1847] How to improve the Art of Medicine. 397 versity which has had a Cullen and a Gregory among its teachers, and is still graced by the names of an Alison and a Christison ;-it is not by such means as these, that the errors of the healing art in the present day are to be corrected. No. It is by the inculcation of a more sedulous observation of diseases and of their symptoms, by a more minute enquiry into their predisposing and exciting causes, by a more exact scrutiny of the condition of every part of the body, fluid as well as solid, internal as well as external, and by a more diligent examination of all the excretions, but not an exclusive attention to any one of them; it is by carefully observing what things do harm and what do good, and by remembering how much may often be effected by regulation of the food and drink which a patient takes -a wide field of therapeutic research-of the air which he breathes, the locality where he resides; it is by studying the operation of Mind and its thousand feelings upon the health of the Body, and of the influence of evil habits, unrestrained indulgencies, vicious practices on the physical constitution of our nature;—it is in this way, and in this way alone, that the practice of Medicine can be improved, and our profession made to maintain that place in the estimation of the wise and the good, which it was designed to occupy. The natural, and indeed inevitable, result of following such a plan will be, that medical men will be simpler in their treatment of most diseases, more scientific and less mechanical and routinist in the selection of their remedies. Many maladies, we all know, will cease quite as well and almost as quickly without medicines-but not without medical treatment—as with them. The numerous cases of catarrhs, rheumatic pains, &c. which are so rife just now (February), will generally subside under the use of the most simple means, provided due attention be paid to diet, clothing, exercise, &c. He, who doctors such cases by mere physic, may unquestionably consult the interest of the chemist or the business-like appearance of his own daybook, but assuredly the patient will have no cause to thank him. Lower the diet, forbid strong meats and drinks, give diluents, enjoin warm clothing, and all will speedily be well;- more speedily perhaps, if some mild diuretic febrifuge be given at the same time. We have daily occasion to regret the too frequent neglect of hygienic, and the undue attention that is paid to medicinal, therapeutics. The physician, who does not give exact instructions as to the former, in almost every case that he is consulted upon, has done but one-half-and that often the least important-of his duty. In the treatment of some maladies, indeed, the direction of the regimen is almost every thing. Scrofula, in its hundred forms, bears witness of this. There is therefore quite as much skill required in the management of the diet, &c. as in the selection of the appropriate medicinal remedies to be employed. Nor are we to suppose that the treatment of diseases more by hygienic, and less by pharmaceutic, prescriptions affords any argument in favour of the extravagant notion that, because Nature is the agent in the cure of diseases, and as she acts in accordance with fixed and invariable laws, therefore the aim of the physician ought always to be to facilitate her efforts by acting in harmony with, and not in opposition to, these laws." There is just about as weak and pernicious folly in ascribing all, or nearly all, to the "vis medicatrix naturæ," as there is in neglecting its operations altogether. In some cases, there is no curative effort at all NEW SERIES, NO. X.-V. E E made by the system. What, pray, would become of the Chlorotic girl, if the cure of her malady was left to-nay, were it even influenced by-the suggestions of her own feelings, and the cravings of her appetite? Or, is the patient, we may ask, affected with Diabetes, led by the instinctive promptings of Nature to avoid the use of those very articles of food which will inevitably exacerbate his malady, and aggravate all his sufferings? Again, in other cases, Nature may indeed effect a cure, or rather a termination, of an exciting disease; but it will be at the inevitable induction of a most serious lesion, or perhaps at the cost of life itself. Where is the homœopathist who, if he was labouring under an attack of Iritis, threatening the loss of sight, would be satisfied with anything short of the very active remedies which every enlightened physician would at once employ? And if inflammation is seen to produce such grave effects in the case of the Iris, its consequences are not less so in other parts which are hidden from our immediate inspection. That the subjective symptoms—those, we mean, independent of auscultatory investigation-of Endocarditis, for example, will often cease under the employment of the most simple remedies, cannot be denied; but is there not more than sufficient warrant to believe that, under such circumstances, the liability to incipient organic mischief of the Heart will be tenfold greater than if the patient had been treated according to the principles, which have been explained in a preceding article of our present Number? We should like to have pursued these remarks, and to have endeavoured to point out what are the classes or families of diseases wherein the inexperienced practitioner is apt, on the one hand, to do too much, and, on the other, to ascribe undue importance to the medicinal agents which he may have employed in their treatment. But this we cannot do just now. Suffice it therefore merely to say, that it is more especially in the management of idiopathic Fevers of all sorts, that the operations of nature ought to be watched with most sedulous and patient attention, with the view of determining the line of practice that should be adopted. Infinite mischief has been done of late years by laying down dogmatic and peremptory rules for the treatment of diseases which change with every season, and almost vary in every individual. Had the indications of Nature, derived from a most diligent observation of all the symptoms of disease, been more faithfully followed out, and had the bold pretensions of pathological anatomy and physiology been more cautiously received, we should not now have been exposed to the taunts of the empiric, nor to the still more humiliating conviction within our own minds, that the boasted discoveries of modern medical science have not taught us how to treat a large proportion of diseases a whit more ably or successfully than did many of our predecessors in the old time before us. 1847] Renouard's History of Medicine. 399 I. HISTOIRE DE LA MEDECINE DEPUIS SON ORIGINE JUSQU'AU XIX. SIECLE. Par le Dr. P. V. Renouard. Tom. II. pp. 980. 8vo. Paris, 1846. II. ESSAI SUR L'HISTOIRE ET LA PHILOSOPHIE DE LA CHIRURGIE. Par M. Malgaigne. [Concluded from page 316.] Medical Organization in Europe during the Arabic Period.-In Europe, amidst the chaotic confusion consequent upon the barbaric invasions, the ecclesiastical schools placed under the protection of the bishops, alone retained a slight image of literary and scientific instruction. The exercise of all the liberal professions, and especially of medicine, thus fell into the hands of the clergy; and we read of priests, abbots, and bishops officiating as the physicians of kings and popes. Several of the female religious orders likewise meddled with the practice of physic. Between the 9th and 13th centuries, the Jews, in spite of the canons of the Church which forbad them, divided this monopoly with the clergy. Several of them learned in Arabic were enabled to peruse the medical works in that language, and acquired a degree of skill in their treatment which caused their services to be sought in the courts of princes and even in the palaces of pontiffs. The acquirements of these practitioners, however, whether Jewish or Christian, were usually of the most meagre character; medical education, by reason of the rarity of books and the want of teachers, being an impossibility. No restriction on, or examination for, practice being in existence, crowds of low ignorant persons, barbers, bathmen, and women assumed the titles of curers of disease. Although the law provided no security against ignorant persons assuming these functions, it visited accidents which resulted from their ministration with fine or imprisonment. M. Malgaigne suggests that such severity was especially employed in surgical cases, the practice in which was abandoned to persons of the lowest condition, internal medicine only being in the hands of the clergy. It is probably from about the 7th century that medicine became disunited from surgery. This separation, so little rational in itself, was in violation of the traditions of the great masters, and was gradually brought about by the ecclesiastical prohibitions against the clergy spilling blood, prohibitions which, from their frequent iteration by popes and councils, accompanied by the severest menaces, seem to have been constantly violated. However, in the course of the 12th century, the secular authority commenced endeavouring to remedy the abuses produced by this pernicious exercise of medicine. Roger of Sicily seems to have been the first sovereign who (1140) published an ordinance compelling those who would practice physic to obtain an authorization, and other monarchs gradually followed his example; while the institution of university grades and faculties completed medical organization. 5. The School of Salerno.-The origin of this celebrated school is someEE * what obscure. It was said to have been founded by some of the refugees from Alexandria; but the period of its greatest splendour was from the tenth to the thirteenth century. The great reputation its professors obtained, far exceeding that of any other part of Christendom, induced persons afflicted with diseases difficult of cure to repair to it from all parts of Europe. Among the most illustrious of the professors was Constantinus Africanus, who flourished in the middle of the eleventh century, and rendered great service to his epoch by his compilations from the Greeks and Arabs, and powerfully contributed to popularize the knowledge of the East, in an age remarkable for its ignorance. During the thirteenth century, Frederick II. of Naples decreed that no one should practise medicine without having first been received into the College of Salernothe course of instruction occupying five years according to Sprengel, and but two according to Malgaigne. The candidate was examined in the therapeutics of Galen, the first book of Avicenna, and the Aphorisms of Hippocrates, and compelled to take an oath that he would exercise his profession honourably, and not participate in the gains of the apothecaries. He who desired to exclusively practise surgery, was obliged to study only for a year, especially directing his attention to anatomy. The celebrated Dietetic Precepts of the School of Salerno, composed in 1100 for the use of Robert Duke of Normandy, who repaired there for the cure of his wounds on his return from the Crusades, has long excited much attention and been the subject of numerous commentaries. 6. Origin and Development of Universities." In the time of Charlemagne, every Cathedral possessed its school, and in some of these the elements of medicine were taught. When the medical profession had been declared by many councils incompatible with the priesthood, the Popes, in order to retain the jurisdiction they had so long maintained over the members of the medical body and the bar, erected certain of these schools into Universities, in which were taught philosophy, theology, laws, and medicine, or only some of these faculties. In this way arose, during the thirteenth century, most of the principal European universities. All science,' says M. Malgaigne (Introd. to the works of Ambrose Paré), was in the hands of clerks, and instruction for having quitted the cloister was no less catholic. These new clerks, attached to the head of the church by their oaths and their privileges, constituted for him a numerous and powerful militia; and while, by the clergy properly so called, the popes reigned over the consciences, by means of the university clerks they governed the intellect. Who can feel surprised that they should impatiently desire to concentrate all their power in the same hands? We must, however, render the act of justice to the popes, monks, and clergy of allowing that they prepared the way for the intellectual movements of modern Europe. The universities, by bringing studious men together, afforded them the occasion and the means of mutual enlightenment, excited their emulation by honours and rewards, and, in fine, contributed very efficaciously to the elevation of the Christian civilization above all others. "The great effects of these liberal institutions, it is true, were not immediately perceived. It required several generations to develop the consequences and ripen the fruits. This is why the end of this historical period, less barbarous than its commencement though it be, has transmitted to us few names worthy to arrest our attention. Men who then gained a reputation in science, and especially in medicine, shone less by reason of the merits of their works, than by their love for instruction, and the zeal they exhibited in seeking this and propagating it. At the present day, when literary riches abound, we can with difficulty form an 1847] The Arabic Period-Guy de Chauliac. 401 idea of the price they must have cost our ancestors. We are astonished at beholding them making journies as expensive as painful: without any encouragement or hope of remuneration, merely to obtain a manuscript or hear a renowned professor." P. 450. Among the learned persons enumerated by M. Renouard who, at this period, made some efforts to restore the fallen condition of medical science, we can only briefly notice the most famous one of them, Guy de Chauliac, who flourished at the commencement of the 14th century. He studied medicine at various schools, was deeply versed in the ancient authors, and became himself a prolific writer, exhibiting, as M. Malgaigne observes, a certain independence in form and criticism not found among the Arabic and Greek commentators. His Magna Chirurgia, which he terms the Inventory is the principal work which he produced. In it he exhibits a vast erudition, and thus happily reconciles the services of the ancients and moderns. "The sciences are formed by successive additions, and the same men cannot lay their foundation and conduct them to perfection. We are as children riding on the neck of a giant; aided by the works of our predecessors, we are enabled to see all that they saw, and something more." He traces the requisites of a surgeon, M. Malgaigne adds, with a nobleness of language and terseness of expression which the medical world had not seen since the time of Hippocrates. He says, he should be well-read, expert, ingenious, and very morigenous," that is, according to his own interpretation of this last word, bold in sure things, careful in danger; he should avoid bad cures and practices; he should be kind to his patients, indulgent to his colleagues, and wise in his predictions; he should be chaste, sober, compassionate, and merciful, not greedy or extortionate for money; receiving a moderate recompense according to his labours, his dignity, the circumstances of his patient, and the nature of the issue or event." He insists upon the necessity of dissections, observing that, for some time, anatomical demonstrations had been made on animals at Montpellier, and suggests the expediency of their also being performed on the bodies of criminals. He is the first author who alludes to some anatomical plates, which were designed by one Mandeville. His work, giving a critical abstract of the surgical writings of all prior authors, and that at a period when books were both so scarce and so dear, did immense service for the surgeons of the epoch. For nearly two centuries it became the surgical code of Europe; translated and commented upon in all languages, and reproduced in various forms, it has long been a classic, and preserves some of its interest even at the present day, as exhibiting the state of the science at the end of the Middle Ages." Guy punctured the abdomen in ascites, attempted the radical cure of hernia, and seems to have operated for cataract; but, although he describes lithotomy, after the Arabs, he left its performance to the itinerant adventurers who at that period undertook it. " 7. Accessary Institutions.—Charitable establishments multiplied wonderfully during this period, both among the Mahomedans and the Christians; and numerous religious associations devoted their attention to the sick. Sovereigns and Popes not unfrequently offered examples by dressing leprous sores with their own hands: and at no period of history were zealous exertions more required. The leprosy and other cutaneous diseases |