room of DoctF A letter from the committee of Frederic town, Church. (Maryland,) enclosing sundry intercepted letters of Connolly, taken on Dr. John Smith, (one of Con­ October 17, 1775. 297 nolly’s associates,) and brought by the guard who The Congress proceeded to the election of director had the charge of bringing down said Smith, was general and chief physician of the Hospital, in the laid before Congress and read: room of DoctF (Benjamin) Church, and the ballots Resolved, That it be recommended to the commit­ being taken and exam’d, tee of safety of Pennsylvania, to take the examina­ DoctF (John) Morgan, (of Philadelphia,) was elect­ tion of Dr. Smith, and then commit him to safe ed. and close confinement. November 7, 1775. 334 January 25, 1776. 87-8 Resolved, That Dr. Church be close confined in A letter from Richard Huddleston, . . . .7 some secure gaol in the colony of Connecticut, with­ The same Committee on considering Dr. Hud- out the use of pen, ink, and paper, and that no per­ dlestone’s Letter, are of Opinion, son be allowed to converse with him, except in the That he be immediately set at Liberty on the presence and hearing of a Magistrate of the town, Terms he mentions. And that a verbal Proposition or the sheriff of the county where he shall be con­ be sent by him to General Carleton, to enter into a fined, and in the English language, until farther Stipulation on both sides, not only to release all orders from this or a future Congress. Physicians and Surgeons; but that if by the For­ tune of War, the Hospital of either Arm y should November 10, 1775. 344 fall into the Power of the other, the same Subsist­ Resolved, That the medicines purchased in this ence and Supplies should be afforded to the Sick city for the army at Cambridge, be sent thither by 6This petition is in the Papers of the Continental Congress, No. land. 41, II, folio 5. 7 The letter of Huddleston is in the Papers of the Continental * Material placed in brackets is crossed out in original mss. Congress, No. 78, X I, folio 13. H isto ry of th e A rm y M ed ica l D epa r tm en t D u rin g th e R evolution 207 and Wounded as if Friends; and that neither they March 23, 1776. 229 nor the Attendants of the Hospitals should be con­ The Committee of Claims reported that there is sidered or detain’d as Prisoners. And it is farther due, the Opinion of the Committee, that if Govr. Carle- To Dr. Jonathan Potts, for attendance on the ton should not agree to the mutual Release of Sur­ second and fourth Pennsylvania batallions, the sum geons, Dr. Huddlestone is to be on his Parole, to re­ of 125.6.9 = 67.6 dollars. turn immediately hither.8 March 30, 1776. 242-3 January 30, 1776. 101 Resolved, That each regimental surgeon be allow­ Resolved, That Dr. Cadwalader and Dr. W. Ship- ed a mate: pen, JunF be desired to inspect the room of the gaol Resolved, That the pay of a surgeon’s mate be 18 where General Prescot is confined, and enquire into dollars per month. the state of his health, and report to Congress. Resolved, That (suitable chirurgical) instruments be purchased with each medicine chest. January 31, 1776. 105 Dr. Cadwalader and Dr. Shippen returned their April 11, 1776. 271 report respecting the room where General Prescot To Dr. Jonathan Potts, for attending the prison­ is confined, and the state of the general’s health, ers at Reading, the sum of £28.15.0 (= 7 6 .6 dollars); which was read. and for sundry medicines, &c. provided for the mid­ dle department, the sum of £50.9.1 ( = 13 4 .6 dollars,) March 1, 1776. 180 amounting, together, to the sum of £ 7 9 .4 .1= 2 11.2 Resolved, That the Secret Committee be empow­ dollars. ered to treat with the owners of some medicines lately imported, and purchase the same on the most April 29, 1776. 317 reasonable terms for the use of the continent. A letter from Thomas BuIIit and a petition from Dr. J. Potts, was presented to Congress and read.9 March 7, 1776. 188 Resolved, That they be referred to the foregoing Resolved, That the Committee appointed to pro­ committee. vide medicine chests be directed to supply the first and third New Jersey batallions with proper medi­ M ay 6, 1776. 330 cine chests and instruments. Resolved, that the convention, or committee or council of safety of Virginia, be empowered to ap­ March n, 1776. 197 point surgeons to the batallions raised in said col­ Resolved, That the committee on applications and ony, for the service of the continent. qualifications &c. be directed to provide 6 medicine chests for the 6 Virginia batallions. M ay 10, 1776. 344 G. 6. That Dr. Potts be taken into the Pay of the March 22, 1776. 225 Continent and be employed in the Canada Depart­ A petition from Thorowgood Smith, and others, ment or at Lake George as the GenI Schuyler shall was presented to Congress, and read, setting forth, think fit. But that this Recommendation be not that they have procured a vessel, and raised money considered so as to supersede Dr. Stringer. That the to fit her out as a privateer, in order to guard and Pay of Dr. Potts be Dollars per Mo. cruise on the coast of Virginia, and praying that a commission be granted to William Shippen, to May 11, 1776. 348 whom they propose to give the command of said Resolved, That two sets of trepanning instruments vessel; and that the Congress will grant them a be sent to Virginia for the use of the surgeons of the small quantity of powder, upon their making satis­ continental troops there; and that two sets of tre­ faction for the same: panning instruments, and 100 lb. of Peruvian bark, Resolved, That a commission be granted to Wil­ be sent to North Carolina, for the use of the conti­ liam Shippen, as captain of the above mentioned nental troops in that colony. vessel, for the purposes aforesaid. Resolved, That Captain William Shippen be sup­ May 13, 1776. 350 plied with three hundred weight of powder by the Sundry petitions were presented to Congress and Secret Committee, he paying for the same. read, viz.: One from Benjamin Church, accompanied 8 This report, in the writing of Benjamin Franklin, is in the with one from Benjamin Church, Samuel Church Papers of the Continental Congress, No. 19, III, folio 215. The fol­ and Edward Church, and a certificate from three lowing notes in the writing of Franklin are in No. 78, X IX , folio 7. Doctors (respecting the health of Dr. B. Church;) “ Agreed to set Dr. Huddlestone at Liberty on the Terms he mentions. And send by him a Proposition to Gen. Carleton, that one from John Connolly and John Smith, accom­ it be Stipulated on both Sides, not only to release all Surgeons; panied with a letter from Dr. (Thomas) Cadwala­ but that if by the Fortune of War, the Hospital of either Army der:10 should fall into the Power of the other, the same Care should be taken of the Sick and Wounded as of Friends, and that neither 9 . . . The petition of Dr. Potts is in the Papers of the Con­ they nor the Attendants of the Hospital should be considered as tinental Congress, No. 78, X V III, folio 56. . . . Prisoners. And if Govr Carleton should not agree to the mutual 10 The petition of Connoly is in the Papers of the Continental release of Surgeons, Dr. Huddleston is to be on his Parole to Congress, No. 78, V, folio 39. That of Smyth is in No. 78, X X , return immediately. . . folio 29. That of Cadwalader is in No. 78, V, folio 43. 208 Annals of Medical History

May 14, 1776. 352 June 18, 1776. 460-461, 463 The committee to whom the petition of Dr. Ben­ A memorial from Dr. (John) Morgan, director jamin Church, now confined in gaol in Norwich, in general and chief physician of the Hospital, was laid the colony of Connecticut, and also a petition from before Congress, and read :15 Benjamin, Samuel, and Edward Church, together Resolved, That it be referred to the committee with a certificate from physicians, respecting the appointed to provide medicines. dangerous state of the aforesaid Dr. Church, were Resolved, That Mr. (Thomas) Heyward (Jr.), and referred, brought in their report, which was read Mr. (Lyman) Hall be added to the committee for and agreed to: Whereupon, providing medicines. Resolved, That Dr. Benjamin Church be sent to the colony of Massachusetts bay, and that the coun­ June 19, 1776. 466 cil of the said colony be requested to take a recog­ To Mary Thomas, for nursing and boarding two nisance from him, with two good sureties, in such of Captain Benezet’s men, in the small pox, the penalty as they shall think sufficient, not being less sum of £4.10.0=12 dollars: than one thousand pounds, lawful money, for his Ordered, That the said accounts be paid. appearance before such court as shall be erected for Resolved, That the committee for preparing medi­ his trial, and at such time and place as such court cine chests, be directed to send a chest of medicines shall direct, and to abide the judgment of the same; to the surgeon of said batallion. and that they be farther requested, to take his A memorial from the mates of the Hospital was parole, not to hold any correspondence with the laid before Congress and read:16 enemies of the United Colonies, or at any time, to Resolved, That it be referred to the committee for depart out of the same colony, without their license; providing medicines. and that, upon the performance thereof, the said June 20, 1776. 469 Dr. Benjamin Church be set at liberty. To Abraham Mills, for nursing and boarding six May 16, 1776. 358 soldiers in the small pox, the sum of £ 1 2 .1 4 .8 = A letter from General Washington, of May (15), 33 36/90 dollars: enclosing a letter (to him) from Dr. Stringer.11 Resolved, That a committee of five be appointed Resolved, That the letter from Dr. Stringer to to consider what provision ought to be made for General Washington, be referred to the committee such as are wounded or disabled in the land or sea appointed to prepare medicine chests: service, and report a plan for that purpose: May 18, 1776. 284 The members chosen, Mr. (Robert Treat) Paine, That a continental Hospital be established in Vir­ Mr. (Francis Lightfoot) Lee, Mr. (Lyman) Hall, ginia, and a director to the same be immediately Mr. (William) Ellery, and Mr. (Francis) Lewis. appointed by Congress. Ju ly 8, 1776. 528 May 22, 1776. 378 Resolved, That the committee for providing medi­ 15. T h at------Surgeons and------mates be added cines, be directed to supply the militias aforesaid, to the Hospital in Canada and that DoctF Stringer with a sufficient quantity of suitable medicines. be directed to procure them.12 July 12, 1776. 556 June 5, 1776. 419 The committee appointed to take into considera­ That the pay of the regimental surgeons be aug­ tion the memorial of the director general of the mented to thirty three dollars and one third of a American hospital, brought in their report, which dollar a month. was read: June 6, 1776. 424 Ordered, To lie on the table. Resolved, That doctor Jonathan Potts be em­ July 15, 1776. 562 ployed as a physician and surgeon in the Canada Resolved, That a chief physician be appointed for department, or at Lake George, as the general shall the flying camp, and that his pay be four dollars direct; but, that this appointment shall not super­ per day: sede Dr. Stringer. The ballots being taken (and examined,) June 17, 1776. 449, 453 William Shippen, JunT was elected. U. 6.13 July 17, 1776. 568-571 R. 8. That the committee, appointed to provide medicines, be directed to send a proper assortment The Congress took into consideration the report of medicines to C an ada:14 of the committee on the memorial of the director general of the American hospital; Whereupon, 11 The letter of Washington is in the Papers of the Continental [ Resolved, For the better Government of the gen­ Congress, No. 152, I, folio 685. It is printed in Writings of Wash­ ington (Ford), IV, 80. eral Hospital of the American Army, for explaining 12 Against this paragraph is written: “ Referr’d to to-morrow.” and ascertaining more fully the duties of the Direct­ 13 This paragraph, relating to the appointment of Dr. Jonathan or-General, the directors of Hospitals, the Surgeons Potts, is stricken out of the Jefferson report, having been printed and Mates, both Hospital and Regimental:] under June 6, p. 424, ante. 14 In the Jefferson report this paragraph read: “ Resolved, That 16 This memorial is in the Papers of the Continental Congress, a proper assortment of medicines be sent to Canada.” Against it No. 41, V I, folio 3. Harrison has written “ Come.e already appointed to provide 16 This memorial is in the Papers of the Continental Congress, medicines.” No. 41, III, folio 167. H isto ry o f th e A rm y M ed ica l D epa r t m en t D u rin g th e R evolution 209

Resolved, That the number of hospital surgeons nent be disposed of [by sale till the army is fully and mates be increased, in proportion to the aug­ supplied] till further order of Congress: mentation of the army, not exceeding one surgeon Resolved, that no Surgeon or Surgeon’s Mate shall and five mates to every five thousand men, to be receive a Commo as such in the Army, without hav­ reduced when the army is reduced, or when there is ing first undergone an Examination by the director, no further occasion for so great a number: of the hospital of the Department in which he may That as many persons be employed in the several desire employment or the director GenI and ob­ hospitals, in quality of store keepers, stewards, man­ tained a Certificate from the Commdr and director agers, and nurses, as are necessary for the good of of that department, or the Director GenI, of his the service, for the time being, to be appointed by Abilities and knowledge in his business.18 the directors of the respective hospitals: That the pay of the hospital surgeons be increased That the several regimental chests of medicines, to one dollar and two thirds of a dollar by the day; and chirurgical instruments, which now are or here­ the pay of the hospital mates be increased to one after shall be, in the possession of the regimental dollar by the day; and the pay of the hospital surgeons, be subject to the inspection and enquiry apothecary to one dollar and two thirds of a dollar of the respective directors of hospitals, and the di­ by the day; and that the hospital surgeons and rector general; and that the said regimental surgeons mates take rank of regimental surgeons and mates: shall, from time to time, when thereto required, ren­ Resolved, that the Storekeepers of the several der account of the said medicines and instruments Hospitals be paid by the month, and the Stewards to the said directors, or if there be no director in and Managers of the said Hospitals be paid by the any particular department, to the director general; Month a sum not exceeding dollars.18 the said accounts to be transmitted to the director Resolved, That the duties and privileges of the general, and by him to this Congress; and the medi­ Surgeons and Mates, not heretofore particularly as­ cines and instruments not used by any regimental certained, be conformable to the established Usage surgeon, to be returned when the regiment is re­ of other well regulated Armies, as far as is consist­ duced, to the respective directors, and an account ent with the Good of the Service, until otherwise thereof by them rendered to the director general, settled and directed by this Congress.18 and by him to this Congress: Resolved, that the Appointments of Surgeons (Sur­ Resolved, That an Additional Apothecary with geons Mates) Storekeepers, Stewards, Managers and such Number of Mates as the Service may require, Nurses, heretofore mentioned, shall be made by the be allowed, under the Title of Apothecary to the Director General in the Northern and Eastern De­ Army, and in subordination to the [General Hospital] partments ; and of the Middle department by the Apothecary of the General Hospital.17 Director, which may hereafter be app’d in that That the several directors of hospitals, in the sev­ dep’t; and in the Southern Dep’t by the director of eral departments,, and the regimental surgeons, that dep’t with the approba. of the Commandr of where there is no director, shall transmit to the di­ the respect departments.19 rector general regular returns of the number of sur­ Resolved, that it be recommend to Congress to geons’ mates, and other officers employed under purchase the Medicines (now in Phila) belonging to them, their names and pay; also, an account of the Doctor Morgan.19 expences and furniture of the hospital under their Resolved, that in all levies of Troops hereafter direction; and that the director general make report to be raised for the Service of the Continent a stop­ of the same, from time to time, to the commander page of out of the month’s pay of each Man be in chief, and to this Congress: made for the Use and support of the several Conti­ That the several regimental and hospital sur­ nental Hospitals.19 geons, in the several departments, make weekly That the director general, and the several direct­ returns of their sick to the respective directors in ors of hospitals, be empowered to purchase, with their departments: the approbation of the commander of the respective That no regimental surgeon be allowed to draw departments, medicines, and instruments for the upon the hospital of his department, for any stores use of their respective hospitals, and draw upon the except medicines and instruments; and that, when pay master for the same, and make report of such any sick person shall require other stores, they shall purchases to Congress.20 be received into the said hospital, and the rations of the said sick persons be stopped, so long as they Ju ly 20, 1776. 595 are in the said hospitals; and that the directors of Resolved, That Dr. Senter be recommended to the several hospitals report to the commissary the Dr. Morgan; who is desired to examine him; and if, names of the sick, when received into, and when (upon examination,) he finds him qualified, to em­ discharged from the hospital, and make a like re­ ploy him in the hospital as a surgeon. turn to the Board of Treasury: That all extra expences for bandages, old linen, Ju ly 26, 1776. 612 and other articles necessary for the service, incurred Resolved, That an order for 2,000 dollars be by any regimental surgeon, be paid by the director drawn on the treasurers in favor of Dr. W. Shippen; of that department, with the approbation of the he to be accountable. commander thereof: 18 A paragraph that was not retained. That no more medicines belonging to the conti­ 19 A paragraph that was not retained. 20 This report, in the writing of Thomas Stone, is in the P apers 17 A paragraph that was not retained. of the Continental Congress, No. 19, IV, folio 181. 210 Annals of Medical History

July 31, 1776. 622 The Medical Committee, to whom Dr. M ’Henry’s Resolved, That the committee for providing medi­ petition was referred, brought in their report: Where­ cines be directed to provide, and send forward, such upon, a quantity of medicines as may be necessary for the Resolved, That Congress have a proper sense of Hospital in the northern army: the merit and services of Dr. M ’Henry, and recom­ That the said committee be directed to procure mend it to the directors of the different hospitals and send forward such a quantity of medicines as belonging to the United States, to appoint Dr. may be necessary for the hospital in the southern M ’Henry to the first vacancy that shall happen, of department. a surgeon’s berth in any of the said hospitals. August 6, 1776. 633 August 29, 1776. 717 Resolved, That the committee for procuring medi­ That the said committee be directed to import cines be directed to supply the director general of the medicines ordered by the Medical Committee. v the Hospital with such medicines as he may want. September 7, 1776. 742 August 7, 1776. 636 Resolved, That Mr. (Gustavus) Risberg, the as­ Resolved, That Dr. (Benjamin) Rush be added to sistant to Colonel Biddle, be directed to take proper the committee for procuring medicines. measures for providing the sick soldiers in Philadel­ August 16, 1776. 661 phia, with proper lodgings and attendance. A petition from Dr. Samuel Stringer, was present­ September 18, 1776. 781 ed to Congress and read: That the Medical Committee send an assortment Resolved, That it be referred to the Medical Com­ of proper medicines to the northern a rm y:22 mittee. Resolved, That the Medical Committee be em­ September 24, 1776. 812-813 powered to purchase such medicines as they judge Resolved, That a committee of five be appointed proper and useful for the army. to devise ways and means for effectually providing the northern army with provisions and medicines, August 20, 1776. 673 and supplying their other necessary wants: The committee to whom was referred the peti The members chosen, Mr. (Benjamin) Rush, Mr. tion of Dr. Stringer brought in their report, which (Lyman) Hall, Mr. (Samuel) Chase, Mr. (Thomas) was taken into consideration; whereupon, Johnson and Mr. (Richard) Stockton. Resolved, That Dr. Morgan was appointed direct­ Resolved, That the Medical Committee be direct­ or general and physician in chief of the American ed to apply to the council of safety of Pennsylvania, hospital: for a quantity of medicines; to be repaid in kind or That Dr. Stringer was appointed director and in cash, as they shall chuse. physician of the hospital in the northern depart­ ment only. September 25, 1776. 822, 823, 826 That every director of a hospital possesses the ex­ The committee appointed to devise ways and clusive right of appointing surgeons and hospital means for providing the northern army with pro­ officers of all kinds, agreeable to the resolutions of visions, medicines and other necessaries, brought Congress of the 17 of July, in his own department, in a report, which was taken into consideration; unless otherwise directed by Congress: Whereupon, . . . That Dr. Stringer be authorized to appoint a sur­ That the committee be empowered to make regu­ geon for the fleet now fitting out upon the lakes: lations for the hospitals in the northern depart­ That a Druggist be appointed in Philadelphia ment, and to remove or suspend any person em­ whose business it shall be, to receive and deliver all ployed therein, and to employ such as they may medicines, instruments, and shop furniture for the think necessary and proper; and that they report benefit of the United States: to Congress the state and condition of the army, That a salary of thirty dollars a month be paid to and any further regulations which they may think the said druggist for his labour. necessary, for the better government and supplying Congress proceeded to the election of a druggist, the said army: and, the ballots being taken, Dr. William Smith was That the committee consist of [three] two, and elected. that to Morrow be assigned for electing the said August 26, 1776. 705 committee. To the steward of the Pennsylvania hospital, for Provided, that all such officers and soldiers that boarding William Whiting, a wounded soldier, four may be entitled to the aforesaid pension, and are weeks, by order of Congress, 5 30/90 dollars: found to be capable of doing guard or garrison duty, shall be formed in a corps of invalids, and subject September 30, 1776. 836-837 to the said duty; and all officers, marines, and sea­ That it be recommended to the legislatures of men of the navy who shall be entitled to the pen­ the United States, to appoint gentlemen in their re­ sion aforesaid, and shall be found capable of doing spective states, skilful in physic and surgery, to ex- any duty on board the navy, or any department thereof, shall be liable to be so employed: 22 This report, dated “ at a board of war, Septr. 14th, 1776” and Ordered, That the above be published.21 in the writing of Richard Peters, is in the Papers of the Continen­ tal Congress, No. 1 4 7 ,1, folio 5. It is endorsed: “ partly agreed to. 21 Printed in the Pennsylvania Gazette, 4 September, 1776. Two paragraphs postpon’d, Septr. 18, 1776.” H isto ry of th e A rm y M ed ica l D epa rtm en t D u rin g th e R evolution 21 i amine those who offer to serve as surgeons or sur­ That the commanding officer of each regiment be geons’ mates in the army and navy; and that no directed, once a week, to send a commission officer surgeon or mate shall hereafter receive a commis­ to visit the sick of his respective regiment in the sion or warrant to act as such, in the army or navy, general hospital, and report their state to him: who shall not produce a certificate from some or That for the promoting health in the army, the one of the examiners so to be appointed, to prove commissary general be directed to cause the same that he is qualified to execute the office: to be well supplied with Indian meal and vegetables. That all regimental surgeons and mates, as well October 14, 1776. 869 as those of the hospitals, be subject to the direction A letter .... One from General Washington, and controul of the directors in the several depart­ of the 7, enclosing a letter from Dr. Morgan, were ments : laid before Congress, and read. That no soldier be discharged from the service as Resolved, . . . That the letter from Dr. Morgan, disabled, unless the certificate of disability be coun­ enclosed in General Washington’s letter, be referred tersigned by the director, assistant physician, or to the Medical Committee. first surgeon of the hospital, nor be excused from duty for sickness, unless the certificate of sickness November 4, 1776. 921 be countersigned by one of those persons, where ac­ It being represented that some of the marines in cess may be had to them. the barracks are sick, Resolved, That the remainder of the said report be Resolved, That Doctr Rush be desired to take postponed. them under his care, and see them properly provided for. October 7, 1776. 852-3 November 12, 1776. 940 . . . . Three Camp Kettles for the use of the A letter, . . . and one, of the 9, from Dr. Ship- Hospital, to W. V. Wimple Surgeon; . . . pen, were read.25 That said Nicholson delivered five Camp Kettles, to Colo. Hazen, 3 ditto to Doctr. Lynn for the Gen­ November 13, 1776. 948 eral Hospital, and 3 ditto for the red hospital at St. To Doctor Samuel Wilson, for board, attendance, Foys. and medicine, to sick soldiers of the 6 Virginia regi­ ment, 33 60/90 dollars: October 9, 1776. 857-8, 9 That there should be paid to Thomas Armer, on Congress resumed the consideration of the report account of Elizabeth Robinson, for so much short of the committee who went to the cam p;23 Where­ paid on settlement of her account, the 14th October upon, last, for board, &c. of sick soldiers belonging to Cap­ Resolved, That no regimental hospitals be, in fu­ tain Grier’s company, 10 dollars: ture, allowed in the neighbourhood of the general That there should be paid to the Pennsylvania hospital: hospital, for the support and cloathing of John That John Morgan, Esq!" provide and superin­ Hughes, a wounded soldier, 36 54/90 dollars: tend a hospital, at a proper distance from the camp, for the army posted on the east side of Hudson’s November 19, 1776. 965 river. That, on any sick or disabled non-commissioned That William Shippen (Jun.), Esq!- provide and officer or soldier, being sent to any hospital or sick superintend an hospital for the army, in the state quarters, the captain or commandant of the troop of New Jersey: or company to which he belongs, shall send to the That each of the hospitals be supplied by the re­ surgeon, or director of the said hospital, or give to spective directors with such a number of surgeons, the non-commissioned officer or soldier, so in the apothecaries, surgeons’ mates, and other assistants, hospital or quarters, a certificate, (countersigned by and also with such quantities of medicine, bedding, the pay master of the regiment, if he be with the and other necessaries, as they shall judge expedient: regiment,) of what pay is due to such sick non-com­ That they make weekly returns to Congress and missioned officer or private, at the time of his enter­ the commander in chief, of the officers and assist­ ing the hospital or quarters; and the captain or com­ ants of each denomination, and also the number of mandant of the troop or company, shall not receive sick and deceased in their respective hospitals: the pay of the said soldier in hospital or quarters, That the regimental surgeons be directed to send or include him in any pay abstract during his con­ to the general hospitals such officers and soldiers of tinuance therein. And, in case any non-commis­ their respective regiments, as, confined by wounds sioned officer or soldier shall be discharged from or other disorders, shall require nurses or constant the hospital or quarters, as unfit for farther service, attendance, and, from time to time, to apply to the a certificate shall be given him, by the surgeon or quarter master general, or his deputy, for conve­ director, of what pay is then due to him; and the nient waggons for this purpose; also, (that they ap­ said non-commissioned officer or soldier, so dis­ ply to the directors in their respective departments, charged, shall be entitled to receive his pay at any for medicines and other necessaries:) 24 pay office, or from any pay master in the service of That the wages of nurses be augmented to one the United States; the said pay master keeping such dollar per week: original certificate, to prevent impositions, and giv-

23 See note under October 3, p. 844, ante. 25 The letter of Dr. Shippen is in the P a p ers o f the Continental 24 This sentence is in the writing of John Hancock. Congress, No. 78, X X , folio 75. 212 Annals of Medical History ing the non-commissioned officer or soldier his dis­ cure the Pennsylvania hospital, for the purpose of charge, or a certified copy thereof, mentioning, at accommodating the sick belonging to the continen­ the same time, his having been paid: tal army. Resolved, That the Medical Committee be em­ November 26, 1776. 983 powered to procure suitable persons to take care of That the committee, who are sent to the camp, the sick, and to remove them to such convenient be directed to make particular enquiry into the places in the country, as they shall think proper. abuses in the medical department in the army, and report thereon to Congress. December 12, 1776. 1024 November 28, 1776. 989 That 5,000 dollars be advanced to Dr. Nicholas The Medical Committee, to whom Dr. Shippen’s W ay, (of Wilmington,) for the public service; he to letter was referred, brought in a report, which was be accountable. taken into consideration; Whereupon, Resolved, That the continental apothecary be di­ Resolved, That Dr. Morgan take care of such sick rected immediately to pack up all the continental and wounded of the army of the United States, as medicines, and send them to the quarter master are on the east side of Hudson’s river, and that Dr. general: Shippen take care of such of the said sick and That the quarter master general be directed to wounded as are on the west side of Hudson’s river; remove all the medicines belonging to the continent and that they both be directed to use the utmost in this city to a place of security: diligence in superintending the surgeons and mates STANDING COMMITTEES of the army, so that the sick and wounded may be effectually provided with everything necessary for 1775-1776 their recovery...... Medicines p. 1065 14 September, 1775. Eliphalet Dyer November 29, 1776. 990-991 Thomas Lynch Resolved, That Mr. Mease be directed to supply John Ja y the sick soldiers, in the House of Employment in John Adams Philadelphia, with one shirt apiece. Francis Lewis Resolved, That the Medical Committee be directed 18 June, 1776. Thomas Heyward, Jr. to provide sufficient quantities of antiscorbutics for Lyman Hall the use of the hospitals in the northern army: 7 August, 1776. Benjamin Rush That the hospital at Fort George be continued for the reception of soldiers labouring with con­ January 3, 1777. 13 tagious diseases, and that there be a general hospi­ Resolved, That Dr. (Jonathan) Elmore and Dr. tal erected on Mount Independence: (Nathan) Brownson be added to the Medical Com­ That a suitable spot of ground for a garden be mittee. enclosed in the neighbourhood of the general hospi­ tal, to supply the army with vegetables; and that January 9, 1777. 24-5 labourers be hired to cultivate it, under the direc­ Congress resumed the consideration of the report tion of an overseer, to be appointed by the general of the Medical Committee; Whereupon, or commanding officer: Resolved, That Dr. John Morgan, director general, That the general, or commanding officer, in each and Dr. Samuel Stringer, director of the hospital in of the armies, cause strict enquiries to be made into the northern department of the army of the United the 26 conduct of the directors of the hospitals, and States, be, and they are hereby, dismissed from any their surgeons, officers, and servants, and of the farther service in said offices: regimental surgeons, that if there has been any just That the directors of the military hospitals grounds of complaint in those departments, the of­ throughout the army, with the assistance of the hos­ fenders may be punished: pital and regimental surgeons in each department, That the colonel or commanding officer of every make returns to Congress, as soon as possible, of regiment, make frequent enquiry into the health of the kind and quantity of medicines, instruments, the men under his command, and report the state and hospital furniture that remain on hand. thereof, with any negligence, mal-practice, or other misconduct of the surgeons or others, to the general, January 14, 1777. 34 and to Congress, delivering copies of such reports Resolved, . . . That the Medical Committee to all persons therein accused: provide a suitable assortment of medicines, and December 1, 1776. 998 send them to the hospital in the northern army, Resolved, . . . That the Medical Committee be with all possible despatch, together with other nec­ directed to take such steps, as they shall judge essaries for the sick; and that the list mentioned by proper, for the accommodation of the sick of the Dr. Stringer, in a paper, No. 1, enclosed in General army. Schuyler’s letter, be committed to them: That Dr. Potts be directed to repair to Ticon- December 5, 1776. 1006 deroga without delay: Resolved, That it be and is earnestly recommend­ That Dr. Stringer be directed to deliver to Dr. ed to the council of safety of Pennsylvania, to pro- Potts, such medicines, and other medical stores, as 26 The original report here contained “ past as well as future.’} may be in his hands belonging to the Continent. H isto ry of th e A rm y M ed ica l D epa r tm en t D u rin g th e R evo lutio n 2 13

January 17, 1777. 44 priety and expediency of causing such of the troops A letter with a number of papers, from Dr. Mor­ in his army, as have not had the small pox, to be gan, were laid before Congress, and referred to the inoculated, and recommend that measure to him, if Medical Committee. it can be done consistent with the public safety, and good of the service. January 18, 1777. 48 To Dr. J(ohn) Witherspoon, for wood supplied February 20, 1777. 139 the troops at Princetown; for the expences of sick To Dr. Frederick Phile, for the amount of his ac­ soldiers; and the allowance due to John M ’Kinzie, count for medicine and attendance to the German a prisoner from North Carolina, from the 18th Oc­ batallion, in Philadelphia, (£74 16 6=) 199 48/90 tober to the 10th January, inclusive, being 12 weeks, dollars: . . . 105 78/90 dollars:27 Ordered, That the said accounts be paid. Ordered, That the said accounts be paid. At a Board of War, 20th Febv., 1777. January 29, 1777. 70 Agreed to report to Congress: .... Resolved, That Dr. Mackenzie, who has the care That the Assembly of the State of Maryland be of the sick in the hospital in Baltimore, be empow­ requested to deliver to Doctor McKensie so much ered to appoint a mate to assist him. Medicines of the following Denominations as he shall want and they can spare, to enable him to January 31, 1777. 79-80, 81 inoculate the Continental Troops in this Town, in Resolved, That a committee of four be appointed the following Proportions for one hundred Men. to consider what honours are due to the memory of Six ounces Calomel General Warren, (who fell in the battle of Bunker’s- Two Pounds Jallop Hill, the 17th of June, 1775;) and of the late Gen­ Three Pounds Nitre eral H. Mercer, who died on the 12th instant, of EIixr Vitriol the wounds he received on the 3d of the same One Pound Peruvian Bark month, in fighting against the enemies of American One Pound Virginia Snake Root.28 liberty, near Princetown: The members chosen, Mr. (Benjamin) Rush, Mr. February 22, 1777. 143 (Thomas) Heyward, Mr. (Mann) Page, and Mr. Resolved, . . . That 1,500 dollars be paid to Dr. S(amuel) Adams. Samuel M ’Kinzie, for the use of the hospital in Bal­ To Dr. Samuel Mackenzie, for sundry medicine timore; he to be accountable. purchased by him for the use of the hospital in Bal­ timore, 86 74/90 dollars: February 25, 1777. 155, 156 To Dr. John Hindman, for sundry medicine sup­ Two officers of the 2d and 7th Virginia batallions, plied by him for the use of Colonel Richardson’s who were left to bring up the baggage of their re­ batallion of Maryland forces, 20 6/90 dollars: spective batallions, and a surgeon’s mate belonging February 4, 1777. 87 to the 2d batallion, of the Virginia forces, being ar­ A memorial from Dr. Thomas Young was read, rived in Baltimore, applied for two months’ pay and referred to the medical committee. . . . (for themselves and the men with them,) to enable Resolved, That Dr. (Thomas) Burke be added to them to proceed with their companies. the Medical Committee; and that he be appointed Resolved, That they be referred to M r- Jonathan a member of the Marine Committee, in the room of Hudson, who is directed to pay the said officers and Mr. (William) Hooper, who has leave to return [their] men [one] two months’ pay; [and to the sur­ home for some time. geon two months’ pay]; and return an account to the General, and to the pay master general. February 5, 1777. 91 Doctor (John) Witherspoon, having represented Ordered, That the Board of War digest the said to Congress that the situation of his private affairs conference, and bring in a proper report on the requires his returning home for a short time, desires several matters mentioned, saving what relates to leave of absence. medicines. Resolved, That leave be granted. Resolved, That the Medical Committee be empow­ To Dr. Benjamin Rush, for sundry medicine and ered to employ a suitable person in each of the attendance to sick soldiers and prisoners, the sum states, to purchase such medicines as they shall di­ of (£177.9=) 473 18/90 dollars: rect, for the use of the army, which can be procured To Richard Stockton, Esq. and to be paid to Dr. at any reasonable rates. Benjamin Rush, for the hire of two horses, a sulky, || Ordered 11 That the said committee enquire what &c. for his journey to Ticonderoga last fall, by order is become of the medicines which Dr. Morgan took of Congress, 151 30/90 dollars: from Boston, and which Dr. Stringer bought for the northern army, and take measures to have them February 27, 1777. 161-4 secured, and applied to the use of the army. The Medical Committee, to whom the report on February 12, 1777. no the hospital was re-committed, brought in a report, Ordered, That the Medical Committee write to which was read: General Washington, and consult him on the pro- The Medical Committee having taken into their 27 This report is in the Papers of the Continental Congress, No. 28 This report is in the Papers of the Continental Congress, No. 132, I, folio 17. 147, I, folio 85. 214 Annals of Medical History consideration a plan 29 for establishing Military Hos­ each military hospital be furnished with a number pitals, [transmitted to Congress by General Wash­ of shirts, sheets, blankets and cases for straw for ington], agree to report— the accommodation of the sick. Section i. That the Continent be divided into That each regiment be furnished with a number three districts. The Middle to extend from Hudsons of hospital tents according to their number of men, river to Potomac. The Southern to extend from a full regiment not to have more than six tents. Potomac to Georgia, and the Northern from Hud­ 10. That the pay of the Surgeons and physicians sons river to Quebec or Crown Point. Generals, be four dollars and six rations a day. 2. That there be a Surgeon and Physician Gen1- 29, That the inspector General have five dollars and 12 with a suitable number of Senior physicians, Senior rations a day. That the pay of the Apothecary Surgeons and mates to each district. That the sick General be 3 dollars, and 4 rations a day. That the be taken care of by the physicians, and the wound­ assistant Apothecaries appointed by the Apothecary ed by the Surgeons in different apartments. General have one dollar and 1/3 per day. That the 3. That there be a physician and Surgeon General Purveyors of the hospitals have 2 dollars and 3 with the main army whose business it shall be to rations per day, and that the pay and rations of the attend the general and principal Officers of the hospital Apothecaries, senior Surgeons and Mates Army, to enquire into the quality of the food of the of the hospital be the same as formerly established Soldiers, to superintend the regimental Surgeons and by Congress. That the pay and rations of the senior Mates, and to attend when called upon in consulta­ physicians of each hospital be the same as those of tion with them in all extraordinary cases. a senior Surgeon. 4. That there be an Apothecary General whose 11. That the pay and rations of the commissaries business it shall be to purchase such medicines and of the hospitals be the same as the deputy com­ instruments as shall be judged necessary by the missaries in the Army. Surgeons and physicians general of the Army. That 12. That the pay and rations of the Wardmasters he have the liberty of appointing three assistant be the same as that of a Commissary. Apothecaries in different parts of the United States, 13. That the pay of the Clerks, Cooks, Nurses, in order to supply with the more convenience the Washerwomen, Servants, &c., be regulated by the several hospitals, and regimental and Naval Sur­ Physicians and Surgeons General. geons with medicines and instruments. 14. That the pay and rations of a regimental Sur­ 5. That there be an Inspector General of the geon be the same as those of a Captain and the pay Arm y of the United States whose business it shall and rations of a Mate be the same as those of a be to visit the Military hospitals and Apothecaries Ist Lieutenant. Shops in every part of the Continent; to examine 15 -16 . That no senior Physician, or Surgeon, no the medicines and instruments belonging to the hospital Mate, nor shall any regimental Surgeon or States; to enquire into the conduct of the several Mate be appointed in the Arm y who has not previ­ Officers in the medical department and report to ously undergone an examination before one or more the Congress, and Commander in chief at least once of the Physicians and Surgeons General, or before a month. the Inspector General of the medical department. 6. That the Surgeons and Physicians General of 17. That a Sergeants guard be constantly placed the hospitals have the liberty of appointing hospital at each general hospital to prevent the unnecessary Apothecaries, senior Physicians, and Surgeons, visits of Strangers, and the desertion of convalescent Mates, Purveyors, Clerks, Commissaries, Wardmas- patients, and to assist, if necessary in inforcing the ters, Servants, Washerwomen, Nurses, Cooks, and rules, and orders of the Surgeons, and physicians of all such Officers as shall be necessary for the accom­ the hospitals. modation of the sick and wounded in the hospitals. 18. That the Officers of the several regimental 7. That the business of the Commissaries shall be companies to which the sick and wounded belong be to provide provisions, and liquors, also straw, hay ordered to concur by means of their Authority with and fuel for the hospitals. Also to bury the dead. the Surgeons and physicians in taking care of their He shall likewise provide, and superintend the wag­ respective Soldiers. gons employed in transporting the sick, and wound­ 19. That the physicians and Surgeons General ed, and the baggage of the hospitals. with the Inspector General of the medical depart­ The business of the Purveyors shall be to take ment be authorized to make such further improve­ care of, and distribute the provisions, and other A r­ ments in this plan for regulating the medical de­ ticles provided by the Commissaries for the sick and partment as the exigencies and situation of the wounded both in the camp and hospitals. Arm y may make necessary, and that they report the 8. The business of the Wardmaster shall be to same when made to Congress for their Approbation. take care of the Arms, Accoutrements, and cloathes 20. That it be recommended to each of the States of the sick and wounded, and to take care that to make suitable provision for the maintainance of proper attention is paid to the cleanliness of the such maimed, and incurable Soldiers and Seamen as patients, and their respective wards, rooms, or tents. shall be discharged from the service of the united 9. That one Clerk be allowed to every general States.30 hospital, and one Nurse to every ten sick. That Ordered, To lie on the table. 29 This plan, in the writing of William Shippen, is in the P a p ers of the Continental Congress, No. 22, folio 9. It was prepared by 30 This report, in the writing of Benjamin Rush, is in the P a p ers Doctors Shippen and John Cochran, and was transmitted to of the Continental Congress, No. 22, folio 1. Against paragraphs Congress by Washington, February 14, 1777. 1, 2, and 4 is written “ Query if necessary.” H ist o r y of th e A rm y M ed ica l D epa r t m en t D u rin g th e R evolution 215

March 15, 1777. 180 Nurses to attend the sick when Necessary; and also Resolved, That as Congress proceeded to the dis­ from Time to Time furnish the Regimental Surgeons mission of Doctor Stringer, upon reasons satisfac­ with such Medicines and instruments as they may tory to themselves, General Schuyler ought to have have Occasion for out of those furnished them by known it to be his duty to have acquiesced therein: the Apothecaries, taking receipts for the same, and Resolved, That the suggestion in General Schuy­ render Accounts of all medicines and instruments ler’s letter to Congress, that it was a compliment by them received or delivered out when required due to him to have been advised of the reasons of thereto by Congress. Doctor Stringer’s dismission, is highly derogatory to 3rd, That a Commissary for the Sick be appoint­ the honour of Congress; and that the president be ed to attend each grand division of the Army, who desired to acquaint General Schuyler that it is ex­ shall appoint one or more assistants if necessary, pected his letters, for the future, be written in a whose business it shall be to purchase and deliver stile more suitable to the dignity of the representa­ to the purveyor all such Provisions, Liquors, and tive body of these free and independent states, and other necessaries for the Sick and wounded as di­ to his own character as their officer. rected by the Senior Surgeons, and keep accounts of and take receipts for the same: he shall provide March 19, 1777. 186 Straw, hay and fuel for the hospitals, and have the Resolved, That the extract of Mr. Deane’s letter, care of burying the Dead: he shall furnish the hos­ relative to Dr. Williamson, be referred to a com­ pital with such a number of shirts, sheets, blankets, mittee of five, who are empowered to send for Dr. and cases for straw for the Accommodation of the Williamson and examine him: Sick as the General commanding in such grand divi­ The members chosen, Dr. (John) Witherspoon, sion of the Arm y shall direct: he shall likewise pro­ Mr. (Jonathan Bayard?) Smith, Mr. (George) Cly- vide or obtain from the Quarter master general a mer, Mr. (James) Wilson, and Mr. (Thomas) Hey- proper number of hospital tents for the Sick in case ward. the Arm y is likely to be stationed in places where houses convenient cannot be obtained for that pur­ March 22, 1777. 193 pose: and also provide and Superintend the Wag­ The report of the Medical Committee was taken gons necessary to be employed in removing the Sick up and considered; (and, after debate,) Whereupon, and wounded, the number of hospital. tents and Resolved, That said report, together with Dr. Waggons necessary for the above purposes to be Shippen’s plan, be recommitted. fixed and ascertained by the Generals commanding Resolved, That a committee of five be appointed each division, and certified under their hands re ­ to devise ways and means for preserving the health spectively: of all which Articles above enumerated, of the troops, and for introducing better discipline when provided, the Commissary shall take proper into the army: receipts and vouchers proving that the same were The members chosen, Mr. (Oliver) Wolcott, Mr. furnished, which he shall lay before Congress when (Daniel) Roberdeau, Dr. (John) Witherspoon, Mr. required. S(amuel) Adams, and Mr. (Abraham) Clark. 4th, That one Purveyor be appointed to attend March 24, 1777. 197-200 each grand division of the Army, with one or more The Medical Committee, to whom the plan of the Assistants if necessary: whose duty it shall be to re­ general hospital was recommitted, brought in a re­ ceive from the Commissary, take care of and dis­ port, which was read: tribute the provisions and other necessaries provid­ The Medical Committee, having taken into their ed for the sick and wounded in such manner as the consideration the establishment of the medical de­ Senior Surgeons shall direct: which provisions and partment in the Army, Report as follows: necessaries are to be delivered in lieu of well rations. Ist, That to each regiment there be appointed 5th, That the General commanding in each De­ one Surgeon and one Surgeon’s Mate, who shall partment or grand division of the Army, direct one constantly attend the Regiment, to afford present hospital to be provided in some Convenient place relief to the sick and wounded, and take care of contiguous to the Arm y consisting of different or such as it may be proper to remove to the hospital. separate houses, if such can be had, in order that 2nd, That Senior Surgeons of approved Abilities the wounded may be kept apart from the sick, and in Physick and Surgery be appointed to each Brig­ also that: he sick may be properly divided, as may ade or a greater number of Regiments as the Gen­ be most conducive to their recovery: to which hos­ eral commanding in each department or grand divi­ pital all such sick and wounded are to be sent as sion of the Arm y shall judge necessary; whose busi­ the Senior Surgeons may think proper, and whose ness shall be, to Superintend the Regimental Sur­ circumstances will admit being removed, which hos­ geons and Mates, see that they do their duty, ad­ pital shall be supplied by the Commissary for the vise and direct them in all difficult cases, and direct sick, with such provisions and other necessaries for or perform all Capital Operations, give Assistance the use of the sick and wounded, as the director to the director of the hospital when such assistance shall require in lieu of well rations. is necessary; direct the Commissary of the Sick in 6th, That one director of approved skill in Phy­ the Articles Necessary to be procured for the Sick sick and Surgery be appointed for each hospital, and wounded out of the hospital, and see that the who shall have the liberty of appointing one assist­ Commissary, purveyor and Nurses Regularly per­ ant Surgeon and four mates; a purveyor and such a form their respective duties, and provide proper number of Washerwomen and Nurses as he shall ' Annals of Medical History judge necessary for the comfortable accommodation March 27, 1777. 206 and attendance of the sick and wounded under his Congress resumed the consideration of the report care, always observing that no more than necessary of the Medical Committee on the hospital; are employed. Also that the director M ay call to his Resolved, That it be [referred to a Committee of assistance one or more of the Senior Surgeons when the Whole. Congress then resolved itself into a the number of sick and wounded in the hospital re­ Committee of the Whole, to take into consideration quires such assistance. Also that the director take the report of the Medical Committee, and after an Account of each of the sick and wounded under some time, the President resumed the chair, and his care, with the Time of their coming to the hos­ Mr. (Daniel) Roberdeen reported] re-committed. pital, and when discharged, or deceased: and also of the Number of attendants employed in Nursing and April 2, 1777. 219 taking care of the sick: and make due returns there­ Congress resumed the consideration of the report of every month to the general commanding in each of the (medical) committee on the hospital, and, grand division of the Arm y to be by him transmit­ after debate, ted to Congress. Ordered, That the said report lie on the table (for 7th, That there be two Apothecaries, one in the farther consideration). middle, and one in the eastern department, whose Resolved, That a committee of three be appointed business it shall be to receive all such Medicines and to revise Dr. Shippen’s plan for the regulating the instruments as shall be procured by the Secret Com­ hospital, and report thereon. mittee, and to purchase such others as they shall di­ The members chosen, Mr. (Elbridge) Gerry, Mr. rect. That the Apothecaries prepare and put up such (Thomas) Burke and Mr. J(ohn) Adams. medicines and instruments for each hospital, and for April 4, 1777. 225 each Regimental Surgeon, and also for each Senior Surgeon to be used by them or dealt out to the The Committee on the hospital, brought in a re­ Regimental Surgeons when needed, as the medical port, which was taken into consideration, and after committee shall direct, and forward the same with debate, Supplies from Time to Time agreeable to their or­ Resolved, That the farther consideration thereof ders, keeping exact accounts and taking proper re­ be postponed till to morrow. ceipts for the same to be laid before Congress when April 5, 1777. 227 required. Each Apothecary to be allowed one mate. Congress resumed the consideration of the report 8th, That the sick and wounded as well in the on hospitals, and, after debate, Arm y as in the hospital be kept separate from each Resolved, That the farther consideration be post­ other, when circumstances will admit thereof; and poned till Monday next. that the sick be always placed at such a distance from those in health as to prevent the spread of in­ April 7, 1777. 2 3 1-7 fection in the Army. Congress resumed the consideration of the report 9th, That the pay of the medical department be on the hospital; Whereupon, as follows— Resolved, That there be one director general of all the like weekly returns to their respective directors, The director of the hospital dollars per month mutatis mutandis: and rations per day. That the deputy directors general cause the like The Senior Surgeons and assistants to the direc­ returns to be made, once every month, to the di­ tors dollars per month and rations per day rector general, together with the names and de­ each. nominations of all the officers in the respective hos­ The Apothecaries dollars per month and pitals : rations per day each. And that the director general shall make a like The Regimental Surgeons dollars per month return for all the hospitals and armies of the United and rations per day each. States, once every month, to the Medical Commit­ The directors Apothecaries and Surgeons mates tee: dollars per month and rations per day each. That the Medical Committee have power to ap­ The Commissary of the sick dollars per month point any of their members to visit and inspect all and rations per day each. or any of the medical departments, as often as they The Purveyors dollars per month and ra­ shall think proper, to enquire into the conduct of tions per day each. such general officers of the hospital as shall be delin­ The Assistant Commissaries and Assistant Pur­ quent in this or any parts of their duty, and to re­ veyors dollars per month and rations per day port their names to Congress, with the evidence of each.31 the charges, which shall be brought against them.32 Ordered, That it be referred for consideration to Resolved, That the farther consideration of the re­ morrow morning. port be postponed till to morrow.

31 This report, in the writing of Abraham Clark, is in the P a ­ 32 This report, in the writing of Thomas Burke, is in the P a p e rs pers of the Continental Congress, No. 22, folio 15. of the Continental Congress, No. 22, folio 19.

(Continued in the next issue.) EDITORIAL

T h r o u g h the courtesy of Colonel Wil­ for instance, wrote the medical history of liam O. Owen, Curator, Army Medical New Jersey (1879); Dr. Samuel Abbott Museum, Washington, D. C., we are able Green, the medical history of Massachusetts to print, in this number, the first install­ (1881), and of Groton, Mass. (1890) in par­ ment of the complete procedure of Con­ ticular; Dr. Eugene F. Cordell, the “ Medical gress in regard to the organization of medi­ Annals of Maryland, 1799-1899” (1903). cal service during the War of the Revolu­ Drs. Samuel C. Busey and Daniel S. Lamb tion (1775-83). As archival material of have covered the medical history of the Dis­ greatest value for the earlier medical his­ trict of Columbia in several volumes; Dr. tory of our country and of interest to all Frederick P. Henry wrote the medical history American physicians of colonial extraction, of Philadelphia (1897). Dr.Otto Juettner has we regard it as a privilege to print this given an exhaustive history of medical Cin­ record, lengthy as it is. It shows exactly cinnati in his “ Daniel Drake” (1909). Old what Congress did or did not do for mili­ medical New York has been the theme of tary medicine in the most crucial period of memoirs by John W. Francis (1858), and our history. In this connection, however, Francke Huntington Bosworth (1898). it would seem apposite to specify our in­ Early medical Chicago has been treated by tention in regard to the printing of ma­ James Nevins Hyde (1879) with subse­ terial of this kind in future. Any archivis- quent material in the earlier numbers of tic material of exceptional national and the Bulletin of the Medical History Society historical importance, if not too extensive, of Chicago. The story of the Boston Society will be most welcome in these pages. Real­ for Medical Improvement was given by the ly valuable material of this kind is exces­ late Dr. Jam es G. Mumford (1901). Old sively rare in this country. We cannot, how­ medical Boston is in the hands of Mr. ever, engage to print the archival histories James F. Ballard of the Boston Medical of medicine for separate states, counties, Library. Medical histories of all our impor­ cities or smaller localities. This we con­ tant states and cities will undoubtedly ap­ ceive to be the proper function of the jour­ pear in course of time, and it should be a nals of the state medical societies, the city matter of local pride and patriotism to and county journals, and the local period­ have them completed and printed in each icals devoted to medical history. Moreover, particular locality. We cannot engage to these separate histories have already been cover this extensive field, but we would very well taken care of for some of the sev­ particularly solicit such archival material eral states, cities and counties, whether in as unpublished letters of great physicians book or periodical form. Dr. Stephen Wickes, and surgeons—particularly those of which 2 l8 Annals of Medical History the content is of historical and biograph­ stimulate interest in our subject or serve ical importance—brief autograph letters of as basic material for future historians. medical celebrities for reproduction in fac­ We realise that this is a new departure, simile, rare photographs of eminent physi­ and in the absence of such old medical cians not heretofore reproduced, rare en­ manuscripts as Europe abounds in, we gravings and prints of the same description, solicit the help of our subscribers and and other medical curiosities which may contributors.

MEMORIAL NOTICE SIR MARC AMAND RUFFER

KT., C. M. G. (1859-1917)

Original investigation in medical history the palseohistology of the pathological of late years has been furthered in remark­ lesions found in mummies of the X V III— able ways by archae­ XXVII dynasties. ologists, anthropolo­ H e was born at gists, numismatists, Lyons, France, in antiquarians, collec­ 1859, the son of the tors of engravings, late Baron Alphonse sinologists, Egyptolo­ Jacques de Ruffer. His gists, and particularly mother was a German. by travellers and ex­ He was educated at plorers. Indeed, the Brasenose College, journey method of Oxford, where he took Sudhoff goes to show his B.A. degree in 1883, that he who enjoys the and at University Col­ advantages of travel is lege, London, becom­ much more likely to ing bachelor of medi­ turn up new facts than cine and surgery in the stationary investi­ 1887 and M .D . in gator. One of the most 1889. He then became prominent exponents a pupil of Pasteur and of this new tendency Metchnikoff at the was Sir Marc Amand Pasteur Institute, de­ Ruffer, late President voting special study of the Sanitary Coun­ to the then novel sub­ cil of Egypt, who died ject of phagocytosis. at sea during the In his papers of 1890, spring of 1917 on his he gave an early and return from Salonika, timely exposition of whither he had gone to Metchnikoff’s concept S ir M arc A mand R u f fe r (1859—1917) reorganize the sanitary of inflammation as a service of the Greek Provisional Govern­ protective mechanism against infection, ment. He made his mark in the medical particularly in the intestinal canal. He history of ancient Egypt by his contribu­ described the diphtheritic membrane as “ a tions to its palseopathology, in particular battlefield,” in which pathogenic bacteria S ir M a r c A m a n d R u f f e r 219 and ameboid leucocytes contend for mas­ to exhibit microscopic sections of patho­ tery. In 1891, Ruffer became the first logical lesions in mummies at the Cairo director of the British Institute of Preven­ Scientific Society. In this field, Fouquet was tive Medicine, his assistant being Professor the pioneer (1889), but Ruffer made it his Henry G. Plimmer. At MetchnikofPs in­ own by his expert skill in microtomic tech­ stance, Ruffer and Plimmer took up the nique and staining methods. To overcome study of cancer and established the provi­ the hard, brittle and friable character of sional status of the quasi-parasitic forma­ the tissues, before cutting with a Minot tions in cancer cells. While testing the microtome, he softened them in a solution new diphtheritic serum at the Institute, of alcohol and sodium bicarbonate, with both Ruffer and Plimmer fell victims to subsequent hardening in alcohol. For this the disease, and Ruffer was so severely new branch of pathological histology he de­ smitten with the paralytic sequelae that vised the term “palaeopathology.” His he felt compelled to resign his directorship. “ preliminary note” of 1909 (Brit. Medical He then went to Egypt for recuperation Journal, 1909 I, 1905) was followed by a and subsequently took up his permanent striking series of papers on the presence of residence at the Villa Menival, Ramleh. Bilharzia hematobia in Egyptian mum­ Ruffer was one of the ablest organizers mies of the X X dynasty, 1250-100 B.C. of medical administration in recent times. (Ibid., 1910, I, 16), on a varioloid eruption He did much to make the present Lister in the skin of a mummy of the same period Institute what it is to-day, became pro­ (J. Path. & Bact., Cambridge, 1910-n, X V , fessor of bacteriology in the Cairo Medical 1-3, 1 pi.), on arterial lesions in mummies School (1896), which he reorganized, and of 1580 b . c .— 525 a . d . (Ibid., 453-462, was the president of the Sanitary, Mari­ 3 pi.), on the osseous lesions in Egyptian time and Quarantine Council of Egypt skeletons, ranging from 2980 b . c . to the (1901-17), in which office he was instru­ Greek period (Ibid., 1911-12, XVI, 439- mental in ridding Egypt of cholera by rig­ 495, 9 pi.) on dental, osseous and articular orous hygienic policing of the routes of pil­ lesions in Coptic bodies of 400-500 a . d . grimage at the Tor Station and elsewhere. (Ibid., 1913-14 XVIII, 149-162, 6 pi.) on In this work, he enjoyed the confidence and a tumor of the pelvis from the catacombs support of both Lord Cromer and Lord of Komel Shougafa, 250 a . d . (Ibid., 480- Kitchener. He served on the Indian Plague 484, 2 pi.) and a monograph on “ Histolog­ Commission, was Egyptian delegate to san­ ical Studies in Egyptian Mummies” (Cairo, itary conferences of 1903, 1907 and 1911, 1911). In 1910, Elliot Smith and Ruffer and from the outbreak of the present war, described a case of Pott’s disease in a was highly efficient as head of the Red mummy of the XXI dynasty, circa 1000 Cross in Egypt. He was the recipient of b . c . (Giessen, 1910), perhaps the earliest many honors and decorations, and was landmark we have in the history of tuber­ knighted in 1916. A man of the world in culosis. In these studies, Ruffer showed the the widest sense, he was a remarkable lin­ presence of calcified Bilharzia eggs in the guist, a talented violoncellist, and an ex­ kidneys of two mummies, a common cause pert at his favorite game of billiards. of prehistoric hematuria, as shown in the In December 1908, in connection with hieroglyphs and medical papyri; also the the excavations made in Nubia by Elliot common occurrence of arthritis, spondy­ Smith, Wood Jones and Derry prior to litis deformans, dental caries, rarefying peri­ the flooding of the country by the raising odontitis, pyorrhoea alveolaris, Bouchard’s of the Assuan dam (1907), Ruffer began nodes, malarial enlargement of the spleen, 220 A finals o f Medical History

biliary calculi and particularly arteriosclero­ ( 7 5 0 -5 0 0 b . c . ) in the Sudan (Sudhoff’s sis (atheroma) which was found even in Mitth., 1914, X III, 453) lead him to the con­ the aorta of Rameses II, and was as fre­ clusion that these people were short-lived, q u e n t 3000 years ago as it is to-day. Its dying before 50. The war interrupted Ruf- causation Ruffer leaves an open question, fer’s work, which was cut short forever by since, in his view, alcohol, tobacco, meat his untimely death, but he had already diet, strenuous exercise and “wear and prepared a volume of antiquarian studies tear” could, none of them, have availed to for the press which will probably be a per­ produce it. His final studies of dental and manent record of his unique and memorable osseous lesions in specimens dug up at discoveries in palseopathology.

F a r a s (100 B.c-300 a . d .) and at .Merawi F . H . G a r r i s o n .

ANTYLLUS ON ANEURISM

There are two kinds of aneurysm. In this thread finds itself placed beneath the the first the artery has undergone a local dila­ artery; cut the threads near the extremity of tation; in the second the artery has been the needle, so that there will be two threads ruptured. The aneurysms which are due to having four ends; seizing, then, the two ends dilatation are longer than the others. The of one of these threads, we bring it gently aneurysms by rupture are more rounded. toward one of the two extremities of the To refuse to treat any aneurysm, as the aneurysm, tying it carefully; in like manner ancient surgeons advised, is unwise; but it is also we bring the other thread toward the also dangerous to operate upon all of them. opposite extremity, and in this place tie the We should refuse, therefore, to treat aneur­ artery. Thus the whole aneurysm is between ysms which are situated in the axilla, in the the two ligatures. We open then the middle groin and in the neck, by reason of the volume of the tumor by a small incision: in this of the vessels and the impossibility and danger manner all which it contains will be evacuated, of isolating and tying them. We should not and there will be no danger of hemorrhage. touch an aneurysm of large volume even when To tie, as it has been advised, the artery on it is situated in some other part of the body. both sides the vein, and then to extirpate the We operate in the following manner upon dilated part which finds itself between, is a those which are situated upon the extremities dangerous operation; frequently, in fact, the and the head: I f the aneurysm be by dilata­ violence and tension of the arterial pneuma tion, make a straight incision through the push off the ligatures. skin in the direction of the length of the vessel, I f the aneurysm owes its origin to the and, drawing open by the aid of hooks the lips rupture of the artery, we isolate with the of the wound, divide with precautions the fingers as much of the tumor as we can, in­ membranes which cover the artery. With cluding the skin, after which we pass under­ blunt hooks we isolate the vein from the neath the isolated part the needle with the artery, and lay bare on all sides the dilated double thread and proceed as before; after part of this last vessel. After having intro­ which the tumor may be opened at its summit duced beneath the artery a probe, we raise the and the superfluous portion of the skin cut tumor and pass along the probe a needle armed away. with a double thread in such a manner that Oribasius. BOOK REVIEWS

F inch and B a in e s, A S e v e n te e n th C en tu r y little light on the life and methods of study F r ien dsh ip. By Archibald Malloch, B.A. at that time. Finch is interested in his sister’s (Queen’s); M .D . (M cGill); Temporary Captain, headaches, and writes about a Universal Canadian Army Medical Corps. Cambridge, at Medicine and the cures of Van Helmont. the University Press, 1917. He also sends his sister long discourses on This is a large quarto volume well illus­ philosophy and natural history, and inci­ trated with nine full-page, halftone pictures dentally does not think much of Descartes. of Finch and Baines and of things associated He refers to only one of his teachers, Moli- with them. Dr. Malloch, the author, has netti, who succeeded Vestigius in the chair done an interesting piece of work, and made of anatomy. Baines wrote a very lauda­ a contribution to medical history which will tory poem on Molinetti’s skill, much in be much prized by those interested in the the line of the canticles and eulogies to the humanities of medicine. He has put Doc­ anatomists of those and earlier days. tors Finch and Baines, so to speak, “ on the “ Ne dissecas, Molinette, sed adornas cor­ map,” for neither of them is mentioned in pora: the standard histories of medicine. Doctors Finch and Baines were two Eng­ sic non Te Anatomicum lishmen born in the early part of the seven­ Praestas sed id quod abunde magis est, D eum .” teenth century. They studied at Cambridge and graduated there—or at Oxford—in arts. During the next years Finch was especial­ Having formed a warm friendship, they then ly interested in anatomy. In 1656, he was went together to Italy and took up the made Pro-rector of the University and in study of medicine at Padua at the sugges­ 1657 the friends took their degrees in Medi­ tion, it is said, of Dr. Harvey, whose niece cine. Two years later they went to Pisa was married to Finch’s elder brother. Dur­ and Finch was made Professor of Anatomy ing the trip, and while at Padua, Finch kept in the University, although he had been a journal, and wrote frequent letters to his graduated but a short time and was about much beloved sister, Viscountess Anne Con­ 33 years old. At Pisa they had as associates way, a learned woman, who was an invalid, Malpighi and Borelli, and they made studies and a patient of Dr. William Harvey. in comparative anatomy and natural history. Finch, in his journal, gives some interest­ In 1660 they returned to England, where ing notes of the hospitals and sanitary con­ Finch was made physician to the Queen dition of Paris, whose streets were “ more and Baines a professor of music. Both be­ durty” but better paved than those of came Fellows of the Royal College of Phy­ London. (Finch could not spell.) “ At the sicians and Finch was knighted, an honor Hotel Dieu,” he says, “ there were eight in which Baines received later. a bed, but at the Hotel Charite everyone In 1665 Finch with Baines attending re­ has his own bed.” sumed his lectures on Anatomy at Pisa. Finch and Baines finally reached Padua Three years later he was made ambassador and began the study of medicine. This was at the court of the Grand Duke of Tus­ about 1652. The letters of this period throw cany and began to get into politics. 221 222 Annals of Medical History

Finch kept a note book and would now out any pain whilst wee dined together; and then write in it some rather melancholy which seemes to confirm the interpretation and entirely non-compromising poems. of those who make the dreaming of the Iosse of a tooth to be the prediction of the About this time Finch took a trip to Iosse of a friend.” Rome and Naples with his nephew, leaving behind for the first time poor Dr. Baines, Sir John and Sir Thomas lived together who was suffering from stone and also for 36 years, and in very intimate friend­ from a tremor which prevented his writing ship for 26 years. At the time of Baines’s very much. In 1670, the doctors gave up death Sir John wrote a “ dedication” to Italy and returned to England, living at the him. It is a touching and eloquent tribute Inner Temple with Sir John’s elder brother, to his friend and to friendship. Chancillor Heneage Finch. “ But lastly Sir when I consider that of Most of the writing quoted in this book the twenty-six y^ars wee spent together was done by Dr. Finch. We suspect that since wee first left England, that wee never Dr. Baines was the cleverer man, and the have been separated two months from each other unlesse it were in the exercising more important of the two; but he did not some act of kindnesse though two and have quite the social connections of Dr. twenty of them spent in foreign parts: Finch. Dr. Malloch thinks that perhaps he . when I consider your inimitable had paralysis agitans, as he had a tremor as well as unrequitable friendship though all his life, but this is unlikely for he could you were wracked with stone and torment­ not have lived with it to such an age. ed by the gout, inspiring you with courage to accompany me in your declining years In 1673 Finch was made ambassador to and strength all this length of time and Turkey, and he and Baines sailed for Con­ voyage: the greatest temporall blessing stantinople. While there he wrote often to could have befallen me—so that I may say his sister; and his journal contains notes of as truly of you as Aneas did Anchises, and persons met, and of discussions, mostly I doe say more affectionately, religious in character. The friends had Ille meum Comitatus iter maria omnia dropped out of medicine. mecum Baines died in 1681, aged 57, of a ter­ Atque omnes Pelagique minas coelique tian ague. Sir John Finch has a touch of ferebat Invalidus vires ultra sortemque Senectae. superstition, and he makes this curious note regarding the demise of his friend: When dear Sir I consider all this, I find that under all the ties of honour, friend­ ship, gratitude and justice, you are entitled “ Two things I cannot omitt. The first is to this dedication. . . that Sir Thomas and I sitting at table in our Finch did not long survive his friend. He allery at Pera, after supper, about a year efore his death, there was a loud knocking died of pleurisy in 1682. upon the round table wee sat at, for near C h a r l e s L. D a n a . the space of a quarter of an hour. We called in three servants, my secretary, Der- D r . L ym an S palding, th e Originator of th e ham, and Zacar, which last, astonished at U n ited S t a t e s P harmacopoeia; Co-laborer with the thing threw off the carpet (i.e. the Dr. Nathan Smith in the founding of the Dart­ table cover) and crept under the table; mouth College Medical School and its first and then the knocking seemed to be above Chemical Lecturer; President and Professor of the table: as it seemed to us to be under­ Anatomy and Surgery of the College of Physi­ neath it. cians and Surgeons of the Western District, at “ The second was that about foure dayes Fairfield, N. Y. By his Grandson, Dr. James before Sir Thomas his sicknesse, one of my Alfred Spalding. W. M. Leonard, Boston, 1916. dentes incisores dropt out of my head with­ 8vo, pp. 379- B ook R e v i e w 223

This book tells the story of the life and We welcome with much satisfaction this achievements of an interesting character second edition of Dr. Garrison’s popular who lived a hundred years ago. The book is “ Introduction to the History of Medicine,” full of letters and reminiscences connected no doubt the best history of any substantial with the prominent physicians of New Eng­ length, which has been published in English. land, and of New York and Philadelphia Such a work, we need hardly say, of very during that time. To those who are inter­ solid labor, can only be accomplished by an ested in the customs and habits of life of exceptional combination of diligence and medical men of America during this period, zeal. Indeed, the term “ zeal” is too faint; and in the teachings of the professors and we might substitute enthusiasm or self- in the development of medical and scien­ sacrifice and yet not go beyond the mark. tific education, the book will afford in­ The American physician has only just struction and very great entertainment. discovered as it were, new veins of gold, The names and doings of Drs. Nathan opened up by Sudhoff, Neuburger, Sticker, Smith, Shattuck, Warren, Ramsay, Mit­ Wickersheimer, Allbutt, Curtis, Singer and chell and Waterhouse are most frequently others in the study of the history of medi­ mentioned, but there is hardly a notable of cine, and the mine is being eagerly worked. that period who is not referred to. Dr. Dr. Garrison is a sympathetic writer who Spalding evidently mingled with and knew grasps the leading features of medical history well the Fathers of American Medicine. and delivers his impressions with clearness He gives many interesting notes of lec­ and ease, never losing sight for a moment of tures by famous surgeons and physicians. his main theme. One is astonished to find Here is one: within the covers of a single volume the exhaustive and rich amount of material given “ At a lecture by Dr. V. Physick a pa­ in such a brief manner. tient with unreduced dislocation of the fe­ In the preface he quotes from a private mur was brought in for reduction. After counterextension and rotation, the neck of letter of Dr. Charles Singer (Oxford), who the femur broke to the confusion of the says: “ The history of medicine is a history surgeons and the amazement of the class. of ideas, and biography is only of value in ‘ I go next, said Dr. Physick without ap­ so far as it bears on ideas. The history of parent interruption, ‘ I go next to speak of medicine is not concerned with tattle about strangulated hernia in which a high enema the lives of the great, nor with the absurdi­ of tobacco is better than tobacco smoke.’ ” ties of ancient error, nor with the quaintness of antique expression.” The time is not yet The book contains several illustrations very long past when a historical work, es­ including a portrait of the hero of the pecially an elementary and popular work, Pharmacopoeia, and reproductions of auto­ was scarcely anything but an endless series graph letters by eminent physicians. of names, dates and facts arranged in regu­ C h a s . L. D a n a . lar succession. Now, however, our concep­ tion is changed. We ask of the historian, not

A n Introduction to th e H istory of M ed ic in e, to load our memory with facts but to recall with Medical Chronology, Suggestions for Study the dead past to life, to give us a vivid, ani­ and Bibliographic Data. By Fielding H. Gar­ mated, and truthful picture of the times that rison, A .B., M .D ., Principal Assistant Librarian, are no more. We require him to make us live Surgeon-General’s Office, Washington, D.C. Sec­ ond Edition, Revised and Enlarged, Illustrated. the life of our medical forefathers; to initiate W. B. Saunders Company, Philadelphia and us into their ideas, their beliefs, their pas­ London, 1917. Octavo, pp. 905. Cloth. sions; to disclose to us all the motives good 224 Annals of Medical History or evil, on which they acted; to reveal to us Pennsylvania. The medical features of the their virtues and vices; and we thus say of cuneiform inscriptions of the Assyrians and the historian, what used to be said only of Babylonians have not been very generally the poet, that he must be a painter. No studied and the first good account of Assyro- small part of the charm of the literary excel­ Babylonian medicine was given by Pro­ lence of the book is due to£the character fessor Jastrow. Although not a physician, painting which our author indulges in. he has paid much attention to the subject, Not only in the case of a long and de­ and students of medicine are indebted to tailed history, made as complete as possible, him for some clever discoveries therein. We but even of a summary, an elementary book, admire his patience and learning displayed the object of which is to narrate briefly in one in collecting and arranging in an under­ short volume the whole history of medicine, standable order the facts which he has we do not accept a simple record of dry and gleaned from the broken fragments of the lifeless facts, but require the author to clay libraries of Nineveh and Babylon. It is present us a picture addressing the imagina­ hardly necessary to say that this crude ma­ tion as much as the memory, and enabling terial needs interpretation of the kind Jas­ us to understand what were at various trow has given. Many other investigations periods the manners, the intellectual con­ not accessible in the first edition are also ditions, the character, the tendencies of considered. In particular, the researches in periods, which is the subject of his work. ancient medicine of Erwin Rohde, Max Such, then, is the end which the author Hofler and Max Wellman, those in mediaeval of this “ Introduction to the History of medicine by Karl Sudhoff, Neuburger, Wick- Medicine” has kept in view, and this end ersheimer and Singer, the investigations in he seems to us to have attained. Drawing epidemiology of Georg Sticker, the history his inspirations from Osier, Baas, Pagel, of pharmacy of Tschirch and Schelenz, the Sudhoff, Neuburger, and other authorities, paleopathology of ancient Egypt of Elliot he has composed a scholarly and delightfully Smith and Wood Jones are very accurately entertaining account of the development of rendered. These are only some of the points medicine from the ancient and primitive of interest touched upon in this entertaining period to the present. He has composed an and delightful book. attractive story, which, while easy reading, Dr. Garrison has been extremely fortu­ is fully adequate to instruct the readers for nate in his position as Principal Assistant whom it is intended, and to prepare for Librarian in the Surgeon-General’s Office more complete studies those who wish a which enables him to take freely from its more minute acquaintance with a special unlimited resources and treasures. Few period or subject. For this purpose Dr. English writers, moreover, are so well Garrison has added three appendices, viz., qualified in a scholarly way for the task of medical chronology, hints on the study of using these references. We are grateful to medical history and bibliographic notes for Dr. Garrison for having taken up and collateral reading. brought to so happy a conclusion the labo­ The composition of such a book needs rious work which he had begun in his first much art, and also really scientific knowl­ edition. It remains to say that in course of edge; the author possesses both qualifica­ reading steadily through large consecutive tions and has acquainted himself with the portions of the book, we have been led to most recent works as shown in his account view it not only as an utilitarian book of of Assyro-Babylonian medicine by Pro­ reference but as a source of genuine literary fessor Morris Jastrow of the University of pleasure. M o r t i m e r F r a n k .