“As a point of history pregnant with valuable deductions, it is good to look back upon the conditions of medicine in former times and find that it has always kept pace with the progress of the physical and moral sciences. Where these, however, have been marked by folly and credulity, medicine has exhibited the same imperfections.”

It is difficult to trace the improvement in successive eras, because they melt into one another by indefinable gradations. During the earliest period it was believed that physic was an art which was supposed to be most mysterious, and it was presumed that the practicers held communion with the world of spirits. The practice of medicine in those days consisted in the usage of agents necessarily unreliable, as, for instance, the word abracadabra hung around the neck as an amulet to chase away the ague, etc.

Much time has been wasted in attempting to portray the first origin of medicine. Bambilla, a surgeon of Vienna, has asserted that Tubal Cain was the inventor of cauterizing instruments, apparatus for reducing fractures, and other instruments for surgical procedures, thus endeavoring to prove that surgery antedated medicine. It is evident that medicine must have had a very early origin, for mankind even in the earliest ages suffered pain and the train of sequences due to exposure, and hence soon discovered a method of alleviation. Their category probably consisted of herbs. Unacquainted, however, with the construction and function of the human economy, practitioners were unable to trace the progress of disease, and the more fatal internal maladies were ascribed to the deities whom they feared. Hence, various superstitious practices would arise and be handed down from one generation to another. We may imagine this to have been the origin of the healing art, and such is nearly its present condition amongst the savages of Africa, Australasia, Polynesia, Sumatra, etc.

Later on, the priests became the physicians, from being the oracles of the divinity whom the people wished to consult. The various remedies were handed down from one to another, as medical science did not exist at that time. Herodotus informs us that even in his time the Babylonians, Chaldeans, and other nations had no physicians. When any one was attacked with disease the patient was carried into the public street, and passers-by who had suffered from a similar affection, or nursed one who had, advised the sufferer to employ the measures that proved successful in former cases.

The earliest writers on medicine trace its origin, in common with that of most other branches of knowledge, to the Egyptians. They appear to be the first nation that cultivated medicine and furthered its progress. Many peculiar medical properties were attributed to the deities. All diseases were supposed to originate from the anger of Isis. Resin was burned in the morning, myrrh at noon, and a composition termed cyphy in the evening, in the temples of Isis, and the sick were taken there to sleep, during which the oracles might reveal to them the means which they should employ to effect a cure. This is an illustration of the superstitions which prevailed at that time.

The earliest authentic records which we can ascertain from collateral reading are to be found in the Scriptures. Here it is stated that Joseph commanded his servants and physicians to embalm him (1700 B. C.). This shows that Egypt at that time possessed a set of men who practiced the healing art, and that they embalmed the dead. This must have required an idea of anatomy, which, needless to say, was crude and unscientific, as dissection of the human body at that time was prohibited, the penalty being death.

According to Pliny, the Egyptian kings encouraged post-mortems, for the purpose of ascertaining the cause of diseases; and this method was fostered by the Ptolemies, during whose reigns anatomy was raised to a higher standard.

Through the writings of Moses in the sacred Scriptures, we learn that the medicine of the Hebrews appertained mostly to public hygiene. Meat of the hog and rabbit was forbidden, as being injurious in the Egyptian and Indian climate. The relation of man and wife and the purification of women were regulated. The measures suggested by Moses for the prevention of the spread of leprosy have not yet been surpassed. Next to Moses, Solomon acquired quite an efficient knowledge of compounding remedies.

The Indian races were divided into castes, the priests alone enjoying the privilege of practicing medicine. Their medical knowledge was condensed in a book which they called Vagadasastir. They believed the body gave rise, through seventeen thousand vessels, to ten species of gas which conflicted and engendered disease. So far as we know, they were the first to record a way of testing the specific gravity of urine. Though accused of many absurdities, they claimed to cure the bites of venomous snakes and compounded an ointment which eradicated the cicatrices of smallpox,—a result which has not as yet been attained in the present epoch. The Chinese attribute the invention of medicine to Hoâm-ti, one of their emperors, who lived about 2687 B. C.; but possessing no anatomical knowledge, their surgery, to say the least, was barbarous. For over four thousand years the Chinese were not allowed to communicate with foreigners, and naturally their progress was at a standstill. They used cups, acupuncture, fomentations, lotions, plasters, baths, etc. Their midwifery practice consisted mainly of murderous principles, and it is only since the introduction of missionaries that a reformation in the medical practice of the Chinese empire has been accomplished.

The condition of medicine in Greece did not differ from that of the “rude and uncivilized nations.” But later, Greek physicians are credited with the most brilliant discoveries. The most distinguished of Chiron’s pupils was Æsculapius, who occupies the most conspicuous place in the history of medicine. Æsculapius is always painted with a staff, because the sick have need of a support; and the serpent entwined around it is the symbol of wisdom. The sons of Æsculapius are considered the fathers of surgery, and, for their distinguished valor at the siege of Troy, have been classed by Homer among the Greek heroes.

The first operation of venesection, or blood-letting, formerly so promiscuously done, with at times good, but oftener disastrous, results, and now rarely resorted to, is attributed to Podalirius, of recognized Grecian medical skill, the patient being a princess.

The early Greeks above all recognized the value of physical culture, which to-day occupies a prominent place in our curriculum. Were the children of to-day, like those of the ancient Greeks, compelled to follow a routine of physical training, a rugged constitution would replace many a “delicate” and “infirm” one, and the race propagated would tend to develop a stronger character. Then the weak-minded, now so conspicuously present, would be eradicated, and many diseased conditions fostered by an “inanimate” race would disappear.

Hygeia, from whence comes Hygiene, or the art of preserving health, was a pretended sister of Æsculapius. Anatomy could not flourish in Greece, because a most exemplary punishment awaited any untoward conduct toward the dead. Their peculiar religious beliefs regarding the rest of the soul were responsible for this.

The knowledge of the functions of the body in health and disease was appreciated by Pythagoras. Diogenes asserts that Alcmæon, one of the Pythagoreans, wrote a work on the functions, which work would consequently be the most ancient known treatise on physiology.

The age of Hippocrates (B. C. 460–370) was marked by a revolution in medical science. “This central figure in the history of medicine” was descendant of a family in which the practice of medicine was hereditary. He was an extensive writer on such subjects as epidemics, acute diseases, dislocations, fractures, etc. Owing to the impossibility of establishing a physiology without an anatomical basis, his references to these subjects are crude and incorrect. To Hippocrates we owe the classification of endemic, sporadic, and epidemic forms of disease, and their division into acute and chronic. He wrote on diseases of women and epilepsy, and his therapeutics, though crude, were a marked improvement on what had preceded. He wrote fully on external diseases and surgical therapeutics. In obstetrics he was a close observer and a thoughtful teacher. The brilliant theories and practices so diligently observed and urged by this master were thrown in the shadow by his thoughtless followers. The well-instructed physician is not ignorant of the opinions of Hippocrates, for truly the “divine old man” is the “Father of Physic.” He caused a revolution in the practice of medicine, semeiology, pathology, and dietetics. He taught physicians to observe attentively the progress of Nature, proved the inutility of theories, and showed that observation is the basis of medicine.

An important age, and one of marked progress in medicine, is from the foundation of the Alexandrian Library (320 B. C.) up to the death of Galen (A. D. 200). Under the Ptolemies dissection of human bodies was allowed, and hence, as already stated, the science of medicine received quite an impulse. Herophilus deserves first mention as a dissector. He described the brain and its vessels, the eye, the intestinal canal, and parts of the vascular system. The valves of the heart were more exactly described by Erasistratus, who discovered the lymph vessels and pointed out that the epiglottis prevents the entrance of food into the lungs.

Aretæus, more than any other up to his time, attempted to found pathology upon a sound anatomic basis, an effort which shows the scientific progress of his age.

Of all the physicians of antiquity, Galen was probably the most brilliant genius. In the midst of disorder he led back to the safer road of sound doctrine and accurate observation which distinguished the Hippocratic school. He wrote extensively on anatomy, especially regarding the muscles. He was the first vivisector, by exposing the muscles of animals and demonstrating their functions, and his classification according to their use is at present in vogue. Carefully regulated vivisection has been, and always will be, of incalculable benefit to the development of accurate medical knowledge, and an indirect aid in the alleviation of human suffering. Galen divided the body into cranial and thoracic cavities, and described the organs, etc., contained therein. Anatomy and physiology, the fundamental bases of medicine and surgery, made the most progress during the period just reviewed, and next came the description of diseases, their medical and surgical therapeutics.

After the sixth century medicine was exercised almost exclusively by the monks of the West. They were unworthy the name of physicians, as they resorted more to prayers, and were retarded by ignorance and prejudice.

During the seventh and eighth centuries there were among the monks a few traditionary remains of science, originating from the East. The prelates, archdeacons, etc., though continuing the practice of the healing art, were gradually discouraged by the church, but as late as the middle of the fifteenth century the Bishop of Colchester was chaplain and first physician to Henry VI. In 1452 physicians of the University of Paris were not allowed to marry, the applicant, prior to admission, taking the oath of celibacy.

During the twelfth century the school of Salernum, through the personal interest manifested by Emperor Frederick II., acquired a degree of reputation attained by few similar institutions in ancient times. Schools in Paris and England were placed on an advanced standing, the professors being salaried; and about this period the titles of bachelor, licentiate, and master, were granted to the physicians.

During the thirteenth and fourteenth centuries medicine made remarkable progress in France under St. Louis. During the reign of this prince the teaching of medicine and surgery was divided into separate and distinct classes. Medical institutions now became greatly encouraged, and in the leading cities of Europe universities were erected under the auspices of royalty.

Medical instruction experienced an important revolution in the European countries during the fourteenth century. For the first time in Europe anatomy was taught by dissection of the human body. Guy de Chauliac, who lived at the end of this century, wrote a treatise on surgery which served as the basis of European instruction until Ambroise Paré of France published his celebrated work upon the same subject.

The fifteenth century was also one of improvement. The Arabs added a few observations on pathology, especially of the eruptive fevers. Some useful works on pharmacy and materia medica were published during this epoch. During this era the operation was devised for replacing the nose when removed by accident or disease, by using for the purpose a piece of flesh taken from the arm, and applying it by a grafting process. About the middle of this period the internal administration of metallic drugs was introduced. Towards the latter end, the invention of printing tended to assist the progress of medicine. Near the close of this century scurvy was first noticed in Germany. During this period more energy was devoted to postmortem demonstrations and the study of symptoms of diseases.

To Benevieni we owe the commencement of the study of gross pathology and pathological anatomy. Malgaigne remarks of him: “A eulogy which he merits, and which he shared with no other person, and which has not been accorded to him up to this time by the many historians of surgery, who have superficially searched among these precious sources, is that he was the first who had the habit, felt the need, and set the useful example, which he transmitted to his successors, of searching in the cadaver, according to the title of his book, for the concealed causes of disease.” His observations on anatomical heart lesions, gall-stone, and presence of parasites in the body, were original. John Fernel, who has been surnamed “the modern Galen,” divided medicine into physiology, pathology, and therapeutics. The fundamental maxim of therapeutics, that every disease must be combated by contrary remedies, was early laid down by him, and he claimed that anything that cured a disease was contrary to it. Surgery was placed on a high scale during this era, as thorough a course as the time afforded was given, and a rigid examination held at its termination. Ambroise Paré contributed largely toward making this a glorious century. He rose from the lowest walks of life to the highest professional attainments and honors. He was the first to control hemorrhage by tying the bleeding vessels, thus doing away with the former crude and painful method of pouring on hot oil. This procedure proved quite a boon to surgery; as an instance it may be mentioned that prior to the introduction of this method in amputations the bleeding was controlled by means of a hot iron, and this before the days of anæsthesia.

Every age of ancient, mediæval, and modern medicine has had its charlatans, and the more civilization progresses, the more popular these quacks become with certain types of people, particularly those of the middle and lower classes, although no class appears to be exempt. Latent, unscrupulous, and unprincipled, they play upon the credulity of the ignorant.

The central figure of the mediæval charlatans was Paracelsus, who was given to drink and debauchery. He advertised extensively, similar to the charlatans of to-day, and exerted an influence in his time. “The school which he would have founded was nothing but a school of ignorance, dissipation, and boasting—a school of medical dishonesty.”

During the sixteenth century the greatest discoveries took place in anatomy, based upon dissections, the only rational method of ascertaining anatomical knowledge. The lesser circulation of the blood, or that through the lungs, was appreciated.

The officers of the universities were chosen by the students, who assisted in laying out the curriculum. Compare this with the rigid methods of medical instruction now in vogue. The practitioners were of roving habits, which were evidently contracted during their student days, as it was customary for them to go from one school to another, the poor classes defraying expenses by begging and singing.

There was evident improvement in the social and mental status of medical men upon the approach of the seventeenth century, and this period is signalized by the discovery of the circulation of the blood, one of the most important ever made in medicine. Chemistry now assumed the dignified aspect of a science, which fact benefited the progress of medicine.

It is difficult for us at the present time to understand why the circulation of the blood was not discovered prior to this period, but to the ancients it was incomprehensible. They believed the arteries contained air, because after death they were found empty. William Harvey, the discoverer of the circulation of the blood, did not publish the results of his investigations until 1628, first submitting them to fifteen years of proof. This naturally revolutionized physiology. The capillary circulation, or that intermediate between the arteries and veins, was described by Malpighi in 1628. Of course this was possible only through the means of a microscope. No less remarkable was the discovery of the lymphatic vessels. Peruvian bark (the alkaloid quinine being more commonly employed) so universally employed as a specific for malaria, was first used in the early part of this epoch.

During this period ophthalmology (which treats of the diseases of the eye) was cultivated in France, cataract was first recognized, and the diseases of the ear first systematically described. Altogether the century showed marked progression, closing with the teachings of Sydenham, “the English Hippocrates.”

The eighteenth century was one of continued progress. The eminent observers devoted more time to microscopical work, studying the minute structure of the tissues and cells. One of the most prominent is Lieberkühn, who invented the solar microscope, with which he was enabled to exhibit the circulation of the blood. The systematic practice of the preventive inoculation against small-pox by vaccination originated in this decade. The first inoculation with cow-pox was in 1774. Edward Jenner, the English surgeon, was “the father of vaccination,” which he first did in 1796. About 1800, Dr. Waterhouse, then professor of medicine in Harvard College, performed the first vaccination in America, the patients being his four children.

The treatment of the insane was changed from one of torture and barbarous methods to a more scientific one, conducive to the comfort and return to health of the patient.

This period marks the earliest example of medical teaching in this country, consisting of the demonstrations of anatomy in Philadelphia by Dr. Thomas Cadwalader, upon his return from Europe. This was previous to 1750, about which time a body was dissected in New York. In 1754–56 Dr. William Hunter of Scotland delivered a series of lectures on anatomy, accompanied by dissections, at Newport, R. I.

In 1762 Dr. Shippen laid the foundation of a medical school in Philadelphia, which finally developed into the Medical Department of the University of Pennsylvania. This was the first medical school established in this country. In 1768 a school of medicine was organized in New York, and the next in succession was the Medical Department of Harvard College in 1782. The fourth was established at Hanover, 1797, being connected with Dartmouth College. These were the only medical colleges instituted prior to the present century. The first book on American surgery was written in 1775 by Dr. John Jones, the title being “Wounds and Fractures.”

“The tendency of the nineteenth century seems to be a continuation, and, perhaps, in some respects an exaggeration of the condition that obtained in France during the previous century; in other words, the world has become practically an enormous school of pathological anatomy and diagnosis—a school inaugurated by Bichat, as representing so-called scientific or exact medicine.”

Darwin has promulgated “the most influential philosophic doctrine of this or any other century.” Our materia medica and the laws of physics have been enriched by botanical discoveries, aiding greatly the experimental researches of to-day. Helmholz has given us an instrument called the ophthalmoscope, containing a series of numbered magnifying lenses, with which the interior of the eye can be explored by looking directly through the pupil of the eye, similar to looking through a door into a room. Through his knowledge of physics, Seebach was able to make fame through his discovery of thermal electricity. Daguerre, who invented photography, must not be overlooked, as by means of this process, many conditions are directly appreciated by the eye which could not be told in words and still convey an idea of the tumor, etc., being described. It may not be amiss to mention here that the biograph will in a few years prove an important factor in teaching the various operations. One surgeon in France is now employing it. We must not overlook Edison and his electrical achievements which directly and indirectly affect medicine; nor Bell’s telephone, which is sometimes used to locate a bullet. By placing the receiver to the ear and probing for the bullet with electric conductors, the making and breaking of the circuit upon contact with the missile is transmitted to the receiver and distinctly heard. This procedure, however, has been discarded since the introduction by Röntgen of the X-ray.

A very significant feature of the age has been the extraordinary development of associations devoted to scientific discussions and the publication of medical literature and journals. The formation of medical societies, especially in the United States, has been quite active. But few counties are without a medical organization, referred to as “The ... County Medical Society.”

The American Medical Association was established by Dr. Nathan Smith Davis in Philadelphia fifty-two years ago (1847). The first two years no meetings were held, but since then regular annual meetings have been in progress, the place of assembly being decided upon by a majority vote of its members. It has met in the city of its birth five times, the founder has been elected president twice, and is still (1900) in active practice at the age of eighty-two. He has attended all its meetings held in various cities from Boston to San Francisco.

The first medical journal in this country appeared in New York, 1797. It was called “The New York Repository,” was published quarterly, and managed to reach its twenty-third edition. Fifty years ago there were about twenty journals published in the United States. At the end of the century there are two hundred and thirty.

In 1810 there were six hundred and fifty students of medicine in America, and one hundred graduates. At the present writing about twenty thousand medical students are enrolled in our various colleges, and during the spring of 1899 about three thousand five hundred received the degree of M. D.

The original branches, practice of medicine, surgery, obstetrics, physiology, anatomy, therapeutics, and chemistry, have been subdivided and specialized. Among the chief of these specialties are gynecology, which treats of diseases of women; pediatrics, which treats of diseases of children; dermatology, which treats of diseases of the skin; ophthalmology, which treats of diseases of the eye; laryngology, which treats of diseases of the throat and larynx; otology, which treats of diseases of the ear; neurology, which treats of diseases of the nerves; medical jurisprudence, which treats of the relation of medicine to law; pathology, which treats of diseased tissues and organs; bacteriology, which treats of the microbes; and physical diagnosis, which treats of the art of discriminating disease by means of the eye, ear, and touch. The nucleus of the teaching regarding the latter subject is due to the efforts and observations of Corvisart, of France. He was the first to ascertain the diseased areas of the lungs, by tapping on the chest with the fingers, and listening to the pitch of the note thus elicited. A low, dull note indicates that the lung is solid, as in pneumonia; a flat note that fluid is present, and so on. By placing the ear to the chest wall, sounds in health and disease are heard, which vary in intensity, degree, etc. Laennec discovered by accident that this method was greatly improved and the sounds more distinctly heard if a cylindrical tube was interposed between the ear and the chest wall. The outcome of this principle is the stethoscope.

The name of Pravaz, the Lyons surgeon, has been perpetuated by the hypodermic syringe which he devised. The employment of suitable drugs in this instrument is the method par excellence for relieving pain. With it drugs can be injected into unconscious patients. Suicides who refuse to swallow emetics can have their stomachs emptied most effectually of their contents by a hypodermatic injection of apomorphine.

The thermometer used for taking the temperature of the human body is so arranged that the mercury does not descend into the bulb until shaken down, hence after taking the temperature it remains uninfluenced until shaken down. Were an ordinary thermometer used, by the time it was removed from the patient to the light the mercury would descend several degrees.

Pasteur began the studies of fermentation in 1854. Through his observations, aided by the microscope, the opinion was reached that micro-organisms played an important role in the causation of disease. Many of the laboratory investigators became imbued with the spirit, and through their diligent observations the microbes causing many diseases have been isolated. It remained for Koch to discover the tubercle bacillus, or Bacillus tuberculosis, which is the cause of consumption. The sputum of a patient, properly stained, and examined under the microscope, will at once decide whether that individual has consumption.

Having ascertained that bacteria were the cause of disease, sepsis (blood poisoning), etc., it then remained to discover a method of killing them, without any undue injury to the patient. Sir Joseph Lister began experiments upon this hypothesis, and in 1867 was able to publish favorable results. But lo! the world was slow to bend to a new thought ably demonstrated, and for a score of years he was bitterly opposed.

It was Crawford W. Long, in a little village of Alabama, who, in 1842, was the first to put to sleep a patient with ether, and remove a small growth. The patient, upon awakening, had experienced no pain. This method of relieving pain was christened “anæsthesia” several years later, by the distinguished Dr. Oliver Wendell Holmes, whose writings did more than those of any other American to eradicate “child-bed fever.” Every woman in the land owes him an eternal debt of gratitude. To Guthrie, of Sackett’s Harbor, New York, is due the credit of first discovering chloroform, but Sir James Simpson, of Edinburgh, deserves the credit of first employing it in medicine.

The surgeons of America laid the foundation of gynecology, the progress of which has been more marked than any department of medicine. The first ovariotomy in the world was performed by Dr. Ephraim McDowell in Kentucky, December, 1809. This was prior to the days of anæsthesia and antisepsis, and a howling mob awaited outside, ready to murder the brave surgeon should his patient die during the operation. “In five days,” says Dr. McDowell, “I visited her, and much to my astonishment found her engaged in making up her bed.” Dr. J. Marion Sims, our illustrious genius who established an international reputation, did much to promulgate plastic work on the female genitalia. The deeds of medical men are soon forgotten by an ungrateful public, and the sons of Æsculapius are the last to have monuments erected to their memory. But four exist in America; one, in New York, to that grand old gynecologist, Dr. J. Marion Sims; one in Washington, to Dr. Samuel D. Gross, “the Nestor of American Surgery;” one in Bushnell Park, Hartford, Conn., to Dr. Horace Wells, the discoverer of anæsthesia; and one in the Public Garden in Boston to the discoverer of anæsthesia. This last bears no name. Antisepsis and anæsthesia have played an unusually important role in obstetrics, by alleviating the sufferings of childbirth and eradicating child-bed fever, thus reducing the mortality of both mother and child.

Physiology has made very rapid strides during this era. Beaumont, in his famous work, describes digestion in the stomach and experiments on the gastric juice. He was enabled to observe this in a voyageur who was accidentally wounded in the stomach by the discharge of a musket, June, 1822. Quite a large opening remained, which Nature closed with a valve. By pushing the valve to one side, the interior of the stomach could be explored.

Through the work of the experimental physiologists in the laboratories, the study of the action of drugs on the lungs, heart, liver, stomach, nerves, etc., has been greatly enhanced.

Anatomy is now being taught by the only true method, and that is dissection. Didactic lectures are given, but the student must dissect every part of the human body before he can receive his degree. Formerly graves were robbed, and the bodies sold to the colleges. Now, however, through legislative enactment, unclaimed bodies are turned over to the colleges, where they are preserved either by injection, a pickling process, or by cold storage.

The ophthalmologists of to-day fear nothing inside nor outside the eye. Cross eyes are straightened, cataracts removed, eyeballs taken out and glass eyes inserted.

This article would be incomplete, were not a few remarks directed toward the trained nurse.

The first training school for nurses in America was established in connection with the Lying-in Charity Hospital of Philadelphia in 1828. This school, still in existence, thus has the honor of being the oldest in this country, and is antedated by only one abroad.

The generally recognized profession for women, that of the trained nurse, is practically of recent development. Twenty-five years ago the training school connected with the Bellevue Hospital, New York, graduated a class of five nurses. This was a marked departure in the medical history of this country. Since then the demand for the trained nurse has been great, and no hospital is complete without such a training school.

The progress of medicine in the nineteenth century has been far more rapid, creditable, and momentous than during any like period of the past. This is true not only in the United States, but in every civilized country. Its entire scope, meaning, and purpose have undergone changes equivalent to revolution. Antique superstitions, idle theories, foolish speculations, absurd practices, the ridiculous jealousies and incriminations of opposing schools, have been largely eliminated. Medical institutions are upon the loftiest plane in their history. Teachers are better endowed than ever before. Periods of scholastic preparation have been lengthened and curriculums enlarged, thus securing for the fields of practice a higher mental equipment and more conscionable devotion to duty. Never before have the auxiliary and material agencies been turned to so frequent and preventive account. Electricity, the microscope, anæsthesia, antisepsis, laboratory experiment, hospital opportunities, etc., are ever constant inspirations to skilled treatment and fresh researches. As the grand army of humanitarian workers was never so large as at the end of the century, so it was never better fortified for attack upon the enemies of health, fuller of enthusiasm or more deeply established in the public confidence. One may not, as yet, assert that medicine is ridding itself of empiricism with a satisfactory degree of rapidity, or that it has arrived at the stage of an exact science, but it surely has approached such a stage as nearly as conditions will allow.