A History and Practice of Medicine

The topic assigned me as a title for my paper did not indicate that I must confine my discussion to the modern lay. I have therefore, as a matter of interest to you, chosen to follow the practice of medicine from its early beginning, tracing some of the misconceptions, not only of the lay, but, as we now know, of the doctor himself, down to the present time. As the story unfolds, you will see how the primary school child of today has a more complete, true and accurate knowledge of medical science than did the learned wizard of 260 years, B. C.

Of all sciences, the medical has been the slowest in growth, considering the amount of attention that has been given to it. There are but few branches of medicine, even now, which have reached the position of true sciences, and the venerable approach that medicine is only a matter of fashion and empiricism is still flippantly thrown at the profession. In this regard, a study of medical history will show that the present status of the profession is not a result of the work done in the 4000 years of its existence, but of the last 400 years of rational investigation. Medical science, therefore, is in reality comparatively new growth and is to be estimated from this view point. Furthermore, we find that, although some branches of medicine are not yet sciences, each one of them is established on a scientific basis and id gradually becoming more and more the organized, growing body of real knowledge which a science is held to be.

In the history of medicine, there is no more notable feature than this prolonged absence of all real progress. As with other branches of science, however, it is not difficult to discover causes for this phenomenon, causes in this case peculiar to medicine itself; the ancient prejudice against dissection, which kept back anatomy and physiology for 2000 years, or the methods of Aristotle which loftily aimed to turn medicine into philosophy and thus became its bane.

Then, too, the innate horror of sickness and death in the primitive mind made mysticism and quackery more acceptable than patient or sensible work, as shown in the popular manifestations of mesmerism, animal magnetism, spiritualism, phrenology and so forth, which have always diverted ambitious wanderers from the true field is science. There was for centuries, too, an absurd prudery, which retarded the development of obstetrics and gynecology, while the low repute attached to surgeons hindered the growth of their science for more than a thousand years.

Agencies such as these were continually hampering the progressive energies of medicine; and this was to go on until humanity and reached the state of intellectual freedom and civilization which distinguished so brilliantly the 17h century. We find the first and longest stage of medical history beset, therefore, with futile theories and stupid routine, to the neglect of scientific investigation and the disgrace of medicine as an art. Only here and there in the story does a man of genius appear, who sees what his profession needs and contributes to its advancement.

Although the Assyro-Babylonians and Egyptians were the earliest cultivators of medicine, translations from heiratic script on papyri which they left reveal that they had a very limited knowledge of anatomy and disease and that their treatment was largely confined to fanatic incantations against demons of the disease. They had, however, a fine code of medical ethics and some stipulation as to the regulation of fees.

The Greeks were the founders of medicine and Aesculapius, whether a myth or not, was associated with its early development. He is supposed to have lived before the Trojan War, 1200 B. C., to which his sons went as surgeons to the Grecian army. Aesculapius wrought wonderful cures, even angering the gods by his skill.

As time went on, temples were erected all over Greece to Aesculapius. In these temples lived priests who were supposed to be his lineal descendants and who held secret the theories of his art. These secrets consisted on no definite, scientific knowledge of the body or its ailments, but simply of certain hygienic rules, the use of a few medicines like emetics and cathartics, and more than all the employment of suggestion and appeals to credulity and imagination, persuading the patient that the god was intervening to cure him.

The system had one good result. After a cure it was customary for the patient to present to the god some offering, often a tablet containing a description of his disease and of its treatment. The data on these tablets was collected later by the remarkable man who founded rational and scientific medicine, Hippocrates.

Hippocrates was born 460 years B. C., the son of a priest of the Aesculapian Temple at Cos. He was not satisfied with the knowledge handed him by his father, but went forth to collect facts, make new observations, inculcate rational principles of investigation and separate medicine from jugglery and priest-craft. He was a close and careful observer. No one ever described the symptoms of a disease with more graphic concision. He taught his followers not to be guided by theories but to notice symptoms closely and to treat each indication. Nor were they to adopt any principle which was not the rigid inference from any facts. Sounds like a modern cold-blooded scientific investigation – but he could not free himself from the influence of his times and indulged to some extent in speculations which bore fruit in theories to hold the public eye and mind for more than 2000 years.

Matter was then believed to be composed of four elements: fire, water, earth and air. These gave the eight properties of hot, cold, moist, dry, hot and dry, hot and moist, cold and dry, cold and moist. Applying this, it was asserted first that the body, which consisted of solid and humors, contained four of the latter: blood, yellow bile, black bile and phlegm. Of these, the blood was hot and moist, the yellow bile hot and dry, the black bile dry and cold, the phlegm cold and moist. A preponderance of any one of these caused a disease with the character of the humor. Thus, too much bile would cause a fever which was a hot and dry disease.

In acute diseases they bled the patient and gave a famine diet until the crisis passed with the generous use of purgatives. Some may think it’s not so different now, except that we give the famine diet first, then bleed the patient and when they get the bill, do not need a purgative.

Aristotle, who came 50 years later, was a close friend of Alexander the Great. Alexander was very interested in learning and supplied all kinds of animals for Aristotle to dissect and study. Thus he discovered the nerves and taught that the heart was the origin of the blood vessels. Proxagaros, who lived about the same time, discovered the use of the pulse in diagnosis. He believed, however, that the blood vessels carried air around to the body and only bled under abnormal conditions, like a cut, when the blood would rush into them and spurt out. This theory was accepted as late as the 17th century.

Under the rule of Ptolemy Sotier, Alexander’s successor, dissection of the human body was allowed and Erasistratus came very near to the discovery of the circulation of the blood which was not actually discovered and demonstrated until Harvey did so in the early part of the 17th century. Erasistratus performed a very wonderful cure on Prince Antiochus who was wasting away from a concealed passion for his mother-in-law Stratonice. No physician had been able to discover the cause of his illness until Erasistratus, suspecting it was love, caused the ladies of the court to pass by the patient one by one, the physician keeping his hand upon the invalid’s heart. The violent throbbing as Stratonice passed by revealed the secret.

During the 1st century a lage group of Romans, Greek educated, flourished in popularity. Their education and practice was based on old methods with modifications. A long popular remedy for epilepsy devised by Serapion showed the extreme of their fanciful empiricism. Rx: brain of camel, rennet of calf, excrement of crocodile, heart of hare, blood of turtle testicle of boar. Some preparations contained 40 to 60 substances.

The public bath came into great popularity as a therapeutic measure at this time and hot and cold baths were supposed to cure all forms of disease. Antonius Musa cured Augustus Caesar with his cold water treatment and so achieved a temporary popularity. With the advent of hydrotherapy, the douche first came into being medicinally.

Galen, who came to Rome in 166 A. D., gave much to the advancement of medicine which influenced it for 1500 years. He was a liberal and profound thinker and prolific writer. In physiology and anatomy, he taught that the body was composed of solids, humors and spirits. The spirits were believed to originate in the liver as natural spirits. These were then carried to the heart where they united with air to form vital spirits. Galen divided the soul into three faculties: the vegetative, residing in the liver; the irascible in the heart; and the rational in the brain. This doctrine was the basis of all physiological theories.

For many, many years following Galen, medicine remained in a state of coma, practiced largely by the clergy. The layman, on the other hand, who ventured into practice was regarded with scant respect and the law required hard and degrading things of him. If under his bleedings and prescriptions a common man died, he had to furnish another to his lord. If he injured a gentleman, he had to pay a fine, while if the patient died, the unfortunate doctor was placed in the hands of relatives who could do with him as they chose. Possibly, at this time, the mortality among physicians measured the strength of domestic affection. It did in one case that was recorded. The Queen of Burgundy, upon her dying bed, requested that her husband have her attending physician executed immediately after her death. The bereaved husband performed the desired ceremony and the spirits of the angelic queen and the inefficient physician took a synchronous, and it was hoped, a peaceful flight into the unknown together.

In the 16th century, the barbers who then did nearly all the blood letting, wound binding and cutting for stone, produced a young man by the name of Paré, who by honest, conscientious effort and liberal thinking, elevated surgery to a much higher degree and himself to a seat of fame. At his death, he had been surgeon to four kings He substituted ligature in wounds for the old, repulsive method of boiling oil upon them. The modern colored advertising sign of the barber is a hark back to his blood letting days.

With the 17th century, we enter a period of scientific research and emancipation from the dogma of Hippocratic philosophy. Physiology was really founded by Harvey’s discovery of the circulation of the blood. We find also in the first stages, a popular school of chemical physicians whom waning orthodoxy wages a fierce war, but is finally obliged to yield.

Harvey was born in 1578. Although he lived in the bloody time of Cromwell and Charles I, he was isolated from their influence by his quiet and studious nature. As physician to Charles I, he was at the Battle of Edgehill in 1642. On that fearful day, when the fate of his royal master and perhaps his own were so fiercely and bloodily contested, an “elderly man was seen sitting under a hedge reading a book.” It was Harvey, and the book a work upon generation. The physiology of the reproduction of his species was more exciting to him than the mechanics of its destruction being enacted before him. In 1615, Harvey had lectured to his students at St. Bartholomew’s Hospital on his demonstration of the circulation of the blood, 15 years before he gave it to the world. When he did finally publish his findings, they were met with great opposition and ridicule. He lost some practice and was sneered at as “The Circulator,” But such persecution was mild and did him little harm. King Charles patronized Harvey and made him his court physician. Not long after, the great anatomist Malpighi demonstrated capillary circulation from arterial to venous radicles, thus sustaining Harvey and “The Circulator” lived to find himself honored and his discovery generally acknowledged.

Of the great events of the 18th century, none was so laborious in its accomplishment or so grand in total results as the discovery of vaccination by Jenner. Jenner’s character and work both inspire enthusiasm. We often hear of unselfish devotion and pure love for humanity. In Jenner we find them gloriously exemplified. When his discovery had been laid before the world, and its reliability nearly established, a London physician sent him word to come to that city and make $50,000 a year. Jenner, though a poor country physician, refused this offer, which meant essentially that he should sell his discovery. Aside from his high moral qualities, Jenner showed a marvelous power in the persistence of his investigations ad in his undoubted patience. He examined and tested his theory in every way and withheld the beliefs that must have been burning in his bosom for 30 years until he had strengthened with every possible experiment their value and certainty. The first announcement of his discovery in 1798, was, of course, greeted with distrust and suspicion; yet it was tried and three years later, very extensively acknowledged. Then jealousy arose and malignant articles and even books were published against his discovery. But through opposition, financial losses, misrepresentation and ridicule, Jenner bravely and at last triumphantly struggled, confidant that through him a horrible and destructive pest would be removed from society.

During the 19th century, American medicine began to assert itself, and with the old world advances, medical misconceptions were laid low in a wholesale manner. Every known disease and human complaint received a dose of the burning light of scientific investigation and the true facts were laid bare for public knowledge.

Pasteur of France who discovered the bacteriological cause of diseases, was followed closely by Lister of England who applied the knowledge in the antiseptic preparation for operation and surgery strode forward by unbelievable bounds. The discovery of surgical anesthesia by Dr. Long of Danielsville, Ga., in 1842 and its wide application by Morton of Boston in 1847 released one of God’s greatest gifts to humanity and paved the way for surgical progress.

It has been truly a race for the human mind to lay aside pet ideas and handed down theories and keep pace with truth and the actual facts concerning their medical conceptions. I spite of the radio, newspapers, close communication by rapid traveling and widespread interest for greater knowledge, there still remains many medical misconceptions of the layman to often try the patience of the busy physician. In this respect, the present physician’s attitude is markedly different from that of the old doctor who must cloak his ignorance in an air of knowing mysticism. Today, medical knowledge is sufficiently accurate, and universally disseminated that the doctor finds him self thinking the logic of his problem out with the patient himself and arriving at a conclusion with the full cooperation of the sufferer.

Having wandered up through the years of medical knowledge with some of the fallacies, misbeliefs and their overturning, I shall now turn to some of those more common and persistent misconceptions which cross our paths from day to day.

We often hear someone speak of hereditary syphilis. There is no such thing. It is con genital and is transmitted only by the mother as the child develops in utero. In other words, the father, if he has it, must give it to the mother before the child can be born with syphilis. Even then, it is not hereditary from the mother but is simply transmitted by contact. The spirochete pallidum or causative germ of syphilis is as large as the spermatozoa and would undoubtedly have a fairly difficult time in the act of transit, riding from parent to offspring. However, it is not definitely established, we do believe that the ravages of syphilis on the human body, create certain weaknesses of that organism which cause to be produced a less virile spermatozoa and offspring; the same as does alcoholism or any other ravaging disease. This above statement I offer with some skepticism as an assumed fact. I do not feel certain that changes take place in the germ plasm of one afflicted with syphilis which produce any effect on the offspring. Many good thinkers do, however, and I shall put it down as a fact in the light of our present knowledge.

As a matter of interest it might be apropos to state that syphilis is considered an original American disease – transmitted for the first time to the old world by the sailors of Columbus on their return following the discovery of the new world.

Many people believe or assume that gonorrhea can be contracted from the toilet seat, and that it is no worse than a bad cold. These assumptions always give the doctor a quiet little laugh up his sleeve and are generally accepted as an alibi. While, with a gigantic stretch of imagination, it might conceivably be contracted that way, it never is. Probably more actual suffering, mental and physical follows, in the wake of the onslaught of gonorrhea than any other single human affliction. It is much worse than a very very bad cold. Gonorrhea and syphilis are two separate and distinct diseases and one never leads to the other, although both are often contracted at the same time.

I doubt if any of the gentlemen present still believe in he marking of children by prenatal impressions of the mother; but it is so common a superstition as to lead me to speak of it here. I have seen red birth marks that were the result of the mother seeing blood before the child was born, or perhaps eating very nice red strawberries – gray moles on the infant’s body that were caused by a Maltese cat jumping before the pregnant mother. Harelip has been laid to the expectant mother being confronted by a stare from a cow – although she has looked the family cat in the eye at frequent intervals. Common logic would seem to dissipate this theory for there is hardly an object, visible to normal human beings that does not come under the eye of the expectant mother and if such were possible, the offspring should be marked by all sorts of impressions and each human being would be able to qualify for a seat in Barnum’s side show.

Quoting from Dr. Lee, “The arguments against the theory are, first, there is no nervous connection between the mother and fetus. Virchow, himself, could find none. Kolliker found nerves in the umbilical cord, but no connections were demonstrated. Second, the child is completely formed at the end of the 6th week, a time that pregnancy is not usually recognized, and in most of the cases reported the causative mental shock occurred much later in gestation. Third, all the monstrosities observed in the human are found in the lower animals, birds, fish, even in plant life, and in much greater number. Many, many women see ugly or striking scenes during pregnancy and anxiously ask the doctor if the baby is “marked,” but their fears are seldom realized. It would seem then that with our present medical knowledge, the belief in effect of the mother’s mind on the physical well being of the child is absolutely unfounded.”

Many people labor under the impression that a daily bowel movement is necessary to preserve their health. Thus they are led to take a cathartic which empties the bowels completely and the following day there is not enough bowel content to cause a sensation or desire to evacuate, and another cathartic is the only remedy. So a vicious cycle is started and a very bad habit. I believe that, barring some mechanical obstruction to the passage of intestinal debris, a physic is seldom if every justified. I would advise not taking a cathartic if there were no bowel movement for 2-3-4-5-6 or 7 days. Perhaps it will cause a stuffy feeling or headache, a lot of which would be psychological, but there are better ways to overcome it than by cathartics. Regulation of the diet, fixed period with concentration for stool, kneading the abdomen and perhaps a low enema to start things, rarely necessary at first, until a natural condition has been set up and nature is allowed to pursue a normal course.

How many kidneys are erroneously blamed for a pain in the back? Doane’s picture advertisement of a man with a cane in one hand and his other hand on his back, agonized expression on face and general attitude of misery, has led many a patient to the doctor’s office with a sample of urine. As a matter of fact, the more serious of kidney afflictions give no back symptoms and a complete examination most often reveals an old back sprain with engrafted low grade rheumatism – the sample of urine completely negative. Pain in the back may be and is caused by infection of the kidney pelvis, hydronephrosis, tumor or stone, but the great army of human beings who have some form of nephritis, and it greatly exceeds the above mentioned, have rarely, if ever, any back pain. There are many interesting features of this question that would bear discussion. I shall leave it open for that purpose.

Although even the majority of doctors, including myself, and I know all of the laity, are addicted to the use of copious plasters, liniments and gargles, I question very seriously any great beneficial results from them, outside of their psychological value. For instance, how can we logically assume that a mustard plaster poultice applied to the outside of a chest wall, can penetrate the skin, which is so constructed to daily protect our internal workings from shocks of heat and cold, so that they maintain a remarkable equilibrium, the superficial layer of fat, the facia, the muscle, the body chest wall, two layers of pleura and change or alter the condition of the lung beneath. The same is true of liniment, although here the penetration need not be so deep and alternation of blood supply and massage may have some effect. In a case of tonsillitis, the whole tonsil is usually inflamed and infected, does a gargle, which washes the surface materially, change the course of the infection? I doubt it. The disease would probably progress to a certain stage where the inherent body forces rally to overcome it and subside in exactly the same number of days, gargle or no gargle. Te contained ingredients of the medication no doubt soothe the diseased parts, however, and can possibly be recommended for that purpose.

Now in regard to goiter, there seems to many mistaken ideas among the lay concerning this important disease. There are mainly two types of goiter – the large tumorous type or the so-called outside goiter and the small scarcely visible type called inside goiter. Of the two, the small type ios much more serious. This type, due to an overproduction of the secretion of the thyroid gland, produces a rapid pulse, bulging eyes, great nervousness. Loss of weight due to increased metabolism, trembling and shaking and often severe prostration. It is a condition that requires operation after careful preparation. Previously the preparation consisted of prolonged rest in bed, digitalis, nerve sedatives and frequently a two or three stage operation at which times the large blood vessels leading to the gland were tied or cut to lessen the activity before the gland was removed. Now, with rest, sedatives and liberal doses of iodine, we can cut down the period of preparation and seldom if ever need to resort to litigating the blood vessels. The iodine, however, gives only a temporary relief so that the operation must follow at the proper time following its use. Iodine is not the panacea or cure all for all goiters, however, and must be used with accurate knowledge of the case for if given in the outer type, the large tumorous type, which has never given any symptoms except perhaps pressure, it will probably set up on activity with all topic symptoms similar to that which I have just described. It should, therefore, never be taken indiscriminately for any swelling in the neck but only under the direction of a competent physician. One other type of goiter which is benefited by iodine is the adolescent type. Even here the extracts of the internally secreting glands are often more rational and beneficial.

Not infrequently following an operation on the pelvic organs of a female, the husband will approach me with the question “Which ovary did you remove Doctor? The boy or the girl ovary?” The explanation which follows is generally only preliminary to the more substantial one which follows when the mother goes ahead and produces both girls and boys.

Nearly everyone is under the impression that all infections of the hands, arms, feet and legs,, which reach any degree of severity, are cases of “blood poison.” Of course, there is a certain amount of toxin thrown into the blood stream from any infection, no matter how small, as evident by temperature, prostration and the like, but the only true cases of blood poisoning, as we conceive of it, are those in which the infecting germ invades the blood stream and we have septicemia. Nearly all of these cases are fatal in spite of the most heroic measures such as transfusion and injection of chemicals (formaldehyde and mercurochrome) directly into the blood stream. Of course, we encounter infections which are not septicemia and in which the invading organism does not get into the blood stream in sufficient severity to cause death. As a rule, these cases, by wide open drainage and proper conscientious care, can be kept localized to the original site and will heal as soon as nature has sufficiently rallied her resources to overcome it. The famous, so-called “blood poison” doctor at Salamanca has thrived and prospered on this misconception of the layman. These infections need an opening to evacuate the pus and something moist to keep it draining instead of drying over. She provides a slow opening by the use of a hot, moist, herb poultice which softens and macerates the skin so so that the pressure beneath forces an opening, then the continuation of poultice or the use of a salve keeps it open and draining. The danger in this method lies in the slow opening which often nallows unnecessary destruction of tissue beneath with consequent prolonged absorption of toxin and even in some cases the fatal invasion of the blood stream by the germ, when an early, simple incision, followed by hot, wet dressings would have cleared the thing up in a hurry.

I often ponder over the paradox when a family facing an acute appendicitis operation will hesitate, vacillate and call in consulting physicians and the following week treat an infection of the hand with all the lightness of an approaching holiday. To my mind, the infection of the hand requires infinitely more judgment and skill for nearly any doctor can diagnose and remove an acute appendix, but only one who has knowledge, judgment, alertness and a sense of his duty should face the problem of a progressing infection of the hand. Perhaps you may consider me a bit of a radical on this subject, but I have seen too many such cases bungled purely from a lack of sense of its importance. I am not crying for less care in appendicitis but for more in infection of the hand.

Perhaps I have rambled enough to bring up some points for discussion. What I have stated as fact tonight may be overturned as ridiculous tomorrow. We live to learn. What I wonder is do we ever learn to live?