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are not the following names in our mouths every day: Basedow, Valsalva, Santorini, Winslow, Soemmering, Levret, Gimbernat, Scarpa, Galvani, Goulard, Meckel, Monro, Pott, Anel, Tenon, Petit, Dover, Heberden, Lieberkühn, Portal, Reil, Gasser, Descemet, Belloc and Chopart? Prominent also were: Stephen Hales, the experimental investigator; Haller, the author of the doctrine of irritability; John Hunter, the founder of modern scientific surgery; Morgagni, the founder of pathological anatomy; Auenbrugger, the inventor of percussion; Bichat, the founder of general anatomy; James Currie, of cold water fame; Sprengel and Freind, historians; Oliver Goldsmith, poet; and the American, Rush.
And what a great period that was for progress and research which has just closed—the nineteenth centurywhich we would fain believe to be the greatest of them all! No longer now do the anatomists predominate, but there is development in many directions. The specialties all come to the front. Clinical teaching and work are conspicuous. More exact methods and instrumental aids of all sorts are introduced. All the sciences are called on to contribute. Auscultation and percussion, improved microscopes, the ophthalmoscope, laryngoscope, endoscope, and specula of various sorts, the thermometer, electricity, the x-ray apparatus, etc., open new fields to our vision, and multiply our diagnostic resources. With the discovery of anesthesia surgery takes a great bound forward, acquiring a further acceleration of speed upon the discovery of antisepsis. Pathology and histology are cultivated with increasing success and the new science of bacteriology is created. What an array of names one can call up: Corvisart, Laennec, Louis, Bright, Addison, Hodgkin, Bennet, Wunderlich, Skoda, Trousseau, McDowell, Mott, Astley Cooper, Esmarch, Wells, Paget, Langenbeck, Billroth, Strohmeyer, Lister, Simpson, Récamier, Sims, Semmelweis, Hebra, Magendie, Broca, Bernard, Charles Bell, Marshall Hall, Charcot, Helmholtz, Beer, Donders, Graefe, Pinel, Griesinger, Erb, Weir Mitchell, Czermak, Türck, Bayle, Virchow, Cohnheim, Klebs, Rokitansky, Koch, Laveran, Walter Reed, Pasteur !
In this rapid survey my only object has been to show you at a glance, as it were, how rich our past has been in exam
ple and inspiration. I have thrown but a few pictures upon the historical canvas; I might have increased the number to a thousand, but these are sufficient for my purpose. Now, I would ask, are our young students to be deprived of all the benefits of a knowledge of these, our medical heroes?-these men who, as Plato said, have "handed on the torch of life from generation to generation?" Is there nothing in such lives for them-nothing that will help them onward and upward in their professional career? Is education to be for them merely a mastering of the dry details of anatomy, physiology, practice? Is there to be no attempt to direct motives, to strengthen conscience, to build up character? I tell you again there is danger in such a course.
There are two other thoughts suggested by this survey. One is that there has been no degeneration in these latter days. Where do we find higher patterns of all that is noble and inspiring than in Pasteur, Virchow, Lister? Nay, we do not have to go beyond the limits of our own city to find those who are the peers of any whom I have named, great leaders in medical progress, beacon lights among us for all time to come.
Another thought is the solidarity of our art. Although differing in importance, each age has contributed something of permanent value to it, each stage of progress is indissolubly bound to all the other stages. “What we know and what we think," says Foster,1 "is not a new fountain gushing fresh from the barren rock of the unknown, at the stroke of the rod of our own intellect; it is a stream which flows by us and through us, fed by the far-off rivulets of long ago. ” In the house that we are building, each stone, each brick, each arch, has its place, contributing to the strength and symmetry of the structure. Nor because we are living on the sixth floor can we be indifferent to what is going on in the first and second. We stand, as it were, upon the shoulders of our predecessors and it would be very little to our credit if we did not see further than they, but to imagine, as some appear to do, that they were blind and saw nothing, indicates a very shallow knowledge and a judgment warped by the greater relative size of near objects. It
Lectures on the History of Physiology. Cambridge, 1901.
would be interesting to know whether posterity will assign to us the precedence that we think is our due.
But not only do we profit by the high ideals and the inspiration of great lives, which we derive from the past, but it is of the greatest practical benefit to trace the history of great researches. Let us review for a few moments that which led to the discovery of the circulation of the blood.
Before the days of Harvey–in the previous centurythe lesser or pulmonary circulation had been clearly enunciated by Servetus and Realdus Columbus, and both lesser and greater circulations had been described by Caesalpinus. But these views seem to have been purely theoretical; there is no evidence that they were based upon direct observation or experiment, and they made no impression on contemporary sentiment. The old Galenic doctrine was still held by Harvey's teacher, the great anatomist of Padua, Fabricius ab Aquapendente, at the beginning of the seventeenth century. The blood was still supposed to pass in part by invisible pores through the septum of the ventricles, and this was the only connection acknowledged between the venous and the arterial blood. There were, in fact, two distinct and independent circulations, the venous blood with its natural spirits derived from the liver, passing out from the right ventricle along the veins to the tissues, and the thin arterial blood containing the innate heat of the heart and the vital spirits derived from the lungs in like manner proceeding from the left ventricle, both by a to and fro movement. The idea held of the action of the heart was just the reverse of the truth. The active period (the systole), corresponding with the impulse, was supposed to be that of dilatation, when the air and blood were assumed to be drawn into the left and right ventricles respectively by the suction force thereby exerted. Harvey did away entirely with the “spirits,” because he could find no evidence of their existence in his researches. He denied the pores in the septum of the heart for the same reason, and taught that all the blood passes through the lungs. He ascertained the action of the auricles and ventricles with their respective valves. He realized that the active period of the heart was
that of contraction upon its contents and that the blood was thereby driven into the arteries, producing the pulse. He calculated carefully the amount of this blood passing out from the heart at each systole, and thus found in a few minutes as much must pass as is contained in the whole body, that is, that all the blood passes through the heart. It was also obvious that the amount was far greater than that which is absorbed by the veins from the food and drink, previously considered its sole source, and that the far greater part must be blood which has passed from the arteries to the veins in the tissues, in some such hidden manner as it does in the lungs. Harvey never saw the capillaries, either in the lungs or elsewhere; he had only a logical evidence of their existence. Their discovery was reserved for Malpighi and the microscope.
Fact after fact arose to confirm Harvey's views : that the heart was emptied when the vena cava was tied, and filled to distention when the aorta was tied; that a moderate ligation of a limb made it swell with venous blood, but a tight one kept the blood from entering by compressing the arteries; that the whole of the blood in the body could be drained away by opening a vein; that the valves of the veins (discovered by his master, Fabricius, but misinterpreted by him) were designed to prevent reflux of blood in its passage onward to the heart. Harvey's solution of the circulation was a purely mechanical one, based on patient anatomical examination and comparison of various animals, on the adoption of some explanation for what he saw and the confirmation of this explanation by repeated dissection, vivisection and experiment—in other words, on true Hippocratic principles. Who will say that it is a matter of indifference whether such a work be brought to the attention of our students or not?
Again, medical literature is a mine of neglected and overlooked discoveries. Take, for example, club-foot, both the true nature and successful treatment of which were known to Hippocrates, but lost for many ages after his death. Says Adams,2 "In all the works on ancient surgery, I ver
1 See Foster. Loc. cit.
ily believe there is not a more wonderful chapter than that which relates to club-foot. In it he has not only stated correctly the true nature of this malformation, but he has also given very sensible directions for rectifying the deformity in early life. Now, it appears to me a lamentable reflection, as proving that valuable knowledge after being discovered may be lost again to the world for many ages, that not only did subsequent authorities, down to a very recent period, not add anything to the stock of valuable information which he had given on the subject, but the important knowledge which he had revealed to the profession came to be disregarded and lost sight of, so that, until within these last few years,” (he refers to the introduction of tenotomy by Strohmeyer and Delpech) "talipes was regarded as one of the opprobria medicinae. Hippocrates was also acquainted with dislocation of the acromial end of the clavicle, the knowledge of which was entirely lost until the eighteenth century. According to Celsus, lithotripsy, which held so prominent a place in the surgery of the latter part of the last century, was invented and practiced by Ammonius of Alexandria, about B. C. 230.2 Heliodorus, about A. D. 100, was well acquainted with torsion of arteries, a particular mode of operating for the radical cure of hernia by excision of the sac, and excision of stricture of the urethraall of which have been proclaimed as marvelous discoveries in later days. You all remember the statement of the late Dr. T. Gaillard Thomas, which formed the theme of my predecessor's Presidential Address last year, that more had been done for the advancement and growth of medicine in the last half of the last century than in all the preceding ages from the days of Hippocrates. Yet hear the acknowledgment of the author of that statement in his well-known work on the Diseases of Women:4 "Some of the most valuable contributions to modern gynecology will be found to be foreshadowed, or even plainly noticed, by the writers of
1Baas (J. H.). Outlines of the History of Medicine. Translated by H. E. Handerson. New York, 1889.
2Celsus. De Medicina. VII, 26. 3Billings (J. S.). In System of Surgery. Edited by F. S. Dennis. Phil., 1895. Vol. 1, p. 30.
Thomas (T. G.). A Practical Treatise on the Diseases of Women. Phil., 1891, p. 17.