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The　Evolution　of　Modern　Medicine

by　William　Osler





A　SERIES　OF　LECTURES　DELIVERED　AT　YALE　UNIVERSITY　ON　THE　SILLIMAN　FOUNDATION　IN　APRIL；　1913

by　WILLIAM　OSLER




THE　SILLIMAN　FOUNDATION

IN　the　year　1883　a　legacy　of　eighty　thousand　dollars　was　left　to　the　President　and　Fellows　of　Yale　College　in　the　city　of　New　Haven；　to　be　held　in　trust；　as　a　gift　from　her　children；　in　memory　of　their　beloved　and　honored　mother；　Mrs。　Hepsa　Ely　Silliman。

On　this　foundation　Yale　College　was　requested　and　directed　to　establish　an　annual　course　of　lectures　designed　to　illustrate　the　presence　and　providence；　the　wisdom　and　goodness　of　God；　as　manifested　in　the　natural　and　moral　world。　　These　were　to　be　designated　as　the　Mrs。　Hepsa　Ely　Silliman　Memorial　Lectures。　　It　was　the　belief　of　the　testator　that　any　orderly　presentation　of　the　facts　of　nature　or　history　contributed　to　the　end　of　this　foundation　more　effectively　than　any　attempt　to　emphasize　the　elements　of　doctrine　or　of　creed；　and　he　therefore　provided　that　lectures　on　dogmatic　or　polemical　theology　should　be　excluded　from　the　scope　of　this　foundation；　and　that　the　subjects　should　be　selected　rather　from　the　domains　of　natural　science　and　history；　giving　special　prominence　to　astronomy；　chemistry；　geology　and　anatomy。

It　was　further　directed　that　each　annual　course　should　be　made　the　basis　of　a　volume　to　form　part　of　a　series　constituting　a　memorial　to　Mrs。　Silliman。　　The　memorial　fund　came　into　the　possession　of　the　Corporation　of　Yale　University　in　the　year　1901；　and　the　present　volume　constitutes　the　tenth　of　the　series　of　memorial　lectures。


CONTENTS　CHAPTER　I　INTRODUCTION　Chapter　II。　Greek　Medicine　Chapter　III。　Mediaeval　Medicine　Chapter　IV。　　The　Renaissance　and　the　Rise　of　Anatomy　and　Physiology　Chapter　V。　The　Rise　and　Development　of　Modern　Medicine　Chapter　VI。　　The　Rise　of　Preventive　Medicine


PREFACE

THE　manuscript　of　Sir　William　Osler's　lectures　on　the　〃Evolution　of　Modern　Medicine；〃　delivered　at　Yale　University　in　April；　1913；　on　the　Silliman　Foundation；　was　immediately　turned　in　to　the　Yale　University　Press　for　publication。　Duly　set　in　type；　proofs　in　galley　form　had　been　submitted　to　him　and　despite　countless　interruptions　he　had　already　corrected　and　revised　a　number　of　the　galleys　when　the　great　war　came。　But　with　the　war　on；　he　threw　himself　with　energy　and　devotion　into　the　military　and　public　duties　which　devolved　upon　him　and　so　never　completed　his　proof…reading　and　intended　alterations。　The　careful　corrections　which　Sir　William　made　in　the　earlier　galleys　show　that　the　lectures　were　dictated；　in　the　first　instance；　as　loose　memoranda　for　oral　delivery　rather　than　as　finished　compositions　for　the　eye；　while　maintaining　throughout　the　logical　continuity　and　the　engaging　con　moto　which　were　so　characteristic　of　his　literary　style。　　In　revising　the　lectures　for　publication；　therefore；　the　editors　have　merely　endeavored　to　carry　out；　with　care　and　befitting　reverence；　the　indications　supplied　in　the　earlier　galleys　by　Sir　William　himself。　In　supplying　dates　and　references　which　were　lacking；　his　preferences　as　to　editions　and　readings　have　been　borne　in　mind。　The　slight　alterations　made；　the　adaptation　of　the　text　to　the　eye；　detract　nothing　from　the　original　freshness　of　the　work。

In　a　letter　to　one　of　the　editors；　Osler　described　these　lectures　as　〃an　aeroplane　flight　over　the　progress　of　medicine　through　the　ages。〃　　They　are；　in　effect；　a　sweeping　panoramic　survey　of　the　whole　vast　field；　covering　wide　areas　at　a　rapid　pace；　yet　with　an　extraordinary　variety　of　detail。　　The　slow；　painful　character　of　the　evolution　of　medicine　from　the　fearsome；　superstitious　mental　complex　of　primitive　man；　with　his　amulets；　healing　gods　and　disease　demons；　to　the　ideal　of　a　clear…eyed　rationalism　is　traced　with　faith　and　a　serene　sense　of　continuity。　The　author　saw　clearly　and　felt　deeply　that　the　men　who　have　made　an　idea　or　discovery　viable　and　valuable　to　humanity　are　the　deserving　men；　he　has　made　the　great　names　shine　out；　without　any　depreciation　of　the　important　work　of　lesser　men　and　without　cluttering　up　his　narrative　with　the　tedious　prehistory　of　great　discoveries　or　with　shrill　claims　to　priority。　Of　his　skill　in　differentiating　the　sundry　〃strains〃　of　medicine；　there　is　specific　witness　in　each　section。　　Osler's　wide　culture　and　control　of　the　best　available　literature　of　his　subject　permitted　him　to　range　the　ampler　aether　of　Greek　medicine　or　the　earth…fettered　schools　of　today　with　equal　mastery；　there　is　no　quickset　of　pedantry　between　the　author　and　the　reader。　The　illustrations　（which　he　had　doubtless　planned　as　fully　for　the　last　as　for　the　earlier　chapters）　are　as　he　left　them；　save　that；　lacking　legends；　these　have　been　supplied　and　a　few　which　could　not　be　identified　have　with　regret　been　omitted。　The　original　galley　proofs　have　been　revised　and　corrected　from　different　viewpoints　by　Fielding　H。　Garrison；　Harvey　Cushing；　Edward　C。　Streeter　and　latterly　by　Leonard　L。　Mackall　（Savannah；　Ga。）；　whose　zeal　and　persistence　in　the　painstaking　verification　of　citations　and　references　cannot　be　too　highly　commended。

In　the　present　revision；　a　number　of　important　corrections；　most　of　them　based　upon　the　original　MS。；　have　been　made　by　Dr。　W。W。　Francis　（Oxford）；　Dr。　Charles　Singer　（London）；　Dr。　E。C。　Streeter；　Mr。　L。L。　Mackall　and　others。

This　work；　composed　originally　for　a　lay　audience　and　for　popular　consumption；　will　be　to　the　aspiring　medical　student　and　the　hardworking　practitioner　a　lift　into　the　blue；　an　inspiring　vista　or　〃Pisgah…sight〃　of　the　evolution　of　medicine；　a　realization　of　what　devotion；　perseverance；　valor　and　ability　on　the　part　of　physicians　have　contributed　to　this　progress；　and　of　the　creditable　part　which　our　profession　has　played　in　the　general　development　of　science。

The　editors　have　no　hesitation　in　presenting　these　lectures　to　the　profession　and　to　the　reading　public　as　one　of　the　most　characteristic　productions　of　the　best…balanced；　best…equipped；　most　sagacious　and　most　lovable　of　all　modern　physicians。

F。H。G。


BUT　on　that　account；　I　say；　we　ought　not　to　reject　the　ancient　Art；　as　if　it　were　not；　and　had　not　been　properly　founded；　because　it　did　not　attain　accuracy　in　all　things；　but　rather；　since　it　is　capable　of　reaching　to　the　greatest　exactitude　by　reasoning；　to　receive　it　and　admire　its　discoveries；　made　from　a　state　of　great　ignorance；　and　as　having　been　well　and　properly　made；　and　not　from　chance。　（Hippocrates；　On　Ancient　Medicine；　Adams　edition；　Vol。　1；　1849；　p。　168。）


THE　true　and　lawful　goal　of　the　sciences　is　none　other　than　this：　that　human　life　be　endowed　with　new　discoveries　and　powers。　（Francis　Bacon；　Novum　Organum；　Aphorisms；　LXXXI；　Spedding's　translation。）


A　GOLDEN　thread　has　run　throughout　the　history　of　the　world；　consecutive　and　continuous；　the　work　of　the　best　men　in　successive　ages。　From　point　to　point　it　still　runs；　and　when　near　you　feel　it　as　the　clear　and　bright　and　searchingly　irresistible　light　which　Truth　throws　forth　when　great　minds　conceive　it。　（Walter　Moxon；　Pilocereus　Senilis　and　Other　Papers；　1887；　p。　4。）


FOR　the　mind　depends　so　much　on　the　temperament　and　disposition　of　the　bodily　organs　that；　if　it　is　possible　to　find　a　means　of　rendering　men　wiser　and　cleverer　than　they　have　hitherto　been；　I　believe　that　it　is　in　medicine　that　it　must　be　sought。　It　is　true　that　the　medicine　which　is　now　in　vogue　contains　little　of　which　the　utility　is　remarkable；　but；　without　having　any　intention　of　decrying　it；　I　am　sure　that　there　is　no　one；　even　among　those　who　make　its　study　a　profession；　who　does　not　confess　that　all　that　men　know　is　almost　nothing　in　comparison　with　what　remains　to　be　known；　and　that　we　could　be　free　of　an　infinitude　of　maladies　both　of　body　and　mind；　and　even　also　possibly　of　the　infirmities　of　age；　if　we　had　sufficient　knowledge　of　their　causes；　and　of　all　the　remedies　with　which　nature　has　provided　us。　　（Descartes：　Discourse　on　the　Method；　Philosophical　Works。　　Translated　by　E。　S。　Haldane　and　G。　R。　T。　Ross。　　Vol。　I；　Cam。　Univ。　Press；　1911；　p。　120。）



CHAPTER　I

INTRODUCTION

SAIL　to　the　Pacific　with　some　Ancient　Mariner；　and　traverse　day　by　day　that　silent　sea　until　you　reach　a　region　never　before　furrowed　by　keel　where　a　tiny　island；　a　mere　speck　on　the　vast　ocean；　has　just　risen　from　the　depths；　a　little　coral　reef　capped　with　green；　an　atoll；　a　mimic　earth；　fringed　with　life；　built　up　through　countless　ages　by　life　on　the　remains　of　life　that　has　passed　away。　And　now；　with　wings　of　fancy；　join　Ianthe　in　the　magic　car　of　Shelley；　pass　the　eternal　gates　of　the　flaming　ramparts　of　the　world　and　see　his　vision：


Below　lay　stretched　the　boundless　Universe！　There；　far　as　the　remotest　line　That　limits　swift　imagination's　flight；　Unending　orbs　mingled　in　mazy　motion；　　　　Immutably　fulfilling　　　　Eternal　Nature's　law。　　　　Above；　below；　around；　　　　The　circling　systems　formed　　　　A　wilderness　of　harmony。　（Daemon　of　the　World；　Pt。　I。）


And　somewhere；　〃as　fast　and　far　the　chariot　flew；〃　amid　the　mighty　globes　would　be　seen　a　tiny　speck；　〃earth's　distant　orb；〃　one　of　〃the　smallest　lights　that　twinkle　in　the　heavens。〃　Alighting；　Ianthe