THE HISTORY OF PATHOLOGY.1 By CHARLES WORKMAN, M.D. Medicine in the very earliest times of which we can get any record seems to have commenced along two lines. One of these, which we might name primitive surgery, was the treat- ment of injuries caused by accident or in battle with men or animals; in this case the cause of the lesions was readily seen and understood. But on the other hand, we find that our forefathers had to deal with many conditions of which the causes were to them absolutely unknown, or, at least, very obscure indeed; such conditions were the fever and delirium produced by wounds, the effects of some poisons, and zymotic diseases ! These conditions were immediately ascribed by them to the malevolent action of the spirits of animals or men, the interference of the gods, or the power of witchcraft brought upon the invalid by his living enemies. And as these two lines of primitive surgery and primitive medicine were soon seen to have close relations, we find in very early times that a guild of medical practitioners arose specially trained to undertake the treatment of both these forms of disease; and as many of the diseases which they had to treat were supposed to be due to the anger of God, which must be appeased by sacrifice, this medicine-craft became often amal- gamated with priestcraft. This was by no means always the case, as the medicine men in many countries remained quite distinct from the priests of religion. Medicine having reached this stage made very little progress 1 Address delivered at the opening of Session 1897-98, St. Mungo's ?College, Glasgow. 340 Dr. Workman?The History of Pathology. for a long time, and we find that among savage races the healing art is confined to a special guild of medicine men and sorcerers, or is in the hands of the priests to this day. The delay in progress would seem to have been due largely to the superstition or reverence for the dead, which hindered anyone from making any anatomical investigation of the bodies of those who had died from disease or injury; and although a knowledge of the anatomy of animals was acquired at a comparatively early date, no one supposed that the information thus obtained could throw any light on the diseases and injuries of man. A great advance would appear to have been made in very early times (three to four thousand years B.C.) in both China and Egypt, though this advance was almost wholly empirical, as very little was known in either country of human anatomy or physiology, and it was due apparently to the increase of practical knowledge of the effects of different drugs on the body. In Egypt, also, considerable dexterity was acquired in the treatment and diagnosis of disease of the eye and of the skin. But in spite of the knowledge which we might expect the people of that country to have obtained from the operation of embalming, no progress seems to have been made by them either in normal or pathological anatomy of the internal organs. The first advance on the lines of anatomy seems to have been made by the early Greek physicians, though most of them only made dissections on the bodies of the lower animals. The advance made by Hippocrates seems to have been brought about chiefly by his wonderfully careful clinical observations. Some three hundred years before Christ the medical school at Alexandria had broken through the barrier of reverence or superstition, and Herophilus and Erasistratus not only used the bodies of the dead for dissection, but it would even seem that they used condemned criminals for the purpose of vivi- section. The latter (Erasistratus) also appears to have made post-mortem examinations on the bodies of persons who had died from disease, and to have observed and noted certain changes in the organs due to the disease, as he describes changes in the liver, &c. For some four hundred years after this time medicine appears to have made little or no progress?that is, till the time of Galen; and, indeed, the knowledge of anatomy and pathology seems rather to have lost ground than to have advanced, though practical surgery and medicine advanced in an empiric fashion. Galen, however, was much in advance of Dr. Workman?The Histoi-y of Pathology. 341 his time, and though not a man of the type of Hippocrates .nor of his ability, yet he made very considerable progress in anatomy by his dissections of the lower animals. He does not seem to have often dissected human bodies, for he mentions with surprise that those physicians who attended the Emperor Marcus Aurelius in his campaign against the Germans had the opportunity of dissecting the bodies of the barbarians slain in battle. His own description of the human hand is evidently taken from that of an ape with undeveloped opponens pollicis. Galen allowed his philosophical notions to outweigh the observation of nature, and he endeavoured to systematise his knowledge when he had far too slight data on which to found his systems, and thus in his writings we find much that is valuable and of interest among a mass of false and confused ideas of anatomy and physiology. His ability and personal power were so great, and his writings so vol- uminous and so much in advance of his time, that they became and remained the text-books of medicine and surgery for a thousand years after, and all medical writers were taken up simply with discussing and commenting on his works. This condition of things lasted till the time of Vesalius and Harvey?that is, till the beginning of the seventeenth century ?and it would seem to have been the study of anatomy and physiology which brought about the change. Harvey himself realised the value of careful pathological observation, for he states that he considered the dissection of one body dead of phthisis or of any lingering disease of more value than the dissection of ten hanged people. An immense impetus was given to these studies by the improvement made about this time in the microscope as an instrument of precision, by the means of which such men as Hooke, Loewenhoek, and Malpighi added enormously to the knowledge of histology; and Loewenhoek may be considered the discoverer of those most wonderful creatures, the bacteria and infusoria. In pathology the improvement shows itself first by the careful noting of post-mortem appearances and their relation to clinical symptoms found in the works of Bonetus, Valsalva, and above all of Morgagni of Forli, who may well be called the father of pathology, for his careful descriptions of clinical symptoms and of the related post-mortem appearances are of the greatest interest and value even to this day. His book on The Seats and Causes of Disease is a model of careful investigation well worth your study. Giovanni Battista Morgagni was born in 1682. Following, 342 Dr. Workman?The History of Pathology, and perhaps inspired by, the works of Morgagni, William and John Hunter set about making the most careful observations, the first chiefly in anatomy, the latter more in pathology, and, at the same time, they saw the importance not only of publishing their observations but of forming collections illustrating the experiments they made, and the facts which they had discovered. These collections remain as a grand memorial of their labours in the Hunterian Museums of Glasgow and London. The Senate of the University of Glasgow has shown but little appreciation of the treasure left to its care by William Hunter, as it is only now beginning to put the collection in order, and make it available to our students; and the collection is even yet in a very unsatisfactory position in a badly heated and inefficiently lighted loft. It is also only by special grace that students can gain admission to the collection. The museum of a public institution such as the University should be thrown open not only to the students and teachers but to the public without fee or charge, as in this way their value would become more generally known, and those who have the opportunity would the more readily add to them and subscribe money for their better preservation and exhibition. Since the time of the Hunters, who were born in the early part of the eighteenth century, John in 1728, very steady progress has been made in the etiology, pathology, and treat- ment of disease. It is curious to note that this revival of scientific investigation was first started in Italy by Morgagni, from which country the impulse passed to England and France, while Italy, for long after Morgagni, made no advance ; then the impulse seems to have passed to Germany, and the great names in practical and experimental pathology with which we conjure now are German. A few of these are of such importance that they may be specially mentioned. Cohnheim, of Leipzig, who has made his name known by his book on General Pathology, and by the work he has done in the experimental investigation of the subject; Robert Koch, the bacteriologist who has gained world-wide fame by his discovery of the bacillus tuberculosis and of the spirillum of cholera; and, above all, Rudolph Virchow, of Berlin, who has done such splendid work as is evidenced in his books on Cellular Pathology and Die Krankhaften Geschwiilste, as well as in editing for many years the magazine which is known by his name, Virchoiv's Archives.