Stalkers of pestilence

[From

Fernelius’

Universa

Medicina,

BOOKSHELF

OF PESTILENCE

WADE W.

OLIVER, M.D.

BROOKLYN, PXHT

T

ANTIQUITY

N. Y. 1

A!IAN To

PIEHISTOKIC THE

x679.1

BROWSING

STALKERS

OF DISEASE

HE pro\.ed antiquity

Geneva,

of disease makes it probable that illness has thrown its black shadoiv across human affairs ever since man emerged as man. And because man, e\‘en when most primiti\.e, tends to pour the chances and mischances that befall him into the mould of symbol, it is quite probable that, before the dawn of recorded history, certain rudimentar> concepts of the nature of disease had found their m-a>-into his brain. In this connection, a few references* to the scientificaIl>- proved evidence of the antiquitv of disease may not be amiss. The o&in and development of disease can be traced to some extent from the pathological lesions found on the fossil bones of ancient races of man and extinct as well animals, as by pathological researches on ancient Egyptain mummies. From the researches of Sir Marc Armand Ruffer, G. Elliot Smith, Bernard Renault, Roy L. Moodie and others, it has been demonstrated that the history of disease properly begins with the early Paleozoic or Proterozoic, 100,000,000 or more J-ears ago. The fossil remains of primiti\,c \~erte-

G;\Lw

brntes of the Paleozoic Era ha\,e 1\.ieldecI abundant evidences of such diseases as dental caries, p>-orrhea nI\.eoIaris, osteomyelitis and fracture, diseases which apparently have changed but little, if at all, in the past IOO miIIion years. As examples, may be mentioned the fact that caries has been found in the bones, scales and teeth of fishes from the Permian period in France; the mandible of a three-toed horse shows caries jvhich resulted in absorption of the al\.eoIar margins and exposure of the roots of the teeth, i.e. the sequence of events \vhich may occur in pyorrhea alveolaris as we know it toda)-; and caries of Pleistocene elephants has been noted. One of the most interesting facts of recent development is that arthritis deformans, a disease found in so man? Egyptian mummies, is idcntica I Lvith the “cn\.e gout ” CHohlenpieht ) which Virchow found in bones of prehistoric men and bears, and which also is common in the skeletons of the earl!German forests. In regard to our knohvledge of the existence of bacteria in prehistoric times, two methods of gaining knolvledge ot

434

such ancient bacteria ha1.e been cn~plo~ecl: I / ;lctunl obserx.ation of bncilli, coccG or \pores in thin sections of rock and (2 1 I>! int’erring their presence from results lvhich present -clay knowledge has conlirn~rcl 3s tfuc to Ixictcrial action. In 1914, I%‘nIcott :~ctunll> clisco\~ered bacteria in the olclest t;wtl-bearing rocks of North .4mericx, I’ountl in central hlontnna and dating lxic[i tl) the Cambrian and Pre-Cambrian l)eriods;; in other wvrds in the \ cry du\vn of the geological histor) of :Ininwls. The l>nc.tcri:\ disco\ erecl lverc I,?_ \\‘aIcott micrococci, oc>curring :is single cocci and in short chains; their ;I\ et-age clinmeter \V:IS t’rorn o.95 p to I .;p. The>- I\ erc found in rocl\s in assoc.i:ition Lvith the earliest t’osxilized plnnts and anim:lls, forms which tlourished in the dalvn of the world’s history.. Doubts that such delicate microor,:;Lnisms as bacteria arc cap;lbIe of preserx-ation in :t fossilized condition hn1.e l~ecn rather- definiteI>dispro\ cd I~>-other in\-estigators, \vho ha\-e sho\vn th:lt fossil brains, fossil flo\vers, fossil blood cells, muscle and kidne!. structures may be so \\-ell preserved that minute detnils of the tissues an be :\ccurntely seen. of t\\-enty-four Renault, as n result \-ears of labor, found bacteria in the petrified feces or coprolites of fishes and of bone rcpt i [es: :IS well 3s in fragments isolated from I-ock which dated back to ;geological ages succeeding the De\-onian. He also obs&-ed bacteria in the stomach cxmtents and in the teeth and ja\vs of fossil prehistoric \-ertebrntes. It is well lino\yn that certain fishes ha\-c m-ithin their rectum a spiral \ all-e which gi\.es to the extruded feces an irregular ellipsoidal t;)rm, with characteristic markin,ns. These ioprolites Renault found at alI levels of the Autun Lake, in France, especislIy in certain areas, as if the fishes had lived in this prehistoric Permian in x\varms lake. FrequentI>in sectioning ;i coprolite one: finds remains of bones, scales and morsels of food, the residue 01’ digestion, \\-hich have contributed to the preserl-::tion of the coprolite. In fragment% of bones

and sc~~les found in his coprolites, Renault cIisco\~erecl on sectioning the bones, that the Iacwnne and canalicul:\c often cont:Lincd niicrocwci ; lvhereas bacilli seemed to bc mot-c numerous in sections of scales than did micrococci. Renault named the micrococci 11. Icpidoph:lgus, :~ncl described them as spheric:) I cells ranging in cliametr~rfrom o._c,~ to 3.2,~~ with :I tenclenc.!. for the cocci to appear in the cliplococcus grouping :1ncl ; I1 short ch:l;ns of four members. The bac*illi Renault tlesignntcd K. lepidophagus, :rncl clwcribecl them as c!~linclricaI rocls h:~\-ing :I length (If’ from A.Z~ to j.2F and :I diameter of from O.-P to I .op. According to Renault’s description of the coc>ci :IncI bacilli fount1 in these ancient bon>. pl:ltes, one ni:iy surmise that the clestruction of bone \vas performed in :lnc,ient times 1)). n~icrococc‘i and bacilli \\.hose fornl and proportions :rl)pronch in :I most remarknblc mannerthose bncteri:l which \YC describe toda! a\ the c‘.:Iuse of caries of bone and teeth. In the case of the earliest I\no\\ n exsmplc of osteomyelitis, in the frncturecl \ertebr:ll spine of ;I Permian reptile from Terns, bar,teria of the micrococcus t! pe \vere found b! h’looclie to be abundantI>, preser\.cd in the distorted osseous l:~cun:~e. They n-ere similiar in all respects to those found b?. Renault in the fossil bones of fishes.

The earliest prehistoric men probable had no formulated idea of the nature of disease. The hurts which the>- acquired their pursuit of food, and in d uring battles \\-ith their human :lncl anim:ll enemies, the) probabI~- acceptecl Lvith the same unreasoning calm as they dicl the flicker of sunlight in front of their c:\Y.et started The “LvhJ- of things” its multitudinous echoes in his brain. Rut, in common with the lower animals with iThorn he contended for his eristencc, the instinct of preser\.ation was strong \vithin him, supplemented, :IS it :kIvr-nys is, by- :I certain rude and prin1itix.e instinct for caring for his wo~~~~cIs, as \\.ell 3s b\-

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an instincti\.e h)-giene. He shared with the wild beasts of the forests the instinctive hygienic lore which caused him to stretch and warm his body in the sunlight; when hurt he, too, hid in hoIes and caves; like the anima1 he, too, Iimped when his foot was maimed. Like the animaIs he perhaps sought out certain herbs and grasses when he \vas sick. In this sense, the statement of “the first man was the first Le CIerc’ physican ” is true, because instinct teaches a11 beings possessing sensibility the rudiments of caring for their wounds. However, it would seem that these primitive, common-sense procedures more accurateIy represent the origina rudiments of the art of nursing, which probabIy preceded the medica art, and was its initiative. As the brain of primitive man developed, al1 sights and sounds in nature, the rustIing of Ieaves, the flicker of sunlight, the flash of Iightning, the crash of thunder, became visibIe signs and manifestations of spirits, maIevoIent gods, or demons. In other words, he inextricabIy wrapped up the natura1 in supernatura1 trappings. Therefore, he lvorshipped the sun, the winds, the Iightnings, the thunders-the era of simple nature worship. A further development in primiti\:e man occurred when he first set up carved sticks and stones to represent these naturn agencies, and thereby entered upon “fetish worship,” and the practice of sacrifice to, and propitiation of, these symbols. Primitive man, as the lowest grades of human life today, heId originaIIy to the concept that disease is an evi1, extrahuman spirit or the work of an evi1 spirit. Perhaps the next eIaboration of the idea came when he began to Iook upon disease as the maIevoIent visitation of a human enem)possessing supernatura1 powers, whose speIIs and sorcery had to be met with simiIar hveapons. And then, perhaps, as intimations of a spirit worId outside the worId of his daily- affairs came to his awakening brain, disease began to be Iooked upon as the work of hostiIe or offended spirits of the dead.

SEPTLMBER. ,929

of Pestilence

From these primiti1.e concepts of disease, the primitive “medicine man” and the “witch doctor” were perfectly natura1 and logical developments. They both assumed a soIemn, and somewhat mysterious, supervisory relation to disease and its cure, not unlike that of the priest to reIigion. Quite generaIIy, irrespective of geographica boundaries, the primitive “doctor” empIoved therapeutic procedures whose uI&nate purpose was to “out-demon” the disease demons. Hence, he dressed in terrifyjng costumes and these, combined lvith hrs shaking of rattIes and his ra\-ings, both physical and x.ocaI, were calculated to frighten the disease out of the patient in whom it had taken up its residence. As a prophyIactic procedure, charms and amulets were provided his patients, to \?-ard off the demon’s return in the future. ANCIENT

EGYPT

AIthough it is to ancient Egypt that \ve must Iook for the first beginnings of the art of medicine, as weJ1 as of phiIosophy, it is probabIe that the ancient Egyptian civilization, as we11 as that of Mesopotamia, was nearer to, and deveIoped more closeIy from, the arts of prehistoric men of the Later Stone Age than has hitherto been beIieved. However, the earIiest known physician of which history- makes mention was an ancient and ceIebrated Egyptian of the third dynasty (Ajo0 B.C.), known as I-em-hetep, “He Who Cometh in Peace.” He was a physician of such repute that he was Iater worshipped at Memphis, and a ternpIe was erected in his honor upon the isIand of PhiIae. In ancient Egypt, at first the priest and the physician were identified, and medicine never became fuIIy dissociated from religion. Disease and death were believed to be not natura1 and inevitabIe, but to be caused by some malign influence which couId use any agency-, natura1 or invisible: Often it belongs to the invisible world, :md onIy reveals itself hy the malignity of its attacks; it is a god, a spirit, the souI of a dead

tn;~n, th;tt has cunningly- enterccl 21living person, or t li;lt throws itself upon him \vith irresistible \~iolcnc~c. Once in possession of the I,otl>-, the ck\.il intlwncc h-c& the hn~s, su~lis out the 111;1m1\\, drinks the blood, gnaws the intestines ;~n(l the heart, antI devours the tTcsh. The in\~litI perishes according to the progress of this c.Icstructi\-c I\-ork; and tle:lth sptccIi1~ c’llSIICS, unlw5 the evil gcniiis can be driven out of it before it has cornmittcct irreparable (Inn~gc. \\‘hoc\-cr treats a sick person has, t lied~~rc~, two cc~ually important cluties to pedorm. He must first clisco\,er the nature of the spirit in possession, ancl if ncccssnr!-, its n;l me, and then attack it, drive it out, or even destroy it. He can only succeecl 13~ powerful nwgic, so he must be an expert rn reciting inc:lntations, and skilIfu1 in making amulets.” Incantations, with their implied or apparent magic element, \vere looked upon by- the ancient Egyptians as of very great In ancient days men, too, importance. sickened and died, with much the same diseases as they do toda;\-, and the voice of the white-robed Egyptian priest comes with a patheticahy remmiscent ring across the centuries as he lifted his brown arms to the sl\, and spoke the follo\ving magica who art lvithin the t;mJlllln : “0 demon abdomen of So-and-So, son of So-and-So, 0 Thou Jvhose father is surnamed He who causes heads to faI1, kvhose name is death, Jvhose name is the male of death, whose name is accursed to Eternit\-.“4 The amulet is the oldest ‘form of proph>-Iaxis against disease.” Originally, organs such as the brain, testicIes and marrow of animaIs were devoured, for the purpose of reinforcing an individuai’s functions and his natura1 resisting powers. From this origina concept MXS derived the simpIer custom of wearing on the body portions of animals, or insects such as spiders, which were behex-ed to be immune to poisons, or even rare and odoriferous obiects. AIthough the ancient Egyptians heId orugm of disease, to the “spirit” or “god” and aIthough magic, spells, incantations and prayers held a major part in their going back ?-et records therapeusis,

thousands of years establish the fact that the early Egyptians emplo> et1 emetics, purgatil-es, euemntn, diuretics, diapiioretics and e\:en bleeding as ndjuvants to their psychotherap\.. Later, specialism de\.elopcd to such an extent that Herodotus remarked “the countr?is ful1 ot physicians; that one treats only the diseases of the eye; another those of the head, the teeth, the abdomen, or the internal organs. ” In another connection, Diodorus remarks that so evenly ordered \vas the whole manner of life of the ancient EgJ.ptians that it was as if arranged by a learned physician rather than a Ia\y-maker. Clennliness of the person, of houses, and of cities was strictly reguIatecI 1~~ Ia\v, and the priests, by their frequent ablutions and their spotless clothing, did much, by force of example, to stimulate interest in personal hwiene among the people. .h Moreover, according to both Diodorus and Herodotus the ancient Egg-ptian’s belief that most diseases came from overeating Ied to the custom of employing, for three consecutive days in encJl month, proph\-lactic emetics and enemata for reasons. It is of interest to note that the ” is said to be derived from \vord “chemistry “Chemi” (the “BIack Land”), the ancient name of Egypt, bvhence the science was caIled The “ BIack Art. “I’ Egyptian gods were thought to have maIadies as ~did men. Be had sudden diseases of the eye (thought to be s?-mbolic Horus not; alone had of ecIipses) ; and headaches and interna pains, but he had dysentery and anal \veakness as ~.cll.~ Worm diseases were recognized by the a rather remarkable ancient Egyptians, feat in view of the fact that c:\.~II todayand often microscopic, expainstaking, necessnr>to is amination frequentI> establish a diagnosis. The Egyptian :I nemia, considered to be hoc)kworm x-ariously disease or biIharziosis, was thought by the ancient Egyptians to be sent by A A A, the God of Death and, according to the Papyrus Ebers, its immediate cause ~3s ascribed to the worm NeItu.

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According to Klebs,’ Herodotus ,yi\,es an account of regulated inspection of the meat destined for sacrifices. He states that the priest, or inspector, was on the Iookout for- such relatively small parasitic invaders and that in instances as the CJ-sticercus, of the animal were lvhcre only parts sncrificed, the remainder \vvns available for consumption , after n sanitary- inspection h:lcI been made.

The ancient Babylonians and As;):rians also attributed 3 supernatural orrgm to disease, belieLying it \vas caused by the presence in the body of spirits, ghosts or demons. Again it might be due to the “evil eye, ” or to the attack of n human enemy operating through n wizard or witch or other practitioner of bIack magic, or even through the agency of an offended deit>-. Cure of disease, therefore, depended upon the dislodgement and expulsion of the evi1 being by some higher, divine power ; hence the treatment of disease \vas n matter of religion and \vas under the direction of the priests, who for the most part acted as ph>-sicians.!’ Their not infrequent practice of administering to the patient foul and ill-smeIIing substances such as dung and urine, was apparently in order to disgust the invading demon of disease, and make his residence within the body so disagreeable that he \vouId depart.‘” The Babylonians had a Iarge number of healing gods, to whom they sacrificed, and both the ancient Babylonians and Assyrians gave names to the individual demons of disease. Ashnkku was the demon of hvasting diseases; Namtar the demon of plague; Alu a demon that clouds one’s vision. Jastrom.” says: The BabgJonians ant1 Assyrians thus recognizccl an entire facuJt~ of tJemons. The age of specialization had set in which assigned a special function to each cJemon, although the profcssionn1 ethics of tIemonoJogy cJicJ not bar the demons from encroaching on the domain of :I colleague.

of Pestilence

S,.F,l,\,,11.1<, ,,,2O

Mcbs,~ commenting on the fact that primitive peopIes unschooled in modern scientific methods of experiment often of minute and accurate give evidences mentions that on various obser\,ation, monuments divinities ancient Ass!-t-in n are depicted in the act of manualI! fertilizing the flower of the date palm. In another connection, he savs: Theurgic :I nc I numinal concepts form the Ixrsis of tlre nosoJogic:~l nomcncJ:~turc of the ancient BaI, lonians. Tlrc stud>. of cuneiform inscriptions has opc~ic’tl our eyes to a new \vorlcl. Thcx tests which tlcnl Ivith incantations, divinations, corijurntions (exorcisms) and the. Ike contain :I great tlc:rI of information on mcclic:~J sul,jccts. Tlrc priest, \vlro filled thr place of the physician, as so ohm in histor), used these tests as a sort of practical guicle-hook in his claiJ>- routine. They v,a-c to led him to diagnosis, prognosis, prophvJ:lsis and treatment of human ills. The com$Jation of the most important ones can 1x2 trawl to the nonsemitic priests and magicians \vho practiced their craft lxfore the advent of the scrnitic Bal,>~lonians (dated \-ariousJ>- between jooo and qoo r3.C. or, roughly-, before 3000 B.(:.). hlontnigne, Babylonians, the physican. explained by Herodotus (,I

in referring to the ancient sag-s: “the kvhole people was ” This remark is probabl? the foIIo\ving quotation from : 80) :

They bring out their sick to the market ~>Jace, for they have no physicians, then those who pass J>y the sick person confer with him about the disease, to discover whether the>ha\-e themscJ\-cs been dlJictcc1 with the snmc tliscnsc as the sick person, or ha\-c seen others So afflictccl, thus the passers-I,,v confer with him , and atl~ise him to h:i\x2 recourse to the same trcatrnent as that by bhich the?; cscnpecl a similar cliscase, or as the>- have known to cure others. Anti they are not aJlo~ccI to pass fly a sick person in silcncc, n.ithout inquiring into the nature of his clistcmpcr.

According to the Code Hammnruhi (2230 B.C.) a physican’s fees in Ancient Babylonin lvere strictI>- regulated by law. Ten shekels was the statutory fee for treating a wound or opening an abscess of the eye. If the doctor caused the

pntlcnt \ihion, sit.;ln’s

to lose his Iife, the Inw prescribed hands be cut off.

or

his that

organ of the phy-

L’er\- little is knon-n regarding the 1 ie\vs of’ disease held bv the Phoenicians and other pagnn Tvest-Semites, but theurg-, or magic, \v;\s apparentI>the basis of their methods of hc:rling. \NCIENT

1SDl.k

In 1 he earliest Sanskrit documents, the Rig ‘l’eda (I~OO B.C.) and the Athar\~n Veda, KC find that the Aryans of ancient [ntli:r regarded disease as the manifestation 01‘ the pwver of some supernaturnl being: not infrequently arising from the gods in punishment for sin, or sometimes due to a met~c caprice of ;I maIevolent or capricious deity. Hence treatment \vas largeI)a matter of spells and incantations, h\-mns and sacrifices, and because often the’ gods \T cre x-ague and uncertain, the people :Ittributed great power to magic and i;orcer,v in compelling the gods to obey the uill of man. In ancient Hindu writings are found frequent references to the demons 01’ discnsc

Susruta, the famous Rrahni:ln pii>sicixn of the iit’th centuqA D., g:1 \.e :i \‘CI.\ recognizable description of m:il3ria. and to tnosc~uitot5. attributed the disease After the ~lohummedan conquest, Ilintlu medicine \.irtuaII~ceased to exist. The of the ancient Hindus h(vent contribution \v:ls the ren~nrknble skill the!. tl~\~clopd in operati\.c surgery.

I Ii the I rmiart religion, I-ci;mned 1,~ Zoroaster, disease \vas looked up1o11 3s :I diabolical entity, and \vas often named after the p:\rticul:tr demon causing it. Sin and disensc xvere on much the same plane; sin Ixing :I spiritual. and disenw :I bodil>. malady, :I breach of the moral or physical order resulting from pollution, \-isible or in\ isible. This pollution must be removed 64 some rite of purification; hence invocations, hymns and magic must :~ccompan,v the adn&istration of n;ituraI remedies. Like the Babylonians, the Iranians n-orshipped, and sacrificed to :I consid<‘rable number of Healing gods. -\NCIENT

In the Brahmnnical period I 8oo B.C. I ooo ,-I.D.) medicine was in the hands of the Brahmnn priests and schoInrs.

IlERIIE\~

\lEDl(:IU~-.

The Bible and the Talmud arc’ the sources of our lino~~1edg-c ot principal early Hebrew medicine. In the oltl TcstnIS listed as an expression nient , disease of the wrath of God, and cure is to he effected I,- moral reform, pra+7-4 :I nd sacrifice. Ill EXodUS ( I j: 26) Cot1 S:l\ S: “ I ~vill put none of these diseases up011 Lvhich I have brought upon the thee, Egyptians; for I am the Lord that healcth class, kvere 3 distinct thee. ” Physicans apart from the priests, ancl howe\w, professional mid\vi\ es are mentioned in Exodus. The only surgical prowclu I-C mentioned in the Bible is found in the second book of Exodus (4: 25 J \yhr:re Zippotxh, “tcook :I sharp stone the Mife of hloses, and cut off the foreskin of her son.“’ out the fact th:lt the lilebs’ points

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correlation between mice and bubonic pIague was recognized in BiblicaI times, as recorded in II SamueI (2 : 3). After the Ark of the Covenant was captured bs the PhiIistines and taken to Ashdod, a pIague of emerods (hemorrhoids, or tumors, usually identified with bubonic plague) broke out in the town. After the pIague had spread alon g the coast, the priests and diviners advised that the Ark be returned to the IsraeIites, with a trespass offering, consisting of five goIden emerods and five goIden mice “according to the numbers of the Iords of the PhiIistines, ” to represent “images of your emerods and images of your mice that mar the Iand . . . to lighten his hand from off you, and from off your Gods, and from off your Iand.” (~11SamueI 6:5.) KIebs further states: “The concepts of the insect pests among the Biblical people are IargeIy derived from the BabyIonians. Thus the fI)-, the mosquito and other diptera pIay aIso with them a r81e in cuIt and eIsewhere. Ekron heId an ancient and famous shrine dedicated to BaaI-Zebub x\-hich name, IiteraIIy transIated, means the “Lord of Flies.” The TaImud, aIthough essentiaIIy a In\\-book dating from the second century A.D., contains some rather detaiIed information concerning Jewish medicine. In the TaImud is dispIayed considerable knowIedge of anatomy, as we11 as of surgery, probabIy derived in considerabIe part from the fact that the ancient Hebrew religion heId that the meat of diseased or injured animaIs was unfit food. The autopsies performed upon sIaughtered animals Ied to some knowIedge not aIone of comparative anatomy, but of comparative pathoIogy as weI1, and it is interesting to note that the ancient Hebrews were acquainted with caseous degeneration and tumors of the Iungs, as we11 as with atrophy and abscess of the kidne?-, and cirrhosis and necrosis of the liver. The sanitary code of the Jewish people, contained in the OId Testament, is one of the epocha contributions to sanitary

SFPIF-2‘111 I?. ,gzo

of Pestilence

and the science of IegisIation, hygiene can be said to date from it. ANCIENT

socia1

GREECE

Before Hippocrates. In the Iliad and the Odyssey of Homer, it is made e\-ident that in the earIy period the Greeks looked upon disease and death as punishments inflicted on mankind by angry or vengefu1 gods. In the Odessey (I 1:411-412) is written : “It is by no means possible to avoid disease sent from Zeus; yet do thou at Ieast pray to thy father, even unto King Poseidon.” ReIigion in ancient Greece \vas an affair of rituals, not beliefs, and sacrifice \yas the recognized expression of piety from early times. The ancient Greeks heId an intimate and friendIy attitude toivard their gods, and their religion and worship of the celestial deities w-as joyous and bright. Herakleitos said: “Men are mortal and gods are immorta1 men.” gods, In one phase, howex.er, their reIigion was dark and gloom>-, nameIy in their worship of the black and hidden di\.inities of the Earth and Underworld. “These divinities ranged from Hades, the great death-god, and his consort, the dread Persephone, ruIers of the Underu-orIc1 realm, to demons, demigods, heroes and the vast horde of the spirits of the dead.’ ‘l’ As has been said, disease and death lvere Iooked upon by the ancient Greeks as caused by superhuman agencies of the CeIestial World, of the Earth or of the Underworld. Disease was thought to be sent by Zeus, yet in the Odyssey i I :30) Zeus says to the immortaIs: “Alas! How, for sooth, do mortals reproach the gods! For they say that their eviIs are from us; whereas thev themselves, through their own infatuation, suffer griefs beyond what is destined. ” In the IIiad (I :~o) ApoIIo sends diseases and death among men; and Artemis inflicts disease, particuIarIy menta1 and nervous disorders, and death among women. In the treatise of Hippocrates, “De Morbo Sacro” (The Sacred Disease) it is written : “But terrors which happen during the night, and fevers,

ancl delirium, and jumpings out of bed, and frightfu1 apparitions, and fleeing a\va\. _~ al1 these they hold to be the plots (;t Hekate, and the-invasions of the Heroes.““’ ,4ncI in the same treatise, it is said of cpilept its that

knowledge of his predecessors and contentporaries into systemmatic science he became the master to \vhom modern meclicint~ O\VCY

It’ they imitate a goat, or grintl their teeth, or if their right si& be con\-ulsctl, the!- sag that the mother of the go& (C\-Mv) is the cxuae. If the)- speak in n sharper, shriller tone, they- liken this state to :L horse antI say that Pos~Glon (Neptune) is the cause . . . but it’ f’onm Ix emittecI I+- the mouth and the patient !&~I, with his feet, Ares (A1m-s) gets the blame. Sudden

illness

was

ascribecl

to

Pan

I Euripides, hledea, I I 70 t.f. ). Contagion as the cause of the spread of disease \vas not recognized by the ancient Greeks. Before the time of Hippocrates, Greek medicine was regarded mereI? as a branch of philosophy. The Classk Period (Ape of Hippocrates). If, as ‘1 preIiminarv to a consideration of Hippocrates, The ” Father of hledicine, ” xve endeavor to recapitulate the development ~)f’ man’s ideas concerning disease front the time of earl\- prehistoric men up until about four centuries prior to the birth of Christ, Lv2-eare immediately struck by the uniformity of concept held 1~); cIi\ ersc races and peoples. There are minor \-ariations ancl eIaborations, it is true, but the basic thread of thought running through the minds of ancient men \\.;Is that disease represented the \-isitation of malignant or offended spirits of magic was so (or gods. The element clominant that thought and accurate Iargcly inhibited, ancl \VilS obwr\ ation tre;rtment 1x2s intrinsicnll~a matter of ritu:ll. It \vas the pecuIiar distinction of Hippocrates (460 -3-o R.(:. I that he was the tirst to discard the idea that disease was due tct the gods or other fantastic im:lgitling:s; he dissociated medicine for the tirst time from religion anc1 philosophy. This alone wouId ha\-e been sulficient to hai c insured his immortaIity, but he Ivent further ancl I~>-crystnIlizing the loose

the art of clinical inspection and observ:1p(nvel-s (Jf tion. So I\eeIl LYeIT +3pK’t?lteS’ observation and so clear are his \I-ritten cIescriptionsof such diseases as tubt~rculosis, puerperal (childbirth) con\ulsions and epilepythat, as has often been said, \vith a fe\v changes and additions, the\ might be incorporated entireI>- in an> modern test-book of medicine. Flourishing at a time when the ,4thcnian democrat\- xvas in ful1 flwver, a c~oriteniporary cJf’SophocIes ancl Euripides, Aristophanes and Pindar, Socrates and Plato, Herodotus and Thuq-dides and Phidias, Hippocrates crowned his scientific labors by gi\-ing to the world his immortal “‘Oath ” nhich. for o\.er t\vo thousand years, h:\s

\-oiced the highest aspirations of the medicnf profession. The incidents of Hippocrates’ life are shrouded in considerable obscurity. He was believetf to have been either nineteenth or seventeenth in direct descent from Aesculapius and, according to Soranus, \vas born in Cos. He is said to havestudied medicine under Herncfides, his father, and Herodicus of Selymbria, and philosoph! under Democritus of Abdera, the originator of the doctrine of atoms. He taught and practiced medicine in Athens, as beI1 as probably in Thrace, Thessafv, Delos and Cos. He died at Larissn :n Thessaly, at an age variously estimated from eightgli1.e to one hundred and nine years. The broad basis of reasoning upon which Hippocrates built his s>-stem of medicine is profitably to be considered before a closer nnafysis of his views concerning of disease is attempted. the nature Although a member of the famil), of the Asclepiadne, priest-physicians steeped in traditions of magic and priestcraft, the bedrock of his contention was that medicine must be dissociated from priestcraft and philosophy. In his “de Acre,” (29) he expressly states that attention should excfusivefy be directed to the natural history of disease and that diseases must be scientifically treated as subject to naturaf Jaws. Charms, amulets, incantations were anathema to him, trappings of an outworn magic which has no place in medicine. Here we have enunciated the “Magna Chart:\” of medicine, and to Hippocrates can rightfully be given the title of the “Emancipator of Medicine” from superstition. It is no proper reflection upon his genius that some of his medical descendants, ancient as well as modern, attempted to rewed medicine and magic. Hippocrates, inteffectual giant that he \v;\s, WFIS handicapped by certain delinite limitations of knowledge. The sacred veneration which the ancient Greek felt for a dead body precluded dissections, and hence the knowfedge of anatomy, pfigsiofog~and pathology possessed b\-

Hippocrates was incomplete and confused. He seemed to have 110 conception of the infectiousness of epidemic diseases, as WC and he attached a quite know it today, erroneous importance to “miasmas” as a of disease. In his book entitlecl cnusc to all “On 1l’inds ” he wrote : “According appearance the cause of disease shoufd f>e found in the air, when it enters the body in excess, or in insullicient qu:tntitJ-, or too much at a time or when tainted by morbid we niicwiias. ” In his book on “Humors” odours from Iind : “ Diseases develop exhaled from mire and mnrshes,” and in his “On the Nature of Rlan” Hippocrates states that the cause of epidemic diseases “in the air from which escapes a resides morbid exhalation contained \\ ithin it” and he lists the air as the onI!- possible “uni\~ersaIfy acting cause” of wide spread disease. And yet Hippocrntcs seemed to have rather definite ideas regarding infection from heater, for we find that not alone did he ad\-ise that Lvater be boiled before it was drunk, but \ve lind him kvriting in his famous treatise “On Airs, Waters and PI aces” the following: The still and stagnant n-:itcrs ul’ mnrshcs 2 11( are thr cause of tliarrhea, cl?-sentcry I intermittent fever (maI:&). Those cities which ;ire favorably pl:~~tl i;,r the sun :mtI the wintk, and whcrc the uxters arc of good quality, are less touched II>- thcsc clisadva~itages. But those whcrc st:ignnnt and ninrsli~waters are used, and \~hosc site is bad, sutl’~,~ more from them. It is interesting to note, as pointed out 1)~. Singer’” that Thucgdides (B.C. 4-1-391). :I of Hippocrates, was the contemporary first writer to Lvhom can be traced a definite and formal belief in the passage of specific infectious disease from one person to another. In his “History of the Pelopennesian War,” (I I :_[I ff.) he snvs, in speaking of the pfague of Athens, that those who came most intimately in contact n-ith the sick were the most fiabfe to contract the disease. Thus \ve Iind th:it, among the ancient Greeks, as well as the ancient Romans, although the kviclr-

spread nature of epidemics ~vas largely a mystery, yet the effects of’ escesG\.e rn~ntnll, certnln lvinds, the seasons, o\.ercrowding and the inhalation of air breathed by others, as well as unburied corpses, were alI considered dangerous to health. However, with the ancients, it nns miasma r-at her than con tngion that LV:IS most feared. Although the central idea of Hippocrates’ humornl pathology in regard to the causetion of disease h:ts largeI>- been discarded, xet it marked :I distinct advance over concepts hitherto held by its insistence that disease resulted from a derangement of certain fluids of the body, brought about by natural Iaus that are subject to no magical influence. The monumental advance made by Hippocrates in his concepts of disease becomes the more graphic mhen one realizes that the \~erJ’ essence of his teaching NXS the existence of :I formative, caonservative ant1 curative power in the human body, by which it presetxes itself antI combats morbid causes of disease, and the effects produced Fy them. Its scientilic virtue lay in centralrzlng attention upon bodily changes, :I \:irtue not \-itiated by numerous errors of detail kvhich are incorporated in Hippocrates’ theor>-. It postulated that, corresponding to the four elements ilire, air, water and earth) and the four qunlitites (hot, cold, moist and dr),) there are four humors or Ruids of the body, viz. blood, phlegm, yellow biIe nnd black bile. Health \vas considered to depencl upon a proper balance of these humors, and disease upon an imbalance. Hippocrates taught that such general as heredit!., climate, causes of disease the seasons, and the epidemic:11 constituton acted by disturbing the equilibrium of the body, specificnll>~ I~)- changing the humors. For example, fe\ er results from a heating of the bile or from an increased production of phIegm \vhich auses the tissues to swell, thereby interfering with the sec.retiot1.s; ;I chill \v:is considered to bc an indication that phlegm had become mixed bvith the blood. The terment:ltion or putrefaction

of

the hu nwrs, from \\,Iiich tc\-c:r 3ncl contagion \vere belie\-ecI b!. the Hippoc.r.:itic School to arise, might manifest itself ezternally, as in \.nrious skin diseases nncl in septic sore throats, or it might be confined to the internal structures of‘ the hod\-. antI not become Gsible. The tremendous influence kvhich Iiippocrates exerted upon medical thought is :llllpI\~ attested I~?- the fact that his do&ine of disease sur\.i\ ed, \yith rninc,l modifications, for ahnost t\l-ent? -two ccntw ries. The masterful cIinic:lI grnsp of I-iippt )crates, largely made possible by his po\vers of minute obserx-ation and nnalvsis, are :~buncIantl~~ testified in his wt-iiings. In his book on “The Uses of Liquids” he that hvhen Iishermen SuffrY observes suppuration does not tend to \\.OWlck, unless the wounds arc meddled occur, \vith; and he extols the nnti-putref:~~tion properties of sea-water. Infectious processes foIIo\;Ling \vounds, such :IS p!,erni:i, and tetanus were :~cc‘ur:~tel~ erysipelas described I)\. Hippocrates, as \vcll ;IS infeL,tions folIoking labor ant1 miscarri.:igc. 1n his “Diseases of Women” he writes: II’ the MY)I~I) is ulccratc~tl, I~lood, pu> ant1 icherous lluid arc cIischnrgctL . the‘ l)cIl\ Ix~011ics distcncted _ . . antl it is p:iini‘ul 10 touch as is a wxuntl. Fc\.cI-, grinding 111‘tlw teeth, continued pain in tlic g:crlit:II parts. pubis, Io\\cr al~donirn, llanl\s xntl llilnlxt1. region crlsuc; this disease is cspcciall\ pI’oIIC to OCC~IIaf‘tcr 2 I:rIx~ur when somctl~ii~g putfx‘iics in tlic \\oml>;it also ocx’urs ;iI‘tc’r al)ortion. “ Epidemics,” In the books of the Hippocrates details a case of ;I wouncl of the skull with splinters of bone which Hc tells how pus required trephining. formed and how, on the eighth day, a chill occurred, followed by fearer. IIe points out that the fever and chills are due :kccumulation :Incl he of pus to the reconlrnencls a thorough csleaning cut of the \~ourtcl by a surgeon as the onI\. means ot sax-ing the patient’s life. In the same 110o1, he refers to a case of abdominal suppuration inlvhich cauterization stopped &discharge of pus, but because of :t mistake in clict

344

American

Journal

ot Sorgrry

Oliver-StaIkers

warm n-eather fever and during very and the patient died. diarrhea developed, It is interesting to observe that H&IJOcrates not only resorted to heat for destroying the focus of pus, but he attached great importance to the patient’s resistance, and comments on the fact that the good effects from his operative procedure were vitiated by the patient’s indiscretion in the matter of diet. Hippocrates also recognized the connection between pus and fever, because he writes: “The majority of patients who have suppurative processes are seized with chiIIs and fever.” After the death of Hippocrates, his son-in-law PoIybus carried on the torch of medicine which he had lighted, as did Dioxippus of Cos and Petronius and DiocIes, the latter being called bv the Athenians “the second Hippocrates.” The School of AIexandria, resuIting from the coIonization of Greek medicine in Egypt, is particuIarIy notabIe for its anatomical discoveries which so profoundly influenced ancient medicine. Of this school, the most famous Ieaders were HerophiIus and Erasistratus (300-225 B.C.), the famous anatomists who are said to have originated dissecting. The activities of the AIexandrian SchooI were concerned with more or Iess minor modifications of Hippocrates’ methods of treatment. THE GRAECO-ROMAN PERIOD (146 B.C. - 476 ;\.D.) Before Galen. \Vas it CarIyIe or Emerson who said: “ BeLvare when God Iets Ioose a thinker on the world, for a11 things then have to rearrange themseI\-es?” An Hippocrates has some such action in changing the latent but unorganized possession of facts to definite conscious possession of truth as does a crystal added to a supersaturated soIution. Not aIone that, but a ferment is set in other men’s minds, a cataIyaer of the inteIIect that activates otherwise Iatent and sIumbering thought processes. Before Hippocrates, the supirnaturn trappings Ivith Ivhich disease had

SEPT6MBEH. 1929

of Pestilence

been invested had served to inhibit men’s imaginings in regard to the nature of disease. After Hippocrates, the floodgates of theorizing opened. Following his lead, attention became centralized upon bodil) alterations as constituting the essence ot morbid processes, but theory unsupported by experimental facts Ied medicine during of the Graeco-Roman the major part period into cuI-de-sacs of sterile dialectic. Thus n-e find AscIepiades, born in “ atomic ” or an 124 B.C., advancing of disease, based “ corpuscuIar ” theory on the teachings of Epicurus. He taught that the human body, Iike other matter, is composed of smaI1, unchangeable and individua1 atoms, the soul aIso consisting of atoms in a more subtIe state. IIIustrati\-e but misguided Iengths of the ingenious, to which he went is the foIIowing quotation from Cumston . li Ascfepiades states tflat tllc human I&!remains in its natural state as fong as nlatter is freefy nbsorhecf between the pores, tfle intcr:ltoniic spaces, so that heaIth results from :t correct proportion of pores in rcfation to the matter which they should nhsorb and allow to pass. Death is a result of a disproportion fxtwwn the pores and matter. The most common accident is obstruction of these pores, which, nccorcIing to Ascfepiacfcs, produces phrensy, lethargy, pleurisy, high fever and pain. If the pores are too oblique, the rcsuft will fle the production of fainting, languor, exhaustion and so forth, while extreme emaciation and hycfrops>- are the resuft of extreme dilatation nt the ports. Hunger is cngcnderctf by opening of the f:qe pores of the stomach nncf abdomen. while thirst is cIue to opening of the smaffcr ones. Finaffy, from a rather ofxcure passage in Caefius Aurefianus, it ~voufd appear that Ascfcpindcs ncfmitted :L third cause of disease, namely, a clisturbnncc or confusion of the flotf~juices, or the mixture of ficluicf matter II e espfainetf with the spirits. intcrmittcnt

fcvcr

(nlaI:Lri:~) as foIIows:

Tfle cluoticfi:Ln is

producecf J>y the retention of the largest of a11 the atoms, the tertian I,>- that of the mecfium atoms, ant1 the quartan by that of the smnffcst. AscIepiades

are

an?-

discarded

specific

the

remedies

idea

for

that

the

there

\-arious

organs of the body, and he ridiculed the passiveness of the Hippocratic School, SaJ’lng: “the practice of the ancient ph> sicians \vas merely a meditation on death.” The so-called Empiric School of \Iedicine, of Lvhich he \~as the leader, 11X gone into the Iimbo of historica c.urlosities, but Asclepiades remains of interest because of the fact that he ~vas the lirst tc) mention tracheotomy. The ma in contribution of Themison ’ 123-43 B.C.) who practiced medicine in Rome during the reign of Augustus, \vas his di\.ision of diseases into t\vo classes, the acute and the chronic. Founder of the so-called Xlethodic School, he modified the “pore” theory of Asclepiades by teaching that the principal causes of disease kvere ( I) a constriction (stricturn) of the pores of the body, (2) a relaxation (la.uum) of the pores, and (3) a mixed cause, resulting from a constriction of the pores in one part of the body and a relaxation of the pores in other parts. Themison follon-ed Hippocrates in distinguishing three periods in the e\.olution of disease: i I) a period of increase, (2) a period of full de\.elopment, and ( 3) a period of decline. Thessalus (A.D. ho), who also practiced in Rome, introduced a still further modification of the “pore” theory. Whereas Themison and Asclepiades had taught that health resuIted from :I symmetr? of proportion of the pores, and disease from a disproportion, Thessnlus beIie\,ed that in order to cure a disease the condition of the pores in the diseased part shoukl be and from this theory entirely changed, ;, “ metasyncrisis, is tIe;i\-ed the word Lvhich signifies ;I change in the pores. metas)-ncritic !Mustard LVRS ;1 favorite drug employed by Thessalus. Not content \rithdamningHippocrntesb?.ch:\racterizine as a tissue of lies, a n d his “,4phorisms” \vith stating that all physicans \vho had Ii\.& before him had done nothing useful, Thcssalus made a pathetically ridiculous gesture to posterity by ordering that upon his tomb should be engraved the wwrds: “The Conqueror of Physicians.”

nlethodism, founded b,y Themison, continued to be the most important of medical sects during the second centurx .\.I)., at least in Rome, and during this clentuty its t\vo most distinguished champions Lvere Sornnus of Ephesus, the greatest. gynecologist of antiquity, antl Cnelius Aurelianus, :I contemporar> of Galen. Both Soranus and Caelius held strongly to the pore constriction and pore rclaxltion idea of the causation of disease, and they divided the principal types of acute diseases into three main categories: (I 1 phrensy (ntaxic fever) anti letharg?, (ncl~~nsmic I‘e\-er) result from a constriction of the pores; (2) cardiac disease is due to relaxation of the pores, and t 3) pneumonia and pleurisy are in the mixed t\-pe, i.e. these diseases result from a constrjcticjn of the pores in certain parts of the bod,y and :I relaxation oi the pores in other parts. Among chronic diseases, vertigo, asthma, epiIepy-, melancholia, jaundice, paralysis, catarrhs, phthisis, colics and dysenter!are due to constriction of the pores (Caclius); diarrhea and hemorrhagic and menstrual flux, Lvhen excessive, are due to relasation whereas h\:dropsv belongs of the pores; \I a 5 Llil Caelius to the mixed t>-pe.lx ardent champion of the belief that no such thin,g as :I 10~~11 disease exists; he contended that when a person is ill, the entire hod? is diseased, an opinion that the ultramodern todav is considered conception of such a disease as pneumonia, Lvhich is Iooked upon as a disease of the entire bocl!., with marked localization in Soranus held the From this, the lung. extreme opinion that the search f’or the organ principally diseased is a bootless tash, and both Soranus and Caelius dcniecl that there \\-ere any specific drugs, i.e. drugs ha\ ing a particular action on a given organ. During the second centur) A.D. Aretaeus the Cappadocian extended the theor>, of infection advanced bv Thuc! didcs. I II his \ olume on “The Causes and Svnptoms he distinguished clef;of Acute Diseases,” n&l>- bet\veen contact infection and infer,tion at a distance.

446

Amcric.,n_l,,urn:,l

01 Sor:rl-y

Oli\Ter --Stalkers

Galen and the Restoration of Hippocratic ;Vledicine. Medical thought during the Graeco-Roman period was characterized b-y rebeIIion against the teachings of Hlppocrates and a grotesque theorizing upon the nature of disease, unsupported by a sufticient body of facts. The ad\;ent of Galen marked a return to Hippocratic medicine. whose full name \vas Claudius GaIen, Galenus, fIourished from 130 to 200 A.D. After stud_ving medicine in Greece and Egypt, he came to Rome to practice Lvhen scarceI>, thirty !.cars of age. He was contemptuous of the \-arious sects, such as the hlethodists, Empirics, etc. and he accepted the teachings and precepts of only one master, Hippocrates. Equipped hvith an extremely active mind whose tendenc>was al\vays to espIain facts by h!-potheses, and possessing an encylopedx knowledge of meclicine, Galen did not so much advance man’s knowIedge of the nature of disease as to refurbish the Hippocratic doctrines in more popular and attractive trappings. This statement nould seem to hold true in spite of the fact that Galen was not alone the supreme nnatomist up to the time of Lenonardo Da Vinci (1~10) and VesaIius (1543), but certain of his disco\.eries wouId seem to entitle him to consideration as the first great experimental clinician. He demonstrated the difference betcveen the motor and the sensory nerves, and even distinguished the motor and sensor! roots leaving the spinal cord; he also recognized the difference betkveen intercostal and diaphragmatic breathing. Like Hippocrates, Galen recognized four elements (fire, Lvater, earth and air) and their four qualities (heat, moisture, cold and dryness) as constituting the basis of all parts of the body. He taught that the body consists of three distinct parts: ir ) the soIid parts, such as bones, ligaments various organs, etc., which he likened to containers; (2) the liquid parts or contents, such as the bIood, lymph and bile; and 13) spirits, or forces. These latter “spirits” he believed to be three in number (a)

of Pestilence

SLF’TLMBLH, ,019

natural spirits, which were a subtle vapor arising from the blood iwhich, itself, was formed in the liver); (6) \,itaI spirits, which were formed by natural spirits going to the heart and there combining .with air; and (c) animal spirits, which resulted from the transformation of vital spirits in the brain. (ParentheticalIy, it is to GaIen that the doctrine of VitaIism, still debated in physiology and biology, is to be traced.) Galen, moreover, admitted four principal body humors: (I) the blood, a hot and moist humor, (2) pituit, or lymph, a cold humor, (3) yeIIo\v bile, a hot an d moist and dry humor, and (4) black bile, a cold and dry humor. lClost diseases, he held, arose from an excess, or deficiency, or an aIteration in these four fundamental humors and their specific quaIities. Perfect heaIth, on the other hand, occurs onIy when complete equilibrium exists between the four humors and their four qualities. It was from these concepts that Gnlen built up his CIassification of temperaments, which he subdivided into four primarytypes: (I) the sanguine, (2) the phlcgmatic, (3) the bilious and (4) the melanchoIic. Each of these temperaments he believed to be either hot, or cold, or moist or dry. Differences between temperaments, and their divergence from the normal, he looked upon as predisposing causes of disease; the exciting causes being a disordering of the humoral equilibrium. Hence, each disease demands its particular curative treatment; in one disease the humors must be thinned; in another thickened; in one cooled, in another warmed; in one purified, and in another evacuated. GaIen was an ardent advocate of bloodletting, but he said it kvas better to err on the side of insufficient bloodletting than of excess. Galen’s idea that “co&on” or suppuration is an essential part of the healing of a wound gave rise to the theory of “laudable pus,” an error which was not completely dispeIIed unti1 the researches of Lister and Pasteur, in the Iatter haIf of the past century. GaIen followed the Hippocratic school

in attributing the cause of epidemics to atmospheric conditions; he emphasized the effec,t of climate, as well as the degradation of the air, this latter being brought about most commonly by swamps and stagnant \vaters. Galen \vas the most \,oIuminous of all the ancient \\,riters and the greatest of the theorists and systematists. His works are a gigantic encvclopedia of the knowledge of his time, incI;ding nine books on anatomy :incI SC’\enteen books on physiology (apparcntlx, Galcn \vas the first to dissect the musc~lc:s and describe them, probably 1,~ tlisscction of apes, and his writings give us the most complete picture of the anatom,v ancf the physiology of the human hod?of an!. I!-orks handed down from antiquity); six books on pathoIogJ-, sixteen essays on the pulse, the “ Megatechne (Ars magna) ” or therapeutics, in fourteen books; the “ hlicrotechne (Ars pnr\pa I ” or practice, and thirtv books on phnrmac!-. The domination which GaIenic medicine held o\er the thoughts of men during the major part of the Christian era presents an interesting psychological problem. He constituted the Delphic oracle ot’ medicine, and his pronouncements upon all matters relating to disease became surrounded lvith ;I 1111s~ aura of infallibility. Rut time has dealt harshly with Galen’s theories, and in the light of modern experiment:!1 medicine his h!-potheses and system of medicine ha\,e been completely overthrown. On the other hnnti Hippocrates, with his unfailing insistthe \-alue of accurate, painse I1cc on tzliing obser\.ntion and his impatience \vitIl theorizing, has gro\vn in stature as the centuries have passed. .tSCIEST

<;FIINESE

THEORIES

OF

DISEASE

It has been said that medicine in China reached its highest development at about 2000 R.C. and has remained at about the S:III~~ Ie\eI up until very recent times. Chinese medicine is of practical interest mninlv because of certain therapeutic measures which were introduced by the Chineqc into IVestern medicine, among

these being dry cupping, massage and acupuncture. The ancient Chinese are saitl to ha\~e practiced preventi\.e inoclllation against smnilpos, as well as to havoc employed mercur,y for inunction in syphilis. According to Read,‘” the art of pulsefeehng in China is very ancient, dating from before ioo B.C. :

Da\vson’s”’

article,

concerned

urith

:I

pre\-iousI?untranslated \\x)rk, “Su-\j’en” t,>- LIl-1 iinkrio\vri or Simple Questions, Chinese Lvriter bvho probablyIi\.cd prior to the end of the fourth ccntur> A.D.., is 01’ especial interest because it sums up thr physiological and medical knowledge of CuriousI,v centuries. all the preceding the theories ha\-e been little, enough, or not at all, modified and they form the foundations of present day Chinese physMan is pictured iolog) and psychology. as containing fl\,e Gscera: c I j the heart, the seat of the \-ital spirit: (2) the Ii\.cr, the seat of the aerial soul, Lvhich directs the internal distribution of the breath; (3) the lungs, the seat of the spermatic soul; (4) the spleen, the seat of the intelligence and of the &II, and (,jj the kidncb, the seat of the fecundating sperm, and the procreating organ. Disease is thought to come from :I t’unc.tionnl disorder of a viscus, and the onI\~ method for determining the sick L~ISCUS is an examination of the pulse. Each t1) \.arietJ of pulse (i.e. sIo~vness, rapidit,v, lveakness, etc.) is taught to bc pathognoof the disfunct.ion of a given manic viscus. Ll’hen the sick organ has been diagnosed, dietar>- measures are immediatel>to be instituted. For example, if the heart is afyected, it is because the patient has o\-erindulged in hot and bitter foods; if the kidney is diseased, it means th:it

cold and salty

foods have

excess. D:1wson states

:

been

used

to

0. 7. 8.

Irations. NCV I lawn, YxIc Univ. Prc,ss, 1()2j. A. C. The historv of int’cctlon. Ann. .Iled.

KLEIE.

Finally, let us speak of therapeutics. Here I cdl attention to an important fact. Before the 0. IO. Christian era the Chinese did not rccognizc antI clicf not USCmedicaments properly speaking. in ancient times, there \vere no So then, I I. medic~iments properly so called, but a unique proccccfing fxfievecf to hcaf all ills, namely the 12. 13. famous Chinese wupuncturc. Antiquity kno\vs 14. only this: The in\.ention probably dates from 15. primitivits, for the needles for a long time \verc of flint. Here is the theory of acupuncture: IO. . . . Ever?- mafatly is a x,isceraf tiisordcr. A viscus either cloes or does not secrete its IT. cnianation, or does not secrctc enough of it, 18. or retains it insteacf of circulating it. In a word 1’). paralysis of the organ, I>atf work . . . No\\-, 2”. what does one c-10 to the OS n.fien lie clramz Ixtclf3_? One gives him ;I fdo%v with a goacf. is nothing else. The Chinese acupuncture BOOK REVIEWS One prick the rccafcitrant organ. The SLI-\~~CII gives the instructions for these cfirect pricks, but it also indicates rather I\-cl1the inconveniences and the danger of the mcthotl, if one uses the neccffe too violently, if one pricks ever so little to the sicfe and so forth. The This book by ~4 contributors has the tlcf’wts direct prick shouftf f,e reserl ccl for desperate of its qualities, a fact \vhich is i’acetl 1,~~the cases, m.hen there is nothing to lose. Etfitors who state in the prcfxc: “ In :I s>-sIn ordinary cases, indirect acupuncture tematic worfi lq- many authors one dots not shouId be practiced, which consists in cspect to find the degree of consistent>- usual pricking the skin area, or cutaneous disin a booli \vritten entirely by one’ author. trict, over which a given \.iscus is supposed Intlectl it is one of the advantages of such a to preside : gvorli that conflicting opinions I,>- leading nuthoritics may be prcscntcd. The x-u\- comFor esnmpfc, if the pufsc has incriminated plete index kvill refer the reader to cl’ifYcrcnt the heart as the ofl‘cntfing \-iscus, a certain articles in which certain subjects are separateI\ cutaneous region ol‘ the back correspontfing to consitlerecl I,- two or more authors from radithe heart is prickctl, \vhcrcIly the heart frisks calf?_ different points of view.” This makes it nith pain and then settles tfomm to its norninf a splcntlitl refcrcncc \vorl; for the general functioning. practitioner but as to the \vistlom of placing (To Be Continued) all the different \,iewpoints lxforc students there ma)- lx much tlifferencc of opinion and REFERENCES it is likely that this I,ooli \\ill Ix more popular \vith the gencml practitioners ;I ncI niecIic:~I men than as ;I testlx)ok for the students. The 2. 1 I; CLEKC, D. Ilistoirc dc I:I .\lidccinc. Amct(~rd., need for such a book has long been felt and this G. G:lllct, I ;02. I1oofq \vrittcn I,>- the Icatling men in the countr!. and ecfitctl I]>- Che\-alicr Jackson, 11ill it is hopetf f’ulfill this ncetf. Appended is a list of the contributors. The subjects treatecl are thoroughly coverecl. As is to Ix expected the :Irticfes