Chapter VII: Part 7

These were the days when the students organized themselves into so-called "nations," whence arose that conspicuous features of German university life of today of so-called students' Corps. These nations--each composed, for the main part, of men of one nationality--had their own meeting-places, their own property, etc. One of the principal means of instruction in those days was disputations, or, as we would say, debates, held between students, often of different nations, in which they were expected to prove their knowledge and mental alertness. When it is recalled that universities were larger--i. e., better attended--in those days than now, it will be seen to what an extent these nations were developed. Oxford, in 1340, is said to have had no less than 14,000 students; Paris about the same time had 12,000; and Bologna had some 10,000 students, the majority of whom were studying law.

The title of doctor came into vogue about the twelfth century. At first it was confined to teachers proper, and was bestowed upon the learned--i. e., those who had almost solely studied internal medicine, and who were required to take an oath to maintain the methods which had been taught them. For the title of doctor certain fees were paid, partly in money and partly in merchandise. The so-called presents consisted of gloves, clothes, hats, caps, etc. At Salernum it cost about $60 to graduate in this way, while at Paris the cost was sometimes as high as $1,000, and this at a time when money had much more purchasing value than it has to-day. It was then, as now, a peculiar feature of the English universities that but little systematic instruction in medical science was given. Just as the majority of English students at present study in London rather than at one of the great universities, so in those days did they go to Paris or Montpellier.

This will be perhaps as good a place as any to emphasize the fact that the clergy, having so long monopolized all learning and teaching, and having, at the same time, an abhorrence for the shedding of blood, which indeed had been prohibited by many papal bulls and royal edicts, permitted the practice of the operative part of medicine--i. e., surgery--to fall into the hands of the most illiterate and incompetent men. Inasmuch as the Church prohibited the wearing of beards, and as many of the religious orders also shaved their heads, there were attached to every monastery and to every religious order a number of barbers, whose duty was to take care of the clergy in these respects. Thus into their hands was gradually committed the performance of any minor operation which involved the letting of blood, and from this, as a beginning, it came about that no really educated man concerned himself with the operations of surgery, but left them entirely to the illiterate servants of the Church. This is really the reason that the barbers for many centuries did nearly all the surgery, and why, at the same time, surgery fell into such general and wide-spread disrepute. From this it was only revived about one hundred years ago. Did time permit, this would be a most appropriate place to digress from the subject of this paper and rehearse to you the various stages in the evolution of the surgeon from the barber; but time does not permit it, and it constitutes a chapter in history by itself, which must be relegated to some other occasion. (See p. 296).

It was about the beginning of the fifteenth century that the better class of physicians began to belong to the laity, and were called "physici" in contrast to the "clerici." Later they were known as "doctores." Until the fourteenth century most of them studied in Italian or French universities, the Germans even being compelled to go to these foreign institutions. In Paris they were required to take an oath that they would not join the surgeons. This regulation was founded as much upon spite and envy as upon any other motive. Many of the clerical physicians belonged to the lower class, and were so ignorant that even the Church itself was forced to declare many of their successes miracles. Although monks and the clergy in general had been frequently forbidden to practice medicine, the decrees to this effect were quite generally disregarded, except in the matter of surgical operations. In the ranks of the higher clergy it must be said that well-educated physicians were occasionally found. There is, for instance, the record of a certain bishop of Basel, who was deputed to seek from Pope Clement V. an archbishopric for another person, but finding the Pope seriously ill, cured him, and received for himself in return the electorate of Mayence, which was perhaps one of the largest honorariums ever given to a physician.

These were the days when magic, mingled with mystery, played no small rôle in the practice of medicine, and when disgusting and curious remedies were quite in vogue. Superstition and ignorance everywhere played a most prominent part. For instance, it was, in those days, an excellent remedy to creep under the coffin of a saint. When a person was poisoned it was considered wise to hang him up by the feet and perhaps to gouge out one of his eyes, in order that the poison might run out. It should be noted that putting out the eyes was frightfully common in the Middle Ages, mainly as a matter of punishment. It is said, for instance, that the Emperor Basil II. on one occasion put out the eyes of 15,000 Bulgarians, leaving one eye to one of every thousand, in order that he might lead his more unfortunate fellow-sufferers back to their ruler, who, it is said, at the sight of this outrage swooned and died in two days. It is said, too, that this is the reason why the Emperor Albrecht was one-eyed.

What the revival of learning could thus and did accomplish under these conditions as above portrayed may be readily appreciated. The restoration of Greek literature, the revival of anatomy, the habit of independent observation--all told materially in this renaissance of medicine. The Italian universities became the objective point of all who desired a thorough medical education. The students chose the lecturers and officers of the university and had a large voice in the construction of the curriculum. The officers of their selection negotiated with those of the State, at least until the close of the sixteenth century.

In spite of this general renaissance of medical learning and the impetus felt by the inspired few during the sixteenth century, it must be said that the general condition of medical science and of those who practised it was not greatly improved. The superstition of the common people and the timidity and indolence of all concerned were about as marked as they have ever been in the history of human error, and the practice of medicine was at least a century behind the applied knowledge of the other arts and sciences. At that time the best physicians and doctors were to be found in the Italian universities, the French coming next, and, last of all, the German. The Italian universities were the Mecca sought by those who desired the best education of the day, and of all the Italian medical faculties those of Bologna, Pisa, and Padua ranked highest.

Those were the days, also, of the travelling scholars--a very marked feature of mediæval life. They migrated from one of the Latin schools to another, and from one famous teacher to another, sometimes travelling alone, at other times in groups or bands, and practising often the worst barbarities while _en route_, supporting themselves by begging and stealing. On their marches they stole almost everything which was not tightly fastened down, and prepared their food even in the open fields. The result was that most of them fell into dissolute habits of life. A somewhat better class of vagrant students sang hymns before doors and received food as pay. Some earned money singing in the churches. They apparently both drank more beer and at less cost than at present. At that time the cost of beer was about one cent for a large glass.

The younger students were called "schutzen," and, like apprentices in trades, were obliged to perform the most menial duties. The older students were known as the "bacchanten," and each bacchant was honored in proportion to the number of "schutzen" who waited upon him. When, however, this bacchant himself reached the university he was compelled to lay aside his rough clothing and rude manners and take an oath to behave himself.

Not only the students, however, wandered from place to place, but even the professors of the sixteenth century were nomadic, wandering from one university to another; for example, Vesalius, the great teacher of anatomy, taught in Padua, in Pisa, in Louvain, in Basel, in Augsburg, and in Spain. These habits may be partly accounted for by the fact that the students elected at least some of their teachers, and the professors who failed of re-election certainly may be considered to have had a motive for moving on. Salaries were certainly not large in those days. Melanchthon, the great theologian, received during his first eight years a salary of $43 per annum, and by strict economy was able during this period to buy his wife a new dress. During his later years his salary attained the sum of $170, which would be equivalent to $750 to-day. When Vesalius died his salary was $1,000 per annum, to which certain fees were added. It is not strange, therefore, that many of the professors pursued reputable occupations during their odd hours or that they took students to board. We hear to-day of frequent illustrations of the pursuit of knowledge under difficulty, but certainly during the ages to which I have referred the ardent student, were he undergraduate or professor, put up with an amount of hardship, meagre fare, and trouble of all kinds which would stagger most of the young men of to-day.

Men were human then as now, and the universities were not above disputes and quarrels, which sometimes became very bitter and dishonorable, but were the indirect instrument of good, since they led in not a few instances to the founding of other universities. Thus, about the beginning of the sixteenth century, Pistorius and Pollich were both teachers in Leipzig, but holding antagonistic views regarding the nature of syphilis, became so embittered that they could not bear each other's presence, and each resolved to seek another home. The former influenced the elector to select Frankfort-on-the-Oder as the site of a new university, while the latter was the means of founding another at Wittenberg.

It is pretty hard to keep away from the relation of the barber to the anatomist and surgeon when discussing this subject. In another place I have dealt with the evolution of the surgeon from the barber, (See page 296) and have endeavored to show that the principal factor which operated to keep back the progress of surgery during the eighteen centuries previous to the last was the influence of the Church, which opposed the study of anatomy and degraded the practice of surgery. In the times to which I am referring now, an operation which caused the shedding of blood was considered beneath the dignity of an educated physician, and, in some circles, was regarded even as disreputable. It was, therefore, left to the only class of men who were supposed to know how to handle a knife or sharp instrument, i. e., the barbers. When operations were done in universities papal indulgences were often required, and these cost money, since in those days the Pope gave nothing for nothing. Public dissection required also papal indulgences, although in Strasburg, in 1517, permission to dissect the body of an executed criminal was granted by the magistrates in spite of papal prohibition.

The ceremonies attending demonstrations of this kind were both fantastic and amusing. A corpse was ordinarily regarded as disreputable, and had first to be made reputable by reading a decree to that effect from the chief magistrate or lord of the land, and then, by order of the University, stamping the body with the seal of the corporation. It was carried upon the cover of the box in which it had been transported into the anatomical hall, which cover, upon which it rested through the ceremonies, was taken back afterward to the executioner, who remained at some distance with his vehicle. If the corpse was that of one who had been beheaded, the head during the performance of these solemn ceremonies lay between its legs. After the completion of the ceremonies the occasion was graced with music by the city fifers, trumpeters, etc., or an entertainment was given by itinerant actors (Baas).

In time, however, this folly was given up, and by the latter half of the sixteenth century public anatomical theatres were established. The most celebrated was built by Fabricus ab Aquapendente, in Padua. It was so high, however, and so dark that dissections even in broad daylight could only be made visible by torchlight.

The zeal with which gradually the better class of physicians pursued their scientific studies became more and more conspicuous, evidenced in many ways by the hardships with which some of them had to deal, as witness the struggles of many of the great anatomists of those days.

And so in time the clergy disappeared almost entirely from the ranks of public physicians, and after the Thirty Years' War completely lost their supremacy even in literary matters, this being gradually usurped by the nobility and the more educated laymen; but even then knowledge was pursued under difficulties, especially the study of anatomy. It was not until 1658 that a mounted skeleton could be found in Vienna. Strasburg obtained one in 1671. The handling of the dead body, which we regard as so necessary, was in those days avoided as much as possible. The professor of anatomy rarely, if ever, touched it himself, but he lectured or read a lecture while the actual dissection was done with a razor by a barber, under his supervision.

Practical instruction in obstetrics, which would seem almost as important as that in anatomy, was not given in those days; male students only studied it theoretically. In the Hôtel Dieu, in Paris, that part which was devoted to instruction in midwifery was closed against men. It was the midwives in those days who enjoyed the monopoly of this teaching, and upon whom the greatest dependence for obstetrical ability was placed. The physicians proper, or _medici puri_ of the seventeenth century, were individuals of greatest dignity and profoundest gravity, who wore fur-trimmed robes, perukes, and carried swords, who considered it beneath them to do anything more than write prescriptions in the old Galenic fashion. Some continuation of this is seen in the distinction made even to-day in England between the physicians who enjoy the title of doctor and the surgeons who affect to disdain it. These old physicians knowing nothing of surgery, nevertheless demanded to be always consulted in surgical cases, claiming that only by this course could things go right. Still when elements of danger were introduced, as in treating the plague, they were glad enough to send the barber surgeons into the presence of the sick, whom they merely inspected through panes of glass. Very entertaining pictures could be furnished you illustrating the habits of the physicians of two or three hundred years ago in dealing with these contagious cases. The masks and armor which they wore and the precautions which they took would seem to indicate protection rather against the weapons of mediæval warfare. At one time they were advised that if they must go into actual contact with these patients they should first repeat the Twenty-second Psalm. You may find in the old books, if you will hunt for them, curious pictures illustrating the precautions taken a few hundred years ago against the pestilence, of whose nature they knew nothing, and seeing them you may imagine the vague dread and even the abject fear which led the _physici puri_ or physicians to send the barbers in to minister to plague-stricken patients, while they contented themselves with ministering at long range to their needs.

But gentlemen, I fear lest I weary you with a longer rehearsal of mediæval customs and student follies. While they have all passed away some of them have survived either in tradition or in modified form, as will surely have occurred to you while they were rehearsed. You will not fail to note the steady progress of an ethical evolution which has toned down the barbarities and the asperities of the past, and which has substituted a far more ennobling life-purpose and method of its accomplishment than seemed to actuate your predecessors of long ago.

It is small wonder that the students of those days bore an ill-repute with their surrounding neighbors. You may see better now, perhaps, why the medical student even of to-day has to contend with a prejudice against both his calling and himself, a prejudice begotten of the many debaucheries and misdeeds of his predecessors, and, I am sorry to say, even certain excesses of to-day. I do not know how I may more fittingly terminate these remarks than by reminding you that the profession which you students hope to enter has suffered most seriously in time past from the character of the men who have entered it, and that even to-day certain of its members fail to have a proper regard for its dignity. It is axiomatic that those slights and indignities from which we often suffer, and the neglect and indifference of which we often complain, are in effect the result of our own shortcomings, and that we are ourselves largely to blame because of that which does not suit us. I beg you then to remember that even at the outset of student life there should be ever before you such an ideal of intellectual force and dignity, of power, of co-ordination of mind and body, as may keep you ever in the right way, so that when you at last attain your goal you may deserve that sort of benediction which I find in one of Beaumont and Fletcher's plays (_Custom of the Country_, v. iv.):

"So may you ever
Be styled the 'Hands of Heaven,' Nature's restorers;
Get wealth and honors, and, by your success
In all your undertakings, propagate
A great opinion in the world."

IX

A STUDY OF MEDICAL WORDS, DEEDS AND MEN[6]

[6] Address in Medicine, delivered June 24, 1902, at Yale University Commencement.

[Reprinted from the _Yale Medical Journal_, July, 1902.]

_Study nature for facts; study lives of great men for inspiration how to use them_

Never have I more earnestly craved the gift of eloquence than on occasions like this, when young men are about to leave the halls in which and the men with whom they have grown into man's estate, in order to assume the solemn and weighty responsibilities not only of their own lives but those as well of others. The day upon which you are thus released from duties of one kind to assume those of another, welcome and joyous though it may be, should nevertheless be interspersed with some serious and earnest thoughts and resolutions. Old Yale sets now her stamp upon you. It will prove a passport to many homes, but must never be abused. It will entitle you to the society of the cultivated and to the respect of scholars everywhere. It will admit you to the ranks of the learned and cause you to be treated with respect and equality by some of the profoundest and most scholarly thinkers the world has even known. Yale has now furnished you with that which her ripe experience has shown to be requisite for young men commencing professional careers. As contrasted with the total of human knowledge its aggregate is not large, but it has not for centuries been the custom for men to grow gray in studies before undertaking to practice medicine, and when your own qualifications are compared with those which we of the passing generation possessed at the corresponding period of our lives, the comparison will furnish at the same time the most startling illustration of the rapid advance of medicine in the past twenty-five years.

Yale has always been eminent for the versatility and originality of her teachers. Her medical history has been so well told during the past year by one of her most honored sons, Dr. Welch, that it is not necessary nor wise to go now into such historical details. The trend of science to-day is along the lines of comparative investigation, and the Bible is by no means the only literary collection which to-day is being subjected to the "higher criticism." The inspiration claimed for the contributors to that great ancient Collection is denied to the writers of great modern works, where, nevertheless, fundamental truth is as requisite for the welfare of the body as in the other for that of the soul. Only by painstaking research, laboriously repeated, do we clear the old paths of the rubbish of centuries or discover totally new ones.

Pathfinders of this description have always abounded in this great institution, drawn by common impulses or attracted by some centripetal force. And though it were perhaps invidious to mention names, I nevertheless must select two of Yale's great teachers whose names are still green in the memory of all men, and ask you to note how the examples they have set and the work they have done may furnish the line of thought in which I wish you to follow me for a little while.

The science of comparative philology would seem to be far removed from that of medicine. Still, it is based upon an ultimate analysis of parts of speech, and men like Professor Whitney were, not only the comparative anatomists, but even the histologists--if I may use the phrase--of words. Comparative philology then is to medical terminology what embryology and comparative anatomy are to a study of the structure of the human body. The philologist loves to dissect words and trace them back through rudimentary stages and roots to their earliest forms. He loves also to study the evolution of an idea as conveyed by a word, and trace atavism or reversion in human speech.

Again you have here at Yale a wonderful collection of extinct animal remains restored with marvellous accuracy to semblance of their original form and appearance. The indefatigable industry and wonderful ability of Professor Marsh and his co-workers have enabled us to form ideographs of the living forms of earlier geologic ages upon this earth, which could not have been furnished had it not been for their remarkable knowledge of morphology and skill in synthesis. Indeed, where have powers of analysis and synthesis been more brilliantly displayed than by these men. It used to be said of Cuvier, the great French comparative anatomist, that if given a tooth from any beast, past or present, he could describe the animal and its habits as well as reconstruct his skeleton, so wonderfully are minute differences perpetuated, and so familiar was he with them.

Let us see, then, if it be possible to take some of our common medical words and by applying to them the methods of Whitney and of Marsh follow them back to their early forms and significances, and then construct from them ideographs of the customs, habits and superstitions of the men who used them. Such a plan systematically carried out might furnish both a fitting and a novel introduction to the history of medicine. Coleridge, you know, said we might often derive more useful knowledge from the history of a word than from the history of a campaign.

Take, for instance, our word _idiocy_. The Greeks, especially the Athenians, were a race of politicians. Private citizens who cared little or naught for office were the _idiotai_, as distinguished from the public officials and office holders. It came about in time that men of such retiring habits and modest tastes were regarded as persons of degraded intellect and taste. And so the _iviwrai_ were considered of inferior intellectual capacity. In other words, the idiot of those days was the man content with private life. How different from the present day when conditions seem so nearly reversed.

Our kindred word _imbecile_ has also present reference to those of feeble, dwarfed or perverted intellect, and refers rather to mental than physical defects, though both must often be associated. But originally the lame and the deformed who were obliged to use artificial support, walked as it was said, _in bacillum_, upon a stick or crutch, and from this expression we derive our word imbecile.

Let us trace, for instance, again, the etymology of our word _palate_. The Latin _palatum_ is the same as _balatum_, that is, the bleating part. The ancient shepherds of the region of the Campagna watched the sheep as they went bleating (_balatans_) over those hills, one of which subsequently became the _Palatine_.

Or take again our word _mania_. It is derived from _unv_ the moon, meaning the moon-sickness, and corresponds to lunacy from _luna_. You see the ancient superstition concerning the influence of the moon abides in the name. This brings up again the old ideas concerning the metal silver which was sacred alike to Diana and the moon, and consequently feminine in sex and attributes. Hence comes the mediæval alchemistic term _lunar caustic_, and hence, too, comes its use in the treatment of epilepsy for which it was formerly much in use, since epilepsy was regarded as a form of mania caused by the evil influence of the moon.

By the way, this may also remind us of the peculiar views of the alchemists of the middle ages, who believed that the property of sex inhered in the metals. They believed, for example, that arsenic was masculine in sex, and so named it from _arsen_, male, and _arsenikos_, masculine. Medical, like comparative philology, is the more or less direct outcome of the earth's physical features as they have influenced the commingling of races and the conquest of nations.

Medicine seems a science of Aryan parentage; in the Sanscrit the literature of medicine is rich; it was cultivated by the Greeks, but it lost much of its original significance by virtue of Roman supremacy, as the Latin races took it over. Under the Arabians it flourished after a fashion. With the revival of Greek learning there was a restoration of much that had been lost, but the supremacy of the Church kept it within extremely narrow limits, though the clericals could not eliminate all the Arabian words which had crept into its terminology. Greek is to-day the language to which we turn for aid when it becomes necessary to invent new terms by which to indicate fresh discoveries or concepts.

The debt of medicine to our Aryan forefathers is great. Surgery was then a dignified branch of the science. Their autoplastic methods were conceived with great ingenuity and carried out with much, albeit with crude skill. The so-called Indian method of reconstructing a nose bears witness to their ability in plastic art. Their itinerant surgeons performed many capital operations; i. e., lithotomy and coeliotomy. There is good reason to believe that Hippocrates knew nothing of practical anatomy, whereas, long before him Susruta urged that all physician priests should dissect the human body in order that they might know its structure; and gave, moreover, directions for the selection of suitable subjects. The Sanscrit writers knew the properties of many plants and of at least five of the metals. Many Greek names of drugs are derived from the Sanscrit, or else they had a common Aryan origin. Thus the Greek equivalents for our words castor, musk, cardamon, chestnut, hemp, mace, pepper, sandal-wood, ginger, nerve, marrow, bone, heart, and head, are unmistakably of much older, i. e., Sanscrit or Aryan stock, several of them coming down in Romanized form, but almost unchanged--e. g., os, cor, moschus, cannabis, castorion.

Although many of the ancient Greeks visited India, it appears that but relatively few words have come to us from this ancient source.

Our word sulphur, though, is of Sanscrit origin, the Greek word _theion_ indicating its divine or god-given purifying power, with possible allusion to its utility in that lower world with which the theologians most often associate it. The Greek word appears in our chemical nomenclature as dithionic, trithionic, etc.

We note also an almost complete absence of Egyptian words, though many cultured Greeks visited Egypt. Nevertheless, the latter looked with small favor on barbarisms of speech, and our word pyramid is one of the very few which they thus adopted. The term surgery is of very distinct Greek origin, and meant handwork as distinguished from the action of internal remedies. Medicine seems to be derived from _medeo_ to take care of, to provide, and physic and physician from _phusis_, i. e., nature. The physici were originally naturalists, or scientists, like Aristotle, medical science being but a part of their study. Campbell in his book ("The Language of Medicine") gives a list of at least two dozen common terms of to-day which were employed by Homer. In addition to these, many other Homeric terms are still in use, but with more or less altered or perverted meanings; for example, æther, when used in the sense of its being a narcotic agency; astragalus, which originally meant a die, since the analogous bones of the sheep were used for dice; amoeba, from _amoibe_, change or alteration, alluding to constant change of shape. Ammon originally meant a young lamb, iris a halo, meconium has reference to the juice of the poppy, from _mekon_, opium; molybdenum was so named from its resemblance to lead, narcosis originally meant numbness; the pleura was the side; the original phial was a saucer; the phalanges were so called because they were arranged side by side as it were in a phalanx; our troche was at first a wheel; and our tympanum was the original Greek drum, the word still persisting in musical terminology. The arteries were so named because they were supposed to contain air, while the veins were the gushers, from _phleo_, to gush or flow. The original confusion of nerves and tendons appears in the term aponeurosis.

Long ago there were two rival medical factions among the Greeks, the Empirics, from _empeirikos_, meaning experimental--who believed there were no philosophic underlying principles of medical science, and that experience alone was the safe guide,--and the Methodists, from _methodos_, who believed it better to follow the _hodos_, or "middle of the road." The present use of the word empiric shows the contempt with which the former came to be regarded.

As cure (_curo_) meant to care for, so did medicus have the same meaning, as already remarked, while the Greek slave, _therapon_, who waited on his master, became later the therapeutist who cared for his ailments. Our word to heal has also a somewhat similar dislocated meaning, since originally it meant protection, i. e., covering. The same root persists in hell, i. e., hades, referring to a certain supposititious locality so well covered that from it there is no escape.

Note, too, the influence of ancient mythology in medical phraseology. Jupiter Ammon, the horned god, is recognized in hartshorn or ammonia. Mars, the god of war, whose symbol is iron, persists in the so-called martial preparations or ferruginous tonics. Venus and Aphrodite naturally appear in venereal and aphrodisiac, while Vulcan's rôle is indicated in the heat to which caoutchouc is subjected in vulcanizing rubber. Mercury appears not only in Roman form as a metal, but in his Greek rôle as Hermes, not to be forgotten when receptacles are hermetically sealed. Let us cut short a longer list by simply noting in passing how the Greek Cupid Eros and his mate Psyche are perpetuated in our terms erotic and psychiatry, while Morpheus, the god of sleep, can never be forgotten so long as morphine is in use. That the wrath of the gods was to be dreaded is indicated in our word plague, from _plege_, meaning a _blow_ from that source, that is their vengeance. You thus see the antiquity of the notion that epidemics were a divine visitation, and not due to bad sanitation.

Melancholia, _melas_ and _chole_, meant originally black bile. In ancient physiology the bile played a very important part, and the results of hepatic insufficiency were not only indicated by this name, but the advantages of the use of calomel were amply emphasized by its name, _kalos_ and _melas_, for it was a beautiful remedy for this blackness. Another condition indicating trouble with the liver, which we call jaundice to-day (from the French _jaunisse_), was known as icterus from _ikteros_, a yellow bird. The poultice which the average housewife of to-day is so fond of using, was originally a _poltos_, or pudding, or perhaps a bean porridge.

In the days of ancient sacrifices one part of the animal was not placed upon the altar as an offering to delight the gods. It was that now known as the _sacrum_, which is usually defined to have been considered the sacred bone. The adjective _sacer_ (sacrum), had not only the meaning generally ascribed to it, but meant also execrable, detestable, accursed. The sacrum meant then rather the part that was not acceptable to those to whom it was offered. The word _calculus_, like the term to calculate, must remind us of the presence of pebbles and their early use in facilitating reckoning, while our common terms testimony, testify, must necessarily recall the ancient sacred but phallic methods of oath-taking. Another superstition connected with deity is perpetuated in the term _iliac passion_, formerly applied to volvulus, or one form of acute bowel obstruction with its violent pain, which has been compared to that produced by the spear-point as part of the suffering upon the cross.

A keen analysis of the situation at the beginning of the Christian Era reveals the subtlety of the Greek character. The names of those organs which called for deep investigation or dissection are taken directly from the Greek, e. g., hepatic, sphenoid, ethmoid, the aorta, while many of the superficial parts have Latin names, e. g., temporal, frontal.

It is to the Greek that all nations almost invariably turn when they seek to fashion new terms with which to characterize or name new discoveries. The Romans showed their appreciation of that which was good when they so readily adopted the science and learning of the Greeks, and were willing to take over even their gods. The Latin races have always been good imitators but poor originators, save perhaps in war and politics. Had they been willing to imitate the Greeks in these their history might have been very different. When the Latin translators of Greek medical literature lacked for a word they cheerfully took the original, sometimes giving it a Latin dress. For instance, that which we now call the duodenum, meaning only twelve, was originally the dodekadaktulon, meaning that it was of a length equal to the width of twelve fingers, while they twisted the name _eileon_, the twisted intestine, into _ileum_. But the names of most diseases, like those of the more concealed parts, they copied almost exactly.

While in later ages the Church completely dominated, then subordinated, and then finally almost terminated the study of the natural sciences, it is yet of no small interest to note the effect of the rise of Christianity upon the study of medicine. It has been well said that the same "cross which brought light to religion cast a gloom over philosophy" (Campbell). Certain it is that the creed and the tenets which were for centuries the mainstay of Christianity, and which did so much for the uplifting of mankind, were made the excuse for the gradual suppression of all tendency toward investigation of natural phenomena, and the monasteries, where scholars congregated, became the graves of scientific thought and study. And so in time knowledge was exiled from Christian domiciles and transplanted to a Mohammedan environment. With Christian mythology and mysticism soon came also Christian demonology, and disease was generally regarded as an evidence of diabolical possession. This gave rise then, as even now, to the imposters who pretended to cure it by exorcism of evil spirits or invocation of divine or superhuman aid. It has always been a sorry time for rational medicine when superstition is rife. Even under the Arabians science flourished to but a limited extent. Their religion forbade the portrayal of any living object, animal or vegetable, consequently their works contained mere descriptions, never any illustration of any kind. This, by the way, is the explanation of their fondness for geometric tracery and of the richness of their ornamental designs. They professed the same horror of the dead body that was later inculcated by the Church and most of them scorned dissection. What wonder then that under Christianity and Islam alike our profession fared badly.

But very little now remains in our terminology to remind us of the period of Arabian supremacy. The Arabic words naphtha, sumach, alkali, alcohol, elixir and _nucha_ (neck) are almost the only ones which have survived the renaissance. How different the monkish Latin sometimes is from the classic may appear in the use of the two words os and bucca for mouth, or os frontis and glabella for the frontal bone.

But this enumeration must not be prolonged unduly. Let us select three or four more examples almost at random and then pass on. But few will associate Christianity with cretinism. The early Christian inhabitants of the Pyrenees were known as _Christaas_, or in French, as to-day, as Chretiens. A mountainous region did for them what it has done in Switzerland for the races of to-day, and dwarfed the intellects of many while their thyroids underwent great enlargement. Such degenerates are known everywhere to-day as cretins, i. e., Christians.

Tarentum was the old Calabrian city later known as Tarento, where during the middle ages the dancing mania appeared in aggravated form. The frenzy was known in consequence as _tarantism_, while the spider whose bite was supposed to cause it was called _tarantula_, and a rapid dance music which alone would suit such rapid movements is still known as the _tarantella_.

Nightmare has reference to the old Norse deity or demigod Mara, who was supposed to strangle people during sleep.

The Sardonic grin has reference to a tradition that in Sardinia was found a plant which when eaten caused people to laugh so violently that they died.

But turn we now from words to those deeds which are reputed to proclaim yet more loudly the manner and the worth of their authors. Where may one look for a profession which shall afford greater opportunities? And where may he find one in which incentives are so small? The world's great rewards have been paid to the great destroyers of our race rather than to its saviors. Do you suppose that if Napoleon had saved as many lives as he lost he would have figured in history with his present lustre? It is true that Lister's discovery has saved many more lives than Napoleon took. If so, the Hôtel des Invalides should, when the time comes, contain Lister's monument and not that of a great murderer.

Personal courage is one of the noblest characteristics which any man can display, particularly so when it combines the moral and the physical type. Public bravery brings nearly always its meed of public recognition. In fact, publicity is often the stimulus to a kind of bravery which without it would hardly respond to the tests. But your really courageous man is he who cares not for a search-light to reveal his deeds, one who dares and does within the quietude of his own environment that from which his weaker brothers would shrink.

The soldier stirred to frenzy by the intensity of his passion will accomplish with but little dread that which might easily baffle the resolution of a reasoning man in a calm mood. The religious fanatic, be he Mussulman or Christian, may permit himself to be rent asunder rather than recant; but his motives are essentially selfish, since he looks forward to the Mohammedan's or the Christian's paradise, and so they are far from altruistic. But for that quiet heroism which shuns publicity, which calls for the highest quality of both mental and physical courage, which looks forward neither to the golden present nor the mystical yet sensuous future, commend me daily, yes hourly, to the sick rooms of patients suffering from diseases which menace the welfare of others, the infectious, the dangerous, the loathsome. One may read of late many stories of army surgeons doing heroic deeds under fire, and one's heart naturally thrills with emotion as he imagines the scenes and wonders what manner of daring may lead a man to risk his life after this fashion. But I submit to you, that brave as is such a deed and worthy of all possible honor, it has been hundreds of times for one exceeded in the actual devotion to duty and the resolution required to brave the elements, or to face death elsewhere than on the battlefield, or to surrender strength or mayhap life itself, or to invite disaster by infection, or to wear out and work out life in the constant grinding altruistic work of doing for others, who perhaps have violated every known sanitary law and forfeited their every right to live.

Here is a theme that might well stir the most eloquent poet or orator that ever lived. How then shall I do it justice? Joanna Bailie has well put it:

"The brave man is not he who feels no fear,
For that were stupid and irrational;
But he whose nobler soul its fear subdues,
And bravely dares the danger Nature shrinks from."

This recognition of our profession was accorded much more unstintingly nearly two thousand years ago, at a time when it was much less deserved, when Cicero wrote (_De Natura Deorum_) "_Homines ad Deos nulla re propius accedunt, quam salutem hominibus dando._" (Men are never more godlike than when giving health to mankind).

But we can hardly delay longer here and at this time with the subject of heroism in medicine. I shall not have completed the matters which I wish to present to you to-day until I invite your attention to a short sketch of the careers of four or five of the men who, during the past two or three hundred years have set the example for men of all times and most climes, whose lives are so replete with that which is interesting, instructive or important that they may be well held up before a graduating class as illustrations of everything which may be advantageously imitated. They belong to that class of whom Longfellow wrote:

"Lives of great men all remind us
We can make our lives sublime."

One of those was Jean Fernel, who was born in France about 1497 and died in 1558. I do not know that his life history offers anything so very startling, although he came to be regarded as the most memorable physiologist of his generation, but he adopted a motto which I think we all might well select for our own, and it was because of this motto that I have mentioned his name at this point. It was this: "_Destiny reserves for us repose enough._" If each of you will take this individually to himself he will find in it stimulus enough for all kinds of hard work.

The first of the eminently great men now to be mentioned in this connection was Herman Boerhaave, born in 1668 and died in 1738. He enjoyed the reputation of being perhaps the most eminent physician who ever lived. The eldest son of a poor clergyman with a large family, he was originally intended for theology, and with this in view studied philosophy, history, logic, metaphysics, philology and mathematics, as well as theology. A mere accident, resulting from intense party spirit and doctrinal differences, prevented his devoting his life to theology, and he turned next to mathematics and then to chemistry and botany, subsequently studying anatomy and medicine. He graduated in 1693 and began at once to practice in Leyden, with such success that he was early offered the position of ordinary surgeon to the king, which, however, he had the moral courage to decline. Subsequently he taught medicine and botany, to which chairs was also added later that of chemistry. This fact of itself will show to you something of the condition of medical science of that day, when one man could teach chemistry, botany and medicine. His rarest talents, however, were developed in the direction of clinical instruction, and in this particular field he won such repute that hearers were attracted to Leyden from all quarters of the world and in such numbers that no university lecture-room was large enough to contain them. His practice grew in extent and remunerativeness in pace with his reputation, and when he died he left an estate of two millions. So famous was he that it is said of him that a Chinese official once sent to him a letter addressed simply "To the Most Famous Physician in Europe." That he had fixed convictions and practices may be better understood from the fact that so little difference did he make between his patients that he kept Peter the Great waiting over one night to see him, declining to regulate his visiting list by the means or position of his patients.

Boerhaave was universally regarded as a great student and a great physician, but it was probably his qualities as a man which led to the astonishing extent of his reputation. Essentially modest, not disputatious nor belligerent, he had a remarkable influence over the young men who came near him, while he had a habit of speaking oracularly or in aphorisms, which are not always so profound as they sound and yet often make a man's dicta celebrated. Save that he introduced the use of the thermometer and the ordinary lens in the examinations of his patients, his teachings do not form any really new system. In the classification of men he would be regarded as a great eclectic, in the purer sense of the term. Probably his greatest service to medicine was in the permanent establishment of the clinical method of instruction, and perhaps his next greatest real claim to glory is the character of the instruction and the inspiration which he gave to two of his greatest scholars, viz.: Haller and Van Swieten. He was not the founder of a school. He left no great nor memorable doctrines for which others should contend, but he left a name for studiousness, honest and logical thinking, which was a priceless heritage for the university with which he was connected.

The next great scholar to whose life and works I would invite your attention for a moment, is Morgagni, born in Italy in 1682, died in 1772. He was a pupil of Valsalva, whose assistant he became at the age of nineteen. Brought up in this way, as it were in the domain of anatomy, it is not strange that he devoted his attention throughout his life especially to the anatomical products of disease. It matters little to us now that he was wont to regard these products as the causes of disease and thus neglected their remote causes. He it was who taught us to apply to pathological anatomy the same scrupulous attention to tissue alterations and changes which the ordinary anatomist would note in dissecting a new animal form. He was scarcely the founder of the science of pathological anatomy, for this credit belongs to Benivieni, but he did very much to popularize the study and to show its importance. More than this, he wrote a work which for his day and generation was colossal. It bore the title "_De Sedibus et Causis Morborum per Anatomen Indagatis._" It consisted of five books. The first appeared in Venice in 1761. This proved a perfect mine of information to which one may often turn even to-day, and read with wonder the observations published one hundred and fifty years ago. They stamp Morgagni as a great scientist as well as anatomist. His industry will be indicated by the fact that even after he became blind he did not cease to work.

Perhaps the most wonderful figure in the whole history of modern medicine is that of Albrecht von Haller, of Berne, born 1708, died 1777, and often known as the Great. No more versatile genius than his has ever adorned our profession. A most precocious child, he developed remarkable abilities in the direction of poetry and music, as well as medicine, and the only wonder is that he lived to such a ripe old age, enjoying the fruits of his labors, having displayed throughout his entire life an industry and productiveness which were most remarkable. Before he reached the age of ten he had written a Chaldee grammar, a Greek and Hebrew vocabulary, and a large collection of Latin verses and biographies. During the next few years he translated many of the Latin authors, and wrote an original epic poem of some four thousand verses on the Swiss Confederacy. All of this work he had completed by the age of twenty-one. It is not strange that among those who knew of his precocity he was generally known and regarded as a "wonder child." It will thus be seen, too, that medicine was but one of the many subjects of his study. He studied a year in Tübingen, where the riotous living of his fellow students repelled him; then he went to Leyden, falling there under the influence of the illustrious Boerhaave. How much he drew from this source no man may accurately say at present, but a more brilliant example he certainly could not have had. He finished his studies in Leyden before he was twenty and then traveled through England and France, but was compelled to flee from Paris to escape arrest for hiding cadavers in his room for purposes of dissection. This will prove an evidence of taste for study if not of taste in other directions.

Suddenly developing a passion for mathematics, he went to Basle and worked so hard as to almost ruin his health. This necessitated a trip to the mountains and here his interest in botany was aroused and indirectly that in medicine continued. Soon after he returned to Berne to take up the practice of medicine. Here he studied and worked so hard as to arouse a suspicion of his sanity, but he kept up his health by frequent trips to the Alps in search of flowers. His fondness for botany and his taste for poetry seemed to grow with equal pace and he seems to have been among the first of modern students to appreciate the beauty and grandeur of Swiss mountain scenery. When he was twenty-five years of age appeared the first edition of his poems, many editions appearing later. Here in Berne also he published so many essays on botany, anatomy and physiology that widespread attention was attracted to his eminent learning, and he was called to fill the chair of anatomy and botany in the new university of Göttingen, where he spent seventeen years of extraordinary mental activity, publishing countless papers and at the same time continuing his poetic and his nomadic habits. He established in Göttingen a great botanic garden, founded scientific societies, published five books on anatomy, all elaborately illustrated, printed a series of commentaries on Boerhaave's lectures, and is said to have contributed altogether thirteen thousand articles relating to almost every branch of human knowledge. It is not strange that the fame of the University of Göttingen depended largely upon Haller's reputation.

But Haller developed a clear case of nostalgia, and after being fêted by the nobility, honored by almost every monarch in Europe, and receiving every honor that universities and philosophic societies confer, he resigned from his chair in Göttingen and returned to Berne, to his _fatherland_. Here, amid his old home surroundings, he worked for twenty years more at the same tremendous rate, discharging diverse duties of state and private citizenship, founding and promoting industries and asylums, and serving constantly upon commissions of all kinds. While thus engaged appeared that phenomenal work, his great Treatise on Physiology, so full of original observations that it has been stated that should discoveries which have been re-discovered since Haller be collected they would fill several quarto volumes. The physiological institute of Berne is to-day known as the _Hallerianum_, as it should be, for it is distinctly the product of his genius. He died at a ripe age, after having performed an incredible amount of work, the greatest scholar of his own or perhaps of any century, revered and honored, faithful to the last and exhibiting in his last moments that "philosophic calmness of the cultivated intellect" of which Cicero loved to write. It is related of him that on his deathbed he kept his fingers on his own wrist, watching the ebbing away of his own existence and waiting for the last pulsation from his radial artery. Finally he exclaimed, "I no longer feel it," and then joined the great majority.