boards because of its literary quality. We occasionally repeat one in order that an old actor may enjoy the opportunity to play youthful success or that a young actor may have the feeling of doing something his forbears did, but that is all. For plays that live we go back to the seventeenth and sixteenth centuries.

We have come to recognize now that we cherished some mistaken notions with regard to the accomplishments of the past mainly because our own interests were so narrow.

We are still quite sure, however, that in certain departments, notably in science and above all in applications of science, we are doing some wonderful work that the world has never before even thought of and that this shows the marvelous progress of humanity. It might be well for us to realize the possibility at least of ignorance of the past, in this, just as in the previous state of mind being accountable for this also. Certainly anyone who thinks that the eyes of the past were held in the matter of science and its applications, or in what concerns observation and experiment, is quite mistaken. It is just a question of not knowing enough that permits anyone to hold such an opinion.

If we think for a moment that they did not know how to apply the great principles of science to what they wished to accomplish then we are forgetting the monuments of the past that we have before us. There are bridges still standing over streams that become swollen torrents at certain seasons of the year which were built over five hundred years ago. Our railroad stations are magnificient examples of the size of our constructions, yet it must not be forgotten that even the largest of them is practically not so large as St. Peter's at Rome. The choir of the cathedral at Beauvais is 210 feet from the floor to the ceiling, a wonderful piece of construction that rivals any of our architectural work even with the facile steel of the modern time. Their bells, their casting of bronze statues, especially equestrian statues, their knowledge of pigments for glass making and for painting, all show how much of applied science there was in the old time. It is sometimes asked a little impatiently "why did not the people of the middle-ages look around them in the great book of Nature instead of occupying themselves with their dry-as-dust old books?" Nature study is supposed by many apparently to be new in the world. It is not thought to be new, however, by anyone who knows the poets of the olden time. Dante knows his nature with marvelous detail. He knows about the ants and their ways, the metamorphoses

of the insects, the habits of birds and beasts, and besides he has introduced descriptions of many scientific experiments into his great poem and he knew the science of his time better than any poet of our time knows our science. The amount of information that he has at command and uses, not to display his erudition, but to illuminate what he has to say about subjects that need such lighting from without, is simply marvelous.

When it comes to the question of the medical sciences our immediate forefathers were quite sure that here at least the past was quite neglectful, lacking in proper curiosity and depending on authority and not on observation. I sincerely wish that some of the people who talk of our time as one of observation and the old time as one of the following of authority would look around them now and ask themselves how many physicians in our time make any observations for themselves and what an immense proportion of them almost blindly follow the opinions of others. This has always been so. And it will always continue to be so. We cannot expect the immense majority of men to think for themselves. Indeed this very matter of depreciatory opinion with regard to the old times is due to a blind following of older authorities whose information was very incomplete and whose opinions were positive just in proportion to this lack of completeness of their information.

During the past twenty years we have had the advantage of the republication of a series of old text-books of medicine and surgery and the careful study of the work of some of the old medical schools and these have completely revolutionized our views with regard to medieval medicine and surgery. To take the single example of the school at Salerno, we have come to admire it as a fine development of medical education, making many acomplishments that ought to have endured, though surprisingly enough they did not. The most interesting feature of Salerno was its readiness to take teachers of all nationalities. We find men from Asia, from Africa, from Spain, as well as from various parts of Italy teach there. Students came from all over Europe. Patients also came from far and wide, attracted by the fame of the school. An English monarch and his son and various dukes in the north of France went down to Salerno to be treated. That journey was much farther than for us to go to Europe now.

The school deserved its wide reputation. When it began its work, Arabian medicine had introduced the system of treatment by prescriptions containing a large number of ingredients. Ori

ental subtlety had somehow come to the conclusion that the more medicines you used the surer you were to benefit the patient. It was hoped that someone of the many ingredients would surely do good. Just how there was any assurance that the others would not do harm is not clear. We talk about gunshot prescriptions. In the older time they called them calendar pre scriptions because there was as many ingredients in them as the list of days in the month, and the prescription looked like a sheet of a calendar or almanac.

Salerno modified all this and exalted particularly the natural modes of healing. Fewer medicines were used, and air, exercise and diet were made the basis of therapeutics. Salerno was particularly strong on diet, but hydrotherapy with hints now and then of various manipulative procedures reminding one of massage and some of our modern surgical system were in great vogue.. While Salerno was doing this her rival at Montpellier was calling attention to the use of red light in small-pox and to the value of light generally as a curative agent as well as to the use of water internally and externally.

What Salerno is famous for particularly, however, is its surgery rather than its medicine. About the middle of the Thirteenth Century, the "Surgery of the Four Masters" was written, a text-book of surgery, not unlike the collaborations of the modern time. This text-book came to be used at Bologna and during the course of the next century its teachings bore fruit. A series of men, Theodoric, Hugo of Lucca, William of Salicet, Lanfranc, and then finally Guy de Chauliac, who had studied in Italy, wrote textbooks of surgery which have been rendered easily available for study in recent years.

There is scarcely a phase of our modern progress in surgery that was not anticipated at this time. They operated on the skull for abscess and tumor of the brain; they operated on the thorax for pus and other fluids, and did all sorts of operations in the abdominal cavity. They were especially insistent on operations for the radical cure of hernia. The patient was placed in an exaggerated Trendelenberg position fastened to a slanting board with his head down so that the intestines might fall away from the site. of operation, and various technical methods, such as the introduction of wire of various kinds, the application of sutures of all sorts of texture and various modes of sewing up the tissues were suggested as likely to prevent the recurrence of the hernia. They did not believe that every hernia should be operated on and they discussed

this very wisely, but they did insist that operation in a good many cases would save great discomfort and avoid serious risk.

Of course, the thought that comes at once on hearing this is that it would be impossible to perform such extensive operations, requiring so much time, without an anesthetic. As a matter of fact, they had various forms of anesthesia and used a number of substances apparently with good success in producing insensibility to pain. The principal narcotics were wine, opium and mandragora in combinations, and they seem to have systematized the use of these rather well. A number of poets of the olden time talk of "the mercies of old surgeons," who put their patients to sleep before operating on them. Tom Middleton, our seventeenth century English poet, is an example, but somehow this development seems to have been missed to a great extent in the ordinary histories of medicine. We know now all about the use of these anesthetics and one of them was applied by inhalation, a tincture of opium and mandragora being allowed to dry on a sponge and this being placed in hot water and the patient allowed to breathe the steam from it.

Such extensive operations would surely be followed by very high mortality without antisepsis. While of course they did not understand the principles on which our modern antisepsis was established by Lister, they did have and used with excellent success one antiseptic at least. This was strong wine, which they poured over their wounds and applied on the dressings. This is an excellent antiseptic familiar even in scripture times, and it is not surprising that these old surgeons could boast of getting union by first intention, indeed it is to them that we owe the expression per primam intentionem, which derives any meaning that it has for us in the modern languages from its Latin significance. They even went farther, however, and insisted that surgeons whose wounds only healed after suppuration had made a mistake in their mode of operating, that is, of course, if they had operated through a previously unbroken skin surface.

There are various bits of technic employed by these old surgeons that are very interesting as anticipations of what we are likely to think of as modern inventions. In operating on wounds. of the intestines they emphasized very strongly the fact that if the intestine was wounded and not sewn up the patient would surely die. They invented various needle holders and suggested technical aids to secure proper union. In large wounds of the large intestine particularly it was suggested by Hugo von Pfohlsprundt in the

fifteenth century that the intestine should be completely divided and then the ends brought together over a metal tube with flanges. In this way the intestinal ends were kept in contact until agglutination took place and leakage was prevented. Pfohlsprundt declared that many of his patients had lived for years after such operations and he seems to have been quite secure about the ultimate passage of the metal tube. This anticipation of the Murphy button is probably of special interest here in Chicago.

A predecessor of Pfohlsprundt's, however, made what seems to me at least, perhaps because of my lack of surgical experience, a better suggestion. He removed the trachea from animals and used this as the tube over which the intestines were fastened and declared that the cartilage was stiff enough to maintain the intestines in such a position as would prevent leakage until agglutination took place, but then it would be gradually disintegrated by the juices of the intestinal tract and thus disposed of. This disintegration, however, would be delayed for a sufficiently long time to secure the safety of the patient.

Such anticipations of our modern inventions seem almost impossible to us, but that is because of the foolish notions we have cherished as regards the lack of practicalness of these men of the olden time. Let us not forget, however, that the brothers of the physicians who were making these fine technical advances in medicine were building bridges, inventing locks for canals, erecting cathedrals and town halls, making the most wonderful stained glass in the world, doing wonderful work in all the arts and crafts that we are now learning to admire and beginning to imitate, and that, of course, it is not to be supposed that only the fools of the families studied medicine and that those who took up our glorious profession were incapable of accomplishing at least as good work in what may be called the craft side of medicine as their brothers were doing in other departments.

It is indeed hard to understand how we should have come to accept this foolish notion of the men before our time, in our own profession, proving deficient and lacking in anything like even common sense. Our self-complacency has simply carried us away and has been fostered by a number of side issues. For one thing a religious controversy has been allowed to creep into medicine. A case had to be made out against the old church after the so-called reformation and this was bolstered up by emphasizing in every possible way the presumed suppression of education and intellectual development. Νο

more trace of any such suppression is to be found than occurs at the hands of any conservative body of men at the present time when there is a question of novelty, but the old church's influence was supposed to be eminently destructive of anything and everything that led to progress. There is literally no truth in this at all, but our medical history has been tinged with it until the republication of these old text-books shows us how utterly at fault were our previous notions.

Of course, the question of how these discoveries were made and then subsequently lost,' is a mystery. This is, however, the constantly recurring mystery of history. We find no trace of anything like regular progress upward, but many evidences of discoveries being made and then lost. The Suez Canal was opened before our time and allowed to close. America was discovered several times-we have documents from the thirteenth century relating to missions on the Labrador coast, which might have meant anything as far south as Massachusetts, and abundant references to Greenland. Evidence in the old tombs in Egypt seems to show that steam carriages were used there a considerable time before Christ (see Scribner's for February, 1913) and there are any number of lost arts of which Wendell Phillips used to tell us so eloquently which will surely be found again and constitute further examples of these losses and recoveries.

The ligature has been invented and reinvented many times in the history of surgery. It is easy to understand why. When ligatures are made of new fresh material and are applied in new clean hospitals they work beautifully. Whenever septic conditions intervened, then they worked irretrievable damage. Secondary hemorrhage was so common from their use under septic conditions that no wonder surgeons looked around for other modes of stopping bleeding. When an artery the size of the radial would begin to bleed in secondary hemorrhage because of the coming away of a septic ligature the patient would be dead from the furious bleeding before anything could be done for him. After a few such experiences, that would be the end of the use of the ligature for several generations. When it was invented again, however, the discoverer knew nothing about its previous use. Hot knives, hot pincers, torsion, everything would be had recourse to in the meantime.

It is harder to understand the rise and fall of interest in the specialities in medicine. We are sometimes inclined to think of this as the first great era of specialism, but we do so only when we are ignorant of the past. In Egypt, between

600 and 1,000 years before Christ, some thirty-six specialties developed, and Herodotus tells us that there came to be many complaints that the field of treatment of each of these specialties was too narrow and the patient often as a consequence suffered. Apparently each specialist found the seat of the patient's ailment in his own department. We have gotten far beyond that in our development of specialties, but it is just as well for us to realize that this curious complaint of the specialist was heard nearly 3,000 years ago. Unfortunately our hints of medical history do not go back much more than 6,000 years, or we would surely have complaints in previous periods.

As I have said, specialties developed at many times in the history of medicine. The treatment of the eye for cataract was particularly developed at a number of periods. A generation that will perform cataract operation may confidently be expected to do almost anything on the eye and tear duct operations and other surgical intervention in the eye was not uncommon. The throat and nose specialty was rather well developed at several periods, and men insisted on the necessity for clear breathing space through the nose and on the removal of polyps and the straightening of the septum and other things of that kind. Perhaps the greatest surprise is to be found. in dentistry. This at least we are inclined to think of as new, but it is possible that there was an interesting development of dentistry in Egypt and we have specimens in museums in Italy from the old Etruscan tombs which show how far dentistry had gone in the sixth, seventh and even eighth centuries before Christ in central Italy. There is good bridge-work and the fastening in of loose teeth by gold bands and other phases of prosthetic dentistry. One of the laws of the Twelve Tables at Rome forbade the burying of gold with the corpse-they were protecting their gold reserve at Rome as we do now-unless it was fastened to the teeth. This law was made about 450 B. C., and shows how common must have been the use of gold for dental purposes in the mouth. We have specimens of crown work and many dental appliances. Martial laughs at the women who got so scared that their false teeth fell out and their false hair came down. I believe that it was he who originated the expression that he knew that a lady's teeth were her own because he knew that she had bought and paid for them. During the middle ages dentistry developed again and Guy de Chauliac describes the filling of teeth, insisting that the cavity must be cleared out carefully and then washed out with wine before filling. Curiously enough, tin, which is

coming into use somewhat again for tooth stopping and which has the distinct advantage it is said of helping in the preservation of teeth in which it is present as a filling, was considerably used in the middle ages. Gold was quite commonly employed at this time. A well-known papal physician, John de Vigo, declared, however, that gold should be used only when people wanted it, because it was too conspicuous. Arcu

lanus, John of Arcoli, developed dentistry in a scientific way in the fourteenth century, and Guerini, in his "History of Dentistry," has given a long chapter to his work.

In a word the new is much older than we have any idea of, as a rule, in medicine and surgery, as well as in the arts, literature and the crafts. It was only what we would expect quite naturally if we once dropped the fond self-complacency that makes us think that the people of other times than our own must have been fools. Among ignorant people, there is a tendency for those in any country to think of the inhabitants of any other countries as foolish, and even wellinformed people often have the most curious notions of those distant from them in space, though particularly, of course, distant from them

in time.

Perhaps the best illustration of the anticipation of our modern progress in medicine and surgery and at the same time the explanation for that anticipation is to be found in the development of medical education toward the end of the middle ages. About the middle of the thirteenth century, according to a law of Frederick II, promulgated for the Two Sicilies, as the South of Italy and Sicily proper were called, a student of medicine must have spent his three years at the university before he could take up the study of medicine and then was required to spend four years at medicine before he was given his degree of doctor. This allowed him to teach in the subordinate position, but did not permit him to practice. Before the license to practice would be issued he must have spent a year with a physician. This is the standard of medical education that we are trying to climb back to. We want men to have made their undergraduate work in the university and then require four years at medicine and a year of hospital work. There are very few colleges as yet, however, that insist on such requirements. Two generations ago all our medical schools in this country required but two years of study. A man was allowed to study medicine if he could write his name, and he did not have to write it very plainly, either. His two years of medical study so-called consisted

of two terms of four months each of ungraded lectures as a rule; that is, the students heard the same lectures each year. How we ever got down so low as that is hard to comprehend. There were many reasons. The chief one was that men were engaged in making money out of medical education. Whenever any form of education pays there is likely to be something wrong about it. Let us not forget, however, that the men who came out of these medical schools were often capable of thinking for themselves, making observations for themselves, and sometimes doing better work in their early years of practice than the men who are now able to answer so many questions, but who never think for themselves.

There is just one reason for this talk to you. I have been writing books about "Old Time Makers of Medicine" and "Education, How Old the New" and "Modern Progress and History," until it has come very poignantly to me that whenever the men of any generation or any country despise the men of any other time or any other place they are belittling themselves. We have a glorious history in medicine, six thousand years of professional work with many generations of thoughtful observers. Medicine has gone up and down in its achievement, but there has never been a century when someone has not been doing serious thinking and writing on medicine well. worth preservation and containing good lessons. for the after time.

Unfortunately, we have taken our history of medicine from all sorts of out-of-the-way sources. The books that were written and printed in the largest editions and therefore most frequently preserved for the after time, were often those on popular medicine. Popular medicine is always absurd. Suppose we were to be judged by our popular medicine. Suppose that the advertisements in our medical journals, to say nothing of the lay press, were to be preserved for some future generation to judge our medicine by. Suppose for instance that the family medical. books of the present day were to be taken as representatives of what we thought about medicine in our time. It makes one fairly shudder to think what succeeding generations would think of us. It would be quite bad enough to be judged by some of our supposedly scientific advances; the Brown-Séquard remedy for old age; opotherapeutics for the heart and the brain; some of the exaggerations of internal antisepsis; our abuse of the coal-tar products, and all the rest. We have judged the past unfortunately, largely by its popular books and by the foolish absurd notions in the therapeutics of our forefathers.

Professor Richet once said that the therapeutics of any generation was always absurd to the second succeeding generation. Are we going to be the first generation to violate the law? Perhaps so. I do not know, but I have my doubts. I know a little of the absurdities that have passed under my own eyes in the past twenty years while as a medical editor I have been keeping track of a wide field of so-called medical literature.

We live in glass houses and we must not throw stones. Above all we are professional men with. a magnificent professional history of six thousand years. Let us not smirch our own nests, but learn to appreciate some of the great workers of the past. There is much to be learned from them, particularly from their mistakes, very often even from their absurdities and if we will only remember that they were men like ourselves, struggling with the deeper, more complex even than in our time, insoluble problems of the therapeutics of humanity, with insufficient knowledge though with the best good will in the world as a rule, we shall have a much better idea of the true history of medicine than can possibly be obtained from the cheap calumny of the past, because at places we happen to know only the side of it that lends itself to ridicule.

I have to thank you for your kind attention to this rambling talk and hope that it may prove suggestive enough to make you go back and study in the volumes that are now so readily available some of the genuine history of our dear old profession of medicine.

THE ILLINOIS COUNTY TUBERCULOSIS ACT

E. MAMMEN, M.D. BLOOMINGTON, ILL.

In the August issue of this JOURNAL, Dr. Sachs described the Glackin law for the establishment and maintenance by cities and villages of tuberculosis sanitaria. This article does not speak of what would seem to be a much more important act for the same purpose passed by the legislature of 1909 and now in force. This consists of a very brief amendment to the statutes governing county administration and enables counties to establish and maintain such sanitaria. It will be readily appreciated that unless farming communities can be benefited by tuberculosis sanitaria, the larger part of our population will be excluded from such benefits. It is true also that