Medicine. Lucretius imagines for us the first rude attempts of prehistoric man to repair the injuries received in conflict with wild beasts; and, according to Celsus, the most backward tribes have never been without their remedies for wounds and general ailments. The healing art, indeed, is coeval and co-extensive with humanity; but of its two great divisions—surgery and medicine—the former, as will be shown in its proper place, was incomparably the earlier, and, in practice, the more effective.
Egypt furnishes the earliest indications of medical art. The Papyrus-Ebers was written 3500 B.C., and is entitled Book of the Preparation of Medicines for all the Corporeal Parts of Individuals. In it formal invocations of a blessing on those medicines are followed by prescriptions and the names of the maladies they cure—disordered evacuation, intestinal worms, &c., while prominence is given to an obscure wasting-fever called 'uchet.' Anatomy, in its strict sense, was unknown to the Egyptians; and their medicine, while empirical, was highly specialised. Every physician belonged to a sacerdotal college, and the sick had recourse to the nearest temple, whence they procured the practitioner best suited to their case. The fees took the form of gifts to the temple, from the revenue of which its medical staff was maintained. Till Hippocrates appeared the physicians of Egypt were the most famous; but with her subjection by Alexander the Great, and the sway of the Ptolemies, her medicine gradually succumbed to the Greek, which for centuries had one of its chief schools at Alexandria.
The Israelites were in medical practice followers of the Egyptians, and, as with them, the priesthood attended the sick. Cleanliness was the distinctive note of their medicine, till like the Egyptian it became merged in the Greek, and, later, in the Arabian.
The sacred books of the Indians containing their oldest records of the healing art—the Vedas—date from about 1500 B.C. In them sickness appears as the work of hostile, recovery of friendly deities—the remedial agents being propitiation, prayer, and the sacrificial drink Soma (q.v.). The next or Brahmanic period is very prolific in medical literature, its most celebrated authors being Charaka and Susruta. To what age their works belong is much debated, some orientalisists placing Susruta's Ayur-Veda long before Christ, others as late as the 8th or 9th centuries A.D. Just as difficult is the question whether the Indian medicine is an aboriginal product or an importation. But its earliest position was an exalted one, and its young votaries were drawn from the higher castes. Their curriculum lasted from the twelfth to the eighteenth year; decorum, piety, benevolence, unselfishness were inculcated on them as duties; and on the threshold of practice they took an oath significantly resembling the Hippocratic. Dietetics and bodily cleanliness play an important part in Indian medicine. From the vegetable, mineral, and animal kingdoms it draws remedial agents innumerable, including many antidotes to poisoning, snake-bite especially.
The old Persian medicine, as revealed in Zoroaster's Zend-Avesta, stood in the closest connection with religion. But Greece made her medical superiority felt in Persia, as in Egypt and India, and in later times the schools founded by the Nestorians were important centres whence Greek medicine was diffused throughout the East.
Chinese medicine meets us historically only in the 5th century B.C. Elaborate rules for noting the pulse and a portentous array of vegetable, mineral, and animal remedies are its chief characteristics. Old Japanese medicine was borrowed from it.
Greece is the mother-land of rational medicine. Already in Homer we find practitioners ranking with musicians and architects, and visiting patients for professional fees. Medicine, as distinct from surgery, is not in the Homeric foretime subordinate to religion as in the East. It has its tutelary deities—Apollo, Artemis, and Pallas, and its tutelary demigods—Esculapius and his daughter Hygieia; but these were above and outside the medical art, while the sick who repaired to their temples were healed, not by treatment, but by such religious exercises as the 'temple-sleep,' in which they dreamt the dreams from which the priests divined their malady and prescribed the appropriate sacrifice. The service of Esculapius had nothing to do with medicine or its practitioners, and was in the time of Hippocrates resorted to only by the superstitious among the lower orders.
Early in the Greek mainland and islands medicine had rounded itself off as a distinct science with application to practice. As a profession it became open to every free-born citizen, and included two classes—the qualified and the amateur. Its votaries began in boyhood with the study of remedial plants, the preparation of unguents, draughts, and plasters, the practice of blood-letting and minor surgery, and finally treatment at the bedside. Duly qualified, the physician took the celebrated 'oath'—and thereafter received patients in a house of his own (iatreion), or visited them under their own roofs, or went on circuit. The fee included the cost of prescriptions when made up—the humbler practitioners receiving it in advance; but many towns kept a physician for the public service; and in some cases physicians of eminence became attached to foreign courts. Such was the position of the medical profession when Hippocrates (460 B.C.) gathered up all that was sound in the floating doctrine and practice, and not only augmented it, but gave it a character and direction of his own.
He strikes the keynote of his school in denying to disease a supernatural origin. 'From God comes one disease as well as another; but nothing happens except in conformity with nature.' In medicine proper his method was threefold: to ascertain the past, to examine the present, and to forecast the future of the patient. After carefully noting the previous history, generally from the patient's own lips, he made a thorough review of the symptoms as the basis of a diagnosis. This review, performed preferably in the morning when the physician's faculties and senses were at their best, included the general nutrition, the bodily, particularly the facial, complexion, the temperature, the respiration, and the state of the digestion and genitourinary systems. The pulse received quite secondary consideration. The Hippocratic diagnosis was seen to special advantage in thoracic and abdominal diseases. Percussion was not neglected; and succussion (i.e. shaking the patient to induce internal movements which were carefully listened to) was also among the aids to diagnosis. Prognosis, the third and last step in dealing with a patient, was likewise based on minute examination, and grew naturally out of the peculiarly Hippocratic doctrine of 'critical days.' Among the favourable signs were tranquil sleep, the setting in of perspiration, ease of bodily movement; while of contrary import were the facies Hippocratica (still the classic description of approaching dissolution), sinister revelations of the eye, the breath, the sputum, and the abdomen, with those of the excretions, particularly the urine. Dietetics hold the first place in the Hippocratic treatment. In acute cases the sustenance was the barley-ptisane, the drinks water mixed with honey, with acid, or with wine. External agents were oil, water, bay-salt in acid solution, wine, and acidulated lotions; in chronic cases diet and gymnastics, with vocal exercise in singing and declamation, sometimes the artificial production of obesity were employed. Venesection was sparingly employed—cupping more frequently. Drugs of indigenous and Egyptian, even of Indian origin, mostly in solution, were used with discrimination. See also SURGERY.
For at least a century after Hippocrates medicine advanced but little. His Greek successors, Diocles, Praxagoras, and Chrysippus, supplemented him by theorising and in a less degree by independent observation, and were for the former characteristic called Dogmatics by Galen.
The break-up of the Macedonian empire into kingdoms gave rise to so many foci of medical culture. The Alexandrian school, purely Greek in personnel and character, was represented by Herophilus and Erasistratus, both of them great anatomists. The former took account of the immediate causes of disease and such symptoms as the pulse and anatomical changes, while in treatment he relied mainly on drugs and venesection. The latter, much less loyal to the Hippocratic name, found in excess of nutrition with its results, dyspepsia and plethora, the chief causes of inflammation and fever. Herophilus and Erasistratus each headed a school, both called Dogmatic from their tendency to supersede their sound anatomical traditions by premature generalisation. Out of the conflict of Herophilite and Erasistratæan sprang the Empirics, whose professional 'tripod' was clinical observation, previous history of the patient (anamnēsis), and 'transition from like to like' (analogical inference).
Rational medicine entered Rome with the Grecising wave that followed the expulsion of the learned from Alexandria and the subjection of the Hellenic world, and received a great impetus from the dictator Julius Cæsar, who extended the Roman citizenship to all in the city who possessed the healing art. Among these was Asclepiades of Bithynia, recommended to the Romans by his philosophy, rhetoric, and reliance on the gymnastic already in favour with them. Regarding the human body as composed of countless atoms divided from each other by invisible interspaces (pores), he made health consist in the normal behaviour of these atoms, by which the pores retained their proper calibre, and illness in their derangement, whereby the pores were widened or narrowed. He enjoined observance of the Stoic maxim, to live conformably to nature, bodily exercises, including the manipulations of the bath-attendant ('massage'), and dietetics being his chief remedies. His immediate follower, Themison, simplified his etiology, and, ignoring the atoms, insisted on the abnormal condition of the pores as the one cause of disease, finding health in the methodus or 'middle passage' (as Häser explains it) of these channels, and the loss of health in their constriction or relaxation, or in the partial co-existence of both conditions. His therapeutics aimed at inducing a state opposite to that in which the patient was found, and so relaxation was treated with astringents, constipation with laxatives. The Methodics had the merit of ignoring mere authority, even the Hippocratic 'humoralism' still dominant, and studied the patient's general condition as the safest ground of diagnosis. Despising etiology, even in local affections, their therapeutics became an unreflecting routine. But their skill in dietetics amply explains their acceptance with the Roman world, ensuring the patient fresh air, and a pure and healthy skin, while rejecting all drastic or lowering medicines.
Anulus Cornelius Celsus, an adherent of no school and perhaps not a professional man at all, is yet the highest name in the Roman healing art, for his treatise De Medicina, which formed part of his encyclopædia—a sort of 'Whole Duty of the Roman Patrician.' Himself one of the order, he had doubtless to interest himself in the ampla valetudinaria, or infirmaries for slaves attached to every country-seat or urban palace. His experience of such hospitals enabled him to test the practice of the profession, and from the knowledge thus acquired, especially in dietetics, pharmacy, and surgery, he compiled his elegantly written book. Historically its value is priceless, as the source from which we have distinct knowledge of the Alexandrian period. He bases medicine, with Hippocrates, on anatomy, physiology, and the scientific investigation of the causes of disease, while, without excluding the hypothetical, he allows no hypothesis to influence practice. The whole work forms a compendium which, since its re-emerging to light in the 15th century, has held the first place in Latin medical literature. In the next generation to Celsus, Pliny the Elder deserves notice for his valuable, though incidental, allusions to medical authors. But to return to the Methodics. In the reign of Nero, Thessalus of Tralles was their most popular representative; half a century later Soranus of Ephesus took his place in Rome as the most distinguished of the school. His masterwork, written in Greek, is on obstetrics, while in medicine proper his treatise on acute and chronic diseases (lost in its Greek original, but preserved to us in the African Latinity of Cælius Aurelianus, who lived about the end of the 4th or beginning of the 5th century) exhibits the Methodic practice in its most favourable light. This, though with diminishing strength, resisted even the influence of Galen, till in the middle ages it took a fresh start.
An offshoot from the Methodic school had already appeared in the 1st century—viz. the Pneumatic, which sought to reconcile it with the Hippocratic humoralism. Its originator, Athenæus, derived its central doctrine from a hypothetical pneuma or soul pervading the universe; but in practice he combined the empiric and methodic therapeutics. About the same time arose the Eclectics, whose chief representatives were Rufus of Ephesus and the much abler Aretæus of Cappadocia, who, for general culture, moral worth, and professional skill, to say nothing of the purity of his Ionic Greek, comes next to Hippocrates.
We have now reached the epoch-making Galen, born at Pergamus in 131 A.D., who, after varied studies in the Hellenic schools of the Levant, came as a qualified practitioner to Rome in 164. His rapid success aroused the jealousy of the profession there, and he again travelled in the East, to be recalled to Rome by the emperors Lucius Verus and Marcus Aurelius. He found medicine speaking a Babel of tongues while claiming to be a science, and posing as a profession. He sought to rehabilitate it by restoring to anatomy and physiology the value withheld from them by Empirics and Methodics, and by reinforcing practice with the discoveries of the Alexandrian school; in other words, to make diagnosis scientific by basing it on anatomy and physiology, and to reconstruct therapeutics by an unprejudiced clinical experience. His guide was Hippocrates—the treatise on Prognostics in particular; but unhappily he abandoned the sound Hippocratic method, and tried to unite professional to scientific medicine with a philosophic link. This he found in a hyper-idealistic Platonism, from which he evolved a teleological system which provided every question with an answer and every riddle with a solution. Hence arose a plausible appearance of infallibility, which kept medicine in chains till the 17th and 18th centuries. Adopting the Hippocratic view of the corporeal elements as consisting of the solid, the liquid, the warm, and the cold, he found them blended equally in the blood, while in the bile the warm predominated, in the phlegm the cold. His vivifying principle, the pneuma, reaches in man its highest development as the 'psychical,' the 'vital,' and the 'natural' spirit, and manifests itself in 'spiritual,' 'pulsating,' and 'natural' force. The processes regulating nutrition and structure he explained by attractive, secretive, propulsive, and expulsive powers. Recognising, however, that these do not cover all physiological processes, he added to them the occult powers of the 'whole substance,' the 'specific qualities' of his later followers; thus opening the sluice-gates to every kind of superstition.
Disease he ascribed, first, to immediate causes (such as plethora and corruption of the juices); next, to the disturbance thence arising; next, to the abnormal structural processes started by such disturbance; and finally, to the symptoms. Maladies he distributed according to their anatomical substratum: (1) those of the elementary substances (blood, phlegm, yellow and black bile); (2) irregularities of homogeneous substances (tissues), which, again, fall into anomalies of the physical condition (strain and atony), and of the primal qualities (warm, cold, &c.); (3) ailments of special organs. For the Hippocratic 'crudity,' 'coction,' and 'crisis,' manifested only in acute disease, he substituted the 'beginning,' the 'progress,' the 'culmination,' and the 'decline'; but retained the doctrine of crises and critical days; and he agreed with Hippocrates that the recuperative principle is nature, working necessarily through the attractive, transforming, and expulsive powers. He originated the doctrine of 'indications' in their bearing on the prevention of disease; on its character, stage, type, symptoms; on the idiosyncrasy of the patient and the nature of the affected organs—even on his dreams. Diet, gymnastics, baths, friction, and blood-letting formed his main therapeutics. Consistently, with his theories he classified medicines, according to the prevalence of one or more elements, into simple, compound, and those operating through their 'whole substance' (emetics, for instance, purgatives, poisons and their antidotes). In his own practice he preferred simples, and set peculiar value on opium, introduced by the Alexandrian school. It was not till after his death that his influence began to prevail. His comprehensiveness, his prolix style, and sectarian jealousy kept his authority in the background, and it was with the philosophers rather than the profession that he was most in favour. Gradually his writings, having been translated into Latin, began to be studied in the West, till in the 6th and 7th centuries they were much in vogue. But it was the physicians, of the Nestorian creed, expelled from Byzantium, who became his true apostles. Revering him for his teleology and almost Christian worship of a benevolent creator, they diffused his name and authority till the Arabian physicians became his devoted adherents, and spread his influence through East and West alike for more than a thousand years.
After Galen may be noticed the Byzantine school—viz. the compilers Oribasius (physician to Julian the Apostate), Aetius, the abler Alexander of Tralles, and the yet more independent Paul of Ægina. In the West Cælius Aurelianus, above referred to, alone redeems medicine from the deterioration it had reached in the hands of herbalists and receipt-mongers.
Arabian medicine arose out of the Greek in those Hellenic cities which had passed under Moslem sway. Its importance begins with the Persian Rhazes (925–26), a follower of Galen, though not unacquainted with Hippocrates, practising in Bagdad. After him may be mentioned Mesua the younger, of Damascus, whose materia medica, dating from the 11th century, was much in vogue and was used by the London College of Physicians in framing their pharmacopœia in the reign of James I., and Abulcasis, author of a medical cyclopædia. Haly, compiler of the 'Royal Book,' was the standard Arabian writer till Avicenna, who, famed also as a philosopher, is the highest name in Arabian medicine. His 'Canon,' lucid in style and method, is an encyclopædia of the healing art, based on Aristotle, Galen, and his successors, Greek as well as Arabian, but evincing no clinical experience or research. His opponents were Avenzoar and the latter's pupil Averrhoes, compilers mainly, as was also the great Rabbi Maimonides, the last noteworthy writer on Arabian medicine. No advance was made by this school on the Greek, except in the description of smallpox and measles and, more distinctly, in pharmacy and the virtues of drugs. The Arabs owed this superiority to their chemical skill, which originated new or modified old remedies, and also to their more familiar relations with the East, imperfectly gleaned by their predecessors. Apothecaries' shops, and even the pharmacopœia, are among the innovations medicine owes to them.
European medicine, however, manifests no real break from its rise under Hippocrates. In the early middle ages the religious orders were the custodians of the degenerate knowledge and practice of the healing art transmitted from the later Roman authors till the curious mixture of ancient science with the black art, characteristic of monastic medicine, was superseded by the Benedictines, whose house at Monte-Cassino in Campania was the seat of the Hippocratico-Galenic revival, afterwards extended by the school of Salerno. This latter was a non-religious establishment, in which law as well as philosophy was taught, while the preponderance it gave to medicine as early as the 9th century earned for it the name of 'Civitas Hippocratica.' It attracted prominent men of the time in quest of health, among them the Norman invaders of Southern Italy. William the Conqueror was one of the visitors, and his son Robert is supposed to have been the king of England for whom was written the famous Regimen Sanitatis Salerni, the rhyming Latin poem on 'health and the means of maintaining it,' which afterwards circulated so widely through Europe. The Salernitan school had many students, and, proportionately, a considerable staff of teachers, some of whom were women, their wives and daughters; the best known of them is Trotula (11th century), wife of Joannes Platearius, first of a medical family bearing that name, and author of Practica, a manual of medicine which long held its ground. But none of the Salernitan writers are other than compilers, chiefly from Hippocrates, Galen, and their successors. Diet was their sheet-anchor, though their pharmacy improved on the previous European standard, and their clinical teaching was also favourable to rational medicine. But the Arabian wave swept over the school, and, after the 13th century, almost obliterated it. It survived, however, though but the shadow of a name, till its suppression in 1811 by Napoleon.
Latin renderings of the Arabian compilers were the main channel through which Europe recovered its knowledge of the classical medical writers—Constantine Africanus (1050) being the earliest of these translators. Transmitted through the Arabic, the Greek medicine wore an eastern dress, and in such guise it found its way to Montpellier, a school which developed as that of Salerno waned. Bologna and Padua, too, derived their medical teaching from this oriental travesty of the Greek; but no great independent authority arose in any of these seats of learning. Häser points out that the practical tenor of the treatises they put forth—notably the Montpellier school—was due to British authors, who, like Gilbert the Englishman, and Gordon the Scot, had graduated there. But the fall of Constantinople and the immigration of Greek scholars into Europe reopened the fountains of ancient learning. Hippocrates and Galen now became known in the original, and the masterwork of Celsus, till then a forgotten book, was once more read with profit. Rational medicine had returned to its parents.
To the writings of Galen was due the revived study of anatomy, and with it physiology; to Dioscorides the resuscitation of medical botany. The discovery of America, followed up by inland exploration, led to the introduction of new medicines, vegetable and mineral. The reaction against the Arabian masters was completed by 'authorised versions' of the Greek originals—versions chiefly the work of physicians who were also Hellenists, and by the middle of the 16th century Galen was re-enthroned in the schools. The downfall of Arabian medicine was of earlier date in Italy and England than in France, while Germany was under the temporary sway of Paracelsus, a meteoric genius who followed no school, but vitiated his independence of judgment and great acuteness by the haughtiest arrogance. He had a positive as well as a mystical side, and, while regarding disease as 'spiritual,' with which, unassisted, nature herself could often cope, he also relied on chemical agencies for its cure. These owed their virtue to their secret power over disease, whence he called them 'arcana.' Opium, in the form of tincture, and antimony were among these. Beyond compelling a closer study of chemistry and showing an example of independence amid the universal belief in Galen, Paracelsus did no good to medicine, and indeed, outside Germany, was held in little account.
Meanwhile, the outbreak of disease on an epidemic scale, in forms unknown to the Greeks, threw the medical art on its own resources, and started that revolt against authority to which it owed its next advance. The sweating sickness was minutely described by Kaye (Latinised, Caius) in England, and syphilis by physicians on the
Continent. Hospitals, moreover, the special contribution of Christianity to the relief of the sick or physically injured, now became seats of clinical study, Italy leading the way in her celebrated school of Padua, which then began to attract students from all countries. Physics, which received a fresh impulse at the Renaissance, had also its effect on biology and medicine—Galileo and Cæsalpinus representing in Italy what Bacon and Harvey represented in England—a sounder scientific method on the one hand and a more penetrating physiological research on the other, leading to the discovery by Harvey of what Cæsalpinus and others had dimly adumbrated, the circulation of the blood. Concurrently with the mechanical contribution to biological and medical study, that of natural history was equally important, pharmacy in particular receiving new accessions, notably cinchona bark, which found a place in the dispensaries or pharmacopeias now beginning to multiply. Love of system, however, a perennial hindrance to medical progress, was no less prolific than inductive research, and so, contemporaneously with Harvey, we have mystics such as Van Helmont, who, like Paracelsus, left no enduring mark on sound medicine beyond encouraging independence of authority and innovations in treatment. The Iatro-mechanical school was another development in the theorising direction, its most prominent names being the Neapolitan Borelli, the Roman Baglivi, and the Scottish Pitcairne. Physiology is more indebted to these quasi-scientific systematisers than therapeutics, which, however, is under distinct obligations to another school, the Iatro-chemical, whose Dutch founder, Sylvius, applied to treatment the results of the improved biology and chemistry. He had many followers in Germany as well as Holland; but his ablest disciple was the English Willis, who worked permanent good in the examination of secretions, to say nothing of his still classic account of diabetes and of nervous maladies. Reaction against the theorising tendency was led by Sydenham, whose guide in practice was Hippocrates, with his 'natural history of disease.' Nature he held to have a self-restoring power, which it was the physician's duty to watch and assist. As a practitioner Sydenham was especially great, while his descriptions of disease—gout, for example—are those of an artist in medicine. But it was in his rejection of theory and as an observer and utiliser of facts that his influence was soundest. Coming as it did after the anatomical, physiological, and chemical work of the previous generation, it gave practical direction to so much of it as had stood the clinical test.
Theory, however, is too attractive for ingenious minds to be long idle, and again we find medicine turning into 'the high priori road.' The Iatro-mechanical school underwent something like a revival, thanks to the brilliant astronomy of Newton and the able advocacy of Pitcairne and his pupil Cheyne. Sydenham's example, however, was still powerful enough to curb the theorising tendency, so that enthusiastic mathematicians like Mead did not allow their love of hypothetical symmetry to vitiate their practice. The next great name in medicine is that of Boerhaave of Leyden, a disciple of Hippocrates and Sydenham, familiar with all that was valuable in other schools, but strenuous in his pursuit of anatomical and physiological fact, in which he worked assiduously with the microscope. As a clinical lecturer he was the forerunner of the most refined teaching of the modern day, and his clinic was resorted to by aspiring students of every country. The love of system which he shared with so many of the master-minds of medicine is seen in his Institutiones, long a text-book, but now, like his Aphorisms, superseded by the juster knowledge of which he was the pioneer. Among his pupils was Van Swieten, founder of the Vienna school, while contemporary with him were Hoffmann and Stahl, both of them professors at Halle, in advance of their time as chemists, and enthusiastic systematisers, the former eager to reconcile the 'spiritual' with the 'materialistic' view of nature, the latter bent on eliminating the 'material' from man and making the 'psychical' the essence of his being.
Physiology and rational medicine made a new start under the all-accomplished Swiss Von Haller, whose teaching prevailed for good in spite of recurrent outbreaks of the systematising tendency. Muscular irritability, to the exclusion of the hypothetical anima, and as distinguished from nervous sensibility, was a discovery of his which threw fresh light on living movements, while medicine proper owes to him a series of experiments, better appreciated by later science, on the influence of drugs on the healthy subject. Morgagni of Bologna laid practical medicine under yet more lasting obligations by his elaborate work in morbid anatomy, of which he may almost be regarded as the creator. His De Sedibus et Causis Morborum may still be consulted with advantage, followed up as it was and its results extended by other pathologists, the Scotsman Baillie in particular. From the sound leading of Von Haller and Morgagni a partial deflection was made by Cullen of Edinburgh, an expositor of rare ability. His Lines of the Practice of Physic and his larger Nosology were a skilful adaptation of the new physiology and pathology to classification and therapeutics, and from their attractive clearness were long in favour with teacher and student alike. A more brilliant, though far less judicious systematiser was his pupil John Brown, father of the Brunonian system, of which the keynote is the part played by 'excitability' in health and disease. To maintain this property at its normal strength was the object of the physician, who, indeed, in 97 per cent. of the diseases brought before him, had to make his treatment a 'stimulating' one. The superficial simplicity of the system explains its wide acceptance and tenacious vitality, though its popularity was always greater in Italy and Germany than in Great Britain. Another exemplar of the systematising spirit in the same century was Hahnemann, the creator of the Homœopathic school. Dwelling chiefly on the symptoms of disease, he constructed an elaborate scheme of therapeutics (see HOMŒOPATHY), and benefited practical medicine, even as Brown did, by favouring a milder than the so-called heroic treatment.
Before quitting the 18th century, its contributions to special departments of medicine must be noticed. In Italy Valsalva and Lancisi did good service, the latter by his observations on the causes of sudden death, including cardiac and aneurismal lesions, while Albertini was also meritorious in the same walk. Germany produced Auenbrugger of Vienna, author of direct 'percussion.' In Britain state-medicine owes its start to Baker, followed up by Jenner, whose discovery of vaccination is memorable not only for its prevention of smallpox, but for its influence on the study of infectious disease. Pringle, ably preceded by Huxham, enlightened the profession on fevers, especially as occurring in prisons and camps; and Fothergill on putrid sore throat ('diphtheria') and tic-douloureux, and Heberden in therapeutics did honour to the English school.
The 19th century opened with a sound preference for inductive research over premature generalisation, and France, in the background for many years, now came to the front with Bichat and Broussais—the former a great anatomist and physiologist, the latter distinguished in pathology. Pathological anatomy had contributed much to localise disease, and diagnosis was made still more precise by Corvisart and Piorry in perfecting the 'percussion' of Auenbrugger. By Laennec's advance upon this—auscultation to wit—the movements of the lungs and heart are heard through the thoracic walls by the stethoscope. Concurrently with this 'mediate auscultation,' morbid anatomy connected the lesions of the intra-thoracic viscera with the sounds so transmitted—a twin-source of medical knowledge, rich in results on diagnosis and treatment. Bayle, Chomel, Louis, Cruveilhier, and Andral, each in his own way, did memorable work in scientific and practical medicine, founding the great clinical school which, continued under Bretonneau, Rostan, D'Alibert, Rayer, and Trouseau, made Paris the resort of aspiring young physicians from both hemispheres. In Great Britain medical education was steadily improved by sounder chemical and physical, as well as anatomical and physiological knowledge, while the preference of rational observation to theory was admirably illustrated by Willan on the skin, Bright on the kidney, and Addison on the supra-renal capsules. The Paris school found apt pupils in the British Islands—the Scottish Forbes and the Irish Stokes, with the English Hope, Latham, and Watson, doing much to diffuse a sounder diagnosis and treatment of chest diseases; while Scotland, in particular, maintained the traditional celebrity of her clinique by Gregory, Abercrombie, and Alison in Edinburgh, to whom worthy counterparts were produced in Dublin by Graves, Stokes (already mentioned), and Corrigan. In the northern capital Christison, the Begbies, father and son, Hughes Bennett, and Laycock upheld the fame of the school, and south of the Tweed Parkes, Murchison, Hilton Fagge, and Jenner have bequeathed a rich harvest of practical doctrine to their successors. Italy, with Galvani, Volta, Nobili, and Matteucci, is the parent of electro-therapeutics; but it is to Germany that recent medicine owes its greatest and most productive achievements. Vienna, under Van Swieten and Auenbrugger, had already won a European name for clinical research when Skoda enhanced it by improving on Laennec's discovery, and Rokitansky and, quite recently, Bamberger carried Viennese teaching to the highest pitch of academic efficiency. Romberg is another representative name; but Schönlein, by the unanimous voice of Germany, has placed her in the van of medical progress. Founder of the modern 'natural history school,' his teaching has led up to bacteriology, which already in the hands of such men as Pasteur and Koch has for cholera, malaria, lupus, and tuberculosis (see TUBERCLE) become one of the most powerful instruments of which medicine, in diagnosis and even in practice, has yet been able to boast. The marvellous advances in cerebral physiology, from Broca to Hitzig and Ferrier, have had great results in practice, surgical as well as medical; and the Americans have done splendid work, especially in therapeutics.
Häser's Grundriss der Geschichte der Medicin (Jena, 1884) and Puschmann's Geschichte des medicinischen Unterrichts (Leip. 1889) have been closely followed in the foregoing article. The student who wishes to pursue the history of medicine into minuter detail should consult the larger work of Häser, in 3 vols. (Jena, 1875-79); Daremberg's Histoire des Sciences Médicales (2 vols. Paris, 1870); and Puccinotti's Storia della Medicina (3 vols. Pisa, 1859). For a key to the very numerous articles on diseases, see DISEASE, and the list appended to ANATOMY. See also SURGERY, HYGIENE, BACTERIA, GERM THEORY, and the notices of HIPPOCRATES, GALEN, and other great physicians.