INTRODUCTION.

We propose to abandon the plan hitherto followed in previous editions when treating of Medicine, and to consider it rather as a branch of politics and of political economy, of singular interest to the citizen and statesman, than as a mere matter of science and art. It has a large encyclopedic literature of its own, to which our restricted space would not allow us to do justice in any degree. We propose, therefore, to give a general summary of the development and present condition of medicine and of the medical profession, with a more especial reference to their social and political relations. To this end we have traced their advancement and progress from the earliest period concurrently with fundamental changes in creeds and governments, so as to show under what conditions of society they rose and fell, and what their future development may be. The review is necessarily very general.

The word "Medicine," in its narrowest sense, signifies anything taken or applied by a person suffering from disease, with a view to relief or cure. Thus used, it expresses the means available in the art of healing. In a wider and philosophical sense it signifies all the knowledge applicable to the exercise of the art. This knowledge constitutes the science of medicine. Medicine is a term, therefore, which has a very varied and comprehensive signification, and includes every branch of medical science and every division of medical art. Practical psychology, surgery, midwifery, and pharmacy, and medical chemistry, botany, and zoology, are consequently departments of practical medicine.

this comprehensive sense, is synonymous with the Theory and Practice of Physic. By the 32d clause of Henry VIII., cap. 40, § iii., the members of the London College of Physicians had expressly reserved to them the right to practise surgery. It runs as follows:—"And forasmuch as the science of physic doth comprehend and contain the knowledge of surgery as a special member of the same; therefore be it enacted, that any of the said company of physicians, &c., may, from time to time, as well within this city of London as elsewhere within this realm, practise and exercise the said science of physic in all and every her members and parts," &c.

When we examine in detail what is the knowledge that is necessary to this end, we find that it is, in fact, nothing less than a knowledge of the nature of man, and of its relations to all nature around him. Hence physics, the old term for the science of nature, was formerly synonymous with medical science, and the physician was but another name for the medical practitioner. This grand old name, nature, for the students of the science of human nature is so comprehensive, and so clearly indicates the duties and privileges of him who has to apply that science to the welfare of man, that it is to be hoped it will not be permitted to pass out of use, but, on the contrary, the physician shall henceforth be, as his name implies, able and fit for the practice of medicine "in all and every her members and parts." The physician looks at the human body as an artificer would look at a complicated piece of machinery, the construction of which is unknown to him, but which he has to keep and maintain in good working order, and, if possible, to render more perfect. He studies the preservation of the vital machinery in health, the restoration of it to health when disordered, and the development of it to greater perfection. These constitute the three great branches of medicine—the prevention of disease, the cure of disease, the improved condition of man. Every man desires to enjoy and continue in life. Now, life is the continuous co-operation of those various organs which make up the body, and is enjoyed when they work harmoniously together. When this harmonious co-operation is interrupted, disorder or disease arises, and the vital functions are performed with pain, or at least languidly, imperfectly, and uneasily. It is one of the primary conditions or laws of life that the organism shall aim at the maintenance of the healthy or harmonious working of these various machines. The fulfillment of this condition has been attributed to variously designated powers, as—the vital principle, the archæus, the soul, instinct, the vis conservatrix nature, and the like. It is a law of existence common to all organisms, whether animal or vegetable, and is fulfilled by them all with little or no knowledge of the end of the law, or of the means by which it is attained. An infinite number of processes are going on in man, in fulfillment of this law, of which he is even yet wholly ignorant; and it is only by the most assiduous observation of the order of succession of vital phenomena and of their relation to various organs, that he has been enabled to determine in any degree the extent to which this law of existence is operative, and to learn the conditions under which it is fulfilled. It is by no means necessary to man's existence, when in health, that he should even know that he has organs. He is so little cognisant of the working of the brain as the organ of the mind, that to this day the greater number of mankind are practically of opinion that the soul can and does act independently of any organ whatever. As to the heart, lungs, stomach, and other viscera, it is a sign of perfect health when the man knows nothing whatever sensationally of their existence, and when their functions are performed wholly without his cognisance or aid. But these various organs are apt to be thrown out of gear. Then sensations are felt other than those of health, and a fundamental law comes into operation, in virtue of which the organism works to the beneficial object of repairing the disorder, and so removing those sensations. This is but a modification of that law of life in virtue of which the healthy action is maintained. The fulfillment of this law has therefore been attributed to the same forces; that is to say, to nature, the vital principle, an archæus, a vis medicatrix nature, vis conservatrix nature, &c. Nature appears to be the best of these terms, inasmuch as it more simply than others expresses the general law itself, without particularly specializing a subordinate agent. Nature, then, may be said to indicate what is necessary to be done in cases of disorder in the working of the viscera. If the disorder arises from mechanical causes, then in the lower animals—and in man when ignorant of medicine—the natural instruments or weapons are used for medicinal purposes. Thus the dog licks a wound it has received; the man covers it with his hand, supports the wounded limb, and the like. This is natural or instinctive surgery. Surgery, as a branch of medicine, includes the treatment of all mechanical injuries, together with all strictly external diseases, and the use of all mechanical or instrumental means of cure. Medicine, in its restricted sense, excludes these external diseases and remedial agents; as distinguished from the surgeon, and as a specialist, the physician neither treats them nor applies the remedies. His sphere of study is the great group of internal diseases, and their cure by drugs, together with the general principles of medical art—a knowledge as necessary, indeed, to the surgeon as to the physician. When, then, the cause of the disorder is not external, but within the organism,—that is, either in the fluids or the tissues of the body,—an attempt is equally made by nature to remove it. Now, noxious agents are formed within the organism during the natural processes, but in the state of health they are eliminated as rapidly as they are formed, constituting the secretions. If they are not eliminated, but accumulate in the organism, they cause disorder and disease. Again, noxious agents may be received from without (such as poisons, irritants, &c.), and these will generally operate in like manner as the retained secretions. In either case nature seeks the restoration to health by attempts at elimination or removal. These are often of a painful character, as coughing, vomiting, purging, and similar processes. It was considerations like these that induced the most distinguished physicians the world has ever seen to look upon the phenomena of disease as results of the efforts of nature. Ναυτος φύσεις ἐπίστημον, is the pithy remark of Hippocrates—"Our natures are the physicians of our diseases." Sydenham (often designated the modern Hippocrates) adopted and promulgated the same theory. It has also been made the basis of modern systems of practical medicine. Unfortunately, the theory is only true in part; it applies strictly to individuals passing from a state of health to a state of disease, and who are living under the natural conditions favourable to health and to the exercise of the restorative powers of nature. But civilized men are surrounded by circumstances adverse to healthy function or structure; are in a large proportion not strictly healthy; and are therefore in a condition of body unfavourable to the exercise of the natural restorative powers, so that these natural efforts at cure are usually more or less imperfect. Nor even in the healthy is it a process to be implicitly trusted, for in them a temporary functional disease of an important organ may embarrass the action of other organs, and lay the foundation of chronic disease; and thus, if not arrested at the outset, may render nature's efforts more or less incompetent to restore to health. Medicine, then, seeks to know the natural processes, or physiology, so as to determine when the aid of art may be limited, or when it may be fully used.

CHAPTER I.—ANCIENT MEDICINE.

SECTION I.—ORIGIN OF MEDICAL SCIENCE AND ART.

Instinctive Medicine.

A knowledge of the conditions of health and of the curative uses of drugs is instinctive. Both the dog and the cat take medical remedies when ill; the dog, in particular, selects a certain art grass and eats it medicinally. In the Greek mythology we find that a shepherd (Melampus) discovered the use of white hellebore by noticing that his goats purged themselves by eating it. He applied it to the cure of the daughters of Precius, who, having taken vows of celibacy, appear to have become hysterical and monomaniacal. Bees apparently display in their political arrangements a knowledge of the laws of health, or of public hygiene. They ventilate their hives by a process admirably adapted to the desired end; they inclose dead animals which they cannot remove from the hive in hermetically sealed coffins.

In man a simple reason takes the place of the instinct in the lower animals. Thus, if he is nauseated, he thinks he will be easier if he could vomit, and accordingly looks about for some means to fulfil his purpose. The historians of medicine have found it necessary to go back for its origin to a very early period in the history of mankind; but this seems hardly necessary to the philosophical inquirer, because modern society, and the most highly civilized races, present the science and art in every stage of development. An unlettered peasantry, remote from towns, and without a resident clergyman or practitioner, exhibits the practice of the art in all its simplest and primary forms. The sick rely upon their own experience or upon that of their neighbour, of whom one may be more sagacious or more pretentious than the rest. To this experience are added traditional medical knowledge of unknown origin, a belief in occult and mysterious agencies for evil and for good, a superstitious dread and worship of those agencies, and therewith superstitious practices and remedies. The "wise man" of the Christian village is a witch-finder, a meteorologist knowing in storms and strange appearances, a herbalist, a cunning trader on the superstition and ignorance of the people, and not without power to compel obedience to his commands. Many such still exist in every part of civilized Europe, as they have existed everywhere from the remotest history of society.

Origin of Scientific Medicine, and of a Medical Profession.

The development of scientific medicine, and of a medical profession, always takes place through successive phases. The simplest form of medical art readily passes into the patriarchal, in which the head of the tribe or community is the healer of disease and the depository of all power. To this, in a more developed state of society, succeeds the sacerdotal, in which the heads of the people bear predominantly a sacred character. Out of the sacerdotal body next arises a distinct professional body, separate from it, and therewith a distinct science of medicine; and then, as the latter is developed, antagonism and conflict take place between them. Next society passes into the phase of high civilization, and finally falls under the power of the military hierarchy. Concurrently with this change, religion, civilization, science, and medicine decay; to rise again from a renovated society. We have glimpses of this succession of phases from an early period of history. The earliest historical development of scientific medicine is everywhere traced from a priesthood, and the development of a priesthood to that combination of mental qualities and duties exhibited in the village magos. The "medicine man" of the Indian tribes in North America indicates what must have been the germ of the great sacerdotal caste which ruled so long and so powerfully the great nations of the east. Politics and law, religion and science, and (in close connection with religion and science) medicine, both as a science and an art, were all in the hands of the priesthood. This is the stage in human society of sacerdotal predominance. To this union of the priest, lawgiver, and physician, we owe that remarkable remnant of medical science found in the Mosaic writings—the system of public and domestic hygiene established amongst the Hebrews on a religious basis, and manifesting a very practical knowledge of various diseases and their origin. Learned as Moses was in all the knowledge of the Egyptians, it is more than probable that his system, in all essential details, was a reflection of the Egyptian doctrines and polity. Seventeen hundred years before the birth of Christ, Joseph commanded "his servants, the physicians," to embalm his father; a command sufficiently indicative of chemical science. Recent researches into the natural history of parasitic animals—the Entozoa—have rendered it probable that the Mosaic laws regarding clean and unclean animals had a foundation in a knowledge of these organisms—their nature, habitats, and the diseases they induced. We also get glimpses of the medical knowledge of the Egyptians in the older Greek authors. In the fourth book of the Odyssey, mention is made of Jove-descended Helen putting into wine a drug "that frees men from grief and from anger, and causes oblivion of all ills." This and other excellent drugs were given to her by the wife of Thoas, "an Egyptian;" where the bounteous land produces very many drugs; many excellent when mingled, and many fatal; and each physician is skilled above all men."

The cultivation of science could only be carried on through records of observation and experience. It was amongst the priesthood that writing arose and was first practised." Medicine, as an important branch of natural science, was necessarily a constituent element of the hieroglyphical or sacred literature, and was studied by the priests and priest-kings with ardour and success. Samuel was the chief of a school of prophets or magoi-priests; Solomon, King of Israel, was a great botanist, zoologist, and pharmacist, as well as pontiff, ruler, legislator, and moral philosopher.

Origin of a Medical Profession and Medical Literature in Asia.

The Levites, or sacerdotal caste of the Hebrews, appear Early to have practised medicine exclusively in the earlier period Asiatic of the Jewish nation. To what extent the books of Hermes are authentic and ancient admits of question; but there is no question that the sacerdotal or hierarchical division of the people into castes extended over the whole of Asia, as well as through Egypt, during the earliest periods of civilization, and that the study of philosophy and the practice of medicine passed into the hands of a subdivision of the priestly caste, and thus the profession arose. The Ayur Veda appears to be the most ancient of the Hindu sacerdotal medical writings. Its date has been fixed at not later than the fourteenth century before Christ—that is, 900 years anterior to Hippocrates; but it appears to have been nothing more than a summary or abridgement by professional writers of still more ancient medical doctrines and practice. It contained eight divisions. The first two were surgical, including obstetric surgery; the third contained general pathology and the practice of physic; the fourth, psychological medicine, or the treatment of insanity, founded on the theory of demoniacal possession, so prevalent throughout the east amongst all nations; the fifth treated of the care of infantile diseases or paediatrics; the sixth was devoted to toxicology; the seventh to personal hygiene and metallurgical chemistry; and the eighth to the diseases of the generative functions. The medical caste Hindu (Vaidya) amongst the Hindus received their designation from this ancient work—the term meaning one who understands the Vaidya,—i.e., the Ayur Veda. Besides the matters detailed, this ancient Veda contained anatomy, systematic general pathology, materia medica, and therapeutic hygiene. The ancient Hindu philosophers who lived subsequently to this work were termed Rishis; they also appear to have been a distinct body or college of commentators on the Ayur Veda, and teachers of philosophy and medicine. The Charaka, an ancient Hindu cyclopaedia of medicine, was written by one of them; it is in the form of a dialogue. Another ancient standard work of this kind is the Sushruta. It is also a commentary on the Ayur Veda, but treats more especially of surgery, in addition to other branches of medicine. The Rishis were peripatetic lecturers on medicine; they also travelled about, like the ambulant physicians of Greece, curing diseases, and illustrating the influence of customs, manners, climate, and the like, on health. Their pupils went with them and took notes of their lectures. Many of these, in the form of compilations, are still in existence. Hindu medicine has been stationary or degenerate for a lengthened period. Its origin is wholly lost in a remote antiquity.

1 Commentary on the Hindu system of Medicine, by T. A. Wise, M.D., p. 12. European Medicine in Greece.

European medicine dates as its literature from the time of Hippocrates. The Hippocratic writings constitute a very complete summary of medical doctrines and practice as they were taught in Greece about 500 years B.C. The origin of Greek medicine and medical literature is as mythical to us as the origin of the Ayur Veda is to the Hindus. The first founders of it are also equally mythological personages. Chiron evidently corresponded to the Brahmans and to the priests of Egypt in his knowledge, and to the ascetic Rishis of the Hindus in his life and conduct. The myth is, that he held a school of physics in a grotto in Thessaly, and taught philosophy, music (or the principles of art), astronomy, the military art, political science, and medicine. A majority of the Argonautic heroes, and of the commanders at the siege of Troy, are represented as having been his pupils. Hercules and Asclepius are also mentioned amongst the number. It is probable that the name indicates an ancient learned class, or incorporated body of professional teachers, rather than an individual, and points especially to the science and practice of surgery; for Chiron was celebrated for his surgery, as were his pupils. Hermes, like Chiron, was a mythical personage; and the books which bore his name in ancient Egypt are believed to express nothing more than the literature of the sacerdotal or learned corporations of Egypt. Sanchoniathon, the name of another author of this class, it is said, is a Phenician word which signified a magus (philosopher or priest). The Phenician writings that go under that name date probably from the age of the Ayur Veda. Whatever Chiron may have been, his successor Asclepius was certainly already a purely mythical person in the time of Plato, and probably for 800 years previously.

The sacerdotal period of Greek medicine commences in the twelfth century B.C. with the erection of a temple to Asclepius, about fifty years after the Trojan war. These were shortly multiplied throughout the then civilized world, and the priests were designated Asclepiads, or descendants of Asclepius. They were in all particulars a sacerdotal medical caste. Their method of treatment being carried on in the temples, comprised all the essential elements of modern systems of empirical medicine. They had hydrophatic establishments situated at or near thermal springs or fountains of living water, or upon the sea-coast, or amidst beautiful mountain scenery. Diversion of the mind, exercise of the body, regulated diet and regimen, friction and injection of the skin, sea-bathing, mineral baths, and waters,—these and similar agencies constituted their remedial means. Besides these, they acted upon the imaginations of their patients by nocturnal religious solemnities and illusions of an impressive character, performed within the sacred precincts of the temple. Modern mesmeric processes and false miracles are, in some of the details, analogous to these, and wholly so as to the general principle upon which the method of treatment is founded. These delusions of the imagination were made subjects of ridicule amongst the Greeks at a later period of national culture. Aristophanes, in one of his comedies, puts an absurd description of the whole affair into the mouth of one of the characters who had been a patient. "The priests of the temple of Asclepius," he says, "after having extinguished all the lights, told us to go to sleep, adding, that if any one should hear a hissing, which indicated the arrival of the god, he should not move in the slightest manner. So we all laid down without making any noise; but I could not sleep, because the odour of an excellent broth that an old woman held near me agreeably excited my olfactories. Desiring most ardently to slide along to it, I raised my head very quietly, and saw the sacristan going the round of the altars, take away the figs and cakes from the sacred tables, and put into a sack everything that he could find. I believed that I had a right to follow his example, so I rose up to go to the old woman's pot."

Origin of a lay Greek profession, and stage of conflict with Sacerdotal power.

These temples of Asclepius being hospitals, were also Origin of the medical schools of the time. History has preserved lay Greek the memory of four of the most celebrated:—that of Rhodes 500 B.C., was the most ancient, and was already extinct at the time of Hippocrates; that of Epidaurus was consulted by the Romans; the school of Cnidos originated a small treatise of practical aphorisms—the Cnidian Sentences; and that of Cos gave birth to Hippocrates. It was at this school that the greater number of the Hippocratic treatises were commenced, if not written, although some are doubtless of a subsequent period. The appearance of these treatises therefore indicates one of those epochs in science, like that of Sanchoniathon and the Ayur Veda, in which the accumulated knowledge of a people is re-est and digested by professional men. It was the age of Pericles,—that age in which the Greeks attained to so high a position both in arts, war, and philosophy,—the age when Socrates brought moral philosophy so near to Christian truth, and when natural history, logic, and metaphysics received a definite culture. The whole period during which the Hippocratic writings appeared extends, in fact, from the time of Pythagoras, about 500 B.C., to the death of Aristotle, 322 B.C.

This advance in Greek philosophy and science appears to be mainly due to Pythagoras in the first instance, who, having studied philosophy and medicine in the then existing schools of Egypt, Phenicia, Chaldeia, and India, returned with an ample knowledge of Hindu, Chaldean, and Egyptian science and philosophy. From the fragments that are left, we may conclude that the philosophy and system of teaching of the Brahmins was that which he adopted. His philosophical views as to the transmigration of souls, his novitiate, code of morals, rules of abstinence, temperance, and purity of person and conduct, are very similar. He also, like the ancient Rishis, travelled from town to town as a teacher or lecturer, and established communities, apparently of a monastic character, in the principal cities of Magna Graecia. Pythagoras seems to have been contemporary with Confucius, the great reformer of religion and morals amongst the Chinese, and to have closely resembled him in essential particulars. But Pythagoras and his followers were not so successful in politics as the Chinese reformers. So soon as they interfered with the established religion and governments, they became obnoxious to the priesthood and to the tyrants who governed through them; so that the Pythagorean communities were broken up, and not a few of the sect were driven into exile or put to death. The life, trial, and death of Socrates may be taken as an example and illustration of the conduct, moral philosophy, religion, and fate of the followers of Pythagoras. Science had departed from the priesthood, and was already in antagonism to it. The diviners, soothsayers, and augurs,—the pontiffs and priests, with their idols, temples, omens, and oracles, were but the participants or agents of the ruling power in the state. The natural science they possessed was mainly used as an instrument for deceiving the multitude in various ways, as by simulating the miraculous, imitating thunder and lightning, contriving the flight of birds on this side or on that—in the east or in the west. With these men the earnest seekers after truth, as well religious as physical, came necessarily into conflict; and we have enough of the history of those times remaining to judge of the result. The palmy days of the ancient Greek republics were analogous in this, as in other particulars, to the era of the modern Italian republics. A degenerate priesthood, rich in temples and lands, and possessing the secret springs of political power, held an almost undisputed sway over the unlettered populace, just as in the period of the Reformation. Equally at both periods they had become the mere exponents of hero-worship, and reflected nothing better than the vices and superstitious traditions of a sensual and ignorant people.

Votive tablets were hung up in the ancient temples by the populace, expressive of their gratitude to a deified hero for medical aid afforded, just as had been done for many centuries previously in Egypt and India, and just as has been done for many centuries past in Europe in the temples of a similarly degenerate Christian period. Strange it is to see a medical superstition like this maintaining its hold upon man, and encouraged by the priesthood, through a long succession of vicissitudes, from the earliest dawn of Babylonian and Egyptian history to the latest day of the nineteenth century. And when Galileo, like Pythagoras, developed a truer system of the universe, the dominant sacerdotal body repelled it as being fatally opposed to their traditions, and persecuted the author. We shall find that in successive eras of man's history a similar antagonism between philosophy and traditional theology,—between scientific truth and the corruptions of revealed truth,—was developed. Nay, it is far from improbable that now, in the nineteenth century, we are on the very verge of a similar conflict.

SECTION III.—RISE OF THE ALEXANDRIAN SCHOOL.

The Military Power predominant in Greece.—Decline of Greek Medical Culture.

The wars which filled up the life of Alexander, the conqueror of Greece and Asia, interrupted the progress of science and philosophy in Greece. With the loss of freedom national culture became debased, and science was trampled under feet of a cruel military superstition. Hero-worship attained its highest development in the assumption of divinity by Alexander, who outraged science in the person of Calisthenes, his friend and fellow-student under Aristotle, and whom he put to death of torture for refusing to fall prostrate before him. But after his death science soon reared its head again in Egypt, in that city to which Alexander had given his own name. Two of his lieutenants and successors (Eumenes and Ptolemy) became its firm friends, emancipated it from the control of a corrupt religion and an effete priesthood, and gave its cultivators protection and a home. Pergamos was already celebrated for its temple of Esculapius, and as a school of medicine. Here Eumenes collected in a large library all the recorded knowledge of the times. It was from this school, more than four hundred years later, that Galen sprung.

Ptolemy Lagos, the uterine brother of Alexander the Great, rivalled Eumenes in his endeavours to advance science and art. He had already interested himself in the philosophy of India, where he had witnessed the self-immolation of an Indian magus. When he ascended the Greek throne of Egypt, he endeavoured to systematize the vast erudition that had been accumulating for many centuries throughout the civilized world, to utilize it, and to advance all branches of knowledge. It was this spirit that produced the Serapion. His son Ptolemy Philadelphus not only gathered together all the written science and literature within his reach, and so founded that great library of Alexandria which survived the political vicissitudes of more than nine centuries, but he also invited to, and encouraged learned men at Alexandria from every quarter of the world, irrespective of creed or race.

This era was another of those epochs at which the human mind stops to take an estimate of its knowledge, and to lay the foundation for a new superstructure. Medicine participated in the general impulse given to science; but its greatest advancement was due to the establishment of schools of practical anatomy, and the cultivation of natural history, the materia medica, and pharmacy. Alexandria became so distinguished as a school of medicine that, in the time of Galen (nearly five hundred years after its foundation) a physician had a certain reputation already simply from having studied there. Almost all the distinguished physicians of the time were from the school of Alexandria. Herophilus was the principal connecting link between the Herophilic-Greek and Alexandrian schools. He was born at Chalcedon (not at Carthage, as some writers state), a small town in 285 B.C., and studied medicine at Cos under Praxagoras, the last of the Asclepiads, and the successor to Hippocrates. Having completed his studies, he went to Alexandria, where he reduced the dislocated shoulder of Diomedes Siculus, one of the many learned men which Ptolemy Philadelphus had gathered around him. He was an attractive public teacher, and wrote a learned, complete, and highly-esteemed theory and practice of medicine, of which, unfortunately, only fragmentary notices and extracts remain. But his chief merit was his indefatigable anatomical and physiological researches. Aristotle had already prepared the way for a great advance in human anatomy and physiology by his investigations in comparative anatomy and physiology, of which he laid the foundations. Hence, when the Alexandrian school carried their inquiries into human anatomy and physiology by careful dissection and experiments, they had their labours rendered much easier by this important advance. So extensive and comprehensive were these researches, that Herophilus may be declared with entire justice to be the founder of scientific anatomy and physiology. To him is due the great discovery of the anatomy of the nervous system, and the fundamental principles of neurology. Plato and Aristotle hardly knew that there were nerves; Herophilus demonstrated the functions of both the motor and sensitive. The anatomy of the brain and spinal cord was also much advanced by him; and it is pleasant to know that his name still sounds in the ear of the medical student when the position of the torcular Herophili is demonstrated to him. He it was who fixed the seat of thought in the brain, and more especially in the fourth ventricle. Herophilus would have been more successful if he had been free from the trammels of philosophical and religious dogmas; for it is evident that, like many original investigators, he attempted to square his researches with the established creeds of the day. Thus, although he placed the seat of the intellect or of thought in the brain, he made it only one of four forces, the other three being seated in the liver (the nutritive), the heart (the preserving), and the nerves (the sentient or feeling). In this he followed Plato and Aristotle. His great practical contribution to science was an elaborate doctrine of the pulse, which seems to have become part of the Chinese system of medicine, and is still extant in China.

Erasiatratus was the contemporary of Herophilus, and, like him, was a light of the Alexandrian school. He was a practical anatomist, a skilful and bold surgeon, and a good physician. He was sparing in the use of the lancet or powerful remedies, preferring abstinence and rest. He introduced chicory into practice for hepatic affections.

Serapion, the head of the sect of empirical practitioners, Serapion was also of the Alexandrian school, and lived about fifty years after Herophilus and Erasiatratus. To this sect belonged also Heraclides of Tarentum, who advanced general pathology and the practice of medicine, materia medica, pharmacy, and surgery. After his death toxicology had special attention. Mithridates, King of Pontus, has connected his name with a composition (a theriaca), which he prescribed as an antidote to poisons. The fact is a significant comment on the uses to which an improved knowledge Medicine of materia medica and pharmacy were then (as now) put. Elaborate pharmaceutical compounds characterized the second century before Christ. The Theriaca and Alexipharmaca of Nicander of Colophon, are two of the few works of this era which have come down to us. The formula for the Damoclean confection, invented by Damocrates, a contemporary of Nicander, contains forty-four ingredients. It was given in the Pharmacopoeia of the College of Physicians of London, published in 1746, together with others of the same period. The Phellum (a sedative compound containing opium as the efficient ingredient) was one of these; it bore the name of Herennius Philo, a native of Tarsus, the metropolis of Cilicia.

During the period intervening between the death of Alexander the Great and the first century before Christ, medicine had hardly taken root in Rome. It was studied principally in Greece, Asia Minor, Egypt, and Magna Graecia, or Southern Italy, where medical schools abounded. Some of the family of Herophilus appear to have founded a medical school at Laodicea, a city that at the time carried on a lucrative commerce, especially in wines, with Alexandria, and another at Smyrna. These seem to have been termed Herophilian.

We have nothing but fragments of the medical works which emanated from the Greek school of Alexandria prior to the Roman conquest. There is reason to think, however, that the prejudices of the people sooner or later threw obstacles in the way of the practical anatomist, and that thereupon succeeded a period of speculation and decline. This most probably began anteriorly to the Roman conquest and the burning of the great library by Julius Caesar. Cleopatra undoubtedly carried out the philosophical traditions derived from her predecessors the Greek kings, and endeavoured to replace the loss of the library by substituting that of Pergamos, which she solicited as a gift from Mark Antony. The measure served to maintain the reputation of Alexandria as a great school of philosophy, medicine, and science generally; but the ancient religion was become effete; the Roman arms triumphed everywhere, and the metropolis of the world was next to become the centre of science as well as of government, to which the great Greek schools became merely tributaries.

SECTION IV.—ORIGIN AND DEVELOPMENT OF MEDICINE IN THE ROMAN EMPIRE.

The Patriarchal and Sacerdotal Stage of Roman Medicine.

The Romans (if the early annals of the city may be trusted) were warlike agriculturists,—not civilized, yet not barbarous,—being in close intercourse with the cities of the great Etrurian confederacy, and of Magna Graecia, in which scientific culture and the arts attained to as high a development as in Greece itself. Medicine, nevertheless, passed through its successive stages of development in the Imperial city.

The Roman national mind, when fully developed, was essentially political and military; it had little sympathy for science or philosophy. The Roman people were content to be without native physicians for nearly five centuries after the foundation of the city. The elder Cato (about 200 B.C.) practised patriarchal medicine when the Greek schools were in their glory, and was himself the physician of both his household and his domestic animals. It is said, indeed, that his unskilful treatment proved fatal to his wife. Cabbage was one of his most reliable remedies; and the magical words he used for the reduction of luxations and fractures are still extant. With him this patriarchal medicine was a matter of principle, or perhaps more correctly, of pride and ignorance. He hated the medical profession. He pretended to believe that the Greeks had sworn among themselves to kill all barbarians (and to the Greeks the Romans were eminently of that class) by means of drugs. He was indignant at the imputation of barbarism. He was a type of a dominant but ignorant class still plentiful in the world. His haughty temper could not brook superior knowledge, or the claims to it. As he detested the people, so he detested the philosophers, rhetoricians, and physicians, of Greece; he accused them of corrupting the Roman people, and at last succeeded in obtaining a decree for their expulsion. Nevertheless the physicians were exempt. Two hundred and fifty years later Pliny exhibited similar national prejudices against Greek science and literature, although his Materia Medica was almost wholly copied from Greek writers. Like Cato, he denounced all foreign, that is Greek physicians.

It was when the increasingly numerous population of the city of Rome was seriously diminished by a pestilential disease, about 187 B.C., that the Romans first appear as showing an interest in medicine. On that occasion, in accordance with their superstitious prejudices, a deputation of six went in quest of advice to the great Æsculapian temple and medical school at Epidauros, when (according to the legend) they appropriately received one of the sacred serpents to take home with them, that they might build a temple to the god where the animal chanced to go ashore. This temple was duly erected, but it does not seem to have secured the usual results, that is, the establishment of a college of sacerdotal physicians. Yet it is hardly probable that sacerdotal medicine was not practised. The Etrurians possessed a knowledge of the physical sciences, and were the engineers of the day; they were also the metallurgists, chemists, and manufacturers, and they supplied augurs and a knowledge of augury to the Romans. We may conclude, therefore, that from the Etrurians sacerdotal medicine was also introduced into Rome.

Origin of a Medical Profession and Medical Literature in Rome.

When medicine became a separate profession in Rome, the Roman members did not arise out of the sacerdotal class, as in Asia and Greece. The Medici of the Romans were at first chiefly slaves or freedmen, prisoners of war captured in their campaigns against the nations of the then civilized world. The first purely professional man seems to have been a Greek named Archagathus, upon whom, according to Pliny, the senate conferred the freedom of the city, purchasing for him also a shop and surgery in the Aelian Causeway. In proportion as the Roman empire extended over the flourishing and refined cities of Sicily, Greece, Asia Minor, and Egypt, Rome became cosmopolitan, and consequently attracted to it from every quarter the ambitious intellects of the day. One of these was Asclepiades, a native of Prusa in Bythinia, who having studied at Alexandria and Athens, established himself as a teacher of rhetoric at Rome, about the year 90 B.C. The Greek language and literature were then cultivated by the Roman nobility and gentry, for it was the fashion amongst them to send their sons to study at the great seats of science in Greece. These, when they returned to Rome, welcomed Greek professional and literary men to their city, and to their personal friendship. Asclepiades had the honour of Cicero's intimacy, and of that of other illustrious men of the day. He abandoned rhetoric for the practice of medicine, and, like all characters of his stamp, not only opposed the doctrines of the medical schools as then taught, but set forth a medical philosophy of his own, which was wholly speculative. It was a sort of medical atomic hypothesis, founded on the philosophical systems of Democritus and Epicurus, then popular with the educated Romans. It is from him that the popular medical theories as to the "pores" of the body have descended. He designated the Hippocratic method of patient observation of nature as θεωρία μόρατον, "a meditation on death." His medical theories led to a simple enough practice. He had his plans for closing, opening Medicine, and relaxing "the pores," so that the imprisoned molecules could escape freely or not. Fevers, inflammations, and other "asthenic" diseases were due to obstructions of the pores; dropsy and similar asthenic diseases were due to relaxation.

He had a sort of homoeopathic maxim that one fever would cure another. Wine he administered according to the same theories which were adopted by Brown of modern times; a man whose history closely resembled that of Asclepiades in several particulars. Asclepiades was also hydropathic; for he made large use of cold water, and was the inventor of the shower-bath—the Balneum pensile.

Themison, his pupil and successor, came from Laodicea, where already there was an important medical school,—an offset of the Alexandrian. He favoured the sect of the Methodists—a term which, derived from this body, received a singular application to a religious sect in the United Kingdom, founded in the year 1739 by John Wesley, a great ecclesiastical reformer, and a fellow of Lincoln College, Oxford. John Wesley and his friends at Oxford divided the day and the week into periods, during which they occupied themselves exclusively with certain pursuits, literary, charitable, and religious. It was from the practice of this orderly routine of duties that they were termed Methodists by their fellow-students at Oxford, for that ancient medical sect adopted a similar routine of treatment of disease. It was comprised within what was termed a metasyncretic circle; during this period each day had its allotted diet, regimen, duties, the treatment in minute details being distributed over successive days in periods of three days, or ternaries. Juvenal, in one line of his first satire, has intimated what success Themison had. "Quot Themison egregios autumno occiderat uno." Methodism was a simple system; was therefore easily acquired; and, like all such, soon became very popular, especially amongst the unlearned.

Thessalus, a native of Tralles in Asia Minor, succeeded Themison, and filly flourished during the reign of Nero. He was a man of low origin, and of ignorance and audacity unparalleled in that age of charlatans. Pliny describes him as professing to make his pupils perfect in medicine in six months. By this means he attracted a multitude of students, chiefly from the lower classes, whom he took with him on his visits to his patients for half a year, and conferred upon them an authority to practise medicine.

Soranus, a native of Ephesus, but a student of Alexandria, seems to have settled in Rome with the object of succeeding to the practice of the Methodists. He was, however, a man of scientific culture. He studied anatomy, published a work on the reproductive organs of the female, wrote an interesting life of Hippocrates, and systematized the practice of medicine. His contemporary and co-sectarian, Caelius Aurelianus, a Numidian, wrote one of the best works of the day on the practice of medicine, embodying not only the doctrine of Soranus, but all the most approved doctrines of the time. With a return to scientific culture in the leaders, the sect of the Methodists disappeared.

Cornelius Aurelius Celsus appears to have been contemporary with Asclepiades and Themison, or else to have lived shortly after them. He wrote on military affairs, agriculture, and rhetoric, as well as on medicine; and was probably a practising physician at Rome. He may be taken as the type of the learned or scientific Roman, and was evidently an eclectic. His work on medicine takes almost equal rank, as a classical work, with the Hippocratic writings; or he may, perhaps, be more filly compared to Aretaeus of Cappadocia, the most elegant and finished of the Greek authors of that day; and also, like Celsus, an eclectic. Celsus recommends, for the cure of hydrophobia, that the patient should be plunged over head into water, kept there for a short time, and then raised for a brief period and dipped again, repeating, alternately, the submersion and withdrawal. This practice has been preserved in the United Kingdom as a popular remedy (Vide article Medicine. Jenner, vol. xii., p. 720), and is a curious piece of folklore, evidently derived, like many similar theories and practices, from the literature of medicine.

Period of culmination of Medicine in the Roman Empire.

The eclectic sect of Rome had in Galen its most distinguished member. He was, in all respects, a representative Galenian. At this period science had recovered from the depression which followed upon the subjugation of Asia Minor, Greece, and Egypt by the Romans; and during the subsequent two centuries had even made considerable advance. Pliny had laid the foundation of natural history; Dioscorides of materia medica and botany. All the Greek schools supplied an uninterrupted immigration of scientific men into Rome and into the large commercial cities of the empire. It was about A.D. 165, and in the thirty-fourth year of his age, that Galen went to Rome on the invitation of the Emperor Marcus Aurelius. He was born at Pergamus, and was the son of Nicon, a geometrician, who took the greatest pains with his education. He was carefully grounded at Pergamus in anatomy, and was instructed in pathology and therapeutics by two masters; the one Stratonicus, being of the Hippocratic school; the other, Æschiron, of the Empirics. After the death of his father he went to finish his medical education at the great school of Alexandria. Having mastered all the theories and knowledge of the times, he gave his talents, and much time and labour, to constructing a summary of them. His works are therefore very voluminous, and constitute a perfect encyclopedia of the medical science of the day. It is for this reason that they took rank with those of Hippocrates, and that they constituted, equally with the latter, the text-book and manual of medical literature, down to the revival of learning in the fifteenth century. The term Galenist is hardly yet extinct in some parts of Europe.

The era of Galen was the culminating point of Roman science and literature. Marcus Aurelius, his patron, knew well how to value scientific culture. He was a man descended from a long line of noble Roman ancestors, and traced his pedigree, by his father's side, to Numa the philosophic king. He had every advantage of parental example and education, and was of the sect of the Stoics. The most distinguished member of that sect was Epictetus—already a Christian in his life and moral philosophy. This man Aurelius took for his model. When he travelled into Greece he patronized science and philosophy of every kind; and on one occasion, when at Athens, founded four professorships for Platonics, Stoics, Peripatetics, and Epicureans, together with one for Rhetoric. He forbade persecution for religious opinions, and granted toleration to the Christians. Never was there a fairer prospect for science, and especially for medicine, than during the era of Galen.

The Military Power Supreme, and Decay of Medicine in the West.

Yet the works of Galen constituted the last production of ancient Roman medicine. Everywhere the empire was being spoiled by barbarian foes, and the civilization of Rome was about to experience that long eclipse which continued through the dark ages. Aurelius passed, in defence of the empire, from the Rhine to the Danube, from the Danube to the Euphrates. Insurrections occurred in all parts; the unity of the empire was at last only maintained by military force, and the military force reigned supreme, electing and deposing emperors at pleasure. The effects of this grand change were soon manifest. The military power hated science. Hardly had Galen died, when Caracalla, the parricide and fratricide, visiting Alexandria under the pretence of worshipping the god Serapis, gave up the city to indiscriminate plunder and massacre, deprived the

Medicines professors, who were Aristotelians, of their chairs, and suppressed all public discussions. He avowed a hatred of Aristotle; forbade the teaching of his doctrines; burnt his works; and persecuted to death his disciples. Caracalla was a representative man. He typified the age—an age when emperors had divine honours,—the military hierarchy was predominant, and religion and literature were equally debased. From this period the decline of medical science in Western Europe was rapid and continuous, until the incessant irruptions of the uncivilized nations of the north, and the interminable wars which resulted, reduced society to its elements. Boethius, born about A.D. 470, was the last of the Roman era of science; he was the martyr of philosophy. Thenceforward there was no longer anything but a shadow of philosophy or medicine, and all that remained was gathered under the wing of the new sacerdotal power that had arisen on the old; and which alone was able to overawe the brute force of the barbarians, and maintain social order. The era of Gregory the Great witnessed their revival.

SECTION V.—MEDICINE IN THE GREEK EMPIRE.

Partial revival of Greek Medicine in the East.

Although medicine was all but extinct in the West, it survived in the East, which withstood longer the elements of social decay, and found a new starting point in the new metropolis of the empire, founded A.D. 328 by Constantine the Great. Greek medicine had never been extinct; it was only eclipsed by the cosmopolitan grandeur. All the cities of Greece proper, and the Greek colonies of Asia Minor, as well as Alexandria, cultivated every branch of science during the Roman dominion. Yet, when the centre of medicine thus returned to its cradle amongst the Greeks, a great change had come over its social relations. It was no longer in subjection to the Pagan mythology of ancient Greece. That was about to become extinct in a faith and a religion destined to be paramount, as it had been, over the civilized world. The change had proved fatal to society in the West; in the East the empire went through the process with less disaster. But the Greek empire, with all its schools, did little to advance medical science. The Christians objected to human dissection even more strongly than the Romans. Tertullian, partly a contemporary of Galen, but several years younger, vilified the memory of Herophilus, 500 years after his death, by designating him as "that physician, or rather butcher, who dissected 600 men in order to learn the structure of his frame; who hated man, in order to find out nature?" untruly adding that his victims "did not die a natural death, but expired amidst all the agonies to which the curiosity of the anatomist was pleased to subject them." Hence, when the Christians came to power, anatomical research was less than ever possible. The succeeding authors were, for the most part, mere copyists and commentators on Hippocrates and Galen. In the middle of the fourth century Oribasius flourished, who was one of this class. He also, like Galen, was born at Pergamos, was educated at Sardis, at the school of Zeno (who afterwards settled at Alexandria), and became attached to the court of Julian the Apostate, who repeatedly appointed him the Quaestor of Constantinople. He wrote seventy-two books, which, at the request of Julian, he abridged into one. He collates from several authors not noticed by Galen, so that his works constitute a valuable appendix to those of the latter. It is interesting to notice that, towards the close of the fourth century, a Phoenician bishop (Nemesius of Emessa) appears as a physiological writer. He closely verged, it is thought, upon the discovery of the circulation of the blood, but this is not well established.

Actius, the Christian, born at Amida, a city of Mesopotamia, on the Tigris, and who wrote about the beginning of the sixth century, was a student of Alexandria. He summarized like Oribasius, and quoted also like him from authors not mentioned by preceding writers, and whose works are lost. He made a large collection of formulae, including those of many secret remedies. His writings are more interpenetrated with Egyptian and Persian knowledge than those of Oribasius; and it was probably in consequence of his oriental birth and associations that he introduced into medicine the doctrine and use of spells, rites, and incantations, and which even then had begun to disfigure and corrupt Christianity. Alexander, the son of a physician of Tralles, a city of Lydia, was a contemporary of Actius, and also a Christian of Tralles, medical writer. He was a more original author than the latter, but, like him, was a believer in magic, charms, and incantations. He furnishes the only known instance of a medical writer who avowedly borrowed anything from Osmanes, one of the most ancient of the Persian magi.

Procopius, the historian, appears to have been a man learned in medicine, if not actually a physician. He mentions the names of several of his medical contemporaries, and records their services. He describes the plague of 543, which spread from Egypt over the known world, and carried off, at Constantinople, 10,000 persons daily when at its height. He uses terms of a scientific and technical character.

Culmination and Decline of Eastern Greek Medicine.

Paul of Egina was the last of the more distinguished medical writers who lived during the palmy days of the Eastern or Byzantine empire. His birth is fixed sometime in the seventh century. He was a representative man, perhaps being a learned and practical physician, a voluminous commentator, and a skilful surgeon. He was a great compiler, adding from authors not quoted by his predecessors, as well as the original matter their own works contained. His works brought up the science of medicine to its latest development in the East, as Galen's had done in the West. Already while he wrote, the tempest which was to fall upon the empire with destructive force was gathering. Heraclius had to defend his empire on all sides; from the Longobards in Italy; from the Avars, who crossed the Danube, invaded Thrace, and marched upon Constantinople; and from the Persians, who advanced through Egypt and Syria, on the one hand, and Asia Minor on the other, as far as Chalcicodon. In 622 he commenced his successful expedition against the latter, and in the same year Mohammed openly assumed the character of a legislator and a prophet. In 640 the Arabs under Amrou captured Alexandria. The schools of science and philosophy were broken up, the professors driven away, and the great library, as is stated by some, was burnt by order of Omar II. While the followers of Mohammed were wresting its fairest provinces from the Christian empire of the East, the Emperor Heraclius was engaged in a theological dispute with Pope John IV., who procured his doctrines to be formally condemned by a council.

The Greek empire was able to maintain itself at Constantinople against the Arabs; but it was mutilated, and became more and more degenerate, so that at the time when medicine was flourishing with the caliphs, in connection with political energy and vigour, it languished with the emperors, in association with religious and political decadence. Only one Greek name is prominently connected with the history of medicine from the century subsequent to the fall of Alexandria to the date of the capture of Constantinople. John, the son of Zacharia, lived at the close of the thirteenth or beginning of the fourteenth century, and was surmamed "Actarius," an honorary title for the chief physician Actarius of the court. The religious bigotry and persecution which prevailed among the Greek Christians had at an earlier period the effect of exiling the best minds of the nation, and driving them for refuge to the colleges and Medicine. universities of the politic caliphs. At a later period the ravages of the Turks drove them alike from the Moslem and Greek academies. Already, therefore, there were numerous literary Greek exiles in Italy and France, where they were cordially welcomed, when in the year 1453 the Turks having captured and pillaged Constantinople, a number of learned Greeks fled into Italy, taking with them all the literary treasures they could carry off. That event closed the era of the old Greek civilization and science, and at the same moment was the birth of modern and true European civilization, yet after a long period of gestation.

SECTION VI.—MEDICINE UNDER THE ARABS.

Revival of Asiatic Medicine.

The exodus from Alexandria carried the light of medical science back again into Greece, and Magna Graecia or Southern Italy. In the former its decline was delayed; in the latter, the school of Salerno was either founded, or materially strengthened, by the Alexandrian refugees, and the foundation laid for the revival of letters in Europe, under Charlemagne. Later on, when the Turks took Constantinople, and the last remains of Greek science were finally stamped out, Italy was in like manner benefited by the irruption of barbarians, and became the source of light to Europe. But the central seat of medical culture was now transferred to Asia, and once again medicine was developed by an Asiatic priesthood. No sooner had the conquering caliphs consolidated their government, than they encouraged the arts and literature with the same enlightened zeal and success as the Ptolemies. Science was again cultivated over a wide extent of territory, extending from the Indus to the Tagus. It is more than probable, indeed, that medicine and philosophy were taught in very remote regions of Asia; and even flourishing medical schools existed in India and Tartary. Of these, however, little is known, although it is expected that the extension of archaeological research to Bokhara will throw much light upon the former state of civilization in these distant regions. Be this as it may, the sacerdotal power was once more triumphant in Asia, but with a new faith; and while every branch of science had its patronage, medicine in particular met with every encouragement. The Arabs generally had not only a strong liking for medical studies, but there is reason to think that the prophet himself was a student of medicine and a medical author. The schools at Alexandria appear to have been also re-established, for mention is made of professors there so late as the close of the seventh century; and at the commencement of the ninth, the patriarch of Alexandria was so celebrated for his medical skill, that the Caliph Haroun-al-Raschid sent for him to visit one of his sick wives.

Syriac translations of the Greek medical writers were made a few years previously to the capture of Alexandria, which were termed Pandects. Through these the Arabians acquired a knowledge of European science. In 687 they were translated into Arabic. In 767 Bagdad was founded by the Caliph Almanzor the Victorious, a great patron of science. He was attended in a severe illness by George Bactishua, an Indian physician, who had been educated at Nisabur, the capital of Kharassan, long the seat of an important medical school. Bactishua was most graciously received by the caliph, and at his departure was presented with the imperial fee of 10,000 gold pieces. At the caliph's request he translated numerous medical works into Arabic. The great translator, however, was Honain, a Christian well acquainted with Greek, Syriac, and Arabic, and possessor of a library rich in works on every branch of science. It is stated that the Caliph Almanzor paid him in gold, for translating Aristotle, a sum equal in weight to each volume of his translation. He was known as Honain the Translator. His example was followed by his son Isaac, Medicine, and his grandson Hobaish, both of whom enriched Arabic literature by translations of the best European writers.

The fifth caliph of the House of Abbas, Haroun-al-Raschid, Era of was remarkable for his love of science. He welcomed scien-Haroun-al-tific Christians to his court, adorned Bagdad with colleges, Raschid, and hospitals (which were added to under Almanzor), until A.D. 784. It rivalled Alexandria and Athens as a seat of scientific culture, and contained not fewer than 6000 learned Christian exiles within its walls. He it was who first set the example of attaching to every mosque that was built a college and an hospital,—an example which was most strictly followed by the Spanish Moors. The most distinguished medical professor at Bagdad at this period was Mesue, the son of a druggist, born at Nisabur. The pupil of Gabriel, the son of George Bactishua, he was especially commissioned by Haroun-al-Raschid to collect and translate into Arabic all the Greek works to be met with in Ancyra or other towns in that part of Asia.

Almanzor, the second son of the great caliph, ascended the throne in 840, and devoted himself with the utmost enthusiasm to the advancement of science. He collected the works of the learned from every quarter, applying, on the one hand, to the Greek emperors at Constantinople for assistance in his pursuits, and rendering the Sanscrit literature available on the other. He erected observatories, and had astronomical instruments constructed for the purpose of facilitating astronomical observation. He derived much knowledge of astronomy from Hindustan.

Rhazes was born in the year 852 at Rei, a city of Persia, Rhazes, and educated at Nisabur. At the age of thirty he removed A.D. 882, to Bagdad, where he subsequently attained to a high reputation. He was a voluminous writer, but the greater number of his works were compilations from the Greeks. He wrote original works; amongst these is a treatise on smallpox and measles, which was translated into Greek at the desire of one of the Byzantine emperors.

The beginning of the eleventh century witnessed the highest development of Arab culture in Asia. Haly Abbas and Ebn Sina, or Avicenna, were nearly contemporaries, and both copious Arabian writers. The former has left a full account of the state of medicine A.D. 1035, amongst the Arabs, and a history of their medical writers. Avicenna. About the year 980 he wrote a voluminous work, intended A.D. 980, to be a complete system of medicine, which he called Almuc- leus. But Avicenna was the Galen of the eastern Arabian empire. His great work was entitled the Comon, and became the text-book of Arabian commentators and teachers during the twelfth and thirteenth centuries. It had also an extended reputation in Europe even at an earlier period, which it maintained until the revival of letters. Avicenna died in 1036. Besides medicine, he cultivated philosophy, mathematics, and politics, and was at one time vizier to the sovereign of Hamadan. Only one other name appears in the history of the caliphs of Bagdad in connection with medicine,—that is Abdallatif, contemporary with Saladin. While that prince was at Jerusalem after the peace was concluded with the Christians, he gave lectures in the temple.

At the time of Avicenna the caliphate of Bagdad had already gone through the same changes as the Roman empire at the time of Galen. The body-guards of the Caliph, Asia, the head of the faithful, possessed the same power as the praetorian guards of Rome. The distant regions of the empire were being attacked by the Turks, and various provinces formed into independent kingdoms under military commanders. Henceforth medicine made no progress amongst the Arabs. The physicians were little better than commentators and theorists. It was the period of political and religious decay. The Turks finally conquered Bagdad, and swept away all traces of science. Rise of Arab Medicine in the West.

common with other sciences, found amongst the Mohammedans of the West the same support and encouragement as amongst those of the East. In the year 711, the Arabs penetrated into Spain from Africa, and laid the foundation of the Moslem empire in Western Europe. For nearly fifty years it was a distant dependency of the eastern seat of Arab power, and exposed to civil wars; but when the Ommiades or Beni Umeyah dynasty was overthrown by the Abassides in 748, a descendant of it, Abd-el-Rahman escaped from Bagdad and took refuge in Spain, where, after a series of conflicts, he established himself in the government, making Cordova his capital. His successor, the third of his name, who reigned in the tenth century, was the greatest monarch the Spanish Moors ever had. He followed in every respect the example of Almanzor and Almamon at Bagdad. He fostered every kind of science and art, founding colleges, schools, libraries, and constructing roads, canals, and aqueducts. The impulse then given was continued during the reign of his son and successor Al Hakem II., who, himself a scientific man, had an unbounded love for science and literature. He attracted the learned men of every country to his court, and founded the library of Merwan, of 250,000 works, at Cordova, the unfinished catalogue of which filled forty-four folio volumes. Within five hundred years from the conquest of Spain by the Arabs, science had been so developed that it could boast of seventy public libraries, three academies at Seville, Toledo, and Marcia, besides the world-famous university of Cordova, and hundreds of authors and teachers.

Culmination and Decline of Arab Medicine in the West.

Avenzoar was the Galen and Avicenna of Spain. He was rich, of noble birth, but a Jew both by religion and race. His father and grandfather were equally men of high reputation in the medical profession, as indeed was his son. A learned commentator, he was also an original observer, so that his works were hardly less valued in the scientific world than those of Ebn Sina. He flourished at the beginning of the twelfth century. Averroes was junior to Avenzoar, but also a contemporary, being his reputed pupil. He was educated in the university of Morocco, where he first studied law, but which he abandoned for medicine, mathematics, and philosophy. His father was the high-priest and chief judge of Cordova, and to these offices he succeeded on the death of his father. He was, however, subsequently deprived of them, and thrown into prison for his avowed scepticism. He illustrated the Aristotelian philosophy, from which circumstance he acquired the surname of "The Commentator;" and he wrote a system of medicine expressly intended to be a compilation. Averroes died about 1206.

Science was thus at its culminating point in antagonism with traditional theology. Concurrently the Moorish empire was declining, and at last was rent by bloody civil wars. The great battle of Las Navas, fought in 1213, struck at the root of the Moorish power. In 1226 Cordova, with its famous university, was surrendered to the Christians, and the Moorish King of Granada purchased peace by becoming the vassal of Ferdinand III. Spanish literature, arts, and science, declined with the declining power of the Moslem, so that Albucasis, the last of the Moorish practitioners of Spain, and who lived about the beginning of the fourteenth century, writes of surgery as being at the lowest ebb.

Spain still retained, however, her universities and much of her learning after the expulsion of the Moors. In 1512 George Almenar published on syphilis; but the succeeding Christian governments fell under an exclusively sacerdotal and fanatical influence. The Jews and Moslems had been, and were, the chief supporters of science; but that scientific toleration which the latter had accorded to all creeds was not accorded to them. Jews and Moors were diligently extirpated by the Inquisition; their literature was pronounced devilish,—themselves accursed. This priestly blight of science fell upon Spain at the identical epoch when the rest of Europe was beginning to cultivate every branch of human learning, and is felt in that country to this day. So ended Saracenice medicine.

CHAPTER II.—MODERN OR EUROPEAN MEDICINE, SECTION I.—FIRST PERIOD: FROM THE DARK AGES TO THE REFORMATION.

Sacerdotal Stage of Modern Medicine.

The imperial dominion of Rome virtually ended with the First capture and sack of the city by Ricimer in 472, and actually riled of with the abdication of Augustulus in 476. This finished dear or the succession of phases of ancient European society. Commencing with the sacerdotal power of the old priesthood, A.D. 466 to it had ceased with the fall of the military hierarchy, and 1453, once again the whole series began anew with a new faith and new races of men. Amidst the troubles of the dying empire, the municipalities had held to laws and government, and the people had found the best guarantee for peace and order in the superior wisdom and influence of the clergy. It was, however, in 466 that the sacerdotal period of modern European civilization formally commenced, in which year the Bishop of Rome (henceforth to be so powerful) was elected to fill the episcopal chair by the united voice of the clergy and people. From this date, the sacerdotal caste was gradually but surely to rise above the military, and become predominant; not by means of a conquering prophet or a military caliph, but by a reconstruction of the framework of society on the first principles of human nature. The period between the close of the fifth and the middle of the seventh century was occupied in a slow but gradual civilization by religion of the barbarous populations of both the West and the East. As a consequence, we see a gleam of light bursting forth at last in the eighth and ninth centuries over the whole earth, from Ireland in the west to the farthest east of Bokhara and Hindustan. It was a period of a grand onward movement of the human mind from that state of degradation to which the old pagan idolatry (commencing first with symbolism) had reduced it. We have already seen what the monotheistic priesthood and warriors effected in Asia.

Charlemagne in the eighth century rivalled his contemporaries, the caliphs of Bagdad, in his encouragement of the magne, arts and sciences. In his reign the cathedrals and monas, A.D. 771, tories of Christendom, like the mosques of the Moslem, had libraries, schools, and colleges attached to them, in which medicine was taught in especial under the name of physics, or the philosophy of nature. Priests, abbots, and bishops were students of medicine and the physicians of kings. Nay, even abbesses and nuns studied and practised the art. While the Arabs were encouraging the sciences and arts in Asia, Africa, and Spain, Alfred of England was endeavouring to develop them in Britain. The epoch was England, in fact one of general revival of science and civilization; but its onward movement was interrupted by the continual attacks of the pagan barbarians of the North on the one side, and the Moslem on the other. The former at last got possession of the fairest provinces of Northern Europe, and with them ignorance and a retrograde social condition of that country came on. In the regions of Europe most distant from their attacks, as Italy, the south of France, and Spain, medical and general science continued to advance up to the close of the thirteenth century. Salerno, in the south of Italy (the old Magna Graecia), which Medicine was already in high repute as a medical school so early as the eighth century, maintaining an eminent position from the tenth to the thirteenth. Constantine Carthage, one of the professors during the latter half of the eleventh century, travelled like a second Pythagoras, in search of knowledge through Egypt, Ethiopia, Arabia, Persia, and India,—countries in which the natural sciences and the arts were at their zenith under the caliphs, and would doubtless return, like his great predecessor, well stored with the philosophy and medical science of the East. Probably the development and vigour of this school was due to its proximity to the East. Portions of Naples also maintained close ecclesiastical relations with the Byzantine empire for several centuries, and the old Greek culture flourished there for a longer period than elsewhere in Europe.

Rise of a Medical Profession in Europe.

During this period the people inhabiting the shores of the Mediterranean went through the successive phases we have repeatedly traced already. Commerce introduced wealth,—wealth was followed by science and arts; then freedom of opinion was demanded, and the power and dogmas of the priesthood questioned: this in turn appealed to the military power. Next arose the old conflict between traditional dogmas and new opinions, with a loosening of the ties of society, to end in the loss of political and religious freedom. Thus in these regions the twelfth, thirteenth, and fourteenth centuries were remarkable for great commercial, religious, and intellectual activity, and an attempt at a reformation of religion; upon this followed the establishment of the Inquisition and the wars against the Albigenses. The sacerdotal power triumphed and became absolute; and the next phase came. It was now that the practice of medicine was separated from the priestly caste, and declared to be incompatible with the sacerdotal office. For several years decrees of councils and bulls of popes were launched against the combination of the two by the priesthood. Science and philosophy were thus secularized, for the study of medicine was then (as since) the study of all branches of human knowledge; hence another important social change arose. The cathedral schools were very generally erected into universities by the popes of the twelfth, thirteenth, and fourteenth centuries; science and literature thereby received the highest patronage, a home, and a special organization, and with these advantages they were rapidly developed. Encouraged by popes and prelates, the acquisition of literature from all available sources became an enthusiastic pursuit. The schools of the Moslem and Greek were visited, and their great medical and scientific authorities commented on and used as text-books. In short, it was an anticipation of the age of Leo X.

Of the mixed scientific and medical authors of this era, Albertus Magnus and Roger Bacon are the two most distinguished; the one a prelate in high favour with the papacy, the other a Franciscan priest alternately encouraged and persecuted. Both took a grand and comprehensive view of natural science in its practical relations, and included therein medicine and its accessory departments.

Practical anatomy was restored by Mondini, professor of medicine at Bologna, in 1316. He dissected the bodies of two women, and published a work on anatomy with plates. Surgery and medicine were advanced by Arnold de Ville-neuve and Guy de Chauliac. The former travelled into Moslem Spain at the close of the thirteenth century, to be instructed in Arabian pathology, materia medica, and chemistry. It was here that he probably acquired a knowledge of alcohol, of which it has been alleged he was the discoverer. The name is manifestly of Moorish origin.

Guy de Chauliac was a representative man, and deserves special notice. He flourished in the middle of the fourteenth century, and was one of the learned surgeons of this epoch.

He had mastered Arabic and Greek literature, and his Medicinae writings constituted a summary of all the then existing knowledge, and took rank with the established authorities of medical science and art. They were adopted as text-books for both professors and practitioners, and were translated and commented upon by the learned of all nations.

During this entire period the sacerdotal power was irresistible. At the beginning of the thirteenth century an attempt was made to assert and maintain religious liberty in both the south of France and in Italy, and the former last became the seat of bloody religious wars, in which the dawning Reformation was finally quenched in blood. In Italy the Inquisition was put into full operation, and the heretics were unsparingly persecuted during the whole of the thirteenth and the beginning of the fourteenth centuries. Medicine and the natural sciences did not escape. Roger Bacon suffered the same fate as Galileo in the succeeding epoch, two centuries later; and the Inquisition tried Peter de Apono, a physician and naturalist, for heresy, after his death, and ordered his body to be disinterred and burned. In this age, therefore, there arose a bloody struggle between religious truth and corrupt traditions, and between natural and experimental science and the dogmatic theology based on the philosophical speculations of Aristotle. The latter was victorious. The sacerdotal power exercised a triumphant tyranny over the people, and so became more and more wealthy and corrupt. From this date a sensible decline may be observed in medical science and art for a century.

SECTION II.—SECOND PERIOD OF MODERN MEDICINE: FROM THE COMMENCEMENT OF THE GREAT REFORMATION TO THE FALL OF THE SACERDOTAL POWER.

Phase of Development under the Priesthood.

At the commencement of the fifteenth century commerce had acquired an extraordinary development in Italy and along the shores of the Mediterranean, and therewith modern European arts and sciences,—for they always follow in their train—medicine. Before its close, editions of the Greek and Latin classics, hitherto only to be met with in manuscript, were printed. Andreas Verrochio, the director of the Academy of Arts at Milan, and the master of Leonardo da Vinci, impressed upon artists the necessity to excellence in art of anatomical knowledge. Da Vinci (born in 1452) carried out these ideas into practice, and carefully dissected the human body at Vaverola. He made very many beautiful anatomical drawings, which still exist. Da Vinci was also an observant physiologist, a profound mathematician, a skilful architect and engineer, as well as a painter and sculptor.

The period was in truth one of immense progress in every direction. Society was more and more consolidated, commerce extended, political freedom developed. It was, like the period of the Greek republics, an age of large cities and small independent communities, the rulers of which encouraged science and art and learning by all the means in their power.

The first manifest movement arose with the wealthy merchants and republican governments of the large commercial cities of Italy. As they declined from intestine wars and feuds, the military power usurped authority, and the republics fell under the power of successful military commanders; yet, nevertheless, these also continued the public patronage of science and art already begun. The history of the Medici family of Florence, in its relations to philosophy, science, literature, and the arts, from Cosmo the Father Patriae, born in 1389, to Leo X., who died in 1521, is in fact a history of what this class did for science in all parts of Italy. Giovanni de' Medici died, in 1428, a wealthy and successful merchant, leaving two sons, both of whom, as well as their descendants, occupy an important position in the story of Italian progress. Cosmo the Elder continued the ex- Medicine. extensive commercial enterprises of his house, and at the same time surpassed almost all the princes of Europe in his magnificent support of literature and science. He founded a philosophical academy at Florence; collected, by means of his numerous commercial agents, the Greek, Latin, and Arabic MSS. which formed the basis of the Laurentian Library; and administered a liberal hospitality to learned men. He died in 1464. His grandson, Lorenzo the Magnificent, carried on the scientific and literary enterprises which Cosmo had begun. He also encouraged the cultivation of the Platonic philosophy; collected MSS. from every quarter, but especially from the East; and when the art of printing was discovered, instigated the publication of collated and correct editions of the classical writers.

On the capture of Constantinople by the Turks, he welcomed and employed the learned Greek refugees as professors and teachers of the Greek language, literature, and philosophy.

Leo X., a great sacerdotal ruler,—the Haroun-al-Raschid of his era,—was the son of Lorenzo the Magnificent, and trod in the steps of his ancestors in their patronage of literature. He founded a Greek college at Rome; established a Greek press under the management of John Lascaris, who had brought 200 MSS. from the East for his father; restored the university of Rome in all its departments; collected all available talent about him, whether of science or art; and took every possible means to add to the literature of the times. This was "the age of Leo X." It was the culminating point of European medieval civilization and science, and the hour of final departure of the old Greek. Its great characteristics are two,—the restoration of Greek philosophy and literature to Europe, and the discovery of the art of printing. Henceforth science was to march forward independently of kings and priests; with a printing-press it passed over to the people, and there won a dominion of its own.

The immediate effect on medicine of the capture of Constantinople was to give a new impulse to the cultivation of Greek medical science and literature. The learned fugitives who became teachers of both the Greek medicine and philosophy in the Italian universities and academies, attracted to their lectures enthusiastic students from all parts of Europe. In 1484 Thomas Linacre, the founder of the College of Physicians of London, left Oxford for Florence that he might attend the lectures of Demetrius Chalcondylas, an Athenian refugee, and became at the same time an inmate of the palace of Lorenzo de' Medici, as companion to that prince's children. From Italy the taste for books, libraries, and sound learning was diffused over Europe. A great number of ancient works were edited, translated, and commented upon. The authenticity of MSS. and the purity of texts were closely scrutinized; and finally the great mass of Greek and Arabian medical literature was irrevocably made European. In little more than a century from that date, Amice Foes had completed his great undertaking,—the first and best Latin translation of the Hippocratic writings. Concurrently with this important movement, original authors arose in great numbers, who contributed to its progress, or summarized the results. Of the latter class was John Fernel, born in 1497 at Clermont, and physician to Henry II. of France. He was both a Greek and Arabic scholar, a profound mathematician, and an original thinker. He boldly questioned the dogmas of Galen, then almost considered sacred, and gave a new impulse to systematic medicine. He was, in fact, the Ebn Sina and Galen of his epoch.

Phase of Conflict with Sacerdotal Power, and Decline of the Latter.

It may facilitate the comprehension of the true position and character of existing modern medicine to look back upon the long and devious course we have travelled, extending, indeed, over 3000 years. Our first glimpses of medicine show it in intimate connection with sacerdotal Phase of predominance in India, Egypt, Judea, Phoenicia, Greece, conflict as far back as we can see in its history. Fifteen centuries modern of the Christian era have elapsed, and we find it in intimate connection with sacerdotal predominance still. The head of sacerdotal power of Christendom bears the title of Pontifex Maximus, like his Egyptian prototype and his Roman predecessor; and that power has been predominant for more than 1000 years. Already, in the fourth century, the bishops and clergy were the ruling municipal authorities; and when the Bishop of Rome assumed and asserted supreme power over all other authority in Christendom, he was but the proclaiming and impersonation of a long existing reality. But that power is at its culmination, for we find all those phenomena in the development of medicine which mark an epoch. Religion is, in fact, no longer the binding tie of society; the head of the church hardly thinks it necessary to be even of good moral conduct; the augurs laugh in each other's faces; and the financial, aesthetic, and scientific development of the church is at the highest. For all that, the decay of the sacerdotal empire of Rome has already commenced. The new reformation begun in Italy at this epoch by Savonarola and others was quickly quenched in blood, as in the thirteenth century; but the field of conflict was wider than in that period, and in a few years it burst forth in Germany. There Tetzel was impious with his indulgences as Alexander when he assumed to be Jupiter, or as the Roman emperors when they proclaimed themselves to be divine. Savonarola was executed on May 23, 1498; Luther affixed his ninety-five propositions to the gate of the castle church of Wittenberg on 31st October 1517. From that day commenced the disintegration and decline of the sacerdotal empire in Europe. Since then the seat of sacerdotal power has been transferred to the north-east, and the Emperor of Russia wields the dominant sacerdotal sceptre of the world. He is who, from small beginnings at this era, has risen to be the usurping head of the Greek church, with his chair fixed temporarily at Moscow, but his hopes on Constantinople. All experience shows that the course of the sacerdotal czars will be necessarily militant and aggressive,—that is, conquering. The head of the Mohammedan priesthood is all but extinct; his extinction is but a question of time and accident: he is a political necessity only,—a Turkish high-priest supported by Christians.

It was not long before medicine experienced in Italy, in common with the sciences generally, the consequences of the change we have described. The impulse given to them during the era of the free commercial republics ended finally in depression under a leaden despotism. Throughout France and Germany the era of those religious wars succeeded which thinned the population, devastated towns, interrupted commerce, and by again rendering the sacerdotal power secure, although with diminished empire, laid the foundation for the great revolution which commenced at the close of the eighteenth century. Great Britain and the Baltic states being remote from the thick of the fight at the great Reformation, happily escaped in great measure: the north of Germany sank down exhausted.

The discovery of printing placed the means of acquiring the true knowledge in the hands of the people. Protestantism demanded and obtained for them the right to the free use of those means. The great political principle of Christianity, that all men have equal rights before God and the law, became an article of faith both political and religious. It is upon this principle that the true European civilization is based; all others are but a continuation of the old and really oriental civilization. Hence the Reformation was the great muniment saliens of a new form of social life destined to be Medicine, ever in conflict with the old; and to the countries of the Reformation medical science at last fled. While, then, the centre of sacerdotal empire has passed from Rome to Moscow, the centre of commercial and scientific empire has passed over to London and the universities of Great Britain. Remarkable is it to see this empire already confronting the great sacerdotal ruler of the world in both Europe and Asia, and supporting politically the two decaying priestly rulers of Rome and Constantinople, as a counterpoise to the younger and more vigorous. Remarkable is it, too, to see that her language is spreading through every region; that her scientific arts are changing the face of civilization by giving an incalculable increase of social and material power to man; and also, which is more to our purpose, remarkable is it to see that she is restoring medicine and the arts to those countries from whence, in connection with the sacerdotal form of government, they seem to have originally sprung. British medicine has taken root in both India and China. In India, schools, colleges, libraries, are established and multiplying, and the educated natives acquire a knowledge of English science and literature as the ancient world of Europe sought a knowledge of Greek, and the medieval of Latin. The history of medicine may with justice, therefore, be especially associated for the future with its progress in Great Britain.

SECTION III.—THIRD PERIOD OF MODERN MEDICINE: FROM THE REFORMATION TO THE CLOSE OF THE NINETEENTH CENTURY.

Origin and Development of a Medical Profession and Medical Literature in Great Britain.

Linacre proceeded from Florence to Rome, and studied medicine and natural philosophy, applying himself more especially to the works of Galen and Aristotle. Having graduated at Padua, he returned to Oxford, where he gave temporary lectures on physic, and taught the Greek language. Henry VII employed him professionally; and he stood high with his successor Henry VIII, who patronized men of letters. Cardinal Wolsey was like-minded, and, as the result of this patronage, it was stated that the English court contained more men of learning than any academy. Thus dawned the Elizabethan age in England. At this time the bishops in their several dioceses had the power of granting licences to practise medicine. It was therefore followed as a profession chiefly by illiterate monks or by unlicensed empirics. To remedy this evil, Linacre exercised his influence with Wolsey, and procured letters patent, dated 1518, founding a college of physicians in London, and was elected the first president. He entered into holy orders before he died. (See LINACRE.)

John Kay, born in 1510, succeeded Linacre. He founded the only medical college existing at Cambridge. Like Linacre, he was an erudite physician, and studied Greek and medicine in Italy as well as at home.

Harvey lived at a time when the novelty of Greek literature had passed away, and men's minds were turned to original research. Like Linacre, he graduated at Padua, where he studied anatomy under Fabricius ab Aquapendente. Returning to England, he made the famous discovery of the circulation of the blood. (See HARVEY.) Sir Thomas Brown, the author of Religio Medici, was his contemporary, but his junior.

Sydenham was another of the first great English physicians who were born and educated before the civil wars. He has raised the name of English medicine as high as any. Montpellier was then a celebrated school of medicine (for the Italian schools were already declining), and to this Sydenham repaired after graduating at Oxford. Like Harvey, he took a side in the civil war, but as a parliamentarian, and was more of a partisan; Harvey being the physician to Charles I., remained simply faithful to his friend and king. Sydenham was, however, younger than Harvey by 46 years, the date of his birth being 1624, when the discovery of the circulation had been already before the scientific world for four years. These two men initiated great changes in medical science.

Several distinguished men arose on the Continent at this Rhodian epoch, and influenced the progress of medicine. John Riolan of Paris was the principal opponent of Harvey, and being the greatest anatomist of his age, his opinions had much weight with his contemporaries, and delayed the recognition of Harvey's discovery by the medical world. When at last it was accepted, the changes in medical researches and theories were rapid. Malpighi, Anatomy, working in 1661 with the microscope, demonstrated the Malpighi motion of the blood-corpsesles in the capillaries. The discovery of the anatomy of the lacteal vessels (1647) by Pecquet, a student at Montpellier, had already overthrown Pecquet, the current theories as to the relations of the liver to the circulation; and in 1661 Malpighi showed the true anatomy of the pulmonary tissue and its relation to the circulation. Hence arose new theories of nutrition, respiration, and circulation. In 1668 Mayow approached very near to the Mayow modern theory of respiration. While anatomy and physiology were advancing with such long strides, all the other branches of medical science were progressing too. The cultivation of the occult sciences had led the physicians and philosophers of the latter end of the fourteenth and the beginning of the fifteenth century to Arab literature; and knowledge acquired by the Moorish chemists, especially of Spain, was applied to medicine. Thus the foundation of modern chemistry was laid. Very soon the principles of the science were applied to anatomy, physiology, and pathology. In 1527 Paracelsus was professor at Basle, teaching a strange Paracelsus mixture of magic, astrology, geomancy, and medicine, and introducing powerful chemical remedies into practical medicine, especially mercury and antimony. He commenced his first course by publicly consigning to the flames the works of Galen and Ebn Sina. A century later Van Helmont partly founded the iatro-chemical school of which Sylvius, or Francis de la Bois, professor of medicine at Leyden in 1648, was the most distinguished ornament on the Continent, as was Willis in England.

Thomas Willis was one of the physicians of the time of the great civil war. He took the side of the king. At the psychological Restoration he received the appointment of Sedleian professor of natural philosophy in the university of Oxford. Willis in the preceding year (1659) had already published chemical theories of fever and of the urine, in which he adopted the doctrines of Sylvius. Willis was, however, more remarkable for his researches into the anatomy, physiology, and pathology of the brain. He it was who first distinctly advanced and applied the modern doctrine, that the brain is a congeries of organs, and who especially assigned the cerebellum to the involuntary movements. Van Helmont in the preceding century had broken the ground of physiological metaphysics, and had theorized on the Archeans. Willis, following Van Helmont in this department as well as in that of intro-chemistry, entered into those profound metaphysical discussions which then occupied the greatest thinkers of the day, such as De la Bois, Descartes, Newton, Leibnitz, Locke, Hobbes, Grew, Sydenham (in his Theologia Rationalis), Wedel (of Jena, then a renowned university); and, later on in the century, Hoffmann and Stahl. Willis was a man of great practical piety. He appropriated all his Sunday fees to charitable purposes; he procured a service to be performed early every morning in a church in St Martin's Lane, that he might be able to attend before he visited his patients; and he dedicated his treatise De Animalium Brutorum to the Archbishop of Canterbury. All this did not prevent the calling in question of his orthodoxy by the theologians; for the old sacerdotal spirit of unquestioned predominance and Aristotelian preference still remained in the reformed clergy.

Midwifery. Midwifery first took its origin in this century as a distinct department of medicine. The sage-femme of Marie de' Medici published in 1609 or 1626 a collection of obstetrical observations; and in 1668 the appearance of a formal treatise by Francis Mauriceau, chief accoucheur to the Hôtel Dieu in Paris, laid a stable foundation for the science and art.

Surgery. Surgery had not such a crowd of promoters as the other branches of medicine. Foremost amongst them was Richard Wiseman, surgeon to Charles I. and his son during the civil wars. He was taken prisoner at the battle of Worcester. At the Restoration he was appointed serjeant-surgeon to Charles II.

Botany. Botany had already been largely advanced in connection with materia medica in the sixteenth century. Its revival arose partly from the efforts of commentators, as Anguillara and Facho, to illustrate the older writers, partly in the occult doctrine of signatures adopted by mystics like Paracelsus, Baptista Porta, and Crollius. Conrad Gesner of Basle principally laid the foundations of modern botany in the middle of the sixteenth century. He was followed by Andrew Cassalpin and others. In England Grew, in the year 1682, advanced vegetable anatomy and physiology far beyond his contemporaries; while John Ray laid the foundations of zoology as well as of English botany. Woodward, one of the founders of English geology, belongs more to the next century.

Mathematics was much cultivated at this time, but more particularly in reference to dynamical philosophy. Two natural philosophers, Sir Isaac Newton and Leibnitz, were at the head of the mathematicians; but several physicians engaged in the study, and applied the science to medicine. These were the iatro-mathematicians. The discovery of the circulation and of animal mechanics in connection with anatomical research, naturally led to this method of investigation. Borelli of Pisa was the founder of the sect. The first volume of his great work De Motu Animalium was published at Rome in 1680, the year after his decease. Bellini, his pupil, followed up his views; and later on, Baglivi, the Roman Hippocrates, applied them to pathology. In Great Britain Archibald Pitcairn of Edinburgh, the pupil of Bellini, applied mathematics to medicine. It was, however, in the beginning of the following century that these iatro-mathematical theories received their full development.

This very general and rapid survey of the state of medicine in the seventeenth century will at least suffice to show that it advanced more in every department during that stirring period than in any preceding century, not excepting that in which the school of Alexandria was established. The age was one of progress throughout. The impulse given to learning during the close of the sixteenth century was felt in every department of human knowledge; nor did the civil wars in Great Britain and Ireland at all diminish its effects; perhaps they rather kept it up by developing men's energies.

The most striking event of this epoch in the history of medicine is the foundation of the Royal Society of London, the first of the kind constituted out of Italy. It is of sufficient importance to merit special notice. We have seen that in the eighth century the learned societies were sacerdotal in their origin, being connected either with mosques, monasteries, or collegiate churches; that in the thirteenth and fourteenth centuries they were less sacerdotal, and appeared as universities, yet under the protection and control of the church. In the sixteenth and seventeenth centuries medicine (still as physics) had so widely extended its limits, that it required special institutions for their development, for in truth they comprise within them every branch of natural philosophy. The universities were leavened with the old Aristotelian philosophy; medicine wanted the new. The theologians were still predominant in them, and fettered inquiry; medicine wanted freedom. Politics were discussed with sword and gun; medicine wanted to seek after truth in peace. Hence it happened, that in Origin of the very hottest of the great civil war some of the most the Royal distinguished of the English school of medicine handed Society themselves with other investigators of nature, and, with A.D. 1643, their co-operation, finally established the Royal Society of London, the modern head and home of natural science.

It is worthy of notice that the supporters of the sacerdotal power instinctively perceived the new society to be an enemy; and in 1667, seven years after its formal foundation, Dr Sprat, afterwards Bishop of Rochester, had to defend it from their attacks. It was objected that the society neglected the wiser and more discerning ancient philosophers, and depended too much upon their own unassisted powers; that, by admitting men of all religions and all countries, they endangered the stability of the established church; and, more than all, that a philosophy founded on experiment was likely to lead to an overthrow of the Christian religion, and even to a formal denial of the existence of God. It was on such grounds that the old Greek philosophers were persecuted to death. The Roman priesthood of Christendom had met the scientific men and discoveries of the two previous centuries in the same spirit and with the same argument. Unhappily for themselves and for religion, they also possessed the power of compelling at least an apparent submission to them. Galileo Galilei demonstrated the falsehood of the Ptolemaic system; but the priesthood had affirmed its truth, and as their authority rested on the assumption that they were infallible, to question their dogmas was to shake the very foundation of their power. Galileo was therefore compelled to recant his opinion, that the earth moved round the sun; but his whispered reservation of "It moves for all that," was as prophetic of the advancement of philosophical truth as of the certain recognition of his own doctrines.

In Protestant countries natural science was now free. Medicine. The beginning of the eighteenth century was especially in the eighteenth century characterized by the establishment of Clinical Medicine, seventh century or bedside teaching on a systematic plan. The obvious necessity to the student of a practical acquaintance with disease must have been felt at all periods of the history of medical art. The simplest method of securing this to him would be for his master to take him to the bedside of the sick. In private practice the facilities for this method are limited by the inconvenience which is necessarily inflicted if any number of students enter private houses. Hospitals, therefore, or at least public institutions of some kind for the reception of the sick, have been usually used for this purpose. In modern times the first recorded attempt at systematic medical instruction was made at Padua in 1578. About the commencement of the seventeenth century, Otto de Heurn introduced it at the university of Leyden.

The celebrated Francis le Bois succeeded him in 1658, and attracted numerous students for a period of fourteen years. The fame of Leyden as a medical school seems to have begun at this time. The method does not appear to have been continued after his death, or went on at least with much less éclat; but in 1701 Boerhaave, a representative man, was elected to the chair of the institutes of A.D. 1701, medicine, or physiology. He was destined to impress his character upon European medicine for half a century.

Hermann Boerhaave, the son of a country Protestant clergyman, resident two miles from Leyden, was originally intended for the church. At the age of eleven he could read Greek and Latin with tolerable accuracy. To these languages he added the study of Hebrew and Chaldee, with ancient and modern ecclesiastical history and mathematics. When aged twenty-one (in 1689), he took his degree of Doctor of Philosophy, and selected as the subject of his inaugural thesis, "the distinction between the soul and the body." This indicated the bent of his mind. He was taught mathematics that he might be able to pursue his studies in medicine; and finally, at the age of twenty-five, took the degree of Doctor of Medicine. Eight years afterwards (1701) he was appointed lecturer on the theory of medicine at Leyden; and in 1705 he became physician to St Augustine's Hospital, and lecturer on the practice of medicine. From this date he commenced systematic clinical medicine, and gave clinical lectures twice a-week.

Boerhaave was professor of both chemistry and botany at the time he held the chairs of theoretical and practical medicine. He was therefore an encyclopaedist. His mathematical and classical knowledge made him a man of extensive erudition, so that he was admirably calculated for the duty of reducing to order and systematizing the vast mass of scientific materials which had been accumulating during the preceding century. He placed physiological science in immediate relation with pathological research; he advanced practical medicine in all its departments; he was the first to make chemistry intelligible and delightful; and he largely developed botanical science. His system of medicine was eclectic, and, in some way or other, comprised the doctrines of the ancients, and the views of the iatro-mathematical and chemical theorists, together with his own speculations as a blending medium. He was the Galen, the Ebn Sima, the Fernel of his age. Already, therefore, a social epoch is ending, and another is about to commence. Before the end of the century the old institutions of European society were being swept away; the sacerdotal power was being annihilated, and the "goddess of reason" installed in the capital of France, in which, within a few years afterwards, the representative of that power was a captive to the military. Standing a while at these epochs to look back, we see that human affairs ebb and flow in grand tides as regularly as the tides of the ocean; for a while they seem to be restrained within safe limits, but one wave at last surely towers high above the rest, and falls with thundering and irresistible force upon the shore. In such a catastrophe, although beginning so favourably, the eighteenth century closed. The retrospect is a warning to the present generation.

In England, at the beginning of the eighteenth century, there were men who belonged to an earlier period than Boerhaave, but they were engaged in the same work. Mead, like Boerhaave, was the son of a Protestant minister. He was educated at Utrecht, studied medicine at Leyden, but graduated in 1696 at Padua, then a famous school. In 1703 he became physician to St Thomas's Hospital, and lecturer on anatomy at Surgeon's Hall. He was physician to George II. when Prince of Wales, as well as after he ascended the throne. He was the friend and successor of Radcliffe; was a learned man; wrote elegant Latin; read Greek and Arabic. He translated Rhazes's work on smallpox and measles from the only remaining Arabic manuscript, supplied to him by Boerhaave. Like Boerhaave, he had a vein of piety in his character, and to this probably was due his work entitled Medicina Sacra. Freund, the friend and contemporary of Mead, wrote a history of medicine. This was also done by Le Clerc about the same time.

To this era belong also Sir Hans Sloane, Arthurnot, Garth; all learned men, collectors of manuscripts, books, coins, and the like; chemists, botanists, poets, and the associates of the literary men of the time, as Dryden, Pope, Swift, &c.

British medicine is closely connected with the university of Edinburgh from the close of the first half of this century. A chair of theoretical medicine and botany had already existed for several years, when in 1713 a chair of chemistry was founded. The success and the example of Boerhaave at Leyden were not lost upon the university, so that shortly after his death a chair of clinical medicine was established on the same model. There was no medical school at either of the English universities, and the schools of the metropolis had no collegiate character, and were imperfectly organized. Rutherford and Monro were the first clinical professors at Edinburgh; the one lectured on surgery, the other on medicine. Whytt, the Monros, and Gregory were Whytt, eminent teachers and writers at this time, or a few years subsequently, all being more or less under the influence of Boerhaave. But the chief man of the Edinburgh era was Cullen. He it was who formed the principal link between Cullen, the doctrines of Boerhaave and those which arose during A.D. 1756, and at the close of the great revolutionary wars. Associated in early life with William Hunter (with whom he always maintained a warm friendship), Cullen, after various struggles, commenced in 1746 a course of lectures on chemistry in the university of Glasgow. In ten years after he occupied a similar chair at Edinburgh. In 1763 he succeeded to the chair of materia medica; in 1766 to the chair of institutes of medicine, or physiology, and resigned that of chemistry in favour of Dr Black. On the death of Rutherford he was associated with Gregory as alternate occupant of the chair of practical medicine. That distinguished physician did not live long, and Cullen became the sole professor. Cullen, like Boerhaave, systematized medicine, which his varied knowledge and great original powers enabled him to do well. In this work Van Swieten in Germany was his rival. But during his career the spirit of original research and investigation was awakened, and although he began with a compiled exposition of the doctrines of Boerhaave, he ended with a set of doctrines of his own. Albert von Haller, his contemporary, Physio- was at the same time laying the foundation of a new system of physiology, and pursued the same course. Up Haller, to 1747 Haller had used the Institutions of Boerhaave as the groundwork of his lectures on physiology; but in that year he published his Prima Linea Physiologica, and thenceforth to the end of the century, he was one of the great lights of medicine. In London, at this period, John and John and William Hunter laid the foundation of the English school of physiology.

At the same time that medicine began a fresh starting-point science and literature also took on a fresh development. Influence Voltaire, although a few years senior to Haller, ran a course in philosophy and literature somewhat parallel. Religion at this time, as in the fifteenth century, had greatly ceased to be a reality, and had degenerated into ceremonial observances. The Jansenists, to which sect Voltaire's eldest brother belonged, had attempted a reformation, but were wholly scattered by persecution at the time that Boerhaave was at the height of his reputation; and the Roman priesthood had nothing better to offer to the people than a rigid adherence to ecclesiastical discipline and forms; that is, a submission to the power of the priests. In 1730 the celebrated actress Adrienne Lecouvreur was refused the rites of sepulture because of her profession. Voltaire wrote verses on the subject full of indignant invective, and from that time his whole life was a contest with the sacerdotal power. The reaction against the formality and laxity of the priesthood took place later in Great Britain than in Roman Catholic France, and did not begin, in fact, until the time of Wesley and others, when Jansenism was already extinct on the Continent, and the new reformation suppressed.

While religion decayed more and more, and the court, Natural nobility, and higher clergy became more and more luxurios, science, as in former epochs, was continually progressing. An era like that of the close of the fifteenth century was, in fact, in full vigour; and a large number of scientific men were developing every branch of science. Medicine being so intimately related to every branch, largely participated in the movement. It would be a vain attempt Medicine, to indicate in our limited space the progress made in each. It must therefore suffice to point out the grand advance made in what may be termed the science of matter, organic and inorganic, or chemistry. In Great Britain, Black, the friend of Cullen and Watt, led the way by his discovery of carbonic acid gas and the laws of heat; Cavendish discovered hydrogen gas; Priestly oxygen and other gases. These preceded Davy. On the Continent Bergmann and Scheele were working in the same direction, together with Guyton de Morveau, Lavoisier, Berthollet, Fourcroy, Klaproth, and others. A new nomenclature was given to the science, and it was re-cast from the foundation, and placed on a stable basis.

SECTION IV.—FOURTH PERIOD OF MODERN MEDICINE.

The first half of the Nineteenth Century.

At the commencement of the present century an improved chemistry, springing from the bosom of medicine, almost established modern civilization anew. On the one hand, numerous vital processes became intelligible, or at least it was at last possible to discover their nature by scientific research. Physiological science thus received an impulse, and therewith practical medicine, which even now is far from its maximum. On the other hand, the means of controlling nature, and of discovering her secrets, were placed within the hands of man. The laws of heat, as developed in steam, in metallurgy, and in manufactures; of electricity and galvanism; and of chemical affinity; have been applied to the practical uses of society, with results already so remarkable, that one mind would not suffice for their full expression. From the same causes, every kind of philosophical aid to research has been so improved that no branch of physical science is without good and appropriate instruments. Astronomy and meteorology have, however, most profited by them. The results of the last half-century, as it regards medicine, will be best shown by a note, however brief, of the present state of medical science, and of the medical profession in the United Kingdom.

Present state of Medical Science in the United Kingdom.

The extent of the teaching, and the number of subjects taught, constitute a measure of a science. The entire number of medical schools in the United Kingdom, not including Oxford and Cambridge, is 39. Of these, 12 are attached to the great hospitals of London, and 11 to those of large towns in England. There are 6 in Scotland, and 10 in Ireland. The entire number of recognised teachers in the various departments of Medicine cultivated in these schools is 493, being nearly 13 teachers to each school; besides tutors, private lecturers, and assistant lecturers. In the London schools there are 182; in those of the English provincial schools, 164; in Scotland, 68; in Ireland, 79. In Oxford and Cambridge there are 11 medical chairs, occupied by 9 professors. The entire number of students of medicine at these schools is about 3000, or about 1400 in England, 1000 in Scotland, and 600 in Ireland. With few exceptions, these institutions are wholly self-supporting, having no endowments from either private individuals or the state; in many instances the pecuniary remuneration is of trifling amount, and in some is even insufficient to meet the current expenses of the course of lectures.

The subjects taught are from thirty to forty in number, and are divided as follows:—ANATOMY, or the structure of the human body, has several subdivisions. First in order is general or descriptive anatomy, as the parent of all. ANATOMICAL DEMONSTRATIONS teach structure from actual dissection of the body. HISTOLOGY demonstrates the minute anatomy or composition of structures as discernible by the microscope only. COMPARATIVE ANATOMY (including palaeontology) teaches the anatomy of the lower animals, with special reference to human anatomy and human physiology. MECHANICS, PRACTICAL ANATOMY is that branch which applies a knowledge of structure to the right performance of the operations of surgery. PATHOLOGICAL ANATOMY points out the aberrations from the normal or healthy structure of the tissues or organs of the body.

Anatomy is essential to a knowledge of healthy or of diseased function, or, in other words, to physiology and pathology. To both, but in particular to Physiology, are also subservient the departments of ORGANIC CHEMISTRY, or the chemical constitution and composition of living tissues and products in health and disease; NATURAL PHILOSOPHY in all its branches, except medical meteorology, which has not yet been taught separately; and NATURAL HISTORY, including ZOOLOGY and BOTANY. Pathology takes in a wide range, inasmuch as it includes the nature, causes, and symptoms of disease, or etiology, symptomatology, and doctrinal questions. The ART OF MEDICINE is Art of teaching in the schools in numerous departments or subdivisions. First, as we have general or descriptive anatomy, so we have courses of general PRACTICAL MEDICINE, in which, in addition to general principles of treatment, the relief or cure of special visceral diseases, not included in curative special courses, is considered. This is PRACTICAL MEDICINE. Similar courses of instruction are given in SURGERY and OBSTETRICS. All these, again, have their subdivisions. Thus, as subdivisions of practical medicine, PSYCHOLOGICAL MEDICINE teaches the nature and treatment of insanity, and EPIDEMIOLOGY treats of epidemical diseases. Surgery subdivides into MILITARY SURGERY, OPERATIVE SURGERY, or practical training in the performance of surgical operations; and the surgery of the principal organs of sense, or OPHTHALMIC and AURAL SURGERY; to which may be added the treatment of diseases or defects of the teeth, or DENTAL SURGERY. Obstetrics has the sub-departments of OPERATIVE MIDWIFERY, and DISEASES OF CHILDREN. Further, all the great departments of the art are systematically taught at the bedside in the principal hospitals. These are designated CLINICAL COURSES. There are, therefore, courses of clinical medicine, surgery, and midwifery. Under this head HOSPITAL ATTENDANCE, or "hospital practice," must be included.

Medicinal agents are largely used in every department of practice. These are included under the term MATERIA MEDICA, and courses of instruction are given as to their nature, composition, and uses. Subservient to materia medica are GENERAL CHEMISTRY (comprising heat, galvanism, and electricity) and MEDICAL ZOOLOGY and BOTANY. THERAPEUTICS includes instruction as to the application and administration of every kind of remedy.

The prevention of disease has not hitherto had that special attention devoted to it in the United Kingdom which medicine it deserves, and as yet there are only three chairs of PUBLIC HYGIENE. The subject has been usually included under etiology, practical medicine, and medical jurisprudence. In like manner, DIETETICS (of which there are two chairs) has been usually included either in practical medicine or materia medica and therapeutics.

State medicine, or MEDICAL JURISPRUDENCE, is taught in Political all the schools, and discusses all questions of medical science and art bearing upon the administration of the law. Practical hygiene as to nuisances, disputed questions of mental capacity or moral responsibility on the ground of imbecility or insanity, and the causes and modes of violent death, are included under medical jurisprudence. TOXICOLOGY is one of its most important subdivisions, but has also relations to materia medica, pathology, and practical medicine.

The cultivation of all these departments of medicine, whether they be considered as branches of the science or of the art, is not possible without a knowledge of the means and modes of research available thereto. The principles Medicine of optics, acoustics, and hydraulics have been applied to the construction of several aids to the senses, of which the microscope and stethoscope are the chief. Skill in the use of these is part of the necessary qualifications of the efficient practitioner, and must be taught to the student. So also with the art of chemical analysis, whether inorganic, physiological, or pathological. The use of these and of other aids to investigation are taught in separate courses, or by separate teachers, in all the principal schools. In this department of medical art an immense advance has been made of late years. Perhaps from no quarter will so much advantage to medical science be derived, nor is it possible to divine to what extent our knowledge of human nature may be increased by the conjoined aid of those two potent instruments of research—chemical and microscopical analysis.

After the training of the senses comes the training of the intellect. To this end a knowledge of Logic and of mental or moral philosophy is required. Only two of the medical schools of the United Kingdom (we except the universities) have chairs of logic. In this direction much has yet to be done in the culture of the professional mind. The defect being, however, felt, it will doubtless be remedied as opportunity serves.

The medical profession has of late years endeavoured to define its duties and its rights. Medical Deontology or Ethics has consequently received considerable development; and the fact that already there is one school in the United Kingdom having a chair of medical ethics, is an earnest that questions of professional morals are likely to have more and more attention directed to them.

The History of Medicine, and its political and social relations, have also been treated in a separate course of instruction in one school. To the statesman and the intelligent layman it is a subject of great interest and importance. It cannot, however, be expected that these will occupy their minds with it when it is neglected by so large a number of the profession. The career of great conquerors, and the deeds of destroyers of mankind wholesale, are far more exciting themes than the silent unobtrusive doings of those who have preserved more lives than even the most ruthless conquerors have destroyed. The time will come, if modern civilization endures, when the moral grandeur of medicine will be acknowledged; then its progress will be felt to be one of the most interesting chapters of the history of mankind. That time, however, is not yet.

State of Medical Science Abroad.

Science breaks down the selfish barriers of states and nations, and gathers its cultivators into one great republic. This is particularly true of those who speak a common language and possess a common literature. Hence it is that the great republic of English medicine includes the medical schools of the United States of America and of the British colonies. Between these and the schools of the United Kingdom there exists the most intimate union, with a free interchange of knowledge. In the United States the number of schools and of teachers of medicine equals, if it does not exceed, that of the United Kingdom. It has been estimated that they are attended by 5000 students, and that 1000 of these graduate every year.

On the continent of Europe, the activity of medical life varies greatly according to the people or nature of the government. In France, Germany, Belgium, Holland, and Switzerland, medicine is cultivated as vigorously and as successfully as in the British or American schools. At Rome, Hippocrates is still commented on, as in the time of Leo X. In Italy generally (except Piedmont) and the non-German provinces of Austria, medical science is depressed; in Russia medical education, for the uses of the people at least, is by no means adequately developed, the few schools being wholly insufficient for so great an empire. Special departments of medicine have had a more diligent cultivation on the Continent than in the United Kingdom or the United States. This remark more particularly applies to medical police and public hygiene, which having had in the latter no encouragement from the state until of late years, has obtained no special attention. Late inquiries into the preventible causes of disease amongst the people of Great Britain, and the consequent establishment of boards of health, have laid the foundation for a new and most important department of practical medicine—the prevention of disease.

State of Medical Practice in the United Kingdom.

In all civilized countries the practitioners of the art are divisible into classes, the counterparts of which may be found in the United Kingdom, so that an analysis of British practitioners will apply, mutatis mutandis, to those of Europe and the United States.

The practice of medicine is carried on in the United Medical Kingdom by persons having various designations and qualifications. They may be divided into three classes. First of the United Kingdom are those who are "duly qualified" in virtue of having followed a prescribed course of study, and undergone successfully the examinations conducted by the collegiate or academical boards of examiners: this is the medical profession proper. Secondly, those who practise medicine as a business, yet have either not studied regularly or not at all, or having studied imperfectly, have no diploma or letters testimonial of having duly undergone an examination: these are empirics or "quack doctors." Thirdly, those who practise medicine as amateurs, or while engaged, ostensibly at least, in other pursuits: these are empirics also, but not professionally "quack doctors."

The qualified practitioners of medicine in the United Kingdom are known under various titles according as they practice follow one or another department of the art. The great proportion (about 20,000, or four-fifths) are general practitioners who, in accordance with the demands of thinly populated districts, or of the great majority of the population as represented by the middle and lower classes, minister to the people in every department of the art, and at the same time supply the necessary drugs and appliances. The metropolitan cities and the large towns have, in addition to these, a class of practitioners in special departments. There is the consulting or "pure physician," who excludes operative surgery, midwifery, and pharmacy from his practice. There is the "pure" consulting or operative surgeon, who practices neither midwifery nor pharmacy, but does not refuse his opinion in cases purely medical,—practising, in fact, as a surgical physician. The obstetric physician, while excluding pharmacy, and devoting himself more particularly to midwifery and the diseases of women and children, does not usually exclude the other departments of medicine. One or two minor departments of medicine and surgery are followed exclusively by a few individuals. The most numerous of these are the dentists, numbering about 1200 in the United Kingdom, who, however, are not for the most part "duly qualified" practitioners of medicine, but "mechanical" dentists. Of professed oculists and aurists exclusively there are very few, these usually combining general surgery with the practice of the special branch. In a similar manner, amongst physicians there are those who, having made a special study of special diseases, are specially consulted as to those diseases. Under this head are physicians skilled in the treatment of insanity and consumption, or diseases of the skin, the liver, the kidneys, the uterus, rectum, &c. The valuable discovery of anaesthetic medicines has called into existence another department, and this important class of remedies is already made a specialty in practice in the metropolis at least of the empire. In surgery a few "coppers" still practise Medicine, that branch of minor surgery exclusively. Chiropodists, or "corn-cutters," belong to the second class.

Of late years a class of practitioners has arisen which, in so far as it is constituted of persons "duly qualified," may be designated sectarian; nevertheless, it is made up for the most part of charlatans. It comprises those who, whether duly qualified or not, practise medicine upon the basis of some exclusive dogma or principle, or with reference to some exclusive remedial agent. Legitimate medicine is catholic and eclectic; it has neither exclusive dogmas nor creeds; it requires its members to seek knowledge from every available source, and apply it in every available mode as may be demanded by the circumstances of the practitioner or the patient; the object of the exercise of the art being the relief or cure of the patient as promptly, safely, and pleasantly as possible, without any formal restriction as to the means or mode. This sectarian class therefore separates itself from the catholic profession by following professedly an exclusive method. Of the followers of Hahnemann (designating themselves homoeopathists) there are reported to be about 300 in the United Kingdom. (See Homoeopathy.) Of the followers of Priestnitz (the hydropathists) and of Mesmer (the Mesmerists) the numbers are much less. Indeed, the latter are not unfrequently homoeopathists also.

The "quack doctors" are a motley body, comprising every kind of specialty—worm-doctors, water-casters, bone-setters, astrologers, herbalists, "wise men," and "witchfinders" (who prove to be occasionally, as of old, professed poisoners and procurers of abortion), curers of syphilis and diseases of sexual organs (with hardly an exception a group of scoundrels), the "falling sickness," &c. In this class may be found also vendors of secret remedies in connection with some absurd hypothesis, as Coffin's herbs, or Morrison's pills; or itinerant practitioners of homoeopathy, mesmerism, &c. The ranks of the quacks are also swelled by outcasts from the legitimate profession: men who are excommunicated either because of their vices or of their follies, and who have been morally punished by a de facto deprivation of professional intercourse with their brethren. In the third class of amateurs and others are comprised country clergymen, ladies having a taste for medicine, persons in private station with a smattering of knowledge, but especially the retailers and compounders of drugs, and professed nurses. Those who, when young, have abandoned or neglected the study of medicine as a profession, and have been led to follow other pursuits, are particularly apt to take up the irregular practice of it in after life.

Present Organization of the Medical Profession.

The organization of the profession of medicine takes two directions,—an external and an internal. The external organization has reference mainly to the wants of the public or the state. The army and navy have their respective medical officers; the public medical charities have their staff, comprising physicians, surgeons, obstetric physicians, apothecaries, oculists, aurists, cuppers; the medical relief of the sick poor engages the services of above 2000 practitioners. The public health is being gradually placed, in various towns and districts, under the cognisance of a body of special practitioners,—the medical officers of health; and the health of emigrants to the various colonies of the empire is committed to the care of surgeon-superintendents. These last are all practitioners in hygiene, as, indeed, are virtually the medical officers of the army and navy.

The internal organization of the profession has been determined by the operation of the great fundamental laws in virtue of which all human societies are constituted. So soon as the profession attained to a separate existence in the sixteenth century, the members thereof associated themselves together, and colleges of physicians were established. The humble assistants to the physicians of that era—the barber-surgeons and apothecaries—were also organized in like manner, but in guilds, which have developed themselves into colleges of surgeons or societies of apothecaries. Very lately the druggists or chemists (successors to the apothecaries of the last century) have organized themselves into "The Pharmaceutical Society;" and in like manner the surgeon-dentists propose to be incorporated into a college of surgeon-dentists. Nor has it been otherwise with the teachers of the different departments of medicine. With the development of the profession medical schools arose in the large towns, where only medicine can be taught in all its details—first in the metropolitan cities, then in the large manufacturing and commercial towns of the United Kingdom. Some of these are formally incorporated by royal charter; others, when firmly established, will undergo a similar change.

There are in all twenty medical corporate or licensing bodies in the United Kingdom. The colleges were originally founded in the metropolitan cities because the most active members of the profession were collected there in the greatest numbers. The same principle of combined action which led to their foundation has united the profession in other large towns, and in entire districts, in "medical societies" and "associations." These are virtually much of the nature of colleges; but the latter, starting from a legal basis and chartered rights, have gradually developed themselves into public authorities having control over the education of persons about to enter the ranks of the profession. That such control was, in the early history of modern medicine, most necessary and very useful, cannot be doubted; but the beneficial action of these colleges has not been had without some counterbalancing disadvantages. The corporate spirit is essentially contracted and narrow in its views; and the subdivisions in professional pursuits are apt to generate antagonism. The principal evil to which these colleges have given rise is, that the unity of all departments and branches of medicine, with reference to both its practical and philosophical relations, has been lost sight of. From this source has arisen much of the difficulty experienced for the last half century in the better organization of the medical profession. The repeated attempts made of late years to separate them legally by a sharp line of demarcation, and to arrange the practitioners of the various departments of the art in distinct legal classes, is but another form of the principle of caste, and which seems to have been strictly applied in ancient Egypt, where special practitioners abounded, and where they were restrained to their own department. Such legislation must always fail, for it is opposed by the ever vital principle of unity of the medicine. If rigorously carried out, decadence of the science and art is the inevitable result; if not rigorously carried out, the principle asserts its power as a disturbing agent. Consequently, whenever any special class of practitioners has arisen in this country, one or other result has followed. Having organized itself on the restrictive principle, its first efforts have been directed to a sharp limitation of its educational and municipal relations; but it has finally broken that limitation down, and returned to unity of teaching and of practice; otherwise it has gradually become more and more feeble.

The colleges of surgeons in the United Kingdom, first coming into existence as corporations of barbers and barber-surgeons, have constantly struggled upwards from that pernicious, humble form of special practice, until at last their examinations and curricula of education are made to include, nominally at least, and their members practise, every branch of medical science and every department of medical art. The apothecaries' companies of London and Dublin have, in like manner, risen from corporations of drug-compounders and unlicensed practitioners across the counter, to be the examiners (virtually) of the great body of medical practi- tioners of the people. On the other hand, the physicians gradually lost their catholic character by refusing to perform the humbler services of the art, and by discountenancing the practice of them as ignominious. They have thus been as gradually changed into specialists themselves, with the effect of weakening their own influence, and retarding the progress of medicine. Hence, while the corporations of special practitioners have been constantly rising in power and influence in proportion as the principle of unity of medicine has been developed in them, the colleges of physicians and the medical faculties of the universities have been failing in power and influence in proportion as they have departed from that great vital principle. There is hardly a remnant of a medical faculty left in the two great universities of Oxford and Cambridge; while the College of Physicians of London, once so influential, and still in possession of stringent legal powers, is the least powerful of the medical corporations of London. In its palmy days, when it maintained the principle of unity, it could produce an anatomist like Harvey, could give its imprimatur to the works of a surgeon like Wiseman, and dictate the pharmacy of the kingdom. In later years, when to be associated in any way with pharmacy, surgery, or obstetrics, was discreditable to a Fellow, and to perform so simple an operation as venesection or vaccination was forbidden by its laws, the college dwindled into a small club of specialists, who weakly surrendered the actual government of the profession in England to a company of London apothecaries.

The medical faculty of the University of Edinburgh, happily for its fame and prosperity, has never abandoned the principle of unity of medical science and art. Candidates for its degree in medicine are required to study all those departments of science a knowledge of which is necessary to the successful cultivation, teaching, and practice of the art. They are also required to give evidence that they possess a competent knowledge of every department under the three heads of Medicine, Surgery, and Midwifery.

SECTION V.—THE FUTURE PROGRESS AND DEVELOPMENT OF MEDICINE.

Such, then, has been the past, and such briefly is the present condition of medicine. What will be its future condition? Two elements, external to medicine, will materially influence its future progress for good or evil: the one is the religious belief and condition of the people; the other the wealth and civilization. As to the former, human physiology is become in modern times what, in truth, the phrase designates—the science of human nature; and medicine the practical application of it. The advance of medicine in this direction is bringing it into collision with theological philosophy. We have seen how strenuously this has aforetime resisted the progress of natural philosophy, and we know how much discussion the entrance into its domain of geology and natural history has excited; what, then, will happen when a psychology, springing out of natural history and human physiology, confronts, not corrupt tradition only, but dogmatic and speculative philosophy, especially as applied to theology? Will the old ties of society resist its progress in the old world to its decay? and are we to look to the young states of the Western Hemisphere for unfettered freedom of discussion? or will a new reformation break forth in Europe, and herald a new era in religion, philosophy, and therewith in the medical sciences? Whichever of these may happen it may not be possible to divine; but few thinking men doubt that a great conflict of opinion is impending, if it be not already begun.

If we examine the condition of society more minutely with reference to these phases of development, which we have traced as repeatedly occurring in successive epochs, we shall find that different parts of the world are in different stages of progress. It is necessary, therefore, to examine them in relation to each other.

In Western Europe the sacerdotal power has risen from its suppression at the beginning of the century, and is as busily as ever engaged in its old conflict with its old antagonist from all time—the spirit of free inquiry and free expression of opinion. Its success varies on different parts of the field of battle.

In the United Kingdom the event is yet hanging in the balance, and it is doubtful whether it will advance farther, or be made to recoil. The historical parallel of our age and nation is to be found in the age of the old Greek and the mediaeval Italian republics. A widely-extended commerce is rapidly accumulating wealth; wealth is developing every branch of science and art. The national power and prosperity are continually increasing in every direction. This is the material side. On the religious and philosophical side there are both retrocession and progress. The sacerdotal power is seeking by all available means to resuscitate its glories of the medieval age of Europe; while philosophy, whether natural or mental, is questioning the fundamental dogmas of the whole superstructure, but especially those branches included under geology, ethnology, and mental physiology.

In France freedom of opinion sleeps; the military power reigns, but leans upon the sacerdotal power, which it protects. All history shows that that state of society never continues. In which direction will the edifice fall? Upon that the fate of medical science in France depends.

In Central and Southern Europe the military power, and therewith the sacerdotal, is more supreme than in France. Change here is also inevitable, but its character may more easily be anticipated. The sacerdotal power is more dominant than in France—more antagonistic to science—more hated. The scientific element is feeble, but more popular; the military power will therefore probably lean to the latter, and support science and art.

In Eastern Europe the social condition is Asiatic; that is, almost purely patriarchal and sacerdotal. From that region a military sacerdotal power may fall upon Western Europe whenever the nations are torn by discordant religious factions, and success may be hoped for from the weakness of disunion; or that empire may itself fall a prey to civil discord, and be dismembered under military chiefs.

To the Turkish empire the last stage of decrepitude has come; but signs of reconstruction already appear; and if the enterprise and energy of commercial Europe again pour into it, as appears probable, Greek civilization will spring up once again in Asia Minor, and flourish amid the light of Christianity more vigorously than ever.

In Hindustan medicine is even now lifting its head; and the vivifying power of British freedom may happily restore to Asia more than its pristine greatness in science and literature.

On the American continent, and in the colonial empire of Britain, medicine will probably follow the fate of science in the mother country.

It will be seen at least from all this, that medicine, as the science and art of human nature, is of profound interest to the philosophic statesman. Looking at philosophy and religion from the medical point of view, he may also recognise in the present time one of those great eras in which a conflict of opinion shakes society to its foundations, and perils its very existence.

There are cheering indications that the practical English mind will compromise the quarrel, and philosophy and religion be once again combined for the welfare of man. On the one hand, science seeks in many ways to develope religious truth; on the other, not a few of the clergy are meeting science half-way. If by such a compromise all that is corrupt and traditional in Christianity be weeded out, and all that is true and practical in philosophy let in, we may anticipate the commencement of a new era of civilization.

But to this end it is necessary that the human mind be trained from childhood to a free use of its powers, and the great mass of the people be so enlightened as to be able to judge what is true or false, especially in relation to the nature of man. If a wise government could, single-handed, save a nation of ignorant and superstitious people, Marcus Aurelius, the patron of Galen, would have saved the Roman empire. Scientific truth must be amongst the people if it is to save the people.

The organization of the medical profession as students of human nature, and as the men who apply the science of human nature to the wants of mankind, is therefore a problem worthy the consideration of the philosophic and far-seeing statesman. Obscure as they may appear to the superficial observer, and contemptible as they are in the eyes of the mere man of the hour, medical science and the medical profession are working out great changes in the social condition of mankind, and not the less powerfully because silently and imperceptibly. Thus it is, indeed, that all great forces operate, whether in the physical or moral world; else a few fishermen could not have overthrown empires. The revealed action of a force consists often rather in the manifestation of its results than of its working.

The statesman who should succeed in so organizing medicine in all its departments as to give it a full and free application to the wants of society, and in aid of human progress, would surely take rank with the greatest benefactors of mankind. To the attainment of this object it is, however, of all things a primary necessity that a knowledge of human physiology,—that is, of the science of human nature,—be thoroughly diffused through every class of society. This knowledge is indeed necessary to the solution of all social questions; so true it is that "the proper study of mankind is man."

(M. L.)